Pragmatically Blind

A few months ago I listened to an episode of a podcast called Invisibilia and the topic was expectations. They recounted how expectations can have both positive and negative results, and talked to a blind man named Daniel Kish who has a remarkable sense of his environment.

What struck me most about the discussion was not the discourse surrounding sight or the lack thereof, but on the arguments in favor of or against the use of 'clicking' for blind people to navigate their world (referred to as echolocation). Many blind people are discouraged from clicking, it seems, as they are told that it is not socially appropriate. By whose standards is it not appropriate? By sighted people.

I find it appalling that individuals out there "helping" people are limiting functional behaviors which can foster independence because people with sight may not understand it or somehow find it uncomfortable. In this case, it's not blind people who need to adjust, but everybody else.

Movement and the Brain ⇒

A very interesting case study came out recently, looking at the neurological function of a particularly active 93-year-old woman named Olga Kotelko (she died in 2014 at age 95) . She became an athlete in her sixties playing softball, then started track and field at age 77. Exercise benefits are often assumed to apply to our physical state, and it also seems to be associated more and more with good mental health. This study took things a step further and looked at her overall brain function to see if her routine exercise had any impact on both the brain itself as well as cognition.

“In general, the brain shrinks with age,” [University of Illinois Beckman Institute postdoctoral researcher Agnieszka] Burzynska said. Fluid-filled spaces appear between the brain and the skull, and the ventricles enlarge, she said.

“The cortex, the outermost layer of cells where all of our thinking takes place, that also gets thinner,” she said. White matter tracts, which carry nerve signals between brain regions, tend to lose their structural and functional integrity over time. And the hippocampus, which is important to memory, usually shrinks with age, Burzynska said.

Previous studies have shown that regular aerobic exercise can enhance cognition and boost brain function in older adults, and can even increase the volume of specific brain regions like the hippocampus, Kramer said.

Kotelko’s brain offered some intriguing first clues about the potentially beneficial effects of her active lifestyle.

Though it wasn't strongly emphasized in the article, something else really grabbed my attention:

“During dinner after the long day of testing, I asked Olga if she was tired, and she replied, ‘I rarely get tired,’” [Beckman Institute director Art] Kramer said. “The decades-younger graduate students who tested her, however, looked exhausted.”

It really does seem that our culture has a problem with sleep. I'm as guilty of not getting enough sleep as anyone. I have a bad habit of getting only around 6-7 hours of sleep per night. I blame the amount of things I have on my plate at any given time for this, but the likelier truth is that if I would get enough rest, I could probably manage all of these things with greater efficiency.

In any case, one of my goals since transitioning settings has been to both increase the amount of sleep I get and also start to exercise more. Forming new habits is hard, but watching Olga herself on video shows that it's clearly worth it.

Farewell, Oliver Sacks ⇒

Oliver Sacks, famous writer and neurologist, has died. From his website:

Oliver Sacks died early this morning at his home in Greenwich Village, surrounded by his close friends and family. He was 82. He spent his final days doing what he loved—playing the piano, writing to friends, swimming, enjoying smoked salmon, and completing several articles. His final thoughts were of gratitude for a life well lived and the privilege of working with his patients at various hospitals and residences including the Little Sisters of the Poor in the Bronx and in Queens, New York.

It's interesting to read his thoughts on life and death, as well as cancer. Cancer has had a profound impact on my family this year. Knowing that death is approaching is a strange feeling, especially for someone you love. The biggest challenge, I think, is keeping perspective, which Oliver Sacks always did well. From his New York Times op-ed in February 2015, when he revealed his terminal cancer diagnosis:

I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.

That fear can be both for the person with cancer and for their loved ones. These words are helpful even for those who survive their loved one, and I hold them close to me always.

Rest in peace, Oliver Sacks. Thank you, for everything.

The Importance of Sleep ⇒

This New Yorker article (a 3-part series) has been showing up a lot in my internet world recently. It's a worthwhile read and one that's meaningful both for patients and for clinicians. For my part, I wonder how much adequate sleep might be helpful for preventing burnout.