Life & Death

>> Saturday, June 9, 2012


What an odd juxtaposition.  It was the day of my friend's funeral, the friend I wrote about in my last post.  A part of me demanded that I be there for the funeral but alas I could not.  I was on call.  My last ob/gyn call.  The least I could do was ask my dad to go in my stead.

And on my last ob/gyn call, I delivered and caught two babies.  One of them was to a woman I had seen in clinic almost weekly for the last 3-4 weeks, so she knew me well and was more than comfortable with me delivering her son.

What an odd juxtaposition.  A good friend leaves the world as two little babies enter the world.  Life and death always engaged in a dance.

Backlog: 05-08-12

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And The Dreamer Shall Dream Eternally

>> Sunday, May 13, 2012

Jared,

I don't know who made first contact, you or I.  But I recall that we met the very first day I moved next door to you.  We became friends almost instantly.  Though you were 1 year younger than me, I always considered you my peer and one of my closest friends.

I remember the days when we'd run around in our backyards, absorbed in our imaginary worlds.  From Power Rangers to alien worlds to simply a game of tag, we would sometimes play all afternoon until after the sun set.  I remember you coming by to this one window in the back of my house when I was stuck inside studying.  I'd crack open the window and we'd chat for over an hour; I now marveled that you had bothered to stand for that long.  I remember when your brother, Taylor, and I came back from school one day talking about the alien worlds we had conjured up in class.  You eagerly joined in and became a crucial fabric of that made-up universe.  That day was the birth of your unfinished trilogy, The Ascension.

When I moved to the other side of town after 7th grade, our friendship cooled but never disappeared.  Those were the days of dial-up internet and email was not yet ubiquitous.  Months would go by before we chatted or hung out again.  Whenever we got together, it felt as if no time had passed.  We remained friends for over 20 years, ever since that day I moved in next door to you right before kindergarten.  There's something to be said for that.  Even till recently, months would go by without a word from you but we'd somehow manage to find a way to catch up . . . eventually.

You have always been a dreamer.  You dreamed of faraway worlds and stories.  You dreamed of goals and aspirations.  You had more imagination and creativity than almost anyone else I know.  And you were making your dreams reality.  You were one of the few people who could, with a word, reignite my creativity and passion when I had become too busy with my daily hustle and bustle.  There's something to be said for that.

I had envisioned us growing old together as life-long friends.  I hoped to see you reach the pinnacle of your career, and complete The Ascension.  I hoped to sit with you in retirement, on a beach somewhere, reminiscing of days gone by.  Alas none of this was meant to be.  You are a dreamer, and now you shall dream eternally.

I will miss you.  I will always carry my memories of you with me.  I will carry your passion.  I will not forsake the imagination and creativity of our childhood.  You are, and will always be, one of my closest friends.
Me and Jared at Taylor's wedding.

Jared Adam Radtke
September 19, 1987 to May 1, 2012

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Treatise on the Zen of Music

>> Thursday, April 12, 2012


When one reaches a certain level of proficiency in playing music, one begins to appreciate music on a unique level. It's a sense of connection and "oneness" with music, and this sense becomes an almost zen or spiritual state. It's no coincidence that there has always been a close relationship between music and religion/spirituality.

This treatise discusses the zen of playing a musical instrument and thus experiencing music through the act of playing and creating music. This may be a different experience compared to when one listens to music.

I. The Three Ensembles
There are, in essence, three main ensembles: solo, ensemble/chamber, and orchestra. The musician experiences music somewhat differently in each of these three.

The soloist plays alone, and thus only experiences music through his/her instrument alone. The sense of connection with music is a very personal one, as the instrument becomes an extension of music's soul, the vessel through which it sings. The soloist is in complete control of the music, and thus it is very personal and individualistic.

The ensemble plays in a small group, whether that be two, three, four, or more players. There is no one acting as the locus of the music, but rather, each player must understand his/her role and connect with the music of the others as a piece of a puzzle fits together. The sense of connection with music is a very intimate one, as each player must be attuned to the other players and understand each voice of the music.

The orchestra plays in a large group, with the locus of the music channeled through the conductor. Each section must play as one and every section must obey the conductor for the music to sound seemlessly. The connection with music is one of unity, as each player must be in unison with his/her section, and every section must be one with the conductor who directs the music.

A nice article, Connecting Music and Gesture, explains this idea quite well.

II. The Connection
In Section I above, the phrase "sense of connection with the music" is mentioned in each paragraph. What is this sense? What is this connection? The answer lies in the answer to, "What is music?"

Music is an art medium consisting of sound and silence. There is much variation in the sound - pitch, tone, rhythm, etc. We typically learn music through rote practice of "notes," or written representations of a particular pitch. Through the composer's annotations, we add tone, volume, rhythm, and such. This alone is not what makes music truly music. By this definition, even a robot is capable of producing music.

What is lacking is that human touch - those slight imperfections that add emotion and intent to music. When we play a piece of music, we play it as we interpret what the composer meant it to sound like, but we also play it as we interpret what it should sound like ourselves. The same piece of Beethoven or Dvorak, played by different people, may in fact sound quite different.

It takes time - years of practice - to transition from rote practice and "regurgitation" of the notes faithfully written on the score, to producing music full of emotion and intent. What is it about music that allows us to instantly gain insight into the player's mind? To understand the player's emotion? To appreciate music's intent? There has been much research into this kind of empathy - to how we feel a connection with music.


III. The Zen of Music
Now that the foundation of the different ways to experience music through playing have been established, and the connection with music somewhat defined, this next section is aptly titled "The Zen of Music." I will admit that this state of zen is not always achieved, but when it is, it can leave one with a sense of awe.

Musicians can speak of "letting the music take over" or "getting lost in the music." Many minutes and even hours may go by unnoticed when one finds himself in this "zone." It is, most likely, a connection to music so close that one is touched by the music on the most personal and intimate level. It is as if the soul has become attuned, and the music is now an extension. It is a sense of peace, completion, and/or euphoria.

This zen is not unlike a sense of spirituality. As in the preamble, it is no coincidence that music and religion were, and are, so closely associated. The sense of connection and oneness can be likened to that same sense of connection some may have with God - it is on par with that very level of closeness.

Conclusion
There are many ways to experience music as a player, whether that is through a solo, an ensemble, or an orchestra. Each of these paths offers a slightly different avenue to connect with the heart of music. This connection, through years of practice and maturation of the musician, becomes strengthened and increasingly personal. Ultimately, this connection transcends to a state of zen where the musician and the music, quite literally, become one.

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At Peace

>> Sunday, February 26, 2012


About 1 year ago I was excited at the prospect of returning to UM SPH to complete my MPH in Hospital & Molecular Epidemiology (see post here). It's strange how much things have changed in 1 year. Now I've pretty much decided that I will not go back and finish my MPH, and I'm okay with it - I'm at peace with it.

I didn't come to this decision lightly. I had spoken with family, many friends, and several faculty. I've had people try to convince me to either side. It was the words of my M4 advisor (whom I greatly respect) that clarified my decision. His words to me were something to the effect of:
"I'm going to tell you what I tell residents who're going back and forth on doing a fellowship. A fellowship, like your MPH, is something you have to give it your all and your total dedication. If you're going back and forth like this, ask yourself: is this what you really want? Or is your doubt telling you something?"
In that moment, it became clear. What do I want? What do I want out of my career? Where do I see it heading?

I am obviously still at the beginning of my career, but several things have risen to the top over the last several months. 1.) I want my career to be clinically focused on treating patients. 2.) I want my career to have a public health/community engagement component. 3.) I want to teach students - they need not be med students. 4.) I want a good work-life balance.

None of the above requires an MPH, much less in my highly focused MPH program. When I asked a faculty physician - who basically does what my MPH would've prepared me to do - for his opinion, he emphatically said that I did not need an MPH to do peds or peds ID. What I need for success was talent, hard work, and good networking.

Furthermore, I have no desire (as of right now) to do bench research. There may come a day where I come full circle and find myself back in a lab. And it's not like I'm necessarily giving up on getting an MPH - I may still end up getting it as a part of a preventive medicine or ID fellowship. True I'd have to start an MPH over again from scratch, but being several years removed from it, it actually doesn't sound like a bad thing. But these are all matters in the future, not now.

Will I regret not having finished my MPH now? Well, I'm not the kind of guy who gives up on something half-way through. But things have changed. I have changed (insofar as my outlook regarding my career). I do not regret my decision. I am at peace.

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Year of the Dragon

>> Tuesday, January 24, 2012


January 23rd, 2012. Year of the Dragon. It came and went like any other day (partly because I was stuck in clinic from noon to 8pm-ish seeing patients). But I'm hopeful for good things this year. I foresee a year of change - whether that will be good or not remains to be seen.

Regardless of what's to come, bring on the year. Bring on the day!

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To Save a Life

>> Sunday, January 22, 2012


On Saturday I was volunteering at a student-run free clinic. As an M3, I had an M1 and and M2 under me. They first gather a history and do a preliminary physical exam on each patient before I talk and examine them.

After briefly presenting to me, the M1 and M2 took me to see our first patient. He was a middle-aged guy who had been having nausea for the past 2 months. After talking to the patient for a bit about his history of hepatitis C, I move on to the physical exam. Per my routine, I begin by listening to his heart and lungs. Then I move to his face, eyes, and neck before asking him to lie down for an abdominal exam. I look for every sign of hepatitis and liver disease - jaundice, scleral icterus, spider angioma, etc - none of which he had, which reassured me.

Then I felt something odd. While palpating for his abdominal aorta, I found the edge of it pulse to the right of his bellybutton. I move to the left of his bellybutton and felt the same pulse of his aorta there as well. I move back to the right to double-check. I call out to the M1 and M2 to feel the edges of his abdominal aorta on either side. They confirm that they could feel the pulse on both sides. Eyeing the distance, I ballparked the diameter of his abdominal aorta to be about 4cm. He had an abdominal aortic aneurysm (aka AAA or "triple A").

This was an amazing catch! It's not every day that med students pick up on something so serious, and an AAA is a very serious matter. I ask the patient if he knew what an AAA is, and he said that his father and grandfather both died of AAA's around his age. Coupled with the fact that the patient smoked about 1/2 pack of cigarettes a day, this solidified the diagnosis in my mind. Immediate imaging was warranted to accurately determine the size of his AAA - not knowing its exact size, it might as well be a ticking time bomb inside his abdomen set to rupture at any point inside.

I reassure him that, because he was asymptomatic, he had some time and that we will figure this out. I further counsel him to reduce (and preferably/ideally stop) smoking, as smoking is a huge risk factor for AAA's. Also, smoking cessation can stop an AAA from growing any larger in some cases.

I walk out with the M1 and M2 to find a physician to assess the patient. While they do that, I move on to another pair of M1 and M2 students to see their patient. Later when I touch base again, I was glad to hear that the physician agreed with my assessment and plan. Although a CT scan is the most accurate way to determine the size of an AAA, the clinic didn't have access to "free" CT scans, and so we ordered an MRI for the patient. Really, it's kind of a waste of resources overall because in this case a CT scan is much better and cheaper than an MRI. But, we have to work within the limited resources of the clinic.

Talking to several M3's later, they were impressed that I had caught the AAA. They kept saying how I had, quite literally, saved this man's life. As much as I'd like to believe that, it didn't quite feel like I did. True, I had caught a potentially fatal condition early enough for interventions that would indeed save his life. But the imaging test we had to get for him was expensive and less than optimal, and we had to send him to a nearby hospital to get it done. For all I know, he may never go to the hospital to get the MRI. And even if he did get it, who will follow-up with him? Who will track the size of his AAA? Who will do the surgery when it reaches the dangerous size of 5.5cm? Would he survive long enough to make it to an emergency department if it were to rupture?

There were too many loose ends. This is the limitation of healthcare in the US - this patient is uninsured and we volunteer at a free clinic where continuity of care is fragmented. I may have the knowledge and ability to save this man's life, but he needs regular access to healthcare in order for that to happen. The academic and political discussions about healthcare are no longer abstract. Here is a patient with a life-threatening condition. It need not be so. But he doesn't have access to regular healthcare. Our hands our tied, our resources limited. And so, it remains life-threatening.

I hope he went to get the MRI. I hope it was far less than 5.5cm. I hope he stops smoking. I hope he is able to obtain health insurance. Right now hope is all I have to save a life. But it need not be so.

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Welcome to Life

>> Wednesday, January 18, 2012


Welcome to life. I know you're tired and unfamiliar with this world, but open your eyes and see the love that has brought you here. Sleep in the arms that embrace you, linger in childhood while you can, but grow up healthy and strong. You are full of the world's hope and potential - anything is possible! What will you choose to be? You won't remember me, despite me prodding and poking you. But I hope my thoughts are etched deep into your heart: I wish you the best on this journey called life, and I hope you are equipped with the love and the help to get through anything. Welcome again to this thing called life.
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About a month ago, I had the privilege of rotating through the newborn nursery for 2 half-days. I had the opportunity to hold and examine a baby less than 48 hours old. His mom handed him over to me (in my mind practically throwing him at me), trusting me unequivocally that I wouldn't hurt him.

He peeked at me through suspicious eyelids before returning to his tenuous sleep. Of all the people to have examined him in his brief existence, he tolerated me the best - perhaps he liked me best. It's something special to hold a baby and not have him instantly cry at you to get away, but rather to tolerate you in a way that almost says, "I don't like what you're doing, but you're okay so I'll let you."

All the meanwhile the parents watch your every move, searching you for the slightest hint that their baby is not all right. The breath in the air hangs suspended as you move methodically through each motion designed to detect the slightest defect, the slightest indication that something may be wrong. And when you finish and everything is okay, the breath falls almost as a sigh of relief.

I read an article, A medical student experience in the newborn nursery, and it struck me just how true his account and his words resonated with me. I'm not sure I can even adequately express in words what it is like to have a family accept and trust you, a total stranger, to hold their newborn child. It's almost like holding unadulterated hope and potential in your arms - so fragile yet resilient.

My interaction with this child is but a flicker of time in his life ahead, mere minutes out of the potential years he could/will have on this earth. But all the same, it was truly an honor and a privilege to welcome him to life, in my own way.

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About This Blog

Welcome to my running commentary on my life and about life. This is my space to express my opinions, thoughts, and reflections. This blog is but a small window into the workings of my mind.

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