Yu-Han Chao's Blog, page 2

Garden of the Gods

“The mind is its own place, and in itself can make a heaven of hell, a hell of heaven.”― John Milton, Paradise Lost

I. Open/Closed
Eden, Olympus and
gilded capitol building closed
but the cherry-blossomed city
& green-carpeted mansion:
    Open

Flesh & flowers in the mirror
qHS warm scent of skin & soap
qAM aroma of salted pig

Q hr at the airport
planes line up
families crammed in queue    Whatever happened to covid?  
The city never sleeps
Ms. Pacman won’t stop
    Würk

America’s open again
just not to certain countries.

Too much snow and ice close a road
a heart for decades

A pandemic closes countries
though sometimes opening windows
    to another
Alternatively:
double doors to
intensive
    care(not everyone makes it through)  


II. Day/Night

Every day a new adventure
plains, snow, caves, treacherous heights

The sun scorches in
Garden of the Gods
the unknown and
    forbidden
guarded by burning phalluses

Paradise lost, moments stolen
visiting hours 10-6
with full PPE

Spontaneous breathing and awakening trials
in the day    Awake, arise or be forever fallen     What has sleep to do with night?
No rest for the weary

We sedate you
then we wake you
like every hour

Würk
stat dialysis
drips to keep stuff circulating
breathing synchronous with machines
MRIs and CTs don’t stop at night
nor do codes

Knowledge of Good bought dear by     knowing illGoing up or going
down?
Boosted bed so high
went straight to not quite heaven
but next floor up
or two

The Valley

Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me. -- Psalm 23:4


I. Air

From first cry of separation to
last sigh between bagged breaths
after nasal cannula, high-flow, bipap, proning, central lines, ventilation, chest tubes, trach, peg, double bags

        We fear
and we are alone
and those not alone
        somehow
punished with infection

Desert wasteland with sun bursts, joshua trees, weeds that tumble, mountains studded with jeweled brush. Natural bridge, via unreal road, too far gone to turn back, so many passed under

        But why?
There are things other than covid
        Aren’t there?
Or has it taken all the hosts, carriers,
swabs, masks
PPE
body bags, morgue space
    happiness?


II. Salt

        What’d you have children for if they send you to a SNF?
No visitors
maybe no visitors ever again
but Marla Grayson got you--
        she got you good--
Tyrion Lannistor:
        not your son.

The people bad, water bad, crusted with mineral snow, salted heart with nonviable defect
Canyons gold, mountains pastel
avoid the precipice
in strong winds

The sun sets.
        Please turn back before it’s too late and too dark        If you fall and cannot get up no one will find you until sunrise

You reach out your hand and do not see five fingers
        how many fingers now?
        how about now?
Do you feel this?

Who knew the heart of darkness would be this pretty and this cold?
What are the risks, benefits, and alternatives?

Wind, water, solar
cold water
        no electricity except human power


II. Dunes

In the desert it’s hot or cold, drenched in sweat under gown, or frigid in morgue. Too much or too little, too late.
A sandstorm makes it easy to cry, difficult to open one’s eyes
    
        Waves, ripples,
footprints up and down conquered hills
lips and ginas in quicksand
nothing like a
        dick
in the face

Bandanna cloth surgical KN95 turtle duck BYD 1870 top bottom shield bonnet booties

First wave
second spike
current surge

CDC warns new variants may wipe out our recent progress
        (what does the CDC know about our recent progress?)
        (just went down on peep and fraction of inspired oxygen)
undone so much
        so many

Sticks and stones won’t break my bones
        (but proning and repositioning might)
 
Woman.
Man.
        Who is that third holding a device?
The Shadow of Darkness
        on zoom or facetime        with family


III. Light

Miniscule crescent moon in broad daylight
swelled to huge
        and full
against fruitless pears (the oxymoron tree)
between home and hospital
behind turbines
        setting
        confused
Night sky planisphere of guilt catching dreams and dippers

For we are all but looking for
        the way home
        (Is home other people--
        or was that hell?)

Between darkness and light
medjool dates
wasteland to hope
        to dust
funeral home
        lizard under pandemic treehouse
burial of which symbolic of
countless childhoods
buried
under pale sand
the hourglass
only half full         it'srunning out

Translation= mRNA -> Protein

To celebrate the completion of my vaccine passport, here's the beginning of my poem this blog was named after ("Six Degrees of Polypeptide," published in Black Warrior Review Issue 43.1, 2016, craft essay here--please excuse the atrocious autocorrect typo that turned phenotype to phonetype). The rest of the poem, not included here, is very much Not Safe for Work, but this relatively PG excerpt begins to explain (or perhaps confound) what mRNA (as seen in Pfizer & Moderna vaccines) does.

Six Degrees of Polypeptide

AUG.

i. transcription

In the nuclear envelope: Let me 

helicase your jeans, DNA, cleave 

you, polymerase you back into two 

wholes, polymerase you again, splice 

exons of mRNA transcribed from your

negative space, U for your A.

ii. translation

Out in cytosol: mRNA t-t-fucks your uneven-

lipped ribosome (anticodona dentata)

the t-ts squirting polypeptide until

UAA / UGA / UAG stop. 

Every day, our bodies take the DNA we were born with, unzip it, and transcribe it into mRNA that gives ribosomes (little protein factories in your cells) the instructions for what proteins (aka amino acids) to make. 

In the case of mRNA vaccines, we get pre-made mRNA injected into our arms. This mRNA carries instructions for our body's ribosomes to to make spiked proteins like those on the surface of the coronavirus, without ever having been exposed to any actual virus particles--our bodies make the proteins, which then cause our immune system to create antibodies against the gross spiked proteins, and voila, we are better equiped to fight the virus whenever the spiked protein from real life covid tries to dock onto the ACE receptors on our blood vessels, lungs, etc. when someone coughs/sneezes all over us.

People (who are waiting to see if I die from the vaccine before they get theirs) keep asking how I feel 48 hours after the second dose of Pfizer, but so far both doses weren't more sore than the flu shot, and any fatigue, soreness or headaches weren't worse than the usual side effects of twelve-hour nursing shifts that involve every two-hour repositioning of folks and not drinking enough water. 

Will continue to monitor.

Core 1 Quantitative 2: Vaccine Scenario

If you were a Core 1 student or instructor, you may remember the flu scenario known as Quantitative 2, where there was a (fictional) flu outbreak that had to be contained with measures (such as quarantine, closures & travel restrictions), and limited quantity of vaccines insufficient to meet herd immunity*. In this assignment, groups of (sometimes very cold-hearted) 18-22-year-old college students hypothetically decided the fate of Americans, proposed containment measures & calculated who gets vaccinated, who doesn't. Instructors (in horror at times) graded them based on accuracy, method, ethics, etc.

Oh Tom, how did you know?

*Herd Immunity: when enough of a population has immunity (through infection & recovery or vaccination) that a disease will not spread widely in the commmunity. Also known as herd effect, community immunity (it rhymes!), population immunity, or social immunity.

Scenario 3 shows successful herd immunity

One year, we had enough vaccines to vaccinate 70% of Americans, and herd immunity was 85%. We got numbers from the Census Bureau (which undercounts), guidelines from CDC & WHO (no comment), and complained about how wildly unlikely this would ever happen in a first world country, and why are we being forced to expose ourselves as the terrible people we are?

But somehow we are here. Who do we vaccinate, and in what order/priority? Those most likely to die? Those most likely to be carriers? Healthcare workers, elderly, those with health conditions, essential workers (including teachers at this point), political leaders, homeless, prisoners, children, parents, young adults? 

Then there's another question: would you get the covid vaccine if it were offered to you?

Seven Daughters of Eve

One fine morning, 6:55am, while waiting for Charge Nurse to start our socially-distanced morning huddle, my well-read and whip-smart colleague, Sally, gave me a personalized book recommendation as we had been discussing the origins of life, evolution, and mitochondria for the past few minutes (and you thought all nurses did was gossip & play cards?) 
The Seven Daughters of Eve by Bryan Sykes, Sally said. Read it. What genre? I asked. Anthropology? Historical fiction? Yes, Sally said. 
Took me five months since I was reading 5-10 other books ranging from garbage to textbook, but Seven Daughters is a fascinating read that combines genetics and anthropology with fictional poetic license. 
We'd discussed previously that mitochondrial DNA (present in all of us) only passes from Mom's side because eggs delete mitochondrial DNA from sperm, so after a lot of sampling, including making "soup" from old toes, skull and teeth fragments to extract ancient DNA, human geneticist Bryan Sykes and his team were able to identify seven female ancestors who are our great, great, great,...great, grandmothers. He calls them daughters of Eve because there is a mitochondrial Eve all of us are descended from, a woman who lived in Africa about 150,000 – 200,000 years ago.

Incidentally, we're looking at statistical prevalence of mitochondrial genes in regional populations, which is not an indicator of race or ethnicity. Race is a social construct and not based on genes.
These, according to Sykes, are the seven daughters of Eve:

Ursula (Latin for she-bear): 45,000 years ago, clan of the first modern humans in Europe. Descendents all over Europe, esp. western Britain and Scandinavia. Also, Central, Western, & South Asia.
Xenia (Greek for hospitable):  25,000 years ago, second wave of modern humans in Europe prior to the coldest part of the last Ice Age. Descendents common in Eastern Europe & central Europe as far as France and Britain. Also includes Western Asia, North Africa 1% of Native Americans.
Helena (Greek for light): largest European native clan, 20,000 years ago. Descendents widespread in Europe, esp. Basque people of northern Spain and southern France. Also: Siberia, Africa, Inner Asia.
Velda (Scandinavian for ruler): 17,000 years ago, descendents mainly in Western & Northern Europe, the Saami people of Finland and Northern Norway, and the Near East.
Tara (Gaelic for rocky hill): 17,000 years ago, descendents widely distributed throughout Southern and Western Europe, esp. Ireland and west Britain. Also: Near East.
Katrine (Greek for pure): 15,000 years ago, descendents in Italy, Central & Northern Europe, South and West Asia.
Jasmine (Persian for flower): only clan with origins outside Europe. 8,500 years ago, descendents include Middle East & 12% of Europeans. 
If you're curious which daughter of Eve your mitochondrial DNA came from, you can take a wild guess based on family history, and also there are tests for that. At least unlike 23 & Me, they don't make claims regarding "what" you are.
Reference:Sykes, Bryan (2001), The Seven Daughters of Eve:The Science That Reveals Our Genetic Ancestry. New York: W. W. Norton.

Mitochondria = cellular energy factories

In Greek: mitos, thread; chondrion, granule. Mitochondrion have layered membranes, granulated appearance, and ATP synthases that generate energy through the Krebs cycle (every Bio 1 student's nightmare) or when things go wrong, anaerobic respiration (nightmare of anyone with a septic patient).

Before discussing mitochondria & their role in evolution, here's a disclaimer (that anyone involved in Core curriculum at UC Merced is familiar with). Evolution and creationism are not either/or. You can believe in God/Allah/____ and evolution at the same time. God/Creators are outside of time, so who's to say they did not create all matter & energy (E=mc^2 etc.), including life (through evolution) in 7 "days" (which could very well be 4.5 billion years)?

However evolution got started, mitochondria, one of the most awesome little powerhouses to ever appear on earth, are key to life as we know it. Mitochondria and the tree of life is more entertwined in its branches than some older textbooks led us to believe, however.

Based on carbon, minerals, fossils and other evidence, scientists have attempted to piece together the evolutionary puzzle, in spite of missing pieces, intermediate species. Not everything leaves a mark. Nick Lane, in his The Vital Question, discusses LECA, the last eukaryotic common ancestor, the origin of plants, fungi, and animals like us. Eukaryotes have a nuclei containing genetic material, and organelles (tiny cellular components, like organs) such as mitochondria. 
The incredible thing is that one of the early single cell organisms on premordial earth swallowed an early mitochondria and decided to keep it rather than digest it. It was such an incredible generator of energy that it made it possible for the early organism to aspire to multicellularism--developing into a creature with more than one cell. 
Some of these eukaryotes with mitochondria also swallowed an early organism that became a chloroplast, and was able to perform photosynthesis that made the Great Oxidation Event possible. Some little organisms created oxygen and carbs from CO2, while some, like us, used oxygen in cellular respiration to metabolize carbohydrates, and a few billion years later, here we all are. One of the most awesome things about mitochondria is your mitochondrial genes come from your mother, grandmother, great-grandmother, etc., because only the egg contributes mitochondria (RBG would approve). Any trace mitochondria that sneak in through sperm are targeted & destroyed by the egg. Nick Lane also discusses why this is an evolutionary trait that facilitates survival by decreasing incompatabilities between nuclear and mitocondrial genes or fatal mutations in mitochondrial genes.
Anyway, mitochondria are so amazing they deserve a few more posts, including an awesome book recommendation by my wise and well-read colleague, Sally, next time.
Reference:Lane, Nick (2015), The Vital Question: Energy, Evolution, and the Origins of Complex Life. New York: W. W. Norton & Company.

Influenza delle stelle

Flu, from Italian influenza, and Medieval Latin influentia (in the astrological sense, as the illness was once believed to result from the influence of the stars.)

Emma Donoghue's 2020 novel,  The Pull of the Stars, set in the fever/maternity* ward of an Irish hospital during the 1918 flu pandemic, is so eerily timely one wonders if some kind of necromancy or crystal ball was involved when the author wrote the manuscript back in 2018. 

Phrases from the book like, "Cover up each cough or sneeze . . . fools and traitors spread disease," "If in doubt, don't stir out," sound all too familiar to us these days. Just like us, people in the book wear cloth coverings over their faces (occasionally stopping to argue their efficacy), shun anyone who coughs in public, and worry about fevers and hypoxia (not getting enough oxygen).

The Pull of the Stars' central image of influenza delle stelle is both poetic and damning, because while reading historical fiction with a known ending (that civilization will prevail), we may not feel so certain about our current world in the midst of our very own pandemic (among other problems). 

Influenza delle stelle literally means influence of the stars, the pull of the stars. According to Donoghue, "Medieval Italians thought the illness proved that the heavens were governing their fates, that people were quite literally star-crossed." When it was one's time, the stars pulled, gave a little yank, and one would be sick, then gone. 

No Shakespearean star-crossed lovers, just star-crossed.

A young helper in the hospital dies in the book, recalling healthcare workers that have succumbed to our virus since early days. Is it really our virus, though? Who claims ownership of whom at this point? Maybe it depends who wins, becuase history is written by the fittest, whoever adapts and survives.

How tired we are of staying at home, of being paranoid, scared, until finally what sets in like neuropathy is desensitization. But when we stop feeling the pain or the wound is when infection truly takes hold, sometimes through the blood, all the way to the bone. Sepsis, organ failure, shock, ashes to ashes, stardust to stardust.

Depressing reality and poetic metaphors aside, if you liked the PBS series Call the Midwife (available on Netflix) and don't have PTSD too bad from covid, The Pull of the Stars is not a bad read. It ends a bit abruptly, not quite deus ex machina but rather the opposite of a machine god, though at least the main protagonist, a nurse, lives to tell the tale (and has immunity, by the way).

May we all have immunity--if not already, soon.

*Basically mother/baby + covid ward, except not covid, but the 1918 flu.

Vitamins for Life

Vit, life.

Amine, amino acid/protein, because vitamins were thought by Polish biochemist Casimir Funk, who coined the term vitamin, to contain amino acids (they do not.)

Like many things, vitamins can be good for you in moderate amounts. Lets talk about the ones you should NOT take too much of, to avoid toxicities and complications, first. 

Unlike water soluable vitamins that you can pee out, vitamins A, D, E, & K are fat soluable and can accumulate in the body, sometimes to dangerous levels. It's pretty hard to eat your way to toxic levels, however--over-supplementation is usually the cause for toxicity.

Vitamin A (Retinol): stored in the liver, good for the eyes and skin, vitamin A is abundant in dairy, meat, fish oil, fish, spinach, and orange stuff like carrots, cantaloupe, mangoes, and sweet potatoes. The recomended daily intake is 700-900 mcg/dL, and the upper limit is 3000 mcg a day. Above that dose, vitamin A can cause birth defects (pregnant/child-bearing women beware), liver injury, and bone related disorders.

Vitamin D: critical to bone health, deficiency can manifest as rickets (soft bones) in children and osteomalacia (bad bones) in adults. Some studies show vitamin D may protect against arthritis, diabetes, heart disease, autoimmune disorders, and certain cancers due to its ability to regulate immune response.

Vitamin E: available in multiple forms, present in vegetable oils, nuts, whole grains, and mustard greens, vitamin E has antioxidant actions and rare deficiencies may be associated with neurologic issues. More than 200 mg a day increases the risk of hemorrhagic (bleeding) stroke by making platelets less sticky.

Vitamin K: needed to produce factors that help blood clot (the opposite of bleeding); deficiencies can increase bleeding. Babies are born without the bacteria that synthesizes vitamin K in the gut, therefore get a shot (wahhh!) of vitamin K1 soon after birth. People on blood thinners such as Warfarin have to watch their dietary vitamin K intake.

Vitamin C: required to produce collagen, is an antioxidant, helps iron absorption, and regulates the respiratory cycle in mitochondria (helps cells use sugar). Deficiency (usually seen in pirates...not so many of those these days) causes scurvy with bleeding gums, bad bones, & loose teeth. Taking no more than 2gm a day is recommended.

Vitamin B1 (Thiamine): coenzyme (facilitator) for carb metabolism, present in enriched grain products and pork. Deficiency produces beri-beri, which comes in two flavors. Wet beriberi involves water retention and heart failure, whereas dry beriberi involves neurologic and motor problems. Deficiency in the U.S. occurs commonly with chronic alcoholics, manifesting as Wernicke-Korsakoff syndrome, with symptoms of vision, motor and memory issues.

Vitamin B6 (Pyridoxine): coenzyme for metabolising proteins, deficiency can lead to neuro issues including nerve pain/tingling, depression, confusion, and convulsion. Deficiency can be due to genetic errors, alcoholism, or isoniazid therapy (for tuberculosis). Extremely large doses over 100mg a day can cause neurologic injury. B6 interferes with levodopa therapy for Parkinson's disease. 

Vitamin B9 (Folate/Folic Acid): low levels of B9 can cause anemia, and deficiency during pregnancy can lead to neural tube defects such as spina bifida (like Meredith's kid in Grey's Anatomy) or anencephaly (no brain, like Amelia's baby). It is enriched in grain products. Avoid more than 1000 mcg a day.

Vitamin B12 (Cyanocobalamin): also causes anemia if deficient.

You've been waiting for me to say something about covid, haven't you?

DISCLAIMER: no medical advice is provided here, and you should speak to your doctor or pediatrician about covid-related concerns and seek immediate medical treatment for emergency symptoms such as severe difficulty breathing, confusion, blue lips or face, and chest pain. 

There have been unofficial recommendations for covid home care involving moderate doses of vitamin C, vitamin B1 (to prevent kidney stones from vitamin C), vitamin D, zinc, and melatonin--feel free to ask your doctor, not me, about those, and remember that supplements are not regulated by the Food and Drug Administration. I'm not recommending anything, though healthy eating, hydrating, quitting smoking and exercise as tolerated can't hurt!

Reference: 

Lehne's Pharmacology for Nursing Care, 9th ed. (Not going to bother with APA today.)

Antibodies are good

Just got back from donating a tiny vial of blood to the covid-19 antibody research study sponsored by St. Joseph's Medical Center. If you are a member of the Merced community, the SARS-CoV-2 Antibody Research Study will test you for covid antibodies for free. Just call the Research Coordinator Office at (209) 564-3607, schedule an appointment to sign consents at the UC Davis Cancer Center, pop next door to 315 Mercy Ave to get your blood drawn, and they'll call you if you've got antibodies.
Also known as immunoglobulins (Ig--not to be confused with IG, for instagram), antibodies are part of your body's immune system. An antagonist is a bad guy, but antibodies are good. They are your body's microscopic, globular, Y-shaped secret weapons. You want antibodies.  Having the right antibodies in your blood means you won't have to get three more hepetitis B vaccines, two more measles-mumps-rubella vaccines, or whatever other big honking shots the MA at your doctor's office comes in with on a silver tray, a glint in her eye.
Antibodies come in five flavors: IgG: the stuttering antibody that crosses the placenta, comes in four forms and is the main, long-lasting flavor.IgA: present in body fluids, the gut, respiratory, & urogenital tracts, produces antimicrobial factors.IgM: first on the scene when sh*t hits the fan, riding humorous B cells.IgE: protects against parasites but mostly responsible for annoying allergies.IgD: antigen receptor on inactivated B cells; activates basophils and mast cells to make antimicrobial factors.

Antibodies can do five things:Neutralize microbes by making them ineffective in their evil acts against your body.Agllutinate: turn pathogens into tasty clumps for other immune cells to devour.Precipitate: separate pathogens out of fluids into tasty clumps. Nom.Complement activation/fixation: latch onto foreign cells to get complements (tiny proteins, not compliments) to attack cell membranes to pop them or at least cause inflammation. 
We don't know enough about covid-19 antibodies to say for sure how long antibodies last, how much conveys immunity, if any, and whether herd immunity is on the horizon, but your contribution could help scientists get more answers and shorten this surreal limbo period. All it takes is a vial of blood and maybe half an hour of your time. I specifically asked if they would be hitting us up for convalescent plasma if we're positive and the research coordinator said no, but you can always offer your life-saving 500mls to a blood bank!

Mask. Social distance. No party.

Dear Readers,

I’m a Red Hen author and a hospital nurse who also does some contact tracing for public health. I won’t pretend to be an expert or try to tell you what to do with your life, but if you care about the future of the human race, please help us.

Yes, you–Dear Reader–can personally save the world.

All you have to do is stay at home as much as possible, wear a mask when you leave your home, maintain a 6 feet distance from other people if you can, and not host or attend that upcoming 4th of July block party in your neighborhood.

I would rather not see you and your loved ones in a rubber-banded stack of “4th of July party outbreak” positive case files and have to call all of you about isolation or quarantine, and worry when someone cannot answer the phone because they are already in a hospital. I would love to support you in the hospital if you need medical attention for any number of health matters (please do come in if you need help), but would rather not see you or any of your loved ones come in with difficulty breathing and end up having to be transferred to the ICU and placed on a breathing machine, especially if it is preventable. And it is preventable. Not 100% preventable, but preventable in the way that if you skip that party or wear a mask consistently, you might save someone’s grandma or baby or mother, father, sister, or cousin, through the butterfly effect. We could discuss the R number or exponential algorithms on a graph, but I think most of us understand the subtlety of the butterfly effect better. One small action by you can change the fate of the universe.

You can do this. You can change the world. Mask. Social distance. No party.

Sincerely,

Yu-Han

Reposted from https://redhen.org/2020/06/18/red-hen-recommends-authors-edition/