Anatomy Lesson: Mandy’s Malady

Welcome all anatomy students! It has been a while since I posted a lesson because, frankly, I have been dealing with my own malady – a shattered left ankle! Six months out and beginning to feel and function better. 🥳

Outlander fans recall that in episode Episode 702, “The Happiest Place on Earth,” Brianna gives birth to her second child, Amanda Hope Claire MacKenzie-Fraser. Dr. Claire is there to reassure Brianna and ease the process. The wee one is adored by all and affectionately nicknamed, Mandy.  Fraser’s Ridge is the happiest place on earth and all is well! 🥰

Young Mandy is quickly introduced to the Ridge’s denizens as Granda’ Jamie takes her on a wee stroll to meet a new foal at the stable. Do you see it, Mandy? It is a cutie-beauty like you! 😍 

Mandy’s doting Granny takes her on a guided tour of Claire’s fav room – the surgery! Mayhap she will follow in Granny’s footsteps? 👩🏻‍⚕️

Claire coos to Mandy, admiring the beautiful, wee lass. Then…. she sees Mandy’s fingernails. A closer look and a startled Claire exclaims: “Bloody hell!”  (Couldn’t have said it better myself)  

Ever observant Claire spies a bluish tinge at the base of Mandy’s wee fingernails (below, red arrows)!

Fun Fact: This is not hyperbole.  Fingernails and toenails give clues to at least a dozen possible medical conditions that require evaluation and followup. And, Mandy is no exception.

A quote from Diana’s 6th big book, “A Breath of Snow and Ashes,” documents the moment Claire observes Mandy’s nail beds: ”

“The minute nails were faintly tinged with blue.” 

Bree senses Claire’s concern and asks what is wrong.  She kens that look on her mother’s face. After Claire explains, Bree reports her own maternal observations: Mandy does not nurse well nor is she gaining weight like Jem. What is wrong? 😯

Claire determines that the wee lass has a heart defect requiring more advanced care than Claire is able to provide in the 1700s. She is clear that Mandy’s Malady is life-threatening and she likely will not survive for long without corrective cardiac surgery. Brianna and Roger decide to return with their children to the 20th century to obtain the necessary care to save Mandy’s life.

Arrangements are made for the MacKenzie family to travel through time at the standing stones on Ocracoke Island. Everyone agrees this is the best course of action, but this time and place is no longer the “happiest place on earth!” Will they ever see Fraser’s Ridge and one another again? 🤷🏻‍♀️

Time to start our lesson….What leads Claire to her startling diagnosis? The following are symptoms and clues that Doctor Claire considered:

    • Lethargy and weakness
    • Fast or labored breathing
    • Tachycardia (a heart rate exceeding the normal resting rate)
    • Cyanosis (blue-ish skin color due to a lack of oxygen), primarily seen in lower extremities
    • Dyspnea (shortness of breath)
    • Poor feeding
    • Failure to thrive
    • Distinctive murmur

Another pithy quote from “A Breath of Snow and Ashes:” 

I moved my stethoscope over the tiny chest, ear pressed to it, listening intently. It was my best stethoscope, a model from the nineteenth century called a Pinard—a bell with a flattened disc at one end, to which I pressed my ear. I had one carved of wood; this one was made of pewter; Brianna had sand-cast it for me.

The following image is a wooden Pinard stethoscope, currently for sale on the Internet for about $180 (there are much less expensive versions)! 💰

Claire placed her ear against the cup shaped disc at the top; the bottom of the tube was placed on Mandy’s chest. The stethoscope amplifies the sounds of blood rushing through the heart and striking its valves.  

What did Claire listen for? she was listening for a distinctive murmur: a soft, continuous shushing sound, particularly audible near the base of the neck. It is usually the first diagnostic sign of a problem with a fetal heart vessel.  

Although Mandy exhibits only some of the above symptoms, Claire diagnoses Mandy’s condition as a Patent Ductus Arteriosus (PDA).  

But, before we can understand PDA, let’s look at normal heart anatomy.

Heart Anatomy: To better understand Mandy’s Malady, let’s consider the normal anatomy of the heart and its great vessels. Now, I kid you not, the heart is a very complex organ, both anatomically (structure) and physiologically (function). We will only cover the basics. Understand that there are many more anatomical details that are beyond the scope of this lesson. But, we fearless folk press onward!

Chambers: The human heart has four chambers (next image). Right atrium and left atrium are thin-walled filling chambers. Right ventricle and left ventricle are thick-walled pumping chambers . The walls are composed of cardiac muscle, a specialized tissue found in the heart. (psst….don’t forget, the patient’s left is your right, and vice versa) 🤓 

Vessels: The heart has eight (!!!) vessels carrying blood to and from its chambers. These are (next image):

    • Superior vena cava – delivers blood from upper body into right atrium
    • Inferior vena cava – delivers blood from lower body into right atrium
    • Pulmonary artery – deliver blood from right ventricle to lungs
    • Four pulmonary veins – deliver blood from lungs to left atrium
    • Aorta – delivers blood from left ventricle to body 

Blood Flow: Next, let’s review the pattern of blood flow through the heart. As you read the details, check with the image below to verify the flow.

    • Deoxygenated blood (low oxygen – O2; high carbon dioxide -CO2) from  superior vena cava and inferior vena cava pours into right atrium and then into right ventricle.
    • Right ventricle contracts and ejects blood into the pulmonary artery which branches to supply left and right lungs. 
    • Blood releases carbon dioxide (CO2) in the lungs which is exhaled and picks up O2 from inhaled air.
    • Oxygenated blood (O2-rich) is carried to left atrium via four pulmonary veins. 
    • Blood pours into the left ventricle which contracts and ejects O2-rich blood into the aorta.
    • Branches of aorta carry blood to all other regions of the body (except lungs).  

OK, students, hang in there! With normal anatomy under our belt, let’s look at the fetal circulation. 

Fetal Circulation: Blood circulation in the fetus is different because the placenta provides the functions of lungs, gastrointestinal tract, and kidneys. Thus, a normal blood supply to these maturing organs is not required.

Ductus Arteriosus: The fetal heart has a vascular bridge between pulmonary artery and aorta that shunts blood exiting the right ventricle into the aorta and bypasses the lungs. This vascular bridge is the muscular ductus arteriosus (aqua arrow – below image). Again, because lungs do not process gasses during intrauterine life, most blood is shunted away from them. 

The ductus arteriorsus is patent (open) throughout fetal life and normally closes within 24 hours after birth as blood flow to the lungs is established. Within 2-3 weeks, it turns into a fibrous band, the ligamentum arteriosum. 

All of this is highly regulated by various chemical and physiological substances including oxygen levels. 

Patent Ductus Arteriosus: If the ductus arteriosus does not close soon after birth but remains patent (open), it is diagnosed as PDA, a congenital heart lesion. PDAs are most common in premature babies but can also occur with full term infants. 

Nowdays, if a ductus arteriosus does not spontaneously close after 8 weeks post-birth, it usually is treated with medications, plugged, or surgically closed. Small PDAs may not be a cause for concern and are often not treated.

Adding a bit of perspective – PDA is not new. It was known as early as 129 A.D. to Galen, a Greek anatomist and physician, although he didn’t understand its significance. It wasn’t until 1938, almost two millennia later, that Dr. Robert E. Gross of Harvard Medical School and Children’s Hospital in Boston, Massachusetts, perform the first successful ligation (closure) of a PDA. This was also the first congenital heart lesion to be successful corrected, surgically.

Now, let’s return to Mandy’s Malady. This was her problem. Mandy’s ductus arteriosus did not close after birth and she exhibited some of the concerning symptoms outlined above.  Blood from her aorta flooded her lungs subjecting fragile lung tissues to excessive blood pressure (hypertension). Allowed to go unchecked, the fragile lungs will be permanently damaged and she  eventually will experience right-sided heart failure.

Diana explains all of this with her usual magical writing skills in this excerpt from “A Breath of Snow and Ashes:” 

The ductus arteriosus is a small blood vessel that in the fetus joins the aorta to the pulmonary artery. Babies have lungs, of course, but prior to birth don’t use them; all their oxygen comes from the placenta, via the umbilical cord. Ergo, no need for blood to be circulated to the lungs, save to nourish the developing tissue—and so the ductus arteriosus bypasses the pulmonary circulation. 

At birth, though, the baby takes its first breath, and oxygen sensors in this small vessel cause it to contract—and close permanently. With the ductus arteriosus closed, blood heads out from the heart to the lungs, picks up oxygen, and comes back to be pumped out to the rest of the body. A neat and elegant system—save that it doesn’t always work properly.

The ductus arteriosus doesn’t always close. If it doesn’t, blood still does go to the lungs, of course—but the bypass is still there. Too much blood goes to the lungs, in some cases, and floods them. The lungs swell, become congested, and with diverted blood flow to the body, there are problems with oxygenation—which can become acute.

Lastly, this is a brief video about PDA which you might find useful. It is easy to understand and accurate: https://youtu.be/7DKaCqubuSg. 🤓

Fast forward! It is clear that the MacKenzies arrived safely in the 20th Century and Mandy received the medical intervention needed for her PDA repair. When we meet her next at Lallybroch, she is a healthy, happy, and feisty wee lass, played by Rosa Morris. 🤗

As William Shakespeare once wrote, “All’s Well That Ends Well!”

(Well, it would end better if they were all together, but we shall see) 🤞🏻

The deeply grateful,

Outlander Anatomist

Follow me on:

Photo creds: Sony/Starz; www.commons.wikimedia.org; www.heart.org; www.kidshealth.com; www.medicalsuppliesgh.com; www.medlineplus.gov; www.outlander.fandom.com; www.theoutlandermuse.com; www.twitter.com (now X)

Anatomy Lesson Outlander Trauma-Drama, Part 2

Hey, all.

Hope you had a grand couple of weeks awaiting part two of Outlander Trauma-Drama… Here it is. Yay! 🤗

Our last Anatomy Lesson, Outlander Trauma-Drama, Part 1, showed the system pathologists use to classify trauma. In that lesson, we covered different types of mechanical trauma including contusion, abrasion, laceration, incision, avulsion, projectile injury, and puncture wounds.

Remember? Yasss! 😊

    • Mechanical trauma
      • Contusion
      • Abrasion
      • Laceration
      • Incision
      • Avulsion
      • Projectile injuries
      • Puncture wounds
    • Thermal Injury
    • Radiation Injury
    • Personal Exposure (tobacco and alcohol)
    • Therapeutic Drugs
    • Air Pollution
    • Industrial Exposures
    • Agricultural Hazards
    • Natural Toxins
    • Oxygen Deprivation
    • Infectious Agents
    • Immunological Diseases
    • Genetic Derangements
    • Nutritional Diseases

Today’s lesson continues with the trauma-drama theme ‘cos there are still loads of Outlander owies to uncover and discover!

Again, examples from Diana’s big books and the Starz Outlander series will serve as anatomical models for the injuries. 👍🏻

Today’s lesson will cover thermal injury and alcohol abuse. So, let’s get started!

There are six types of Thermal Injury:

    • Thermal burns
    • Hyperthermia
    • Chilblains
    • Hypothermia
    • Frostbite
    • Electrical injury

Here we go!

Thermal Burns: Thermal burns are caused by harmful exposure to heat, electricity, chemicals, or radiation.

Thermal burns are usually classified as first, second, or third degree burns. Occasionally, we hear of fourth degree burns, but do you ken there are also fifth and sixth degrees? Indeed there are! 🤓

Some students may have read Anatomy Lesson #5 and Anatomy Lesson #6 wherein we learned that skin is composed of epidermis (surface layer of skin cells) and dermis (underlying connective tissue). Thus, another useful way of grading thermal burns is to describe their relative depths.

Partial-thickness Burn: This type damages the epidermis or both the epidermis and outer dermis; it includes first and second degree burns. Such burns are red and may blister and are very painful. Most partial-thickness burns heal without scarring because hair follicle cells regenerate to cover the damaged surface. Even here, if a partial-thickness burn is too large, a skin graft may be required.

Full-thickness Burns: Full-thickness burns extend through both epidermis and  dermis and into underlying tissues. Such wounds are typically aesthetic (painless) because nerve endings are destroyed, although the rim of such a burn is usually painful. Full-thickness burns include third, fourth, fifth and sixth degree burns which may pass into muscle and bone. Fifth and Sixth degree burns are typically fatal.

We can imagine fifth and sixth degree burns suffered by poor Father Alexandre and Johiehon, his love interest in Outlander episode 412, Man of Worth.

Diana’s fourth big book, Drums of Autumn details the sad and horrific conflagration as the lovers burned to ash.

When the Indians had nearly finished with the priest, they untied him from the stake and fastened his hands instead to a long pole, held above his head, from which to suspend him in the flames….

… It was then that he had seen the Indian girl standing on Claire’s other side, with a cradleboard in her arms. … “She didna look to left or right, but walked straight into the fire.” … The flames had embraced the girl in moments. 

… “Her clothes caught, and then her hair. By the time she reached him, she was burning like a torch.” Still, he had seen the dark silhouette of her arms, raised to embrace the empty body of the priest. Within moments, it was no longer possible to distinguish man or woman; there was only the one figure, black amid the towering flames.

…The smell of burnt things hung in the air. We passed close by the pit and I couldn’t help seeing from the corner of my eye the heap of charred fragments, shattered ends frosted white with ash.

Hyperthermia: Hyperthermia  occurs if body temperature rises significantly above normal (>104 °F / 40 °C ). Many challenges, including infections, cause excessive body temperature.

Typhoid fever,  a.k.a. enteric fever, is caused by food and water contaminated with salmonella bacteria. Symptoms include:

    • High fever
    • Headache
    • Stomach pain
    • Constipation or diarrhea

A great example of hyperthermia appears in Outlander episode 310, Heaven and Earth. You remember Claire’s splendid  wee aide, Elias, who falls ill with typhoid? Claire is comforts him as he bravely succumbs to fever and dehydration. 😭

Cold temperatures 🥶 also cause thermal injury because the human body is poorly equipped to regulate and prevent heat loss; this is especially true of children and the elderly. Normally, fat deposits, heart, blood vessels, brain, skin, and muscles help combat cold. These organs provide insulation, induce shivering, re-direct blood flow from skin to vital organs, and reduce energy consumption.

However, exposure to cold temperatures over long periods of time overcomes our coping mechanisms and produces a range of thermal cold injuries such as chilblains, hypothermia, and frostbite.

Chilblains: Chilblains is a 16th century term for skin trauma due to repeated expose to cold, but not freezing, air. Digits are most commonly affected. The skin becomes red, swollen ,and itchy (next image), but usually heals without permanent damage.

Outlander TV episodes do not feature chilblains. But have no fear, our amazingly witty and resourceful Diana writes about it in her second book, Dragonfly in Amberwherein Claire treats imprisoned men with chilblains.

She’s a wonder! Which “she” do I mean? Take your pick – either woman works!

I talked my way into the cells of the prison, and spent some time in treating the prisoners’ ailments, ranging from scurvy and the more generalized malnutrition common in winter, to chafing sores, chilblains, arthritis, and a variety of respiratory ailments.

Ouch, that looks a wee bit uncomfortable!

Hypothermia: Hypothermia occurs when the body’s core temperature drops below 95°F / 35°C as a result of extended cold exposure. Symptoms include low core temperature, vigorous shivering, confusion, sleepiness, slurred speech, shallow breathing, weak pulse, low blood pressure, changes in behavior, and slowed reactions.

Put simply, the victim of hypothermia experiences  the “umbles” meaning grumbles, mumbles, stumbles and fumbles because cold affects muscle and nerve response.

If the core temperature drops to 90º F / 32.2º C, then bradycardia (slow heart rate) and atrial fibrillation (fast and irregular contraction of the heart’s two upper chambers) may ensue.

The teenager, bad-lass Laoghaire, wasn’t suffering from hypothermia when she exposed her “ladies” to Jamie  in Outlander episode 109, The Reckoning, but she was well on her way!

Take a keek at that goose flesh! 😉

Frostbite: Frostbite is cold injury in which the body’s surface is exposed to freezing temperatures; it affects mostly feet, hands, noses, cheeks, and ears. And, as Prince Harry points out in his tell-all book, “Spare,” the todger must be protected from frostbite. This makes sense since it is also an appendage. 😉

Frostbite occurs in three stages:

    • Frostnip: Frostnip is a mild form of frostbite. Continued cold exposure leads to numbness in the affected area. As the skin warms, the sufferer feels pain and tingling but no permanent skin damage.
    • Superficial Frostbite: Superficial frostbite causes slight changes in skin color. The skin may begin to feel warm — a sign of serious skin damage. Rewarming at this stage causes the skin to appear mottled. The victim may notice stinging, burning and swelling. Fluid-filled blisters may appear over the next 12 to 36 hours (next image).
    • Deep Frostbite. As frostbite progresses, it affects all layers of the skin and underlying tissues. The skin turns white or blue-gray; all sensation of cold, pain, or discomfort is lost in the affected area. Joints or muscles may stop working. Large blisters form 24 to 48 hours after rewarming. The tissue turns black and hardens as it dies. Amputation is usually warranted.

Claire teasingly relates how she and Jamie avoid getting frostbite in this steamy tidbit from Drums of Autumn.

His mouth was warm and soft, and whether he approved of what he was doing or not, he did it awfully well.

…“Ooooh,” I said, and shuddered ecstatically as his teeth sank delicately into my earlobe.

….“Oh, well, if it’s like that,” he said in resignation, and taking my hand, pressed it firmly between his thighs.

..“Gracious,” I said. “And here I thought the cold …”

…“It’ll be warm enough soon,” he assured me. “Get them off, aye?”

…It was rather awkward, given the cramped quarters, the difficulty of staying covered in order not to suffer frostbite in any exposed portions, and the fact that Jamie was able to lend only the most basic assistance, but we managed quite satisfactorily nonetheless. 😅

Electrical Injury: What is this? Electrical injury is damage to the skin or internal organs after a person comes into direct contact with a high-voltage source. An electric shock can be life-threatening.

Good advice: Get emergency help if the source of the injury is a high-voltage wire or lightning. Even those with minor injuries or no symptoms should be checked by a physician for internal injuries because these may not be evident to the non-professional.

Rare but life-threatening symptoms include severe burns, muscle pain and contractions, seizures, and unconsciousness. In some cases, heartbeat and breathing may be difficult to detect.

In the US, there are approximately 1000 deaths per year, as a result of electrical injuries. Of these, approximately 400 are high-voltage electrical injuries and lightning causes 50 to 300. There are also at least 30,000 shock incidents per year that are non-fatal.

If you think these stats are grim, consider the UK: Faulty electrical equipment and sockets cause approximately 70 deaths and 350,000 injuries in UK homes every year (RHA, 2022). Such figures show how important it is to follow electrical safety guidelines.

Outlander book and TV don’t really contain much about electrical injury. the closest I can come is Claire’s eerie encounter with Otter-Tooth’s ghost in Outlander episode 403, The False Bride. Here, she experiences the aftermath of a lightning strike.

Diana describes the scene in vivid detail. Again, from Drums of Autumn:

Sheet lightning shimmered far away, across the mountains. Then more bolts, sizzling across the sky, each succeeded by a louder roll of thunder. The hailstorm passed, and the rain resumed, pelting down as hard as ever. The valley below disappeared in cloud and mist, but the lightning lit the stark mountain ridges like bones on an X ray.

I woke all the way to the smell of burning, and sat bolt upright. The rain had stopped; it was the silence that wakened me, I thought. The smell of smoke was still strong in my nostrils…

…The ground rose in front of me to a small ridge. At the top of this stood a large balsam poplar tree, the source of the smoke. The tree had been struck by lightning; half of it still bore green leaves, the canopy bushy against the pale sky. The other half was blackened and charred all down one side of the massive trunk. Wisps of white smoke rose from it like ghosts escaping an enchanter’s bondage, and red lines of fire showed fleetingly, glowing beneath the blackened shell.

Echoes of the shock of impact wavered through my flesh, and I tried frantically to fit myself back into my body. Then I drew breath, a painful gasp, and found myself shaking, the shock turning to the first intimations of damage. I lay still, eyes closed, concentrating on breathing, conducting an inventory. 

…The rain was still pounding down onto my face, puddling in my eye sockets and running down into my ears. My face and hands were numb. My arms moved. I could breathe a little easier now.

Drenched in cold, relentless rain, Claire spies the spooky ghost of Otter-tooth. Careful, lest you get hyperthermic, Claire!

And, there he is. Sharp as an Otter’s Tooth!

That is it for thermal injury. But….

Here’s some exciting thermal news: The US Department of Energy is developing clothes with thermal properties that adapt to the environment and to the wearer’s body. By changing the make-up or shuttling heat to and from the body, the garments can keep people comfortable whatever the external temperature (30 January 2016, New Scientist). I’m ready for one of these jackets, how about you?

Onward! 

Alcohol: Alcohol is a colorless, volatile, and flammable liquid that is the intoxicating element of wine, beer, and other spirits (duh!); it is also used as a fuel and is an industrial solvent! 😮

How the body handles alcohol: The stomach lining contains alcohol dehydrogenase (ADH), an enzyme which metabolizes alcohol. The liver also has ADH plus other enzymes that help break down alcohol. But, bad news for the lassies: Women naturally have lower levels of GAD than men and often develop higher blood alcohol levels after drinking the same or even less alcohol. So, be wary if ye are an XX!

Claire offers a pithy analysis of alcohol in this quote from the big book, “Drums of Autumn,“wherein Jamie gets John Quincy Myers drunk in preparation for his hernia surgery.  (Psst…Non-book readers ken Claire performed this surgery on Edmond Fanning in episode 408, Wilmington.)

“Alcohol isn’t a good anesthetic at all,” I said, shaking my head. “It’s a poison. It depresses the central nervous system. Put the shock of operating on top of alcohol intoxication, and it could kill him, easily.”

And, there we have it in a nutshell!

Not surprisingly, alcohol is the most widely used and abused toxic agent in the world. (Not meaning to preach as I enjoy a wee bit now and then)

Alcohol injury ranges from binge drinking to full on alcoholism with a myriad of accompanying ailments. Most of us are well-versed on the effects of excessive alcohol intake and realize some effects are acute and others are chronic.

Acute Alcohol Intoxication: In the US, there are over 3,000,000 reported cases of acute alcohol intoxication (AAI) from drinking too much, too quickly. Symptoms include slurred speech, incoordination, mood and behavioral changes, and poor judgement. Acute alcohol intake effects breathing, heart rate, body temperature, gag reflex, and can lead to coma and death. (psst… I wager many more cases go unreported) 🫢

Risk factors include:

      • Injuries, such as motor vehicle crashes, falls, drownings, and burns.
      • Violence, including homicide, suicide, sexual assault, and intimate partner violence.
      • Alcohol poisoning, a medical emergency that results from high blood alcohol levels.
      • Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
      • Miscarriage and stillbirth or fetal alcohol spectrum disorders (FASDs) among pregnant women.
Alcohol intoxication is managed with rest, hydration, and abstaining from alcohol. It is worth noting that severe cases may require hospitalization, intravenous fluids, observation, and supportive care.

Oh, Jamie is in the throes of AAI at Lallybroch (episode 112, Lallybroch). He is stinking drunk as he stumbles into the bedchamber reeking of booze; Claire is not “amoozed.” 

But, he looks marvelous in his da’s splendid leather coat! 😜 

Chronic Alcohol Use: Alcohol Dependence Syndrome (ADS or alcoholism) is a condition characterized by long-term alcohol dependence and alcohol abuse that result in specific physiological and behavioral problems. ADS  includes ten or more different signs and symptoms, but from a medical standpoint, only two are required for diagnosis. Chronic use causes a host of problems, including:
    • High blood pressure, heart disease, stroke, liver disease, and digestive problems.
    • Cancer of the breast, mouth, throat, esophagus, larynx, liver, colon, and rectum.
    • Weakening of the immune system, increasing the chances of illness.
    • Learning and memory problems, including dementia and poor school performance.
    • Mental health problems, including anxiety and depression.
    • Social problems, including family problems, job-related problems, and unemployment.
    • Alcohol use disorders, or alcohol dependence

In season six of Outlander, we witness Fergus falling into ADS as he struggles with the cruelty and intolerance toward his dwarf son (episode 603, Temperance).  Alcohol  is commonly used to cope with personal tragedy and trauma.

You remember Colum MacKenzie back in Outlander, seasons 1 and 2?  Yes, of course ye do! 😊 Claire diagnosed Colum as a sufferer of  Toulouse-Lautrec Syndrome, also known as pycnodysostosis. 

Colum required large quantities of rhenish wine (9% alcohol content) to quell and dispel the agony of his existence (Outlander episode 102, Castle Leoch). 

…  “I beg your pardon?” I turned, having missed Colum’s words in the growing noise, to find him offering me the decanter, a lovely bell-shaped thing of pale green crystal.

The liquid within, seen through the glass, seemed green as the sea-depths, but once poured out it proved to be a beautiful pale-rose color, with the most delicious bouquet. The taste was fully up to the promise, and I closed my eyes in bliss, letting the wine fumes tickle the back of my palate before reluctantly allowing each sip of nectar to trickle down my throat.

“Good, isn’t it?” The deep voice held a note of amusement, and I opened my eyes to find Colum smiling at me in approval. I opened my mouth to reply, and found that the smooth delicacy of the taste was deceptive; the wine was strong enough to cause a mild paralysis of the vocal cords.

“Won—wonderful,” I managed to get out. Colum nodded.

“Aye, that it is. Rhenish, ye know. …”

Clearly, Colum suffered from his genetic disability but also from ADS . Near the end, when rhenish no long offered the needed relief, he turned to Claire to assist him in end of life options (Outlander episode 210 Prestonpans).

ADS is considered a medical emergency because it can lead to coma and death. Guidelines exist about the amount of alcohol the liver can metabolize per hour and these rates should not be exceeded. Again, please get informed if this is an issue in your life.

As a final example, we see wee Flora MacDonald taking a wee nip from her personal hip flask in Outlander, episode 605, Give Me Liberty!  Now, just because she carries a personal flask, it doesn’t mean she is suffering from either acute or chronic alcohol poisoning! 😉

Finally, this is an interesting tidbit. Some people carry a gene variant encoded for alcohol dehydrogenase (ALDH2*2) that stops the enzyme working, so these folks experience flushing soon after drinking. This happens because they have a lowered ability to metabolize alcohol and includes some 8% of the world’s population. Now, a link has been found showing that this gene raises heart disease risk in those who experience alcohol flush (New Scientist, 4 Feb. 2023). The risk of heart disease is four times greater in regular drinkers with the defective gene! if you flush immediately after alcohol ingestion, you may wish to consult your physician?

OK, that is our lesson for today. But before we call it quits let’s have a –

Pop Quiz! 

Name the injury (red arrow) Jamie sports after the Battle of Alamance, in Outlander episode 507, The Ballad of Roger Mac.

What was that you said?

An abrasion?  🚫

A laceration? 🚫🚫

An avulsion? 🚫🚫🚫

What was that you said?

 

 

A contusion? Yep!

Well done, anatomy students! 👏🏻👏🏻👏🏻

Next time, Part 3!

The deeply grateful,

Outlander Anatomist

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Photo creds: Sony/Starz, www.en.wikipedia, www.britannica.com

 

Herself, Two Highlanders & A Lord at NYCC 2022!

Good day, all!  Apologies, this has taken a week to get to you! 😜

Sunday, October 9, was the final day of 2022 NYCC and, for me, it was the best!

Each morning walking to Javits, we were greeted by a “herd” of pigeons waiting for treats. Roomies, Jody and Jim, point to the feathered army!  Usually, they were perched on the power lines reminding me of the 1963 Alfred Hitchcock film, The Birds! 😳 

Inside the Javits, more cosplay.

Don’t know who this is but I’ll wager some of you do? It is a fab costume! 

And, this intricate tableau…..

Anyone know? Wow! 😮

Onto the show floor where Jody quickly found her fav store, Tokidoki!

Next, Jody, Jim, and I were overshadowed by a huge Maga character!

Soon it was time to find a seat at the “Tea with Two Highlanders and A Lord” panel…. although, the title should have included “THE  Lady.“  

And, who might that be? Herself, of course! 🥰

I videoed the hour-long panel. My apologies for its homemade look. Occasionally, I had to switch hands and I also had to record most of it from the Jumbotron because I was too far back to capture a good stage view.

The panel was great and will speak for itself.

Enjoy!

(Psst….I never got any tea!) 😉

Afterward, the panelists retired behind the curtain for official photos. Then, as pre-arranged, Diana and her publicist emerged through a side door and I greeted her with a big hug!

She looked beautiful in her dramatic red cape, although this photo was taken sometime later.  😉 (It was a chill and windy day!)

I should mention, her splendid cape is made of warm wool with a tartan-lined hood. The sterling silver clasp appeared to be of Celtic design. I asked if it was from Scotland and she said, “I think so.” 😊

Pretty woman!

Then, we  headed for lunch.  It had been almost three years to the day since we shared a meal together and it was wonderful to see her again!

Her publicist took us down a private elevator to the basement of the Javits Center. I was intrigued by all the workings, supplies, and stuff in the “bowels of that  building!” 😜

We hopped into golf carts and were escorted to the far end of Javits.

This is a video of our “zip ride.”  You can hear me saying to Diana, it feels a bit  like “James Bond.”  😆

We were driven to a door that opened street-side and walked to Hudson Yards to enjoy a quiet lunch.

We took a moment to admire the  beautiful  ”Vessel” at Hudson Yards.

Fortunately, no fans took notice, and we snuggled in for a quick lunch.

She was gorgeous, as always, with her beautiful big smile and thick black hair. Red is my favorite color on her!

Her nails were beautiful, as always – a glossy, cornflower blue polish (I am sure someone knows its name).  And, she happily posed for a photo.

Her very strong nails are a gift from her father. She doesn’t wear gels, just regular nail polish! I always admire those lucky people who enjoy sturdy nails. 🤗

What did we talk about? Well, lots of things:

    • Children
    • Grandchildren (new photos of her darling grandsons)
    • Nails
    • Her brain 🧠
    • Her corpus callosum
    • Everyone’s right and left brains
    • Scientists
    • My anatomy lessons and FF using Sam as model
    • Titans of Fantasy panel

The following is a bit of what we talked about.  

I complimented her for her splendid performance at the “Titans of Fantasy” panel.  Her responses were  thoughtful and informative which held my attention. Made me proud!

I shared how her explaining her scientific journey to audiences delights me. Not everyone grasps what it means to be a scientist or the rigorous work entailed in becoming one. I think she helps people appreciate what science can contribute to a person’s life skills.

We talked about how science trains the left brain for details and analysis and how she patently trusts the intuitive side of her right brain.

I reminded her that the last time we met, I said she had an admirable corpus callosum because she clearly engages both sides of her brain.

Her very logical response was, “Well, why would you only want to use one side of your brain and leave the  other side behind?”

To which I replied…  “Pulling it along like a dog on a leash?” 😜

This may seem weird talk to you, but we always discuss things that others might find odd. (I make it a point not to press her for Outlander info. She is my friend.)

As a note of explanation, the corpus callosum is an area deep in the brain which allows right and left sides of the brain to communicate. And her sides communicate very well, indeed! 

Forty-five minutes flew by and suddenly, it was time to go, she had another panel starting in minutes. This time it would be solo with no backup if she were to be late!

We headed back toward Javits, stopping at the Equinox Hotel where her ride awaited her.  Her publisher was also waiting and took this photo of us, which I absolutely adore! ❤️

Then a quick hug goodbye and I returned to the Javits Center to grab a seat for the “Diana Gabaldon Spotlight’ panel.

Unfortunately, seating was very close so this was the best video I could shoot. Apologies to the lady in front! 

Which part of her panel was your favorite?

I loved hearing the excerpt from book 10! ❤️

But, in addition, I enjoyed learning about her writing Outlander on her husband’s garage computer! 😮

“Who’s Jamie?” 😂😂😂 

If only he knew at the time what a juggernaut her “practice book” would become! 

That evening, I joined members of the FB group, Hudson Highlanders, for dinner. It was wonderful to meet these lovely ladies, two of whom I had only met via Zoom (L to R: Tonise, Lynn, Gwen, Susan)! 🤗

Then to bed for an early rise.

Next morning, I had to say goodbye to Jim and Jody.  We have room-shared many times at various comic cons and they are the best!

In front of the red and white Empire State Building.  I think they look like newlyweds although they have been married 36 years!

Farewell my friends, old and new. Until next time!

The deeply grateful,

Outlander Anatomist

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Photo/Video Credits: Outlanderanatomy, www.timeout.com, Jody Kawamata-Chang, Diana’s publicist, kind waitress at “The Restaurant” eatery!