Saturday, October 31, 2009

A year ago today

I was interviewing (and falling in love with) Boston University School of Medicine.

Monday, October 26, 2009

First line of defense

In class our professor said, you have a patient with high blood pressure. You need to bring it down ASAP. What do you do?

"Beta blockers? ACE inhibitors?" We say, feeling smart that we know the terms.

"Nope. How could we have corrupted you so early? He says. The first thing you do is get him exercising, modifying his eating habits and give his body a chance to do what it does best. If his risk is too high, he might need a pharmacological agent to help in the short term. But, that's what it is supposed to be...a crutch until his body can make the necessary modifications to help itself. Any time you put someone on blood pressure medicine, it is with a lifestyle change plan. And, it's with the expressed expectation that they are weaning off in the not so distant future.

Of course drugs have side effects. Our bodies are amazing, really complicated machines. If you stick a butter knife in your computer fan because the noise is bugging you, how's that going to go long term? Drugs are the backup. They're for when you've done all you can do by eating healthy food, exercising regularly, sleeping well, investing in friendships to keep stress low and you're still having a problem. They aren't permission to behave badly. When used that way, they will backfire. And, really, is it their fault?"

Sunday, October 25, 2009

The good, the bad and the magic pill

You eat. Let's say eggs. Eggs and bacon. And, some toast.

The fat and cholesterol get zapped by some pancreas juice and broken into smaller pieces. They float into your intestine, get packaged up with a phospholipid shirt and a protein hat. A clever little huckster convinces the package to give up it's fat in exchange for...nothing. The clever cheat shoves the fat in a nearby cell and floats away. The remaining shrively package gets sent to headquarters...the liver. HQ can take the cholesterol that's left in the package, puff it up, repackage it and send it back out there. With a fresh shirt and three hats, it ends up selling a couple hats for snacks and end up chock full of cholesterol. He looks like a fat guy in a little coat. His protein hat is tiny and his cholesterol belly is enormous, hanging out. That's LDL. Low density lipoprotein (lots of lightweight fat, not much heavy protein). He's the bad guy.

He can prowl around looking for a home indefinitely. If he's out on the streets all night long, he might find some kindhearted cell to take him in, but he might run into a gang and get oxidized. If he's oxidized, he loses his mind, starts foaming and ends up lodging in an atherosclerotic lesion. Enough LDL's on the street, getting oxidized, lodging in lesions...some artery gets blocked with the nasty foamyness. Then, that's real trouble.

Fortunately for you, there are good guys to counteract this evil. A fit, muscular superhero with a large protein cape and just enough fat to not look scrawny roams the streets collecting bloated LDLs from the kindly neighbors who might have taken them in, and returns them to the liver to be dealt with by a higher authority. That's HDL. High density lipoprotein. He's the good guy. He actually chases down the slacker bad guy, hauls him off and gets him help.

As you can imagine, it's important to have a good ratio of superheroes to bad guys, or the whole happily ever after thing gets kind of screwed up. As if this wasn't enough, your body actually makes it's own cholesterol - you need it for making hormones, membranes, etc. So, there's LDL, parading his cholesterol-filled self all over the place, and your own cells are churning out cholesterol. Our whole town is threatened to be overrun.

There's a magic little pill to keep us in fairy tale land. Magic pill puts a wrench in the pipe that makes bodily cholesterol. Now, your neighborhood is panicking...where are they going to get the supplies they need to make doors, messengers, etc.? They start taking in bloated LDLs they find on the street like nobody's business...and sacrificing them (ok, so my story breaks down a little here...creepy neighbors, but go with it). They pull out the cholesterol inside LDL, use it for making doors, messengers and if they have any extras, superhero HDL will be by tonight to take it away. That's a statin. And it has saved millions and millions of happily ever afters.

Of course, the best possible solution is to stop throwing away the neighborhood by inviting so many bad guys into your city. But, it's pretty impressive that even if you make a few mistakes, you might still have a happy ending.

The End.

Saturday, October 24, 2009


Have you ever thought about why your body stores energy as fat? You've probably heard that fat has 9 calories/gram whereas protein and carbohydrates have just 4.

So, if you could choose between a 3lb battery for your boombox that played for 10 hours, or a 6lb one that played for 9 hours, which would you pick? The 3lb one, of course! And, that's why your body picks fat. Energy dense storage to minimize how much you have to carry around.

The bummer is that while our bodies were smart for millions of years, in the past hundred or so, they're sabotaging us.

In the entire history of humankind, did you know that it's only in the last few (50-100) years that we've had access to more food than we could eat?

Less than 100 years ago the development of fertilizer, pesticides and herbicides meant we could stop sharing our food with the weeds and bugs. Add to that vast improvements in preservation and distribution channels and...voila...a truly unique experience in all of human history.

Our clever bodies worked hard over the years to be sure that when we planted and worked our field for months and a swarm of pests came through a week before harvest and destroyed 70% of the crop, we'd be ok. Our bodies learned to efficiently store fuel to tide us over when we ran out.

Now that we have the problem of too much food, we are seriously fighting our instincts and natural body systems to maintain a healthy weight.

Friday, October 23, 2009

I get this! But, what if I don't?

After passing my first round of tests, I've started to feel like, "ok, I think I'm getting this." My study system seems to be working, I'm still sleeping at least 8 hours a night, eating/cooking/watching Ron cook healthy meals, exercising almost every day and...well, I don't do anything else, but still, not a bad life!

I've been feeling like I'm really getting this whole med school thing. I'm going to be the best med student in history and have a balanced life and revolutionize health and wellness in our country.

Then, I went to class last week and had trouble understanding two lectures in a row and now I'm certain I probably don't get it. Maybe I never really did get any of it. I'm never going to be able to maintain this, and I might hate medicine and it might hate me.

That about sums it up.

Thursday, October 22, 2009

View from our world...

You will never look at possums the same way again

We've gotten to the pelvis in our study of anatomy.

Yesterday in class, our professor explained that male possums have forked members. The gents who noticed this examined a female possum and looked for a compatible structure. After much debate, they concluded that the only possible corresponding part could be her nose. They developed a whole theory about how after member/nostril-course she sneezed and delivered tiny fetuses into her pouch. This was published in a reputable scientific journal.

Years later, someone did a bit more investigating and determined that the female possum has two uteri joined by a common opening.

The lesson is, the fork fits in the glove, not the nose.

Wednesday, October 21, 2009

Class of '99

We flew home to Seattle for a whirlwind weekend attending my 10 year high school reunion. Friday night's event was at a fancy place downtown, and Saturday afternoon was a BBQ held on the lawn out in front of the high school.

To be honest, high school wasn't my favorite time of life. But, I had a wonderful time at the reunion. I think part of the fun was showing myself how much I've grown and changed. It's good to look with adult eyes at people/places that used to have the power to make you feel so insecure/afraid...and with the logic of a not-17-year-old, realize just how far you've come.

I really enjoyed seeing my old classmates and hearing what has been happening in their lives for the past ten years. I've already hosted an old classmate for dinner who was traveling to Boston!

It felt good to make peace with the past and to move forward knowing that I have grown up a lot.

(My graduating class was about 100 people. The bottom picture was taken towards the end of the BBQ and many people had already left. There are some professional pictures of the whole group from Fri night, but they're not posted yet; I'll post it when I see it!).

Tuesday, October 20, 2009

A year ago today

I was nervously, excitedly attending my first medical school interview. Full of hope, anticipation, wonder about what it might be like.

It has been one heck of a year.

My dad is the best

During the aforementioned friend/occupation crisis when I was feeling lonely and sad, my dad was my number one ally.

He's exceptionally empathetic and can just tune into exactly what's going on. Every once in a while, like when you're standing outside class with five minutes and you start crying uncontrollably because you didn't realize you were upset until someone said "what's that feel like?"'s a mixed gift =).

Later that night, he sent me an email with this exceptionally special message...

It takes time

From my journal, about three weeks ago...

I am trying to make friends, but, it takes time. I know everyone's name and have a million acquaintences, but it's only been six weeks. Also, I'm noticing that while this really "diverse" group of people are really interesting to talk to, not having much in common makes it a tiny bit harder to get past the initial, "wow, that's interesting, what's it like to be raised in India?"

And, they're all science people. Turns out I really am 50% marketer, 50% scientist...which should serve me really well when I'm practicing =), but now, makes me feel like kind of a freak.

Just the other day at lunch, people were talking about what their parents do. I said, "my parents own and run an advertising agency. " The whole table looked at me really confused and said, "Oh, so he does fashion?" Now, I'm trying hard not to laugh at them because I'm picturing my dad in a leopard print leotard, with a black beret on and an orange feather boa around his neck.

How have these people not heard of advertising?! What kind of people are they? I'm insulted and wondering how to go about explaining it.

"Not exactly. Have you seen a commercial on TV, or a radio ad, or billboard? Advertising agencies make those."

"Really? I thought that McDonald's made their billboards."

"Well, maybe every once in a while. But, the process is pretty specialized and time consuming, so most companies spend their time and money making their product and hire professional 'advertisers' to at least produce it."

I'm not even going to begin explaining to them that we're just talking about mass media, not direct, or interactive, etc.

"Weird. Does it really take that much time? I always figured they just decide to put something on sale and then you know, make a commercial."

"Well, they might. But, someone has to decide who is going to be in the commercial, what they're going to say, what kind of burger to put in the picture, what time and on what stations it will air..."


Now, I launch into a brief summary of what I did at my last job and they look at me like I just said ten sentences in Japanese. They're kind of impressed and kind of weirded out. So, I'm not exactly feeling "understood." You add in that I'm from Oregon, "the state with the suicide doctors" and well, I'm kind of a freak.

Monday, October 19, 2009

Move it!

People in Boston walk fast. I mean REALLY fast.

I have always been a fast walker. My co-workers used to make fun of how quickly I'd get up and down the halls. When you've got somewhere to be, get there already. Don't dink around. So, I move. And, I have little legs, but I accommodate for that with extra determination.

Here in Boston, I'm maybe in the top half of fast walkers. Maybe. I'm regularly passed walking to the subway, along the Common, to school, everywhere. Not just by 6'7" boys either. Old ladies, homeless men, everyone. This is a place on the move.

And, I love it!


"lasting but a short time"

Great word!

Sunday, October 18, 2009

It's snowing!

It is October 18th and it is snowing!

Did you know?

Your lungs start with your trachea, then they branch into two primary bronchi, then they keep branching and branching until they end up in these minute little air sacs of capillary thinness called alveoli. It is here that all the key exchanges take place (oxygen, carbon dioxide, etc.). The way they're stuffed into your lungs is incredible.

If you stretched out all the surface area of all your alveoli flat, it would cover the square footage of a tennis court.


Where to start?

There's so much to say. The problem is, the more full life gets of bloggable events, the less time to do the blogging.

On the top of my mind is my second Biochem test tomorrow, which means there are no more "first" tests. In Anatomy we're working on the Thorax, Abdomen and Pelvis section of the class. Honestly, I find it even more interesting than the Back & Limbs section. This Biochem test is all about metabolic pathways, which has yielded a lot of interesting tidbits, but/and required a LOT of memorization.

More to come...

Trinidiom #70

"If we get stuck in a pickle"

Trinidioms #69

"...gets tizzled into a fit."

Monday, October 12, 2009

Trinidiom #68

"You've got to take up your mantra."

Saturday, October 10, 2009

Trinidiom #67

"Let me have my humor."

(if this confuses you, as it did me, it derives from Humor Me.)

Wednesday, October 07, 2009


I like this word.
Excessive or flashy ornamentation or decoration.
A fuss over a matter of little importance.

Tuesday, October 06, 2009

Felony Murder and the Merger Doctrine

I like to share legal oddities, so here is one.

In Felony murder, there is no mens rea requirement in the traditional sense. If you accidentally kill (take that for granted, assume it is proven) a person while committing a felony (or in some jurisdictions, a certain set of felonies, rape, burglary...) it is treated as first degree murder.

First degree murder is otherwise only an intentional killing with premeditation of some sort--the highest form of culpability (and, consequently, it is a capital crime, meaning life in prison without parole or a death sentence).

Is someone who accidentally kills while robbing someone morally the same as a person who kills on purpose with premeditation? Is he more culpable than someone who intentionally kills without premeditation (second degree murder)? This rubs me the wrong way. Why not charge for just the accidental death and the robbery separately? That's what he's actually guilty of. It's as if we multiple the culpability for the offenses, not add them.

This is complicated. What if Joe rapes someone and a week later kills that same person accidentally? What if instead he rapes someone and she has a heart condition and she dies (accidentally) during the attack? Why should these be fundamentally different?

The issue becomes more hairy with the merger doctrine. Some kinds of felonies (assault with a deadly weapon) are really just a part of murder. Because they are essentially an element of murder, the question of guilt turns on the normal issues related to murder (was it intentional, was it premeditated, etc.). Okay, that makes sense (if you don't have the merger doctrine, then almost all murders are just felony murders, which makes all the rules about murder pretty much moot).

But given that, if you if assuault someone with a gun and kill them, that means you get the traditional analysis (was it intentional?, was it premeditated?). And if you accidentally kill them while robbing their house (you accidentally knock over a candle while escaping and it kills someone because of the ensuing fire) you don't get that analysis (you just are guilty of felony murder). Is the latter person more culpable than the former? Clearly no. But we treat them as such; it makes an enormous difference in his sentence.

There are historical reasons we have felony murder, but whatever the case, this is what we are left with in many jurisdictions.