Split Decision

These days I divide my time between clinical and consulting work.   in my consulting job I work as a medical command physician for ambulances, helicopters and airlines needing advice and direction on all sorts of medical emergencies.

For the past several months I have been fielding several calls a day regarding screening for *possible* Ebola patients wanting to board a plane or currently in the air and suddenly developing symptoms.

Of all of those phone calls…only one of them had recent travel in Liberia and originated from a West African airport.  All of the rest were from random passengers that vomited, or had diarrhea…but had no travel history, no fevers, no exposure to anyone who had an recent travel history, exposure to the virus, etc, etc.

Part of my job is to reassure and clear those patients who have absolutely zero risk of carrying this particular virus.   But there is so much fear and paranoia that we are fielding calls about nearly anyone who vomits.

God forbid a passenger on Coumadin develops a nose bleed!  That’s a sure call to screen for Ebola even if the passenger is a little old lady from Pasadena who always gets a nosebleed on a plane.


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Getting Oauth2 to work with Python on a Mac

I am ataking a coursera course in Data Science and having trouble getting the prelim check for the first assignment to run without errors.  Here are the details  any help is appreciated!

Using Mac OS 10.8.5
Which Python returns:

Running the first assignment script after updating teh API calls results in this:

$ python twitterstream.py > output.txt
Traceback (most recent call last):
  File “twitterstream.py”, line 1, in <module>
    import oauth2 as oauth
ImportError: No module named oauth2
So I go back double check my oauth2 installation

$ pip install oauth2
Traceback (most recent call last):
  File “/usr/local/bin/pip”, line 5, in
    from pkg_resources import load_entry_point
  File “/System/Library/Frameworks/Python.framework/Versions/2.7/Extras/lib/python/pkg_resources.py”, line 2603, in
  File “/System/Library/Frameworks/Python.framework/Versions/2.7/Extras/lib/python/pkg_resources.py”, line 666, in require
    needed = self.resolve(parse_requirements(requirements))
  File “/System/Library/Frameworks/Python.framework/Versions/2.7/Extras/lib/python/pkg_resources.py”, line 565, in resolve
    raise DistributionNotFound(req)  # XXX put more info here
pkg_resources.DistributionNotFound: pip==1.5.2

So now I investigate PIP:

$ which pip
Not even sure what that means, but it’s there.

I investigate the pip file and see this, the version looks consistent internally with the error I am seeing above.

# EASY-INSTALL-ENTRY-SCRIPT: ‘pip==1.5.2′,’console_scripts’,'pip’
__requires__ = ‘pip==1.5.2′
import sys
from pkg_resources import load_entry_point
   load_entry_point(‘pip==1.5.2′, ‘console_scripts’, ‘pip’)()
I try easy install and get this result:

$ easy_install oauth2
error: can’t create or remove files in install directory
The following error occurred while trying to add or remove files in the
installation directory:
    [Errno 13] Permission denied: ‘/Users/suzanne/Library/Python/2.7/site-packages/test-easy-install-8879.write-test’
The installation directory you specified (via –install-dir, –prefix, or
the distutils default setting) was:

SO I try with SUDO

$ sudo easy_install oauth2
Searching for oauth2
Best match: oauth2 1.5.211
Processing oauth2-1.5.211-py2.7.egg
oauth2 1.5.211 is already the active version in easy-install.pth
Using /Users/suzanne/Library/Python/2.7/site-packages/oauth2-1.5.211-py2.7.egg
Processing dependencies for oauth2
Finished processing dependencies for oauth2

This seems to have worked?  But I still get the ORIGINAL error above when running the twitterstream.py file.

Do I have more than one python installed? THis command shows basically one (I think??)
$ type -a python

python is /Library/Frameworks/Python.framework/Versions/2.7/bin/python
python is /usr/local/bin/python
python is /usr/bin/python
python is /usr/local/bin/python

When I look using my finder I do see folders for Python 2.3, 2.5, 2.6 and 2.7
I recall playing with Python installs awhile ago so I’m not sure if I added 2.7 myself and if that broke anything.

Here is my $PATH

$ echo $PATH

I am stuck.  I have googled/stackoverflowe searched everything I can think of and I can’t get the pre-assignment one command to work.

Any help? PLEASE??

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Local WordPress Installation using MAMP

This is as much for my own records as to help anyone out, but this is the collection of softwares I used while considering using Genesis as a new framework for custom wordpress installations. I should probabaly outsource this, but seeing as the costs tend to range from $500 to $25oo for a PSD -> WordPress framework conversion, I think it’s worth tackling myself.  I’ve done minor custom codes for wordpress but not straight from PSD files, just from other design ideas and havn’t done too shabby. If I can up my game a bit perhaps I can code for others as well?

Anyway here’s the softwares:




Troubleshooting guide for My SQL Server not starting



Installing WP Manually



How to fix PHPMy Admin after making the same mistake everyone else makes with changing the root password:

Using Terminal, type: /Applications/MAMP/Library/bin/mysqladmin -u root -p password <NEWPASSWORD>

At the next prompt type the same password

Then Tools->Clear Cache (on your browser) and restart


Random key generator for wp-config:



And a couple of tutorials I’m browsing:





I hope someone else finds this helpful, please leave a comment if you do!

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Installing Ruby on Rails in OSX 10.7.5

Want to install Ruby on Rails on your lastest OSX Snow Leopard version?

You’ll need to do a couple of steps which look intimidating but aren’t that hard.

  • First, download RVM on your computer
  • Next, download the GCC compiler separately since the latest version is not installed with the current XTools from the app store (but if you have a previous version of Xtools, apparently it is)
  • Finally you can install Ruby and Rails from the RVM command line in your terminal.

More details on all of these below…

Having never installed developer tools on a Mac before (other things have intervened since switching over to Mac that precluded me from any development), I followed this tutorial to get Ruby & Rails up and running on my mac:


However it appears that the latest release of Xtools does not include a key compiler for the full install.   So after installing Xtools, I did a little more googling and found this update:


Followed the download link to this site:


And installed the latest GCC package.

After installing the GCC package, I went back into my terminal shell and ran this:

>rvm install ruby-1.9.3-p194

And was happily greeted with this message…

Install of ruby-1.9.3-p194 - #complete

IN between those steps I was successfully able to install RVM, but not by cutting and pasting the command lines, I had to type them into the shell.

Read this for some additional details

If I can do it, you can too….I honestly have little idea of what I’m doing, but having created a fresh backup and still having an active apple care subscription, I had little fear of anything bad going on!

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Hanging up the Stethescope

Well, it’s been a long time in coming, but I feel that it’s time to share it with all of you.  Doc Shazam is hanging up the stethescope.  I’ve had it, I’m through. The healthcare field sickens me both literally and figuratively.  I’ve gained weight, can’t sleep, suffer from migraines, have chronic shift worker’s disease, chronic sleep deprivation, and am horribly out of shape. I’ve sacrificed not only my physical health for this profession, but also my social health. I get anxious and feel panic well up inside of me when my friends mention going away for a weekend.  Why? Chances are more likely than not I’ll have to work that weekend. If not the weekend, then definately the friday night before.   Last year I didn’t get to participate in a single weekend bike race…a passion of mine, because I either worked every weekend, or every friday night until 1 or 3am.  For long time readers of Doc Shazam, you know how much I love to bike.

For all the wonderful things that come from being a doctor…the priveledge and thrill of saving lives, running codes, knowing how to set broken bones and suture kids faces without scarring…there are far more downsides for me.

No matter what the paycheck, it’s not worth it if I’m constantly tired, constantly have a headache, cannot pursue relationships with friends or family on a routine basis.

Yes, I know that there are many other physicians that (seem) to be able to do all of this, but when I discuss my recent decision with them, they all express a wish that they too could follow the same path.

What will Doc Shazam do?  Hopefully write.  Ride her bike. Coach Triathletes & cyclists. Garden. Find myself again.  Rid myself of insomnia, anxiety and panic.  Restore relationships with friends and family.  And become a better bike racer.

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I’m not quite sure what this rhythm is…

“Umm, can I have a doc in this room? ”

The nurse was casual and collected.  But anytime a nurse asks, “Can I have a doc in here?” you can be pretty certain there is some excitment in your near future.

She & I alternated glances between the patient and the monitor.

Patient:  awake but confused.  Monitor: Rapid heart rate, undetermined rhythm.

The nurse said, “I thought she may have been in vfib for a second, but she looks OK now.”   For a brief moment I felt all knowledge leave my brain. I was unable to neatly categorize this patient into a diagnostic box.  We knew nothing about her.  The paramedics brought her in on a stretcher, provided no history and said, “She’s fine,” then they left.

As I ran out of the room to pull up an old EKG looking for a similar tachycardic rhythm the nurse rapidly stuck leads to the patients chest to run a 12 lead.  I scanned through her old EKG images as if I were playing a game of concentration with a deck of children’s playing cards…no 2 EKG images looked alike.  Fast, slow, narrow complex, wide complex…did this woman have any EKGs that looked “normal”?

The new EKG looked nearly identical to one I pulled up from a few months ago.  Rapid Atrial Fibrillation.  I was relived.  Her blood pressure was in the 160s…plenty of room for some calcium channel blockers to slow her heart rate down.  The only thing I didn’t have an explanation for was …

Massive Confusion.  Suddenly her eyes got as wide as dinner plates as she gripped both bedrails with either hand. Her mouth gaped open as if she was trying to communicate…something…anything to us.

The nurse and I looked back at the monitor.  Her heart rate had gone up to 200 and her blood pressure dropped to 70.

“Let’s shock her,” I quietly said to my reliable team of two nurses.

I felt myself getting hot as if a warm bucket of surreal had been poured over me.  I asked for some ativan to be given before syncrhonizing her cardioversion, but I couldn’t wait any longer.  In the old days, this is where I would have turned to the life pac monitor, grabbed the paddles from their holsters and had a nurse squirt conductive gel on the metal surfaces.  I would have rubbed them together, placed then on the patient’s chest while I leaned in with my body weight yet avoiding all contact with the bed and any random patient body parts like wandering hands or floppy arms, shouting “SHOCKING ON THREE”.  Cardiac resuscitation used to be so much more dramatic…TV show dramatic.

Instead, we gently placed adhesive pads to the patients chest & back.  I turned to the crash cart and rotated the knob from “monitor” to “defibrillate” while the nurse pressed “synchronize”.  After I saw the reasurring punctuation of the course LCD monitor identifying each QRS complex I checked the patient one more time.  Heart rate 200, in a sine wave shape.  She still had dinner plate eyes and her pressure continued to drop.

I hated to do it but I had to.  “Shocking on three,” I quietly said to my team.  One, two, three...I pressed the button and the unnerving pause that accompanies a synchronized cardioversion made my heart skip a few beats.  After what seemed like an eternity, but was probably a fraction of a second, there was a click, followed by a shriek.  Her body briefly convulsed but her eyes remained open.  After a moment, she’d forgotten what happened entirely, but her heart had fallen into line in a rate controlled atrial fibrillation.

It’s not often we see someone’s rhythm convert right in front of us, and even less often that a single shock does what we are told it should do.  Most often we see patients when they are far beyond reasonable methods of resuscitation, but today was different.  Thanks to the nurse who was not too timid to ask for another set of eyeballs on her patient we were prepared to do what we are trained to do best…shocking on three, one, two three…

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Reviving Sourdough

Thought I’d try to revive this blog the same way I’m reviving my sourdough starter…by cultivating the good and allowing that growth to eliminate the bad.  This blog used to be about my discoveries & fun encounters with a variety of things…birding, biking, learning medicine, etc.  Then it became a rant against the current status of american health care & delivery.

Well I don’t want to cultivate that anymore.  I want to revive my expression of learning & wonder about the world that surrounds us.

Sourdough, i learned, is active due to two primary organisms…yeast & lactobacillus.  The particular strains of each are what gives sourdough it’s wonderful taste.  2 days ago I dug out a starter I’d made nearly a year ago. It was more like a science project than a starter.  I carefully scraped off the mold & oxidized gray parts and scooped the rest into a bowl. I added some warm water, stirred vigerously to reoxygenate and added some flour.

To may amazement, the next day I found bubbles!  I carefully stirred & fed it again following the instructions here for reviving sourdough.

This morning, I actually got out a food scale, I want to do it right. I measured out 100 grams of my revival project, added 50 g of water and 50 g of flour and set it in the oven with the light on.  If all goes well, I’ll be blogging about some amazing bread in a few days. Stay tuned.

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History of Doc Shazam…a Recursive Trip down Memory Lane

I invented blogging. No really.  As a first year medical student in 1998, I was trying to develop a Visual basic application that would auto-publish entries from an access database on my home computer to my University web account, but alas, I was busy with things like anatomy and biochemistry.

The following year, a senior student introduced me to the idea of creating a blog, which at that time, was still an unheard of medium for creating web content (and who had ever heard of “content”?).  Finally, by the end of my intern year, while sitting in the ICU trying to keep a twenty year old race car driver alive, I wrote my first blog post.   Then I wrote another and another. I documented my revelations about learning medicine, the journey that my own patients revealed to me.

Daily as my sleep deprived mind both memorized standard practice and absorbed new journal articles, I was constantly writing.  I’d care for a sick child and in my mind I was blogging about it.   I performed my first trauma resuscitation and in my mind I was blogging.  When the Amish family of a dying man sang in the ICU…I blogged about it.

At that point, my blog was one of the most popular medical blogs and the first emergency medical blog that I know of. As popularity increased I tried hard to both capture my thoughts, emotions and experiences while remaining anonymous. I shared my journey of becoming a physician with my readers..through the cold clinical discoveries, to saving my first life, to learning (again) that patients are people…my thoughts were all open.  All of these things I shared publicly, with the world, with anyone who had an internet connection.

Interview requests from medical writers came and I declined.  I did not want anyone to know who I was, I feared that I had shared too much about myself.  But at the same time, my family felt closer to me than they ever had. My father still recounts stories from that time…stories I’d never told him personally, yet he’s got the words nearly memorized. My grandmother kept a printed stack of my stories on her reading table. When I miss my grandfather…I can just revisit my blog and the memories come flooding back (and I usually shed a tear or two).

Through my anonymous blogging life I made friends, grieved for friends, watched friends rise to (relative fame) and yet I retreated.  At points in my life my blog was my solace, my retreat and my joy. My blog sits now docile for the most part, a series of a thousand or so tiny milestones in the process of becoming a physician. It will always be  a part of  who I’ve become, who I was then and who I’ll be tomorrow.

Blogging is a powerful tool.

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The Landmark Forum -My experience at the Introduction.

I quickly texted to my friend, “google landmark forum, is it a cult”?

I texted this  line to a friend while sitting in the “introductory” session of the Landmark educational meeting. A  friend had invited me, after telling me some of the good experiences she’d had.  When she described it, it sounded like a combination of motivational coaching, business coaching and personal development. All good things I thought, and I’m always interested in “bettering” myself.

From the moment I walked in, I knew that this was not what I was expecting. I had brought work to do, planning to simply listen in on their meeting and get my work done (it still remains undone as I type this).   The room was laid out like a church with pulpit almost, and as people strolled in the greetings were similar. Warm hugs, arm squeezes, even a tear or two.

I was quickly spotted as a visitor and many people came up to greet me.  I began getting uncomfortable almost immediately and sent of the above text to my friend.

After introdcutions, the “guests” were whisked off to a separate room for a separate session.  I was a little dissapointned as I’d come to sit in on the interesting information that my friend said they’d be covering (Brain science).

There were only 2 of us, plus a nice man with a nametag that read “Introduction Leader”, and an “introduction leader in training”.  Wow…whatever this thing is…to need to have introduction leader’s in-trianing  means that they’ve got a pretty big funnel of educational training for their “leaders”.

In the tiny room, our leader sat with a book stand next to him and his 3 ring binder with all the information he was supposed to cover with us.   He led us through a not-uninteresting exercise, but clearly one with an specific motive…to get you to see how messed up you really are inside.

I am currently going through some business buildign activities, and I’ve been very proactive and trying to launch a new branch of my small business…making phone calls, gathering market information, etc.   I picked this activity as my item to work on for the session.  But this didn’t fit his model at all…the leader’s example of “what I’m already doing”, “what I already have”, and “what I’m already being”, were all negatives….his was also a business situation…what he was already doing was letting sales leads slip by, not closing calls and spending his time doing efforst that were not buildign the bottom line.  What he was already being was…”selfish, irresponsible and close minded”.  He said that the point of the last part was to really “tell one on yourself”.

HUH?  What I was already being was forward thinking, proactive, seeking new education and opportunities…all good stuff…I just need to complete the last pieces of the puzzle to make it all a go.

If I didn’t already feel uncomfortable this was really starting to seem like an ill-intended, misguided effort at getting vulnarable people to sign up for an expensive course in self-help and common sense.  Not that those are bad things, but having gone through a number of small business coaching sessions that were all quite helpful, as well as being in a business that helps others achieve things they never dreamed possible (completing a triathlon), I was very dissapointed at the Introduction Leader’s approach to “discovering possibilities”.

None of the introductory session was aimed at finding solutions…and I certainly wouldn’t expect to find a solution in 90 minutes to a large problem.  Instead, it was devoted to giving you “carrots”, with examples of personal breakthroughs due to realizations of childhood traumas that have defined your personality to adulthood. (Things like being told by your school-age crush that you’re ugly, not being able to make final ammends with a deceased loved one, etc).

The suggestion taht every one has some childhood trauma causing limiting behaviors in adulthood I find very insulting. I live an examined life. I’ve overcome innumberable obstacles to get into medical school, become a  physician, invest profitably, start a small business and help other people reach their goals.  I constantly read business books looking for new,  different and better ways to accomplish my goals.

At intermission, I tried to leave, by politely telling him that I was just going to wait in the lobby until my friend’s session was done.   He turned bright read and got very fidgety.  He said, “Before you decide to leave, can we have another conversation about this?” Man, was he desperate to have me stay in the room.   I already knew that I was not interested in this thing, whatever it was (I still don’t know).

I took a break and did some pushups, handstands and planks in the hallway (I was missing valuable exercise time!!), and checked my cell phone.  Not only did my friend text me back, but her boyfriend too. There on my blackberry, two texts one right above the other simply said, “CULT!”  I laughed about it, knowing that somehow my instincts of “this just doesn’t feel right” were correct.

During the second portion ( I did decide to stay), we opened up a new pamphet, and I took the registration card out and obnoxiously tossed it in the air behind my chair, making a statement that yes, I am interested in being a better person…no, I am not going to sign up for the landmark forum tonight.  Now what do you have to tell me?

I could paraphrase what he talked about in the 2nd half, and there was nothign inherently good or bad about the content…but I failed to see the connecting of how signing up for the landmark forum TONIGHT was going to be the only way I’d slove the puzzle of letting my past limit my future.

In the end…it was 3 hours wasted, and my work is still not done.  But I felt compelled to share this with my readers and whomever else my stumble across it.

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Mike Leach Suspended over Concussion Controversy

Mike Leach, head coach of Texas Tech football is suspended for allegedly mistreating a player who had suffered a concussion last week in practice.

Reactions around the blogosphere range from the ridiculous to the absurd.  Former wanna-be football players are basically saying that the player should “suck it up” and that coaches hazing football players is a rite of passage.  It reminds me just a little bit of surgeons and docs (like me) trained pre “residency work hour restrictions” and post.

Those of us trained pre were of the opinion that “it’s just part of the training”, “you’ll be a better doctor for it”.  And I’m sure that many of these former football players feel the same way.

What I can’t understand though, is how anyone can think that they know the best way to treat and diagnose a concussion when they have no medical background or concept of what real head injury is.

In my previous post on Concussion Rules Stir Controversy, I commented that were I a sideline coach, I’d pull every “mildly concussed” player from the game.   The standard of care at one point was that if any syptoms were present, that the player should not return to contact sports until at least 7 days have passed without any sypmtoms of a concussion.

Since many concussions result in a “post concussive syndrome” that can persist for days to months, there’s no way to predict when I player can return to play.

It’s a sticky situation, and if you have an abusive or belittling coach, it can really put the player in a tug of war between phsyicians and coaches.

Regarding the suspension of Texas Tech Coach Mike Leach, whatever the truth is, it highlights that every school, be it high school or collegiate, needs to adopt a policy on concussion management for players.  Remove the head coach from the decision as he should not be involved…let him coach football.

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