Sunday, August 31, 2014

A colony of bacteria

Richard Dawkins once claimed in "The Richard Dimbleby Lecture: Science, Delusion and the Appetite for Wonder (1996):

For the first half of geological time our ancestors were bacteria. Most creatures still are bacteria, and each one of our trillions of cells is a colony of bacteria.

Hm, "each one of our trillions of cells is a colony of bacteria"? Sorry, I couldn't leave this glaringly inept bit unchallenged. I'll try to keep it short and only say a couple of things for now:

  1. What does Dawkins mean by "each one"?

    a. For starters, "each one" of our cells is a single cell, not a "colony" of cells (let alone bacterial cells). But maybe Dawkins simply expressed himself poorly here.

    b. Or does Dawkins mean all the constituent parts of a cell within a single cell are themselves "a colony of bacteria"? If so, then that's just dumb. Are the constituent parts of a bacterial cell likewise "a colony of bacteria" within a single bacterial cell such that we have an infinite regress of "colonies of bacteria"? It's turtles (or bacteria) all the way down!

  2. By the phrase "each one of our trillions of cells," I presume Dawkins is referring to a group of the same type of cells within the human body. Say brain cells like neurons. But how are neurons equivalent to "a colony of bacteria"?

    a. Does Dawkins mean neurons are literally "a colony of bacteria" residing in our brains? If so, there are several problems. For one, it fails to distinguish between self and non-self. If neurons are indeed "a colony of bacteria" in humans, then wouldn't we expect our immune system to recognize them as such and deal with them accordingly? (Or are they like gut flora, which if so would raise other issues which would appear to contradict established medical science?)

    b. Does Dawkins mean evolutionarily speaking neurons originated from "a colony of bacteria"? If so, that's a pretty big ask. And of course there are many arguments against neo-Darwinian theory as a whole (such as from the ID community).

As an aside, if we are "a colony of bacteria," does that make the Earth a Petri dish (or at least the appearance of a Petri dish)? :-)

Monday, August 25, 2014

Ectopic pregnancy

For what it's worth, if anything, here are some of my thoughts on the topic of ectopic pregnancy:

  1. Keep in mind I'm a mere med student, not a physician, let alone an OB/GYN. I'm open to correction on the medical science and other related data.

  2. The vast majority of ectopic pregnancies are tubal ectopic pregnancies. Specifically, 95-98% of all ectopic pregnancies are tubal ectopic pregnancies. This simply means they're in one of the Fallopian aka uterine tubes.

    Other types of ectopic pregnancies are far less common (e.g. ovarian, cervical, abdominal).

  3. My understanding is if an ectopic pregnancy occurs (e.g. the embryo implants in one of the uterine tubes), then there are basically two possibilities:

    a. The pregnancy will end in miscarriage.

    b. The baby will grow too big and rupture the uterine tube. This may in turn damage adjacent organs. Worse, the rupture could likewise cause the mother to hemorrhage to death.

  4. If ectopic pregnancy is discovered early on, and doctors think (a) is most likely, then doctors will attempt what's called "expectant management." This means the doctors will closely monitor the mother and hope the pregnancy will naturally resolve itself in a miscarriage. That way, nothing much needs to be done by the medical team, and the health outcomes for the mother are probably best (e.g. she'll still likely be fertile).

    But if (b) is more likely, then medical (in the form of an abortifacient drug i.e. methotrexate) and/or surgical intervention is needed. It could be a medical emergency depending on how close to rupturing it is.

  5. A few possible if currently perhaps unrealistic pro-life options:

    All these assume the baby in the ectopic pregnancy is developing normally or at least not developing too abnormally. This may be a pretty big assumption though. It's quite possible the baby won't be developing normally. Not getting enough blood and nutrients from the mother and so on since it's not implanted in the mother's womb but outside it (by definition).

    a. A potential option is to surgically transplant the embryo from the uterine tube (or wherever else it is) to the uterus aka womb.

    However, at least to my knowledge, medical science isn't advanced enough to do this let alone do this safely.

    Maybe someday in the future.

    b. Another possible option is to allow the ectopic pregnancy to grow and develop as much as possible, and then to surgically remove the baby as a preemie.

    However, this is highly unrealistic in a tubal ectopic pregnancy. The diameter of the uterine tube is approximately half an inch or thereabouts (about 1.25 cm). While the uterine tube is extensible to some degree (depending on several factors), the bottom line is if the baby grows too much bigger than the diameter of the uterine tube, then it could rupture the tube, and put the mother's life at risk. The baby would already be about half an inch at around 6 weeks. By 8 weeks or so, the baby would have doubled this size. At this point, or not too much beyond this point, it's possible the uterine tube could be at grave danger of rupturing. But to remove the baby at even 10-12 weeks would mean it'd die.

    Currently the earliest we've been able to save babies is around 20 weeks, give or take. And that's extremely rare. Most don't make it.

    But maybe future medical technology will make this a viable option.

    c. In the vast majority of ectopic pregnancies (i.e. tubal ectopic pregnancies), unfortunately it seems the best option is either to allow the ectopic pregnancy to naturally end i.e. miscarriage, or to intervene and abort. This is where some philosophers and ethicists justify the abortion by the doctrine of double effect. But in a small percentage of ectopic pregnancies, it may be possible to save the baby and/or mother. Basically, my understanding is these are in general only realistic in abdominal ectopic pregnancies, although there may be some cases where it's happened in other types of ectopic pregnancies.

    If the ectopic pregnancy is in the abdomen, then there might be more room as well as sufficient blood supply (depending on where in the abdomen the baby is) for the baby to grow and develop and with some luck make it to 20+ weeks, and thus we could hope to remove the premature baby such that neonatologists have a fighting chance to work their magic and rescue the baby. Although even 20+ week old babies are still at huge risk of dying. (A full-term pregnancy is at least about 37 weeks.)

    But even still there's absolutely no guarantee both baby and mother won't die. I think it'd be best to look at abdominal ectopic pregnancies on a case by case basis and see what, if anything, can be done to save both, or one (if not both).

    Here is a list of some successful ectopic pregnancies. But note the vast majority of them (if not all of them) are abdominal ectopic pregnancies, not tubal ectopic pregnancies (which again constitute the vast majority of all ectopic pregnancies - i.e. 95-98%).

Saturday, August 23, 2014

Acute porphyria

According to an atheist named porphyryredux:

The reason this philosophy [i.e. empiricism] is likely true or else the best one within the competing marketplace of ideas is that those who attack it, cannot do so unless data comes to them via one of their 5 physical senses, and they send out data intending to stimulate one of the 5 physical senses. If you are using empirical data to disprove empiricism, that is sort of like biting the hand that feeds you, isn’t it?

I should start by saying: although there are probably more sophisticated arguments for empiricism, at this point I'm just assuming porphyryredux means traditional empiricism. After all, it's not as if porphyryredux offers anything more.

1. Who uses "empirical data to disprove empiricism"? Who does he have in mind or what arguments does he have in mind?

2. As others like William Lane Craig have pointed out, empiricism is too narrow. It would exclude logical truths, mathematical truths, moral truths, aesthetic truths, etc.

3. Why should we think our sensory experience is a reliable source of knowledge anyway? Something like Plantinga's EAAN could be relevant for the atheist, for instance. What about arguments for solipsism, to take another example?

4. Why couldn't empiricism coupled with atheism logically lead to a denial of morality, value, meaning, purpose, etc.?

5. Also, what if the empirical data give us conflicting facts or truths?

6. Likewise, there's no empirical data for the existence of certain objects (e.g. the mutliverse, theoretical sub-subatomic particles). Presumably there never can be empirical data for the existence of say sub-subatomic particles either, at least short of building a particle accelerator the size of the solar system.

7. Finally, here is another way to look at empirical knowledge, and if true then it seems our knowledge is mainly a matter of probabilities rather than proofs. If so, then I presume probability type arguments for theism or against atheism would be relevant (e.g. Tim and Lydia McGrew, Richard Swinburne).

Friday, August 15, 2014

Two boundless oceans

Yesterday I saw a cardiac arrest. In fact, two cardiac arrests, in the same person.

The person was an obese woman around the age of 60.

I only came in at the very end of the surgery, but from what I could gather as I entered the OR the patient had had blocked arteries in her legs, and was having surgery to clear up the blockage (i.e. recanalization of femoral popliteal bypass).

The surgeon had just finished the surgery. It looked like a success. She was perfectly stable. The anesthesiologist was beginning to wake her up (e.g. putting in a reversal agent).

Suddenly, she went into cardiac arrest. Someone hit to call for help - code blue, resus team needed stat! The alarms in the OR went off and the lights at the entrance of the OR began flashing so people could see which OR needed assistance (since hospitals have hallways full of ORs).

At the time, near the end of surgery when I walked in, there were only a handful of people in the OR. Maybe 5 or 6 people. In a matter of seconds, there were about 20-25 people. (A senior anesthesiology resident later told me there didn't need to be so many people in the OR.)

A medical resident jumped on her chest and immediately began chest compressions (CPR), while the head anesthesiologist began barking out orders to get more IV access into the patient, fill up syringes with various drugs so he could push the meds, etc. It was all quite chaotic, but from what I could tell everyone was doing their jobs well enough.

They were able to get a heart rate, blood pressure, and so forth again. Everything looked fine. The patient was somewhat conscious again. She was waking up, breathing, but was doubtless exhausted, to say the least.

After several more minutes, when it looked like she was stable and medical staff were no longer needed, well over half the staff began going about their business again.

At this point, there were maybe 10 people in the room including me. While I was talking to a friend about all that just happened, we looked over at the anesthesia machine and noticed the patient's BP begin dropping precipitously. I think it started at 80/50, but then it dropped to 70 (systolic, i.e. the top number), then 50, then 20, then it actually read negative somehow on the machine, all within a matter of seconds.

Of course, the anesthesiologist and other staff noticed as well, and they began CPR again. Another mad rush to save the patient's life.

While the doctors and nurses were rescuing her, my friend and I noticed her left ear had gone dark blue and purple. It was cyanosed. Not enough blood perfusion, not enough oxygen circulating. Bad news.

Eventually the medical staff were able to resuscitate her once again. They got her ready to be transported to the cath lab, where they'd have a better chance to figure out what happened to her as well as to fix it (e.g. the leading theory seemed to be a rogue blood clot). They attached equipment to monitor her vital signs, made sure she had a defibrillator on her bed in case she went into cardiac arrest en route from the OR to the cath lab, bag valve mask ventilated her so she would be oxygenated, etc.

I still don't know what happened to her. Hopefully I'll find out next week when I return.

As for what directly necessitated the code, I thought she had gone into VF (ventricular fibrillation, which is a type of erratic beating of her heart). However, another staff member told me he thought she had in fact gone into asystole (which means flatlined and no heart activity).

Either way, one thing was for sure: she was teetering on the brink between life and death.

As a med student, I don't know much in any case, and thus I wouldn't have been allowed to do anything, but I wish I could have done something to help. Still, it was medically instructive for me to watch.

As I watched, though, I wasn't actually thinking about medicine. Instead, the overriding thought I had in my mind was how close she was to crossing over from life into death, and hence into either heaven or hell. One second she was perfectly stable and ready to emerge from her sleep, and then in a flash everything changed and she could have died on the operating table. She may have in fact died in the cath lab for all I know. How near to eternity we are, and usually without even realizing it.

As John Wesley once said to his brother Charles Wesley: "I desire to have both heaven and hell ever in my eye, while I stand on this isthmus of life, between two boundless oceans."

Sunday, August 31, 2014

A colony of bacteria

Richard Dawkins once claimed in "The Richard Dimbleby Lecture: Science, Delusion and the Appetite for Wonder (1996):

For the first half of geological time our ancestors were bacteria. Most creatures still are bacteria, and each one of our trillions of cells is a colony of bacteria.

Hm, "each one of our trillions of cells is a colony of bacteria"? Sorry, I couldn't leave this glaringly inept bit unchallenged. I'll try to keep it short and only say a couple of things for now:

  1. What does Dawkins mean by "each one"?

    a. For starters, "each one" of our cells is a single cell, not a "colony" of cells (let alone bacterial cells). But maybe Dawkins simply expressed himself poorly here.

    b. Or does Dawkins mean all the constituent parts of a cell within a single cell are themselves "a colony of bacteria"? If so, then that's just dumb. Are the constituent parts of a bacterial cell likewise "a colony of bacteria" within a single bacterial cell such that we have an infinite regress of "colonies of bacteria"? It's turtles (or bacteria) all the way down!

  2. By the phrase "each one of our trillions of cells," I presume Dawkins is referring to a group of the same type of cells within the human body. Say brain cells like neurons. But how are neurons equivalent to "a colony of bacteria"?

    a. Does Dawkins mean neurons are literally "a colony of bacteria" residing in our brains? If so, there are several problems. For one, it fails to distinguish between self and non-self. If neurons are indeed "a colony of bacteria" in humans, then wouldn't we expect our immune system to recognize them as such and deal with them accordingly? (Or are they like gut flora, which if so would raise other issues which would appear to contradict established medical science?)

    b. Does Dawkins mean evolutionarily speaking neurons originated from "a colony of bacteria"? If so, that's a pretty big ask. And of course there are many arguments against neo-Darwinian theory as a whole (such as from the ID community).

As an aside, if we are "a colony of bacteria," does that make the Earth a Petri dish (or at least the appearance of a Petri dish)? :-)

Monday, August 25, 2014

Ectopic pregnancy

For what it's worth, if anything, here are some of my thoughts on the topic of ectopic pregnancy:

  1. Keep in mind I'm a mere med student, not a physician, let alone an OB/GYN. I'm open to correction on the medical science and other related data.

  2. The vast majority of ectopic pregnancies are tubal ectopic pregnancies. Specifically, 95-98% of all ectopic pregnancies are tubal ectopic pregnancies. This simply means they're in one of the Fallopian aka uterine tubes.

    Other types of ectopic pregnancies are far less common (e.g. ovarian, cervical, abdominal).

  3. My understanding is if an ectopic pregnancy occurs (e.g. the embryo implants in one of the uterine tubes), then there are basically two possibilities:

    a. The pregnancy will end in miscarriage.

    b. The baby will grow too big and rupture the uterine tube. This may in turn damage adjacent organs. Worse, the rupture could likewise cause the mother to hemorrhage to death.

  4. If ectopic pregnancy is discovered early on, and doctors think (a) is most likely, then doctors will attempt what's called "expectant management." This means the doctors will closely monitor the mother and hope the pregnancy will naturally resolve itself in a miscarriage. That way, nothing much needs to be done by the medical team, and the health outcomes for the mother are probably best (e.g. she'll still likely be fertile).

    But if (b) is more likely, then medical (in the form of an abortifacient drug i.e. methotrexate) and/or surgical intervention is needed. It could be a medical emergency depending on how close to rupturing it is.

  5. A few possible if currently perhaps unrealistic pro-life options:

    All these assume the baby in the ectopic pregnancy is developing normally or at least not developing too abnormally. This may be a pretty big assumption though. It's quite possible the baby won't be developing normally. Not getting enough blood and nutrients from the mother and so on since it's not implanted in the mother's womb but outside it (by definition).

    a. A potential option is to surgically transplant the embryo from the uterine tube (or wherever else it is) to the uterus aka womb.

    However, at least to my knowledge, medical science isn't advanced enough to do this let alone do this safely.

    Maybe someday in the future.

    b. Another possible option is to allow the ectopic pregnancy to grow and develop as much as possible, and then to surgically remove the baby as a preemie.

    However, this is highly unrealistic in a tubal ectopic pregnancy. The diameter of the uterine tube is approximately half an inch or thereabouts (about 1.25 cm). While the uterine tube is extensible to some degree (depending on several factors), the bottom line is if the baby grows too much bigger than the diameter of the uterine tube, then it could rupture the tube, and put the mother's life at risk. The baby would already be about half an inch at around 6 weeks. By 8 weeks or so, the baby would have doubled this size. At this point, or not too much beyond this point, it's possible the uterine tube could be at grave danger of rupturing. But to remove the baby at even 10-12 weeks would mean it'd die.

    Currently the earliest we've been able to save babies is around 20 weeks, give or take. And that's extremely rare. Most don't make it.

    But maybe future medical technology will make this a viable option.

    c. In the vast majority of ectopic pregnancies (i.e. tubal ectopic pregnancies), unfortunately it seems the best option is either to allow the ectopic pregnancy to naturally end i.e. miscarriage, or to intervene and abort. This is where some philosophers and ethicists justify the abortion by the doctrine of double effect. But in a small percentage of ectopic pregnancies, it may be possible to save the baby and/or mother. Basically, my understanding is these are in general only realistic in abdominal ectopic pregnancies, although there may be some cases where it's happened in other types of ectopic pregnancies.

    If the ectopic pregnancy is in the abdomen, then there might be more room as well as sufficient blood supply (depending on where in the abdomen the baby is) for the baby to grow and develop and with some luck make it to 20+ weeks, and thus we could hope to remove the premature baby such that neonatologists have a fighting chance to work their magic and rescue the baby. Although even 20+ week old babies are still at huge risk of dying. (A full-term pregnancy is at least about 37 weeks.)

    But even still there's absolutely no guarantee both baby and mother won't die. I think it'd be best to look at abdominal ectopic pregnancies on a case by case basis and see what, if anything, can be done to save both, or one (if not both).

    Here is a list of some successful ectopic pregnancies. But note the vast majority of them (if not all of them) are abdominal ectopic pregnancies, not tubal ectopic pregnancies (which again constitute the vast majority of all ectopic pregnancies - i.e. 95-98%).

Saturday, August 23, 2014

Acute porphyria

According to an atheist named porphyryredux:

The reason this philosophy [i.e. empiricism] is likely true or else the best one within the competing marketplace of ideas is that those who attack it, cannot do so unless data comes to them via one of their 5 physical senses, and they send out data intending to stimulate one of the 5 physical senses. If you are using empirical data to disprove empiricism, that is sort of like biting the hand that feeds you, isn’t it?

I should start by saying: although there are probably more sophisticated arguments for empiricism, at this point I'm just assuming porphyryredux means traditional empiricism. After all, it's not as if porphyryredux offers anything more.

1. Who uses "empirical data to disprove empiricism"? Who does he have in mind or what arguments does he have in mind?

2. As others like William Lane Craig have pointed out, empiricism is too narrow. It would exclude logical truths, mathematical truths, moral truths, aesthetic truths, etc.

3. Why should we think our sensory experience is a reliable source of knowledge anyway? Something like Plantinga's EAAN could be relevant for the atheist, for instance. What about arguments for solipsism, to take another example?

4. Why couldn't empiricism coupled with atheism logically lead to a denial of morality, value, meaning, purpose, etc.?

5. Also, what if the empirical data give us conflicting facts or truths?

6. Likewise, there's no empirical data for the existence of certain objects (e.g. the mutliverse, theoretical sub-subatomic particles). Presumably there never can be empirical data for the existence of say sub-subatomic particles either, at least short of building a particle accelerator the size of the solar system.

7. Finally, here is another way to look at empirical knowledge, and if true then it seems our knowledge is mainly a matter of probabilities rather than proofs. If so, then I presume probability type arguments for theism or against atheism would be relevant (e.g. Tim and Lydia McGrew, Richard Swinburne).

Friday, August 15, 2014

Two boundless oceans

Yesterday I saw a cardiac arrest. In fact, two cardiac arrests, in the same person.

The person was an obese woman around the age of 60.

I only came in at the very end of the surgery, but from what I could gather as I entered the OR the patient had had blocked arteries in her legs, and was having surgery to clear up the blockage (i.e. recanalization of femoral popliteal bypass).

The surgeon had just finished the surgery. It looked like a success. She was perfectly stable. The anesthesiologist was beginning to wake her up (e.g. putting in a reversal agent).

Suddenly, she went into cardiac arrest. Someone hit to call for help - code blue, resus team needed stat! The alarms in the OR went off and the lights at the entrance of the OR began flashing so people could see which OR needed assistance (since hospitals have hallways full of ORs).

At the time, near the end of surgery when I walked in, there were only a handful of people in the OR. Maybe 5 or 6 people. In a matter of seconds, there were about 20-25 people. (A senior anesthesiology resident later told me there didn't need to be so many people in the OR.)

A medical resident jumped on her chest and immediately began chest compressions (CPR), while the head anesthesiologist began barking out orders to get more IV access into the patient, fill up syringes with various drugs so he could push the meds, etc. It was all quite chaotic, but from what I could tell everyone was doing their jobs well enough.

They were able to get a heart rate, blood pressure, and so forth again. Everything looked fine. The patient was somewhat conscious again. She was waking up, breathing, but was doubtless exhausted, to say the least.

After several more minutes, when it looked like she was stable and medical staff were no longer needed, well over half the staff began going about their business again.

At this point, there were maybe 10 people in the room including me. While I was talking to a friend about all that just happened, we looked over at the anesthesia machine and noticed the patient's BP begin dropping precipitously. I think it started at 80/50, but then it dropped to 70 (systolic, i.e. the top number), then 50, then 20, then it actually read negative somehow on the machine, all within a matter of seconds.

Of course, the anesthesiologist and other staff noticed as well, and they began CPR again. Another mad rush to save the patient's life.

While the doctors and nurses were rescuing her, my friend and I noticed her left ear had gone dark blue and purple. It was cyanosed. Not enough blood perfusion, not enough oxygen circulating. Bad news.

Eventually the medical staff were able to resuscitate her once again. They got her ready to be transported to the cath lab, where they'd have a better chance to figure out what happened to her as well as to fix it (e.g. the leading theory seemed to be a rogue blood clot). They attached equipment to monitor her vital signs, made sure she had a defibrillator on her bed in case she went into cardiac arrest en route from the OR to the cath lab, bag valve mask ventilated her so she would be oxygenated, etc.

I still don't know what happened to her. Hopefully I'll find out next week when I return.

As for what directly necessitated the code, I thought she had gone into VF (ventricular fibrillation, which is a type of erratic beating of her heart). However, another staff member told me he thought she had in fact gone into asystole (which means flatlined and no heart activity).

Either way, one thing was for sure: she was teetering on the brink between life and death.

As a med student, I don't know much in any case, and thus I wouldn't have been allowed to do anything, but I wish I could have done something to help. Still, it was medically instructive for me to watch.

As I watched, though, I wasn't actually thinking about medicine. Instead, the overriding thought I had in my mind was how close she was to crossing over from life into death, and hence into either heaven or hell. One second she was perfectly stable and ready to emerge from her sleep, and then in a flash everything changed and she could have died on the operating table. She may have in fact died in the cath lab for all I know. How near to eternity we are, and usually without even realizing it.

As John Wesley once said to his brother Charles Wesley: "I desire to have both heaven and hell ever in my eye, while I stand on this isthmus of life, between two boundless oceans."