Stories [9]: A Healthy Volunteer

20 09 2010

The host of Next Grand Rounds (Pallimed) asked to submit a recent blog post from another blogger in addition to your own post.
I choose “Orthostatics – one more time” from DB Medical rants and a post commenting on that from Musings of a Dinosaur.

Bob Center’s (@medrants) posts was about the value of orthostatic vital sign measurements (I won’t go into any details here), and about who should be doing them, nurses or doctors. In his post, Bob Center also mentioned briefly that students were seeing this as scut work similar as drawing your own bloods and carrying them to the lab.

That reminded me of something that happened when I was working in the lab as a PhD, 20 years ago.

I was working on a chromosomal translocation between chromosome 14 and 18. (see Fig)

The t(14;18) is THE hallmark of follicular lymphoma (lymphoma is a B cell cancer of the lymph nodes).

This chromosomal translocation is caused by a faulty coupling of an immunoglobulin chain to the BCL-2 proto-oncogene during the normal rearrangement process of the immunoglobulins in the pre-B-cells.

This t(14;18) translocation can be detected by genetic techniques, such as PCR.

Using PCR, we found that the t(14:18) translocation was not only present in follicular lymphoma, but also in benign hyperplasia of tonsils and lymph nodes in otherwise healthy persons. Just one out of  1 : 100,000 cells were positive. When I finally succeeded in sequencing the PCR-amplified breakpoints, we could show that each breakpoint was unique and not due to contamination of our positive control (read my posts on XMRV to see why this is important).

So we had a paper. Together with experiments in transgenic mice, our results hinted that t(14;18) translocations is necessary but not sufficient for follicular lymphoma. Enhanced expression of BCL-2 might give make the cells with the translocation “immortal”.

All fine, but hyperplastic tonsils might still form an exception, since they are not completely normal. We reasoned that if the t(14;18) was an accidental mistake in pre B cells it might sometimes be found in normal B cells in the blood too.

But then we needed normal blood from healthy individuals.

At the blood bank we could only get pooled blood at that time. But that wasn’t suitable, because if a translocation was present in one individual it would be diluted with the blood of the others.

So, as was quite common then, we asked our colleagues to donate some blood.

The entire procedure was cumbersome: a technician first had to enrich for T and  B cells, we had to separate the cells by FACS and I would then PCR and sequence them.

The PCR and sequencing techniques had to be adopted, because the frequency of positive cells was lower than in the tonsils and approached the detection limit. ….. That is in most people. But not in all. One of our colleagues had relatively prominent bands, and several breakpoints.

It was explained to him that this meant nothing really. Because we did find similar translocations in every healthy person.

But still, I wouldn’t feel 100% sure, if so many of my blood cells (one out of 1000 or 10.000) contained t(14:18) translocations.

He was one of the first volunteers we tested, but from then on it was decided to test only anonymous persons.

Related Articles





Stories [8] How Not to Reassure (or Treat) a Patient

23 08 2010

The host of the next edition of the Grand Rounds is Fizzziatrist at A Cartoon Guide to Becoming a Doctor. Thus it is no surprise that the theme of this edition is “Humor in Medicine”. The Fizzziatrist:

When I host Grand Rounds, I will post the links in order of how many times each one made me go “ha!” (…) It’s all quite scientific.

Well that’s a tough job. First both as a medical librarian and  a patient, I’m not in the situation to experience a lot of the humorous aspects of a doctors job. Furthermore I’m not the HA-HA-HA LOL-REAL SCREAM type. I’m more of the smile and the grin.

So what to do? I hope you find the following enjoyable. And perhaps many little ha’s do make one big HA.

——————–

How not to reassure (or treat) your patients (own experience)

My GP (the leading character in this story; he resembles a bull in a china shop, sometimes, but other than that, he is o.k.)

  • At one of my first visits he was trying to (manually) find the card of my husband. 
    When he thought he found it, he muttered:
    “that old guy?”
    Apparently he had mistaken my father (I still had my maiden name) for my partner.
    Lucky (both for me and my gp)  he was wrong. But how embarrassing if he
    had been right.

    wikipedia (CC)

  • Once I phoned him for I don’t know what and he said:
    “I’m not seeing  you often”
    “Why, is that bad?”
    “Well, it is exceptional”
    “Exceptional?”
    “Yes, I see women of your age regularly”

    “For what kind of disease, if I may ask”.
    “Well, the flu .. and for pill or IUD-controls”
    [sneering] “Sure, but I’m never seriously ill and I have a gynecologist for the latter”.
  • When I was pregnant of my second child, I phoned him for a prescription for anti-Rh antibodies, which I needed for prenatal testing. Since I hadn’t visited my gynecologist after my first child, and the hospital nurses had assured me that gp’s and midwives normally prescribed, this should not be a problem.
    I began: “I’m a few weeks pregnant and ….”
    He interrupted me, confused: “but that..….. but ….. you were pregnant a few months ago“.
    He was half right. I had had a miscarriage then. (Dang! A heavy blow)
    After a curt explanation, I hung up.
  • Later he phoned me back (with a thin excuse) and I asked him for the anti-Rh antibodies, but he just didn’t get it.
    Ask your  midwife”.
    “But I don’t have a midwife”
    “Everyone has got a midwife, nowadays”
    “No, I got a gynecologist”
    “Then  ask your gynecologist”
    “But  I’m not his patient anymore”
    “Then ask him to be your doctor again”
    “But I need the prescription right now“.

    I tried to convince him in vain. He finally mumbled something like: That is of my beat, I don’t do pregnancies and deliveries anymore.
    [luckily one phone call to the gynecologists' wife was enough to get the prescription. She passed the message immediately, and said that if I liked him to take care of me again, it was best to make an appointment soon after the test.]
  • My gp had the same attitude another time.  I had signs of a Addison crisis. I tried to explain to him what might be wrong. He asked one or two things, shrugged and then said: “You better make an appointment with your specialists. This disease is beyond my practice.”
    At the time it seemed ok to me, but my endocrinologist said it was irresponsible: “Suppose he wouldn’t immediately refer someone with an acute crisis: that could be fatal. [I was hospitalized in this case, but it was not that urgent] See also “the Doctor and the Patient”
The Doctor, by Sir Luke Fildes (1891)

Image via Wikipedia

My gynecologist/obstetrician [a friend of mine recommended him, because he was kind and puts you at ease. It really is a wonderful doctor, and after all those deliveries he still considered birth a miracle. However, his way of reassuring was not always effective]. 

  • March 31, late afternoon: “It is time to get your baby ( 2,5 weeks post-term), but we better postpone it for two days. It is not such a nice day to celebrate the child’s birthday, don’t you think” (meaning April Fools day)
  • When I had my first check-up he warmed the speculum, trying to break the ice with some humor: “they do warm the cutlery for each course at the Chinese”, don’t they?
    (I found it rather tasteless, but remained silent: he meant it well)
  • When we discussed where I would deliver, he said that that would be in his hospital. I sighed with relief. As any new mother I was nervous about it.
    But he didn’t want me to have false expectations:
    Of course I hope I can personally deliver your baby. However, the chances are real that someone else will be around at that time. But believe me, if the moment is there, you don’t care who stands at the foot of your bed. Even if it is a gorilla..”

My Dentist (the best, most skillful, pleasant dentist there is, but still ….  a dentist)

  • Once, just finished drilling, she said carefully: “Don’t be scared when you look into the mirror….. I just touched your tongue”.

This concludes my experiences.  If you would like to read more serious stuff about “how (not) to reassure”, then you can read this old article The Art Of Reassurance (PDF) or this recent blog post at « HealthSkills WeblogIs reassurance reassuring?

One main advise (from the latter blog):

Never reassure a patient about something they are not already worried about. It would be a mistake, for example, to earnestly reassure patients that they do not have cancer when the thought had never entered their minds!”

Related Articles





Stories [7]: A Strange Doctor

30 05 2010

The theme of the next Grand Rounds hosted at TECHKNOWDOC’S SURGICAL ADVENTURES is “Humor in Medicine”.

I have been thinking and thinking, but I failed to come up with a funny story other than I have told before (and one I have to check with my mom). Most of my experiences in the medicine/health field aren’t that funny (from my perspective). I can imagine it is different for people working in the field, and especially in the field of emergency care. Life in the Fast Lane and Other Things Amanzi are a rich source of medical humor.

But I have a short story to tell, that is on the interface of science and medicine…

As you probably know I worked as scientist for many years. I did my PhD in a lab where we worked with mice and guinea pigs. I tested the immuno-enhancing effects of cytostatic drugs in mouse models, whereas others tested immunotherapeutic effects of cytostatics, interleukins and/or vaccines in tumormodels, both in mice and guinea pigs. Good for science, but not so nice for the animals: I was glad I didn’t have to do the tumor-experiments.

My boss was a guinea pig expert, he knew everything about guinea-pig immunology. As most project leaders he had his PhD-degree. In the Netherlands he is therefore called a doctor (dr.), which is different from a “dokter” (in Dutch) or a doctor of Medicine (English). But many do not understand the difference.

Sometimes in the school holidays my boss’s little girls came along. They were shown the guinea pigs, but were (of course) kept from the experimentation rooms (the rules were not that strict in the eighties, one could just walk in and out of the stables). Dad tried to explain to them why the guinea pigs were there and what he was doing with them in a simple and not too rude way.

Later, the teacher of one of the girls asked the children of the class what their parents were doing for a living. When it was the turn of my boss’s daughter, she said that both of her parents were doctors. One was a GP and the other, well…. he cured guinea pigs ….

Photo Credits

Guinea Pig: http://www.flickr.com/photos/sween/4465737889/





The Doctors & the Patient.

25 04 2010

Once there was a woman with secondary Addison’s disease. She took her replacement medicine (cortisol, thyrax, growth hormone, DHEAs) as she should and everything was reasonably under control.

However, gradually she began to feel weak. She often disliked food, sometimes to such an extent that she had an urge to vomit. After a month or so, she began to feel dizzy, especially when standing up. Then her heart suddenly banged very quickly against her chest. It felt frightening.

Her work wasn’t going well in this period. Feeling weak and not being able to sleep, she could not concentrate and often felt like she could just cry or lay  down on the floor, because she was so extremely, extremely tired.
But it was a busy and important period. She should write a research proposal, finish a paper, and present a poster at a congress. Furthermore her paper was chosen for a press conference, that was recorded live.

Nobody took her serious, no one thought that she might be ill. She did recognize some symptoms that could be manifestations of an Addison crisis (weakness, dislike of food). However there was no reason for a crisis: she took all her medicine and had no flu or fever, thus there was no need to raise the cortisol dose.

Before she went on vacation she just wanted to check with her endocrinologist, but the endo was on vacation too and according to the policy of the hospital she had to be referred by her GP. Her GP also had vacation, so she went to the locum. He reserved his lunch time for her, which was really nice.

Because this doctor wasn’t familiar with the disease, he looked it up in a book and decided to determine whether she had orthostatic hypotension (drop in pressure and dizziness when standing up), because this is typical for an Addison crisis (she learned then). She had to lay down and stand up several times. He failed to demonstrate orthostatic hypotension (but she felt it was taking him too long to measure the blood pressure after standing up; she didn’t say anything though).

Then this GP phoned the attending endocrinologist at the hospital. This was one of the endocrinologists who had been in charge of her during the years. Usually she got a new doctor each year.
From the conversation she could infer that this endocrinologist didn’t think there was really much wrong. Afterwards the GP urged her to take her medicine (as if she didn’t take enough) and to take more if necessary. He gave her a form for blood tests, but urged her only to do the tests when it was REALLY REALLY REALLY necessary…..

She felt bad, like a show-off. She excused herself, she was sorry to have bothered him. She never did the blood test, but took some extra cortisol though.

She went on holidays (why would she stay home?), but from there it only went worse. She couldn’t sleep at all. She had gradually lost up to 8-10 kilos in 2-3 months time (about 15% of her body weight). She was dizzy and nauseous and regularly had migraine .

Back home she went to her own GP. He didn’t examine her, but sighed: “This diseases is too complicated. I think you better see your endocrinologist….”

So she phoned her (own) endocrinologist and she was invited to come after the regular consultations. The doctor did a physical exam and noticed orthostatic hypotension. Blood tests were done, which revealed a low blood sodium (125), not as dramatically low as during her first crisis (106), but still abnormal (<140). The next days the sodium dropped further and the creatinine got outside the normal range, so the endo proposed to hospitalize her, saying: “this is not an emergency, but i don’t trust it, because this is not like you. It is not like you at all. I don’t want to wait for the weekend.”

Her endocrinologist had to convince the internist to make a bed available for admission.

During the intake, the two internists behaved very skeptical. Even though the lab results pointed at a too low cortisol level (later confirmed by the lab). One of them kept repeating that a cup of salty soup would pick her up (lack of salt mainly plays a role in patients with primary Addison’s disease, who also lack aldosterone). He would even say that after she recovered by her cortisol infusion. The recovery was very quick. The other internists said that it was a miraculous metamorphosis.

Well that female patient? That was me, six years ago.

And all doctors were males except the doctor who finally hospitalized me.

Yes of all doctors I had seen as an Addison patient over the years, she was the only woman. Many of the male practitioners were excellent doctors, but none of them would have hospitalized me because his intuition told him “something was not o.k.” Maybe I’m wrong and it is just by chance that this happened to be a female doctor. But somehow I feel that, on average (!) female doctors listen a little bit more to their heart, and male doctors a little bit more to their brains.
It is only intuition, but then I’m a woman. ;)
My doctor was not interested in a career as the other doctors, she didn’t like the competition, she didn’t like the hierarchy and she didn’t care for a publication in top journals. Her patients came first.
She has now moved to another (non-academic) hospital and I have a new doctor again. A man, indeed.

——————-

This post is submitted to the upcoming Grand Rounds at Chronic Babe, with the theme Babes:
Your post might be about what it’s like to have women patients. Or to be a woman patient, or a woman who’s a health care provider. It could be about trends in health care for women, or how awesome women are, or how annoying they are. It could be about a particular patient who was very ladylike, or someone who totally wasn’t. It’s your choice. Whatever you send, just please make sure it’s related to the Babes in some way, or else I won’t be including you. This is Grand Rounds, ChronicBabe-style, so it’s Ladies Choice!





Stories [5] – Polly Matzinger, the Bunny & the Dog

22 03 2010

Stories is a new series that tells a selection of my personal stories, mostly from the time I was a student or worked as a scientist.
I wrote the draft of this post a year ago. The theme of the Grand Round hosted by Ramona Bates at Suture for a Living
posts that have to do with women in medicine as patients, as providers, as scientists” prompted me to take up the thread.

The present story took place at my first job as a scientist in the early eighties. I worked with Pavol Ivanyi, a well known immunologist, specialized in inbred mice strains and the MHC (Major Histocompatibility Complex, i.e. major transplantation antigens). Once a week we held a sort of Journal Club, that took place in our office, a small and dark room without any windows. There was a table, a blackboard and our desks. Pavol often wore the same brown woolen sweater. We had no computers, not to mention powerpoint presentations. We just had a flip-over and a blackboard.

Once it was my turn. The paper I discussed was written by P. Matzinger as first author and if I remember it well R. Zamoyska.

Little was known at that time about how the immune response reacted to foreign material but not to “self”. The MHC plays a major role in this and P Matzinger had  truly original ideas about how this worked.
I guess I must have been nervous, because it was quite a difficult theoretical paper (for me at that time).

Many times I said: “he thinks, he had the bright idea, he proposes, he concludes…”.

After I finished my presentation, Pavol took a deep breath and said frowning:

“…..It is not a HE.”

I gazed with a kind of wonder. He continued with his typical Czech accent, serious but with a twinkle in his eyes.

“It is a SHE” …….

“It is a she and …. a very beautiful one”

Then he told us that Polly Matzinger, for that was her name, was once a Playboy bunny and a waitress at a bar frequented by scientists. A well known professor noticed her talent and persuaded her to become a scientist and get her PhD.
She appeared to be a very original, but also controversial lady. Pavol knew her well.

Pavol carried on:

“Polly has written a paper together with Galadriel Mirkwood* (see pdf here). Do you know who that is?

I nodded: “No” (how should I know?). The name Galadriel, one of the elves of  Lord of the Rings, might have been a hint.

“Mirkwood is her Afghan Hound, it is a dog, She found that her dog was as much involved in research as many other coauthors.”

727px-polly__annie1

According to Ted Anton’s book Bold Science, the dog was put on as a coauthor for this Journal of Experimental Medicine paper [1], because  she refused to write in the usual scientific passive voice (‘steps were taken’) but was too insecure to write in the first person (‘I took the steps’). Once discovered, papers on which she was a major author were then barred from the journal until the editor died and was replaced by another (see Wikipedia).

But as a matter of fact, one of her main ideas originated from observing her sheepdog (she is a sheepdog expert as well, and a jazz musician, carpenter, lab technician and problem-dog trainer). “I suddenly realized that there was a cell in the body which behaves like a good sheepdog – the dendritic cell. The dendritic cell would be activated by a cell dying in its midst and kickstart the immune response. And that puts the model together”. (The Independent)

Polly Matzinger is famous for her Danger Model, published in many prominent journals, like Science,  Ann N Y Acad Sci, J Immunol, Transplant Proc, Nature Med, Nature Immunology (see refs).

The BBC even made a Horizon -edition about her and her ideas. Horizon, as you may know, is a current and long-running BBC popular science and philosophy documentary program. She does now how to stand out, although sometimes this desire to stand out can overshadow her skills as a scientist and presenter according to some.

Her Danger theory challenges core beliefs about how our immune system works.

The paradigm developed by Janeway (and the Nobel Price winners Medawar/Burnet) is that non-self (foreign) triggers an immune response, while self does not. According to Polly the “self/non-self” model is not adequate.

A system that attacked everything foreign would lead to the system attacking the food we eat; a mother’s body would reject the foetus it carried. Instead, Matzinger thinks, what the body (and notably the dendritic cells) notices is danger.

This is how she explains her danger theorie in the New York Times (1998):

Q. How does your Danger Model differ from the standard Self/Nonself Model of the immune system?

A. It isn’t really insurrectionary — it’s just a different way of looking at things. Let me use an analogy to explain it. Imagine a community in which the police accept anyone they met during elementary school and kill any new migrant. That’s the Self/Nonself Model.

In the Danger Model, tourists and immigrants are accepted, until they start breaking windows. Only then, do the police move to eliminate them. In fact, it doesn’t matter if the window breaker is a foreigner or a member of the community. That kind of behavior is considered unacceptable, and the destructive individual is removed.

The community police are the white blood cells of the immune system. The Self/Nonself Model says that they kill anything that enters the body after an early training period in which ”self” is learned.

In the Danger Model, the police wander around, waiting for an alarm signaling that something is doing damage. If an immigrant enters without doing damage, the white cells simply continue to wander, and after a while, the harmless immigrant becomes part of the community.

She emphasize for instance that tumors are often not seen as dangerous and therefore not attacked by the immune system, until they outgrow their blood supply, undergo chemotherapy, or otherwise are harmed. Then the damaged tumor cells release endogenous danger signals that help trigger the adaptive response. (see this excellent blog post at Mystery Rays from Outer Space for more detailed discussion).

Her theory also implies that transplants could be permanently accepted if the danger signals could be blocked at the time of the transplant with a short course of drugs. Indeed some of her experiments point that way.

Others insist that it is not much different from the original theory, if one implies the need of a second signal (danger-signals, besides the recognition of non-self).

However, whether she is right or wrong doesn’t really matter in the long run.

Indeed like she said in the NY times:

“It is said the scientist who is willing to stick his neck out and be clear will contribute to the field whether he or she is wrong or not, because if they are wrong someone will do the experiments to prove they’re wrong and in the process will learn something about nature. So whether I’m right or wrong doesn’t matter.”

Her truly original ideas have stimulated the progress of science. She is an outstanding scientist. According to her own definition science is ” about describing nature, and so is art: We’re painting nature.(…) Actually, it’s a sandbox and scientists get to play all of our lives.

She is a scientist who is changing our world.

References

  1. Matzinger, P. and Mirkwood, G. (1978). In a fully H-2 incompatible chimera, T cells of donor origin can respond to minor histocompatibility antigens in association with either donor or host H-2 type. Journal of Experimental Medicine, 148, 84-92.
  2. Ted Anton. Bold Science: Seven Scientists Who Are Changing Our World (Paperback) 193 pages; Publisher: W. H. Freeman (May 1, 2001) ISBN-10: 0716744481 ;ISBN-13: 978-0716744481
  3. Matzinger P. The danger model: a renewed sense of self. Science. 2002 Apr 12;296(5566):301-5.
  4. Matzinger P. An innate sense of danger. Ann N Y Acad Sci. 2002 Jun;961:341-2. Review. No abstract available.
  5. Alpan O, Rudomen G, Matzinger P. The role of dendritic cells, B cells, and M cells in gut-oriented immune responses. J Immunol. 2001 Apr 15;166(8):4843-52.
  6. Celli S, Matzinger P. Liver transplants induce deletion of liver-specific T cells. Transplant Proc. 2001 Feb-Mar;33(1-2):102-3. No abstract available.
  7. Guimond M, Veenstra RG, Grindler DJ, Zhang H, Cui Y, Murphy RD, Kim SY, Na R, Hennighausen L, Kurtulus S, Erman B, Interleukin 7 signaling in dendritic cells regulates the homeostatic proliferation and niche size of CD4+ T cells. Nat Immunol. 2009 Feb;10(2):149-57. Epub 2009 Jan 11.




Empathy

13 12 2009

The next Grand Rounds will be hosted by Barbara Olson of Florence dot com. The theme will be Simplify, identical to the theme of the annual conference of the Institute for Healthcare Improvement in Orlando. We are invited to share what’s on our mind about any healthcare-related topic indicating with one word why it is important.

My word is Empathy, because it is a versatile,  important skill doctors should have (besides knowledge and technical expertise to name a few other important skills). Empathy is especially important with vulnerable patients, the old and very young.

It strikes me that pediatricians are often very kind and pleasant doctors. They know how to ‘handle’ kids. GP’s also have to deal with kids a lot, but they’re often less patient and kind. At least that applies to our GP. I have had various issues with him, although never outspoken. He is a good doctor, but can be rude at times.

This is a funny story.

Once upon a time, we had to regularly visit our doctor, because my daughter, then 4 to 5 years old, had all kinds of small complaints.

Once she had (innocent) warts. He had to scrape them, but because my daughter found this painful, we had to pretreat the warts with EMLA plasters that numb the skin. I had to do that at home, but the plaster at the inner side of her knee had loosened after a half our walk to the doctor’s practice. He grumbled that I didn’t do it right and that I had to come back another time, meanwhile hard-handedly removing the other warts, forgetting half of them. My daughter didn’t enjoy the scrapings, the corners of her mouth trembling in her attempts not to cry.

After most of the warts had been removed, the doctor took a big flat box with all kinds of little presents, he obviously gave to children at the end of the ordeal.

“Here. You can choose a present!”

My daughter looked at all the minute presents, pondering which one to choose.

There were a lot of rings, with blue stones, red stones, pink stones. There were necklaces, little toys, games….

“Choose one”.

She choose a ring with a pink stone. But wait, that blue ring was nicer and she returned the ring with the pink stone .

But the little patience my doctor had was at an end.

He grabbed something from the box and put it into my daughter’s hand: “Here!”

It was a simple round cardboard with the most silly sheep drawing I have ever seen. With open mound my daughter received the present. Speechless she stared at the gift.

The doctor gestured we could leave the room. He apparently met his obligations with the gift.

With the door handle in my hand, I saw my daughter making a sudden turn. She took one last look at the sheep to throw it as an experienced pitcher straight at the doctor’s desk.

We heard a loud “Well, I never!”, when we left the room.

Added 2009-12-15:

Summary by Barbara at Florence.dot.com:

Jacqueline at Laika’s MedLibLog captures the arachnoid spirit, giving her post a one word title: empathy. The post shows how much we long for care that considers more about who we are than our “chief complaint” often reveals. If Jacqueline had been in the mood to spin longer, she could have called this post, “What comes around, goes around!”
Hit the nail on the head, Barbara!

Photo Credits:

“You are a lamb”, adapted from: http://www.flickr.com/photos/onegoodbumblebee/ / CC BY-NC-SA 2.0

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Stories 3. Science or Library Work: what is more rewarding?

20 04 2009

2267526122_f4376fc6bfAmy Tenderich of Diabetesmine, will celebrate her birthday at the very same day as she hosts the next Grand Round. She has therefore chosen a very appropriate theme (see announcement):

I’m favoring any and all posts having to do with birthdays and special occasions – or anything that smacks of serendipity, perks, or gifts related to the work you all do.

First of all I would like to congratulate Amy on her birthday.

I have been hesitating whether I should contribute to this round. It is not an easy subject and a bit out of scope. However, thinking about it, many ideas came up and it even became difficult to choose one. But here it is. It is even the first post in a series: STORIES, a selection of personal stories.

Most of you will know that I’m a medical librarian by profession, but a medical biologist by education. Many years I worked as a scientist, with mice, patients, cells, DNA and proteins.3419163183_91968b96d6

I was an avid scientist. My motivation was to unravel mechanisms and understand life. I liked to ask questions: “why is this? why do I find that? how does it work?” The greatest reward you can get is: looking for explanations and finding the answer to a question. Thinking about it and discussing it with others is exciting.The more difficult a question is, the more rewarding it is to find the answer. The gift that science gives you is science itself.

In those twenty years I did have my little successes. I had a press conference at a congress (1) (because it was the only subject that was understandable for the public) and I had two papers that were frequently cited (2).

The finding that gave rise to those two publications was very serendipitous. We found a very tiny band in B cells that were used as a negative (!) control for follicular lymphoma in a PCR for the t(14;18) chromosomal translocation. This translocation is considered the hallmark of this type of B-cell cancer. If this was true, it would mean that the lymphoma-associated t(14;18) involving the BCL2 oncogene could also occur outside the context of malignancy. My task was to prove that this was true. This was not an easy task, because we had to exclude that the tiny bands in the tonsils were due to contamination with exponentially amplified tumor DNA. A lot of tricks were needed to enable direct sequencing of the tonsil DNA to show that each chromosomal breakpoint was unique. To be honest, there were quite some moments of despair and most of the time I believed I was hunting ghosts. Certainly when the first band I sequenced was from a contaminating tumor. But finally we succeeded.

And although science can be very rewarding:

  • Most ideas aren’t that new.
  • There are many dead leads and negative results (see cartoon).
  • Experiments can fail.
  • There is a lot of competition
  • It takes very long before you get results (depending on the type of experiment)
  • It takes even longer before you get enough results to publish
  • It takes still longer before you have written down the first version of the paper
  • … and to wait for the first comments of the co-authors (see cartoon)
  • … and to rewrite the paper and to wait …
  • … and to submit to the journal and wait..
  • … to get the first rejection, because your paper didn’t get a high enough priority
  • and to rewrite, wait for the comments of the co-authors, adapt and submit
  • to be rejected for the second time by referees that don’t understand a bit of your subject or are competitors
  • to rewrite etcetera, till it is accepted…and published
  • to wait till somebody other than you or your co-authors find the paper relevant enough to cite.
  • but most importantly even with very good results that make you feel very happy and content:
    • each answer raises more questions
    • most research, whatever brilliant, is just a drop in the ocean or worse:
    • it gets invalidated

I loved to do research and I loved to be a researcher. However, it is difficult for post-doc to keep finding a job and wait for the contract renewals each year. So almost 4 years ago, just before another renewal of the contract, I was happy to get the opportunity to become a medical librarian at a place not far from where I lived. In fact, after all these years it is my first permanent job.

And it is a far more rewarding job than I ever had before, although perhaps not as challenging as research.

  • Results are more immediate.
  • Answers are clearcut (well mostly)
  • People (doctors, nurses, students) are very happy when you learn them how to search (well generally)
  • they are also happy when you do the search for them
  • or when you help them doing it
  • It is very rewarding to develop courses, to teach, to educate
  • the job has many facets

The rewards can vary from a happy smile, a hand shake and “a thank you” to acknowledgments and even co-authorships in papers. Sometimes I even get tangible presents, like chocolates, cookies, wine or gift tokens.

Last week a patron suddenly said when seeing the presents gathered: “Is it your birthday?”
Presumably it is about time to drink the wine I got.Cheers!

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Photo credits (Flickr-CC):





Ex soccer player now a med student; tv shots at our library

16 10 2008

Wanna see the previous soccer player Arjan de Zeeuw now continuing his medicine study, after a long intermezzo in the English league?? Or wanna see tv-shots of our academic Medical Centre (AMC) and our Medical Library than follow this link and click at the video (Voetballers in vergetelheid). Takes less than 4 minutes.

No surprise that Arjan, who is father of 4 kids, wants to become a sports doctor.

(Notably Arjan seems to read mostly books, whereas most students are behind the pc)

Special thanks to my collegue Marjan of Bidocblog for providing me the link.

http://voetbal.nos.nl/nieuws/artikel/ID/tcm:45-429888/

———————–

Ex-voetballer nu geneeskunde student: opnames in AMC-bibliotheek!

Arjan de Zeeuw heeft zijn studie geneeskunde weer opgepakt na een lange onderbreking als voetballer in de Engelse voetbalcompetitie. Hij is nu te zien in een serie van de NOS: ‘vergeten voetballers’.

Arjan is inmiddels vader van 4 kinderen, heeft zo te zien een aardig woonstekje en tuft elke dag heen en weer naar het AMC. Hij wil graag sportarts worden.

Het leuke is nu dat de opnames in het AMC en met name in onze bieb gemaakt zijn. Dus wil je daar een indruk van krijgen en/of wil je graag iets meer weten over Arjan als medische student, kijk dan naar de volgende video (klik op de tekst naast het oranje-witte pijltje). Tussen 2 haakjes wel opvallend dat hij vooral boeken erop naslaat en niet achter de computer in het digitorium zit.

Met speciale dank aan mijn collega Marjan van het Bidocblog die me op de link gewezen heeft.

http://voetbal.nos.nl/nieuws/artikel/ID/tcm:45-429888/








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