Bert O'Malley Awarded National Medal of Science

As you may recall, Dr. Bert O'Malley surfaced in the news a few months ago, linked to the Roger Clemens steroids probe. I voiced my opinion on the matter, but I figure I should give credit where credit is due. Dr. O'Malley was awarded the 2007 National Medal of Science, to be awarded by President Bush at the White House in a ceremony this month. The official award for O'Malley states, "For his pioneering work on the molecular mechanisms of steroid hormone action and hormone receptors and coactivators which has had a profound impact on our knowledge of steroid hormones in normal development and in diseases, including cancer." Regardless of my earlier views, clearly, a well-deserved honor.

Is Boredom Good for You?

Everyone gets bored sometime. However, could boredom be good for you?

Scientists know plenty about boredom, too, though more as a result of poring through thickets of meaningless data than from studying the mental state itself. Much of the research on the topic has focused on the bad company it tends to keep, from depression and overeating to smoking and drug use.

Yet boredom is more than a mere flagging of interest or a precursor to mischief. Some experts say that people tune things out for good reasons, and that over time boredom becomes a tool for sorting information — an increasingly sensitive spam filter. In various fields including neuroscience and education, research suggests that falling into a numbed trance allows the brain to recast the outside world in ways that can be productive and creative at least as often as they are disruptive.

In a recent paper in The Cambridge Journal of Education, Teresa Belton and Esther Priyadharshini of East Anglia University in England reviewed decades of research and theory on boredom, and concluded that it’s time that boredom “be recognized as a legitimate human emotion that can be central to learning and creativity.”

Interesting. Boredom as an emotion. Well, call me very emotional during most of my med school lectures then.

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Stephanie Tubbs Jones, 1949 - 2008

Stephanie Tubbs Jones died last week of a brain hemorrhage after a cerebral aneurysm ruptured. Per reports, she was found unconscious in her car and rushed to an Ohio hospital with limited brain function. She died the next day. Her story sparked some controversy as she was initially reported to have died while she was in fact still alive but in critical condition. On a tangentially related note, recently named Vice Presidential candidate Joseph Biden has also suffered from cerebral aneurysms. He was absent from the senate for roughly 7 months in 1988 to correct 2 aneurysms.

Why mention this sad news here? Well, I don't know much about aneurysms but I wonder if we will ever able to develop a cost-effective, benign way to screen for them. Right now, I believe the options are basically a CT head with contrast or a cerebral angiogram, but the former exposes the patient to radiation while the latter not only has the radiation exposure but is also invasive. Still, given the catastrophic outcomes of a ruptured aneurysm, I wonder what the cost-benefit analysis of screening would be. Anyone out there have any idea? Just curious.

What's the difference between the INS and U.S. Hospitals?

Answer: Only INS has the legal right to deport illegal immigrants.

Yet, some U.S. hospitals have taken it upon themselves to deport patients who are illegal when they overstay their welcome. In this NYTimes piece, writer Deborah Sontag chronicles the journey of an illegal immigrant from Guatemala Luis Alberto Jiménez and his misadventures with Martin Memorial hospital in Florida. After work one day, Mr. Jimenez was in a car driving home when the car he was in was struck by a drunk driver. He was taken Martin Memorial where he was initially given a poor prognosis due to his traumatic brain injury (TBI) and other trauma. He was in a comatose state for nearly a year. But then:

Eight years ago, Mr. Jiménez, 35, an illegal immigrant working as a gardener in Stuart, Fla., suffered devastating injuries in a car crash with a drunken Floridian. A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him as a ward for years at a cost of $1.5 million.

What happened next set the stage for a continuing legal battle with nationwide repercussions: Mr. Jiménez was deported — not by the federal government but by the hospital, Martin Memorial. After winning a state court order that would later be declared invalid, Martin Memorial leased an air ambulance for $30,000 and “forcibly returned him to his home country,” as one hospital administrator described it.

While I understand the hospital's dilemma, the article notes that other options were available:

Jack Scarola, representing Mr. Jiménez’s guardian, said that he empathized with the hospital’s “significant economic burden” but said that it was the “quid pro quo” of accepting Medicare and Medicaid funds to help finance the hospital’s services. (About 45 percent of Martin Memorial’s net operating revenues came from Medicare and Medicaid last year, based on state data.)

“Also,” he continued, “they chose the wrong way to deal with it. The right way would have been through the Legislature. There is no program in place to appropriately distribute care to undocumented persons who are catastrophically injured, and there should be. But you don’t stick a brain-injured immigrant on a private plane and spirit him out of the country in the predawn hours.”

Keep reading to see what kind of conditions the hospital left Mr. Jimenez in. In public hospitals, as many medical students know, the issue of 'disposition' often becomes a patient's most significant one, far outshadowing their medical concerns. Still, no matter how dire the disposition issue may be, hospitals and communities must find better solutions than dumping their patients overseas.

Randy Pausch's Last Words

Many of you have seen Randy Pausch's Last Lecture on Youtube and elsewhere. If not, check it out (1 hr, 16min):

Although his talk does not directly relate to medicine, it is generally applicable to people in many walks of life. For us in medicine, I think the parts about brick walls are especially useful. A recent post noted what were quite possibly his final words:

Mr. Seabolt only shared a few moments with viewers, noting that even near death, Dr. Pausch’s sense of humor remained. He said Dr. Pausch talked about how glad he was that he was home and his family and friend were close, and laughed, saying, “I just feel so bad about the dying part.”

Mr. Seabolt also relayed a conversation he had with Dr. Pausch’s 6-year-old son, Dylan. They were talking about cancer and he told the boy that “some problems can’t be solved, or they can’t be solved yet.'’

Dylan responded, “My daddy has taught me that every problem can be solved, and that I should believe that every problem can be solved, and that I’m strong enough and smart enough that I should never let a problem get in my way.”

At the end, as Dr. Pausch’s body was clearly failing, Mr. Seabolt said he told his friend, “It’s important for you to feel like you can let go. It’s okay.”

Dr. Pausch’s reply: “I’ll get back to you on that.'’

And those, according to Mr. Seabolt, were the final words of Randy Pausch.

Hopefully some good has come of his tragically early loss to pancreatic cancer.