Archive for the 'Medicine' Category

“When Breath Becomes Air”: A call to life before death

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“Go, go, go, said the bird: human kind
Cannot bear very much reality.” — T.S. Eliot, Four Quartets

whenbreathbecomesairI picked up When Breath Becomes Air (hardback; ebook; audiobook) at about 10pm on the first day of spring by a recommendation from the inimitable Jesse Kornbluth. From his and other reviews, I roughly knew what the book was about: death. What better time to meditate on death than on the very cusp of Earth’s re-awakening?

In one sitting, it was read. It’s a tonic against the unreality that assaults us in the world today — politics, entertainment, advertising, broken promises, missed meetings — because it’s the most real book I’ve read in recent memory. Paul Kalanithi is 36 years old, and chief neurosurgery resident at Stanford Medical School. Every day, he opens up people’s skulls with a drill and saw, dissecting through the dura and meninges to get to a tiny tumor in the cerebellum. One false move of his scalpel by 2mm, and instead of a productive career and fatherhood, his patient is fully paralyzed for life. This is not about shifting around some spreadsheet numbers or holding meetings with middle management about shareholder value, folks. Kalanithi’s work is at the interface between thriving and withering, life and death, every day.

And then, Kalanithi’s life takes a turn for the even more real: he himself is diagnosed with lung cancer. At that point, he has to decide whether he will be spending the remainder of his time on Earth dying or living — a span of 1 to 10 years, depending on disease progression. He chooses to live: to rehabilitate himself and go back to full-time surgical practice in spite of his exhausting chemotherapy regimen; to repair his marriage; to have a child; and to write this book. I am very glad he made that decision.

It turns out that Kalanithi’s time on earth was much closer to the lower end of the predicted range, which makes his story even more poignant and the creation of this book even more heroic. Between 100hr weeks at the hospital, mind-fogging chemotherapy, and a newborn, when did he write?

This is a book that stays with you. It’s a lucid exposition from a consummate insider on the practice of medicine and work of healing. When can doctors heal? What do they tell patients when they can’t? How do they react when a patient dies? How do they convey that news to the family? Is life always worth living?

Paul’s days were numbered, and he knew the number was small. But so are ours. If you’re 25, that number is 18,000 to 20,000. If you’re 45, it’s closer to 13,000. If your light plane crashes, or you have a mountaineering accident, or have a freak untreated food poisoning, that number could be much smaller, like it was for my three friends who died in the past year, all under the age of 35.

So the bad news is that we’re all going to die, folks. Especially you. The good news is that every moment that you live is a gift. You can have that fact impressed upon you by a terminal diagnosis. Or you can read When Breath Becomes Air. Let that inform your days, and you just may infuse every moment of your existence with greater meaning, purpose, and joy.

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The Science of Sleep: A Talk With Matt Walker

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Last night I attended Matt Walker’s conversation with Indre Viskontas as part of the City Arts & Lectures series at the Nourse Theater on the science of sleep. He and Indre did an excellent job of conveying a ton of useful information in a conversational format that was both accessible and entertaining. Some highlights from the talk:

1. Sleep is so important from an evolutionary standpoint that organisms will develop byzantine mechanisms to make sure they get their shut-eye without becoming dinner. For example, marine animals (e.g. dolphins) sleep with one brain hemisphere at a time. And when a flock of birds sit on a branch, the birds in the middle will go to sleep with both hemispheres. The birds on the sides, however, will sleep with only one hemisphere and keep one eye open as a lookout – the opposite eye from the birds on the other end. Then, after a while, they will turn around and switch hemispheres, close one eye and open the other! That way, they always have a 360-degree lookout for predators. This is a movie I would pay to watch.

2. Every language that Walker has looked into has an expression for “sleeping on the problem” as a prescription for

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On pain and how to handle it

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On the morning of Saturday, March 15, I woke up to shooting and stabbing pain down the right side of my neck, upper back and right arm. The pain encircled my ribs and was literally breathtaking.

I figured I must have slept with my neck in a funny position and a little massage would relieve it. But there was no part of my neck and back that my visiting friend could touch without eliciting a howl from yours truly. So I called my acupuncturist and bodywork specialist Steve, who was kind enough to accommodate me on short notice. Although the session gave me some relief, I realized that this was a different beast than a simple stiff neck.

Eventually, I found an experienced physical therapist/bodyworker based in San Rafael named Al Chan, whose deep knowledge of anatomy combined with his iron paws (I call his technique “Ow now, wow later”) helped put me on the mend.

This article is not about the clinical course of my ailment, though. This is aboutpain – where it

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Dr Obama, Vaccination, and the Health of a Nation

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Recently I read about a new movie about a person with polio. “Wow. I’m really lucky not to have gotten polio,” I thought, for the first time ever. A tingly wave of gratitude washed over me for functioning limbs that can run, dance and kick a football.

Come to think of it, nobody in the U.S. has polio these days. And the disease has been nearly eradicated worldwide. Why?

Because of vaccination, that’s why.

In fact, as you are sitting there, reading this, chances are you don’t have measles, mumps, pertussis, diphtheria, hepatitis A, hepatitis B, or TB. It’s no exaggeration to say that vaccines are the single advance most responsible for the elevated standard of living in industrialized nations today.

At the same time, it’s a pretty sure bet that you’re not sitting there thinking, “Omigod! I just noticed that

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‘God’s Hotel’ by Victoria Sweet: A Profoundly Human Book

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A book that can delight you through its entertainments or instruct you with useful knowledge is a good book; one that does both is a great book. Rarely, a book comes along that not only instructs and delights but also deepens your humanity, carving out extra space inside us to carry even more compassion. God’s Hotel by Victoria Sweet is such a book. [A hat-tip to Jesse Kornbluth of Head Butler for introducing me to it.]

There were many reasons I enjoyed this book, which is really many books at once:

1) The author, Dr Victoria Sweet, who has a PhD in medieval history as well as an MD, shares the ancient Latin and Greek etymologies of many terms used in patient care today. Hospitality, community, charity – what do they really mean? Through her stories about her time taking care of patients, Dr Sweet shows how those formed the three foundational principles of Laguna Honda Hospital.

Hospital comes from hospitality, the root of which is hospes, which means both ‘guest’ or ‘host’. This is how Sweet explains this:

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What I learned at SXSW 2012

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I recently got back from the South By Southwest Conference and had a marvelous time. One unusual thing that happened this time around was that several people asked me, “Why are you here?”  It was a bit like asking why do you drink water, or what’s the big deal about this whole breathing thing anyway.

And yet, a trivial question it is not.  In fact, I very nearly didn’t go this year, so it’s important for me to remind myself why I do take 6 days off from work, buy a non-cheap pass, pay for non-cheap airfare and scrounge for accommodations in an overstuffed Austin during the second week of March every year to go to SXSW Interactive (NB: to add the Film and Music portions would frankly be too much). Here are my five reasons:

1) Encountering new ideas.  SXSW consistently pulls to its stages some of greatest minds in science, business, technology, entrepreneurship, journalism and all-around awesomeness.  Because there are so many stages, these speakers have incentive to share their best work with us lest we leave for another of the 35-40 simultaneous talks.  This year alone, I was lucky to catch talks by neuroscientist David Eagleman, inventor Dean Kamen, game designer Jane McGonigal, Mathematica creator Stephen Wolfram, and X Prize founder Peter Diamandis (about all of whom I will share below).

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Notes from a great conference

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I just came out of a four-day conference (which shall remain nameless), and it was such a life-affirming, mind-expanding, invigorating experience that I thought I would share my notes.  I got doused by a downpour of novel ideas from disparate fields in the many talks I attended.  Here’s a sampling, in no particular order:

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Why you should not go to medical school — a gleefully biased rant

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In the few years since I’ve graduated from medical school, there has been enough time to go back to medical practice in some form, but I haven’t and don’t intend to, so quit yer askin’ already.  But of course, people keep on asking.  Their comments range from the curious — “Why don’t you practice?” — to the idealistic — “But medicine is such a wonderful profession!” — to the almost hostile — “Don’t you like helping people, you heartless ogre you?”

Since it’s certain that folks will continue to pose me this question for the rest of my natural existence, I figured that instead of launching into my 15-minute polemic on the State of Medicine each time and interrupting the flow of my Hefeweizen on a fine Friday eve, I could just write it up and give them the URL.  So that’s what I did.

Now, unfettered by my prior obligations as an unbiased pre-med advisor, here are the myriad reasons why you should not enter the medical profession and the one (count ’em — one) reason you should.  I have assiduously gone through these arguments and expunged any hint of evenhandedness, saving time for all of you who are hunting for balance.  And here are the reasons:

1) You will lose all the friends you had before medicine.
You think I’m kidding here.  No, I’m not: I mean it in the most literal sense possible. I had a friend in UCLA Med School who lived 12min away, and I saw her once — in three years (UPDATE: twice in 4 years). I saw her more often when she lived in Boston and I was in LA, no foolin’.

Here’s the deal: you’ll be so caught up with taking classes, studying for exams, doing ward rotations, taking care of

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