Sunday, October 28, 2007

CDC and the White House

A good cartoon tells it the best sometimes. I am behind on this story, and a bunch of other folks have covered this really well. Such as Mr. Mooney, Pugwash, and Mr. Mad Biologist. So all I have to offer is this clever cartoon by David Horsey from my local newspaper. The incident referred to is just the latest in a string of censorship that our great leader has perpetrated against science.
I would like to think that this sort of thing will not continue after Jan 20, 2009. But something deep inside me feels like the threat of political interference in science will always be there...

Saturday, October 27, 2007

First Birth

Yesterday I witnessed my first birth. Not in recent memory have I experienced such rapid emotional cycling. I have a new understanding of the common parlance use of "emotional roller coaster," and have a new respect for the process by which human life begins. We hear in the lay press about the artificial intensiveness that hospital births impose on patients; my experience as a medical student sometimes confirms the believe that kids get put through more than they need to be. This episode pushed me in the other direction. There is a reason why certain procedures are necessary; when medicine occurs at the brink of life and death, I want life to prevail.

As part of my pediatrics core clerkship, I participate in care at the university hospital's newborn nursery. The team of medical residents I join is not the same as the doctors who take care of infants in the neonatal intensive care unit (NICU). The NICU cares for babies that have already been born and need additional care; the nursery team cares for babies immediately after birth. Those of you who have had kids, they are the folks who assign Apgar scores, conduct the baby's first physical exam and look after the babies in the newborn nursery while mom is resting in the wake of her birth. Whenever there is the possibility that the baby will not do well in the minutes after delivery, this team in on hand to revive and restore the infant's vital signs.

Our first call came in the afternoon - about 20 minutes after the other team passed the pager to us. A normal vaginal delivery had failed to progress, so the doctors decided to do an emergency Caesarian section. This was a good choice, because the baby's skull probably would not have fit through the mother's pelvis. When we entered the room, the only sounds I noticed were the beep beep of mom's heartbeat and the constant calm voice of the baby's father. Dad's retelling of their shared memories was a distraction for mom; for me it put into context the significance of what was happening. An epidural anesthetic kept mom from feeling anything but pressure below her belly button. This was important, because a few minutes after our team entered the room, two different doctors were up to their elbows (literally) trying to extract the baby. A normal C-section looks like the picture at right. The baby is removed from a horizontal cut about 8 inches long at the mom's waist. That's not what I saw.

As Dad relayed stories from their honeymoon and spoke of a recent family gathering, I provided a foot-stop so the ob-gyn resident could push the baby back up through the vaginal birth canal. Her body was at about the angle you want to see a second row lock at in a rugby scrum; 30 degrees to the ground is how you get the best forward push without falling on your face. At this point, you can expect there were more sounds in the delivery operating room than the heart rate metronome accompanied nostalgia. I was surprised about the C-section incision, disgusted by the amount of blood and fluids being schlepped about, fascinated by the procedure, and incredulous that mom was not screaming through it all.

Finally, after the longest 6 minutes I can recall, I glimpsed the baby's head and snapped back into my role. In the midst of the joy associated with seeing a new baby, my job was to provide the team with fresh warm towels to clean and stimulate the baby. The cleaning part should be obvious; the neonatal team also uses warm dry towels to stimulate the newborn. Maybe you have heard about smacking the baby to make it cry? I am not aware that this is still done, but there is still plenty of jostling that is done to help the infant take its first breath. Repeated rubdowns with a warm towel is also useful for this purpose.

When the baby was removed, there was no cry, there was no gasp for air, he wasn't even moving his limbs. Furthermore, since mom was under local anesthetic, she didn't know the baby was out until the obstetrical surgeons told her. The parents had decided not to know the gender. This was good, it was about the only positive finding we could report about his first minute of life.

They say the Apgar score at 1 minute describes how well the baby did during delivery, while the Apgar at 5 minutes tells how well the neonatal team did. When he came out, this baby's face, arms and legs were blue, he had a pulse less than 100, he didn't respond to stimulation (with a grimace or cry), there was hardly any muscle tone, and he wasn't breathing. That makes for a score of 2/10. Most births score from 7 to 9 in the first minute. Our baby had a way to go and I was scared.

Every 30 seconds I retrieved a new warm towel from the oven. In between, I watched the team slap the soles of baby's feet, rub his head, belly and flank, suction his lungs, and apply positive pressure ventilation by mask. It looked a lot like the picture at left. We were patting and rubbing him, sticking tubes down his throat, and forcing air into his lungs. All we wanted in return was for him to scream at us. After 4 minutes, he took a breath; 30 seconds later we heard a weak cry. The intern kept imploring him to tell us how angry he was. When he did, I wasn't the only person in the room with wells for eyes. We invited dad to come look. I saw immense relief behind the ob/gyn resident's face mask and noticed blood on her arm above the glove. By the time 10 minutes had come along, Seattle's newest baby boy was screaming his displeasure at us. Being stuck in the birth canal left him with some superficial head injuries, so we ordered some head x-rays just to check in on him.

Usually the pediatrics team is the first to leave the delivery room; later, after showing mom and dad the baby, a nurse transports the high risk kids to the nursery for attentive care. In this case, we were the last to leave. Our team waited for the attending physician to come and examine the baby's skull, and conducted his first physical exam. By then he had a good suck reflex, was pink and screaming and had a heart rate of about 150; his hips were healthy and he even opened his eyes. Before we left the ob/gyn attending came back to tell us this delivery was the most difficult she could remember.

Body fluids and betadine were being mopped from the floor as we carried the babe down the hall to the nursery. In my emotional state, it was all I could do to open the doors for the team. Just as I sat to collect my thoughts in the residents' lounge, the pager rang with its distinctive sing-song. I was on my way to my second birth.

Images from Wikipedia.

Tuesday, October 23, 2007


Hold on to your pants! It's time for outpatient medicine!

The previous 3 weeks of my pediatrics clerkship was spent as a member of a team of doctors caring for sick kids in the Seattle Children's Hospital. As a medical student, I cared for 1-3 patients at a time, was responsible for all of their medical needs, including: deciding which labs to run (to either monitor progress or figure out what is wrong), following up on all of the tests and diagnostics, and deciding whether the kids are well enough to go home. This was surprisingly busy, since the kids are complex, and as medical students, we spend our days committed to a number of other tasks like rounding on the teams' patients, learning from case presentations, attending didactic seminars, going to med student afternoon teaching and finishing up all of the paperwork for patients' charts. The upshot is that I worked from 7:00 AM until about 8:00 PM. That time could probably be cut down if I know more about what I was doing - but I have all year to boost my efficiency!

Yesterday, I started the first day of the outpatient rotation. It is at this cool clinic in Seattle's Central District called Odessa Brown. It was pretty slow yesterday. I observed 3 well-child checks and didn't do any charting. There were only two providers seeing patients. Today was a different universe! Four providers and 2 medical residents were in clinic. Each of them had 4-10 appointments. This meant that almost every exam room (8 of them) was full. And today, it was up to me to do the history and physical exam on 5 patients. Or was it 6? Either way, having only been used to 2 kids at a time, I think I can be pardoned if they all ran together.

There was:
  • boy with funny lip rash
  • 2 month old boy for well-child and a bunch of shots
  • 9 year old girl for a checkup
  • 4 year old asthmatic with a head cold
  • 2 year old boy with sickle cell and ear infections
So I guess it was five. That doesn't count the other patients who I merely observed. Fortunately, I just used check boxes for the well child visits, but the sick kids each needed a note. So for me, it was a sprint to the finish. Complete with the damp underarms. On the wards, I got used to having an hour to finish my complete note; now I have 15 minutes.

Everyone works like mad for 9 hours and then at 5:30, I was the last provider to leave the office.


Sunday, October 21, 2007

Teetotaling Vindicated

Recently, a professional acquaintance was surprised that I choose not to drink alcohol. I have always said that I am willing to trade the health benefits from a class of red wine a day for full control over my cognition. If it's the health benefit you seek in consuming ethanol (or is that just an added benefit), it turns out that epidemiological evidence is tipping the balance in favor of my decision.

Check out this article summarizing an unnamed, unreferenced study (I hate it when the lay media does this!) about the risks of drinking as little as one drink a day. Here are some cherry-picked quotes for you:
According to data compiled by the Centers for Disease Control and Prevention (CDC), alcohol consumption is the third-biggest cause of preventable death in the United States, after smoking and obesity. The CDC estimates that drinking caused nearly 93,000 deaths in 2001.
Alcohol reduces the risk of heart attacks and strokes caused by blocked arteries by 10 to 15 percent. That's probably because alcohol increases good cholesterol and prevents blood platelets from clumping together. "On the other hand, alcohol is detrimental for more than 60 diagnoses," said Juergen Rehm, head of public health and regulatory policies at the Ontario Center for Addiction and Mental Health.
If after I track down these articles there are elements that are misrepresented here, I'll be sure to update you. In the interim, I'll raise a glass of Diet Coke to your health. It will probably be a little while longer before word comes my way of that being bad for me.

Saturday, October 20, 2007

Normative Values in Health Care for Latinos

After finishing my first three weeks of a pediatrics clerkship at Children's Hospital in Seattle, I will spend the next three weeks at the Odessa Brown outpatient pediatrics clinic in Seattle's Central District. Whether your classification is by economic status, race and ethnicity, or language group, this clinic serves a wide diversity of patients. It will be fun to learn there.

I was reading a little about ways that different cultures interface with health care and thought I would share some of my findings about cultural values and medicine in the Latino population.

As with any cultural group, assuming that Latinos are all alike is problematic. Some studies suggest that differences among Latino subgroups (e.g. Guatemalans, Puerto Ricans, and Mexicans) do exist in terms in sociodemographics, health status, and use of health services and may be greater than differences among other major ethnic groups. Despite the differences, normative cultural values seem to exist within this large umbrella of cultural groups. Normative cultural values are beliefs, ideas, and behaviors that a particular cultural group values and expects in interpersonal interactions. Described below are five Latino normative cultural values and their potential clinical consequences.

1) Simpatía - kindness in Spanish; politeness and pleasantness in the face of stress; avoidance of hostile confrontation. Simpatía includes the assumption that physicians have a positive regard for them. The relatively neutral attitude of many US physicians may be viewed as negative, leading to decreased satisfaction with care, an inaccurate history, nonadherence to therapy, and poor follow-up.

2) Personalismo - formal friendliness; the expectation of developing a warm, personal relationship with a clinician. To promote personalismo, consider decreasing the physical distance during interactions with patients, providing contact information such as a beeper number, and showing an interest in patients' lives at each visit.

3) Respeto - respect; deferential behavior based on a position of authority, age, gender, social position, and economic status. Health care providers are viewed as authority figures deserving of respeto. Patients expect reciprocal respeto from the provider, especially if the provider is younger than the patient.

4) Familismo - collective loyalty to the extended family that outweighs the needs of the individual. Extended families, not individuals, make decisions on important issues such as healthcare. When possible, provide ample time and opportunities for the extended family to gather to discuss important medical decisions.

5) Fatalismo - fatalism, belief that an individual can do little to alter fate. Can lead to less preventive screening and avoidance of effective therapies.

It seems to me like the suggestions to address simpatía, respeto and familismo are good for the majority of patient encounters. Fatalismo seems like a more subtle aspect of a care encounter, and would be harder to address; personalismo is something that I've been working on with colleagues and friends - a pat on the shoulder or elbow and a warm smile seem to draw friends closer. I am a little tentative to try this with strangers, but will consider it.

Flores G. Culture and the patient-physician relationship: achieving cultural competency in health care. Journal of Pediatrics. 2000;136(1):14-23. Link (may need institutional access)

Wednesday, October 17, 2007

My First Portrait

Over the past week, I have had the privilege to care for an amazing patient. He is a 5-year-old with inflammatory bowel disease. If you haven't heard of IBD, it's not a very nice disease. Flare ups feature bloody diarrhea, intense abdominal pain, vomiting, weight loss and a number of other things that go along with not having a functional gut. In most cases, the clinical course includes surgical removal of the diseased sections of intestine. It is rare to develop IBD at such a young age as 5.

What made it a privilege to care for this patient was that he permitted me to experience both his lows of pain and the joys of recovery. I checked out what his poop looked like, watched the colonoscopy, examined the histology slides, chatted with him and his parents every day, and conducted a physical exam each morning. He was particularly interested in my reflex hammer.

I almost cried when he gave me this finger-painted portrait the day before he went home.

It kindof makes me want to dye my hair pink and wear green lipstick.

My patient and his family approved my posting this story. The little guy wanted to know if the picture would be on the TV!

Tuesday, October 16, 2007


How is it that being a third-year medical student can both suck the life out of you and inject you full of it?

Speaking of getting injected full of it, did you get your flu shot yet? You medical types can get it for free, and the last time I checked, my local Safeway had doses for $10. That's $10 that can save your life. In the United States, 36,000 people die every year from influenza, and 200,000 will be admitted to the hospital this season.

Last week in my hospital's virology lab, I saw the first positive viral fluorescent antigen test for influenza A in Seattle (and maybe the state of Washington). It's still a little early for the cases to be rolling in, but what you get today should protect you for the whole season.

Just do it.

Saturday, October 13, 2007

Medical Translators

This week, I had a very good experience using an interpretor on the wards. My meager Spanish skills are hardly even sufficient to ask mom how the patient feels and if there is anything I can do to help. By using one of my hospital's legion of interpretors, I was able to get all of the pertinent information about her child.

Latino parents identified language problems as the single greatest barrier to health care access for their children. A cross-sectional survey of 467 native Spanish-speaking and 63 English-speaking Latino patients at a public hospital emergency department found that an interpreter was used for only 26% of Spanish-speaking patients; professional interpreters were used for only 12% of patients.

It is bad that the hospital in the study had in-house interpretors on call, but worse is that a shortage of interpreters is a common problem in Emergency Departments in the United States. Failure to appreciate the importance of culture and language in medical emergencies can result in multiple adverse consequences, including difficulties in obtaining informed consent, miscommunication, dissatisfaction with care, lower quality of care and clinician bias.

I don't like the thought of any of these interfering with medical care. That's why I like medical interpretors.

Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783-788.

Kill Your Television

Or send it to its room for a timeout.

A recent study found that 32% of 2- to 7-year-olds and 65% of 8- to 18-year-olds have television sets in their bedrooms. The average child in the U.S. watches television an average of 3 hours a day. This figure increases to 6.5 hours a day if other media such as videotapes and video games are included.

Although television may serve as a positive educational medium, several negative associations have been described, including increased violent and aggressive behavior, poor body image, substance use, early sexual activity and obesity. The American Association of Pediatrics recommends limiting children's total media time to no more than 1-2 hours a day of quality programming and removing TVs from children's bedrooms.

Okay - maybe you shouldn't send the TV to its room. Instead, send it out of the room.

Who knew that television was a medical issue!

Science and Peace

Did you hear? Science won the Nobel Peace Prize this year.

The Nobel committee said that Al Gore “is probably the single individual who has done most” to create worldwide understanding of what needs to be done to halt the damage caused by greenhouse gas emissions. With this award, the committee also implicitly support the positive role of science in decisions made abut mankind's future.

Way to go, Al!
Way to go, science!

Saturday Reflections

If you ever have to be admitted for care at a hospital, the chances are good that you will be cared for by young people. Specifically, most of your physicians will be young. (Important note: thus far all of the hospitals I have been in are teaching hospitals; my comments therefore are affected by a skewed sample set. I will share with you my observations anyway.)

You might think that you would want an older, more experienced doctor to care for you when you are sick enough to be admitted overnight. On the surface, I would too. But I'm beginning to realize that the lifestyle of a care provider who works in a large inpatient hospital just is not compatible with having older on-call staffs.

Fortunately, saftey does not appear to be an issue for patients at teaching hospitals. Such care centers have many many checks built into them. This is one of the reasons a hierarchy needs to exist in medicine. Stratification varies between hospitals; consider the following hypothetical care structure.

One medical team may cover 30 patients on three services and work with three attending (medical faculty) physicians. Each of those attendings may have responsibility for 5-15 patients. The team is run by two or three senior residents; they've been on the wards for two or three years and are nearly finished with their training. Then there are 3-5 interns, sub interns and junior residents who are the workhorses of the team; they have direct contact and primary responsibility for the medical care of 4-6 patients. Usually teams only have 1 or 2 medical students, who do recommend care for their 1-3 patients, but also are learning and need approval for anything related to medical orders. We students can spend more time with the patients and families and can track down information important to them or the medical team.

All of us on the team spend some of our time working 'on call,' This also varies between hospitals, but basically means we work around the clock to admit new patients and cover for the care of other team members' patients. The on call part is what selects for young people. We are generally more physiologically equipped to stay alert for 30 hours straight every four days and have less social commitments (family etc) than our older colleagues. Yet between age 25 and 35, we are mature enough to handle responsibility and have learned enough to be competent.

I think that's why your hospital doctor is so young.

Thursday, October 11, 2007

Pondering Placebo

Here's a brainteaser for you:

You are skeptical about the efficacy of an alternative medical treatment. In fact, you believe said treatment works through the mechanism of the placebo effect. You do, however, accept the physiological reality of placebo. Indeed, you have the feeling that placebo is a legitimate therapeutic modality - a sugar pill works better than not doing anything at all. If you persist using said alternative medical treatment to gain the desired effect of placebo, is this cure still a placebo?

Anyway, I used this logical twist to convince my wife to try the generic version of Airborne. Evidently, if it wasn't invented by a schoolteacher, it costs $3.00 less for 120% of the doses. Then I asked the same question of the checker. He brought it upon himself by pointing out that we were trying the generic... Now he's thinking, "What a nerd."

The Pox

I was on call today. At my current hospital, this means that I work from 7A to about midnight and take care of some of the new patients that join our team. ("Join our team" has an interesting but not so inappropriate second meaning...Someone remind me to explore that later.) On the bus ride home, I realized my two charges have an interesting connection: Varicella.

Varicella is the virus that causes chicken pox. My first patient came in for an inflammatory disease, and because of his parents' beliefs about immunization, had not received any vaccines. He got the chicken pox as a toddler and then a few months later, shingles. Ouch. My second patient was a baby who got the chicken pox from a teenage sibling. The child in between (age 5) had been vaccinated and had no symptoms. My patient is 7 months old - too young for varicella vaccination.

I will refrain from comments about vaccination here, since my impression of the chicken pox is that it's a harmless disease. I will say the chances are good the facts are at odds with my sentimental 'when I was a kid' perspective.

Two kids: one from the northern and western hemispheres; the other from the southern and eastern hemispheres. Both in Seattle. With important chicken pox stories. On the same floor. Three doors down. Under my care.


Tuesday, October 09, 2007

Animal Meme

I was tagged by Kate to play a kind of get-to-know-you game bloggers play. We call them memes. The idea for this one is to talk about the way you have interacted with animals. In participating, you provide a personal side to your posts. My answers are brief - hopefully they will inspire your imaginations.

An interesting animal I had as a pet:

Aquasaurs. Basically, these are sea-monkeys on crack.
Triops sauncauditus

An interesting animal I ate:

Why be kingdom-centric?

Protist: Kelp
Animal: Jellyfish
Fungi: Chanterelles
Plant: Marigolds
Monera: Salmonella

An interesting animal in the Museum:

Jackalope. Does Wall Drug count as a museum?

An interesting thing I did with or to an animal:

I embedded an entire rat liver in paraffin wax. It's now in my living room.

An interesting animal in its natural habitat:

Coyote. Natural habitat in this case is the ravine behind my apartment. Coyotes are awesome. And ferocious.

I tag Bunnies with Sharp Teeth, Dear Science, and My Sister. Ready, GO!!!

Religious Man

So I think I have a biphasic energy profile. I wake up pretty easily and am a morning person without caffeine. Then come 5:00 PM, I hit a second wind that may last late into the night. Let's not talk about the hours between Noon and 5... Anyway, I typically hum or whistle under my breath in the morning. Yes - I am one of those people.

One of the interns (a first year resident) on my medical floor team came up to me the other day, and said, "You must be a religious man." Now, I like this doctor. He's a guy from Eastern Washington with whom I can lament our respective alma maters' losing football records. Evidently there's a saying somewhere that, "He who hums is a religious man." Anyone out there know this one? It could be en espanol.

His proverb was accurate, but what about the secular and non-religious hummers out there?

Want to know what I was humming?
If you're going to San Francisco
Be sure to wear some flowers in your hair
If you're going to San Francisco
You're gonna meet some gentle people there
Not exactly a religious song...

People That Give Me Papers

I like people that give me scientific and medical papers to help me learn about diseases.

So I think it's the PhD training, but for some reason I've developed this affinity for the dense prose of academic journals. I might actually learn well from reading (and dissecting) them. Anyone in my entering medical school class could attest to the strong correlation in me between lectures and drool, so I know the classroom's not the best way for me to learn. I've always been a tinkerer, so being on the wards and actually doing stuff works for me. But how to learn about the umpteen diseases I actually will not see this year? Maybe journal articles...

On the other side, I bet the people giving me these papers already think they are good - it's a built-in screen for quality. I bet there are a bunch out there that I might not learn so well from. I do not remember primary literature playing any role in the first two years of medical school. I wonder if my colleagues learn this way.

Monday, October 08, 2007

Asus Eee

My laptop is on the fritz. Five years of service and it doesn't want to start up sometimes and blue screens once week. Usually it just needs a timeout. Anyway, since I just will be using it for word processing and email, I am thinking of replacing my 6 pound monstrosity with an Eee PC, weighing in at just under 2 pounds. The beauty of this one is that it's all flash drive, fits in your palm and is going to cost around $250... if it ever comes out!!! It was supposed to be on sale last month, but everything seems to be hush hush. Anyway, I am on the lookout for it. I'll probably want a test drive to see if my gigantic fingers are too clumsy for the thing... What does Eee stand for?

Standing Around

I don't like how when we round as a team, I get lost in the details of the 20 patients or so that are on our board. I realize that this is the most efficient use of everybody's time, and that as a medical student it is my job to figure out the system so that I can make it work when I get to that point, but right now, I don't like the frustration, confusion and lower leg fatigue entailed in supporting the system.

Patty Cake

I like that I can play patty cake with my patient, and not have anyone think I'm crazy. More specifically, I can help Olivia the bear play patty-cake with my patient.

New Series

My five regular readers probably know that my life is in a bit of transition as I transition from lab-land to the world of medicine. It follows that my blog is in flux! While I figure out what it is I want to do with Hope for Pandora during my clinical years, I hope you will bear with me.

Here are my ideas:
  • A running tab about what I like and don't like about medical school.
  • Occasional poetry - that could be messy.
  • Clinical vignettes that are either instructive or touching.
  • Questions of medical ethics.
  • Responses (likely several news cycles behind) to local and national science & medicine policy events.
What do you think?

Museum Quality Framing

The Matt Nisbet and Chris Mooney Speaking Science 2.0 show made it to Seattle. Since I don't have much time these days, I'll leave it up to everyone else for their digests of it:
  • Matt's review describes the events and his take on how it all went.
  • Chris's interview on KUOW was one of the features.
  • Puget Sound blogger Mark Powell has his take on the evening event.
  • Science Beat writer Brian Smoliak wrote about Speaking Science in the UW campus newspaper.
  • Chris has his take on the event and FOSEP on his blog.
I'll come back and add more if there is more. The FOSEP members that planned this event did a most excellent job. Kudos to Kate, Clemens, Justin, Lisa, Gina and Rembrandt from FOSEP and Lauren from the Pacific Science Center.

Sunday, October 07, 2007

Churched Stem Cells

You know those polls that separate out weekly churchgoers and Democratic voters? Or that distinguish scientists from folks that consider themselves spiritual AND religious? Well I break both of those molds. If you didn’t know already, I am a church attending, Democratic voting scientist. So shake of the surprise when I tell you that the other day I was sitting in church and the pastor opened his prayer with this statement: “The stem cell of worship is gratitude.” Often in times of public prayer, I usually zone out into my own way of meditating, but you can bet that this time I tuned in!

As a stem cell scientist (Oh yeah – I forgot to disclose above that I am an Christian embryonic stem cell scientist), I have taken full advantage of the metaphoric power of stemness. Believe me, there are plenty of opportunities for so-bad-you-can-groan puns and fantastic wordplay built into my field. Is your stem cell totipotent, pluripotent, multipotent or omnipotent? But from the pulpit?

Any good sermonette should have some numbered points. Let me make two reflections:

1) I am really glad that Pastor Dave (he officiated at my wedding, by the way) brought science into the sanctuary. Granted, this particular sanctuary is in a church situated adjacent to a large public university in liberal Seattle. There is a reason the Clergy Letter Project exists: there is the need to infuse science conversations into church life.

2) From my elementary understanding of theology, this makes sense. Think of stem cells as the progenitor. Whether worship is the act of expressing joy for your situation or it occurs as an activity to support yourself in the context of faithfulness, there is an underlying relationship with God that is dependent on the worshiper’s gratitude. If we approach whatever situation we find ourselves in – whether gifts or challenges – in the context of thankfulness, we may be able to more clearly approach our calling or purpose. This can happen with both corporate worship (as in Church), or personal worship (like when I ride my bike into work.)

I think it is the first point that got me really excited about the pastor’s use of the stem cell metaphor. If the language of science makes it into the sanctuary, can its ideas be far behind?

Meet the Intern

After a week of being internless, I finally got to meet the person in the hospital hierarchy that I will work most closely with. I'll call her Lou. You see, last week all of the first year residents were away at a retreat getting to know each other. That left the floor teams (who depend on the dynamo interns) understaffed and the new medical students listing - especially me, having not been a part of a care team before. On Saturday, I was on call with my intern, so was able to follow someone both familiar with the hospital and cognizant of the medical student's position. At one point, she asked, "Do you learn well from reading papers?" I wanted to say, "I did just receive a PhD," but instead replied, "I think so." This could work out nicely. At least for two more weeks, when I move on to outpatient training!

Friday, October 05, 2007

Sinking SCHIP

You should know by now that the president has vetoed the State Children's Health Insurance Program, which provides low cost health coverage to poor families and children. He says it's because the program is akin to socialism. Or did he invite the kids to eat cake? I haven't had time to read the specifics.

One thing that I am happy about is that one of our chief residents at Children's Hospital in Seattle wrote a letter for us medical students and interns to sign and send to the one Washington State congressman who voted 'no' for SCHIP. Ironically, his name is 'Doc' Hastings. (He's not really a doctor.) Anyway, consider looking up who in your delegation voted 'no' and calling their staffs or emailing them to ask them to change their votes. The house is about 50 votes short of an override, as I understand it. The house is holding off until Oct 18 or so to build grassroots support for the override. You're the roots! Yes, You!

Wednesday, October 03, 2007


Fifty years ago today (10/4/1957), a beachball-sized hunk of aluminum was launched into orbit. The consequences of this single action propelled the US and the USSR into a space race. Sputnik resulted in more than escalation of the cold war. It also highlighted the role of science in society. I could ramble on about this here, or you could head over to Thursday's Seattle Post-Intelligencer to read my guest column, titled, "Where did Sputnik lead us?".

To be fair, several other Sputnik-themed articles have hit the presses. Some of Seattle's are again in the PI (by way of the Economist), and in Crosscut. I am glad they permitted me to plug Friday's Speaking Science 2.0 talk at the Pacific Science Center.

Soooo Different


Medicine is way different from science.

Details later...

Monday, October 01, 2007


The first day of my pediatrics clerkship was great. It was a little slow in the hospital, so there were not many chances for my absolute cluelessness to show through... And I am not on call tonight, which means I will be on call tomorrow, which means I will not be on call on Friday which means I can attend and do the introduction for the Seattle Speaking Science 2.0 talk!

In case you didn't hear about it, Chris Mooney and Matt Nisbet are coming to Seattle this week where they will be participating in a host of events. Head over to the Forum on Science Ethics and Policy website for more details: abstracts, times, locations, etc.

Be there and be square! (Framed that is.)