“It turns out that living beings are less like bags of sloshing water, as I imagined in grade school, and more like a stew. While water makes up most of it, water alone is thin and empty of the organic molecules from which organisms are built—the stew thickeners. Water alone is lifeless. Instead, it is the mucus in our bodies that—so long as it has the correct qualities and consistency—is the key to a healthy life. The ‘fact’ that our bodies are made mostly of water is misleading. What we are actually made of is mucus.”

Jonathan Reisman is an internal medicine-pediatrics physician and author of The Unseen Body: A Doctor’s Journey Through the Hidden Wonders of Human Anatomy.

He shares his story and discusses his KevinMD article, “We are actually made of mucus.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Jonathan Reisman. He is an internal medicine-pediatrics physician. He’s the author of the book The Unseen Body: A Doctor’s Journey Through the Hidden Wonders of Human Anatomy. There’s an excerpt from that book on KevinMD titled “We are actually made of mucus.” Jonathan, welcome to the show.

Jonathan Reisman: Pleasure to be here.

Kevin Pho: So we’ll get into your excerpt and book in a little bit, but first off, can you just share your story and journey to where you are today?

Jonathan Reisman: Sure. I’d say my journey sort of started in college, when I became really interested in the natural world and in traveling. That led to an adventurous spirit and a wanderlust that I ended up carrying into my medical career, and that has sort of shaped my medical career. When I first got interested in those things, I did not want to be a doctor and had no interest in going to medical school, but I eventually did end up going to medical school. I have tried to incorporate my love of travel, my love of the natural world, including human culture, and just all the different interesting things to see in the world, which have helped shape my medical career and also led to my writing, which led to this book.

So I brought that interest in different cultures, and in how the natural world has shaped our bodies, the practice of medicine, and the medications that we use, and it has led to me wanting to travel all over the world and practice medicine at the ends of the earth, which has also provided some good stories that ended up in my book.

Kevin Pho: So give us an example of how your love of travel and the natural world, how does that intersect with your clinical practice today?

Jonathan Reisman: Well, it’s certainly been harder to travel the last two years, and I also have two small children, which has made it even harder. But a few months after finishing residency, I went to do a locum tenens job in an emergency room in Arctic Alaska, even though I had not trained in emergency medicine; I trained in internal medicine-pediatrics. I had just always been fascinated with the traditional cultures of the natives of the far north, so I made some connections and just flew there for an entire month and worked in the ER. It was really very rewarding. I learned a lot, and it sort of led to my path, where I mostly work in the emergency room now, in various rural emergency rooms.

I’ve since worked on an Indian reservation in South Dakota, I’ve done some wilderness medicine trips as a ship doctor in Antarctica and the Russian Arctic, and I’ve worked at high altitude in Nepal. As I’ve said, the last few years have been harder to travel, but that’s sort of how I’ve shaped my career.

Kevin Pho: So you’ve clearly worked in a lot of disparate, remote, rural areas around the world. What are some of the biggest things that you’ve learned from these?

Jonathan Reisman: The biggest thing is the doctor’s mindset. If you’re working in a big university hospital, you have every kind of medical imaging technology and every lab test at the ready, including every subspecialist available to come see your patient. That’s almost a different universe from being in the middle of Arctic Alaska, let’s say, where everything is airplane evacuation. If it’s very foggy, or like one time when there were a lot of tundra fires in northern Alaska and the wind was blowing all the smoke through the town I was working in, called Kotzebue, it was just impossible. No planes could come or go, so no matter how sick your patient was, you were kind of stuck with them, and there was no specialist to help you. So it’s a very different mindset of evacuation, of planning ahead and being resourceful.

Kevin Pho: So how did you adapt to that?

Jonathan Reisman: Nervousness and worry. But I had a patient, for instance, with an obstructing gallstone who needed an ERCP, a scope to remove the stone. The smoke was blowing through town, and he could not leave, and he was getting sicker and getting a fever. I was looking up on YouTube how to do a procedure called a percutaneous chole tube. Luckily, he passed the stone on his own, so I didn’t have to try it for the first time up there, but those are the kinds of situations you sometimes find yourself in.

Kevin Pho: All right, let’s talk about your book and article. Your book is titled The Unseen Body: A Doctor’s Journey Through the Hidden Wonders of Human Anatomy. Now, for those who didn’t get a chance to read your book or read the excerpt, tell us a little about it and the story of why you decided to write it.

Jonathan Reisman: Sure. As I said, I was fascinated with the natural world. I saw myself as an amateur naturalist. I loved reading the great naturalist writers like Henry David Thoreau, Emerson, Barry Lopez, and others. I kind of wanted to be a nature writer and wanted to be a travel writer, and then I started medical school, and I brought that same mindset to learning about the human body. I took a similar approach to what a nature writer or a travel writer might take: exploring a new world, learning all about the species of animal and plant and fungus and the unique human cultures, thinking deeply about what they see, and connecting it to unexpected things, aspects of life, history, what we’re made of, and how we live and relate to each other. So I tried to bring that same approach to the human body. This book is kind of my attempt to be the Henry David Thoreau of the human body instead of Walden Pond, in a way.

Kevin Pho: So talk about the excerpt that you wrote. It’s titled “We are actually made of mucus.” Fascinating title.

Jonathan Reisman: Right. My book has a chapter on mucus, naturally, because it’s a very important bodily fluid, and I always found it fascinating that people, including nurses and doctors, seem to be the most grossed out by mucus, more than anything else, more than vomit or stool. It’s all about mucus.

So I thought back to when I was in grade school and had learned that we are made up of mostly water. That’s sort of a refrain that everybody learns in grade school or high school, and it’s true. But when I thought about what the human body is made of, there’s very little thin water. There are a lot more thick things, mucus included. Urine is watery, and tears are watery, but other than that, most of the things inside of us or flowing out of us, like blood, etc., are thicker. Blood is thicker than water. That’s physiologically true as well. So what I realized is that it’s misleading to say we’re mostly made of water. What we’re actually made of is a thicker, more gelatinous thing that oozes instead of flows. So the truth is that we’re mostly made of mucus.

Kevin Pho: All right. What are some other unexpected things about our body that you want my audience to know about from reading your book?

Jonathan Reisman: In the chapter on urine, I talk about how urine is my favorite bodily fluid, not only because it’s so useful clinically and tells you all about the urinary tract through which it flows, but also about other parts of the body. We diagnose type 1 diabetes, the failing of the pancreas, through the urine. You can see what drugs someone ate recently. You can determine what type of microbe is causing their pneumonia with certain urine tests. So urine almost seemed like this all-seeing fluid. I also always loved how the salt proportions in the urine, in our blood, which are maintained by the flow of urine from the kidneys, sort of match the oceans: high in sodium and chloride, low in potassium. So I always like thinking about how the kidneys and the flow of urine help us each carry around a little bit of ocean inside of us. That made me love urine all the more.

Kevin Pho: All right. And if physicians want to get in touch with the more natural side, we don’t necessarily have to travel all around the world like you, but let’s say physicians wanted to incorporate more naturalism into their practice or into their daily lives. What are some ways they can do that?

Jonathan Reisman: Yeah, I think, for us and for our patients, it’s about being closer to the natural world, whether that’s with recreation, getting outdoors, or even through our diets. Obviously, a big thing is having a good diet: the less processed, the closer the food is to its origin in nature, probably the healthier. But also, I think there are a lot of connections that even we don’t normally see. When you look at where medications came from, or where they still come from, there are all these natural sources, whether it’s antibiotics that come from some random mold growing in the natural world, or Lovenox, where on the package it says it comes from the intestines of pigs. Even convalescent plasma or fecal microbiota transplants come from the bodies of other humans. We’re just another corner of the natural world from which you can extract treatments, from blood transfusions to organ transplants. So I think the connections are already there, in a way. You just have to see them.

Kevin Pho: So after writing your book and going through all these fluids and parts of the human body, what are some of the biggest unexpected things that you’ve learned after writing the book?

Jonathan Reisman: Let’s see. After writing the book, I’ve gotten in touch with a lot of readers who have brought to my attention some things that even I hadn’t thought about, which is great, maybe fuel for my next book. One of the topics, actually: I have a chapter on fat, where I tell stories about Arctic Alaska, where the traditional Iñupiat diet is very high in fat. But I also touch on the problems of obesity and the patient experience of health care. I’ve actually learned a lot, even since writing the book, where I tried to explore the patient’s perspective and how doctors do tend to have biases and fat shame. Even more patient perspectives have been brought to my attention since then that were very enlightening, and I feel like I’ve learned a lot by connecting with people.

Kevin Pho: We’re talking to Jonathan Reisman. He is an internal medicine-pediatrics physician. He’s the author of the book The Unseen Body: A Doctor’s Journey Through the Hidden Wonders of Human Anatomy. Jonathan, for those people who may be inspired by your story and want to travel around the world and practice in more remote settings, where can they get started? What kind of advice do you offer them?

Jonathan Reisman: I would say the way I did it was I looked on the map and found a spot that I felt like I wanted to go work in. We’re very fortunate as physicians or health care providers; our services are needed almost everywhere. I always wanted to go to the far north of Alaska, so I literally looked up the hospitals that are there on Google Maps, called them, and said, “Can I talk to your HR department?” One thing led to another. Generally, they usually need help in some of these remote and rural parts of the country, so it was pretty easy. They were lucky to find someone who wanted to come, and I was lucky to find that opportunity. So just calling and asking is a big part of it.

Kevin Pho: And what kind of characteristics should this physician have if they want to practice in under-resourced facilities or areas?

Jonathan Reisman: Definitely, being very flexible is very important. You will not find every medical supply and every ability in some of these smaller rural hospitals. I was very surprised by what you can and can’t do in some of these places. So it’s important to be flexible. It’s important to understand your own limitations, the limitations of your medical knowledge, but it’s also important to know where to fill those holes as needed. Maybe being a little bit of a cowboy, but hopefully not too adventurous or too dangerous, or overstepping the bounds of the scope of your practice or your abilities, is very important. But that can be a fine line when you’re the only doctor around to help someone.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Jonathan Reisman: I think, for me, I love being a doctor, and one of the best parts of it is just that we’re always learning, and I’ve at least still maintained my fascination with the human body, how it works in both health and disease. I’ve been practicing for about a decade or so, about eight to 10 years since residency, and I think maintaining that fascination is really important, maintaining that love of people, not only their bodies and how they work and how they fail, but people themselves and their stories, and wanting to listen. If I ever notice that I’m losing that, it could be an important sign of burnout. So keeping that fascination is really important, and my book is basically my attempt to share my fascination with people.

Kevin Pho: Jonathan, thank you so much for sharing your time and insight, and thanks again for being on the show.

Jonathan Reisman: Thank you so much.