Raghav's blog

The science behind terrariums

Ever seen a terrarium and wondered how a living green plant could survive without having access water and air? It’s an interesting concept – one that relies on three basic but vital plant processes – photosynthesis, respiration and the water cycle (the latter not being a plant process per se but a common phenomenon).

I myself enjoy gardening, and love making terrariums (I’m not terribly good at it, and need some help from my mother from time to time). I’m quite intrigued by terrariums and decided to do some research into how they sustain themselves.

The most vital process is photosynthesis- the process by which plants convert light energy (from the sun) to chemical energy (stored in the plant in form of glucose or other sugars). Plants use CO2 and water along with photons (derived from the sunlight) to make glucose. The equation of photosynthesis is given below –

The equation of photosynthesis (source-quora)

Part of Photosynthesis is light dependent, which means that it can only happen when exposed to a light source (in our case, the sun). This means that the rate of photosynthesis is greatly reduced during night (only light independent phase of photosynthesis takes place during night, the light independent phase being dependent on the products of the light phase). During night, another crucial process becomes more significant – respiration.

Respiration is the breakdown of chemical energy stored as ATP (Adenosine Triphosphate) to release energy available for the plant to use. Respiration uses Oxygen and releases CO2. Respiration is like combustion, in which chemical energy in form of let’s say wood is released as heat energy by burning wood in oxygen. However, they’re not exactly the same.

Now you might ask, how are these two processes related to a terrarium? Well, respiration and photosynthesis form a cyclic process – the CO2 utilized by photosynthesis is produced by respiration, while the O2 involved in respiration is produced by photosynthesis. The plant, therefore, becomes self sufficient.

However, there’s one thing that’s still lacking – water. Water is an essential component of both processes. Here we turn to the concept of the water cycle.

Plants, after absorbing water from the soil, transpire water (which means that they remove excess water through microscopic pores in their leaf surface called stomata). This water condenses on the glass surface, and ends up back to where it was – the soil (our water cycle doesn’t include evaporation, but that’s fine).

The water droplets are visible after having condensed.

Now, having read the science behind a terrarium, you might want to make one yourself. Look no further! You’ll find steps to make your own terrarium below. Don’t worry – it’s not that hard!

Step 1- get the following materials – porous, nutrient rich soil, plants which love humidity, are slow growing and can survive indoors (I’ve planted a variety of Fittonia and Philodendron), gravel (color to your preference) and charcoal. For the plants, be sure to use a plant which has a node (a sort of swollen portion on the stem) if your using a plant that you’ve just cut.

The materials…. you can use a long stick to adjust the plant and a few stones to decorate. Use plastic wrap and a rope to cover the top.

Step 2 – place your gravel. Use a brush/stick to distribute the gravel evenly. I also covered the gravel with a porous paper (a steel mesh is preferable) to prevent the soil from penetrating the gravel layer (I was, as you’ll see, unsuccessful in doing so)

Step 3 – add a little of charcoal on the paper – charcoal has very good purifying abilities. The pieces should be small and evenly distributed.

Step 4- Put the soil. Use a funnel if the mouth of the container is narrow.

Step 5 – put your plants in. Use the stick/brush to get them in place and press their roots/nodes into the soil.

Step 6- put your decorative materials. Be sure to use small objects, as larger ones may take up the space plants require to grow.

Finally, don’t close the terrarium immediately. Give a couple of days for the plant to settle in its new environment, after which you can close the terrarium.

The final thing! I’ve yet to close it, but I’ll do so after a few days.

I hope this post was interesting and that I’ve inspired you to go and make you own terrarium! These little ecosystems are truly fun to make and a joy to keep around!

Book review – This is going to hurt by Adam Kay

‘This is going to hurt’ is hands down the best medicine related book I have ever read. Written in a hilarious yet kinda heartbreaking way, this book allows a reader to dive into the difficult life of a junior doctor. The book is actually Adam Kay’s diary, which he maintained during the course of his employment as a junior doctor by the NHS.

The book is divided into 4 general areas, each covering the following job positions – House officer (HO) Senior House officer (SHO), Registrar and Senior Registrar (these four positions are the order in which a doctor in the NHS goes from his initial posting as a HO now called Foundation year (FY) 1) to a Consultant. Kay, however, doesn’t become a consultant in the end, having taken the decision to quit his job.

I loved the way in which the book was written – it’s quite a contrast to other medicine related books, and is the raw, largely unaltered experiences that Kay had. The book remains hilarious throughout, but becomes quite sad and serious at some points, specially at the end. Throughout the book, Kay recounts his funny encounters with patients, as well as his extremely busy life, having to almost always resort to the coffee and adrenaline to keep himself going through the 12 hour shifts.

The front cover of the book ‘This is going to Hurt – Secret Diaries of a junior doctor’ by Adam Kay.

One of my favorite parts of the book is Kay’s overall feeling towards the profession. He states to some high schoolers during a career field day that being a doctor has ‘terrible pay, long hours, mental and physical stress, but at the end of the day, is the best job that there is’. Kay brings to notice a very important point – the life of a doctor is grueling, hard and filled with emotional and physical hurdles, but in the end of the day, is one of the most satisfying jobs that one could do, since he or she gets the feeling that they have made a difference in someone’s life.

Another thing that I enjoyed about the book was that it’s a virtual roadmap of a doctors life – the changes in personality and behavior as you evolve from learning to being in a position of responsibility. A very distinct shift is seen as one progresses through the book – as an HO, Kay learns a great deal from his fellow colleagues and seniors. As he reaches the post of senior registrar, he goes around prowling and poking his head in every room to ensure that all his patients are fine. Being the senior most doctor in the department (save for the consultant), Kay realizes that it’s his responsibility to ensure that every patient is well take care of. He realizes that whenever he is paged, he will be facing a case that neither the house officers or the junior registrars could solve. In fact, it is this feeling of responsibility that makes him quit the profession after one of his patients dies, even though he did everything he could have to save her life.

Overall, the book is an amazing read. I learnt a great deal from the book and hope that everyone reads it, including medical aspirants and the common public, so that they understand the importance of doctors in our life, and the huge number of problems they face in their lives to ensure that our lives go without any physical or mental difficulties.

Book Reviews – Better, By Dr. Atul Gawande

When we talk about books related to medicine, one often comes across books whose authors extensively write about their own experiences in medicine – their first day as a surgical resident, the first complex procedure that they performed solo, the kinds of patients they operate on, etc. However, one hardly comes across books that explore not only the author’s own practice but also the miracles of medicine that keep the whole world healthy. One such book is Atul Gawande’s Better – A Surgeon’s notes on Performance.

The book is written in a lucid way, and keeps the reader interested throughout. Each chapter addresses different topics, which means that the reader doesn’t need to specifically follow the order in which chapters are given – he /she can just start with any chapter.

I myself started the book from the fourth chapter (Casualties of war) as it addressed 2 of my 3 greatest passions in life – medicine and defence (the third is aviation). The chapter had me riveted the second I read it’s first page. It concentrated on the working of emergency medicine in war zones, following trauma medicine and surgery’s evolution to the precise and lifesaving speciality that it is now. Dr. Gawande extensively writes about the extremely busy life of surgeons in the war zone, with detailed descriptions of Forward Surgical Teams (FST) (basically, a mobile mini hospital containing about 7 beds, divided between ICU and surgical beds) and how the treatment of patients goes about. Unlike in large major city hospitals, surgeons in FSTs do not have the resources or time to ensure that each patient is fully cured. With hundreds of patients with life threatening injuries to every part of the body streaming in, surgeons often are only able to patch up and stop bleeding in a patient before having them shifted to larger military hospitals (in Afghanistan’s case, Bagram) and then to Germany or the US.

I loved reading about the lives of military surgeons in this section of the book – one of my reasons for wanting to become a surgeon is that I want a life that is not passive – I want to lead a life that is meaningful – personally, I do not want to have a job that just involves shifting through hundreds of papers. In the operating theatre, every small move could either destroy a patients life or improve it substantially. It is this thrill and adrenaline that I wish to have – to be able to access the deepest depths of a human body in order to repair any defect – working relentlessly on the front lines to fight any disease that may come about and make a person’s life better.

I also loved a number of chapters related to medical ethics – chapters like ‘Naked’, which talks about the various measures doctors have to take today to prevent any discomfort to the patient or potential lawsuits from disgruntled patients. The other chapters which I particularly found interesting were, ‘What Doctors Owe’, which follows medical malpractice cases as well as a particular case of Dr. Kenneth Reed, a dermatologist who was sued by the relatives of one of his late patients who died of skin cancer (Dr. Reed won the lawsuit, much to my relief, since I believed that he had nothing to do with the patient’s death), and the chapter ‘Doctors of the Death Chamber’, which follows the ethical and moral dilemmas that doctors asked to supervise Lethal injection executions face.

Another chapter that I absolutely loved was ‘The Mop-up’ in which Atul Gawande takes us on a ride with the doctors in India who are fighting a battle with Polio. The chapter gives us an insight into large scale medical operations, and follows an Indian WHO paediatrician Dr. Pankaj Bhatnagar who supervised massive Polio vaccinations in the Indian state of Karnataka when one case of Polio popped up.

Overall, I loved Better. I learnt a great deal about medical ethics (something that will help me immensely in my University applications) and gave me an insight into medicine outside the clinics that cater to the normal public. I’ve already started Gawande’s Being Mortal (another wonderful but rather reflective book dealing primarily with end of life care and Geriatrics) and have finished Complications, a book dealing with Gawande’s own experiences with surgery. I would certainly recommend Better to anyone who wants to get introduced to the amazing world of medicine.

My experiences in care environment

‘Everybody is a Genius. But If You Judge a Fish by Its Ability to Climb a Tree, It Will Live Its Whole Life Believing that It is Stupid’

Have you ever reflected on how easily you are to be able to carry out daily activities without any difficulty? We hardly ever give any thought to the fact that some of us may face challenges to be able to do such tasks.

I myself never gave attention to this before volunteering in care environments but my outlook completely changed after I began volunteering in a Centre for specially abled children. The experience was really enlightening and I gathered learning that I am certain to use in my life.

For starters, each student there is unique. Some of them are wonderful conversationalists, who will be able to engage in lengthy conversations and not allow you to get bored. Some of them are great martial artists, elegantly performing moves that they have learnt. Some paint very well while some are engaged in yoga. I helped students in various activities such as art, martial arts, exercise, yoga and learning support.

The end goal of the Centre is to bring the people of determination to a level of independence and develop the ability to carry out certain tasks. Students often differ in the degree of challenges that they face.

I assist in various activities there under the guidance of instructors. Take learning support for instance- my tasks in learning support are often to make the students recognise colours, letters, numbers or objects. One of the students I am often asked to take care of is a person who has only recently lost his father. Unable to comprehend his father’s demise, he regularly asks me, ‘where is daddy?’ to which I am forced to answer, ‘daddy is sleeping’ or ‘daddy is resting’. He is pretty good at numbers, but isn’t able to concentrate during the teaching period, often breaking out into inaudible mumbling. Another student i’ve worked with needs to be monitored with great caution, since she has a habit of swallowing small pieces during learning support or yank out the light switch during martial arts.

Even in martial arts and yoga, some students have difficulty in comprehending the instructions given to them, and have to be coaxed to perform a certain pose. One of the students has a severe addiction to mobile devices, and starts uncontrollably screaming when denied one. During yoga, she often begins to wander around the class, angry at not having access to a device.

The instructors at the centre employed many ways to train the students to carry out the work assigned to them. I learnt how to interact with the students by observing the staff, and took their tips to effectively set up dialogue with the students. They had to mould their reactions in accordance with the situation- certain situations called for firm and strict behaviour while others demanded calm and soothing tones. Take the example of the girl who had an addiction to devices – if she began to scream loudly and demand a phone, the yoga instructor would first bargain, telling her that she would get it after the last pose. When it slowly got out of hand, she would change her tone to a firm one.

I have, of course, enjoyed each session. My volunteering sessions have given me the opportunity to give back to society- the joy that one feels by talking, teaching and helping people of determination cannot be measured. I have found that volunteering and helping people of determination is a calming and soothing experience- with piles of books and syllabus to cover, such sessions are my way of reconnecting with my mind.

I’ve also discovered that each session makes me a bit more compassionate, sensitive and patient. I have already had some truly moving experiences, including the aforementioned one in which a certain person of determination has lost his father, and, unable to understand the concept of death, expects his father to come back soon.

All in all, I hope to keep on volunteering in the care centres. I have learnt a great deal and am certain that I couldn’t have got such experiences anywhere else. I thank the centre I volunteer at for giving me such wonderful opportunities. All the experiences that I have gained are ones that I shall, no doubt, remember forever.

COVID-19- What causes it, what’s the current situation and are we closer to a cure?

The 2019 novel coronavirus, officially called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that has taken the world by storm. Similar to the 2002-2003 SARS virus (about 80%) which attained worldwide attention when in killed over 770 people, COVID-19 has crossed 64,000 infected people and over 1400 deaths as of February the 14th.

STRUCTURE OF THE VIRUS

COVID-19 is a positive sense, single stranded RNA virus. Basically, COVID 19 is a virus whose viral sequence can be directly interpreted by the host cell without the need for an intermediate RNA structure. The virus takes over the host cell to produce proteins necessary for it to reproduce (a virus cannot reproduce on its own, but can reproduce by using the host cell’s protein production chains. It may do so through the lytic or lysogenic cycle, both concepts that I have learnt in school). COVID-19 is also single stranded, just like Hepatitis C, MERS and SARS viruses.

COVID-19 coronavirus is seen in yellow, emerging from cells (in blue and pink) cultured in the lab. This image is from a scanning electron microscope. At present, this is the most detailed picture of COVID-19 which is available. Source- NIAID laboratory, Hamilton

A meat market in Wuhan, China has been identified as the epicentre of the disease, and the virus itself has been proven to originate form Bat meat, a meat which is often consumed in the region (COVID-19 is about 95% similar to Bat Coronaviruses).

HOW FAR HAS THE VIRUS SPREAD?

As seen in the image above, the coronavirus has spread to about 25 to 30 countries. China, of course, has the highest number of infected patients, with Japan following in second place with about 200 infected patients. Few patients outside China have died, and the virus outside China seems to be largely contained, save some worrying areas in countries like Singapore and Japan where the cases are rising relatively quickly. COVID-19 on an average infects anywhere from 1-3 people, a figure that is much less than the infectivity of Measles.

Inside China, COVID-19 has brought life in many cities including Wuhan to a standstill, with once bustling streets deserted with not a soul in sight. China is also facing a shortage of masks, and the demand and prices of masks has skyrocketed.

Healthcare professions in China are at the greatest risk, with 1700 doctors already infected. In a sad occurrence, the first doctor to raise the alarm about COVID-19, Li Wenliang, died a few days ago.

WHERE’S THE CURE?

As the world started expressing concern over the virus’ spread in Wuhan in January if 2020, multiple organizations started working on the cure.

Various companies are developing different cures for the Virus, along with national organizations like the Chinese Center for Disease Control and Prevention and the United States National Institutes of Health.

Companies include Inovio Pharmaceuticals who are working on a DNA based vaccination. Various universities such as the University of Hong Kong and University of Queensland are working on the cure, with the Imperial College faculty of medicine starting to test a vaccine on animals.

However, the cure is still far away. Hospitals around the world have experimented with medications, including administering HIV medication in heavy doses. A new medication has, however, given some hope to infected patients. The medication involves injecting a cured patients plasma into that of an infected one – the neutralizing antibodies in the previously infected patients may cure an infected person of the virus.

One important part about the cure is to identify the people who have been infected and quarantine them as soon as possible. With 63000 cases and counting, doctors in China are overburdened by the patient flow, but AI has a solution to quickly provide diagnoses. In my previous post, I talked about the project that I did at Inspirit AI to detect Pneumonia from chest Xray scans using machine learning. In China, AI is being put to a similar use to scan and detect the telltale signs of COVID-19 in lung scans.

In the interim, doctors are advising people to go about their daily routine with some caution. Washing hands regularly and covering your mouth with an elbow while sneezing/coughing are some simple acts that can help keep the virus away.

Artificial Intelligence workshop

Humankind never stops innovating, and one of the technologies that is driving innovation is artificial intelligence. Artificial intelligence is predicted to cause a paradigm shift in the way medicine and healthcare works . Since it’s never a bad idea to get yourself upto date with the latest technologies, I decided to participate in a 10 day AI workshop named Inspirit AI scholars conducted by Stanford University alumni.

The whole program was really interesting, and I learnt many new concepts related to AI. One of the highlights of the program was the environment in which it was conducted. I got to interact with students from different countries and was instructed by Stanford alumni who were not only very learned in their spheres of knowledge but also treated us like fellow colleagues, answering every question we had related to AI and even college life. The program wasn’t all studying – the instructors had some really exciting games that helped us to bond and get working as a team.

The first few sessions were concentrated on learning the basics of python, the programming language that we were going to use. During that period we learnt about different concepts that we would integrate in our projects that we had to present towards the end of the program.

For me, the most interesting part of the program was the project – my team and I made a project on how to detect Pneumonia from chest X-ray scans. We used a number of models in python to predict whether a lung had Pneumonia or not. We used a type of Machine Learning known as Supervised Learning to do this (Supervised Learning means that the machine finds certain patterns and makes predictions based on a set of input and output data). Here’s how we went about designing and executing our project-

For starters, we had a set of 2400 chest X-rays that we had to sort into testing (400 images) and training data (2000 images). Our input was the 2000 images, while our output was the predictions made by the program. The training data images had labels on them – we essentially told the program that this image had Pneumonia while this image didn’t have Pneumonia. The program created its own rules regarding the detection of Pneumonia (chest X-rays with Pneumonia appear darker due to a build up of fluid in the lungs – this could be one of the parameters that a program could use to differentiate between not Pneumonia and Pneumonia). The rest 400 testing data images were the images that we would feed into the program to see how well our models worked (basically, how correct their predictions were).

Some of the models that we used were logistic regression (given by the function Log), K Nearest Neighbours (knn) and decision tree classifier (Dt). These three were comparatively primitive models that gave us accuracies of 68-72 percent. More complex models that we used were Convolutional Neural Networks and Multi Layered Perceptrons , the MLPs giving us 83.35 percent accuracy.

This made me realize that by using better models and using more amount of data the predictive power of the program increases. AI is a very powerful tool in various fields specifically medicine, where certain tasks that are currently performed by doctors can be performed by AI in the future. Perhaps deficiency of doctors can also be countered by integrating AI into healthcare, providing faster and accurate diagnoses.

Overall, the whole workshop was an amazing experience. During the program we started with the basics of programming, introduction to AI and within a short period of time working with our project teams and instructors made our own AI application based projects. My project in the area of healthcare application of AI opened doors of curiosity for me. Apart from the technical aspects, I had an opportunity to hone my soft skills, like communication, working in cross cultural teams and problem solving.

I would like to thank Mr. Adeesh Goyal and Mr. Artem Trotsyuk (my instructor) of Inspirit AI for organizing this workshop along with all the instructors who taught me so much and made this experience one that I shall remember for a long time.

Artificial Intelligence and how babies learn to walk

I recently undertook a ten day artificial intelligence course that was conducted by Stanford grad students and alumni. The experience was pretty great, and I learnt everything from python programming to the applications of AI (I’ll be covering more on the course in the next post).

My course mainly focused on machine learning (ML), which is an application of AI that gives machines the ability to automatically learn and improve without being explicitly programmed (basically, I don’t need to micromanage the computer – it should be able to perform tasks without the need of writing specific lines of code for every contingency). I should be able to feed in an amount of data, and the machine should be able to learn and identify patterns from that data to give an output or achieve a predefined goal.

There are three types of MLs- Supervised ML, unsupervised ML and reinforcement learning. While supervised ML is the most widely used from the three, I’ll be talking about reinforcement learning (RL) today.

Basically, RL is an area of ML which concerns itself with how systems (computers, machines, etc) should take actions in a certain environment in order to attain some predefined reward or achieve some goal. RL focuses on exploration of the environment the machine finds itself in, rather than exploitation of the current dataset it has. I do not have to feed in huge amounts of data, as opposed to supervised ML – I have to let the machine explore and decide what is a way it can achieve a certain goal.

While watching my one and a half year old cousin try to get from one place to another, I realized that RL is quite similar to babies trying to move. Nobody can actually teach a baby how to walk – it defines a goal (getting from place A to place B) and tries to get there using a variety of combinations, including crawling, walking or a combination or both (it could also be walking on one leg and dragging the other one behind, in a fusion of crawling and walking). Whatever it is, the baby learns how to perform a task in order to arrive at a goal (in our case, getting from A to B) just like reinforcement learning.

My visit to the body world exhibition

It’s not very often that one gets a glimpse of what it looks like inside the human body. There’s only one place you can actually see that – an Operating Theatre (or a dissection room, for that matter). I’d had already seen live operations, but the Body Worlds Plastination exhibition in Khalifa University, Abu Dhabi brought to the table some amazing new things- stuff that even operation theatres can’t show.

In many ways, Plastination is an art (like surgery). There were some exhibits (like the artery man, as shown below) that would have undoubtedly taken months to complete. The ability of the people carrying out Plastinations is amazing- I can only imagine the precision it would take to remove larger layers of tissue just to expose a fine nerve lying underneath (a bit like what surgeons do, only that surgeons will operate on a living body).

The Artery Man, showcasing all the arteries in the face

Here’s how Plastination works – the first step involves the use of a formaldehyde based solution. This prevents the specimen from decaying. It also gives the specimen a degree of rigidity, which can help keep tissues in a specific shape or arrangement. After the first step the dissection of the specimen begins. The dissection can take anywhere from a few weeks to six months.

After the first step, the specimen is placed in an acetone bath at temperatures ranging from -20*C to -30*C. The acetone to specimen volume ratio is kept at 10:1, and the acetone bath is renewed twice over the period of 6 weeks. Acetone, as a matter of fact, creates a hypertonic environment, thus drawing all the water out of the body cells (this is something we learnt in 10th grade).

In the third step, the specimen is placed in a bath of a liquid polymer like silicone rubber. By creating a vacuum, the acetone that filled the cells in step two vaporizes out (due to its really low boiling point of -95*C). As the cells are left empty, liquid polymer fills the empty spaces, and the cell is filled with empty plastic.

The third step is one that I could connect my internship to. The step was quite similar to the process used to prepare tissue slides in a hospital lab. The lab specimen is completely covered in wax and is eventually cut into micron thick pieces, just like step three in Plastination, when the cells are virtually buried in a wax like substance.

Step four is shorter and involves the treatment of the specimen with gas, heat or UV rays to harden it. The specimen can also be cut into thin sheets, a process known as sheet Plastination.

a sheet Plastinated specimen of an enlarged prostrate gland

Below are pictures of some displays in the exhibition-

A knee joint with severe osteoarthritis

The human lung. Notice the heart sac in the centre of the two lungs

A heart with the pacemaker leads inside it. Pacemakers are used in a cardiac condition known as bradycardia (a type of arrhythmia in which the heart beats slower).

The arteries of a leg. Notice that the arteries look really odd – that’s due to the accumulation of plaques in the arteries, a conviction known as arteriosclerosis.

Human specimen weren’t the only ones in the exhibition

Overall, the exhibition was really interesting and informative. One really amazing thing that I was able to do was compare normal organs and organs with various diseases – there was everything from hearts affected by CAD to lungs affected by smoking. I’d like to thank my biology teacher Mrs. Srividya for organizing such as wonderful trip – this experience will, no doubt, help students to understand human anatomy better.

Vaping- the man made epidemic

While going through the news a few days earlier, I was surprised to see that the world’s first double lung transplant due to vaping was performed recently. This wasn’t, of course, very surprising- it has been proven that E-cigarettes contain toxic substances like Nicotine, Glycerol, heavy metals and Carcinogens, which makes them a perfect recipe for cancer, just like cigarettes.

WHAT ARE E-CIGARETTES?

E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air. Initially designed to provide a ‘less toxic’ alternative to cigarettes, vaping has now become a huge problem of its own.

WHAT ARE SOME ILL EFFECTS OF VAPING?

Since they contain nicotine, E-cigs can cause harm to brain development in adolescents. Using nicotine in adolescence can also harm the parts of the brain that control attention, learning, mood, and impulse control.

E- cigs come with another added risk- there have been documented cases where E-cigs have exploded in the pockets of their carriers. This can cause significants burns to the skin of the carrier.

And the worst of all? Studies have shown that people who vape are much more likely to take up drugs and cigarettes in the future. Once they start consuming narcotics and smoking, it’s very hard to stop, and they’ll most likely cause irreversible damage to their body.

For some information on the harmful effects on smoking, check out my video on smoking that I made for the Khan Academy Breakthrough Junior Challenge in 2017.

As previously mentioned, E-cigarettes were designed as a less toxic alternative to cigarettes. The initial designs of E-cigs only involved water vapour, but E-cigs have become a problem that we never thought they would evolve into. This proves to be a big learning for us- technology isn’t always the ‘boon’ that people consider it to be, as seen in stuff like E-cigs and synthetic drugs. This is the unintended use of technology and we have to be judicious in our choices.

My Internship

While having a passion for a certain future job is certainly good, it always helps if one gets first-hand experience as to what the job entails. I’ve had some seniors who had a future goal in mind, but decided that the job was just too boring for them. I myself was pretty sure that medicine was the stream I wanted to pursue, but I decided that a doctor shadowing experience at a hospital would be ideal to really see if it was what I wanted.

This wasn’t my first doctor shadowing experience- I’d already had done two prior to this (one in India and one in Dubai). However, there was no doubt that each one had brought new learning- my Third internship exposed me to some high tech equipment, and I had the opportunity of observing surgeries as well as patient consultations.

I interned at the hospital from 30th June to 14th July. The daily duration varied, with most days being from 9 am to 5 pm.

I shadowed the medical director, a very distinguished Emirati General Surgeon, for the longest period of time. While in consultation, there used to be another doctor who acted as the medical director’s surgical specialist. The doctors had 4 days of consultation in a week, with 2 days ( Sunday and Wednesday) being set aside for surgery days.

I was able to observe nearly 60 patients and was exposed to a variety of diseases and procedures, ranging from hernias, skin grafts, breast lumps, gastric problems, orthopedic issues such as arthritis and cardiac issues including patients complaining of heartburns and chest pain. These patients were of varying ages, including infants to old men/women. I was also allowed to see procedures conducted in the Cath lab and the functioning of the hospital laboratory. The pinnacle of the internship, however, was the surgeries- I saw a total of 5 operations, including a total thyroidectomy, breast excisions, and breast Quadrantectomy.

I learned a great deal from the consultation sessions. The most important aspect of being a good doctor is how you care for the patients and how you interact with them. Both doctors heartily greeted the patients on meeting them. The MD, in particular, used to clap his hands whenever he had good news for the patient. They also had basic knowledge of a lot of languages and made it a point to try to greet the patients in their own native languages. The MD greeted his endoscopy patient in Gujarati and a patient with a skin graft in German.

Patients needs were always the first priority. This included ensuring that the patient felt comfortable and his/her privacy was respected. Before every consultation session, the doctor used to Introduce me to the patient so as to ensure that they did not have any problem with me being there.

Along with this, both doctors were very careful of the legal and emotional implications of their actions. Both the doctors used to create a lighthearted atmosphere around the clinic by cracking jokes with the patient. This formed connections and bonds with the patient, instilling in them a feeling of confidence and trust. This very feeling of trust was very important- the patients understood that they were in good hands. It came to my attention that both doctors used to vary that behavior with the kind of patient they met. Younger and newer patients were dealt with a professional and comforting manner while repeat patients were presented with a very humorous attitude.

Both were careful not to show any annoyance and anger in front of patients who were arguing with them. When it came to discussions with families about conditions like cancer something I noticed was that they never mentioned the word cancer or any other serious ailment until the test results came out. For that particular endoscopy/colonoscopy patient, a small white mass was found in his large intestine, along with many regions in the stomach where patches of blood were seen. While the MD told me that the possibility of cancer was high, he did not repeat the same thing to the patient’s family- he told them in a very comforting manner that he could not reach a conclusion till he had received the lab reports.

Teamwork was a very important part of all the procedures I saw. From complex surgeries, procedures in the lab and even when filling paperwork, the doctors and the nurses coordinated their actions to ensure that all tasks were carried out properly.

The doctors went to great lengths to make every patient understand about his/her own condition – they would often draw diagrams of anatomy and explain to the patient which parts of the body the problem may affect. They were also keen on teaching – both doctors often showed me interesting cases that they had the opportunity of treating. During a total thyroidectomy, they asked a junior doctor to perform a certain surgical procedure while under their supervision so that the doctor would learn how to perform procedure skillfully.

I also learned to come out of my comfort zone and learn some useful behavioral aspects – for example, I had to coordinate with hospital staff to check the doctor’s schedule. In a particular instance, I missed communicating with the doctor about his next day’s schedule and was not able to shadow while he performed some interesting surgeries. The doctor made it a point to tell me to regularly check his schedule. I was, luckily, able to recover the lost time by coming one extra day after my internship ended.

Apart from patient-doctor interactions, a large part of my internship was observing the medical equipment. I was able to observe the various sub-departments of the hospital lab, including Hematology, Microbiology, Biochemistry, Clinical Microscopy, Histopathology and the blood bank. I was also able to visit the Cath lab, where I learned how the whole procedure was conducted, along with X-ray videos of the chest while the procedure was being conducted.

All in all, my doctor shadowing experience was truly phenomenal. Not only was my internship very interested and illuminating but it also helped me cement my belief that being a doctor was truly the profession I wanted to pursue. This internship will, no doubt, help me in my college applications, along with the fact that the knowledge that I have gathered will help me in UCAT too. I hope that I shall get the opportunity to undertake such internships again!

The Nobel prize for Medicine, 2019

Source: © Nobel Media
Left to right the winners of the 2019 physiology or medicine Nobel prize William Kaelin Jr, Peter Ratcliffe and Gregg Semenza

The Nobel for medicine has been awarded to a scientist trio- Dr. William G. Kaelin, from Harvard University, Dr. Peter Ratcliffe from the UK’s University of Oxford, and Dr. Gregg L. Semenza from Johns Hopkins University. Their research on how cells adapt to various levels of oxygen availability has opened up many new ways to fight often fatal diseases like Anaemia, Kidney disease, Heart disease and Cancer. Here is a summary of their discovery-

Oxygen levels can fall at various places in the body, depending on the Oxygen availability in the environment around the body. Hypoxia (the starving of cells of oxygen) triggers the formation of new blood vessels, along with triggering a release of the hormone erythropoietin, which in turn makes the body produce more blood cells. The new discovery explains the mechanism of how this process takes place.

Dr. Semenza demonstrated that hypoxia triggers expression of the Erythropoetin gene. Using genetically modified mice, showed that DNA segments near this gene regulate its response to low oxygen levels. He discovered a protein complex called hypoxia-inducible factor (HIF), which is composed of two transcription factors (proteins that can convert DNA to RNA ). As a matter of fact, this concept was something that I learnt in from my biology textbook – Viruses use reverse transcription (the opposite of transcription) to make RNA copies of themselves.

Now these proteins, HIF-1α and ARNT perform some rather important tasks. When oxygen levels are high, HIF-1α is degraded. But when oxygen is low, HIF-1α increases, binding to the Erythropoetin gene and other genes and triggering red blood cell formation. Dr. Ratcliffe also studied how oxygen regulates this gene.

Dr. Kaelin, however, conducted research on how hypoxia and cancer were related. Dr. Kaelin was studying an inherited syndrome called von Hippel-Lindau (VHL) disease, a disease that increases the possibility of a cancer appearing in some families. He showed that the VHL gene encoded a certain protein that inhibited the spread of cancer, and that cancerous cells that lacked this gene had high levels of activity in the very genes that were connected to oxygen deprivation. When the VHL gene was introduced, the activity of these genes went back to normal.

Kaelin and Ratcliffe demonstrated in 2001 that when oxygen was abundant, hydroxyl groups are added to HIF-1α, allowing VHL to bind to it. This leads to its degradation.

My understanding is that when oxygen levels are low, hydroxyl groups are not added to HIF-1α, which means VHL cannot bind to it. If HIF does not disintegrate, it sends a message to the body that new blood cells need to be produced. However, when the VHF gene is absent , HIF does not disintegrate even in the presence of oxygen. This sends a false signal to the body that new cells need to be produced. This uncontrolled production is what is known as a tumour.

Though complicated, I found this topic extremely exciting. I also realised the scale of this discovery- the fundamental reasons as to why cancer takes place are slowly becoming clearer. I hope that you had a stimulating time reading through this article!