A humbling reminder

Dear Lord, the great healer, I kneel before you. Since every perfect gift must come from you. I pray, give skill to my hands, clear vision to my mind, and meekness and kindness to my heart. Give me singleness of purpose, strength to lift up a part of the burden that is my suffering, fellow man, a true realisation of the gift that is mine. Take from my heart all guile and worldliness, that with the simple faith of a child, I may rely on you.

- Mother Teresa

Lost for words

post modern 

we can't say what we want to 

directly anymore

avoid cliche

we fill our lines 

with meaningful 

meaninglessness

favor irony 

to avoid sounding trite

words are just words 

all they are is hollow 

black and white

i project what meaning i want 

imbue these screens with hue

visible only through my tinted lenses 

nowadays

we can't say what we want to 

directly anymore

i write these words

and hear them ring inside my head

to potential music space

an emptiness i can't efface

we can't go it alone

we can't go it alone 

we can't go it alone

we can't go it alone

we build up to a rhythmic drum

that no one else can hear

could we ever;

we can't say what we want to 

directly anymore

In transit

It's in these electrifying moments that
you realise
just how alone you are.




Whispering baby, come back to me
Even when you don't know who it is who is gone.

House of Cards

The earlier you fold, the less you lose. The longer you stay in the game, the more you have to lose.

Chopping Broccoli

So today I was chopping broccoli and thinking, "There has to be a faster way." I have in the past picked up good tips on the internet, for example Jamie Oliver's video on how to chop vegetables quickly and safely (hold the vegetable in a knuckled under position instead of with your fingers poking straight out, and push the vegetable along as you chop). So I turned to youtube once more, and typed in "chopping broccoli".

And stumbled on this little nugget.



Addendum: With regards to chopping broccoli, I reckon there's no easier way to do it than the way I always have been, which is to cut off the florets one by one in roughly equal pieces so it all takes the same amount of time to cook. One possibility I have encountered is plucking the florets off, but then you still need to trim them, so it seems to all even out in the end.

Always look on the bright side of life

Like many of my friends, I've been struggling during the final years of med school with stress. I've been constantly run down and tired. I've fallen ill so many times, for so long this year, I've lost count. I've been angry, snapped at people more. Instead of being genuine, I've maintained a pleasant demeanour motivated sheerly by the need to remain professional.

And I've been questioning why. Something definitely isn't right. Something more than just being sleep deprived. Cynicism and pessimism has crept in. I've been getting stuck in the negatives.



So this talk is a good reminder. In it, Alice Ledgerwood discusses our human tendency to remember the negatives over the positives. We find it easier to change from a positive mindset to a negative one. By contrast, it is much harder to change from a negative mindset to a positive one.

She suggests two ways to combat this; ways which closely parallel Christianity. Ledgerwood firstly describes how important taking time to be thankful is, how it makes a difference in terms of health, happiness and wellbeing. As Christians, saying grace, and thanking God, is an integral part of the relationship that we have with Him, and the practice of our faith.

The second point is addresses the way we tend to fixate on negative perspectives. We remember the insult far longer than we remember the compliment, and we pass on that negativism. Someone shouts at you, and you shout back, and you snap at another person, who snaps at another person, who snaps at another person... Ledgerwood suggests that returning good for bad is a way to break the chain. She suggests we return negative interactions with positive ones. For instance, giving the waitress with a bad attitude the extra large tip. This bears a striking resemblance to Jesus' preaching to love our enemies:

27 “But to you who are listening I say: Love your enemies, do good to those who hate you, 28 bless those who curse you, pray for those who mistreat you. 29 If someone slaps you on one cheek, turn to them the other also. If someone takes your coat, do not withhold your shirt from them. 30 Give to everyone who asks you, and if anyone takes what belongs to you, do not demand it back. 31 Do to others as you would have them do to you. 

32 “If you love those who love you, what credit is that to you? Even sinners love those who love them.33 And if you do good to those who are good to you, what credit is that to you? Even sinners do that.34 And if you lend to those from whom you expect repayment, what credit is that to you? Even sinners lend to sinners, expecting to be repaid in full. 35 But love your enemies, do good to them, and lend to them without expecting to get anything back. Then your reward will be great, and you will be childrenof the Most High, because he is kind to the ungrateful and wicked. 36 Be merciful, just as your Father is merciful. 

- Luke 6, NIV

Positivism doesn't just affect you, one person, but it affects others around you - your network. About a year ago, I read a thought-provoking book written by Daniel Goleman called Social Intelligence. Contrary to what the title might suggest, this wasn't a self-help book on improving your social skills and emotional intelligence. Rather, it explored the implications of the neuroscience of our social brain, and how it affects our lives. Goleman names the phenomenon put forward by Ledgerwood emotional contagion and discusses its effect in relationships. Research has shown that stressful relationships and conflict drives up stress hormones and blood pressure, and lowers immune function. By contrast,  positive relationships providing a major source of satisfaction and well-being, as well as general good health. This opinion piece describes a similar phenomenon with regards to marriage. Goleman goes on to cite numerous scientists and physicians who provide both anecdotal experience as well as supporting data to show how important emotional support, or simply put, the Christian tenet to love thy neighbour, can make all the difference in preserving quality of life and coping with disease. Reflecting on my course of my study, I have found that this echoes resonates with a significant base of evidence to show that in numerous conditions, from suicide risk to heart attacks, from stroke to dementia, the presence of emotional support, such as a spouse, can make a critical difference.

So how do we skirt illness and death? How do we find happiness? How do we find meaning in life? Peace? It would seem Jesus is right. Ledgerwood is right. That the answer is simple, simply love others, and be thankful. Jesus terms this loving God and loving others. There are many ways to love God, but a major way we do this is by giving thanks to Him. And perhaps, in some very indirect way, all these things - happiness, good health, and everything we think we want - will fall into its place.

27 “Consider how the wild flowers grow. They do not labor or spin. Yet I tell you, not even Solomon in all his splendor was dressed like one of these. 28 If that is how God clothes the grass of the field, which is here today, and tomorrow is thrown into the fire, how much more will he clothe you—you of little faith! 29 And do not set your heart on what you will eat or drink; do not worry about it. 30 For the pagan world runs after all such things, and your Father knows that you need them. 31 But seek his kingdom, and these things will be given to you as well.

- Luke 12, NIV

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On another vein, these thoughts have interesting implications on the practise of health. To my knowledge, public health has generally revolved around epidemiology and prevention, but the importance of "soft" factors like staying postive, like being loved, are still under-recognised.

Letter to a lost love

Dear lungs,

Long have I laboured in ignorance of the music that you make. 

Yesterday night I sat down and thought about you, attempting to ponder over your intricacies as a lover would their love. Then I suddenly realised that you are just as simple as my love, the heart, to understand. Like the vascular system, you too have tubes, and fluid dynamics that obey laws of relationships between pressure, volume, velocity, wavelength, and frequency. Just like the heart, you are a musical instrument which obeys the same laws that govern a Classical orchestra.

Bronchial breath sounds

You can simply be thought of in terms of a series of pipes (trachea, bronchi), branching like a tree into smaller and smaller (mini bronchi known as bronchioles) in cross sectional area / radius. When air enters this instrument by breathing in, it reverberates through the bronchi, creating the bronchial component of the breath sound. This would theoretically result in a long inspiratory sound as one breathes in, a pause of variable length, and long expiratory sound as one breathes out, with no gap in between them as the air reverberates (bronchial breathing). 

The air that enters the larger airways are at a high pressure, low velocity, but as they progress to smaller airways, they are at low pressure, high velocity. Low velocity sounds are low frequency. High velocity sounds are high frequency. Thus the air travelling through the bronchi sounds deeper than the air travelling through the bronchioles. This accounts for the rise in pitch that is heard when you take a breath. Correspondingly, the sigh (lowering of pitch through the sound) of expiration is the product of the air being expelled from the most distant, narrowest passageways (bronchioles) through the larger passageways to the nose and mouth. 

Vesicular breath sounds

Thinking about the breath sounds as a continuous rising pitch, then fall in pitch, does not account for the final component of your musical abilities - your alveoli, or tiny sacs at the end of those pipes. At the end of these pipes, there are small bags (alveoli, sing.=alveolus), which may collapse and expand depending on the air that enters them. As one breathes in, creating the inspiratory component, the air travels to the end of the air passageways, and the bags get inflated. When one breathes out, air leaves the lungs, starting with the alveoli. Imagine how suddenly, the pipes become encased with multiple deflated little sacs - almost like a porous sponge. This sponge acts to dampen the end part of the expiratory phase when you listen over the area with a stethoscope (vesicular breathing). Therefore, normal vesicular breathing through the pipes and bags has a long inspiratory phase, and shorter expiratory phase due to the muffling of the soft expiratory sounds at the end of expiration.

Crackles

Now, these bags may be surrounded by fluid (infection, oedema), or surrounded by a connective tissue wrapping (fibrosis), like little sweets in plastic wrappers. This makes for some interesting acoustics. When the bags are lined with fluid or surrounded by connective tissue wrappings, they tend to collapse. When air enters into the collapsed bags, they pop open. With infection, the fluid that lines the bags comes from the bags and the pipes themselves. In chronic bronchitis / COPD, the passageways that are closed off by obstructing fluid are the distal bronchi. As air passes into the ends of smaller bronchi, and terminal bronchioles, which are filled with fluid, the passageways snap open with a pop (early inspiratory crackles of COPD). Although this has not been suggested in the books that I've read, the way I see it, it is the sound of the pipes opening up that is heard, rather than the sound of the alveoli. This would account for the fact that the early inspiratory crackles of COPD are often less than 4 pops (fewer bronchi:alveoli) and occur early on in inspiration (air passes through the bronchial passageways first to get to the alveoli). Although I can't logically explain the reason why, the fewer 'pop' sounds correspond to their lower frequency (coarse quality). In contrast, when the fluid fills the alveoli/bags, rather than the bronchioles/pipes, as with pulmonary oedema, what one hears is the sound of the alveoli snapping open against the surface tension of the fluid filled bags, creating a higher pitched sound like bubbles popping (medium quality). This occurs later than the opening pop sounds of COPD crackles (late inspiratory). The more alveoli: bronchioles accounts for the fact that the medium late inspiratory crackles of pulmonary oedema are more pops  compared with bronchioles (4-9). With bags popping open against fibrosis, imagine the rustle of sweet wrappers as they are opened. The crackles produced are >10 pops (estimates are from Talley's) and also occur in late inspiratory crackles. Once again, increased number of pop sounds corresponds with the higher frequency, i.e. fine quality of their sound (and are therefore described as fine late inspiratory crackles of interstitial fibrosis). As you know, the human ear hears higher frequency better, so although they are described as fine, high pitched sounds sound louder (and harsher) compared the lower-pitched coarse crackles.

Variables	Pneumonia(n = 37)	CHF(n = 5)	IPF(n = 13)
Inspiratory crackles
Crackles per breath	9 ± 5	13 ± 06	24 ± 17
Crackle frequency or pitch, Hz	316 ± 71	326 ± 43	441 ± 80
Expiratory crackles
Crackles per breath	6 ± 4	6 ± 2	8 ± 5
Crackle frequency or pitch, Hz	289 ± 79	303 ± 55	421 ± 78

Taken from Chest. 2009;135(1):156-164. doi:10.1378/chest.07-1562 

Wheezes

The lumen of these pipes can become clogged with mucus (as with asthma or chronic bronchitis), thus becoming smaller in cross sectional area, or may obstruct complete such that no air can pass through (in which case no sounds would be transmitted). When one breathes in, the pipes expand slightly due to their compliance. When one breathes out, they reduce in diameter slightly as well. According to Poiseuille's law, when the diameter of the lumen is smaller, the air will travel at a faster velocity (and correspondingly, produce a higher frequency, or pitch, of sound which is be more likely to be heard than lower frequency sounds which may be inaudible to the human ear). Additionally, when the fluid-lined lumen is dilated during inspiration, the surface tension of the fluid is higher than when the lumen is constricted, as it would be with expiration. When the fluid is at high tension, it is less likely to generate as much vibration. When the fluid is at a lower tension in expiration, as is the case in smaller diameter airways during expiration, an audible sound is more likely to be produced. The air rushing along the surface of the fluid creates a wave, generating a musical note, similar to the way a violin string would if it were plucked (wheeze). If that process were more severe, i.e. more fluid in the airways, the smaller the diameter of the airways, and the greater the potential of the fluid to vibrate at an audible level. That would result in the transmitted wheeze being heard earlier and earlier. Wheezes can even be heard during inspiration in severe blockage. 

So how would I manage the stuff that plagues you? Get rid of the fluid, make the airways bigger, and address the thing that causes the fluid to appear in the first place. As for fibrosis, well, there's not much I can do but appreciate your contribution to the music. 

Oh lungs, if only I had known sooner how sweetly simple, and how simply sweet your melodies are. 

Your dedicated servant,

Xin

References

1. Chest. 2009;135(1):156-164. doi:10.1378/chest.07-1562 
2. Talley's Clinical examination

Restoring my faith in Australian samaritans

[tl;dr] Aussie bloke found my lost phone and returned it. #onlyinaustralia #faithintheworldrestored [/tl;dr]

So (lately, I've been noticing how most anecdotes start with 'so'), the other day I was at Coogee for brunch and I'd brought my handphone along in my relatively shallow pockets. After about an hour of walking, I realised my phone wasn't in my pockets anymore.

The person I was with checked his phone and saw a call placed by 'me' 20 minutes ago. We tried calling my phone but there was just no response. We tried retracing our steps. We tried checking the cafe. We tried calling again. We tried calling at least 10 times.

But to no avail.

Still, I was in a rosy-minded fuzz and just couldn't rouse myself into a state of anxiety. Somewhere inside me, I felt sure that someone had picked it up and returned it, and had tried calling the numbers on my phone to get it back to me. I thought it didn't matter that he (or she) wasn't picking up anymore, because maybe it was on silent and he was in the car or something and didn't realise. By contrast, my friend was concerned that it could have been a pocket dial and my phone was in the hands of a malevolent miscreant (I just couldn't resist the alliteration) who had no intention of ever returning my phone.

Anyway, my friend asked me if I had any sensitive information on my phone and advocated that I should see what I could do about calling my service provider and blocking the phone from use. I took his advice. The service provider required additional details about my phone that I couldn't remember offhand. So I headed back home to check them up, and, would you believe it - found my phone at home!

It turned out that the bloke had called up another of my friends on the list of recently called contacts on my phone, so that friend drove over to pick up the phone for me and dropped it off at my place. Apparently the good samaritan had said 'losing your phone can be the most distressing thing' and wanted to get it to me as soon as he could. So here's a shoutout to the awesome samaritan and to my friend who picked up my phone for me.

Hugh Laurie is coming to Sydney! =)

If I could write a dictionary

Great literature is simply language charged with meaning to the utmost possible degree

[Ezra Pound, "ABC of Reading"]

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Poetry [n]:
from Gk poein "to make/form"

Any practical attempt to parse language and create meaning, or form, in the most economical way.

I can't get to

stillness ascends while I
descend into restlessness
darkness slips into darkness
I cannot get away
I croon I cry I rock myself
I count time
lonelier hours I have never spent
than watching the promise of you slip away
a false reckoning
I'm spent
awake as we separate
like ripples on a black shore
restless
restless
darkness
slips into darkness
drifting
you slip away
into another yesterday

you slip

you
you
you

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On insomnia. In homage to Reckoner, by Radiohead, and to be read with it.