Archive for August, 2010



The call to discipleship – 8

On piety:

The witness of the disciple consists in the fact that he refrains from attesting his piety as such. If we are to display the kingdom of god and proclaim it from the housetops we will not make a show of our own devoutness but keep it to ourselves.

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The call to discipleship – 7

With regards to the family:

The coming of the kingdom of god means an end of the absolute of family no less than that of possession and fame.

The call to discipleship – 6

With regards to force and violence Barth says this:

the decisive contradiction of the kingdom of God aginst all concealed or blatant kingdoms of force is to be seen quite simply in the fact that it invalidates the whole friend-foe relationship between one person and another.

If the world ends

This is the way the swine flu ends, not with a bang but a whimper

Note to self: Don’t die

Atul Gawande is an endocrine surgeon in North American who has a good way with words. For a doctor at least.

His two books – Complications and Better are a wonderful inspiration for someone who genuinely cares about how the job is done (as an aside if you were a dermatologist with similar passions you could never get the stories to make the books interesting. That seems unfair). His call to audit our practice – to measure something got me all excited about audit and research.

He made news headlines (with lots of other folk) with the surgical safety checklist. A mixture of almost comedic routine and common sense that should help stop the surgeon leaving his car keys in your abdomen.

He writes regularly in the New Yorker and this piece about end-of-life care caught my eye. Both morally and personally I have an interest in this.

On the inability of medicine to consistently “save lives”

We’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets—and have only the rudiments of a system to prepare patients for the near-certainty that those tickets will not win. Hope is not a plan, but hope is our plan.

The USA spends a colossal amount on people in the last 6 months of their lives. This would be great if it helped them but it’s not clear it does. The following comment belies the different attitude between the UK and the USA on ICU admission. I worked in ICU for a over a year and we were deliberately choosy about who we would bring to intensive care – partly a resource issue but largely because we put people through horrible things in ICU and for a lot of people it simply won’t work. In the US it seems as if ICU is a frequent option for those who might be allowed to pass on without a tube in their throats in the UK.

I spoke to Dr. Gregory Thompson, a critical-care specialist at Gundersen Lutheran Hospital, while he was on I.C.U. duty one recent evening, and he ran through his list of patients with me. In most respects, the patients were like those found in any I.C.U.—terribly sick and living through the most perilous days of their lives. There was a young woman with multiple organ failure from a devastating case of pneumonia, a man in his mid-sixties with a ruptured colon that had caused a rampaging infection and a heart attack. Yet these patients were completely different from those in other I.C.U.s I’d seen: none had a terminal disease; none battled the final stages of metastatic cancer or untreatable heart failure or dementia.

I find the article interesting as it’s one of the few articles that talks about how we deal with dying in the terminally ill as opposed to how we bring about death in the terminally ill.

Gawande nails the underlying issue that both the medical profession and society needs to learn:

But the issue isn’t merely a matter of financing. It arises from a still unresolved argument about what the function of medicine really is—what, in other words, we should and should not be paying for doctors to do.
The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.
This is what I think what medicine is here to do (primairily and given here without thinking out all the implications) our role – is to relieve suffering in whatever form we find it.

The apple of my eye

There are nerds out there. I know you’re there somewhere. Nerds with macs and iPhones who’ll appreciate this.

Following is a list of (mainly free) stuff I’ve recently picked up off the net via blogs like lifehacker and people I know.

[And I’m obviously a mac user –  i’m sure you can do all this stuff on a PC or simply using your hands just as easy but forgive me this once…]

Papers

For those of you involved in any form of academic research or any fellow medics who are trying to keep on top of the medical literature then this program is great.

I was beginning to get a bit befuddled by own filing system for PDFs (there’s over 400 by now) so it’s nice to see someone has thought about it more than I have.

Basically you dump all your PDFs into this program and it tries its best to pull all the meta data (references, authors, abstracts etc…) off PubMed or whatever suitable database and then organise them all into one nice database on your computer so you can actually find them again.

I am an organisational obsessive and as a result this was like heroin to my veins.

I’m still on the free trial and it costs 30 Euro for the full version.

PS there is a built in reader in the program which you can make notes with but I still prefer Preview for the cool annotation tools.

Itunes Remote Control

I’ve had remote on the iPhone for a while which is pretty useful as a remote control for computer I use as a media player but I always wanted an easy way to do the same thing from my lap top. I only got ITRC today. Took me a while to get my mac to connect to it but now it seems to work pretty well as yet another way not to exert calories in having to get up and turn the volume down.

Bean

Everyone hates MS Word (don’t they?) – just a bit of a beast of a program. Far too many features for what most use it for. But .doc files are an essential part of life but this free open source desktop app will open and let you edit the vast majority of what you need from a word file.

Free Books and Free Audiobooks

Despite the irony of a free books app costing $1.99 this is a great set of apps. They contain thousands of all the out of copyright classics that any monkey can pull off the net for free – this just puts it all in one place.

It’s companion – free audiobooks –  does the same thing with the wonderful and ambitious Librivox project and gives you access to several thousand fairly high quality amateur audiobooks.

Simplenote

I know there’s lots of others like Evernote out there but I started on this and now i’m sticking to it. Keeps all my notes synced to any possible place I might need them. Plain, simple, free – can’t beat it.

Dropbox

This and simplenote (and i suppose everything google that i touch) has been my first foray into the world of the cloud. And I love it.

If everyone I knew was on dropbox I’d use it a bit more too. Nice favourites feature on the iPhone that lets you store all your errr… favourites on the phone off line.

Join dropbox – if you want I can get you an invite then I get more free storage.

Well I suppose that’ll do me for now, and I didn’t even get started on the joys of Skype, Google Docs or Angry Birds.

I’m planning a blog on aesthetics and functionality in regard to technology but it needs some serious thinking.

The call to discipleship – 5

The call has consequences for b) position in society

the disciple of Jesus can descend from the throne – the little throne perhaps – which even one may be allotted in human society


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