Medicine as a profession. Vol I. A chemist-fantasy pharmacist’s eyes

• Pharmacological Group Name: Delivery vehicles of medicinal substances.

• Profession in the Metaphor: Chiefs of logistical hubs, dispatchers of vehicle fleets, airborne drop platforms, and capsules for ultra-fast delivery.

• Site of Service in the Organism: Respiratory system, gastrointestinal tract, major blood highways, and cutaneous borders.

Job Description of the Specialist

The primary responsibility of any logistical service in the Body-State is to deliver the right specialist (molecule) to the site with maximum speed and minimal losses along the way.

In classic logistics, medicine is most frequently sent by a standard passenger train through the gastrointestinal tract. However, a rugged customs checkpoint awaits it there — the Liver, the main chemical plant of the country. Pharmacists call this the first-pass effect through the liver. The local customs enzyme-officers do not care about the good intentions of the guest: they perceive any foreign molecule as a potential saboteur and mercilessly send up to 50—90% of the useful cargo to the recycling press.

The percentage of the personnel that survives the harsh inspection and breaks through into the major bloodstream is called bioavailability. The logistical service is obligated to thoroughly know all the shortcut paths of the State, be able to convert molecules into the required states of matter, and flawlessly select transport platforms to deliver aid on time and without losses, bypassing the liver cordons.

Local and Systemic Action: The Scale of Special Operations

Logisticians strictly divide operations by the scale of their impact into two types: regional repair brigades and general state mobilization.

1. Local Action — Targeted Repairs on Site

This means providing aid strictly at the crash site, without involving the resources of the entire country. The specialist arrives covertly at the scene, does their job, and does not go out onto the central highways. Neighboring Ministries do not even suspect that any work is being done.

• The Ointment Example: If a worker at a construction site damages a knee, we apply a pain-relieving ointment directly to the skin over the joint. The molecules penetrate through the border tissues and work locally. They do not wander through the entire body, do not fly into the kidneys or stomach, and do not cause any production noise there.

• The Inhaler Example: When a person suffers a bronchospasm, a pocket inhaler delivers a dilating molecule directly through the airways into the lungs. The specialist expands the pipes on site, saving the person from suffocation, but barely enters the general bloodstream, thanks to which the heart does not begin to pound furiously.

2. Systemic Action — Mobilization of the Entire State

This is a large-scale operation where a molecule is required to dissolve into the general transport flow (blood), spread across all roads, and reach every single living cell, including the Central Administration.

• The Inhalation Anesthesia Example: The patient simply breathes gas through a mask, but this gas possesses a powerful systemic action. The massive surface area of the alveoli allows the molecules to be absorbed into the blood instantly. With the blood flow, they fly up to the Central Administration (the brain), turn off consciousness, and plunge absolutely all Ministries into a therapeutic sleep.

• The Tablets and Injections Example: Any routine blood pressure pill or antibiotic injection always works systemically. They circulate throughout the entire circulatory system, affecting the general economy and vital activity of the country.

Delivery Speed and Duration of Action

In logistics, time is life. A molecule’s work is evaluated by two parameters: how quickly the specialist reaches the site (delivery speed) and how long they can hold the defensive line (duration of action).

1. Delivery Speed: Express Draisines vs. Freight Trains

• Supersonic Express (Sublingual Nitroglycerin): When the heart is squeezed (an angina attack), there is no time for an oral train — the engine might stop in a couple of minutes. The patient places a Nitroglycerin tablet under the tongue. Here, beneath the thin mucous membrane, runs a direct high-speed subway line that completely bypasses the liver customs. The molecule is absorbed in 1—2 minutes and instantly reaches the heart vessels, lifting the blockade.

• Heavy Freight Train (Standard Tablets): Most routine specialists are slow to get moving. They need to travel to the stomach, dissolve, be absorbed in the intestine, and pass inspection at the liver customs. This entire journey takes anywhere from 30 to 60 minutes. Such transport is categorically unsuited for extinguishing emergency catastrophes.

2. Duration of Action: Short Shifts vs. Around-the-Clock Garrisons

As soon as a molecule arrives at its workplace, the internal environmental services (the liver and kidneys) immediately begin an operation to deport it from the country (half-life):

• Short-Shift Specialists (Benzylpenicillin): This distinguished military antibiotic is an excellent combatant, but it has a catastrophically short shift. Literally 3—4 hours after an injection, the kidneys completely flush it out of the organism. If the patient forgets to dispatch a new squad to the site on time, a hole opens up on the frontline, and the bacteria immediately launch a counterattack. This is exactly why penicillin is injected in hospitals strictly every 4—6 hours, even at night.

• Around-the-Clock Garrisons (Azithromycin): A modern heavy paratrooper. Upon entering the organism, it does not just float in the blood — it boards military macrophage-cells and rides with them directly into the focus of infection. There, it builds a fortified base and slowly, methodically destroys the enemy. Its work shift lasts more than 24 hours, and its accumulated resources are enough to last another week after the course ends. Therefore, it is hired for just one shift a day (1 tablet every 24 hours), and the entire contract lasts only 3 days.

Dosage Forms: The Vehicle Fleet and Special Transport of Molecules

For a specialist to successfully reach their workplace, it is not enough to issue them a job description — they must be placed into the right transport vehicle. Pharmacists call these machines dosage forms.

1. Solid Transport: Tablets and Capsules (Passenger Trains)

This is the most common and familiar type of transport. Molecules are packed into tight “train cars” and set off on their journey through the main station — the oral cavity.

• Tablets are standard open commuter trains. Upon entering the stomach, they fall apart under the action of the local acid, dropping passengers right onto the GI tract platform.

• Capsules are premium executive trains. Molecules sit inside a protective “armor” (a gelatin shell). This is necessary either to protect a delicate medicine from the aggressive stomach juices or, conversely, to shield the stomach itself from the harsh nature of the specialist. Such a train opens its doors later, strictly in a designated region — for example, in the small intestine.

2. Liquid Transport: Solutions for Injections and IVs (Special Forces Armored Vans)

When a red alert level is declared in the State and there is no time for trains, logisticians call in armored vehicles. The medicine is converted into an ideally clean liquid form and breaks through to the site through special airlocks (injections).

• Intramuscular injections are like deploying troops into a tent camp (a muscle depot). Molecules group together in the tissues and, from there, gradually leak in steady squads into the nearest capillary roads.

• Intravenous injections and IV drips are an instantaneous teleport. Bypassing absolutely all stations, traffic lights, and liver customs, one hundred percent of the personnel is thrown directly onto the central high-speed highway of the State (into the bloodstream) for immediate systemic action.

3. Soft and External Transport: Ointments, Gels, and Patches (Border Couriers)

Sometimes a problem needs to be solved at the farthest outskirts. Driving special forces down central roads for this makes no sense.

• Ointments and gels are local repair brigades. They are applied directly to the external border and work superficially. Dense, greasy ointments sit on the site for a long time, creating a protective layer, while light, water-based gels are absorbed instantly, delivering molecules slightly deeper to the capillaries.

• Transdermal patches are clever smugglers. They stick to the skin and, for hours (or even days), smuggle molecules across the border in tiny, unnoticed portions directly into the subcutaneous vessels, ensuring stable systemic action without unnecessary injections.

4. Gaseous Transport: Aerosols and Inhalations (Airborne Assault)

• Working Tool: Inhalers and nebulizers (delivery capsules and drop platforms).

• Main Target on Site: Deep provinces of the lungs (alveoli), requiring a particle caliber strictly between 1 and 5 microns. Anything larger gets stuck in the throat, and anything smaller is exhaled right back out.

Occupational Risks of the Express Delivery Service

Even the most ideal airborne drop has its overheads. A portion of the squad inevitably settles along the route — on the walls of the oropharynx. If we are delivering, for instance, hormonal inspectors (glucocorticoids), they locally reduce the immune defense at the landing site. Without proper hygiene (mandatory rinsing of the mouth), “illegal migrants” (candidiasis) can run rampant there, causing hoarseness of the voice.

Hiring Requirements

• Indications: Need for emergency resuscitation, spasm of transport routes (bronchial asthma, COPD), surgical operations (inhalation anesthesia), or local treatment of damaged areas.

• Contraindications: Severe pulmonary or local bleeding in the administration zone, individual intolerance to the carrier gases or components of the transport capsule, as well as the patient’s technical inability to perform a synchronized inhalation.

Main Idea of the Chapter

Logistics and supply teach us the main point: it is not enough to have a talented molecule; you must know how to properly calculate its route. The choice between a tablet, ointment, injection, or inhalation is not just a matter of convenience. It is a strategic decision on whether the specialist will go to restore order locally in one specific department or will launch a systemic operation across the entire country, risking production noise in neighboring regions.

Chapter 3. The State Governance of the Organism

In any developed state, orders from the White House reach local operators in two ways. The first is via urgent, lightning-fast government telegrams. They fly along the secure fiber-optic cables of the Nervous System in the form of electrical impulses, demanding an instantaneous reaction here and now.

The second path is followed by official Presidential decrees, printed in state newspapers and delivered via paper mail to all regions. They move without haste, but their influence is fundamental and their impact is long-term. In the human body, the role of these official state decrees is performed by hormones.

Hormones are the ministers, high-ranking officials, and special envoys of the supreme state power. They do not need to run and trip over nerve-fiber cables. With aristocratic composure, they properly enter the general transport stream — the bloodstream — and sail across the entire country, visiting the most remote provinces. However, not just any passerby can read their decree. Locally — within tissues, cells, and organs — their circulars are awaited by special secret departments called receptors. Only a cell that possesses the required receptor-key at its security checkpoint has the right to open the sealed envelope containing the hormonal decree, review its text, and unquestioningly begin executing the directive.

At the very center of governance, deep within the secure brain bunker, sits the country’s supreme leadership — the inseparable duo of the Hypothalamus and the Pituitary Gland.

The Hypothalamus is the éminence grise, the intelligence chief, and the head of the Security Council all rolled into one. It works around the clock, with no breaks or weekends, gathering analytical reports from all corners of the state: what is the radiation and thermal temperature in the regions, how much gold and foreign exchange reserves (sugar) are left in the blood, and have any external enemies attacked?

The Pituitary Gland is the loyal Prime Minister. He does not travel to plants, mines, or factories himself, and he does not get his hands dirty with grease. Yet, it is he who, based on the Security Council’s reports, issues “tropic hormones” — strict government directives for subordinate Ministries. His orders sound formidable: “To the Ministry of Energy (the thyroid): immediately increase heating in freezing regions! To the Department of Demography: start the production conveyor belts! To the adrenal glands: declare a state of combat readiness, prepare for assault!”.

When a global systemic failure occurs within the operations of these ministries or the state economy, the internal strength of the officials is no longer enough. The system begins to fall apart. It is at this moment that independent, highly specialized experts from the outside — medications — are called upon to aid the exhausted State.

1. Crisis Managers of the Department of the Economy

Glucose is the primary national currency and the key gold-mining resource of our state. Without this energy injection, all cell-factories immediately grind to a halt, production freezes, and the lights go out. However, these financial flows cannot simply wander the streets in millions of editions unsupervised. If too much currency accumulates in the blood and it is left uncontrolled, the state descends into economic chaos, total inflation, and the destruction of vessel-streets — a severe systemic catastrophe known as diabetes mellitus.

To prevent this, the Minister of Finance — Insulin — labors in the Organism around the clock. His direct job responsibility is to collect excess glucose from the blood, distribute it to the secure underground vaults of muscle and adipose tissue, and send the strategic reserve to be stored in the state liver reserves.

But what should be done if a collapse occurs within the System? Sometimes Insulin simply goes on strike and ceases to be produced (Type 1 diabetes). Far more frequently, however, the cell-factories completely lock their gates due to years of stress and overload, post guards, and flatly refuse to listen to their own minister of finance. Insulin knocks on their doors, but his keys no longer fit the receptor-locks. This economic blockade is called tissue insulin resistance (Type 2 diabetes). The glucose-currency piles up on the vessel-streets, eroding the road walls, while the factories inside starve without energy. The economy collapses. At this critical juncture, strict external administrators — glucose-lowering drugs — arrive at the facility.

Metformin enters the city like a stern Crisis Manager equipped with a search warrant and emergency powers. He has no intention of persuading lazy cell-factories to open their gates. Metformin penetrates inside and activates a secret internal lever — the intracellular enzyme AMPK (AMP-activated protein kinase). This lever literally cuts the rusted locks off the cell doors, forces them open, and sharply increases their sensitivity to Insulin’s commands. The cells finally begin accepting the currency.

Yet Metformin does not stop there. He heads to the liver chemical plant, where local management is panicking and attempting to print new volumes of glucose, believing the country is facing a deficit. Metformin tightly shuts off these valves, blocking the excessive release of unrefined currency. This specialist deploys his audit program methodically and gradually — maximum control over the financial system is established after several days of a scheduled course of oral tablet intake.

Would you like to continue translating the next paragraph about sulfonylureas (debt collectors), or should we review the terminology for this section first?

2. Debt Collectors of the Ministry of Finance

If the situation requires more radical measures, sulfonylurea drugs begin working alongside him. These specialists act as ruthless debt collectors. They do not bother visiting the cells; instead, they burst straight into the private office of the exhausted minister, Insulin — specifically, into the beta cells of the pancreas.

The collectors tightly block the ATP-dependent potassium channels on the cell membranes. This shuts down the organ’s internal ventilation, creates a powerful electrical shift, and forces the pancreas to work three shifts straight. It literally squeezes out and deploys massive new volumes of the hormone into the bloodstream to break through the factories’ blockade.

Professional Risks:

Introducing such authoritarian external administrators always carries serious side effects for the infrastructure. While restoring order, Metformin enforces a harsh reorganization of sugar logistics within the intestines. This triggers an immediate rebellion from the local microflora, resulting in strikes, abdominal cramps, diarrhea, and a persistent metallic taste at the mouth-customs.

At the same time, insulin stimulants (sulfonylureas) can overstep their boundaries and drive the minister to such an extreme that, in a frenzy, he clears out absolutely all currency from the blood down to the very last cent. The State is left without a single penny, and the brain is deprived of its energy rations. This instantly cuts power to Central Administration, leads to critical hypoglycemia, and plunges the city into a state of severe hypoglycemic coma.

This is precisely why these specialists are strictly banned from approaching the facility during pregnancy, in cases of diabetic ketoacidosis, or when the state’s sewage treatment facilities — severe renal failure — break down. If the kidneys cannot flush these harsh inspectors out of the city in time, they will accumulate and cause a dangerous toxic condition known as lactic acidosis.

Specialist Profile

• Name of the Pharmacological Group: Oral hypoglycemic (glucose-lowering) agents.

• Place of Service in the Organism: Muscle and adipose tissue cells, the liver, and beta cells of the pancreas.

• Working Tool (Mechanism): Metformin activates the enzyme AMPK (AMP-activated protein kinase). Sulfonylurea drugs block ATP-dependent potassium channels on the beta-cell membrane.

• Side Effects: Diarrhea, abdominal cramps, and a metallic taste in the mouth (for Metformin); a critical drop in glucose levels — hypoglycemia (for sulfonylurea drugs).

• Affected Organs (Risks): The gastrointestinal tract and the brain (in the event of a hypoglycemic coma).

• Conditions of Admission (Indications): Type 2 diabetes mellitus, metabolic syndrome, and tissue insulin resistance.

• Categorical Contraindications: Severe renal failure (the sewage systems will become clogged with the medication), diabetic ketoacidosis, and pregnancy.

• Site Restrictions: Metformin requires mandatory emergency suspension before the administration of radiopaque contrast agents (due to the risk of developing lactic acidosis).

• Transport and Logistics (Dosage Forms): Tablets (standard and extended-release). The route of administration is strictly oral (by mouth).

• Delivery Speed: Average deployment speed. Metformin rolls out its crisis management program gradually, with maximum audit control established after several days of a scheduled course.

2. Understudies and Saboteurs of the Ministry of Energy

The thyroid gland is the state’s primary thermal power plant (TPP) and the Ministry of Energy all rolled into one. Its hormones determine the cosmic speed at which the Body-State must burn its internal resources during the basal metabolic process. This department decides exactly how much coal to toss into the furnace to warm the regions, spin the muscle turbines, and keep the gears of the brain turning at the required RPM.

But what happens if an accident occurs at the TPP and the Ministry retreats into a deep, forced energy-saving mode? This catastrophe is known as hypothyroidism. A prolonged ice age instantly blankets the country. The boilers chill, the factories barely breathe, and electricity is supplied with rolling blackouts. Thoughts within Central Administration flow slowly and sluggishly, like thickening fuel oil. A bitter cold paralyzes every region, and because the drainage pumps have ground to a halt, public utilities cannot clear water from the streets — the city begins to rapidly freeze and become covered in dense edema.

For the emergency resuscitation of the collapsed energy grid, an outside expert is appointed to the facility — Levothyroxine. He is a precise, flawlessly trained external understudy of the TPP’s native chief. He is forced to operate under strict regulations. He demands to be delivered to the city strictly at dawn — orally as a morning tablet, on an empty stomach, while the rest of the organism’s logistics and transport flows are still asleep. Upon arriving at the TPP, Levothyroxine freely penetrates into all freezing tissues and binds directly to receptors inside the cells. He personally reignites the boilers, starts the turbines, and slowly but surely returns long-awaited warmth to the regions. This specialist requires 7 to 12 days of continuous duty to completely overhaul the country’s shattered heating network and lead the State out of its ice age.

However, the TPP can also be struck by the exact opposite madness. Sometimes, the Ministry of Energy goes mad with power and orchestrates total, uncontrolled overheating — thyrotoxicosis (hyperthyroidism). Officials begin throwing all coal and gold reserves into the furnace indiscriminately. Boilers boil over, steam bursts from the pipes, pistons melt, and the country’s vital resources burn away in a matter of seconds. The heart-motor roars at extreme RPMs, street temperatures skyrocket, the city shakes with tremors, and it literally burns up from the inside.

To prevent a thermal explosion, official saboteurs — Antithyroid agents (Thiamazole) — are dropped into the crazed TPP. In personnel documents, they are listed as “saboteurs”. Their operational task is to carry out targeted sabotage on the Ministry’s assembly lines. Thiamazole penetrates the workshops and tightly blocks a key enzyme — thyroid peroxidase — which is responsible for assembling new energy hormones. Production ceases. The turbines stop, and the thyroid gland can no longer supply the “fuel” used to scorch the country. The saboteurs act methodically: they completely extinguish the raging boilers over the course of several days, patiently waiting for the old, previously created hormone warehouses to be depleted.

Professional Risks:

Working at such a hazardous strategic facility entails colossal risks. If the understudy, Levothyroxine, exceeds his authority or miscalculates, he will trigger an artificial overheating of the system himself — causing panic, insomnia, hand tremors, and rampant tachycardia in the city.

Meanwhile, the saboteur, Thiamazole, acts too aggressively in rare instances. Getting carried away with the diversion at the TPP, he may accidentally block the operations of other vital facilities — the strategic defense plants of the bone marrow. This halts the production of protective blood cells (agranulocytosis), leaving the State defenseless against any infection. For this reason, sending saboteurs to the TPP is strictly prohibited if the city already faces severe problems with its blood count and safety.

Specialist Profile

• Name of the Pharmacological Group: Thyroid and antithyroid agents.