[SciShow Tangents Intro theme music]

Hank: Hello and welcome to SciShow Tangents, the lightly competitive knowledge showcase! I'm your host, Hank Green, and joining me, as always, this week is science expert, Ceri Riley. Ceri, what is space?

Ceri: [There's a slight echo to Ceri's voice for this whole episode, as if she's recording in a cave] Hello! I'm in space right now, if you can't tell from my sound effects—

[Hank and Sam laugh]

Ceri: —which are definitely intentional and not because I'm sitting in an empty room in a corner, like a sad boy. Uh, space is...I mean, this is the problem. What is space flight? Space flight, apparently, is if you just go high enough in the atmosphere that a commercial plane can't fly. If you go a little bit farther than that, where it's, like, a little bit thinner and harder to breathe—if you were outside of the vehicle—then you're in space, basically.

Hank: Right. But also, I am in space right now because everything is space. And I'm made of space, space is all—space is everywhere. There's not, like—there's outer space, but, like, everything is space and the Earth is a giant spaceship and we shouldn't be trying so hard just to get there 'cause we're already there. We should only be going there to do stuff. Not just to go there!

Sam: I hope he hears this, Hank.

Hank: We're talking about this because as—as we are recording, Jeff Bezos has recently landed on Earth after being spa—in space for 12 minutes. We're also joined, as always, by our resident everyman, Sam Schultz—

Sam: Hello!

Hank: —who is just like Jeff Bezos in that he is not a scientist. He is just a everyday normal guy.

Sam: I'm also like him in that I have a—a cowboy hat that's way too big on right now.

Hank: I appreciate you wearing your way-too-big Jeff Bezos cowboy hat for this. Every week here on Tangents, we get together to try to one-up, amaze, and delight each other with science facts while also trying to stay on topic. Our panelists are playing for glory and also for Hank Bucks, which I will award to them as we play. And at the end of the episode, one of them will be crowned the winner. And now, as always, we're going to introduce this week's topic with the traditional science poem... this week from Sam.

[Science Poem theme music plays behind Hank saying "traditional science poem”]

Sam: Scrubby up my hands nice and clean, we gotta take out this guy's spleen. Put on my gloves so I don't touch his belly full of squingy guts. It's time to do medicinal battle—nurse, hand me that shiny scalpel. I assess the patient with a studied gaze. Should I make this incision length or sideways? Eh, either way, I'm going in. A slice. A spurt! I need suction. I'm in wrist deep and feeling 'round 'til that pesky organ is found. Give me a dab, my brow's all sweaty. These guts, they feel just like spaghetti. He's flat-lining, hurry! Those shocky things, stat! Dammit, man, we've just got to bring you back. Give me 50ccs of some medicine stuff. Whew! His heart's restarted—all right, pal, hang tough. Aha! That's it! The forceps, now! To heal this man's my solemn vow. Pull out the spleen, stitch up his slice. Procedure's done, nice and precise. At least, that's what it looks like on TV. If I left something out, please educate me.

[Ceri and Hank laugh]

Hank: Sounds right to me. That sounds like surgery, which is the topic for today's episode. Uh, Ceri what is—what—what—what—what—what is surgery?

Ceri: You know, I also had the same question, because I—I feel like I could watch a TV episode and be like, ah, they're going into surgery, but I wasn't sure how to describe that sciencey. So, according to the American College of Surgeons Statement, and I'm paraphrasing 'cause it's a long paragraph—but surgery is changing the human body by either cutting into or cutting away tissues for medical purposes.

Sam: When you cut your fingernails, is that surgery?

Ceri: I think it—I don't know if it's for medicine.

Sam: Hmm.

Ceri: It's, like, making your life more convenient, which maybe is medicine, uh...

Sam: If you pop a pimple, is that surgery?

Ceri: I think if you include all those, then everyone is a surgeon.

Hank: So I was watching a TikTok recently of a person removing an ingrown hair. And she said, "I'm in Idaho and I'm an esthetician. So in Idaho you can't poke it or cut it. You have to just use tweezers. And so I can't cut or poke the skin." And I'm like, "This is where it gets a little iffy, huh?" 'Cause now—'cause now, like—like, you're just pushin', but if you got out a needle, then you'd be a surgeon.

Sam: Like, legally, she can't poke the skin?

Hank: Yeah.

Sam: Interesting.

Hank: Yeah. Anyway, there were two hairs in there and she did a great job of getting 'em.

Ceri: [Laughs in a grossed out way] I do not like that kind of video. I do not watch any type of surgery video, big or small.

Hank: Yeah. I feel like there's a—there's a—there has gotta be a clean line somewhere, but I don't know where it is.

Ceri: Yeah, it might be the tools. Like, I feel like tools is maybe where you narrow it down a little bit? So in this statement they say—they list some examples, like "lasers, ultrasound, ionizing radiation, scalpels, probes, and needles. The tissues can be cut, burned, vaporized, frozen, sutured, probed, or manipulated by closed reductions, or otherwise altered by mechanical thermal light-based electromagnetic or chemical means," which is, like, quite a bit. That—that, like, feels like it encompasses putting ointment on your skin. But I think it's like—like, in your poem, Sam. You, like, get to the gushy bits. Or you go, like—

Hank: [Overlapping] Yeah, you gotta get through the skin.

Ceri: —yeah.

Hank: And you have to be doing it for good.

[Ceri, Hank, and Sam all laugh]

Sam: Yeah, that is a very good point as well.

Ceri: You have to be a certified or licensed physician, or a certified nice guy.

[Sam laughs]

Hank: Yeah, exactly. 'Cause, like, there was a time before the certifications and those people were still surgeons. Now you maybe have to have a—a—a certification, but back then—

Sam: —they were just helpful fellows.

Ceri: Not always helpful! Sometimes they were just weird men who were like, "Let me implant some other animal's testicle into your testicle. And let's see what happens."

Sam: [Overlapping] Oh, yes.

Hank: Ceri, do you know where the word "surgery" comes from? Is it from, like, uh—is it, like, cut? Is cut in there?

Ceri: Cut is not. Any other guesses?

Hank: Surge! The alternative to Mountain Dew.

Sam: Could be that... This word was invented in 1997...

Ceri: In early surgery, they sterilized it with Surge.

Sam: It's such a unique word, I can't think of any other words that are even, like, related to it.

Hank: Except for Surge!

Sam: [Laughing] Except for Surge, the alternative to Mountain Dew.

Hank: Or just the Italian man Sergio.

Sam: [Laughing] Oh yeah, that one!

Hank: [Insistent] Was it Sergio?!

Sam: Was it him? He invented it?!

Ceri: [Gently] No.

[Hank laughs]

Ceri: And, in fact, it's related to lots of different words once you go back to Greek. So the Greek word is "kheirourgia," which comes from "kheir," which is hand, uh, and "ergon," which is work. So it's handiwork, basically! You are doing something by hand, and that is surgery. And I think then it evolved in—like, separately from other types of craftsmanship. The—the hand root also informs where it's, like, "chiropractic" or, like, anything to do with—uh, like a chiral molecule for handedness. The—the "ergon" word for work is in—[laughs] it's in the—it's—it's in George. [Surprised] I didn't look at this! I just have a list of words that are related to it. But apparently George comes from work.

Hank: Good old workers, Georges.

Ceri: Yeah, good ol' Georges.

Hank: They work hard, those Georges. Also, I imagine, ergonomics.

Sam: Yeah.

Ceri: Yeah, ergonomics, organism...

Sam: Did people just start saying the word you said wronger and wronger until it became surgery?

Hank: That's basically how it works, yeah. It's not really wronger. It's just different-er.

Ceri: Different-er. Yeah, Greek "kheirourgia," old French "surgeure," and then—so, like, the French kinda made it zhuzhy.

Hank: The French were like, "That doesn't—that does—that's way too harsh of a noise. We need to be sexy."

Ceri: Too many [makes a harsh noise] KUHs. And then they were like [in an attempted French accent] "surgery" and then everyone was like, "Ah, yeah, surgery! Sure."

[Hank and Sam laugh]

Hank: I feel like this has been well-defined. And that means that it is time to move on to the quiz portion of our show. This week we're playing a new game—a brand new game! It's called The Scientific Definition and the rules are simple. The points will be complicated. In fact, the rules might also be a little bit complicated.

Ceri: Oh dear.

[Sam laughs]

Hank: I'm gonna give you a word and you're gonna attempt to define that word. And whoever gets closer,, in my estimation, will win that round. I have three things. And for this inaugural The Scientific Definition game, we're going to take a vocabulary tour of the history of surgery. I'm going to give you the name of a surgical tool, and each one of you will give me what you think the definition probably is. And then I will pompously correct you, because I know all of the answers, because I was given them beforehand. Your first word you must define for me is the scarificator.

Ceri: Sam, do you want to go first?

Sam: It does seem maybe related to scarring, but... what are you scarring if you're surgery-ing something? You're already gonna make a scar. It's going to be there no matter what.

Ceri: Yeahhh, but it could be, like, a cutting—cutting implement or a—like, a meat tenderizer. You know, before you surgery someone, you meat-tenderize them. Make them nice and soft.

Sam: Okay okay. See, I'm thinkin' it could be to, like, add texture to something that needs texture in the ol' guts. Okay. So you put texture on a pump—some part of your heart gets scarificated and that's helpful.

Ceri: That sounds horrible!

Sam: That's my guess.

Hank: Yeah, you put some—put some extra new scar tissue on the heart. [Sarcastically] Everyone knows that's good!

Sam: It's needed! It's necessary for some reason.

Ceri: [Laughs] I think before we had, um, what's the thing called... Where you, like—if you cut off a limb, you need to seal it off so that it stops bleeding. I think it's...

Sam: [Thinking through words] Suture—cauterize or whatever?

Ceri: Cauterizing, yeah! I think it's like an early cauterizer. You, like, did something to seal it up.

Sam: Like put a cheese grater on it or something. [Overlapping] Is that it? That's what it sounds like.

Ceri: [Overlapping] Yeah, they—it gets clogged up in the cheese grater, and then nothing bad happens.

[Hank and Sam laugh]

Hank: So we have two definitions here. One is a device that will cause scarring to the heart. And one is a device that stops bleeding. I'm gonna give it to Sam because it is specifically a device that causes bleeding. So Ceri could not have been more wrong.

Ceri: [Laughs] Oh no.

Hank: A scarificator was a device for bloodletting from the 19th century. It's a brass box that had blades on it.

Sam: [Excitedly] It's a cheese grater!

Hank: It—well, also it was kind of a cheese grater. So, like, but I had to make the—the decision somehow. And also you said cheese grater.

Sam: I added the cheese grater part in, so I should get extra points for double right.

Hank: You're—you're getting—you're getting more than you deserve already.

Sam: [Laughs] Okay.

Hank: Uh, uh, so when leeches were unavailable, it was just a bunch of blades that the doctor could push onto you and make you bleed a bunch.

Sam: I'd make them go look for more leeches if I was in that situation.

Hank: Yeah. [Pretending to be a patient] "Please, please, do not—do not put that brass box that you have already put on other people onto me."

Sam: Bleh! I forgot about that part.

Hank: So the doctor would use a lever that retracts the blades and put it on the patient's arm and then press a button. And the blades would pop into the patient's skin. And they were, uh, supposed to be quick. That would make it less painful. And the device could be heated to create a vacuum that would draw out the blood.

Ceri: So they—they made a little robot leech. They were like, "Oh, what do leeches do? They bite, and then they suck. And so [laughs] let's make a little robot that bites and sucks."

Hank: Oof! All right, well, congratulations, Sam on getting your first point. Second: the word that you have to define for me is dental key.

Sam: Uh oh! Well...

Ceri: [Laughs] Well, it—it has to do with mouth rocks, unless “dental” at some point meant something else.

Sam: Like other parts of your skeleton that could be...? Nah, I wouldn't think so. I'm sure we've defined dental before and—

Hank: It's the dents.

Sam: Well, my brother had braces and he had to have a key to crank his mouth open wider. But are braces surgery? I don't think so, I guess.

Hank: Braces are not surgery.

Sam: Ceri, you go first with what a dental key is.

Ceri: Okay. I'm gonna—I think it's like—uh, like a keystone in that it's, like, an essential part of the dental system. And so if—if they had to remove a tooth or remove a chunk of the jaw, a dental key is like a replacement stump that they put in there before they had other technologies to do it. And so, like, you just stick a key into the hole.

Sam: Maybe it's like some kind of drill. It's a drill for drilling out the jawbone hole where the tooth was. Similar to Ceri's but opposite.

Hank: So we've got Ceri with an object that you place into the jaw when there is a piece of the jaw slash teeth—teeth missing to take up that space.

Sam: [Under his breath] That's not right.

Hank: We've got Sam with a drill that is specific for drilling out jawbone.

Sam: Yep!

Hank: And again, I think that I have to give it to Sam. It is ultimately just a device that removes teeth. It is the key that opens the tooth door for there to not be a tooth there anymore.

Sam: [Laughing] Oh no.

Hank: Uh, so it was invented in the early 1700s and it was a—a hook that would wrap around a tooth, and a rod that could be turned like a key to remove the tooth. So basically—and it had like a handle on it, so you could, like—just, like, really get a good grip and pull it on out. And I hate it a lot. And, uh, local anesthetics were not available for tooth removal, so dental keys were the—a way to do it really quickly, but they could still be a pretty rough thing to go through. In an 1849 work called "On the Extraction of Teeth," Henry Gilbert wrote "the gums are not infrequently crushed and the tooth is not rarely broken."

Sam: [Grossed out] Ohhhhhhh.

Hank: [Joining in, also grossed out]. Ahhhhhhhh.

Sam: They're so bad-looking. I'm gonna post pictures of all of these things. So... it was so bad-looking.

Hank: [Overlapping and mumbling] Yeah, you go see a picture of it. [Hosting again] All right, Sam, well done! Two outta two so far, but now I've got another word for you and I'm going to attempt to pronounce it: [in an attempted French accent] the écraseur.

Ceri: Another French guy.

Sam: Ohh, I assumed that massive amounts of blood are involved in whatever this is. It just sounds like something that would, uh, exsanguinate you instantly to me.

Ceri: Well, we already had one that was, like, blood.

Sam: Well, it's all blood, Ceri! It's, uh, surgery.

Ceri: [Overlapping] Okay, okay.

Hank: Uh, so I will say that all three of these will not not result in blood loss. [Laughs].

[Sam laughs]

Ceri: Okay. Um, this is probably the totally wrong direction, but the only word that I can think of that sounds vaguely like this is croissant. [Laughs].

Sam: [Curious] Oh... okay.

Hank: [Quietly laughing and attempting a French accent again] Eh, croissant.

Ceri: Yeah. So—so my guess is it's like—like, if you had a—a cyst or something... and if you needed to poke it to, like, de-juice it—there's a word for that—or cut it off, then you'd use an écraseur. And you would like, [makes a gentle crushing sound] "Kkrrrr"

Hank: Yeah just—just... Nice. Some—some Dr. Pimple Popper shit.

Sam: Um, I think that it's just some kind of, like, spigot you would hook up to somebody and you'd just turn it on and the blood would come out.

[Hank laughs]

Sam: I don't know what part of your body it goes on, but it's draining blood out of you from—from a nozzle of some sort.

Hank: Well, Sam, you were never gonna get it because Ceri was remarkably close to right!

Sam: Wow!

Ceri: [Whispers victoriously] Croissants!

[Hank and Sam laugh]

Hank: It actually—that word means to crush.

Ceri: Oh. [Laughs].

Sam: Oh, boy.

Hank: But it—it was specifically used to remove growths. Uh, so it was like a wire or chain loop that would be wrapped around a projecting mass and then slowly tightened until "the mass is disconnected from the body." Uh, and an écraseur, uh, would be used for tumors, uh, but also for, uh, castration of animals. Is what it is often used for.

Sam: It looks like it would be good at that.

Hank: Yeah. And it just, like, tight—tightens up the chain more and more. And it was designed for situations where a blade was difficult to use. In his case, uh, in this—the doctor-who-designed-it's case, he used it in 1854 to amputate a tongue. According to an 1892 edition of the Transactions of the American Surgical Association, it was still used for tongue amputations in the 1890s. But, uh, it was also contentious. One man they quoted said, "The instrument is barbarous and obsolete and not in conformity with the principles of surgery. It represents the most slovenly and least efficient method of removing a part."

Sam: You don't want that when you're getting your tongue cut off.

Hank: No! I mean like... [noises of hesitation] I guess I'm not, like, intimately familiar with 1850s maladies, but how often do you have to cut off a tongue?

Sam: I don't know! Enough to make a whole thing that just does that for you.

Hank: So, uh—so the situation at hand is that, uh, Sam has two points and Ceri has one point and I found that game quite enjoyable to play. Thank you for playing it with me.

Ceri: [Overlapping] Yeah that was fun!

Hank: Next up, we're gonna take a short break and then it will be time for the Fact Off.

[A transitional snippet of the SciShow Tangents Intro theme music plays]

Hank: Welcome back, everybody! It's time for the Fact Off.

[Fact Off theme music plays]

Hank: Our panelists have all brought science facts to present to me in an attempt to blow my mind. And after they have presented their facts, I will judge them and award Hank Bucks any way I see fit. But, to decide who goes first, I have a trivia question for you: One of the earliest surgeries we have evidence of is trepanning, or boring a hole in the skull to treat cranial diseases or release pressure from an injury. And at times throughout history, trepanning was pretty popular. In northeastern France, there is a burial site that dates back to 6500 BCE where several skulls with trepanning holes were found. What fraction of the skulls uncovered there had undergone trepanning surgery?

Sam: I feel like that would be something they'd just do at the drop of a hat. 'Cause they could do it. So... 32.

Hank: 32%?

Sam: Yeah.

Ceri: That feels like way too many for me! Uh, but maybe I have—I mean, we just learned about three medical tools that sound, like, very bad. I'm gonna say 5%.

Hank: Well, let's say 33%!

Ceri: [Overlapping] Oh my gosh!

Sam: [Overlapping] Oh no!

Hank: Exactly one-third of them.

Ceri: Aw, jeez.

Hank: So Sam, you couldn't have been much closer and you get to decide who goes first. And that's of—that's not, like, of, like, three skulls. That was 40 of 120 skulls.

Sam: Well, I guess when every, uh—when all you got is a hammer, every problem looks like a nail. So—

Hank: That's right.

Sam: —you're drillin' some holes in some heads.

Hank: [Laughs] Every head looks like a nail.

Sam: Yeah. Uh, I'd like Ceri to go first, I believe.

Ceri: So our skin, besides being our biggest organ, provides incredible production for our squishy insides, which is why injuries that damage the skin can be so dangerous. Burns, for example, can leave a hole in our skin shield so harmful microorganisms can wreak havoc and cause serious sickness or even death. In the late 1800s and early 1900s, surgeons treated serious burns by spraying or soaking them with a solution of tannic acid. And tannic acid can be extracted from oak trees in various forms and is most recognizably used for tanning non-human animal hides to make leather. And... that's basically what happened in hospitals. Tannic acid is anti-microbial and would sterilize the treated area, but it would also coagulate all the skin and blood and whatever goop into a hard dark surface that couldn't be infected easily. Then, after a while, the dead skin would peel away at the edges, at which point the surgeon would help lightly cut it away to leave a scarred but healed area. So it kind of worked in that it increased survival rates compared to leaving the burns alone, but tannic acid treatments were extremely painful and often left intensely scarred skin behind, which affected the quality of life because there have always been people biased against people with any sort of disfigurements. And this is where a surgeon named Archibald McIndoe, and likely his colleagues, come in. He was trained in plastic surgery, and as the story goes, during World War II, he noticed that burn patients who were pilots that fell into the ocean had better healing than any other burn patients.

Hank: Huh!

Ceri: So instead of the gold standard of drying out burned skin with tannic acid, McIndoe went the opposite direction and tried to keep the skin moist with a saline solution, aka saltwater. These saline treatments were less painful, still anti-microbial, and improved survival rates even more. And he was able to do surgery earlier in the patient's stay, grafting other skin onto the moist burn tissue and reducing the intensity of the scarring as they healed. And, as a side note, he seems to have cared a lot about the social aspect of disease, which I felt was worth mentioning. After he treated burn patients, he actively encouraged and accompanied them as they reentered the community and went to events and stuff, which seems very nice of him. But anyway, nowadays still the top priority, uh, for skin wounds is disinfecting them to protect from bacteria or other pathogens, but keeping burns and other skin wounds moist has become the gold standard for treatment, especially before any kind of reconstructive surgery. And tannic acid is largely a thing of the past, thanks to this surgeon.

Hank: Eh, so when they were deciding to try out tannic acid, was it really because they were like, "Well, it works for leather."

Ceri: I think it was partially that, but partially it's very anti-microbial. So they were like, "We've got to keep the burns as clean as possible. And then also it happens to work and, like, create this, like, leathery husk of dead skin."

[Hank groans]

Sam: It's like making a band-aid out of your own body or something.

Hank: Yeah. Well, Sam, can you beat it?

Sam: Um, I don't know, but I'll try! So enough of this old stuff. Let's talk about robots! But first: a quick definition. So laparoscopic surgery is a type of surgery where the patient isn't cut, like, all the way open and instead a tiny cut is made and a little camera with a flashlight is fed into the patient's, like, inflated abdomen. And then little thin tools are also fed in and they look through the camera and use these little tools to do stuff like remove appendixes, perform colon surgery, lots of procedures that you just don't have to open up the whole body for. Uh, it's great because cutting a person open isn't great for the person, no matter the circumstances, even if you're trying to help them. And laparoscopic surgery just requires, like I said, a teeny tiny little hole in you. But there are a few downsides, like doctors using a little, like, clamper on the end of a stick that's in, like, an inflated body are not as precise as they would be if they were just manipulating something with their fingers or, like, a tool that was just directly in their hands. And looking through a camera, it really messes up depth perception. So more and more often laparoscopies—I hope I'm saying that kind of right—are performed with robot assistants. So the tools are held by a collection of robotic arms and the surgeon sits in another room or, like, across the world even, and controls those arms with joysticks and buttons and stuff. So this solves for a few problems, like a surgeon can be more precise with the little tools on the end of the robot arm. And some systems even have, like, haptic feedback, so if you, like, bumped into a gut with your little grabber claw, it would, like, vibrate. So you'd know, "Oh, I can't keep going that way." Uh, plus it solves for some other common operating room problems, like the surgeon can sit in a chair or something and not have to stand up for hours and hours at a time. But one thing that it still doesn't solve well for is depth perception. So you're using a little joystick and moving, like, an avatar, basically, around a 3D space on a little 2D screen. And that disconnect—the 3D-to-2D disconnect—can be really hard for some surgeons, but it's not hard for surgeons who are also elite gamers. So a recent study from the University of Ottawa looked at, um, surveys and stats of surgeons who performed lots of robot-assisted lapar—lap—laparoscopies. Uh, and one of the bits of information that they self-reported was if they were a gamer or not, and how much of a gamer they were. So what they found was that surgeons who played video games were faster, more accurate, and just overall way better at robot-assisted laparoscopies. So some of the games that the best surgeons of all of the surgeons they looked at played were the first-person shooter Half-Life, the car soccer game Rocket League, and Super Monkey Ball, all of which are extremely precision-oriented games that require thinking in 3D while looking at something 2D—especially super monkey ball! I feel like if you're good at that, you'd be the best, uh,surgeon in the whole wide world. That's a tough one! Uh, and of course there are VR rigs and specialized programs to train surgeons to do robot surgery, but they're really expensive. And there kind of aren't that many of them. Uh, but everybody and their grandma has a Wii that can play Super Monkey Ball. So training using video games, the researchers think could be a way to make training more accessible and help doctors who are having that 3D-to-2D problem get better at the surgery and just help all surgeons get more precise and better at this kind of thing. So if you're despairing over your kids playing Fortnite or Minecraft 24/7, they possibly aren't just wasting their entire lives. They could be training to be the best surgeons in the history of the world in the future.

Hank: Well, I mean, sometimes I see somebody do a no scope and I'm like, "I wouldn't mind having that person take out my appendix." Like, that—

Sam: [Laughs] I never thought about it before, but yes.

Hank: It's like a cry—it was like a cross-map snipe with just the blink of—of lifting the sniper rifle to your virtual eye.

Sam: Yeah, and if they have a robot arm on a laser that's responsible for zapping the—a thing off your eyeball, you want that person doing it.

Hank: Can—can you just plug me into Fortnite and turn, like, my appendix into the opponent? And then, like, they don't even know they're doing surgery.

Sam: Oh, it's like Ender's Game except that they're all doing surgery. That's a really good idea! [Laughs]

Hank: And it's just a bunch of teenagers and you don't have to pay 'em very much 'cause they're teenagers.

Sam: Yeah, and you're just like, "Kids, if you get this ball in this hole, you're gonna—well, you know, you're gonna be really good at this game and everyone's going to respect you."

Hank: Yeah. And if they screw up and I die, they don't have to have that guilt. They don't know. They just think they lost a game.

Sam: Wow. This is a really great, grim and dark futuristic idea. I like it.

[Hank and Sam laugh]

Hank: Oh, well I think—you know what, because this never happens and because I—I thought that it was a—it was a good, weird story that has resulted in good outcomes. And also I liked that there was, uh, a touch of the, uh, of the connection to the patient and the care for the patient.

Sam: [Exasperated] Oh my god.

Hank: I'm going to give Ceri not just the win here, I'm going to give her the win for the whole episode.

Ceri: Suck it, Sam [laughs]. Suck it like that mechanical leech tool.

Hank: [Laughing] Suck it like you are a box full of knives that could be heated to become a vacuum somehow.

Sam: Okay... if I have to.

Hank: But that does mean that it's time for—to—for Ask the Science Couch, where we've got a listener question for our couch of finely honed scientific minds.

[Ask the Science Couch theme music plays]

Hank: It's from @Pdximport who asks: "If you get an organ transplant from someone, do you have two different sets of DNA?" And I am pretty sure the answer is yes. Like, if it's a tissue, no. But if it's an organ, yeah. But that's all I—that's—I—I got, I'm pretty sure. The rest is for Ceri.

Ceri: I'll—I'll bump up that "pretty sure" to a "yes," because there is DNA in all cells and your—your cells will have your set of DNA and the donor cells will have different DNA. And this is, like, a big conundrum in the field of organ transplants. Like, this is why they're so difficult and they have been so difficult and they continue to be so difficult is because anything that is foreign material, so whether it's a bacterial genome or a—or a virus or another human, uh, genome in our bodies—aside from being pregnant, which is its own weird alien thing—your body sees it as foreign and your immune system mounts a response to it. And so with organ transplants or any sort of transplant, even like a skin graft, if it's from someone else, there is going to be a chance of rejection, which basically means your immune system is attacking the new tissue and saying, like, "This is not good. This is not mine. This is not us. And I want to destroy it." And that's why if you get an organ transplant, not only do you have two different sets of DNA, but you take immunosuppressant medication—those are those anti-rejection meds—to dampen that immune response and try to make your body okay with the fact that it has two different types of DNA inside it.

Hank: But that—it's not like the, uh—it's not like your body comes in and, like, eventually replaces all the cells with its own cells? That's not how it works.

Ceri: No, unfortunately not, uh, 'cause the donated organ or the donated tissue will have—I think will have some stem cell component to it. So if, like, you get a donated kidney, that kidney will still—as the cells die and turnover, it will still be produced from those stem cells and still have the donor DNA in it. Uh, there are situations where the connective tissue cells, so, like, where the organ gets sutured to your connective tissue, your cells can grow in a little bit more, but that doesn't stop the risk of rejection because this—the main big chunk of it is still donor DNA.

Hank: Well, thank you, Ceri, for that excellent answer. If you want to ask your science questions to our science couch, you can follow us on Twitter @SciShowTangents, where we’ll tweet out topics for upcoming episodes every week! Thank you to @hansrat42, @moonyriott, and everybody else who tweeted us your questions for this episode.

[SciShow Tangents Outro theme music plays under Hank speaking]

Hank: If you like this show and you want to help us out, it's super easy to do that. You can become a patron at patreon.com/scishowtangents, where you can get access to things like our newsletter and our new podcast, Poopoopeepeepedia, which we did, today, record an episode of. And much to Sam's chagrin, it was awesome.

Sam: [Reluctantly] It was really good. Mm, dammit.

Hank: [Laughing] Second, if you want to leave us a review wherever you listen, that's super helpful and helps us know what you think about the show. And finally, if you want to show your love for SciShow Tangents, just...

Ceri, Hank, & Sam: Tell people about us!

Hank: Thank you for joining us, I've been Hank Green...

Ceri: I've been Ceri Riley...

Sam: And I've been Sam Schultz.

Hank: SciShow Tangents is created by all of us and produced by Caitlin Hofmeister and Sam Schultz, who also edits a lot of these episodes. Our social media organizer is Paola Garcia-Prieto. Our editorial assistant is Deboki Chakravarti. Our sound design is by Joseph "Tuna" Metesh. And we couldn't make any of this without our patrons on Patreon. Thank you, and remember: "the mind is not a vessel to be filled, but a fire to be lighted."

[SciShow Tangents Outro theme music plays louder]

Ceri: But! One more thing.

[Butt One More Thing theme music plays]

Ceri: King Louis XIV had an anal fistula, an infected tunnel between the skin and the anus that developed following treatments of a pus-filled mass near the area. His chief surgeon effectively cut and drained it in 1686, starting a wave of surgeons being treated with higher esteem. Also, anal fistula surgery became fashionable because everyone wanted to be like the king and surgeons had to turn people away who didn't need the treatment. But, more importantly for the medical community, surgical training improved and under Louis XV, the Royal Academy of Surgery in France was established in 1731. So this was the fistula that rocked the medical world.

Sam: So it was so cool that his booty hurt that everybody was like, "Oh, my booty hurts too."??

Ceri: It was so cool that his booty hurt and got treated by a surgeon who he then, like, praised with—with esteem and wealth that everyone was like, "Oh man, I want—I want the butt guy to come do my butt."

[Sam laughs]

Hank: I mean, what a thing to be like—well, first of all, what a thing to be the king and say, "God damn it, my ass hurts so bad. I am the king of a country and I can't stop that—my ass from hurting." And then it's like—it turns out that you can. Look, you're the most powerful person ever. And now, we can all get a person to help us with our butt pain. As long as—if you have a lot of money.

Sam: We really gave it to the French this episode.

[Ceri, Hank, and Sam all laugh]