Until today, in the first-year class at IMS Milan, we have only spoken about disease. Today, under the microscope, we actually looked at it — and the experience was profound.

Our professor semi-surprised us, this week, with real-life medicine. Last night, she gave us a number of papers to look over, about two diseases: Acute Respiratory Distress Syndrome (ARDS), and Balkan endemic nephropathy. We quickly learned that both of these are quite dangerous.

ARDS is a form of severe lung injury. Fluid builds up within your lung’s air sacs, called alveoli. This can be caused by an infection, trauma, or inhaling a high concentration of smoke or chemical fumes. With fluid in your lungs, there is less room for oxygen. You end up having trouble breathing, low blood pressure, confusion and fatigue — and often, ARDS is fatal.

Balkan endemic nephropathy is a kidney disease which has been particularly prevalent in the Balkan region. Scientists are not sure of its cause. However, one possible factor is ochratoxin A poisoning. Ochratoxin A, found in mold, can suppress and kill your immune cells. It also may cause kidney inflammation, one of whose long-term consequences is fibrosis — that is, the development of fibers in-between the cells of the kidneys. You end up with weakness, anemia, and a copper coloration to your skin. Eventually, you develop kidney failure, and often cancer of the urothelial tract; that is, the kidney, bladder, or ureter. This can also be fatal.

After describing these diseases to us, our professor took us downstairs to the microscope lab…

…and asked us to look at slides of kidneys with ochratoxin A poisoning, and lungs with ARDS.

Here is a sick kidney. Do you see how groups of cells are surrounded by red lines? Those lines are stained; the stain marks collagen fibers. This kidney is full of fibers; it is very damaged, and you are looking at this life-threatening condition, close-up. It is not a car accident, or blood clot, or giant tumor, that is killing this organism. It is nothing big and easy-to-imagine. It is the microscopic by-product of a tiny little toxin.

Here is a slide of a lung with ARDS, colorfully commented upon by my classmate. He notates the markers of the disease. Do you see the clumps of pink material? That is infiltrate — the liquid which has invaded the lungs. Normally, when you look at a healthy lung, you see nice, round air sacs. Here, however, you will notice, the lines are jagged and every which-way. That is because, in essence, these sacs have been deformed. Whatever organism had this lung, was nearing death.

Why did this feel so profound? For almost the entire history of humankind, people died for reasons we did not know. If they hard ARDS or nephropathy, no one would have been able to look through a microscope at the physical conditions causing it. No one would probably even have known what organs were in trouble.

Meanwhile, in our class, for months, we have been talking and reading about life-threatening illnesses. It has always been abstract. Today, however, it became very real, very concrete. What we saw through the microscope, is a sample of what we shall attempt to battle, for the rest of our lives — in order to save those of others.

Erik Campano

Chief Editor at MEDschool.it
Blog Editor
Erik Campano is a graduate student in Umeå, Sweden, studying the ethics of artificial intelligence in medicine. He formerly was an academic consultant to the English-language medical school of the University of Turin. Erik completed his Bachelor’s of science in Symbolic Systems (cognitive science) at Stanford University, and then he worked for about eight years as a radio news anchor, before moving to biomedical scientific study and research at the University of Paris and Columbia University. Erik grew up in Connecticut, is a citizen of the United States and Germany, and his family is a mix of Filipino, Italian, and German.
Erik Campano