A radiologist once told me what at first sight seemed to be a very strange story. It was about a man who went to see his GP because every time that he emptied his bladder he got a terrible headache. There is no medical condition that presents in this way and so the GP was rather puzzled. As was I. There is no obvious 'cause-and-effect' type pathological process that could explain what was going on. The man was duly sent for tests at the local hospital.
In brief, what they found was not one but two pathological processes operating at the same time. Firstly, the man had a condition called hydronephrosis. This literally means a 'water-logged kidney'. This causes the kidney to become swollen with the urine it produces. This swelling can be relieved by passing that urine. However, hydronephrosis is a well-known condition and headaches when passing urine is not one of them. So, to explain the man’s headaches, there must be more.
Upon further examination, it was found that the man also had a tumour of one of his adrenal glands. (There are two - one situated above each kidney, hence the name.) This tumour was of an adrenaline producing variety. Again, these are quite well known and the man's symptoms were, again, not fully explained.
When both diagnoses were put together the picture became clear. The adrenal tumour was of the adrenal gland that sat upon the water-logged kidney. When that kidney was swollen, it pressed on the adrenal gland and its tumour squeezing it against the diaphragm and posterior abdominal wall. This impeded the venous drainage of the adrenal gland. Thus, a reservoir of adrenaline produced by the tumour built up inside the gland. When, upon urination, the swelling of the kidney was alleviated, so too was the squeezing of the adrenal gland. Thus, a big rush of adrenaline was released. That immediately sent the man's blood pressure rocketing giving him his post-urination headache.
Even though a clear chain of events could ultimately be determined, this is not a simple story of cause-and-effect. The urinary system is involved, as is the endocrine system (since that system includes the adrenal gland). So too is the cardiovascular system. It was the pressure in that system that rose upon the release of the stored-up adrenaline. Then again, the nervous system was also involved. It was there that the headache was both generated and experienced. It came about due to the pressure in the arteries within the brain. Then there would have been the other effects of a large dose of adrenaline elsewhere in the man's body which were not immediately obvious.
This, then is really a story about what happened to a whole organism - and to a person. It is not simply a clinical case study about pathophysiological details but an example of the integrated nature of ourselves as organisms. Indeed, all case studies are ultimately really stories about persons.
