Seinfeld Breaktime

The grinning visage you see on the left is none other than Kenny Kramer, a.k.a. "The Real Kramer". He was apparently the real-life next-door neighbor of Larry David (creator of Seinfeld) for six years and the man upon whom the character of Cosmo Kramer is based. There is an excellent biography of Kenny Kramer, who made his fortune even before Seinfled became popular by manufacturing a piece of electronic jewelry in the 70s, on his self-maintained "Real Kramer" homepage. You can also sign up for the Kramer Reality Tour (which was parodied on a Seinfeld episode in which Kramer takes unsuspecting New York tourists on the "Real Peterman" Tour after selling all his stories to the head of the J. Peterman catalogue company) on his homepage.

In a bit of unrelated news, Pat Morita (who played Mr. Miyagi in "The Karate Kid" movies) unfortunately passed away recently. There is an excellent article remembering these classic tales on The Sports Guy's column this week.

The Little Purple Pill

As I have procrastinating my grant-writing to an impressive degree over the past week or so, I thought I'd procrastinate further and spout out a few factoids from the book I'm currently reading: Blood and Guts by Roy Porter. It's a brief history of medicine, a topic about which I recently decided most doctors (myself included) don't know enough about.

One of the interesting aspects of the book that I’ve enjoyed thinking about is just how much the role of the physician has evolved with respect to a social context through the ages. As an example, try on this statistic for size: the average American visited the doctor 2.9 times a year in 1930; by 2000 this had doubled. Why is this so? One might think that now we have many more effective medications and can cure or help medical conditions more frequently than we were able to do in 1930. On the other hand, such breakthroughs might otherwise be expected to lead to a healthier society, and therefore shouldn’t need to visit the doctor so much. I think the difference is largely explained by what people expect when they go see a doctor. Nowadays there is so much marketing on television—e.g., “Ask your doctor about the little purple pill!”—that many people feel that in order to get the best medical care available they need to focus on these issues, rather than the truly important ones (like quitting smoking, for instance).

In the Waiting Room

It turns out we arrived in the waiting room about 3 minutes after Cathy had finished the delivery. As we anxiously awaited our turns to see the newest member of the O'Malley/Hellman clan, we entertained ourselves by horoscope reading (Susie), picture-taking (me), and trying to coax the charge nurse to give us the news of the baby's gender early (Bob O' Malley, Cathy's father-in-law). Fortunately a smiling Tim entered the waiting room a few minutes later and uttered the words "It's a boy!" and we were held in suspense no longer. Here are a few photos of the waiting room action....

Henry Michael O'Malley

I'm pleased to announce the newest member of the family!

Henry Michael O'Malley was born on Saturday, Nov. 26th in Washington, D.C. Henry certainly kept us in suspense, but managed to enter the world just under the wire--my parents were actually a full hour into their cross-country journey home when they were informed that Cathy had just gone into the hospital and were fortunately able to be called back to witness the historic occasion.

Henry was born at 6:33 pm. He weighed 6 lbs 14 oz and was 21 inches in length. A future point guard perhaps?

Congrats to Tim & Cathy O' Malley as well as two sets of parents who have now made the happy leap to grandparents! It was the perfect end to a very memorable Thanksgiving!

Thanksgiving Recap

It's been chaos as usual for the Hellman Thanksgiving celebrations. My sister Cathy who is fittin' to burst with her first pregnancy just went to the hospital about 20 minutes ago with regular contractions--it's her due date and despite a few false alarms this might be the real thing. I'm so excited to be an uncle! I'm also cheering for this baby to come out soon, because I have to go back to work on Monday unfortunately. Oh well...we'll just have to let the Miracle of Life work according to its own schedule...

We've had a joint Hellman-O'Malley (my sister's in-law's family) Thanksgiving this year b/c of the impending baby. Yesterday marked the first ever Hellman-O'Malley Olympics which took place at Bob O'Malley's health club in McLean, Virginia. In a closely fought battle, the team consisting of both Dads, my (non-pregnant) sister Susie, my wife Claire & my friend from medical school Doran Fink eked out a victory over the team consisting of myself, Tim (my bro-in-law), Julie (Tim's sister), and Emily (Doran's wife).

Other highlights included a yummy Thanksgiving dinner replete with the traditional Hellman Thanksgiving family desserts of chocolate mousse & grasshopper pie, playing the latest version of the board game "Life" (surprisingly fun), taking a run along the Potomac, hanging out with the family dogs, and finishing the new David Sedaris book (as I haven't read a book for pleasure since my honeymoon last September).

Turkey Day

Time for some turkey.

Claire & I are about to depart on a drive through the eel-infested waters between Philadelphia and our nation's fine capital.

We're going to D.C. to spend the Thanksgiving holiday with my family which should be a lot of fun. I'll try and write more there if I have internet access...

Tonight's Sixers Game

Thanks to Claire's boss (and his most excellent 15th row season tickets) we got to see tonight's Sixers-Hornets game at the Wachovia Center.

Philadelphia had no problem dispatching the New Orleans/Oklahoma City Hornets; it was pretty clear from the get-go that the 76ers had much more talent and a deeper bench.

A few observations: One, Allen Iverson is still one of the most exciting players to watch in the NBA (and remains on my All-Nate team which also consists of Reggie Miller, Kevin McHale, Hakeem Olajuwon, & Kevn Garnett). It's quite remarkable to realize that he's by far and away the shortest dude on the team, yet is by far and away the best player. Two, the Hornets don't have a lot of depth but certainly play hard--they won't have the worst record in the league. Three, I really enjoyed watching Chris Webber play tonight, who due to a variety of surgeries through the years has required him to use a bunch of tricky "old man" moves to be effective--but was suprisingly effective tonight with a bunch of boards and pretty assists to go with 15 points. The Sixers could be pretty good this year with their blend of vets & youngsters (I was particularly impressed with Andre Iguodala as well).

Lazy Sunday

It's been a very nice lazy Sunday afternoon...

C'est la pied. This is the French expression for "it's paradise" and literally means "it's the feet"...which I sincerely believe every day that I am on elective...

I did a little bit of work on my grant (still trying to dig up funding for next year in France), went to Best Buy to get a camcorder (as a wedding gift to ourselves, and will come in handy documenting the first few days of life of my niece/nephew who should be arriving in this world any day now), cleaned up after last night's Frenchie dinner (a going-away party for our good friend Elsa who is going back to France to be with her husband), and watched some football. What a glorious Sunday!

2 Bets I Recently Won With My Wife

What did people do before the Internet I wonder? Amongst the many areas that it has undoubtedly revolutionized, one is certainly Bet Resolution. Get into an argument with your friend about whether or not the city of San Francisco has less than a million inhabitants ? (It's only about 700,000 by the way). Just hop on the 'Net and resolve your differences in a matter of seconds!

Two bets I recently won with my wife with the Internet serving as the final arbiter:

#1: I said that your average cup of coffee has way more caffeine in it than a standard 12 oz can of Coke. I was of course correct. About 100 mg of caffeine in the typical coffee, about 30-45 mg of cafeine in your typical soda (or "pop" for all you small town Midwsterners out there). Which explains my observation that coffee drinkers can often be seen with a crazed look of madness on their faces shortly after their morning fix...

#2: Are potatoes vegetables? I said YES (in part to refute the accusation by my wife that I don't eat enough vegetables), she said NO. The U.S. Department of Agriculture on its newest version of the Food Pyramid clearly states that the potato is a bona fide veggie.

Blue Lou Sighting in the Big Apple

So my little sister Susie Hellman has moved to NYC to seek her fame and fortune as an opera singer. Right now she is working as a waitress/hostess at some restaurant in Manhattan not too far from the Met while she seeks for opera gigs via auditions (and she recently got an offer to work in Florida at the Sarasota Opera for three months--go Susie!)

Anyways, she is working at a restaurant which is occasionally frequented by various celebrities. Of note, I was *quite* impressed to learn that she had recently had an encounter with none other than "Blue Lou" Marini, the saxophonist from the original Blues Brothers movie! How cool is that! I know "Blue Lou" is no "Donald Duck" Dunn, but in my opinion he outranks Matt "Guitar" Murphy, Steve "the Colonel" Cropper, and Mr. Fabulous.

"We're putting the band back together."

Photos of the Champs

As promised, our victory photo from last Tuesday's rousing Quizzo victory. Apparently we are giving the "gang symbol" for Botswana, although I doubt this is true. My friend John Evans in the back looks totally trashed.

I received some very good news yesterday...my friend Becca Moen revealed that she is DEFINITELY getting a blog of her own shortly...(I know you're reading Becca....:)

Fun with Johnny Goodtimes

Had a very spontaneously fun evening yesterday upon returning home from my first night of Renal Consult!

First off, I made Claire watch The Princess Bride for the first time ever. Giants from Greenland! True Love! The vengeance of a Spaniard! Rodents of Unusual Size! Swashbuckling galore! Miracle pills by Miracle Max! Is there any doubt that this movie's got it all? I still remember when I was coaching the Lester Park High School 5th-6th grade boys' basketball team, and for our end of the year party we showed this movie...they were transfixed!

Inconceivable!

After the movie (which, by the way, was spent simultaneously dining on yummy bbq'ed sausage & chicken) I got a phone call from my buddy John Evans, back from Botswana. We headed over to The Bards for some beers with some other friends, and ended up playing an impromptu game of Quizo, the Philadelphia area bar quiz game as hosted by none other than Johnny Goodtimes hisself. We improbably beat local legends Sofa King in a close match and walked away with a gift certificate and a bunch of free concert tickets. I'll put up a photo of the winning team in short time...

Bad Night

How much did my last night on Super SAR suck ass? On the universal scale of suckitude, let me tell you, it sucked a pretty damn lot.

It started off in a benign enough fashion. The first hour or so was pretty quiet, so I went upstairs to visit my friend Aravind, on call in the CCU--he's a big Steelers fan and was hoping he might have time to catch a bit of the Sunday night Pittsburgh-Cleveland game. Well, Aravind was busy trying to put in a central line into an unstable patient and I somehow got roped into helping him out. 30 minutes later the line was in but the patient was coding and soon after had expired.

The night got worse after that. The lowlights included:
-the 23 yo guy with idiopathic hypertrophic subaortic stenosis (the same thing which resulted in the death of basketball legend Hank Gathers about a decade ago) who showed up unannounced in the CCU after his defibrillator fired.
-the 4 a.m. surgery patient who was transferred to the MICU due to hypotension & hypoxia possibly due to a pulmonary embolism or maybe sepsis, not sure which.
-the patient called in from the ER at 6:30 a.m. with ulcers in the genital and buttocks areas--not exactly the kind of thing you want to see at that hour.
-spilling lukewarm coffee on my scrubs just before going home.

All of this is of course tempered by The Good News: it was my last night of SSAR for 3 wks! I go onto elective (and a normal person's 9-to-5 schedule) starting tomorrow...

Magnificent Desolation

So I'm back at work as the SUPER SAR tonight after a wonderful 3 days talkin' kidneys and visiting with my family. C'est la vie.

We went to go see the IMAX movie "Magnificent Desolation" today, which is about man walking on the moon. Pretty good, but certainly not the best IMAX I've seen in the past...

It's 9:04 pm and the ER is relatively quiet thus far...hopefully that will stay the same & I can catch up on my zzzz's!

Kidneys, Kidneys, and more Kidneys...

Holy crap, that's a lot of kidney beans.

So I've spent the past 2 days at the American Society of Nephrology (ASN) annual meeting, which is fortunately here in the City of Brotherly Love. I'm a little kidneyed-out after spending the past 48 hours inundated with talk on nephrons, polycystic kidney disease, dialysis, and erythropoietin, so I won't get into great depth except to say that it's been a very exciting meeting & I can't wait to get on with my Nephrology training--both in the lab as well as my clinical fellowship...

The highlights:
*presented my poster today which went reasonably well.
*realized that I now belong to the same professional society as my father...which is both weird and cool at the same time.
*having chance to talk and meet with Corinne Antignac & her lab--helping solidify my plans to spend next year in Paris.
*great breakthroughs in cystic kidney disease.
*met some friends from medical school I hadn't seen in several years--and finding out that they too are being trained in the Ways of the Kidney.

Now I'm waiting for my mom to fly into town (my dad is already here) so we can fire up the raclette maker and go to town...

Greetings from The Hospital

Greetings from your friendly neighborhood Super SAR!

It's 3:13am (which is, for me, kinda like late afternoon with my flip-flopped schedule working the night shift) and I'm chilling out in one of the call rooms. Fortunately we're experiencing a lull in the action so I thought I'd try some on-duty blogging just to take a break.

So the Super SAR job is a little more challenging than I had originally anticipated. Not only am I the resident whose job it is to assign patients to the appropriate admitting teams, but I do end up admitting a fair number of the patients as well as "night floats" (that is, I see patients who come into the ER at night, work them, get them tucked in, and in the morning pass them off to a different resident). Tonight so far I've had some variety: an asthma, a cellulitis, and a shortness of breath which I'm pretty sure is heart failure. Yesterday night I had four chest pains and a blood clot in the leg.

I'm actually taking a 3-day hiatus from this gig--my friend Jen has agreed to cover my Super SAR shifts so that I can attend the American Society of Nephrology meeting which is taking place here in Philadelphia (I of course am paying her back later on in the year). The photo above is a dog kidney cell cyst which has been induced to form tubules by a growth factor called HGF--it's taken from my research, which I will be presented as a poster at the ASN Meeting. Should be fun!

Super SAR begins

It's Monday, time for a new rotation block to begin...

This time it's something completely foreign to me...I will be the nighttime "SuperSAR", a rotation I've never done before. It's kind of like being the chief admitting resident for the Internal Medicine service. I'm in charge of assigning any new admissions to the appropriate team & room. To some degree, it sounds a little bit like a glorified administrative job--assigning admissions follows a well-thought-out and often-tweaked set of rules which I just have to follow to the letter--and my patient contact is fairly minimal. Tonight (and for much of the remainder of the week) I work the night shift, from 8pm until 8am. Wish me luck!

Not sure exactly where the illustration on the left came from....perhaps a Pediatrics residency program elsewhere with the same position? (SAR, incidentally, refers to a "senior admitting resident".)

Eastern State Penitentiary

A very nice & productive Sunday! The beeper's been silent (knock on wood...still have about 12 hrs to go 'til I'm officially OFF jedopardy duty), slept in, got some good work done on my NRSA grant, had lunch with a bunch of friends at "The Bishop's Collar", and took a tour of Eastern State Penitentiary, this crazy fortress-looking building in the Art Museum neighborhood of Philadelphia. It was built in 1829 as the first example of a new movement of jail reform which looked upon prison as an opportunity for true reform as opposed to simply punishment. While this may sound like a good idea on the surface--and had many famous proponents (Benjamin Rush, Benjamin Franklin)--this was accomplished by basically placing the prisoner in his own room in a state of solitary confinement for the entire duration of his/her sentence, which was often several years. Then I went running, now I'm back and looking forward to kicking back and catching some of the T.O.-less Eagles game this evening.

Luck's Run Out

My luck officially ran out at approximately 5:45 pm when I was called in by our chief to perform jeopardy duty...I was on call as the overnight resident for the Geriatrics Service. I've spent most of the day napping/recovering.

Another curious thing happened to me. I flushed my glasses down the toilet. No kidding, hear me out--this is friggin' weird. I've had the same pair of glasses since 1997. They're bent all to hell and sometimes the lens pops out, after which I just pop it back in and tighten the screws. So tonight at the precise instant that I'm in the action of flushing the toilet after taking a piss my left glass lens pops out, falls into the toilet, and is immediately whisked away into the netherworlds of the Philadelphia sewer system.

The truly bizarre thing is that Claire had just a few hours earlier left on an errand...to pick up my new glasses!! She returned shortly afterwards. I can't help but think that some element of fate is involved here...

Real-Life Superheros

As many of you may know, I have been a comic book collector for a number of years. Although my collection contains multiple different genres of comics (e.g. science fiction, horror, detective, relationships, etc.) it is still dominated by the genre of superhero comics (e.g. SpiderMan, the Hulk, the Fantastic Four, etc) which really has been the focus of the comics industry for many decades.

Which led me to wonder....if there are so many books about super heroes, why aren't there more true-blue, honest-to-goodness superheroes patroling our streets, righting wrongs, and fighting crime?

Well, I did a little bit of web research and it turns out there are quite a few of them scattered around the globe. For instance there is Angle Grinder Man, an individual somewhere in London who dresses up in the costume shown on the right and sneaks out at night to anonymously free cars which have been booted by the local police. Needless to say, this sounds blatantly illegal, but he certainly seems to fulfill all the requirements for being a superhero as set forth by the World Superhero Registry:

"1. Costume: The purpose of a costume is not simply to protect the identity of the Real-Life Superhero from criminals that might seek revenge, but to make a statement both to the evil-doers that you fight against and to the world at large: you are not simply someone who happened upon crime or injustice and made an impulsive decision to intervene. You have vowed to actively fight for the betterment of humankind and to serve as an example for others. The costume of a Real-Life Superhero must be of sufficient quality to show some care went into it's creation.
"2. Heroic Deeds: The purpose behind becoming a Real-Life Superhero must be for the benefit of mankind, and the Heroic Deeds must be of sufficient degree as to exceed normal everyday behavior. If proof of Heroic Deeds is not present, a listing may still be added to the Registry, however, it may be marked as "inactive" or "unconfirmed" in the description.
"3. Personal Motivation: A Real-Life Superhero cannot be a representative of an organization, not even a benevolent one. The motivation to become a Real-Life Superhero must come from the individual: not an advertising gimmick or a public relations campaign."













Other modern-day superheros include Terrifica, a woman whose not-so-secret alter ego is Sara, who patrols the bars and clubs of the Big Apple in search of women who have had too much to drink...and making sure they don't get taken advantage of by prowling sleazebags. And then there is Polar Man who is some dude in Candada I can't find out much about, but the picture is funny.

What would I do if I were a superhero? I guess in Philly with my numerous experiences with having my bike stolen, I would stalk the streets at night looking for bike thieves and then thwarting their attempts to steal bicycles.

Now I just gotta start working on my costume...

Bob

The big claim to fame of Duluth, Minnesota (my home town), apart from being the Western-most port on the Great Lakes, is being the birthplace of Robert Zimmerman aka Bob Dylan. What is Dylan's greatest album? Most people think Blonde-on-Blonde (1966) but I've got to go with Blood On the Tracks (1975). This puppy's got my all-time favorite Dylan song ("Tangled Up in Blue", the lyrics to which are perplexing and have been the matter of interpretation over the years) as well as a bunch of other quality tracks such as "Idiot Wind", "Simple Twist of Fate", and "Shelter from the Storm".

You may ask yourself: Where does Nate find the time to rate Dylan albums and peruse wacky Halloween costumes if he's a doctor? The answer, my friend, is blowin' in the wind....no just kidding. The answer is that I'm currently on my "Jeopardy" block, in which I basically have the time off to do as I please, but if anybody gets sick or if there's an emergency I have to be prepared to get to the hospital within an hour's time. It's a pretty sweet deal when the pager is silent (as it has been thus far...knock on wood) and has been much more quiet than my past tours of duty on this rotation.

Biology Review

The other day I got into a disagreement with my wife about which of the Kingdoms (evolutionarily speaking) Saccharomyces cerevisae (baker's yeast) belonged to. I said "Fungi" and she said "Animals." Not surprisingly, I was right, but the point was is that I actually had to think about it for a sec.

A refresher on how life is broken up again. There's actually been a change since when I took high school biology with Mrs. Mendoza.

Traditionally, there were 5 kingdoms: Monera (bacteria), Protista (kind of a waste-basket category which includes simple animal-like and plant-like organisms which can be unicellular or multicellular--an example most people are familiar with is Paramecium), Plantae, Fungi (which does include yeast), and Animalia (that's us).

However, in the 1990s Carl Woese, who pioneered the analysis of ribosomal RNA as a means of showing more direct evolutionary relationships, noted that amongst the group "Monera", there were really two distinct groups, Eubacteria (the stuff we usually think of when we use the word "bacteria") and Archaebacteria (many of which have been in the scientific news in recent years due to their ability to live in "extreme conditions"). Woese proposed a "3 Domain" system which is used today. The 3 domains are the Archaebacteria, the Eubacteria, and the Eukaryotes. Amongst the Eukaryotes there are 4 Kingdoms (Protista, Plantae, Fungi, and Animalia).

The Flu

I got my flu shot yesterday. So bring it on, flu season!

"The Flu" is a tricky term. I've found that its useage amongst doctors and laypersons often differs, which makes communication difficult at times. Often I will have a patient come into my office and say, "I think I've got the flu", and they will be referring to any wide number of symptoms including muscle aches, headaches, vomiting, diarrhea, fever, runny nose, etc. etc. Or sometimes they will even be more specific, stating "I've got a bad stomach flu" which usually refers to the nausea, vomiting, and diarrhea aspect of things.

However when a doctor uses the word flu they are referring specifically to influenza virus, the symptoms of which DO NOT typically involve GI stuff (nausea, vomiting, diarrhea--at least this is true in adults) and usually involve more severe fever, muscle aches, sore throat, and headaches than are found with your typical upper respiratory tract infection/cold. I've never had the flu, but I'm told that people who DO get it "wish they could die". It's fairly serious.

The "flu shot" is an inactivated vaccine (the viruses have been killed before it gets injected) which is comprised of the 3 most common strains of flu virus that year--one from the most common strain of influenza A (H3N2) virus, one from the most common strain of influenza A(H1N1) virus, and one from an influenza B virus. "A" and "B" refer to the two most basic types of influenza virus. The "H" and "N" nomenclature describes which type of hemagglutinin molecule (of which there are 16 types) and which type of neuraminidase molecule (of which there are 9 types). The vaccine is not perfect (there is still the possibility of getting the flu even if you get the vaccine) but it's pretty good & it's the best treatment we've got. There are antiviral medications out there in pill form (e.g. amantidine & oseltemavir, or Tamiflu) but they generally need to be taken as soon as you start having symptoms or they don't really help. Fortunately the flu vaccine shortage situation we had last year is much improved (or at least it seems to be within my own health care system, and I've heard less about it in the news). It usually doesn't even hurt too much, unless you're a wussy (see picture on right).

Which brings me to my next topic: The avian flu virus, and should we all be freaking out about it right about now? Well, yes and no. The avian flu virus is an H5N1 influenza A virus, meaning that its "molecular signature" is extremely different from that of the influenza viruses which typically infect humans. Our immune systems recognize this virus as a foreign invader and ramps up its immune response something nasty. Not suprisingly, our flu vaccine doesn't work (remember, it's made against the most common strains of human flu virus). It has resistance to most, but not all, of our oral flu medications. In 1918, something similar happened in which the flu virus jumped from pigs to humans, causing a Flu Pandemic resulting in the death of between 20-40 million people in a year's time, eclipsing the death toll from both World War I & the Bubonic Plague. All of these things I'm telling you would seem to suggest a strategy of freaking out. However, there' s some good news. For one, the disease has not yet occurred in Europe or the United States and has been thus far restricted to Southeast Asia. Zero recorded cases thus far. Also, while the disease has scarily been observed to pass from birds to humans, it has not yet been observed to pass from human to human. It could certainly evolve to do so, but thus far it hasn't yet. Also, researchers are currently working on a vaccine for the avian flu. Our ability to make a decent flu vaccine in a short time is pretty good--the mass-production and distribution of such a vaccine is a whole other issue--but generally speaking the technology is there. So let's hold off on the freaking out for right now but take the threat seriously enough to come up with a worst-case scenario plan. Okay, Commander-in-Chief? Unless of course, you can think of any wars we could fight which would be more beneficial to us as a country...

But that's another issue for a later time...