Did You Know...

... that all the blinking you do in one day amounts to having your eyes shut for 30 minutes?

... and that in a lifetime the average person spends over 25 years SLEEPING?

Gets you thinking doesn't it?

Southpark: Too Far This Time?

I stumbled a cross this bit of news on CNN (Read News Article) reporting that Southpark creators Matt Stone and Trey Parker might have gone too far on one of their notorious skits on religion and major religious figures, by allowing one of their episodes to feature Muslim Prophet Mohammad wearing a bear suit.

"This is a show, after all, that once painted God as a gap-toothed rhinoceros-monkey, portrays Satan as a simpering milquetoast and regularly features Jesus as a superhero -- the kind who's not afraid to ignore the peaceful teachings of the Sermon on the Mount to smite his opponents. The show has mocked Jews, Catholics, Mormons, Scientologists and atheists, among (many) others." - CNN

I have been a fan of Southpark for years and years so this really caught my attention because, while I found their fun poking at religion and its figures was witty, hilarious, and as bold as one can imagine, I've always wondered when and how it would get them in trouble (and I'm laughing as I write this!).
So here it is! "Revolution Muslim" a radical Islamist organization and movement based in New York City that advocates the re-establishment of a structured Islamic state, terrorism in both the US and in democratic countries around the world, the removal of the current rulers in heavily Muslim populated regions, the destruction of Israel, and an end to what they consider 'western imperialism' - Wikipedia -- Is it just me, or does it sound a bit odd that this group would be based in NYC??? Excuse my digression! -- has taken offense at the portrayal of their prophet and has released a 'warning', or so they called it, to Trey Parker and Matt Stone, reminding them of the murder of Theo Van Gogh, who was killed in 2004 by an Islamic extremist. Among his works was "Submission, a short film about abuse of women in Islam. The release included pictures of Van Gogh's dead body. According to the group, however, this was in no way a threat but a mere warning of what might happen as a consequence of the airing of the episode.

I can't help but laugh at the wonderful work of the makers of Southpark. Of note was one representation of almost all religious figures in a group gathering, with Prophet Mohammad covered by a black square with the word "CENSORED" contrasting in white.

I am not sure about the repercussions of this and what they can be, or if any other movements with more power have taken more serious offense than Revolution Muslim. And if they have, how different would the reactions be in NYC as compared to the Middle East? I am also wondering about freedom of speech and how it applies in this case! How can groups be allowed to run around threatening people who don't live by their values?

Video From CNN

Thank You Ayaan - You are the first Muslim I have ever heard speaking with such objectivity.

Blind Item

I snapped this photo of the Lebanese Norwegian Cultural Week poster...
A funny twist!

What's Lebanon's Stance on Slavery and Racism Again??

So here's another lie us self-righteous Lebanese tend to force feed ourselves. We don't condone slavery. We turn our backs to racism. Right?

Think again...

To your right is a nice classified ad for the exchange of a 1991 Dodge for a Sri Lankan domestic worker.

Please read No Maids in the Pool.

[Edit:This is to clarify that the classified is NOT in a Lebanese paper].

What more do we need? how much more disgrace, how much clearer does this picture need to be for the Lebanese to just shut the hell up and realize that we are probably the most self-absorbed, superficial, and prejudiced (oh yeah the list goes on...) people on the face of this planet?

I can only try and say how dumbfounded I was when I saw that classified. And in light of the no maids in pool article I can tell that it's only a matter of time before we find a few like these in our Lebanese media.

I really thought I'd have so much to say about this matter, so much to talk about and criticize, so many questions and so much eloquent rhetoric. Instead, I have only speechlessness, disbelief, and shame. I am ashamed of my country, ashamed of being Lebanese. This shame is growing by the day, exacerbated by the fake, smug, and holy stance that the Lebanese take on these and other matters.

Lebanese people are a friendly, welcoming, and humanitarian people. Or so would the media say. Of Course they do not tell you the whole story. I will stop here, too disgusted to continue writing.

Modern Medicine and Cruelty... The Positives?

Read Cruel Discussion and Modern Medicine.

I've talked and talked and rambled on about the disillusionment one stands to feel during one's progression in physician training over the years. My avid readers will remember the "Ladies and Gentlemen, Your Future Doctors!" 'saga'. If you don't, check out Part I and Part II. (Does time fly or what?).

Anyways in the second part I go on about how you lose this sense of idealism, this cleanliness, if you will, that people commonly associate with medicine. Now some one and a half years down the line, this incident comes and reshuffles my perception of the world of medicine and what it all stands for.

In the OPD (Out Patient Department) we care for patients on a visit-to-visit basis. It is usually the least expensive form of healthcare, and so inevitably we get to see the less fortunate patients who are paying petty fees for consults with doctors in a high-ranking hospital. The ramifications of this, which I will save for another -long- post, and the experience of such 'encounters' sometimes shakes you to your core. The socioeconomic aspect that we never really come to face on the ward floors with high class (I hate to say it) patients is a rude awakening to say the least. So one of my last patients in the OPD Pediatrics rotation was K. an 11 year-old boy whose chart (We view charts before meeting with patients) said that he had growth failure. As I read more and more pages, and came across more and more test results and differential diagnoses, I got to the note that was written when K. had last visited the OPD clinic. At the time (some 2 years ago) he was diagnosed with Laron-type dwarfism. In brief, Laron type dwarfism (also Laron Syndrome) results from a mutation of the Growth Hormone receptor, and a subsequent Growth Hormone insensitivity leading to failure of growth due to severe IGF1 deficiency (IGF1 mediates the action of Growth Hormone).

The Visit

K. walked into the room and I immediately saw his prominent foreheaed (typical of the syndrome). To me he looked like a 4-5 year-old toddler, physically, and somehow even though I knew about his condition, I was still dumbfounded when he greeted me with a noisy low-5 followed by a firm handshake worthy of a grown man. Or when I heard his 11 year-old voice and his 11 year-old vocabulary. Or as I saw his 11 year-old movements manifest in a 4 year-old body. His 11 year-old self confidence, assertiveness, and demand of autonomy also struck me as he insistently forbid his mother from answering my questions for him. I think I've stressed it enough, it was one hell of a surprise, despite the fact that I knew about it.

K. was without a doubt the most pleasant patient I've had during this rotation. He had a persistent contagious smile that revealed a set of run down, crooked and decay nibbled teeth. He made jokes, played with my stethoscope, and everything else he could find in the room. The whole interview and physical exam took place in a light atmosphere and in the best possible conditions. NOT to be soon forgotten.

Of The Sadness of Reality
One promising modality for the treatment of Laron Syndrome is recombinant IGF1 (marketed under the name Increlex in the U.S.), which can bypass the action of GH on its deficient receptor, thereby restoring growth satisfactorily if treatment is initiated in a timely fashion.
Sadly, Increlex is unavailable in Lebanon. And apparently it is a very expensive drug, which as you might have concluded makes it a problem for an OPD patient struggling to pay even the LBP 10,000 OPD fee.
As documented in K'.s chart, K.'s mother was told about this treatment when they had last visited OPD. She was also told that it was not available and that there was no way she could afford it even if it were. She was coming a couple of years after that visit in the hope (in her own words) that "Dr. N had something new for her and her son".
- Dr. N: There still are no significant efforts to market the drug in Lebanon.
- Mother: Oh.
- Dr. N: As I told you last time we are trying but your son's condition is so rare that it's hard to find proper treatment here. And the expenses would be just impossible.

Dr. N once again sent K. and his mother home empty-handed. I could not tell whether the expression on the mother's face was one of disappointment, helplessness and resignation, or of expectation.

My Reactions and Thoughts

I was deeply saddened by this outcome and for a brief moment I felt helpless and ashamed that we had to send a patient home after telling him in no uncertain terms: "there is a drug for what you have, we're sorry but you just can't have it". So what are the issues here? I mean after stepping out of that personal, humane, human, emotional roller coaster ride of a first reaction, what are the circumstances that need to be discussed?

We hear a lot every day about how medicine has been commercialized to a degree where incidents such as these are possible. We also hear about how shameful it is that medicine is a financially driven institution. And what we hear most are the sad individual stories such as the one I've told you in my long and by now surely boring account. But what is the bottom line? If anyone knows me they know I'm a bottom line kind of person. So what is it in this case?

Well the bottom line, stripped of all emotion, all sentience, and all humanity, is a sad realization that money is and always will be a major, major factor in the drive for research of all kind. Putting all of this baggage aside, a patient is buying a product (in this case a drug that is the result of years and years of expensive research and trials), in order to use that product for personal reasons.

This is how impersonal and desolate the bottom line of modern medicine has become. And to me that's all that matters because there simply is no point trying to discuss how and why it comes down to this. So is it correct to assume that my disillusionment has surpassed all the good that medicine has brought and is bringing to this world? That in the end it can be boiled down to a simple transaction between a care provider, a pharmaceutical company, and an ill person?

The answer is a resounding NO. To me there is always a positive side to this. One positive side that will not be affected by the source of motivation of pharmaceutical companies, is that no matter what happens, medicine will always strive toward a common goal. And that common goal (besides, of course, the financial rewards) being what it is, which ranges from the curative eradication of disease to the palliative nature of the most trivial of pain medication, I can confidently say that medicine does more good than harm.

Sure, unfortunate patients will benefit less than others and K. here is a prime example. But if we consider the long term outcome of the situation, we are hard-pressed to see that had there not been this monetary incentive for research, Increlex would have probably never seen the light of day! But the bottom line is that it HAS. As a result of this, we HAVE a drug, it IS helping SOME people and maybe one day this drug WILL be available to everyone. I will go out on a limb here and say that an inevitable period during the life of this drug (and this applies to all drugs and forms of medical treatment or diagnostic tools one can think of) when it will be administered in a discriminate fashion among patients is only an obstacle, a hurdle that we will overcome in our drive toward global availability and affordability of the drug. This situation now is better, in my humble opinion, than not having any drug at all, and I would be surprised if anyone argues otherwise.

Sad. But true.

Brilliant Recap on Religion

Came across this skit by George Carlin on religion and its shortcomings.

I know some of what he says may be a bit disrespectful and his language might be a bit raunchy. But look past this and you'll find a good argument. And a funny one!

I somehow identified with Carlin on this one. I was never a believer. Since childhood, and since I could remember having any sense of logic and my own opinion on a few things in life, I just couldn't get myself to accept the dogmata of religion. There always seemed to be just too many discrepancies, to many dissonant axioms for me to just believe blindly. And let's face it, blind faith is the requisite in this department.

So what Carlin says in this skit summarizes (very briefly) my views on religion.

One thing though is that I've always been sincerely respectful of people's beliefs, as I've said in earlier posts; what drives me out of my mind though are people who use the 'faith argument' in discussions to try and convince people of the validity of the God Theory and all that it entails. These are the only instances where anyone will hear me badmouthing religion (and not spirituality).

Yesterday was holy Thursday and I tagged along with milady and a few friends for the traditional 7-Church visit. "This isn't tourism", smiled L., who was all too aware of my views on the matter, "you should have some thoughts, maybe say an informal prayer here and there!"

The thing is, there were many, many thoughts entering my mind at the time. At every church visit, every time I walked into a church since I was a kid, I would start thinking and thinking. Wondering, asking myself questions. Questions and thoughts about how people seemed taken and immersed in their belief, and the sense of their trance-like state. Every time, the experience is touching to say the least. And every now and then, I felt like one or two of my thoughts were of my family and loved ones, and these were the thoughts that I felt were somehow 'emitted' or 'sent off' without me necessarily wanting them to, in some raw and random hope that someone really is up there. But... you know the rest. These feelings and thoughts never consolidated into anything more powerful and for me, I don't know. I guess something more compelling will have to happen for religion to have a better chance with me. Don't ask what.

So please for those of you who will view this video, don't be outraged and blinded by a few bad words and scream blasphemy!

Cruel Discussion and Modern Medicine

Overheard at the OPD Pediatrics Clinic between physician and a patient's mother.

Mother: What can we do Dr. N?

Dr. N: There is a new and effective drug for what your son has. But it's too expensive. Neither you nor I can afford it.

Mother: So what's the solution?

Dr. N: ..........................................

P.S. I will elaborate on the case soon.

The Snail

Shweifat, Lebanon - March 2010

"The snail he lives in his hard round house,

In the orchard, under the tree:

Says he, "I have but a single room;

But it's large enough for me."

The snail in his little house doth dwell

All the week from end to end,

You're at home, Master Snail;

that's all very well.

But you never receive a friend."

- Anonymous

A Late Rite of Passage

Walking on Bliss street had never been such a complicated task, what with all the 10-year old –or less- mendicants and lottery ticket ‘agents’ or shoe cleaners. For the longest time I felt annoyance at the heavy task of brushing off these pesky and persistent solicitors that seemed to be after nothing other than your money. The annoyance not circling around the money itself, but about the ethics and principles of discouraging the presence of alms-askers and the associated child abuse and whatnot; let me not digress and wander off into these treacherous discussions for now.

So one of my tricky walks along the famous street, while I was looking for that after lunch cup of coffee, got me to Epi D’Or. -Don’t let the name “Epi D’Or” fool you. Fancy name for a place that’s affectionately and more commonly called “Abou Naji”, the little store across the street from the AUB main gate-. Waiting for my coffee, I get elbow-tugged outside by an as-yet unknown figure who turned out to be one of Bliss’ seasoned shoe cleaners

. “Here we go”, I thought to myself. But then, all thought processes angled at getting rid of that annoyance were instantly stopped by the cleaner’s marketing skills… “Eza ma 3ajabak ma tedfa3 wala lira!” Translation “If you don’t like my work don’t pay a dime!”

Said in a convincing and confident tone, these words made me think ok what the hell? My shoes were dirty, hadn’t been cleaned in a while and a good buff would do no harm! So I told the guy to do a good job and he got to work. I have not seen hands move so fast. The sound of swishing as his run down piece of tissue carved through the air and onto the now polished leather told the tale of a shoe cleaning veteran with years of training!

All done, shoes shining, and face smiling as M. took a few snapshots of the event, I was thinking about the going rate on a premium job like this! So I thought 3,000 LBP. M. frowned in disagreement and so I gave him 5,000 LBP.

In retrospect, seeing how his face lit up as he tugged on that bill and all the good wishes for prosperity and long life I got at that time, I know I overpaid! But I would do it again and pay the same price!

But hey. An honest living, a job well done, make me rethink my stance on the good shoe cleaners out there! This is one rite of shoe-cleaning passage not to be soon forgotten!

Drafts from the Past

For a few days now, I'd been wondering how to get back on the blogging track. For me it's one of those times when you have a lot to write, but not enough time. So much to write you can't just cram it into one post and expect it to make sense... So I thought why not see what I had been up to before my unjustified hiatus...

Here's to fishing a few drafts from the past, a few posts that were never posted. Figured we'd go from there!

August 22, 2009 - A Med Student's First Patient Crush

"Well here it is. It finally happened... It had to, I guess it was only a matter of time. I guess it's always only a matter of time before any med student gets infatuated with one of his patients. I had to check on a total of 6 patients yesterday, and these include two patients from my previous post.

So after a long on-call day at the hospital, I get beeped for my last admission of the day. I thought to myself, "here we go. One more intestinal obstruction or jaundiced patient and I'll be on my way..." And so I got to 7 South. I saw Dr. K (one of our residents) and R. (a visiting student from Syria) at the end of the long hallway leading to the desk. As I got closer, I started hearing tidbits of what they were saying, and the little that I could put together was "She's status post whipple procedure in 2007".

When I heard this, I tought "ok, here comes another 90 year-old... [end of draft]"

September 26, 2009 - Enraged Med Student Slays Many in Elevator Frenzy.

"What is wrong with people? What is wrong with Lebanese literacy? what is wrong with normal psychomotor and cognitive development?

You're probably wondering why I'm asking these questions... Well let's see. In order of appearance and respectively, here's what they... [end of draft]"

November 6, 2009 - Some Will Never Learn...

"Ever wonder why you seem to keep making the same mistakes... [end of draft]"

December 24, 2009 - Wandering Attention, You're Welcome

It's 2 am and I'm awake, wondering what it is that drives the seemingly coincidental encounters, the apparently arbitrary events, large and small, that seem to just explode in apparent randomness until they inevitably crash back together and make up that mess that we call life... [end of draft]

I had been thinking about a few of these posts, the few worth posting, that is, and wishing I had posted them when I remembered more of what made them worth writing. But I have to say that while a bunch of fine-script details are lost to hazy recall, some memories are tenacious and come out vividly as soon as they are elicited.

Like L., my 26 year-old patient with not only the most intriguing and sorrow-inspiring medical history and problems, but also with the most unforgettable face and big blue eyes and out of this world sweetness one could imagine. One of the many patients I will never forget.

Or that insane feeling I get everytime I get in the elevator at AUH and people start pushing and shoving to get in before anyone has a chance to get out. When they look in at some of us 'elevator insiders' and ask: "Going up?" with that bewildered look on their faces! And finally, when stuck in a packed elevator for 10 floors with a stop at each and every single floor with agonizing slowness and the same sketch of pushing, shoving, and moronic questions, the nice feel of less-than perfect hygiene: the 9 out of 10 people with breath odors prompting the eloquent question: "WTF???" and let's not forget the 8 out of 10 people with body odors worthy of wildebeest! I used to think about that frenzy every day! "LOOK OUTSIDE YOU MORON! THERE'S A LARGE ARROW POINTING EITHER UP OR DOWN! AND GUESS WHERE THAT !@@#$% ELEVATOR'S GOING!! AND TAKE A GOD!@#$ SHOWER AND BRUSH YOUR GOD AWFUL TEETH!" Oh that felt good!

As for the last two drafts, I can't seem to remember what I was on about. I'm sure it would have been interesting though!

Ok so there was my flashback. My way of dotting the i's and crossing the t's paving the way for a few more memories fished from the past as I catch up.