Thanks but no thanks

I’m going to go out on a limb here and say that maybe, just maybe, someone who spends two half-days a month seeing patients should not be giving unsolicited career advice to someone planning to spend 6-8 half-days a WEEK seeing patients.


Aphorism du jour

Haste makes … it likely that you’ll send your PI a veeeeery rough draft (as in, a methods section without methods…) such that the bulk of his feedback was along the lines of “Um. Have you written a paper before?”

Ugh. Embarrassing. This is why you don’t try to write a paper on an iPad mini in the airport jetlagged on 3 hr sleep.



Conferencing is hard

I just got back from two major conferences, the 2017 American Academy of Neurology meeting in Boston and the 2017 Movement Disorders Society congress in Vancouver. They weren’t back to back, but even just 6 weeks apart felt too close. All my post-AAN time was spent finalizing the poster for MDS (and stressing about whether my passport would arrive).

In terms of networking… I continue to be not great at this. AAN was a little better in that it was more interactive, and I felt more comfortable going up to speakers after their talk. AAN also has a very strong focus on mentorship and career development — this year, like last, I mostly went to career development and research methodology talks, rather than content-based talks on movement disorders, and made some good connections including some folks on committees.

MDS, on the other hand, was very lecture-driven, and very basic science heavy. Day 1 was 8 hours of lecture! It was like being back in school. My co-fellows and I peaced at 6pm (9pm Eastern time!) in favor of beers. Days 2-5 were similar; although there was plenty of clinical content (eg management of non motor symptoms in PD), the plenaries were heavy on immunofluoresence stains. I can’t pay attention with that stuff. And for some reason, slides and syllabi were not available, which meant that most of the plenaries were full of people taking pictures of slides on their phones, which is incredibly distracting in a dark theater!

The things I really liked about MDS were Grand Rounds (expert clinicians examining actual patients; a bit rushed and artificial but nice to see a few different exam techniques), Video Rounds (individuals submit cases for review, which are then discussed by a panel of experts and MC’ed by Tony Lang and Kapil Sethi who are hilarious), and the MDS Pavilion (small TED talk style presentations about topics like “How to write a winning journal article” and “How to get engaged with the Society.” There was also a Young Members Reception which was great, and a Young Members Lunch.

And then, you know, I got to look at this view every morning:


So all in all, not a bad time. Next year in Hong Kong!


Can Scientists (Not) Be Activists?

I just went to a talk titled this, given by a leading climate change scientist and activist. I was hoping for some practical advice from his 20+ years advocating for alternative energy sources and reducing dependence on fossil fuels (which is not only bad for the environment, but also bad for human health).

Unfortunately, what I got was a rambling lecture on how young people need to rise up and do something. Didn’t say what. Didn’t say how. But something. Then he showed more pics of himself age 4 on the family farm in Iowa.

I don’t know if I even count as a “young person” any more (it’s all relative, right? but seriously, when did they start admitting children into medical school?), but I can tell you that my generation, or at least my bubble of my generation, has the passion. We have the science. What we lack is the generational knowledge of the folks who pushed for the Clean Air Act of 1970 and the Clean Water Act of 1972. Unfortunately, it appears that generation is committed to blaming us for perceived apathy, while withholding the practical knowledge they acquired in pushing forward the most important pieces of environmental legislation since the creation of the National Park System.

So anyway, can scientists not be activists? I don’t know, because to me, being one is being both. See you all at the March for Science next week!



One of the first patients I met in medical school was a 10-year-old boy with SSPE, a not-so-rare and always-fatal complication of measles infection. He was blind, deaf, severely encephalopathic, and spastic. It was a peds GI clinic, so I guess he had some GI issues too, but the thing I remember most about him was his father lifting him out of his wheelchair and carrying him across the room to the exam table. His head flopped as Dad laid him down; he had scissoring clonus at both legs.


He was the first neurologically devastated person I’d met, and it was shocking. I was pretty naive, I guess — I was a first-year medical student, 22 years old, still wet behind the ears. In the decade since, I’ve taken care of a lot of people in various stages of coma, but that kid stands out to me. That kid, more than anything else — more than the science, even — convinced me that vaccines were essential.


So when I heard that SSPE is on the rise (previously thought to be 1:10k cases, but with vaccination rates falling, appears to be more like 1:600) and that Europe is facing a massive measles outbreak that’s left 17 children dead in Romania alone, I’m struggling a bit with the appropriate response. Yes, sympathy for the families of those kids — no parent should ever, ever have to bury their child. But I can’t quite silence the little part of me that wants to say, “What did you think was going to happen? You withhold a lifesaving preventative measure from your child; therefore they die. Do you make sure your kid wears their seatbelt? Brush their teeth? So why don’t you vaccinate?”

I’m a big believer in the patient’s right to bodily autonomy, but I think we’ve lost sight of the fact that the patient here is the child. I can’t think of anything that strips your bodily autonomy faster than complications of a vaccine-preventable disease.

[Please, no anti-vax arguments in the comments. I’ve heard them. They are wrong. And if there is a God, there will be a special circle of Hell for Andrew bloody Wakefield, who is directly and personally responsible for this current iteration of the anti-vaxxers. Preferably involving torture by the souls of the children he has killed.]
culture · fellowship

Physician suicide

This week, the New England Journal published two articles on physician well-being, or the rather, the lack thereof. One, Kathryn, is the story of a fourth-year medical student who jumped out of her apartment window last August. The other, Breaking the Stigma, is about how the culture of medicine is one of ritual shaming, particularly when it comes to mental illness. [I think both are open access, but please let me know if they are paywalled.]

Tragic stories, both of them, and sadly common. There were no suicides in my medical school, but there was at least one almost. I’m glad that there is growing awareness — at least among medical educators, hopefully among the wider public too — of how severely we are failing each other. When one in ten medical students contemplate suicide, we are failing each other; we are failing our future.