Homecoming

I went back to New Hampshire for Dartmouth's Homecoming this past weekend. While making my way toward the Upper Valley, I found myself reflecting on the occasion, whose name seemed especially apt. As much as anywhere else, Hanover is home for me. I spent the four most formative years of my life there, during which time I met both my Savior and my future wife. What's more, I'm going back after paramedic school to get married and begin wedded life there.

But that lies ahead, and Homecoming is ultimately an occasion for looking nostalgically backward. As an undergrad I had never paid much attention to the visiting alumni, but then again, I could barely imagine life apart from Dartmouth, either. And whether it was the football team thinking wistfully about November 3, 2007 (the last time they had won a game before Saturday's impressive 28-6 victory over Columbia) or the numerous class mini-reunions around campus, The Past had a palpable physical presence throughout the weekend.

I got into the nostalgia act myself, coming out of retirement to take half a shift with Dartmouth EMS. It was a lot of fun to ride with them again, and encouraging besides. The unit has excellent student leadership this year and a small but committed cadre of supporters in the administration. They have made incredible strides over the past two and a half years, and I am eagerly looking forward to seeing where things go from here.

The highlight of the weekend, of course, was getting to see my beautiful fiancee. Below is a photo taken at the Dartmouth Night Bonfire. Just over ten months until the wedding!









In other news, the NBA regular season starts tonight. My Knicks haven't given me much to cheer about recently, but it's a brand new year and anything can happen!

Never a dull moment

It's been a frenetic two weeks (more to come soon on Dartmouth's Homecoming). Paramedic school has been a whirlwind of patient assessment lectures, labs and exams. Patient assessment is often referred to as the cornerstone of EMS care, because it is impossible to decide on a course of treatment without an accurate impression of the presenting condition. In addition to traditional, prehospital patient assessment, we also learned something called expanded scope assessment. This is a more detailed, physician-level set of assessment techniques that is intended for the clinical setting (i.e. a doctor's office).

Some states, such as North Carolina, have an "Advanced Practice" paramedic respond in lieu of an ambulance. He performs an extensive evaluation of the patient and determine if the emergency department is truly the most appropriate destination. If so, an ambulance is called and the patient is transported. If not, the paramedic calls the hospital and makes an appointment for the patient with the appropriate department. This prevents the waste of both ambulance and emergency department resources while simultaneously directing the patient to the most appropriate care. New York does not have such a system in place yet, but we're receiving the training now so that we'll be prepared when it does arrive.

Outside of class, my clinical rotations are continuing in earnest. I spent Wednesday morning in the Erie County morgue observing autopsies, which was a fascinating experience. It's not every day that you get to see a heart being prepared for transplant! Being able to actually see the internal organs instead of simply labeling them on a diagram makes a big difference. And the sound of the bone saw was a bit unsettling, but fortunately they weren't using it for long. This Wednesday I'm heading back to the operating room for more intubation clinical, which I'm looking forward to.

Updating a previous item, the NYS Health Commissioner has rescinded the mandate for all healthcare providers to receive the H1N1 vaccine because of an inadequate supply. This preceded President Obama's declaration that the swine flu outbreak is a national emergency, which has implications only for hospital treatment procedures and has no bearing on the vaccine. The seasonal flu vaccine, of which there is no reported shortage, is still a requirement for NYS healthcare providers.

In other news, the Yankees beat the Angels last night to advance to the World Series. This is the Bronx Bombers' fortieth pennant! The Yankees will host the Phillies on Wednesday night. You can bet I'll be watching.

Nobel Prizes announced

The Nobel Prizes were announced this week. Of greatest interest to me this year were the Literature and Medicine Prizes. The latter was awarded to three American researchers whose biological research has offered important insights into cell aging and death. This is a bit far afield of my own area of expertise, but I'm pleased for them nonetheless. The Nobel Prize for Literature was awarded to Romanian-born German author Herta Muller. It seems less than a quarter of her oeuvre has been translated into English, which might explain why I have never heard of her.

Though the Nobel Prize for Literature is my favorite of the awards, it's also the one with which I am often most dissatisfied. The award was founded in 1901 and since then has been awarded every year but seven. During that time some unquestionably brilliant authors have received it: Eliot, Yeats, Faulkner, Solzhenitsyn and Neruda, to name a few. Other recipients, however, have not been as deserving. 2004 laureate Elfriede Jelinek's The Piano Teacher, for example, is pornographic tripe. It is the nature of these awards that not everyone will agree with every choice of recipient. But let's look at who's doing the choosing.

There are more scientists and historians in the Swedish Academy than novelists, and none of them is widely known outside Swedish circles. Until resigning from her position, one of the members was best known for her detective stories. Are newspapermen and computational linguists really qualified to confer a prize of such global magnitude? Of course not. Great Britain's Man Booker prize, for example, is conferred by a board composed of the leading writers and critics in the Commonwealth.

The public is also culpable for blowing the award out of proportion. There is a certain weight conferred by the Nobel brand, but the award never claims to identify the single greatest author or work in the world. The public too frequently assumes otherwise and heaps exuberant laudation upon individuals who don't always deserve it. I do not mean to denounce any specific laureate (except Ms. Jelinek), merely to shed some light on a widely misunderstood prize. In the meantime, I look forward to reading Ms. Muller to see for myself.

And now I would like to announce a few Nobel Prizes of my own, in the following categories:

Dumb disclaimers:
1) The daily horoscope in the local newspaper: Predictions have no reliable basis in fact
2) Sleep aid warning labels: May cause drowsiness
3) The price-check gun at the supermarket: Small children should not shine laser in eyes

The winner is: The price check gun at the supermarket. It turns out that lasers will blind you at any age. Just ask Phil Cuzzi.

Exasperating engineering:
1) The $0.15 toll on Interstate 90 between Buffalo and Depew.
2) Alarm clocks
3) The jump seat in the back of van-style ambulances

The winner is: The jump seat in the back of van-style ambulances. It'd be more comfortable to sleep on a porcupine's back.

Coolest electronic device I've used in the past two months:
1) MonRoi Personal Chess Manager
2) Garmin GPS
3) Logitech Webcam

The winner is: The webcam. The MonRoi is great to have for chess tournaments and the Garmin gets me from A to B, but only the webcam lets me see Ellen while we're 400 miles apart.

Much ado about swine flu

Distribution of the H1N1 flu vaccine began yesterday amidst a swirl of fanfare and controversy. This vaccine, which specifically targets the dreaded "swine flu," is taken in conjunction with a seasonal flu shot. I'm not big on fad vaccinations; I eluded SARS and the avian flu and I'm similarly unconcerned about a sudden outbreak of bubonic plague or the Vidiian Phage. I even survived twelve years of grade school without a "cooties shot." So ordinarily I wouldn't be paying much attention to the raging brouhaha. The wrinkle is that New York has become the first--and so far the only--state in the country to make the H1N1 vaccine mandatory for all healthcare workers.

My principal concern is that the vaccine has not been adequately tested. No one really knows if the vaccine works or if it is safe. As one classmate, a former combat medic, put it, "They haven't even tested it on the Army yet, and they test everything on us." There was a swine flu vaccine in the 1970's, but problems arose when people began dying from it. Presumably that shortcoming has been corrected with this new batch of vaccines, but new ones have arisen to take its place. The nephew of one of my lab instructors received the new vaccine and promptly developed Herpes zoster (which is distinct from but related to the venereal disease).

The outbreak of Spanish Influenza in 1918 killed upwards of 50-100 million people. One of the major contributing factors to this astronomically high death toll was a lack of appropriate public health response. Nearly a century later, epidemiological knowledge has progressed by leaps and bounds and proactivity is a major weapon in the public health officer's mitigation arsenal. Mass-producing a vaccine with which to protect the population is a responsible and sound decision.

I fear, however, that overzealousness has led to undue haste in the development and approval of this vaccine. No doubt the scientists working on the vaccine were under tremendous pressure to have the final product ready to go in time for "flu season," and the vaccine approval personnel were similarly motivated to put a product on the market. I find it impossible to believe that the H1N1 vaccine was developed and tested with the rigor, longevity and a scrutiny that a less "important" product would have received. (The volume of drug recalls in recent months has also shaken my faith in the entire approval process, but that's a different story.)

If I had a choice, I would not receive the H1N1 vaccine and I disagree with New York State's decision to make vaccination mandatory. The vaccine is available in all fifty states, but the other forty nine are leaving the decision to the individual providers. Surely the Department of Health must realize they're missing something everybody else can see? Nevertheless, I am an EMT and EMTs have to receive the H1N1 vaccine. So bring it on. But please hold the Herpes.

Beginnings and endings in October

October is a highly transitional month. Today, for example, is the last day of the Major League Baseball regular season, with the playoffs beginning later this week. But even as baseball draws to a close, college and professional football are in full swing. My New York Giants have jumped out to a solid 4-0 start; the 3-0 Jets are fighting an uphill battle against New Orleans as I write. Unfortunately, Dartmouth football continues its losing ways. They lost a 30-24 game to Penn for their fifteenth consecutive loss. Next up is Yale; here's hoping for a Big Green victory!

This week was marked by the passing of William Safire and Jerry Hanken. Safire distinguished himself as the resident grammarian of The New York Times and is warmly eulogized by colleague Maureen Down here. Jerry Hanken was a household name as well, if to the slightly smaller demographic of US Chess Federation members. His "Hanken's Corner" articles for Chess Life Magazine and interviews with class winners at major open tournaments had become a staple of the American chess experience. I did not have the pleasure of knowing Hanken personally, but I will miss him nonetheless.

I played another chess tournament yesterday, winning the Sardinia Open with a 3-0 score. My second round opponent played a daring knight sacrifice and even achieved a winning position, but a handful of inaccurate moves late in the game allowed me to equalize material and win the ensuing rook-and-pawn endgame. He was disappointed (and I was relieved) by the result, but I'm sure we'll both learn a lot from the game. My third round victory over 1581-rated Matt Peck is as follows:

1. d4 e6 2. c4 Nf6 3. Nc3 d5 4. Bg5 Be7 5. e3 0-0 6. Nf3 c6 7. Qc2 Nbd7 8. Bd3 h6 9. h4 Ne8 10. Bxe7 Qxe7 11. g4 dxc4 12. Bxc4 Nd6 13. Be2 e5 14. g5 e4 15. Nd2 f5 16. 0-0-0 hxg5 17. hxg5 Qxg5 18. Qb3+ Nf7 19. Rh5 Qf6 20. Rdh1 g6 21. Rh7 Nb6

22. Ndxe4 fxe4 23. Nxe4 Black resigns

I went back to the operating room on Wednesday for another round of advanced airway clinicals. Unfortunately the trip was only a partial success. I didn't get to place the required number of airways, so I have to go back a third time later in the month, but as always it was neat to see everything that goes into a safe and successful surgery.

I'm trying to get excited about the National League playoff cycle, but it's tough when all it confers is the right to lose to the Yankees in the World Series . . .