Exercise!

Sweewawa and I have been working hard this spring to get in shape. Have been jogging by the ocean, watching the seals, dolphins, and sandpipers along the way. Also have been playing tennis at UCSB and at the end of our street in Carpinteria. Swimming at UCSB pool with the beautiful mountains in the background has also been a favorite. As well as hikes through the beautiful local terrain. So much fun outdoor stuff to do in the Santa Barbara area! To supplement these great activities and to work on the all-important core, I have decided to start doing the onehundredpushups and twohundredsitups challenges, starting this week. These are great, free, programs that look very cool. Links are below:

hundredpushups.com

twohundredsitups.com

Happy exercising!

Cheers,

Dr. Kowawa

New Word

Today I made up a new word. The word describes an acquaintance who is friendly but rather cold. This person is a "nicicle" :)

Thesis Completion

Sweewawa has completed her Physics PhD thesis and is mailing the final version today!

And here are some photos from her PhD defense in August:

June was busy

Busy month of moving from VA to CA. Not a lot of posting . . . but glad to have finally settled down in the Santa Barbara area!

Global Warming bill must be stopped

Click below for an excellent read on the Global Warming bill aka Cap-and-trade:

David Limbaugh : Cap-and-Tax: Government vs. America - Townhall.com

Blog turns 1!

Song of the Day: There Is No Greater Love - Coleman Hawkins

Quote of the Day: "To love someone deeply gives you strength. Being loved by someone deeply gives you courage." --Lao Tzu

Thought of the Day: Dr. Kowawa the blog turned 1 yesterday. I've enjoyed this first year of posts and plan to continue on. This past weekend celebrated the marriage of my sister & Brad. Congratulations to them, may they have a happy lifetime together! The Song of the Day was part of the outdoor wedding ceremony, played by the great Charlottesville trumpeter John D'Earth with Pete Spaar on bass. The ceremony was beautiful and the weekend at Mont Fair farm was enchanting.

Cheers, Dr. Kowawa

Backcountry camping

Below is the link to the three day circuit we chose:

Big Run, Doyles River, and Frazier (PDF)

Memorial Day Weekend

Fun, fun, fun! Today Sweewawa and I head out for a half day at Busch Gardens before heading West to Crozet, VA for a BBQ with old friends. We're all packed up to for the camping trip to begin Saturday morning though Monday afternoon. Can't wait, will update the blog with some photos on our return. Cheers, Dr. Kowawa

Planning camping trip

Song of the Day: Dock Of The Bay - Otis Redding

Quote of the Day: "He who hath many friends hath none." --Aristotle

Thought of the Day: Today have spent much time planning a two-night, three-day camping trip for Memorial Day weekend with Sweewawa. Planned out our circuit hike, our menu (cooked solely by stove, no open fires allowed in Shenandoah National Park), and our gear. I expect it will be a fun time of tranquility, exercise, picture-taking, and philosophizing.

Cheers, Dr. Kowawa

Graduation from medical school

Songs of the Day:

Weird Fishes - Radiohead

My Way - Frank Sinatra



Quote of the Day: "The mind is not a vessel to be filled but a fire to be kindled." --Plutarch

Thought of the Day: Today completed the second day of graduation ceremonies from medical school. The songs of the day are two that are dear to me. Weird Fishes is a Radiohead tune I really like, and is one I have listened to again and again during my years of studying. For some reason it seems even more special to me now that I have graduated. The second song is a tune made most famous by Frank Sinatra, My Way. Dr. Collins, one of the founders of the Human Genome Project, was the commencement speaker at the VCU graduation. At the end of his commencement speech he did a brilliant modification of "My Way", shown above.

After four years of near-constant, hard work I am done! I matched at my first choice for my desired specialty, Radiology, and am feeling on top of the world. All my work has paid off, and I am humbled and deeply honored to have earned my M.D. degree. I look forward to the next years of providing excellent care to my patients and continuing my studies of Medicine and Radiology.

Cheers, Dr. Kowawa

Ricercar

Song of the Day: The Musical Offering, BWV 1079 - Ricercar a 6 - Johann Sebastian Bach

Quote of the Day: "If there is any religion that would cope with modern scientific needs it would be Buddhism." Albert Einstein

Thought of the Day: Just finished reading Godel, Escher, Bach, An Eternal Golden Braid. What a brilliant book! Can't say I understood every concept in the 777 pages, but I definitely enjoyed the book immensely. This book is intellectual exercise, but Hofstadter has a wonderful sense of humor so it's fun. The last chapter ends with a 6 part dialogue that re-explains some of the author's methods and mirrors Bach's masterpiece 6 part fugue that concludes the Musical Offering. I would absolutely recommend this book to anyone interested in music, philosophy, mathematics, or religion who is looking for a challenging, intellectual read.

Ceci n'est pas un message

Song of the Day: Dream - John Cage

Quote of the Day: "How can you tell if your own logic is 'peculiar' or not, given that you have only your own logic to judge itself?" --Douglas R. Hofstadter, from Godel, Escher, Bach

Thought of the Day:

My thoughts these last couple of days have been with the people of Santa Barbara, CA as the wildfires continue to blaze. Fortunately there have been no deaths but some firefighters have been injured and there has been substantial loss of property. May the blaze be contained soon with minimal further damage.

Of late have been continuing reading Godel, Escher and Bach, and am on the final chapter. This has been an extremely rewarding, though quite challenging, read. The quote of the day is a really interesting one from Hofstadter. Love this loop of questioning. The Song of the Day is from John Cage, whose work is frequently mentioned also in the book. The pic at the top is from Magritte, who challenges viewers of his works to question the reality of representations or symbols. In this piece he highlights that the reality seen through the window is represented on the painting, and the viewer takes another step back to see that this representation is itself a painting on a canvas. Which is itself also a further two-dimensional reality-representing symbol, the one the viewer is witnessing. Take it back a step further by interpreting the whole visual concept a la the philosophy of Descartes . . . Here is a quote from Magritte on this work:

"I placed in front of a window, seen from a room, a painting representing exactly that part of the landscape which was hidden from view by the painting. Therefore, the tree represented in the painting hid from view the tree situated behind it, outside the room. It existed for the spectator, as it were, simultaneously in his mind, as both inside the room in the painting, and outside in the real landscape. Which is how we see the world: we see it as being outside ourselves even though it is only a mental representation of it that we experience inside ourselves."

First Music

Song of the Day: Fanfare for the Common Man - Aaron Copland

Quote of the Day: "What the superior man seeks is in himself; what the small man seeks is in others." --K'ung Fu-Tzu (aka Confucius)

Thought of the Day: To keep a semblance of political balance I like to mix up my news sources a bit. When I'm driving I'm almost always listening to NPR, which offers a fairly in depth, albeit extremely left-slanted, account of many news and general interest stories of the world. My conservative news sources are drudgereport.com, townhall.com, and boortz.com. To round out the two ends of the spectrum I enjoy reading google.com's News section. I skip television news entirely as Sweewawa and I very very rarely watch television. Anyway, when driving back from the hospital last week I heard on NPR this delightful general interest piece on Music for Newborns. In it was discussed what choices various public figures had made as far as what music to play for their newborns or young kids. The Song of the Day is Aaron Copeland's Fanfare for the Common Man, which one of my favorite jazz vocalists, Rene Marie, would often play for her young boys. I look forward to the day when Sweewawa and I will choose the music our kids will be exposed to early in life.

So despite being a 4th year med student I have been quite busy of late. I recently spent quite a lot of time filling out all the forms and completing other tasks required to begin my internship year. I also have been busy exercising daily and contributing to an online bulletin board Ethics course. Today I would like to share one short essay I wrote for this course, on the case of Jesica Santilan. Here is a brief synopsis of the case (offered by a classmate):

Jesica Santillan was a 17 year old girl originally from Mexico who died from a botched heart/lung transplant. Jesica and her family originally came to the United States as illegal immigrants in order for Jesica, suffering from restricitive cardiomyopathy with secondary pulmonary hypertension, to get life-saving medical treatment. After entering the U.S., the family moved to Louisburg, NC near Duke University Hospital in order for Jesica to get the best treatment. Her medical care was paid for by private donors in her community.

On February 7, 2003 Jesica received a heart-lung transplant. As the surgery was ending and the doctors were closing up, they received a phone call that made them realize they had made a fatal mistake. Jesica and the donor did not share the same blood type and no one had thought to check. The organs were originally made available from Boston to another one of the transplant doctor's patients at Duke. Once the transplant surgeon realized the organs would be no good for the other candidate, he asked about giving them to Jesica. A few hours later, the transplant surgeon was given the go ahead for Jesica's transplant. He assumed the blood type matched and no one checked until the surgery was almost over.

On February 20, 2003 another set of lungs/heart were found for Jesica and were transplanted, but the damage had been done. She was pronounced brain dead a couple of days later. Her family did not donate any of her organs.

**********************

While there are a number of fascinating ethical questions regarding the case, one aspect I chose to write about is the debate about to what extent illegal immigrants should be given access to the public health system in the US. Here are my thoughts:

I think one of the most interesting aspects of this case is the question of whether and to what extent illegal immigrants should be allowed access to the US health care system. This issue has been a big one in California, where a steady flow of illegal immigrants has led to dramatic increases in costs for hospitals (and all social services) and the government. In 1994 the CA voters passed Proposition 187, which required publicly funded health care facilities to deny care to illegal immigrants and to report them to government officials. The proponents of the proposition declared "While our own citizens and legal residents go wanting, those who choose to enter our country illegally get royal treatment at the expense of the California taxpayer." The proposition was in 1997 found in federal court to be unconstitutional, in part because it was out of the scope of the state of California to pass legislation that encroached on the federal domain of immigration law.

Speaking as a citizen and not as a physician, I am a nationalist when it comes to this debate. I often get irate when I hear or read news stories where the rights of illegal immigrants are discussed. These people broke the law by evading detection on entrance into our country or overstaying visas. I have always wondered what the debate is when the entire premise of their being present in the US is an illegality. According to our law these people have no right to reside in the country, let alone to request public services. If you want to reside in the US then use the legal process of immigration. Side note: it also bugs me that the politically correct media have shifted away from using the term "illegal immigrants" to the less offensive (and less accurate) term "undocumented workers".

So the nationalist part of me wishes we didn't even have to have this debate. But the reality is that the problem of illegal immigration is not going to go away. This is a debate that we must address as citizens and as physicians. And when you look past the pure nationalist gun-toting border enforcer view of it this is a debate that has considerable gray area.

First there's the notion mentioned by others in previous posts that barring illegals from receiving medical care may result in a forced breach of professional ethics for us physicians. As physicians our job is to help to improve the health of those who walk in the doors of the hospital or medical office. We abide by the Hippocratic oath first and foremost. I like how David S. separated his opinion on the subject in terms of whether or not he was wearing his physician's or citizen's hat. I do think it's actually comforting to think that when we are in the hospital or medical office setting we just wear the physician's hat, we just follow the Hippocratic oath, and we just help people to improve their health. Proposition 187 would have required physicians in California to occasionally toss off that hat and call the INS.

Interestingly there are arguments to be made FOR providing the public-funded medical care to illegals from a public health or even from an economic standpoint. For example, if we refuse to treat illegals but many remain in the country anyway, one projected outcome is that the rates of Tuberculosis will rise dramatically. Thus, by trying to save the funds appropriated towards the handful of illegals you actually can end up with a national crisis affecting many people if the incidence of tuberculosis increased dramatically. Another interesting argument is that even from a purely economic standpoint -- it is arguable that illegals are actually providing near-equal benefit to society even if they are not legal residents paying income taxes. They pay sales taxes, they do jobs citizens don't want for very low wages, and in general they can be a driving force to keep companies and the economic engine running along smoothly.

So I do see there are arguments for and against providing publicly-funded health resources for illegal immigrants. If I had to pick one side for this case I would side with the nationalist viewpoint and state that I don't believe this patient who was here illegally should have been given a higher place than citizens or legal residents on the organ transplant list. This, however, is just my personal opinion and I respect the complexity of the issue and differing opinions.

Cheers, Dr. Kowawa

Hamlet

Song of the Day: Roads - Portishead

Quote of the Day: "This above all: to thine own self be true, And it must follow, as the night the day, Thou canst not then be false to any man." --Shakespeare, from Hamlet

Thought of the Day: Sweewawa and I had a wonderful time over the weekend re-reading Shakespeare's Hamlet and then going (with my folks) to see the play at the Blackfriar's Theatre in Staunton, VA (http://www.americanshakespearecenter.com). It is a timeless and superb masterpiece, and was brilliantly performed by the players of Blackfriar's.

Day and Night

Song of the Day: Castles Made Of Sand - Jimi Hendrix

Quote of the Day: "Knowledge speaks, but wisdom listens." --Jimi Hendrix

Thought of the Day: I have been really enjoying reading more of Hofstadter's Godel, Escher, and Bach book. I am now approaching half way through. Now am continuing to learn a little more about Zen through the book. Was struck by this neat concept presented in the book: that an ultra-concise summary of "enlightenment" would be . . . transcending dualism. The world is made up of night/day, happy/sad, self/non-self, life/death . . . or is it? I love how in the M.C. Escher woodcut shown above Escher blurs the distinction between duality. To mentally accept this painting one has to abandon the idea that it is night OR day. It is both. Similarly perhaps there is good and bad contained in all things, and in fact even "all things" are just one.

One of the really weird concepts to get around in studying Zen is that it's not meant to be studied. To commit the Zen concepts to words is challenging the duality. It's really interesting that perhaps one of the reasons Zen didn't become a powerful movement like Christianity is that its "preachers" actually resisted putting words about Zen on paper to spread to others. One Zen student once asked, if Zen eschews intellectualizing it, then how am I to study and learn it? The student was given the response that any path towards understanding Zen is equal. If the student wished to use intellectual study as his path towards Zen, then part of the process of reaching enlightenment would be to fall away from this chosen path. Quite a concept.

One of the modalities used in "teaching" zen and helping students reach enlightenment is the koan, which are stories like the one I presented in my last post. These stories do not have self-evident "morals" at the end but rather bring the audience to a state at which they can appreciate reality from a new perspective, perhaps by abandoning previously held views. I have always been struck by the lyrics of Castles Made of Sand by Jimi Hendrix, shown below. Was he a modern-day Zen practicer? These lyrics feel to me like a koan.

Down the street you can hear her scream you're a disgrace
As she slams the door in his drunken face
And now he stands outside
And all the neighbors start to gossip and drool
He cries oh, girl you must be mad,
What happened to the sweet love you and me had?
Against the door he leans and starts a scene,
And his tears fall and burn the garden green

And so castles made of sand fall in the sea, eventually

A little indian brave who before he was ten,
Played wargames in the woods with his indian friends
And he built up a dream that when he grew up
He would be a fearless warrior indian chief
Many moons past and more the dream grew strong until
Tomorrow he would sing his first war song and fight his first battle
But something went wrong, surprise attack killed him in his sleep that night

And so castles made of sand melts into the sea, eventually

There was a young girl, whos heart was a frown
cause she was crippled for life,
And she couldn't speak a sound
And she wished and prayed she could stop living,
So she decided to die
She drew her wheelchair to the edge of the shore
And to her legs she smiled you won't hurt me no more
But then a sight she'd never seen made her jump and say
Look a golden winged ship is passing my way

And it really didn't have to stop, it just kept on going...

And so castles made of sand slips into the sea, eventually

Now and Zen

Song of the Day: West Coast Blues - Wes Montgomery

Quote of the Day: "Chance favours the prepared mind." --Louis Pasteur

Thought of the Day: The song of the day is one of my favorite Wes Montgomery tunes, love his soloing on this track. I played guitar on this tune a few times with my old jazz group, the Jazz Action Committee. Sweewawa and I have lately been debating about the merits of organized religion, and have as part of this discussion been sharing some Zen stories. Over the couple of years I'm eager to explore further the ancient philosophers thoughts on organized religion and also to delve into studying Zen Buddhism. I hope in these continued studies / discussions to arrive at a shared "conclusion" about what role spirituality will play in our lives. For starters I'll share now on this blog a cool Zen story I just encountered:

A man travelling across a field encountered a tiger. He fled, the tiger after him. Coming to a precipice, he caught hold of the root of a wild vine and swung himself over the edge.

The tiger sniffed at him from above. Trembling, the man looked down to where, far below, another tiger was waiting to eat him. Only the vine sustained him.

Two mice, one white and one black, little by little started to gnaw away the vine. The man then saw a luscious strawberry near him. Grasping the vine with one hand, he plucked the strawberry with the other.

How sweet it tasted.

Cheers, Dr. Kowawa

March showers

Songs of the Day: Fake Plastic Trees - Christopher O'Riley (song from Radiohead's album The Bends)

Let Down - Christopher O'Riley (song from Radiohead's album OK Computer)



Quote of the Day: "We must not let our Leaders, load us with Perpetual Debt" --Thomas Jefferson, in 1816

Thought of the Day: Another rainy March day today, we haven't seen much sun lately. Last couple of days have really enjoyed listening to Christopher O'Riley, who is a pianist who does wonderful solo arrangements of Radiohead tunes. Sweewawa even prefers his music to the real thing, though I myself don't go quite that far . . . Today did brave the rain enough to make it through the parking lot to the apartment complex gym, for another good workout. Tomorrow will be a day off from exercise in preparation for the Monument Ave 10K which Sweewawa and I will run on Saturday (rain or shine!). The following Saturday is the Charlottesville 10 miler. The photo at the top of the page is one I took recently of tulips and daffodils at the Lewis Ginter Botanical Garden in Richmond. Maybe some of these March and April showers will lead to some May flowers.

Cheers, Dr. Kowawa

Forms within forms

Song of the Day: In A Landscape - John Cage

Quote of the Day: "The more powerful and original a mind, the more it will incline towards the religion of solitude." --Aldous Huxley

Thought of the Day: Today begins my Spring Break, and I spent a good part of it reading Godel, Escher, Bach. Encountered during my reading the awesome Escher piece shown above. The forms within forms concept illustrated in the woodcut is really cool, and has some basis in reality, as genotype DNA which is the blueprint for our whole self, or phenotype, is contained within each individual cell. Also during my reading encountered some descriptions of musical offerings by John Cage, a modern musician who championed the concept that randomness and chance in music could be beautiful. He commented that he would like "to let sounds by themselves, rather than vehicles for man-made theories or expressions of human sentiments." The song listed above is not so much random (it does have considerable melody), but it is a selection I encountered on exploring Cage works to which I was particularly drawn. Hope you enjoy it too.

Cheers, Dr. Kowawa

Liberation

Song of the Day: 15 Step - Radiohead

Quote of the Day: "Now if you are going to win any battle you have to do one thing. You have to make the mind run the body. Never let the body tell the mind what to do. The body will always give up. It is always tired morning, noon, and night. But the body is never tired if the mind is not tired. When you were younger the mind could make you dance all night, and the body was never tired...You've always got to make the mind take over and keep going." --George S. Patton

Thought of the Day: Music, art, and philosophy merge: This morning got up determined to run 10 miles. The Charlottesville 10 miler is in 2 weeks, and I wanted to make sure I'm ready. Sweewawa and I watched Patton a couple of nights ago, and I was impresed with the strength of mind and body he displayed in the film and the way he was able to inspire this strength in his worn-out soliders. I did my run today thinking that it was nothing compared to marching through Germany in the winter with a heavy pack on dodging bullets and shells. And it turns out 10 miles wasn't actually that hard once you get your mind past it.

The run was also made easier by the choice of some quality music -- started off with a little Belding Principle (my old band), moved on to Dream Theater, and then listened to Radiohead's In Rainbows. In Rainbows is one of my favorite albums of all time and is one I'll never forget in that it got me through a long period of studying for USMLE Step 2. The Song of the Day is the 1st track from the album, a song particularly funny to listen to while running around a circular track as it laments "How come I end up where I started?"

Back home I enjoyed the afternoon / evening by continuing my reading of Hofstadter's book Godel, Escher, Bach. Encountered in it the beautiful work Liberation by M.C. Escher. The transition region between geometric figures and free-flying birds is really intriguing . . . perhaps the process of our inner-most thoughts percolating out and translating into actions and words is a little like his drawing.

Cheers, Dr. Kowawa

California dreaming

Match Day

Song of the Day:

California Dreamin' - The Mamas & The Papas

California Dreaming - Wes Montgomery

Quote of the Day: "L'audace, l'audace, toujours l'audace!" --French proverb

Thought of the Day: Match Day 2009 yesterday at noon was an amazing experience. About 170 of us medical students gathered in the historic Bolling Haxall house in Richmond. The tension in the air was so thick you could cut it with a knife. 170 people, waiting to be handed the white envelope that would tell their fate for the next 3-5 years. My heart was sure beating faster as I waited for them to call my name. Names were called in random order, and finally they did call me (more than halfway through the names). Then Sweewawa and I opened the envelope and were ecstatic/surprised/happy/relieved to find out that I had matched at my first choices for both internship and residency! I will be staying at VCU to do my internship in Internal Medicine and then will be heading out west to Santa Barbara, CA to do my residency at Santa Barbara Cottage Hospital. It couldn't have worked out more perfect for us. We're thrilled. I felt so proud to have matched at my first choices, it was very validating that all the long hours of studying and work in the hospital was worth it! Included also in this post are some beautiful pictures of Santa Barbara. Cheers, Dr. Kowawa