Physician Drug Abuse - where is the grey line?

We had a great lecture yesterday about impaired physicians that abuse recreational drugs like alcohol, prescription painkillers, cocaine, etc. It was a pretty black and white conversation - doctors shouldn't be under the influence while practicing medicine. But the gray area grows when we get to other forms of drug abuse - what about people who use drugs as a supplement? Is it wrong for a med student to Adderall to study late into the night?

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Let me go on a 3 part sports sidenote - 

1) Lance Armstrong recently came out on Oprah to admit his doping status. What he did might have been cheating, but was it wrong?  Everyone else in the Tour was doing it. (New Yorker article about what Lance did wrong)

guilty until proven innocent

2) Baseball Hall of Fame voting came out this past week and ZERO people were enshrined this year because of steroid accusations.  This included players like Mike Piazza who were great home run hitters during the steroid era, but never tested positive for steroids.  First of all, is it fair to assume these guys are guilty by association? Second of all, is it our place to stop these guys from their pursuit of greatness?  If they understand the consequences of steroids, should we stop them from bulking up, getting big time contracts, and trying to become the best baseball player that they can be?

3) Take endurance running.  One form of training is running in the mountains where there's less oxygen.  By training at altitude you train your body to produce more red blood cells, which carry more oxygen, and make your running more efficient. You have to work harder at altitude - but you get more result out of it.  Nobody would call this extra advantage cheating.

Technology has figured out how to mimic this effect with altitude tents where you can sleep in a low oxygen environment.  Whether you sleep in a low oxygen tent or you train up in Wyoming, the way your body makes more red blood cells is by producing more of a molecule called EPO.  Should sleeping in these tents be allowed?

Endurance athletes have also learned that you can inject yourself with a synthetic EPO solution to induce this RBC producing effect. Injecting EPO isn't allowed, but altitude tents are, even though neither of them require any extra work.

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Anyways, back to medicine: On an average day I have green tea in the morning. In the afternoon I have coffee around 12 or 1 PM to avoid the post-lunch coma. If I go past 2 PM without that delicious coffee, I'm hitting a wall and getting pissed off. Once I get that caffeine influx, I'm in a great mood and it's easily the most productive hour of my day.  

So if I can drink coffee to help me study, is it wrong to use ADD medication as a studying crutch?  Nobody has ever offered me Ritalin or Adderall, but if someone offered it to me.. what would I say?  Honestly.. I might consider it.  I could study more in less time. I could have more time and energy left to be a good husband. Not to mention I would be learning medicine better, and I would become a better doctor, so I would be saving lives, right?  

What if I thought I could get diagnosed with ADD and pick up some prescription fully legal Adderall?  

What if a surgeon decided to self-medicate to be especially focused for a tough case at the end of a long night?  What if he was doing heart surgery on your kid? 

..where do we draw the grey line?

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

Repost: there is no finish line

I'm editing/reposting this post (my favorite post) which will be my submission to "Humanitas" - MUSC's annual Art and Literature publication.  There's a cash prize, so if I win all proceedings will go towards my search for the finish line.

See you on the other side,

from ken

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there is no finish line

I’ve been running for longer than I can remember doing anything else in my life. 

I ran cross country and track in college and high school.  I was elected captain, not because I ran fast but because I cared.  I spent one summer running 1000 miles, putting in week after week of ninety miles, just to prove to myself that if I was going to be a nothing at running, it wasn’t because I didn’t try.  At one time in my life, I owned more track spikes than my girlfriend owned shoes.  I once ran a hundred mile week, finishing the last run with a Turkish soccer player who could barely speak English and had never ran more than four miles, but as we finished the seven mile run he was sprinting and yelling, “NEVER GIVE UP, NEVER GIVE UP.” 

But over the past few months, I’ve come to see running as a relic of my past. 

a great season

After that 1000 mile summer, I had the best running season of my life.  For those few months, I was a far greater athlete than I ever imagined I could be.

At the end of that season, I ended up as the alternate on our regionals squad.  The alternate travels with the team and hangs out as everyone else broods over the race before them.  It feels helpless because there’s nothing you can do, except supporting your teammates. 

It was at this point that I realized, this is the final lesson running has to teach me.  My role in this life is to be a cheerleader.  My contribution to the world was not going to be about my race, but rather my teammates’ races. 

After that season, my running was never the same.  I lost the heart for it, but I still ran to support my friends and teammates, I wanted to see them succeed more than they could’ve ever imagined.

In the cult classic running novel Once A Runner the protagonist refers to demons that haunt his running.  I remember feeling these demons in my own life.

just another day in the life

The demons would come on in those few minutes just before a race, when you’re waiting on the track, having stripped off your warmups, spikes on, your race is about to start, and feeling like you have to pee for the fifth time in the last fifteen minutes.  I remember telling my friend, if I ever stopped feeling like this, I would stop running.

Perhaps the demons in your life are where your heart is.  And wherever your heart is, that’s where your life should be.

Well, the demons in my life don’t haunt my running anymore, and I have left behind the life of a runner. 

For those of you still running, I really really wish you the best of luck.  There is nothing else like it. 

And of course, to my old teammates, those of you from Kenyon and those from Needham, I hope to enjoy a leisurely run with you again some day.  Or maybe just a leisurely beer.

Why I am not a fan of Interprofessional Day

Here are the 4 stated Learning Objectives of Interprofessional Day via screen shot:

I'm all for all of these things.  I'm all for doctors and nurses and techs having better communication and helping patients get better treatment, but the real question has to come back to basic human psychology - in a work environment, how can we get people to communicate better?  

shoutout to the best
lab bench mate ever

When I look back to my last job where I was a lab manager, I know that I often chatted with one of my co-workers that was one of my good friends.  We regularly drank coffee, had lunch, went out to bars, and had a mutual respect for each other.  Naturally, this made it easy to communicate at work and ask each other questions.  

On the other hand, I had other co-workers that only talked to me when they needed a new reagent.  These were co-workers I rarely talked to, even if when I knew it would help me.

So based on n = 2 I'm going to draw a conclusions - co-workers that have a relationship, or at least have respect for each other will communicate better.  Interprofessional communication is important.  At the same time, my fear with Interprofessional Day is that it's just lip service.  If you did a controlled study across academic health centers before and after Interprofessional Days were implemented, would you actually see an improvement in communication between nurses and doctors?

My thoughts would be - no change.  Which isn't a huge problem.. except that having an Interprofessional Day allows the administration at academic health centers to claim that they're addressing the lack of interprofessional collaboration, then after that one day everyone forgets about the problem, and the status quo goes on.  Med students still think everyone else hates them for being so awesome.  Nursing students still know med students have never respected anyone.  No respect, no relationship, no communication, patients still suffer.  Real change is not about a single big day of celebrating interprofessionalism, it's about day after day of getting it drilled into student's brains through practical experience.

So I'll leave you with a half-baked idea: instead of spending a day talking about how we need to work together.. what if we actually spent a day working together?  What if we went elementary school-style and had field days?  Split everyone up into teams by alphabetical order, and spend all day competing in dodgeball, 3 legged relays, whiffleball?  

What if we just spent a day with our classmates, had fun with them, and in the process, learned that nursing students and medical students aren't so different after all?  This is the truth - we're all just people, and no right-minded person wants to sit and listen to lectures and run through cookie cutter small group activities on a Friday afternoon.  

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

half-baked idea: building moral muscle

Part of my new plan for sidenote is to post more often, and that's going to result in me writing whatever bs is on my mind. Hopefully it's more good than bad, but either way I'll keep posting. 

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It's Tuesday, day 2 of being back at school. Fortunately, I'm studying from home and Starbucks instead, so it still kind of feels like vacation. 

Looking over the surface anatomy of the gut, my head was definitely spinning in all the new vocab. I wonder if it would be easier to learn if I had abs. Damn Netter.. now I'm definitely self-conscious about the cookies I ate yesterday. Just did ten push ups. Also, I would have posted a real picture of my abs but this blog is rated PG.

sidenote - on the topic of anatomy, I had a half-baked about building moral muscle. I'm not sure who came up with the idea of moral muscle, but it sounds like moral muscle = intangibles.  sidenote within a sidenote - I have this philosophy that intangibles represents everything that actually matters about humans, but it also represents everything that's difficult to quantify. So instead, we judge people by silly measures like MCAT scores, salary, lbs bench pressed, etc. One my life missions is to figure out how to understand intangibles better. Anyways, back to my idea: is it possible to build intangibles in the same way you'd build regular muscle? 

ie - if I wanted better abs I would do two hundred sit-ups everyday for a year.  ergo - if we take use humility as an example - I'd force myself to do something I'm obviously bad at everyday, and the process of making mistakes and seeing my limitations would eventually make me more humble..? Kind of a fake-it-till-you-make-it strategy.

What we need is an app that could keep track of every time you do something humble, like a workout log.  We'd also need certified trainers that would tell us how to become humble, as well as workout buddies to keep us accountable.  I really like the parallel of athletics to life. I feel like this is going somewhere but I'm out of ideas.

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

Virtual Coffee Date with Sean Nguyen: midseason NBA notes from two league pass watchers

Sean Nguyen

Sean is my fellow M1 from MUSC - we're the only Asian guys in our class, so naturally we had to be friends.

Ken: So we'll start with an easy one: who are your eastern/western conference finals teams?

Sean: As of today, I would say the thunder vs spurs and Heat vs Knicks.

I am hesitant about the clippers, the lack of free throw shooting from their bigs will hurt them down the line as you have seen in the last couple games.  So I'm kind of half and half between spurs and clippers.  "fundamentals" vs "flashy".  But make note of the nuggets, ty lawson, iggy, manimal and company could have a run.

The east seems more predictable. the knicks and the heat are the most dominant and will remain that way through the playoffs.

I am sad to say that I do not think anyone can dethrone the heat without an unpredictable run like the mavs in 2010-2011 during the playoffs.  Lebron is playing at his best and is almost averaging a triple double every game.  The team chemistry is high with the trust they have amongst each other. (Ray allen taking the go ahead basket or even shane battier).  I'd still bet biasly on my thunder though.

Ken: Yeah, the xmas Heat-Thunder game was really telling.  The Thunder just didn't quite have the composure of the Heat.  

Sean: Westbrook looked out of control Xmas day so until that's fixed... Rings will be on hold. Although, he has developed well over the post season.

Ken: sidenote - favorite dunk?

Sean: My personal favorite is harrison barnes over pekovic but as of last night, I think JR smith's reverse alley hoop had me stunned.

Ken: So what about the Celtics, are they hopeless?

Sean:  One name. Avery Bradley. I think he will spark the teams defense again given his perimeter d. He is playing second game tonight after rehabbing double shoulder surgery. The team is quite new so I'm expecting a couple more streaks to get them in the playoffs. 

Ken: Bradley helps, but they need a big man. Wilcox/Bass/Sully aren't getting it done. Where do you stand on Rondo?  I just don't see him as a bonafied franchise player.  He can get to the hoop at will, but if he's not willing to get fouled, it's hopeless.  

Sean: I think Big sully will get into his game.  He is still young but he can bump and grind in the paint.  He is just missing some experience.  Rondo is impressive (on my fantasy team), but I agree he is not a franchise "Star" player.  I think he is an exceptional player like westbrook but i don't think he is a cp3, drose type of player.  He needs a scorer but I do not think his attitude and composure will allow another star to fit that role.  

Ken: Yeah some days I wish they would deal him, but ultimately I love him for being this guy: 

So I guess I'm willing to play it out a few more weeks.  

Sean: Teams are starting to peak. I'd give it another two weeks before determining who is hot and has a playoff run.  The lakers actually looked good vs the clippers yesterday.  Dwight and kobe playing exceptional with nash giving good dimes.  (although pau was garbage) Their intensity looked great but it was a rivalry game.

Ken: Yeah, the next couple weeks will be telling.  Anyways, we'll end here.

See you on the other side,

from sean and ken

taking requests for future blog posts. please comment or email.

New Year's Resolutions

My New Year's Resolutions:

1) Study less, blog more. The more I think about med school and my career goals, the less I feel like investing my precious time trying to do well on med school written exams is worth it.  

2) 10,000 total push ups.  I usually don't have that much trouble going to the gym since it helps keeps me sane, but I don't really like doing push ups.  10k is 60 every other day, which seems doable. sidenote - my least favorite part of New Year's Resolutions is the crowd of people at the gym. If I worked at a gym, I would find someway to take advantage of the January influx.  

3) Make the year awesome for my wife. A big part of marriage is deciding your own happiness is not about your own stats or paycheck, but rather the good of the whole. I want to help Katie thrive in Charleston this year.  

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My friend from Wyoming, Corey Schneider had the best Resolution I've seen, so I'll just wrap up with it:

"This year is going to be different. I am going to starting eating better, exercising more. I will cut down on drinking. I'll smoke my last cigarette. I'll lose 10 pounds. I'll stop watching television, and spend less time on the computer.

Corey and I climbing mountains,
working on our squinting

I will be more positive, more humble. Become a better friend and a better boyfriend. I'll stay in better contact with my family members. I will make new friends, and reconnect with old ones. I will stop giving my time and energy towards people in my life who do not do the same.

I will work a job that I do not hate. I will worry less about money, and and even less about material possessions. I will stop supporting large corporations and chains, and start supporting local and family owned businesses. I will volunteer my time to organizations that deserve it.

I will skateboard more, and go camping more. I will shoot more photographs, and make another short film. I'll see more local bands, and listen to more new music. I'll devote all my free time towards creative endeavors. I will embark on the trip of a lifetime, and finally see Europe. I will take a 3 day camping trip on a motorcycle, with or without you.

I will sleep less, and live more. 

And I will stop using facebook."

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I love it, except for the facebook part.  I plan to dominate the internet this year.

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

Running Diary: this is water tattoos

Apparently, when you get married you're supposed to give all your groomsmen a gift.  I wanted to gift something that had Ken written all over it, so I went with a short (you're welcome groomsmen) book that was originally an inspirational commencement speech given at Kenyon College.  It was given by David Foster Wallace (DFW), a literary legend.  The book was entitled, This Is Water.  

Quick summary: Two young fish are swimming along the river one day when they come across an older fish who says to them, "Morning boys, how's the water?"  And swims on.  The two young fish swim on and one of them asks, "What the hell is water?"

My friend Amulya really loved the book, so a few months ago we decided to get "this is water" tattooed on ourselves.  Here's the running diary:

9 PM: Amulya arrives at my mom's house in Newton, MA.  sidenote - my bedtime is usually around 9 or 10, so I was about ready to pass out at this point, but we drove over to Amulya's house for a bro slumber party and watched the Celtics-Kings game.  DeMarcus Cousins went for a triple double and the Celtics lost 118-96 to the second worst team in the West.  Classic 2012 Celtics.  sidenote - I would love to see this trade: straight up, Cousins for Rondo.

Fast forward to 2 AM: Listening to DFW give the This Is Water speech at Kenyon.  Analyzing it one last time for its significance.  

Next morning, wake up at 10 AM: Take Amulya's dog out to walk through fresh New England powder.  I wish I had a dog.  Except when it poops.  I want someone else to pick up the poop.  

1 PM: Start the drive towards Providence, RI - the land of tattoos.

1:15 PM: Ken checks phone.  hmm...  You have 3 new messages from Katie Noguchi.  This can't be good.  Katie doubts ken will actually come home with a tattoo.  

1:40 PM: Arrive in Providence, surprisingly short drive.  The first tattoo parlor only has about 4 font options..  Pass.

1:55 PM: Arrive at tattoo shop #2 - Providence Tattoo, referred to on yelp as the BMW gallery of tattoo shops.  

sidenote - I would have live tweeted this epic event but I don't know how to use twitter yet.  Although, I did just read an idiot's guide to twitter.

2:15 PM: Ken and Amulya make a reservation for 5 PM, and embark on one last tattoo strategy session at a hip coffee shop - Cafe Zog.  SO much time spent on dafont.com going through hundreds of possible fonts.  Countless screenshots and editing different images in powerpoint eventually resulted in this:

font: daniel

Amulya decided to go with his own handwriting. A brilliant idea I would have copied, except I have doctor handwriting which looks like this:

4:30 PM: Leave Cafe Zog, back to Providence Tattoo.  

5:10 PM: Our tattoo artist drew out "this is water" trying to copy Amulya's handwriting, but it looked girly so we had to make a last minute switch to:  

font: garamond

Didn't feel right to audible this late, but we had to.  

6 PM: Walking out of Providence Tattoo with ink.  

7:15 PM: Back in Newton, dazed and confused, we stopped at Starbucks to get some coffee and reanalyze the lingering question: Why did we just do this?  

yolo

Our temporary conclusion: This Is Water is about paying attention to water.  It's too easy to get caught up in our day-to-day routines.  Wake up, make coffee, go to class, go for a jog, eat dinner with wife, call it a day. I love a good routine, but the danger is that we become numb to the details.  

And that was the major reason Amulya and I wanted these tattoos. To have a constant reminder of all the small decisions that surround our inevitably routine lives.  Take the example of owning a dog - loving a dog isn't just about having a friend that's always around, it's also about being a responsible dog owner and picking up its poop.  This Is Water is about realizing that we need to pay attention to poop.

But at the end of the day, Amulya and I just love doing bold things like this together.

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

updated look

I loved the dynamic blog template, but I was having trouble with the commenting function.  My goal for 2013 is to figure out how to use sidenote as an ongoing dialogue of ideas, so naturally comments are super important to me.  The new template is step one of the many changes I have in mind for 2013... so please try commenting. 

See you on the other side,

from ken

now taking requests for future blog posts. please comment or email.

best of sidenote 2012

watch your back, Dwight Howard

Top 5 things I did during break:

5) Shot 100 free throws, made 41.  Extremely proud of myself. 

4) Tried my hardest to grow facial hair.  I plucked one out and measured it using the lab microscope - achieved a few millimeters.  

3) Saw my first 3D IMAX movie (The Hobbit) and got motion sickness.  Still loved it.  

2) Started researching possible jobs after getting an MD/PhD from MUSC.  Top 2 options: match in orthopedic surgery and become the medical consultant for Grantland, or follow Rembert Browne's career trajectory - graduate from a small liberal arts college in '09, write a funny blog for a while, get picked up by Grantland as a full-time writer. 

sidenote - here's how my career idols have evolved over the past five years:

1) Went to Anthropologie in a hoodie and sweatpants.  Probably the #1 time I felt like an outsider.  I'm sure they thought I was trying to shoplift $80 tanktops.  

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Anyways, here are the most popular posts of the year 2012:

MUSC Orientation running diary

The Decision: I'm going to take my talents to South Carolina

2012, the year of the palm tree

What do you want to do with your life?

Relationships in med school pt 3: Marriage Review yr 1

Insane in the Sarcolemma: test week #2

Why Kenyon College Kicks Ass

Why MD/PhD?

Metzger/Keyserling wedding in review

Thank you for a great 2012!  Expect more bullshitting in 2013.

See you on the other side,

from ken

now taking requests for future blog posts. please comment or email.

Math > Mayans: a Nate Silver Book Review

The Mayans came out with the bold prediction that the world would end two days ago.  For better or for worse, the Mayans were full of it, and we're all still here. But according to the hottest thing since sliced bread - Nate Silver - we shouldn't be surprised.  

If you've never heard of Silver - he hit it big for using math to predict the election.  Before that he developed one of the top major league baseball forecasting systems - PECOTA.  And before that he was a professional online poker hustler.  Silver's recent book The Signal and the Noise: Why Most Predictions Fail - But Some Don't is all about his specialty - predicting.  The thesis: predicting is hard, but some things are easier to predict.  For instance, Silver analyzes earthquake predictions and weather forecasts - while the computing industry has allowed weather forecasters to take leaps, earthquake hunters still have miles to go  

While Nate Silver is definitely a bonafied genius.. he's not quite an original, more like the remix. He's the same genius as Bill James and the Moneyball crew that first applied mathematical analysis to baseball.  He's the same genius as the guys who decided to infuse bioinformatic analysis to biomedical research.  Silver was simply the latest to add a splash of math to a field in desperate need of it.  

So my question is: how can we apply the same genius to medicine?

to be fair, it's not like airplanes
have advanced much either

Here's one of the main reasons I think med school education is outdated.  We need a clearer definition of a good doctor.  Since our current definition is utterly vague, med students are left with the same training program that educated doctors in the era of kitty hawk.  

In track - you have the goal of running as fast as possible.  In order to do this, you don't just run around in circles randomly.  You run according to a rigorous schedule, each day with a set purpose.  One day might be optimizing VO2 max, another increasing lactic acid tolerance, and yet others to train neuromuscular junctions to fire optimally.  It's a real science.  

We need to get med school education to that same point.  Once we have a scientific defintion of "a good doctor" it'll become a lot easier to figure out how to educate "a good doctor."

I bet you thought we were just
running around in circles

So this is where it gets hard - quantitatively defining a good doctor.  What sort of stats should we be keeping on doctors?  I don't have any good ideas, so instead here's a list of half-baked ideas Kevin Wildes-style.

1- (%age) times washed hands per opportunity

2- # of times yelled at a nurse per shift 

3- total amount of shit other doctors talk about you (respect of co-workers)

4- triathalon time (endurance is important)

5- miles walked per shift (shows commitment and effort..?)

Anyways, please send your half baked ideas my way.  I need to incubate some more ideas.  

See you on the other side,

from ken

now taking requests for future blog posts. please comment or email.