Shoes

Sunday morning my son decided to play outside. After much opposition, I gave in, and - shoes on his feet - he opened the back door and sprinted outside with a giggle.

Not more than 30 sec later I hear a blood-curdling scream. I jump up and out the door to see my son sprinting around the house crying "doggy! Scary!" The large hunting dog next door had charged the chain-link fence and barked. Down by the fence were his two shoes precisely where he was standing. He'd been scared out of his shoes like a cartoon! I tried hard not to laugh, but eventually broke down & rubbed his back while consoling him in-between laughing.

Pancakes

Yesterday was the Kiwanis of Baton Rouge Pancake Breakfast. $4.50 got me unlimited pancakes and sausage, and either milk or juice. For $0.50, you could get extra drinks. Wonderful. It was held at the Maravich center on LSU campus from 6 am to noon. Great location, time, and food. 

I blog about it to highlight a couple points. 

First, I only heard about it at the last minute from my attending. This is common here on Baton Rouge: advertising ineptitude. I searched for it online, and only found something accurate after probably 10 minutes of googling. I am a proficient computer user. It should never take ms 10 minutes to google anything. 

Secondly, I've eaten there and I still don't know what it was for. Where is the money going? Who will it benefit? So a horrible job of advertising during the show happened too. 

This might be a great object lesson for future businessmen or physicians (who are businessmen too). Physicians have the opportunity to teach about healthy living before during and after visits. This is especially critical in pediatrics, where we have to teach parents and patients. 

The breakfast had an art wall to showcase student artwork, a face painting area, a stage for little children talent competitions, a first aid area, and an area selling jewelry and Christmas ornaments. They knew how to sell things, but not how to make lasting impressions. 

So too, physicians know how to do things. We currently think procedurally - do that I&D, place that central line, even "educate that patient." health isn't viewed on a continuum hence the disconnect between the advertising and the outcome often comes into play.

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Pride of my Fathers

Two nights ago I set about creating a birthday cake for my son. When I was young, I remember nights spent outside in the garage with my father, working on cakes for the Cub Scout cake auction. "What?" you say. "The garage?"

Yes, the garage.

My father the engineer never made a regular cake. One year it was a windmill, complete with working (rotating) fan. Another time it was an airplane with propellers, and yet another time we made a lighthouse - complete with light of course.

I used to stand amazed at how smart my father was. How could I ever be like him? When would I ever learn all this stuff? (I still wonder this, since he is an engineer and hence infinitely smarter than myself). Our cakes always took first place (unless the took second place to my brother's cakes - also made by my father) and raked in the most dough. Ah, how my chest swelled with pride!

And so, when my son's birthday got closer, and my wife asked me to make the cake, I immediately started getting flashbacks to those nights in the garage. A Thomas the Tank Engine party only deserves a train cake with working light, right?

So two nights ago I set about making my first simple circuit since college. When I flipped that switch and the light shone, my chest swelled with pride again. Perhaps I did learn a thing or two from all those nights watching my father? Next step is placing the circuit properly in the cake and cake board. Then my son can turn it on at his party.

And then my chest will swell with pride again.

Belated Congratulations

... to the Forever Young Foundation and Tuan for winning this year's Play for a Cause.

This year we raised $120 for the Forever Young Foundation (FYF), an organization that uses sports to provide opportunities and learning experiences to disadvantaged youth. Pretty cool idea, if you ask me. Also, it was started by Steve Young, the hall of fame quarterback for the San Francisco 49ers, and one of my personal favorite NFL players.

Part of the reason for my tardiness was a delay in receiving all payments. Another is my busy life. I went to Vietnam during April, graduated in May, moved in June, started residency in July. By the time I got all the money together and donated it, June was ending and I was jumping into my residency. Hence no time to report back to you that, yes, it was done.

However, I want to say how proud I am of everyone. For three years now, we have all given a little to help others. The variation in winners - Heifer international, Diabetes Research and Wellness Foundation, Forever Young Foundation - belies are innately different likes and personalities, but each program achieves the same goal of helping our fellow, less fortunate, brothers and sisters.

Who will win next year? I can't wait to find out. Congrats again to Tuan and the Forever Young Foundation.

A New Chapter

So this post marks a new chapter in the bleeding ear, because no longer am I a college student typing away at my laptop creating a blog from scratch back when blogs were not fully understood nor when I was a medical student with great ties to Vietnam and Asia trying to put my two cents into the world about politics. I've moved on to residency, where its long hours leave me little time to write in the traditional mode and so I am trying something new something different - I am dictating my blog post. Maybe this will work. I dictate admit history and physicals for patients as well as discharge summaries. Much work needs to be done to train my voice and the dictation software box perhaps I can get back to blogging and perhaps make a difference in peoples lives other than my family and my patients. Wish me luck!

Expensive Health Care

Over the last year, as we in America have been swept up in political wrangling over health care, and the inherent power struggle between democrats and republicans that is ultimately at the bottom of it all, I have had the opportunity to have a front row view. I sat on the board of trustees for the Texas Medical Association and sat through numerous conference calls and strategy sessions with doctors in Texas, the American Medical Association, and politicians in Washington DC.

For sure the problem with healthcare is multifactorial, and our solution undoubtably must be as well. However, a favorite argument thrown out by both sides is the "cost of health care." One need not look far or read many webpages to hear someone opine about needing to reign in those outrageous costs (and his or her solution). This past July, Veronica Gunn, MD, chief medical officer for the Tennessee Dept of Health spoke to us about this and other topics.

The scare tactic she used was common: put up a graph that shows $12.7B spent on healthcare in 1950 and $2400B (yes, $2.4 trillion) spent in the USA in 2008.

"Holy cow!" you say?

Yep. That's right. An almost 188-fold jump in spending. That's like going to McDonalds and wanting a $1 hamburger only to be told it now costs $188. You'd choke then & there - way before you got the hamburger! Anyone and everyone should rightly be concerned about such a jump.

"Why would the hamburger cost so much," you ask?

Well, McDonalds gives you the standard answer: yesterday we made hamburgers, but our board decided overnight to do a couple things. We now have all new state-of-the-art machines for making patties the same size every time, and a super fryer that makes our delicious fries even more so - and healthier! We've also decided that you have to buy your own buns separately - but only the ones we decide for you to buy (and write you a prescription to get) and the bun makers say they have special no-fat buns that taste good but cost a fortune to invent. Oh, and don't forget the new program to give free hamburgers and fries to everyone who comes in without the money to pay.

You see, we've decided it's immoral to refuse hamburgers to someone who doesn't have the cash on them, so we give it out free and charge you more. But don't worry. If $188 is too much, we'll allow you to pay $40 a month (whether you'd have eaten 40 burgers a monh before or not) to another company who pays us, and then you can get each dollar hamburger for $1.

Now, before we hear the cries of "Health care is a right! Eating hamburgers is not!" I want you to put aside your righteous indignation at an admittedly flawed (but I still think decently effective) parable, and follow me to the numbers.

Ms. Gunn said $12.7B spent on healthcare in 1950 and $2400B spent in 2008. If adjusting for inflation according to the consumer price index, $12.7B was really $112.4B in 2008 dollars.
Now, that's still a large gap, but the 188-fold difference that made your eyes pop out of your head has dropped to 21-fold. Crazy large? Yes. Space-time continuum splitting? No.

Now let's adjust for population. 1950 - 152,271,000 people. 2008 - 301,621,157. That increase in spending just dropped to 10-fold.

10-fold is a lot different from 188-fold.

Essentially McDonalds is saying, "Our hamburger now costs $10 a burger, from $1 in 1950. So, pay us $40 a month regardless of the amount of hamburgers you eat, and you can have your hamburgers for $1, plus, we can give free hamburgers out to people who can't pay for them."

Even if you believe ideologically that you should give free hamburgers to the poor, spending $40/month is a lot harder to stomach when the price of the hamburger is only $10 and not $188. The Democrats and certain special interest groups (including many physician organizations) understand this, so they play up the $188 burger. Health care becomes an easy way to redistribute wealth.

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Argentina

From this article on Messi:

The easy conclusion, of course, is that the country is mad. Yes, anyplace can seem bizarre to a stranger, but let's agree that Argentina's lunacy is more obvious than, say, Denmark's. Argentina is, after all, the nation with the most psychoanalysts per capita; the country whose still-feverish devotion to a long-dead First Lady resulted in a town, Ciudad Evita, built in the shape of her head; the land where citizens fearlessly consume beef for breakfast or with afternoon coffee and erupt in street protests for any reason at all. On an April afternoon, for example, picketers halted rush-hour traffic on the highway into Buenos Aires, expressing outrage over the damage caused by a recent hailstorm. "Protesting the hail," said a lifelong resident with a shrug. "Of course."

Wonderful.

Yea Duke! Boo Duke!

Congratulations to a small private school for shocking the basketball world and defeating another shocking, small private school.

Yes, I was rooting for Butler. But, it was a great game and that's what really matters for my non-partisan self. The real championship came in Duke vs West Virginia. That's not because I think WVU is better than Butler (they're not), but because the winner of that game determined the winner of TBE Play For A Cause 2010... and THAT is far more important.

So, the final came down to David and Teach for America or Tuan (Vince) and the Forever Young Foundation. Unfortunately, WVU decided not to show up. Duke won, and so did the Forever Young Foundation. It was a hard fought victory.

With the rules valuing later round wins, even though David came within one game of winning the whole pool, he didn't even finish in the final top 3. That would be Tuan, Dennis (Diabetes Research & Wellness Foundation), and Matt O. (Avon Walk). Fourth was Roger (LDS Charities). Dennis deserves special note because he came in second this year after winning last year, and clearly has performed the best overall during the 3 years of this event. Everyone watch out for 2011!

However, it does me great pleasure to note that for the third year we have a new winner. This shows that 1) everyone has a chance to win, no matter how much you know or don't know about basketball, and 2) we get to learn about a lot of good charities we might not have known about before, and 3) we get to help people. What a wonderful life we have.

So, without furthur ado, congratulations to the Forever Young Foundation. the $120 pot is the most raised in this pool to date, and I'm sure it will go to a worthy cause. See everyone next year!

I Wish I Were A DJ

Many people don't know this about me: In another life, I'd be a DJ.

 

The beat -- bum bum bum bumbum bham bham bham ... -- the strobe lights, mixing board, laptop.  It turns me on.  Tonight I went to my first club in Ho Chi Minh City.  It reminded me a lot of clubs in Las Vegas: special effects, pretty girls in dancewear, well dressed waiters serving drinks -- but I couldn't take my eyes of the DJ. 

 

I walked upstairs and surveyed the octagonal dance floor.  To the right, elevated, was a young man, large, noise-reducing headphones on his ears like helmets, bouncing to the beat.  Up, down flowed his hands across the electronics in front of him. First, left lever up, bounce, then right lever down a bit.  Pause.  Type on his Mac. strobes change pattern.  Bounce.

 

I wished I could be him, or at least behind him, watching his hands work; a pupil studying the master.  And it occured to me that no one here got it.  Sure, the guys were scoping out the girls and vice versa.  But the true beauty in the room wasn't the heavy-makeup-wearing 20-something looking for a guy to "befriend," but the beat that got the bodies gyrating.  With every step, drop of sweat, turn, pump, smile, and slide, the beauty in the room was what flowed through the air between it all - no - it was the movements of the master creating the music. 

 

My secret love affair with jockeying started as a spin-off from my more well known relationship with music.  As a ten year old boy, I sat in music class singing everything from Simple Gifts by Aaron Copeland to "I saw the sign" by Ace of Base (hey, it was the '80s).  Something moved me, connected parts of my soul I didn't know existed.  Junior high saw my romance blossom -- music and I were a true item.  I lived for choir.  Engrossed myself in the radio.  Groused at not being able to do other things because there wasn't enough classes - but I wasn't giving up choir.

 

Matriculation proved almost sensual.  Like any good relationship, once the formalities and casual dating is over, you dig deep into a person to try and understand them and build a new "us."  Music and I were no different.  Through talented minds and voices, I loved theory.  I wanted to understand music at its basest levels.  I came to understand much of myself, my romanticism, my goal-driven nature, my desire to compete.  My refusal to settle for anything less than sucess.  Of course, no relationship is complete without a few difficulties.  My lungs collapsed.  Made it hard to sing competitively.  I flirted with computer science before realizing the grass really ISN'T greener.  But through it all, music and I grew stronger.  It never waivered in its belief in me, or its desire to meld my soul with my circumstance.

 

Then one day, ironically in a church setting, I was called to use my relationship by dj-ing some dances for my youth group.  I planned ahead, listened to songs, put together a play list, beats, got my cds ready (hey, it was the 90s).  For hours one night a month, I left my love of music and dabbled with her cousin.  It enticed me that I could use technology.  My heart beat a little faster at the idea that I could create musical synergy.  I was infatuated with the realization that I influenced hundreds of people, their movements, their feelings, their futures, by what songs I played and in what order.  Would he dance with her?  Would she leave him for her girlfriends to share a favorite song?  Or maybe he wants to sit this one out because it reminds him of a previous flame.  Examples.

 

But time moved on, and I moved to Utah and college.  The ability to jockey remained in Texas, and you know long-distance relationships - they don't work.  Slowly my schoolwork encroached on my time with music and displaced what little unreserved time had been saved for jockeying.  My tastes matured.  The immediate became important as people changed, circumstances changed.  I thought I had moved on, leaving music and its passions for the metered feelings of medical school, but tonight brought it all back.  I love the lights, the sounds, the movements.  But mostly, I love the responsibility and position I have to create something new, even actions and thoughts, and influence people in ways they don't comprehend. 

 

That is beauty.  That, is being a DJ.

Kentucky or Duke?

... or West Virginia or Kansas St or Baylor?

The Sweet Sixteen finished yesterday with a whimper. St. Mary's showed up to their game at halftime, and couldn't dig out of the 29 point hole their fill-ins put them in. Tennessee and Michigan St. ensured that someone outside the top 3 in a region will make the Final Four, but that's not really surprising since (outside Kansas), they're probably the two best coached teams in that region, if not the tournament.

Of much more interest is that the establishment of the Elite Eight has also whittled down our pool to our "Super Six" - the six charities that have a chance of winning it all.

Yes, my charity is not super. In fact, it's second from the bottom.

So, without further ado, here are the 2010 TBE Play For A Cause "Super Six":

Star of Hope (Blake)
Jesus House (Matt)
Avon Walk (Matt O.)
Teach For America (David)
Phú Mỹ Orphanage (Julie)
Forever Young Foundation (Tuấn)

Below is a spreadsheet that lists all possible outcomes of the Elite Eight and the winner of our pool. This was much easier than expected because nobody chose Tennessee, Michigan St, or Butler to reach the Elite Eight, and only two chose Kansas State. That said, those two soothsayers happen to be among the Super Six, so the Kansas State game holds big ramifications.



Today there are two games: Kansas State vs Butler and Kentucky vs West Virginia. The Kansas State game is easy. Both Matts (Jesus House and Avon Walk) picked K-State. If you root for either of those charities, you'll want K-State to win, because it helps your cause tremendously.

Kentucky vs West Virginia holds a lot more weight. Essentially, if Kentucky wins, we're guaranteed that the pool winner will be Star of Hope, Jesus House, Phú Mỹ Orphanage, or Avon Walk.

However, if West Virginia wins, we've got the cadre of Teach For America, Forever Young Foundation and Avon Walk. Choose your sides!

Obviously, Avon Walk is in the driver's seat, especially if Kansas State wins today. This is because if West Virginia beats Kentucky and then makes the final, Teach For America wins UNLESS, Kansas State wins and Duke wins their elite eight game.

So, pick your side, Kentucky or West Virginia, and may the best charity win.

18 Strength or 18 Charisma?

Poor, poor Cornell. I really liked those future rulers of humanity (or at least financial planners for the people that defeated them). Cornell played an ugly game, but it was the right game. The problem was, they went through a period of about 10 minutes in the first half where they forgot to play defense, and Kentucky ran up and down the court - scoring inside at will.

Once the second half started, Cornell brought the pace to a halt and brought the game within reach, but just couldn't get over the chasm they had allowed in the first half.

Then there's Kansas State. Cornell's brains are juxtaposed with K-State's tatoos. It all kinda reminds me of Dungeons and Dragons. When you were 12 and were creating that awesome character for your quest (and yes, you did play, even if you deny it now), you were always stuck, because you had only so many attribute points and you had to divvy them up between the basic attributes. If you wanted 18 strength, you were sure to have a low score somewhere else, but if you gave yourself all 10s, you character was pretty average - literally and personality-wise.

(Now, some people tweaked the rules, and rolled 3 dice for every attribute, allowing the possibility that your character could be the mythical all 18s super-God, but that wasn't how it was really supposed to be done.)

Cornell reminded me of that conundrum last night. They have Intelligence of 18, and obviously Charisma was pretty high too. But compared to Kentucky, Strength and Dexterity was too low to overcome. Meanwhile, schools like Kentucky have clear one-and-done athletes destined for NBA greatness. But all of that effort on basketball makes their scholastic endeavors farcical.

And so, in the arena of sport, 18 Strengths and 18 Dexterities will always beat those who put the time in to develop other attributes. A school with 18 Intelligence may never win the dance, but at least I can dream. Who knows? Perhaps someone will come along who bent the rules, and has all 18s. That would sure make things interesting.

Editor's Note: For those of you who really didn't play Dungeons & Dragons, each attribute score was randomly generated by rolling 3 six-sided dice and taking the total. 18 is the highest possible (natural) score a character could have (and obviously 3 is the lowest).

SO, at least 1 #1 seed is still alive and on to the Elite Eight. Kansas was slain by Northern Iowa, and last night Butler showed its muscle and decapitated Syracuse. Duke plays tonight it what could eviscerate the remaining brackets in our pool.

Here are the updated futures on each charity listed by possible points remaining:

Charity: Points + PPR = Possible Total
Avon Walk (J. Lamp): 430 + 840 = 1270
Forever Young Foundation: 490 + 760 = 1250
Jesus House: 430 + 760 = 1190
Diabetes Research & Wellness Foundation: 450 + 680 = 1130
Teach for America: 460 + 640 = 1100
LDS Charities: 410 + 640 = 1050
Star of Hope: 550 + 280 = 830
Pazapa Center for Handicapped Children: 420 + 400 = 820
Action For Healthy Kids: 420 + 400 = 820
Phú Mỹ Orphanage: 450 +360 = 810
Doctors Without Borders, USA: 390 + 400 = 790
Epilepsy Foundation: 320 + 0 = 320

After the Sweet 16 is over, I'll take a more in-depth look at who's mathematically in it to win it, and who's hanging out with the Epilepsy Foundation.

Will the Madness Subside?

Well, March Madness really was mad. Round 2 was not as crazy as round 1, but there are some significant bracket busters into the Sweet 16. All that has made this year's 3rd Annual TBE Play for a Cause the most crazy one yet.

For example, I thought I was pretty safe with Kansas to win it all, and my gamble was BYU to the final four. If BYU could get past Kansas St., they would have the next two games in Salt Lake City, and would have a really good chance of going to the final four. Unfortunately, BYU laid an egg over the last 10 minutes of the first half against K-State and never recovered (It didn't help that the refs allowed K-state to basically mug players on the court). I suggest investing in firearms and personal bodyguards the next time someone has to play those thugs.

Because of Kansas' early loss to Northern Iowa (can you have a North & South if your state is that small?) and Villanova playing like scrubs, and my gamble failing, most of my future points hinge on Kentucky making the championship game. But they're playing Cornell, who I love, so I'm forced to root against myself.

All this craziness has Star of Hope in the lead, followed closely by Teach for America and the Forever Young Foundation. However, when we look at possible points remaining (PPR), we see some interesting things:

Charity: Points + PPR = Possible Total
Star of Hope: 430 + 400 = 830
Teach for America: 420 + 800 = 1220
Forever Young Foundation: 410 + 840 = 1250
Epilepsy Foundation: 320 + 40 = 360
Phú Mỹ Orphanage: 410 +520 = 930
Pazapa Center for Handicapped Children: 380 + 440 = 820
Diabetes Research & Wellness Foundation: 370 + 800 = 1170
LDS Charities: 370 + 960 = 1330
TBA (MGO_Undecided): 350 + 960 = 1310
Jesus House: 350 + 840 = 1190
Doctors Without Borders, USA: 350 + 480 = 830
Action For Healthy Kids: 340 + 600 = 940

The race has really narrowed to the six charities in italics above. LDS Charities has the most total points possible.

Unfortunately, the Epilepsy Foundation takes this year's Lovable Loser award (yes, I made it up right now, for the first charity mathematically eliminated). You get a pat on the back, and a suggestion to never, NEVER choose Temple to win it all.

Crazy Day 1

A very crazy day 1 is in the books. ESPN said they had over 4.8 million brackets in their contest, and after yesterday, only 56 were still perfect. Insane.

On the good side, my BYU won. It took them coughing up a 13 point lead and two overtimes, but they finally shook that first-round-loss monkey off their backs. On to the final four!

I made an error this year with the competition. I told everyone the deadline was Thursday at noon, because I thought that was when the first game started. However, I forgot that ESPN locked the brackets in the morning. So, at least 4 people who told me they'd play didn't get to sign up. I have brackets from 2 of them, filled out before the first game's result was known. I will link to them once they are digital so everyone can see them. Transparency. Amazing isn't it.

Congratulations to Tuấn (Vince) for winning the first day. You get nothing. Sorry. But I do wish you continued success in the tourney. These first round games really set the tone for what comes later.

Finally, thanks again to everyone who's playing this year. We'll raise the most money ever in TBE's Play For A Cause lifetime. Hopefully, by this time next year you'll be able to go to an official website for my new non-profit organization, Play For A Cause - as I try to expand this idea to other people and other events.

Which Cause is Mine?

Now that another year of March Madness is upon us, the most common question I receive from people (and myself) is "What cause should I play for?"

Who do I play for this year?

I admit that in past years it wasn't so hard. First was the wanton disregard to human rights in Tibet. So I played for Students For A Free Tibet. Then I was touched on my Pediatrics rotation by the trials couples face losing a newborn, and I found Now I Lay Me Down To Sleep, a great organization that provides photographers - free of charge - to take professional-style portraits of families with their newborns before that young child passes away.

But this year I'm indecisive. So to help me (and any of you in the same boat) here are some resources:

First, a great website I've talked about before is Charity Navigator. You can search for charities there, and the site ranks these organizations based on how efficiently and productively they run.

Perhaps you want to give to an organization to help Haiti or Chile after the horrible natural disasters recently? Follow those links to lists of quality organizations working in those countries.

Also, here is a list of all the organizations represented the previous two years:

Heifer International (winner 2008)
Ovarian Cancer National Alliance
Students For A Free Tibet
Diabetes Research & Wellness Foundation (winner 2009)
Now I Lay Me Down To Sleep
National Alliance on Mental Illness
Autism Speaks
St. Jude's Children's Research Hospital
American Cancer Society
Save Darfur

Remember, you have only until Thursday at noon to fill out your bracket. Do it now so you don't forget! Good luck!

Mirror, Mirror, On the Wall

This morning, while doing P90X, my son, who awoke early, thought the scene of daddy doing sit-ups in the middle of the room was hilarious so he jumped onto my chest and effectively ended my workout session. While I tried to do crunches, he hung on like Curious George (who he happened to be watching at the same time), giggling and unknowingly taunting. "Why can't I be healthy and fit anymore like my son?" I thought.


But immediately my flight of ideas landed on this: what does my son think of me? I love my son, and don't begrudge our memory together - even if I couldn't finish today's "Ab Ripper X" - but 20 years from now, will he feel the same? As I've grown and (hopefully) matured, I see my father mirrored more and more in myself. This is a good thing. My father is a great man - honest, intelligent, kind, charismatic. And although my mother can undoubtedly delineate his faults (nobody's perfect), I'm convinced the world would be a better place if more people were like him.

I am currently reading Open, Andre Agassi's autobiography. His depiction of his father contrasts mine.

(p. 35)Violent by nature, my father is forever preparing for battle. He shadowboxes constantly. He keeps an ax handle in his car. He leaves the house with a handful of salt and pepper in each pocket, in case he's in a street fight and needs to blind someone. ...

...He boxes in his dreams, and frequently hauls off and punches my dozing mother. In the car too. ... I'm driving with my father one day, going to Cambridge, and he gets into a shouting match with another driver. My father stops his car, steps out, orders the man out of his. Because my father is wielding his ax handle, the man refuses. My father whips the ax handle into the man's headlights and taillights, sending sprays of glass everywhere.

... Such moments, and many more, come to mind whenever I think about telling my father that I don't want to play tennis.

Agassi's father lived vicariously through Andre, teaching with fear, and setting an example of aggression. Those are things I definitely don't want to emulate with my son. Sure, I'd like him to achieve great things, but I want him to decide what those are.

I guess things are off to a good start. This evening, before my son went to bed, he spontaneously came up to me on the couch and kissed me on the cheek. Then, he said, "TV, daddy!" and turned on the television for me before grabbing his pillow and heading to the bedroom. Now if he just played tennis like Andre Agassi...

TBE Play For A Cause 2010

The time has come ...

Four years ago, I parked my motorbike just inside the large gates of the orphanage and walked into the central room. In it, among numerous children of various ages and infirmities, sat Huy. Huy was an 18 year old young man who sat daily in a wooden highchair, his broken body unable to allow him to walk or play since birth. His mind was sharp, his personality infectiously funny, and he always had a smile on his face, even when I had to wipe porridge from his mouth because he couldn't do it himself. Money was scarce for the Phu My Orphanage in Ho Chi Minh City, Vietnam, and the few hours I volunteered each week impressed the nuns who ran the orphanage almost as much as the children impressed me. I can only imaging what $100 would have done for Huy and his friends.

This year you can play for your Huy - your cause. What is it that gets you up in the morning? Who have you met that has left an indelible impression on your soul? What wrong would you right if you could?

Two years ago I started this March Madness tournament pool as a way to funnel a good time into good deeds. Heifer International, played for by Sara, received $100 that year. Last year Dennis' Diabetes Research & Wellness Foundation received $90.

So, I ask you for $10 - the price of a lunch at Au Bon Pain or a ticket to the movies on the weekend. Pick a cause you want to play for, and enter a bracket. No need to know anything about basketball to play and/or win. If you win, your cause gets the whole pot.

For the price of a movie ticket, you can help Huy eat something better than porridge.

See below for instructions on how to join:

The official tourney is ran through ESPN's 2010 NCAA Tournament Challenge.

1. Go to http://games.espn.go.com/tcmen/en/frontpage to join.
2. If you have an account, sign in. If not, click the large red button to create one and follow the instructions.
3. After signing in (or up), create a bracket. NAME IT AFTER YOUR CHARITY/CAUSE.
4. If you aren't sure who to play for, go to this post about a site that rates different charities. It might help you decide. Or ask me!
5. After naming your bracket, click on the "My Groups" link in the middle of the page, and follow the drop down list to "Create or Join a Group."
6. Search for "TBE Play For A Cause 2010"
7. Join the group. Congrats! You are now entered into the TBE Play For A Cause 2010 pool!
8. Selection Sunday is this Sunday, March 14, 2010. The first round starts Thursday, March 18th. Please have your brackets entered before the first game on Thursday.

The $10 pool contribution can be given to me directly or through the paypal link in the top right corner of this webpage.

We will follow all the official ESPN tournament rules for scoring including tiebreakers.

Good luck! Contact me if you have any questions.

Kneel at the Altar of Your God

Yesterday I was reading an article at The Reinvigorated Programmer (hat tip to my brother for the link) about the changes in computer programming and coming to grips (or not) with them. The writer laments the metamorphosis of programming away from a creationary enterprise.

Today, I mostly paste libraries together. ... Is that programming? Really? Yes, it takes taste and discernment and experience to do well; but it doesn’t require brilliance and it doesn’t excite. It’s not what we dreamed of as fourteen-year-olds and trained for as eighteen-year-olds. It doesn’t get the juices flowing. It’s not making.

How universal is this desire to create? It drives humanity, and has since the beginning. Adam & Eve got kicked out of the Garden of Eden and started creating our race. The Pharaohs of Egypt built huge pyramids to remind us of their power. America boasts of creating an environment (government and economy) that fosters creation of products and ideas.

EBM not only takes the individuality out of case management, but stifles innovation

Medicine is the same. To some extent each of us, definitely myself, got into medicine to help others. Put another way, we wanted to create health from sickness. Surgeons say "a chance to cut is a chance to cure," but it could also be said "...a chance to create a new, healthy patient." 80% of physicians are still in private practice instead of large, academic settings because - in part - we enjoy creating that medical practice. We enjoy hiring our nurses, finding our own building, being our own boss. We enjoy creating a relationship with our patients.

Quoted in the article is Don Knuth, from Peter Siebel's book Coding at Work:

There’s the change that I’m really worried about: that the way a lot of programming goes today isn’t any fun because it’s just plugging in magic incantations — combine somebody else’s software and start it up. It doesn’t have much creativity. I’m worried that it’s becoming too boring because you don’t have a chance to do anything much new. Your kick comes out of seeing fun results coming out of the machine, but not the kind of kick that I always got by creating something new.

...The problem is that coding isn’t fun if all you can do is call things out of a library, if you can’t write the library yourself. If the job of coding is just to be finding the right combination of parameters, that does fairly obvious things, then who’d want to go into that as a career?

The current trend of Evidence-based Medicine (EBM) is the mirror of Don Knuth's antagonist. We are taught in medical school and Continuing Medical Education (CME) seminars that we must practice EBM. Medicare has adopted it as measures of quality and tied it to repayment. for example, hospitals are rated by Medicare according to how fast a heart attack patient gets to angioplasty once arriving at the ER.

This isn't a bad thing. When numerous studies show that mortality improves when a patient gets to the cath lab in under 60 minutes, who will argue with saving lives?

But the problem with implementing EBM on a systems level vs a personal level, is that the physician becomes the cog in a machine.

In an article on insurance companies using EBM to determine care, it says,

Under EBM, medical treatment decisions are made primarily using guidelines from existing literature rather than a doctor's own expert opinion. Advocates of the practice say such guidelines limit variation in physician practice thereby improving quality of care.

But critics dismiss a reliance on such standardized treatment protocols as "cookbook medicine" and argue that EBM not only takes the individuality out of case management, but stifles innovation by removing insurance companies' obligation to pay for treatments they may deem "experimental."

And so the problems are two-fold for physicians:
1. The adoption of systems-wide EBM results in elaborate flow charts and checklists that impart a feeling of "cookbook medicine" on the viewer. For a physician this negates the creator feeling. As this pervades the profession, would-be physicians who understand this will follow that creator feeling to other professions & medicine will lose a valuable part of its talent pool.
2. Without individuality, the decision-maker leaves the physician-patient relationship. A third-party insurance company who stands to gain from denying care, interprets the literature and decides whether a procedure is necessary or not. More physicians will leave when they feel their position usurped by these companies, and the talent base of medicine is further eroded.

It’s not what we dreamed of as fourteen-year-olds and trained for as eighteen-year-olds. It doesn’t get the juices flowing. It’s not making

Plus, it's bad for patients. Last month I was learning ultrasounds in a high-risk Ob/Gyn office. One morning an Indian woman arrived for a scan due to previously seen IUGR (her baby wasn't growing). However, the family were immigrants, and mother was small. Talking about this with my attending, she remarked that the growth charts we used were standardized among middle-class Caucasian New Englanders. Totally inapplicable to the patient before us. In Britain, they've determined that many IUGR babies are normal when plotted on curves specific to that ethnicity. The same would be true with this woman's child. However, we as physicians couldn't make that decision because too many third parties would look at us not following up this baby's weight as bad medicine because it didn't follow EBM. So, she was here to get a second scan, wasting her time and money.

Let's see EBM for what it is -- a wealth of accumulated human knowledge that elucidates the generally best way or an individual physician to practice medicine. Following it is the right thing to do. But let's not kneel at the altar of EBM. You go to medical school, and establish a practice, and cultivate relationships with your patients so that you can have the knowledge-base and intuition tailored to your patients so you can understand when the rule and when the exception is applicable. It's at that point we physicians step back from connecting libraries into a program and start to create again.


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100 Books to Read

Obviously I'm not writing much. Why? Because I've spent the last year and half going insane. About a year ago, I went to work in the research lab and I was talking to my professor, when he made an interesting comment.

"So, it's good to see you looking happy," he said.
"Well, I am. I really am."
"A lot of people have a hard time with third year [of medical school], but you seem to be doing well."
"Umm...I think I really like third year much better than the first two. I feel like I'm really learning medicine, and I get to work with people -- no more nose in my textbooks all day long."
"That's good to hear. A lot of students that move to the wards have a hard time with it. Over my years, I've seen a lot of them crack under the pressure."
"Well, I dunno about that, but we did have one girl drop out a month or so ago."
"No, I mean they really need to see psychiatrists. They just can't handle the responsibility and the change from being a student."
"Oh... That's not me. I'm liking this much better than before."

His reference to people cracking under the pressure rang too true then and now. I've been ruminating over it for the last four days. Mainly, I find that doing medicine all day, every day, kills me. I need a release. Mostly, I need a book to read.

Throughout third year, I longed for the day when I could read what I wanted to read, because it piqued my interest, not because I had to. Even medical books -- I used to go down to the medical library in the Texas Medical Center and read medical journals for fun, because I found them interesting. Now those same journals are a chore, because I'm forced to read them daily.

Things turned for the better when my friend posted a list of 100 books on his facebook page. Supposedly the BBC thinks the average American has only read 6 of the 100. I've read 29. But therein lay my release! I'd been wondering what to read to get my mind off of medicine, and now I'd decided: I would read each book until I'd read all 100.

As my fourth year of medical school got underway, I was amazed at how much free time I truly had. Medicine started to become fun again - outside of the required courses, I could study what I wanted and typically had a little free time to read something outside of medicine.

Trying to find the list online, I ran into some other lists. Every list is a little different, but there are many similarities between them, which I think speaks to the strengths of those respective books.

http://artofmanliness.com/2008/05/14/100-must-read-books-the-essential-mans-library/
http://www.time.com/time/2005/100books/the_complete_list.html
http://www.randomhouse.com/modernlibrary/100rivallist.html
http://www.guardian.co.uk/world/2002/may/08/books.booksnews

Here's one list from the BBC that had the most interesting (to me) books. In April 2003, by popular vote (one person, one vote), it tried to find the most popular book of all time among UK readers. This is the list in order:

1. The Lord of the Rings, JRR Tolkien
2. Pride and Prejudice, Jane Austen
3. His Dark Materials, Philip Pullman
4. The Hitchhiker's Guide to the Galaxy, Douglas Adams
5. Harry Potter and the Goblet of Fire, JK Rowling
6. To Kill a Mockingbird, Harper Lee
7. Winnie the Pooh, AA Milne
8. Nineteen Eighty-Four, George Orwell
9. The Lion, the Witch and the Wardrobe, CS Lewis
10. Jane Eyre, Charlotte Brontë
11. Catch-22, Joseph Heller
12. Wuthering Heights, Emily Brontë
13. Birdsong, Sebastian Faulks
14. Rebecca, Daphne du Maurier
15. The Catcher in the Rye, JD Salinger
16. The Wind in the Willows, Kenneth Grahame
17. Great Expectations, Charles Dickens
18. Little Women, Louisa May Alcott
19. Captain Corelli's Mandolin, Louis de Bernieres
20. War and Peace, Leo Tolstoy
21. Gone with the Wind, Margaret Mitchell
22. Harry Potter And The Philosopher's Stone, JK Rowling
23. Harry Potter And The Chamber Of Secrets, JK Rowling
24. Harry Potter And The Prisoner Of Azkaban, JK Rowling
25. The Hobbit, JRR Tolkien
26. Tess Of The D'Urbervilles, Thomas Hardy
27. Middlemarch, George Eliot
28. A Prayer For Owen Meany, John Irving
29. The Grapes Of Wrath, John Steinbeck
30. Alice's Adventures In Wonderland, Lewis Carroll
31. The Story Of Tracy Beaker, Jacqueline Wilson
32. One Hundred Years Of Solitude, Gabriel García Márquez
33. The Pillars Of The Earth, Ken Follett
34. David Copperfield, Charles Dickens
35. Charlie And The Chocolate Factory, Roald Dahl
36. Treasure Island, Robert Louis Stevenson
37. A Town Like Alice, Nevil Shute
38. Persuasion, Jane Austen
39. Dune, Frank Herbert
40. Emma, Jane Austen
41. Anne Of Green Gables, LM Montgomery
42. Watership Down, Richard Adams
43. The Great Gatsby, F Scott Fitzgerald
44. The Count Of Monte Cristo, Alexandre Dumas
45. Brideshead Revisited, Evelyn Waugh
46. Animal Farm, George Orwell
47. A Christmas Carol, Charles Dickens
48. Far From The Madding Crowd, Thomas Hardy
49. Goodnight Mister Tom, Michelle Magorian
50. The Shell Seekers, Rosamunde Pilcher
51. The Secret Garden, Frances Hodgson Burnett
52. Of Mice And Men, John Steinbeck
53. The Stand, Stephen King
54. Anna Karenina, Leo Tolstoy
55. A Suitable Boy, Vikram Seth
56. The BFG, Roald Dahl
57. Swallows And Amazons, Arthur Ransome
58. Black Beauty, Anna Sewell
59. Artemis Fowl, Eoin Colfer
60. Crime And Punishment, Fyodor Dostoyevsky
61. Noughts And Crosses, Malorie Blackman
62. Memoirs Of A Geisha, Arthur Golden
63. A Tale Of Two Cities, Charles Dickens
64. The Thorn Birds, Colleen McCollough
65. Mort, Terry Pratchett
66. The Magic Faraway Tree, Enid Blyton
67. The Magus, John Fowles
68. Good Omens, Terry Pratchett and Neil Gaiman
69. Guards! Guards!, Terry Pratchett
70. Lord Of The Flies, William Golding
71. Perfume, Patrick Süskind
72. The Ragged Trousered Philanthropists, Robert Tressell
73. Night Watch, Terry Pratchett
74. Matilda, Roald Dahl
75. Bridget Jones's Diary, Helen Fielding
76. The Secret History, Donna Tartt
77. The Woman In White, Wilkie Collins
78. Ulysses, James Joyce
79. Bleak House, Charles Dickens
80. Double Act, Jacqueline Wilson
81. The Twits, Roald Dahl
82. I Capture The Castle, Dodie Smith
83. Holes, Louis Sachar
84. Gormenghast, Mervyn Peake
85. The God Of Small Things, Arundhati Roy
86. Vicky Angel, Jacqueline Wilson
87. Brave New World, Aldous Huxley
88. Cold Comfort Farm, Stella Gibbons
89. Magician, Raymond E Feist
90. On The Road, Jack Kerouac
91. The Godfather, Mario Puzo
92. The Clan Of The Cave Bear, Jean M Auel
93. The Colour Of Magic, Terry Pratchett
94. The Alchemist, Paulo Coelho
95. Katherine, Anya Seton
96. Kane And Abel, Jeffrey Archer
97. Love In The Time Of Cholera, Gabriel García Márquez
98. Girls In Love, Jacqueline Wilson
99. The Princess Diaries, Meg Cabot
100. Midnight's Children, Salman Rushdie

So, since last June, I've tried to broaden my reading, and perhaps read the books on these lists. So far I've read:

All 7 Harry Potter novels
All 5 Dan Brown novels
Blink by Malcome Gladwell
Watchmen by Alan Moore and Dave Gibbons

and I'm currently reading Open by Andre Agassi.

Plus, my scholastic freedom culminated last month on ultrasonography. There I worked 8 to 5 but could read whatever I wanted, allowing me to study things I found interesting. Since I didn't work nights or weekends, I had the freedom to read Watchmen - a decidedly un-medical novel - to help me unwind. That was a truly great month.

So, as I continue my exploration outside of medicine, how many novels on the list above have you read? What are you currently reading?