Facing Mortality

Environmental & Science Education
Death
Medicine
Health
STEM
Edward Hessler

In March 2016, Stanford University Paul Kalanithi, MD, an eloquent writer about facing mortality died of lung cancer. He was 37 years old.

Kalanithi had only recently completed his neurosurgery residency at the Stanford University of Medicine. He was also a first-time father.

Kalanithi did his undergraduate work in English and biology at Stanford, graduating in 2000 with three degrees: a bachelor's in biology, and a bachelor's and a master's in English literature. While still in high school his career goal was to be a writer.

The Stanford School of Medicine announcement of his death has several links, one  to a short video (roughly 8 minutes) where Dr. Kalanithi reflects on being a physician and a patient. The film is titled Days are Long Long, Years are Short. Kalanithi is the author of the widely acclaimed memoir When Breath Becomes Air, published posthumously.

Nora Krug reporting in the Washington Post (January 5, 2018) writes about what has happened since his death.. Lisa Kalanithi, an assistant professor of internal medicine at Stanford Medical School, has fallen in love with Nina Rigg's widower, lawyer John Duberstein. His wife, Nina Rigg died of breast cancer.

It was Nina Rigg who first put the two in contact. As she was facing death, she was concerned with how her husband John Duberstein was going to deal with the focus. She suggested that he contact Dr. Kalanithi. The reason, as reported by Nora Krug, was that "She (Lisa Kalanithi) has experience with this, she told him; she’ll know what to do." She did. Nina and Lisa became fast friends and John found someone to help him safely to the other shore.

Nora Krug's column also links to the video mentioned above. No guarantees on this link but I think an infrequent user will be granted permission to read it, otherwise it may be available only by subsciption.

Bicycles: The Early Years

Environmental & Science Education
STEM
Engineering
Society
Edward Hessler

A short and delightful film on the evolution of the bicycle.

CRISPR

Environmental & Science Education
STEM
History of Science
Nature of Science
Medicine.
Edward Hessler

CRISPR is a powerful gene-editing technique.

Analogies are often used to help in understanding the impact and potential power of this technique. Among the most used are these, ranked from worst to best: a knock-out punch (#10), the hand of Gog, a bomb removal squad, a handyman at work, an eraser, a surgeon's scalpel, a pair of scissors, "search and replace" in MSWord, photoshop, and a Swiss army knife (#1).

These are from a critical essay in STAT by Rebecca Robbins (December 8 2017). She and Sharon Begley, the senior science writer at STAT, evaluated each analogy based on three criteria: creativity, clarity, and accuracy. You may read the results here.

STAT's Jeffrey Del Viscio and Dominic Smith recently published a visual attempt to show the genetic complexities involved in making the invisible visible and they hope understandable. Take two minutes to view their animation.

CRISPR is short-hand for Clustered Regularly Interspersed Short Palindrome Repeats. There is a history of CRISPR at the Broad Institute website.

Friday Poem

Environmental & Science Education
Poetry
Art and Environment
Edward Hessler

Today's poem is by Wendell Berry.

U. S. Department of State Science Envoy Program

Environmental & Science Education
STEM
Society
Culture
Medicine
Health
Edward Hessler

Epidemiologist Michael Osterholm is director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP).  He is also a Regents Professor at the University of Minnesota.

On June 11, Dr. Osterholm was one of five scientists chosen by the U. S. Department of State to serve as a science envoy, a year-long appointment.

The other four scientists are chemical engineer Robert Langer (MIT), bioengineer Rebecca Richards-Kortum (Rice University), environmental engineer James Schauer (University of Wisconsin) and NASA Administrator (retired) Charles Bolden.

There is a short interview with Professor Osterholm in Science by Jon Cohen which includes a link to the science envoy program.

Congratulations, Dr. Osterholm.

Reading a Dog's Mind

Environmental & Science Education
STEM
Behavior
Edward Hessler

This video on animal consciousness comes from the point-of-view of a neuroscientist. The project is known as the "Dog Project."

It is from Science Friday's The Macroscope (May).

What I like about this website is that it includes the video as well as some still shots and text.

Leeches: Beyond Fishing

Environmental & Science Education
STEM
Medicine
Health
Edward Hessler

This video from KQED Science describes the use of leeches in medical treatment. The accompanying essay by Emma Hiolski notes that "the humble leech is making a comeback. Contrary to the typical derogatory definition of a human 'leech,' this critter is increasingly playing a key role as a sidekick to scientists and doctors, simply by being its bloodthirsty self."

I hadn't known that leeches can be used--a low tech method--for assessing local biodiversty. Leeches retain the blood they remove while feeding and that blood can be used through the analysis of the DNA to identify the donor.

Some basic biological research on leech behavior and neurobiology is also described.  An advantage of studying such a small nervous system is that it is easier to understand basic mechanisms on how information from the environment is used in decision-making.

The video shows a bandaged hand after reconstructive surgery and here is where leeches enter the treatment regimen. They remove stale blood from damaged veins that are too small to repair. There is another benefit, too. The enzymes found in leech saliva prevents blood clotting.

Friday Poem

Environmental & Science Education
Poetry
Art and Environment
Edward Hessler

Today's poem is by Tony Hoagland.

I add a thoughtful essay about children's poetry by Imogen Russell Williams that I've long intended to include.  She writes about the narrowing of education in an examination based system, referring to the "GCSE behemoth" grinding "over the horizon," which often has the effect for many students "that poetry exists for one purpose alone: to be broken down into techniques and terminology for the optimal acquisition of marks."

The GCSE is the acronym for the General Certificate of Secondary Education, a set of examinations taken by students aged 15-16 in England, Wales and Northern Ireland.

The poems Williams discusses put paid to the analytic, not that analysis is unimportant but the joy or poetry and nourishment poetry provides are not to be lost. To give you a taste of her aim in this essay about liking poetry, she includes a few lines from Roger McGough's Apostrophe.

'twould be nice to be
an apostrophe
floating
above an s
hovering
like a paper kite
in between the its ... 

There is more and you may read her comments here.

The Apgar Score

Environmental & Science Education
STEM
Medicine
Health
Edward Hessler

Today's Google Doodle honors Dr. Virginia Apgar, who invented what became the standard test for assessing the health of a newborn infant within a few minutes of birth. She would have been 109 years old.

This quick diagnostic measures infant health using five dimensions: Appearance, Pulse, Grimace, Activity, and Respiration.

Dr. Apgar's career also included work in genetics. She became a public health advocate for congenital birth defects.

You may read about her and see the Google Doodle at Quartz.

When it Is Brain Surgery

Environmental & Science Education

STEM

Medicine

Health

Edward Hessler

After reading Joshua Rothman's essay in the New Yorker on the eminent London neurosurgeon Dr. Henry Marsh, I put the Marsh's memoir on my "want to read" list. One reason was this searing quote from Marsh's memoir. "'As I approach the end of my career I feel an increasing obligation to bear witness to past mistakes I have made.'"

Rothman noted that "Marsh isn't interested in the usefulness of error. He is the Knausgaard of neurosurgery: he writes about his errors because he wants to confess them, and because he's interested in his inner life and how it's been changed, over time, by the making of mistakes."

Long after reading Rothman's essay I found Marsh's memoir Do No Harm: Studies of Life, Death and Brain Surgery, in the new books section of Hamline University's Bush Memorial Library. The title is from the Latin, Primum non nocere, "first, do no harm," one of medicine's most fundamental and difficult precepts. It means that attending physicians are first to weigh uncertainties regarding risks and benefits with their patients before proceeding. It does not mean or imply that the way forward is clear or without risk or without the possibility of a mistake but it means that these have been considered and that the treatment chosen is the best in the physician's and patient's judgment.

The memoir is organized by compelling and brutally honest case studies, 25 total. The cases consist of neurological disorders, strokes, spinal cord problems and, of course, cancers. Marsh was among the pioneers of anesthesia free brain surgeries. He also worked for years with neurosurgeons in Ukraine, after the fall of the Soviet Union who had at best second-hand and antiquated equipment. This work was funded by a charity Marsh established. And, of course, he trained residents, including some from the United States who came to study and practice with him for a year. 

Marsh is also a fierce and relentless critic of the British National Health Service. His comments will make you both laugh (first) and cry/wince (second). You are likely to recall similar experiences from your own life experiences --"trainings," as they are called.

A fragment from the BBC documentary, The English Surgeon, shows Marsh's work in the Ukraine. You may want to bark, "Henry, wear a helmet!" when you see him riding to work without any head protection, his standard almost daily practice. There is a lovely scene of Marsh and a Ukrainian colleague sliding, just like kids, across an icy pond using their shoes as skates.

In his memoir Marsh comments on the use of technology in brain surgery, e.g., infrared cameras which allow him to "see" where his instruments are on a brain scan taken shortly before the surgery but neurosurgery remains fraught with danger, measured in a millimeter or two.  

Dominic Smith, who writes for STAT describes a new technology being developed by neurosurgeon Dr. Alexendra Golby and her colleagues at Brigham and Women's Hospital in Boston which uses magnetic resonance imaging technology coupled with powerful computing technology to create personalized 3-D models of the brain in near real-time so that the surgeon can know where s/he is throughout the surgery.

Smith's essay includes a short video explaining the new technology. If you'd like to see a day in the life of Henry Marsh, the BBC produced a film (~10 minutes) is about the problems Dr. Marsh finds with the British National Health Service.

Marsh is the author of Admissions: Life as a Brain Surgeon which is on my reading list.