The Grapes of Exchange

Ashley Davidoff MD Copyright 2007

The Grapes of Exchange is a story of romance, unspoken promises, wrath, passion and a ditched lover that happens with a single inspiration. In the end, a mission is accomplished for the good of all.

This is a photograph of me, the bronchiole in teal blue next to my friend the arteriole. It was taken at the airport before we embarked on our inspiring trip.Story and illustrations by: Ashley Davidoff, M.D.

From the minute I saw him I loved him and I knew that no matter what evolved, we would spend our lives together… little did I know what the working relationship would be.

Here follows a true story about me, the bronchiole, and my lifelong buddy the pulmonary arteriole.

He and I were on a mission. I had my origins in the atmosphere and he from the heart. We came from very different backgrounds and had come a long way on this trip on the highways and byways of the airways and circulation. My mission was to take products from the air in the atmosphere and deliver them to the grapes of exchange and his was to deliver blue blood to the same grapes. In this communication we will speak mostly of the journey to the grapes in the house of the pulmonary lobule. The grapes of exchange in my imagination had something to do with bonding and marriage – perhaps the exchange of vows. The story turns out quite differently. We had great travels together and took a lot of pictures!!

I think by this time you know what we had already been through. He had started out as a large elastic vessel off the right heart called the main pulmonary artery (nickname “MPA”) and I had started out as the trachea. (nickname “trach”). We met at the doorway of the lung called the hilum, and took a fancy to each other right away and so we decided to travel together. We had traveled a long way by the time our story begins both experiencing many divisions and were right in the middle of an inspiration. We both looked quite different at this point having given birth to many offspring. In the new language – we had both “morphed” quite a bit but this was a necessary part of the mission. Of course we were much smaller than we had been. He had lost some of his elasticity and developed a bit of muscle. I had lost my entire cartilagenous skeleton and had developed some muscle as well. We were told that from now on we were both going to lose muscle and I in particular was going to change drastically. I could not wait! I secretly hoped that this change would make me more attractive and bring me closer to a happy union since I was promised a happy union in the end. My name at this stage was “terminal bronchiole”. A foreboding and deathly chill rattled down my muscularis as I said the word “terminal” knowing that I was going to lose the small amount of muscle that I had.

We reached the doorway surrounding the secondary lobule and faced the polyhedral entrance. It was quite beautiful I thought in my teal blue outfit.

At this time we were already up in the air and on our journey. This is a picture of me, the terminal bronchiole in teal blue in the center and my buddy the pulmonary arteriole in royal blue at the doorway of the polyhedral secondary lobule. We were told by our guide to prepare ourselves for a “centrilobular” entrance since our entry point was to be through the center of this doorway.

We took a quick walk around the polyhedral structure.

Here is a picture of the outside of the polyhedral pulmonary lobule from the side. It looked quite futuristic. Through the transparent side window we saw a couple similar to ourselves. From this vantage point the morphing did not look too different from what we had already been through – division after division – leaner and meaner.

We returned to the entrance and took a closer look at the goings on inside through the large front entrance windows of the pulmonary lobule. Below is a picture of what we saw.

We noted there were other pairs of people they called the pulmonary venules (red) and lymphatics (yellow). A joyous union with these pairs was also promised. I could not imagine how. They looked so different to each other – the lymphatic, tiny and dressed in a bright yellow suit and the vein in passionate red. They seemed so foreign, almost from another space, time zone and culture. At this vantage point we got a vague sense of what was to come, but in our wildest dreams we could not have imagined how our bodies were going to change and what was to happen as we moved inward into the chambers of gas exchange.

As we were ushered into the lobule, we were faced by a refreshing atmosphere of comforting air and a hub of activity. In addition to the swishing sounds of air movement we heard a hubbub of clinking and clanking. We were told that the sounds were coming from the grapes of exchange (wedding bells?). We also noticed that there were at least three other couples that looked like the people of our tribe – three other bronchovascular bundles. We called our tribe the “bronchovascular bundle” with the one part of the bundle being the progeny of the bronchus and the other, the progeny of the pulmonary artery.A group picture inside the lobule is shown below. Fortunately the flash was working because it was a little dark inside.

This picture shows us with a white ring around us (we were the tallest) and the other couples who looked so much like us (also ringed). We called our tribe the “bronchovascular bundle” with the one part of the bundle being the progeny of the bronchus and the other the progeny of the pulmonary artery. In the distance at the periphery we could see the pairs from the other friendly tribe – the red pulmonary vein with its smaller yellow buddy the lymphatic. Behind them we could see the transparent window membrane through which we had peaked earlier. Oh my goodness!!! Look what has happened to my body!!

I did not realize that my body had already started to morph at the time of the picture – little sac-like love handles spreading all along my formerly sleek and beautiful body. Yech! I did not look good at all. My buddy the arteriole on the other hand as well as members of the other tribe maintained their sleek tubular looks. “Why me?” I shouted. “All for the good of the nation and good gas exchange!!” they shouted above the swishing of air and clanging of the factories. “Easy for you to say,” I replied. “Some of us have to suffer some bad morphs for the good of the whole” they said, “but those love handles kind of suit you,” they exclaimed with a wry smile. I was so sad.

Well the divisions started coming rapidly and so we all became smaller very quickly. I was getting rounder and rounder while they were getting thinner and sleeker. Things seemed to be rushing at an accelerated pace and I must say that there was some excitement in the air as we all got closer and closer to each other. In the big picture we seemed to be coming together as a team, and the whole landscape seemed more colorful and more promising. We reached out to the other tribe and they too us.

This picture was taken just before the real drama started. The image gives a sense of what was to come. You can see here in the house of the lobule that we were all dividing into smaller parts and were getting smaller and the picture was quite colorful and rosy. I fully expected to have intimate contact with the arteriole… but it did not happen as I expected…

I remained on the plump side as my love handles grew more pronounced and rounder while the clanging noises grew louder and louder. I was dividing into alveolar ducts and alveolar sacs and finally into alveolus which of course is a complete transformation from my former tube like shape to the spherical shape of the grape. In the mean time my buddy the artery grew as small as an 8-micron red cell and remained true to his tubular form. He started to surround me completely but was more in concert with that beastly red vein as he ran headstrong in blind passion to join her in capillary union. For a moment they each lost their identity becoming the tiniest of tubes neither arteriole nor venule. I on the other hand became at one with the fruit of the vine and in stuporose state I think I became the grape itself. Through my waist I felt the pleasant freshness of gusts of air going back and forth through my skin. My delivery of fresh air moved very quickly into the capillary. Little did I know that it was the oxygen that I carried which gave my competition the beautiful red glow of health. The odious carbon dioxide moved the other way. This toxic waste came directly from the man I had known and trusted for so long. Thanks for nothing.

I do not like to show the next picture much since for me it is a sad one. There I am a ditched lover, fat as a grape, in the middle of the capillary union between my blue “ex” and his new partner in crime, the red beast. Yes of course it was for the better – they all say that – but what about me?

There I am the fat alveolus surrounded by the gracile capillary network, with breezes of oxygen and carbon dioxide whiffing through my waist. The authors of this module seem to like this picture – but for me I an in my worst physical shape.

As you have learned already, the blood circulation needs two types of vessels: one to carry the blood to the lungs and a second to carry it from the lungs. I on the other hand do it all by myself. On inspiration I take air to the lungs and on expiration I take it away through the same vessel to the atmosphere. This is the lot of all women. We do double the amount of work schlepping here and there and everywhere and get no respect for it.

So at this junction we are in the middle of an inspiration (for me – what kind of inspiration could I feel in my morphed format) and we were just about to start the expiration. While I was traveling to the exit of the lobule during this phase of my life, my “ex” was going in the same direction – now transformed into a beautiful vessel with that healthy glow. Despite my odious load and my downtrodden feeling I moved with a sense of optimism.

What do you know? As I left the chamber of the lobule I shed my love handles one by one and my saccular form started to take on the sleek and tubular look again. I looked and felt brand new. “Hmm… I thought – perhaps he will fall in love with me again. I was hoping for another inspiration, just to show him once again how beautiful I was both on the outside and the inside. And that my friends was my nightmare in the Grapes of Exchange.