RETHINKING SUBCULTURAL RESISTANCE Core Values of the Straight Edge Movement by ROSS HAENFLER University of Colorado–Boulder

What does it mean to resist?

I thought this was fascinating.
So many of my heroes achieved great things through civil disobedience and nonviolent resistance to the status quo.
How many times can you turn this around?
Is it bad to resist certain things simply to protest?
Is resisting desire (for instant gratification) the root of all success?

Just finished biochemistry/genetics for the year.
Was a very humbling final exam that made me aware of the limits of my memory.

No to tackle a very long to-do list before I head SE for some biking.
Springtime is here!

babies and differentiation

Neonatology.

The study of neonates.

Neonates = very small babies, newly born.

Four of us visited the acute care unit

and had the privilege of being taught how to examine a very small baby

his femur was the same length as my index finger

magical life

how do cells do that?

that's my job to describe actually

on genetics/biochemistry final this friday...

Where did winter go?

I have been horrible at keeping this blog up to date. It's not because there's not enough to write about, but rather because it has not become part of my routine and the demands on my time tend to eliminate anything that is not part of a routine.

Today I'm attempting to get my bike back in working order after perhaps waiting too long to replace the chain. Put a new chain on last week, and now it's skipping when I try to go up hills. Luckily we have a wonderful community bike shop in town staffed by volunteers. Just find the parts and they'll help you keep your transportation in working order. And that's just what they've done! The bike is ready to go. Now will go spend the rest of the day in the library before heading out to see an Amerks game this evening.

Assumptions vs. Directed Questions

It was the first day in PM&R and my partner and I were assigned to interview and examine a 30 yo male. Let's call him Leroy. Right away upon entering the room, we started trying to piece together what was going on, because it seemed odd to us that somebody only 30 should have had a stroke. The interview went rather well, and we both felt that we had obtained a complete history Leroy.

The interview was however, remarkable for how many times my partner and I were surprised by our patients answers to our questions. In fact, the answers surprised us so much in some cases that there were seconds of awkward silence because the question had been framed in a manner that anticipated an answer other than what we got. This was embarrassing at times, but more importantly, it could have easily led to misunderstandings or complete omissions because a patient might feel it's easier to just give an answer that is more expected by the way that a question was asked.

The first one came when we asked about where Leroy had gone to school. I think our question was "when did you finish school?". Now I know it seems obvious that the question is loaded with assumptions, but we slipped over this first hurdle easily. "2003". Quick math. Wow, seems that it took Leroy a while to finish school. "Where did you go?". Leroy- "Arkansas State". Oops, apparently Leroy finished college, and played DI football while majoring in business. Why did that surprise us so much? Perhaps it was the fact that Leroy is unemployed, obese, and African American. How much did we stereotype and then ask questions that fit the stereotype but not reality?

Our next line of questioning was about Leroy's family. "Do you live with anyone?" Leroy - "my cousin and his friend". Do you have a partner, male or female? Leroy - "yes, my girlfriend lives across town with three children". Now for some reason, we both assumed that perhaps they were not his children, but kids from an earlier partner. Then we asked some more about how he got along with his girlfriend's kids. Leroy -"They're my kids". We both paused. Why was this so surprising? How had we made so many assumptions?

We both felt confused after the encounter. We are supposed to use everything in the room to give us hints about who our patient is and what ails him. Yet here every clue we had lead us astray. Perhaps we simply forgot about pre-test odds, and they idea that a hint does not guarantee a corresponding etiology. The solution is obvious: assume nothing. Yet is this possible? Is there enough time to ask about everything without using your other senses to make assumptions and apply reasonable judgements?

The answers to these questions may become clear with more clinical experience. For now, we have decided to apply the lessons of cultural sensitivity more carefully. Mindful listening only works well with mindful questioning.

Ethical Principles in Research

One part of developing a narrative research study is applying to my institution for an Ethical Principles in Research Program number (EPRP). 

Perhaps I should back up. 

I'm putting together some ideas for this summer. I'd love to travel to Central America to see what I can learn about how to age with grace. I have been interested in this subject ever since I was able to grasp the vast differences between how people in Ukraine age and die versus how people in the United States age and die.

In Ukraine, elders are often taken back in by their children and nursing homes are virtually non-existent.

In Ukraine, elders are given chores and tasks to help support their family, whether chickens to look after or napkins to sew.

In Ukraine, people die at home without extreme or radical (often expensive) attempts to prolong life a few more months.

In Ukraine, people accept death as part of life and are able to talk about it with ease.

Note: all of the above are vast generalizations and not always true in Ukraine, just as the converse is not always true in the United States.

Anyhow, this fascination with the transition from life to death has lead me to pursue funding for a trip to Central America where I will be able to talk with and observe a third culture dealing with aging and dying. My institution will fund such an enriching trip so long as it meets basic requirements, such as being scientifically based and completely ethical. My proposed research will most likely be of narrative qualitative design with data being collected in interviews, photographs and documents. The ethical benchmark is tested by completing an EPRP education program and taking a test at the end.

The Ethical Principles in Research Program requires that I read the Belmont Report. This document was written by a panel of experts in 1976 after the full extent of the Tuskegee Airmen syphilis atrocities had been revealed. It seems to be a whole-hearted attempt at achieving more ethical research by applying the principles of "respect for persons", "beneficence", and "justice". I found their definition of justice to be particularly interesting. 

"Almost all commentators allow that distinctions based on experience, age, deprivation, competence, merit and position do sometimes constitute criteria justifying differential treatment for certain purposes. It is necessary, then, to explain in what respects people should be treated equally. There are several widely accepted formulations of just ways to distribute burdens and benefits. Each formulation mentions some relevant property on the basis of which burdens and benefits should be distributed. These formulations are(1) to each person an equal share, (2) to each person according to individual need, (3) to each person according to individual effort, (4) to each person according to societal contribution, and (5) to each person according to merit."

It is good to think with this recently ignored part of my brain about broad philosophical concepts such as justice. 

Here's another great quote, apparently one that Ron Paul has not read and thinks is a matter of belief rather than fact.

The Belmont Report goes on to speak to the application of the three comprehensive principles.

Application includes:

1. Informed consent (information, comprehension, voluntariness)

2. Assessment of risks and benefits

3. Selection of subjects.

"Injustice may appear in the selection of subjects, even if individual subjects are selected fairly by investigators and treated fairly in the course of research. Thus injustice arises from social, racial, sexual and cultural biases institutionalized in society. Thus, even if individual researchers are treating their research subjects fairly, and even if IRBs are taking care to assure that subjects are selected fairly within a particular institution, unjust social patterns may nevertheless appear in the overall distribution of the burdens and benefits of research. Although individual institutions or investigators may not be able to resolve a problem that is pervasive in their social setting, they can consider distributive justice in selecting research subjects."

When medicine is overruled

So much of medicine is prevention. Now even things that we were trying to pin on genes are coming back to lifestyle. Check out this visual representation of cancer risks. It strikes me that most of these changes do not require doctors, yet failure to learn from this data results in the need for many doctors.

In another example of when doctors may not have enough sway to advocate for health, a team of surgeons donated their time to provide a kidney transplant to this man, yet were denied an operating suite by their hospital. Extremely frustrating that Republicans argue against a lifesaving and money-saving operation simply because this man is from Mexico. How can they claim Christian religion and say it's okay for undocumented immigrants to donate organs but not receive them?

"Organ registries do not record illegal status, but a study estimated that over a 20-year period noncitizens donated 2.5 percent of organs and received fewer than 1 percent."

"They should not get any benefit from breaking the law, especially something as expensive as organ transplants or dialysis," said Representative Dana T. Rohrabacher, Republican of California, who contends that care for illegal immigrants is bankrupting American health care and has sought to require that emergency rooms report stabilized patients for deportation unless they prove citizenship or legal residence.

"If they're dead, I don't have an objection to their organs being used," Mr. Rohrabacher added. "If they're alive, they shouldn't be here no matter what."

It sounds like the old "us vs. them" crap that has lead to immoral and unjust policies for all of recorded history...

Last week of the first semester. Positive thoughts

As I drove out to my last indoor soccer game of the semester last night along with fellow medical students, we talked a lot about the difficult and frustrating parts of medical school. It led me to think about how much easier it is to complain and vent about the frustrating parts of school rather than recognize all of the amazing things we are learning.

Today was our last day in the anatomy lab, though I'll go back for one more review visit before the final exam on Friday.

The physiology part of our final covers renal function and gastrointestinal secretion+absorption. The physiology is extremely interesting though I often don't have time to delve into the small details. Without the mechanistic details down to the smallest level, I often feel that the ratio of memorization/understanding gets too large. Looking forward to getting to NM for a little sunshine next week.

Time to pay attention to this radiology lecture again. Most of it is going over my head, but it is a good anatomy review.