Who says you have cancer?

Only your pathologist determines the “final diagnosis” for a patient’s illness. This is the first medical book of its kind that describes pathology, the unseen doctors and workers who who are behind the scenes working for patients in every hospital. Dr. Apple donates all her book sale profits for those in need of a wheelchair through Joni and Friends, and those who lack access to food through the Valley Food Bank.

Available at Amazon

“Pathology is one of the most misunderstood fields of medicine. In Doctor Apple’s book, she makes it clear what pathologist do, the joys and rewards of practicing pathology, and why she choose to enter the field. This is a must-read for any medical student contemplating their choice of specialty, any physician trying to better understand their pathology colleagues, and any patient who may incur the services of a pathology laboratory.”Michael H. Kanter, MD, CPPS, Professor and Chair, Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine

Part IV: Martin’s Story

Chapter One

I am mad as hell! How dare they kill my daughter Julie! All the sons of bitches have to pay for this and I will make sure they pay a hefty price! Slowly but surely, I will torment and destroy them one by one starting with the lab doctor. How can the top hospital like Beverly Hills hire such an incompetent doctor who butchered up my daughter’s case? Who is this bitch? What does she look like? I just want to meet her and see her face to face. She should not be mucking around being a doctor but should just have children and a husband to attend to. And leave these matters and important job of medicine to men doctors. How could Dr. Kline, my trusted doctor, have done this to me, leaving such an important job to a woman doctor when I have been giving him a ton of money for his research? Not only that, but he also botches up my daughter’s care by not giving her radiation treatment in time. Now I regret giving him so much research money after he helped my wife deliver all three of us girls.

I thought he was my friend. Doctors are all the same, they protect each other when there is a lawsuit. And those two must have been hiding something and not telling me the truth. Well, it will all be revealed in the courtroom. My hired guns will reveal their secrets and display them in daylight. Let’s see how these doctors look when we put them on the stand and see if they can extricate themselves out of the situations. I will make sure my lawyers bite them like sharks. We’ll make them spit out all their mistakes with as much bleeding as possible. They will get a dose of their own medicine by the time I get through this lawsuit. The jury will see how vulnerable doctors really are and I will bring them down from their high and haughty white tower, prideful egos and put them to shame. Even so, I am not sure justice will be served. My Julie is still dead, and she will not be with us, forever. This pain of losing my child is so overwhelming and devastating. I can’t think about anything else but to be hyper-focused on revenge. I am her father, and I did not protect her. Feeling like a failure torments me. I have not been talking to my wife or Jane, my second daughter. Luckily, June, my first daughter is at college and there is my excuse to avoid talking. I do not have to see her every day. But Mary and Jane, I must see every day and I have no idea what to say to them. They keep distancing themselves from me, and from each other, too. Everyone goes to our own rooms, closing the doors behind. We no longer have family dinners. My wife does not want to see me anymore. She locks the master bedroom door, so I cannot even get in. She does not address me about the scene at a hotel, as if nothing happened. Sometimes I even wonder if she actually witnessed me standing with another woman in the elevator. I make several attempts to talk about this, but Mary won’t budge.

She avoids me and does not acknowledge I am in the house. Right after the elevator incident with my paralegal Beth, my wife decides to give me cold looks. She will not even talk to me. I cannot believe Mary followed me into the hotel! I almost kissed Beth in front of her. I saw Mary but it did not register I was seeing her right in front of me. I got caught. Guilty as hell. But I deny it, of course. And I will deny it all the way if Mary asks me. Sometimes women can overlook and overthink, and I can fool them to think otherwise. I still have my charm and smarts to get out of a sticky situation like this. Over time, Mary will think maybe she thought she saw things that were not really what appeared to be. I never cheated on her before this time, and we have a fantastic marriage. She will forget about all this because we have girls with us, a family. I have supported my family as a bread winner successfully. They have a beautiful house, private schools and many vacations all over the world with my company’s private plane.

We have a beautiful lake house in Lake Tahoe we enjoy every summer. I always provide for them spectacularly well. What more can anyone ask from me? I am more than a capable man and support my family in prolific abundance. Besides this little slip with the paralegal, I am a perfect husband and a good father. With Beth, it just happened so naturally. I spend a lot of time in the office, and still pull 70–80 hours a week as a senior partner. Making money can be a little addicting. As I make more and more money, I notice there is no limit to the amount that satisfies. If I make a half million dollars, then, I want to see if I can achieve three quarters of a million, then a million, and why not ten or hundred million? Sky is the limit. Nothing is more exciting than to know my capability to profit my company and earn a good living. What is wrong with that? Regarding Beth, it is momentary fire and flirtation I could have resisted, but I said to myself “why not?” Why would a capable man like me settle to have just one woman for life? Although I do not really believe women can be as capable as most men in my business, we are required to hire more attractive female attorneys and paralegals. Plus, they can be helpful in many of our cases. They somehow approach problems in different ways; shall I say more softer and at times manipulative ways, and some of our clients listen to their voices more than mine. We pay very competitively and can be choosy in selecting who will join our company. Stacks of applications pour into our place every year and we can be very selective, and what is wrong with selecting only the attractive ones? This applies to both females and males. After all, it is a fact that attractive people are more successful and they get what they want more easily. Beth is perhaps the most attractive lady in our company. She is a blond, blue eyes, tall, young and thin with figure. Her high heels make her body swing; her full buttocks, it is a killer especially with those long legs of hers crossing when she sits. She flaunts it because she knows she’s got the looks. Among senior partners, we bet who will get her first. Well, not actual money but in a joking manner. Competitive edge always serves me well. I never lose anything when I put my mind and priorities in place. When I begin sleeping with Beth I do not think through things or how it will affect my family. I’ve just got to have Beth. What does she look like naked? She addicts me. I’m willing to do just about anything when a competition is set in front of me. Being first is important, but I have to think about the consequences, unfortunately. I never think about getting caught, to be honest. Beth is becoming more demanding. “Why don’t you buy me this or that? How come I can’t see you in public? Why can’t we go to Hawaii for a vacation together?” Her annoying lists become long, and I am tiring of her whining voice, straining to fulfill her demands. We go to Hawaii, and I lie that it is a business trip to my wife.

At lunch I stop by Tiffany’s to find Beth something, open my wallet and there is not enough cash. My credit card works. Rushing back to the office, I realize Mary now pays the bills. I relinquished that responsibility to her just last month. Now I have to buy something else for Mary and cover up the first charge I just made for Beth. I forget it was from Tiffany’s in Beverly Hills and a couple days later I pick up a necklace from Nieman Marcus for my wife, not thinking whether or not it is packaged in a Tiffany blue box. On top of this, I totally forget about our wedding anniversary. I just took a Hawaii trip with Beth. 

“Oh, it’s not from Tiffany’s!” Mary screams.

I know I blew it, immediately. I have become an insensitive son-of-a-bitch to my wife. Why have I come this far? It is not fair for Mary. She has been a good wife and a good mother to my children. I feel remorse but she will not even face me, and I will tell her how sorry I am if I must. Maybe I have come too far to fool her to think I am not having an affair. My only hope is to show her how much I care about her and the family by winning this lawsuit case. That will show Mary and my family how great I am to take care of matters with my own hands. Not only do I pick five top-notch senior partners for my medical-legal team, I add five more associates who are aggressive, rising stars in our firm. I release hungry sharks to be free in the water for them to seek prey. They will have a field day as they destroy these doctors and that hospital.

Read the entire novel. 100% of profits from book sales are donated.
https://www.target.com/p/forgive-to-live-by-sophia-k-apple-hardcover/-/A-86990304

The unspoken language

Amazing patients in my brief encounters taught me their view and philosophy in life.

One such patient lost almost half of her face due to head and neck cancer. She came to the FNA clinic because of a tumor regrowth in her scar site. She was severely disfigured and shocking to see. She wore a hat and wrapped half her face with a scarf. She lived in fear that people would look at her with disbelief and disgust. She was in pain and shame. The extent people prefer to stay living by paying such a costly price is astonishing. Life is indeed priceless. She hesitated to show the lump or allow me to procure samples. As she began unwrapping her face and revealing her scar, she was crying. It was difficult to disguise the horror in my body language. I held her hand. She knew that I had my own sets of physical limitations and knew I had gone through emotional and mental pain not too dissimilar to hers. (I have polio on my right leg). There was unspoken language of understanding and compassion with each other. We had a special bond at that moment and there was a mutual understanding of enormous burdens we each carried in our daily lives. This kind of human understanding needs no words and felt between people who go through certain amounts of pain. After the procedure, I hugged her without a word. This patient helped me realize why I must suffer from my own physical limitations. From my new book, “Who says you have cancer?” available on Amazon.

Images of cancer patients courtesy of pixels-shvets-production

Unnatural action: Forgive

Forgiveness and a metaphor from Italian medical history

Pacinian Corpuscle is a major tactile sensory mechanism in mammalian skin, discovered by Italian anatomist Filippo Pacini. It detects pressure changes and vibrations in the skin. When the external pressure such as touch is applied to the skin, it senses the vibration by deforming layers of lines until the nerve ending in the center processes the touch. The Pacinian corpuscle can be described as oval-cylindrical-shaped, 1 mm in length and consists of 20 to 60 concentric lamellae (like onion rings) connected by nerve endings at the center.

This microscopic image depicts the inner struggles we as humans experience via external stimuli, especially when it is negative. Natural reaction when the core of the structure is sensed as unfavorable is to recoil, retreat, shrink, flee, and finally fight if necessary.

Act of forgiveness, whether it is given or received, requires unnatural process of action. The power of the unnatural process of forgiveness is perhaps not possible by natural selection of human ability. God needs to intervene, so that humans can live peacefully with others and our own selves.

Photo of Florence by #Josh Hild

How I measure up.

My male colleague once said, “Medicine used to be all men.”

Even now, certain specialties such as orthopedics and neurosurgery are pretty much exclusively men, secretly and sometimes outspokenly against women joining their exclusiveness. White older males perpetually dominate key positions in medicine, and their defense is, “Bring us the qualified women!” with no intention to hire a woman. How can women enter a leadership position when men are not providing opportunity into their exclusive club? 

Women are “the other sex,” the “second sex,” the “sex to be further explained.” My anatomy training in medical school featured a male body. It is the model and norm. The study of entire organ systems modeled a male body in 90% of our anatomy studies and a woman’s body introduced as the “different reproduction system,” as if a woman’s breast, ovaries, fallopian tubes, uterus, cervix, vagina, and vulva are aberrant and complicated organs. 

Researchers, usually males, further identify women with an ever-so-growing phenomenon of syndromes with mostly problematic connotations attached such as premenopausal (PMS), menopausal, superwomen, imposter, and battered women syndromes. The implication is that women are deficient and should measure up to what is considered “normal.”

This concept extends further by saying since women are hormonally dependent on their mood with a monthly cycling “problem.” Ironically, these speculations are tested to not be true that hormonal imbalance will lead to irrational behaviors. It places the burden of adjustment on women. Countless books and conferences have existed to “fix women” of their inferiorities while mostly men published lists of their problems. If women did not fit, it was their own fault.

A woman often faces a “double bind,” frowned upon for being too aggressive but weak if she is too sensitive or cries in public. What is wrong in showing emotion? Just because most white male leaders are stoic does not mean female leaders must act and dress like them and meet the same expectations in social behaviors.

Men are still the standard against which women are judged. A woman leader who acclimates well to the male norm of being outspoken, decisive, assertive, self-confident, independent, and courageous is often described as a “bitch” who lacks feminine qualities of kindness, consideration, warmth, pliability and her gaudy display of female emotions. No wonder many women struggle to find balance in the workplace as a leader. They have a double standard. The values of females become “deviant” when the measurement definition starts from males. No wonder why females often fail to measure up. 

I define good leadership as:

  1. excellent communication
  2. sound decision-making
  3. integrating connection
  4. empathy
  5. emotional cue-taking
  6. consensus-building and 
  7. mutuality

However, these leadership values become misconstrued as a “less-than or weaker” leadership style which clashes with the dominant male culture of charismatic leadership, top-down authoritative style of leadership. This is reflective of our social and family culture; he respects his father’s authoritative voice, and he runs to his mother for consolation. 

If the society’s value system were to flip and emphasize what is wrong with males, the problem lists might include an inflated or overly confident identity, unrealistic self-esteem, rigid and selfish, offensive sense of humor, insensitive, aloof, autonomous, uncooperative, angry, linear in thinking and a pathologic inhibition to express their emotion, suppression of pain, guilt, shame, remorse and fear of losing control. 

Currently, women outnumber men in college and medical schools—they account for about 55%. Women tend to have higher grades and drop out less frequently than men. Yet according to a study sponsored by the Rockefeller Foundation, women hold only 4% of leadership positions in Fortune 500 companies.

I became a leader physician believing that the mission is to serve patients by offering excellent care, to transform health care by innovative research, and to teach the next generation with knowledge, transparency, and compassion. The mission is clear which both genders are equally capable to achieve. But I came to realize throughout the centuries, women are seldom seen as chairman of the department, chef, conductor, pilot, president, CEO, dean, astronaut, ship captain, sports coach or any other visible leadership position. Women do not need affirmative action requiring women in leadership positions to fulfill an institution’s public image, and to meet a diversity quota. We do not want the job as a leader for the social sympathy and endure suspicion that we are in the “inclusive program project.” We want to be a leader based on merit and talent. As Ruth Bader Ginsburg said, “I ask no favor for my sex. All I ask of our brethren is that they take their feet off our necks.”

Women doctors share inspirational and heroic stories to successfully navigate sexism or discrimination in medicine, overcome impostor syndrome, or powerfully stand up for equity.

All of these stories are empowering and inspirational. But this too is measuring up to someone else’s standard; a mere illusion of being the winner. In truth, there are no winners or losers. No tombstones ever mention how much one worked and stood up for inequality. The writing merely says BELOVED WIFE, or MOTHER.

In the end, it is about who you loved and who loved you when you lived in this place called earth.

Being truthful to oneself and living comfortable in one’s skin in honesty may be the most heroic and meaningful story.

Read more about women in medicine in my new book, FORGIVE TO LIVE.

Mutation of virus is as sure as we pay taxes.

Viruses are efficient creatures that borrow human cells to reproduce themselves without our consent.

From the perspective of the virus, its function and purpose are to replicate and infect the host as much as they can and fast as they can.

Image of Coronavirus from CDC/Dr. Fred Murphy

Mutations in the virus’s genome are normal and guaranteed as it is copied over and over. The GISAID database identified thousands of changes along the genome. Viruses are clever and naturally select mutations that can result in a strain to be more transmissible or impervious to proposed vaccines. University College of London Genetics Institute researcher Lucy van Dorp is a co-author of a study that identified more than 12,700 mutations in the SARS-CoV-2 virus.

The naming of these variants is done by WHO, in collaboration with partners, expert networks, national authorities, institutions and researchers in the established nomenclature systems for naming and tracking SARS-CoV-2 genetic lineages by GISAID, Nexstrain and Pango. The letters of the Greek Alphabet, i.e., Alpha, Beta, Gamma, Delta is chosen to be more practical for discussion by non-scientific audiences.

The working definition of Variant of Concern (VOC)

VOC of SARS-CoV-2 are Alpha, Beta, Gamma and Delta variants which meets the definition of a Variant of Interest (VOI) and one or more of the following changes:

  1. Increase in transmissibility or detrimental change in COVID-19 epidemiology,
  2. Increase in virulence or change in clinical disease presentation,
  3. Decrease in effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics.

The working definition of Variants of Interest (VOI)

VOI of SARS-CoV-2 variants have genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape and to cause significant community transmission or multiple COVID-19 clusters to suggest emerging risk to global public health. VOI includes Eta (B1.525), Iota (B1.526), Kappa (B.617.1), and Lambda (C37) from various countries. Recently the Lambda variant has met the definition of VOC. 

So far seven VOC have surfaced throughout the globe:

B.1.1.7, (Alpha) first detected in the U.K. is known to be 50% more transmissible and found in Florida, Michigan and Colorado. 

P.1, (Gamma), first detected in Brazil and Japan, and the U.S. has reported 323 cases of this variant.  

B.1.351, (Beta) first detected in South Africa, again 50% more transmissible and the U.S. has reported 224 cases of this variant. 

B.1.427, first detected in California, 20% more transmissible, and 

B.1.429, another variant first detected in California, 20% more transmissible. 

All these variants do not have clear information whether the various vaccines are capable of protectinginfection or have significant effect on neutralization by antibodies. 

The trend appears that the states which had successful vaccine delivery seem to have decrease in death rate by COVID. 

B.1.617 (Delta variant), originated from India.

C.37 (Lambda variant), originated from South America, particularly Peru.

The coronavirus is composed of five different components: envelope small membrane protein (E), membrane protein (N), spike glycoprotein (S), nucleoprotein (N) and genomic RNA. 

The virus’ genomic RNA is a complete set of genetic instructions that is written in 30,000 “letters” of code composed of A, T, G and C.

Within the genome are various parts: see the diagram below.

Below is the process of how the virus enters into the host cell, which in this case is humans.
Schematic of the SARS-CoV-2 S protein and the mechanisms how virus enters into human cells to replicate themselves using human engines.  
a. The schematic structure of the S protein. 
b. The S protein binds to the receptor ACE2. 
c. The binding and virus–cell fusion process mediated by the S protein. 
d. The life cycle of SARS-CoV-2 in host cells. By Y. Huang et al Acta Pharmacologica Sinica (2020) 41:1141–1149; https://doi.org/10.1038/s41401-020-0485-4

Pfizer and Moderna vaccines are made from mRNA in the different spike protein area, a new type of vaccine to protect against infectious diseases by triggering an immune response unlike many vaccines which is made from weakened or inactivated viruses. Vaccines trigger immune response, which produces antibodies, which protects us from getting infected if the real virus enters our bodies. Before releasing these vaccines, both companies conducted rigorous studies and the vaccine effectiveness is proven to be 95% from the original coronavirus before mutations when tested among 30,000 people ages older than 18. This means 5% or less still can have a chance to get COVID-19 infection. While the vaccine is not effective in 100%, it is still excellent in preventing infection and at least subsiding its significant symptoms and deaths. 

Will the virus escape vaccines?

If the virus changes by mutation substantially, particularly the spike proteins, then it might escape a vaccine. The race against the virus mutations is on. As the entire population gets vaccinated, we seek herd immunity; likely ~70% of population vaccinated. The goal is to slow transmission globally and slow the clock. If people do not get vaccinations, the COVID-19 pandemic prolongs. We do not have to see any more additional deaths beyond 609,000 people. When the virus mutates increasingly, more vaccinated people will be susceptible to infection because the vaccines were not made from the variants. Time is of the essence to race against virus mutations by vaccinating most people. This is the only way to win over the war against the coronavirus.


God was with the science and scientists who developed these effective and great vaccines in the US. Both mRNA vaccines are superior to any other vaccines known from other countries including China and Russia. We can celebrate superior vaccine science in America and be thankful to live in such a great country.

Comments? Go to top of page on left.

Read Dr. Apple’s fictional novel based on real events at:

https://www.amazon.com/dp/B08P7486XX

  • Ms. Apple is a practicing pathologist…she brings a perspective to the effect of the pandemic that unfortunately is seldom seen, and millions would be enriched and informed by her unique vision…The story begins with a woman intern pathologist arriving on Hart Island to an unimaginable scene of mass burials. The web of relationships and events expands to an international scope. This is a medical but personal story, not a political one. I hope everyone can read and share this book, whose proceeds are going to charity. – Amazon book review