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Nary a day goes by that I don't walk down the street and encounter somebody asking if I have some money to spare or if I can buy them something. This is a characteristic endemic to the little corner of the Caribbean I presently inhabit, but it is also a feature of other leftist bastions I have inhabited. Have you ever noticed that there is a positive correlation between the frequency of solicitations for money ant how far left the ruling class tends?
The island where I currently make my residence is a product of three types of imperialism. There is the American capitalist imperialism implicit in playing host to a large medical school that caters mainly to North Americans. This influences the people of the host country to go into business to reap the rewards of catering to a bunch of students flush with government education loans. I view this as a positive influence on the people. It has enabled many residents of the island to become financially productive and take care of their families. Also, they are working for their money, so at the end of the day they can come home and know that what came out in the black for that day is theirs. They are in control of their own destiny.
There is another sort of chap around here though. That is the one constantly looking for a handout. Hey can you spare some change? Hey will you buy me a soda? Hey can you buy me some lunch? I feel bad for these souls, because each time someone assents to their wishes, they are further ingrained with a world view that causes them to seek entitlements. Their government is complicit in their non-productivity because many of their basic needs are provided gratis by the centralized regime. These are the people who are ripe to fall for the more pernicious forms of imperialism that wait in the wings.
The first in this category is fairly benevolent, but still damaging. This is the influence of the Cuban regime on the political and professional sphere of the society here. This influence is seen in the number of Cuban professionals and the amount of Cuban aid that flows into the medical system and other governmental programs. There is no doubt that medical care is needed here as anywhere else, but the acceptance of the handout is a Faustian bargain. The Cuban influence perpetuates the socialism that flourishes here. People are conditioned to accept a handout that solves and immediate problem, but furthers their dependence on an external government.
The other in this category is the influence of Venezuela. The people of the island are currently at a crossroads. They can continue to orbit in the sphere of influence of the United States. This has allowed them to live reasonably prosperously, democratically, and without the need to field a military. Or they can accept the gifts on offer by Hugo Chavez, the two-bit socialist Che Guevara acolyte who rails against the united states like a petulant child. He also provides a foothold for increased influence by the Russians and Chinese in South American affairs.
Chavez's vision for the island is that it would be a nice place for an oil refinery or some other Venezuela-focused economic development. This would change the face of the island dramatically. It would become a much more hostile environment for western business in general, and the medical school in particular. The short term benefits for the leaders is clear: It allows them to continue to neglect the economic development aspects of their country's operations, in favor of letting someone else do it. But in the long term, they have to give up a lot of self-determination and freedom.
It reminds me of the panhandlers I routinely encounter here and encountered in the Bay Area. They can get by, but each day is the same old thing. Their dependency on handouts is also a shackle that keeps them bound to a life of only to one choice: to ask for more.
Sunday, October 12, 2008
Saturday, October 11, 2008
Wonderfully and Fearfully Made
I believe in God because I opened my heart and my mind to the possibility and He answered. The gift of faith has given me a new way to perceive the world and a clearer prism through which to understand meaning. Being called to serve God through medicine as I have been, my eyes are opened to the wonder of His creation, life, on every scale I study it on. It is easy to appreciate the miracle of man simply by meeting one of your fellows on the street. We, each of us, are inner worlds of experience, thought and emotion and external marvels of engineering. But what inspired me to write this essay are the wonders of life on the submicroscopic level.
The story of characterizing life and how it works is the story of peering into the progressively smaller and smaller. Leuwenhook discovered a world hitherto unknown with his microscope. This lead to understanding of the fundamental building block of life, the cell. Further scientific inquiry revealed the inner workings of the cell on the level of organelles. And another area of science altogether revealed the very smallest building blocks of life, the molecule and the atoms. The activity of life on this level of magnification is a wonder to apprehend. That the myriad reactions that collectively comprise our metabolism can work together to support life is a miracle of inscrutable coordination.
If you are reading this at a wooden table with a glass of water placed on it, you are looking at the very same stuff of which you are made. The difference between the table and the water and you is the relationship of the parts contained within with each of them. The table and the water are inert. The wood is dead, its metabolism has stopped. Now it is carbohydrate, and residual enzymes frozen. They are chains of carbon and hydrogen along with other elements such as oxygen collectively serving as a table, and an oxygen and two hydrogens serving as water. But we are animated assemblages of the same stuff.
The difference is that we are processing energy contained in the chemical bonds of the food we eat. Carbohydrates and other molecules of food such as proteins and fats are broken down by enzymes into glucose. The glucose can be split apart in the aqueous interior of our cells to produce a little energy that is transiently stored in a molecule called ATP, the currency of energy in all living systems, molecularly very similar to one of the constituents of DNA. But this would not be enough energy to keep life going, the products of that initial reaction are shuttled into a series of reactions within one of the organelles of the cell, the mitochondron, which leads to many more ATP being generated through a series of reactions called the Krebs cycle and oxidative phosphorylation. These pathways, as they are called, couple reactions called oxidation and reduction to generating ATP and the waste product carbon dioxide. We need to breath oxygen because we need to oxidize substances to release their energy into the bonds of ATP. All of these reactions are driven by little wonders of nanotechnology called enzymes.
The ATP goes on to drive any process in our bodies that requires energy, be it, moving your arm, breathing, or generating substances that are used by other parts of your body.
But what is making all of these reactions occur? Enzymes. Enzymes are submicroscopic machines that allow chemical reactions that would take a long time to occur on their own to happen much faster. This is the biochemical key to life. The enzymes essentially bring two or more molecules into the right physical relationship with one another for a vital chemical reaction to occur, one that might take eons to occur if such assistance weren't rendered. The enzymes are encoded by life's great information technology, the DNA. Our genes hold the information to create enzymes and proteins that control how the miraculous machinery of life works for each individual.
Many say that this machinery is the product of a geologic accident that spontaneously created the first cell and a series of random accidents that over time gave rise to increasing complexity. That in a nutshell, is the atheists' creation story. Their theory has not been convincingly demonstrated experimentally in the way that say the Theory of Relativity has been, and yet it is accorded the rights and privileges of a theory nonetheless.
I read the Psalmist who explains it to me in a way that rings truer.
I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. Psalm 139:14 (New International Version)
Indeed.
The story of characterizing life and how it works is the story of peering into the progressively smaller and smaller. Leuwenhook discovered a world hitherto unknown with his microscope. This lead to understanding of the fundamental building block of life, the cell. Further scientific inquiry revealed the inner workings of the cell on the level of organelles. And another area of science altogether revealed the very smallest building blocks of life, the molecule and the atoms. The activity of life on this level of magnification is a wonder to apprehend. That the myriad reactions that collectively comprise our metabolism can work together to support life is a miracle of inscrutable coordination.
If you are reading this at a wooden table with a glass of water placed on it, you are looking at the very same stuff of which you are made. The difference between the table and the water and you is the relationship of the parts contained within with each of them. The table and the water are inert. The wood is dead, its metabolism has stopped. Now it is carbohydrate, and residual enzymes frozen. They are chains of carbon and hydrogen along with other elements such as oxygen collectively serving as a table, and an oxygen and two hydrogens serving as water. But we are animated assemblages of the same stuff.
The difference is that we are processing energy contained in the chemical bonds of the food we eat. Carbohydrates and other molecules of food such as proteins and fats are broken down by enzymes into glucose. The glucose can be split apart in the aqueous interior of our cells to produce a little energy that is transiently stored in a molecule called ATP, the currency of energy in all living systems, molecularly very similar to one of the constituents of DNA. But this would not be enough energy to keep life going, the products of that initial reaction are shuttled into a series of reactions within one of the organelles of the cell, the mitochondron, which leads to many more ATP being generated through a series of reactions called the Krebs cycle and oxidative phosphorylation. These pathways, as they are called, couple reactions called oxidation and reduction to generating ATP and the waste product carbon dioxide. We need to breath oxygen because we need to oxidize substances to release their energy into the bonds of ATP. All of these reactions are driven by little wonders of nanotechnology called enzymes.
The ATP goes on to drive any process in our bodies that requires energy, be it, moving your arm, breathing, or generating substances that are used by other parts of your body.
But what is making all of these reactions occur? Enzymes. Enzymes are submicroscopic machines that allow chemical reactions that would take a long time to occur on their own to happen much faster. This is the biochemical key to life. The enzymes essentially bring two or more molecules into the right physical relationship with one another for a vital chemical reaction to occur, one that might take eons to occur if such assistance weren't rendered. The enzymes are encoded by life's great information technology, the DNA. Our genes hold the information to create enzymes and proteins that control how the miraculous machinery of life works for each individual.
Many say that this machinery is the product of a geologic accident that spontaneously created the first cell and a series of random accidents that over time gave rise to increasing complexity. That in a nutshell, is the atheists' creation story. Their theory has not been convincingly demonstrated experimentally in the way that say the Theory of Relativity has been, and yet it is accorded the rights and privileges of a theory nonetheless.
I read the Psalmist who explains it to me in a way that rings truer.
I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. Psalm 139:14 (New International Version)
Indeed.
Friday, October 10, 2008
Wednesday, October 8, 2008
"Doctors" of chiropractic learning real medicine
Of the many toolish personalities I routinely encounter at my Caribbean medical school the most pitiful, the most grating must be the unrepentant chiropractor. Medical schools such as mine attract many former chiropractors because most American medical schools view a former affiliation with the profession as a disqualification. Aside from the shear ridiculousness of the theory that underlies chiropractic and the shadiness of its practices, one of the problems chiropractors pose to genuine medical educators is the conviction that they already know something about health care. One such character is in my PBL group. Not a week goes by without the suggestion that he is qualified to augment the instruction presented to us by our professors because of his ten years “practicing” chiropractic. He wants to offer another perspective. He is always first to get up and demonstrate an examination technique because he's done it so many times before. Never mind the fact that he almost invariably has a different way of doing things than the faculty of the school. He finds it difficult to unlearn his way because it made so much sense. He gushes over the economy of the chiropractic way of doing things.
Please spare me. Describing yourself as a qualified medical practitioner on the basis of an education at a college of chiropractic is tantamount to insisting that you are qualified to fly a 737 across the country because you have 40 hours of instruction in a Cessna. The fact that you were once a chiropractor calls in to question not only your judgment, but also your grasp on ethics. Chiropractors are notorious for duping their patients into needless courses of treatment. Their professional expertise is in practice building rather than the actual delivery of healing modalities. They try to hang their single out as an alternative to primary care physicians, and yet they have no ability to accurately diagnose or competently treat even a problem with the back.
The fact that one has already been to a professional school and would then put him or herself through another should be a sign that something is amiss with the first attempted profession. Many chiropractors are good people who will admit that there was just too much hokum in their original course of study, so they have come back to learn the real deal. Many of these folks did learn some useful information at their former schools, like anatomy, and are able to keep things in the proper perspective as to the areas of knowledge they lack and need to be real doctors. I admire the chiropractor who wants to become a real doctor and is ready to humble him or herself, come back to school, and learn how really to treat patients. But the ones who think they already know something need to consider why they've come back to school, and maybe keep their former associations to themselves.
Don't buy my rant? Check out some well researched sites on the matter:
http://www.quackwatch.org
http://www.rebuildyourback.com/chiropractic/school.php
Please spare me. Describing yourself as a qualified medical practitioner on the basis of an education at a college of chiropractic is tantamount to insisting that you are qualified to fly a 737 across the country because you have 40 hours of instruction in a Cessna. The fact that you were once a chiropractor calls in to question not only your judgment, but also your grasp on ethics. Chiropractors are notorious for duping their patients into needless courses of treatment. Their professional expertise is in practice building rather than the actual delivery of healing modalities. They try to hang their single out as an alternative to primary care physicians, and yet they have no ability to accurately diagnose or competently treat even a problem with the back.
The fact that one has already been to a professional school and would then put him or herself through another should be a sign that something is amiss with the first attempted profession. Many chiropractors are good people who will admit that there was just too much hokum in their original course of study, so they have come back to learn the real deal. Many of these folks did learn some useful information at their former schools, like anatomy, and are able to keep things in the proper perspective as to the areas of knowledge they lack and need to be real doctors. I admire the chiropractor who wants to become a real doctor and is ready to humble him or herself, come back to school, and learn how really to treat patients. But the ones who think they already know something need to consider why they've come back to school, and maybe keep their former associations to themselves.
Don't buy my rant? Check out some well researched sites on the matter:
http://www.quackwatch.org
http://www.rebuildyourback.com/chiropractic/school.php
Monday, October 6, 2008
The first four weeks of my fifth semester
It has been an eventful couple of weeks in this, my fifth semester of medical school. I have begun to do clinical rounds with physicians in different services around the hospital. I started with radiology, moved on to anesthesiology, and this week I am in ICU.
Radiology was interesting, but it was cold and removed from the reality of the living, breathing patient being examined.
Anesthesiology was more revelatory. I witnessed many surgeries on anesthesiology week. I have dissected a human cadaver before, but nothing compares to a living person being cut into alive. Blood spurts from small arteries being transected, fat and muscle are laid bare to a group of masked personnel peering into the newly-created void in which the surgeon must work. There were two hysterectomies, a diabetic foot being debrided, a young kid who had his small intestine herniated out of a hole cut into his abdomen—he claimed it was a bike accident, but a knife wound is more likely—and a woman who had broken her femur in two and needed to have it realigned, reattached and set back to as close to normal as possible.
Surgery is a bloody but fascinating affair. At the crescendo of the procedure the patient gapes there on the table, dozens of clamps sticking out of the incision. The surgeon makes his final manipulation or resection, and then everything is sewed back up, layer by layer. The patient, violated by metal and hands lies there peacefully in a cocoon of anesthetic, none the wiser
Today was the beginning of my ICU experience. The surgeries I witnessed the week before were all happy endings. These were people, who were basically healthy aside from the problems that brought them to the OR, who would recover and walk out of the hospital eventually. They had shocking injuries or illnesses, but the virtuosity of the surgeon saved them to live life just as before, almost as if nothing had happened. But in the ICU, you meet a different kind of patient. Many stabilize and recover, but there are some who teeter on the brink and slip finally to the void, the inevitable merely delayed for a few days by our artificial contrivances that support life when the body can't.
I saw a woman today whom I fear will meet such a fate. She was 22 years old and perfectly healthy looking except for gauze and bandages around her head. Looking over at the CT films that had been ordered by the ICU physician, the problem was clear. She had a brain abscess. I had studied this entity in pathology, but to see it in the flesh is something else. Her eyes were fixed in a deathly gaze, completely unresponsive to light or any other stimulus. I was allowed to draw blood out of her femoral artery for analysis. Not a flinch or any sign of pain was evident as I jabbed a syringe into her leg and drew out blood.
Her heart beat irregularly due to a probable electrolyte imbalance and the only reason she was breathing was the respirator pumping oxygen and air into her lungs, coldly and imperturbably. She was the victim of an ear infection that had gone too far. An infection that could have been cured by a $2 course of antibiotics was now refractory to four separate drugs, because they can't penetrate the pouch of brain liquefaction that is consuming her. No one is to blame. Had she been aware, had she gone to the doctor earlier, it would have been treated as a matter of course, as routine as taking an aspirin. But now, survival is possible but hardly assured.
Radiology was interesting, but it was cold and removed from the reality of the living, breathing patient being examined.
Anesthesiology was more revelatory. I witnessed many surgeries on anesthesiology week. I have dissected a human cadaver before, but nothing compares to a living person being cut into alive. Blood spurts from small arteries being transected, fat and muscle are laid bare to a group of masked personnel peering into the newly-created void in which the surgeon must work. There were two hysterectomies, a diabetic foot being debrided, a young kid who had his small intestine herniated out of a hole cut into his abdomen—he claimed it was a bike accident, but a knife wound is more likely—and a woman who had broken her femur in two and needed to have it realigned, reattached and set back to as close to normal as possible.
Surgery is a bloody but fascinating affair. At the crescendo of the procedure the patient gapes there on the table, dozens of clamps sticking out of the incision. The surgeon makes his final manipulation or resection, and then everything is sewed back up, layer by layer. The patient, violated by metal and hands lies there peacefully in a cocoon of anesthetic, none the wiser
Today was the beginning of my ICU experience. The surgeries I witnessed the week before were all happy endings. These were people, who were basically healthy aside from the problems that brought them to the OR, who would recover and walk out of the hospital eventually. They had shocking injuries or illnesses, but the virtuosity of the surgeon saved them to live life just as before, almost as if nothing had happened. But in the ICU, you meet a different kind of patient. Many stabilize and recover, but there are some who teeter on the brink and slip finally to the void, the inevitable merely delayed for a few days by our artificial contrivances that support life when the body can't.
I saw a woman today whom I fear will meet such a fate. She was 22 years old and perfectly healthy looking except for gauze and bandages around her head. Looking over at the CT films that had been ordered by the ICU physician, the problem was clear. She had a brain abscess. I had studied this entity in pathology, but to see it in the flesh is something else. Her eyes were fixed in a deathly gaze, completely unresponsive to light or any other stimulus. I was allowed to draw blood out of her femoral artery for analysis. Not a flinch or any sign of pain was evident as I jabbed a syringe into her leg and drew out blood.
Her heart beat irregularly due to a probable electrolyte imbalance and the only reason she was breathing was the respirator pumping oxygen and air into her lungs, coldly and imperturbably. She was the victim of an ear infection that had gone too far. An infection that could have been cured by a $2 course of antibiotics was now refractory to four separate drugs, because they can't penetrate the pouch of brain liquefaction that is consuming her. No one is to blame. Had she been aware, had she gone to the doctor earlier, it would have been treated as a matter of course, as routine as taking an aspirin. But now, survival is possible but hardly assured.
Obama: Community agitator cum leader of the free world.
Back in my university days I was a liberal. Attending a notoriously left wing campus in California, I was steeped in all the cliches and memes of modern American progressivism. Warmed over collectivist sentiment wafted into the air and mingled with marijuana smoke and patouli. If I were the person I was then now, I would be thrilled at the prospect of Barack Obama as our next president.
The notion of a great unifier here to save us backward Americans from further humiliation on the world stage, here to reverse the damage done by an evil and stupid president on his way out, would have thrilled me. Finally the French would like us. I would be satisfied knowing that I was on the side of the intelligent, the enlightened masses who finally get it, who will finally redeem our country by dint of electing an evolved and educated man to save us from our backwardness.
But then I sobered up. What I didn't get then, and what I suspect many on the left don't get now, is that the very values I thought I was championing, individuality, freedom from oppression, and freedom of thought are not left wing values. They are actually values of classical liberalism, or conservatism. American conservatives are trying to conserve the liberal values upon which our country was founded.
There is a stultifying conformity among left wingers. The Obamamaniacs are a prime example of this. The cultish movement around Obama is both frightening and unprecedented in modern politics. He can't do wrong. Any criticism of the man is instantly tossed out of countenance. You just don't get it, his followers will say. The moment you criticize their secular Messiah, the moment you try to rationally point out the hypocrisy of his statements, the moment you point out that the prime players in the current economic mess were all Democrats and cronies of the One, a wild eyed rage wells up in them. It is like trying to convince a Scientologist that he is not an operating thetan and that no part of the world's history involved casting evil spirits into a volcano.
Apart from their current political convictions, liberals are pressured to conform in other ways. There is a nonconformist uniform, a set of correct cars to drive, there are correct places to live, correct products to buy, and correct views to espouse. What of the freedom to do as you wish, believe what you want, and live as an individual, completely self determined?
It is interesting to note that, apart from the heinous crimes against humanity perpetrated by the Nazis, their social platform is strikingly similar to the modern liberal agenda. The Holocaust was where they went wrong, but their harnessing of youthful passions, hatred for religion and capitalism, exultation of action and activism over reason and moderation are all spot on for todays liberal. Bill Maher and John Stewart are today's unwitting channels of the worst movements of the Twentieth Century
Obama is an exemplar of the triumph of the politically correct. He speaks in platitudes that one can't argue against because they lack any substance to confront. One can't criticize him lest they be labeled a racist. His is a will to power and nothing else. His career has been marked by a constant jockeying for the next level of power. What will he do with it when he has attained the greatest power our country has to offer?
The notion of a great unifier here to save us backward Americans from further humiliation on the world stage, here to reverse the damage done by an evil and stupid president on his way out, would have thrilled me. Finally the French would like us. I would be satisfied knowing that I was on the side of the intelligent, the enlightened masses who finally get it, who will finally redeem our country by dint of electing an evolved and educated man to save us from our backwardness.
But then I sobered up. What I didn't get then, and what I suspect many on the left don't get now, is that the very values I thought I was championing, individuality, freedom from oppression, and freedom of thought are not left wing values. They are actually values of classical liberalism, or conservatism. American conservatives are trying to conserve the liberal values upon which our country was founded.
There is a stultifying conformity among left wingers. The Obamamaniacs are a prime example of this. The cultish movement around Obama is both frightening and unprecedented in modern politics. He can't do wrong. Any criticism of the man is instantly tossed out of countenance. You just don't get it, his followers will say. The moment you criticize their secular Messiah, the moment you try to rationally point out the hypocrisy of his statements, the moment you point out that the prime players in the current economic mess were all Democrats and cronies of the One, a wild eyed rage wells up in them. It is like trying to convince a Scientologist that he is not an operating thetan and that no part of the world's history involved casting evil spirits into a volcano.
Apart from their current political convictions, liberals are pressured to conform in other ways. There is a nonconformist uniform, a set of correct cars to drive, there are correct places to live, correct products to buy, and correct views to espouse. What of the freedom to do as you wish, believe what you want, and live as an individual, completely self determined?
It is interesting to note that, apart from the heinous crimes against humanity perpetrated by the Nazis, their social platform is strikingly similar to the modern liberal agenda. The Holocaust was where they went wrong, but their harnessing of youthful passions, hatred for religion and capitalism, exultation of action and activism over reason and moderation are all spot on for todays liberal. Bill Maher and John Stewart are today's unwitting channels of the worst movements of the Twentieth Century
Obama is an exemplar of the triumph of the politically correct. He speaks in platitudes that one can't argue against because they lack any substance to confront. One can't criticize him lest they be labeled a racist. His is a will to power and nothing else. His career has been marked by a constant jockeying for the next level of power. What will he do with it when he has attained the greatest power our country has to offer?
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