Lifeboat Foundation

One of the things I love most about being a Surgical Oncologist is that I see my patients for years after I have treated them. However, my clinic days are inevitably like the opening scenes from the old Wide World of Sports television program that aired on Saturday afternoons on ABC. I remember watching this show on weekends as a child and teenager. The “thrill of victory”, with images of athletes crossing the finish line in first place, equates to those patients who receive good news during their clinic visit. I tell them I am confident I can perform an operation to remove their cancer; or I confirm that their blood tests and scans show that tumors have not recurred after surgery, chemotherapy, and other treatments; or we pass some major chronologic milestone without evidence of cancer rearing its ugly head again (many patients still believe the 5 year anniversary of being cancer-free equates with being “cured”, if only that were always true). In contrast, the “agony of defeat”, forever seared in my memory in the opening scenes of Wide World of Sports with the ski jumper falling off the end of the jump and bouncing hard off the slope, represents the distress and depression felt by patients and their family members when I deliver bad news.

I would never make it as a professional poker player because I can’t bluff when I’m holding a bad hand or keep from grinning when I have a good one. My patients can tell from my face when I walk into the clinic room what the news is going to be. When all of the blood tests and scans reveal no evidence of cancer recurrence, I walk in smiling and immediately tell all gathered in the room that everything looks great and I see no evidence of any cancer. The remainder of the visit becomes a combination of medical checkup and social enterprise. I inquire about the well-being of their children, grandchildren, parents, other friends and relatives I have met, their pets, their gardening, their recent travels, and sundry snippets of their ongoing lives. Patients frequently bring pictures of children and grandchildren, or travel photos of places they have been since their last visit with me. Often I’m asked for medical advice on conditions totally unrelated to their cancers as they get farther and farther away from that diagnosis. My patients also know about tidbits from my life. They ask about the status of soccer teams that I coached, how my son or daughter were doing in college (both graduated and onto successful careers, thank you), and whether I have progressed from owning a Ferrari lanyard to hold and display my medical badge (I’m a fan of Ferrari F1 racing) to actually owning a Ferrari automobile (I do not).

I am told by patients, family members, and members of my patient care team that I am quite solemn when I walk in a clinic room to deliver bad news. No “light-hearted” chatter or discussion of recent family events or outings occurs. The nervous, hopeful smiles on the faces of the patient and the family members in the room quickly fade as I describe what I am seeing on their blood tests and the scans I have reviewed. Friedrich Nietzsche, the pejorative poster boy of pessimism, is credited with the aphorism, “Hope is the worst of evils, for it prolongs the torments of man.” Thankfully, he was not involved in the care of patients with cancer or other chronic illnesses. A particular patient comes to mind when I remember the importance of dealing with both the highs and the lows of talking with cancer patients.

The patient in question was the wife of an Emeritus Professor of Engineering at a prestigious American university. The Professor knew a thing or two about scientific investigation, statistics, and assessments of probability. Mrs. Professor had a large, grapefruit-sized malignant vascular tumor in the center of her liver called an epithelioid hemangioendothelioma. Quite a mouthful of a name for a rare malignant tumor of the liver. Her tumor was in an unfortunate location in the center of the liver and was wrapped around two of the three veins that drain all of the blood out of the liver into a large blood vessel called the inferior vena cava. The tumor was abutting a portion of the third vein. As a hepatobiliary surgical oncologist, I know I must preserve at least one of these veins to allow blood that flows into the liver to flow back out properly. She had seen surgeons at several other hospitals in the United States and was told that the tumor was inoperable and untreatable. If she was lucky, she might live a year, these doctors told my patient and her husband. The Professor contacted me, and I examined Mrs. Professor and evaluated her prior scans, and then obtained some additional high resolution scans to better understand the appearance of her tumor. I realized that her particular tumor had a very thick fibrous capsule surrounding it. I explained to the patient and her husband that it may be possible to remove the tumor, but that it would be challenging. This lady who had been sullen, withdrawn, and tearful every time I had met with them previously suddenly looked up and said, “If there’s any chance, I’m willing to take it!” I preceded the next week to perform an operation that removed the entire left lobe and a portion of the right lobe of her liver and I was able to gently dissect the tumor capsule free from the third hepatic vein. The operation was successful and the patient recovered well over the next several weeks.

Continue reading “Good News Bad News” »

A disarmingly simple model of ecology does everything well — except for predicting how rapidly nature can change. Can it become more realistic while still avoiding biology’s messy complexities?

Life’s chemistry, it appears, is quite kludgy. Such computer metaphors help explain Dr. Venter’s perspective on synthetic biology. Is a genomic version of Moore’s Law in the offing?

I learn useful life lessons from each patient I meet. Some are positive messages, reminding me of the importance of maintaining balance between family, work, and leisure activities, but more frequently I witness examples of the remarkable resilience of the human spirit when facing the reality and risks of a major surgical procedure and a diagnosis of cancer. Rarely, patients and their family members utter remorseful or simply sad remarks when they are faced with a grim prognosis and the emotions associated with an onrushing date with mortality. These comments invariably involve an inventory of regrets in life, including, “I should have spent more time with my kids,” “I wish I had told my father (or mother, brother, sister, child, or some other person) that I loved them before they died,” and “I have spent my entire life working, I never took time for anything else.” I wince when I hear these openly expressed remonstrations, I recognize that I am hearing painful and heartfelt truths. Not a week goes by that I am not reminded that I do not one day want to look back at my life with a long list of regrets, should have dones, and what ifs.

I was blessed to meet a great teacher in the guise of a patient early in my academic career. He came to my clinic in my first year after completing a Fellowship in Surgical Oncology, my first year as an Assistant Professor of Surgery. My patient was a 69 year-old Baptist Minister from a small town in Mississippi. He was referred to me by his medical oncologist who called me and said, “I don’t think there is anything you can do for him, but he needs to hear that from you because he doesn’t believe me.” This tall, imposing man had colon cancer that had metastasized (spread) to his liver. The malignant tumor in his colon was removed the year before I met him, and he had received chemotherapy to treat several large tumors found in his liver. The chemotherapy had not worked and the tumors grew. At the point I met him, the medical oncologist told him he would live no more than 6 months, and because he was an avid fisherman when not preaching or helping others in his community , the doctor suggested that he go out and enjoy his remaining time by getting in as much fishing as possible. I learned two invaluable lessons from this patient and his family. First, never deny or dismiss hope from a patient or their family, even when from a medical perspective the situation seems hopeless and the patient is incurable. Second, quoting the minister directly, “Some doctors think of themselves as gods with a small ‘g’, but not one of you is God”.

When I first walked into the examining room, this man was slouched on the examining table in the perfunctory blue and white, open-backed, always unflattering hospital gown. He made eye contact with me briefly, then looked down to the floor. In that momentary meeting of our eyes, I saw no sparkle, no life, no hope in his eyes. He responded to my initial questions with a monotonic and quiet voice. Several times I had to ask him to repeat an answer because his response was so muted. Mid-way through our first visit, the patient’s wife told me he had been very depressed by his diagnosis of untreatable metastatic colon cancer. She reported, despite his occasional side-long warning glances requesting her silence, that while he was eating well, he was spending most of his time sitting in a chair or laying in bed, and that the active, gregarious man with the quick wit and booming voice she had married was gone.

Continue reading “The Importance of Hope” »

Interesting Question to ask.

The battle between the FBI and Apple over the unlocking of a terrorist’s iPhone will likely require Congress to create new legislation. That’s because there really aren’t any existing laws which encompass technologies such as these. The battle is between security and privacy, with Silicon Valley fighting for privacy. The debates in Congress will be ugly, uninformed, and emotional. Lawmakers won’t know which side to pick and will flip flop between what lobbyists ask and the public’s fear du jour. And because there is no consensus on what is right or wrong, any decision they make today will likely be changed tomorrow.

This is a prelude of things to come, not only with encryption technologies, but everything from artificial intelligence to drones, robotics, and synthetic biology. Technology is moving faster than our ability to understand it, and there is no consensus on what is ethical. It isn’t just the lawmakers who are not well-informed, the originators of the technologies themselves don’t understand the full ramifications of what they are creating. They may take strong positions today based on their emotions and financial interests, but as they learn more, they too will change their views.

Continue reading “As Technology Barrels Ahead—Will Ethics Get Left in the Dust?” »

Scientists have redefined the classification of animals due to genetics; 1st time in 300 years. I wonder how the Vets and the Vet Colleges will respond?

The classification system for animals has been hotly debated and frequently changed since it was created 300 years ago, but now researchers have actually found a genetic basis which confirms that part of the system we use today is actually pretty accurate—and they think this part can be defined even more specifically down to the genetic level.

An international team led by Professor Itai YanaAi of the Technion-Israel Institute of Technology Department of Biology made the discovery after using an extraordinarily powerful technique known as CEL-Seq. CEL-Seq monitors individual cells for their gene activity (as detected via mRNA)—and they applied it across 10 different species, with CEL-Seq being applied to 70 embryos per species.

Continue reading “Scientists redefine animal classification system; Change confirmed” »

By Warren Duffie, Office of Naval Research

An exciting new scientific frontier-synthetic biology-took center stage as a celebrated scientist from the Massachusetts Institute of Technology (MIT) recently spoke at the headquarters of the Office of Naval Research (ONR).

As part of a Distinguished Lecture Series celebrating ONR’s 70th anniversary, world-class scientists, researchers and experts from diverse fields will be speaking at ONR in 2016. Dr. Christopher Voigt, an MIT professor of biological engineering, inaugurated the lecture series with a look at the revolutionary potential of synthetic biology.

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I believe that AI holds a lot of promise and many great things; however, we have to correct some very critical issues 1st before compound a huge issue that we have today. And, that is Cyber Security and re-establish trust with our consumers and customers. Without these 2 being fully addressed; you will compound these two challenges with AI plus run the risk of having an IoT that most people will not wish to use due to hackers, bad data, etc. Not to mention lawsuits for Wi-Fi connected robotics that were hacked and injured or worse some innocent person.

I believe need to ensure priorities are in order before we make things worse.

Unexpected convergent consequences…this is what happens when eight different exponential technologies all explode onto the scene at once.

Continue reading “Where Artificial Intelligence Is Now and What’s Just Around the Corner” »

http://www.transcendencemovie.com/

Dr. Will Caster: “For 130,000 years, our capacity for reason has remained unchanged. The combined intellect of the neuroscientists, engineers, mathematicians and hackers in this auditorium pales in comparison to even the most basic AI. Once online, a sentient machine will quickly overcome the limits of biology. And in a short time, its analytical power will be greater than the collective intelligence of every person born in the history of the world. So now imagine such an entity with the full range of human emotion. Even self-awareness. Some scientists refer to this as ‘the Singularity’. I call it ’Transcendence’. The path to building such a super-intelligence requires us to unlock the most fundamental secrets of the universe. What is the nature of consciousness? Is there a soul? And if so, where does it reside?”

Luddite: “Dr. Caster.”

Continue reading “‘Some scientists refer to this as the Singularity. I call it Transcendence.’” »