Complications [Book Review]

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Complications: A surgeon’s notes on an imperfect science.

I need to find more books written in this type of style. A book chocked full of page-turning stories and thought-provoking narratives. It’s like watching a thriller of a man/woman about to accomplish a tremendous feat, where portions of the video cut out to flashbacks on life-changing events that sculptured the dream in which the individual is driving to complete. This book takes that feeling and applies it to surgery. This isn’t just the imperfections of what we know about the human body, but also the social implications behind the medical sciences.

The author, Atul Gawande, is a resident surgeon. A resident is someone that is fresh out of medical school and starts practicing medicine and surgery. Yes, they start practicing it. They acquired the textbook knowledge and proved that they have the mental perseverance to stick it out through 8 years of college. Then they start learning how to do specific procedures on patients.

There’s always the question of when and on whom new doctors should work on. While it’s important that residents get the experience to become the leaders of the next generation of treatment, even doctors themselves will try to avoid treatment from other residents. They are just like us, they want the best treatment for their loved ones, but they have the inside knowledge.

Even when the doctor has 1 or 20 years of experience, mistakes always happen. Each human is relatively similar, but different enough that you can never truly break every procedure from easily read statistical model. However, our society makes both doctors the ultimate fail-proof machine but will socially destroy those that do make mistakes. This makes it difficult to learn from those errors to the point that hospitals can only do it internally [Morbidity and Mortality (M&M) conferences] with a strict sense of discreteness involved. The system itself, ironically, can lead to many “burnt out” professionals, which ironically can result in the production of “bad doctors.” It’s almost a chicken-and-egg scenario of which came first.

The novel has another section devoted to the treatment of “mysteries.” This includes a lot of nerve and hormonal based diseases including unknown pain, uncontrollable blushing, and insatiable appetites. Regardless of how far we have come, there’s still a lot to learn about the human body. Due to the pressure of society for something to be done, either in the form of an easy pill or a instant-fix surgery, the medical society has implemented various forms of “experimental” procedures with some becoming norms throughout the industry (ex. gastric bypass surgery). The author pads some specific topics with the results of scientific studies, but still shows the struggles doctors face when dealing with similar topics.

The most thrilling, and my favorite, section of the book was the last third titled “Uncertainty.” It’s main theme is the interaction between the doctor and patient in terms of limited judgement, individual variation, and the doctor’s unique prior experiences.

When someone is approaching death, there are many options one can choose. However, who should be the one that has the final say? Does the doctor with the medical degree? Or the individual that has to risk possible side effects and mortal consequences? It’s this difficult balance where the patient wants the best for their future, but they may not be in the state of mind to make the best call. Individuals may know what they want, but sometimes don’t want the commitment of possibly choosing the wrong treatment and suffering the long-term guilt associated with it. Even doctors (including the author) will give up medical decision making for themselves and their family to their co-workers, knowing their decision is free from emotional stress and attachment bias.

In the other half of cases, doctors and surgeons need to convince their patients when…. or when not ….. to undergo certain procedures. Some may want to risk surgery at the cost of their life. Others may be too afraid to look into the possibility of what they may have……cancer, infections, genetic diseases. And not all decisions can be made by a supercomputer-driven algorithm crunching statistical data……”making decisions under uncertainty everyday” is what makes doctors the miracle workers that they really are. They are able to connect with their patients and reason out the best course of action for each unique individual.

I learned at a young age that I am highly susceptible to stress and what it can do to your body. Every time some sales person barks to me over some urgent matter that needs immediate attention for “the customer,” it unconsciously drives a vicious cycle of stress hormones in my body. But when it does occur, I can stop, take deep breaths, and come to the realization that no matter the outcome……. no is dying over the choices I make as an applications engineer.

That’s why I have a lot of respect for many career paths that result on the fate of people’s lives: police officers, soldiers, ……… and doctors.

 

 

 

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Black Edge [Book Review]

In terms of financial investments, individuals can make money based on the knowledge behind the monetary value of various stocks. Edge is the term coined to represent this knowledge, and it has “degrees” of publicity. If you read the information in the New York Times, it was in the public domain and this white edge was safe. However, since everyone knows this information and digitization responds to public announcements almost instantaneously, you can’t make a living just off of white edge. And that’s where black edge comes in……

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Black Edge, written by Sheelah Kolhatkar, is a story behind the “inside information” that is illegal to utilize in stock market profits. Black edge can come in the form of unpublished revenues, unannounced merges, and internal project findings (medical, technical, digital) before being published in any form that can be obtained without fancy dinners, sport outings, or just general “business relationships.”

The main focus of the book is on one man, Steven Cohen, and his rise from being a son to a poor family to becoming a business owner of his own hedge fund company (SAC) as a successful billionaire “built” on an aggressive hierarchy of shady trades. The books goes into a hefty story behind the interactions between the SAC, the Securities and Exchance Commission (SEC), the FBI, and the multiple individuals involved. I won’t go into the details behind these specifics, but it does involve doctors, art auctions, FBI rivalries, an a few condemned traders (just not Cohen).

Lesson learned: If your company is going to thrive on illegal operations, make sure that there’s no links that trace yourself back to your minions doing all the dirty work.

Just sayin….

The narrative, however, does lead to many introductions into the details behind multiple topics that the audience can learn from, outside of the limitless possibilities when one becomes a billionaire. Nothing like collecting  art, right?

https://en.wikipedia.org/wiki/The_Physical_Impossibility_of_Death_in_the_Mind_of_Someone_Living

If you aren’t familiar with hedge funds, their name originally came from a technique of “hedging your bets.” You would buy stocks that you think were going well, and you would short stocks that weren’t going to do so hot. [Shorting stocks, explained in simple terms, is selling a stock that you don’t own….yet. You’d buy it later when the price (hopefully) drops]. Thus, you would return some sort of profit regardless of if the economy boomed or busted. Original hedge funds were very stable, like bank investments that looked at the long term potential, until ….. they weren’t. They just started looking at quarterly returns and then to weekly returns.

And finally, hedge funds no longer “hedged their bet”……they just traded however they liked to maximize profits. This trend took off in the financial sector and is now the huge swing in corporate American focus that everyone grumbles about today. Short term investments, at the sacrifice of the long haul. This has even led to the “demonizing” of target companies that specific individuals were planning to benefit from; publicly ridiculing (anonymous, of course) a company to force their stock prices to drastically go down (and shorted stocks to be profited from).

Black edge, thus, has been the main ingredient for this financial monster to keep dredging through the years, even after the stock market crash within the last decade. As observed through this book, it can be handled in different ways. It can be developed from a false sense of trust and relationship between individuals. It can be from a tit-for-tat trade deal, where each party is the benefit of a financial gain. But most importantly, for the legal security of the interested parties, it was treated as a Fight Club. The first rule of Fight Club………

The alternative tactic in gaining an edge over other investors is in gray edge. Something in the middle, where it feels wrong, but not bluntly wrong. While everyone will have a different sense of what would be difference between white and black intel, the only opinion that matters is the government. And even that changes over time!

The epilogue describes how recent court rulings have set a new premise in what is considered illegal trading. This involves something on the lines of……

“The benefit the leaker received in exchange for sharing the information had to be something tangible, akin to money. Friendship or favor-trading on its own was not enough.” (page 291)

People were let go, charges were dismissed, and others continued to make millions in weeks.

Personally, I don’t know what is truly right or wrong. When you think of crimes, there’s typically harm [physical, financial, social, mental] done to a specific individual or group. However, in the stock market, who is losing? It’s similar to the selling price of a house, where someone may not make that money because they were not available, physically or mentally, able to take that risk in buying/selling at the right time. Stocks, on the other hand, are so anonymous that illegal trading can feel extremely harmless……..

 

 

 

Gut [Book Review]

Everyone has heard their stomach growl. I’m currently at an airport on a Sunday after skipping breakfast, and I’m experiencing this at this exact moment. I always thought it was just one of the ways your body communicated to you when it’s an ideal time to eat again. However, this is the acoustical effect caused an internal process called the “migrating motor complex,” which is a fancy way of saying how the stomach and intestines are doing a routine cleanup of your digestive tract. The stomach releases a powerful wave into the small intestines to “sweep away” the interior walls of all residual food particles for some internal maintenance.

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This is one of the many new facts that I learned while reading Gut, by Giulia Enders. You would think that this book would be another book of boring fact as of old…..the stomach is filled with acid to break down food, the liver creates bile to help break down fats, the small intestines is made up of villi and microvilli…..blah blah blah. But it turns out there is so much more that the author gladly writes about, and she knows which facts are enticing for the audience to discover, regardless of their background. And it all starts with the topic of pooping.

What a way to capture an audience’s attention, right? The story of the cooperative tango between your two sphincters making up the rectum: one voluntary…..one involuntary. While the internal sphinctor is constantly moving material through out of your system, you have the final say when it comes to “cleaning out the back end,” regardless if it’s solid, liquid……or gas.

And don’t worry, there’s more “shit” where that came from, halfway through the book!

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Reviewing the underlying themes in this book, food digestion by itself is roughly only a third of the material. Another large chunk is the interaction between the digestive and immune systems. Tonsils are known to play a strong role in bacterial and viral detection, playing the role of a sampling center delivering a small dose of what the body can expect down the road. The appendix has been theorized to have a similar role with the additional function as a microbial warehouse that is extracted after the person has gone through diarrhea and flushed all the beneficial microbes out of their large intestines.  While the entire gastrointestinal system has many additional sites for collaboration, the tonsils and the appendix are commonly known to have the largest concentration of inflammable tissue from bacterial-immune cell interaction. Thus, these two locations tend to have a higher rate of surgical removal in our current age.

The last third of the book is on your gut micro-biome. While most of the bacterial in your body thrive in the large intestines, they also survive and have an apparent impact in your mouth (cavities), your stomach (ulcers), and your small intestines (inflammation). While bacteria are mostly associated with negative events, it’s rarely ever a parasitic relationship. Many bacteria supply assistance in the breakdown of complex molecules, the production of essential nutrients, and the regulation of hormonal balances in the body. There is evidence that these gut residences can play a significant role in their host’s mood and unconscious desires, sometimes even suicidal ones!

All of this information, including theadditional subjects not listed above, captivated my attention and flowed smoothing between chapters. While no non-fiction book is a page-turning thriller, I always looked forward to the next page in this novel.

One of the largest barriers in reading a non-fiction book is for the audience to keep track of all the unfamiliar terminology. This is not an issue here. Remember the term “migrating motor complex?” It’s only stated once, as it’s a simple name tag in case one wants to dig through a dusty, out-of-date text book that’s been waiting for some love at the bottom of your bookshelf…….sorry, old radar handbook of mine. While it does help that Gut is about the human body, a topic we are acquainted with on a daily basis, the author does take great care to remove any literary road blocks and make the eye-opening theories stand out.

I also have to bring up the illustrations throughout the book. They are all done by the author’s sister, Jill Enders. And they are a riot! They make the book seem childish at times, but they always related to the scientific text in such a creative way. Graphics in a book not just help explain the topics in a book, but they also help you remember prior chapters and allow one to look back at the work as a whole and re-navigate it if backtracking or re-capping is necessary.

As you can tell, I thoroughly enjoyed this book. If the author has another novel on the shelves, I’m definitely picking it up. Giulia has proven to me that reading her books is worth the investment, and this includes the numerous “small talk” subjects that have occurred since I started reading this book around a month ago.

 

Random fact: Sea squirts digest their own brain once they settle down…… a habit that I’m grateful that humanoids, myself included, don’t possess!