SYSK TRENDING -Taking a Tour of the Human Body

The human body is full of strange, ingenious, and often overlooked features that keep us alive every second of every day. And some of the most fascinating parts are the ones we rarely think about — until something goes wrong. Dr. Jonathan Reisman takes us on an unusual tour inside the human body to reveal what our organs, tissues, and bodily fluids can teach us about how we work. He explains why certain parts of the body are far more remarkable than they appear, what doctors can learn from the substances our bodies produce, and why understanding anatomy can change the way you think about your own body. And yes, you’ll also hear why, of all the bodily fluids to choose from, urine is his favorite. Jonathan Reisman is a physician specializing in internal medicine and pediatrics and author of The Unseen Body: A Doctor’s Journey Through the Hidden Wonders of Human Anatomy (https://amzn.to/37vUz8u). Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Do you want to hear about visionaries creating a better world? People working in conservation, exploration, science and tech alongside storytellers imagining and creating a better future? I'm Alex Honnold, professional rock climber and founder of the Honnold Foundation, bringing you season six of Planet Visionaries. This season, I speak to guests like National Geographic photographer Tom Pechek and Anna Rattman, executive director of the Jane Goodall Institute, USA, in partnership with the Rolex Perpetual Planet Initiative. Watch Planet Visionaries on YouTube or wherever you get your podcasts.

• 0:32Mike Carruthers?

  You live inside your body every moment of every day, but how much do you really know about what's going on in there? Your heart beats about 100,000 times a day. Your kidneys are constantly filtering your blood. Your liver performs hundreds of different jobs. And your heart, lungs, brain, bone, blood vessels and digestive system are all working together in ways most of us rarely stop to think about. But maybe we should. So that's why today's SYSK trending topic is taking a tour of the human body. Dr. Jonathan Reisman is a physician who has explored the human body in ways most of us never will. And he's going to take us on a tour inside to explain what your organs actually do, why

• 1:17Mike Carruthers?

  they look the way they do, and reveal some truly strange and fascinating things about this body you've been walking around in your entire life. It's an intriguing journey that will begin right after this.

• 1:31Mike Carruthers?

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• 2:56Mike Carruthers?

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• 3:10Mike Carruthers?

  So how about we take a tour together? A tour of the human body and how it works. You must have questions or wondered how it is that all the parts of the human body work and work together to get you through the day, through your life. Today, you'll come to understand how some of it all works. Let me introduce you to your tour guide today, Dr. Jonathan Reisman. He's a doctor of internal medicine and pediatrics who has practiced medicine in the world's most remote places. He's author of a book called The Unseen Body: A Doctor's Journey Through the Hidden Wonders of Human Anatomy. Hey, doctor, welcome to something you should know.

• 3:51Speaker 02

  It's a pleasure to be here.

• 3:52Mike Carruthers?

  So why don't we start the tour, if you don't mind, with the throat? A lot of people wouldn't consider the throat a body part, but I guess it is. And so what is it about the throat that you find interesting?

• 4:05Speaker 02

  The thing I like to focus on in the throat is, is how kind of unnervingly close the food tube, the esophagus, is to the air tube, the trachea. You know, in our throats, the job of our throats is kind of to deal with everything that we inhale, that we swallow, that everything that comes in our nose and mouth sort of coalesces in the throat. And then our throat's job is to keep everything but air, you know, out of the airway. Everything we swallow must go down the food tube, the esophagus to the stomach, and only air should go down the windpipe to the lungs. And the amazing thing is, you know, we swallow thousands of times a day, whether we're eating food or we are subconsciously swallowing.

• 4:46Speaker 02

  And every time we swallow, whatever that is, food, drink, saliva, is coming within millimeters of the opening to the windpipe. And so one small slip up, if some of that goes in the windpipe, you could, you know, pretty much choke and die.

• 4:59Mike Carruthers?

  And so when, when I take a drink of water and choke, and people often say it went down the wrong pipe, is that exactly what happened?

• 5:09Speaker 02

  Yeah, that's exactly what happened. Some of that water went down your windpipe or your trachea and ended up in the lungs. And the body has evolved many ways of dealing with that because it's sort of inevitable, given how close the two entrances to the tubes are, you know, sort of inevitable, something's going to go down the wrong tube. And when you laugh or speak while trying to swallow, you're kind of opening up the airway. And if you try to swallow, you're opening up the food tube. And so if you do those two things at the same time, both tubes are open, which is why things happen, like things going down the wrong pipe. And coughing, which probably resulted after those instances, is one of the ways that we kind of clear out the lungs. Coughing is a mechanism for kind of clearing out whatever goes down the wrong tube. And it's quite effective at getting rid of it.

• 5:52Mike Carruthers?

  Can you talk about the liver? Because that's one of, you know, many internal organs that most of us don't know much about. We know we have one and we know it probably does something. So what does it do? Why is it there?

• 6:05Speaker 02

  And so the liver is almost like 100 organs packed into one. The liver is, is one of our most complicated organs. It's the biggest internal organ. The skin, which is also an organ, is actually bigger. But as far as internal organs go, the liver is the largest and which is appropriate because it has a ton of jobs. It really, in a way, oversees all of digestion and all of metabolism. So whenever you eat or drink anything, it comes into your intestines and then is absorbed into the bloodstream. And the first place it goes from there is to the liver, where the liver sort of checks out, you know, what is this thing? What did we just take into our body? Is it nutrition? Is it poison? And what do we do with it? So the liver from there will sort of sort and package.

• 6:49Speaker 02

  It's almost like, you know, the Amazon sort of sorting and packaging center where it determines where everything's going to go. It packages up all the protein, all the fat, all the cholesterol, sends it to its appropriate organ somewhere else in the body. And it also obviously detoxify, you know, famously detoxifies poisons, including our favorite poison, alcohol. And so really the liver just does a tremendous amount every day to keep us alive. And, you know, the best illustration of how important it is, is when it fails in people with cirrhosis of the liver, really everything kind of goes wrong with the body in those cases.

• 7:23Mike Carruthers?

  Well, that's one of the things it's always, there's so many things, like what you just described about the liver, and then there's all these other organs. It's a wonder things don't go wrong more often. I mean, things do go wrong, but there's so much to us that you would think we would break down more than we do.

• 7:42Speaker 02

  You're right. And that in many specific instances, I got that same feeling while learning about the body. You know, for instance, there's bacteria right all over us, even in us, in our throats, our noses, throughout our intestines. Many of those bacteria could kill us if they got into our bloodstream and perhaps landed in the right organ, you know, landed, let's say, in our central nervous system, causing meningitis. I mean, there's bacteria that could kill us if it got to the right part inside our body. And yet here it is sort of millimeters, you know, it's on us or even inside our gut perhaps. Yet it's sort of only millimeters away and kept at bay by, you know, various parts of the immune system, white blood cells, also just membranes that sort of prevent it from invading.

• 8:25Speaker 02

  And so sort of like, I always think of the body as sort of the barbarians are right at the gate and any moment they can sort of slip in. Not only can you aspirate, choke and die with any swallow, but you know, if your guard is let down for a moment, these, these virulent bacteria can invade and kill you. And yet we go about our day sort of happily for decades at a time, perhaps suffering no ill consequences from these things.

• 8:48Mike Carruthers?

  So since the skin is the largest organ in the body or of the body, I guess we have to talk about that. So what is it you find so fascinating about the skin?

• 8:59Speaker 02

  There's, there's kind of the social aspect of skin where we, you know, skin is what we see in other people. When we look at someone's face that we recognize, you know, mostly what we're seeing is skin and that's how you know people. But on a biological level, the skin is really amazing. It's almost, it doesn't get credit for being a very intelligent organ, almost predicting the future. You know, when, when sun rays bombard your skin, the skin is smart enough to want to become tan and tanning involves producing a dark pigment and putting that pigment right in front of the nucleus of every cell in the skin. Cause the nucleus where the DNA is, and that's where the harmful sun rays, the UV radiation can disrupt the DNA and result in a skin cancer. So it produces these little plugs of dark pigment right in front of the DNA,

• 9:44Speaker 02

  almost like putting sunglasses over, you know, your eyes. In the same way, it's building this wall in front of all of its DNA, knowing that more sun might be coming in the future and it will want to protect its DNA from the harmful radiation. And the same, same kind of amazing ability when the skin creates a callus. So if you get a repetitive friction on your skin, the skin thickens and hardens into a callus, almost to anticipate future, future friction in a way, you know, and sort of will be better protected against that future friction. So, and not to mention when people get cuts or lacerations when they come to the ER, you know, I usually will repair them with sutures or stitches. But skin really has an amazing ability to repair itself.

• 10:27Speaker 02

  You know, any wound almost, as long as the person's healthy and well nourished, will, you know, the skin cells will invade from all sides of the wound and fill that defect and just kind of fix the hole in the body that shouldn't be there. So skin is, is really amazing for all those reasons.

• 10:43Mike Carruthers?

  Talk about the eyes.

• 10:45Speaker 02

  The eyes are, eyes are a really peculiar organ. I mean, their function is incredible. Obviously, everybody knows that. The fact that they can, you know, allow us to see the world around us. Another aspect of the eye that I really enjoyed while, while learning to become a doctor was how I use it a lot in, in emergency medicine. It's often the most important thing I look at in certain cases. So if someone comes in, let's say comes into my ER completely comatose, unresponsive, even when I push hard with my knuckles and rub their breast bone, called a sternal rub, if they don't respond to that, you know, something's really, something terrible is going on. Like why are, why are they comatose? And actually the first thing I'll do in those cases is look in their eyes. So I won't grab my stethoscope, I won't grab anything else.

• 11:30Speaker 02

  I'll grab a light off the wall behind their bed and I'll peel open their eyelids and shine it into their eye. And in a way, I'm sorry, the eyes are telling me what's going on in the brain. So, you know, there's this old saying, the eyes are the window to the soul. In, in the practice of medicine, the eyes are actually a very useful window to the brain and can tell me what's going on. So if I peel back their eyelids and for instance, see that one of their pupils, not both, but just one is really large, wide open. And when I shine a light into it, it does not shrink as it should in response to the light. We call that a blown pupil and that can tell you that there's high pressure inside the skull. If on the other hand, as often happens, a patient comes in,

• 12:11Speaker 02

  I peel open their eyelids and I see that each of their pupils are very, very tiny black dots, almost like a little black poppy seed on both pupils. That actually suggests that they've had opioid overdose, like heroin or fentanyl.

• 12:24Mike Carruthers?

  Certainly if we're going to talk about the human body, we have to talk about the heart because, because that's probably one of the organs people think of the most and the blood, you know, since that's what the heart is doing. So why, and heart disease I think is the number one killer in this country. So what, what's so special about the heart to you that, that you find so fascinating?

• 12:47Speaker 02

  Its main function obviously is to push blood. You know, in one way, the heart is sort of a simple mechanical pump, which, you know, maybe is much simpler than let's say the, the liver, which has sort of all these millions of metabolic biochemical reactions going on all the time. The heart is sort of in a way simpler in that it just squeezes and pushes literally blood up into the aorta and then into the rest of the branching vascular tree of blood vessels. And what, what the, the heart and the blood do together really is just deliver nutrition and oxygen in the blood to the, kind of the doorstep of every cell in our body. You know, we have something like a trillion or more cells.

• 13:30Speaker 02

  And so each one, every moment must be receiving oxygen primarily, but also nutrition of various kinds. And also the blood has to then take away the waste from those cells. So in a way, when, you know, our ancestors in the distant past started as single cell organisms, that was sort of easy. The fluid of life was sort of surrounding them all at all times. And so it could, you know, it was, they were surrounded by it and it didn't need to get delivered to them. But once you start getting multicellular organisms, especially a trillion cells like us, you know, getting that nutrition, that fluid containing all the things you need to live, getting it to every, every cell requires this kind of infinitely branched cardiovascular tree, pushing blood to each, to each cell and then bringing away the waste.

• 14:15Speaker 02

  And so that's kind of the job that the heart and blood do every moment. In a way, when we, you know, in cardiac arrest, for instance, when the heart stops beating and stops pushing any blood forward, it's almost, you know, the whole body is sort of dead at that moment. We often note the time of death when the heart stops in particular. You know, people, your, your liver can fail, you might have weeks to live. Your kidneys might fail, you might have days to live, but when the heart stops, you're dead.

• 14:43Mike Carruthers?

  We are taking a tour of the human body with Dr. Jonathan Reisman. He's a doctor of internal medicine and author of the book, "The Unseen Body: A Doctor's Journey Through the Hidden Wonders of Human Anatomy." I thought I had a pretty good idea of where my money was going. And then I started using Monarch. And it turns out there's a big difference between thinking, you know, and actually seeing it all laid out in front of you. I've spent some time with Monarch now. I've connected everything and really tested it out and I like it a lot. Your accounts, investments, savings, goals, spending, they're all there in one place. But what really got my attention is Monarch doesn't just show you what's happened.

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• 17:32Mike Carruthers?

  So, Doctor, often when you go to a doctor visit, they want you to pee in a cup and they want a stool sample. And so what is it that you can tell from that?

• 17:44Speaker 02

  That's a great question. So I often say, you know, the bodily fluids are kind of the medium of a doctor's craft. Most of the time, what I'm doing as a doctor is getting a patient's bodily fluid, whether it's urine, or stool, or blood, and sending it to the lab, or testing it myself in some bedside manner, where you're kind of, in a way, reading messages from these bodily fluids. You know, urine is a language, and blood is a language, and is talking to your provider, your healthcare provider, your doctor, telling you what's wrong. And so, as a doctor, you know, learning about disease meant learning about those bodily fluids and what the messages mean. So when urine turns red, for instance, depending on the clinical context,

• 18:28Speaker 02

  you know, if I see red urine coming out of the patient, or in the cup that they then delivered to me from the bathroom, I could think they have a kidney stone. I could think they have a bladder cancer, or a kidney cancer, or some other injury, you know, maybe they were just got punched in the kidney by someone. So it's kind of, depends on the context, of course, but those colors are telling me something, and I have to interpret them and figure out what's going on with the patient. And every bodily fluid has its own kind of messages, you know, whether it's color, consistency, smell, you know, and then, obviously, beyond that, things you can measure under the microscope, or measure, you know, electrolytes, or blood cell amounts, and other things. There's sort of a million messages contained in these fluids.

• 19:11Speaker 02

  And so, reading them is a really important part of figuring out what's wrong with the patient, which is sort of the first step to alleviating it.

• 19:18Mike Carruthers?

  Yeah, I remember hearing someone talking about this, that it's pretty seldom that if you go to the doctor, you know, for your physical, and I think this was in a discussion about how necessary is an annual physical, that very rarely does somebody go to the doctor feeling fine and find out that there's something horribly wrong with them, and they had no idea. That if you've got some condition that's fairly serious, you probably have some inkling that something's wrong.

• 19:50Speaker 02

  In most cases, I do think that is correct. Not all cases, you know. For instance, high blood pressure is sort of considered the silent killer. But you're right, you're right, there's been a lot of appropriate questioning of the annual physical. You know, a lot of the times, to be honest, the doctor puts a stethoscope on a patient's chest to hear the heart or the lungs. Honestly, most of the time, it's unnecessary, to be honest. Not talking about in ER where someone's coming in with chest pain, but, you know, in the general doctor's office. Like, you're very unlikely to find something new. And then, there's also the question of, you know, if someone goes to their doctor and they don't listen with a stethoscope, they might feel like, well, what kind of doctor is this? Are you supposed to listen to my heart? Are you ignoring my internal organs? You know, I didn't get my money's worth.

• 20:32Mike Carruthers?

  Well, I think people feel that a lot, because nowadays, you go to your physical, and the doctor spends a lot more time on his keyboard than he does touching you. And it's like, well, wait, what about me? Wait.

• 20:46Speaker 02

  That is a huge problem. And I've had that experience myself. I've been the patient, actually, when I was in medical school, which is funny, it's because I was sort of, you know, supposed to be learning how to be a doctor, how to be a good doctor. And the doctor I saw for a kind of a general checkup, I don't think he looked me in the eye once. He was a very slow typer, which I sympathize with, though I'm a fast typer. But, you know, there is so much, the burden of documentation on doctors, especially primary care doctors, kind of grows every year. So I understand the, you know, the need to look at their computer and type while they're talking to the patient, especially as the number of minutes you have with each patient gets lower and lower, as reimbursements are cut back, you know, needing to kind of finish your notes

• 21:30Speaker 02

  before you go home and have dinner with your family is a bigger and bigger burden. But still, I think, you know, it definitely, I mean, it's dehumanizing. You know, it makes you sort of wonder, do they know I'm here? Do they care that I'm here? Is the opinion on the diagnosis and treatment actually going to be worth anything, given how little they're sort of looking at me? And it also, it sort of points to the fact of how important eye contact is, and just sort of basic human-to-human interaction. A huge part of medicine is just kind of being a human and having a sort of, a normal social interaction between the doctor and the patient, where you're hearing their story, they are feeling heard, you're making eye contact, and sort of, you know,

• 22:14Speaker 02

  not touching them too much, not touching them too little. It's kind of this fine balancing act, where you're in this sort of very bizarre social interaction, where you just met each other, and yet, I'm asking you about the color of your stool, how often you have sex, what the color of your snot, I mean, everything. It's sort of the most intimate conversation you could imagine with someone you just met.

• 22:36Mike Carruthers?

  From all your experience as a doctor, and you've had an interesting career, is there anything, or any set of things, that you wish people would do that would really help?

• 22:51Speaker 02

  Yeah, well, I guess that, you know, I think a lot of time is spent in ER is sort of wondering, why did the patient come? Why didn't they just stay home? You know, and I don't blame the public for this. I feel like sort of the basic medical education for the public is not great. And I wonder if there should be sort of basic courses in high school, you know, instructing people how to deal with their sort of basic, you know, colds and other things like that. People just don't know. So, for instance, we see a ton of children, let's say, coming into the ER with a fever, and the overwhelming majority of those fevers are, you know, a viral illness that might get better, that will most likely get better on its own, doesn't need any antibiotics, or any even x-rays or blood work,

• 23:36Speaker 02

  just needs some Tylenol or Ibuprofen, and just make sure the kid's hydrated, and that's it. But I think people, you know, understandably, don't know that. They, you know, most viruses, thankfully, are kind of, can be ignored. This, of course, does not count, you know, is it COVID? I need a note saying my kid can go back to daycare, back to school. That I understand. And let me repeat, I completely understand if people don't feel comfortable making that call for themselves. But like, 90% of what I do for children, and the ER is giving them over-the-counter medications, like Tylenol, Ibuprofen, and sometimes Benadryl for hives and other rashes.

• 24:10Mike Carruthers?

  Well, I imagine that a big part of a doctor's job, and perhaps one of the more enjoyable parts of your job, is to let people know there's nothing wrong. That, yeah, maybe you have a symptom, but it'll go away, or that you'll be fine.

• 24:25Speaker 02

  I think that you're right, that is a big part of every doctor's job, but it's especially the case with pediatricians, partly because usually, nothing is wrong with the children. Not always, obviously, you know, sometimes, things are wrong. But for the large part, for the most part, when children, let's say, come to the ER with a fever, the large, large, large majority are just viral illnesses that will go away on their own, need no workup, need no testing, and need no specific treatment. And, you know, I get a lot of, I'm an internist and a pediatrician, so I see both adults and children, and work in ER. A lot of internists who only treat adults will often say to me, you know, I don't know how you do pediatrics, the parents just must be so difficult to deal with. And I don't find that at all.

• 25:06Speaker 02

  I find parents, for the most part, you know, yes, some worry too much. I mean, I'm a parent, too. I've worried too much about things that ended up being nothing myself, even though I'm a pediatrician, it happens. But I find parents are very reasonable, and very, understand your reasoning, and the reassurance really works. That was almost one of the most shocking things, was when I became a doctor, and I could tell people, oh, it's, you know, for reasons X, Y, and Z, this is not a serious illness, and you don't need antibiotics, and just keep an eye on them, and they'll get better. They really responded to that, like, it was sort of this message coming from the mountaintop of the, like, sort of, universal truth. And I sort of was surprised that they trusted me, or believed me. But they do, and they're just looking for someone

• 25:50Speaker 02

  who has experience evaluating a child during with fever, which I've done thousands of times, you know, to tell them, you know, I've seen, I've seen tons of deadly infections, I've seen tons of mild infections, this one's mild. And they're reassured, and they go about their life.

• 26:03Mike Carruthers?

  What's one thing about the human body that you find so interesting that might surprise me?

• 26:10Speaker 02

  You know, I could say, one thing I particularly enjoyed learning in medical school was about urine. As a bodily fluid, I can mention that it is my favorite bodily fluid of all. And while most people never thought of having a favorite bodily fluid, you know, as a doctor, I mentioned bodily fluids are kind of the medium of our craft. It's what we spend a lot of time analyzing and interpreting to make a diagnosis. But urine, in particular, I find really fascinating, not only because, as a doctor, it tells me so many messages about the body. It tells me about the urinary tract, through which it flows from the kidneys to the bladder, tells me about diseases in those organs, but also tells me about body parts that are distant from the kidneys and seemingly completely unrelated to the urinary tract.

• 26:54Speaker 02

  But one thing that I really love about urine is how the salt levels in the bloodstream, the sodium and chloride are high, the potassium is low. And the kidneys are responsible for keeping those salts, those electrolytes, in just the right balance. And that balance happens to match the concentration of salts in the ocean. And I sort of love that, because, you know, our ancestors sort of evolved first in the ocean. And so, the only reason that we were able to sort of crawl out onto the land and live as, you know, air-breathing animals with lungs, the main reason is because the kidneys, by making urine, carry around the ocean inside of each of us. So in a way, we're each sort of still have that ocean inside of us, and our cells, which are fed blood,

• 27:40Speaker 02

  and fed the nutrients and electrolytes in blood, almost don't know we ever left the ocean at all. Because as far as they know, it's, everything's still just as salty with the same proportion of electrolytes. So that makes me love urine even more, the fact that, as it flows, it's sort of keeping everything in balance, and keeping this little bit of ocean inside of each of us.

• 27:58Mike Carruthers?

  Well, in all my conversations, in all the interviews I've done, thousands of them, I've never spoken with anyone about their favorite bodily fluid. So, this was fun and unique. My guest has been Jonathan Reisman. He is a doctor of internal medicine and pediatrics, and his book is called, "The Unseen Body: A Doctor's Journey Through the Hidden Wonders of Human Anatomy." There's a link to his book in the show notes. Thanks, Doctor.

• 28:24Speaker 02

  Awesome, it's been an honor to chat with you, Mike. I really, really enjoyed it.

• 28:28Mike Carruthers?

  My pleasure. And that's today's SYSK trending episode. I'm Mike Carruthers. Thank you for listening to Something You Should Know.