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Anesthesiology, Medicine and Literature, Neuroscience

Exploring the conscious (and unconscious) brain in every day life

Exploring the conscious (and unconscious) brain in every day life

line of peopleThe first time I fainted, I was seven. I passed out while racing my fellow second-graders across the playground. One minute, I was leading the pack in the race; the next thing I knew, I was lying in the nurse’s office with adult faces hovering all around me. My parents explained to me that I’d lost consciousness – it was like falling asleep for a minute, they told me.

It frustrated me to no end- even as a seven year old – that I didn’t know where that time had gone. Why couldn’t I remember those moments where I collapsed onto the grass and got scooped up by a petrified teacher? I ended up fainting a handful of times over the next few years (luckily doctors chalked it up to nothing more than dehydration and a genetic propensity to faint), and each time I was reminded of that frustration of not being able to grasp what was going on in my brain during those lost minutes.

As a seven-year-old, I didn’t have the chance to call up scientists and ask them to explain the brain to me, so when I started working on a feature article on consciousness for the latest issue of Stanford Medicine magazine, I was thrilled that maybe I’d get that chance to finally answer those questions that had been lingering in my head for decades. What makes the brain go from awake and aware to such a blank state, and then back again?

But it’s not that simple, I learned: There’s no single switch that flips the brain from conscious to unconscious. In fact, consciousness isn’t an on-off switch at all; it’s a whole spectrum of states. Anesthesiologist Bruce MacIver, PhD, pointed me toward this handy chart that shows different levels of consciousness. Each state of consciousness has its own unique place on two scales: physical arousal and mental awareness. As I looked at it, I realized that my experience with altered consciousness wasn’t just limited to my childhood fainting episodes – we all go in and out of multiple states of consciousness on a daily basis, and not only when we fall asleep and wake up.

“If you’re an elite athlete and you get in that so-called ‘zone,’ that’s an altered state of consciousness,” anesthesiologist Divya Chander, MD, PhD, explained to me. I’m no elite athlete, but after talking to Chander, I suddenly started paying attention to those not infrequent times when I “zone out” while driving or exercising. And when I woke up to a noise in my house on a recent night, I immediately noticed my heightened senses – that alertness is an altered state of consciousness too.

“What I’m always hoping is that hearing about this kind of work makes people ask more questions about what it means when they themselves enter different states,” Chander said to me when we talked. Her message was not lost on me; I’ve become an active observer of my shifts in attention and awareness.

My Stanford Medicine story delves much deeper than these observations of daily life, to look at how and why anesthesiologists are probing what it means to be conscious – and how their research could lead to better anesthetic drugs. But I hope that in addition to conveying the science, it also helps readers realize that subtle changes in consciousness happen in your brain all the time.

As for the questions I had as a seven-year-old, they’re not fully answered, but I’ve only gotten more intrigued to know how the brain mediates consciousness, and more excited to follow where this research goes in the future.

Sarah C.P. Williams is an award-winning science writer based in Hawaii, covering biology, chemistry, translational research, medicine, ecology, technology and anything else that catches her eye.

Previously: Stanford Medicine magazine opens up the world of surgery, Your secret mind: A Stanford psychiatrist discusses tapping the motivational unconscious and Researchers gain new insights into state of anesthesia
lllustration by Jon Han

Medicine and Literature, Patient Care, Stanford News, Surgery

Surgery: Up close and personal

Surgery: Up close and personal

gholami - smallTens of millions of patients undergo surgery every year in the United States, yet very few have the opportunity to be on the other side and observe a surgical procedure in action.

I had that rare privilege recently in the course of writing a story for Stanford Medicine magazine about surgery and how far the field has come in recent decades. The operating room, I discovered, is a world unto itself. It’s governed by a strict set of rules to help safeguard patients, but within those strictures, there is an elaborate kind of dance and much artistry in the way clinicians work together and finesse the tools to help heal their patients.

Sepideh Gholami, MD, a six-year surgery resident at Stanford who is featured in the story, said it was in part this sense of artistry – the movement, rhythm and pacing – that attracted her to the profession. And like many surgeons, she found it gratifying to be able to use her hands to fix a problem to quickly restore a patient’s well-being. She describes one of her early experiences, assisting in a procedure to remove a life-threatening tumor from a young man’s colon.

“I remember going to the family afterward, saying that we were able to get it all out, and seeing the glow in their faces,” she told me. She said it was reminiscent of the experience of her own mother, who had a tumor extracted from her breast: “This is how it happened for my mom, who is now disease-free,” she said.

In the story, Gholami talks about her rather unusual path from an early childhood in revolutionary Iran to becoming a surgeon in the United States, as well as the changes in the profession that have opened the way  to young women like her. The story also explores the remarkable innovations in technology that have made the patient experience today far less invasive and less painful. Those innovations, as well as new workplace rules that limit trainees’ hours, have dramatically changed the way young surgeons like Gholami are being trained to become the independent, skilled practitioners of the future.

Previously: Stanford Medicine magazine opens up the world of surgery
Photo of Gholami by Max Aguilera-Hellweg

Medicine and Literature, Stanford News, Surgery

Stanford Medicine magazine opens up the world of surgery

Stanford Medicine magazine opens up the world of surgery

surgeon hands - 560

It used to be “big hole, big surgeon” — but no more, according to Stanford’s chair of surgery, Tom Krummel, MD, who’s one of the surgeons featured in Stanford Medicine magazine’s report on surgery and life in the operating room, “Inside job: Surgeons at work.”

During his career of more than 30 years, Krummel has seen a massive shift from open surgeries to minimally invasive procedures — major surgeries conducted with tools that work through small openings.

“We do the same big operation. We just don’t make a big hole,” he said in the article leading off the report.

In the same issue, CNN’s chief medical correspondent, neurosurgeon Sanjay Gupta, MD, talks about why he’s “doubling down” on his support for medical marijuana.

As the editor, I’m biased — but I think it’s worth a read, along with the rest of the issue, which includes:

The issue also includes a report on research on Alzheimer’s disease, and an excerpt from Surgeon General’s Warning, a new book by Associated Press medical reporter Mike Stobbe on the fall from power of the U.S. surgeon general. The digital edition offers audio interviews with Gupta, Stobbe, Stanford surgeon and humanitarian-aid volunteer Sherry Wren, MD, and photographer Max Aguilera-Hellweg, MD.

Previously: The vanishing U.S. surgeon general: A conversation with AP reporter Mike Stobbe, Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions, From womb to world: Stanford Medicine Magazine explores new work on having a baby and Factoring in the environment: A report from Stanford Medicine magazine
Photo by Max Aguilera-Hellweg

Behavioral Science, Medicine and Literature, Stanford News

Does the sight of blood make you queasy? You're not alone

Does the sight of blood make you queasy? You're not alone

drop of blood2

After writing about my blood phobia — and what I did to tame it — in the spring 2013 issue of Stanford Medicine, I was surprised to get a lot of e-mail from readers suffering from the same condition or similar ones, or both. (In the world of mental health, blood phobia is categorized together with injection phobia and injury phobia, and known collectively as BII phobia.) Their responses gave me a welcome sense of solidarity.

Some sought guidance. A reader in the Philadelphia area wrote:

I now realize I have this phobia. And I had no idea there was a treatment for it.

I pass out with needles, blood and sometimes when someone just talks about blood! Your article actually made me queasy reading it. It took me a while to get through it. But I’m glad I did.

So you know of any treatment centers in Philadelphia who specialize in this?

A reader in the Boston area explained:

From a very young age, I have experienced BII anxiety and vasovagal responses to various medical stimuli.  I used to not be able to talk about injections without feeling uncomfortable or faint, and now I am able to get them without being anxious or needing any medical aides (I used to take Valium).

I am getting closer to my clinical rotations in PA [physician assistant] school and am worried about my irrational fears of blood, surgery, etc.

I was wondering if you had any further suggestions for the student going into health care with these types of BII vasovagal responses.  I am certain I want to be a physician assistant, I am just so concerned that I will not be physically able to carry out my surgical rotations!

Others, like this Bay Area reader,  just wanted to share their experiences:

I first fainted when I was 12 watching a vet surgery! I had no idea what happened or the reaction I had, but I knew it didn’t feel good. I’ve had a few episodes thereafter, usually at doctor’s offices drawing blood. In fact, last year I almost fainted getting my finger pricked at an office health thing! I think the fasting didn’t help… I am so excited to read something like this. To know I’m not the only one, but that there is something you can do, a real exercise to practice that helps!

Thank you for writing this. I truly enjoyed it and feel better already.

Previously: Longreads pick: Blood, sweat and fears
Photo by Alden Chadwick

Global Health, Medicine and Literature, Stanford News

Exploring global health through historical literature

Exploring global health through historical literature

deskPhysician-authors, including Abraham Verghese, MD, and efforts such as Stanford’s Arts, Humanities and Medicine Program draw the general public’s attention to issues important to the medical field. They may also elicit reader empathy by discussing real-world problems, even in fictional contexts, while situating literature and the arts in an influential position.

This relationship between medicine and literature is longstanding and complex. A Stanford News article discusses some examples of public health and humanism in historical literature and profiles the work of Alvan Ikoku, MD, PhD, an Andrew W. Mellon Fellow in the Humanities at Stanford.

From the piece:

As a scholar of 19th- and 20-century movements in international literature and health, [Ikoku] studies the place of long narrative forms, especially novels, in the development of tropical medicine and global health.

In his current book project, Forms of Global Health, Ikoku reads not Dickens or Gaskell, but writers such as Joseph Conrad and Andre Gide, who added to a “library of metaphors about the tropics and colonial spaces,” one that was referenced by “the fathers of tropical medicine” – returnees from colonial medical services, particularly malariologists, who wrote and lectured publicly about the need to establish a new medical specialty for the colonies.

Ikoku points out that literature provided an opportunity for readers to not simply feel an emotion, but to also actively help define a medical field and its knowledge base.

The article notes that Ikoku taught a course for Stanford students from many disciplines this spring called “The Literature of Global Health,” examining “how literary and medical writers have used narrative to explore the ethics of care in the developing world.”

Previously: Thoughts on the arts and humanities in shaping a medical careerMedical students and author Khaled Hosseini share their muse with Stanford community and Intersection of arts and medicine a benefit to both, report finds
Photo by Ben Sutherland

Events, Medicine and Literature, Medicine and Society, Stanford News

Inside Abraham Verghese's bag, a collection of stories

Inside Abraham Verghese's bag, a collection of stories

What’s inside Abraham Verghese’s medical bag? Visit the Smithsonian Institution’s National Museum of Natural History to see. Verghese, MD, vice chair for the theory and practice of medicine and a physician at Stanford, is one of the notable Indian Americans featured in the exhibition “Beyond Bollywood: Indian Americans Shape the Nation,” which runs through August 2015 in D.C. and then will tour the U.S.

An article in The Caravan dives into the diversity and complexity of experiences lived by Indian Americans in the United States and opens this way:

IN JOHNSON CITY, Tennessee, in 1982, an Ethiopia-born, India-trained medical resident named Abraham Verghese coveted Dr Steven Berk’s doctor bag. He saved enough money to purchase one for himself, then rubbed it with neatsfoot oil to approximate the well-worn, talismanic quality of his mentor’s bag. Verghese then filled it with his kit—eye drops, calipers, prescription pads—and his hopes of assimilating into the American medical establishment.

Verghese’s bag, one of the exhibition’s hundreds of objects on display, is coupled with the physician-author’s memories from earlier in his career: “I had to ask someone how to tie my tie with a thinner knot so I could fit in,” the article notes. “And the only way I could eat the bland hospital food was to put Tabasco sauce on everything.”

The piece continues:

Verghese’s words capture the familiar dual imperative of immigrant life: on the one hand, fitting in, with a tie knot of appropriate girth; on the other, maintaining one’s tastes, through the strategic application of chilli-approximating Tabasco. His story reminds us that even blue- and white-collar immigrants have to negotiate resistance to the perceived “Third World invasion” of the United States, whether through neutralising accents or by softening the stiffness of difference with neatsfoot oil.

Previously: Abraham Verghese shares what’s in his lab coatStanford’s Abraham Verghese honored as both author and healer,  Stanford’s Abraham Verghese = “today’s most creative person” and Abraham Verghese’s Cutting for Stone: Two years as a New York Times best seller

Events, Medicine and Literature, Medicine and Society

Intersection of arts and medicine a benefit to both, report finds

Intersection of arts and medicine a benefit to both, report finds

An article today on Cleveland.com notes that, at least in Northeast Ohio, collaboration between medicine and the arts benefits both camps as well as the region’s economic health. A preliminary report from the non-profit Community Partnership for Arts and Culture looks at ways art and medicine enrich one another in Cleveland and provides recommendations for enhancing those partnerships. From the news piece:

The report identifies four principal ways in which the art and medicine intersect productively:

• The use of arts and culture in medical settings;

• Participatory programs that involve patients and communities in activities and therapies that promote positive medical outcomes and general wellness;

• The potential shown by arts and culture to serve as a rallying point from which public health and social equity can be addressed; and

• The enrichment of medical training.

Meanwhile, at Stanford, art and science lovers prepare for this evening’s Medicine and the Muse symposium, featuring author Khaled Hosseini, MD. Stay tuned for a recap on Scope next week.

Previously: Stanford’s Medicine and the Muse symposium features author of “The Kite Runner”, Literature and medicine at life’s end and Thoughts on the arts and humanities in shaping a medical career

Events, Medicine and Literature, Medicine and Society, Stanford News

Stanford's Medicine and the Muse symposium features author of "The Kite Runner"

Stanford's Medicine and the Muse symposium features author of "The Kite Runner"

Hosseini SmallNext Wednesday, Stanford’s annual Medicine and the Muse symposium will bring together medical student art, music, photography and literature in a series of performances and exhibits. During the event, Khaled Hosseini, MD, bestselling author of The Kite Runner, A Thousand Splendid Suns and And the Mountains Echoed, will join Paul Costello, chief communications officer for the School of Medicine, in conversation. He will also be available for book signing.

This year’s Medicine and the Muse theme is “Renewal,” informed by Hosseini’s writing. The event “is an opportunity for medical students to share their artistic talents, and to hear from a physician who has followed his muse to success in writing,” said Grace Xiong, a member of the medical student committee organizing the event.

Medicine and the Muse takes place April 16, from 5:30-8:30 PM in Berg Hall of the Li Ka Shing Center for Learning and Knowledge on the Stanford campus. The event is free and open to the public, but RSVPs are requested. To RSVP, e-mail mandm2014@lists.stanford.edu, or call 650-725-3448.

Photo by Elena Selbert

Autism, Medicine and Literature, Medicine and Society

"No, I'm not ready yet": A sister's translation for her brother with autism

Over on Medium.com, Abby Norman shares experiences from her youth in a family with a brother, Caleb, who has autism and a mother with an eating disorder. Able to observe and interpret Caleb’s ways of communicating, Abby acts as a translator to give him a voice that others will hear and, one hopes, understand.

From the piece:

What calmed him was lying on the bed for hours, motionless, watching the numbers of the digital clock change.

He did not potty train on schedule. Instead, he had somewhat of an intense penchant for smearing feces all over the rug and walls of the house. This was his way of saying, “No, I’m not ready yet.” … His relationship to the toilet had nothing to do with his bodily needs: the toilet was his method of rejecting objects. If he didn’t want something, he’d flush it down the toilet.

He was only aggressive in the sense that, when startled or overwhelmed, he would kick and scream. They started out seeming like normal tantrums; but while most kids could be consoled, Caleb could not be, and he would have to literally wear himself down before he would stop.

The author notes that even in understanding her brother’s differences, she was not necessarily his ideal caretaker. The piece continues:

Once he started school, the nightmare only intensified. I say that not to describe what life was like for us, but for him. School, with its unpredictable nature and constant social interaction, its lack of structure for kids who needed anything other than “normative learning.” The truth was, Caleb wasn’t really special needs. He was extremely intelligent.

At home, his day to day life was more or less consistent. While my experience growing up with a mum with an eating disorder was difficult, for Caleb, the obsessive-compulsive nature of her lifestyle was exactly what he required to stay calm and safe. He and my mother had, and to this day still have, a very symbiotic relationship.

Previously: Inspired by his autistic son, a Stanford researcher works to understand the biochemistry of autismThe Reason I Jump: Insights on autism and communication, A mother’s story on what she learned from her autistic son and Autism therapies: It still comes down to parents

Medicine and Literature, Stanford News

Stanford's Abraham Verghese honored as both author and healer

Stanford's Abraham Verghese honored as both author and healer

Verghese signing booksSeveral times I’ve heard Stanford physician Abraham Verghese, MD, champion of hands-on medicine and bestselling author, answer the question: Which does he considers himself first – a doctor or an author?

Always, I’ve heard him give the same answer. He is a physician first. For him, medicine is “a ministry with a calling.” The meaning to his life is in his ministry to the patient; how best to fulfill that ministry is his life’s journey. This he tells the entering first-year medical students during orientation, reminding them to always hold onto to the desire that drew them to medicine in the first place. The desire to help people.

But obviously, it’s not that simple. For Verghese, the author of nonfiction and fiction books and numerous articles in both the general and academic press, the two passions are intertwined and feed into each other. For him, writing is a path of discovery to become a better physician.

Now, Verghese’s work of combining the two fields has again been honored, this time with Verghese being named today the recipient of the $250,000 Heinz Award for Arts and Humanities. In a news story I quote Teresa Heinz, chairperson of the Heinz Family Foundation, which administers the annual Heinz Awards in five categories, on the choice:

Dr. Verghese’s widely acclaimed writings touch the heart and inform the soul, giving people of all walks of life a true understanding of what it is to heal the whole person – not just physically, but emotionally.

Verghese, who will be the commencement speaker for the Stanford medical school graduation in June, said he was excited about the award, which he considers “a lovely validation of work that is in that realm of being on the edge of science yet very much about the art.”

He also received another recent honor. His only novel (he’s currently working on his second), Cutting for Stone, has made the list of Amazon.com’s “100 Books to Read in a Lifetime.” It’s an accomplishment, he told me in an e-mail, that he’s indeed proud of. What writer wouldn’t be honored to have their book listed alongside the likes of Hemingway’s The Sun Also Rises and W. Somerset Maugham’s Of Human Bondage?

Hearing of these two honors – along with recently having reread Verghese’s second memoir The Tennis Partner - reminded me of how close the author’s love for both art and medicine are wedded. And it reminded me yet again that for Verghese both art and science – which includes the entire medical establishment – ultimately exist as tools to help heal patients.

Previously: Abraham Verghese’s Cutting for Stone: Two years as a New York Times best seller, How Abraham Verghese writes, How a battle with Napoleon helped Abraham Verghese write his novel, Abraham Verghese at Work: A New York Times profile and Physicians turn to books to better understand patients, selves
Photo by Singer, 2012

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