Retrospective: Red No. 40

Above: Robert Moore, Director of Patient Simulation, Ross University School of Medicine - Bahamas campus demonstrates use of a patient simulator. (From Derek Caroll, BahamaIslandsInfo.com)

IN MY DAY,
WE CALLED HIM STAN.

2008. I remember during fourth semester in Dominica, I was ready to draw blood for a blood test on the patient. My proctor was watching me as I went for the median cubital vein for the draw, and I only pulled out air. He said, try again, and as this was my first shot at drawing blood, I mistakenly pushed the syringe in the wrong direction, pushing the air into the patient.

STOP! WHAT DID YOU DO!?
He shouted.

Back then, I didn't know. He told me I almost triggered an air embolus in a patient. Fortunately, I never harmed the patient. After a second try, I hit the median cubital vein, and I drew blood properly using the syringe method. Okay, I fibbed, it wasn't blood... more like a watery substance colored with loads of Red #40 food coloring.

----

If you didn't catch it by now, I was working on a full-blown human simulator.

I'll admit that it wasn't exactly like working on a real patient: the simulator couldn't give feedback (only through what our proctor interpreting as the patient), techniques that require fine hand skills (e.g. placement of IVs or drawing blood) could only be coarsely worked upon, and we always had a second chance if one of us did something wrong. In the case of the failed blood draw on my part, I was glad I did: an air embolus might have killed the patient.

However, it was different in years past. From a recent New York Times article by Pauline W. Chen, much of her clinical experiences on patients was done directly to real patients with that risk, and teams reviewed their cases on videotape. Now, patient simulators can be used for full clinical situations, putting away that risk that lies with working with patients needing critical care. It seems to be the answer to the ethical dilemma of if its acceptable to use patients as "airplanes or machines" (according to Dr. David M. Gaba from Stanford University School of Medicine) to test on.

With the simulators at Ross University in Dominica, we were able to work in teams of eight directly on a simulator with a professor as a proctor. And if a group of eight of us, for the first time, had issues with figuring what to do in such a critical situation, imagine us doing the same with a real patient. We'd definitely scare them, and not to mention put them at harm. The simulator room gave us a "safe zone" where we could try our best to develop a team dynamic so we could work efficiently towards the patient. Seconds count with the simulator, but fortunately running out of them doesn't mean life or death (in real terms, anyway).

The one thing I found initially annoying though was how easily the program running the patient could be manipulated. Sometimes our proctor would go right to the controlling computer and click a button, and all of a sudden the patient would be undergoing a deadly arrhythmia. However, I responded exactly as I would have with a real patients, with greater alertness toward the situation, and our team made the appropriate actions. This flexibility enhanced the realism and educational benefit of a simulator session, and in the end, I actually appreciated the switcheroo.

I really hope that simulator technology improves for the next generation of doctors, as I found it very valuable in my medical education. Thanks for the memories, Stan.

Sources: BahamaIslandsInfo.com & The New York Times

The Times, They are A'Changin'

Above: Movie poster to the 2004 film Super Size Me.

1995. The summer of McDonald's was the way I named it. Every Monday to Friday for lunch, my dad and I would go. I think we made a multi Mickey-D's trip, with one of them with the classic red/brown roof, one of them inside a Wal-Mart, and another with modern - and quite hip - styling. My menu looked like this:

A Daily Double (think Mickey D's version of the Whopper, Jr.)
A Small French Fry
A 16 oz Hi-C or Coke/Sprite Mix, with another refill.

Mind you I also was a growing 10-year-old boy with metabolism as fierce as a tiger. So, even after a full summer, before going back to school, I didn't gain many pounds. Oh I forgot, I was also totally a fan of those 7-eleven Super Slurpees (40 ounces of Brain Freeze goodness) too.

Every time my mom would come home and ask where my dad and I ate, she'd always say, "Again?"

2010. My dad and I have spent the time I've been home going to Mickey-D's once again, but this time around, especially with a metabolism more like that of a slug, traditional fast food doesn't go down well with me, so my ordering off the menu has changed:

A Wrap (either Mac, or a Grilled Chicken Chipotle)
A Side Salad
A Fruit & Yogurt parfait
A Water or a 16-oz Diet Coke, with refills

Ever since the movie with the quite appropriate name came out, McDonald's has impressed me with its healthy options. I've done the calorie calculations and the above meal calculates in at about 550-700 calories/kcals (depends on my wrap, dressing, and crouton preferences), and doesn't really blow me out of the water in terms of fat content or cholesterol. It's a pretty balanced meal.

So, nowadays, this goes to show that going to Mickey-D's isn't synonymous with bad food anymore, provided the right choices off the menu are made. And that's why Americans are getting larger and acquiring health problems as portrayed (sometimes exaggerated) in Super Size Me, some people just make the wrong choices and say those three deadly words at the counter when ordering.

However, don't get me wrong: although times have changed in the way I eat, my mom still says "Again?" when she comes home from work. I'm used to it... so is my dad.

Shortie: Accumulating the Miles

Above: Summer 2009. my 2002 Ford Focus with 22500+ miles on it.

ROADS? WHERE WE'RE GOING...
WE DON'T NEED ROADS.

Wrong, Doc Brown. For my adventure we're going to need them, and lots of them.

Starting February 15th, you'll start to hear about some of my adventures on the wards. I'll be honest: I think its too cliche to measure an adventure by days, so I'm going to go out on a limb and do it in miles. You see, my Ford Focus is 7.5 years old and has been to many places and been through many things (inclusive of: high school prom, Walt Disney World, college, weddings, blizzards, and even into stupid potholes). However, even with all that, my car still just has over 22,500 miles on it (as I've been away from the U.S. for a while). So, to me, as much as this will be important for my car to get the miles, I see my clinical years as a rite of passage, as with each mile I get on my car, I'm a mile closer to getting my M.D. and hopefully my residency.

Most of my drives will be commuting, but there will be others which will be much more than that. So... Stay tuned. We'll get that odometer running soon.

One Man, One Hospital, One Haiti

Above: A snapshot of Ian Rawson's blog accounting the care at Hopital Albert Schweitzer in Haiti.

When I was watching ABC News coverage of the Haiti earthquake, I saw someone from Haiti that I recognized from years back.

Ian Rawson is a very humble, cheerful man I met several years ago at a conference my mom went to in 2002 or 2003. I think my mom introduced me to him because he was a man who knew how things worked in the medical circuit (I had been interested in working in medicine since high school). He also was a former hospital administrator. I remember during breakfast, over some chopped fruits and a danish in a large ballroom, we were talking about how it was to get into medical school. He gave me some good encouragement and wished me the best with a smile before we had to leave. I had to take a picture with him, and it was so good it landed in one of our family albums.

A few days ago, however, there his face was on TV, and this time, not smiling... crying. As he talked to the reporter, he looked like he was in pain, as a country who he has dedicated his life to has been struck with disaster. Mr. Rawson serves on the board of directors for the hospital, a hospital that he showed that he clearly cares about. According to the accounts on ABC news, people are making a 50 mile, 3 hour trip out to Hôpital Albert Schweitzer, which was not damaged by the earthquake, to get medical care not currently present in the capital.

Mr. Rawson started a blog covering day-to-day accounts at Hôpital Albert Schweitzer. And at present he seems to be getting a hold of the situation, with surgical teams and doctors coming from the United States to take care of the increased load. With the hard work of the staff that is evident in the blog, along with the heart that Mr. Rawson has, I can see them reaching to as many people in Haiti that they possibly can. I send Mr. Rawson, the doctors, and the patients my prayers.

• For those of you interested keeping up with the day-to-day accounts with Mr. Rawson,
  Visit: http://hashaiti.blogspot.com/.
• For more information on the hospital and Mr. Rawson,
  Visit http://www.hashaiti.org/.
• To donate directly to the hospital,
  Please follow the link on his blog or the website.
  

Pass or Play?

PLAY.

We're pretty aware of what has been going on in Haiti. It's not pretty. A lot of images and stories that we're getting are coming from the truckloads of reporters (that come with the truckloads of supplies) making the trip to the hit country.

I was reading an article on Sphere, covering how reporters are doing "double duty" acting as both reporters and humanitarians in Haiti. However, this goes much against the journalistic rule of not getting personally involved in the stories they are covering. I've posted the most dramatic video footage from the article above, which features Anderson Cooper (when it says viewer discretion is advised... CNN means it) pulling a injured boy to safety. Also according to the article, Dr. Sanjay Gupta was criticized for getting into the action too often.

However, I see the journalists also as people who have human common sense. Unless the danger is too much, how can someone just watch people struggle when their two hands can make the difference between life and death? If I was in that situation down there, I'd try to give my hand where help was needed. I think many of the journalism doctors (Dr. Sanjay Gupta of CNN, Dr. Jennifer Ashton of CBS, and Dr. Richard Besser of ABC, and others) are doing right for helping out. Any doctor to help out with traumatic surgeries and to aid the hundreds looking for medical attention, is helpful. Their health care infrastructure is truly non-existent right now.

In Halti, safety is a gamble, but when the opportunity calls, (its kinda like a game show), like in Port-au-Prince, I think its worth it to take a risk.

I wish I could go down there, and from what I've heard, a lot of us medical students want to do so too. However, we are always willing to offer our thoughts, prayers, and donations to the people of Haiti.

Putting Two-and-Two Together

INVENT.

A poster in the room where I spend some of my days studying is one of few words, including the one above and "motorola.com" (from the respective sponsor of the poster), but to me it means a lot. It has various gears on the poster in a red/blue/green color scheme, and sometimes I'll just look up to Learning medicine isn't just about the memorizing of rote details and quirky facts, it requires an ability to put information together. Kary Mullis in the short TED talk I had an opportunity to watch a few days ago was a man who was able to do the latter.

Kary Mullis, who is credited for invention of the Polymerase Chain Reaction (PCR), in this talk took two very well known pieces together and was willing to take a risk with them:

1) Knowing that there are specific molecules in transplants that are attacked by the human body.
2) Knowing that there are species of bacteria that are achieving resistance to antibiotics.

Putting two-and-two together, as seen in this talk:

Why don't we come up with a way to tag these antigenic molecules to the resistant bacteria, so the body utilizes the molecule to increase effectiveness of the immune system on these organisms?

I'll have to say that is good thinking there. I betcha the idea to some scientists might have seemed quite silly at first, but Mullis went ahead and tried it. He seems to have progress with his research. And I admire him for his ideas, for that's medicine (like I've probably seen seventeen-thousand times in my blog): not just treating people, but working towards preventing any health obstacles foreseen (and unforeseen) ahead of us.

Thinking about how "simple" it was just to put those two ideas together, in reality it seems to take a lot of guts, risk, and work.

First Lecture of 2010

Above: The best of all pictures from Randy Pausch's Update Page featuring his daughter, Chloe.

DID YOU CATCH THE
HEAD FAKE?

I'm really looking forward to the year 2010. As I enter the new decade, it was welcomed by my mom and dad, my best friend Neal and his wife (who were in town visiting), and of course, James Taylor. Okay, I'll explain the latter.

It usually spend New Year's with my family (which has come to mean a lot to me), as I was never into all that celebrating/partying/yackety-smackety. I honestly think that the moment that the clock strikes 12 simply means that the calendar turns to another day. What's more important to me is seeing how the new year can mean something that +1 on the calendar but more what can I do with that year. So, I avoided anything on TV regarding countdowns (even the NYC ball drop) until the last 2 minutes of the Chicago countdown. After flipping through channels, I thought that James Taylor singing his hit songs on acoustic guitar on PBS would be perfect for a toned down night.

Taylor's One Man Band DVD is highly recommended, btw.

However, the next day on YouTube, I found a video that unexpectedly set my new year on the right note. It was a lecture given by Randy Pausch, formerly a professor at Carnegie Mellon University.

The video I found was described as his "Last Lecture," which was an academic tradition at Carnegie Mellon University that was to be given as if it was the person's final one... ever. For Pausch, it truly was. Although Pausch was championing his pancreatic cancer (he was outliving his original expectation to live 3-6 months), Pausch knew that at a point he was going to lose the battle (it had already spread to other organs). Yet, in front of a standing room crowd, Pausch proved that he was still much stronger than much of crowd by demonstrating his pushup skills (alternating between 1- and 2-handed versions). His "accidental celebrity" status (as he termed it) all started with a lecture that has attracted 10 million plus views on YouTube. In it, Pausch spoke about his dreams.

... and not just achieving them. How we make them come true. Who helped us along the way. How the dream came true even though it wasn't they way one imagined. The effort needed to achieve them. How grateful we need to be for what we can get...

In the talk he gives, called "Really Achieving Your Childhood Dreams," he tells the audience about how he wanted to play in the NFL, meet Captain Kirk, and even become a Disney imagineer (something I also have wondered about doing), and how the dreams had came true, but not in the way he had originally expected. Yet to Pausch, the outcomes were quite satisfying. I never expected to stay on board for his 1.25 hour long lecture, but his humor and personality caught my attention and grabbed my curiousity.

Just by watching the video, I knew that Pausch was a man that really wanted to live life to the fullest, and for knowing that he wouldn't be in the world much longer, I salute the man for having the strength to make the best of what remaining life he had. He used his efforts to improve awarness of Pancreatic Cancer and even coming back to Carnegie Mellon again to share more of his lessons with the graduating class of 2008. Pausch passed away that year, 22 months after his original diagnosis of pancreatic cancer, leaving behind his wife and family. Although his life had ended, he went on to motivate his family and millions of others. He was featured on news outlets such as Good Morning America, Time magazine, and CBS Sunday Morning. He also wrote a book called The Last Lecture which eventually went to become a New York Times Bestseller.

After watching and learning about the Carnegie Mellon professor, I ended up making one of my objectives this year to work even harder towards my dreams... the dream of not just becoming a doctor, but to hopefully to turn out to be a great one.

Randy, thanks for making me learn a lot from my first lecture of 2010. Here's to you.

DO YOUR HOMEWORK: Watch the lecture. It might be just what you need to start the New Year. When you get a chance to watch his video, watch out for the "head fakes" (aka deeper messages) in his lecture and see if you can figure out what they are before he tells you what they are at the end of the video (I'll give you a hint, there's two). I know you'll get a few of those "Aha" moments when you learn what they are. Just trust me.