Wednesday, August 25, 2010

Genome by Matt Ridley

The first book I've ever read about genetics, this book guided me on a layman's tour of the human genome, pointing out one interesting gene on each chromosome. I need to work on my genetic language and cannot yet express freely my intrigue with any of the ideas presented because I simply lack the vocabulary. 

It was nice to have chemistry behind me which gave some insight into how substrates and enzymes function, and how methalization and other changes might take place. 

Mad cow disease turns out to be particularly interesting because it is not created by DNA or RNA yet affects genes. These prion molecules are scary and mysterious. Crazy to see just how vast our ignorance is. 

Some other interesting issues raised about nature vs. nurture and how impossible it is to separate cause and effect. Both genes and environment affect behavior and trying to determine which is more important is futile and pointless.

Lots of other stuff which I'm sure will become more clear as I learn biology and biochemistry...

The Master and Margarita by Mikhail Bulgakov

Psycho-religious thriller in true Russian style. Took half the book to figure out who was who and what was going on. Pretty enjoyable because of all the twists and turns. Many references were a bit opaque. Would be fun to sit down and read closely again and analyze for political dissent of Stalin's regime, under which Bulgakov suffered. Interesting to think that had it not been for Russian imperialism, Bulgakov would have been Ukrainian and his books somewhat cheerier. 

Thursday, May 13, 2010

Better; A Surgeon's Notes on Performance by Atul Gawande

Really got me thinking about performance as it relates to medicine. The differences in outcomes that we see are not due to varying education, finances or technology, but instead, these differences reflect human performance.

Gawande used various examples of...

I Dilligence
Handwashing
Polio in India
Battlefield medicine

II. Doing Right
Chaperones and nakedness
Malpractice
Doctors' salaries
Doctors of the death chamber
When to stop fighting

III Ingenuity
APGAR score
Inter-hospital competition
Performance of surgeons in India

How can I become a "Positive Deviant"? This is what Gawande suggests.
1) Learn something about your patients and co-workers by taking an extra two minutes to listen. It makes you remember the people you see.

2) Don't complain. It's boring, doesn't solve anything and it will get you down. Keep the conversation going down more positive roads.

3) Count something. Remember that medicine is partly science. Find something interesting and learn about it with the help of the numbers that define it.

4) Write something. Writing lets you step back and work through a problem. Lets you keep your sense of purpose. Your audience connects you to the larger world.

5) Change. Be willing to recognize the inadequacies in what you do and to seek out solutions.

Thursday, April 15, 2010

People Care: Career-Friendly Practices for Professional Caregivers by Thom Dick and Friends

This book speaks to some of the reasons I want to become a doctor. It reminds healthcare professionals that caring is in the career title. For me the idea is wrapped up in patient advocacy, where as a doctor, I will be 100% on the side of my patients' best interests. This is a somewhat unique position especially for those people who cannot pay or who have been pushed aside by society. Almost no other professionals are 100% on their side to fight for what is right. Health and the pursuit of happiness.

A lot of this book is common sense, but a few parts really stand out in my mind. 

Taking care of myself has to come first. I cannot be a competent caregiver if I have not cared for myself.

Symptoms are real and it's not my perspective on the injury/illness that matters, it's how the patient sees it. We have to start there and then work toward an understanding.

A kind touch, warm smile are essential parts of compassionate reassuring care.

Situational awareness/perceptiveness and attention to all the details of the surrounding circumstances.

The very best care would be unconditional love, but since I'm not Jesus, I'll stick to my very best care for every patient.

It's not my emergency.

Suspend judgment and put yourself in your patients' shoes.



Saturday, March 27, 2010

"God Has a Dream" by Desmond Tutu

This book took way to long to read, in fact, my borrowing privileges at the library have been suspended. Oops!
Once I sat down and just read it, I realized what a powerful writing and speaker Tutu really is.

I'll just write some powerful fragmented ideas that have stuck to the inside of my brain.

We make people inhumane when we remove their moral responsibility for some action. 

All people are family.

Our fear of failure drives an ugly competitiveness which often leads to putting down other people.

"Love is more demanding than law. No law tells an exhausted mother who wants nothing more than to collapse in exhaustion that they must get up in the middle of the night to comfort their baby, walking for hours until their child calms down, but this is what she does, because this is what love commands" (p. 36).

Valuing strength over weakness is a philosophy which leads people to despise weakness and weakness in others. "We can love others, with their failures, when we stop despising ourselves, because of our failures" (p. 39).

Prejudice is ridiculous, no matter what it's based on.

"Theologically, biblically, socially, ecumenically, it is right to ordain women to the priesthood" (p. 48).
"Ending sexism and including women fully in every aspect of society not only ends its own great evil--the oppression of women--but also is part of the solution to the rest of the world's problems" (p. 49).

"Confession, forgiveness, and reparation, wherever feasible, form part of a continuum" (p. 57).

Change and growth almost always occur through some pain.

Love is an action, a choice of will, not a feeling, or at least not always a feeling.

I can be a center of love, an oasis of peace.

Children are small people.

Death is physical. The mental/spiritual part can be overcome.

The physical can be truly spiritual. It can be transformed from the profane into the sacred. All Hellenistic dualism has sought to refute this idea, making the physical principally antagonistic to and alien from the spiritual. 

Tutu is on to some Quaker principles with his emphasis on stillness and contemplation and on all of us being able to hear God. 

An authentic spirituality is subversive of injustice.

I am waiting for a leaders "who are willing to take risks and not just seeking to satisfy the often extreme feelings of their constituencies. They have to lead by leading and be ready to compromise, to accommodate, and not to be intransigent, not to assert that they have a bottom line. Intransigence and ultimatums only lead to more death" (p. 119).

"So remember you are a moral agent, capable of creating a particular kind of moral climate that is impatient with injustice and cruelty and indifference and lies and immorality" (p. 123).

Three Cups of Tea by Greg Mortenson and David Oliver Relin

Verbose verbose verbose.  Man o man, way too many words, too many details, too many words. Did I say there were too many words in this book?

Quite a beautiful story of a mountain climbing nurse turned school-building-community-empowerer.

I was inspired to continue my study of languages and never forget the interlocking importance of health and education which form the foundation for justice. Or the other way around. Chicken and egg.



Rich Dad Poor Dad by Robert T. Kiyosaki

I was thrown off by the casual writing style and poor editing, but there were some good points.

Rich people think about money differently than poor people. This is pretty obvious, but it was interesting to think about some of the reasons behind this and the effects of these attitudes. It is good that Kiyosaki is concerned about the growing gap between rich and poor but his concern stems only from self-preservation instincts. He does not cite the injustice of this gap but rather the danger to our "empire".

I dislike that Kiyosaki...

1 believes that paying taxes is bad. He states repeatedly that most people "work from January to mid-May for the government just to cover their taxes". This is not working "for the government". Those tax dollars provide services create the conditions necessary for having a job in the first place. Try making money in Afghanistan...

2 forgets about the peace of mind that forgetting about money can bring. Decisions to 'buy' or invest in such "liabilities" as art, academic knowledge and love are the foundations of happiness. Education is an asset!

3 assumes that the government is somebody else, somehow separate, not made up of people

4 his constant differentiation between rich and poor which begins to imply some intrinsic difference within people themselves.

5 assumes that only profit fosters creativity.

6 thinks of money working for him. It's not his money that works for him but other people's creativity and hard work that adds value to his investments. He completely forgets about the human aspect of financial growth.

7 considers buying a Porsche some kind of accomplishment (what a looser)

8 brags about pre-tax "expenses"

9 Kiyosaki describes being a landlord and what happens when somebody does not pay. "The court system handles that" (p. 119). Yet this is the court system funded by the very taxes which Kiyosak intends to avoid. 

It's very interesting how Kiyosaki...

1 separates your profession vs your business

2 knows that "the rich are not taxed" (p. 95). It is enlightening and sickening to know how people can use the legal structure of a corporation to shelter their assets from taxation (p. 98).

3 Realizes that government fails when it does not incorporate good business principles such as efficiency.