Some stories never get old...

...especially if you haven't heard them before. The story of a king finally gets told some 2000 years later thanks to the amazing discovery of an ancient Mayan mural dating back to 100 B.C. Click on the image below, courtesy of National Geographic, for more info...

Also, interestingly, the "Body Worlds" exhibit which was in Chicago earlier this year, has started stirring up controvery in Florida, and now in New York. The bodies are from Chinese prisoners and unidentified bodies that no one claimed. The issue is that the people whose bodies are being used never gave any informed consent to donate their bodies to science or for such an exhibit.

Back in July, I expressed my own concerns about the commercialization and public display of the bodies. The organizers of the display state that they obtained the bodies legally from the Chinese government. The exhibit has attracted record audiences and as a result, the museums don't seem to be saying much at all about the ethics of the situation. Guess money talks loud enough for them...

Growing out a little heart...

I attended a fascinating lecture today by Dr. Joshua Hare, MD, from Johns Hopkins University here at the University of Chicago. He talked about research he is doing using stem cells from bone marrow to repair hearts damaged by heart attacks.

While the public debate over embryonic stem cells continues to rage, many researchers are avoiding that ethical quagmire altogether and simply using the stem cells that already exist in the body for their research. It has long been known that some adult stem cells exist in the bone marrow because they are responsible for generating new white and red blood cells, which the body is continually replenishing as old ones die out.

Embryonic stem cell researchers would contend that adult stem cell are not as useful as the embryonic ones because they are too mature (or differentiated). They believe that only embryonic stem cells that will allow us to achieve the goal of "regrowing" organs damanged by injury or disease.

In his presentation, however, Dr. Hare pointed out that one of the biggest problems with embryonic stem cells is that they tend to form teratomas, a type of tumor. Adult stem cells, when implanted or injected into damaged tissue, do not seem to be as likely to form such teratomas.

Dr. Hare discussed his research in which they took a certain type of adult stem cells from the bone marrow, called mesenchymal stem cells (MSCs), and injected them into heart tissue that was damaged by a heart attack. Tissue that is damaged by a heart attack is dead tissue, because it no longer receives any blood flow. This dead tissue can no longer contract, or beat, and is usually weaker than the remaining heart tissue.

After about two months, Dr. Hare's team found that new heart tissue had grown in the spot where the mesenchymal cells were injected. Not only that, but this new tissue was actively beating, in sync with the rest of the heart! An area of the heart that was totally dead and not beating had regained its function and started contracting again.

The question for Dr. Hare and his team is whether this new tissue is the result of the MSCs transforming into cardiac myocytes (the cells that make the heart beat) or whether the MSCs stimulate the heart to produce these myocytes.

This second hypothesis comes from the fact that adult stem cells have been discovered in the heart. In 2004, research by Messina established the existence of cardiac adult stem cells. This was a major breakthrough because the prevailing dogma has been that our organs are "terminally differentiated", that they have reached the limit of their maturation, and thus do not have adult stem cells. Messina's research, and research like hers, is starting to reveal that stem cells may be more ubiquitous than previously imagined and that our organs may be more flexible and dynamic than we ever thought.

Dr. Hare's technique of injecting MSCs into damaged cardiac tissue (called "cellular cardiomyoplasty") is exciting because it offers the chance for therapy that actually reverses the damage of a heart attack. This is far ahead of current therapy which assumes that a heart attack will cause a certain amount of irreversible damage (depending on how large the heart attack is) with therapy aimed to minimize its progression. This has given rise to the concept of "cardiac regenerative therapy" in which one can actually regenerate at least some of the dead tissue and its function.

These initial experiments were done in pigs and Dr. Hare and his team have already moved into Phase I clinical trials, to see if they can replicate their success in humans. If so, it heralds an exciting new era of treatment in medicine.

Sources:

1. "Cardiac repair with intramyocardial injectionof allogeneic mesenchymal stem cells after myocardial infarction." Luciano C. Amado et al. Proc Natl Acad Sci USA. 2005 Aug 9;102(32):11474-9.

2. "Isolation and expansion of adult cardiac stem cells from human and murine heart." Elisa Messina et al. Circ Res. 2004 Oct 29;95(9):911-21.

Diet Coke vs Coke Zero: what's the diff?

I drank some Coke Zero this weekend for the first time. I know, very adventurous...

[Dude, man, I had a great weekend.
No way bro, what'd you do? Surf on Lake Michigan? Parachute off the Hancock?
Naw dude. I did the Zero.
You did the Zero! Bro, you know you can't be doin' that stuff. Whoa. The Zero.]

While I was drinking it, though, I couldn't help but wonder, how's it different than Diet Coke? I thought maybe it was a little sweeter, but couldn't be sure. So I did some investigation and, luckily, there is a blog devoted to dieting, called Diet Blog.

And they cleared it up for me: Coke Zero has half the aspartame and more of acesulfame potassium (called ace-k in diet lingo), another sweetner.

The same blog also has a post about how Coke is going to come out with a coffee drink that is half cola and half coffee, called Coca Cola Blak. Yep, those of you mixing your Starbucks and your Coca Cola can now come out of the closet. Coke's going to do it for you...

My current favorite diet drink: 7UP Plus Island Fruit. Technically, not diet, but only 10 calories per 8oz and it has calcium with 5% fruit juice. It's yummy.

Snowed in...

From the inside looking out, the snow that is steadily falling tonight looks wonderful, fat big flakes plopping down on the ground, blanketing everything in the powdery snow. Tree branches, that have long been bare, seem adorned with glistening silver, and the dusty brown sidewalks are carpeted with white, inviting someone to be the first to leave their footprints. Even the streets cratered with potholes are filled in tonight, making the roads look like smooth paths suitable for a sleigh ride (...but which are probably better traversed with a Hummer...)

I reflect on all this tonight because I have the time to do so. I'm at the U of C these days, into my second week of a heart failure/transplant rotation, and the marvellous snowfall has also shut down traffic on the highways, with the local traffic report indicating that it will take me more than 3 hours to get home, for a commute that normally takes 45 minutes to an hour.

As I walked to the Regenstein library, I had a few moments to realize how utterly transforming and beautiful the snow really is. And I also realized how it's been a while since I've noticed that; for perhaps the past few years, I looked at snowfall as a nuisance that slushed up the roads and added an hour or two to my commute.

I find that kinda sad really, I mean I remember how much I used to love playing in the snow as a kid and how snowfall was about the most exciting thing that could happen in the winter. It has been a long while since I've built a snow fort, a snow man or even had a good old-fashioned snowball fight.

So it was nice to be on campus, to walk through the snow and just enjoy it. Let it snow, let it snow, let it snow. I'll deal with the commute in the morning.

Afghanistan in pictures

An interesting photo gallery of Afghanistan by Emilio Morenatti, who worked for a year as a photographer in Kabul for the Associated Press (AP).

http://www.emiliomorenatti.com/

The pictures offer small glimpses into daily life in Afghanistan and speak volumes about how land mines, weather, poverty and poor infrastructure are just a few of the problems the Afghani people face.

Amazing videos

People,

Check this link out, it's called "Tom Kills Oprah", just hilarious

And then I came across another one that's really amazing, a video of a giant octopus eating a shark at the Seattle Aquarium. It is legit, from PBS's Nature show. Unreal. Don't mess with the octopi...

All courtesy of Google Video, a highly addictive habit...

A crazy week

So, my time in the ICU has come to an end, just in time for Thanksgiving. A symbolic end to a month where I have seen some of the sickest patients I have ever encountered. This last weekend I had to work both days in the ICU and had quite an experience.

One patient came in because of problems with a "G tube", which is a tube put in through the skin into the stomach to allow a person to be fed. In this patient's case it was put in because he had two massive strokes and could no longer swallow. When we looked at the CT scan of his brain, it looked like a significant portion of the right side of his brain had been removed. And there were changes in other parts of his brain that looked like what an old stroke would look like.

One of the effects of the stroke is that he has "expressive aphasia." He can understand what we are saying to him, but, when he tries to speak, he is unable to think of the words he wants to say. It's like constantly having something "on the tip of your tongue" but not being able to say it. So the primary way he communicates with us is through gestures. We later found out from family that he had surgery to remove part of his brain because of complications from the first stroke. The G tube works fine now but he's still in the ICU because he developed an infection, though he's been started on the right antibiotics and God willing will do well.

I guess this guy's case was so striking to me because I would never have guessed that more than half of the right side of his brain was taken out...

Another patient was a trauma patient, who was developing a pneumothorax, which is basically air in the lung. The air "leaks in" and one lung starts overinflating, pushing your windpipe to the other side and smushing the other lung down. It can happen after trauma, such as the motor vehicle crash this patient was in. So surgery was in the process of putting chest tubes in him, and I was there helping to hold his legs down while they did so. After getting the tubes in, they started suctioning through his mouth to get rid of some secretions, when he suddenly vomited blood, much of which landed right on me. There are few things more revolting than having blood vomited onto you, but I just reminded myself that I was there to help someone whose situation was much worse than mine. Since there was more than enough help around, I went out, showered and had a quick change of clothes...the patient will probably never remember me (he wasn't totally conscious) but I doubt I'll forget him anytime soon...

If all that wasn't enough, there was a patient who coded (heart stops) but was successfully resuscitated with CPR and, last I heard is actually doing well. Usually people do not fare well after resuscitation, so I was glad to hear this patient made it through...

Still another patient who has an abdominal aortic aneurysm (AAA), which is when the walls of the aorta (the largest artery in your body) get weak and the artery dilates. This guy's AAA was 6cm and he was so skinny you could easily palpate it through the skin. It's something you read about in physical exam books, but rarely get to see or feel. On top of all this, he had air leaking into his body, but in his situation we couldn't find any source or reason for it. The air was tracking all the way from his brain, in his chest (but not in the lungs, so he was breathing fine), and down into his abdomen. We got a bunch of CT scans in which we inject contrast, to search for the leak, but could not find one. The surgical team was going to do exploratory surgery, but since his clinical condition was stable and he had a large AAA that could rupture, they elected not to. Last I heard he was sent to hospice because his overall prognosis was poor. He is still something of a mystery, as I don't think anyone ever figured out where all that air was coming from. I hope, at the very least, that he is comfortable wherever he is. He seemed like a very nice man, a World War II vet.

Today, I had a lady who had a hypertensive, hemorrhagic stroke. Essentially her blood pressure was so high, it caused a blood vessel in her brain to rupture and bleed, causing a stroke. It was on the right side of her brain and she has left sided weakness. She could understand everything we said, and responded appropriately, but had a lot of slurred speech because of the stroke. Prior to the stroke, she was being treated for high blood pressure with more than 5 different blood pressure lowering medications, but she has a resistant form of hypertension. So the blood vessel ruptured, despite all the medicines we were giving to try and prevent that from happening.

She apparently has had many "mini-strokes" in the past (the fancy medical term is transient ischemic attacks or TIAs) but none caused any major neurological deficit. The stroke she just had, however, has caused her not only to slur her speech, but also to become weak on the entire left side of her body. She can no longer move her left arm or foot. I can only hope and pray that she makes some sort of recovery from this stroke. Apparently her mother and grandmother both died of strokes as well. The strange thing is she never smoked but she is diabetic (although she controls it well through diet alone, which is pretty impressive). In addition, her kidneys are barely working and she was likely going to start dialysis in the near future, prior to the stroke. Poor kidney function could also be at the heart of her resistant high blood pressure (renovascular hypertension) or maybe something more exotic like an arteriovenous shunt...another mystery, waiting to be solved...

I did also interview in Milwaukee on Monday for a prelim spot. Great program up there, really resident focused. I've started noticing that smaller cities in the Midwest really do a better job in terms of taking care of their residents. Plus traffic in Milwaukee is way, way less than Chicago. From where I live to get to the Chicago Medical District is a 2 hour drive in rush hour, just ridiculous. In Milwaukee, one of the attendings told me he leaves his house at 7:15am in order to start his 7:30am rounds...I really don't think you can put a price on that...

Well, enough blabbering...happy Turkey Day everyone...

NYC Baby

Last Sunday, I left for New York City for an interview and, like every journey worth taking, I began my adventure by heading in the opposite direction. Yes, thanks to the friendly folks at Northwest Airlines, my odyssey would begin by going west, to the exotic confines of Minneapolis/St. Paul.

I was, actually, somewhat curious to see the great state of Minnesota, for I had no reason to ever go there before and a stopover on a flight to NYC seemed like as good a reason as any to visit the state of 10,000 lakes. I was particularly curious to see what it would look like from overhead, as I imagined the aerial view of thousands of lakes would simply catch my breath and thus entrance me never to leave Minnesota.

Of course, I slept all the way on the flight over. So I never saw the panoramas I envisioned, groggily arising to realize I had better get off the plane before they decided to go to Tulsa or something.

I will say, however, that Minneapolis/St. Paul has a rather impressive airport, MSP International, complete with tram and an expansive shopping center area. There were several boutique shops including ones called, appropriately enough, Minnesota. Seemed like an upscale souvenir shop, which usually means you end up paying $30 for a t-shirt that says something creative like, "Minnesota." I meant to get a shot of one of the stores with a big moose in front of it, but had to settle for this one that had two bears. But perhaps the best feature of the MSP Airport is the fact that it has a large replica of Snoopy, who I guess pays the bills these days by endorsing Mall of America and the MSP International Airport. It's always the sponsorships that pay the bills...you go Snoop...

From Minnesota, my next destination was New York City and I made it to LaGuardia Airport and hopped on the M60 bus to Manhattan and then the subway to Tareq's place, where I would be staying. Tareq is one of my homies from U of C and is in his second year of law school. It was great to see him and hang out like we used to do back in Chitown. He has a nice place right next to the subway, which I discovered is absolutely vital in NYC.

After settling in, we went out to grab a late lunch at Patsy's, a well-known pizza joint. We were met up by two other U of C alums and good friends, Murtaza and Yazen. Murtaza is working for a hedge fund company while Yazen is in his fourth-year of medical school, looking to go into med-peds.

When we were at Patsy's, and deciding on toppings, I confidently told the waiter that I wanted spinach and mushrooms, without even looking at the menu. The waiter replied, "where do you see spinach on the menu?". Of course, I then looked down at the menu and realized, with total shock, that they did not, in fact, offer spinach on their pizzas.

Let's stop for a moment here and ask ourselves an important question: what kind of self-respecting pizza joint doesn't offer spinach? I know you can't get it at Pizza Hut, Domino's or Little Caesar's but any classy sit-down pizzeria in Chicago will give you pizza. Giordano's, Gino's East, Pizzeria Uno, Edwardo's. I just didn't know what to say at this point, so I just left it to Murtaza to pick the other topping...Chicago pizza is undoubtedly the best...

Afterwards, Tareq and I did a little walking tour of his neighborhood and I got to see some of NYU's campus, which has a nice Parisian-style "Arc de Triomphe" at its entrance, and stopped off to eat at a small restaurant called Istanbul Cafe, which makes unbelievable kefta kebob sandwiches. I mean, home-made good. This place easily made my top-ten list of restaurants and the sandwich was quite filling. Not a bad deal...

Later that night, we decided to have dessert and meet up with my cousin Nadia and her fiancee Omar at a place called Cafeteria. We were also joined by another good friend of mine, Fares, who also went to U of C and is a lawyer practicing in NYC. I wasn't particularly impressed with the restaurant, but it was great to catch up with friends and family and have a non-medical discussion for once...

It was getting late, but late takes on a whole new meaning in New York, where I think the air is caffeinated. So Nadia graciously offered to take me down to see Times Square, since I had never been before and it was amazing to see it at night. The place was so lit up, it could have been the middle of an overcast afternoon. And the other thing that was amazing to me was that there was much heavier traffic than I would have expected for a Sunday night and street vendors out peddling their wares and stores open like it was 2 in the afternoon. I mean, really, this city never sleeps...

After getting back to Tareq's place, (Nadia was nice enough to call to make sure I didn't get lost on the way), Tareq and I spent most of the night catching up on things, and what our futures might hold. Luckily, he didn't have class until midmorning and my interview was scheduled for after lunch.

The rest of the trip, and interview, almost seem anti-climactic compared to my Sunday/early Monday. The interview went well, thank God, and afterwards I was taking the subway to go to the airport. I realized that I had left my coat at Tareq's place and, after calling him, he left his place right away and took the subway all the way to where I was, to make sure I had it before I left. It was quite kind of him, especially since, when I got to Chicago, it was freezing and I wouldn't have had a coat unless he did that...

A great whirlwind of a trip, I was thoroughly exhausted afterwards (I reached home near midnight--had a layover in Detroit--on Monday and had to get up bright and early for another day at the ICU) but had a great time.

Thanks to all my family and friends for making it so much fun!

Is it time to unplug...

A couple days ago, one of the ICU nurses was telling me that she has seen a lot of patients come into the ICU, often in such bad shape, she was sure they would never leave. Yet, more often than she expected, these patients who had death cloaking their very breaths would leave the ICU alive. At the same time, she has seen patients who were sitting in their beds, eating dinner and then dying within a half hour, their lives lost to a paroxysmal death. She told me that these experiences convinced her it is God who determines the outcome.

I really enjoyed that insight from her, for God is rarely mentioned or considered in the ICU. You are too busy calculating corrected calciums, interpreting ABGs, or figuring out vent settings to remember that a little prayer for the patient could only help in the midst of placing central lines, G tubes or peering into the patient's body with CTs or xrays...

The remembrance of God also seems surprisingly absent when it is time to make decisions about the final disposition of patients in the ICU. Today, the daughter of one of my patient's decided it was time to transition her mother to hospice and withdraw the ventilator.

I feel sad for the patient. She cannot talk, she cannot move herself, her heart beats too fast and in an irregular rhythm, her lungs don't work well enough to allow her to breathe on her own, her kidneys are failing, her body is swollen with fluids, and she has a huge ulcer on her back that goes down almost to the bone. That's only a few of the things wrong with her...

Despite all this, she still opens her eyes and looks around the room. She will still wince when in pain. To me, she is very much alive. Although she does not seem to gaze in a particular pattern, and will not track your movements, her eyes do open and move about. The nurses, and I, feel that sometimes she understands what we're saying or doing, though we have no objective evidence of that at all.

I feel like we should still fight for this patient, that there is still hope for her. Yet all the physicians, nurses, residents, clergy and, now, even the daughter, feel like she has gone beyond hope. That she is in some sort of living death and that it is time to remove the ventilator and see if she will complete the journey or, miraculously, remain.

As we were discussing the case, prior to meeting the daughter, a priest working for the hospital said he felt it was a moral sin to keep such people going when there was no benefit, no real chance for survival, that we were only prolonging their suffering.

I found that comment strange coming from a Catholic priest, as I always thought the Catholic Church thought highly of those who endure suffering, in line with the Christian belief that Jesus (peace be upon him) suffered on the cross so humankind would be forgiven for their sins. So I would have expected some other line of reasoning to support withdrawing care, one not based on notions of suffering, but rather on notions of beneficence, mercy, etc.

Of course, Muslims do not believe Jesus (peace be upon him) suffered on the cross, rather he was miraculously lifted to Heaven and thus never crucified. For us, forgiveness is not dependent on anyone's suffering, but rather on our repentance and God's Grace and His Love of Forgiving...

Yet it seems the entire question of whether or not to continue my patient's treatment hinges on the notion of suffering, or quality of life. The argument is made that withdrawing care will benefit her more because it will relieve her of suffering and because further treatment is futile, that no meaningful recovery is likely.

I don't think any of us really know how much my patient is suffering. The only real objective sign of suffering we get are the winces, and changes in respiration and heart rate, when we insert a central line. Many studies, in fact, have revealed that physicians are remarkably bad at assessing a patient's suffering. Surveys that asked patients with disabling conditions about their quality of life, almost always rate it higher than the physicians or nurses who treat them...if we make that mistake with people who have their cognition intact, than why should we be any better with people who do not?

I think we need to remember God in such situations and ask whether or not He has given us any guidance on this issue. Rather than focusing exclusively on the patient's quality of life, or suffering, we should also consider the inherent sanctity of life, and the tremendous virtue associated with protecting and preserving life placed by all Abrahamic faiths. I am sure we would find the guidance if we devoted more of our efforts to pursuing it...

One other factor one must not ignore is the economic incentive that exists to withdraw care. It is "cheaper" for society to unplug, and it consumes far less resources if you decide it is time to let the patient die a "natural" death. Sometimes patients have to make the horrendous decision of how to pay for expenses for such care, and some may feel forced by economic circumstance to pull the plug. Economics muddy up the waters, and many family members feel great guilt in such situations.

In the end, I still find myself at something of an impasse. Rationally, I can understand the arguments in favor of withdrawing care. Emotionally, I refuse to pull the plug, to cut loose the one tether they have to this world and, along with it, all hope of them ever coming back.

Once my patient is transferred to a hospice, she will be made as comfortable as possible and the ventilator will be withdrawn. The outcome, as it has been all along, is God's decision. I only hope we all made the right one in bringing her up for judgment...

Too Little Yardage...

Rented the remake of "The Longest Yard", with Adam Sandler, over the weekend and I wasn't particularly impressed with the movie. Sandler's character wasn't really that compelling, or funny, and the comic relief of Chris Rock relied too heavily on tired stereotypes of black people in a way that wasn't particularly inventive or fresh (though one line was funny, "I was so bad at sports that when I was in school they would usually pick me after the white kids."). The most amusing character was Bob Sapp's Switowski, the giant of a guy who turned out to be as gentle as a kid. Basically, if it's on TV and you've got nothing else to do, you could watch this flick, but not worth a rental...

Also saw "In Good Company", featuring Dennis Quaid and Topher Grace. It started out real good, could've been an interesting commentary on big corporations and office politics, especially dealing with a young hotshot boss who is half your age. Instead, it wanders off course exploring a romance that really wasn't compelling and tries to find its way back by the end, but it is too late by that point. A disappointing flick, since it started out well enough...

Man, had a long day at the ICU today. I'm exhausted...you get to see some really interesting cases in the ICU but the hours are draining. I think there should be mandatory afternoon naptime anytime you have to come to the hospital before 7am...

Bulls lost tonight in overtime. Luol Deng, however, had an amazing game for the Bulls, had some really nice moves. Caught about 10 minutes of the game...

Eid Mubarak!

Ramadan has come to an end and I would like to wish everyone Eid Mubarak! May Allah accept our fasting and worship during Ramadan and give us its full reward, a blessing only He can give. It is always a joy to celebrate Eid, a great time to be with friends and family. It is also customary to give gifts, so if any of you like to give rather than receive, you can hook me up...

I won't be able to take a day off for Eid this year, such is life in the ICU, but I will be celebrating on the inside while looking up lab values, talking to attendings and sitting in lecture...you can keep me away from the party, but you can't keep the party out of me, if you know what I'm sayin...

Eid Mubarak

The Arabic phrase for Blessed Holiday

is rendered in Kufi by Mamoun Sakkal (c) 2002

I see you...

I just started my Intensive Care Unit (ICU) rotation and it's been quite the adjustment, getting to the hospital at 6am. My last rotation was infectious disease and it was a great experience because the attending is brilliant and loves to teach. In addition to that, he usually started rounds around noon, so we usually started our day around 10am...man, that was nice...

ICU is interesting because you have patients that have nearly everything wrong with them and need it all managed. There is a lot of opportunity to learn and solidify concepts you've been exposed to in med school.

As we were doing rounds, walking from bed to bed and discussing the patients with the resident and interns, another med student pointed out to me that it was almost like we were at a zoo, the patients in their rooms with their exotic illnesses, as we walked by, gawking and remarking on how amazingly bad someone's ABG was or how severe someone's urosepsis had gotten...

It made me realize that in our earnestness to learn, you can't forget these are people grappling with very serious illnesses. I think part of the reason it is easy to forget is that more than one person in the unit has diminished mental status, so it's easier to think of them as just some "problem list" that you need to work on "solving". And yet these people are the ones who are most in need of our extra efforts and compassion. Their illnesses have overwhelmed them to the extent that they have lost awareness of themselves; and yet their eyes remain open, with vacant stares that chill you...

Many people that see such scenes, whether it is physicians, nurses or the patient's family, often say they would never want to end up in such a state, that life is not worth living under such conditions.

I'm not sure where I stand on the issue.

I do think we should do our utmost to preserve and extend life. I'm not sure what role quality of life has in that equation, that is, at what point can quality of life override the imperative to preserve life? If we say that quality of life can override efforts to preserve life, then where do you draw that line? Doesn't that open up a slipperly slope?

Too much for me to delve into right now...gotta get up at 4:30 so I can get to work by 6...

Sweep Home Chicago...

As the whole world knows, after all it was the World Series, the White Sox are the best team in baseball. In the whole world. Well, the Sox have actually never played any teams from Venezuela, Japan or Cuba in order to earn that distinction, but we have players from each of those countries, so that's good enough...

All geopolitical joking aside, the White Sox are the best team in the United States. Without doubt. They simply dominated the postseason, losing only once, and crushing big names like Boston and Los Angeles on the way...

Some people will say that their string of losses near the end of the regular season, when they dropped from a 15.5 game lead to 1.5, tarnishes their accomplishment and keeps them from being mentioned among the ranks of the greatest teams in baseball history.

I don't buy that. I mean, those losses were frustrating and almost inexplicable. A team that was so comfortably ahead should never have gotten so close to losing the division. But you know what? They didn't. They won the division and then they beat Cleveland when it counted most.

What's more is the beat the defending champs without even flinching. If the losses were a sign of inherent weakness in the club, then they shouldn't have sailed through Boston without a loss.

The simple fact is this team was unbelievably strong in the postseason and they deserve all the accolades and respect of any World Series winner and should well be mentioned among the best teams because they truly won this Series as a team.

The selfless style of play, the lack of egos, the desire to win are all hallmarks of this team. This is something we haven't seen in a long time. When it came time to name a Series MVP, one is almost at a loss to pick a single player because so many were responsible for the wins (not to take anything away from Dye). The only thing one could criticize is the selection of the song, "Don't Stop Believin'", but even that has grown on me (I find myself humming it for no apparent reason with alarming frequency...)

So for all the fellow Sox fans out there, enjoy this win. It was truly unique, a gift to the city of Chicago and fans of baseball everywhere. The fact that so few watched it doesn't take anything away from it. The rest of the country missed one of the greatest stories baseball has seen in a long time...

Some local coverage:

ABC 7 News
CBS 2 News
NBC 5 News

Yeah Sox!

The thing about coats...

As I made my way through another blustery day on campus, I came to the realization that one of the standards by which all coats should be measured is by the number of discreetly located pockets. When the weather turns cold, it seems like there is no end to the number of uses such pockets afford. I have one pocket dedicated to fresh breath (tic tacs and "Maximints" given to me by a drug rep for Maxipime), one for my cell phone, one each for my gloves and one for random pieces of paper that I seem to collect (usually notes that have phone numbers written on them with no name, so I never know what the number was for).

Of course, the key to all this is that the pockets must not be obvious, they must not be a patchwork of pockets that incidentally come together to form a coat. No, rather it must be a coat that, incidentally, has a lot of really great pockets...

Perhaps you are not convinced by my theory of great pockets. But then perhaps you live in southern California, where exotica such as coats are seen only on late-night television movies, which you fall asleep to, so that when you wake up in the morning, you can chalk off coats as just some bad dream...thought so...

Kneeling and bowing...

Had an interesting experience today. Went to pray zuhr in the hospital chapel today and, after finishing, saw an elderly white gentleman walk in and sit down in one of the back pews. I was getting my stuff together, putting my white coat back on, and the man said, "You know, that is really beautiful, the way you pray."

I was silent, sort of shocked, really, that someone, ostensibly a non-Muslim, would say that. I mean usually when I pray in hospital chapels, and there are non-Muslims, they either pretend like I don't exist or have expressions of annoyance. But never did anyone stop me to say what I was doing is beautiful.

At this point, I figured I should say something to this remarkable stranger. I thanked him and told him that I am a Muslim and that the kneeling and bowing help us remember Who is in charge.

He replied, "You know all that kneeling and bowing is really wonderful. The Catholic Church used to have a lot more of that, a long time ago. We've gotten away from that."

I was still somewhat speechless, almost expecting the man to make a joke about Muslims and our way of praying. In the media, the Muslim prayer is almost always depicted in the background of violent images, as if it is the menace from which such violence is born, rather than the ultimate act of submission that it is, an act that when performed sincerely, and consistently, produces people of serenity and peace.

We introduced ourselves and, as I left, the man said, "if I ever switch sides, I'll let you know."

I walked away truly happy. Someone had looked past societal stereotypes, and perhaps even their own prejudice, to see the beauty in an act of worship so intimate as the Muslims. In no other religion will you find a form of worship that, in humbling the servant, also brings him or her so near their Creator. I have heard it said that the believer is never closer to his Lord than when his head is on the ground in prostration. Lowering our heads to the floor in acknowledgement of His Lordship, the Heights of His Majesty, is the very thing that brings us closest to Him. It is beautiful.

May Allah guide my new friend to Him and bring the beauty he sees in others into his own life. Ameen.

Grinder Ball, winning it big!

(c) 2005, Getty Images

"I don't think anyone in the ballpark

was thinking about me hitting the ball

out of the ballpark"

- Scott Podsednik

Even now I can hear the Sox's self-adopted theme song, "Don't Stop Believin'" playing in my head as I think about the remarkable win in Game 2 of the World Series. After Konerko's grand slam, it looked like the Sox had the game in the bag, but Houston mounted a heart-breaking comeback on Vizcaino's hit, to even the score on last night's darling, reliever Bobby Jenks.

I heard Ozzie say he was thinking of pulling Jenks out, but AJ Pierzynski and someone else told him not to, that they would get it back. A sign of the remarkable unity on the team and, boy, did they ever get it back, with Pods hitting a homerun, only his second this entire season...

What a great game! It is amazing to see the Sox tough it out and get the two big wins at home. While it would be nice to have them win at home, I have a feeling this series will be settled in Houston, God willing...

As one of the signs I saw in the stands at US Cellular, so aptly put it:

Houston, you have a problem

Go Sox!

Sami Yusuf

Sami Yusuf is a great singer who's got a new album out, entitled "My Ummah," which continues his tradition of reflective, spiritual music. One difference that strikes you immediately is that the musical accompaniment is more sophisticated and textured than in the debut album, "Al Mu'allim." The first album seemed to rely more heavily on percussion, and the music was almost inobtrusive, serving to highlight Yusuf's singing and the vocal harmonies. In "My Ummah" the music is more of a partner, making its presence felt in a welcome way. Of course, the real instrument is Sami Yusuf's beautiful, otherwordly voice. When you listen to him, it feels as though you are transported to an oasis in the desert for a brief respite from the furnace of daily existence.

He continues to sing in Arabic and English, switching between languages with perfect fluency and ease. His songs range from those which praise the Prophet (peace be upon him) to those which call attention to the injustices being waged against Muslims in the world. An excellent example of the latter is the song, "Try Not to Cry" which features vocals by the group Outlandish (Isam Bachiri, Waqas Qadri, and R. Lenny Martinez), a hip hop band that became internationally renowned, especially in Denmark, where they started and are most famous. The song speaks more to the pain of oppression rather than promoting any sort of political agenda. Indeed, this is what is most compelling about Yusuf's lyrics, they paint a picture and leave you to make your own conclusion, giving voice to a perspective that is rarely heard in the mainstream media.

What also impresses me about Yusuf's songs are their emphasis on self-improvement in order to effect change that is meaningful. Truly, it is only when we make ourselves better people, morally and spiritually, that we can hope to effect change that is just and lasting. Yusuf specifically denounces the senseless violence of extremist groups (a violence that has no place in traditional Islam), reminding listeners that Islam's revolution is against one's own vices and shortcomings. As Waqas sings in "Try Not to Cry":

I throw bricks at the devil so I’ll be sure to hit him
But first at the man in the mirror
so I can chase out the venom

This, after all, is what Muhammad (peace be upon him) was sent for, as he himself stated, "I have been sent to perfect noble moral standards". It is this mission of the Prophet (peace be upon him) that Sami Yusuf so poignantly reminds us of us through lyric and voice. In short, Sami Yusuf has come out with a gem of an album that should be good listening for people of all backgrounds.

Of course, you don't have to take my word for it, you can download songs from iTunes, MSN Music, or watch some videos online for free. Enjoy!

No fluke!

Sox win big with lights-out pitching from Garland, who's showing that his 18 regular season wins were no accident...and this on a night that the Angels had every reason to want to win, after the Game 2 controversy.

I'll be the first to admit the Sox got a lucky break in game 2, but there is something to be said for Pierzynski's efforts, to try and make a play though the game looked to be all but over. Isn't it the moments of unexpected success that we most savor? And ones we should be most grateful for...

Hey, we got a gift in Game 2's win. Game 3 was just evidence that the gift was not totally undeserved...

Go Sox!

Ramadan Mubarak!

I meant to post this earlier...the Holy Month of Ramadan started the evening of October 4th, with the first fast on Wednesday October 5th in the USA. I haven't come across any articles on the net that do a good job of explaining Ramadan to a non-Muslim audience, other than giving the subject a very superficial treatment.

For Muslims there are a variety of great resources, starting with an excellent article on Ramadan by Shaykh Zulfiqar Ahmad, that is well worth a read. Also came across an interesting reflection on Ramadan by Ibrahim Abusharif, and an audio lecture (Real Player format) by Shaikh Abdal Hakim Murad on Ramadan given back in 1999.

Also, please consider donating toward the relief efforts for the earthquake in Pakistan:

1) Islamic Relief
2) International Federation of Red Cross and Red Crescent Societies
3) UNICEF

I'm sure other organizations are also coordinating relief/donations...

Major Earthquake hits Pakistan

Please pray for those who have passed away and the survivors. Newer estimates are reporting 18,000 as dead, 40,000 as injured with many villages having been wiped out...

White Sox heading to AL Championship!

White Sox Clinch Division!

Green Cars

There's a pretty interesting site, called the Green Car Congress that posts news and info on alternative fuel sources for cars. I've always thought not enough is being done to promote technologies, that already exist, to improve fuel efficiency...

What's Cookin...

I've been too caught up in sports to mention that I'm at Cook County Hospital (now known as Stroger) doing a cardiology rotation. I have to say interventional cardiologists get to do some really cool cases. Nothing like taking a person with a heart attack to the cath lab and opening up the patient's vessels and, quite possibly, saving his/her life. There is a certain adrenaline rush that pervades the air when you hang out with interventional cardiologists.

In addition, the attendings at County are like walking encyclopedias of cardiology. One thing that impresses me about County is that no matter how busy everyone is, education is taken very seriously. Teaching conferences are like religion there, and everyone is excused from clinical duties to attend lectures.

The other thing that strikes you about County is that it could have easily been lifted from some city in India or Pakistan. A large percentage of the doctors are of South Asian ethnicity, and you can bust out in Urdu/Hindi or English to discuss your patients. Thing is, I'm convinced these docs have all memorized Harrison's. I was listening to a noon lecture one day on drug therapy for cardiac patients. The lecture was so good, I thought it was being given by a cardiologist, and later I found out that it was an internist who gave the talk. Just gives you a sense of the level of education of the attending physicians.

Rounds are also very educational. I am on the consult service, so for every case, the attendings ask us to interpret EKGs and come up with our impression and recommendations. And they are always teaching in the process.

Of course, the most memorable thing about County are the patients. From drug abusers with failing heart valves whose legs are handcuffed to their beds, to patients that speak no English, whose eyes dart around nervously, unsure of what ails them and uneasy about what it is we are doing to them.

There is also comedy amidst the drama - on Friday, there was a "code red" for a fire that was apparently started by a patient who was smoking in bed (smoking in the hospital is totally forbidden), who then ran out of the room, without bothering to tell anyone that the room was on fire. Luckily someone noticed and actually did something about it (not a given at County) and the fire was quickly contained...just another day...

This week will be my last at County and it's been a blast. My next rotation will be ID at St. James (Olympia Fields) which should be a nice break...the commute to County ranges from 1.5 to 2 hours thanks to rush hour. I can't wait til the day cars will drive themselves...

Don't Cry for Me...

This past week, I have suffered a series of reversals in the sporting world that has been quite the test of perseverance. First, Imran beats me big time in Madden 2006. One game by 60 points, another by over 40. After these stinging virtual defeats, I of course challenge him to real test of manhood, a best of three series on the basketball court. Of course, I dominate and win the first one. But then the little punk goes out and wins the second one (15-10) and then somehow sinks a two in the last game to win like 16-14. Painful beyond words when I saw that two go in... My ego took a major beating of the kind it is not normally subject to on its own volition...

But to add to the pain, Green Bay goes out and loses in a most unceremonious manner. What is the deal?!? Favre, wake up dude. In the same weekend, McNabb throws like 5 touchdowns, the Bears score more than 30 points and the Patriots lose...what's going on?

And then the White Sox, killing me softly with their cruise control playing. Hello people, the Indians went from being a footnote in the season to 2.5 games back. If the Sox blow this, they will effectively lose any chance of postseason play...the Cardinals manage to clinch the division at Wrigley, but the Sox just go ahead and lose at home against the Indians...

All is not lost...the Sox won tonight...I can always rechallenge Imran to virtual and actual tests of manhood...and Green Bay had a similarly slow start last year before going on to win the NFC North...

Hope springs eternal. No lloras por me...

Advice for Medical School

I was cleaning out my messages and came across an email I wrote giving advice to incoming first-year medical students on how to prepare for the rigors of medical school...I thought I should share this "wisdom"...

Best place to study: Depends who you are. Gunners can be found on the second floor of the library on the far end. Slackers at any number of Starbucks, Borders, Barnes & Noble. Those in between seem to study at home, second floor of the library just off the stairs, public libraries, other university libraries, in the dorms. Me? Well, I'm here and there...

Best instrument for dissection: If you want to impress your labmates, or eternally cast yourself out as a social pariah (depends what your lab group is like), your bare hands. This follows in the grand tradition of Dr. Allin himself, who has upheld the tradition (just watch the anatomy videos from the 60s) despite the advent of things like "scalpels" and "probes". But if you are not a traditionalist, I suggest #3 scalpels and forceps with the two little hooks on the end.

Most helpful books during first year: Dr. Atkins' New Diet Revolution. Because we all put on a few pounds now and then. Seriously? The blue sections in Moore's Clinically Oriented Anatomy are priceless and Berman's histology. I was a Netter fan back in the day but Grant's has grown on me. Maybe a physio book for the uninitiated. Some say reading books like First Aid along with the sections they're studying is useful too but what do I know, I never did it...

Least helpful books during first year: The Relationship Rescue Workbook by Dr. Phil. Doesn't do a thing for you. Oh, you mean medical books? AOA Foundations. I mean, really, who is going to read that? Unless you're the Hermoine of OMM wizardry.

How did you prevent the "stink" from lab from sticking to you?: Don't go to lab. If you go, you will stink. I have double gloved, petroleum jellied (not as much fun as it sounds, I assure you) all to no avail.

Best/worst bar in the suburbs: Don't do the bar scene, wouldn't know. Though I did hear some people spent more time researching this issue first quarter than reading anatomy notes. But that's all hearsay...

Best/worst place for lunch: Safari has the best (and most filling) lunch deal you can find; it's on Roosevelt Road and I also recommend the Date and Banana Smoothie...yummy...I've been known to do Chipotle but it's too busy during lunch. The school cafeteria is actually pretty decent. Worst is any place where you can say "Super Size" and they know what you mean...

What was the biggest surprise of 1st year: All nighters for anatomy don't work. Took a couple of surprises to figure that out.

Help is on the way...

I came across an interesting picture gallery from someone down in New Orleans about Hurricane Katrina. He took some pictures before, during and after the storm hit. Some amazing pictures.

Thought I would also mention that American Muslims are leading efforts to bring help to the survivors of Katrina. So far American Muslim charities and organizations have pledged $10 million in relief aid. In addition, a large number of groups have come together to form a Muslim Hurricane Relief Task Force, to coordinate American Muslim relief efforts. Besides money, many Muslim healthcare workers are already on the scene providing direct help to the Katrina survivors. These stories, of course, are not as widely reported as they should be...

Caffeine fiend...

I have to be honest and retract a statement I made in one of my earlier posts about how, as a Sox fan, I prefer a cup of coffee to any tall cappucino...well, that's not really true...

See it all started with this last rotation in Peoria. Part of the deal they give visiting students down there is free food in the always-open cafeteria. Anytime, all day, as many times as you want, as much as you want. And, every day, I would see, in nice tall glass coolers, all these bottles of Starbucks Frappucino. And, while I love coffee, I can never drink it hot and always need to wait for it to cool down. This is something of an inconvenience (I know, I'm weird) especially when you only have a minute or two to scarf down breakfast in order to start on time. So one day, I gave in and decided I would try these refrigerated coffees that looked so tempting in their slick packaging and their promise of sugar, coffee, mocha and milk...

And I became hooked. I mean, I absolutely love the stuff. I could drink it all day, any time, on any pretext.

I felt bad about it. I mean, here I was, this South Sider going soft, flirting with danger. I mean, if I started drinking Frappucinos, what was next? Wearing polo shirts? Saving up to buy a Jetta? Watching Gilmore Girls?...well, actually, I do watch Gilmore Girls...for the great plots...

As it was, I started drinking Frappucinos every day and, towards the end of my rotation, even experimented with the "Double Shot" a super-caffeinated espresso (very good) and Mountain Dew's Amp (not very good, too much sugar, not enough caffeine).

So there, I've confessed (perhaps more than I wanted to). I'm still a Sox fan, but I love Frappucinos, cappucinos and pretty much anything else Starbucks makes. Heck, I would drink them at a Sox home game. And I'll take all the disapproving stares, because they just don't know what they're missing...

Sweet taste of victory...

So Sunday night, after realizing I had Monday off, I decided to play Imran in a late night game of Madden 2006. Imran is under the illusion that he is the best Madden player in the greater Bolingbrook region, which probably stretches from Bangor to San Ysidro in his virtual little world. So to make the game a little more interesting, I picked one of the best teams in the NFL, the Green Bay Packers, which immediately forced him to pick the Chicago Bears. My support of Green Bay is particularly irksome to Imran and I could see him already contemplating exactly how smug his look of satisfaction would be upon defeating me, a virtual dressing down of my Benedict Arnold-level defection to the Frozen Tundra...

The game was intense. Imran's offensive production is somewhat legendary, as he is known for quick scoring drives lasting less than a minute, usually on account of his West Coast-style offense. Unfortunately the West Coast would face a Tupac-like demise as my secondary mercilessly picked away at the inexperienced Rex Grossman, tallying over seven interceptions by the game's end.

I had built up a 14-0 lead from two interceptions that were converted into two successful scoring drives. It was looking like a break out game for me, but Imran launched a major comeback, shutting me out offensively for most of the second quarter and the entire third quarter. Meanwhile, he started scoring, but made a series of inexplicable mistakes when he missed the kicks for the extra point on two separate touchdowns and a failed two-point conversion on another TD.

Unfazed by his errors, he went on to take the lead in the 4th quarter with about 2:30 left in the game. It looked grim for Green Bay, as the offense had choked, sputtered and run itself into the ground. On the next posession (or maybe it was off an interception), I drove the ball all the way to the red zone and on 4th down was about 3 or 4 yards out from the end zone.

It was a big decision: take the field goal and then onside kick and try to take the game or go for it all and risk everything?

Of course, I went for it all and on a running play Ahman Green ran it without hesitation and danced his way in for the score. This is what separates a legendary sports team from one that has only the receding memory of 1985...

I won 35-32. Rather than the smug look of satisfaction, Imran looked like he had swallowed a box of prunes. I believe I looked considerably more elated, especially as I reminded Imran that the game would have been a tie and gone into overtime if he had only made the extra points after 3 of his touchdowns...

But as they say, a win is a win. And I'm savoring this one...

An extra day...

Thought I was scheduled to start a rotation in cardiology on Monday (Labor Day) and was kind of bummed out about having to work on a holiday. Then I thought I would double-check my paperwork and was more than pleasantly surprised to find out that we are to report on Tuesday...

The elation of having a day off that you thought you were working is hard to describe. It would be like having recess again in the middle of your work day ("Okay everyone, you can stop writing notes on patients because it's time for recess! First two to the blacktop get to be captains for 4 square"). Those were the days, when the best part of the day was playing kickball, running to the jungle gym or going so high on the swings the poles holding the swings down would shake. It's been a long while since I've swung on a swing...maybe I'll get to it tomorrow, with the day off I wasn't expecting...

Back from P-town

I'm back from my rotation in radiology down in Peoria. It was a great experience and I'm really impressed with the residency program and would love to go there. The faculty are distinguished and a forward-thinking group (interventional radiologists with their own clinic?) and they have a dominant position in the hospital as far as turf goes, which means that the surgeons (thoracic or vascular) and cardiologists don't steal all the interesting cases. It is a busy hospital and the support staff and services are just great. It would be perfect if only the cafeteria's guiding philosophy wasn't "it's not good eatin' til it's dead and fried".

These past few days have been dwarfed by the magnitude of Hurricane Katrina. I didn't watch much news while at my rotation and just watched about an hour of coverage now and am just shocked by the living conditions of the refugees. The violent crimes being committed are almost as shocking - it is in this setting that one truly begins to understand the Quran's injunction that whosoever kills a person unjustly, it is as if he has killed all of humanity. At the same time, I've heard stories of hospital staff in New Orleans taking turns to ventilate patients by hand when they lost power - and this reminds me of the other half of that verse in the Qur'an, that whoever saves a life, it is like he has saved all of humanity. Examples of both evil and nobility are rampant in New Orleans...certainly my prayers are with the sick and displaced, may Allah replace their hardship with ease and grant the sick cure that leaves behind no illness.

I don't get much of a break in my schedule - start a cardiology rotation at Cook County on Monday. Will probably have to spend the weekend reviewing cardiac pathophysiology and finalizing my application for residency programs. Busy times for this fool...

Random

Well, tomorrow I head off to the southerly climes of Peoria--well, okay it is just two hours or so south of where I live--to do a rotation in interventional radiology. I am really looking forward to the rotation as Peoria has a strong residency program that is affiliated with U of I and I would love to train there. And it's not so far away that I wouldn't be able to visit Chicago on weekends...

Saw the movie Hotel Rwanda last night. It really captures the horror of what took place there and the drama of survival in such circumstances. In 1994, when the movie took place, I was a high school junior whose primary obsession was figuring out how to get into the best colleges and whether I would win at weekend speech competitions. Yet across the ocean, there were nearly a million people that died in a brutal genocide during 100 days of madness.

Interestingly, Illinois just passed a law requiring high schools to teach students about modern-day genocides, from the Holocaust to Bosnia, Rwanda and the current crisis in Darfur. Illinois was also the first state in the nation to pass a law, this past June, cutting all financial ties the state had with the Sudanese government.

Interesting news stories

NASA announced the discovery of a tenth planet in the solar system...and it's got the exciting name 2003 UB313. Since the planets are named after mythological Roman gods, I say we call this latest planet Vulcan...which would make the folks in Birmingham, Alabama proud but would probably upset Trekkers...

There have been monsoons in Mumbai (Bombay), with 26 inches of rain falling, the heaviest rainfall that has ever been recorded in India. Over 800 are dead and aid workers are on the scene to try and limit the spread of disease...

A report in the medical literature came out saying that right-sided strokes are often missed in patients because they do not present with the language/speech disturbances common to left-sided strokes. Right-sided strokes tend to affect perceptual and spatial skills and these can be harder to pick up clinically.

The FDA has banned the use of Baytril, an antibiotic used in poultry, over concerns that use of Baytril leads to the development of antibiotic-resistant bacteria, which can then infect humans and become much more difficult to treat. Many people have been arguing that the routine use of antibiotics in livestock has worsened the problem of antibiotic resistance in humans, and the FDA's action is finally giving some credence to that theory.

I produce fewer allergic reactions

Apparently the word "hypoallergenic" doesn't really mean anything at all...I thought products with that description underwent some rigorous cleansing process to remove allergens or something...but I guess it doesn't have to mean much at all according to the FDA.

My body works

Yesterday I went to the Museum of Science and Industry and saw the "Body Worlds" exhibit. It is an amazing display that uses over 200 actual, preserved human bodies to reveal the inner anatomy of the human body.

Apparently the bodies are preserved, in great form and detail, using a process called "plastination". You can see muscles, nerves, and blood vessels in exquisite detail. Not only did the exhibit feature normal structures, but it also contained several specimens ravaged by disease, such as a cirrhotic liver, a cancerous lung, even examples of prosthetic hip and knee joints. The bodies were often arranged in imaginative poses and there was even one display of a person on top of a horse.

As a medical student, these displays were fascinating because they gave me a chance to see some expert dissections of the human body and to appreciate the gross anatomy of several disease processes (e.g. the cirrhotic liver) and also the sheer beauty of our inner anatomy. We always read, for example, that the brain gets 20% of the blood pumped out by the heart, but when you can actually see the tiniest of vessels preserved all over the surface of the brain, you can also picture it.

But I am somewhat troubled by the commercialization of the exhibit. It is one thing to study the body in a gross anatomy lab as a medical student and it is quite another thing to have an exhibit open to the public that you are charging people admission for (on top of the general admission to the museum). I think it diminishes some of the dignity of those who donated their bodies to science in the first place. I've often thought of gross anatomy as a necessary contingency for medical students in order to gain first-hand knowledge of how the body is put together. Is it really necessary for the general public? Is there a compelling need for the public to get this kind of education?

I don't know the answer to that question, but it isn't easy for me to answer. Intellectually I found the exhibit fascinating (I spent over an hour going through it) but emotionally there is a morbidness and a sense of disrespect to the bodies that doesn't sit well with me. Perhaps this is a Muslim sensibility, since Muslims believe in a physical and spiritual resurrection whereas Christians predominantly believe in a spiritual resurrection.

The exhibit runs through September 5th and those in medicine (except maybe pathologists) will find it well worth their time...

Evolution - or why I'm a Sox fan

My last post on the Sox evoked an interesting reflection on the dynamics of Cubs-Sox allegiance in Chicago by my younger brother, who remains conflicted as to where his loyalties truly lie. As in many cities, one is meant to be a fan of only one of the two baseball teams in town, and your choice, in many ways, defines who you are.

Imran bemoans my defection to the Sox (I was a childhood Cubs fan) as a sign of bandwagon loyalty, making me just another fairweather fan chasing the winds of fortune.

But, of course, my defection to the ChiSox, while eased by their winning record, is more profound than that. It's about whether you wake up with a cup of joe or Starbuck's Mint Mocha Chip Frappuccino®. You see, once upon a time, the Cubs were the lovable losers, the guys you had to root for because their efforts always seemed foiled by some freakish accident, like a wild pitch with the bases loaded or an in-park home run. These types of mistakes were always forgiven, examples of mishaps that could happen to anyone. That they happened so consistently to the Cubs somehow added to their charm, along with a cast of characters that were hard to forget (Ryne Sandberg, Rick Sutcliffe, Andre Dawson, Mark Grace, among others).

But, somewhere along the line, the Cubs started to get good. Really good. And along with their rise to the top, they became less lovable and more corporate yuppie. The rooftop parties on neighboring buildings became the target of shameless profiteering (by both sides) and, in ways I can't define, the Cubs just seemed to become more "slick", less the lovable heroes of my youth and more the petulant Sosa and the enigmatic Dusty Baker...

Meanwhile, on the South Side, another team continued to toil away, almost unnoticed, with 11 seasons above the 500 mark since 1990 (compared to just 6 for the Cubbies), 3 division victories (just 1 for the Cubs) and players (Thomas, Konerko, Buehrle, Garland) who have risen to the occasion. This team won in spite of itself, in the face of poor management decisions, low home game turnouts, arguments between players and managers, through it all they play well. They may not have gone to the World Series, but they brought respect back to Chicago baseball.
So I may have left the Cubs behind, but for better, much better...the same reason why, despite growing up a fervent Bears fan, I eventually crossed over to the "dark side" and became a fan of the Packers...and, because, ultimately I still prefer a cup of coffee to a tall cappuccino...

We're Number One

Did you know that the White Sox have the best record in all of baseball?!? I knew they were in first place in their division, but I didn't realize the extent to which they were winning. Of course, the naysayers out there will say this is the way the Sox usually perform - they're stellar when it don't matter and will just do something tragic like lose 24 games in a row to ensure they miss the playoffs. This would hurt if it weren't true, so it is particularly traumatic since it has some basis in fact. One can only hope the Sox keep up the level of play and that the management doesn't do something outrageous like trade all our pitchers for Barry Bonds.

If you want to keep up on the ChiSox, you can check out their blog which is at:
http://whitesoxpride.mlblogs.com/

Today was a light day for neurosurgery. Saw two cases, one a laminectomy (remove part of the vertebra) and one a foraminotomy (make a hole in the vertebra). The lami was at L4 in a guy with a major disc herniation, looked like a tennis ball was compressing his nerve root while the foraminotomy was at C2 to decompress tension on the nerve root in a lady who was in a motor vehicle accident. Both cases went well and I got to leave relatively early...

Jargonator

My vast readership (which at this point can be counted on one hand) informs me that there is too much medical jargon in my posts, but I'm afraid the jargon will just have to keep piling up because part of this blog is really a selfish exercise designed to help me remember the cases I've seen on rotations. When you're working >10hrs/day, things tend to blur and writing it down is one way for me to remember...anyway, I'll be sure to sneak in some bad movie reviews and inane comments about the ennui of the daily grind, but give up the jargon? Did Pepé Le Pew ever give up on love?

So last Friday we did a spinal angiogram with embolization of a tumor metastasis from a renal cell carcinoma (RCC). The RCC had been treated with a nephrectomy (kidney removal) but the location of the new tumor (near L2) is suspicious for metastasis from the primary RCC. This is the first metastasis in this patient, hopefully her last.

I got Saturday off and Saturday night met up with Vince and Andy, two of my crew from back when I roamed the mean streets of the south side of Chicago (okay, so it was Hyde Park...) We saw a movie, which was an exercise in metrosexuality ("Bewitched") upon which I won't comment other than to say there was one really funny sequence with Will Ferrel. I still feel like I violated some rule of the XY club and plan on making up for it by seeing the next meaningless action thriller that comes out...we had dinner afterwards at Mongolian Barbecue and caught up on things past and plans for the future...

Sunday morning I rounded on patients in the hospital for a few hours and then got the rest of the day to spend with family.

Monday we took out the tumor we embolized from the lady on Friday and the procedure went well and the patient is recovering well, thank God, though she is definitely dealing with postop pain. That case took about 5 hours to do and I spent the rest of the afternoon on the floor, rounding on patients.

Today we did a L3-L5 fusion on an elderly lady with degenerative scoliosis, dural adhesions and lumbar stenosis. Preoperatively she was in a great deal of pain, but the procedure went well and God willing she will improve, as we really freed up a lot of space for her. Also saw a cervical foraminotomy today for a lady who had a history of motor vehicle accident (a drunk driver hit her head on). Quick case and a relatively light day today...

I keep on fallin' in & out...

I am always tempted by the surgical specialties. Neurosurgery just has so many cool procedures, it would be awesome to do it. It's just the training is so rigorous...typically, these guys are working at least 14 hours, if you add 1 hour for commuting that leaves you with 9 hours to fit the rest of your life in. And I haven't even included call (or sleep) into that schedule...

Didn't get a chance to wrap up yesterday's events, lot of stuff went on. The patient that came in for the vertebroplasty, secondary to a compression fracture at L3, also had moyamoya syndrome, which is a situation when you have progressive bilateral stenosis/occlusion of the carotid system, usually quite proximal at the ICAs but it can be further up. In response to the decreased flow, you get tufts of arterial collateralization (usually lenticulostriate vessels off MCA) that look like puffs of smoke (moyamoya is Japanese term for that) on angio.

Here is an example, from Yoon et al that was published in AJR 2000; 174 (195-200) on what moyamoya vessels look like (arrows are pointing to them). Etiology of moyamoya disease is unclear, but it seems to have higher incidence in Asians and is often associated with other conditions. I don't think there is concensus on treatment, but EDAS (encephaloduroarteriosynangiosis) is one option, where you basically take the superficial temporal artery and lay it on the brain tissue to induce collateral formation to feed the brain. EDAM is similar except you lay part of the temporalis muscle on the brain to do the same thing.

We had another patient yesterday who came in for a followup cerebral angio that had EDAS, EDAM and burr holes secondary to severe moyamoya disease. It's amazing to think she is talking and raising children when the major supply to her brain are just collateral vessels...

On top of all that we had a bunch of traumas come in yesterday. One of them was a UIC religion professor who had blunt trauma to the head and was brought to Loyola where he was pronounced dead leaving behind a wife and 1.5 year-old daughter. Tragic story that made the local news: http://www.chicagotribune.com/news/local/chi-050623professor,1,1122218.story?coll=chi-news-hed

Today we removed a tumor, most likely a hemangioblastoma, in the posterior fossa roughly between the SCA and PCA on the right. I got to watch the neurointerventional radiologist embolize the tumor's blood supply yesterday, so it was neat to see it get taken out today by the neurosurgeon. The patient looked good after the surgery, we'll see how he is in the morning...

Who's lovin' it?

On the way home today, I saw a billboard for McDonald's, showing a big picture of an Egg McMuffin and a caption reading something like, "Don't you wish you looked this good in the morning?"

I found this to be a rather strange ad, I mean how many of us really compare how we look to food? I'm not in the habit, for instance, of saying, "Dude, my hair is so mostaccioli today" or "She looks so tiramisu". I mean, even if I did compare how I, or anyone else looks, to food, I doubt the Egg McMuffin would be the benchmark by which I would establish my metaphorical scale. I mean really, I would rather look like chicken tikka in the morning, I think that has a much more pleasant hue to it than the Egg McMuffin. Come to think of it, there really isn't anything that I wish would look more like an Egg McMuffin. Nothing at all...I'm guessing the intern at the advertising company came up with this one...what future jingles will we have to look forward to on I55?

As far as rotation news, observed a vertebroplasty, cerebral angio and embolization of a cerebellar hemangioblastoma. The cerebral angio was a cool case, a patient who previously had an EDAS done. Will write more later, gotta get up early...

Of medicine and machines

Some important legislation has been introduced that will make it easier for medical students to repay their educational loans. You can support this effort by going to:
http://capwiz.com/aoa-aoia/mail/oneclick_compose/?alertid=7742211
Although the form letter is written for osteopathic medical residents, you can easily modify it to your own situation. The website will then send an email on your behalf.

Today, I saw an interesting case - coiling of a left MCA aneurysm. First we shot an angio of the anterior circulation by selective catheterization of the involved MCA side branch. We then performed intracarotid sodium amobarbital test, or Wada test, in order to lateralize speech and assess memory function. We also had a neurologist come in and administer an exam to test the patient's language skills. After all that, a balloon was inflated to temporarily occlude the artery and determine the area supplied by it (the "wedge"). It looked like there were sufficient collaterals supplying the wedge from the anterior circulation, but it was decided to see whether or not the wedge was also supplied by the posterior circulation (i.e. branches of the PCA). The angio confirmed this and the decision was made to treat the aneurysm by coiling it. Before doing that, however, we also delivered a dose of radiotracer for the SPECT scan which we would obtain two hours later, after the procedure. Anyway, the branch of the MCA was again accessed, and first a "mesh" was delivered into the aneurysm followed by the coils. I think we used 5 sets of the coils in order to fill it properly. Afterwards, we shot another angio which showed obliteration of the aneurysm (good thing) and good filling of the wedge from surrounding collaterals (a very good thing). Clinically, the patient did real well w/no neurological deficits after the procedure. We are still waiting for the nuc study to get read but, thank God, it looks like it all went really well for the patient. Cool procedure, done by the neuroradiologist...

In totally unrelated news, Lexus has put up a preview site for the 2006 IS which looks tight, may replace the Acura TL as my current favorite. You can check it out here:
http://lexus.com/2006is_preview/?s_ocid=20117
I don't know what the Germans are doing to their cars, but I really think Audi and VW are going in the wrong direction and I can't say I like any of the new BMW designs except for the 3 series. Mercedes has some saving grace with the redesign of its SUV (2005 M-class) and the 4-door CLS500 coupe, but all that is almost cancelled out by its plan to introduce the R-class, a strange looking cross between a mini-van and station wagon...

NSx updates

Week 2 of neurosx of Loyola and am continuing to see some great cases. Saw a repair of a Chiari malformation (suboccipital craniotomy with duraplasty). All I can say is it is so cool to see the arachnoid after dissection of the dura - the CSF pushes it up, so it is like glistening saran wrap...and I'm still not quite used to the practice of using drills, which seem to be the tool of choice whenever a neurosurgeon needs to go through bone. I also saw an embolization of a dural fistula (between a small branch of the left PCA and a vein that dumped into the transverse sinus), which was embolized with that space-age substance called...you guessed it...glue. Yep, no matter how advanced medicine gets, there's still nothing like a little crazy glue in the brain...

I've been impressed with the neurosx attendings at Loyola, they are quite nice and answer questions readily. The residents, while busy, are about as laid back as you can be when 12-hour shifts are considered "short" days...they are also willing to teach and are remarkable, well-adjusted people. I've also been impressed with the scope of neurosx, never considered, for example, that they do PNS procedures (like decompression of left common peroneal nerve which I saw last Friday). Whether it's the head, spine or down in your legs, there's nowhere these physicians can't go...

Also nice to see some fellow Midwestern medical students out at Loyola - I've spotted at least two colleagues (both doing anesthesia). I don't get out on the floor much, so if they aren't in the OR or Specials, I won't see them (morning rounds start at 5:30 AM and finish around 7:15 AM, when others are just getting started). There are a decent number of residents who also have "D.O." emblazoned on their lab jackets, which is nice to see...

One thing that is weird - Loyola medical students get white coats that are as long as attending coats...what's up with that? They do have really nice facilities for their medical school, which is right next door to the main hospital.

And so it begins

Christopher Nolan may not be a household name yet, but if his latest movie "Batman: Begins" is any indication, he is well on his way. The 35-year-old Nolan first received widespread attention with his film "Memento" which earned him rave reviews from critics, two Academy Award nominations and around $24 million from the box office. He followed that effort with the Al Pacino thriller "Insomnia" which made $26 million in its opening weekend but didn't quite have the same critical impact as "Memento".

I never sat through all of "Memento" but I had seen "Insomnia" and thought it was good enough. Certainly not memorable enough that I could tell you much about the plot other than a couple of scenes where Al Pacino took an inordinately long amount of time to close some blinds in his Alaskan hotel room. And so it was that June 18th found me standing in line for the 3pm IMAX showing of "Batman: Begins" with some apprehension. After all, Batman is one of my favorite comic book characters and I still have not been able to sit through "Batman and Robin" the last film starring the caped crusader, a disastrous work by Joel Schumacher who seemed bent on running the series firmly into the ground.

Thankfully, there were other avenues through which one could get a Batman fix, the original animated series, which explored the complexities of Batman's character with the noir atmosphere that Bob Kane probably intended. That may sound like high praise for a cartoon, but it is not undeserved. Apparently, Mr. Nolan watched at least a few of those episodes, because "Batman: Begins" is a fantastic hit, better than any Batman movie before it. While the original "Batman" by Tim Burton is a great film, it does not capture the transformation of Bruce Wayne into Batman in the way Nolan's film does and Burton's film had a less imaginative script and plot. While both Burton and Nolan created a dark atmosphere for Gotham, there is something more compelling in Nolan's version of it, perhaps driven by his extensive use of the Chicago cityscape in creating Gotham. Of course, that may come from having a $150 million budget, but the money was well spent.

Christian Bale's portrayal of Bruce Wayne/Batman is also convincing, and his physical presence is also more compelling than Michael Keaton's ever was. And who can argue with the choice of Michael Caine as Alfred or Morgan Freeman as Lucius Fox? Liam Neeson was excellent as Ducard and even Gary Oldman surprised me as Gordon (I almost didn't recognize Oldman). The only disappointing choice in casting was Katie Holmes whose crooked smile is almost as annoying as her total lack of talent...oh well, at least she has Tom...

The dynamic between the Bruce Wayne and Ducard characters gives a lot of energy to the plot and the special effects were great (I even grew to like the Batmobile, which is a little too SUV in its styling for my taste).

An interesting question the movie seems to raise for me is the question of vigilantism. Batman works outside the law to bring justice while the archvillain in the movie works outside the law to bring about his own evil and disturbing conception of justice. Which seems to me to be the big problem with vigilantism in the first place, it opens the door for anyone to mete out their own version of "justice". As Rachel Dawes (Katie Holmes' character) suggests, it's wrong to work outside the law in the first place though by the end of the movie, she seems resigned to accepting Batman's role as a necessary contingency for the city of Gotham, though, motivated in part for personal reasons, she waits for the day that the city won't need him.

Of course, that day won't be anytime soon in coming, otherwise we wouldn't have any sequels to look forward to. Whatever one's issue with vigilantism, it's hard to not enjoy Batman's style of it, as he does what only he can do to save Gotham. And given the opening week success of Batman (over $70 milllion in five days) we can expect to see Mr. Nolan bringing us more of the Dark Knight's quests in the years to come...

NSx at Loyola

Started neurosurgery at Loyola this week and it's off to a great start. I've always wanted to see neurosurgery and it's amazing to see what these physicians get to do on a regular basis. So far, I've seen skull biopsies for possible mets from prostate CA, ommaya-reservoir placed for CNS prophylaxis of ALL and clipping of SCA aneurysm. Today, spent the whole day on removal of an acoustic schwannoma, which looked like the size of a grapefruit, and did not come out easy...

Welcome!

Well, I've crashed the blogging party. Let's see how it goes...