Duchenne de Boulogne (Sept 17 1806 – Sept 15 1875)

If there is a “father of modern neurology” it would be Duchenne de Bologne, whose work started the field. Though many consider Jean-Marie Charcot its founder, Charcot himself often described de Bologne as his teacher and the true first Neurologist. Talk about bros giving credit.

Duchenne de Bologne is in my list of unsung heroes because his light is dimmed by Charcot’s and Ramon y Cajal’s, both of which did amazing and important work and are (rightfully) lauded for them.

But there are a few things that remain: his work on muscular dystrophy, while it opened the field to research into so much more, is immortalized in the naming of Duchenne Muscular Dystrophy, Duchenne-Aran spinal muscular atrophy, Duchenne-Erb paralysis, Duchenne’s disease (Tabes dorsalis), and Duchenne’s paralysis. You’ll probably have heard of at least one of those.

But there is more. He also invented the trocar, a surgical instrument to retrieve fluids or small amounts of tissue. He used it to do the first muscle biopsies.

Then he moved on. Believing that nerves had something to do with electricity that was conducted in them as it was in copper wires (not quite accurate, but pretty astounding for this time), he started to use small currents to activate muscles. While doing so, he not only began to map the path of nerves in the body, he also discovered the difference between afferent and efferent nerve strands, and posited that all nerves met near or at the spinal column, but not all took the trek to the brain and back to have reactions to events (this we know for sure is right) but, instead, reacted to signals from the muscle directly via a “shortcut” near or in the spinal column.

He then set out, to analyze facial expressions and emotions. He was the first to talk about microexpressions, about facial reactions so minute you’d have to not blink to see them, and how the brain used them to mimick the person opposite in order to observe itself and see what a specific reaction might say about the person’s mindset. This theory was long forgotten until it was picked back up in the mid 2000s and has now seen multiple verifications in studies.

And the most metal part about this great man? His name. Duchenne got his “de Boulogne” appendix from his colleagues who were concerned that anyone could confuse him with “Duchesne” a big prick of a self-involved physician in Paris with a star attitude. Duchenne embraced the change (he was born and raised in Boulogne) and published under this name until his death two days before his birthday in 1875.

Duchenne’s downfall in fame was his disposition. He is reported to have been a nice person, calm and friendly, until his wife died shortly after the birth of his son. Focussing on work and showing an increasingly erratic attitude, he estranged from his family and his colleagues, antagonizing senior staff he worked for. This period lasted until long after he started his work and might have contributed heavily to the more jovial and collegial Charcot, his student, receiving most of the credit.

His greatest success, however, might be that after his death he still made massive waves in that he influenced Darwin’s theory of facial expressions (which laid the groundwork for Ekman and others) and taught Charcot, who finalized the field of Neurology into a standing discipline. He also taight himself to draw portraits and did so amazingly well from memory, documenting many facial features caused by muscle contractions. The buccinator and sternocleidomastoideus muscles were the first he documented and they torture students with innervation and action to this day.

Åke Senning (14 September 1915 – 21 July 2000)

Senning was born September 14 1915. He didn’t want to become a physician, wanting to be an engineer instead, but it somehow happened. After watching some open heart surgeries, however, he found his passion and trained as a cardiovascular surgeon.

The surgeon he watched, Clarence Crafoord (a hero by himself), would become his mentor in 1948 and, recognising Åke’s talents, Crafoord allowed him to experiment on means to implant pacemakers. In Rune Elmqvist, a former physician who did go on to become an engineer, Senning’s secret passion, he found the perfect partner.

In 1957 he made history for the first time, but not as an engineer or with a pacemaker, but by performing the first successful repair of a congenital heart defect in which blood vessels are transposed called TGA.
Scantly a year later, he and Elmqvist were back, this time with their implantable pacemaker. Subsequent pacemakers lasted longer and longer, leading to the models you know today.

In 1969, having been the head of Cardiothoracic Surgery at the Universitätsspital Zürich for eight years, he performed the first heart transplant in Switzerland.

Senning spent his final years, from 1985 to 2000, relaxing, teaching, and despite a long illness being a good sport about it when younger physicians asked for autographs or came calling for advice. He’s remembered not just as the father of the Senning Procedure [PDF] (that’s the TGA one) and implantation of the first pacemaker, but also as an extremely nice person who abhorred celebrity antics and fame mongering.

When he was interviewed about his first transplant, he humbly suggested that “Man muss nur nähen. Und wenn man weiss, wo man nähen muss, ist es kein Problem” (“All you have to do is suture. If you know where to suture, you’ll be fine.”)

Picture: Senning, Elmqvist, and Craaford. Credit: Ann Thorac Surg. 2004 Jun;77(6):2250-8.

A forgotten Emergency

Someone walked into my ER this morning (I am a day’s worth of travel south of it) and handed the triage nurse flowers and chocolate for me, to thank me for “caring so much.

“Now, it’s nice to get recognised. But at the same time: I do not do much more than what needs doing, so how bad must this person have felt they have been treated before, to consider my conduct worthy of recognition?

And is it bad that I can not recall the case for the life of me? I a wracking my brain, I have been told the diagnosis, sex, age, and status of the patient, even the day.

And, still, I do not remember them. Not in the least.

I think, honestly, that this is one of the issues we have with health care these days. Patients feel like they are not being taken seriously (every single one of them is, we literally kill ourselves to make them better. We just do a piss poor job, apparently, at showing it), and patients realize that they are but blips on our radar.

People we will (and have to) forget, the second they leave our care.

This was probably one of those cases that fell into a lull in the stream of patients arriving every night (I only did nights for a long time). I probably had the time to explain to them what happened. I probably had time to listen. And I probably had time to show I cared, rather than just caring and carrying on.

This should not be my place. This should be the domain of GPs.

The advocacy role of GP is being eroded by a system that focuses on defensive and rapid medical intervention over lifelong care and support. We’re not healing, we’re fighting fires. This system kills nurses, specialists, and physicians.

In a fantasy world where strong GP/PC physicians are the champions of their patients, there would always be a physician and a bunch of nurses who do not forget. Who will watch over procedures and, very importantly, translate “hospital” to “patient” showing them, that we do care, that we do worry about them and that they do matter.

We can do better. But for this, we have to have a cohesive and coherent medical system in which the patient is not funneled from provider to provider but guided through it by one, strong, advocate.

This starts in policy and politics and does not end with addressing a toxic image of what makes a “good hard” nurse or physician. The patient isn’t the only one suffering from this, and we’d do well to do better, for ourselves and for our patients.

Nachgedanken zum BarCamp München (#bcmuc)

#bcmuc war toll.

Jetzt ist’s also vorbei, das Wochenende. Und, wie bei jedem BarCamp, gilt mal wieder: für jeden alten Bekannten macht man drei neue Freunde. Zum ersten Mal Nils und Johannes Mairhofer IRL getroffen, und dutzende andere tolle Menschen. Vom „Vorglühen“ am Giesinger Bräu bis zur Abschlußveranstaltung war hier alles spitze und super gut organisiert.

Amazing Sessions

Dana’s „Mein Körper 2.0“ war ein spitzen-Vortrag. Auch wenn ich mich persönlich und beruflich manchmal mit dem Thema der Transsexualität beschäftige, bin ich als Cis-Mann doch nur ein Besucher in dieser Welt. Es passiert, daß uns ein Fenster in die Problematik und Herausforderungen der Transition geöffnet wird, Dana jedoch tat mehr: sie öffnete die Tür und bot uns an, in ihre Welt zu treten. Wir brauchen mehr Danas auf BarCamps.

Hannah erzählte mutig von ihrer Depression und dem Werdegang bisher. Ihre Session war nicht nur informativ, sie gab auch Anderen den Mut, sich mit einem „ich bin das auch“ an die Gruppe zu wenden. Wir brauchen mehr Hannahs auf BarCamps.

Zudem gab’s Interessantes aus der Welt des Bahnfahrens (wie man’s billiger macht), über Nahtod-Erlebnisse mit Schlaf-Apnoe, und mehr. Das Essen war toll, auch wenn nicht genug veganes für die Veganer unter uns da war, und die gesponserten Getränke rockten.

Die Beate Mader machte Sketchnotes von den Sessions auf denen sie war. Hier sind sie, zusammen mit einigen Beobachtungen. Martin Emmerich benutzt Freemind, auch toll, und hier sind seine Notizen als PDF. Auch die MindMap Datei kann man auf seinem Blog finden.

Meine Session(s)

Nachdem die „Programming your Brain“ Session am Samstag gut ankam, wurde ich gebeten auch eine am Sonntag zu machen, was dann auch passiert ist („Brain Wars 2: The Medulla Strikes Back“). Ich denke, wir hatten Spaß, ein paar Errata und Links zu meinen Sachen sind auf meinem GitHub Profil zu finden. Für #bcbs17 denke ich mir, daß ich eine Session mit Experimenten anbiete.

Besonders happy macht mich die Adoption des Wortes „Schwurbel“ für alle Versuche, Behauptungen ohne evidenzbasierte Beweise aufzustellen.

Die Sketchnote des zweiten Vortrags kann man auf Beate’s Seite finden.

Vorschläge und Ideen

Gleich neben/hinter dem Microsoft Campus ist das Ibis und Novotel Gebäude. Mit etwas Geschick hätte man hier eine schöne #bcmuc Rate erarbeiten können, was Zogroasten es etwas einfacher gemacht hätte, auch nach dem schon sehr frühen Schluß (17:30) noch Anschluß zu finden.

Der Microsoft Campus war toll, aber so richtig „Gelassenheit“ konnte, schon wegen der notwendigen Sicherheitsmaßnahmen und zeitlichen Limitierung nicht aufkommen. Ich finde Microsoft’s Engagement super, frage mich halt aber auch, ob — wenn man so eine Location nimmt — es nicht besser wäre, auch eine fixe Afterparty Location gäbe. Weil…

Hotel-Lobby Tracks machen Spaß.

Im Allgemeinen verbinde ich mit „Camp“ immer noch 48 Stunden durchgehende Action. Die 11:30-17:30 Session blocks sind ja, eigentlich, nur der Aufhänger für die richtigen Events. Da brechen dann aber leider die Gruppen wieder in Zugroaste und Lokale, Cliquen, und Vorbekanntschaften auseinander. Das Schönste und Wichtigste am BarCamp ist das Kennenlernen neuer Menschen und Ideen, das Vertiefen von Sessions, und das ist leider halt mit dem Format so nicht wirklich möglich.

Und…

Die morgendlichen Einleitungen waren, meines Erachtens nach, zu lange. Bietet stattdessen eine „Welcome auf dem BarCamp“ Session für die „Neuen“ an, ganz am Anfang des Tages, legt Planungs- und Ideen-Sessions auf den selben Slot, und macht danach die Session-Planung. Erarbeitet mit den Neuen einen Session-Vorschlag, erklärt „Bring Yourself“ und „We Talk about BarCamp“, etc. Sponsoren-Bauchpinseln ist besser über den Tag verteilt, denen gefällt es auch besser, wenn sie nicht am Morgen als notwendiges Übel sondern durch den Tag als kompetente Partner wahrgenommen werden.

Aaaaaber….

es war spitze. Danke an die Orga, die Menschen die gekommen sind, die tollen Sponsoren, etc. So muß BarCamp sein!