S2.3 Relatively Defining



We define ourselves in many ways. People select titles such a “fighter”, “contrarian”, and “creator” and use these terms to define themselves. Dependent identities such as these have the concerning feature of being highly laudable, unspeakably evil, or anywhere in between depending on external factors. In many contexts to be a fighter is a good thing. To fight for other people, to fight for new knowledge, to fight against disease, are all commendable. However to fight for selfish gains, out of spite, or to marginalize a specific people group would be despicable. Using this term to describe oneself is similar to using the term “non-profit” to describe an organization; it provides incredibly little information about the person or organization themself and only provides a passing reference to a relative characteristic. 

Christopher Hitchens, reknown author, speaker, intellectual, and atheist was often well known for his independent thinking and contrarian views prior to his untimely death. He wrote a book titled Letters to a Young Contrarian in which he discusses, as the title would suggest, contrarian thinking, that is holding and articulating positions that go against the prevalent tide of thoughts. The issue with identifying as contrarian is that contrarian is a relative term, it relies upon prevalent thought in order to take a position. To further clarify, it would be better, more descriptive, and more reliable to describe oneself as an independent thinking, that is someone who is willing to put in the difficult work of gathering and analyzing data for oneself and coming to their own conclusion independent of the persuasive powers of the masses. If I am contrarian and you decide that apples are tasty I am obligated to disagree and label them as unpalatable. If I am an independent thinker I am free to try the apple and decide for myself if I believe the apple to be agreeable or disagreeable. In an information and choice rich environment, one of the key underpinnings of societal improvement and uptrending will be a large population of independent thinkers who search out information and do their own analyses. A large population of contrarians will get relatively little done. 

Thinking independently is difficult. Gather information, think critically, and be willing to defend your conclusions. Being either ‘yes’ men (or women) or contrarians both hand all of the power to others as our stance is relative to theirs and not an absolute based on a well reasoned articulation of our analyses. 

One of the key aspects to maturing is defining oneself. This is a good and natural progression. As we are taking on labels and crafting our own definitions of ourselves, we must define ourselves as absolutes, things that are irrespective of the whims of the mob. We must define ourselves by what we are for, what we actually stand for and believe in, not a reactionary definition reliant upon what we are against.

S2.2 Welcoming the Sceptic, Inviting the Questions


Science is a system, a methodology, that is used to approach empiric truth. It is a construct by which we ask questions, search for answers, and attempt to construct working theories of the world and universe around us. Nothing more, nothing less. Perhaps the most important part of being a scientist is curiosity, having an inquisitive mind that wonders at the world around oneself. Of course there is more to it than just asking questions. Doing science then entails figuring out a way to answer that question, collecting the necessary data, performing the proper analyses, and then drawing the proper conclusion to answer the question that one set forth to answer in the first place. But the question always comes first. 

We should never be afraid to ask scientific questions in good faith. Nothing should be out of bounds as long as curiosity and a search for truth is the driver of the question. As soon as one begins to engage in science, it becomes painfully, and excitingly obvious how little we know about the world around us. Even well founded theories can be questioned and tested. For example at CERN at the beginning of the decade scientists thought particles had exceeded the speed of light, something that challenged the theory of relativity, one of the most foundational physics theories in existence. Although a faulty wire was subsequently found and relativity was upheld as a theory, the fact that something so cherished and foundational could be openly questioned is one of the beautiful aspects of science. In medicine things that we have thought for many years, such as the transfusion goals for blood products, proper ways to prevent infections or do procedures, and even the composition of an “ideal” healthy diet are constantly being challenged and redefined. 

Concerningly there are topics that people are often discouraged from questioning or challenging. When one is unable to challenge or question a particular theory or teaching this is dogma and not science. Three notable examples are evolution by natural selection as the driver of organismal progression to advanced life forms, global warming induced by human actions, and the safety of specific vaccines. First let me clarify that there is great evidence for all three of these points (although for natural selection the specific mechanisms and probability of such a feat occurring is still debated freely and the safety of the common vaccines on the schedule has been well validated although there have definitely been harmful vaccines given in the past). The point is not whether any of these three theories are right. The point is that practitioners of science should ALWAYS be allowed the latitude to question and experiment in order to get closer to the truth. Any time science attempts to limit questions this is simply not science. Skeptics and questions are always welcome to science as long as they want to do science- that is ask questions and address those questions with the proper methods, data, analyses, and conclusions. To limit questions in science is to limit the beauty of the discipline and hamper the search for truth

S2.Intro: Welcome to Season II


Welcome to Season 2 of the Blog! After the first season we took a break to recalibrate, reimagine, and reorganize. Now we are back and enthusiastic for the start of Season II. Over the next 50 weeks we look forward to exploring medicine, leadership, motivation, and struggle as well as a handful of other topics.

As always the goal is to think on, explore, question, and celebrate the many adventures and challenges of life. We are excited to have you here with us as we start Season II!

S2.1 Pandemic, the new normal


We have been worried about a global pandemic, something akin to the Spanish flu of 1918, for some time. Whether SARS or Ebola or the new coronavirus, there are always possible pandemics lurking on the horizon. We have dodged the bullet on avian bird flu and swine flu, although that may have had as much to do with luck than with successful intervention from the health system. Is the new coronavirus “the one?” The unfortunate reality is that we live in a time when “the one” is a foregone notion and we will always live with the threat of epidemic or pandemic on the horizon. No innovation currently in the works will completely remove that threat. Here, I outline a few, brief thoughts on what we can be relatively certain about concerning the next pandemic(s): 

  1. There will be other outbreaks of varying severity with a handful reaching pandemic levels after this current outbreak of coronavirus.
  2. Many will originate from Asia. This is due to varying reasons including population density and proximity of animals, including birds and other livestock, to people.
  3. Pandemics will likely be a strain of influenza or a similar virus that is spread through respiratory droplets. Although a bad disease, Ebola was much easier to contain than Tuberculosis or the Coronavirus for which respiratory precautions must be taken and spread is much more difficult to contain. 
  4. Pandemics will likely begin by a known virus mutating to behave in new ways, recombining with another virus to spread or evade the immune system by a different mechanism, or gaining the ability to jump from species to species. In particular the ability to transmit to humans and then transit from human to human will be a likely feature. 
  5. Those with comorbidities will be hit the hardest. Underlying heart disease, lung pathology, cancer, diabetes, and other health problems all make fighting the infection and maintaining homeostasis more difficult. Long comorbidity lists will generally be predictors of lower chances of survival. 
  6. Isolation and low population density will be protective. Especially during the period of an epidemic or pandemic where not targeted treatment exists, preventing human to human transmission is critical. One of the easiest ways to prevent human to human transmission is to be in a community with a low population density and with a low volume of influx from the outside. 
  7. Vaccines or targeted therapies will take many months to affect the population. In the meantime containment measures and supportive care as well as screening similar therapies for efficacy will be critical in mitigating the effects. As always, wash your hands, cover your mouth when you cough or sneeze, and …did we mention wash your hands? 
  8. Hospitals and other healthcare settings will be high risk places where disease is readily spread. This can be limited by the correct preventative measures and precautions, but the simple fact that many of the known cases will come through the hospital means the risk will always be high. Healthcare workers and their families will be at greater than average risk of contracting the disease. 
  9. In advanced stages the flow of goods, including food and water may be affected. Our lives today are enabled by trade from all corners of the world. Our medications, food, clothes, and everything else come from many miles away and require many people to get to us. In the advanced stages of a pandemic, food scarcity, loss of power, water shortages, and medication shortages may all be realized. Having an emergency supply of food, water, and other vital supplies including medications for chronic diseases will be essential. 
  10. Recovery will take years. Similar to recovering from a World War, the loss of human power and faith in economic and political systems will require years, not months to rebuild. 

“God is in control”


Copy of 20180705_140525The family of a patient who was unresponsive after a major bleed in the brain posted a card on the clear glass door to her hospital room.

“God is in control”

It struck me how many different ways this could be read.

A question thrown out to the universe, a shout into the void. A query as to whether there was a God and if anyone was in control.

A prayer that in the midst of trials and difficulties there was a compassionate God holding the patient in forefront of his mind. A plea that as their world spun out of control a loving God remained sovereign and sufficient.

A statement of faith proclaiming a truth, a belief that God had not abandoned them, had not grown weary, and remained capable and intimately concerned with the ultimate good of the patient.

Most likely it is all three simultaneously. With each reminder that “God is in control”, a question, a prayer, and a statement of faith are simultaneously made. This was the way of many of the Psalms… a progression from doubtful to prayerful to faithful in one breath.

Regardless of whether today was life-altering or routine may our prayers carry the same pattern. A question as we struggle with the difficulties of reality, a prayer demonstrating our insufficiency and throwing our hopes on another, and a statement of faith confident in the character and nature of God.

A New Straw Man

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In a debate, constructing a straw man argument provides a neat way of constructing a foe from your own imagination who is easily and conveniently destroyed. For better or worse technology has allowed us a neat way of avoiding the trouble of gathering the straw and propping up a straw man ourselves. Instead of carefully creating the shape and character of the hapless scarecrow that we will later destroy, we decided that even this task was too great an effort. Now lounging in bed or draped across a sofa we can, by activating only one thumb, scroll through our feed of news and friends and interests until we find something ridiculous to which we can respond. ‘How dare they’ we cry, forgetting the thousands of reasonable thoughts and suggestions we passed by to get to this atrocious viewpoint. We mutter under our breath and type furiously our response. As we hit “post” we sigh contentedly knowing that we have made the world a safer place, a better place, a smarter place. That was one small post for man, one giant comment for mankind. Settling back into the cushions we begin to scroll, but what is this? Our foe has replied? Surely our wise insight must have brought them to their senses, and they have merely returned to thank us for bearing the lone light of knowledge in a sea of ignorance. But wait, they are doubling down? How could this be? And the ridiculousness has spread to multiple points each of which we must address. Settling in to begin to type, we realize that what began as a quick strike has now become a war of attrition. And thus passes a perfectly serviceable afternoon. But at least we were fighting the good fight against… who again?

To Appear Busy


Intentionally or unintentionally we, as a society, have begun to equate the importance of someone with how busy they appear to be. What this has inadvertently led to is an atmosphere where people feel that they must constantly appear to be busy even when they are not doing something necessary, enjoyable, or productive. How many of us actually have to be reachable at any time of the day for any reason? Very few. In one interview Jeff Bezos, founder of Amazon, comments on the fact that he tries to focus on one thing at a time and is intentional about avoiding a constant stream of emails and calls. And yet there are many people who’s decisions matter significantly less who are glued to their phones and are willing to interrupt anything they are doing if they hear any email or come in. The problem with multitasking and believing that our importance goes up if we have many different things going on at once is that multitasking actually makes us less productive in the tasks that matter and decreases our happiness and satisfaction while performing a given task.

Whenever we get sick this seems to reveal itself the best. Something about feeling ill and uncomfortable motivates us to cut out the chaff from our schedules and focus on what actually matters. Most of our emails do not need a reply. We realize that many of the tasks we think keep the world going are actually just fillers. We realize that we actually have time to get 8 hours of sleep per night and that many of the tasks that we thought that we were absolutely essential for actually do not require us to the degree that we once thought. We realize that many other people are willing and more than able carry on without our attention.

There are very few things as valuable as your attention. Consider how much advertisers are willing to pay for your attention. In the United States in 2016 just short of 200 billion dollars was spent specifically on advertising. That amounts to hundreds of dollars per person each year. We should begin to value our attention and focus as much as advertisers value it. For definite increments of time make yourself unavailable to interruption. Focus on one and only one task. Realize that the more valuable your time is, the fewer interruptions you should have. Be productive not simply busy. Productivity is the end goal, not busyness.

With the Best We Have


Fast forward 20 years into the future and we will be able to answer research questions that it took me 4 years of work to figure out in a matter of days or even hours. In 20 years many of the treatments and principles that we use in the clinic today will be replaced by better techniques and interventions. In 20 years the devices that we use to communicate and conduct business and pleasure will be radically different.

To an already existing example of this rewind 20 years. Molecular cloning and cell based assays for biological research were long and arduous with ambiguous readouts. Cancer treatments were far from targeted, contained a wide array of severe side effects, and we had a poor understanding of what actually contributed to the genesis and spread of the disease. And it would still be another 9 years until the first iphone was introduced.

However, as J.R.R. Tolkein writes through the words of Gandalf, “All we have to decide is what to do with the time that is given us”. We can look back at times in the past or dream of the days to come, but what our main concern must be is to decide how we can best use the time that has been given to us now. Likewise we can wish that our talents and gifts were different. Perhaps we think about how much greater of a difference we could make if only we were naturally a better athlete or naturally more intelligent.

The goal then is to be productive and efficient with what we have been given without pressure to perform outside of those constraints. Future advances and the achievements of others do not diminish what we do today. And at the end of the day, we are the ones who know if we did our best; our best after all is the most stringent and valuable metric of all.

Consider what it will be like to be gone


Hindsight is 20/20. One of my memories of first grade was on the playground in the line for tetherball. A disagreement arose centered around the ambiguous guidelines we were calling the “rules” for playground tetherball. With tears welling up in his eyes at the perceived unfairness of the situation, one of the popular kids disinvited another one of the popular kids from his birthday party. A hush fell over the playground. Disinvitation from a birthday party was the pinnacle of first grade anger and hatred.

Looking at people who are in a stage of life through which we have already passed through, such as elementary school, high school, the first job, or any number of other stages, it is easy to maintain a context and objectivity. However when actually living through those stages, it becomes extraordinarily difficult to maintain context and objectivity. As stupid as a birthday party sounds now, when you are 6 years old and can only remember 1 or 2 of your own birthdays, these trivial cultural celebrations become of ultimate importance. Relationships, awards, publications, jobs, and tests that felt like they had the weight of the world resting on them can be looked back upon with barely an afterthought.  Peter Thiel, co-founder of paypal and venture capitalist, writes about how difficult it was to quit at his law firm. From the outside it looked easy to quit, simply walk out the door. But from the inside the difficulty in leaving was more akin to an escape from prison.

Often the opinions of our current peers and supervisors feel like they mean the world to us. It is often helpful to imagine what leaving your current job, social circle, or school will feel like. That supervisor who you were always trying to please, well their opinion no longer has any bearing. Your arch enemy in the adjoining cubicle is reduced to a mildly annoying memory. Your work, while certainly having some meaning, likely will not have the same life and death consequences that you imagined them to have. What you will take with you is the experiences and knowledge you gained as well as the friendships you DECIDE to maintain. Everything else will be like an invitation to a 6 year olds birthday party.

So even as you work hard in your current phase of life, consider what it will be like to be gone.

Never Quit on the First Day



Starting things are difficult. Whether it is living in a new city, starting a new job, going to a new school, or standing at the beginning of anything for which you do not have a good routine, the start is rough. When I run, the first three miles are always painful. When I start a new service in the hospital the first few days are always disorienting and confusing. I often get lost several times a day, am generally of very little help to anyone, and am not too certain of what my actual job or responsibilities in this new team are. Whenever I have moved to a new city the first month is always difficult. Where to get cheap gas, find good food, and connect with new friends is difficult and leaves one wishing for “the good ‘ole days”. During these periods of transition I will often give myself a date or time in the future when I can quit if I so choose. When I run that’s at the 3 mile mark since I know that by that time I will have found a rhythm and adjusted to the exercise. When I start a new service it is generally a week since I know that by that time I will have made some friends, figured out what I am supposed to be doing, and have established a general map of where things are in the hospital. When I move to a new city it has generally been after I have accomplished something such as the end of the first quarter of college or the completion of one cycle of medical school. At that point I have found a routine and can ride a sense of accomplishment into productivity and a happier frame of mind.

When starting something new try to avoid thinking about how you feel and whether you are enjoying your time until after the first day. Because invariably the answer is that you are uncomfortable, slightly tired, and generally wish you were back in bed. But keep going and often you will find a new rhythm, a new pattern, and a new satisfaction. If nothing else you will have developed a strong sense of grit and a new set of experiences that will be informative in the future. Whatever you do, never quit on the first day.