Saccadic Eye Movements

Put one finger about arms length in front of you. Now slowly sweep your finger from the far left of your visual field to the far right, while tracking your finger with your eyes. Notice how you can "see" the blurry background even if you are focused on your finger.

Now place the finger of one hand at arm's length near the border of your peripheral vision on the left and the finger of your right hand at about arm's length near the rightmost border of your peripheral vision on your right. Now quickly switch from focusing on one finger to focusing on the other finger.

By now you are probably thinking, "This is supposed to be interesting, it seems pretty routine to me." But dig a little deeper. In order for you to switch your focus from one finger to the other, your eyes "saw" everything in between. But did you experience a sweeping image, or did you see one image "jump" to the next image.

If our brain merely interprets the information from our eyes as is, you should see a fast, blurry sweep as you shift your gaze. But you don't! Somehow your brain blocks out almost all of the input from the time you decide to shift from one finger to the next. It's almost as if all that exists between one focus and the other is a timeless vacuum. The movement of focus from one object to the next is called Saccadic Eye Movement.

And where does the time go? When you looked from one eye to the other, did you perceive any delay? I don't think that I do. Although the time between looking at something on one end of your vision and the other end is only a matter of tenths of milliseconds, imagine all the times that you switch focus during a year--it must be on the order of minutes when all added together. Not to make this stray into the realm of science fiction, but where does all the time go? It seems as if your brain tells you that the time never existed.

We know so much about the human body but we know so little, and it's things like this that keep us coming back for more--despite the drudgery.

Where Do We Get Off

Where do we get off. When did medical students start thinking that they run the show? Has disrespectful behavior always been a problem at schools of graduate education? Is it because we all have a bachelor's degree in something and we think that qualifies us to complain nonstop?


One of the most disturbing trends that I have witnessed while at medical school is the drastic increase in the amount of complaining and improper conduct towards professors. During the class time, a student once raised his hand to ask a professor a question, here's how it went:



Student: Doesn't that enzyme do the opposite in the presence of insulin

Professor: Well, I don't think that is correct

Student: No, that is correct



Since when is this considered acceptable behavior? Since when have we decided that that is appropriate for future professionals?

I think it goes back to how many in my generation were raised. A lot of people have mentioned that our generation was the first "you can do anything!" generation. What I mean by that is that most of my generation had parents that told them they could do anything. Never mind that they have no singing ability, you are the worst parent in the world if you don't make them feel like they are the next Pavaratti.

I've always thought my parents did it well. When I was a kid, I wanted to play professional basketball. Rather than just say, "Sure you will someday, you can do anything you set your mind to," he was very pragmatic about it. He said things like, "If that is something that you want to do, than you will have to make big sacrifices to get better at the sport." And I did, for awhile--but then my friends wanted to play with GI Joes, or there was a new movie out at the theater, and I gradually realized that professional basketball wasn't in my future.

I think the best thing that parents can do is encourage their children that many things in life are attainable through hard work, but without having certain innante physical or mental gifts, not everything is possible. If I am 4'7" I'm probably not going to play center for the Piston's someday. If I don't have anything resembling a singing voice, I probably won't be a world famous singer. This doesn't mean that I shouldn't work hard, but I should have parents who can see the gifts that I have and steer me in the right direction.

Another reason that I think that there is so much trouble with respect and discipline is the Political Correctness wave of the 90s-2000s. Don't get me wrong, there are aspects of PC that seem reasonable, such as eliminating the terminology of phrases such as "you people," e.g. "you people are all the same... But one of the downsides of the PC movement is the idea that there is nothing that is right or wrong.

Heaven forbid a teacher uses red ink to grade a paper! Who knows what might result from that! The child's fragile psyche could be forever damaged as a result from the 70% that they got on a test. It's pure ridiculousness and I think that it has contributed to the mentality that many of my peers have that they are always right. Not to mention the fact that they are probably angered that medical school grades are on a strict curve, and that 2/3rds of the students don't get scores above 90% anymore.

In summary, it's very frustrating to be surrounded with so many smart yet rude medical students, especially when the few obnoxiously vocal will be thought of as representative of the entire class.

Top Ten Pistons Buzzer Beaters

I was wasting time on YouTube when I stumbled across this clip--my dad and I were at the game where Stack hits the game winner (#9). Also, if you look close you can see Alvin Gentry and Doug Collins--two former Piston coaches.



Here's one by Rasheed

The Allure of the Mountains

What is it about mountains that draw so many people to them? Second only to living on the water, people seem to have an almost magnetic draw to living at higher elevations (or at least near them). So sacrificing the rich, sea-level air millions of people either hike, climb or live among the mountains.

In my experience with some of my family members, you can never explain the allure of the mountains to someone that does not have an innate draw to them. So if you have never dreamt of what it might be like to stand atop a mountain, you may not resonate with any of this. I can explain to my parents what an awesome experience it was to climb Horn Peak (see above and right), but they just don't get it. Maybe it is because they are from a time where there wasn't alot of free time to pursue interests such as hiking or mountain climbing, or maybe it is just because they have no inner "call of the wild," but for some reason, I can try to explain my motives until I'm blue in the face but they never seem to "get it."

To me the mountains represent the unknown. Every step upward is a step into a world that very few get to experience. A world of mountain meadows, evergreen forests, and snow capped peaks. The time I've spent in the mountains has been an opportunity to spend a day in another world. In an age of urban sprawl and suburban developments, mountains represent one of the last natural frontiers onto which the spoiling hands of humanity haven't yet reached.

Mountains also offer one a measuring stick. A test of willpower and overcoming the screaming pain in your legs with mental toughness. They allow you an unparelled test of endurance, as many climbs last hours to days.

Mountains are the place where world class athletes and a run-of-the-mill healthy individual are brought to similar levels. Many people falsely think that anyone who climbs mountains, does it so that they can inflate their ego by saying that they summitted Mountain X. Perhaps due to the huge numbers of people who attempt to climb Everest with little previous experience, often resulting in unnecessary deaths, many people have it in their minds that the only reason you would want to climb is so that you will have one more trophy for the mantel. But for me, climbing was much more than just reaching the top.

It was the stream that we found halfway up, with hundreds of small waterfalls as the snow melt made its way down the valley. It was the 10 of us, encouraging one another to keep going. It was the last 100 yards that couldn't be covered more than 5 yards at a time. It was the 10 of us encouraging each other to keep going. It was the knee deep snow we had to tromp through. All of these things came together to make for a once in a lifetime experience.

In a world of entertainment with increasing television watching and increasing obesity, mountains offer the opportunity to step into a world that few others will ever enter. A world of reality, where goals their accomplishment are crystal clear. An opportunity to see the world around you in a way like never before. A chance to get away from the constant noise of modern society and think clearly for the first time in a long time.

Simple NCAA Tournament Picking Rules

Here is the backbone of my rules for picking teams in the NCAA Tournament.

1. Always choose the #1 Seeds in the first 2 rounds, almost always in the third round.

1a. The following rules should be disregarded in the final four. Then you are on your own.

2. Never pick a team whose name is "X State" unless it is Michigan State (Kansas St. got me this year, but it almost always holds true).

3. Never pick the underdog that everyone else is picking--George Mason proved this point.

4. Pick the Big Ten teams to beat any other team not in the ACC--even then think about picking the Big Ten team. See point 14 for a clarification.

5. Pick West Virginia to win unless they are seeded worse than 11.

6. Pick Syracuse to win at least two games any time they make the tournament.

7. Don't pick teams that got in because they have done well in the past, e.g. Arizona (I almost pick AZ because of Kevin O'Neill--the former Detroit Piston's assistant, but luckily I realized that would have almost violated rule 15).

8. Pick any team with the word "Texas" in it until you would be forced to violate one of the other rules.

9. Never pick 16 seeds over 1 seeds or 15's over 2's, nice try though Belmont.

10. If all else fails pick teams that you want to root for, it will at least make the games more interesting.

11. If you are going to pick a big upset, pick a team that is "hot" coming into the tournament. If George had beaten Xavier like it looked like they would, that would have shown this to be true.

12. Never pick Duke to go far if they are a 2-6 seed. For that matter, ACC teams that get seeds between 2-6 don't usually do that well.

13. Michigan State will either be eliminated in the first round or make it to the final four, in most years.

14. Never pick low seeded Big Ten teams, the probably suck and only got in because of the "strength of the conference."

15. Don't pick a team that lost its coach midseason. This could be called the Indiana 08 rule.

16. Never pick against a Tom Izzo disciple (this is one of my Cardinal rules). This applies to Tom Crean at Marquette and wherever Kelvin Sampson ends up. I never picked against Oklahoma when Sampson was there and I wouldn't have picked against Sampson at Indiana. In the case of a head to head pick Izzo over Crean and Crean over Sampson.

17. When rules contradict use your judgement.

18. Bo Ryan at Wisconsin is one of the 5 best coaches in college basketball, pick against him at your own risk.

Why Medical School is Awesome (Opening Black Boxes)

We live in a world of black boxes. Most of us go through the day fairly oblivious to why things are the way they are. We know that a spark ignites a mist of gasoline to power our car. But can we explain the process of the internal combustion engine much further than that? I know that I can't.

The same is true for our bodies. Which isn't to say that the average person is completely ignorant of biomechanical processes, I've known since high school biology that when one puts their hand on a hot stove a reflex arc is triggered that causes you to quickly remove your hand before you are even consciously "aware" of it. But with that level of knowledge, you sometimes don't even know what you don't know.

But one of the best aspects of medical school is that you are constantly confronted with aspects of medicine that most of the world views as a black box. For instance, the subject matter for today was the anatomical basis for pain. To me, pain has always been more of an idea than something concrete. Pain is what happens when you try to open a package with a sharp knife and it slips and cuts into your finger. But in medical school you get the opportunity to dive deeper.

You can understand the basis for why you rub your arm after bumping it on the table. You can understand why people with spinal cord damage have very little return of functionality below the damage, but even better you have a whole new set of deeper questions you can explore.

Somewhere within the difficulty of medical school are the things that keep us coming back, things like opening up black boxes.

An Out of Context Quote

"So if you wanted your orgy to go well you went to Bachhus"
-My Pastor

The Free Clinic (The Importance of Speaking a Patient's Language)

(the details of this story have been altered)

Yesterday at the Clinic that I volunteer at periodically there was a man who came in who is a missionary to Detroit. Yes, that's right he has been sent from his home country of Venezuela to be a missionary to the Spanish speaking population of Southeastern Michigan--perhaps a sad commentary on the work that the local churches were doing to minister to those of the inner city.

So I went out into the waiting room and called Mr. Hernandez back into one of the rooms of the clinic. As we were walking, I asked him if he spoke any English, to which he responded in the negative.

I did my best to stumble through some of the basic spanish that I still remembered from undergrad combined with a few of the medical terms that I had picked up while working at a clinic whose patient population is 50% hispanic. Most of the sentances sounded something like, "Uh...necessito tocar...uh...su......pression." But as is the case most of the time, he was more than happpy to pretend like he understood every word I was saying rather than appear rude.

This guy had really high blood pressure, and I mean really high. 196/120 high, and I noticed from his chart that he had somewhat poorly controlled hyperlipidemia (high levels of "bad" cholesterol etc.). Once I had taken all of his vitals I told him that I would be right back with the "doctor," who is actually a nurse practitioner--but I didn't know how to say "nurse practicioner" in Spanish, and even if I did, I doubt that he would have any idea what the difference was between that and a doctor.

The next time we went back into the room, we brought one of the medical technologists from the clinic who was fluent in both Spanish and English. Here's how it went.

Sandra
"Ask him if he has been taking his medication"

Translator
"Yada yada yada (for the next minute)"

Patient
(Talks to the translator for around 45 secs)

Translator
"He says that he always takes his medication"

Really. That's all that he said in 30 seconds of talking? I take my medication. Tocarlo. It seems like he could have said that in a word or two, what did he use the other 40 seconds to talk about? And what were you saying the whole time? Neither me nor the LPN said anything (and I'm not sure if she even thought about it, but for me it was a bit of a disconcerting experience).

I realized then why the other doctor wanted me to do as much as I could without using a translator--especially when the only translators that we have available have very little background in medicine. A couple more examples:

Later on the translator kept saying that if he came back and talked to the nurse who specializes in diabetes, they could give him a meter for checking his blood sugar. But when the translator repeated the phrase in spanish she said we would give him a machina para pression (basically, a machine for checking his blood pressure).

I really knew that the message wasn't getting across when the translator didn't know the English word "testosterone," when she was explaining what the patient said to her.

So much of the medical interview can hinge on a single word. Did the patient say he checks his blood sugar occasionally or often. Has he had high blood pressure for 5 years or 14 years. What is the nature of the pain in his chest, is it stabbing or is it like someone is sitting on top of him. These difficulties are increased when you get a translator that fancies herself as a doctor and feels that what gets asked during the medical interview is her business.

The best translators that I have seen are those that take one sentance the doctor says in their native tongue and translates it into one sentance in the patients language. When the patient responds, the translator should stop the patient every sentance or so in order to translate back to the doctor. But in a larger sense, this experience has reminded me how important it is to learn as much as I can of Spanish, as it would be one of the most valuable foreign languages to learn as a future doctor in the United States.

Very Old Posts--Take Three.

Here's the only post I ever wrote about medicine until I started this blog, it's funny how I have to learn this lesson over an over again.

Saturday, February 12, 2005

Someone said something that I really should take to heart the other day. At the meeting for pre-med students, I asked what sacrifices the three-doctor panel had to make in med school as well as during their residency, and one of the doctors said something really thoughtful. She said to enjoy the stage of your life you're in. That seemed so true to me because we, as humans, spend so much time wanting to be older when we're young and wanting to be younger when we're old. Not only that, but often times we fall into the trap of thinking that the next stage in life is going to somehow be easier. If I can just get through college then I can start living life and it'll be so much easier... But in reality life really doesn't get any easier. So why not make the most of the life that you're living right now, no matter how bad it may seem.

Second Thoughts on Information Sharing

After being very opinionated about how I would never share information relating to study material here, I found out something interesting about myself.

I received an email informing me of a new program that is just beginning this summer for students in between their first and second years of medical school. As far as I know, this email only went to me, and only because I had applied for a similar program that they decided to discontinue. At the bottom of the email they asked if I might be able to spread the word as they wanted to have 9-10 students take part in the externship this summer.

So what did I do. Without even thinking twice I put together an email that made this program sound like it was the best internship ever, and sent it out to the entire class. For a moment I thought about not sending out the email because the more people that applied, the more competetion I would face, but a second later I decided to send it out anyway. I guess it just goes to show you that someone can support healthy academic competition while still believing that competition doesn't have to extend to all parts of life.