Tag: death

Posted in Psychology & Medicine

Clubbing

Posted on by Jinavie

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

Duel

Posted on by Jinavie

Three gunslingers called Good, Bad and Ugly duel to the death. They each stand an equal distance from each other and shoot at the same time. Good’s accuracy is 30%, Ugly’s accuracy is 70% and Bad’s accuracy is 100%. Who has the highest chance of survival?

Common sense dictates that Bad, with the highest accuracy, will have the highest survival rate. However, when the duel begins, the following scenario will occur.

Good’s most rational decision is to shoot Bad rather than Ugly. Reason being, shooting the person with the higher accuracy improves your survival rate in the next round. Ugly also chooses to shoot Bad instead of Good as it is the best choice. Lastly, Bad shoots Ugly instead of Good. This scenario can be explained by the following diagram:

Thus, the probability of Bad being alive after the first round is (1-0.3)(1-0.7)=0.21, or 21%. This is because Ugly is killed by Bad on the first shot. On the second round, the probability of Good dying is the same as Bad’s survival rate of the first round, which is 21%. Therefore, Good’s survival rate is 79%. On the other hand, Bad’s survival rate becomes 0.21(1-0.3)=0.147, or 14.7%. 

Ultimately, the survival rate of each shooter is: Ugly 0%, Bad 14.7%, Good 21%, making Good the most likely winner. This illustrates the fundamental principles of game theory – an extremely useful theory that helps predict the many choices we make in life.

Posted in Psychology & Medicine

Sudden Death

Posted on by Jinavie

Unlike diseases such as tuberculosis or cancer, some disease processes are known to kill a human being within an hour of onset. Other than the obvious causes such as decapitation, massive bleeding or any other trauma-related injuries, these diseases tend to be cardiac or respiratory in origin.

A common example is coronary artery disease, where the blood vessel providing blood to an area of the heart becomes completely blocked by stenosis (narrowing, often by atherosclerosis) or a clot. This results in immediate ischaemia (lack of oxygen) to heart muscles, which causes cell death. This produces scar tissue which disrupts the electrical activity of the heart, which may lead to a condition called ventricular fibrillation where the heart beats in an uncontrolled, erratic manner. When in VF, the heart effectively becomes useless as it cannot coordinate proper pumping function. Blood circulation stops and the patient goes in to multiple organ failure (the brain goes first) within a very short time. Although it can kill within a short time, early identification and treatment may be able to prevent VF from occurring and save the patient’s life. If VF does occur, it is crucial to begin CPR or use a defibrillator if available.

VF can also occur in other situations. For example, there is a genetic condition called long QT syndrome which predisposes the patient to spontaneous arrhythmias (electrical abnormalities in the heart). Even becoming too excited can sometimes set off a VF in some LQTS patients, thus they require an implantable cardioverter-defibrillator (ICD) to shock their heart back in to normal rhythm every time they develop an arrhythmia.

Some other causes of sudden death include: aortic dissection (tearing of the aorta that may cause massive internal bleeding), pulmonary embolism (a clot obstructs blood flow in the lung, stopping circulation), commotio cordis (a blow to the heart at a certain moment in the heart rhythm triggers VF), ruptured brain aneurysm (ballooning of an artery in the brain), anaphylaxis (severe allergic reaction that cuts off airflow to the lungs) and poisoning (various mechanisms, mainly related to disrupting cellular function).

Death can strike swiftly, even from within your body.

Posted in Science & Nature

Nuclear Explosion

Posted on by Jinavie

Nuclear weapons are quite possibly the most dangerous weapons mankind has ever developed. Through the use of nuclear fission, atoms are split to release the massive amounts of energy contained within, causing a gargantuan explosion. When a typical nuclear bomb detonates, energy is released in various forms: blast energy (40~50%), heat (30~50%), radiation (5%) and fallout (5~10%). The distribution of the energy varies according to the type of bomb (e.g. neutron bombs produce significantly more radiation than heat and blast energy).

The initial damage that follows a nuclear explosion is from the blast energy, much like a conventional weapon. The sheer amount of kinetic energy creates a shockwave that pulverises everything in its path, travelling at speeds over 1000km/h. In addition, the heat from the explosion, over ten million degrees celsius at one point, causes vaporisation of all matter within a certain radius, causing a massive release of gases, fuelling the shockwave from the expansion. In the case of the bomb that destroyed Hiroshima, all structures within 1.6km were vaporised and those within a 3.2km radius suffered moderate to severe damage. A modern nuclear weapon is at least tens of times more destructive and will affect a significantly larger area.

At the same time, thermal radiation spreads out in all directions much like sunlight. Thermal radiation travels far further than shockwaves and can cause severe burns and eye injuries (flash blindness) to people in the vicinity (if they are close enough, they will spontaneously combust or melt). Near ground zero (point of explosion), a firestorm may erupt from the sheer amount of heat energy, as observed as a fireball. 

Next comes the indirect effects.
Ionising radiation is produced when atoms are split and these have detrimental effects on living organisms. Not only are they responsible for mutations in the genome, leading to deformed offspring, sterility and cancer, but if there is sufficient radiation, a person will immediately die from acute radiation poisoning.
The same radiation, especially gamma rays, creates what is called an electromagnetic pulse (EMP). EMP is caught by metal objects and induces a high voltage surge, destroying unshielded electronic devices. Sometimes, nuclear bombs are detonated at very high altitudes so that only the EMP affects the ground, damaging enemy communications and destroying entire power grids.
Lastly, radioactive material rains from the sky for long periods of time, also known as fallout. Fallout causes continuous radiation damage in affected areas.

A nuclear bomb is truly a weapon of mass destruction as it utilises various forms of destruction to devastate all life forms within an area spanning several kilometres, even killing over the course of time in the form of radiation.

Posted in Psychology & Medicine

Stroke

Posted on by Jinavie

A stroke is caused by a disruption in the supply of blood to the brain, which leads to cell death as oxygen is required. There are two types: ischaemic (where a clot cuts off blood supply to an area of the brain by blocking an artery) or haemorrhagic (when a blood vessel ruptures and leaks blood instead of delivering it to tissue). The most common cause of a stroke is a clot that made its way up to carotid arteries into the brain until it wedges in small vessel. There are many risk factors for blood clots, such as smoking, high cholesterol levels, atrial fibrillation and long distance flights.

Because the brain is always in high demand of oxygen (taking 20% of the total oxygen available), strokes can produce devastating effects within minutes. 5 minutes of oxygen deprivation can lead to irreversible cell death, a principle that is also used in cases of shock, where the blood pressure is too low to supply organs, or cardiac arrest. Therefore, it is crucial to recognise a stroke early so that an ambulance may arrive and deliver clot-busting medication such as streptokinase.

The FAST mnemonic is an effective way of remembering the common signs of a stroke. It is also useful in reminding people to respond fast.

  • F – Facial weakness: Is the person’s smile crooked? Disrupted brain function causes facial weakness on the opposite side. The weakness is usually seen around the mouth or eyes.
  • A – Arm weakness: Can the person keep both arms outstretched? This is related to motor function of the brain.
  • S – Speech difficulty: Is the person’s speech slurring or are they having problems understanding speech? This is a combined result of impaired motor function and speech centres of the brain.
  • T – Time to act: Call an ambulance. NOW.

Posted in History & Literature

Apple

Posted on by Jinavie

Apples are strewn throughout history and mythology, acting as a key component of human societies. Its symbolism ranges from the sin of Adam and Eve to the love of Aphrodite. Let us look at some apples that have made a significant impact in the world – real or mythical.

Apple of Temptation: According to the bible, Eve is tempted by the snake to take the forbidden fruit from the Tree of Knowledge. By taking from the tree and eating this fruit (then sharing it with Adam), the two are banished from the Garden of Eden and humanity is cursed to live in the harsh world and for women to suffer the pain of childbirth. Although the bible never defines the forbidden fruit as an apple, artistic depictions during the Renaissance has solidified the idea. The eponymous Adam’s apple (the lump on men’s necks) is said to be a piece of the apple being stuck in Adam’s throat.

Apple of Discord: According to Greek mythology, Eris (goddess of discord) threw a golden apple into a wedding after not being invited to it. The apple was inscribed with the message: “For the fairest one” and Hera, Athena and Aphrodite all claimed the apple was for them. Eventually, the judgement was delegated to Paris, prince of Troy. Each goddess bribed him with power, strength and love respectively but Paris eventually chose Aphrodite and in return, received the most beautiful woman in the world – Helen of Sparta. This sparked the great Trojan War, resulting in the destruction of Troy by the Greek alliance.

Apple of Love: Atalanta (Greek mythology) was a beautiful woman who had sworn virginity to the goddess Artemis. To avoid marriage, she challenged suitors to a footrace and only the winner would take her hand in marriage (the rest were killed). A man named Hippomenes went to Aphrodite’s temple to seek advice and was given three golden apples. He used the apples to distract Atalanta during the race by tossing it near her. This allowed him to win the race and ultimately took Atalanta’s hand in marriage. This story also shows how the ancient Greeks saw apples as a symbol of love, as evidenced by the gesture of one throwing an apple to the person they are in love with. Catching the apple was accepted as a sign of reciprocity.

Apple of Challenge: One of Hercules’ twelve challenges was to take the Golden Apples of Hesperides, protected by Ladon, a dragon with a hundred heads. Hercules bargained with Atlas to hold the Earth while he retrieved it. Atlas tried to walk away free from his damned task, but Hercules tricked him by asking to hold the Earth while he shifted his cloak.

Apple of Death: In the fairy tale, Snow White, the evil queen uses a poisonous apple to murder Snow White. The symbolism of the apple is similar to the biblical story mentioned above. Despite the dwarves warning her about stranger danger, Snow White takes the gift of a stranger without enough caution and suffers the consequences. However, she is resurrected by the kiss of the prince. Perhaps Aphrodite’s apple of love counters the evil apple of death and sin.

Apple of Revolution: A famous Swiss folklore describes how William Tell had to shoot an apple from his son’s head with his crossbow as punishment for not submitting to the occupying Austrians’ leader, Gessler. Being an expert marksman, he successfully hit his target instead of killing his son. When he was questioned why he drew two bolts from his quiver, Tell replied that he was aiming to shoot Gessler if he accidentally killed his son. This infuriated Gessler, who arrested William Tell. However, Tell escaped and went on to lead the revolution against the oppressors, aiding in the liberation of Switzerland (according to the legend).

Apple of Philosophy: There is a record of a young Martin Luther (who founded the protestant church) writing in his diary: “Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree”. The philosophy behind this saying is not that gardening is important. Here, Luther is saying that we should live every day as if it is the last day. Live without regrets. Besides, would we not look silly if the world did not end and we had wasted a day panicking and doing absolutely nothing productive?

Apple of Knowledge: The story of how Isaac Newton devised the theory of gravity after being hit on the head with an apple is a famous story. Although the “hitting on the head” part is dubious, evidence suggests that he used apples falling from a tree as an example of how gravity works. Although the concept of gravity was already established, Newton focussed on how apples always fell perpendicular to the ground and deduced that objects have a gravitational pull on other objects (as the Earth pulls the apple and vice versa). He extrapolated from the apple to discover how Earth’s gravitational field controls the orbit of the Moon. Thus, it can be said that apples played a “crucial” role in the advancement of modern physics (although Newton probably did not need the apples for his theory).

Apple of Innovation: In 1976, Steve Jobs co-founded Apple Inc. to develop the first personal computer. The company would go on to revolutionise mainstream digital technology by coming up with innovative products such as the iPod. Steve Jobs was the face of this new wave of innovation; with his bold outlook on the future and powerful leadership he made Apple Inc. one of the most successful companies in the 21st century. Jobs successfully popularised many pieces of technology, such as personal computers, portable music players and tablet PCs. Interestingly, he came up with the logo and name of the company after seeing a cartoon of Newton and his apple. Perhaps Jobs was seeking to create a company that would be one of the many “apples” that were turning points in history.

Posted in Life & Happiness

Life And Death

Posted on by Jinavie

“No one wants to die.
Even people who want to go to heaven don’t want to die to get there.
And yet death is the destination we all share. No one has ever escaped it.
And that is as it should be, because Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new.
Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away.
Sorry to be so dramatic, but it is quite true.
Your time is limited, so don’t waste it living someone else’s life.
Don’t be trapped by dogma – which is living with the results of other people’s thinking.
Don’t let the noise of others’ opinions drown out your own inner voice.
And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become.
Everything else is secondary.”

~ Steve Jobs, co-founder of Apple Inc.

Posted in History & Literature

Land

Posted on by Jinavie

The following is the synopsis of a short story called How Much Land Does a Man Need?, written by the famous Russian author Leo Tolstoy.

A peasant man called Pahom was complaining of how he did not possess enough land to satisfy him. He lamented: “If I had plenty of land, I should not fear the Devil himself”. The Devil, hiding behind the stove and listening to this, decided to have a tussle with Pahom to teach him a lesson.

The next day, a lady in the village sold her estate, which was bought up by the peasants. Pahom too tried to buy as much land as possible and by utilising the land he pays off his debts and he leads a happier life. But despite having his wish granted, he was still not satisfied and desired more land. His obsession with his land began to cause troubles with his neighbours and he eventually moved to a larger area of land at another village.

However, he was annoyed that he was growing crop on rented land and wanted more land for himself. He found out that the Bashkirs in the village were simple-minded people with large amounts of land. Pahom decided to exploit the Bashkirs and went to them to negotiate the lowest price possible for their land. The Bashkirs counteroffered with a very strange deal: for a thousand rubles, they would let Pahom take a spade to mark out an area of land and claim it for himself. The only condition was that he had to come back to where he started to close the loop by sunset. Pahom joyfully took up the offer, thinking how stupid these people were.

That night, Pahom had a surreal dream where he saw himself lying at the feet of the Devil. The Devil was laughing maniacally over Pahom’s cold, dead body. After jerking awake from this nightmare, Pahom sets out to start marking out as much land as possible. He decides to travel as far as he can to maximise his gain. However, he forgets to take into account the time needed to come back to where he started and hurries back. Although he manages to close the loop by sunset, the exhaustion causes him to drop dead on the spot. He is buried in a hole measuring 6 feet long.

How much more land does a man need than a place where he can rest in peace?


Posted in History & Literature

Pyrrhic victory

Posted on by Jinavie

Sometimes in war, victory comes at devastating costs. Such was the case for King Pyrrhus of Epirus when he battled the Romans at Asculum in 279 BC. Although Pyrrhus was ultimately victorious, due to the sheer size of the Roman army Pyrrhus’ army suffered significant casualties (but still less than the Roman casualties). Pyrrhus’ forces had been so crippled that another assault by the Romans would have utterly crushed them and led to a massacre.

This led to Pyrrhus’ famous saying: “Another such victory and I come back to Epirus alone”, implying that the cost of victory was so high that there is almost no gain. Such a victory is now called a Pyrrhic victory – a victory that is not really a victory.

Posted in Psychology & Medicine

Werther Effect

Posted on by Jinavie

Suicide is the third leading cause of death among young people in the developed world. Every year, approximately one million people take their own lives – far greater than the number of people dying from liver disease, Parkinson’s or even homicide. Despite being one of the most preventable causes of death, suicide still plagues society.
Among the many factors contributing to suicide attempts (mental disorder being the major one), one of the more interesting one is mass media. The effect of mass media on suicide rates can be traced back as far as 1774.

In 1774, Goethe wrote a novel called The Sorrows of Young Werther, where the hero shoots himself after an ill-fated love affair. Shortly after publication, there were many reports of young men who used the same method as Werther to commit suicide. There were even reports of people dressing up like Werther (yellow pants and blue jacket) or leaving the book open to the passage detailing his death next to themselves. After this event, the book was temporarily banned to stop the “epidemic”. Since then, the phenomenon of copycat suicides has been called the Werther effect.

The human brain is trained to think about the information it receives. This applies to suicide as well and people with mental disorders such as depression and bipolar disorder are more prone to suicidal thoughts after hearing stories about it. This effect is amplified by the media tending to glorify or beautify such deaths (as the subject tends to be a celebrity or a fictional character), causing some people to subconsciously believe that suicide is acceptable. In essence, the Werther effect is a form of peer pressure where cognitive dissonance lead people to act irrationally because others in society appear to be doing the same thing.

The Werther effect is surprisingly effective in predicting an increase in suicide attempts after the publication of news regarding suicide. On April 8, 1986, a Japanese singer called Yukko Okada, only 18 at the time, committed suicide by jumping off the seventh floor of her recording studio. Her popularity meant the media were over the story like hungry wolves, reporting the tragic death in every form possible. Within two weeks, 33 young people (including one nine-year old) killed themselves – 21 by jumping from buildings. This episode was dubbed Yukko Syndrome and is one of the most famous cases of the Werther effect in modern society.

Just like in the original case of the Werther effect, the suicide could be fictional and still cause an increase in suicide rates. There was a German television show called Death of a Student that depicted a railway suicide of a young man at the start of every episode. After it began airing, railway suicides by teenage males increased by 175% in Germany. Curiously, there was no increase or decrease in suicide rates via other methods, suggesting that the Werther effect not only affects the choice of method, but also induces suicidal thoughts in those who did not plan on killing themselves.

In 1987, a campaign in Vienna to inform reporters about the Werther effect and the role of the media in suicides led to a dramatic drop in reporting suicides. This was followed by an 80% drop in subway suicide and non-fatal attempts, along with a decrease in the total number of suicides.

The Werther effect is a fine example of how words can kill.