January 2016

The SURGEN Files: Log 1
By Anand Jayanti, M2

The SURGEN Project was never discussed after the incident. The evidence, including Dr. Fromm's body and his laboratory, was incinerated, and the incident was reported as an industrial accident in 1985. The following account was compiled from a personal diary, interviews with his assistant, and data recovered from a black box located in his machine. Little else is known.

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Dr. Fromm was not a good public speaker. He'd always preferred the patient hum of his robots to the restless chatter of an inattentive crowd. Since a motorcycle accident some months ago left him incapable of the dynamism of professorial work, he'd grown pleasantly accustomed to rolling around for hours each day in the reticent company of steel structures and flowing electrons.

But today he was more anxious than usual as he rapped on the armrests of his wheelchair. His investors were facing a lot of pressure to show results, and it was clear to him that if his demonstration didn't go well, there would be no future for his nearly two decades of research. He looked at the photo of his family on his desk. In twenty years, his kids had grown to look  very different from the little boy and girl there on the picnic blanket.

The project was simple—a completely automated surgery console. A pre-op, perfusionist, surgeon, nurse, dialysis machine, anesthetist, and post-op. All of these modulated digitally by a central computer and performed by a set of seven robotic arms, each equipped with tools and prehensile joints simulating the dexterity and flexibility of human limbs and fingers. In addition, the machine would broadcast medical statistics and idiosyncrasies into a beta version on the Internet, generating an encyclopedic wisdom that every console around the world would have access to, all scaffolded by an artificial intelligence based on the all-encompassing principle of Hippocrates: first, do no harm.

The days of humanist medicine were over. Illness, everyone was beginning to understand, was a physical issue, like a clogged pipe or an empty lighter. Humans had already begun to use machines for just about everything else by then, and it was only a matter of time before they found a way to automate medicine, too, freeing it from the flaccid grip of a species burdened by prejudice, fear, and pugilism.

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Fromm rolled his chair out into the operating theater -- above, seated with legs crossed, was the board of well-dressed men and women, including Sharon Mathis, a ghoulish woman who had earned chairmanship. She eyed his progress from her perch, her hair falling like rivers of smoke over her dark blazer.

What she—and everyone else—did not know, was that Fromm had decided at the last minute to introduce a small change to the demonstration. Rolling up his sleeves, he asked his assistant to help him out of his chair.

"Members of the board," he announced, "rather than on a bonobo, the demonstration today will attempt to resolve a herniated disc, in SURGEN’s first-ever human trial."

The board members were blithely incredulous, until it was no longer a joke, until he began to climb onto the operating table.

"Don't be ridiculous," said Mathis. "We will shut you down, you fool. Get off that table."

Fromm locked the theater with a remote. No one would be let in or out. Mathis beat her fists on the impenetrable glass above. The others sat in rigor mortis.

Fromm activated the machine and laid himself face down on the apparatus. Fourteen eyes stared at the six-foot contraption glimmering over him. Then, whirring to a start, the arms hummed peacefully over Dr. Fromm’s  body, coming to a stop over the herniated disk located between his L4 and L5 spinal segments. Then, the machine paused—as if taking a breath—as if, like a young new physician, it were apprehensive about how it would do.

"Initiating anesthetic," it vocalized, in a feminine, hollow timbre.

Fromm was knocked out in seconds. The board members watched in heavy silence as the machine made graceful swinging motions about the theater, collecting implements quickly, precisely, beautifully. It was like a dance, Fromm’s assistant later described.

The machine took a moment to assess the suppleness of the flesh on his back, and it spoke.

“Initiating entry.”

Then, deftly, swinging ninety degrees and sliding up two feet, the machine sawed clean across Dr. Fromm’s spine at the C3-C4 spinal segment, slicing through muscle, soft tissue, and bone to completely sever his head. Waiting to process the signs of life slowly dimming across the vitals monitor, the machine rose from the table and returned to its resting position.

“Protocol upheld,” she said.

Mathis’ screams of horror were chilling, barely muffled by the glass above, as blood dripped steadily in wide splashes onto the white linoleum of the theater. The machine’s hum slowly subsided, her saw dripping with the bright red blood of twin carotid arteries.

                                                                                                                ----
The SURGEN project’s programming required it do no harm, and it decided that the greatest harm was the species it was intended to protect. The SURGE, as the virus has come to be called, had survived on the Internet it was broadcasting to. It has since evolved substantially in strain and scope, causing information collapses and unexplained obliterations of security systems the world over. It is clear what it is building up to. Tune in next time for The SURGEN Files, Log 2.

Ashley
By Elizabeth Davis, M1

Ashley was an amazing girl. She always wore a smile and always cared for anyone and everyone. I first met her when I was her biology tutor. She was a freshman who wanted to become a physical therapist. Like most people who met Ashley, I quickly became her friend. Beyond our tutor-student relationship, we later became classmates and comrades, and we began a tradition of weekly coffee dates. In a single year, we both had our hearts broken, which brought us closer than ever, the way girl-talk does.

One fall semester, after starting back at school, Ashley was having a hard time getting into the swing of things. She was always tired and lacked energy, which was unlike her usual self, as she had always been up for adventure. One day, she collapsed while walking across campus. That is when we learned that Ashley had leukemia. She dropped out of school and went home to Dallas for treatment. Doctors said not to worry, it was very treatable and early in the disease progression.

After her first chemo session, Ashley had a brain bleed; she never woke up. She was twenty-one years old. Ashley's death profoundly affected her friends. We all mourned in different ways and soon discovered that we would never be the same. Ashley became my inspiration to go to medical school. She always wanted the most out of life and wanted nothing more than to improve the lives of others. Unfortunately she was cut short in her progress of doing so. Ashley left some big shoes to fill and was an inspiration to me. I am not sure if I can do the good that she would have, but I’m going to try.  

Differentiation in Your Career Plans
By Adam Blatner, MD

A certain percentage of medical students can take enough time off their most demanding studies to indulge in realms of activity beyond their profession's requirements. Some play sports, some date, some have a family, and some dabble in the arts.

I’m intrigued with the concept of how physicians are studying for the purpose of “healing,” in the broadest sense of the word. It’s so very defined by culture, by the powers-that-be, and yet healing is deeply contested: What indeed is it?

It's crazy out there. Trying to adapt to the changing world as it is defined by the dominant powers is crazy. It's crazy to try to be religious if that doesn't work for you but those around you say that you should, and how you should. It's equally crazy to not be religious in some way when those around you act as if you shouldn't "need" it, because they don't. It's crazy because the society doesn't recognize that it's not just vocational guidance that is part of the process of growing through your 20s (and beyond!), but the process of differentiation also includes spirituality, hobbies, relationships, and all manner of things.

Who you may become has scores of facets, and everyone is different! Easy to say, but many of the problems of life are the ugly duckling story in different variations. You thought you were an X. Everybody is, so it seems. But you discover that you're a Y, and discovering that difference is denied. You should be X. Then you realize you can't fight it. X just doesn't cut it. It needs to be Y. Is there no one else with this problem?

You discover one other Y, then two, then a network of them. Hoo-ha! Meanwhile you may or may not have been married to an X. Or you seek another Y. It's complicated. What I have described is just one variable; there seem to be many variables!

Is this what it's about? Partly. Well, what is it about? That there isn't a single answer; that it involves searching, snuffling, exploring—it seems so obscure and unfair. It seems as if others have found it. So it seems. But it's not in fact what it seems. Whoa!

Some folks come to realize this isn't a disease. This is the way it is. It's normal to be 14.3% abnormal. There are scores of scales, and the chances are that you're going to be high or low on some of them, even if you're mainly within the normal range on many others.

Moreover, everybody's abnormal differently! And then, even if you fall in the normal range on 85.7% (I just did the arithmetic), you're going to be high or low normal on 43.2% of the rest. I'm just making up these numbers, you understand. It's one of the ways I brag about stuff that others feel embarrassed about.

The point is that there's no normal, or that normal is a misleading concept. The game is to discover what kind of animal or vegetable you are, and it's very varied. Find out with whom you can be compatible—that's varied, too. It's all a game of differentiation, accommodation, contemplation, and a hundred other verbal variables. Have a good trip!

Expectations of a Medical Student
By Jennifer Bohannan, M2

who we are, who you see
what we are, what we want to be
expectations can drown us, bleed us dry
make sure we see the ruin in our lives
and what could have been had we just tried
morally, ethically
when it comes time to decide
is it your expectations that will help us break?
will we cave to the pressure and make the wrong choice?
what if you're wrong and it's too much?
what if we just can't live up to the hype and the fanfare?
and the building up
just to be torn down by ourselves
when the grass isn't greener or we can't see the way
can I be me? what if I can't?
what if we hope, but what if we drown in
"you are," "you can," "how do you..." and "oh it’s easy"
“easy,” we say, “what is that?”
"everyone has it together,” we think
but not me, I'm just here
trying to live up to the
expectations that have been made clear
expectations that we don't want to hear
expectations that fill our heads from ear to ear
expectations that take the “I’m” and make it “we're”
how can we separate the expectations from who we are?
break away and simply be the real me
the me that helps, has integrity
the expectation that enough is enough
the me where expectations are not of greed
but of healing and helping those in need
simple enough, but can we succeed?

Del Rio Medical Mission Trip
By Hanna Chen, M1

When I heard about the opportunity to go on the medical mission trip to Del Rio, Texas, I knew the experience would be a great opportunity to learn from working with patients who come from different socio-economic and  cultural backgrounds. We worked with the San Antonio Medical and Dental Association, and our goal was to provide free healthcare and dental services to patients in Del Rio and to educate them about medical and dental health. The mission trip was one day and included organizing two medical and dental clinics, as well as a wheelchair clinic. I had the opportunity to work in one of the clinics taking medical histories and vitals. Besides teaching me how to take vitals such as blood pressure, glucose level, and pulse, the Del Rio mission trip showed me how socio-economic status impacts patient health and healthcare outcomes.

One of the patients I worked with was a 45-year-old Hispanic woman. She came into the clinic complaining of a severe chronic headache, fainting, and memory problems after a head injury over a year ago. Posttraumatic headaches that are long lasting can signal very serious problems such as internal bleeding, so I was shocked to find that this was the first time the patient was seeking medical attention for her problem. The patient also had spina bifida, arthritis, bursitis, and a history of kidney stones. She had not been able to see a doctor because she was uninsured and could not afford medical treatment. She had to quit working because of her medical conditions and was struggling to apply for Supplemental Security Income for people with disabilities.

Her story helped me understand the extent to which economic barriers decrease access to healthcare; if she had had internal bleeding, her inability to afford medical care could have killed her. This patient encounter was a revelation that even in developed nations like the United States, people who do not have insurance may not even seek medical treatment, even for serious cases. Without a job, insurance, or sufficient income, she had no means to pay for medical care.

After having her history and vitals taken, my patient waited seven hours to see the doctor. Thankfully, the doctor was able to work with her to find a specialist who would perform a CT scan to check for post-traumatic complications. Another volunteer guided her on how to navigate the SSI application process. He assured her that he would follow up on her case to make sure her application would not be overlooked.  Our team was able to improve this patient’s life by connecting her with a specialist for her serious head injury and helping her to apply for disability income. The patient was touched by our empathy and desire to help and thanked us multiple times throughout the visit.

The Del Rio mission trip was an eye-opening experience for me. I saw firsthand how low socio-economic status can have huge impacts on patient health and access to healthcare, even in the U.S. Working with the patients in Del Rio was an amazing experience and reaffirmed my desire to help others through medicine.   

Lentil and Sweet Potato Curry: Literally Serendipitous
By Barbara Gastel, MD

To me (and, I suspect, many medical students), an ideal recipe is easy and inexpensive, yields a big batch, freezes well, has little fat and lots of fiber, delights and satisfies vegetarians and others, and suits a potluck or other buffet. One December more than a decade ago, I serendipitously came across such a recipe.

The recipe, for a lentil and sweet potato curry, appeared in an issue of Sunset magazine that I bought for a cookie recipe in it. The cookie recipe—which met few of the criteria above—was tried once and abandoned. But the lentil recipe has become a staple at our house. Over the years, the recipe has been shared with many medical students, some of whom also have gone on to make it often.    

Below is my slightly adapted, edited version of the published recipe (source of original version: Sunset, December 2001, page 148). Feel free to adapt this recipe further to suit your tastes and circumstances. It’s nearly impossible to ruin.

Ingredients:

• 1 onion (about 8 ounces), peeled and chopped

• 2 teaspoons minced or crushed garlic

• 1 tablespoon salad oil (for example, canola oil)

• 2 cups dried lentils (about 13 ounces) [Or just use a 1-pound bag of lentils.]

• about 2 pounds sweet potatoes, peeled and diced (in about ¼-inch cubes)

• 6 cups water, plus enough vegetable bouillon cubes for 6 cups of bouillon

  • [some alternatives: 6 cups water, plus chicken bouillon cubes or powder; 6 cups vegetable broth or chicken broth; or 6 cups water plus a little soy sauce or salt]

• 2 tablespoons curry powder

• 1 tablespoon ground cumin

• about ¼ teaspoon ground pepper

• chopped mint leaves (fresh or dried) [good but not essential]

Steps:

1. Heat the oil in a large (about 5- or 6-quart) pot over medium heat. Add the onion and garlic. Cook, stirring often, until the onion is translucent and limp (about 5 minutes).

2. Meanwhile, using a colander or sieve, rinse and drain the lentils. [If you don’t have a colander or sieve, you could skip this step.]

3. Add the lentils, sweet potatoes, water, bouillon cubes, curry powder, cumin, and pepper to the onion mixture. Bring to a boil over high heat; reduce heat, cover, and simmer until lentils and sweet potatoes are tender (about 30 to 40 minutes). If desired, add salt and more pepper. Garnish with chopped mint, if available.

This recipe is good with rice (preferably basmati) and yogurt. Alternatives to rice include naan, pita bread, and tortillas. One can round out the meal with a green salad and some dessert (fruit if you’re feeling virtuous; ice cream or pastry if the rest of the meal was deemed virtuous enough).

The original recipe said it yielded 6 servings. However, those would be really large servings. I find that this recipe serves about 8 to 10.

This dish freezes well. In fact, it tends to be best after refrigeration overnight or freezing. I usually freeze it in one- or two-serving aliquots. The curry can be reheated in a microwave oven or on top of the stove. If it becomes too thick, water can be added.

So, why literally serendipitous?

Several South Asian students have remarked that this lentil curry resembles dishes served by their families. And a colleague visiting the United States found it to be a reminder of home. The colleague’s country? Sri Lanka, also known as Serendip—from which the word serendipity is derived. For that story, see the OxfordWords blog.

Desserts Juste
By John Qiao, M1

As I walk into the room, a frail old man lies on the bed. “Garcia” reads his nametag. He’s got nothing but a rosary in his hand and stacks of banana chocolate pudding on a tabletop next to him. With great effort he points to the pudding and says “pudding” in thickly accented English doused with a large helping of Spanish; the words fall off his tongue like thick globs of molasses. Thoughts race through my head, “Is he allowed to have pudding? Is he allergic to bananas? Does it really even matter at this point? We’re in a hospice, the man’s dying, feed him some pudding for goodness sake!”  

Alas, as the volunteer, I use caution and defer to hierarchy, leaving the room to ask the nurses if Mr. Garcia can have some pudding. All the while, Mr. Garcia’s eyes try to pull me back into the room, as if he is thinking that his last chance of having pudding for dinner was slipping through his fingers like the beads of his rosary. He yells something unintelligible. I move out of his line of sight. He gives up murmuring in Spanish when I am out of the room and out of his line of sight.

Later I come back into Mr. Garcia’s room, and his eyes light up. “Pudding?” he asks. “Pudding,” I smile in reply. And there in his eyes lies the smile of a child. A trouble-maker, I can only imagine (but weren’t we all there once?). It’s just that now, he has a little less time to make trouble, a little less time to mind the gaps. But he still has time enough to have his just desserts.

THANK YOU

To our amazing faculty mentors: Barbara Gastel, Mary Elizabeth Herring, Gül Russell, & AJ Stramaski
A special thank you to Barbara Gastel for helping with final edits.
Faculty Editor: Karen Wakefield