Cassava

A commonly quoted reason for working memory failure is overload. We try to hang onto too much, and then push our memory past its limits. No less important than overload is mind-wandering. We're grabbed by some attention-seeking thoughts and our mind gets hijacked.

The question, for me, is how many books I should start reading. One after another? Different books at the same time? Once again, this is a question I don't have the answer but I tend to be promiscuous, for that matter.

Two days ago, I was reading about the intriguing streams of paralyzed patients, most of them on crutches or carried by relatives, arriving at Hans Rosling's clinic in Mozambique. They all told the same story: suddenly, both their legs had become useless. No pain, no fever and no other symptoms. The number of new cases was doubling every week. They felt like a television set with bad reception; nobody knew what was happening, and started to move the antenna around and bang on one side and then the other hoping the picture would improve. Could that be polio? Or biological warfare? None of this seems very likely, does it? 

Hans Rosling was flummoxed.

At the same time, I was in the middle of reading another book Sleeping Beauties written by evolutionary biologist Andreas Wagner. He taught me the multitalented molecules develped by plants. One of the superpower chemcial defence armaments is cyanogenic molecules. The name says it all. When an animal or human takes a bite out of a plant containing such a molecule, the molecule releases cyanide. That's the same lethal poison used by the Nazis in the gas chambers of Auschwitz – that much I was certain of. I've never heard about cassava or manioc tubers – staple foods in African countries including Mozambique – which contain such molecules. Macabre as it was, the Africans will get poisoned and become paralyzed after eating cassava unless the tubers are cooked or soaked.

When Hans Rosling drew up detailed maps of the geographical spread of the paralysis epidemic, there were several striking findings. First, it emerged that the disease hit children in particular but none under the age of two. Second, the majority of victims got paralysis during the summer period of no rainfall. It didn't take long for Hans Rosling to find out that the indigenous people could have left the cassava in the ground, hoping for rain but in vain. They soon pulled up cassava – neither cooked nor soaked – when they got nothing to eat. 

That's how people get the cyanide-releasing poisons.

A truly eye-opening read.

Poverty

It's hard for us to imagine the life in Mozambique with a shockingly high child mortality rate. It's even harder for me to read the stories haranguing the Swedish doctor Hans Rosling serving an emergency clinic in Mozambique.

Better known for writing another bestselling book Factfulness, Hans Rosling has written a memoir How I Learned to Understand the World. 

I admitted that his stories are indeed opening our eyes to poverty outside our comfort zone. And it is impossible to read without ooh and ahh. 

One late afternoon in the hospital, Hans Rosling met an elderly with a leg fractured, as carried in by her two sons. The ends of the broken bone were protruding through her skin. There were no X-ray machine and he had run out of anaesthetics. Hans Rosling had not much choice; he asked two nurses take hold of the patient under her armpits and the strongest junior nurse to pull the foot in the opposite direction. After much grappling, he managed to line up the fracture surfaces and close the wound, stitch the skin margins and put her entire limb in a plaster cast. 

Next morning, the patient insisted on leaving hospital, when she was not supposed to put any weight on the leg. I could imagine furrowed brows of Hans Rosling, who tried to explain in sign language, in vain. He then discovered that something had gone very wrong: the immobilised foot was pointing sideways instead of forward. He simply forgot to check alignment before putting on a plaster cast. To his chagrin, he could not persuade the patient to let him reset the foot.

"Doctor, my hens might get stolen so I have to leave," the old lady insisted. 

Hans Rosling never saw her again but learned later she had survived. The plaster had cracked and fallen off after a month and her foot was utterly misaligned. That badly shaped foot didn't bother the patient as long as her chickens were all right.

"When you work in a place of extreme poverty, don't try to do things perfectly," said his mentor who had been a mission doctor all her life. "All you will accomplish is wasting time and resources that could be put to better use."

That's a lesson Hans Rosling learned from the old lady too.

Anniversary

One thing that puzzled me during our plan of celebrating the 24th wedding anniversary was all the coinciding with official release of Taylor Swift's 11th studio album. I joked about Taylor Swift choosing to celebrate our big day.

Taylor's new album is likened to a new star in the galaxy, and her music has been a global phenomenon. 

My daughter, like all other Swifties, has been head over heels for her, and more so in the days leading up to the release of "The Tortured Poet Department". Out of loyalty to their favorite singer, Swifties refused to listen to the songs leaked online early. Because of school schedule, my daughter had to wait few hours after the album's arrival to start listening. She made promise not to log into any social media during lunch break in case of spoilers.

As it turns out, one of the celebration events for our wedding anniversary yesterday was to drive to my daughter's school and pick up two Swifties to our home – to make the history. In case you don't know, Taylor's album takes less than 12 hours to break this year's record for most single-day Spotify streams.

Mental

The story of Michael Laudor, as told by acclaimed author Jonathan Rosen, was heartrending. The author, Michael’s closest childhood and lifelong friend, wrote a story spanning 50 years which took me two weeks to finish. 

In terms of language prowess and intelligence, Michael Laudor could take pride in his encyclopaedia recall, like reading a book in one sitting without losing a word. He read faster than Rosen, remembered more, and processed information more quickly. 

The way Michael studied was not for the faint of hearts. His roommate had to move out because Michael never put his reading light out no matter how often he was asked or how late it got. He ended up inheriting a room of his own, which everyone in the college called “psycho singles.” 

During his first semester at Yale with Rosen, Michael had made a dive into a thorny debate with a Harvard professor who wanted Black parents to decide for themselves whether their kids got bused to majority-white schools or stayed close to home where, Michael warned, they would “suffer from the loss of an integrated environment.” Michael published a long letter in The New York Times defending the racial balance in public schools. Michael had superior intellectual ability. We took it for granted that Michael would rise to scholar status. It never occurred to us that he might one day became the man who needed to be judged as whether to be integrated or to be locked. 

He graduated from Yale Law School with summa cum laude honors despite suffering from schizophrenia. “Either you welcomed people with disabilities to the table,” he later wrote, “or you cast them out like lepers shunned in earlier times.” His story made us think again the way to help people with mental health problems. That’s something even bright guy like Michael doesn’t know the answer.

Out of the Box

I happened to be reading Ozan Varol's book two days ago, when I was on call looking after patients with kidney disease. As a rocket scientist turned award-winning author, Ozan Varol championed moving out of our comfort zone. That means taking off the training wheels and moving away from the familiar path.

One of my call duties was to look after and orchestrate kidney transplant from a brain death donor after a tragic traffic accident. My two patients were waiting for the new kidneys. They didn't speak much, and somewhere in the background rose the ticking of the clock in our medical ward, an unwavering rhythm of stability, sharply at odds with the uncertainty on their faces. I was counting my fingers. We weren't sure how long the wait would be. Waiting, for my patients on dialysis, was a bitter cocktail of aching awareness, visceral pain, and mental crush.

The organs had already been taken out of the road crash victim's body for over ten hours. I didn't want to disclose too much to the two taciturn kidney transplant candidates how we are in a race against the clock as soon as a kidney was recovered and placed on ice. Patients should not be bothered with the science that kidneys would start to degrade during the high-stakes window called cold ischaemic time. Yes, prolonged cold storage of kidneys inside the box is no laughing matter – there are starving kidneys at stake – but, hard as we tried, our operating rooms were all occupied with emergency surgery that afternoon.

Ozan Varol reminds me the pitfall of managing uncertainty. In other words, our brain often steers us toward the seemingly safest path – inaction. The brain, to paraphrase psychologist Rick Hanson, is like Velcro for the negative but Teflon for the positive.

To overcome the uncertainty, my urologist friend and I quickly threw away the training wheels and old rules. We tried out best to generate as many new ideas as we could. So we explored the idea of transporting the kidney organ and patient to another hospital nearby, where we can operate. Before we worked out the plan in more detail, we were told the availability of operation room in our hospital. Not one but two. If we followed our tradition like what we have been doing for the last twenty years, we would have sent the first patient to have the kidney transplant operation, and then the next one. One after another. Such tendency to follow the tradition isn't too wrong, but it means another few hours' wait for the second kidney. We knew the kidneys' quality would be better if we can beat the clock. At the end of the day, we were able to gather more than six hardworking surgeons, not to mention two teams of anaesthetists, to carry out two kidney transplant operations in parellel. Wait. I shouldn’t say “at the end of the day”; our transplant surgery started at one in the very early morning.

I am really grateful. Two days later, I am still telling it.

Dead

Unlike buying cinema tickets, on-demand streaming platform lets us enjoy more movies than we can imagine. The good part about the streaming service is that there's always chance to stop and switch.

When our family first picked the superhero movie Deadpool today, we didn't realise the bloody violence scenes throughout the story based on the Marvel Comics. That unsettled us. So much so that we stopped watching within the first ten minutes.

We were disappointed, but not for long. We went for another movie, Dead Poets Society, which was released in 1989. Looking back, I think we have made a smart choice out of the two movies, both starting with "Dead". The classic Dead Poets Society tells the story of an English teacher, Keating the "O Captain! My Captain!". Keating loved encouraging his students to go with their hearts instead of pursuing conformity. His philosophy of carpe diem, obviously, won't be accepted by the older generations. That's why one of the parents wanted to cut his son's extracurricular activities at all costs. He simply wished his son to study hard for his chemistry or science lessons. Some lesson are harder to learn that others, and the one for his son Neil Perry - that acting is more meaningful than studying medicine - was tragic for all parties.

The movie brought tears to our eyes in the family, and if the story of Keating and Neil doesn’t break your heart, well, I don’t know what will.

Exercise

How many of us have dreamt of living better longer? I know I have.

Today, voluminous research has shown that mortality is an inevitable companion of aging and chipping away one disease at a time is futile, like rearranging deck chairs on the Titanic. The good news, though, is that exercise is the most potent pro-longevity "drug". I was introduced to this strategy by Peter Attia in his eye-opening book Outlive. In short, medicine's biggest failing is in attempting to treat all the conditions at the wrong end of the timescale - after they are entrenched - rather than before they take root.

The beauty of maintaining health by exercise is to make us functionally younger. If anything, we exercise to live longer with good function and without chronic disease, and with a briefer period of morbidity at the end of our lives. The upside of training to improve our VO₂ max during physical exertion is huge. One study found that boosting elderly subjects' VO₂ max by about 25 percent was equivalent to subtracting twelve years from their age.

What better drug can give us such payoff?