DPhil Diaries #4

ICYMI, Parts 1, 2, and 3 are here.

Many (most?) people start their PhDs with at least some element of impostor syndrome i.e. the feeling that you are not good enough, or don’t have the necessary competencies, to actually get this thing done. I certainly felt that way when I started my own journey. Mornings were no longer about hectic ward rounds; instead, I found myself staring at my computer screen, trying to figure out if I should read another scientific paper or just call it a day and go to Blackwell’s home.

Eventually though, things begin to fall into a natural rhythm.

In my case, getting started with neuropsychological testing, calling up participants for MRI scanning, all these helped me establish a routine so I could feel like I was doing something. Of course, everything changed drastically during the pandemic, but at least I knew then what I needed to do, even if it was difficult or impossible to do right then because of all the lockdowns.

Alhamdulillah, I am now in my third year of this DPhil programme. Things are beginning to fall into place. In fact, I can honestly say that I am beginning to enjoy myself. It feels strange to describe a PhD as a vacation, but compared to the hectic life of a clinician, it sure is nice to be able to set aside some time to think about how the brain works, how stuff like memory work etc. Don’t get me wrong, life as an academician is far from easy, but it cannot compare with the life-and-death decisions that one sometimes has to make as a clinician. If I have any regrets about this PhD, it’s the fact that it’s too short. Three years is just about enough to begin to appreciate the complexity of what you are studying, but such is the reality of modern life that you feel like you constantly have to rush from one thing to another just to keep up.

One thing I’ve learnt is that it is important to celebrate small victories around the way. This week, I gave a presentation during our weekly lab meeting and for the first time, I felt that my work met the high standards expected here. I shared with my lab-mates the results from one of my behavioural experiments, and also some work I’d done on probabilistic tractography using diffusion MRI data. Both are not finished yet, but I got some really good comments from the wonderful people in my research group.

Like I said…small victories.

Anyway, in case you are still reading this, I’d like to share with you a quote I got from God-knows-where. I absolutely love it because it reflects the hard work and dedication necessary to achieve big things in life. It goes like this:

Choose your corner, pick away at it carefully, intensely and to the best of your ability and that way you might change the world.

As always, thank you very much for reading.

North Wales

How do I even begin to describe an area like North Wales? Even now, looking at the vacation pictures I took in July this year, I struggle to find the words to convey how beautiful this region is, with its mountains, lakes, waterfalls, and walking trails. I’m not a city person, not by any means; a few hours in London is about as much as I can tolerate, but honestly, I could happily spend ages exploring a place like North Wales.

Upon arriving, we met up with my wife’s cousin Muhsin and his wonderful family who are lucky enough to call the area home. We couldn’t have asked for better hosts (or tour guides, for that matter). I’m not going to bore you with a rambling description of our trip, rather I would like to share with you some of my thoughts and observations about the places we visited that weekend.

Bala Lake

Bala Lake was our first stop, although we didn’t do much apart from snapping a few pictures while the children splashed around excitedly on the shores of the lake. You can rent paddle boards, kayaks, yachts etc. if you had a day to spare.

Cregennan Lakes

Getting there was not easy, involving steep climbs up twisting roads, but it was well worth the effort in the end. Quite simply, this was one of the most beautiful places I’ve ever visited in my life!

Located 785 feet above sea level, the lakes lie beneath the slopes of the Cader Idris mountain range. If ever there is a place you need to see in North Wales, this would be at the very top of my recommendation. When I said that I struggle to describe the view around me, this was what I had in mind.

Betws-Y-Coed

I had to look up the pronunciation for this one; Welsh is such a unique language! It means ‘prayer house in the woods’, which reflects its roots as the location where a Celtic Christian community founded a monastery in the late 6th century CE. Nowadays, it has become a hugely popular tourist attraction, a must-stop for anyone visiting Snowdonia National Park.

Nant Gwynant

Along the way to our next destination, we stopped at some random parking lot that turned out to provide some of the best views of the region. In the distance, occasionally shrouded by low-hanging clouds, was the peak of Snowdon, the highest mountain in Wales. I thought to myself “No wonder people like Muhsin don’t want to leave this place!”

Padarn Country Park

Home to Llyn Padarn, the Vivian Quarry, and the National Slate Museum. Apparently people can dive into Vivian Quarry (if they are crazy enough, naturally) but the path to the quarry was closed when we visited.

It was late evening when we got there, so I just did my wudhu’ (ablution) by Llyn Padarn and prayed with Muhsin next to the lake.

Afon Idwal

Afon Idwal is a waterfall carrying water from Llyn Idwal in Cwm Idwal. There are some steps leading up the mountain but I only went a short distance as my son had already fallen asleep by then. The views here were breathtaking, especially with the waterfall in the foreground and the cloud-topped mountain in the background. We saw a sheep stuck at the waterfall; a few brave souls tried to rescue it but the poor animal simply refused to budge.

Ty Mawr Country Park & Pontcysyllte Aqueduct

The first place we visited on Sunday morning, complete with a ‘Nasi Lemak’ breakfast courtesy of our host! In the background was Cefn Viaduct, and not far from the place was Pontcysyllte Aqueduct. Those of you who are not afraid of heights can try walking across the aqueduct (see video below). Alternatively, you can also cross by boat if you are so inclined.

Coming away from this trip, I wish more people can see the majesty of places like Snowdonia National Park (and North Wales in general). Perhaps then, we will realise how inconsequential we are in comparison to God’s earth, and how we owe a duty to future generations to preserve what we have around us. In closing, I am reminded of the verses below from Surah Ali ‘Imran in the Quran:

There truly are signs in the creation of the heavens and earth, and in the alternation of night and day, for those with understanding, who remember God standing, sitting, and lying down, who reflect on the creation of the heavens and earth: ‘Our Lord! You have not created all this without purpose– You are far above that!– so protect us from the torment of the Fire.

Surah Ali ‘Imran [3:190-191]

The Business of Aducanumab

I’ve written before about how the makers of the controversial drug Aducanumab are selling hope for $56,000/year, but after thinking and reading more about the topic, I’ve become even more convinced that whatever hope they are selling isn’t actually for patients, but for cash-strapped medical centres and drug companies.

Consider this article in JAMA Neurology. As far as I can tell, the author is a very decent person and accomplished physician. But I find it painful to consider the mental somersaults required to portray a positive scenario out of an astoundingly bad decision by the authorities:

Even opponents of the FDA’s decision, and there are many, ruefully concede that it could be the solution to our lack of a business model. Its delivery as an infusion means physicians will receive approximately 4% in revenue from the drug’s $56 000-per-patient annual cost. There is also revenue from the imaging studies and visits to evaluate for possible adverse effects. Funds will flow into memory centers.

And later on in the article:

As this happens, we will have support to hire more colleagues. Our work will of course focus on “whether aducanumab is right for you.” We will talk about its risks, uncertain benefits, the co-pay, coordinating the imaging visits, how to watch out for signs of brain edema and microhemorrhages, and APOE testing, but this education can expand to other topics such as how to organize a day that is safe, social, and engaged. That is exciting.

Wow, how exciting!

In particular, that part about how they will (of course!) focus their work on whether aducanumab is right for patients, well, let’s put it this way, if I desperately needed to believe in some nonsense, that’s exactly what I would say to myself in the mirror.

Much better is this follow-up article, again in JAMA Neurology, about ‘What the Aducanumab Approval Reveals About Alzheimer Disease Research’. It focuses on the lack of Black patients in aducanumab trials, but makes a broader point about the need for more inclusive research in general.

Something is horribly wrong with the healthcare system in America. The fact that an unproven drug like aducanumab can be recommended for use shows what happens when you prioritise profits over the welfare of patients.

Christmas Light Festival

The start of any festive season isn’t an exact science. In Malaysia, for example, as we approach the fasting month and Hari Raya Aidilfitri, more and more places start to sell ‘kuih raya’, or play Raya songs or offer Raya-specific discounts for random items like washing machines, curtains, and cars (!).

Here in the UK, I am beginning to see more and more signs of Christmas season, albeit with the threat of ‘storm clouds‘ (according to Boris) following a dramatic rise in Covid cases in Europe.

The Oxford Christmas Light Festival is one such sign. Various events are happening around the city between the 19th and 20th of November (yesterday and today) including a Victorian Christmas Market, light trails & shows, as well as a photography workshop.

Right next to our house, Cutteslowe Park has been turned into its own festival of light. I’ve written before how trees often remind me of neurons (see ‘Neurons in Nature‘, ‘Dendrite‘, and ‘Dendrite Again‘) but yet again, I was reminded of this fact upon seeing the trees illuminated from below. Here are some pictures from our area:

My favourite picture is this one, which I call ‘Ice & Fire’ in honour of George R. R. Martin.

Ice & Fire

Hopefully this will motivate him to finally finish the novels before, you know, the inevitable happens. All the best George! 🧙🏼‍♂️

Oh, and in case you wanted to see some videos of the light trail, I’ve got you covered as well:

One Keyboard To Rule Them All

I have a dream.

In that dream, I am the owner of a house.

And in that house, there is a room which serves as my refuge from the outside world. It is the place where I can work, think, read, and write in peace. On the wall there is a map of the world courtesy of National Geographic, next to some framed pieces of Islamic calligraphy. The walls are lined with bookshelves full of my favourite books.

In the middle of the room is my desk, complete with a top-of-the-line Mac desktop. Why would I need a top-of-the-line computer? God knows, but hey, it’s MY dream, so I can put any computer in it that I want, mmmkayyy?

More importantly, in front of the Mac is this beautiful keyboard from Drop, complete with its Lord of the Rings keycap set:

It’s a nice dream.