In Chapter 2 of How We Die, Dr. Nuland illustrates how sometimes the body's natural response to injury or illness is maladaptive, a notion critical to a Healthy Survivor's understanding of treatment.
For example, when the heart can no longer pump well, blood backs up into the veins (namely, blood vessels that bring deoxygenated blood to the heart). Evidence of waterlogged tissues can be seen in patients' swollen ankles, enlarged liver and congested lungs that can't oxygenate blood well.
In addition, a failing heart pumps less blood out to the kidneys, limbs and other tissues.
Ideally the kidneys could help the overall situation by filtering out the extra salt and water that is causing fluid overload. But since the kidneys are receiving less blood, they respond by holding on to salt and water.
This natural response is lifesaving in patients who are dehydrated or threatened by blood loss. But it can be lethal in patients who are in heart failure. This is just one example of a natural bodily response exacerbating a health threat.
Healthy Survivors perceive the body as a magnificently complex system that uses checks and balances that usually work well.
Healthy Survivors understand that under certain circumstances, the body's natural responses are maladaptive. They understand that sometimes recovery depends on patients receiving treatments that counteract or override some of the body's natural responses.
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