RIP Randy Pausch

Randy Pausch passed away from complications of pancreatic cancer on July 25th, 2008. He was 47 years old, but he lived to see everything he wanted for himself come true.

He was diagnosed with pancreatic cancer last year -- the 5 year survival rate is 5% -- and this gave him some time to think. He decided to participate in Carnegie Mellon's "Last Lecture" series with a truly great Last Lecture. He talked about Really Achieving his childhood dreams. It was a silly list, as children are prone to do, but it was inspirational to hear how it shaped his life. And the amazing things he was able to accomplish because he had it all written down.

His wishes continued to come true, even after his Last Lecture (Randy Pausch's homepage) as people heard his story through friends on email, youtube and even on TV shows like Oprah and the Dateline.


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I never had the courage to make a list like that as a child. I was a pragmatic and practical kid -- I didn't want to disappoint my future self by coming up with goals like "finding the cure for cancer" or "making sure the world never forgot me." (Which incidentally, were the sorts of things I thought about growing up.)

In honor of Randy Pausch, I'd like to state my future goals/dreams as a human, a student, a future doctor and a future husband/father (distant future for both) for all to see... and perhaps, I can live to achieve them as he had, in spite of the insurmountable odds. It will be just as fantastic and random as his list, I bet.

"The brick walls are there to show us how much we really want something. They
are obstacles only for the OTHER PEOPLE." -Randy

1. Make a movie/film/short about my personal vision OF the world and FOR the world.
2. Do something significant in the field of Science and/or Medicine -- a legacy for others to follow
3. Public service/public health/community building for the people I love in the place I live
4. Go SCUBA diving at the Great Barrier Reef
5. Make my children and my wife my #1 priority, even though other aspects of my life may take more time and be more pressing (at any particular moment in time) and make sure THEY KNOW IT
6. Learn to tapdance and perform a number from Singing in the Rain
7. Write a fairy-tale about my Dungeons and Dragons characters

Hm... I'll have to put an addendum to this list. I need to go to sleep so I can get "psyched" about my Psych rotation. :)

Rest in peace Randy Pausch... I pray that your family and friends pull through in these hard times. May you continue to touch and inspire people as I have been.

100 "Health Quotes"

via ShanelYang.com

I like to read Shanel's self-help stuff... she's got a great attitude. I don't necessarily agree with her list of "100 quotes about good health", especially since it follows a "20lb weight loss in just 15 days" (which can be hazardous to your health!)... Regardless, I thought I'd post a few of my favorites here.

22. Money is the most envied, but the least enjoyed. Health is the most enjoyed, but the least envied.
- Charles Caleb Cotton

33. The best doctor gives the least medicines.
- Benjamin Franklin

59. To insure good health: eat lightly, breathe deeply, live moderately, cultivate cheerfulness, and maintain an interest in life.
- William Londen

74. The … patient should be made to understand that he or she must take charge of his own life. Don’t take your body to the doctor as if he were a repair shop.
- Quentin Regestein

94. Be careful in reading health books. You may die of a misprint.
- Mark Twain

Multiple Gestations

Multiple Gestations

view presentation

A short presentation I put together for my OB/GYN L&D (labor and delivery) team's morning report. They really liked it and I worked hard to keep it succinct (printed it out as a handout, 9slides/page = 1 page, back&front).

The best thing about it was that we had two expecting mothers on the floor with twins and I got to participate in one of their deliveries (via C-section, a Twin A vertex and Twin B breech)! So I was ready for any "pimp" questions thrown my way by the attending. :)

Unearthing Useful Reference Sites

100 Unbelievably Useful Reference Sites You’ve Never Heard Of

My girlfriend forwarded me this link. Rather than letting it slide down the list of my growing priorities in gmail browsing, I thought I'd deposit it back on the internet with the hopes of new discovery!

The section I went straight to was the Health care section. There were a few sites that I use a lot (Medline Plus and Online Medical Dictionary, for example) and a LOT that I had never heard of before. It's geared towards the interested learner more than the scouring expert, so that might have something to do with it. Good to know what's out there, though.

Health Care

Instead of Googling your symptoms, use these authoritative reference sites to get drug information, find a hospital and research a disease or condition.

31. Medline Plus: Look up anything to do with health care on this site from, prescription drugs to local resources to symptoms and diseases.
32. RxList: RxList is "the Internet drug index," and you search by prescriptions dispensed, names searched or just by letter.
33. Google Directory - Health and Medicine: Categories and individual web pages are listed on this Google reference site. Browse topics like health news, history of medicine, medical dictionaries or patient education.
34. Patient Care: Columbia University Medical Center lists a number of patient resources, including tools for finding a doctor, dentist and hospital.
35. MediLexicon: At MediLexicon, you can use the medical dictionary search, hospital search, medical abbreviations search or read all the latest medical news.
36. InteliHealth: This reference site has an Ask the Expert section, as well as a database full of information for diseases and conditions, from asthma to digestive issues to weight management to STDs.
37. Healthfinder: This government site features a Drug Interaction Checker, a Health Library and consumer guides.
38. The Merck Manual: Search this online medical library for diseases and conditions and drug products.
39. Bristol Biomedical Image Archive: Browse thousands of biomedical images on this site.
40. Online Medical Dictionary: This simple search tool lets you browse by letter or subject area.

Leiomyoma

Leiomyoma

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What is a Leiomyoma?

As I described their physical characteristics to some of my non-medical friends, one of them excitedly exclaimed "ooh! they are like little tumor pearls inside your uterus!" Yes, indeedy. I guess they could be like that... or they could become much fatter and larger and gunkier.

Dancing around the world

Where the Hell is Matt? (2008) from Matthew Harding on Vimeo.
Via Astronomy Picture of the Day

Explanation: What are these humans doing? Dancing. Many humans on Earth exhibit periods of happiness, and one method of displaying happiness is dancing. Happiness and dancing transcend political boundaries and occur in practically every human society. Above, Matt Harding traveled through many nations on Earth, started dancing, and filmed the result. The video is perhaps a dramatic example that humans from all over planet Earth feel a common bond as part of a single species. Happiness is frequently contagious -- few people are able to watch the above video without smiling.

For some reason, I got really emotional watching this clip. The spark of common humanity touches me.

Pre-Med content featured in this month's NEJM

Relevance and Rigor in Premedical Education
Jules L. Dienstag, M.D.

In recent decades, scientific knowledge has changed dramatically, once-settled scientific principles have been replaced by more sophisticated concepts and entirely new disciplines, and parallel changes have occurred in medical practice and health care delivery. In the face of these new realities, medical school curricula have had to adapt. Yet despite these sweeping changes, including the permeation of most areas of medicine by molecular and cellular biology and genetics, requirements for admission to medical school have remained virtually unchanged for many decades.
...

This article talks about the ever-expanding knowledge base required to become a physician... and Dienstag questions whether or not the old admission criteria for medical school are appropriate for the always-lifting expectations of our future doctors.
1 year of biology + 2 years of chemistry (1 yr gen chem, 1 yr o-chem) + 1 yr physics isn't enough. I agree.

However, I don't think that raising the bar on the admission criteria will somehow magically improve the crop of incoming medical students. Some of my best friends in medical school are History, English, even Real Estate majors and they are excelling. They have admitted to me from time to time that they struggle with some of the basic science subjects we are forced to learn rapidly on our own (i.e. microbiology, embryology) but really... would requiring people to take these courses as an undergrad really be beneficial? A lot of what I learned as a biology major WASN'T applicable to the study of Human Medicine.

Regardless, Dienstag makes a good point that the best pre-med courses would be INTEGRATIVE... encouraging students to make connections across basic science subject lines. I wonder if medical schools could ever require this, since it would be a pre-med subject that would vary greatly based on the lecturer (as no textbooks exist for such a course.)

From All Walks of Life — Nontraditional Medical Students and the Future of Medicine
Sandeep Jauhar, M.D., Ph.D.

When I was growing up, my parents wanted me to become a doctor, but I had other ideas. I wanted to be a television journalist, or perhaps a trial lawyer or private investigator — something with panache. In college, intoxicated by the mysteries of the universe, I ended up studying condensed-matter physics, in which I eventually earned a Ph.D. But after a close friend contracted an incurable illness, I began to have doubts about my career path. Seeking a profession of tangible purpose — like many older students — I was drawn to medicine.
...

Jauhar talks about the benefit of having "non-traditional" students in a class of students straight from college. While they possess different qualities of maturity and dedication, knowing full well the luxury of a student's lifestyle (as opposed to working paycheck to paycheck with little other reward)... they also have fewer years of output towards society before they end up retiring. They also have more outside life to attend to, with husbands/wives and kids. Can the U.S. medical system afford this in the long run?

I think this is the major sacrifice we have to make to have more well-rounded physicians. More female doctors, more older students, more foreign graduates will help to break down the stereotypes of the medical profession. In the ideal world, I think everyone would be a physician -- basically, the knower of their own body -- in the philosopher-king, artist-scientist Renaissance sort of way where we can all be equally enlightened in our equal access to the information we need (Yay, internet!)

PocketMod on the Wards

The PocketMod is a great way to stay organized while you're running around on the wards. It turns a piece of paper into a mini booklet that you can use to write down patient data. I use it to scribble down the Vital signs and daily information I need when I'm rounding on my patients in the morning. It's also good for writing key notes for the wards.

I have three or four different PocketMod booklets in my white coat right now:
1) Tips for the Wards (with sample admits, checklists)
2) Tips for OB/GYN (with the key parts of the SOAP for post-partum and post-op patients)
3-4) Patient logs (tracking data for the patients I've picked up that day.
* the first page always has the current date in the corner, the room # of my patients, their date of admission and other relevant quick tidbits
* each subsequent page has their patient care summary, Friedman's curve progress, daily vital signs, I/Os, H/H, Rh/Rub/GBS status, etc.

Since I've just finished with OB/GYN inpatient and I'm moving onto Psych, I'm in the process of making a new PocketMod with specific psych info. Since my Psych handbook is online, I'm toying with the idea of doing an e-version and posting it online as a sample.

Gamers ought to do SomethingWorthwhile

So I have a lot of friends who are gamers. They play games in their free time (which they have in abundance, much to my dismay) as a way to... avoid boredom, I suppose. Entertainment is an important "virtue" in today's commercialism-driven society.

Some of them play World of Warcraft. It's a role-playing game where you play a fantasy character like an elf, orc or minotaur and you run around and kill things, take their loot, get powerful gear and new nifty skills. It might sound like I'm disparaging this game, but I really like these sorts of games. I play D&D a lot. It operates on the same principles and I've often converted action sequences in movies directly into game terms.

Take the latest Indiana Jones movie for example. There's an action sequence where Indiana Jones hears a countdown after visiting a surreal little town only realize that he's in the epicenter of an atomic bomb test... and he has less than a minute to find a place to go. Hurriedly, he rushes around the house, jumps inside a lead-lined refridgerator and gets blasted like a piece of shrapnel away from the explosion. The fridge tumbles on the ground and he falls out. Climbing the hill, a huge mushroom cloud blooms up, silouetting him in the desert landscape. I was very excited by this totally impossible scene, because it makes total sense from a gaming perspective. If you throw a character into a deadly scenario, there's always a way out. Since he's a lucky sort of fellow, he made a reflex saving throw and he's got evasion so he took practically NO damage from this explosion!!!!!

Anyway, what I'm trying to say is that RPGs are a way of sharing structured dreams/fantasies/stories with your friends, be it on TV, your computer or in the theater. SecondLife has found some surprising ways of being useful in Real Life:
People can have virtual conferences with each other.
Crippled patients can experience walking and enjoy easy mobility.
People can exercise as they traverse a virtual world.
People with anxiety disorders and social phobias can interact with others in a safe environment.

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I know some people who like to play Pokemon. They know a bunch of random information about the statistics of Jigglypuff or Jujubee or whatever cutesy names are in the game. Each monster has a set of abilities that allow it to fight effectively against a certain foe. There are magazines dedicated to the constant updates to the card game that outline the latest strategies! People pay money to memorize random useless facts about imaginary foes battling each other?!?!?

Shoot, if people spent even a fraction of this effort learning something remotely useful during their entertainment, they'd be set! I propose that Microorganisms be introduced to the world of Pokemon. Instead of Pikachu, kids could learn about the Influenza virus and it's ability to have genetic drift and genetic shift-- requiring new flu shots every year and terrifying people with the possibility of a deadly new epidemic. Then they'd be learning about REAL monsters.

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People sit around and play Solitaire or Minesweeper on their computers all day at work. Why not do something constructive with your mindless puzzle gaming?

Researchers at the University of Washington came up with the idea of combining protein folding scoring and gaming... and put together a puzzle game called FoldIt!

Medgadget shares a little story about the genesis of FoldIt:

Predicting the shapes that natural proteins will take is one of the preeminent
challenges in biology, and modeling even a small protein requires making
trillions of calculations. Over the last three years, volunteers around the
globe — now numbering about 200,000— have donated their computer down-time to
performing those calculations in a distributed network called Rosetta@home.... With the inherent fun of
competition, Salesin thought a multiplayer online game was the way to go.... One
match between teams from the University of California and the University of
Illinois aroused unexpected fervor and cheering among spectators. “30 or 40
people participated,” says Baker. “The competition was very
intense.”
“Foldit” takes players through a series of practice levels designed
to teach the basics of protein folding, before turning them loose on real
proteins from nature. “Our main goal was to make sure that anyone could do it,
even if they didn't know what biochemistry or protein folding was,” says
Popovic. At the moment, the game only uses proteins whose three-dimensional
structures have been solved by researchers. But, says Popovic, “soon we'll be
introducing puzzles for which we don't know the solution.”