People were detained in protests on Sunday and faced up to a year in prison but one demonstrator in a blue mosque said the crowds would continue to defy the ban there have been further clashes on the streets of the semi autonomous territory on Sunday and for the 1st time Chinese army troops garrisoned in Hong Kong have issued a warning to the protesters. Police in Kansas City say they're looking for the suspects who killed 4 people in a shooting at a private member's bar early on Sunday 5 other people were injured in the attack in which at least one handgun was used t.j. Thomas itch is with the Kansas City Police Department we do not believe is random We do believe that this was an isolated incident I guess you would call it we don't feel the base of these suspects are going to go out and do this again. World news from the b.b.c. . Police in Nepal have arrested the former speaker of parliament Krishna behind a Mahatma after a female member of staff accused him of rape he denies the allegations yes under us Senator Rajan Krishna behold the model was a former moister rebel under senior leader of the governing Nepal communist party the woman who works in the parliament secretary 8 accuses Mr Mahara office holding her while drunk at our apartment on Sunday he resigned from the post office speaker on Tuesday saying he wanted to make it easier for an independent investigation he dismissed the allegations as baseless It's a rat in the poll for such a senior politician to be arrested on allegations of sexual assault thousands of French people are marching in Paris to protest against draft legislation that would enable single women and lesbians to get state funded fertility treatment the legislation has been passed by the lower house of parliament and will go before the Senate later this month it proposes allowing all women under $43.00 access to i.v. Have treatment it would also allow children conceived using donated sperm to find out the donors identity once they into adult hood. The president of Mali Abraham Cato has rejected talk of it cooler temps following recent attacks in which nearly 40 soldiers were killed Mr Cater said Molly was at war but that people should not be worried about a military coup suspected jihadist raided 2000000 military camps earlier this week near the border with Turkey in a fast said killing troops and making off with large amounts of arms and ammunition . Iran says the state owned firm Petra pass will take over or work to develop an offshore gas field after a Chinese company pulled out of the project last year the Chinese National Petroleum Corporation signed up to a multi-billion dollar joint venture to bring phase 11 of the south pass gas field on stream then suspended cooperation of the President Grant withdrew from the Iran nuclear agreement b.b.c. News. It's to the best of our knowledge I'm answering champs would you donate a kidney to a stranger last year in March on Facebook there was a little girl in our town that need a kidney. My daughter looked at me because you know mom. Would match up with her blood type so I called the hospital where she was working through. And that's how the process started. This is Missy McKenna. I had to go through all these blood tests and all these tests and everything. And then they tell me the little girl she had gotten a kidney and then her transplant was going forward and I felt like gone so far through the process. I said Ok at best kind of come this far. I'm not going to stop . That's how Missy McKenna decided to give away a kidney. To a stranger. You know what it was like something that once I decided to do it it wasn't. I never thought about it again. It was. There I asked my kids it was a no brainer and I said so you're giving your brain to. Accept you know. It was something that once I thought about it once I decided to do it there's no looking back. This is such an incredible story an incredible case. This is Mrs search and Josh has reach I have so many donors tell me this is the best thing they've ever done and of course that's my goal to lose a kidney. Why really it's the best thing because they're saving these lives it really is it is like the kind of person would run into a burning building to save someone other the donors do really well when you look at the numbers the risks are low but it's true surgery is still asleep. Faith there's going to be a recovery there's going to be pain. Out of their life that they can go through. But I do want to be clear our donors do very very well and I hope. To hear. When you think about it this is astonishing. Missy chose to give away one of her kidneys just because she knows that someone somewhere needs it more than she does. As a kind of donation that's actually on the rise but there's another story here too. Extraordinary field of transplantation and surgeons. Who perform medical miracles every day. His new memoir when death becomes life inside the operating room. Decided to take us there in person. This was such a great opportunity. Just a few blocks from our studio the hospital in Madison is one of the busiest transplant centers in the country they do about $350.00 kidney transplants a year and out of them. This is a kind of surgery that was unthinkable a few decades ago and now it seems like it happens almost every day. I was just thinking about how our bodies can do incredible things every day part above. And it's one of the most moronic things to think about that part of our body can help save another person's body the overhead lights on the table these 2 human beings connected in this really. Amazing way there's a patient actually that's a very You just introduced me to Missy and I asked how she feels and believes. The s.e.c. Are just about to totally put her and her. Right on much in just. Over one tough cookie. As much. I felt like. I want to be a part of this. So. Why. The mood in the room totally changes once the patient's asleep. They turn up the music to. 3. He has this whole playlist he likes to play can't ever do so you know I'm embarrassed to say it but for whatever reason I I like to listen to Tupac on Pandora. And. He's pretty into it 101. Like yours it's fun playing his music and. You can do a lot of long surgeries and a lot of them overnight and you need something with energy that is going to keep you away from me classical music as much as I love it is probably not going to give me the energy I need you know they're going to play lighting from all these pieces go Josh talks pretty much nonstop there are jokes there's chatter I do I should say there was a stretch of time where I did all my case with an English accent that it was quite clever Did he kill. All the nurses were dying to work with me because everyone wanted to try to negotiate he owns the room right and we can everyone do it all moment of how great I am let's. Talk about how great you know just. A hands like this team of people that you know we feel like a family in there and a mate but. It is almost like a performance. I do think to be a surgeon you have to kind of want to be the person who wants the ball you want to take the ball and be the one that's responsible for it I just think about those golfers who will talk about their around and they remember like every shot what the wind was why they use the club and I feel that way about operations it's like a sporting so many ways you have to develop muscle memory you have to practice to perfect it you have to work in a team and you actually can replay the case in your mind I actually want to see him out as replaying and I suddenly remembered I didn't tie. One end of a Dr on this complicated case I was sitting. And I was just replying is it all I'm going to and I actually do run down and take the guy back to the office. Is it messy I mean different operations are more or less messy I think the liver for me is the messiest thing I do there are some cases I've done where we lose more than 100 liters of blood and that is a tremendous amount we probably have 5 or 6 leaders in our body so you can imagine it was just people blood all over the floor just sloshing around everywhere and a kidney is not like that. It's remarkably bloodless it's less risk optics so the doctors are basically putting these large probes into ports in Missy's abdomen All right so part of the harmonic scalpel which brought great sight which is really 2002000 feet per 2nd. This. Is. Such that sound. So it is twisting the port with the camera and it to drill through layers actually of muscle and fashion to enter this is abdomen entry. That's the sound of them twisting something into Missy's abdomen you know the gamma so you can see the arteries and the fat and other organs the guy right there are. Some beautiful letters that I was going to see I always look at the letter because I'm a transplant surgeons I see I feel like I want someone to tell me my liver looks great. It's probably different than what how people picture it I've gone to the point where I see people walking around I can almost picture what the inside of their belly looks like but I try not to overcome the question I was going to ask you know I wanted to know whether because most of us have never seen probably never will the inside of an abdominal cavity do you like if you're standing in line or on the bus glance at people and think. So you look like this inside I have those moments really really small or thin people you think how can they fit that all inside them and my wife's a surgeon and sometimes a certain people walk by with certain body habitus and will comment tough kidney or something like that. Should not make that. One So surgery starts it really is this puzzle you really focused on doing the case . You're not thinking at all about my gosh this is a person with kids or with parents or something like that I think when things go disastrously wrong then you start to get these moments of thinking about their family but during an operation you're really focused on the task at hand. And you know most don't feel like you're operating on a human you're just trying to put the puzzle together. But we're still looking for you maybe you know. You see the Earth is moving. Looks like some sort of sea creature. And to look about you. And she. Was there a point where you thought I'm sure they're taking this surgery thing seriously you know. At one point I thought wow they're really talking a lot but you know as a reporter I usually ask a lot of questions but I kind of felt like. I shouldn't ask too many questions because what if I ask a question they look up maybe answering me and. The surgery is this is right there is laser cutting artery it's you know they are great and they are there they're saying is that they are that's that are they there that's going to. Look at I mean you know there's. Things could go very wrong we see him or relax and we're having fun but like we are able to very quickly kind of turn it off and it. Something goes wrong and thankfully that doesn't usually happen but this is where my my heart rate goes up I think if he found out I'm monitored like a heart monitor on. During these operations. The thing that seems so distinctive about transplant surgery it's literally at the intersection of life and death most of the time for the transplant to work somebody died transplant really starts with death it's a different field in a way we take from death I really believe the donors the deceased donors are my patients too. Sometimes the call comes in at 3 in the morning that there's been a terrible accident and somebody is Dad and there are some organs you and your team are the ones who will then sometimes fly to actually you call it procurement. And the 1st thing you must do is meet with the donor's family what are those conversations like. When I 1st went on my 1st procurement I was really nervous to meet the family because I thought Gosh were these vultures coming in to take their loved ones organs away and it'll be the last memory they have and maybe this will be too hard for them he walk into the room and often it's a big group of people they're in tears there's an unexpected death of maybe a young person but they absolutely hang on to every word they want to know about the transplants they want to know who the recipients are which we can't tell them at that point it's this one positive memory in this otherwise terrible time. They often will want to tell us something about the person that just died. You know in a sense when you're with a donor and you're going to be taking organs the organs are still alive so there is still life there I know I agree and probably every transplant center has a picture like this but our center there was this woman who lost her young daughter in a car accident some years back and she finally met the recipient of the heart at a picnic that we sponsored. There's a picture of her listening 10 years after her daughter died to her daughter's heart with a stethoscope in this recipient and it really is a piece of her daughter that still alive and although she can't talk to her daughter. I just think it's so special and it is at that center of what's alive and what's not are they still alive in some way. Now hold that thought because Mrs kidney Isabelle to be can it's lifesaving journey Ok we've got a plane ticket you can is a plane ticket will be right back time and strange chance it's to the best of our knowledge from Wisconsin Public Radio. And our x. . I am Harry I think every surgeon has to have this proverbial box and in this box you can kind of put your complications and you can keep them there you need to be able to close that box so you can go home and be with your family be with your kids be in the moment and not just be constantly agonizing but you also need to build open that box and own that complication be with the patient see them every day and say we're going to get through this it was my fault or maybe it wasn't my fault i'm sorry this happened I know surgeons who can open the box and become these cowboys and never think it's their fault I know surgeons who can't close the box and they're almost paralyzed. Sometimes if a surgery is going badly the thing that matters the most is the will power of the surgeon you know not necessarily the technical skill just the guts I write about this one case Tito which is this incredible story because I really almost lost my will during the surgery and it went on for hours things had gone wrong we had lost a ton of blood what was so hard about this one when we started to re profuse the liver releasing the clamps the the spot where we had sewn the liver into the vein a caver where it drains out the blood fell apart and the more we tried to get control of it the more it toward to the point that it was just exciting when aging and we could barely controlled by you know holding it with our hands and and kind of at the point where I was like this is we should just stop and I went down to talk to his daughter and she was there alone it was like 4 in the morning and I said to rend I think I don't think we can do this I think he's going to die on the table and she kind of looked at me and she was very respectful a very kind person but she said you know I know I know you will do everything you can to save my dad and I did have this moment where I'm like I don't not going to give up let's go let's go back after this I went back up there and started throwing stitches called some partners in spent more to pull more hours and we actually were able to get through it. But I remember like there was this moment where I kind of lost faith a lost heart in this operation and it's kind of resigning to me to think about that . So let's think of the city saves them in. The city streets. What's it like when it's finally time for the kidney to come out which. Everything becomes more serious to get out of this is critical so once we get the kidney out we'll move it to the back watch it was critical once it's flushed out eyes then we can run the timing is really key because there's somebody waiting with a test device to take it on the plane we have our flesh and it was a. Part of we get there I'm good we got only need. So then they basically get the kidney free anybody's call mom. Please get. A cable all right he's down with all the you think you're great There you. Are. Telling the whole. You love that. Phrase you know you can use fully you know keep and have your harmonic in case we look a perfectly well you keep your instruments you know I'm going to take mine out Josh pulls out the kidney I got here and there it is it is what does it look like flip the kidney in the bag like a fish it looks like a. Big Pink ball how big. Big handful. Ok we get the year. I have to say the mood changes after the kidney came out good light song they start analyzing it and that seems so much more serious right and it was pretty clever West. They start looking on the kidney and then it spurts out says you your me yes yes it does like I actually saw that happen you know they're looking at it and it just shoots out this big amount of heat. Is what you need to arteries and how to be really ready to do it and then they pack it all up I mean I'll go it'll fly across the country and then you know it'll get plugged in and it'll start working right away just awesome. There must be a moment of wonder is that over here in the operating room or is that like later at 4 in the morning when you're lying awake thinking back over your day now it hits me every time I think the wonder that we can even do this the wonder that you so an organ in and it just starts working right in front of your face the liver starts making bile the kidneys starts peeling the heart starts beating the Long starts breathing those things are all amazing. But part of what's so great about this story when we get a donor like this young lady who is joining just into the pool we can actually do something called a chain she will donate her kidney it will fly somewhere else in the country and that patients donor will have a kidney go on a plane to somewhere else these chains can crisscross the country over a period of months I think the biggest chain was more than 30 pairs 60 people involved multiple transplants. I was at a talk through the n.p.r. And this young woman who had started a chain was up there and she said. No you doctors in the audience you guys save lives all the time which I think that's true but that's what she said and she said something like me I don't really have the opportunity to do that and I went through this operation and I saved all these people and it will be the best thing I've ever done for the rest of my life. It's a beautiful thing that people do. So what about the woman at the center of this story Chrissy McKenna She's the reason everybody was there in the operating room what is it going to be like to wake up without a kidney. It's been 6 days. Missy Hyatt Shannon how are you thanks so much for doing this today it's amazing to me last time we met you were in the operating room and you were getting ready for surgery yeah how do you feel I feel also I'm just getting really really tired and I'm not to myself as I'm actually I'm tired out but other than that I would never know I had surgery what's different about what you expected Well everybody talked about all the pain I'm not in any pain and somebody told me that when after you donate you kind of feel like at a loss because it's done and over with I did ask how the kidney was doing and they said it was doing really good and I'm just like an AA and how easy things were and how it went and how I feel now I feel great and at peace you saved someone's life. But you know I guess anti-heroes that sound like that I don't you know. You know. That's amazing I always want to help people so I'm glad that I could save somebody's life. What is it like to think about part of your body being part of someone else's body right now. I have to laugh because my daughter came to me as I was getting ready to go down to Madison for my surgery and she said Mom I can't just say goodbye you know I'll see you and I'm like oh thank you and you know I was think about your kidney. You know I guess being a part of somebody else. I don't even think about it I just hope that the life is more enjoyable would you want to meet the person yes I would. And I don't know why I mean I do if if they want to meet me if they want to meet me if I don't want them to feel that they are have to meet me. Or my kids want to they want to meet the person that has a part of me is what they tell me. You know you've got to feel some kind of closeness there yeah. Do you. You know you're resting a little more and is there some kind of activity you get back to eyeball and a half lots of kids in my house I care so I just look to getting back to doing some of the of that things that I do with like going outside. Like that now that sounds like fun so you do you want bowling night yeah well on Wednesday night I bet your bowling team is excited to have you back yeah they will be. Here it's an incredible story thank you so much Missy what you've done is amazing and incredible . Thank you but I. Miss you McKenna donated her kidney in February 29th. Shannon Henry Kleiber was there for all 3 hours of her surgery which was performed by Chashme as rich parkand singer Josh is a transplant surgeon at the University of Wisconsin and author of the medical memoir when death becomes a life. You've probably figured out by now that our theme this hour is the wonder of the human body. Something it's all too easy to forget and hustle of life. Until something goes wrong. But see one of the 1st times they have the sex. Predators. Early. That bathroom that we had was extremely moldy. Everywhere. When that happened and I fully. I had a sense of my own fragility. Has treatment. How are you feeling. I'm not feeling very well. What's going on. I just had a long day of avi's and I have had an endoscopy a day and I'm having a really bad pain and short of breath I'm sorry to hear that Sis frustrating because. There's just so much to deal with and every part of my body seems to be affected so yeah. I mean in the one hand we know it's wrong with me I have late stage Lyme disease it causes systemic damage but here and you know which parts of the body are being even away by this sort of corkscrew bacteria this spiral key illness that is so insidious can you tell me about how that feels what does it feel like eyes just feels horrible to feel unsafe in your own body I mean you know I don't know why it's happening but it just feels like I'm being eaten by a mound body I feel like I am just. I think the feeling of illnesses you just feel like a stranger to yourself but often times you know. I remember remission just last year what was that like I was very active I lived a normal life I had minor aches and pains that come with Lyme and I didn't didn't even register for me have a very high pain threshold so I didn't make a big fuss about it I wasn't certainly taking a ton of pills or going to doctor every other day as I am now you have your mom with you now right she's helping you yeah. What is it like when you kind of have to explain it to people and you say you know these are my ups and downs and this is what I need how do you ask for the help and how do you know what to ask for my mom turning 41 next week and it's just on some of the humiliating to have to ask my mom to like make me every food meal as last year I could for myself and also it's humiliating and strange to feel like I can't be alone a lot of other parts of your body that you're happy with right now that you think that part is working well. I as is the problem with our culture those parts my body if you look at me right now you'd think Oh she's this like thin probably in shape person I'm rewarded constantly for being extremely thin I fit into clothes I wore in middle school right now that's not normal but in our really disturbing disgusting culture that is rewarded so everywhere I go people think I look great and that really really burns me because I was about 40 pounds heavier to say few years ago and no one thought I looked healthy then but I felt great at night when I'm trying to sleep all I feel are my bones I'm sorry it's hard that's really hard I'm sorry we're catching you on you probably have a lot of days like this yeah that's why when people ask me to do interviews like I don't really say no because I don't really wait to feel better. There are so many moments in your book that were happy but the the book at the end is not a happy healing ending as a writer I can imagine that it was kind of hard to not have an ending did you feel that way as you're writing the book yeah I mean I initially unnerves I sold it as a book that would have won because I was feeling fairly good but I think it's probably a better book for that reason and I think it's reach more people it doesn't have a neat ending the book is not neat but illness is not me and so I feel like it's more of an honest book that way a lot of writers talk about illness as metaphor and can you talk about your illness as a metaphor in your life you know I've been moving away from thinking about illness as metaphor I mean of love the Sontag of course that's something I write about in the book. But more and more I've been walking away from the a d. Of illnesses metaphor as I get sicker because it remand assizes the issue a little bit and I really like the literal and the pragmatic here when we talk about illness as metaphor it creates a distance between us and science and the doctors I can appreciate it a statically But when you're trying to get well you really want to be nuts and bolts and facts and figures I'm not very interested and the mystical aspects of illness nothing speaks to me more than when I look at a lot of work and I see numbers there more and more I step away from the metaphoric in a figurative and the aesthetic and I go in this other direction has nothing to do with my art and I almost think it's a disadvantage when doctors here I'm a writer and I don't want them to. Really think about that you want to be real and scientific and yeah see the numbers I think that art can save in a certain way and live and bring joy to people sure but the end of the day of some a starving on the street or they're losing half the blood in their body art can't save them and I do think science and technology actually can. And you know the artist in me I'm surprised to hear myself even say that but I am at a point where I can't afford the other side of it I need I need my doctors to be excellent scientists excellent detectives of the body and to really know what's going on well there's got to be something that you're trusting in your body as much as your body has has not worked for you in some ways you're trusting part of it in some money too. Trusting Yeah I mean I don't know I don't know if interesting the body I'm trying to or hoping I don't have a choice though I don't think hope is something people can choose I think everybody who's waking up every morning and putting on some clothes and aiding some degree of her. Purchase to thank you so much for being with us today we know you're tired and we want you to go rest thank you. Part. Of the best selling memoir 6. Chatted Harry Potter talk with us. Is it possible do you think to find any sense of wonder Will most. Probably not when it's your body that's falling apart. But there are doctors who can find wonder in something as simple as temperature. One of the many reasons we get a fever is that when you're on well there's some if you like helium invaders into your body that your immune system is engaged with fighting off. Your body picks up on the fact that you're fighting off an infection. Your white blood cells become alerted and they start to secrete certain hormones. Which affect your brain's central thermostat. For good reason because when you're a little bit hotter all the chemical reactions in your body happen a little bit faster. And the hope of our physiology if you like is that is going to help us clear to infection a quicker. And that's why. Drugs like I think in the u.s. Are quote Tylenol. That disturbs the connection between the chemical production and the brain and that's why it brings down the temperature. Scottish physician Gavin Francis on the art and science of medicine next. To the best of our knowledge from Wisconsin Public Radio. And p r x. . It tells Steve Paulson about how medicine is both an art and a science so I'm guessing that as a doctor you see the common everyday cases probably also some extraordinary cases as well and I guess I'm wondering if there is anything in particular that surprises you or maybe even still amazes you about the human body. Well there's something surprising or even amazing happens every week or 2 it's one of the great pleasures of medical practice it's endlessly varied from week to week always stunned by the kinds of things that walks through the door and I guess my books are an attempt to kind of communicate a sense of wonder I still feel not just about the complexity the intricacy the beauty the elegance even of the human body but also how there's tremendous capacities in the body to heal and as a physician we're often trying to take advantages of those changes and trying to help the body along do you find this amazing that the body just has these natural powers of regeneration of healing and it just sort of does it by itself and knows how to do that yeah absolutely it is phenomenal and the scale of it is truly extraordinary too you know when you think of just the simplicity of you reacting to a viral infection so somebody sneezes some viral infection on you and the way your immune system can respond to that by very very quickly recognising if you've ever been exposed to it before if you have been exposed to it before very quickly managing to engage and bring online all the white blood cells that can produce the antibodies to get rid of the infection it quickly start multiplying they start pumping out the right onto bodies and lo and behold you don't catch the infection and the whole thing your body has done for you without you having any conscious awareness of it at all I think immunology the way we fight and. Actions and also a new role in g. The way our nervous system works are 2 of the most extraordinary aspects of our humanity and they're actually still very little understood give me an example of one of these more ambiguous cases where you know you're using your intuition you and the patient are trying to come up with a story about what's happening and giving examples of that and why that's so important to develop a good narrative. Well there's so many conditions which fall under the category of medically unexplained symptoms and they can be recurrent headaches they could be recurrent abdominal cramps it could be even ordered rashes or episodes of fatigue and when the doctor carries a full history to try and find if there's any of the particularly well known culprits for the symptoms can be found they had to run a whole set of blood tests and imaging scans and so on and they perhaps still can't find any cause for this fatigue or the recurrent headaches or for the return of the little crumbs then we're into the realm of trying to understand what these symptoms really mean when do they come on what are the symptoms exacerbated by how is the patient affected by these kind of symptoms what do they hope for from treatment because when medical science and world where modern Western medicine has drawn a blank at trying to understand where they're coming from then we're in another realm of trying to push them from a different perspective and I think those kinds of symptoms are really really very common and then there are some other examples of sort of this interesting connection between brain and mind for instance there's a phenomenon that I've heard various people describe that they're experiencing a heart attack and they have the sense of dread that they're going to die and in fact it seems to be one of the diagnostic signals of cardiac arrest even if the chest pain is not so bad they have the sense that and my God The end is near How do you explain this. Phenomenon you're describing is still called in the medical textbooks we call in Latin anger or I'm in my r I'm going to enemy means I'm of the soul and it's still used regularly on hospital wards and in emergency rooms to describe that experience that somebody has that they're imminently about to die and we take it very very seriously as physicians and I think it shows that. The old idea that from the chin down our bodies are just kind of plumbing and almost going ahead like a robot it's not true actually the connection between our mind and our mental state and the rest of our body is very very intimate but I still don't understand how that happens somehow people just know that something really dire is going to happen what do you think is going on there I think our perspective that the mind and the body have been so separated that position is is just wrong so we don't fully understand all the different ways in which the body and brain are communicating you know it's often described that we have 5 senses but actually we have a lot more senses than that because there's all sorts of senses that are going on in terms of your balance in terms of your proprioception your understanding of where your limbs are in space you have senses there to do with whether your bladder is full or empty you have sense is there to do with whether you're feeling short of breath or Thursday there are all kinds of different senses that are going on are far far more than the classical 5 senses and when you have a disturbance and some of those that's is the way in which I think we're coming to appreciate a fundamental shift like that if you're going to a heart attack there's changes in your blood pressure there's changes in the feel of your pulse all over your body and all these things we can actually sense a subset conscious level yeah i makes you wonder that as we use more technology in medicine for instance an artificial heart would people have the same sensations could have an artificial heart without a pulse right yeah absolutely and there's been a fair bit of research done into this you know some of the artificial hearts they pump in a continuous ceaseless fashion so the blood just move ceaselessly through the body instead of having a pulse a tile floor which is her body is used to be and there. Theory that in some sense our brain needs that pulse that there's a kind of connection between that pulse of tile flow of blood through our brains and our sense of wellbeing so people who go on a heart lung bypass machine for very long surgical operations and they come round from the surgery often describe a really profound shift in their mid often feel very low feeling very depressed sometimes disinhibited almost like they've been drinking and we don't understand why that is happened and there is a feeling that is to do with the loss of this pos of tell flew through the brain fascinating It almost sounds like you're saying that our understanding of the body and what doctors do in the practice of medicine is to some degree still as much art as it is science Well yeah I think very much in doctors have to know what to do but they also have to know how to do it when to do it quite a do it and all those things are still very much an art and you know I think very much I find in my ork as a physician it's helped by the fact that I also work as a right turn I write books and think a lot about language but the 2 go hand in hand so being a writer thinking a lot about language is helped by medicine but Medicine also helps the writing because there's so much art in medicine and it's practice are you saying that because you were a writer that makes you a better doctor yeah because as a writer I'm very interested in people's stories I'm very interested in seeing how they position themselves in their own life story and those around them. I'm trained constantly as a writer and how to say things concisely and elegantly and quickly and being able to communicate elegantly concisely is of huge advantage to Dr so yeah definitely being a writer helps my medical practice. Just really getting back to this notion of the wonder of the body you say that there are some parts of our body there are really kind of miracles of engineering the foot for instance Oh yeah what's so remarkable about the foot the weights engineered. Well most biology students of our generation were told of course that the human hand was a miracle of engineering and that we have these opposable thumbs that make us so much more special than apes but actually the human hand isn't that different from any but what is really unique about us is our feet because all the other mammals have feet are adapted for going around on all fours and our feet are beautifully engineered for supporting our weight on 2 legs of a few different reasons so the shape of the Archies of the foot the 3 different Archies to donors lay in from one across the width of the foot that sustain the weight just like a stone built bridge hands are changed the bones are actually shipped the same way and then there are ligaments on the underside of the arches of the foot are almost like the staples underneath Stonebridge to hold it together and we also have special tendons that come down from the calf they support and lift the center of the arch just the way the suspension bridge is supported so you know there's a great deal about human foot I find truly miraculous and it's such a pity that you know medical students they always leave it to last and. They come into their anatomy exams and they've never studied the foot but as a physician I'm always dealing with people with problems with their feet so. You're saying kind of in the deep evolutionary sense the foot is maybe what made us human Yeah it's probable that the changes in the fit are will enable does to stand up right and then that freed our hands to be able to become toolmakers and that process which allowed the great evolutionary leap for our brains to start developing. Are there particular cases you've seen that are just so out of the organisers so extraordinary that you sort of think wow how does the body do that. But wonder behind your questions that I'm sometimes wondering if you're. Thinking of particular well for this book if you just read there's 11 chapter in there talks about a patient I met who had a horn growing out of the center of her forehead that's exactly what I was wondering about. You know the body is endlessly surprising and that is an example human beings can even grow hardened sometimes and then No 3 days are ever the same in clinical practice you never know what the next patient is going to say to you Ok you have to explain it how can a horn grow out of someone's forehead. Let's look at different reasons are hard to grow Believe it or not Ok sometimes harness derived from the kind of tissue that makes wetlands sometimes it's derived from the skin just as the surface you know the waterproof part of the skin it just undergoes a process whereby instead of flaking off as it should do it just gets more I didn't and grows and grows and grows and grows and if you have one patch of skin that keeps growing a thickened layer and it just grows and grows and grows then you end up with the horn you know there's this wonderful I cannot defeat of Moses from the Bible he's always shown with horns horns are supposed to give you this idea of dignity and authority and I'm not convinced in our modern world people agree Horn's sense. What did you do with a woman with a horn growing on her forehead. Well she was actually very good natured about that particular case I was in a dermatology clinic and a senior consultant in the dermatology clinic made arrangements to have the horn removed and a small skin graft over. The patient turned round and said to well don't do it too soon because I've got a fancy dress party next. Statement going as a unicorn. So sometimes a sense of humor there on a predicament can be helpful. That was Steve Paulson talking with Scottish physician and writer Gavin Francis his most recent book is called shapeshifters. And that's it for this hour of to the best of our knowledge but there's always more online check out our articles and digital extras. Shannon Henry Kleiber produced this hour with help from Charles Monroe came Margaret. Sound designer and technical director. Steve Paulson is our executive producer and I'm in strange chaps. C.c. More cracks murder cases by combining d.n.a. Science with good old fashioned family tree for any type of human identification there really isn't anything more powerful than d.n.a. And genetic genealogy but others say people are being caught in this dragnet it just scares me to think about the world that we are going towards this reveal. Tomorrow at 12 noon here on k l w San Francisco to the best of our knowledge continues with our 2 after the news break it's part of our Sunday ideas line up conversations that investigations from locally and globally lots of the talk your way at 11 o'clock followed at 12 noon by list show with Harry Shearer a unique look at the week's news you can only hear the special mix of programs here on k l w San Francisco. It's to the best of our knowledge from a p r x. . Picture this you're in the Army 22 years old you're sent to Iraq and assigned to guard Saddam Hussein sitting alone in a cell with him for hours. What did you guys talk about we were from and I was sending how we would pass the time he was passing his time and we were passing ours he never talked to us about the evil stuff that he did. I got the 5 and this is just me that he was almost sorry do you think he cared about you. If something would have happened then. We would get over why I was thought that he would. Show mercy on me. I'm as French I'm split our empathy for monsters. First us hello I'm Julie Candler with the b.b.c. News a lawyer says a 2nd intelligence official has come forward and been interviewed about President Trump's dealings with Ukraine Mogs itu made the announcement also represents the 1st official who filed a complaint saying Mr Trump wanted Ukraine to investigate his likely election rival Joe Biden Chris Buckley ripple the lawyer representing the 1st whistleblower to raise concerns about Donald Trump's actions nor has another client Mark Zite says that this 2nd whistleblower has already spoken to the intelligence community inspector general and that they.