Thanksgiving #2 During Pandemic: giving thanks

Dear Reader. This is an email I sent to my Large PIG (physician Informatics Group) this week. I wish you all a restful holiday. CT

Dear Provider Informatics Group members: My General Medicine Division Chair sent this today, and it makes me reflect about Thanksgiving. I wanted to pass this along to you. It has been 20 months of chaos, emergency changes and emotionally draining life at work and outside work.

“The arc of the moral universe is long, but it bends toward justice.”

Martin Luther King

It is a reminder that in our day-to-day, all we see are boulders and rockslides in our path. In the long run we are bending the path to reduce burnout, improve connection and improve care. Our work affects 6000 providers, 15,000 nurses, and a couple million patients. 

I am thankful to be on this journey with you. I hope you can take some time this week with family and loved ones. CT

—–

From: Earnest, Mark
Subject: Giving thanks 

Dear GIM Colleagues,

Ms. Sutton, my third grade teacher, taught me to start letters that way – with the word “dear.”  

Since leaving her classroom, I’ve not really given the word much thought.  Aside from placing it at the start of letters, or employing it generically as a term of endearment for my wife, I haven’t used it much.  I use it even less now since “hi” or just a stand-alone first name have become de rigueur for email greetings.  Using it less, I think, is a mistake.   According to Google, “dear” means “regarded with deep affection; cherished by someone.”

Today, I want to use the word with intention. 

So, let me start again.

Dear GIM Colleagues,

We are approaching the one day in our calendar each year that we set aside for thanks.  I’ll confess that after 20 months of the pandemic and all the associated fire-drills, chaos, and public acrimony, I’m much more facile at bringing to mind the things I’m not thankful for.  That may be the most compelling reason to devote my attention this week to its intended purpose – focusing on the things in my life that I cherish and regard with deep affection. 

I’ll not bother you with my gratitude list in its entirety other than to say how much I look forward to a house that is again filled with its full complement of family.  I do want to reflect for a moment on work.

As a young man, choosing a career path, I was clear about one thing.  I didn’t want a job.  I wanted a purpose.  I was fortunate to find that calling in medicine and ultimately in GIM.  I chose well.  I have always loved caring for patients.  Along the way, I’ve found other, related opportunities for growth and points of purpose: teaching, mentoring, helping others find and actualize their purpose…  In all honesty, work for me has been a great source of joy and satisfaction.  A wonderful side effect to finding my purpose, has been the privilege of working alongside other purpose-driven people.  If I could start from scratch and hand-pick a group of people to take this journey with, I could do no better than you – my dear GIM colleagues.  It is a profound privilege to be part of such a caring, committed, selfless group of people. 

Now – after twenty long months and in the midst of a surge – is almost certainly not the easiest time for any of us to hold our work dear.  It has been hard.  Nevertheless, it is possible to be tired, even exhausted, and thankful at the same time (ask any marathoner at the finish line).   Unfortunately, we are not yet at the finish line.  We have a challenging winter ahead of us.  That in and of itself should be reason to pause and reflect. 

I hope this week that each of you can find a moment to consider our common purpose(s) and find the space to be thankful for it.  Doing so need not deny the challenges we’ve faced or the sacrifices made.  Each day, in ways big and small, you have all made our world a little better.   Because of your work, each day there is a little less suffering, a little more hope and a little more knowledge and understanding.  Surely that is worthy of thanks. 

I am not aware of much more we can do to turn the tide of the pandemic.   Somewhere ahead of us is a finish line.  We will face more challenges before we cross it.  We cannot control all of those difficulties, but in the months ahead, we will be focusing on the ones we can change.  We will be looking closely at the circumstances and structures that impede our purpose and make our work, particularly our clinical work, more difficult and less joyful.   We will be looking for meaningful, actionable ways of rethinking and restructuring our work to make it more joyful and sustainable.

In the meantime, I hope you all can find the space to feel thankful for what you’ve done through this great time of trouble.  I am thankful for each of you my dear colleagues, and hope that this week you will enjoy rest and gratitude among those you hold most dear. 

With gratitude and thanks,

Mark

Mark Earnest from History Colorado dot org website

Mark Earnest, MD, PhD, FACP|Professor (Pronouns: he, him, his)
Division Head –  General Internal Medicine
Meiklejohn Endowed Chair of Medicine

Canyonlands, the Zen of Sand, and my most embarrassing moment

Canyonlands Utah in the 1990’s was a beautiful getaway for me and my then-fiancée. Having heard of this wonderful mountain-bike mecca, we had come, bikes-on-top of my subcompact, met up with our tour group, a diverse crew of men and women of various ages.

100 miles

It would be 100 miles in 4 days across rugged terrain on mountain bikes with a group of 12, a couple of guides and a required-escort (at that time) park ranger. Check it out for yourself, it is a quintessential southwest wonderland.

https://www.nps.gov/cany/planyourvisit/whiterimroad.htm

We begin with a 1000 foot descent into the canyon along a jeep trail. We had brought our old unsuspended bikes with hand brakes. Although the ride was hard on our bodies, we were pleasantly surprised that our equipment was up to the task.

wildflowers from nps.gov
from nps.gov

Our ride was a blast: wildflowers, spectacular vistas, and good company, with mostly flat single track.

Great Canyonlands photography at traveldigg.com

Our guides drive a 4×4 SAG wagon with our gear and food and set up not only our first lunch, but all our meals for the coming days. We have gallons of water that we don’t have to carry! Our camelback hydration backpacks are fantastic for on-the-bike refreshment. This is the life.

Glamping (glamour camping)

At about 25 miles into the trip, at the end of the first day, we get to camp: our guides have driven ahead, set up our site. Dinner is ready and all we have to do is pitch a tent, grab a plate and a folding chair, sit and eat. So awesome. And after dinner, a campfire (apparently forbidden in recent years in the park) and then the Milky Way. Canyonlands, and other national parks, are famous for the lack of light pollution and the spectacular view of the night sky.

photo by the author on an iPhone (!), but in Gunnison National Forest, not Canyonlands

At the end of our third day of riding, as we set up camp, our guide tells us: the Green River is about 4 miles away for anyone wanting an extra excursion. Only I take up the challenge, others choose to rest at our campsite. At the time, I was training to ride my first (and only) double century later that summer (200 miles in a day: the Davis Double, but that is a story for another day), and I was anxious to get in some additional miles.

The Zen of Sand

Solo, I head out. We had learned from our guides about long patches of deep sand on the trail, and the “zen” trick of sitting back, focusing on being “smooth and circular” on the pedals, having a fingertip light touch on the handlebars, and gazing far down the track to improve balance. If done just right, one could “float” over deep sand on the trail. Turns out, this guy agrees with me (youtube).

I actually had a few moments of success doing the sand-float in the shadow of the Airport Tower formation, entirely alone with the crags and formations of the Southwest landscape. Other times, I did the meditative sand-bike-walk.

Sun God

Arriving at the river, I stash my bike in the shrubbery. I see a flat rock jutting out into the river and I determine that I’m going to skinny dip, be clean for the first time in days, and sun myself dry on the rock. Should be great.

To my parched, sand-and-sunscreen-caked, sun-blasted body, splashing in water is heaven. I soak in the cool, rub off the grime, submerge my head and hair and luxuriate.

Then I climb out into the rock, buck naked and unafraid. It has been days since I’ve seen more than our merry biker band, and they’re all kicking back at camp. I shall air-dry, sensually alive and glorious.

Author sitting on a rock outcropping. But not naked. And not the same rock.

I am a glorious human form.

I am one with nature.

I am a Sun God.

Tinnitus?

In the back of my head, I begin to hear a buzzing. What is that? Do I have tinnitus? Odd.

It gets louder. Hmm. A washing machine? Absurd.

Yet louder. An airplane? I look overhead. No contrails. Nothing. Clear blue to the horizon.

Unmistakably the sound of machinery. Rrrr-rrrr-mmm-mmm.

cdn.getyourguide.com

… and around the bend of the river, a 20-seater tour boat, 20 feet away, a gawk-fest of tourists, with a couple kids pointing out the naked man with a bike-shorts-tan splayed out on a rock in the river.

I believe all parties were mortified.

What was there to do, but wave? And then =plop= back into the river.

author, hidden

I am a bottom-dwelling salamander.
I am a shrinking violet.
I am an overexposed slide.

Oxygen masks, John Hodgman, and a hotdog?

This was a good week. Like many of my medical colleagues who are plowing through our next surge of Covid patients, we have feelings of exhaustion, angst and sadness, or as one of my Twitter colleagues on #medtwitter calls it, a new emotion called ‘emptysad.’ So apt.

So it was great to get out of the house, and learn to occasionally ‘put my own oxygen mask on before assisting others’, as our airline colleagues would say. Today, I’d go for a 35 mile loop around Denver. Come along on my visual travelogue!

There’s lots of construction on the Highline canal, the Sand Creek trail, and the Cherry Creek path. I can’t wait to see what turns out. Meantime, we have detours upon detours. Here’s one near Northfield, an expanse of wild sunflowers illuminating the margins of I-70.

This is a 3.5 hour loop for me. The great thing is: very little bike or foot traffic even on a holiday weekend. The smoke is less noticeable today, the sky is blue, the Colorado zephyr winds still cool through the day.

Then, the Confluence of Sand Creek and Platte River, both the wild fowl that frequent the area, and also the industrial ‘aromas’ of Commerce City and the Purina Puppy Chow plant. Such a juxtaposition.

Then it’s a quick dash upstream along the Platte, to Confluence Park, where Cherry Creek meets the Platte. Here, see the crowds for REI and the splashy mess of shore that is kid and dog and kayak friendly.

The hot dog stand is reliably yummy.

On the way home, I found my informatics and physician colleague Steve Rotholz at his outdoor photography booth at the Cherry Creek Arts Festival. Further surprise: he’s reading our book club book for the month: You Look Like a Thing And I Love You. A great explanation of AI and the weirdness that ensues in the development of these tools.

On the quieter parts of the trail, I listen to my current audio book: Vacationland, by John Hodgman, read by the author. I have loved his previous stories on The Daily Show and on public radio. He doesn’t disappoint in this autobiography.

I hope you’re finding ways to have a restorative summer. Go out and do something you love.

How to Get Things Done When You Don’t Want to Do Anything (NYTimes)

How to Get Things Done When You Don’t Want to Do Anything – The New York Times (nytimes.com)

from nytimes.com, George Wylesol, article by Cameron Walker

This spoke to me. Maybe it speaks to you. This pairs well with another recent NYT article by Adam Grant on Languishing:

by Manshen Lo, NYTimes, article by Adam Grant

Feeling Blah During the Pandemic? It’s Called Languishing – The New York Times (nytimes.com)

It is okay to forgive ourselves this feeling, that we’re not 100% on our game, that we’re not giving 110%.

CMIO’s take? I’m taking more breaks, connecting more with friends outside work, disconnecting from work tasks more, finding small, enjoyable things, reading more books for fun. How about you?

Flying Tigers, and Boxing Joe Louis … in the exam room?

I was a nervous first year intern on the internal medicine hospital service. Our team had come down to the Emergency Department to accept the patients being admitted to our service. My resident turned to me: “Room 3 is your next patient. Pneumothorax. We need to care for this patient for a few days and stabilize his lungs until we can remove the chest tube vacuum. Obtain a quick history and exam and place his admission orders.”

I went in to chat briefly with the patient. Since we were busy meeting a host of new patients, I just had the briefest of conversations with him; he had gotten very out of breath, driven himself to the ER, was found to have a collapsed lung (pneumothorax), and had a chest tube vaccuum inserted to re-inflate the lung. Got it. I wondered how it happened, but that mystery would have to wait.

from aliem.com

Later that evening, I went back in the room to chat with my patient with pneumothorax. The chest tube was working, he was feeling less short of breath and more comfortable speaking. He had a long history of injecting cocaine, and as a result of frequent use of needles, had scarred all the accessible veins in his arms and legs. During one of his previous hospital stays, he noticed nurses putting IV’s in other patients’ necks, and found out that he, also, could use a neck vein to inject. This worked well for a time, but THIS time he had inserted the needle too far and punctured his lung. He felt the “pop” and then began feeling short of breath, and immediately drove himself to the hospital, where he passed out in the parking lot at the ER entrance. Fortunately, someone saw him, and the ER team brought him in and resuscitated him.

from lecturio.com

I thought: “this is a cool case. Self-injection into a neck vein leading to pneumothorax.”

My resident agreed. “Why don’t you present this at Dawn Patrol tomorrow morning?”

There it was. It was finally my turn to present to the dreaded Chair of Medicine at Dawn Patrol, the infamous rounds where the post call team would assemble at 6:30am and one unlucky intern would present a selected case history and have a thoughtful ad-hoc pathophysiology discussion.

At 6:30 am precisely, the looming presence of Dr. Silva arrived in the white-scrubbed hallway. “G’ mornin’ everybody! How’re we doin’? Who has a case?”

Joseph Silva MD, Dean (formerly of UCDavis School of Medicine) via California Northstate University website. Hi, Uncle Joe!

“Good morning Dr. Silva, I do.”

“Oh good! Okay CJ, go ahead.”

I was so flustered I didn’t even correct his mis-remembering of my name “CT”, and I just plunged ahead. “This is a 31 year-old prisoner, who presents with sudden onset shortness of breath and is admitted with pneumothorax. His history began earlier yesterday when …

“Stop.”

=I paused=

“Pneumothorax. Interesting. What is his educational background?”

from gentledoveministriesinternational.blogspot.com

“… Um, he is a prisoner. I did not ask.”

“So, he could be a medical student, and you would not know?”

“No sir.”

“Hmm. So you might be speaking disrespectfully to a medical professional and you didn’t find this out. Okay. Is he a rose gardener? You know, sporotrichosis thrives in rose bushes and can cause spontaneous pneumothorax.”

“Um. I don’t know.” (Head hanging lower)

“Or, maybe has he recently purchased or cleaned out a pickup truck he bought from the Forest Service? You know that coccidiomycosis is endemic in the Central Valley nearby, so called “Valley Fever” that can commonly cause spontaneous pneumothorax.”

“I don’t know sir.” (Staring at the ground, hoping it would swallow me up)

from slideshare.net

“You know what? We need to change this. I have been disappointed this year with Dawn Patrol presentations where we have gathered inadequate Social History. This is going to change today. Starting now, Dawn Patrol presentations shall BEGIN with a FOCUS on SOCIAL HISTORY.”

“Yes, sir.” I mumbled my way through the rest of my desultory presentation, the amazing external-jugular self-inflicted needle-puncture of the apex of the lung forgotten in the shame of inadequate “social history” skills I demonstrated that day.

After rounds, my fellow interns came up, punched me (hard) in the shoulder “Thanks ‘CJ’. Good job. As if we weren’t working hard enough already, now we have Social History to worry about too.”

For the rest of that year, every University of California Davis intern gathered a world-class, comprehensive social history. We knew every patient’s educational background, what schools they went to, what they studied and enjoyed, what occupations they held (every one of them since the beginning of time), what hobbies they had, what their families were like, how active they were, what groups they belonged to, every place they had ever lived or visited. 

As for me, for a long time the Social History was my albatross. I wanted to avoid ever getting caught with my pants down again. For the remainder of my residency, my fellow residents never let “CJ” forget what he brought down on all of us.

Over the years, my focus on Social History influenced my interview style. My history-taking skills improved. I did not even notice that I was getting to know my patients better. I saw my patients more as humans and less as diseases.

Joe Louis | Boxing history, American boxer, Joe louis
Joe Louis, heavyweight champion, from pinterest.com

I learned that one of my patients used to practice-box with Joe Louis, the heavyweight champ.

from http://chinaburmaindiawwii.blogspot.com/2015/06/flying-tigers.html

One of my patients flew with the Flying Tigers who challenged Japanese invaders over communist China at the beginning of WWII.

It turns out, the entire history of the world walked in and out of our exam rooms and hospital beds, if we were just aware enough to ask. 

Dr. Silva was brilliant. The surface lesson was: take a good history. Get to know your patients. They’re trying to tell you the answer to the questions you have about their illness.

The second lesson that I only came to understand years later: getting to know your patients, whether through social history, or just being generally curious about another human being, was the gateway to enduring, therapeutic relationships, for everyone involved.

Thanks, Uncle Joe.

Skid marks … and Bad Parenting?

Author and son, out for a ride.

My son and I were out for a bike ride. It was a beautiful Saturday afternoon, and we were learning to pace line and having a good time. Having recently watched the Tour de France, we had enjoyed how the US Postal team cyclists were less than a foot apart on the road, benefitting from the wind shadow of riders ahead. I told my son: 

“Son, did you know that trailing cyclists in a pace line can save up to 1% of energy for every mile per hour they’re traveling? In the Tour, cyclist pace lining at 30 mph could save nearly a third of their energy doing that.”

My son, either breathless on the bike, or couldn’t care less: “Huh.”

We were zipping down the bike path along the Highline Canal in Denver, the wind in our hair, having a pretty good father-son afternoon. We were traveling about 15 mph on long clear stretches of smoothly paved, tree-shaded asphalt. We were alternating the lead. For now, I was leading, and he had developed enough consistency and confidence to be within a foot of my back tire. 

“Do feel the difference? Are you in the wind shadow?”

“Yeah! Actually, this is pretty cool!”

What could be better, an outing with my son, a beautiful day, imparting an occasional word of wisdom, spending time together. I was being a good parent. 

Ahead was the dip in the path towards the tunnel underpass at Iliff Avenue, where the path narrows and pedestrians share the right-of-way. As we approached, I suddenly spotted a pair of elderly walkers heading down into the tunnel, and we were already nearly upon them. Worse, there were bikes emerging from the tunnel from the other direction. I had no place to dodge. I signaled to slow, and immediately hit my brakes. My 16 year old son, immediately behind and slightly to my right, slammed on his brakes as well, squealing to a stop. I stopped just short of the pair. My son, squeezing the brakes for all he was worth, with no escape direction, struck one of the women, who shouted “Oh!”, and went down. 

We were horrified. 

We leapt off our bikes and apologized profusely. 

Fortunately, the woman was able to stand after a bit, limping. 

After glaring at us, she and her partner let us know exactly what they thought of our speeding down the path at unreasonable speeds and striking pedestrians. 

We walked them to a nearby bench and sat with them for awhile, before we rode on, much more sedately, having lost the joy of the day. After a brief period, we decided to abandon the rest of our ride, turn around and head home. 

We passed them again on the path home, and heard them say as we passed “those were the guys.” We felt terrible. 

It took my son 2 months to get back on a bike again, and we have never pace lined since that day. We both take it slower now, particularly around ANY pedestrians or any blind corners or tunnels. The speed and the workout can always wait, right? Why did it ever need to be another way? I see others on bikes flying by, narrowly missing pedestrians, and wonder how we ever survived as a community, as a species. 

Fortunately, my son and I still go cycling together. Thank goodness. 

The scene of the crime.

We approach the spot. Incredibly, it has been 5 years, and the skid marks are still there, indelibly marked into the concrete despite many seasons of sun and rain. He looks at it and sees his shameful past.

“There it is Dad, that spot where I almost killed someone.”

I’m surprised. I had hoped he had let that go, but he had not. I told him that I understood why he felt bad, but I also helped him see that you ought to be able to trust your parent’s judgement, but that =I= had let him down, and worse, I had literally pulled him into a situation where he could not avoid hurting someone. I told him: 

“Those skid marks are not symbol of an error on your part. They’re a symbol of my Bad Parenting.” It was my shame, and not his. 

In the years since, this moment has lost none of its painfulness. Somehow, excruciating emotions are the yellow highlighters of our lives. This memory is as indelible as those skid marks that I see every time I ride by.

Be careful out there, y’all. 

Wall Street Casual (NYtimes) vs Loki?

Some of you remember me, with pre-pandemic bow-tie.

Soooooo long ago. Good old days?

During the pandemic, our family went into full-on Joseph Lister anti-sepsis mode. I’d dress for clinic in a button down shirt, casual pants, mask and face shield, strip down in the garage on getting home, yell “contagion!” to clear my path to the laundry, and wash everything in hot water immediately. No dry cleaning piles, no laundry baskets. Right into the machine.

No watch, no bowtie, no glasses, no dress shoes. My shoes were washable Keens. My wallet became a paper-clip with $20, a credit card, my entry card and ID, and a folded letter that certified that I was essential personnel in case I got stopped at a quarantine checkpoint.

Here we are a year later, and clothing-wise, not much has changed. Casual seems dressy enough. We’re still masking, and starting Monday, I think we’ll be back to wearing face shields, as the Delta variant rages on.

I think the Loki variant is a lot more fun, personally.

My Failure Resumé (a talk)

What lessons can we learn from CT Lin’s failures?

 

Thanks to the Colorado Chapter of HIMSS (Health Information Management Systems Society) and to Bonnie Roberts and Rich Morris for co-hosting my presentation.

Based on my recent Failure Resumé 1 pager. Here are some personal stories, life lessons, and 3 exercises to help you build a failure-tolerant future.

With, of course, a bonus ukulele song at the end.

CMIO’s take: Have you written a failure resumé? Are you building a failure tolerant future? Let me know in the comments.

The Narrows at Zion Canyon: a visual travelogue

In November of 2020, my son and I toured the Southwest US. One of our stops was at Zion Canyon National Park, where we were excited to experience the Narrows. It seemed a great way to escape the pandemic and get away. Spend a few minutes on the journey with us!

Driving, we arrived late in the day at Zion lodge, in darkness. We saw this improbable sight outside our cabin in the morning: canyon walls rising thousands of feet overhead, just outside our door.

We had rented dry suits from Zion Adventures, and laid out our clothing that evening for the hike ahead. In case you’re wondering about the hyperlinks, no this is not a paid post. Just a joyful recollection of an aging parent…

Double boot liners, grippy-soled rubberized river boots, an impervious suit with rubber-gasketed pants and sleeves, and a huge diagonal waterproof zipper across the chest. Hard to wrangle but exciting! We felt like spacemen. We wore several clothing layers underneath.

Normally the Narrows is a super-popular hike through the spring, summer and fall. We had thought that with the pandemic and with wintry November weather, we would have no trouble booking a shuttle ride from the Lodge in the park up to the entrance of the Narrows, 3 miles away. Suffice it to say, plan ahead. Fortunately, we found a last-minute shuttle option with seats remaining. Whew, disaster averted. Otherwise, the lodge had offered us “bikes to rent and ride up there, suits and all.” That would have been more adventure than I needed.

We walked the paved path for the 1st mile. Giddy and nervous, we passed a number of casual hikers who stared at our gear, our dry suits, our 6-foot wooden walking poles, our backpacks. Here, with the residual heat deep in the canyon, the last remnant of fall colors contrasted with the snowscapes outside the park.

And then: the pavement ends. Into the stream! I can feel the cold water sloshing around inside the boot. Hey! my feet stay dry! I don’t care about splashing because I’m sealed in up to my neck, and my backpack has a dry sack inside with food and water. The cyanobacteria poisoning warnings do not deter us. Upstream we went.

Did I mention the incredible geology? We feel puny in its presence.

I was surprised at the grip of these rubber soled river boots. Crunching upstream over large and small rocks was easier than expected. Where was all the slipperiness, the unstable rocks, the twisted ankles? The equipment smoothed that away. I grinned at my son; this was a blast. The water depth was up to a foot and the going was not hard. The current ran a couple of miles an hour.

As we saw fewer hikers, the enormity of the cavern became apparent. At one point, it appeared that the walls were maybe 3 football fields tall, 1000-feet-high sheer walls of stone. These walls plunged right down into the river with no shore or beach to speak of.

From there the river got deeper and faster. In about an hour and a half we arrived at the fork to observation point on the right, with photographers set up to catch the changing light in the canyon. Then we took the left fork to “Wall Street,” presumably named for the impressive sheer walls narrowing in.

At times, the water rises to the hips. Some hikers with only waterproof pants turn back. One couple raised their jackets, exposing bare midriffs to keep their clothes dry, and gamely walked through the first deep crossing. That must have been cold, with the water at 40 degrees. It is sunny, but also snowing.

At a rock outcropping, we paused for lunch. We find a few larger boulders, unpack and have our bagels. Suddenly ravenous, we savor the calories, noticing snowflakes drifting down 1000 feet into the canyon. The light is peculiar: in shadow, with sunlight bathing the Canyon just around the curve, blue sky overhead. It looks like indoor light because of all the bounce and reflection.

This is our turn around point. We rest, recharge, hear the stream burble, feel the snowflakes, our hunger sated, snug in our dry suits, we smell the fall giving way to winter.

It feels – cold, but I’m sweating from effort. The canyon appears unforgiving, but we have supplies and equipment up to the task. Flash floods and cyanobacteria poisoning are a risk, but we have mitigated them. Unlike more extreme adventure-seeking adrenaline junkies, this is the degree of risk and adventure I’m ready for.

It is time to head back. Downstream, like downhill, would be quicker. My main concern was balancing Seeing with Photography.

There is the disappointing idea that the more photos one takes, the less the brain experiences. Or maybe not. Yes, there’s more to show off when you get home, but were you really present? Or did you just line up and frame the shot? But, if you don’t take photos, how interesting is your blog post later? #FirstWorldProbs.

I tried to do both. Who knows.

Downstream was a pleasant splash. Yes, it was 1.5 times easier and slightly faster. There was little resistance to swinging the shins through the water as it flowed with you.

There are great speedway-sized curves to this river, as the millennia of water microscopically carry away molecules of rock every day. The views are magnificent.

It is a hike that promotes mindfulness. Your focus is required for not-stumbling, for pushing upstream, for awakening your senses. The constant, echoed river babble precludes idle chatter.

It is: exploration, sightseeing, photography, companionship, escape, reflection, effort, appreciation for dry-suit and photographic technology, wonder, mindfulness, pure sensation, focus, curiosity, pride of offspring, joy. All at once. Each in turn.

We emerge from the river, dripping and yet perfectly dry. We make our shuttle home.

A perfect day.

The Eppendorf, CRISPR, Covid, and my medicine origin story

This post is THREE THINGS. A personal origin story, a (brief) book review, and a connection to recent stories on Pfizer and Moderna Covid vaccines. And, when we’re done, it might even tie together!

Image above: Dr. NoFronta Lobe, Mad Scientist. No this is not me in the research lab; this is me, a kindergarten parent at Halloween

My Origin Story (I was a budding molecular biologist in 1985)

I was alone in the brightly-lit sterile-white research lab; having spent 20 hours on a long, multi-day experiment. It was nearly midnight on Saturday in 1985. I was a college junior majoring in molecular biology, with aspirations of a scientific research career. I was studying P4 bacteriophage, a virus that attacks E coli bacteria.

The work sequence, I could now perform by heart: inoculate, incubate, centrifuge, enzyme reaction, pipette (fancy eyedropper tool) into an Eppendorf tube (a tiny plastic tapered tube. From a Q-tip-loaded with a single bacterial colony, I had carefully grown a quart of bacterial culture, then sequentially purified my sample down to 20 drops of a pearlescent white DNA solution.

So: 20 hours for 20 precious drops. 

Eppendorf tube, Fisher Scientific

Exhausted and looking forward to heading home, I was on my last steps before overnight refrigeration, so as I held the open Eppendorf in my left hand and my pipette in the right, I randomly thought: “What time is it? Am I going to miss the last Orange Line train going home?”

So, I moved to look at my watch…

And since my watch is on my left wrist, the Eppendorf tube in my left hand did a 180…

And I watched as all the liquid ran out … and onto the floor. 

I looked at the upside down Eppendorf, and then down at the floor and the drops of liquid there, uncomprehending. 

*How… what… nnnnnNNNNNOOOOOOOOOOO!!!*

My late-night-fogged brain finally registered SHOCK, DENIAL, ANGER, BARGAINING. The lab was deserted, I deemed it safe to express myself:

“F$*&@! S!#%! D&$%!” I said, eloquently.

Desperate, I dropped down and started using the pipette to suck up DIRTY droplets of DNA extract from the floor and replace it into the Eppendorf. After a few minutes I had about 1/3 of the liquid, now brown-tinged, back in the tube. Resigned, I put the tube in the fridge. 

NO time to fret, no time to start over. Nothing else to do. I got on my jacket and faced the Boston winter, and jogged for the Orange Line stop. 

Once on board that last train, I started to sob. There was no way that soiled sample would be any good. This COMPLETELY SUCKED. 

And, I realized, I really did not want to be here. I realized: I could do the scientific work, but, unlike some colleagues who revelled in long hours in pursuit of new knowledge, I was despondent, not very good at this, and missed being around people. 

That was the night I decided that bench research was not for me. I had thought my calling was in pure science, but this DNA catastrophe taught me where I didn’t want to be. I needed Humanism AND Science. So, medical school it was. I’ve never looked back. 

Molecular Biology after 1985 (CRISPR!)

Thirty-five years later after my profanity-laced change of career, Walter Isaacson chronicles the recent successes of genetic research, including the discovery of CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) and CAS9 (CRISPR ASsociated protein #9).

Book review rating? 5/5 stars.

In a nutshell: Jennifer Doudna and Emmanuelle Charpentier, and many others raced to understand these strange “repeating sequences” in DNA and mRNA, realizing that they were bacterial defenses against “phage” viruses.

In this work, they discovered that CRISPR-Cas9, an mRNA plus protein complex could identify attacking virus mRNA and SLICE IT UP, deactivating it. They realized that this ancient protein complex could be taught to identify ANY RNA or DNA. Gene editing, invented by bacteria as a survival mechanism a millenia ago, co-opted by humans. Precise genetic scissors.

I enjoy Isaacson’s writing style. Not only does he clearly explain the adrenaline rush of scientific discovery (and the delicate dance between scientific sharing versus the race against other labs to publish and claim credit), but also the technical details of how CRISPR works.

Isaacson writes about Doudna and the response to Covid-19. What is even more astonishing about Dr. Doudna, the bench researcher and lab leader at Berkeley, is that she had the socio-political skills to bring together 40 leading geneticists across the Bay Area to successfully set up a brain trust to develop Covid-19 testing and vaccine development. This team lays much of the groundwork of the accomplishments of this past year.

Drs. Doudna and Charpentier were, deservedly, awarded the 2020 Nobel Prize in Biology “for the development of a method for genome editing.”

A personal note: my brief journey in molecular biology never quite crosses Dr. Doudna’s path, but I recognize the genetic tools mentioned, and studied the work of the luminaries in the field. I feel like a distant cousin to these scientists.

Highly recommended read, to understand the genetic foundation of our modern age.

Molecular Biology: the Covid fight

Here are 2 stories about Covid Vaccines, from the New York Times and WIRED.com, fascinating glimpses into the genomic-industrial complex. As of May 14th 2021, 36% of US adults are vaccinated against Covid-19. It is highly likely that these speedier and more effective mRNA-based detection tests and vaccines will forever be part of our lives. This could shorten development and improve accuracy of future vaccines.

WIRED.com story on Moderna’s Covid Vaccine trials

https://www.wired.com/story/moderna-covid-19-vaccine-trials/

CMIO’s take? Our modern world is built from advances in scientific method, computing and now genome editing. Despite my early failure in the lab, I feel fortunate, in the field of medical informatics, to be close to all 3.