TMC
-The largest medical center in the world spread over 675 acres with 100 buildings.
-Funding approx $ 5 billion- more than many countries' health care budgets.
46 – TMC institutions - Includes 23 agencies of government and 23 private not-for-profit health institutions. List includes Baylor College of Medicine,The University of Texas Health Science, The University of Texas M.D. Anderson Cancer Center, University of Houston System,Texas heart Inst at St Luke's Hospital, Ben Taub etc.
-5.5 Million – Approximate patient visits,10,000+ – International patients
-6,500 – Beds
-10,000+ – M.D.s, Ph.D.s and other doctorates
- 33,000 full time students.
-73,600 – Employees
-26,000+ – Registered nurses, LVN's, clinical caregivers, technicians, and medical support staff
KEM-
- Campus over not more than acres in single digits. 7 buildings.
- Funding I don't know. But I remember LSB saying that PGI,Chandigarh had funding 20 times what KEM got!!
-3 million total annual outpatient visits,83,000 annual admissions.
-1800 beds,( official) unofficial- any body's guess.
- 940 total residents and attending physicians.
- Provides training to 2000 undergraduate, postgraduate and specialty students.
First hospital to perform heart, renal and liver transplant surgeries in India.
Make your comparisons!!
Tuesday, October 9, 2007
From the Archives
At long last-this week's Arch Int Med contains articles of good clinical relevance.About hyponatremia being predictive of mortality in CHF, effect of pneumovax on severity of CAP, a meta-analysis of trials on dual blockade of the RAAS system on CHF.
My interpretations : Hyponatremia in CHF is hypoosmolal with increased TBW- this in turn reflects the severity of heart failure. So the result is expected...you are just calling a spade a spade. Whats new about that?
Why should pneumovax affect severity of CAP? Well assuming they are referring to typical CAP, the three most commonest organisms are pneumococcus, Hemophilus and Moraxella in that order. So if you have protected against pneumococcus you have the relatively less virulent two to deal with. Big deal then!!But if it were atypical pneumonia I think I do not have an explanation entirely. Again the polysaccharide vaccine is not a very good immunogen, memory T cell response in the aged would not be that good with the current policy of one shot at >65 years( which I have never understood)Also most folks receiving pneumovax before that age have specific conditions that predispose to pneumonia occurrence.And pathogens in them might not be the same as in healthy people.So....what gives?I don't know.
I used to think- give a CHF patient Alsikiren plus beta blocker plus ACEI plus ARBs plus Aldactone...khallas. Absolut paralysis.Mother of block nanas. But I think there are problems we have to deal with here. I do not know the prognosis of medical nephrectomy...have seen it just once in a nephrotic we put on ACEIs. But the KDOQI recommends close follow up in a diabetic CRF put on ACEIs, as beyond a few weeks things level of, and the prognosis is actually good.I wonder why someone does not take this up as a thesis topic- multiple RAAS blockade in CHF and prognosis of renal disease if any.
Jhakaas !!! Mast vaatla.Tumhala kaay vatla?
My interpretations : Hyponatremia in CHF is hypoosmolal with increased TBW- this in turn reflects the severity of heart failure. So the result is expected...you are just calling a spade a spade. Whats new about that?
Why should pneumovax affect severity of CAP? Well assuming they are referring to typical CAP, the three most commonest organisms are pneumococcus, Hemophilus and Moraxella in that order. So if you have protected against pneumococcus you have the relatively less virulent two to deal with. Big deal then!!But if it were atypical pneumonia I think I do not have an explanation entirely. Again the polysaccharide vaccine is not a very good immunogen, memory T cell response in the aged would not be that good with the current policy of one shot at >65 years( which I have never understood)Also most folks receiving pneumovax before that age have specific conditions that predispose to pneumonia occurrence.And pathogens in them might not be the same as in healthy people.So....what gives?I don't know.
I used to think- give a CHF patient Alsikiren plus beta blocker plus ACEI plus ARBs plus Aldactone...khallas. Absolut paralysis.Mother of block nanas. But I think there are problems we have to deal with here. I do not know the prognosis of medical nephrectomy...have seen it just once in a nephrotic we put on ACEIs. But the KDOQI recommends close follow up in a diabetic CRF put on ACEIs, as beyond a few weeks things level of, and the prognosis is actually good.I wonder why someone does not take this up as a thesis topic- multiple RAAS blockade in CHF and prognosis of renal disease if any.
Jhakaas !!! Mast vaatla.Tumhala kaay vatla?
Monday, October 8, 2007
Nobel
The Nobel prize for physiology for the year 2007 was announced today.
Mario R. Capecchi, age 70, at the University of Utah in Salt Lake City, Sir Martin J. Evans, age 66, at Cardiff University in Wales and Oliver Smithies, age 82, at the University of North Carolina in Chapel Hill, will share the $ 1.54 million prize for the technique of mouse models for genetic disease- creating knockouts and gene targeting.
Wei used to tell me she was the knock out queen at Astra Zeneca - had quite perfected creating knock outs for various enzymes and thats what she used to do all the time.Of date there are 2500 gene knock out models that people like Wei have helped create.Hmm...
It is really such a simple technique in theory.But innovative. Like the hybridoma technique for MAbs. DRK used to say...you don't need to be all high tech and recondite to be innovative. It might be a simple corruption of pathophysiology.Thats how great ideas take fruition.Listening to Mammen Chandy explain RT-PCR was one of the most enlightening experiences for me.He likened it to a story from the Genesis, almost child like in his narration. And in his exuberance in going from step to next step like episodes in a story taught me that great minds keep things beautifully simple.They don't know all the things all the time. But they know what to do all the time.
We complicate things by oversexing them.We think that if it is difficult to understand, it must be something great. Like Despo's quaint logic- the special theory of relativity is great because so few people understand it in concept.Thats exclusivist.I wonder if Despo ever did. If people do not understand it, what utility is it going to have except being fodder for intellectual masturbation at shibboleth conventions for those who do?
Einstein had this to say: "The only thing that interferes with my learning is my education."
Mario R. Capecchi, age 70, at the University of Utah in Salt Lake City, Sir Martin J. Evans, age 66, at Cardiff University in Wales and Oliver Smithies, age 82, at the University of North Carolina in Chapel Hill, will share the $ 1.54 million prize for the technique of mouse models for genetic disease- creating knockouts and gene targeting.
Wei used to tell me she was the knock out queen at Astra Zeneca - had quite perfected creating knock outs for various enzymes and thats what she used to do all the time.Of date there are 2500 gene knock out models that people like Wei have helped create.Hmm...
It is really such a simple technique in theory.But innovative. Like the hybridoma technique for MAbs. DRK used to say...you don't need to be all high tech and recondite to be innovative. It might be a simple corruption of pathophysiology.Thats how great ideas take fruition.Listening to Mammen Chandy explain RT-PCR was one of the most enlightening experiences for me.He likened it to a story from the Genesis, almost child like in his narration. And in his exuberance in going from step to next step like episodes in a story taught me that great minds keep things beautifully simple.They don't know all the things all the time. But they know what to do all the time.
We complicate things by oversexing them.We think that if it is difficult to understand, it must be something great. Like Despo's quaint logic- the special theory of relativity is great because so few people understand it in concept.Thats exclusivist.I wonder if Despo ever did. If people do not understand it, what utility is it going to have except being fodder for intellectual masturbation at shibboleth conventions for those who do?
Einstein had this to say: "The only thing that interferes with my learning is my education."
Sunday, October 7, 2007
Motivation....
This is all true...I have changed names of course.
Existentialist Pedagogy: Every act we perform has a motivation/ incentive. Many a times it is basic id stuff..survival skills, gratification......the Sex and Violence thing. Other times it is more.More than is readily apparent.It might seem impulse/ spur of moment brainlessness at important moments decide the crucial decisions we make- the so called Gut feeling. But even these mirror an unconscious motivation of the psyche moulded by its aspirations and ideals.
When there is a hand to mouth fight to Just Exist, there are no aims and objectives or even methods. Its a plain oral-anal infratentorial stratum of life.
It is the story of a Bhimadevi, CSW , sometime abducted girl from Nepal, admitted with multiple hyperintense lesions scattered in the cerebral hemispheres which neither radiologist nor clinician nor neurologist could figure out the etiology of. And her paramour Ismail, laborer at Masjid Bunder, who has rescued her from some Grant Road brothel,and would agree to anygoddamnedthing I thought would work and wanted to try on her .All he would say is " Shaam ko laya to chalega na saab?" And by evening he would have money that he would thrust in my hand and say, "ye lo saab, jo dene ka hai usko de do, bas theek ho jayegi aisa karo." She died undiagnosed- speculative differentials included fungal vasculitis, nocardiosis, HSV encephalitis among others.I was unpreparedly naive to this situation - Dickens is dead, so what kept him going? Godammit she was a closed case I had told him- CD4 was 36,no diagnosis, septic, but he would still work his ass out to get the money by evening. That pestilence, a crudely simple, rustic affection could keep one going on vada paav and chai all day, pushing handcarts and carrying loads to pay for her medicines, carry her urine, stool and blood samples ungloved,pet her deliriousness into a calm like no calmpose could - I could not believe this.And all of this for someone who he knew had a DC already written for her when she entered, uncondomized Kamikaze, with puberty being her only qualification required for the job she chose to make a life of - GOD...deliver me.
I have known four people closely who chose to commit suicide at a time when Life had its curtains of opportunity still drawn. Only one succeeded thankfully. These were highly intelligent people, with families which were supportive and 'normal', in medical school and engineering college and youth pumpin the anabolism. I wonder why?I wonder why?What it takes to inject yourself with Propofol, Pavulon and potassium chloride while people outside are queuing at the bathroom to get ready for ward work, your spouse of 6 months is struggling with internship, your parents are making plans of when they could make that surprise visit- and you pull the biggest of surprises on life and its bustling regularity itself.
What goes on in your mind when you ask yourself to b intubated while being exsanguinated despite resuscitative efforts in the ER?
What is your motivation when you have 7 years of post doctoral research, have 7-8 publications in peer reviewed journals, work in one of the world's best cancer institutes, and are applying for residency for PGY1 positions competing with people 6-7 years your junior, attending stupid interviews suited and booted presenting a dumbed down version 'minus 2.0' of yourself? Why I ask....service, money, connection with people are the words I hear....but my inerudition causes me to stumble to make one complete phrase of it.
Your best friend of years suddenly goes out of radar for months. You ask people who know whats going on? "He's gonna do pure research, no practice for him" is what you hear.You wonder, a life out of 'N glycosylation?!' are you kidding? Is he feeling that he has fallen back because of the choices he made? Is he aiming to be a Susumu Tonegawa or Hargobind Khurana? Has he lost his nuts? Is he a true blue research junkie evangelist?
What led him into it?
What keeps you going when you are in hot and humid Kutch, have lost your baggage, passport, thousands of miles away from home; when you know the ground situation better than some random politician who chooses to make a helicopter visit, despite not knowing a word of the local language, have a bowel which reacts most violently to what food you have to bear with daily,don't know when you will be going back, don't care,are equally adept in lifting corpses and doing audit of supplies and writing reports- hell don't mind it really because you started as a jack of all of that? Thats a long and disparate summary of the guy...and I still don't know what kept Paul going.
Reading the wikipedia biographies is an extremely enriching experience. I do not have the energy or the resources to go through whole biographies. But it just gets you interested enough to wonder what the hell did this guy do on a day to day basis? Was he a MDP? Did he love, screw, watch movies, read newspapers with the same ennui as you or I do or was he in constant flux? What were the messages he took from random events of life like apples falling usw.Was he just an aggressive Machiavellian Robert Gallo or an underachiever Ramanujan? Ich kenne nicht.
These are random thoughts. I probably do not understand what their motivation is because I cannot possibly be intelligent a priori. ... have not had a refinement or evolution of thought enough to comprehend everything that life throws at one unexpectedly.Sometimes I do....sometimes I am clueless. Some time I shall sit on a wise rocking chair and know it all. But.. To be certain of everything is a frightening prospect.
Existentialist Pedagogy: Every act we perform has a motivation/ incentive. Many a times it is basic id stuff..survival skills, gratification......the Sex and Violence thing. Other times it is more.More than is readily apparent.It might seem impulse/ spur of moment brainlessness at important moments decide the crucial decisions we make- the so called Gut feeling. But even these mirror an unconscious motivation of the psyche moulded by its aspirations and ideals.
When there is a hand to mouth fight to Just Exist, there are no aims and objectives or even methods. Its a plain oral-anal infratentorial stratum of life.
It is the story of a Bhimadevi, CSW , sometime abducted girl from Nepal, admitted with multiple hyperintense lesions scattered in the cerebral hemispheres which neither radiologist nor clinician nor neurologist could figure out the etiology of. And her paramour Ismail, laborer at Masjid Bunder, who has rescued her from some Grant Road brothel,and would agree to anygoddamnedthing I thought would work and wanted to try on her .All he would say is " Shaam ko laya to chalega na saab?" And by evening he would have money that he would thrust in my hand and say, "ye lo saab, jo dene ka hai usko de do, bas theek ho jayegi aisa karo." She died undiagnosed- speculative differentials included fungal vasculitis, nocardiosis, HSV encephalitis among others.I was unpreparedly naive to this situation - Dickens is dead, so what kept him going? Godammit she was a closed case I had told him- CD4 was 36,no diagnosis, septic, but he would still work his ass out to get the money by evening. That pestilence, a crudely simple, rustic affection could keep one going on vada paav and chai all day, pushing handcarts and carrying loads to pay for her medicines, carry her urine, stool and blood samples ungloved,pet her deliriousness into a calm like no calmpose could - I could not believe this.And all of this for someone who he knew had a DC already written for her when she entered, uncondomized Kamikaze, with puberty being her only qualification required for the job she chose to make a life of - GOD...deliver me.
I have known four people closely who chose to commit suicide at a time when Life had its curtains of opportunity still drawn. Only one succeeded thankfully. These were highly intelligent people, with families which were supportive and 'normal', in medical school and engineering college and youth pumpin the anabolism. I wonder why?I wonder why?What it takes to inject yourself with Propofol, Pavulon and potassium chloride while people outside are queuing at the bathroom to get ready for ward work, your spouse of 6 months is struggling with internship, your parents are making plans of when they could make that surprise visit- and you pull the biggest of surprises on life and its bustling regularity itself.
What goes on in your mind when you ask yourself to b intubated while being exsanguinated despite resuscitative efforts in the ER?
What is your motivation when you have 7 years of post doctoral research, have 7-8 publications in peer reviewed journals, work in one of the world's best cancer institutes, and are applying for residency for PGY1 positions competing with people 6-7 years your junior, attending stupid interviews suited and booted presenting a dumbed down version 'minus 2.0' of yourself? Why I ask....service, money, connection with people are the words I hear....but my inerudition causes me to stumble to make one complete phrase of it.
Your best friend of years suddenly goes out of radar for months. You ask people who know whats going on? "He's gonna do pure research, no practice for him" is what you hear.You wonder, a life out of 'N glycosylation?!' are you kidding? Is he feeling that he has fallen back because of the choices he made? Is he aiming to be a Susumu Tonegawa or Hargobind Khurana? Has he lost his nuts? Is he a true blue research junkie evangelist?
What led him into it?
What keeps you going when you are in hot and humid Kutch, have lost your baggage, passport, thousands of miles away from home; when you know the ground situation better than some random politician who chooses to make a helicopter visit, despite not knowing a word of the local language, have a bowel which reacts most violently to what food you have to bear with daily,don't know when you will be going back, don't care,are equally adept in lifting corpses and doing audit of supplies and writing reports- hell don't mind it really because you started as a jack of all of that? Thats a long and disparate summary of the guy...and I still don't know what kept Paul going.
Reading the wikipedia biographies is an extremely enriching experience. I do not have the energy or the resources to go through whole biographies. But it just gets you interested enough to wonder what the hell did this guy do on a day to day basis? Was he a MDP? Did he love, screw, watch movies, read newspapers with the same ennui as you or I do or was he in constant flux? What were the messages he took from random events of life like apples falling usw.Was he just an aggressive Machiavellian Robert Gallo or an underachiever Ramanujan? Ich kenne nicht.
These are random thoughts. I probably do not understand what their motivation is because I cannot possibly be intelligent a priori. ... have not had a refinement or evolution of thought enough to comprehend everything that life throws at one unexpectedly.Sometimes I do....sometimes I am clueless. Some time I shall sit on a wise rocking chair and know it all. But.. To be certain of everything is a frightening prospect.
Friday, October 5, 2007
HMS
Been to HMS and Dana Farber today. These are the hallowed meccas of medicine supposedly...most of Harrison being written by people who roam the area between Longwood Avenue and Binney St; Eugene Braunwald is sitting some few square feet away, Douglas Zipes and Peter Libby are teaching some residents/fellows some place near, path breaking research is going on someplace else- I mean BWH, Dana Farber, BIDMC, Joslin, Children's hospital all in one expanse of area not more than JJH: this place rocks.I mean ROCKS!!!!!
But then the fact that there is so much snootiness, inaccessibility to the whole place is a one major put off. For all the appeal of the place,its hopelessly overpriced- they put a premium on getting in ....which is too high for me to get through as an IMG.Its a huge fat slippery American ass we have here.
A roll muster of interns gaining admission into PGY1 positions at BWH is available at the Brigham's website. Going through that makes me realize that we follow such a linear path from MBBS, to MD to DM- life is so much more easy in the training phase.These guys take pitstops at Oxford, Colombia and Africa, establish an NGO or two, patent a drug or technique before they enter residency. That they are compensated in that they do not need to have a 'set up' once they finish residency/fellowship and mint the moolah rightaway equals off the input output equation between us and them.But this is probably the most productive phase of your life man- wouldn't one want this to be a once in lifetime experience.
But then the fact that there is so much snootiness, inaccessibility to the whole place is a one major put off. For all the appeal of the place,its hopelessly overpriced- they put a premium on getting in ....which is too high for me to get through as an IMG.Its a huge fat slippery American ass we have here.
A roll muster of interns gaining admission into PGY1 positions at BWH is available at the Brigham's website. Going through that makes me realize that we follow such a linear path from MBBS, to MD to DM- life is so much more easy in the training phase.These guys take pitstops at Oxford, Colombia and Africa, establish an NGO or two, patent a drug or technique before they enter residency. That they are compensated in that they do not need to have a 'set up' once they finish residency/fellowship and mint the moolah rightaway equals off the input output equation between us and them.But this is probably the most productive phase of your life man- wouldn't one want this to be a once in lifetime experience.
Thursday, October 4, 2007
One of those days
We had a metaphor for uselessness at BJ...valloochi pishvi( bag of sand) ....it is a feeling of uselessness packaged and given manifest form, identity and character.Given a power to wield over you.That was II/Ist....a time in your life when you were allowed by seniors to spend entire days in the canteen, driven by registrars out of wards had you dared to venture in, written doses of Haltax in milligrams, barely made the 75% attendance by proxy,and had the temerity to attend term end viva voce unprepared and smile at the examiner saying,"its II/I sir, what do you expect?"
That time has gone. But today was one of those days. When you stare at boredom and boredom just returns the vacuous stare.Even daydreaming seems to evade me, I am staring at the same page of Infinite Jest for hours, like a petit mal status.
Tomorrow shall rise, and we shall shine.
That time has gone. But today was one of those days. When you stare at boredom and boredom just returns the vacuous stare.Even daydreaming seems to evade me, I am staring at the same page of Infinite Jest for hours, like a petit mal status.
Tomorrow shall rise, and we shall shine.
Wednesday, October 3, 2007
In India...
Nodding in agreement to everything the senior says(' haan mein haan milana'),using the word 'wow' so frequently with good or bad events that he/she mentions,sending thank you notes and gifts with lofty poems and dedications...is called 'chaatna'
Here it is just 'being polite'
Here it is just 'being polite'
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