On Saving a Tiny Life

A 93-year-old neighbor, a chemical engineering doctoral student, and I all helped save a baby grackle two nights ago.

The student didn’t have to watch the grackle–it had fallen to the ground and couldn’t fly–until someone showed up to help her.  I didn’t have to stop my night run to ask her what’s going on.  I didn’t have to offer to take the bird home with me in hopes of taking it to a wildlife rehab center the following day.  Nor did I have to babysit the bird until she went up to her office and returned with a plastic bag.  She didn’t have to call nearby vet offices to see if any were open so late at night.  I didn’t have to scoop the bird up and take it home.  My neighbor didn’t have to answer or help me out when I knocked on her door at 10 pm.   She didn’t have to take the bird in–by this time I had put it in a shoebox with some water in an overturned plastic lid–and watch it for me until I returned from work the following day and could take it to the rehab center.  She didn’t have to–she has rheumatoid arthritis–take the bird to the vet in the morning, where they took it from her and put it on track to be rehabilitated.

We could have ignored the baby bird.  Like a typical tourist who skims over the new culture he’s exploring instead of diving deeply into it, we could have let things be as they were.  A stray or feral cat, fire ants, or a campus rat would have probably killed the bird overnight.  But we all chose to engage, and the bird lived at least another day.

Did it make a difference?  Does that even matter?  There’s this deceptively simple idea I’ve been running with for years, which is that you choose what makes you *and* others happy/thrive and you try to be productive along those lines.  In pseudo-biological terms, you choose to be the “anti-prion” that reconfigures proteins in its scope of influence for the better.  This constitutes a “good” life.  Your thoughts?

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Thoughts on “Hello Doctor” CEO’s Talk at Platform Houston

I just returned from a talk by Maayan Cohen, CEO of Hello Doctor. Hello Doctor is an app that uses OCR to digitize patients’ medical documents (lab & radiology results, H&Ps, progress notes, etc.), storing them locally on their mobile devices as well as in the cloud (everything is encrypted).

It’s a simple concept that’s actually very powerful in the fragmented world of medicine.  (In my mind, any moderately clever idea is revolutionary in medicine, because so many things in medicine are inefficient or broken.)  Physicians often see patients who have had extensive care elsewhere, but even when we officially request those records, we sometimes don’t receive them.  The patient who accurately remembers her medical history is quite rare.

An interesting feature of the app is the use of “big data” to help patients see what other patients have chosen at decision points.  (E.g., “65% of patients diagnosed with rheumatoid arthritis were started on this or that medication.”)

Overall, I was impressed with the app and I hope that it does well.  It has a direct competitor, Picnic Health.

This was the first “startup presentation” I’ve ever attended.  I surprised myself by asking her more questions than I expected.  I might have asked more questions than anyone else at the venue!  (Several other people asked very interesting questions, too.)  I asked her if physicians can easily transfer patient data from the app to their own medical information systems.  She said that’s tricky to do, both for legal and other reasons.  E.g., you can download only one document at a time…you can’t download everything in, say, one PDF or something.

After the talk, I introduced myself to a financial analyst who had asked several startup-related questions from the back of the room.  (I was introduced to the concept of “stickiness factor” by a question that he asked.)  We exchanged contact info.

A few weeks ago, I attended a Python programming meetup–this was my first “social” foray back into programming in at least a decade–and met a general surgery resident who had spent two years of a research fellowship creating a “smart” display for the EMR used in the SICU at his hospital.  He’d hired programmers and bought hardware with grants.  He told me something I won’t easily forget:  he said that administrators are too far removed from patient care, clinicians are too busy seeing patients, and that researchers are too busy trying to permanently establish their names in the literature for any of these groups to fix our broken healthcare system.  He said that it’s incumbent upon those physicians with a technological or entrepreneurial bent to try to do something to help out.

A few days later, he gave me a tour of the SICU, the hardware, software, and took me up to meet his team.  If things go well, they might start selling the system to other hospitals.  He suggested that they might have a position open this fall if the startup continues to succeed.  I told him I would consider it.

Lessons from a Brush with Death

This piece was republished by Salon on 7/18/14 and by KevinMD on 7/29/14.

I changed the original title, “Lessons from a Near-Death Experience,” to the above title because the idiom, “near-death experience,” is potentially misleading.

I almost died today. I was driving from one clinic to another, on a busy highway in the rain, when my car hit a standing body of water and hydroplaned. I lost control of the car, spun counterclockwise across three or more lanes, and slammed into the dividing median. I remember screaming “NO!!!” internally right before impact. I couldn’t believe what was happening as it happened.

As soon as I hit, the passenger-side airbag went off and I smelled smoke.  The SOS button flipped down, lit red; I pushed it.  The dashboard LED read “SOS”.  Hard rain.  I was in shock, couldn’t tell if I was hurt.  I wanted to get out of the car, opened the door: a woman came toward me with an umbrella–she had stopped ahead of me–and a man, aghast, ran toward me from the opposite direction.

I got out, she put the umbrella over my head, and they asked if I was hurt.  The man’s eyes were huge.  No, I don’t think so.  I’m not sure.   I don’t feel any pain.  I don’t think I hit my head.  I didn’t lose consciousness.  She said, call 911.  I called 911.  I could barely hear the person on the other line over the traffic.  We tried to tell her where we were.  A volunteer firefighter happened to see us and stopped.  He called the fire truck.  They kept asking me if I’m sure nothing hurts.  “Do you need to go to the hospital?”

Do I need to go to the hospital?

I’ve worked in a hospital more days than not for the past half-decade, spending most of my time and energy trying to heal people brought down by misfortune.  This should be one of the most rewarding activities on Earth.  Recently, though, in the void following a failed relationship that was doomed from the start, I had become increasingly jaded.  It’s one thing to be helped, and it’s an entirely different thing to be the helper.  I was near burnout.  Upon reviewing the past year, I realized that I had made some critical mistakes:  instead of growing outward and integrating as well as possible with society, trying my best to push for positive change in collaboration with others, I had withdrawn inward, hermetically developing my inner world.  Staggered by these insights, I vowed to change.

Today, standing in shock in the rain with two anonymous, good-hearted people as they helped me out of this terrible situation, I realized how critically important it is to be the helper.  For the person in great need, it’s the most important job in the universe.  Nothing could possibly be more important.

I couldn’t believe I was given another chance at life as an intact human being.  I could very easily have been killed or maimed.  Worse, I could have hurt other people.  Miraculously, neither happened.

I shook the woman’s hand, asked for her name, but she said to call her an “anonymous Samaritan”.

Anonymous Samaritan.  As she should be.  We should all be anonymous Samaritans.

As a rheumatology fellow, I often see young patients with rare, potentially debilitating diseases.  Sometimes I diagnose them, or they come to me with a recent diagnosis.  They’re always worried about prognosis.  They feel their soaring flight has been shot out of the sky by a stray bullet.  Is it their fault, they ask?  (Not usually.)  They repeatedly feel out the potential avenues of their fate now that they are among the “marked” people of the world.  I’m always patient with them, giving them the time and space to explore their thoughts.  They are engineers, musicians, programmers, students, and others.  Sometimes, they call me after the visit and we have the entire conversation again.  They don’t want to take medications, especially “serious” medications like most DMARDs and biologics.  My job is to try to restore their carefree flight.  Sometimes, they are too far gone, or don’t respond well.  Sometimes, they feel brand-new again.  It’s always a different story.

When the firefighters arrived, they asked the same questions.  Are you sure you’re not hurt?  Maybe you should go to the ER.  No?  Since nobody was hurt and it was a single car accident, no need to call the police.  They gave me some tips about body/repair shops and dealing with insurance companies.  This was my first experience with a car crash.

The tow truck then arrived, my car was loaded onto it, and the driver, a big, affable man with a gray beard, introduced himself and gave me a ride back toward the medical center.  He said the woman with the umbrella had told him that she saw my car spin toward the median as she drove behind me, and that she’s amazed I’m still alive and didn’t hit any other cars.  He said, “You’re blessed.  You do good things for other people, so the good Lord saved you!”

I’m agnostic, but for a moment I wanted to believe him.

He dropped me off at work, where, after talking about the wreck with attendings, staff, and co-fellows, I called a patient whose MRI had been read, providing the final piece of information needed to diagnose him with ankylosing spondylitis.  He’s only two years older than me.  As at our initial visit, he had many questions.  He’d read many papers on his own about spondyloarthritis and the available treatments.  Online, he had seen those iconic photos of a man with ankylosing spondylitis whose spine becomes progressively deformed and was worried that he might end up the same way.  We explored the prognostic possibilities.  He worried about the potential complications of treatment.  He wondered if he might never feel normal again.  Patiently, question by question, I walked with him through the shocking experience of being diagnosed with a potentially debilitating disease.  In a sense, the vehicle of his life, his body, threatened to spin out of control and off the highway, potentially crippling, if not killing him.  I tried my best to be his good Samaritan with an umbrella, a calming manner and warmth in cold, blinding rain.