As If By Magic An Artery Appears

Even though it has been slow and gentle, my weight loss (yes, 150 pounds without surgery in a couple of years and yes, I will speak of it more later and elsewhere) means, among other things, that I have located some new veins — and today, an artery.

Now the veins that made me happiest were, and still are, the ones on the back of my hands. I have a memory etched into my soul of a chief resident in neurology at the University of Minnesota who told me privately,and with all of the discretion that he could figure out how to muster,that I should be ashamed of being as fat as I was. Because if ever I had a serious health crisis, and nobody could find a vein, someone could die from lack of a proper venous access. It didn’t take any training in psychiatry to figure out that some time, in the past not too distant to that remark, he had failed to find a vein in someone who died. Of course, I felt horrible.  But oh, the joy as I slowly lost weight and was able to locate, when I had enough liquid volume on board, big juicy veins on the back of my hand, even as I can now. Every time I look at them I think “Wow.  Even a first year medical student who has never seen a vein on a living person would not only know immediately I have wonderful veins, but could pierce them with just about any kind of tubing, no matter how poorly suited for the job.  They could not miss. They would be happy. They would think they are the next star of “Boston Medical” and they would call their parents and ask for some spare money to celebrate.  This is what it is to be a “real doctor.”

Actually, most veins are now pierced by far less qualified and far lower paid professionals, certified “phlebotomists.” They have taken my blood in unskilled and inappropriate ways, sometimes screwing up all pretense of sterile procedure by doing things like ripping fingers out of latex gloves to get a better “feel.”  Another cheap doctor substitute, foisted on people who do not know what they are NOT getting.

Yesterday I located not one but both of my superficial temporal arteries.These squiggly entities in joyous pulsating bas-relief sit on either side of my forehead,above and in front of my ears,winding their way persistently toward my forehead like Smetana’s Moldau makes it to the junction with the Elbe river. This wonderful orchestral piece, lovingly performed by the Czech philharmonic, has been removed from YouTube for a “use violation,” but every Jewish lover of classical music knows that it is based on the same Czech folksong as “Hatikvah,” the Israeli national anthem which I belted out almost daily during my early Hebraic education. No song has ever better conveyed the swelling of a mighty river, or my joy at finding my superficial temporal arteries. I realize that more superficial women may consider their appearance a sign of age, and that they could, I suppose, be covered with heavy makeup.

People document the anatomy of this artery in detail, because of its importance in plastic surgery, something I am reasonably certain I will never, ever want. I love my superficial temporal artery for a far deeper, functional, almost sacred reason. It does what the textbooks say it is supposed to do.  I can feel its pulse, above my zygomatic arch (cheekbone), near my temple, in front of my ear. On both sides! Although I cannot see or feel it, I know my superficial temporal artery separates from the maxillary artery, both coming from my external carotid.  My maxillary region is doing pretty OK, I suppose. Upper teeth and gums are pretty good. The internal and external carotids both are branches of the common carotid artery.  Whoop-de-doo.  As usual, the folks at Wikipedia have some nice clear diagrams.

I have been to the places I see in the pictures.  People with hardening of the arteries, or atherosclerosis, or “plaques” sometimes get them at the beginning of the internal carotid.  Blood has to get to the brain.  The creator or the universe or whoever you believe in having put together this system has done it with amazing redundancy. If one artery is stopped up, there are a lot of what you call “anastomoses.”  These are little connecting arteries that may or may not be useful, until you need them. Oh, the hours of terror I spend as first assistant (resident) surgeon trying to clear out plaques from these arteries in their bifucations. Oh, the danger of stroke, the attempt to prevent stroke; all the statistics which I know now exist (and did not yet then) that make me wonder if the risk of the operation was worth it.  I did not know, then, only that you had to clamp off the artery for a bit and remove all the tatty ick and sew it up again cleanly and perfectly.  Me, I mostly had to suction blood out of the way.  Even them, as young as I was, I decided I would do whatever it took so that I could avoid this operation.

If I can feel the superficial temporary arteries, then the blood is getting through to my brain.   I need my brain, I live by my wits. If I have little enough fatty goo in the superficial temporal, maybe the others are doing pretty well, and enough blood gets to my brain, and will keep getting to my brain!  This is a delight beyond words.

I do have other memories of the superficial temporal artery.  I have biopsied my share, for people, older folks who had headaches.Of course I was a surgeon then, so I did not follow the patients, but I know they got Prednisone (a corticosteroid) and what I thought even then were pretty high doses of it, because of the “small but present” possibility it could lead to blindness, and that people got better right away. Now, I hate the idea of giving corticosteroids, but sometimes you have to.

As for me, I am very happy for my superficial temporal artery pulses, the indirect gateway to my brain, the hope that all my prevention, the nutrition and fish oil and whatever, may have worked. Unless you are an anatomy fanatic (like me) it is virtually impossible to find tiny pulses in strange places. It is possible to take part in the joy of prevention, in the joy of health, in knowing that your brain is vascularized.