It was the closest I came to death, according to the doctors at Brooke Army Medical Center (BAMC) in San Antonio, Texas. As a teenager, you kind of have a sense of indestructibility. Most of my life, I grew up around horses. When I was twelve years old, the military moved my family from Hawaii to Washington state. Living in the countryside, I was reintroduced to riding. Unbeknownst to me, my Dad strolled down an old, deserted farm road until he reached a farmer’s ranch and introduced himself. He shared how he had a twelve year old daughter and had noticed the farmer owned a mare. Wondering if the mare needed exercise, my Dad offered my ability to care for and ride his horse. The farmer agreed. Later that day, my Dad took me down that same farm road and introduced me to Nikki, a welch-quarter horse mare. She wasn’t mine, but I loved her anyway. Also, I was provided no saddle nor a bridle, but I didn’t mind. What could possibly go wrong? I would grab a handful of mane and squeeze my knees tightly against her side for balance. With my other hand, I held a rope connected to each side of a halter. Without a bit to control the direction of the horse, I was at the mercy of Nikki. Routinely, I would walk her to the back of the pasture, jump on her back, and canter her towards the stables. She was a compass that pointed only to the barn, and I was just there for the ride. Sometimes she would gallop under low branches in her attempt to knock me off her back, but I would just duck lower and place my head closer to her neck. Her impish behavior never deterred me from riding. Afterall, I was a teenager with nothing to fear.

Mark Lewis said it best, “teenage thinking bears an uncanny resemblance to the delusional profundity of a marijuana high” (53). In fact, cannabinoids are natural brain chemicals that increase neuron activity and is seen most present during adolescents. S.R. Laviolette and A.A. Grace with the Department of Neuroscience at the University of Pittsburgh delineated how locally released cannabinoids in the amygdala region of the brain regulate functional neuronal networks and influence emotional processing and sensory perception (7). The two subtypes of receptors are the predominant CB1 and CB2. Surprisingly, a 2011 study illustrates how CB1 activation is also an immune response to inflammation and tissue injury which “triggers rapid elevations in local endocannabinoid levels, which in turn regulate fast signaling responses in immune and other cells modulating their critical functions” (Pacher & Mechoulam 2). The two critical players for processing sensory information and associative learning are the basolateral (BLA) and the lateral (LAT) nuclei of the amygdala. Inputs from the LAT release natural cannabinoids within the BLA which inhibit inhibitory interneurons (Laviolette & Grace). When tested on mice, the technicians administered cannabinoid from marijuana which effectively blocked their fear response to auditory signals. So it seems that the distortions of adolescent thinking is directly affected by these natural producing cannabinoids in the body. Furthermore, Mark Lewis notes that the emotional center of the brain located in the limbic system is fully connected in teenagers while the frontal lobe that involves decision making and critical thinking is not fully developed. This explains why teenagers are guided by their own ideals and attentive to their own logic. Specifically, this ideology that they are immune to adverse natural consequences combined by their increased neural activity in associative learning.

Eventually, my family moved to the city. My parents had purchased a two bedroom house downtown with a small backyard and a dilapidated garage. Without a horse, I turned my focus to sports, volleyball and pitching for our high school softball team.

Every year my school held an auction to raise funds for building improvements, computers, or miscellaneous expenses. Families donated baskets with a hodgepodge of goodies, framed artwork, airline tickets, skis, a sky-diving package, and a plethora of treasures. My father escorted my mother to the auction as a date, which they regularly did, dating that is. The auctioneer began his chant, and the bidders raised the prices. Towards the end of the night, a bay saddlebred mare was announced as the next ticket item. My Dad looked over at my mom and smiled. He then proceeded to explain how different artful gestures counted as a legitimate bid. The auctioneer proclaimed, “A hundred dollars. Let’s start the bid at a hundred dollars.” My Dad nodded excessively, alerting the auctioneer. “We have a hundred dollars. Will anyone give me two hundred?”

The room was eerily quiet. No one moved. My Dad again glanced at my mother. She looked questioningly at him and mouthed, “What are you doing?”

He tried to reassure her with calming hand gestures and whispered, “Someone else will bid. Don’t worry.”

The auctioneer repeated, “I have a hundred dollars. Will anyone give me two?” All was quiet. “Going once.” My Mom solicitously scanned the room. “Going twice.” All eyes were on the auctioneer. “Sold to the man in the red shirt!”

I know why my Dad did it. He will tell you that he was just showing off, but I know he did it for both my Mom and I. Growing up as Daddy’s little girl, I never really established a close connection with my Mom. But through the love of horses, we became fast friends and true horse kinsmen, the kind that enjoys mucking stalls, shoveling gravel, washing out water buckets, hauling hay, or just being around a horse.

When the horse trailer pulled up next to the house, I was elated. Running down the steps and across the front lawn, I peeked in through the window to greet the newcomer.

I spent hours at the stables talking to Cricket, brushing her mane, and, of course, riding. Sometimes I would pretend to be an acrobat and ride Cricket standing up while holding the reins. As I tried to keep my balance, my whole body would vacillate while she trotted. But I sold Cricket. She was a great horse but not very smooth to ride. Taking the profits, I purchased a liver chestnut Morgan colt who had been orphaned. At ten months old, he was a wild thing! Growing up with other yearlings, he had never learned manners. Sometimes when I was leading him down the path, he would reach over and bite me hard on the shoulder. Now mind you, Major was not a malicious animal; he just lacked horse etiquette. For me, I saw Major more as a challenge than a deleterious problem. Jokingly, I would demote him to Private when he acted out.

Since he was under two years old, Major was too young to be ridden, so I exercised him regularly by lunging him or leading him with a halter and lead rope. Training was ongoing. One of the other boarders suggested that I place Major in the pasture with the mares to teach him some manners. They would not put up with his nuances and biting. After a few days, several patches of hair were missing from his sleek coat. In fact, the older mares would chase him away and not let him eat hay until they were finished. Basically, he was learning how to be a horse. Soon after, I noticed his attitude improved, or so I thought. In order to feed him his grain without interruption, I needed to take him outside the pasture. Every night, I would brush him down while he nibbled on his oats. When he was finished eating, I let him graze on the grass next to the fence.

One night as we were walking towards the barn, Major decided to take off. Unsuccessfully, I tried to thwart his mutiny. Holding tightly onto the lead rope, I began running alongside him, hoping to turn him around by brute force. Major saw me as an impediment to his freedom and kicked out. I don’t remember the kick as much as I remember lying there in the grass feeling queasy. Later, we discovered that Major’s kick had ruptured my spleen and left kidney, as well as bruised my pancreas.

Located in the upper left region of the abdomen, the spleen is about 5 inches long and 3 inches wide (UPMC). As the body’s largest filter of blood, the spleen plays a crucial role in recognizing and removing pathogens such as viruses and bacteria, recycling useful elements from red blood cells (RBC), removing older RBC from circulation (large white blood cells called macrophages destroy unhealthy RBCs), and storing about a cup of blood in case of an emergency (Mebius,R.E. & Kraal, G.). Although the spleen is part of the body’s front line defense, a person can successfully live without one because the liver and lymph nodes take over the spleen’s many tasks.

Thankfully, the kidney comes as a pair of bean-shaped organs, the size of your fist, that is composed of around a million long, thin tubular structures called nephrons which are surrounded by capillaries. Without the left kidney, my right one would eventually pick up the slack. Regulating the composition of blood, the kidney’s primary responsibilities include: keeping the volume of water constant, maintaining a balanced acid/base concentration by secreting hormones as necessary, signaling the production of red blood cells, and removing toxins and wastes (Gatthone II, V.H. 1). The components that are deemed viable are reabsorbed back into the blood while the unwanted elements are secreted from the body in the urine. According to Dr. Craig Freudenrich, the kidney filters 20% of plasma and non-cell elements from the blood (2). While a human averages around 7-8 liters of blood in the body, the rate of filtration is estimated at 125ml/min or 180 liters each day (2). Since my left kidney was obliterated by the kick, my body immediately went into protective mode because I was bleeding internally.

Trauma-hemorrhagic injury causes the body to secrete an abundance of proinflammatory mediators or immune system hormones such as cytokines and chemokines (Liu, Tsai H., Tsai Y., & Yu Intro). Cytokines are small secreted proteins that are primarily produced by helper T-cells (TH) and have a specific effect on the interactions and communications between cells. Specifically, Interleukin-1β (IL-1β) is the principal pro-inflammatory cytokine responsible for the body’s defensive response to cell injury (Lopez-Castejon & Brough). On the other hand, chemokines’ primary function is the activation and migration of leukocytes, a white blood cell that counteracts infection. Doctors routinely check for high levels of chemokines in your urine and/or blood and compare it to what is considered an acceptable range (5 wbc/hpf in urine and 4,500-11,000 WBCs per microliter in the blood) (Zhang & An 2).

Shortly after getting kicked, a military police officer was driving by and noticed my car. He stopped, looked around, and found me lying in a ditch. Throwing up next to his shoe, he assumed it was blood, but I told him it was just vomit. Time seemed to fragment into intermittent scenes because I can only recall a few key aspects with clarity while my perception of certain events or people are distorted. For example, I wasn’t completely aware of my trauma or the fact that I never tried to get up afterwards, but I knew the difference between blood and vomit and I could focus on the officer’s questions.

During the ambulance ride to BAMC, I remember every uncomfortable bump along the backroad, but I don’t remember how they put me in the ambulance. I also recall lying on a hospital bed with a white curtain and the warm sensation of Iodine-containing contrast medium (ICCM) injected into my bloodstream to help reveal if there was any internal bleeding in the x-ray imaging. While the nurses and doctors conducted multiple tests, they repeatedly tried to keep me awake. I just wanted to sleep. Ultimately, my body was shutting down.

Hemorrhagic shock or hypovolemic shock happens from severe blood loss when not enough oxygen is transported at a cellular level (Long & Cannon Para. 4-9). Your body then activates a number of stabilizing mechanisms designed to preserve blood flow to vital organs. Since your cells cannot meet the demands of aerobic metabolism which breaks down proteins and produces ATP, they transition to anaerobic metabolism which is an indicator of low cardiac output (Gutierrez & Wulf-Gutierrez). As a result, ATP supplies, which is responsible for providing the energy needed to support all the body’s cellular functions, dwindles to an unsustainable level. With the combination of oxygen depletion and blood flow as well as the lack of energy necessary to maintain the status quo, your body begins to systematically shut down. This is why patients with traumatic injuries feel tired and just want to close their eyes. However, medical experts have determined that it is best to keep patients alert so they can monitor for changes in neurological status. In the worst case scenarios, some patients might not ever wake up.

According to Dan Long, MD and Jeremy Cannon Md, 1.5 million deaths occur worldwide from physical trauma (Para. 2). Swift response time by the officer and the medical staff who operated on me saved my life, since the average time from onset to death is about 2 hours (Para. 10). In fact, “actively bleeding patients should have their intravascular fluid replaced because tissue oxygenation will not be compromised, even at low hemoglobin concentrations, as long as circulating volume is maintained” (Gutierrez & Wulf-Gutiérrez Para. 11). Most people with hemorrhagic trauma like mine would also receive a blood transfusion, but fortunately the doctor’s resuscitative strategies were successful. While I was in surgery, my parents overheard a couple doctors talking about my case. “I don’t think she’ll make it.” They were wrong.

For a week I lived in the intensive care unit. Four or five times a day, I had to practice breathing into a device to avoid pneumonia. The hardest part was when they made me get out of bed the first time because of the staples running from my sternum to below my belly button. Continually, my parents prayed for me. I didn’t realize how serious my injuries were until later when talking with my parents. Usually death is something you see in the movies or with the elderly. I was young and vivacious but maybe not so shatterproof. Undoubtedly, I know I made some poor decisions that night, but perhaps it could be the result of an undeveloped teenage brain on natural cannabinoid. For one thing, I never made that same mistake twice.

Walking away from this, I learned to let go of the rope. Seriously, I am not stronger than a two thousand pound animal. I also realized to let go of the little things that pop up and annoy you; it’s not worth fighting over and possibly ruining relationships. Additionally, I am thankful for this second chance at life. I still ride. That will never change. As for Major, I kept him until he died at eighteen years of age. He actually turned out to be a great horse, one that my kids even rode. Basically, I taught him to obey voice and leg commands and our adventures included riding straight up the side of a mountain, swimming in a lake and the Pacific ocean, exploring trails, and camping under the stars. As a friend and companion, Major helped me through the toughest times of my high school years, although they were almost cut short from “Major” trauma.

References

Freudenrick, C.,PH,D (2019). How Stuff Works: How your Kidneys Work. Retrieved from https://health.howstuffworks.com/human-body/systems/kidney-urinary/kidney.htm

Gattone, V. (2009). Kidney structure and function. Microscopy and Microanalysis, 15, 74-75. doi:http://dx.doi.org.proxy.consortiumlibrary.org/10.1017/S1431927609096330

Gutierrez, G., Reines, H. D., & Wulf-Gutierrez, M. E. (2004). Clinical review: Hemorrhagic shock. Critical Care (London, England), 8(5), 373-381. doi:10.1186/cc2851

Laviolette, S. R., & Grace, A. A. (2006). The roles of cannabinoid and dopamine receptor systems in neural emotional learning circuits: Implications for schizophrenia and addiction. Cellular and Molecular Life Sciences, 63(14), 1597-1613. doi:10.1007/s00018-006-6027-5

Levy, R. M., Mollen, K. P., Prince, J. M., Kaczorowski, D. J., Vallabhaneni, R., Liu, S., . . Billiar, T. R. (2007). Systemic inflammation and remote organ injury following trauma require HMGB1. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology, 293(4), 1538-1544. doi:10.1152/ajpregu.00272.2007

Lewis, M. D. (2012). Memoirs of an addicted brain: A neuroscientist examines his former life on drugs (1st ed.). New York: PublicAffairs.

Liu, F., Tsai, Y., Tsai, H., & Yu, H. (2015). Anti-inflammatory and organ-protective effects of resveratrol in trauma-hemorrhagic injury. Mediators of Inflammation, 2015, 643763-9. doi:10.1155/2015/643763

Longo, D. L., M.D., & Cannon, J. W., M.D. (2018). Hemorrhagic shock. The New England Journal of Medicine, 378(4), 370-379. doi:http://dx.doi.org.proxy.consortiumlibrary.org/10.1056/NEJMra1705649

Lopez-Castejon, G., & Brough, D. (2011). Understanding the mechanism of IL-1β secretion. Cytokine & growth factor reviews, 22(4), 189–195. doi:10.1016/j.cytogfr.2011.10.001

Mebius, R. E., & Kraal, G. (2005). Structure and function of the spleen. Nature Reviews.Immunology, 5(8), 606-16. doi:http://dx.doi.org.proxy.consortiumlibrary.org/10.1038/nri1669

Pacher, P., & Mechoulam, R. (2011). Is lipid signaling through cannabinoid 2 receptors part of a protective system? Progress in Lipid Research, 50(2), 193-211. doi:10.1016/j.plipres.2011.01.001

UPMC (2019). UPMC Children’s Hospital of Pittsburgh: What does the Spleen Do? Retrieved from https://www.chp.edu/our-services/transplant/liver/education/organs/spleen-information

Zhang, J.M. & An, J. (2009). Cytokines, Inflammation and Pain, PMC 2009, Int Anesthesiol Clin. 2007 Spring; 45(2): 27–37. doi:10.1097/AIA.0b013e318034194e Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2785020/

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JONNA BARTLETT is a senior pursuing a Baccalaureate degree in Mathematics with a minor in English. This piece was selected by Professor Jacqueline Cason.