Of Kidneys and Salamanders [written Wednesday, January 11]

Today was wonderfully jam-packed with knowledge. We were greeted at the MHH by Dr. Kielstein who first gave us the doctor’s perspective into living and working with a social health care system. He told us about all the hidden drawbacks of Germany’s health care system, that, at first look, looks so appealing. Yes, for 14.5% of an individual’s income, their health care, all their treatments and medications, are paid for, but physicians’ budgets for prescribing medications and treatments are restricted, there’s a growing increase in the number of things that are not covered by the state insurance, and all this creates a push for doctors to do unnecessary procedures and make scarier diagnoses so that they can get more money and prescribe more treatments. Dr. Kielstein also discussed his view of palliative care: how people have attached to it a stigma of giving up and allowing the patient to die, how patients and family see it simply as a way for saving money, and how the fundamental concept of the practice is simply to do everything that is medically prudent but not that is medically possible because that only prolongs medical suffering. Dr. Kielstein then gave us an incredibly thorough tour through the dialysis ward, explaining the fundamentals of how dialysis actually works. The first dialysis procedure was apparently tried on a dog, and a sausage casing was what was first used as the semipermeable membrane. Though humans have 6-7 liters of blood and the dialysis machines can process 0.5 liters/min, during a typical visit, a patient must stay for over 5 hours for toxins to be removed from not only the blood, but also from tissue. This was just a taste of the vast amounts of knowledge Dr. Kielstein shared with us, and I frantically tried to absorb every bit of it before it was time for an incredibly filling lunch and our visit to the Axolotl Research Center. Axolotl salamanders are apparently excellent model organisms to study regenerative medicine because they have super fast wound healing and their cells have stem cell properties for dedifferentiation, proliferation, and redifferentiation and pattern formation. The salamanders themselves looked like miniature versions of the dragon from the movie How to Train Your Dragon and acted like little amphibious dogs, recognizing and responding to their scientist caretakers. We also went into the room where the silk spiders were kept, and while seeing the large spiders dotting the large curtain-like webs hanging from the ceiling of the room was a bit out of my comfort zone, they seemed like quite docile creatures. It’s amazing to see how science, after struggling to find the best way to advance medical technology, has finally admitted that nature’s already found ways to do it best. ‘Tis quite humbling.