Posted in Life & Happiness

Growing Pains

Growth is such an important aspect of life. From a young age, we are encouraged to grow in all senses of the word.

We eat well and drink milk to grow tall and strong and healthy. We study to grow and cultivate our minds. We find a job and learn financial skill to grow our savings. We chase our passions and interests to culture ourselves and grow our character. We devote time and energy to upskilling and pushing ourselves to our limits to grow our careers and capabilities. We learn to love, to hurt, to dream and yearn, to lose and to self-soothe to grow our emotional intelligence.

All in all, the world tells us we must grow, grow and grow. Almost to the point of an obsession.

In some ways, it’s true – we must strive to keep growing as a person. Think of the countless people who stop growing after reaching adulthood. Instead of reading, thinking, introspecting and connecting, they choose to live in an echo chamber, spouting off misinformed opinions and closing their minds to any new experiences or viewpoints.

When we don’t challenge ourselves to grow, we cannot achieve flow state and instead become lazy and unmotivated. We run the risk of becoming stagnant or regressing.

In this sense, encouraging our own growth is one of the most useful life skills we can obtain as a young adult. No one other than ourselves will truly care about our growth as a person. This is why goals, systems and insight are important in life.

However, growth also comes with stress.

To grow, we need to put in time, energy and resources, such as money. Sometimes, it is hard enough surviving life, let alone thinking about growing. Sometimes, depression and anxiety gets the better of us and we are in no mental state to strive to thrive. Sometimes, we are barely keeping up with life’s numerous demands, meaning that growth could be the straw that breaks the proverbial camel’s back.

Think of growth in nature. Barely anything grows perpetually. Plants will grow in the summer, then recede for the winter, saving up energy for the next summer. Mountains grow with plate tectonics, then erode with the weather. Even economies will go through cycles of growth and depression, while even the most mighty empires rise and fall. In fact, the only thing in nature that only grows is cancer.

Simply put, uncontrolled, continuous growth is unsustainable.

If a plant was to only grow upwards, it will collapse under its own weight. Businesses that grow beyond their capabilities will stumble and fall as they exhaust resources, or end up relying on shady, unethical practices.

The take-home message is this: it is okay not to always be growing.

Of course, we should strive to never stop growing on the whole, but this should be sustainable growth. It is okay to take a step back for every two steps you take forwards. It is even okay to feel like you are taking one step forward, one step back. Sometimes, it is not a ripe time to grow, like a seed biding its time through the winter.

Be kind to yourself and be patient. Whether you are going through the most amazing growth spout or feel like you are at your lowest point, this too shall pass.

Image credit: Growth Spiral by Seb McKinnon
Posted in Psychology & Medicine

Viscera: Large Intestine

(Learn more about the organs of the human bodies in other posts in the Viscera series here:

The final destination of food travelling through the digestive tract is the large intestine, or colon. It is the site where digested food is transformed into faeces, ready for excretion. The large intestine is much shorter than the small intestine – roughly 1.5m in length. Unlike the small intestine which is relatively free and mobile, the colon is fixed to the abdominal wall. It starts in the lower-right corner of the abdomen in a pouch called the caecum (connected to the small bowel). This is where the appendix is located. The colon then ascends the right-side of the abdomen (ascending colon) all the way to the diaphragm, does a 90-degree turn to the left (transverse colon) until it hits the spleen, then goes downwards to the lower-left corner (descending colon). Here, the colon bends into an S-shape towards the centre (sigmoid colon) until it ends as the rectum, which opens out to the anus. The colon essentially frames the contents of the abdomen.

The colon’s main function is the absorption of water and salts from the food that has been processed by the small bowel. As it sucks out the water in this liquid, it becomes more and more solidified. The brown colour of normal stool comes from bile and bilirubin (from the breakdown of red blood cells) secreted by the liver into the duodenum. For this reason, biliary obstruction (e.g. due to gallstones) causes pale stool and dark urine (overflow). Stool also contains undigested material like fibre, giving it bulk. Because it is at the end of the digestive tract, stool can be used to diagnose many diseases, such as an infection in the gut (bacterial, viral or parasitic).

The colon is a common site for cancer to occur in. Because there is room to grow, colon cancers are often found late when they have already spread and is incurable. The key symptoms of colon cancer are bloody stool (although this can be due to many reasons such as haemorrhoids), worsening constipation, anaemia (from blood loss causing iron deficiency), change in bowel habit and general symptoms of cancer (e.g. weight loss, fatigue).

(Appearance of colon cancer on colonoscopy)

Posted in Psychology & Medicine

Viscera: Pancreas

(Learn more about the organs of the human bodies in other posts in the Viscera series here:

The pancreas is probably the most central organ in the human body. It is situated just under the liver and stomach, surrounded by the duodenum (first part of small intestine) and lies in front of the aorta. It is shaped like a fish and thus is divided into parts named the head, neck, body and tail. The head of the pancreas tucks into the loop of duodenum and drains its contents via the pancreatic duct, which joins with the common bile duct (from the liver and gallbladder).


The function of the pancreas is divided into two functions: exocrine and endocrine.

An exocrine gland is an organ that excretes its products out of the body (including the intestines), such as the salivary or tear glands. The exocrine function of the pancreas is the production and secretion of digestive enzymes that break down proteins, fats and carbohydrates in the small intestine. Because of this, injury to the pancreas often causes a leak of this digestive juice, causing the body to self-digest the pancreas (leading to pancreatitis) and surrounding organs.

An endocrine gland is the opposite in that it secretes its contents into the bloodstream. These glands typically produce hormones, such as the thyroid, ovaries and adrenal glands. The pancreas’ endocrine function is related to an extremely common yet deadly disease: diabetes. Within the pancreas, there are millions of cells that cluster into groups called islets of Langerhans. There are various types of cells, but the most common are the alpha-islet cells that secrete glucagon and beta-islet cells that secrete insulin. Insulin acts to lower blood sugar (glucose) levels by promoting storage and use of glucose after a meal. Glucagon acts to increase blood glucose by promoting the breakdown of glucose storage units (glycogen) and the production of more glucose by the liver. Diabetes occurs when beta-islet cells fail to produce insulin because they are destroyed by the immune system (type 1 diabetes mellitus) or become desensitised by chronically elevated blood glucose levels (type 2 diabetes mellitus).

Another important disease concerning the pancreas is pancreatic cancer. Pancreatic cancer is notorious for its deadliness as it carries a 5-year mortality rate of over 95%. This is because it usually remains hidden – without any symptoms – until it as grown substantially and spread to other organs. However, this prognosis only applies to the most common type of pancreatic cancer involving exocrine cells (adenocarcinoma). There are far rarer cancers of the pancreas that involve the endocrine cells (e.g. insulinoma), which tend to have extremely good prognoses and are usually curable.

Steve Jobs (founder of Apple Inc.) had this kind of pancreatic cancer – an islet cell neuroendocrine tumour. Despite his excellent chance of cure with chemotherapy and surgery, he refused treatment for nine months and instead relied on alternative medicine for cure. However, his disease worsened and he finally resorted to having surgery. By this stage, his disease had spread to the liver due to the nine-month delay in treatment. Spreading of cancer is called metastasis and is often an indication that the cancer is no longer curable. Jobs went against his doctors’ advice and opted for a liver transplant in the hopes of curing his cancer. Organ transplant involves suppressing the patient’s immune system (which also keeps cancers in check) to prevent rejection of the donor organ, which is why oncologists advise against transplants in cancer patients. Jobs’ condition deteriorated quickly after his liver transplant and his decisions ultimately led to his demise.


Posted in Psychology & Medicine

Viscera: Lungs

(Learn more about the organs of the human bodies in other posts in the Viscera series here:

Everyone knows that we need oxygen to survive. The way we get oxygen from the atmosphere is through our lungs – the organ where gas exchange takes place. The pair of lungs take up a large proportion of the chest cavity and they link up with each other to form the trachea (windpipe). The left lung is slightly smaller to accommodate for the heart.

The lung is extremely soft and light, so much that it floats on water. It is essentially made up of an intricate tree-like system of airways, which become narrower and narrower as it divides out from the trachea. Since every airway divides up, the number of airways increases exponentially. Every bronchiole (small airways) ends in a bubble-like sac called an alveolus. Because of the sheer number of alveoli, the lungs actually have a total surface area the size of a tennis court. To picture this, scrunch up a piece of newspaper into a ball to pack a large surface area into a small space. The massive surface area allows for enough gas exchange to occur to give us the oxygen we need and excrete all the carbon dioxide we produce.


When we take a breath in, the chest cavity expands and stretches the lungs in all directions because of the negative pressure (like a vacuum). Air fills the airways all the way to the alveoli. The alveoli are extremely thin; so thin that the oxygen in the air effortlessly seeps through into the blood vessels that surround the alveoli. On the other hand, carbon dioxide seeps out of the blood into the alveoli, which is then breathed out as the muscles of your ribcage contract to force the air out. This process is called gas exchange and is driven by diffusion – the movement of particles from an area of high concentration to an area of low concentration (like how dye spreads throughout water).


It is well-known that smoking is bad for your lungs. This is because of two major reasons: COPD and lung cancer. COPD (chronic obstructive pulmonary disorder) is when your lungs become so damaged by smoking that they cannot function, leading to hypoxia (lack of oxygen) and hypercapnia (excess of carbon dioxide). Smoking causes inflammation in the lungs, which causes airways to shut down from swelling and mucus, while destroying the fine walls of the alveoli. This causes the alveoli to thicken from scarring and less elastic due to the destruction of elastic tissue. Ultimately, the lungs become hyperinflated as the patient cannot breathe out air properly and the lungs are not elastic enough to return to their original shape and size. Ergo, the patient becomes progressively breathless, gasping for breath as they suffer a sensation of impending death as the carbon dioxide level builds and the oxygen level falls.

Posted in Science & Nature

Banana Equivalent Dose

No form of energy has been more feared or creatively explored in science fiction (e.g. Godzilla) as radiation, yet the layman tends to know little about the actual properties and effects of radiation. The word “radiation” is commonly associated with things like Chernobyl, mutation and cancer. However, most people only know that radiation is “bad” while not knowing exactly how and why it is dangerous. Radiation is essentially high-frequency light which can deliver a large dose of energy (just like how microwaves cook food and sunlight can burn paper when focussed through a magnifying glass). When this high-dose of energy passes through living organisms, it damages the DNA in cells, potentially causing irreparable damage. This can lead to mutation and disruption of cell division (which can lead to cancer) or cell death (which is why radiation is ironically used to kill cancer cells).

The more technical question is “how much” radiation is harmful. For example, how much more dangerous was the Chernobyl incident compared to an x-ray? Like many other things in science, radiation is measured using an internationally universal unit called the Sievert (Sv). The radiation received from standing next to the Chernobyl reactor core after meltdown was 50Sv, while a chest x-ray is 20μSv (1000μSv = 1mSv, 1000mSv = 1Sv). Therefore, the Chernobyl incident could be considered to be as strong as 2.5 million chest x-rays. Although there is great variation, it is considered that a dose of 400mSv can cause symptoms of radiation poisoning, while 4~8Sv of radiation will lead to certain death.

Fascinatingly, radiation is not an uncommon thing. Radiation is all around us, with an average person receiving about 10μSv of background radiation per day just by living on Earth. Ergo, two days of walking around gives you the same amount of radiation as a single chest x-ray. A CT scan gives out a significantly greater dose of radiation at about 7mSv (approximately 350 x-rays or a year’s worth of background radiation).

However, the Sievert is a unit that is difficult to understand. Thus, some scientists devised a clever, humorous equivalent unit called the banana equivalent dose (BED). Bananas contain a certain amount of radioactive isotopes (radioactive potassium), making them technically radioactive. A banana contains 0.1μSv of radiation. Ergo, a chest x-ray is the equivalent to eating 200 bananas, a CT scan is 70000 bananas, while the Chernobyl incident gave people nearby a dose of roughly 500 million bananas.

The banana equivalent dose is a rather useful (and hilarious) way of comparing the danger of radiation from different sources. The next time you go to hospital for an x-ray, just picture 200 bananas being shot through your chest.

Posted in Psychology & Medicine

Five Stages Of Grief

Dr. Elisabeth Kübler-Ross was a psychiatrist who was greatly interested in the field of death and dying. She believed that medical students and doctors should be aware of how important the topic was. One of her major contributions to the field of medicine was a theory inspired by her work with terminally ill patients. Dr. Kübler-Ross discovered that patients who were given bad news often reacted in a rather predictable pattern of five “stages”. She also found that these theoretical stages of coping with dying also applied to other grieving processes, such as a child going through a divorce or grieving a break-up. It is important to note that these stages are not absolutely complete or chronological, but only a general theory of how people react to grief.

  1. Denial: A person’s initial response to any bad news or trauma is usually denial. Denial is a hardwired defence mechanism of the brain to protect the mind from trauma. However, it may hinder the process of coping, with some people being perpetually stuck in this stage while never fully coping with their grief. An example thought during this stage is “This can’t be happening to me”.
  2. Anger: Once the person overcomes their denial and recognises reality, they respond with anger. This is an externalisation response where the mind tries to deal with the bad news by lashing out. It can be seen as the mind’s response to the confusion that arises from receiving the bad news, which may be caused by cognitive dissonance arising from the conflict between denial and reality. Because people at this stage often lash out with rage and verbal abuse (sometimes even physical), they may be difficult to deal with. Thus, it is important to recognise that this is a natural response to grief and try to support them even though they are acting abusive. An example thought during this stage is “It’s unfair that this is happening to me”.
  3. Bargaining: When the anger settles down, a person attempts to deal with the grief with logic instead of emotions. They will try to negotiate with a higher power to delay their death, such as through praying. This stage shows how desperate and vulnerable the person is while trying to deal with the bad news. They will try to do anything to make the grief go away, or at least reduce it. However, this stage rarely produces any viable solutions. An example thought during this stage is “If I can have a few more years, I will do anything”.
  4. Depression: With both emotions and logic failing to protect them from the grief, the person will fall into a state of depression. Hope is lost and the person understands that resistance is futile (an example of learned helplessness). By this stage, the person has become quiet and withdrawn, often detaching themselves from family and friends. Ironically, trying to cheer a person up during this stage is ill-advised. It is more beneficial if the person can pull through the depression and process it to make it to the last stage of grief. An example thought during this stage is “Why bother, I’m going to die anyway”.
  5. Acceptance: The last stage of grief is not only accepting that death is unavoidable, but also recognising that there is still time before that. The person reaches a state of clarity and comes to term with the grief, achieving some inner peace. The time taken to reach this state varies and some people may never reach it at all. It is also important to note that just because the person receiving the bad news has accepted it, others around them may not have processed the grief. An example thought during this stage is “Everything is going to be okay”.
Posted in History & Literature

Zodiac: Cancer

Cancer is the Zodiac sign for those born between June 22 and July 22. The symbol for Cancer is a large crab.

The model for Cancer is a crab who served Hera. This story is closely tied to that of Hercules’ twelve labours. Hercules, being the son of Zeus and a human woman, was hated intensely by Hera, the wife of Zeus. Thus, she made him made, causing him to kill his family and being punished by having to undergo twelve near-impossible challenges. One of these was killing the nine-headed monster, the Hydra. Hercules had already accomplished the first task so easily that Hera wanted to distract him. She sent a crab down to the human world and commanded it to attack Hercules. The crab crawled all the way to the battle scene and ferociously bit his toe. But Hercules simply kicked the crab, causing it to get crushed and killed instantly. Hera felt sorry for the crab and sent its body into the heavens where it became a constellation. This is quite possibly the saddest death in all of Greek mythology.

(Part of the Zodiac series:

Posted in Psychology & Medicine


Among the thousands of signs and symptoms in the field of medicine, there is one that every doctor and medical student knows since the development of medicine. Clubbing is an easily noticeable sign in a patient’s fingers that can have wide implications on their health.

Clubbing is essentially when the angle (gap) between the fingernail bed and finger disappears. The formal definition is much more complicated, such as “the loss of the normal <165° angle, or Lovibond angle between the nailbed and the fold”, but for all intents and purposes the simple definition is sufficient.

To see if a patient has clubbing, the physician carefully studies the fingers against light. There are a few ways to check for clubbing but the most popular methods are holding the fingers out straight and holding them parallel to the ground, checking the angle between the nailbed and finger, or the Schamroth’s window test. The latter test is done by holding two opposing fingers (such as the left and right index fingers) against each other nail to nail. The fingers are then held against the light so that the light can shine through the “window” that is made. If the window is not seen, the test is positive and the patient has clubbing.

What does clubbing suggest? Clubbing was first noticed by Hippocrates, the father of Western medicine, who observed that people with clubbing tended to grab their chest and fall dead. This is one of the most common associations to clubbing – a congenital cyanotic heart defect such as tetralogy of Fallot or patent ductus arteriosus. Other common associations are related to the lungs, such as lung cancer (one of the most common causes) and various other lung diseases such as interstitial lung disease, tuberculosis and other chronic infections. There are also a myriad of other diseases associated to clubbing, including but not limited to: Crohn’s disease, ulcerative colitis, cirrhosis, celiac disease, Graves disease and certain types of cancers (lung, gastrointestinal and Hodgkin’s lymphoma mainly). Clubbing can also be idiopathic, where there is no apparent cause for the clubbing and the person just has it (possibly just born with it).

Despite knowing about clubbing for over 2000 years, we still do not know the exact reasons for clubbing. There are theories that it is related to a fall in blood oxygen content leading to vasodilation in the peripheries. As the pathophysiology is not clear and so many diseases are associated with it, when clubbing is found in the patient the physician should investigate the related organ systems (heart, lungs, GI mainly) to narrow down the possible cause of it. As many of the causes (such as lung cancer) carry a rather morbid prognosis, it is quite important to notice whether the patient has clubbing when doing a physical examination.

Posted in Science & Nature

Cordyceps sinensis

Cordyceps sinensis is a fungus known as dongchoong-hacho(동충하초, 冬蟲夏草) in Korea, with the same characters used in China and Japan. It literally translates to “worm in the winter, herb in the summer”. It is a peculiar fungus with an interesting life cycle. In the summer when the weather is warm, the fungus infects its host (usually ghost moth larvae) through spores. The infected caterpillar is slowly filled with mycelium (thready part of fungi), until it becomes mummified with only the shell remaining. The fungus keeps replicating until it bursts out of the caterpillar’s head with a club-like fruit body (which holds the fungus’ spores). This makes it look as if the caterpillar, which was an insect in the winter, turned into a fungus in the summer (technically it is at this stage, but the caterpillar is long dead). In English, it is also called caterpillar fungus or vegetable worm (which is a misnomer as fungi are not vegetables).

Cordyceps sinensis is an important ingredient in traditional Eastern medicine as it is believed to be a perfect balance between yin and yang due to it possessing both animal and plant (actually a fungus) properties. It is used to treat many diseases from fatigue to cancer.

Although Western medicine usually looks down on and ignores Eastern medicine, research shows that Cordyceps sinensis actually has medicinal properties. Cordycepin, a chemical extracted from the fungus, has been shown to inhibit the growth of viruses, fungi and tumours through its inhibitory actions on a certain protein. There is also research that suggests it can protect the body against radiation poisoning.