Friday, June 01, 2007

esophagogastroduodenoscopy

I thought at first it was a typo on the hospital admissions report. Try saying it ten times fast - esophagogastroduodenoscopy, esophagogastroduodenoscopy, esophagogastroduodenoscopy.... It's a diagnostic endoscopy to visualize the gastrointestinal tract up to the duondenum.

That got me to thinking about long words.

apparently, esophagogastroduodenoscopy isn't as long as
antidisestablishmentarianism (28 letters),

Taumatawhakatangihangakoauauotamateaturipukakapikimaungahoronukupokaiwhenuakitanatahu (85 letters) a hill in New Zealand,

or
acetylseryltyrosylserylisoleucylthreonylserylprolylserylglutaminyl-
phenylalanylvalylphenylalanylleucylserylserylvalyltryptophylalanyl-
aspartylprolylisoleucylglutamylleucylleucylasparaginylvalylcysteinyl-
threonylserylserylleucylglycylasparaginylglutaminylphenylalanyl-
glutaminylthreonylglutaminylglutaminylalanylarginylthreonylthreonyl-
glutaminylvalylglutaminylglutaminylphenylalanylserylglutaminylvalyl-
tryptophyllysylprolylphenylalanylprolylglutaminylserylthreonylvalyl-
arginylphenylalanylprolylglycylaspartylvalyltyrosyllysylvalyltyrosyl-
arginyltyrosylasparaginylalanylvalylleucylaspartylprolylleucylisoleucyl-
threonylalanylleucylleucylglycylthreonylphenylalanylaspartylthreonyl-
arginylasparaginylarginylisoleucylisoleucylglutamylvalylglutamyl-
asparaginylglutaminylglutaminylserylprolylthreonylthreonylalanylglutamyl-
threonylleucylaspartylalanylthreonylarginylarginylvalylaspartylaspartyl-
alanylthreonylvalylalanylisoleucylarginylserylalanylasparaginylisoleucyl-
asparaginylleucylvalylasparaginylglutamylleucylvalylarginylglycyl-
threonylglycylleucyltyrosylasparaginylglutaminylasparaginylthreonyl-
phenylalanylglutamylserylmethionylserylglycylleucylvalyltryptophyl-
threonylserylalanylprolylalanylserine

which at 1185 letters, is a coat protein of the tobacco mosaic virus.
Although the word does seem to be cheating a bit, doesn't it, since it's just spelling out the functional groups of the protein. I'm not going to try to pronounce that one.

Monday, May 21, 2007

an unclinical definition of depression

So in my past three years doing sleep research, I've developed a working familiarity with depression. We measure depression with Beck's Depression Inventory, which asks how much you agree with statements about guilt, failure, suicidal thoughts, dislike of self, social withdrawal. The other self-report measures for depression look at similar symptoms. But it's funny, nothing seemed to capture depression (at least my experiences with it) as well as a letter I received in the mail from a Christian organization that I support:

"We are hope guzzling machines...When we're hopeful, he world is full of wonderand possibilities. We have drive and curiousity. We want as much life as we can get. We take on challenges and see adversity as something to be overcome.

But wn we lose hope the world becomes a fearful, threatening place, full of chaotic futility. Hopelessness sas us of energy and dee. It robs us of interest and appetite. We just want to curl up and protect our soul. We call it depression. The Bible calls it hopelessness."

- Jon Bloom, May 2007 letter to The Philippian Fellowship

And that's precisely it! When I'm depressed, it is not because I feel guilty, nor because I can no longer sleep, or hate myself. Those are merely symptoms. But my depression, at heart, is a loss of hope. I have nothing to look forward to. Nothing to dream about. There is no hope for change in me, or no hope for changing the world, nothing at all. At its heart, self-hate, guilt, self-loathing, are a loss of hope.

How do we address hopelessness? The solutions the health profession give are psychotherapy, antidepressant medication, or shock therapy. All those fail to provide the antidote - Hope!

"Why are you cast down, O my soul and why are you in turmoil within me? Hope in God; for I shall again praise him, my salvation and my God (Psalm 43:5)" Hope is the only real lasting treatment. And the only one who can give such an audacious hope? A God who loves, a God who is Just, a God who is Sovereign, a God who will redeem our broken souls and this cursed creation.

I struggle to really believe all this. I have had my times of darkness, when all I saw was the gaping abyss of my black heart, when I could not, would not love nor forgive. (and forgotten that God changes hearts) I've had those moments of bleakness, when I've believed that I would never find a job, or friendship, or love (and denied that God is a good provider). And I've been tormented by guilt, wracked by how I've wounded others, and wondered if I've ruined everything - the lives of those I care for, the possibility of being in a relationship where I wouldn't mess things up. (God paid for that sin in full on the cross, and I do not hold that kind of power . He is a loving Father to them too.)

One song has become my anthem during those times of darkness. In the middle of the chorus of voices casting stones and burying me alive, I hear a still small voice singing:

"Sometimes a light surprises
The Christian while he sings;
It is the Lord Who rises
With healing in His wings:
When comforts are declining,
He grants the soul again
A season of clear shining,
To cheer it after the rain

In holy contemplation
We sweetly then pursue
The theme of God’s salvation,
And find it ever new;
Set free from present sorrow,
We cheerfully can say,
Let the unknown tomorrow
Bring with it what it may.

Tomorrow can bring us nothing,
But He will bear us through:
Who gives the lilies clothing
Will clothe His people, too:
Beneath the spreading heavens
No creature but is fed;
And He Who feeds the ravens
Will give His children bread.

Though vine nor fig tree neither
Their wonted fruit should bear,
Though all the fields should wither,
Nor flocks or herds be there
Yet, God the same abiding,
His praise shall tune my voice;
For, while in Him confiding,
I cannot but rejoice."

- William Cowper

Friday, May 18, 2007

Crossing the Styx: Death and Medicine

I've just started working in a job where we are studying palliative medicine, which cares for patients who often are past curative treatment, often many cancer patients, and to provide quality of life, symptom and pain management, and help with transitions for the patient and the family as they prepare for death. This has made death and dying now a part of what I daily face.

In many ways, medicine sees death as a failure - a failure of the physician, maybe, or a failure of the science to move quick enough in finding treatments. What medicine is unconsciously denying, I think, is that death is really a natural end. Is it really best to "Not go gentle into that dark night, rage, rage against the dying of the light?" When the physician must say, "there is nothing more I can do," he fails to realize that there is still more he can do - he can ease that transition into death, decrease pain, help the patient reconcile to himself/herself that the end of life is near. And that is precisely what palliative medicine aims to do. I'd imagine that the ideal case is that palliative medicine wouldn't have to be a separate unit, but that eventually all doctors would be prepared to be with the dying patient, and not abandon them.

Sometimes when I read about the research on aging, and how some investigator here or there may believe he knows why cells fail and humans die, whether we are in fact a society petrified by fear of death. Our culture is funny, isn't it, that even as we try to erase the effects of aging with exercise, botox, and plastic surgery, we also have a remarkable crop of "thrillers" in our box office. And those thrillers bank on the fact that death is the more fearsome threat we will face, and use sudden deaths to get our adrenaline pumping.

In On Death And Dying, Elizabeth Kubler-Ross, MD writes,
"in our unconscious, death is never possible in regard to ourselves. It is inconceivable for our unconscious to imagine an actual ending of our own life here on earth, and if this life of ours has to end, the ending is always attributed to a malicious intervention from the outside by someone else. In simple terms, in our unconscious mind we can only be killed; it is inconceivable to die of a natural cause or of old age."

In that thought may lie the answer. Although everything has been dying since life began, we are still unreconciled to the termination of existence. There is still something about death that seems unnatural, that seems wrong. And that consciousness of death's wrongness, I think, is evidence of general revelation to us by God that there is a curse - that man's immortal souls were meant to dwell in bodies just as immortal. I have trouble with the idea that death could have occured before the Fall. How could bodies programmed to die be "good"?

But since the resurrection of Christ, death has lost its power, and it merely is the door between one existence and eternity.

Thursday, March 09, 2006

Tuesday, November 22, 2005

Science and Wonder

I appreciate the comments and thoughts that left at the last post. Thanks! The dilemma of homemaker versus career-woman is a hard one that I struggle with. Jeff and Mickey - I like the point you both made about how easy it is to develop a narrow-minded minded view of what education is. On that note,

I've discovered what promises to be a very interesting magazine, The New Atlantis. There was an article that I particularly liked, "The Moral Education of Doctors," which addresses issues broader in scope than just medicine:

"The original defense of natural science, by men like Descartes and Spinoza, was not so much a refutation as a quiet beheading of preceding philosophies. That is, modern science refutes metaphysical questions not by addressing them but by ignoring them. Its view of nature is purely material, devoid of purpose or meaning. Natural science tells us how things work, but not what they are or why they do what they do. It is fair to say that modern science does not even have a definition of nature, including human nature. The project of the modern natural scientist is the material inquiry into objects that are subject to inquiry through material manipulation.
The tool for mechanical manipulation is technology. The original technology of modern science was geometry, because geometry is the science of space. That is, it provides an account of nature as extension in space. The difference between the ancient and modern view of geometry is instructive, since it reveals a great deal about the modern use of technology. For ancients, like Euclid, geometric truths were investigated and demonstrated in “theorems,” or human efforts to give an account of reality. In contrast, modern geometry is concerned with “problems,” or difficulties to be solved. Problems are technical issues, not theoretical ones. Indeed, one can solve problems without any knowledge of the theory that underlies a question. Nature can be mathematized, and technologies can be developed to manipulate nature, unencumbered by theoretical questions. And most problems have a material component that is potentially (if only partially) amenable to a material solution.

A related distinction is the difference between wonder and curiosity. For Aristotle, wisdom
begins in wonder. For modern man, knowledge begins with curiosity. Wonder is an activity of beholding an object, allowing it to disclose itself. Its fruits might be described as the respectful disclosure of the beheld to the beholder. The implication is that the beheld has something to teach us. We must select our subjects carefully and as things worthy of wonder they must be treated with humility and gratitude. Curiosity describes a very different disposition. Curiosity is indiscriminate. Any object is a potential object for curiosity. Moreover, curiosity is famously not an exclusively human act. It knows no limits, and enforces no limits on the curious. One can be curious about the moon or about pornography. The same cannot be said for wonder. Souls can wonder. Cats are curious.

Interestingly, as scientific methods of investigation become increasingly sophisticated and our perspective on nature increasingly minute, it is not only metaphysical understanding that is set aside. Everyday experience itself becomes less and less a part of the scientific account of things. Descartes introduced radical skepticism, the idea that the senses can be deceived and therefore cannot be relied upon. Today, the plane of experience of the scientist is the molecular plane for biology, the atomic and even subatomic for physics. Common experience itself is regarded skeptically, and we instead look to the molecular realm to provide an account. The chain of causality continues to be pushed backward in search of more fundamental, more common mechanisms. The current bedrock in biology seems to be DNA, through which modern science hopes to provide an account of the downstream events that begin with genetically initiated events. There we hope to find what is really going on. As a consequence, the natural scientist spends the working day away from human action. He is in no better a position to be a citizen—or to diagnose and heal souls—than when he woke up.

The proof of the claim that nature is best known through its material manipulation lies in the success of modern technology: By simply attempting to understand and manipulate the world as material, and by ignoring questions of purpose and meaning, the application of modern science has transformed the world. Indeed, the success of the scientific project in terms of change is its very justification, and this was always intended to be the case. Things are getting better all the time. The proper response to our condition is thus a material response, one which eases the burden of man’s estate. Instead of providing an account of the whole, philosophy was beheaded in favor of more practical purposes. Rather than argue about the nature of the good life, man put nature to work in service of our human, all too human, ends." - Philip Overby, Fellow in Pediatric Neurology at Johns Hopkins.

Yes! Overby elegantly articulates my vague dissatisfaction with college-level biology classes, and my disease with studying medicine. I'm not sure how firm Overby stands on his philosophy, not being that strong a philosopher myself (I particularly have questions about his statement about Descartes - is he right?), but I share the same admiration he had for scientists of old, the philosopher/scientist/artist/theologist/political theorist. I've wished before to be a Renaissance woman - perhaps though, the Renaissance was too late.

Modern science seems so near-sighted with its fixation on sub-atomic particles and genetics and molecular reactions, that I have to fight to retain the sense of wonder which drew me at first to science. That wonder that grew with watching the distant stars. And the many camping trips we went to as kids, where we would stick our noses in tree trunks when the naturalist pointed out the vanilla-scented bark of cedar, proudly heft boulders of mica, and look for sticks etched with the trails of engraving beetles, and catch fat velvety comma tadpoles in the shallow water. I loved those camping trips.

Evolution itself, though it gives biology a nice mechanism through which to explain all life, reduces the intricacy and variety and beauty of nature to the product of a mechanical process powered by death. The study of science ought to result in greater awe and worship of God, but I have found no space for wonder of any sort in even in my developmental biology class (which is one of the most mysterious and wonderful of all processes!). God's creation has become not a marvellous sign pointing to God, but a tool for man's own ends. Is this really what God intended when he gave man dominion over the world?