Chapter 12- Zebras

Omar Enrique Taco Sánchez gives his take on chapter 12.

There’s no limit to how much you’ll know, depending how far beyond zebra you go.
— Dr. Seuss

Hundreds of Interlaced Fingers is a journey where Vanessa Grubbs (@thenephrologist) takes us along to her venture into love, nephrology and the realization of the realities surrounding them.

As I read I highlighted many passages but my favorite chapter was “Zebras” initially because of the title; given that a very common part of our work begins by considering usual diagnoses before rare ones since common things are common.

In this chapter, we get in the mind of a 16-year-old Robert during the events surrounding his first encounter with a kidney-doctor. But even more it portrays the fear of the unknown especially when observing patients in a dialysis center "everybody looked miserable ..." these are strong words but without any previous context many can think alike; happily, nowadays we have tools that make it easier to get facts about dialysis from people who have experienced it like

During the search for a "zebra" Roberts gets a kidney biopsy which left him with a residual fear of the procedure. This is understandable given the lack of knowledge prior to the procedure, and the physician describing the procedure as a "controlled stab." Words matter. What is a funny metaphor to the physician can strike fear in patients. The fact it, a kidney biopsy is not a stab, it is a guided puncture via a long needle. We need to balance simplicity with accuracy to give patients realistic and not sanitized descriptions of procedures. There’s a balance to be achieved here, and I am sure I am not the only one still struggling to achieve it.

The biopsy reveals that Robert has focal segmental nephrosclerosis. The doctor tells Robert that this is more common in “people of certain races " Grubbs is frustrated with the imprecision of the concept of race. There's not a clear way to define that one person "belongs" to one race or another, moreover, a person who has the skin color and hair type typical of one race may self-identify in an entirely different way. We undoubtedly have genes that came from numerous groups of ancestral populations; the fact is, that no matter what race you believed yourself to be, we all have a distinctive genetic makeup, that's why, as knowledge improves and medicine explore new implications of the human genome, personalized medicine will theoretically turn out to be more individually tailored.

Sometimes “race” disguises underlying mechanisms for genetic traits as the author demonstrates through a pretty interesting anecdote from a colleague rheumatologist.

The last idea from this chapter, is an issue critical for us kidney-doctors since it is difficult, if not impossible, to measure the exact amount of time we should devote managing chronic kidney disease because of variability among patients in their disease courses, responses to medication, and lifestyle and social issues; that’s why my preferred quote is the last phrase of that chapter because it encourages us not to let chronic kidney disease remain a plain old horse.

Omar (@ErrantNephron)