Posts by Doctor Sophia

One of our hidden doctors. Pathologist, author and seeker of truth in medicine and life.

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

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

America suffers from a deficit of imagining the lives of other people

Everyone knows someone in their lives who died from COVID-19, and everyone knows someone in their lives who is not willing to get vaccinated. Yet the relationship between these is not necessarily correlated. 

As a physician, it is sad to see the public losing confidence in our medical doctors, CDC, WHO and public health care professionals in general. One reason for this loss of confidence is that people are becoming more skeptical and critical to believe in medicine, and even the medical field’s mass recommendation for vaccination. Perhaps this is due to a preponderance of incorrect information in social media, and particularly, unknown sources. Even traditional media generates stories by reporters who do not have a medical degree or scientific understanding often misrepresent or poorly cover stories.

Here are the primary reasons I hear from people who do not want to receive vaccines:

  1. Vaccines are not safe. Many have a suspicion for everything that goes inside the body. The media inadvertently exacerbates this belief by accentuating side effects after vaccinations, such as “a nurse passed out after getting m-RNA vaccine” before the outlet obtained the scientific evidence and facts. Humans are primed to pay attention to threats or negative information. The subsequent beliefs are hard to change because they are initially based on fear, not logic or evidence-based medicine.
    Even the sunshine is an external element which enters our body to produce vitamin D, but if too much, free radicals can cause skin cancers. What’s not taking things in? Chemotherapy and radiation therapy are taking things in, helping to kill cancer cells. Nearly every person in the US takes over the counter medications, and even these alter the natural mechanisms of our bodies. Food is taking things inside of our body. Everything can be beneficial or harmful at the same time. Vaccines help alleviate infection and avoid death.

Even the sunshine is an external element which enters our body to produce vitamin D, but if too much, free radicals can cause skin cancers. 


2. COVID-19 vaccine went through an unprecedently rapid process with shortcuts, no proper vetting or concern for the safety of humans.

“FDA’s speedy decision for emergency usage of the vaccines was coerced. It was a rapid decision by the federal government with pressure from the big pharma companies without observations of short and long term side effects.” (This is a perfect storm for a conspiracy to evolve by asking questions which will use the scare tactic in general population). “What about the other substances or ingredients such as fatty component aside from m-RNA genetic codes in the vaccine? What if there is an access genetic code or other substances that can trace people who received the injection? What if that code can detect the privacy of the people?”

“Social media was created to help consumer’s needs. Later, businesses began using social media to detect and trace almost everything about us. What if the vaccine substances were also initially created to stop the spread of coronavirus, but later have everlasting negative impact on a person?”

What if the vaccine saves lives? First, let us have life to even worry about “what ifs.”

3. Refusal to see COVID-19 as a serious threat.

“The former president’s experience was not serious, and his claims that the coronavirus was not a big deal were ridiculed by many democrats, who also exaggerated the death rates and its risk.”This thinking has resulted in making the vaccine effort more of a political view instead of a scientific view. To some, COVID-19 is like a mild cold and to some others, it is deadly. As a physician and pathologist, the 609,000 death rates in the US are most likely an underrepresentation. Why take risk of hospitalization, long- haul symptoms and death, when one can have definite benefit of preventing infection and death in a vast percentage of people?

4. Previously infected people with COVID-19 will have natural immunity to protect them.

Even President Trump received two doses of vaccines after he contracted COVID-19. He was never against vaccines. He pushed for vaccine discovery. Some research indicates that the vaccine provides stronger immunity than infection via T-cell activations.

5. Concern for side effects that we do not know about are not told.

Mostly I hear, “I saw somewhere that Covid may cause…” Doctors have documented injection site pain, muscle and joint aches, low fever, fatigue, or in extreme rare cases, blood clots. Unknown, undocumented, and unproven long term health risks like “infertility” are flooding social media and drowning out medical facts and scientific documentation. Why trust unknown sources of science, medicine, and news? Why trust in hearsay? It is like midwives’ myths from old.     

6. No trust in vaccines, institutions, companies, government or even the health care system in general.

The public has lost trust in CDC, WHO and even their own medical doctors. The social media growth is exponential, spreading misinformation and hearsay theories and conspiracy so easily. A good dosage of skepticism is healthy. The CDC has indeed conducted themselves poorly at times and wavered on decisions of masks, for instance. Medicine is never a doctrine but a practice. We call it medical practice, and our practice improves as data grows on open source scientific websites. Research and medicine are more transparent than ever. The coronavirus which caused the pandemic is a novel virus, and initially induced medical and scientific findings as scientific discovery and experimental groundwork. CDC and others are trying their best to figure out the virus as we go and recommending guidelines during current circumstances and new findings. The vaccine is not just an experiment. Look at the results and read the scientific findings instead of believing hearsay news that is intentionally and often anonymously fed into each person’s social media feeds and online search results.

We believe these true stories shown on the left. Why can’t we believe true stories from a vast majority of our medical experts?


7. Younger people trust their own immune system to fight back against the coronavirus, and often believe healthy diets, regular exercise, and healthy lifestyles protect them.

Younger people do have better immune systems in general. In 2019, COVID-19 killed older patients with pre-existing conditions but recently, younger people are also dying; 4,535 deaths occurring from March through July in younger adults ages 25 to 44, or 38% of all excess deaths in that group. Not knowing which groups of younger adults may be more susceptible for death, trusting your own immune system blindly is not wise. “Smart” people are those who prevent a mistake by learning how not to fall into a trap, but “wise” people are those who prevent a mistake by observing how others live and learn from those who fell into a trap. Nearly all victims of serious COVID-19 complications regret not taking a vaccine.

A real electron microscopic image of coronavirus image; look how many viruses are attacking respiratory ciliated human cells. Image produced by US researchers shows SARS-CoV-2 virus particles (red), covering human bronchial cilia (blue), and mucus (yellow). (Ehre Lab, UNC School of Medicine)

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.

8. Poor access to get a vaccine.

This is very unfortunate and still quite common. Door-dash vaccine programs and easier access to vaccine sites is urgently required. Millions of elderly and poor community folks may not have access to a computer or technical savvy to register on sites like MyTurn.com. Many people have no transportation even an appointment can be made.


When will this pandemic pass?
It is entirely up to you by getting in line for vaccination. If the virus changes by mutation substantially, particularly the spike proteins, it leads to a distinct possibility it will escape current vaccines. If that occurs, vaccine development begins again, and likelihood of more lockdowns.

We are in a race against mutations.
It is necessary we all come to a sense of protecting others and protecting the more vulnerable members of society and becoming socially responsible; benefit the whole community rather than arguing for individual or selfish interests. Part of the decision to reject a vaccine should include this fact: Decisions not to get vaccinations is resulting in other people dying—for whose sake? 

America suffers from a deficit of imagining the lives of other people.

Chapter 9: Santa Clara Coroner

From my debut novel

February 6, 2020
Payman found Bita dead in their bed on the morning of February 6, just 17 days after Bita could not go to work. Some days, she said she was feeling much better and ready to get up and go to work, but she noticed as soon as she got up she felt too weak, and would fall over.

She spiked a fever again and found herself in bed the entire day. Payman wanted her to go to the emergency department in a nearby hospital, but Bita refused because it would have cost a fortune, and they wouldn’t have been able to pay it. She told him she would be okay if she just rested.

Payman noticed that Bita had stopped coughing and waking him up constantly that night. He had a good night’s sleep for a change, without being interrupted by her movements or coughs. Now, he found her dead, not moving at all and already cold to touch.

Sheer panic set him off, and he ran around the apartment, not knowing what to do. Bita’s parents said to call the ambulance. The kids were dumbfounded and kept shaking their grandmother to get up. Payman called 911 and frantically reported that his wife was dead. The 911 dispatcher sent the ambulance within 10 minutes. The ambulance workers then called the county coroner’s office and the police department.

Soon the whole apartment perimeter became like a crime scene with yellow tape all over the place, a few neighbors gathering to see what was going on in their building, and a white truck with a huge CORONER sign parked nearby. No one could go into Payman’s unit.

Bita’s parents went outside, escaping from the sight because they couldn’t distinguish whether these police officers and other people from the coroner’s office were from the immigration office. All government agencies in uniform were a danger sign to them, and they ran as far away as possible from them.

The kids and Payman were standing outside when the investigation began, not knowing where exactly Bita’s parents were. They probably went out to the nearby park, Payman thought.

Photo by Keira Burton





One police officer asked Payman for the details of how he found his wife dead. He thought they were treating him like he was already a criminal who killed his wife. Somehow, he was stuttering like a guilty person answering the questions. The police made him come back into the bedroom where Bita was still lying in their bed. Payman worried his grandkids would run somewhere to find their grandparents while he was trying to answer what happened that morning when he found his wife dead.

The coroner workers were wearing white coverall suits and taking photos as the police officer directed. Then they moved the body and took Bita into the coroner’s truck. Payman signed the paperwork to give permission to conduct an autopsy at the county coroner’s office by the medical examiner. All these steps were new to him. He did not know why she had to get an autopsy. The police officer said all deaths occurring at home need examined by the medical examiner for possible homicide, or suicide. There was no other information given to Payman as to when he could get the body back for funeral arrangements, and he couldn’t think about asking appropriate questions. He did whatever the police and coroner’s officers asked

By the late afternoon, they were all gone. Bita was also gone. The only remaining thing was the yellow tape around his unit, and a part of his building entrance. He went out to find his grandkids and in-laws. Luckily, they were standing across the street and Payman went to them, hugging all of them, and cried. They all joined in and began to wail.

The Santa Clara County Medical Examiner-Coroner was Dr. Melissa Jordan, who conducted the full autopsy on Bita, including her brain. She signed off on the cause of death on the certificate as pneumonia. Bita’s lungs were heavy and congested with serosanguinous fluid within the pleural cavities. It fit well with a flu caused by influenza, as per the patient’s history of symptoms. Influenza causing pneumonia claimed thousands of lives per year. Dr. Jordan did not see any telltale signs of murder. She sent the blood sample and pieces of lung sample from Bita to the CDC as a precaution to rule out other possible infectious etiology. Bita was only 57 years-old when she died.

Read the entire novel. All of the author’s royalties are donated to those in need. Go to https://www.amazon.com/dp/B08P7486XX

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