New normal, continued

A new piece on Gabby Giffords sheds light on the continued struggle of adapting, and improving upon, her new normal, post-traumatic brain injury. Seems like there's a long way to go...

On the occasion of recently filing a doctoral dissertation

There are two primary steps to officially filing one's doctoral dissertation at UCLA:

1. Bring the following documents to Murphy Hall, Graduate Division, Room 1225: The doctoral dissertation approval form, with the title matching the dissertation title exactly; this form shall include the name of the committee chair, spelled exactly as it appears in the dissertation. The candidate's name, too, includes in the precise form in which it appears on the University Records System Access (URSA) computer system. Along with this, bring a title page of the dissertation, the dissertation approval page (not to be confused with form), which is page iii of the dissertation. The names of candidate and committee members must match exactly with those on the final oral defense approval form, which, by the way, should have been sent to Murphy by the graduate department in which you completed your doctoral work, upon passage of the final defense. However, if filing close to the same day as defending, this form may be brought by the candidate. Also, bring printed-out verification that one has completed the Doctoral Exit Survey (through UCLA) as well as the Survey of Earned Doctorates (through an outside organization), both online.

2. Once these documents are approved at Murphy Hall, proceed to the Young Research Library, Thesis and Dissertations Office (on the second floor of the library), and bring the following: 1) two (2) manila envelopes, each containing a full copy of the dissertation, with the approval page (iii) being a copy of the original, which was submitted above to the Graduate Division in Murphy Hall. Each envelope should have a copy of the title page taped to the outside; 2) one (1) manila envelope (title page taped to the outside as well), containing copyright forms for ProQuest (must be signed), a copy of the title page, a copy of the abstract page (remember, the title on the abstract page must match exactly the title on the title page, which should in turn match all forms; they will most certainly verify this).

On Thursday, June 2nd, I completed the above two tasks, successfully, at which point I gave the UCLA Registrar's office the fully-signed Doctoral Dissertation Approval Form, which they took from me; ten minutes later, they returned to me a new form, this one stating, "Let it be known," that I had completed all the necessary requirements for becoming a Doctor of Philosophy in Molecular, Cellular, and Integrative Physiology.

"Congratulations, you're all done."

That was it, the form was in my hand; at that moment, I stood alone in Murphy Hall, finally having earned my Ph.D.

How fitting, that the actual moment included no fanfare, no one next to me, in front of me, or behind me. It just, sort of, happened.

And with that, I returned to the lab and began to pack up my desk. The end of one stage; the beginning of another. One cliché after another...

I also know this all sounds sort of melodramatic: "Ooooo, loooooook, a Ph.D.; what does it mean? How does it feel? What a moment. What a moment? Too self-aggrandizing? Too self-congratulatory? But what's in a moment anyway? And it's not like I'm any different than I was yesterday. But I kind of am. Am I really satisfied, or is it just because I should be? Do I really feel like I deserve it? etc etc etc."

But I digress in trying to present a few of my many internal dialogs of the past few days. In truth, I think, the main thing is I am relieved to be done, and I am perplexed: I am, in fact, as happy as I thought I would be, being done with my Ph.D. Not any more, not any less -- just as exactly content as I envisioned. Strange, because it seems that throughout my life, I usually over-expect or under-expect; I over- or under-speculate. Not this time. I am simply content.

Over the weekend, I signed a single email with the suffix, "Ph.D." By the time the "Undo" option on gmail had disappeared, I wished I could have not done it. It seemed really toolish. I'm not sure what this little personal anecdote means, but I guess it suggests I won't be signing emails to my like that friends anymore. Just once. It was more than enough; in fact, too much.

I guess my final point here is that the occasion of finishing one's doctoral dissertation is no different than any other "milestone" - like graduating from high school, undergrad, medical school, whatever - but there's an added sentiment in the case of a Ph.D: relief, and an acknowledgment of good fortune. Doing a doctoral degree requires research that is ostensibly successful, and I came to see how, at many steps along the way, I was just plain lucky. Things worked -- experiments yielded interpretable results, new insights were made, and stories primed and ready and successfully submitted for publication. Yes, I worked my ass off, but I was lucky. I also had great teachers, great collaborators, endlessly patient family and friends, and an institutional framework that supported what I was trying to accomplish. The United States Taxpayer supported me through my fellowship funding. I am blessed, through and through. Now I am eager to peel away to the next layer. Medical school, its years three and four, awaits, and I am stoked beyond belief about going back to thinking about medicine full time. It's been three challenging years, and now, onward.

It's been a great ride. I'm at the "right" place. Thanks for the fun, y'all. Let's keep it going.

Out of the woodwork

Many congratulations to all the newly minted MDs and PhDs. A specific shout-out goes to ours truly, Chuck C, who finished his PhD at a torrid pace. Chuck, a job well done; now on to the wards and more boards! I haven't garnered any degrees yet. I did finish my first year of graduate school, though, which I'd like to think is a milestone. I don't have much to show on paper for this past year, but I've gleaned that this is quite typical.

As Chuck has alluded to in previous posts, graduate school is a time of personal growth inside and outside the lab. Some times the inside-the-lab growth bleeds into the outside-the-lab growth and vice versa-- I've had a lot of time to think about science, myself, and the people close to me. While I believe that this type of introspection and learning correlates with age and the reflection of our collected experiences, graduate schools feels like an incubator for these personal exercises. This is my personal experience, though. Unfortunately I do not have parallel-universe-Anthony controls. And I'd love to share examples with you, but I can't. It's not that I'm unwilling to share. It's more like I don't know how to share-- I'm in the midst of it.

With that said, I bid this blog adios. I will make no promises to post more consistently. I've already broken that promise. I will post when I can. Till the next time, Anthony.

Spinal cord injury repair update

Reggie Edgerton, and collaborators at U Kentucky, have successfully helped a paralyzed man regain some function in his lower extremities -- both with motor control and autonomic function -- thanks in part to the years of work Dr. Edgerton has done at UCLA in the study of spinal cord "learning," repair, and re-learning. Expect more to come from this work in the future. UCLA is an exciting place to be.

Losing one's voice

Christopher Hitchens is dying of esophageal cancer. Despite his diagnosis, grim prognosis, and aggressive treatment course, he continues to write, principally, for Vanity Fair. His most recent piece waxes about losing his voice, the inevitable result of the cancer interfering with the function of his recurrent laryngeal nerve. But never mind the anatomy, this is a beautiful piece, and more reason that I love the work of, and the man who is, Chris Hitchens.

Not surprising, but still...shocking

Have you seen this? Getting chronic disease management/prevention under control are essential to any plan overhauling health care in this country. It's one area in which "ObamaCare" got it right. We'll see how the pilot projects play out and whether they are fed into mainstream (i.e. medicare/medicaid) health care delivery.

Remembering a photo-journalist

No one life is more valuable than another. Yet people have talked extensively about two photo-journalists who recently died while covering the fight for Libya. Indeed, there is something haunting, deeply saddening about someone dying while trying to cover the horrors of war. In an effort to bring the carnage to light, photo-journalists are not immune to the dangers of their work. Although this is off the topic of medicine, it is certainly a reminder of our mortality and the sacrifices involved in dangerous work; this moving tribute to Tim Hetherington struck me especially hard.

Is sugar toxic?

A perspective on sugar - refined cane sugar (sucrose) or high-fructose corn syrup - and some of the current research into the havoc it wreaks on the body. Worth a read. The research isn't entirely convincing, but again, why take the chance by eating simple sugars in excess? Regardless of whether everyone who eats large quantities of sugar or not gets diabetes, it's not healthy to binge on the sweet stuff. So again, it's worth a read.

"New Normal"

It has been some time since the tragic Tuscon shootings of January, 2011, and much of what needs to be said was covered elsewhere -- the tragedy, coming together, partisan bickering, blood libels, etc., etc. -- but I am interested specifically in Congresswoman Gabrielle Giffords' remarkable recovery progress. Anyone who has followed the news since January has seen the numerous news reports on a rapid recovery: holding her husband's hand, following commands, breathing on her own, opening her eyes and tracking movements, speaking, asking questions. It all sounds very good, heartwarming, and promising. Gabby may even be back to work in the House of Representatives one day, and she may run for the Senate seat, soon-to-be vacant due to John Kyl's retirement.

But what is her recovery really like? What happens when the rhetoric (101% chance of survival, remarkable progress, determined, brave, courageous) is replaced by realism? What is Gabby's "new normal"? Though difficult to read, this piece in Newsweek attempts to paint a realistic image of what a life of intense rehabilitation is like. There's no discussion of the Senate seat, and, I think most importantly, there's been little discussion of what happened on 8 Jan, 2011.

And it makes sense not to force the discussion on someone who probably has many, many questions but who, because of the ongoing rehabilitation, lacks the full capacity to ask these questions. But this is nonetheless important, because it speaks to the magnitude of the change in Gabby's life. The New Normal is very different from 7 Jan, 2011.

Although Gabby Giffords' story is one of the most high profile post-traumatic recoveries in recent history, her New Normal is similar to that of a war veteran, accident victim, or anyone recovering from a catastrophic injury or illness, regardless of the cause.

Update: 4/25/2011 -- another piece, from the Arizona Republic.

Offer stands

People considering UCLA's MSTP, feel free to comment, email (MSTPLA at gmail dot com), or get in touch w/ us through the UCLA MSTP's official website.

Man, this sucks

High school basketball player makes game winning basket. Then collapses and dies.  It's a cruel world.

Update (4:42 PM): this wasn't unexpected, but still sad - the deceased player had dilated cardiomyopathy.  Although hypertrophic cardiomyopathy has a greater prevalence and is more often a cause of sudden death in young athletes, DCM can also lead to untimely deaths.

Hockey players get it too

C.T.E.

This week in Chronic Traumatic Encephalopathy

Dave Duerson committed suicide last week. That he was a successful NFL safety and businessman in retirement alone justifies the reverberations felt throughout the sports world.

Then there's this: Dave shot himself in the heart, not the head. He suspected the depression with which he suffered mightily in the final years of his life was connected to a career filled with jarring head trauma. So he wanted a post-mortem examination of his brain, believing that he was afflicted with chronic traumatic encephalopathy (CTE). Although the results have not yet been revealed, I suspect they may show the hallmarks of CTE.

Until the results are released, and no doubt in spite of whatever the diagnosis, the NFL remains big business. But what happens in the wake of successful careers is nothing short of astonishing; not to mention tragic.

YOU try the individual market

NYTimes linking begins again.  This time, one well-off, healthy family of three tries to get insurance in the individual marketplace and BOOM, epicfail.

Look, I'm not saying I think ObamaCare is the panacea to our problems with health care. Many of the criticisms (other than "socialized medicine", "death panels", "bankrupt our country", etc) are valid. But have YOU tried recently to get healthcare? Any congressmen/women trying?

Crickets.

Last symposium as a PhD student

Holy crap, tomorrow is the last MSTP symposium I will attend as a PhD student.  Next year, I'll be a third year medical student.

In some ways, time has flown by quickly; in other ways, it's gone by very slowly.  ~5 1/2 years at UCLA, and still ~2 1/2 to go.

I have a boat-load of work to finish in the next few months for this all to be realized, and according to some of the powers-that-be, "productivity" has "declined" over the past few months.  So be it; point taken.  Finishing is indeed a challenge, and in many ways since I turned in the "return from leave of absence" form to the medical school, I'm psychologically had one foot out the door w/r/t being a graduate student.

All that said, I can't complain.

Oh and I get a chance to talk about my research at the symposium tomorrow as one symposium speakers, which is both exciting and daunting: it's challenging to convince people what you do is interesting and very important.  In reality, it's all just another variation on the same theme of nitty-gritty, slow-and-steady work-- character building.

Batshit crazy

Amy Chua confirms what some people have told me about Chinese mothers.  I'm not rendering an opinion about all Chinese mothers, but Chua is clearly, by her own admission, batshit crazy.

And I'm not the only one who thinks this.

Hey Arizona, ur doin' it 'rong...

Gail Collins comes up with a stunning, refreshing rebuke of the idiocy of Arizona's new approach to cut $4.5 million dollars from its state Medicaid expenditures by denying certain types of organ transplants.  The bottom line: government bureaucrats allowed the plug to be pulled on a 32 year-old father.  No, seriously.  This is from a state run by people who said "Obamacare" was going to do just that; when in fact health care reform was put in place, in part, to avoid such devastating consequences of cost cutting in the setting of poor information.

Update (12-17-2010): still sounds like death panels to me.  Wasn't this kind of thing supposed to happen under the watch of "liberals"? Never a state like AZ...

I was, am, and hope to always be naïve.

I hope you think the picture is pretty, but I don’t expect you to be as taken away as I am: I understand that discovering the sight was part of the fulfillment’s process. I take that back, actually. I didn’t discover anything. I just observed some already-well-characterized phenomena.

A couple of months ago, when I just started my PhD training, I saw this image under the microscope. I forgot how much time I spent staring at all the different motor neurons, how they extended their processes to hold figurative hands and pass along chemical love messages. I spent more time taking the highest resolution picture I could, which has been edited to its current state.

If I gave this image to a polite, random neuroscientist, he/she would give me a coy smile and say that the picture was “nice and the TUJ1 antibody stained very well.” If I gave this image to an impatient and nasty, random neuroscientist he/she would scowl at the piece of paper and ask me why I was wasting his/her time: I’m not showing anything new!

I hope this figure will be as stunning to me in a few years, when I’ve read more literature and seen more figures and done more research and graduated with a PhD. Sure I’ll see a lot of similar images; I might be bombarded by them. But I hope to appreciate that the ordinary is beautiful too: because you see it once, doesn’t mean the allure has to fade.

Monday afternoon football update

This weekend in American football:

1. A Rutgers' University student athlete was paralyzed from the neck down after an in-game incident against Army.
Update (10-19-2010): The most recent medical literature says that 90% of patients with complete tetraplegia (aka quadraplegia) at one month post-injury remain complete tetraplegics for good.  After 6 months, there is little change in a person's neurological status caudal to the spinal injury.  In other words, the coming days and weeks will be hugely informative of the athlete's function long into the future.  Here's hoping he regains function.  Also, from what I have gleaned from the news reports, it does not appear that therapeutic hypothermia (TH) was tried.  Recall that TH was used when Buffalo Bills' player Kevin Everett was injured back in 2007.  Although the use of TH in his case is still being debated, he was able to walk within ~one month of the injury.


2. Yesterday's NFL games featured several instances of traumatic brain injuries.

walking, chewing gum

In my recent interactions with one of UCLA's true physician-scientists, I start to get the sense, more than ever before, how this journey is about learning to walk and chew gum...at the same time! Hackneyed cliche aside, I guess I have begun to realize how all of this research and medicine "stuff" isn't so incredibly difficult, but juggling different responsibilities requires intra- and inter-personal patience: transitions are hard, and a deep breath and calm go a long way.  But it's still hard work.