Posted in Psychology & Medicine

Triage

In dire times such as wars, natural disasters and pandemics, we hear news of healthcare professionals setting rules to limit medical treatment provided to certain groups of people. This can come across as shocking to people as it seems unfathomable that a hospital would not do everything within its power to save a life. However, this is a well-known and commonly practised principle in medicine known as triage.

Fundamentally, triage is a system used to prioritise who should receive what level of medical care when. The word triage comes from the French verb trier, which means “to sort“. Modern triage was first designed by a French surgeon named Dominique Jean Larrey, who served in the Napoleonic Wars. Larrey categorised wounded soldiers into one of three groups:

  1. Those who would likely die no matter what treatment they received
  2. Those who would likely live no matter what treatment they received
  3. Those whose quality of life may benefit from immediate treatment

He advised battlefield medics to quickly assess what group a wounded patient would fall under and to focus on the last group. For example, if a soldier had superficial cuts and not heavily bleeding, they would be able to transport themselves back to base. A soldier who is not breathing or lost two or more limbs would be unlikely to survive despite acute surgery (especially with where medicine was at in those times). In other words, medical care would be focussed on those who would likely survive and benefit from urgent medical care, such as the patient who is needing an amputation to stop life-threatening bleeding from an injured limb.

This may sound cruel, but it is the unfortunate reality of healthcare. Ideally, we would like to give the best care to every patient, but we live in a world of scarcity, where resources are finite and limited.

Therefore, we rely on utilitarianism, where we ask “what is the most amount of good we can do with these finite resources?”.

Modern triage is more complicated than Napoleonic times, especially in the emergency department. However, in the case of emergency situations involving mass casualty, triage returns to its simple, original form.

Let us imagine a city struck by a massive earthquake. There are tens of thousands of people with varying severity of injuries. How do we prioritise who will be taken to hospital, need on-site treatment, or left to die or find their own way to hospital?

Physicians and nurses will quickly assess a patient and their vital signs to categorise them using coloured tags, such as red for needing emergency treatment, green for does not need treatment, or black for deceased or likely to die. This is because without triage and prioritisation, the available medical resources will quickly be exhausted and no further care will be deliverable.

If multiple doctors and nurses stop triaging and focus on one patient needing complex surgery, tens or even hundreds of potentially salvageable lives could be lost. If non-urgent injuries are all taken to hospital, the hospital will be overwhelmed and will not be able to provide care to those who are critically ill. If a patient with a non-survivable injury is operated on and taken to the intensive care unit (ICU), they will have lost the opportunity to use those resources on a patient with a better chance of survival.

As harsh as it sounds, saving ten people with moderate injuries who would die without treatment is preferred over the one person who has a less than 10% chance of surviving with maximum medical care. This may be as black-and-white as choosing to not rescue a person with an obviously unsurvivable injury such as decapitation, but it may be as complicated and ethically challenging as deciding if an elderly patient with a lung infection should be intubated and ventilated (breathing machine), fully knowing that a younger, healthier patient with the same infection may need that ventilator to survive, but with a much higher chance of survival and restoring their quality of life.

Triage is a classic example of when the rational solution to a problem such as scarcity challenges ethics and emotions. It may sound as if doctors are playing god when they are declining ICU level of care for an elderly patient, but we must also consider that they have a duty to provide the most effective care for all of society, not just the one patient. These kind of ethical dilemmas are an everyday occurrence in the medical field and can cause significant guilt, anger, pressure and resentment for the healthcare provider.

To simulate the weight of triage, consider the following scenario. Following an explosion in your neighbourhood, you respond to a scene with four patients:

  1. Your 28-year old co-worker with heavy bleeding from a laceration of their leg
  2. Your 83-year old mother who is bleeding from their head and unresponsive, breathing very irregularly and poorly
  3. Your neighbour’s 8-year old child who is not breathing despite straightening their airway and applying rescue breaths
  4. Your 45-year old who is screaming in pain from a broken arm but not bleeding and able to walk
    You have the capability to treat and transport one patient. Who do you choose?

As much as we would like the save the life of our loved ones or a young child first, the principles of triage dictate that the first patient demands the most immediate response.

Triage does not account for emotional connections, personal biases or even justice necessarily. It is a cold, hard rule system that we use so that we can separate our emotions and instincts out amongst a horrific situation.

The algorithm for the START triage system – a widespread system used in many modern mass casualty scenarios
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Posted in Life & Happiness

How’s The Water?

Two young fish are swimming along when they happen to meet an older fish swimming the other way, who nods at them and says:

“Morning, boys. How’s the water?”.

The two young fish swim on for a bit, and then eventually one of them looks over at the other and goes:

“What the hell is water?”.

This is a humorous analogy that writer David Foster Wallace told at the beginning of his commencement speech to Kenyon College’s graduating class of 2005. Although it is short, it can be unravelled to reveal many important guiding truths regarding adult life.

Much like the younger fish, many of us are not aware of the “water” that surrounds us. Although we live in it, reality is hard to process because it is made up of so many different layers of complexity. To make it easier to live our lives, our brains protect us from being aware of our reality, much like how people are not aware that they live in a simulation in The Matrix.

Even when we are aware that we are swimming in water, we keep asking ourselves “What the hell is water?”. We search desperately for the wise, older fish who can enlighten us – someone who can teach us what water is.

Many of us will be swayed by countless teachers, mentors, gurus, politicians and religious leaders who tell us to follow them to learn what water is. Many of us will firmly believe that we have grown up to become the older, wiser fish, and fight stubbornly against others who have different views on what water is. Some us may even choose to ignore that the water exists at all.

At every stage of our lives, many of us fall in the trap of believing that we have things “figured out”. Teenagers will rebel against adults, thinking that they will reinvent the world. Young adults will believe that now that they are working members of society, they are entitled to their “educated”, “mature” opinions. The middle-aged believe they have been adults long enough that surely they must have gained enough experience and wisdom on the way. And if we don’t feel confident that we know what water is, we seek the answer from those who claim they know it.

In short, we are always searching for the answer, or claim to have the answer. But that is not the lesson to take away from the parable of the fish in water.
It is not the answer that is important, but the question.

It is hubris to think that we can possibly understand how the world works completely within our lifetime. Instead, we should continue questioning what water is. Otherwise, we are just pretending to be enlightened, all the while becoming dimmer as we shut off our ability to learn and see things from a new perspective.

Consider the countless complexities that make up our reality: physical laws of the universe, the historical context, political climate, shifting cultural norms, societal pressures, chaos theory, our connections to other people… Even if you were to make sense of all this, you will never understand the reality that other people live in, as believing in only your reality stops you from being empathic and compassionate. Remember that water is a great environment for fish to live in, but a person would drown if left underwater.

This is why the parable does not tell the story of the older fish teaching the younger fish what water is. Instead, he is asking them how the water is. He is encouraging them to be aware of the context they live in and to keep question it and learning about it, while he himself stays curious as to how other fish experience the water.

So, how’s the water?

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Posted in Philosophy

Trolley Problem

Imagine the following situation. There are five people working on a railroad. Unfortunately, a train is travelling down the track at the same time. Neither the conductor nor the workers are aware that a crash is coming. You are the only person that knows. Next to you is a switch that will change the tracks so that the train diverts and misses the five people, but the second track also has one worker working on it. Here is the dilemma: do you pull the switch to save the five workers at the cost of the one worker?

This is the famous trolley problem, a thoroughly discussed ethical dilemma that explores the ethics of utilitarianism. Is it morally right to sacrifice the life of one person to save the lives of five people? Mathematically this makes sense, as you are essentially saving four people through your action.

But now consider a similar yet different situation. Instead of a switch, this time you are standing next to a very large man on a bridge overhanging the tracks. The only way to save the five people on the track is to push the large man on to the tracks, slowing the train down and giving the five workers enough time to escape harm.

Mathematically, the end result is the same: one person is sacrificed so that five people live. But when presented the two scenarios, the majority of people will say they would not push the large man, even though they were willing to pull the switch in the first situation.

This is a complex ethical problem as the rational, logical choice may not necessarily be the “morally right” choice. It directly conflicts with our natural and cultural belief that we should not kill members of our own species. The slippery slope argument also applies here, as if you can argue that killing one man to save five people is correct, then what’s to stop us from sacrificing one person to harvest their organs to save the lives of many people awaiting organ transplants?

Although the original problem was developed to explore the morality of utilitarianism, we are now living in a time where the trolley problem has become an actual logistical issue. The issue lies with self-driving cars. Self-driving cars should theoretically dramatically reduce road traffic accidents as it removes human error such as drink driving and inattention as the cause of crashes. However, if a situation was to arise where the car senses that it is about to collide into a pedestrian (or five), what does it do? Does it swerve to avoid the pedestrian and put the passengers’ lives at risk? How does a computer decide what the morally right choice is?

A computer is designed to make calculated, rational decisions. Mathematically, it may deem that swerving and crashing into a tree – endangering the life of its sole passenger – is the logical choice to prevent hitting five people on the road. But then who would buy a car that willingly sacrifices its passengers’ lives for the greater good?

Technology is advancing at a staggering rate and we are facing ethical dilemmas that we have never had to consider before. It is our job to discuss and explore these issues ahead of time so that we can prevent irresponsible use of technology in the future.

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Posted in Philosophy

Memento Mori

No matter how special you may be, there is one universal truth: we will all die someday. It may be in fifty years’ time, or it could be tomorrow. But nonetheless, we all have to eventually face our mortality. Memento mori, which is Latin for “remember you must die”, is the philosophy of being mindful of this fact.

It may sound morbid to ponder one’s own mortality day by day. However, the true meaning of memento mori is not to live anxiously fearing that death may be around every corner. Instead, it teaches us to not take life for granted, as it is finite and will end someday.

Many of us stress about the future so much that we cannot enjoy the present. We are ambitious: always aiming higher, to reach a higher position, to gain more wealth and to attain pleasure. But we forget that on our deathbed, none of these material things matter. What matters is whether you will be able to look back on your life and say that you truly lived with little regrets.

That said, it is okay to fear death. It is human nature to fear the unknown. Instead, we can harness our fear of death to live a fuller life. Fear is a poison that prevents us from seizing the day. Fear of failure, fear of rejection, fear of judgement… But when we compare it to the weight of our inevitable demise, it is nothing. Although we are all afraid of dying, the vast majority of us are able to live without the fear of death interfering with our day-to-day lives. Therefore, unless death is an immediate consequence of your actions, nothing should make you afraid of trying.

Lastly, memento mori is a reminder of the temporary, impermanent nature of the human condition. Any moment could be our last, no matter how banal it may be. A brief phone call with your loved ones arguing about something petty may be the last conversation you have with them. It is a well-known fact that the human brain remembers the first and last things or events the most (primacy and recency). When you remember that death awaits all of us, every moment becomes a little bit more precious. We start paying more detail to how wonderful life is and how fortunate we are to have loved ones in our lives.

Remember you must die; you might as well make the most of life before then. Or as Ferris Bueller put it:

“Life moves pretty fast. If you don’t stop and look around once in a while, you could miss it.”

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Posted in Philosophy

Quantum Immortality

The famous Schrödinger’s cat thought experiment illustrates the Copenhagen interpretation of quantum physics. Quantum physics is an extremely complicated field of study, but the gist of the Copenhagen interpretation is that a probability remains in a superposition – that is a state where many possibilities exist at the same time – until it is observed, when it collapses into a certain state.

For example, imagine a cat that is locked in a box sealed with a vial of poison, that is set to break open only 50% of the time. Until the box is opened, we do not know if the cat has been killed by poison or not. Therefore, the cat can be said to be both alive and dead at the same time (Erwin Schrödinger initially devised the experiment to mock the Copenhagen interpretation).

There is a fascinating theory that takes this strange thought experiment one step further. Another interpretation of quantum physics is the Everett many-worlds interpretation. This explains that instead of the wavefunction collapsing (i.e. producing a single result such as alive or dead) on observation, two parallel universes are created instead: one universe where the cat died and another universe where the cat is still alive. Essentially, it states there are infinite universes containing every permutation of possibilities that can exist and that whenever a probability is observed, we enter a specific universe.

This is a very confusing concept to grasp, so let us return to the cat in the box. According to the Copenhagen interpretation, the cat has a 50% chance of surviving the experiment the first time. From then on, the chance of the cat being dead grows exponentially with every experiment. However, according to the many-worlds interpretation, no matter how many experiments we perform, there always will be a universe where the cat miraculously survived each one. From the cat’s perspective, it would not know of the universe if it had died. Therefore, the only universe where the cat is able to tell this story to its friends at the end of the day is one where it survives every single experiment

Now let us apply that to our own lives. Imagine that you are crossing the road and a bus is about to hit you. If there is even a 1% chance you might survive this event, your quantum self will move to a universe where it is possible (otherwise you would be dead and your consciousness ceases to exist). By extrapolation, you can never really die as a version of you will forever live on, beating improbable odds until a point where there are literally no possible universes you could be alive.

Quantum immortality is a thought experiment that relies on the many-worlds interpretation. However, it is also extremely difficult to prove wrong. The only way you could confirm this is if you attempted to kill yourself over and over (quantum suicide) and failed each time. But if you were wrong, you would die and not be able to tell anyone. Ergo, you cannot rule out the possibility that you will live forever.

The scariest part of the theory is not that you are potentially immortal. It is that quantum immortality does not account for your well-being – just your consciousness. If an accident were to leave you horribly disfigured but alert, it would still satisfy quantum immortality. You could be trapped in a motionless body for the rest of eternity, unable to communicate to anyone. Yet quantum immortality will keep you alive, forever and ever.

(Infinity Mirror Room by Yayoi Kusama)

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Posted in Life & Happiness

Kintsugi

There is a type of Japanese pottery art called kintsugi (きんつぎ), which translates to “golden joinery”. Kintsugi is the art of repairing broken pottery by filling the cracks with lacquer (treated tree sap commonly used to decorate pottery) that has been dusted with gold or silver powder. This gives the pottery a distinct look as the pattern of cracks are always random and unique.

Kintsugi is not only an art, but a philosophy. When something is broken, the common practice is to repair it in a way to hide the fact that it was ever damaged. Kintsugi takes the opposite approach by directly incorporating the break into the identity of the pottery.

It follows the Buddhist principle of impermanence and imperfection – understanding that the piece is more beautiful for having been broken. Instead of hiding the damage or throwing the pieces out altogether, kintsugi can produce something greater out of the pieces than its original form.

Nothing is constant in life. We are not perfect and cannot remain unflawed. Life constantly knocks us down, leaving us with scars. But when you get back up, you have two choices: to pretend you were never hurt and hide the pieces away, or to embrace that you are flawed but choose to show to the world how you mended yourself to become even more beautiful.

The lesson here is that it is okay to be imperfect or broken. What matters is what you can do with the pieces.

1 + 1 = 3

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Posted in Philosophy

Anthroponuclear Multiple Worlds Theory

A famous theory in philosophy is the anthropic principle, which argues that the reason the various physical constants and laws of nature are consistent with an environment that can support life is because if life were impossible, no life would be able to observe the universe. Simply put, it argues that the reason the universe seems so improbably perfectly tuned for us to exist in it, is that we exist to observe it.

What if we applied a similar theory to modern world history? Since the advent of nuclear weapons, we now have the capability of destroying human civilisation with the push of a button. There have been so many incidents in the past century where international tensions and mistakes have nearly resulted in thermonuclear war, such as during the Cuban Missile Crisis. However, through improbable coincidences (and the moral fibre of certain heroes), we continue to live on as a species.

But perhaps history only seems so full of coincidences because we are still alive to study it. For our reality to exist, human beings have had to resist the urge to annihilate themselves. Ergo, the longer we live through the Atomic Age, the stranger our reality becomes, as otherwise we would have been wiped out. Zach Weinersmith calls this the anthroponuclear multiple worlds theory.

So perhaps this explains why we are seeing crazier and crazier stories on the news as of late. As in any other sensible timeline, we would all be dead.

(Sourcehttp://smbc-comics.com/index.php?id=3994)

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Posted in Science & Nature

Newton’s Flaming Laser Sword

If an irresistible force was to act on an immovable object, what would happen?

A mathematician named Mike Alder decided to approach this philosophical paradox from a scientific perspective. He proposed a simple answer to the paradox – it is not worth discussing.

Alder argued that for an object to be immovable, all known forces must be acted upon it with no effect. Similarly, an irresistible force can only be called that if literally no object could ignore its effects. Therefore, the two cannot possibly exist in the same universe, meaning that the paradox is pointless. As Alder would put it – “Language is bigger than the universe”, as it allows us to formulate impossible scenarios that ignore the rules of science.

The implication of this line of thought is that if you cannot tangibly test an idea, then there is no point in arguing it as it would not add to scientific knowledge. This is a purist view of the fundamental principle of science that is falsifiability.

Sir Isaac Newton was one of the earliest pioneers of this philosophy. He wrote: “hypotheses non fingo”, or “I do not engage in untestable speculation”. Newton challenged the classical school of philosophy, where one would challenge and develop an idea through thought, discussion and argument. When faced with philosophical questions such as whether animals had rights, he would ask: “What set of observations do you consider would establish the truth of your claim?”.

Alder named his principle – that one should only discuss matters that can be tested and verified – Newton’s Flaming Laser Sword (as he believed all good principles should have sexy names). This is a play on Occam’s razor, the philosophical principle that once you shave away the complexities, the simplest truth remains. Alder believed that Newton’s Flaming Laser Sword was a much sharper and more dangerous tool than Occam’s Razor, meaning that as useful as it is, it should be used with care.

Of course, this is an extreme school of philosophy that is only upheld by a group of philosophers who we now call “scientists”. There are still many intangible issues that could only be solved through thinking, such as ethics. Thus, the battle between scientists and philosophers continue.

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Posted in Life & Happiness

Ulysses Bucket List

The following is an abridged story from a user on the internet site Reddit. It details the background of what he came to call the Ulysses Bucket List.

At the age of 15, the user ran away from home with no money or plan. He hopped on a train and decided to ride it as far as it would go. To his surprise, the line only lasted less than an hour and he decided to ride it all the way back again, to give himself more time to think about where to go from here. Just as the train was about to leave – back to where the user first got on – a girl came on the train and sat behind him. A short while later, she got up and sat down next to him, asking why he was writing on a napkin. 

The user told her his story and that he was trying to plan how he wanted to live his life on the napkin. She laughed and they ended up getting to know each other. The 17-year old girl was riding to the end of the line, so he decided to stay on the train to keep talking to her. But the train ride was short and they soon had to say goodbye at the train station.

Before saying goodbye, she turned to him and asked a question that would become a wonderful part of the boy’s life. She asked: 

“Tell me something you have done, or want to do, that you think I should do? It can be anything, as challenging as you want it to be, or as easy. As long as you give me the rest of my life to complete it, I promise I will do it.“

He was confused but agreed, and told her: ”Sing a song acapella in a room full of strangers.” She said that’s perfect and asked him if he would like a challenge as well, to which he agreed. Her challenge was: “Read, from start to finish, Ulysses by James Joyce.” After that strange exchange, the boy and the girl went their own ways, not knowing if they would ever see each other again.

For 12 years, the user tried and tried to read the book from cover to cover, but failed to finish the 780-page book. But even so, each time he picked up Ulysses, he would think back to that day and of her. Soon after parting ways with her, he’d realised something important. He decided to keep it going – with as many strangers as possible. Whenever he would leave someone whom he shared an experience with, he would add them to his “Ulysses Bucket List – he would ask them to give him a challenge, as difficult or as easy as they want it to be, regardless of the fact that they have done it or not; simply something their heart had always wanted to do.

Through his travels, he received and completed challenges such as jumping into a body of water on a cold day without checking the temperature, buying twice as much food he intended on eating in a week and giving half to a stranger, and telling five people he hated the most that he loved and respected them. Some were simple but challenging, such as skydiving, while some were life-changing, such as a girl telling him that whenever he got mad at someone, walk away, sing his happy song in his head for 5 minutes and then go back to the person with a calm mind to work things out.

The Ulysses Bucket List not only pushed the user to broaden his horizons and do things he usually wouldn’t, but it also made all the people he met unforgettable, as each challenge would spark a memory of the person and the beautiful experiences and memories he shared with them. Despite all of the amazing memories and challenges – both those he’s completed and those he’s yet to start on – he has yet to finish James Joyce’s Ulysses, with only 30 pages left at the time of him writing the story. Each time he reads it, he remembers back to the day he met the girl that gave him the gift that has never once stopped giving. 

That, is the story of the Ulysses Bucket List.

Source: https://goo.gl/b8Ap3o

NB: Read the comments and follow the thread to see what happened after he posted the story – almost like an epilogue thanks to another kind Redditor. Alternatively, read his follow-up post: https://goo.gl/S9ZfE8

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Posted in Philosophy

Mary And The Black And White Room

Mary is a brilliant scientist who specialises in colour. She knows everything about colour – the spectrum, wavelengths, properties of light, the mechanism of how human vision works… She knows exactly how a certain wavelength of light will excite the retina and what kind of electrical impulse it will send in the brain. However, Mary has never seen colour. She has lived all of her life in a black and white room and can only observe the world through a black and white TV screen. The question is: if Mary was to leave the room and see the colourful world for what it is, would she learn something new?

Considering that Mary already knows everything theoretical about colour, would her seeing colour change anything? Or is the experience of seeing a colour something that you cannot learn without actually experiencing it?

This was a thought experiment proposed by Frank Jackson to question the nature of knowledge. Is physical knowledge truly everything, or is there something more than that? In philosophy, there is a concept called qualia, which describes the subjective, qualitative properties of experiences. That is, experience is a unique type of knowledge that cannot be learnt without experiencing it first-hand.

A further expansion of this idea is the refutation of physicalism – the school of thought that argues that everything (including knowledge and the mind) is physical. The logic is that since Mary knew everything “physical” about colour before leaving the room, her learning “something’ (i.e. experience of colour) is a direct argument against all knowledge being physical, as she learnt something “new”.

Another way to look at it is this. Some things in life can only be learnt through experiencing it. It is not enough trying to learn about life and the world purely from stories and books. To truly learn everything, you must get out there and experience it yourself.

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