The Descent of Posts

Back in late September I was tagged by Mike for an evolution-themed meme. This meme provided an opportunity for the tagged bloggers to dive back into the vault and contemplate the evolution of their blogs. Since I was tagged in the midst of finishing my dissertation, submitting several papers, and starting the third year of medical school, it has taken me a while to put everything together in a way that makes sense to me and might be interesting to you.

My very first post consisted of one version of a story about my blog's namesake. Long story short, after Pandora unleashed evils into the world, she also had the sense (or luck) to release hope as an antidote to the ills. Pandora's box is an often used frame in conversations about science and society, particularly surrounding technology and ethics. So I thought it was reasonable for my blog to start out with the following goals:

1. To generate a conversation about science and society.
2. To contribute interesting and meaningful content to the digital community.
3. To improve my own writing and argument skills.
4. To learn more about what others think about science.
5. To encourage scientists to think critically about how their work fits into society.

I am happy to say that more than a year later, I am sticking with these objectives.

My first posts were personal - I had been quarantined by the King County Department of Health for mumps. It turned out I had a salivary stone, but because I had traveled recently through some cities with mumps cases, I was to keep out of public places. Here is one reflection inspired by my quarantine:

This brings me to another point: economic productivity. I wonder what the effects of a widespread quarantine for H5N1 avian flu would have on the economy. I'm no economist, but I would imagine that any effects from lost work would hit the poor first and hardest. Do employers make any allowance for workers on quarantine? Is that something the government is prepared for in the reports recently issued about the possible pandemic? Who's responsibility is it to keep food on the table when the breadwinner is quarantined?

I even wrote some bad poetry about the experience That's a path you may not want to travel.

Which brings me to my next theme: carbon footprint. In the interest of contributing content to the web (and attracting readers), I started writing a weekly column about how to reduce your carbon footprint. Each of my posts was personal. I was motivated by what seemed to me shaky science and imaginary economics to pick areas of my own life that I could improve on. This came back to bite me when I wrote about cell phone chargers. I still think I did my calculations correctly, given what I knew. Even the experiments to test the idea that chargers use power when plugged in seemed rigged and misinterpreted. Anyway, my favorite post from that series featured some of my local farmers' markets and added a splash of color to the site.

Speaking of flashes of color, as I grew more comfortable with the blog, I posted more entries that revealed my sense of humor. Many of these fun entries were collected from other sites. Some I embellished or inserted into my own context. Others were enough to stand alone. When I encountered a video of surfing rats, I could not help but point out the link between one Australian animal trainer and the laboratory experiments I conducted at the time.


But it's not all fun and games at Hope for Pandora. As I had the ideas and energy, I would ponder some serious issues. Occasionally, I would rail against how some new stem cell study had been overhyped. Sometimes, I would comment on issues related to science in religion. My most viewed entry (thanks to a link from PZ Myers) was one where I supported the atheist Out Campaign. Go figure: a Christian supporting 'the other side.' I guess that was my way of denying the tenability of the warfare thesis in the science and religion debates. One quote from that post is:

My conversations with atheists about science, politics or religion are as interesting and meaningful to me as discussions on the same topic with Christians. In many instances, my agnostic and atheist friends are more likely to be open to thinking about new and different ideas. In the kinds of discussions I like to have about science, society and social justice, it doesn't matter what people believe in. It matters that they are respectful, honest and open to conversation.

Finally, I recently made a transition in my 'real life' from graduate student to third year medical student. With that comes different blogging patterns - weekend heavy and sporadic. I use my blog these days to record and explore experiences from medical school. It is easy to move from one day to the next without pausing to reflect on the significance of what filled the day. My favorite medical post so far describes my first delivery. When the difficult delivery was at a critical stage,

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 Seattle's newest baby boy to tell us how angry he was. When he did, I wasn't the only person in the room with wells for eyes.

That about does it. Hope for Pandora is an evolving entity that closely reflects its author's evolutions. It is a tool for me to express myself and a way to develop a voice.

In the interest of keeping this meme alive, I will tag a few blogfriends. Mostly because it would be fun to hear about their sites' evolution. I don't want to be pushy about it, so they will have to discover on their own if they've been tagged. The worst that can come of it is that I send a few new readers to those sites.

Mark of blogfish
Kate of Anterior Commissure
Ben of nosugrefneb
Noel of Constructive Procrastination

We're Not in Seattle Anymore, Toto

This is what I saw this morning while eating breakfast:

Three black-tailed deer strutted through the backyard of the house I am living in while studying family medicine in Anacortes, WA. I took this picture from my bedroom window. Next time I'll be better prepared to get a clear shot of them. If only I would see or hear coyotes, it would be just like home... (in Seattle...)

Tonight Only: Science and Blues Revue

Last Thursday I had the privilege of watching a preview of NOVA's Intelligent Design on Trial at the Pacific Science Center. The director (Richard Hutton) presented about an hour of the two hour documentary of the Kitzmiller v. Dover Board of Education court case two years ago. If you haven't heard, the special airs tonight at 8:00 PM on PBS.

I want to get this post up before the big event, but don't have the time for a complete analysis. Here are some bullet points:

• Judge John Jones is prominently featured.
• We weren't shown the whole thing because it was not finished yet (on Thursday).
• There was a bit more of the warfare theme than I thought was necessary.
• I sat next to Carl Bergstrom of the UW Biology department.
• They used actors to portay the court proceedings; Behe's double is excellent.
• The basic introductions to the philosophy of science are adequate.
• I thought the presentation of the science was too simplified.
• I am thinking of using a mousetrap as a tieclip one of these days.

I look forward to the special tonight. I hope you are too.

Eeesy as Pie

This is my first post as an Eee User. I must say, I am hooked. And look how cute it is next to my monstrosity of a laptop! I'll post more here after I take it for a spin... By the way, I turned both of these compy's on at the same time. Eee is ready to go, while HP is still flying the Windows flag.

T's Crossed

You can tell that I took this photo before the dissertation clerk realized that my dissertation's signatory page was printed in size 14 rather than 12 because she has that big smile on her face. It only took one puppy-dog face to convince her that it was actually okay. It's a good thing I didn't have to use the Force; my Jedi mind tricks probably wouldn't have worked on her.

I only had to reprint two pages and re-copy all of my tables. But it is over. I earned my Ph.D. just in time to rush over to Children's Hospital to take my pediatrics clerkship final. I passed the multiple choice part on the first try, but could have done better. I hope my subjective reviews come back stronger.

I am going to celebrate by attending a special screening of Judgment Day: Intelligent Design on Trial at the Pacific Science Center. This is one of Paul Allen's pet projects, and if you read ScienceBlogs, there's a bunch of good buzz (and plenty of ads) for it. I'll give you my take this weekend.

Graduate Ethics Education

This weekend, I'll be heading to Lexington, Kentucky to represent the University of Washington at the National Conference on Graduate Student Leadership. I'm giving a talk about how ethics education should and can be better incorporated into graduate school. I have 8 minutes... Naturally, I'll be speaking a bit about the Forum on Science Ethics and Policy, but I'll also lay out a case for why providing formal and informal training in ethical reasoning makes for better graduate students.

I had hoped to take my new EEE PC, but it seems as though UPS got confused and shipped it to Ontario, California instead of Seattle. I've already weaned myself down to checking email once a day. I think I can cut the cord for a whole weekend...

Playing With Kids

I will miss working in an environment that permits (dare I say, encourages) interactions such as:

Me: "Would you prefer me to listen to your heart with or without my batman mask?"
Kid: "With it, please." (Said in all seriousness)

or,

Me: "What color is your pee?"
Kid: "Green."
Me: "When is it green?"
Kid: "At school."
Me: "When you go to the bathroom at school, is the water in the toilet blue before you use it?"
Kid: "Yes."

It's hard to believe that my 6 week rotation is over. I take my pediatrics final tomorrow. Then I am off to Anacortes, WA to study family medicine. Hopefully the families there have kids.

Carnivals

There are some pretty good carnivals up this week that typically have some really nice articles. If you are looking for something to read, check out:

Carnival of the Liberals
Medical Grand Rounds
Christian Carnival

There are also two new carnivals up that I hope I can check out this weekend:

Linnaeus' Legacy
The Trauma Center

These are all free links (That means I don't have any entries!)

ScienceBlogs Loses One

ScienceBlogs' founding member of the "don't hate the religious" clique, has moved on from blogging and resigned his position as ScienceBlogger. Rob Knopp has never been careful with his words; he writes what he thinks and makes no excuses for it. Evidently, the ScienceBorg (who are very good at generating conversations about science, and I applaud them for it) is not interested in assimilating his posts into their archive now that he has left. This is a shame, since some of his posts shed new light on my own position as a scientist and a Christian. My guess is that Seed (they are the folks who manage ScienceBlogs) wants to extinguish any evidence that scientists and science bloggers can consider religion an important part of life.

Thanks Rob. You will be missed. I hope to see you around someday.

Adsense Payday

Last week, I received my first Google AdSense payment. The electronic statement reads:

10/29/07 REVENUE SHGOOGLE ADSENSE 1454684 $105.81

For those of you not familiar with how having ads on your web site makes money, here's the scoop: Google mines the text of my blog and picks out ads that it thinks might interest you, the reader; then, anytime you click on an ad, the site owner earns 10 to 50 cents. Sometimes the surfer has to sign up for something or buys a product for the blogger/webmaster to get the payment- those ads usually bring in more money. For example, if you do not have the awesome Firefox browser, you can sign up for it on this site through the ad a couple of frames down at the bottom of the light blue banner to the right. If after clicking on the ad, you install the software (with Google toolbar), I get a fat $1.00.

But I don't see the cash right away. Anyone who has AdSense ads embedded into his or her blog or website knows that the paycheck is not cut until the website's total revenue exceeds $100. For me, that took about seven months. I get about 1500 readers on my blog a month, most of whom find me by Google searches. I would bet that about half of my revenue comes from those folks, and half comes from people that are more regular readers. Many of my ads (if your browser does not block them entirely) are intriguing; they hawk stem cell banks, evangelical sites, abortion (pro- and anti-) related organizations, and lately, medical equipment companies. I invite you to click on them if they look interesting to you. Is inviting you to click on my ads working the system? All of this information can be found in the AdSense informational pages. Furthermore, Google has built-in algorithms to determine whether I click on my own ads. Though Google prohibits this activity, sometimes I am just too curious about these offshore stem cell companies to resist the lure. Because of Google's anti-fraud software, those clicks never have counted toward my revenue; I tend to post from the same 3 or 4 ISP addresses. When it comes down to it, most people (>99%) just overlook my content-driven ads. It's just as well.

In the end, $100 once or twice a year for only a little time up front seems like an okay thing to me It almost covers the cost of the ComCash cable internet I am using right now. Is this selling out? I think not - first and last write to better myself and society. (I can really only measure the former.) Those three or four ads in the sidebar: do they scare you away? I hope not. Let me know if they do. I value readers and comments more than candy money. Anyway, if you want to try your hand at AdSense, click on the sign-up button at the very bottom of my blog.

(If it's after November 2007, chances are good you found this through a Google search, anyway, and want information about signing up for AdSense!)

Ethics of Medical Training Vol. 1

You're a patient at your local university hospital. Chances are good whatever is wrong with you is complex enough that you have traveled further than most people do when they go to the doctor. But then again, maybe you live just down the street! In any case, you come to the UXMC for the reputation, for the expertise, and to get an answer for what is wrong. It's your first visit. You've filled in the forms, the nurse has taken your vitals, and you're sitting in the cold, fluorescent bulb-lit exam room waiting to be seen, and who is the first to walk in? A twenty-something wearing a poorly-fit white coat grasping a clipboard like a security blanket. "Who is this?" you wonder, and "why does he look so nervous?"

Congratulations. You have just experienced a critical component of the graduate medical education complex. Shifting uncomfortably in front of you is the first rung of the ladder known as the medical hierarchy. Immediately you think, "How is this spring chicken going to heal me when all of the other docs were puzzled?" The answer is a little complex.

Hopefully the medical student in front of you is a little more comfortable than the way I've described him. Unless it's the month of July (when all of the residents and medical students are new), the student has already interacted with hundreds of patients, so he shouldn't have problems conducting an interview. At the foundation of your observation is a critical tension at the base of medical education and professional ethics: How are we to balance what is in the best interest of the patient with what is in the best interest of society? A byline of this tension is the medical student's concern about evaluation. While we students should be focusing on doing the right thing for the patient, many of us also want to do the right thing for our grades. That usually means thinking inside the box and being conservative with answers. Such thinking is not, however what doctors usually order at tertiary medical centers, and it's not what you need to solve your problem.

Fortunately, the medical hierarchy comes to the rescue. The residents, fellows and attending physicians who are actually liable for patient care benefit from the constant discussion, questioning and brainstorming (all lumped into that unfortunate term, 'pimping') that a teaching environment affords. You benefit from the system that brings you the medical student.

On a lighter note, keep in mind that medical students usually only take care of 2-3 patients at a time in the hospital. This means that they have more time to sit in your room and ask questions, catch overlooked relevant physical exam findings and pore over books (paper or electronic) to learn about your condition. And if you are a kid, maybe the student will take you over to the playroom to use the finger paints!

In many ways, you are the best teacher for medical students (especially those tired of sitting in class). Thanks for working with the medical student. Society thanks you, too.

Advice To Those Who Follow

So let's say you are one of the 400 or so MD/PhD students out there planning on restarting medical school next year. Please give yourself more than 10 days between your defense and your first day on the wards. Trust me on this. No matter how little sleep you need, every day will drain your energy to the extent that the only science you could even consider doing after you get home is the variety served on CSI. And even then, it's a safe wager that you'd be asleep before the killer confessed in light of the evidence.

These days, I've been spending too much time on figures and edits and not enough reading about fever in the newborn or asthma.

I guess that is how it always will be.

We're on a mission from...

...science?

The next time (the late, great) James Brown asks, be sure to remember that, yes, you have seen:and you saw it at the Science Creative Quarterly. What else have you seen?

For a refresher on my second Blues Brothers reference of the weekend, consider watching this clip. Abbreviated start points at 1:00 or 4:00 will get you up to speed.

Perils of Biking

Two incidents in the past month involving have reminded me just how unprepared America is to move forward as a society responsible for its health and environment. One of my friends has been carping on this issue for a while, and for once, I will join his refrain.

The bicycle is increasingly considered a legitimate mode of commuting; many employers provide showers and secure lockers for staff. As the environmental, health and cost benefits of biking are realized by more individuals, there is more contact between bicyclists and automobile commuters. This fact rears its head in some ugly ways. The first is that case of a Seattle commuter who was shot with BBs at point blank range this past week. He blogged about this and his situation described in a local paper. The thing was that he kept riding with a pneumothorax, got home, and told his wife in private so as not to concern his kids! One of the BBs lodged near his aorta, but he is okay and will be able to bike again soon. My other example doesn't have such a happy ending (yet).

When I first started working in the Murry lab (where I completed my dissertation work), I was drawn to certain of the experimental techniques used there - namely murine cardiac surgery. That a mouse heart the size of Roosevelt's head on a dime could be used to approximate human heart function was amazing to me, and that we could surgically induce heart attack was unbelievable. I learned how to do heart surgery from the skilled hands of Jitka Virag. Now an assistant professor at East Carolina University, Jitka was a post-doc in the Murry lab. When she left, I inherited her desktop computer, through which all of my science was done. On October 19, while bicycling home from work, she was struck by a motorist who was traveling as fast as 50 mph. Her helmet may have protected her head, but it could not prevent a T4-5 spinal cord transection. She has been recovering in the hospital since then. A community of support has formed around her, reaching across the country and around the world. Some of the updates on the blog her husband keeps are in Hungarian for family members over there to keep up with the news. I am thankful that she is alive, but hope she can come off the ventilator soon.

Incidents like these make it hard for me to oppose groups like Critical Mass. Some of their tactics are belligerent, but they are not as belligerent as BBs shot at point blank. Their behavior may be irresponsible, but not as irresponsible as clipping a bicyclist at full speed.

Miraculous or Mundane?

One of the most miraculous plays in the history of college football is just another day in rugby. Surely, you've seen this one by now:



Medical school places you a little out of the loop on some things. For example, I heard about this play on NPR's Weekend Edition... The sort of response this single play received suggests to me that rugby, if given a chance, could be really popular in the US. My bias is that I played rugby for 3 years in Pittsburgh and never played American football. But seriously folks: this is what rugby looks like! And really, it only takes a season to learn the rules and strategy.

I Hate Washington Racists

The title above is a bad reference to the 1980 classic movie: The Blues Brothers. In one scene, Jake and Elwood (by that point, well entrenched in their "mission from God") encounter a traffic jam caused by a parade of Illinois Nazis. They ask an officer what is going on; he says the Illinois Nazis got a permit for a parade. Elwood scoffs, "Illinois Nazis!" to which Jake replies, "I hate Illinois Nazis." They promptly accelerate through the parade causing the uniformed Nazis to jump from a bridge into a small river. (Was the bridge in Peoria?) For a refresher, see:



I cite this example of intolerance because of something more relevant to 2007: Islamo-Fascism Awareness Week. This was a nationwide series of events sponsored by David Horowitz from the Los Angeles-based Freedom Center, a conservative think tank. I was annoyed about this issue last week when I read that the event was occurring on the University of Washington campus, but Robert Jamieson really got me (and at least one other person) riled up in a recent well-thought column in the Seattle Post-Intelligencer. Chances are good there were events in your city.

Such ignorance as this makes me want to find a 70's vintage police cruiser and drive it through my school's quad (also called Red Square) during one of the events. It's a good thing 1) the 'awareness' week is over, 2) I don't know where to find old police cruisers, and 3) due to medical school, I don't have time for such tomfoolery.

Married Classmates

Today, an interesting discussion ensued while I rode in a shuttle with some of my medical school classmates between clinic and our teaching didactics. There are a couple of things that medical students who do not know each other very well can talk about easily. At the top of the list is the location of your next rotation. (UW folks have five states where they can be assigned.) My pediatrics clerkship is coming to an end, and soon I will be off to Anacortes, WA to learn about family medicine. When my colleague learned I would be heading up to Anacortes, he inquired if my wife would be able to join me up there. I almost turned to her and asked, "What do you think, honey?"

You see, currently, my wife is one of my classmates and was sitting right in front of me. None of my other classmates are aware of this. My outpatient clinic attending physicians know it (we bring the same food in for lunch); the folks in administration know it (we did put each other as emergency contacts); even my supervising intern knew (sometimes you have good conversations that can only go so far while concealing such a big component). But none of the 9 other students know about us. I bet that they just think we know each other well because we are both MD/PhD students... I think keeping this secret is a fun, harmless game that keeps things interesting for us. Anyway, that fact would just get in the way of the already isolating effect of being an MD/PhD kid.

Anyway, I am pretty sure I pulled off the answer to my classmate's question in a straight face with a simple, "No, she's going to stay in Seattle. Hopefully, we will see each other on the weekends." Susan pitched in with, "How long a drive is it? Two hours?"

Actually it's one and a half.

"Didactics"

I'm willing to bet that many medical students in their third year think that they should be provided with classroom-style teaching as part of their clerkship education process. Medical $chool is, after all, really expensive. One might think that an education that keeps you in debt for many years should have a good amount of structured teaching. Many still think it is important to pull you away from hospital learning to sit in a class with four to fifteen other students to view some Powerpoint slides about the differential diagnosis of pediatric cough or the role of sleep apnea in pulmonary medicine. (My clerkship director thinks this, for example.) Five years ago, I may have agreed with the need for structured lectures.

These days, I much prefer learning in small groups in the care provider room, in patients' rooms, in the halls of the clinic, or even over dinner when on call. The thing about the medical training system, is that MOST people are in the process of learning and teaching. There is an adage in medicine called, "See one, Do one, Teach one," and while this may not be appropriate for some complex procedures, everyone should be in this mode. The residents teach each other and the medical students; students absorb experience from nurses and other providers; everyone learns from attending physicians. That's how teaching hospitals work. And don't just rely on others to teach you! If you are light on heart malformations, ask for some teaching from a cardiology fellow or the sub-intern on the cardiology team! Look up a paper, and present the tetrology of Fallot to your team. Chances are good that several others could use a brush up on that.

I know that the medical school wants to standardize its education so that everyone sees the same thing, or that some people just learn better in the classroom. I am pretty sure that the practice of medicine does not have didactics very often. If you cannot learn on your own or on the fly with and from your colleagues, good luck keeping up. I wish I didn't have to waste a good chunk of my days commuting to the lectures and figuring out ways to keep interested in them.

I mean no disrespect to the lecturers at my medical school, and specifically in my clerkship. It is clear that the administrators pay close attention to students' feedback - the lecturers are hardly ever boring, speakers generally use A/V aides appropriately and they often engage the students - I just think that time is better spent in clinic. We sat in the same chairs for almost 2 years absorbing info in classrooms. I wonder if these 5-10 hours of classroom learning are just a way to wean medical students from the structure of a classroom.

I'd rather go cold turkey.

Grand Rounds

I am a little late in posting this - all of my electronic correspondance are behind - but you should still head over to Running a Hospital for this week's Grand Rounds carnival.

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...