Incurable Optimism

Above: Michael J. Fox on the cover of his latest book, Always Looking Up.

"Simple things can change the world -

be the difference you want to see in the world."

Sam Malek, Extreme Makeover: Home Edition

Optimism has definitely been my "cuppa tea." To me, its quite an interesting concept: How can people who face battles where the odds are against them possibly see a light at the end of the tunnel. I think that strong optimists are goal makers who love to think of the extreme, and perhaps the impossible. Some people term these ideas "blue sky." (I love thinking of it this way: Without blue sky ideas, how can one possibly enjoy the sunshine?)

(One of my fellow med students has given me the nickname Mr. Sunshine, by the way.)

I finished Always Looking Up, by Michael J. Fox a few weeks ago. I loved the subtitle he threw on the book: The adventures of an Incurable Optimist. The obvious meaning first strikes: his optimism is shadowed by a lack of a cure for his condition of Parkinson's. However, I can see him meaning optimism has become such a stronghold of his life, he just can't let go of it. I think Mr. Fox does a great job of showing how it gets him through life and through his foundation and the values he advocates (not only through his public life but through his family).

It got me to think,there have been times I haven't felt a strong sense of optimism surrounding me during my medical school career. And for an optimist like myself, negativity is like kryptonite. I can recall examples: seeing motivations for studying simply driven by potential failure, healthcare agendas in congress seeming more like battlefights to avoid the worst, and even today's doctors simply saying that they either joined a specialty simply for the "lifestyle" or complain about the profession becoming a defensive one, saying our job is basically to avoid being sued.

No, it's not bad to assume the worst or to be realistic. It becomes a problem when one gets infatuated with negative ideas.

Even in the light of those ideas, I still believe medicine is about optimism. I could ask myself: Why should we take care of people, even if the odds are bad? Because, there's hope that person can continue to live life potentially to do something great. I believe that everyone has a right to go on and do something amazing, for themselves (e.g. go explore a place one has never been to before) or even society.

A quick example of the latter: Mom's been on a roll getting me to watch TV. This time it was Extreme Makeover: Home Edition. Sam Malek is a coffeeshop owner in the metro area of St. Louis, Missouri. However, Sam Malek is not your average Starbucks owner. According to Sam, a man who was born premature with cerebral palsy (an umbrella term to describe conditions where damage has occurred in brain areas that affect movement and posture), he was thrown right into a trash can. Today, he goes around with the aid of crutches, but never complains and clearly loves his life. He wanted to give others like him an opportunity he always wanted. He started up a coffeeshop called More Than Coffee, dedicated to employing those who have crutches, wheelchairs or other disabilities who might not find a job elsewhere. His idea was spurned by his philosophy, as quoted above (I love that quote). You know, had nobody taken care of him, I don't think he would have ended up taking that idea to do something that I deem amazing.

And perhaps, I've strolled across another reason why I love medicine. I see it as a field where the work we do teaches (or at least should teach) people about hope and optimism. Through our amazing job, we can teach others to be amazing in their own way too.

Proof Positive?

Above: Dr. Andrew Wakefield surrounded by supporters, found via Google Images.

VACCINES?
FRIEND OR FOE?

My mom always calls me down from upper deck (my term for the second floor of our house) to watch television programs. Sometimes, I don't really care (e.g. America's Got Talent results shows), but when my mom mentioned the words "autism" and "Dateline" put together, I said to myself, "This 'oughta be good." Next thing, I'm flying down the stairs and next to my mom I plopped myself in front of the television. The show: "Dateline: A Dose of Controversy" on NBC.

The story was behind Dr. Andrew Wakefield, formerly a researcher in Britain, now a head of an autism intitute in the Americas called "Thoughtful House." Reporting by Matt Lauer of NBC centered around the growing trend of people stopping vaccinating their children, due to a believed link between autism (a brain developmental disorder that hinders social interactions with others) and the MMR vaccine (a combination vaccine against the Measles, Mumps, and Rubella viruses), an idea being pursued by Dr. Wakefield. It was soon encouraged that patients start taking vaccinations in separate form (one shot for measles, another for mumps, and another for rubella). In the wake of his research, published in The Lancet (a reknowned British Medical Journal, similar to our New England Journal of Medicine), a slew of controversy over motivation for the research arose as families started demanding the single vaccines (creating a shortage of supply) instead of the combination vaccine.

The program also presented the pro-vaccination side of the story, featuring Dr. Paul Offit, a renowned researcher in Pediatrics in the United States, co-credited with the creation of the Rotavirus vaccine, saying that vaccines are not associated with autism and are very safe. In his 2008 book, Autism's False Prophets, he talks about the misinformation going on in the This point of view is shared among many doctors, autism researchers, and medical journals, according to the New York Times. However, in pop culture, Jenny McCarthy, along with Jim Carrey, a Hollywood-led grass roots effort has been going strong, raising questions about the true safety of vaccines. At Autism conferences, Wakefield gathers great support from parents who believe that their kids have autism.

Since the report now over a week ago, a lot of parents and advocates on the Autism Web Newspaper The Age of Autism have spoken out for their support of Dr. Wakefield, and Dr. Wakefield has released a statement saying that Matt Lauer's report on NBC had left out critical facts, such as Dr. Paul Offit's connections and associations with vaccine makers, and crediting research that has supported Dr. Wakefield's findings (Just like other mass media, bias was definitely present in this report towards the pro-vaccination point of view).

For a medial student like me, it makes me wonder, 1) Where did the distrust in medical science begin? and 2) How can we earn the trust in these people again?

That is... especially when our empirical research shows differently from what others believe. Disagreements in empirical research and in the information being conveyed to the public could take away from the giant strides that vaccines have made in fighting diseases. Outbreaks of diseases we thought we have had a control over are coming around in areas that are not being well vaccinated. If this trend grows, these outbreaks may grow.

I wish I had the answers to the questions I proposed in this entry, but at least this debate has a lot of ethical food for thought for both us clinicians and patients in today's world.

Sources: Dateline NBC, Thoughtful House and The Age of Autism.

Oh... So that's where that came from?

Above: My old workspace in the Aquatic Ecology Lab, during my old research days at the University of Illinois, Summer 2007.

“To me it was obvious, we can’t improve survival unless we test new treatments against established ones.”
- Dr. Scott Ramsey, M.D. in the New York Times.

Looking through a First Aid book the first few times may be daunting: in almost 400 or so pages, the book tries to compile the whole nine yards about the human body. And in order to compress all that information, the information comes in quick-n'-dirty tabular form, where usually the information can only be understood if school had taught that concept properly (at least with the way I studied... so I thought).

But amidst this compression, I think sometimes us med students neglect to acknowledge how much effort and time actually goes into the conclusions that is now common knowledge for medical students. At a point, what we sometimes think now is a typical fact, was previously a conclusion that was came upon due to a series of clinical trials or scientific experiments. Who knows how many studies led toward a single line of "common symptoms" that us clinicians (with the MDs, DOs, and others) need to know.

In the series called the "Forty Years War" in the New York Times, I read a few weeks ago about how getting cancer patients to participate in studies has been quite a fight. From a patient's point of view, initially, the costs mount up quite well: the treatments aren't guaranteed to work, there might be risky side effects, and there's quite a deal of "red tape" and extra meetings that the patient needs to participate in order for the researchers to gather data.

For instance, in one of the latest New England Journal of Medicine articles that I've read, 3200 patients were selected for a study. Even before the actual treatments and data collection were underway, 3059 of them were already excluded (everything from not meeting minimum patient criterium to not even wanting to be a part of the study). That left 141 people to represent the thousands of people with similar conditions in the study. That's quite a small sample, but the researchers did the best with what they had.

In the world of research, the smaller the sample size, most probably the less powerful the findings. I don't know we could exactly fix this problem though... the benefits are there, but I can definitely empathize with the patient, and their concerns. However, they are the ones that hold the power towards the progression of treatment in the world of medicine.

Using lab animals just isn't the same as using good old 100% human beings.

Source: The New York Times & The New England Journal of Medicine

Valuable Talents

Above: A former Cuban doctor continues his medical career as a nurse in the United States. From The New York Times, Maggie Steber, 8/4/09.

MORE PROOF THAT ANYONE WOULD DO ANYTHING
FOR A DREAM.

January 2009. I remember that one thing that struck me about the medical staff of Princess Margaret Hospital in Dominica was that the doctors were not just of Dominican descent. In addition to working with the natives, I also worked with a few Cubans, and not to mention an American, and a Filipino (that's luck!). I remember asking one of the Dominicans where he got his medical degree, and he told me that many of the Dominicans really don't go to Ross, but they head to Cuba to get their education. I'm guessing this partnership in medical education explains why many Cubans also found a place in medicine in Dominica.

August 2009. The New York Times featured in their Tuesday Science & Health section, an article about doctors who are fleeing from the political oppression in Cuba and heading for a life in medicine in the states. However, many of these doctors face the challenges that many IMGs face: a language barrier (see my previous IMG entry below) and board examinations that might feature knowledge that outdated textbooks in the Cuban system lack. I really enjoyed former doctor Carlos Domínguez's story about how he traveled to the United States in a boat that didn't have a reverse gear, because he knew he was never going to return to Cuba.

Working with the Cuban doctors during my fifth semester was quite a treat. When working with them, their enthusiasm for the field of medicine definitely showed through their willingness to teach (along with their patience for a set of medical students just bound to mess up). When observing one surgeon perform a hysterectomy, I can clearly remember how excited he was when he saw the patient's fibroid (an abonormal mass originating from the smooth muscle of a woman's reproductive system), and his eyes lit up exactly like a little kid in front of a candy store. After student presentations, the Cuban doctors were more than willing to announce their praise for the students and for the work that went into it.

I absolutely enjoyed working with the Cubans.

The thing I respected a lot about the doctors I worked with was their excellent bedside manner and the ability to speak with them on a first name (okay, semi-first name, because they had us put the doctor title in front of their first name) basis. They also were more than willing to crack jokes left and right to keep the mood light - for patients and for students. For me, it doesn't jive well that doctors from Cuba making it to the U.S. (many of them with great experience, work ethic, and strong motivations) are ending up not working at the level their title, and instead working in other positions in health care (e.g. nurses). Some even go on to work in other unrelated fields.

I understand that coming to the states for freedom is a dream... but there has to be a way for these doctors to be utilized. There's definite potential.

I don't know, perhaps this is a "Hail Mary" idea, perhaps they could be a part of a solution to cure our shortage of primary care physicians? From my experience, they do have the knowledge, the passion, and the ability to be a part of our American Dream of good health care. I don't think that their talents should be wasted; instead, I believe their talents should be refined.

Source: The New York Times

And now...

Above: A saying from Cesar Chavez, posted in the halls of The American Adventure, Epcot, Summer 2009.

LIKE ZACK MORRIS SAYS:
TIME OUT!

When I started this blog in January, one of the reasons I called this blog The Great Medical Adventure (instead of other options I considered like Amazingly Awesome Med Student or Slicing and Dicing for a Living) was to demonstrate how the little things in life allow me to do my best in this field called medicine, and its a long (and at times, extremely difficult) trek. However, now that I'm done with the most important exam of my life (and living in suspense waiting for the score), my adventure has me in a state which is quite similar to hitting a pause button. I'm not going to be in a hospital until I get my score back (which is an unbelievably fast six weeks), so stories from the bedside and inside the wards won't continue until then. I'm hoping I get my rotation schedule soon and can get jumpstarted with practical experience.

However, the adventure has continued in other ways.

It's six weeks (potentially less) to think about issues in health care that I might not get to learn in medical school... whether its learning a little bit more about that humanitarian side, taking some time off to read some literature and get a more in depth with some of the medical science relevant to my career... think about what fields I might really enjoy working in... and yes... take time off to enjoy life. For the upcoming entries, I'll share some of my thoughts & findings with you (the last entry was a good example of one).

However, we'll unpause soon, and we should then be blasting through the gate to continue my trek through medicine. I can't wait until I write about real experiences... again.

Soundbytes

Above: President Obama reading letters in the Oval Office regarding HealthCare. From www.whitehouse.gov, August 4, 2009.

AN AVERAGE TV NEWS BYTE IS
120 SECONDS.

Usually, I'm a fan of the quote, Time is of the Essence. However, with the recent news on health care, I see rushing the issue could be bad... very bad.

I remember being told that the average soundbyte on the news is only about 2 minutes long (after watching today's midday news, I believe it is even shorter). And, with all the news stirring about health care reform, how much can the American people be enlightened with the pros and the cons of the current bill that's being transferred into congress. I'll be honest, with the free time that's been given to me post-examination, I've been digging left and right, trying to find the core of what the bill is and why is there such a rush.

I've started reading up articles online from the New England Journal of Medicine, the New York Times, various websites stating the democratic and republican points of view upon the issue, and even rewatching President Obama's hall conference had on ABC a few weeks ago. To be truthfully honest, it seems that not everyone is addressing the same points, although there might be some overlap, and I find it rather irritating when I can't answer the question, What did the other side think?

I believe that health care is such a complex problem, that there's potential that fixing one thing might lead to exasterbating other problems that might not have been thought of. But something needs to be done.

I respect the president's goals with health care and the viewpoints too, but if I'm a medical student who's been trying to follow this with simply newsbytes, even with question and answer sessions, and now has gone to lengths to start digging for information, YET still has NO idea what the overall costs and benefits of this legislation is, what is it for millions of other Americans who are getting concerned, with only time to get their info through soundbytes? I want to make sure I'm eduated on this issue too, and I hope that my representatives and senators are making educated decisions too.

Healthcare policy is critical for everyone's lifestyle, their budgets, and of course, our economy.

Hopefully with this August recess, I can do that, but I hope that the Government slows down. However, the president is right: we need a deadline (however, realistic) or nothing will get done.

But for now, the digging continues. Soundbytes aren't enough.

Countrified 3 - Suburbified

Above: A view of the 2007 Champaign-Urbana July 4 Parade. In any Independence Day parade, nothing beats the marching guard.

YESTERDAY, I flicked on the television, and one of my classic TV favorites, The Dick Van Dyke Show, was showing. In the episode, I saw that Mr. Petrie, portrayed by Van Dyke, was having an absolute hard time trying to write the story of his life into a biography. Soon surrounded by broken furniture, and a mound of crumpled up paper, he was just so distracted by being isolated from the real world to write his story that he just gave up.

As much as I get distracted, I have keep the story going. To begin, I’m going to take you a few weeks back.

July 4 Weekend: When I was in High School, my congresswoman, was a big help to me, allowing me to volunteer in her local office for my AP Government class and helping me to learn about the ins and outs of congress when I was part of the Presidential Classroom program in Washington, D.C., during the summer of 2002. In return, I help her out every year – provided I’m not in Dominica – I usually parade with her in her congressional district.

However, it wasn’t exactly the best day for a parade, with cloudy skies and light drizzle to light rain (there really isn’t much of a difference to me). In our attire, we were ready to hit the road, awaiting deployment from the gates and onto the main street. Soon, the policemen at the end waved his hands, and our feet started marching.

We then made the turn around the corner and started our route.

A warm feeling of community started to take over me. Even on this cold, dreary day, the streets were lined with people of all races and ages, a lot waving American flags and looking upon the marchers ahead of us with a multitude of smiles. At a moment, I did have to start looking up to wonder if I really am in the suburbs. I never expected the suburbs to have a community-like feel, but at least Hinsdale, the suburb I was marching in, certainly presented itself with one. Walking in the parade surrounded me with an astounding sense of community.

I had felt that a lot of suburban communities have lost their character, with large mass-built subdivisions, with houses that have similar facades and colors and streetlamps that you could probably find on one of the nearby expressways. Nearby businesses would be pushed into strip malls, and all of them could be classified either as a “chain” or a “big box” retailer.

HOWEVER… when we turned our second corner, right into downtown, I started to look at things differently. Many of the commuter suburbs of the western Chicago area have a downtown that surround the commuter/cargo rail line that pass right through it. With the recent trend towards bringing businesses back into the downtown areas in many smaller communities in the nation, a renewed vintage feeling has been instilled in many of them. And here in Hinsdale, the feeling of a small city downtown was preserved, while allowing businesses (such as the Gap or Starbucks) to niche themselves. Wide sidewalks, lots of foliage, and vintage streetlamps really set the scene for a relaxing time for some daytime shopping, or even a classy dinner.

So, in the race about where I should live in the future, suburbia finally hits the ball into far left field for a double. The recent "Downtown Revival" occuring in suburbs across the nation is saving a suburb from becoming just another "suburb." It's true: I enjoy that feeling of being in a small town, but also with the services and the sophistication provides. Perhaps living in a suburb that values its own identity would do the trick.

That’s a critical part of an area I want to live in: it has to have its own charm and character that makes everyday not just another ordinary day.