PLAY YOUR HEART OUT

Kanchha Sherpa, Last Member of First Team to Conquer Everest, Dies at 92

"When she consulted with her father - who was on the Faculty of the Harvard School of Economics - about the possibility of remaining in Boston to continue her quest, his advice was, 'don't go where you are tolerated... go where you are wanted.' Helen Taussig returned to Baltimore to focus on congenital heart disease. Alfred Blalock had just arrived from Vanderbilt as the new Chief of Surgery (1941) and had never even ligated a ductus arteriosus up to that point."

Cardiac Cowboys by Gerald Imber

The purpose of a retrospective study is to kick us in the head, to challenge an assumption, and to stimulate the design of a study that will generate class one data.

Zeeman's mathematical model for the heartbeat used a stable equilibrium, a threshold for triggering an action potential, and a return to equilibrium in describing cardiac dynamics (Jardón-Kojakhmetov and Broer 2014). The model has three necessary characteristics: (1) an equilibrium state that represents the diastole, or relaxed state of the heart, (2) a threshold for propagating electrochemical waves that lets the heart contract into the contracted systole state, and (3) a rapid return to the original equilibrium state as part of the limit cycle. This is a catastrophe. With the limit cycle continuing, the heart continues beating.

Apoptosis or programmed cell death is a highly regulated and energy-requiring process. In cells subjected to pathologic stresses such as ischemia, there is a delicate balance between survival and death.  Estimated duration of apoptotic process is from 12 to 24h, but cellular morphologic changes are visible in 2h; detection of such changes and of previously produced specific biochemical markers are potential methods for early assessment of apoptosis.  In contrast to apoptosis, necrosis is a violent, irreversible and non-regulated process of cell killing in consequence of profound disengagement of cell homeostasis due, for example, to prolonged anoxia or strictly impaired environmental conditions, leading to complete and prolonged ATP depletion.

In his discussion of causal inference, Hume concluded, after much deliberation, that “appeal to past experience decides nothing in the present case” (Treatise of Human Nature 1, III, 6). In contrast, we almost always rely on past experience when planning our future. We often base our decision-making in one clinical case on our own experience with a previous one, and we typically are unable to avoid relying on past experiences of our own and of others.

Chicago architect Louis Sullivan is well known for his progressive philosophy that form should follow function. In anatomy this is demonstrated often, and there is no better illustration of this principle in the human body than the esophagus.

Trauma is a killer of young people, and it's a global disease. If you look at why trauma patients die, the two leading causes of death depending on whether it's blunt or penetrating, are CNS injury and bleeding.   When I was starting my academic career as a trauma surgeon, you look at the landscape and saw, "Where can I make the greatest impact?" Dr. Trunkey described the trimodal distribution of trauma in the 1970s. There was early death within minutes, then there was a second peak within hours, then there was a third peak over the next few weeks. Over the last 30-40 years, the second peak and flattened out and the third peak has completely gone away. If you make it to the ICU, you will live. You make require dialysis, ECMO, etc., but you will live. Where patients continue to die is in the first hour or so after injury. If you have to look at this big number of patients and find where you can have the biggest impact, that would be hemorrhage control.

I made a promise as a kid to my mom I would never remove my turban. Today it is in the Hall of Fame. Embrace what makes you different. It is your superpower. This is the crown I wear each day. Thank you, mom.