About That 36-Year-Old Woman Who Was Healthy Until Covid Gave Her Heart Failure

I have so much to say about this news story that it became this blog post.

For those who don’t want to read the entire article, the tl;dr is: Jamie Waddell, a healthy vaccinated-and-boosted 36-year-old woman, got covid-19, recovered, then got heart failure so severe they put her on a heart transplant list, then recovered from that too.

Why Didn’t The Urgent Care Clinic Test Her for Troponins?

From the article:

Two days later, she was coughing and achy and asked her doctor for a chest X-ray, which came back normal. She called off work two days and went to her local urgent care clinic. She did not test positive for COVID-19 or flu.

“My vital signs at that visit were a little off. My heart rate was a little high. I had a fever,” she recalls. “I came home and basically went to sleep.”

*facepalm*

Given that she had myocarditis, a troponin test at this point would’ve come back positive. Then the doctors would’ve known that she had a heart injury, and she needed treatment. Good treatment at this point in time would’ve slowed or perhaps stopped the progression of her heart failure, and she wouldn’t have needed such intense life support.

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Many Doctors Care More About Their Egos Than Saving Lives

State of the Heart by Haider Warraich ends with these words:

This means that if science continues to advance, perhaps half this book will one day be proven false. Perhaps one day, a historian will cite these words snidely to reflect how ignorant we were and how far we have come since. That thought gives me a lot of joy, and the sooner we can break the untouchable idols of today, the sooner we can strip the masters of dogma, the sooner we can focus on the sum of our organs.

Being proven wrong about his scientific understanding may make Warraich joyful, but many other people in a position of power in medicine and public health would rather cause many deaths than admit mistakes.

History is full of examples. Take for example, Ignaz Semmelweis, who found evidence that washing hands before helping women give birth greatly reduced deaths.

That said, it was Dr. Semmelweis who ordered his medical students and junior physicians to wash their hands in a chlorinated lime solution until the smell of the putrid bodies they dissected in the autopsy suite was no longer detectable. Soon after instituting this protocol in 1847, the mortality rates on the doctor-dominated obstetrics service plummeted.

“In 1850, Ignaz Semmelweis saved lives with three words: wash your hands” by Dr. Howard Markel, PBS News Hour

Did other obstetricians rejoice because they had a simple method to increase the survival rate of their patients? Nope.

Unfortunately, Semmelweis’s ideas were not accepted by all of his colleagues. Indeed, many were outraged at the suggestion that they were the cause of their patients’ miserable deaths.

The same thing happened in the United States when Oliver Wendell Holmes Sr. advocated that doctors wash their hands.

These “doctors” didn’t care about evidence or saving lives. Or at least, they cared less about that than the insults about their unwashed hands’ uncleanliness. To them, it was better than more of their patients die painful deaths than that they go through the inconvenience of washing their hands.

You might also know about the story of John Snow and cholera.

Warraich describes an example prioritizing their egos over following evidence or saving lives I hadn’t heard of before.

In the early 20th century, doctors regarded high blood pressure as a good thing. Some believed it was an effect of aging with no bearing on health, others believed that the higher the blood pressure, the better.

I can say two things in defense of doctors in the very early 20th century: nobody had collected evidence that high blood pressure is dangerous, and the only method they had to reduce blood pressure was extreme salt restrictions.

Then someone gathered and published evidence that high blood pressure is deadly: life insurance companies.

In 1925, the Actuarial Society of America published a report which noted a correlation between high blood pressure and earlier death. While doctors were dismissing the need for blood pressure readings, life insurance companies pushed to have it measured and factored into their policies.

The doctors and scientists ignored this.

In various parts of the book, Warraich describes the various pressures to conform to authority and hierarchy in science and medicine. In a top-down hierarchy, you get ahead by pleasing the people of higher rank. Saving many lives might impress the people of higher status, but a more reliable means to get ahead is to flatter them and not embarrass them. It’s safe to agree with the medical authorities even when they’re wrong, but it’s risky to point out their errors.

Life insurance companies are predictive markets of human death. They bet they can collect more money from living customers than money they spend on the dead. When their bets are accurate, they make money. When their bets are inaccurate, they lose money. Given a choice between conforming to people of high status in medical and scientific hierarchies and understanding reality, they choose to understand reality.

Then the Framingham study began in 1947. It tracked the lives of people in the town of Framingham, Massachusetts to better understand human illness and health. Warraich says, “when the Framingham study was threatened with its funding being cut, life insurance companies helped bail it out, seeing how important the actuarial benefits of the study were.”

The first report published on the Framingham study showed a strong correlation between high blood pressure and heart attacks, as well as high blood pressure and strokes.

Warraich says:

The Framingham study investigators thought their job was done after they began publishing their landmark findings but quickly realized they had run into a wall—that wall was their fellow physicians. The overwhelmingly strong data they had generated failed to change the practice of either the most preeminent doctors of their time or those running mom-and-pop-style clinics in the country. And all this time, people continued to die of untreated high blood pressure by the millions—after the Second World War, every other person died in part due to hypertension. Even in the 1970s, when some medical textbooks started to recognize the importance of blood pressure, they focused on the lower number, the diastolic blood pressure, even as the Framingham investigators continued to show that it was the systolic blood pressure that mattered a lot more. Yet it wasn’t until the 1980s and 1990s, after large clinical trials proved them right, that the medical community fully embraced the findings from Framingham that had been published sequentially over many decades and had long before been supported by the life insurance companies.

(I hope to write a post about what life insurance companies say about Covid-19. Until then, the tl;dr is that life insurance companies are still uncertain about how to adjust their policies.)

To be fair to the doctors of the 1950s and 1960s, they had no way to safely reduce blood pressure other than restricting salt. The first reliable medication for reducing blood pressure was discovered in 1975—though perhaps if scientists had taken blood pressure more seriously, the medication would’ve been discovered sooner (it came from pit viper venom of all places—the viper’s bite causes victims’ blood pressure to drop so low they faint, but a small dose of a chemical in the venom only causes a small decrease in blood pressure).

Today, we have Dr. Anthony Leonardi. Do I believe Dr. Leonardi is 100% correct? No, because scientists are rarely 100% correct. Dr. Leonardi himself would probably admit that he can make mistakes. However, he has predicted the course of the covid-19 pandemic more accurately than the ‘experts’ who claimed that an infection would grant lasting immunity, then claimed that the first generation vaccines would end the pandemic, then claimed hybrid immunity would end the pandemic. In predictions about the future of the covid-19, I think Leonardi is more likely to be right than the WHO or the CDC.

Contemplating this history gives me another perspective on the healthcare workers of today who refuse to wear masks, even around vulnerable patients indoors.

Or maybe, the healthcare workers who refuse to mask even when their patients beg them too has given me a new perspective on the obstetricians in the mid-19th century who, even after encountering Semmelweis’ evidence that handwashing saves lives, continued to touch women in childbirth with unwashed hands.

Western Europe’s Cost of Living Crisis Makes My Jaw Drop

I’ve seen numbers for how the cost of electricity and fuel in Western Europe is rising. Some Western European businesses say they can’t handle the surge in prices and that if this continues, they must close. Many people in Northern Europe need fuel to get through winter—to prevent pipes from bursting and keep the physically vulnerable alive.

All this I understand intellectually, but my feelings refuse to accept this as truth.

We’re going through our own energy crisis in California now. The heat wave has led to more air conditioning, which has overwhelmed our electrical grid. Some people (including some of my contacts) have had blackouts. This is minor compared to what Western Europe faces.

If change doesn’t happen fast, it’s obvious that some businesses will fail. (Dutch greenhouses have already closed). Jobs will be lost—and how will the people who lose their jobs pay these rising energy bills? It looks like a downward spiral. Once some of these businesses are taken down for the winter, some might not come back in spring, even if energy and fuel are cheaper.

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Why Are My Novels Important Enough to Sink So Much Time Into Writing and Revising Them?

The stories which most influenced my novel-series-in-progress have this in common: they’re set in a social order which is about to collapse. So is my novel series.

One is about a French aristocrat… during the reigns of Louis XV and Louis XVI.

Early in the story, she fully believes in the social values of France’s ancien régime. Over time, she notices problems which make her lose confidence in her society’s stability. She finally concludes that the system must fall, fall in the pragmatic sense that it can’t sustain itself, fall because it’s unjust.

During the storming of the Bastille, she dies. The End.

In these stories, the protagonists often die amid the collapse. However, I’m more intrigued by the ending in which the protagonist lives. Alas, the story I have in mind doesn’t run much past the collapse.

My novel series is secondary world fantasy, so historical accuracy doesn’t bind me. (Though I research history for ideas and to check plausibility.)

The protagonist of my series has been raised to believe in her social order without question. The cracks in social order are so glaring even she’s aware of them, but she considers them to be setbacks, not a prelude to the fall.

A wonderful thing about beta reader feedback is getting granular opinions of how people interpret a story. They noticed a gap between what my protagonist observed and her interpretations. One beta reader referred to my protagonist as an ‘unreliable narrator’ (note: the protagonist isn’t the narrator, but it’s written from her point-of-view). None of them predicted the collapse, but they did figure out the true social-political situation is most likely not what the protagonist thinks it is. This is exactly how I want readers to interpret Book 1. I want them to know the protagonist’s interpretation of her world is off without predicting that this entire social order is going to fall apart in the middle of the series.

That’s right. The fall won’t end the series. It’s just the midpoint.

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The Word Is Out: I’m Working on a Novel

Has it already been a year since I wrote the first draft? (Answer: almost a year, I finished the first draft in September 2020).

Sorry I didn’t tell y’all about it sooner. So, so, so many bloggers write novels and… I was self-conscious about being yet another blogger who wrote a novel (why? Looking back, I don’t understand why I felt that way). Since I didn’t tell y’all earlier, I’ve been waiting for the ‘right moment’ to mention it.

The moment has come, even if it’s the wrong moment.

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Are Post-Humanism and Trans-Humanism Anti-Humanist?

In the same interview I commented on in last week’s post, Frank Pasquale claims that 1) post-humanists and trans-humanists are pushing for AIs/robots which simulate humans and 2) this is anti-humanist. I quote:

How, specifically, are these positions anti-humanist?

In part, an essential element of being human is accepting and understanding our limitations. Our frailties. And that effort to transcend it and say, “Well, here’s an immortal entity; let’s treat it as being above and beyond the human,” is problematic. It involves rejecting the fact that we are mortal. That we feel pain. We have a limited amount of things that we can spend our attention on.

I do not understand how trying to deal with our limitations is a rejection of their existence. As far as I can tell, this argument could also be used against writing; our human minds have limited memories, so we should embrace that and stop writing down things that we might otherwise forget. By writing things down, we are rejecting our forgetfulness, which is an essential human quality. Continue reading

When the Giver Gains More, While the Recipient Loses by Accepting, Who Is the Altruistic One?

When, in the acting of giving, the giver gains, while the recipient loses, is the giver the altruistic one?

I recently read Alcestis by Euripides (and yes, this post will have some spoilers). The premise is that Admetus is fated to die in the near future, but due to help from the god Apollo, he can live a long life if a close family member dies his place. His father refuses to die so that he can live, his mother also refuses to die for him, Admetus doesn’t want his own young children to die in his place, so that leaves just one close family member: his wife, Alcestis. She loves him so much that she agrees to die instead of him.

In the play, everyone (except Admetus’ father) says that Alcestis is the most amazing woman ever and that Admetus was truly fortunate to have such an awesome wife, and that because she is willing to sacrifice her life for him, she will be famous forever. And it’s not just this play, it was general Greek opinion that this made Alcestis a great woman (check out this mention in Plato’s “Symposium”).

The Ancient Greeks had this idea that dying (relatively) young on the behalf of someone or something else, and thus attaining everlasting fame, was the best kind of life to have. Take the example of Achilles, who, when given a choice between having a long and boring life which would be forgotten, and a short life which would bring him fame and glory, he chose the latter. The leaders of Ancient Greece initiated a lot of wars, and in order to go to war, they needed to persuade young men to risk their lives. Generally, young men are reluctant to die, so to keep up all of this warfare, the leaders needed to pound the idea that on the behalf of one’s clan or (later) city-state in battle was much better than living to old age. A famous example of this is Pericles’ funeral oration speaking about soldiers who died in the early part of the Peloponnesian War.

Even though Alcestis was not a warrior who died in battle, it’s clear that the concept of martyrdom for fame and glory bleeds over to her.

But is dying for love and/or glory is so great, and his beloved wife is going to the underworld, then why would Admetus want to remain alive? That is the crux of the story. Continue reading

Thinking about Beautiful Aliens during Pride Month

In honor of Pride 2020, I’m writing this blog post about Beautiful Aliens: A Steve Abbott Reader.

I first learned about Steve Abbott when I read Fairyland: A Memoir of My Father by his daughter, Alysia Abbott. The book walks the line between biography and autobiography, since it is told from Alysia’s perspective with first person pronouns, yet her father Steve, not herself, is the main subject, because being a single gay father in the 1970s and 1980s was *cough* unusual. Nowadays, Steve Abbott is probably much better known as The Single Gay Father of Alysia Abbott than anything else.

But I was curious about Steve Abbott’s writing, so when Beautiful Aliens: A Steve Abbott Reader was published, I got a copy. Continue reading

Let’s Put KonMari and Way of Choices Together (Part 2)

Continued from Part 1.

I want to bring up Chen Changsheng’s thousands of swords again, the material item which he has in the most surprising quantity. Those swords are quasi-conscious. They have (very limited) agency. Without someone to wield them, they can, with great difficulty, take a very restricted range of actions independently, which means that on their own they don’t do much but might occasionally do something. When they are being wielded, they can choose whether to assist or resist the wielder, so they are only useful to Chen Changsheng when they are willing to go along with him. They also form memories.

On top of all that, the swords can fly. That is how Chen Changsheng can use 1000+ swords at once in a fight – he is conducting/coordinating them rather than physically moving every single one with his hands. You can see a clip of this in the live-action adaptation and you can also briefly spot in in the 5th season opening of the animated adaptation.

This is far from a new idea in Chinese xia fiction. It’s a trope of wuxia that swords just might have a bit of a life of their own, shaped by how they have been wielded in the past. Being xuanhuan rather than wuxia, Way of Choices gets to push this old trope in a much more fantastical direction.

What does this have to do with Marie Kondo? Continue reading

A Tribute to Jin Yong (1924-2018)

Imagine that J.K. Rowling, J.R.R. Tolkien, the founding editor-in-chief of one of the most important English-language newspapers, and George Lucas all died on the same day, at the same second, and how people in the English-speaking world would react. Because the equivalent of that happened in the Chinese-speaking world on October 30, 2018, when Louis Cha Leung-yung, known by the pen name ‘Jin Yong’, died.

One of the many illustrations which comes with Jin Yong’s stories.

But I’m not going to make this about Jin Yong’s impact on the culture of the Chinese-speaking world (and the cultures of much of Southeast Asia) because, if you are familiar with Chinese-speaking cultures or Southeast-Asian cultures, you already know, and if you aren’t familiar, you’ll think I’m exaggerating. Even the New York Times understates just how huge his cultural influence was (a couple of quibbles with the NYT article: I would actually credit Wang Dulu with raising wuxia to a literary level, and the new wave of wuxia stories which got started in the 1950s was launched by Liang Yusheng; both of these writers led the way for Jin Yong; however, I think Jin Yong was an excellent example of ‘qīng​ chū ​yú ​lán’). Instead, I’m going to talk about Jin Yong’s influence on me.

This pictures evoke a lot of nostalgia for me. They remind me of the experience of reading Jin Yong’s novels.

Most native Chinese speakers encounter the stories of Jin Yong at a young age, and, if they like reading, they start reading the novels as adolescents (or younger – I’ve seen 10-year-olds reading his novels). I was not exposed to his work until I was 22 years old, which feels really late. Furthermore, during that initial encounter, my Chinese was really, really bad, certainly not enough to follow the plot. And yet, even through that haze of bad Chinese (it was ~my~ Chinese which was bad, Jin Yong wrote better Chinese than the vast majority of educated native speakers), I could sense that there was a great story if only I could understand it.

There were two illustrators who made the in-book pictures for the official editions of the novels, but for some reason, only the work of this illustrator really stays with me and evokes the feelings of Jin Yong’s stories, the other illustrator’s pictures do nothing for me.

The very first book of solid prose I read in Chinese was Jin Yong’s Shè Diāo Yīngxióng Zhuàn (Legend of the Eagle-Shooting Heroes), though it usually referred to in English as Legend of the Condor Heroes (yes, I wrote about the new English translation). I was living in a second-tier city in Taiwan which, aside from the sex trade, Hollywood movies, and Southeast Asian movies, offered very few entertainment options for people who were not fluent in Chinese, so I found lots of time to study. I first read the comic book adaptation (it is so much easier to figure out what the heck is going on when there are pictures), and then, once I knew the story, I dared to read the actual novel. Reading my first book in Chinese was like opening a door – before, I could not read Chinese, or I could only ‘read’ Chinese in a limited sense, but after I finished that book, I really felt like I could read Chinese.

Imaging staring at this picture when taking a break from plodding through dense Chinese prose you barely understand.

The first book of solid prose I read in Chinese *without* knowing what was going to happen was the sequel, Shén Diāo Xiá Lǚ, i.e. that novel I keep on mentioning in this blog. If Shè Diāo Yīngxióng Zhuàn is where I opened the door, then Shén Diāo Xiá Lǚ is where I walked through the door.

And wow, what a door. I figured there would be a big reward for learning Chinese (otherwise I would not have put so much effort into studying), but I was not sure what that reward would actually be. I had no idea, before I started studying Chinese, that novels like the novels of Jin Yong existed. It was mind-blowing.

Actually, the illustrations were a useful preview for what might happen in the following chapter as I was improving my Chinese.

One could even say that, in a sense, Jin Yong was my Chinese teacher. I learned a lot of Chinese by reading his stories. For example, I probably learned the phrase ‘qīng​ chū ​yú ​lán’ from his books. They also taught me a lot about Chinese culture.

His novels have occupied more of my headspace than any other writer – than any other artist – during my 20s. I never expected that any single storyteller would so capture my fancy. Thru Jin Yong, I discovered the wuxia genre, and yes, I came to love the works of other wuxia novelists, but it all started with Jin Yong.

When I wrote a fanfic novel a couple of years ago, even though it was based on something which was totally not Jin Yong, I felt a lot of Jin Yong coming through in my writing. In fact, I felt such a strong Jin Yong influence in my fanfic novel, that I sometimes had to pinch myself, and ask myself whether I was actually writing a Jin Yong fanfic in disguise. I suspect that, if I ever write another novel, fanfic or original, in any genre, there is going to be a heavy Jin Yong influence.

Even when I was confident in my Chinese reading skills, I would still look ahead at the illustrations of future chapters for a taste of what lay ahead. For example, I was wondering quite a few chapters in advance what role a blond European woman was going to play in the story (she’s Princess Sophia Alekseyevna, the half-sister of Peter the Great of Russia).

If you’ve read my blog for a long time (or have gone on a binge-read of the archives), you can find plenty of evidence of how much my headspace the stories of Jin Yong have occupied. I even have tried to explain what makes his stories so wonderful, though that is, at best, a very incomplete explanation. When I started this blog, I did not think I would end up writing so many posts about his works, especially not 5+ years after I read them for the first time. In fact, before Jin Yong died, I had already been planning to write yet another blog post about one of his novels (that post will be posted in less than a week).

I don’t like all of Jin Yong’s stories, but his better novels are amazing.

I actually did not upload any of these illustrations specifically for this post, I simply looked through which of the illustrations I had already posted on this blog for other posts.

If you are not familiar with any of Jin Yong’s stories, but are interested in experiencing them, here are my suggestions. If you prefer reading, I will point you to the new English translation of Shè Diāo Yīngxióng Zhuàn. If you prefer to watch TV shows, I will point you to the Sword Stained with Royal Blood 2007. It’s not one of Jin Yong’s better stories, but it’s one of the best TV adaptations available with English subtitles (you can get it on DVD with English subs; it’s also easy to find online versions with English subs).

I’m actually envious of the people who get to experience the works of Jin Yong for the first time. I benefited from not growing up in a culture where Jin Yong’s stories were super-popular because that meant the plot twists were not spoiled for me, I got to have my first encounter with the plots when I was reading the original novels directly.

I love to watch music videos of Jin Yong songs (no, he was not a song composer, but his works have inspired many, many, many songs). They are an easy and quick way to give me the feels of reading his stories without sitting down and re-reading them. Even when I see MVs based on TV adaptations I have not seen, I can usually recognize most of the scenes because his stories stick out so vividly in the mind. I’ve even written an entire blog post about one of these songsObviously, these songs/videos aren’t going to evoke that type of nostalgia in people who don’t know the stories, but maybe something comes across anyways. Thus, I will end this post with links to a bunch of songs inspired by Jin Yong stories that I like.

“Jianghu Xiao” (The Jianghu Laughs) (Return of the Condor Heroes 2006) – One of the best Jin Yong songs, and with English subs!

“Up and Down a Challenging Road” (Demi-gods and Semi-devils 1982) (content note: depiction of suicide in video) – as I have said before, I feel this is one of the songs which best captures the spirit of Jin Yong’s stories.

“Cold Feelings, Hot Feelings” (Sword Stained with Royal Blood 1985) – I think this is an underrated Jin Yong theme song.

“A Laugh from the Blue Sea” (Swordsman 1990) – In The Smiling Proud Wanderer, there is a song called “The Smiling Proud Wanderer” which a) plays a pivotal role in the plot (which is why the novel takes its title from the song) and b) is the most beautiful song the characters have ever heard. This puts no pressure at all on the composers who have to write music for the many movie and TV adaptations of novwl (I also find it amusing to watch TV actors proclaim whatever the composer came up with to be the most beautiful music ever). This is generally considered to be the best attempt to compose the “Smiling Proud Wanderer” song (which is why it was recycled as the opening theme for the 2017 adaptation). I also like State of Divinity 1996’s version of the “Smiling Proud Wanderer” song.

“Ode to Gallantry” (Ode to Gallantry 2016). I really like this song, and of the recent Jin Yong TV shows, this is the one I like best.

“On What Day Shall We Meet Again” (Return of the Condor Heroes 1983). Even though “Jianghu Xiao” is a better song, I feel this is the song which best captures the spirit of the story.

AND LAST BUT NOT LEAST….

“The Thousand Sorrows of Remembering Old Love” (song originally from Legend of the Condor Heroes 1983) – since this is a mourning song, it is the obvious choice for a tribute to the late Jin Yong (just as it is often used in tributes to Roman Tam and Barbara Yung). Indeed, this link goes to a video which was released days after Jin Yong’s death.

Though Jin Yong has died, this is not over. I am sure I will have many thoughts, and thus many things to say, about his stories for years to come.