The Rant

“Don’t judge a man until you’ve walked a mile in his shoes”.
– an Old saying of controversial origin.

Somewhere in Middle America….

What the heck is going on here?
I can hardly recognize this place anymore! Everywhere I go, I hear and see strange people! Where did they come from? Walk down Main Street. Half the stores have names I cannot even pronounce.
Thirty years ago, we were 85% of the population. Now we are only 60%! Let that sink in – 60%. At this rate, we will be an endangered species in 50 years!
They are coming from everywhere, taking our jobs here and shipping the rest out. Look at our towns – deserted landscapes of boarded-up homes and factories!
Together with those bleeding hearts, they even made one of them President and he wasn’t even born here. Consider that! Even worse, I hear he worships differently! And he is President!
He wants to take our money and our guns. He wants to weaken us so he can rule forever.
Now they march around openly claiming they matter more than we do. The nerve! The absolute nerve!
Even scarier are those who want to kill us off, change how we worship and replace our laws. I say, stop them all from coming in. We need some law and order now!
We built this country with our sweat and blood. We fought for it. Our ideas made it what it is. It is ours. We want it back! We need to take it back! We used to be the greatest. Now, we are but a shadow of who we are. I say, we need that greatness back now!
I sit and listen to all theses clowns wanting to be president and wonder if any of them sees things the ways I do and has the guts to say what needs to be said!
I wonder, I really do…

Thoughts from the 2016 DNC

I’ve long been guided by this saying by George Bernard Shaw:
“I learned long ago, never to wrestle with a pig. You get dirty, and besides, the pig likes it.”
I guess the Obamas believe in the same thong and that’s why the FLOTUS said:
“…How we explain that when someone is cruel or acts like a bully, you don’t stoop to their level. No, our motto is, when they go low, we go high.”

Michelle

I’ve always sought to reconcile how this country was founded and the ideals she was founded on. Monday night, Sen Cory Booker of NJ said these words that got me thinking:
“But our founding documents weren’t genius because they were perfect. They were saddled with the imperfections and even the bigotry of the past…
But those facts and ugly parts of our history don’t distract from our nation’s greatness. In fact, I believe we are an even greater nation, not because we started perfect, but because every generation has successfully labored to make us a more perfect union.”

The US is a great nation not only for what she has been, what she is now but the potential she still holds. Change and progress have come in fits and starts but come they have. I look at how divided the nation is now and wonder if it is a fit or a start. I hear the vitriol and rancor and wonder if we can really get it right this time!
History is an interesting thing. If it is not revised, it is a great tool….
After Michelle Obama’s speech on Monday, there was a claim by Bill O’Reilly of Fox that the slaves who worked on the White House were “well-fed”.
Well, there is actually a first hand account that disputes this claim and is from no other than Abigail Adams, the wife of the John Adams, the 2nd President of the US. She moved into the WH while it was still under construction. David Graham has a piece in the Atlantic about this so I pulled up the reference, which is a letter Abigail Adams wrote. It can be found in the National Archives.

“In the letter to her uncle, a Dr Cotton Tufts, she writes:
From Abigail Smith Adams to Cotton Tufts,
28 November 1800
Columbia City of Washington Novbr 28 1800
Dear Sir
…. The effects of Slavery are visible every where; and I have amused myself from day to day in looking at the labour of 12 negroes from my window, who are employd with four small Horse Carts to remove some dirt in front of the house. the four carts are all loaded at the same time, and whilst four carry this rubish about half a mile, the remaining eight rest upon their Shovels, Two of our hardy N England men would do as much work in a day as the whole 12, but it is true Republicanism that drive the Slaves half fed, and destitute of clothing…whilst the owner waches about Idle, tho his one Slave is all the property he can boast, Such is the case of many of the inhabitants of this place…”

I guess they were not that well-fed after all!

In all, I thought the black man who had more reason to be cynical and dark rather exuded more brightness and hope than the billionaire who exuded darkness and cynicism a week ago in Cleveland. Question is, who will the people listen to?

What Do You Have to Offer?

It was around 1996 and the specter of the Clinton Health Plan was scaring US doctors and medical students alike. A lot of programs in specialties like Anesthesiology and Internal Medicine, couldn’t find residents to fill the needed slots. So several top US programs got together and headed to Europe to find young doctors.
I had finished medical school in Germany two years earlier and after my internship, couldn’t find a job. No one wanted to hire an African! Returning to Ghana was not yet an option as I wanted to finish residency.

One winter night, as I left the Genetics lab where I was working on a project, I saw a flyer. It offered the chance to doctors to go work in the US if one had passed the USMLEs. There was a meeting scheduled for the next evening in an auditorium in the building where the lab was. I made it to the meeting. I met the head of the agency who was organizing the search by the top US programs for residents in Europe. I registered for the interview.

Sometime in the summer of 1996, I headed to Munich for the interview. It was an overnight trip from Berlin. I changed into my only suit in a restroom stall at the train station when I got to Munich. I headed to the venue.
I entered a large hall with lots of people. Each program had it’s table. I registered again, got my name badge and headed to the first table.
For the last two years, I had traveled over Germany begging and groveling for a job. Somehow, my transcript from medical school was just not enough. Somehow what I had to offer was not good enough.
I stood there at the first table, hopeless and expecting disappointment. The words I heard changed everything.
“Dr Ghansah, what do you have to offer our program? Sell yourself!”, the gentleman behind the table said.
I was dumbstruck!
Me? What did I have to offer? Me? A poor African doctor no one wanted but who had a thousand dreams? I was dumbstruck!
“Dr Ghansah, we are waiting!”
Right then, I knew the US was different. Right there, I got hopeful.

I’ve been thinking of this a lot lately as I listen to two very distinct depictions of this country. One is dark and cynical. The other is bright and hopeful.
This country is different. The US hasn’t always done right by all, but man, is this an amazing experiment!
It is a given that there are many for whom life is a daily struggle. It is a given that there are many who are shut out from reaping the opportunities this country has to offer. It cannot be denied that racial bias is still an impediment to some.
In spite of all that, I’ll go with the vision of hope then no other country offers it in spades like the US does. I’ll go with hope because cynicism and darkness never helped anyone.

As an immigrant, I am always grateful for what this country has given me and I can say that about all the immigrants I know. Like me, they all heard that question:
“What do you have to offer?”
That day in Munich, my answer was: “Hard work”.
That is the answer of all immigrants – Hard work. You see, when you offer hope and opportunity, you get a lot back. Hard work, perseverance, creativity, new businesses, entrepreneurs, artists and on and on.

Maybe Americans born and bred here in the US do not see what I see. Maybe they expect more. Maybe their standards are higher. That is fine. However, if you would indulge me, I would like to ask a few questions:
“What does cynicism and darkness get you?
What do they have to offer?”

Cynicism rolls

“Cynicism rolls down like the water and mistrust like a mighty stream”.

Antisthenes (c. 445 – 365 B.C.), Diogenes of Sinopes (c. 412 – 323 B.C.) and Crates of Thebes (c. 365 – 285 B.C.) are considered the founders of the school of Cynicism.
For a Cynic, the purpose of life was to live virtuously and in agreement with nature. Living such a life meant having the bare necessities for existence and rejecting all the need for wealth, power and fame. One’s life was free from all possessions and property.

The word “Cynic” comes form the greek word κυνικός, kynikos, “dog-like” and that from κύων, kyôn, “dog. They Cynics may have gotten the name form the fact that Antisthenes taught at the Cynosarges (Place of the white dog) school in Athens. Later the Cynics embraced the term. They saw themselves as dogs. Like dogs they were indifferent to how they lived, shameless in their modesty, good guards of their philosophy and discriminating between friend and foe. To quote Diogenes, “Like a dog, I fawn on those who give me anything, I yelp at those who refuse, and I set my teeth in rascals.”

No one epitomized the life of a Cynic more than Diogenes. He rejected the chains of civilization by eating in the street, masturbating in the marketplace, urinating on those who insulted him, defecating in the theatre, pointing at people with his middle finger and living outside in a clay wine jar.
He was also known to walk around in broad daylight with a lamp. When asked why, he responded, “I am just looking for an honest man”.

How true!

In this election season, isn’t that what we are all looking for? Can we find an honest man or woman? Someone’s whose honesty is visible in broad daylight, enhanced with a lamp? Someone indifferent to the trappings of wealth and power, shameless in how they fight for the common man, good guards of the trust bestowed on them and discriminating between right and wrong? Is there anyone out there like that?

Somewhere in the 19th century, Cynics evolved. They dropped the ascetic lifestyle and replaced it with distrust. A disbelief in the goodness and motives of men.
So as we as a people wander the streets in broad daylight like Diogenes looking for honest men and women to lead us, the dearth of such individuals gives us pause. Those we find, those who have fought their way to the top leave us with a feeling of disgust and disbelief in their actions and words.

In the process we think these leaders are motivated purely by self-interest, greed and power. We feel helpless and like dogs “…fawn on those who give us anything, yelp at those who refuse, and set our teeth in rascals.”
How cynical!

Journal Club

Welcome to Journal Club! For discussion today is the following:

Article: Increasing incidence of metastatic prostate cancer in the United States (2004–2013)
Authors: A B Weiner, R S Matulewicz, S E Eggener and E M Schaeffer
Journal: Prostate Cancer and Prostatic Diseases. July 19, 2016

Background
Prostate cancer cells secrete an enzyme called Prostate Specific Antigen (PSA) into the bloodstream. Measuring the PSA level has been a way of screening for prostate cancer. In 2008 and again in 2012, the US Preventive Services Task Force (USPSTF) came out with recommendations to curtail the use of PSA for screening. The argument was that it led to the diagnosis of a lot of low risk prostate cancers that left alone would not grow to endanger life. Also, the test led to procedures that patients did not really need but which could lead to complications eg. impotence. Since 2012, there has been decrease in the use of PSA for screening,
The question among urologists has always been whether this recommendation would lead to ta spike in prostate cancer cases.
A group from Northwestern in Chicago, led by a Dr Edward Schaeffer decided to find out.

Study type
The study was retrospective.
Using the National Cancer Data Base (NCDB), they found all men who had been diagnosed with prostate cancer from 2004 to 2013. From 1089 institutions that reported each year in that time period, they got 767 550 patients.

PSA-Study

The patients were split into risk groups (depending on the extent of the cancer when diagnosed). The groups were low, intermediate, high and metastatic. The incidence of prostate cancer for each risk group was then compared yearly to the incidence in 2004.
Of the 767 550 men, 32% had low, 45% intermediate , 20% high risk and 3% had metastatic disease. They teased out information from the data with appropriate statistical tools.

Results
Of all the groups, the one that saw the most significant increase, relative to 2004 was the metastatic one. In 2004, there were 1685 cases. In 2013, 2890. – a 72% increase. The largest increase was seen in men aged 55 to 69 years. In this group, the increase was actually 92%.
Comparably, the incidence of low-risk prostate cancer actually fell.

Discussion
One can probably argue that the decrease in using PSA for screening may be causing the inability to catch the very aggressive types of prostate cancer. The problem though is that, the increase was seen even before the 2008 recommendation of the USPSTF came out.
Another factor could be an increase in the aggressiveness of prostate cancer. Also the use of MRI imaging has improved diagnosis and that can increase the numbers. Lastly, the population may just be getting older and sicker.
Perhaps the biggest flaw of the study was that the authors didn’t calculate a national annual incidence rate – the number of metastatic cases as a percentage of the US population. They looked at it as a percentage of cases from about a 1000 hospitals. They argue in the paper that with over 700 000 patients,they thought their results reflected national patterns.

Conclusion
Even though this study has it’s flaws, the fact remains that yearly PSAs can help screen for prostate cancer. In patients at high risk – those with a strong family history and blacks – it may be highly recommended. Done yearly, it provides a trend that can be very informative.
The recommendation is to start screening at age 45 in those at high risk and 50 for those at low risk.
For my lay male friends reading this who are black and 45 or older or not black but with a family history, if you haven’t started screening already, please see your primary care physician as soon as possible. By the way, just in case you ask, NO, you cannot do the exam yourself. It is very much unlike a breast self exam that women do!

All they see

As we walked….

Colors-01

He took me to the town square. It was early so the square was empty. We sat on a bench perched on the side of a knoll that overlooked the square. It wasn’t long before two men walked into the square. They both wore brightly colored clothing. Simultaneously, they both started taking to each other. As I watched, I made an observation – they were both talking but neither was listening to the other. I turned towards him, wishing for an explanation but he seemed lost in his thoughts so I stayed silent.
Gradually more men in brightly colored clothing streamed into the square and like the first two men, they also started talking. Each man seemed to direct his speech to all but no one seemed to listen to another. By now, the voices had reached a din and I could make words out. Surprisingly, all I heard were words like “black”, “white”, “red”, “brown” and “yellow”. All I heard were descriptions of color! I strained to listen closer and over and over, all I heard were the names of colors.
Baffled, I turned to him again. His eyes were on me with a wistful smile on his face. Before I could utter a word, he said:
“All they do is speak. No one listens to the other so all they see is each others color.”

We need an Odysseus

The political situation in the US sometimes reminds me of the Trojan war from Greek mythology.
Like the Achaeans (the Greeks), some feel America has lost something beautiful and precious like Menelaus of Sparta lost Helen. Some feel it has been stolen by globalist like that Paris (a Trojan) stole Helen. So they are on a warpath to win this precious thing back.
However, when one looks at the Iliad by Homer or even the Aeneid by Virgil, it is apparent who really won the war for the Greeks. It was not the overbearing Agamemnon, the brash and fearless Achilles or even the courageous Ajax. No. At the end, it really wasn’t about the heroics on the battlefield, because try as they may, the Achaeans couldn’t breach the wall that surrounded and protected Troy.

Odysseus
The Head of Odysseus

It was the smarts, patience and cunning of Odysseus that helped them to breach the walls of Troy and deliver victory. It was his idea for the Trojan horse that helped them recapture Helen.
Brute strength and violence can get you so far. At the end of the day, patience and smarts rule.
I guess Odysseus describes himself best in these words from Book 8 of Homer’s Odyssey:
The gods don’t hand out all their gifts at once,
not build and brains and flowing speech to all.
One man may fail to impress us with his looks
but a god can crown his words with beauty, charm,
and men look on with delight when he speaks out.
Never faltering, filled with winning self-control,
he shines forth at assembly grounds and people gaze
at him like a god when he walks through the streets.
Another man may look like a deathless one on high
but there’s not a bit of grace to crown his words.
O but Olympus would bless this nation with an Odysseus!

A Strange Odor

An odor hangs in the air
Pervasive and colorless
Our senses it seeks to impair
It’s essence meaningless
It’s fed by the blood of lives
Seeking but to matter
Of him who to protect strives
Yet ends up but a splatter
It permeates a nation divided
Unwilling to see humanity
In their values misguided
Feeing into an insanity
I smell Death all over the Land
I smell Death unnatural and unkind.

The Amazing Professor Leutert

A hush had fallen on the group of young men and women assembled in the lecture hall. One could hear a pin drop.

Professor_Gerald_Leutert_ADA_Dimensionsmalerei®_Benita_Martin

The portly and balding gentleman who stood in front of the chalkboard looked over the group like he dared then to take their eyes off him. Then he spun around and grabbed 2 pieces of white chalk from the tray that was attached to the side of the chalk board. Now facing the chalkboard, he set both hands, each with a piece of white chalk in it, on the board. If one looked closely, only the pieces of chalk touched the board. Keeping the chalk pieces on the board, he swung his hands out in an arc. Both hands worked simultaneously as he drew. Like a conductor, his arms moved around. He reminded one of Kurt Masur, conducting a Bach performance at the Gewandhaus a few miles away.
As he worked, exhibiting his ambidexterity, a collective gasp went up from the collection of young students. They had heard about it but seeing it made it all the more mystical.
Soon he was done and like a maestro, he lay the pieces of chalk down and spun around. The students were on their feet, in thunderous ovation. When the ovation finally died down, he said:
“That is the cross-section of the spinal cord.”

Gerald Leutert was the Professor of Gross Anatomy when I was at the University of Leipzig. He was feared, revered and respected. He was a legend in his day. As first-year medical students, we had heard stories from the older students. The most amazing story was how he drew a cross-section of the spinal cord.
Now a cross-section of the spinal cord looks like two half-ellipses put together, one on the left and the other on the right. Well, Professor Leutert, being ambidextrous, drew both half-ellipses simultaneously and also added in the nuclei, laminae, tracts etc simultaneously. If you cannot imagine the skill it takes to do that, look at the image of the cross-section of the spinal cord below.

SpinalCord copy

Over the years, I have wondered what his intentions were when he made that drawing with so much pomp. Initially I thought he was just showing off. However as first year flowed into second year of medical school and the anatomy lab become a home away from home, I couldn’t overcome the feeling that there was another reason.
The Anatomy Lab. Home of broken dreams and high hopes. Of the end of life fueling knowledge. Professor Leutert ruled it like a king with us as his lowly subjects.
On those days that he came back to inspect our dissections and test our knowledge, it felt like judgement day. Come to think of it, was judgement day! Portly and short, it seemed he could rest his hands on his ample belly. Flanked by two assistants, and holding forceps in his hands like a scepter, he moved from table to table, passing judgement swiftly and mercilessly, in an atmosphere enriched with formalin.
“What is that?”, he’ll ask, picking up the delicate tissue.
“The radial nerve.”
With a nod he’ll be off to the next table.
“What are the structures that border this organ?”, pointing at the liver.
A hint of hesitation and one wilted under a barrage of even more questions, like said organ when cirrhotic.

I survived Anatomy and went on to graduate. All these years that day in the lecture hall has stayed with me. The day that I watched Professor Leutert display his ambidexterity. Recently, the essence of it kind of hit me.
The dear professor wasn’t trying to show off. Not at all. In showing us his dexterity so early, he tried to impress upon us what it took to do a good dissection. He made us realize the importance of learning anatomy and made us gain a deep respect for those whose bodies we had the honor to learn from. He also made us realize very early that medicine is practiced with both the mind as well as with the hands. He was telling us that no matter what specialty we ended up in, we needed to exhibit dexterity and practice medicine with all our senses.
With that he gained our respect. We looked up to him and revered him. Moreover we feared him. Not because he could hurt us. (Well, if one flunked Anatomy, that was it). That wasn’t the reason we feared him though. We dreaded disappointing him. He had set the bar quite high and we all strived to reach it. We feared not reaching it.

Professor Gerald Leutert died in 1999 at the age of 69. Apart from a short stint as Rector of the University of Leipzig, he spent the majority of his over 40-year career teaching and doing research in the field of Anatomy.
In his own way, he managed to grab the attention of the young medical students he was entrusted with and hold it. In the process he formed them, trained them and influenced them. I would know – he got and held the attention of my peers and I and in the process formed, trained and influenced us.

To Our Heroes in Blue

“Too often we judge others by their worst examples, and judge ourselves by our best intentions.”
– President George W. Bush

I can’t summon the courage
That woke you up each day
Even in the gore and carnage
Your dedication was in play.
Others rights you did protect
In exchange for your life
The irony one can detect
Then against you they did strive
The hate that took your lives
Has perished with it’s source
What in Dallas survives
Is love runing it’s course
Go in peace, our Heroes in Blue
Go in peace, we bid you adieu.