I left that road far behind

It’s been well over a month since we’ve been back in the states, and I still get sad every time I have to say “thank you” instead of “danke schön”. In the three weeks we spent in Germany (and Austria) I grew accustomed to adventure. Every day was a new city, a new place, and strange people. I loved it. It was quite a shock to go back to the same routine the first week home, but then two weeks, three weeks, and now a month later I’d say normal life feels normal again. I look back on our trip and I am amazed at all that we learned, all the material that we covered in a way that felt, ounce for ounce, far easier to take in than material presented in a more traditional manner. The formal and informal curriculums both have made a great impression on me and my perspective. I have gained a deep appreciation for the men and women who were pioneers in modern science and medicine. Their fruits, our benefits, were the result of hard work, ingenuity and, for many who challenged the conventional wisdom of their time, courage. I also have a newfound appreciation for inexpensive beverages (har har). A meal in Texas is a coffee in Europe.

I find myself looking at the world differently since we’ve returned. I keep asking myself: Who discovered this? How did they discover this? Was this discovered intentionally and through brute force research or was this discovered by the fortune of the right mind being in the right place? My perspective has shifted in ways beyond science, as well. This trip made me appreciate more fully that the center of civilization is always moving. The United States was not always the center, and we will not be the center forever. The places around, the places far away from, the places that were once, and the places that will be the center are of great importance even now. They are sources of culture and knowledge that we benefit from having, and they are homes to people who are doing the same working and living and dying that we’re doing here, to paraphrase Jimmy Stuart.

If I had to be anything other than a proud black-Irish American, I’d be a proud black-Irish German hands down. Perhaps chance will bring us together again, Deutschland. Until that day, I wish you and all the Germany trippers a herzlichen auf Wiedersehen.

Vienna Send-Off

Yesterday, we went to Freud's old home. It was cool to visit and to hear about his life, but one of the real problems with the musuem is that it is almost completely empty. You see, the Freud's were fortunate enough to plan their emigration to London in 1938 before it was no longer possible to flee from the Holocaust. They took most of their things with them, and their apartment became a Jewish ghetto. What was there was very impressive, especially since the "talking cure" is making a little comeback, from what we were told.
My favorite idea that Freud had was the supreme influence parents have on their children based on what they tell them, and not so much based on their actions. I feel that my personal experience confirms that. For some reason it seems that what parents say has a much greater impact on me than what parents do. It makes me want to be very aware of what I say around my children years from now.
Today was a trip to the medical history museum that is attached to the medical university in Vienna. There were a lot of very impressive wax figures that are extremely well preserved considering their age (many around 250 years old, still with real hair!). There was also a large painting of a surgery with early anesthetics signed by none other than John Quincy Adams. No idea on its authenticity. Some of Vienna's medical history highlights the tension between physicians and surgeons. One of the university's primary goals was to give surgeons a formal education and move away from an apprentice based system.
There's a very good chance that this will be my last time online in Europe. I've had a lot of fun on this trip and I wish I could stay here and see more things like this for a very long time, but I've got some work to do back in the States so I guess this is farewell. I recommend this program to anyone who can get in, no matter what your interests may be. Much of what we've learned on this trip are things every person ought to know. I wish everyone safe travels on their way back to school, and a very good semester in College Station.

Next Time You're Near Bad Oeynhausen, You Should Stop By...

...because you might get to see someone's heart beating in the middle of their chest. We visited the heart and diabetes center in Bad Oeynhausen, and oh, the things we saw! We began by watching open heart surgeries. Amanda and I saw the last half of one bypass and the beginning of another. It was fascinating to see. We also saw the ward they have for patients with artificial hearts. In Germany, the wait for an organ is typically much longer that it is in America, so there is a much larger market for devices that can keep a person well until a new heart is available. We got a chance to meet some of the patients. They were even kind enough to show us the wires coming out of them and into their battery packs. From there we went to see their MRI machine. The radiologist showed us a few tricks that can be done with a 1.5 T magnet. Overall the experience was thrilling. Seeing these professionals and the passion they have... well, it's contagious. Whatever area of medicine--no, whatever sort of career--I end up in, I hope I can be as dorky about it as these guys are about they're work.
Today was day one in Vienna, and it is a terrific city. The place itself is beautiful, and it has a rich and long history. Some of the stories of besieged Vienna seem strangely similar to certain scenes in the Lord of the Rings trilogy... but never mind. Vienna has been attacked several times by the Turks throughout its history, making it feel as if Vienna has been both the center and the fringe of European civilization. I can't wait to see and learn more about Vienna in the next few days.

PS: As an afterthought, I'll share my personal advice on Amsterdam. Make it a day trip.

The Second Half of Blood and Guts

Finished Blood and Guts the other day. Chapters four through eight covered therapies, surgeries, hosptitals, and modern medicine.
For ages the solution for most ills were herbal remedies. Some folk medicine led to greater things. Willow bark for fever began the quest for aspirin, and moldy bread for cuts laid the groundwork in the search for antibiotics. Therapy did not benefit from the laboratory immediately. It was not until 1905 that lab work isolated the parasite responsible for syphilis, but the cure produced two years later due to this research showed the promise that science had for medicine.
One of the most important achievements in medicine was the identification (1928) and production (1940) of penicillin. Not only did this make therapy for many bacterial diseases effective, it also made surgery a procedure that was not excessively life threatening. Of course, surgery was performed before then. Surgery lacked popularity and prestige because it was painful and it very often was deadly. This led to a market where surgeons were valued for their expertise and especially their speed. Without anasthetics or antibiotics, surgeons were not capable of operating for much and were not held in very high esteem. Now that surgery is relatively safe and painless, it's interesting to see how different a role surgeons play in the medical world.
The progress of the surgeon (and antibiotics) follows along the same lines as the progress of the hospital. Hospitals were, for a long time, places of care rather than places of cure. The sick and dying poor along with anyone else looked to a hospital for comfort, but not healing. Advances in therapy, in surgery, and in other forms of medical technology gave physicians the power to truly heal, but at a cost that only a hospital could afford. Hospitals became medicine powerhouses, and today they take up a very large portion of health care costs in the world.
One of the most startling paradoxes of modern medicine is that the doctor-patient relationship has all but faded in an age where the doctor has an unprecedented ability to truly heal. In ages past where a doctor could often do nothing, bonds between a doctor and the families he cared for were quite strong. Perhaps physicians at that time felt it was the least they could offer.
This was a very interesting book and I recommend it to anyone who is looking into the field of medicine for a career. Just look for Blood & Guts by Roy Porter.

Lectures in Berlin at the Charite and in Hannover

The public hospital in Berlin is the Charite. They have an exhibit on the history of modern medicine. The exhibit had a lot of interesting specimens from individuals who suffered various diseases. One of the great contributors to the development of anatomy, Virchow, was a professor at the Charite. He performed about 800 dissections a year and was among the earliest physicians to champion the dissection of victims of disease as a key to finding the cure.
While we were at the Charite we also heard from the current head of Complimentary Medicine, Dr. Witt. I was mostly interested in her explanation of how insurance companies determine if certain forms of complimentary medicine should be covered. The data that they examine to make this decision is not necessarily designed to remove the placebo effect. They focus on the difference in recovery between patients who receive, for example, acupuncture and patients who don't. If the improved level of recovery justifies the cost of the procedure, the insurance companies are often inclined to support it.
The following day in Hannover was spent talking to Dr. Kriestein, a nephrologist. It was especially interesting hearing him talk about the health care system in Germany. Though many Americans assume that all our problems will disappear as soon as we have universal health insurance, there are still in truth many challenges a health system has to face, some of which are indirectly caused by state sponsored health care. In Germany, for example, doctors had no concerns about the cost of a procedure and would blow away large amounts of money on patients with very trivial problems. German health care has recently gone through some reforms, as this has threatened to slowly consume the entire country's wealth. While patients still rarely see bills in Germany, doctors making a better effort now at being economical in their practice. One reform I found interesting is the addition of a small copayment for drugs in Germany. Dr. Kriestein was a proponent of this, because he found that a very large difference between Americans and Germans was that Americans actually knew about the drugs they were taking, what they did, and would generally take them as instructed. Germans, however, seemed to devalue their medicine, having little knowledge of them, how they worked, and were irregular in taking them. In his opinion, the copayment has alleviated this problem as well as some of the issues health care has had in balancing its check book.
The next day was also in Hannover, and we spent the morning in lecture with Dr. Wasser talking about the Doctor Trials at Nuremburg. He explained that after the chief war criminals were tried, there were 12 additional trials held only by Americans in order to try various other Nazis for war crimes. The doctor trials prosecuted 22 men and one woman, mostly doctors, for crimes against humanity, using as evidence records of their experiments and testimonies from survivors of the experiments. The defense claimed that, yes, you can prove that we did these things, but you can not demonstrate that these are crimes against humanity. Scientists have experimented on animals to the benefit of humanity, and we were doing just the same.
The prosecution then set out to prove that among physicians and scientists there was an understood standard for how humans could and could not be treated in experiments. Interestingly, some of the prosecution's expert witnesses were outspoken proponents of animal experimentation. The case laid down in common law what is now sometimes known as the Nuremburg Code, a guideline for the humane treatment of subjects in an experiment. The most well known of these points is the necessity of informed consent.

Reading up on Medicine's History

Blood and Guts has been very interesting so far. The first chapter is a brief history of disease in humanity, the second chapter a history of healers (doctors). I thought the history of doctors was especially interesting, because the devotion to expertise and professionalism in the Hippocratic oath is so familiar to our idea of doctors now. Even the inaccuracies of classic physiology (the four humors, etc.) reflect the need to have an expert put complex concepts into terms that a layperson can understand, which is part of what the very word doctor means. To me, this makes the field of medicine feel at once both old and new in a very special and exciting way.
The third chapter covers advances in anatomy. What was most interesting about this chapter was that discovering a body part seemed much easier than figuring out what it did. That is, even organs whose form one might think would strongly suggest function were not seen for what they were.
The fourth chapter, on the laboratory, felt more like the medical history I was expecting to read. It went through the development of the laboratory and the physicians gradual entry into the lab. Of special interest to me was Koch's Postulate on how to determine if an organism was responsible for a disease.
More on Blood and Guts later!

The Sites of Bonn, Cologne, Berlin, and Dresden

Outside of the curriculum, we have seen a great deal of Germany and learned much about its history. We began in Bonn, where Dr. Reiner gave us a personal tour and explained to us Bonn's role as the capital of West Germany. He showed us the city's cathedral as well as a wonderful view of the Rhine. As we came near the AIB offices at the end of the tour, Dr. Reiner pointed out a nearby building. It was closed to the public, he explained, because it was a seminary. In fact, it was the seminary that Cardinal Ratzinger, now Pope Benedict XVI, attended.
The next day we saw a museum on the history of the Federal Republic of Germany. It was a very informative demonstration of the events that have shaped the development of Germany and Germans over the past 40 years.
We spent the afternoon in Cologne, where we were given a brief tour of the inner city and the cathedral by Andre. He showed us Roman ruins, the old Rathaus, gave us a history of Cologne both in antiquity and over the course of the cathedral's construction, and then took us out to a local bierhaus.
Berlin is overwhelming. We arrived about three hours before the new year. In one hour we were walking out of our hotel toward the New Year Festival. In another hour we were at the far end of the festival. After almost another hour of pushing and shoving, we were in front of the Brandenburg Gate just in time for 2009.
The next day we had our bus tour. Berlin is the worldwide Cold War packed into city size. Checkpoint Charlie had a rebuilt booth (the real one was torn down) and around it were pictures of loaded American and Russian tanks pointed directly at each other, about a football field apart. It gives this member of a younger generation a better appreciation for how dire those times had felt. There were many other memorials, monuments, and musuems that were very nice to see, but I was most of all amazed by how much Berlin was defined by the time it spent divided.
Today we visited Dresden, which still has ruins in the old part of the city. So far we have mainly seen the Zwinger (a sort of festival square) and the Frauenkirche. The Frauenkirche is a Lutheran church that is unique in two ways: the church is named after Mary and the inside is filled with statues and images Jesus and some other important biblical figures (though not a single image of Mary can be found).
We have more to see in Dresden and I still have much more to see in Berlin tomorrow and Monday before we move on to Hannover.

The First Set of Lectures

Our first lecture was in Bonn at the AIB offices. It was given to us by Jürgen Weiland, a homeopathologist who works in Bonn. His focus was on the history of homeopathy, but he also gave us a brief explanation of what homeopathy was.
The whole practice hinges on two ideas. The first is that a substance that produces a set of symptoms in a well person will cure the disease of an ill person that shows the same set of symptoms. The second is that the theraputic effect of a substance can be separated from the toxic effect through a special series of dilutions.
As far as the history goes, a German by the name of Samuel Hahnmann was the founder of homeopathy. He began as a physician, but was shocked by the harm that medicine would often cause his patients. He set out to find a form of medicine that would meet his ideal: one that would cure the patient at minimal discomfort. While I believe that what he settled on was a fantastic demonstration of the placebo effect, I still found this lecture to be very helpful in the sense that it forced me to think about what dreams and ideals ought to be chased after in medicine today.

The second lecture so far was given by Dr. Wasser, and was about the 'racial hygiene' practiced by the Nazis just before and during World War II. The official name of the program was Aktion T4 and was a systematic murdering (under the name of euthanasia) of any kind of invalid, but especially the mentally and physically retarded. Under this program, doctors were no longer expected to consider the health of the individual so much as they were to consider the health of the race. The unworthy had to be cut from the gene pool like a tumor from the body.
It was interesting to learn that many of the individuals involved in this program used their acquired experience for death camps a few years later. Some have even described Aktion T4 as a 'test run' for the Holocaust. Dr. Wasser also spent the first part of the lecture describing some of the intellectuals and their writings that led up to Aktion T4 in Nazi Germany. I was amazed to hear that some of these men were great intellectuals of their day who had very scientific and rational explanations for their views. One of the few hospital directors that refused to permit euthanisation remarked, as best as I can remember, that God would not permit him to do so.

Getting Ready for Deutschland

One summer, my dad took our whole family to Italy because he had a ton of American Airlines miles that he thought were on the verge of becoming worthless. World affairs being what they’ve been, he jokingly quipped, “Enjoy it. We may be among the last Americans who will be able to fly on an airplane anywhere, let alone Europe. You’ll tell your grandchildren what it was like seeing little buildings from way up in the sky.” Since then I’ve been to Germany, and I’m now preparing for my third time in Europe (fourth, actually: I was two years old and have almost no recollection), so let this stand as a warning to all you would-be Oracles. No telling what’s on that horizon.

I can say that I’ve seen Germany and Germans, but I haven’t seen these parts of Germany nor have I seen Germans practicing medicine so I’m very excited about this trip. Like Vincent Vega said in Pulp Fiction: “It’s the little things about Europe that are so different.” I think it’ll be the small differences between American and European medicine that will surprise me the most. The fun thing about catching those differences is asking myself, “What does this way do better? What does this way do worse? How did it come to be this way here and our way over in the states?” I think this will deepen my understanding and appreciation for medicine in a way that is simply not possible within our borders.

My main concern is one I have for any trip I go on. It’s not especially personal, but it is especially specific and I’m afraid that I couldn’t stand the irony of putting it into print only for it to come true. I’ll keep it to myself for now. A secondary concern is, already ironically, posting for this blog. The trial of putting thought and word into writing has never brought me joy. I know that’s a problem, I hope Dr. Wasser isn’t offended for me saying so, and I’ll suffer it like the little kid that knows the gross medicine is good for him.

“…to travel is to leave the inside and draw dangerously near the outside. So long as he thought of men in the abstract… merely as those who labor and love their children and die, he was thinking the fundamental truth about them. By going to look at their unfamiliar manners and customs he is inviting them to disguise themselves in fantastic masks and costumes. Many modern internationalists talk as if men of different nationalities had only to meet and mix and understand each other. In reality that is the moment of supreme danger--the moment when they meet. We might shiver, as at the old euphemism by which a meeting meant a duel.” I think I’m prepared for a little danger, how about y’all? I look forward to seeing all of you in Bonn, and I hope you all enjoy the rest of the holiday at home.