Still home in Arcadia, but devoted readers of this blog (the few, the proud, the frighteningly bored...or maybe they're BOARD...haha) are probably thirsting for an update.
So far, the break has been pretty calm and unproductive...which means that all is well in the world. The new wireless network in my house has been a boon and a curse...most of my days and nights are now spent serenly sitting on the couch in my family room...reading blogs, emails, pretending to work on 3 MSP handouts due Jan 1, editing Matthew's college admissions essays, pondering that manuscript that I must write soon, and watching non-stop episodes of the CW's Supernatural on DVD. In between, I've met up with college friends, high school friends, tasted Pinkberry twice, and gone "threading" with Samantha (boy, that was funny).
A New Year's Resolution List should be due, but it might not make the deadline. It would also be interesting to do a "NOT TO DO" list, but I'm not making any promises since I still owe you a list of things that I am thankful for. I would pun on "do" and "due," but frankly you don't want to hear it.
So instead, I'm going to make of list of ways to unwrap a Christmas present, which occurred to me while watching my family on Christmas morning.
WAYS TO UNWRAP A PRESENT
1) The "Slow-Kill" -- Sliding your finger under the belly seam of the rectangular, wrapped present and cleanly tearing the scotch tape apart like a surgeon opening stitches. The name of the game is to unwrap the present without damaging the paper...usually this is because the recipient is a meticulous girl with OCD who likes shiny wrapping paper.
2) The Peeker -- Tearing open the side flap of the present (the weakest area!) to "peek" at the writing on the box before fully opening the present. This provides a sneak preview of the gift without fully denuding the present of wrapping paper.
3) The Raw Animal Attack -- Tearing open the present into long shredded strips like a crazy dog. Very therapeutic and wantonly destructive.
4) The OCD -- Using scissors to perform the "Slow-Kill."
5) The 99-Cent Special -- Using a gift bag and tissue paper a la Mom.
6) The Jeremy -- Taping together a package of gum and a dog or cat bookmark with scotch tape and a homemade "To/From" tag written with pencil on lined paper. Stuffed into the toe of a stocking. Adorable.
7) The Big Sisters -- an imaginary IOU for one Guitar Hero controller.
Not related to medical school, but this list of unanswered questions from Slate.com almost got me laughing out of my seat. Usually, Slate has a Q&A column that addresses the mysteries of nature and society...such as does the camera add 10 pounds? In this installment for the end of 2007, Slate lists all of the questions that were too random or bizarre to respond to.
Some of my favorites:
• Why are some cats softer to the touch than others? Is it possible I have the softest cat in the world? • There was the most beautiful sunset here in Indiana last evening. Would the California fires have anything to do with that? • Why do most reptiles go to sleep when you rub their bellies? I have done it myself with everything from domestic water dragons to wild alligators, but I heard recently that it is bad for them—and they only appear to be sleeping, when in fact they are having trouble breathing. Is this true? • Is it "open sees me" or "open says me"? • Is there such a thing as "crazy eyes," where the whites go all the way around the corneas and makes the person look psycho, such as those of runaway bride Jennifer Wilbanks and wife-dismemberer Stephen Grant?
Yesterday, I woke up at noon to find an unsual e-mail in my box. There was no subject line and it was supposedly from our Dean, Dr. David Kessler:
"Shortly after arriving at UCSF as Dean, I discovered a series of financial irregularities that predated my appointment. I reported these issues to appropriate university officials at the time, and have endeavored to work with the university ever since to solve these problems. The university characterized me as a whistleblower. During the summer, Chancellor Bishop requested my resignation. I continued to try to solve these problems. Yesterday, Chancellor Bishop terminated my appointment as Dean, effective immediately. Over the course of the past four years, it has been my pleasure and honor to work with the outstanding faculty, staff, students and donors of this remarkable school and institution. I want to thank all of you for the opportunity to foster and nurture outstanding programs on behalf of UCSF.
David A. Kessler, M.D. Professor of Pediatrics, and Epidemiology and Biostatistics"
So on Thursday night, Chancellor J. Michael Bishop dismissed Dean Kessler from his post...very abruptly and with little preparation...but the fallout from this event is going to linger.
What amazes me about oncology is how science moves at a pace that is both slow and exhilarating. It seems that even the smallest steps toward improvement seem vast, and yet only highlight evermore how that elusive "cure" continually escapes us.
Of course, there are a few break-throughs in cancer therapeutics that seems awe-inspiring...whoever invented the bone marrow transplant (wow), the MOPP regimen for chemotherapy, how chemoradiation can cure Hodgkin's, how Gleevac can suppress CML. And even the "smaller" advances, like how you can harvest bone marrow stem cells from a donor's peripheral circulation using G-CSF seems so amazing and wonderful because you can spare donors a radical pelvic surgery and give patients faster engraftments (so that there are "1) shorter hospital stays 2) fewer treatment-related deaths 3) fewer infections 4) fewer transfusions and 5) lower cost"). It's when you can make advances in research that translate into enormous human benefit that makes me feel so inspired.
At the same time, there is always more work to be done. We watched a Frontline clip about a patient receiving alternative medicine for his pancreatic cancer, and it reminded me that there are still so many things to do.
Oh, and reading about bone marrow transplants have made me resolve a few things: 1) Have 3 children so that they can donate bone marrow stem cells to each other (just in case) 2) Save cord blood
Paul recently presented a Cell paper in Basic Science Journal Club about the Japanese researcher who has figured out how to reprogram regular epithelial cells into cells that closely resemble stem cells. The front page of Synapse contains an article describing the recent finding and there is a piece in the New York Times (courtesy of Iris) about how this wayward scientist found his way into research. Of note, Dr. Yamanaka maintains a lab at UCSF and we can semi-claim him as our own (besides the fact that he's a national hero in Japan, haha). One thing that interested me was why he chose UCSF:
"The best place to learn about genetics and knockout mice was the United States, where Dr. Yamanaka had no friends or contacts. He said he sent some 30 letters to American universities and specialists whose names he culled from science magazines and journals. One of the few to respond was the University of California, San Francisco, which offered him a post-doctoral position in 1993."
This is sort of an irrational thought, but thanks, UCSF, for taking a chance 14 years ago. :)
Have you ever thought about what protects our hearts? Just a cage of rib bones and other various parts. So it's fairly simple to cut right through the mess, And to stop the muscle that makes us confess.
And we are so fragile, And our cracking bones make noise, And we are just, Breakable, breakable, breakable girls and boys.
You fasten my seatbelt because it is the law. In your two ton death trap I finally saw. A piece of love in your face that bathed me in regret. Then you drove me to places I'll never forget.
And we are so fragile, And our cracking bones make noise, And we are just, Breakable, breakable, breakable girls and boys.
And we are so fragile, And our cracking bones make noise, And we are just, Breakable, breakable, breakable girls- Breakable, breakable, breakable girls- Breakable, breakable, breakable girls and boys.
1) I am blogging right now because I can't find my syllabus. It has been missing since the midterm. This is the second time that I have misplaced a syllabus (last time was during I3). Syllabus, come back!
2) This week was killer. Today was killer. 8-12 pm - Class 12-1 pm - Synapse 1-6:30 pm - Last pediatric preceptorship 7-8 pm - MSP meeting 8-now - time-wasting (almost as bad as K+ wasting, just call me furosemide).
3) My preceptor gave me a Christmas present: a card, book, and finger puppet. I exhibit inordinate pleasure over my butterfly finger puppet. Maybe I'll bring it to lecture and wiggle it at someone.
4) The next few months are going to suck.
5) The special Tabula issue for Synapse came out today, I am so happy that the photos were printed in color!
6) Tonight, I am so proud that 13 MSP instructors came back to volunteer to teach Respiratory/Renal. The more people teaching, the less burden on everyone. Probably should have held back on teaching chronic kidney disease on Feb. 14th -- but let's be honest, my love life is on dialysis right now anyway. Besides, it reminds me of spending last Valentine's Day in the library cramming for renal...things have come full-circle.
7) I need to take a Nap-a. :)
8) The colored labels on Gmail = agonists on my beta-1 receptors => increased HR and SANS. I'm so ridiculously excited. Colored labels > sliced bread.
There's a strange paradox in leukemia/lymphoma world -- the more aggressive disease has a higher acute mortality rate, but also a greater sensitivity to chemotherapy which offers the possibility of a cure. Meanwhile, the chronic disease is more indolent (median survival is 10 years), but essentially incurable.
**This is purely a thought experiment, but in pathology lab today, the professor remarked that we are lucky that life does not force us to decide whether we (or patients) have the acute or chronic disease -- but that since survival differences between both disease eventually wash out...there is no clear answer to the question. Would you rather have a severe, sudden disease with a shorter median survival period but the possibility of salvation...or the slowly fatal chronic disease that offers you more time? A reckless gambler might bet on the first horse, the deliberate tortoise (or conservative gambler) might choose the latter.
Personally as a young, grudgingly optimistic gambler, I am more inclined to choose the more aggressive disease since it offers me a shot at being free and clear -- despite the more dismal median survival.
Paul also decided that he would rather have the acute disease, remarking, "Invariably fatal just doesn't sit well with me."
Watch out! Jenny and I have clinical research on the brain...it's incurable.
We've begun using nerdy jokes related to biostatistics and clinical studies, and if you imagine two Star Trek fans giggling over obscure, inside jokes about the Starship Enterprise...then you've pretty much got us pegged.
Example #1: It all started with a cup of coffee...Jenny said, "I've started drinking double shot espresso instead of single shot, and I think that it makes me more buzzed."
"How do you know?" I said, "we should do a blinded study."
"Oh, yes, we can randomize the days when I get decaf, single, or double [assuming that you can keep the volume of coffee constant]," Jenny replied.
"Yeah, and I can administer the coffee [NB: the cashier should probably decide the coffee so that I can be blinded too]. We can also see if there's a dose response!"
Example #2: Editing an article for Synapse discussing how men and women have different points of view. Jenny said, "I don't quite know how to say this, but there's a poor concordance between men and women. I mean, the R squared is not very good."
"I totally get you," I said.
Example #3: Email correspondence from Jenny: "cirque de soleil is so cool (p<.0000001)."
I woke up today already a little agitated because I had forgotten to call home to wish Jeremy a happy birthday yesterday night after teaching MSP and then overslept this morning until 7:50 a.m., decided that it wasn't worth coming in 20 minutes late to lecture because it was getting almost embarassingly predictable so I slept a little more and arrived in time for the 9 a.m. lecture.
Probably a good move since my brain was more alert and I actually learned more, but one detail that the lecturer mentioned gave me a little mental static shock. He mentioned that patients with multiple myeloma do not have good prognoses and that bone marrow transplants are palliative measures designed to reduce recurrences and extend survival.
Someone whom I admire very much received a BMT for multiple myeloma -- and it almost made me cry realizing that things in life are so unfair.
Wow, we are rushing headlong into December and to the beginning of 2008. I didn't even make my thanksgiving list this year...next thing you know it will be time for new year's resolutions.
Promise to write more thoughtful entries, but time has been in short supply lately.
If last week had had a theme, it would have been "singing and dancing." - Saw the musical "Jersey Boys" on Wednesday night with friends from medical school -- learned a lot about the Four Seasons and Frankie Valli (Frankie who?). Professional singers and cancers (whoops, "dancers") are AMAZING. - On Friday evening, saw 20 minutes of an acapella concert, the UCSF Vocal Chords (semi-professional singers), and then -Went to Japantown for karaoke (amateurs singing at an AMSA conference event). - Saturday evening saw a dance performance at CounterPulse by the Dance Monks, an interpretative dance troupe (yay for artsy fartsy cancers!). - Later that evening, went to the dance club Impala in North Beach, for an AMSA conference event (good natured sketchy cancers).