No Place Like Home

Spokane has been nice. It's a good place for students to learn medicine. I've learned a lot, and could probably take the final right now and pass. So, thank you Spokane.

There is, however, something about Seattle that whispers to me: "home."

We head there tomorrow. For 4 weeks. It's been 14 weeks since I've lived in the Emerald City; I have some catching up to do. The truth is that I'll see a lot more of Harborview Medical Center than of my 'real' home. But that doesn't matter to me now. My next post will be from the comfy chair in front of the fireplace.

Jackhammers

Fortunately, there was someone on the other side of the brick wall trying to get out, or trying to help me through. I'll probably never know.

It's amazing to me how just a small connection formed with other people can help overcome stress, anxiety and malcontent. Medicine is too full of emotional brick walls for us to get by on our own. Sometimes just the presence of another heartbeat - or in my case, an ECG crew - is all you need to break through.

Hit the Wall

These days, there's a new one around every corner. Just when you get the hang of something, bam, there's another one to climb. Studying, scheduling classes, seeing patients, sleeping. There's always a new challenge. If you have any tips on that last one, I am accepting suggestions.

Neal Lane on ScienceDebate 2008

Both the Washington Post's and the NYTimes' Live Blogs have noted tonight's debate to be the last of the primary season. Clearly, they are forgetting about ScienceDebate 2008. Or else they think the primaries will be locked up by April 18, 2008.

In November 2006 I had the pleasure of hosting Neal Lane for a visit to the University of Washington. The UW's Forum on Science Ethics and Policy invited the former NSF Director and Bill Clinton's science advisor to speak about the future of science in America. He and a large number of science superstars have come out in support of ScienceDebate 2008. Here is a video of him making a case for it.




Find your favorite science star at this page.

Grand Rounds!

Bertalan Meskó of ScienceRoll has compiled a wide assortment of posts for this week's edition of Grand Rounds. If you need your med blogging fix, grab some coffee and head over there...

SPUWing Science and Policy

Hey Seattleites! The Science Policy at the UW social group is meeting this week in the back room of the College Inn Pub. It's an informal meeting where you can chat about, discuss or argue science and politics. Students, faculty, staff and members of the local community are all welcome. If I weren't in Snow-can, WA, I'd be there. Get more info at www.fosep.org.

Wednesday, February 27 5:30 to 7:30

Ben Stein: Tasteless

Have you heard of Ben Stein's latest farce? It's a movie called EXPELLED: No Intelligence Allowed, and is billed as a response to the 'suppression' that Intelligent Design has experienced. Well, the film was supposed to open on February 12 - Darwin's Birthday. I was looking forward to viewing and reviewing it while I was on my outpatient medicine rotation (more time to myself = more blogging... Hi Dr. Novan!) but now they've up and changed the opening date to April 18. I'll be on surgery then!

Leave it to the movie's proponents to point out that this moves the opening from Darwin's birthday to the day he died (April 19). And some of them revel in this decision!

Bad form, guys. Tasteless.

Blogrolling

I updated my blogroll this evening because I was tired of reading about neurology.

White Coat Underground's slogan is "Musings on the intersection of science, medicine, and culture." That is strikingly similar to my own "Where science, medicine and society collide - and something good comes of the mess..." The author is anonymous, so you don't have to put up with any stories like the personal vignettes I tell.

DrugMonkey is no stranger to this blog, but I only now have updated his ScienceBlogs link in my blogroll.

The Inverse Square Blog is authored by a science writing professor at MIT. Reading it makes me feel like I'm sitting on a steam vent in the park on a cold winter's day. His slogan is "science and the public square." (It's just the vent keeping my science writing urges warm.)

I also put the Science Blogging Ethics Wiki in my linklist. Check it out and contribute if you have any bright ideas on that front!

A Democratic Jesus

It's been a while since I've posted anything in overt reference to religion on this page. A piece in the Washington Post today got me fired up, though. I'd encourage all the liberals (religious, skeptic and/or atheist) out there to read this nice article by Amy Sullivan.

She uses some great examples of people from different backgrounds and intentworking together toward a common goal and wraps up with the following account:

Walking through Dulles Airport not long after losing the 2004 election, John Kerry was stopped by a supporter. The man shook Kerry's hand and told the senator that he was an evangelical. "I voted for you," he said, "and so did a lot of evangelicals. But you could have gotten more of us if you'd tried." Kerry was floored. Evangelical Democrats?

No wonder Kerry fared worse among evangelicals than any other Democratic nominee in modern history, losing the votes of nearly four out of five. To engage a constituency, a campaign needs to at least know it exists.

Even so, the Democratic nominee this fall will have advantages Kerry never did. Sen. Hillary Rodham Clinton is a lifelong Methodist with years of experience teaching Sunday school in Arkansas who's married to the party's most prominent evangelical Democrat. Obama, a committed Christian, is more thoughtful and relaxed talking about religion than any other Democratic politician. Most important, they'll have the support of a party that is slowly starting to see that there are many faces of the faithful.

There is a reason to make friends on the other side of the aisle. We may not all agree on everything, but a lot of us agree that something needs to change. Let's find that small voice of hope and use it to tie us together in common cause.

Just Ignore Him

Sheesh. Not again! In announcing his bid this time, Ralph Nader almost endorsed Barack Obama.

He called Mr. Obama a “person of substance” and the “first liberal evangelist in a long time.”

Let's hope the trend of his support by the electorate follows from his past two bids:

2.7% in 2000
0.3% in 2004
0.04% in 2008

Drug Reps 'R Us

Now five months in to my third year medicine clerkship, I'm pleasantly surprised about how little interaction with pharmaceutical company representatives I've had. As I get deeper into it, I am realizing just how tenuous the dynamic between pharmaceutical innovation and controlling costs in health care.

I am pleased to report that I still feel uncomfortable in the setting of drug company schwag or it's provider. Sometimes I feel the same squeamishness I've felt witnessing (illegal) drug transfers. Is it a coincidence? In doctors' offices: Who's the pusher? Who's the dealer? And what does that make the patients? Are they stuck in a crossfire?

Here are a few personal vignettes about my encounters with (legal) drug dealers.

Before my clerkships, I often attended the University of Washington's Chairman's Rounds each Tuesday. That food was provided by a rotating ensemble of drug company reps. They asked for attendees to sign in, and would actively seek eye contact of the audience as we filed in. If I were dressed less formally (PhD casual), I would occasionally be interrogated about which department I was with. (My answer was always pathology.) Most times, I clipped on my medical school ID badge kept my eyes focused on the food or floor and walked past them without noting the company or drug. After all, I was there to keep up my clinical mind. I did take the food, however. Some other students and residents (but never faculty) brought or bought their own lunches...

My first rotation at Seattle's Children's Hospital was pharm-free. The free food at the daily noon conference was provided by the residency program rather than drug companies. Monday's World Wraps and Wednesday's fish burritos were my favorites. Then as an outpatient in the pediatrics clinic, I discovered that the patientmedicine samples were provided by Children's Hospital, not by drug reps. In fact, some of the residents placed the absence of "pharm food" as a positive attribute for that program.

The next stop on my magical medical mystery tour was a family practice office in Anacortes, WA. They had kicked the drug reps out years before in favor of samples provided by Group Health. The idea being that enough of the practice's patients are insured by Group Health that it will pay off to get docs in the practice of handing out and prescribing the generic meds on GH's formulary that it will benefit the insurer even if the docs give the samples to non-Group Health patients.

For the last 7 weeks, I've been in Spokane, WA for my medicine clerkship. The only evidence of pharmaceuticals at the hospital where I worked were in the ubiquitous pens and post-it notes on the floor. Not until my outpatient experience have I had direct contact with drug reps. In the endocrinology (diabetes, thyroid and hormone problems) and dermatology (rashes and acne) clinics, I've encountered piles of free handouts, cabinets full of samples, company provided patient handouts, occasional lunches and the well-dressed woman with a clipboard. "Who is this attractive lurking specter?" I wondered the first time in the endocrine clinic? She was just waiting patiently for the doc to sign a clipboard acknowledging receipt of the samples. She got in one sentence before my preceptor informed her that she had more patients to see.

I am being gradually exposed to the tight grip of pharmaceutical companies on medical practice. Fortunately, I am also experiencing some of the push-back that entities as different as private practice and world-class health care institutions are giving. Whether its the cold shoulder given by docs as they sign the receipt or the broad resistance of entire hospitals, there is certainly a tension that was not there 10 years ago. The consequences of doctors giving free samples of brand-name drugs is not always obvious to patients or doctors. But I'd like to think that the next generation of physicians is ready to approach health care in a less expensive, more sustainable manner.

We shall see.

Fair

Fair is a principle I have been concerned about as a kid. It's probably why I'm interested in ethics, social justice and even medicine. It's also what got me to reading George Will's recent opinion piece in the Washington Post. I appreciate the last paragraph:

The president who came to office with the most glittering array of experiences had served 10 years in the House of Representatives, then became minister to Russia, then served 10 years in the Senate, then four years as secretary of state (during a war that enlarged the nation by 33 percent), then was minister to Britain. Then, in 1856, James Buchanan was elected president and in just one term secured a strong claim to being ranked as America's worst president. Abraham Lincoln, the inexperienced former one-term congressman, had an easy act to follow.

And I was just rewarming to Hillary Clinton...

LOL Zygotes

I'z got 2 faces
I zgot 2 faces
1 zygot, 2 faces
1 zygote, 2 faces

And no, I didn't do any Photoshopping on this one. Read all about it!

Mooned!

The moon passed through the lower aspect of Earth's shadow (also called the umbra) this evening resulting in a total lunar eclipse. My previous attempts at photographing the eclipse failed for three reasons.

1. No good camera
2. No good telescope
3. No tripod

Thanks to Spokane's cloudless sky, look what I can do now!

Actually, I didn't need any of the above to get this image. Instead, I found a nice picture with the help of Mr. Google, then I rotated it in Photoshop to get to just the right angle, then voila! A striking representation of what I saw in the Spokane sky tonight. Well, except that the craters and plains on the moon's surface are in the wrong location...

Update! My former labmate from PhD land was interviewed on Seattle's King5 news about the eclipse. Watch the news segment here, and read about the Green Lake experience on her blog.

Passing (on) Gas

Are you as alarmed as I am about the cost of oil reaching $100 a barrel? Chances are good that you're just worried about 87 octane costing $3.00 a gallon. What are we going to do about it? I've been carpooling. But that's a pretty short term fix. Jonathan Golob (known to some as Seattle's only scientist) has put together a nice little call to arms over at his blog. In a rally the troops approach, he's thinking about environmentally friendly potential of oil shale and coal as dominant American energy sources. It's easier for me to get behind other (closer to implementation) innovations like residential solar, wind, and even geothermal production than by ravaging the land for its energy. But that doesn't mean you shouldn't surf on over to DearScience to read what he has to say. And after you're done there, go over to the World's Fair for an excellent essay linking $100 oil with Cuba.

Total Eclipse of the Heart

I mean moon. Total eclipse of the moon. And for West Coasters, it's at a reasonable time! 7:30 PM! Here's NASA's diagram explaining when to look on Wednesday night:


If you live in a different time zone, go to this page. 'Supposed to rain or snow in Spokane, so I'm not going to get my hopes up for seeing it this time. At least I witnessed the full lunar last August in Seattle.

High School Science Bloggers

I recently stumbled upon the efforts of a high school biology teacher to increase her students' fluency in online learning and discussion. I think it is smart to introduce them to the science blogging community, and what could be the future of science communication. Elissa Hoffman at Appleton East High School is moderating a blog called Endless Forms Most Beautiful, and she is looking for guest bloggers. Here is my unauthorized want ad placed on Hope for Pandora on her behalf:

Seeking scientists who can capture the attention and imagination of AP Biology students in east-central Wisconsin. Duties include posting one or more 500-1000 word entries to a weblog and participating in the online comments section. Candidates need not be local. Compensation in the form of warm fuzzies.

Sound interesting? Read this informational page. Cruise around the other entries and responses, too. But avoid this post.

How Much Longer?

Medical school is full of firsts. Last Friday afternoon included several. Femoral ABGs, chest compressions, calling time of death. There is too much to unpack in one post - I've yet to parse through the entirety of my thoughts. My first attempt at relaying the complexity of experiencing another human's death is up over at The Differential.

Look for more here soon.

Flicker

My wife and I installed a homemade bird feeder fashioned from a gallon milk jug on our back fence. So far, the only critters who frequent it are a pair of squirrels. We've seen a bevy of quail in the park on the other side of the fence, and a few stragglers have investigated the seed strewn in the snow by the messy rodents. But to my knowledge, no birds have actually visited the feeder proper. You can imagine my delight when I saw a flicker sitting above the feeder trying to decide if it was safe to jump down to munch on the delicious seed. It's fair to say that:

The flicker was on the fence about the bird feeder.

Photo lifted from the NaturalVisions Birding Website.

Lincoln Park, Spokane

I am very fortunate during my stay in Spokane, Washington to be living in an apartment that backs up against a nice little patch of nature called Lincoln Park. In the snow, my wife and I can snowshoe out the back door and hike over to our own private sledding hills. Now that the temperature has risen, much of what we thought to be permafrost is thawing. Our afternoon reward for studying was strewn with slick rocks, muddy runoffs, iced puddles, and to say the least, uncertain footing. This brought to mind a conundrum:

When is a walk in the park no longer a walk in the park?

Six-Word Memoir

The World's Fair and in an echo, Adventures in Ethics and Science have issued a challenge:

If you had to write your memoirs in 6 words, what would they be?

This was based on a book called: Not Quite What I Was Planning: Six Word Memoirs by Writers Famous and Obscure, edited by Smith Magazine. Since I've been struggling to get my oral case presentations down to a concise 3 minute overview, this is a pertinent exercise for me. I started out with a list, but it sounded too much like a personal ad. I challenged myself too a sentence. My working six-word autobiography is:

Pieces converge for love and health.

What is your 6-word memoir?

Takotsubo Cardiomyopathy

For all of you out there with Takotsubo cardiomyopathy, or something like it, try not to let today's consumeristic holiday bring you down. And for those of you with something to celebrate today, I would recommend tucking some of those tokens of love away for when your sweetie is least expecting it. Like on Flag Day or something.

But lest you think me a total scrooge, I did purchase a couple of doses of phenylethylamine for my true love.

Looking Good After All These Years

Chuck D turns 199 today.

Hero to some. Pariah to others.
Misunderstood most of the time.

We're still talking about you and your ideas, Chuck.
I hope you don't mind.

Reinventing the ER

Since emergency medicine is near the top of my list of medical specialty choices, I often think about how the emergency room functions in the treatment of emergencies and, well, not-so-emergencies.

One way that hospitals are starting to address the challenge of caring for such diverse patients as car crash victims, IV drug users and uninsured folks with chronic disease is to stratify the care given after you walk through the door (or metal detector). For example, San Francisco General Hospital's free wound care clinic for IV drug users saves a lot of money by providing care there rather than in the expensive ER. By moving less urgent cases into a special care track, hospitals can save money and provide more appropriate care.

An article in today's NYTimes spins it a different way:

An increasing number are taking steps to bring civility and even hospitality to the emergency room, in part because, for all their turmoil, they remain vital points of entry for paying patients whose eventual admission accounts for needed revenue.

So not only is the ER a place to provide health care, it is the point of entry for revenue producing units - I mean patients. So we better make them happy or they will take their care (and reimbursements) elsewhere! Unfortunately the article focuses on remodeling costs and a laundry list of NY City ER's that are under construction.

There is great potential for improving the frontline care for uninsured and underinsured ER users. Sure, customer service reps are nice, but I am guessing that patients really just need problem-focused care. (Score one for family medicine!) If I go into emergency medicine, I want to be part of creative solutions to sorting what is a mixing pot of symptoms, diseases and emergency that keeps medicine affordable, but send patients home less likely to return.

Science Debate 2008

Science is important. It will be more important in April because of:
You don't know how catchy that sounds until you speak it aloud. Say it with me, "Science Debate 2008." Now with syncopation. Now in a group with your friends. There we go - that should be enough to convince you. If not, continue reading.

A couple of units of time ago (I'd put my money on months), I signed up to support Science Debate 2008. I have to be honest, though: I wasn't entirely sure what I was supporting. In principle, the idea is easy: collect the remaining standing presidential candidates to answer questions about science, health and the environment. Among my many questions about this concept were: Would candidates for president actually all come together to debate science? How would you involve Democrats and Republicans before the nominations were set? Would people care?

I underestimated the mobilizing power of Chris Mooney and Sheril Kirshenbaum of The Intersection. They have collected a wide range of Nobel Laureates, university presidents, politicians, science bloggers and regular Joes to endorse the idea. And now with the help of the AAAS, the National Academies and other major institutions of science, a date has been selected and the four remaining candidates have been invited Philadelphia's Franklin Institute to talk about science.

How appropriate! In the tradition of Franklin's Junto, these four leaders will come together to debate questions of morals, politics, and natural philosophy. Yes, I too can dream.

Is your name among the list of supporters? It isn't? Head to this site to sign up. Don't think it matters? You're wrong! There are currently 13,000 signed on to this idea. The networks and media folks need to see an interest among the people to make coverage effective. That's you! They're current goal is 20,000. If you want to do more, contact the campaigns or write letters to your newspaper. If you wish to consider this more carefully, head over to Nature magazine's story about Science Debate 2008. They remain skeptical of the idea, but I believe their criticisms are mostly hollow.

This debate could have an impact on Pennsylvania's primary or could be one of the first formal interactions between the presumed nominees from each party. Either way, I think Ben Franklin would be proud.

RADAR

Sorry I've dropped off the radar the last few days. I had a last minute trip back to Seattle to take care of about a hundred things - all of which needed taken care of and some of which couldn't wait until March. I'll fly back to Spokane tomorrow morning. Meanwhile, I'm hanging with the undergrads at the UW's Odegaard Library while I finish up a response to reviewers.

The reason I decided to make a post is an observation from Saturday's caucuses. About 160 folks from my precinct showed up. 5 delegates went to Obama & 3 to Clinton. The strange thing about the speeches people gave was that several individuals decided to vote for Clinton because the media had wronged the Clinton family, made fun of Chelsea, or otherwise unfairly represented Hillary. Few people actually detailed the candidates' positions. The most interesting speech was by a man my age who had lived in Obama's state legislative district in Chicago before moving to Seattle.

I've procrastinated enough. Back to the grind.

This post was brought to you by the Doctor.

And Speaking of Artificial Hearts...

Those Lipitor (atorvistatin) ads featuring Robert Jarvik make me puke. (Only recently could I fully appreciate the connection with Pfizer's commercials and emesis.) Of all the drug company commercials, this is the most non-sequitur. The basic premise is:

• I'm a doctor.
• I invented an artificial heart.
• I take Lipitor.
• I feel great.
• You should take Lipitor.
• You'll feel great.
• You'll be a doctor.
• You'll invent an artificial heart.

Why did this bother me? Maybe it's because I know Jarvik never has seen patients, he's no cardiologist, and he hasn't done much since crafting together a mechanical artificial heart that was only implanted in a small number of patients because it turned out to cause lots of strokes. Maybe I am jealous of his success. Maybe I just really despise drug company commercials. Maybe it's because simvastatin (the generic form of Zocor) is way cheaper and has the same effect as Lipitor. Maybe it's because Jarvik looks like Randall from Monsters, Inc.

Okay, maybe not that last one.

It turns out that some other people think the Jarvik Lipitor relationship is fishy. There's a big splash in the NYTimes today about how Jarvik misrepresents his physical activity level in the commercial where he is rowing in a scull across Washington State's Lake Crescent.

Someone did dome pretty good digging on this one.

Artificial Poetry

I know. You're itching to read some poetry inspired by my time as a clinical technician for the artificial heart program at the University of Pittsburgh.

Check it out over at The Differential. Then tell me what you think. Really. I have thick skin.

Voting in Washington State

Washington voters: You're up!

My last post about how to vote in Washington State was convoluted and heavy on personal commentary. Here is a simple explanation, with appropriate links.

Are you a Republican? If so, half of the delegates will be determined by a primary election, and half will be decided in the caucus this Saturday. Go to the state party webpage. That site will connect you with each county's party, but you will need to figure out your precinct in advance. If you are in King County, use this tool.

Are you a Democrat? All of the elected delegates are decided this Saturday at the caucus. You might as well tear up your absentee ballot. Democrats in Washington have never used a primary to decide a presidential candidate; hey probably never will. To find your caucus location, go to the state party caucus finder. You only need a name and a zip code, and that server will tell you where to go for the caucus and will remind you of your precinct number.

What's my precinct number? Good question. If you know your precinct number when you get to the caucus, it will save you from waiting in a long line. Most counties have web lookup tools like this one for Martin Luther King County.

Haven't registered to vote? It's too late for you to vote in the primary/caucus, but it's never to early to register for the vote that counts the most. In the state of Washington, you can register online.

Want to know your voting history and information about where to vote? Go to the Washington Voter's Vault. There you can be reminded of which elections you have participated in back to 2004. Which is pretty cool.

Want to Reed more about the primary and caucus system in Washington state? Check out this useful FAQ sheet prepared by the Secretary of State.

Were you thinking of trying to spoil the other party's election by crossing over between the caucus and the primary? Think again! From the FAQ sheet:

Voters can participate in both the party caucuses and the Presidential Primary as long as they participate on behalf of the same party.

Both major parties plan to hold their caucuses on Saturday, February 9, 2008, ten days before the primary. The parties will invite voters to participate in the caucuses and will require participants to sign an oath declaring their party affiliation.

Voters participating in the Presidential Primary will be asked to sign an oath submitted by the political parties indicating that the voter has not participated in the other party’s caucus process. Each party will receive a list of voters who chose to affiliate with that party in the primary.

Is there anything else you need to know? Well, you should probably have a good idea of who to vote for pretty soon. If you haven't made up your mind, Clinton (Pier 30 warehouse Thursday), Obama (Key Arena Friday) and McCain (Before the 2/19 primary) will all be visiting the state in the coming days. Michelle Obama will visit Spokane and Janet Huckabee will be in the state for two nights. Ron Paul may also be making another stop. (He's been in WA quite a bit already.) Look for them! This Seattle P-I article has the most current details so far.

This post may not have been any shorter than my last one. Hopefully it is more informative.

24 States Later

Five hours after I decided to live blog Super Tuesday, I am much more comfortable in my decision to support Barack Obama this Saturday at Washington State's caucus. As I alluded to earlier, I could have gotten behind any of the three leading candidates on the blue side. While I was waiting for returns to come back, I considered in detail some differences between the Obama and Clinton health care plans, and I side with the senator from Illinois. Clinton is better prepared to keep the US on the scientific cutting edge. I bet in the end, the two will end up with really similar policy...

It is strange for me, but a lot of my decision here originates in my gut. I like Obama's approach better. I'd rather have a chat with him than Hillary (though both are in my current top ten!)

Am I glad I did this live blogging thing? Yes. I prefer knowing that I spent 5 hours watching politics than a football game. I did miss out on some quality time for studying topics like HIV disease, and I could have been touching up some comments for reviewers on that paper. But I made this choice. And I don't regret it. It will, however be a while before I live blog. And next time, perhaps I'll just re-edit the same post so that I don't back up my (5) loyal readers' site feeders!

And if for some reason, you missed it live and want to experience my unique perspectives on each state as various major media outlets called them, click here and scroll to the bottom of the page to read my reviews as the polls closed.

Nuevo Mexico

This is the last state for me in my little live blogging adventure. While 30% of the precincts have Clinton winning 51% of the vote, the exit polls break pretty hard for Obama. So, without any press agency calls, I'll dispense with that part of my entry and skip straight to the nostalgia. For that, I have one word: Philmont.

California

Hillary Clinton has scored big in California. I bet Alameda County (Oakland) pulls Obama closer, but without San Francisco, LA and San Diego (Obama has done the best in cities), there is no way that he could win. It also looks like 10 % of voters sent in their absentee ballot indicating John Edwards as their choice... Sheesh. That's why you want to wait in the primary season. Anyway, the way the delegates are split up kindof favors the loser versus the popular vote in each district. If a district has 4 delegates, for example, the winner would have to get more than 68% of the popular vote to get 3 of those 4. Otherwise, the two delegate split them 2/2. Methinks it will take weeks for this to get figured out.


Cali has lots of memories now that my folks moved there. Favorite science memories include trips to the Monterrey Bay Aquarium and my very first scientific conference: the American Society for Artificial Internal Organs in San Diego circa 1999.

Red Earth

Obama and Romney in the West. It's a broken record. They've got Colorado. What of my exposure to science there? As a kid, I was fascinated by the cog wheel tram that ascends Pike's Peak. But not fascinated enough for me to track down a picture for this post.

Alaska

As the results come in by dog sled from Alaska, it seems as though Obama has picked up another giant Western state. Now that I am clearly rooting for Obama, I guess I can dispense with the attempts as objectivity. If only he could do better in that giant western state called California!

Coolest part about AK for me involve watching the marine mammals from the deck of the Alaska Marine Highway System ferry on a poor man's cruise between Juneau, AK and Bellingham, WA. If you stay tuned, you'll start hearing tales from a Fairbanks delivery room come this May.

Fun In The tucSon

My favorite memory in Arizona is visiting my great aunt and uncle in Tuscon for Thanksgiving about 5 years ago. I also met up with a good friend from high school who was studying galactic gravitational lensing for an astronomy PhD at the University of Arizona. Sure the Grand Canyon is cool, but I had a better time with friends & family.

Oh yeah. Arizona. Clinton won. McCain won.

Utah

Guess who won Utah for the Republicans? Mitt!

It hardly matters that Obama is projected to win here, what with 6% of the electorate registered as Democrats... At this point, it looks like Clinton has been successful in the states that matter most. At 9:00 PM tonight, I can safely say that my vote in Washington will matter (should I be able to get back over the passes this weekend.)

I can hit the visit and the science in one swoop: I presented my research at a Keystone Symposium on tissue engineering and developmental biology at the Snowbird ski resort last March.

Kootenai County Comes Through

Just across the Washington-Idaho border from where I live right now is Kootenai County. What a cool name for a county! According to the NYTimes interactive map, Idaho Democrats (all 10,000 of them) voted overwhelmingly for Barack Obama. Unfortunately for him, it does not look so peachy keen for him in California. Clinton is cleaning house there.

Mitt Catches Montana

Looks like Mitt Romney is doing well in the West. He got Montana.
I highly recommend floating the wild and scenic upper Missouri River on a canoe if you ever have a chance. It is largely as Lewis and Clark saw it 200 years ago. Email me if you want some tips or suggestions about this gem of a trip.

Connect A Cut

Obama takes a squeaker and McCain continues his northeastern state sweep (minus Massachusetts, of course). An alternative spring break trip took me to Bridgeport, Connecticut in college. We stayed in a church that had duckpin bowling in the basement. That was awesome. During the day, I worked demolition along-side some ex-prisoners living in halfway houses. I learned a lot about prison rehab. It was the beginning of my eyes opening to much that is broken with the criminal justice system - especially applied to inner city Black men.

Battleground For Evolution

It seems like the kind of people that fight creationism in Kansas (probably Democrats) also prefer Obama over Clinton. In truth, Obama's victory probably has more to do with the KS governor's endorsement of him and his mother's family ties to the state than anything else. Oh, and only 25,000 people showed up to caucus. I wonder if there was some cold weather there or something... Or maybe that's as many Democrats as live in the state.


This topographical map clearlyshows that Kansas is not flat. I believe this is your best bet for amber waves of grain, too... Or is that Nebraska? South Dakota? Hmmm...

You Betcha, Obama!

Thanks no doubt to the work put forth by Tangled Up in Blue Guy at his caucus, Obama has taken the Land of 10,000 Lakes. Looks like Romney's got the red part of the state, which is surprising to me given Minnesota's tendency to elect independents. If you have been to this particular lake, you should immediately recognize its significance. A couple of posts ago, I mentioned I drove through North Dakota en route to Seattle. This is why.

Not Much There

By 'there,' I mean in my memory. I don't mean to speak badly about Alabama. There's a good medical school there and that's where space camp is. As a matter of fact, the only memory I have from Alabama is at the U.S. Space and Rocket Center. My family stopped there on the way to Disney World one year. Obama won Alabama, and Huckabee seems to have the upper hand on the other side.

Bison bison

Obama won North Dakota! I drove through North Dakota when I moved to Seattle! My PhD advisor is from North Dakota! The latin name for buffalo is Bison bison! That's redundant!

The Other Thanksgiving

Before I ended up in college in Pennsylvania, if my family traveled for Turkey Day, it was to St. Louis to visit my Dad's mom and sisters. Favorite November activities included the St. Louis Science Center and playing Rummikub. I traveled back to MO for a med school interview and for the 2006 AAAS meeting. Both times I was privileged to be able to hang out with my aunt and uncle again. What was the point of this post? Oh yeah - it looks like Clinton's got it for the Dems. The Reps are in a three-way heat, however.

Update 9:15 PST: Obama has pulled ahead by a hair in MO.

Thanksgiving

Thanksgiving get-togethers at Bridgewater, NJ. Several cousins with careers in the sciences. Psychiatry. Metallurgy. Medicine. Bioengineering. Conversations about politics that the older (more political diverse) generation avoided... Advice about medical school. Delicious turkey.

Clinton and McCain nab the Garden State according to everyone except the NYTimes.

Going to Mass

They're not Catholic, but Clinton and Romney collected the offering that state had to offer.

This live blogging business is hard. Must stay focused. Maybe I'll try a checklist.

My time in Massachusetts: Staying in the Boston youth hostel to visit my sister at Northeastern.
Science in Massachusetts: Ripping my pants at the Whitehead Institute when I toured MIT as a prospective undergraduate.

Hmmm... I'll strike the checklist. How many states do I have left? 15!!!?!?!?!!! Yikes!

Delaware

Delaware = Obama according to CNN
I built castles of sand at Rehoboth.
Now I'm an engineer. Kindof.

Arkansas

The former first lady has AR on the blue side, and the former governor won on the red. The two were never married, however. That would be interesting, wouldn't it. When I was in high school, I went on a church mission trip to Benton, Arkansas where we did home repair a la Habitat for Humanity. On our day off, we all went river canoeing. When one canoe wedged between the current and a rock, I helped free it. In the process, I smashed a finger. For that, I got a splint and some Tylenol-3. Arkansas ERs look similar to those elsewhere. When I grow up, I might be an ER doctor. I probably will not work in Arkansas, however.

New York!

I got engaged in New York City. It was an elaborate scavenger hunt featuring lions and bears and an awesome sister who took an overnight Greyhound trip from Boston to help stage it. Anyway, the papers seem to think Clinton one this one. She'd be in trouble if she didn't.

New Years' Eve

Southern Miss routed my alma mater in the 1997 Liberty Bowl in Memphis, TN. Three friends from Pitt and I took a winter Midwest road trip to Memphis for the big game. (All Pitt students got free tickets - we just had to show up.) My adventure went from Libertyville, IL to Gary, IN to Newton, IL to Memphis, TN. Pitt lost 7-41. The consolation was seeing Rufus Thomas sing "Walkin' the Dog" on the streets of Memphis. What's the science connection here? One of my friends went on to be the science education director at Pittsburgh's Carnegie Science Center.

Oh Yeah, Fox seems to think Clinton won TN.

Ill: A Noise

I lived in Illinois from 4th grade to high school. Suburban Chicago, of course. I was one of the kids in my group of friends who was allowed to drive into the city whenever I wanted. Well, almost. So I spent a good deal of my high school free time doing stuff down there. Highlights (in retrospect, of course) include taking advantage of my parents' memberships at the Field Museum and Art Institute. I saw a coelacanth (preserved) in a behind the scenes tour once. Lots of formative years as a scientist in Illinois, too. Thank you Abbott Laboratories and Libertyville High School.

Of course, this one went to Obama. I wonder what the margin will be.

Are You OK?

Somebody says that Clinton's got Oklahoma. I'm not so sure. OK is the only state in the union I haven't set foot in. According to my father, with whom I am in a 50 state competition, riding a train through the panhandle doesn't count. As far as I know, Oklahoma is the flattest state. The Earth, however is not flat. But some people used to think it was.

GA was Peachy

The best thing to come out of Georgia for me was a chance encounter with a kindred soul. I was interviewing for the MD/PhD program at Emory & Georgia Tech and met Lee; there for the same reason. We just clicked. Since then, we have probably spent a total of 8 days together. My top three schools were the UW, Emory and UCSD. He preferred UCSD, Emory and the UW. So we ended up on the left coast but in different corners. I saw him when I was in La Jolla for a conference and happened to be at another conference in Michigan the weekend he got married there. Well anyway, it looks like Obama won.

WIld & Wonderful

So the WV GOP goes to Huckabee... If ou're down with GOP, you're down with Huckabee...

My most fond memory from West Virginia is a backpacking trip in the Otter Creek Wilderness with Peter Cheeze and my friend Damion. It rained the whole time. We jumped into streams to clean off the mud. The sky always seemed to brighten, only to pour harder. The trip ended with several hours at a business called Leisure Laundry in back woods WV. Later in that trip, we saw Damion's brother perform in a State Park production of The Hatfields & McCoys. Fun Times!

Image from CNN.

Live Blogging

Since I've decided to skip studying for the political super bowl tonight, I'm going to try my hand at live blogging. Since the major outlets (I'm following NYTimes) have pretty good coverage with political substance, I will provide accounts from each state that range from random to esoteric. (All will be based on my own experiences in each state.)

For those of you who run a feeder with my blog, I am sorry to clog it up today.

An Election Spoiler

Are you planning on reading political commentary, listening to the news channel talking heads or gathering with your friends to watch the election results roll in tonight? If that's all you'll be doing, you'll be missing out on the analytical powers of prophesy offered by one of the most sought after prognosticators of the primary election in one small region of Spokane, Washington. Specifically, I refer to the interactive science art installation titled:

"These Colors Don't Run (they grow mold, ferment, degrade, are infested with insects, turn to slime and just plain smell bad):
A Long Term Study Of The Forces Of Nature On Assorted Fruits From The Western United States"
Wood, Glass, Found Berries
Thomas Robey
January 8, 2008 - February 5, 2008

A longitudinal record of this tool demonstrates its 100% accuracy as a predictor of primary election outcomes - of all parties! But here's a refresher. I started out back on the "First in the Nation" primary on January 8 with an idea that an evolving installation of natural and formed elements could actually tell me who would win the presidential election. To my surprise, by the time Nevada and South Carolina rolled around, the test tubes' predictions corresponded to the outcomes of the race.

But that's all history. Today we face something bigger, something monumental, something so important that I am forced to turn to rotten fruit for guidance.

Let's start by taking account of the facts. The red rose hips are moldy. They have been consumed with different species. A mild filamentous growth is competing with a blue-green bread mold. That's right, red is being consumed by blue. More on that later. The most striking finding is that the snowberries have been consumed by a monoculture pearly filamentous species. The white rose hips are untouched. The small false grape have developed a dusting of white at the bottom inch or so of that sample. Surprisingly, the blue marbles' plaque-like mold has receded from the two fruits closest to the cork.

Here's what I draw from these findings:

1. The Republicans (red rose hips) are spoiled. While not yet rotten, if one were to venture too close, a foul odor would certainly be detected.
2. Red voters are thinking of crossing over to vote for blue candidates (blue mold).
3. What once was portrayed as a leader/follower race on the blue side is now more balanced. One candidate has backed off on the degradation, while the other has wavered from the 'fresh' category to something better described as 'stale.'
4. Whatever snowberries (third from left) represent is doomed. Maybe the middle road is still treacherous in American politics?

Anyone else want to throw in their two cents? I feel like I didn't inhale enough ethylene gas fumes before I started my interpretation. So come on: recruit your inner oracle to help me out. The fate of the free world is depending on it.

Step 1: Vote. Step 2: ...

Tomorrow's the big day. Everyone expects McCain to get the Republican nomination, while that same 'everyone' seems to think that the Clinton/Obama race will not be decided by this time tomorrow. That means that many more people's votes will 'count' in this primary season than in a long time. (Ever?) If you're undecided about voting, please get out there and pick someone. I am not one to criticize how you select a candidate. If you're not careful, I could get all cliche on you with over-the-top statements like, "You've got the power!" or something.

If you are a scientist who wants to make a difference in Washington, you can do more than vote. You can lobby! The best part is that you can get a travel scholarship to do it. I flew to D.C. last year and met with the staffs from three of my elected officials, as well as several others. The Coalition for Life Sciences sponsors three Hill Days each year. You go to D.C., get trained about how to lobby for science, and then go home enlightened/jaded/cynical about the legislative process. Sound interesting? Check out this information. The Hill Days they have scheduled are March 12, 2008, May 7, 2008 and July 9, 2008. The deadline for applications for March is February 13. By the way, this group used to be call the Joint Steering Committee for Public Policy, but who knew that had anything to do with science? I'm glad they changed their name.

I went last year the weekend after I defended. It was the first time someone (other than my family) addressed me as "Dr. Robey." If you want to read about some of my experiences, I wrote a few posts last fall about my time. Otherwise, drop me an email, and I could answer specific questions you have about it.

And don't forget to check back in tomorrow to see the ultimate in elections predictions. I've been tracking the early returns, and I think there could be a spoiler!

A New Convergence?

Is there room at the center to talk about religion and politics? Jim Wallace of the Sojourners thinks so. He's got a new book describing our country as the post-religious right America. I haven't read it, but Seattle PI's Joel Connelly got me interested enough to put it on my Amazon wish list. I think I'd even subscribe to Sojourners Magazine. If only I had more time to read. I've kinda got a backlog. And there's something else I have to do...

What was it?

Shoot, I'm getting forgetful in my old age.

Super Bowl Commercial

If you are as un-American as I am, and will not be watching the Super Bowl this afternoon, or if you happen to live in one of the 26 states that will not have elections this week, you may yet be interested in seeing the first commercial ever placed in the Super Bowl by a political candidate*.



I'm sure it varies by market, but that this spot costs about $250,000 dollars in Boston. Now we know where that $32 million raised in January is going. Might it have been cheaper to buy a national spot?

I still haven't decided, but things keep pointing in the direction of Obama for me... I'm going to review the two remaining Dems' positions on health care again before I make a decision.

What am I doing with my time not spent in front of the TV?

1. During the daylight, I'll be sledding.
2. At night, I'll be working on manuscript revisions.
   

Hat tip to The Caucus blog, who by the way, misuses an apostrophe in the second paragraph of the post. It's not like I never misuse punctuation, but doesn't the NYTimes need to be held to a higher standard?
*I'm actually not sure this is true, but it sounds true. Can anyone out there help me fact check?

Double Dipping

It's time for the Super Bowl, and you know what that means - you'll be going to a Super Bowl party. The folks over at ScienceBlogs are making a big deal about double dipping - you know, the socially scorned practice of going back into the spinach dip or salsa with a chip that you had already munched. Dr. Free-Ride, Greg Laden, OmniBrain and Tara Smith all have chimed in. Evidently there's a lot of bacteria that gets transferred in the mouth to chip to dip to chip to mouth pathway. 10,000 bacteria. That sounds like a lot. Or is it?

1) How many of those bacteria cause disease?
2) How many of them do you not have in your mouth already?
3) What's the equivalent transfer from multiple hands going into the same snack bag?

Frankly, I'd rather get someone else's mouth bacteria than their hand bacteria. Because you know what hand bacteria is the same as? That's right, folks: butt bacteria. And butt bacteria can cause real problems.

And there's one more thing. If you really want to stay healthy during the Super Bowl, don't bother with safe dipping. In this case, I advocate dip abstinence. What's in those dips? Mayo, cheese, sour cream, butter; this equals fat, fat, fat, salt salt salt. And that's before we consider the chip... Now I don't have any evidence behind this, but my hunch is that this stuff will kill you faster than the bacteria you'll pick up this afternoon.

Just say no to dips and chips. You'll avoid anxiety over bugs, and your waist will thank you.

Four Of Twelve

I just spent a good 15 minutes leaning back in a La-Z-Boy staring at a popcorn ceiling thinking about precisely nothing. My wife is cuddled up on the faux leather sofa mumbling about blanket transplants.

These are the small joys of being a third year medical student.

It's nice to be home. Kindof. We've transformed this very brown apartment that the University of Washington provides for us into a semblance of home. Cut apart calenders adorn the walls, her orchids contrast with the snow outside, and my art projects sit around screaming out for explanation.

Today was our last day of inpatient call in Spokane, WA. Eight more weeks of medicine to go, but more on that later.

Today offered nice closure for me. At 1:00 I was invited to do a knee arthrocentesis. (At 12:45, I watched a video about how to do it.) After one unsuccessful poke (not deep enough), the syringe started to fill with a slightly cloudy yellow fluid. I pulled 20 cc out, disconnected the needle and proceeded to extract another 25 cc to reduce the joint space pressure and provide symptomatic relief. We then sent three vials to the lab for cell counts, Gram stains and chemistry.

A successful procedure.

But wait! There's more!

My senior resident had arranged for a rheumatologist to look at the sample. We were thinking septic arthritis (arthritis caused by infection), but had a suspicion that something else was going on. The patient didn't have a fever, both knees hurt and both wrists hurt; this is all a little strange for an infectious cause.

The thing is, the rheumatologist happened to be across town. Guess who filled the role of messenger. I've written about how medical students don't do a lot that is not duplicated. How could I forget about the vital role of urgently transporting samples? I was surprised about how important I felt walking around with a biohazard transport container. (Thinking in my head the irony of the statement, "Get this to rheumatology, STAT!")

When I found the office where the sample was to be read, it turns out that the doc was really busy and someone had totally botched up his microscope. He was having a dandy of a time getting the sample in focus. Isn't it convenient that I spent four years in a pathology research lab hunched over scopes? When I had finished preparing the wet mount, I called him over to look at something like this:

I've said it before, and while it may come off as a little pretentious, I kindof like the sound of:

What's your diagnosis, doctor?

After leaving the scope much better than I found it, I headed back to the hospital, where we promptly started dexamethasone therapy and discontinued the vancomycin he was on (His ears had started to ring).

My adventures concluded by visiting the patient to update him about what we found and how we changed his medicines. I left his room at 3:45.

This is medicine: suspicion, diagnostic procedure, microscopic laboratory examination, diagnosis, therapy decision. Hopefully the result is a patient free of pain and home for the Super Bowl.

You better believe I'll think twice before telling someone "I'm waiting for a lab result" again.

This patient agreed to my writing about him on the internet. ("After all, it's not like you're sticking me with a big needle," he said.) Also, my wife attests to the accuracy of my portrayal of our evening .