Synchronicity

           As I wrote in a previous post, Covid 19 isolation has me cleaning out closets. I found a clipped article from Shambhala Sun, a Buddhist magazine, from November, 2000, written by Rachel Naomi Remen, MD, who in the 2000 magazine is listed as a clinical professor at UCSF School of Medicine and medical director of the Commonweal Cancer Help Program. She has written a very entertaining book called "My Grandfather's Blessings: Stories of Strength, Refuge and Belonging, published by Riverhead. In this article she talks about the strange coincidences that occur in our lives that seem as though they have some outside guiding hand and often serve to awaken us or guide us in some fashion. In this time of great travail, I was moved again by rereading this article. I especially found her opening moving and reproduce it here for your edification.

     "Glimpse of a Deeper Order:  According to the Buddhist understanding of auspicious coincidence, all circumstances can be brought to the spiritual path.  Everything that happens in our lives, whether positive or negative, can serve to awaken us to the nature of the world. But occasionally, events cluster in particular ways that give us a glimpse of the deeper structures of reality, and suggest that time and linear causality may not be the ultimate way in which the world is ordered..

     "There are many possible responses to such happenings, which Jung called synchronicity. Some people give them a highly individualized meaning, finding guidance in a personal decision they are facing or confirmation of a direction they have already chosen. But perhaps the real meaning of synchronicity is more universal than personal, with every instance simply pointing to the possibility of a hidden pattern underlying the events of this world. 

     "Either way, these events offer us a certain reassurance, and they also have the power to awaken us. A common response to such an acausal happening is a sharpening of attention, a sense of the closeness of something unseen. Startled awake, we may listen for the direction in which the universe is moving, and discover a wish to participate in it.

     "Synchronicity often takes us unaware and may restore us to ourselves."

     The author goes on to tell about an experience during the Christmas season when she was so busy with her work that she had no time to prepare for the holiday and especially to do one thing she always did which was add an angel to her many years of collecting angels to honor those who had died that year in her medical practice. She dealt with End of Life care and thus was often placed inside another human being's crossing into whatever lies beyond. She met a lady on an airplane who sensed her troubled state of mind and gave her an angel which that fellow traveler's grandmother had just given to her. What a coincidence or was this occurance the definition of a synchronicity?

     Dr. Remen writes further "I suppose one might call this coincidence and perhaps it is. But it felt as if whatever it is that we really serve when we serve others had reached out and shaken me awake, saying 'You get on with the work...I'l take care of the small stuff.'

     "This is the sort of event which Jung meant by synchronicity, a meaningful coincidence which thumbs its nose at linear causality. At a certain level, synchronicity suggests there is more to life than we realize, and that we and all others may not be alone, I regard such a happening as a blessing. Such things may happen at any time, but in the years I have worked with people facing death and those who survive them I have heard many such stories. Perhaps such things are either more frequent at these times, or perhaps in some way every death is a bridge between worlds, and allows us to see things differently for a little while.

     "Synchronicity is always an experience of the unknown. Events such as these do not really prove anything. They are simply a reminder to wake up and pay attention because the mystery at the heart of life can speak to you at any time."

     When I reread this little article, I felt a few moments of expansiveness which some people of the Buddhist bent have called "kensho."  As a physician, I have certainly experienced what Dr. Remen is talking about and these episodes certainly do seem to occur around death. Many of my patients have told me stories of "coincidences" or "synchronicity" that happened around the time of a death in their family. Some of these stories also seem to involve a "ghost" or "seeing" the deceased again in a very life like way. I will tell a little story about just such an experience in a later post.

 Curious about synchronicity. Here's a starting reference:

 https://lonerwolf.com/synchronicity/https://lonerwolf.com/synchronicity/

Closets, Crocus, and helebores

          This elderly couple is about 3 weeks into our "Safer at Home" policy in Wisconsin. the pandemic surges on. In Wisconsin seems somewhat behind many other regions. Of course, this means that we will probably be at this isolation longer than other places because we started earlier and we will still have to go through the peak and the trough before may people are able to return to work. And then there is, of course, our age and our comorbid conditions that I think means we will have to continue at home even after many populations can return to work.

        The first thing I did was to clean a closet. I missed an opportunity in that I should have taken a before and an after photo of my hall linen closet. This is a large double door closet with 5 very deep and long shelves. I can only describe to you the mess that it was. heeps of unnecessary and unused linens which still sit packed in bags to take to the Goodwill Store as a donation when it reopens. Mixed in with all these linens were very non linen type items such as photo albums from a couple of our trips. I think they got put there because it was handy and other closets were full. There were some automatic plant watering systems consisting of beautiful glass bulbs that you fill with water and put in the plant's soil.  They never worked very well for long trips. I found several nice children's gifts that never got gifted. At 13 and 10 years old, the two older grandsons have outgrown them. But I now have a 2 year old grand daughter and will soon have a baby grandson. I saved those gifts. They may still find a child's home. Of course, there is always my own antique toy collection if I save these long enough. One real itme of interest that made my younger son laugh: a paper grocery bag full of one particular sample drug, folders with 4 small diamond shaped blue pills in each. I am known in my family and among friends as a prepper. Well, these were certainly prepping for a different situation. In case you are having trouble guessing what these pills are, there is a photo at the end of this particular blog.

 

Crocus

We had a couple of nice days and of course, gardener that I am, I had to get my hands in the dirt. I had ordered 12 new hellebores before this whole isolation process began, so on the first nice day I got out and stuck them in the ground, most of them near the house and the rest out in my woods where there are more that have grown over the years. Hellebores are also called the lenten rose because they are certainly among the first flowers to bloom in spring, around Lent. They like shade and are just about indestructible. The blooms lasts for about 3 months and after that the foliage is quite attractive. I wanted some up near the house where I could see them easier since you can't always depend on April weather for a walk in the woods. Here are some photos of the first blooms timed right along with an early crocus near the house.

     Now of course since I was cleaning off some beds near the house, I had to arrange some of my fairy scenes.

   
          During this stay at home time, some of our neighbors started a nice little email group. And I joined another group also that stretches further along the Lake Michigan shoreline, down into Bayside and maybe even up into the next community north. One neighbor got the idea that since this email group has been so active with advise, grocery shopping, and other helpful ideas, she wanted to drink a toast to the organizer. She and her husband left bottles of wine out front and invited people to come up their driveway and drink a toast and then take the bottle home with them.  Since we have some new neighbors with younger children, the next week this same couple put out boxes of animal crackers and invited strollers to come up and take a box. This stimulated the organizer to suggest that since the real zoo was closed, that we create our own neighborhood zoo by putting small toy animals, stuffed or otherwise in the window for the families to walk around the neighborhood and find the different animals. Almost everyone participated, and there was quite a menagerie.

     I have a very large stuffed animal in my toy collection. It is not really a zoo animal but I thought it would work. My oldest son won this at the Wisconsin State Fair when he was a sophomore in high school. He remembers it well. It was a very hot day and he was lucky very early in the day and had to carry this huge animal around his neck for the entire day at the fair. Since he left home, this creature has been sitting in a corner of my toy room. I thought it would fit very well with zoo animals. It is a 4 foot tall stuffed blue performing horse with white mane and tail, and a saddle and golden bridle. He is stuffed tightly with straw, but over the years, he can't stand anymore but sits as though ordered by his trainer into that position. I heard some interesting stories about the horse as the neighbors passed. One neighbor was walking her two dogs and they would not pass the horse. They put up such a barking fuss that she had to turn around and go back toward their home. Another neighbor told of walking her great dane, who also was terrified of the big blue horse. Finally when slowly allowed the length of his leash, he made friends and immediately went around to stiff around the white tail, just as dogs do.  The owner of the dog was seen to absolutely crack up with laughter. So my blue performing horse was a big hit even with the adults and some of the dogs.
   

     Have you figured out what the tresure chest of medical drugs I found in my linen closet? Well here is a big hint. 

April 1, 2020 Some Scientific and Technical Info about Covid 19.

     I previously promised some information about the COVID 19 virus itself. The following website is an excellent source of rather detailed information about this virus and what we have learned since its discovery in December of 2019. For those who want to delve into this science, this is an excellent source of information. Since my undergraduate major was microbiology, I felt I should be able to at least refer you to a good microbiology source.

theatlantic.com/science/archive/2020/03/ and find the article called biographynewcoronavirus.

Your can access this article by going to the above site and type biography (dash) new (dash) coronavirus. My computer's dash is broken so I cannot type that in here. Otherwise you can google Science of Coronavirus and pick The Atlantic article.

I would like to just summarize some of this scientific information here in case you do not want to delve deeply.

     The Coronaviruses are a widespread group of RNA viruses. Most are spherical and have spikes on the spherical surface that have what look like small crowns on the end of the spikes; hence the name Coronavirus. Coronaviruses exist rampantly in bats, pangolins, and have been found in civets and camels. Four of the Coronaviruses are human viruses only and cause relatively mild colds much like the common Rhinoviruses. It is thought that they cause up to 1/3 of  common colds.  They have been named OC43, HKU1, NL63, and 229E.  Research on these viruses, both the cold viruses, and the animal Coronaviruses in the past has been few and far between.  Such research has been regarded as sort of boring and backward.  But we have faced two other Coronaviruses in the past which are nothing like the common cold virus. The first of these was called COV1 and caused the first epidemic of SARS Cov in 2003. SARS stands for Severe Acute Respiratory Syndrome. This Coronavirus also rose in China again from animals and then moved to humans. This particular Coronavirus did not transfer very effectively from human to human but it did do this well enough to move to 26 different countries. Fortunately it was not so communicable because its death rate was very high at 15% overall and 50% for those over 64 years old. The second famous Coronavirus to cross into humans was the MERS Cov 2 virus which caused as the name implies, Middle Eastern Respiratory Syndrome which broke out in Saudi Arabia. But again this virus did not transfer well between humans and stayed mostly in the Middle East. The camel was thought to be at least an intermediary vector. However, this virus also had quite a high death rate. So now we have reached the feared point where a deadly Coronavirus has gained the ability to rapidly and easily transfer from person to person. It is also thought that its origin was in bats in China but it is suspected that there was some intermediary animal between bats and humans, possibly an animal that was sold at the wild animal bushmeat markets of China. This virus is fortunately not as deadly as either SARS COV, or MERS COV, but on the other hand it has very effectively evolved to be able to infect humans very easily.

     Just to clear up some confusions, this virus has several names. Some people in the beginning it called it a novel Coronavirus. Then people began to call it COVID 19 based on its origin in ;ate 2019. The Chinese scientists were able to sequence its RNA very early and did indeed supply that information to the world research community. Since this virus acts very much like the original SARS COV1, it is technically now called SARS COV2. But still the acronym COVID 19 is used both to refer to the disease it causes and to the virus itself.

     Microscopically the crown at the end of the spike is really a couple of pincers held together by a lipid and protein bridge. In order for it to hook onto human cells and hold on long enough to break through the cell wall, this bridge has to break letting the pincer action allow the virus to stick to the cell. This virus has accomplished this mechanism. Actually it has adopted to use a small enzyme that the human cells themselves produce called furin. This protein is readily available throughout the human body and it accomplishes that break of the bond between claws on the crown allowing the grabbing of the human cell by a pincer like action.

     Apparently it has evolved to utilize the ACE 2 receptor which is found on many cells in the human body. It seems that pincer actually grabs the ACE 2 receptor protein. The lungs have a particularly high concentration of these receptors as do the walls of blood vessels, and the gut. You may recognize the acronym, ACE. It stands for Angiotensin Converting Enzyme. Some of those of you with hypertension may recognize that you are on a drug called an ACE inhibitor. Such drugs block the protein, angiotensin and its tendency to raise blood pressure in our bodies. So does being on such a drug have any bad or good effects on this virus or the disease that it causes? Well we don't really know. There are anecdotal ideas, some held even among doctors, that one of the reasons that older individuals with underlying conditions often die from the disease is because they are on ACE inhibitors for their high blood pressure, or heart disease. Doctors have noticed this fact among their ICU patients on ventilators. But there are no studies that would prove this or disprove this idea. Since ACE inhibitors are so commonly used in these conditions that affect older people, it is more probable that this is just a coincidental presence of severe COVID 19 disease and the use of these drugs, and there is not a cause and effect relationship. In fact there is one small study that seems to postulate that being on ACE inhibitors may actually protect against the severe disease. We just don't know at this time. At any rate, we know that the virus uses the ACE2 receptor to stick to the cell wall and eventually get into the cell.

     Many respiratory viruses tend to either cause mostly an upper respiratory illness or an infection of the lower respiratory tract. This virus seems to be able to do both. It first enters human cells probably in the upper respiratory tract and is able to infect cells there and proliferate without a lot of symptoms. This may be why people can seem almost or totally asymptomatic. But then once the virus has multiplied more it seems to in some people move down to the lower respiratory system and cause a viral pneumonia. At this stage several mechanisms can lead to worsening of the patient's condition. One problem seems to be that the secretions are very dry and hard to clear with coughing and this leads to portions of the lungs being closed off to good air movement for proper oxygenation. The body tries to mount an inflammatory response to kill this virus but sometimes that response seems to go berserk especially in compromised people such as the old, or those with other severe underlying conditions. This inflammatory over response does a couple things. First there is something called a cytokine storm where the inflammatory response produces a lot of these inflammatory proteins which in smaller amounts attract the white blood cells that produce killing antibodies and help fight off the invader. But if too much of these proteins are produced they make the blood vessels leaky and lots of fluid leaks out of the blood vessels into the lungs adding more difficulty to the breathing and oxygenation, essentially drowning the person microscopically. Also all of these conditions make the lungs open for invasion by bacteria as well and a bacterial pneumonia may occur. Sepsis is the cause of death in many of these patients which causes shut down of many other organs, such as the kidneys and liver.

     There are a number of ways to attack this virus. Corticosteroids are used to suppress this immune over reaction called the cytokine storm. Now plasma from persons that have been infected and now recovered is being used in the very ill. There is one study from France with a relatively small group of patients who were given the antimalarial drug, hydroxychloroquine, and there seemed to be a good response that was statistically significant. But this was just one study. Currently studies are being done and this drug along with zithromycin are being used actively in the field against this virus, as long as the results are part of an organized study.  Antivirals that have been used for influenza, HIV and other diseases are being tried. Various labs around the country now have live virus and are using those live virus to infect cell colonies and then measuring what various drugs do when added to these small human cell colonies. All of this work is done by robots and is observed microscopically. One drug seems to hold some promise so far, called remdesivir. This drug has been used to fight another very lethal respiratory virus called the Nipah virus which has caused outbreaks in Bangladesh and in Kerala, Inda. Studies are ongoing for this drug. There maybe new drugs that could be effective and perhaps are being safely used for totally different diseases. If any of these drugs have benefit in the lab, they could be introduced to human populations with COVID 19 fairly quickly because their general safety is already known.  Such is the case for hydroxychloroquine and thus it is already being employed to some degree.