Sunday, January 3, 2010

Follow-Up: Part 1

OK, this is where I tackle the first half of the items on that list in my previous post.


Hematopathology is the subfield of pathology that deals with diseases of the blood, bone marrow, lymph nodes, and spleen. About 27 months ago I decided to pursue a career in hematopathology. It's a fairly lucrative field, always in high demand, and offers just the right amount of variety without so much that one becomes entirely overwhelmed. It's also at the cutting edge of medicine. It employs wonderful technologies like flow cytometry, FISH analysis, and various molecular assays, as well as plenty of time behind the scope and even the option of some patient contact (should a pathologist ever actually desire such a thing). Until just over a year ago I thought I had everything settled. I knew I'd have great recommendations from the hematopathologists in my residency program and had little doubt about my ability to get a spot in one of the better fellowship training programs in the country. A little less than a year ago, after having gone through an exhausting application process and interviewed at several top-notch programs, I decided not to pursue subspecialty fellowship training in hematopathology.

Yet another amazing book by one of my favorite authors, living or dead, Ken MacLeod. It's an all too timely tale of an all too possible future (several aspects of which I'd love to see realized!). It includes plenty of enticing themes (super-intelligent robots, space elevators, etc.), but what I particularly enjoyed was the setting: a world in which religion held little sway.


My wife, Kate, is an anesthesiology resident. In march of 2009 she was offered (and accepted) a subspecialty training fellowship in pediatric anesthesiology at Seattle Childrens, giving us a specific reason and date for our long anticipated return to our beloved Emerald City. Also, after not having ever observed an anesthesiologist's role in the OR from the beginning to the end of a case, I recently accompanied Kate to work for a day and watched her perform local nerve blocks and run cases. Very interesting and very technical. In a spirit of reciprocity she accompanied me to work and watched her first-ever autopsy.


After reading one of Ken MacLeod's other books, The Star Fraction I was convinced that my nearly complete state of computer illiteracy would be a tremendous handicap in any possible version of the future, so I finagled my way into an undergraduate introductory course on Unix. It was great fun, and though I don't use Unix or Linux on a daily basis, much of what I learned about computer systems/structures has served me since. I enjoyed the course so much, in fact, that for most of the past year I was thinking I'd pursue a career in biomedical informatics. I spent a month at the Mecca of pathology informatics, University of Pittsburgh, attended three national meetings on biomedical informatics (presented a poster at one of them), and dove head first into every informatics-related project that came my way. Ultimately, however, I decided that even though I do believe that innovations in informatics and the technology to support them are the future of medicine, I was more concerned about the future of a habitable planet, so I chose a different path.


As mentioned above, reading one of Ken MacLeod's books inspired me to take a Unix class. That's not the only manner in which it inspired me though. I read The Star Fraction while I was still planning on a career in hematopathology. It had been several years, however, since I'd discovered that I derived no great joy or satisfaction from medicine, and even as I was making plans for the next stage in my training and career, I was hoping to find something else -- and yet afraid to really look for it. Ken's book introduced me to a vast array of social, scientific, political and (as far as I can tell) completely original ideas that served to shake me into a realization that if I wasn't pursuing a career in which I truly believed and about which I could work up a decent passion, then I might just be wasting the most important (the only truly important?) opportunity of my life. Reading Ken's book also lit a fire under my lazy ass in regard to politics and world events. I've always been vaguely aware of the goings on in the world, but have tended to depend on one (relatively decent) source of information (NPR) and then done little with said information. I still don't pursue the truth as rabidly as I'd like, but I'm far more aware and far more skeptical of any one source... and I'm rapidly shedding my fear of using my voice on behalf of people and causes that are ignored or misrepresented. Thank you, Ken.

health care

What blogger worth his salt hasn't touched on health care in the past year? As 1) an MD working in a university hospital that serves most of the uninsured of the community, 2) an observant individual who has now lived in two of the three poorest states in the USA, and 3) someone with many friends in other countries throughout the world, I have no doubt that the US health care system is a disaster. The worst and foremost failing is that it is a health care system instead of a health system. Until the emphasis is correctly placed on promotion of health through education, healthy living environments, healthy workplaces (and work practices), and real, meaningful reduction of the economic disparity that is running rampant, any health care system is going to be nothing more than an expensive band-aid that rapidly becomes entirely unaffordable. Enough ranting though... especially as I'll return to health care related topics later in this post. Suffice it to say that none of the US health care proposals of the past year have gone nearly far enough, and they've all been "shaved, sterilized, and destroyed" to the point that the end result will only be slightly better than the current state of affairs. It will be better... but there'll still be a LONG way to go before health in the USA is even close to being adequately reformed.


Until seeing trailers for the movie of Watchmen I was entirely unaware of the story. Fortunately I have three cousins who more than made up for my childhood lack of comic books. While conversing with one of them about the film trailer, he told me, "if you only ever read one comic book or graphic novel, it should be Watchmen." So I picked up a copy and read it. It was truly great. The movie was excellent too... and I like it better and better each time I see it. If you haven't seen it, read the book first. If you have seen it, be sure to watch the Director's Cut. If you've seen the Director's Cut, watch the Ultimate Cut, which includes all of the Black Freighter sequences that were left out of the theatrical version. Oh... and Watchmen is not the only comic book or graphic novel I'll ever read. I've already read V for Vendetta and I'm looking forward to starting the Sandman series.


Scotch whisky at it's finest. I do love Laphroaig, Caol Ila, and even Ardbeg, but when push comes to shove, if I had to settle on just one, it would be the Signatory 18-year-old Bruichladdich. Enough said. Slainte Mhath! Slainte Mhor!


For this I'll refer to my previous post on the topic. In summary, I'll paraphrase and respond to a line from the movie Gladiator:
There was once a dream that was Obama. You could only whisper it. Anything more than a whisper and it would vanish... it was so fragile. And I fear that it will not survive the winter.
The man has survived a winter, but the dream has not.

On that rather somber note, I will close this post. I will be back to cover the other half of the topics though, so stay tuned.

1 comment:

Unknown said...

It has been quite a year, with frustration and disappointment (with our country and its politics), realizations and insights that have changed our course, and excitement for our now definite move back to the Northwest in a matter of months. I am honored to have been with you to discuss the issues over delicious home-cooked meals, on runs in our VFFs, and late at night when sleep evades us for one reason or another. Keep up this review of the year; I'm enjoying the memories.