Polite Dissent

A fairly light episode of Fringe, but an enjoyable one

The Plot:The Observer is patiently standing in front of a museum in Boston, taking notes, and spying on brunettes. After a few minutes, he finds the one he wants, grabs her, throws her in the back of a stolen car and drives off. Arriving at an out of town motel, he gags her and ties her to a chair, and then leaves.

With the Observer involved, the Fringe team is called in. The kidnap victim is identified as Christine Hollis, and seems to be an entirely normal young woman. They review the surveillance camera footage and realize that this is a different Observer than the one they first met. It turns out that the Observer accidentally left his notebook behind, so it’s turned over to the team; however, they are unable to decipher the code/language in the book. Astrid identifies over 1200 different symbols, without any repeats. Looking online, she discovers that one of the researchers at Massive Dynamics is also interested in the code. He has not been able to solve it either, but he has documented evidence of Observers at important historical events including the Boston Massacre, the beheading of Marie Antoinette, and the shooting of Archduke Ferdinand. Peter finds a drop of what appears to be blood in the Observer’s journal. Walter notes its orange cast and wonders if the Observer might not have hemophilia.

At a restaurant across town, a group of three Observers are meeting to discuss the actions of the rogue Observer, whom they call “August”. They mention a plane flight and imply that Christine is supposed to be dead, so they send an assassin after her.

August returns to the hotel room, unties Christine, and shows her the television news, which reports that the flight she had booked to Rome crashed en route with no survivors.

The labs tests come back and the drop in the journal wasn’t blood, but hot pepper sauce — and sauce from a particular hot pepper: the King Cobra Chili. Astrid is able to find the address of the individual who imported some last year, so Olivia and Peter head over to check it out. As luck would have it, the Observers’ assassin is there at the same time. There are some fisticuffs and Peter sustains a small wound, but the assassin escapes.

August meets with the other Observers. They tell him that Christine must be killed to set things right. This is not what he wants to hear. He manages to set up a meeting with Walter, asking for his help. All Walter can tell him is that he must somehow make Christine important to the Observers, so they won’t kill her.

August returns to the hotel room and unties Christine. He tells her that she must do exactly as he says. A short time later, the assassin appears at the hotel and in the ensuing battle, August is shot and critically wounded. Olivia and Peter arrive, and August gives his gun to Peter. Together, Peter and Olivia are able to kill the assassin. They find Christine and return her home.

The first Observer picks up August and drives him away from the hotel. As August lies dying in the back, he tells the other Observer that he had developed “feelings” for Christine, even loved her — and that is why he saved her. The first Observer tells August that she is safe now because she is responsible for the death of an Observer, and that makes her important.

1. Hot, Hot, Hot
The King Cobra Chile is the hottest chile known to man, scoring 850,000 to 1,000,000 Scoville units. It is also known as the “ghost chile”, which should be familiar to you if you watch Man v. Food.

2. 15% Tip
Why would it be a surprise that the tip about August was called in from the same hotel? Would it really be a shock that one of the other guests, or an employee, saw him and phoned it in?

3. Color of Love
This is the first I’ve ever heard of hemophiliacs having orange blood, and I don’t buy it. Hemophilia affects the clotting of the blood, not the hemoglobin (which is what gives blood its red color), so why would the blood be a different color?

4. You Go That Way, I’ll Go This Way
I would not want to be Olivia’s insurance agent, and I hate for her to be my backup. Tonight she: 1) was easily distracted by the assassin, 2) nearly shot Peter, and 3) only avoided being shot by the assassin due to dumb luck and Peter.

A much better episode this week. The show does much better when they stick with the Pattern. There is a one-minute improvement on the Doomsday Clock.

This week’s Fringe cipher was: BLIGHT.
A list of all previous Fringe reviews is available here.
Karl has much more to say.

Y: The Last Man #47 “The Tin Man”
Brian K. Vaughan, writer
Goran Sudzuka, penciler

By request, a look at Y: The Last Man #47:

Dr. Allison Mann is experiencing an incredible amount of what appears to be vaginal bleeding. In fact, she’s bleeding so much that she’s going into shock from the blood loss.

What conditions could lead to this amount of bleeding?

1. Trauma
   Like anywhere else in the body, trauma (such as lacerations or abrasions) to the female genital tract can lead to bleeding. The pelvic region has a good blood supply, so heavy bleeding is possible.
2. Uterine Fibroids
   An abnormal (but non-cancerous) growth of muscle cells within the uterus.
3. Hormonal Imbalance
   Especially elevated or unopposed estrogen. A thyroid or adrenal gland problem can cause some abnormal bleeding as well, but generally not this amount.
4. Pregnancy-related bleeding
   This can include a miscarriage or threatened miscarriage. In pregnant women, placenta previa (where the placenta is lying over the cervix) or placental abruption (where the placenta is pulling away from the uterus. This can be fatal to mother and child.) are concerns. Heavy bleeding could also be from retained tissue after birth or miscarriage, such as a retained placenta. A final pregnancy-related cause would also be postpartum hemorrhage, when the uterus does not contract down after birth and continues to bleed. Postpartum hemorrhage can be fatal — but given Dr. Mann’s recnet history, that is unlikely to be the cause here.
5. Genital Tract Inflammation
   Inflammation, most commonly caused by infections, can cause bleeding, but not at the level Dr. Mann is experiencing.
6. Bleeding Disorders
   Hemophilia (though extremely unlikely in a woman), Von Willebrand’s Disease or other blood disorders can lead to heavy bleeding. Use of anticoagulant medications such as warfarin or heparin could also cause heavy bleeding.
7. Cancer
   Cancer, particularly endometrial or uterine cancer, can cause heavy bleeding.
8. Arteriovenous Malformation
   A uterus with an abnormal blood supply could result in heavy bleeding.

Dr. Mann believes the cause of the bleeding is related to miscarriage she suffered earlier, before the series began. Without knowing more about the timing involved or the miscarriage itself, it’s difficult to know for sure. But if I had to speculate: Given that she was not receiving professional prenatal care, she may not have sought professional assistance at the time of her miscarriage. Thus uterine trauma or damage could have occurred during, or due to, the miscarriage. I suppose there could also be retained tissue left over from the miscarriage, but that seems unlikely given the time that seems to have passed since the miscarriage. I think we’ll just have to wait and see what Vaughan has in mind.

Other medical evaluations of Y: The Last Man:Y: The Last Man #29 (plague or botulism?) Y: The Last Man #30 (active and passive Immunity) Y: The Last Man #45 and #46 (homeopathic surgeons?)

Kinetic #1 (“Superzero”), #2 (“Crash”)
Kelley Puckett, writer
Warren Pleece, artist

In Kinetic, we meet Tom Morrell, a high-school senior who suffers from “over a dozen major syndromes.” His mother reminds him that he has hemophilia, diabetes, and monmyelic amotrophy, before scolding him and injecting him with a large shot. Tom has difficulty in school, getting picked on by both teachers (indirectly), and students (directly). Because he walks a pretty girl home and misses his “shots”, he has some sort of spell and passes out, requiring his admission to the hospital. He then resolves to kill himself. Issue #2 continues where issue #1 left off, with Tom trying to kill himself. It also includes a great deal of back story and flashbacks, but not much new medically.

I can find no medical references to “Monomyelic Amyotrophy“. So either writer Puckett has made up a disease (which I have no problem with), or it is a typo for Monomelic Amyotrophy. I suspect the latter because Tom exhibits the symptoms of this condition: a weakness and wasting of the muscles of a single limb. It is most common in males between 15 and 25, so that fits as well.

Tom also suffers from Hemophilia, a genetic disorder where the body is missing one of the proteins that allows blood to clot. Therefore, people with hemophilia are prone to bleeding much more than a normal individual, and even a small cut can prove significant. Tom’s mother was right to worry when he was considering shaving. Hemophilia A is treated with an IV medicine called desmopressin (DDAVP), Hemophilia B is treated with an infusion of clotting factor (either genetically engineered or from human blood donors), and Hemophilia C requires infusion of plasma to stop bleeding.

Diabetes is the third condition that Tom suffers from. Summed up quickly, diabetes occurs when a person cannot utilize the sugar and other carbohydrates they ingest, and the sugars build up to high levels in their blood. There is Type I Diabetes (otherwise known as Juvenile Onset or Insulin Requiring Diabetes) that occurs when a person’s pancreas stops making insulin. It must be treated with insulin injections. Type II Diabetes (also known as Adult Onset or Non Insulin Requiring Diabetes) occurs when a person becomes resistant to the insulin that their body produces. It can generally be treated with oral medication, but may ultimately require insulin. Given Tom’s age and thin appearance, it is most likely that he suffers from Type I diabetes. This requires insulin injection to treat.

Insulin syringes are small slender syringes, either ½ or 1 cc in size. His mother appears to be holding about a 5 cc syringe, but it could be one of the newer multiple-injection syringes which are larger than the traditional insulin syringes. Insulin injection is done subcutaneously — not deep like a flu shot, but just under the surface of the skin. Insulin can be injected in the outer arms, abdomen, thighs, or buttocks, but the injection site needs to be rotated regularly. If Tom were my patient, I’d expect him to be injecting his own insulin by this age, but clearly there are some messed up Mother-Son dynamics here.

I’m not quite sure what sort of spell Tom has while walking home. Most likely he is developing Diabetic Ketoacidosis (DKA). When Type I diabetics develop an extremely high blood sugar, they can become deathly ill and even die. It usually results from stress, infection, poor diet, and/or not taking their insulin. Vomiting is common sign of DKA. However, incontinence does not occur with DKA (just the opposite actually — dehydration). While he did apparently miss his afternoon insulin injection, it’s too soon for DKA to set in as it usually takes a couple of days for the sugar to build up to a high enough level. Of course, his spell could be because of one his nine other unnamed syndromes.

In the hospital, Tom is hooked up to several wires and tubes. There are two leads going to the heart monitor (there should be 4 leads), and a tube in his nose. This tube could be nasal canula (to supply oxygen) — but in that case, it should be in both nostrils — or is could be a nasogastric tube, used to drain the stomach contents or provide liquid to the stomach. He also has an IV line in place, so it makes no sense for the nurse to inject the medicine directly into his arm, the IV would have been much easier and faster.

Overall, it is clear that a great deal of research went into Kinetic. The only concerns I saw were minor, and took place almost exclusively in the hospital setting (we can probably blame those on the artist, not the writer). I am also interested whether Puckett meant Monomelic Amyotrophy, or made up his own disease Monomyelic Amyotrophy.

In reality (such as it is in comics), Tom’s biggest issues appear not so much to be medical, as maternal.