Tuesday, September 30, 2008
Research Question
What do steroids and human growth hormone physically do to the body? Why do so many athletes continue to abuse steroids and HGH even though it is well known how harmful they can be? Why are steroids and HGH the center of controversy in so many sports? How are steroids used medically to help people?
Thursday, September 25, 2008
Never in Doubt
I was standing at the top of a mountain looking down a slope that was steeper than any I have skied before, and I knew that if I was ever going to make it down, I would have to find the courage to slide over the edge and make that first turn. Luckily I found the confidence to make it down the slope safely, and I can now ski slopes such as that like an expert. Had I not found that confidence, to this day I still might have never gone down that slope. Skiing and surgery are vastly different, but they have similarities in that progression is driven by having the confidence to practice, and in that more experience yields more skill. In Atul Gawande’s “Education of a Knife” he discusses different situations dealing with confidence that he encountered during his residency. Whether it is having enough experience to be confident in a task, having the will to practice efficiently, or obtaining confidence from someone else’s faults, it is apparent that having confidence is necessary in order to perform optimally.
Confidence is essential to perform to the best of one’s ability, yet it is difficult to find that confidence without having the necessary skills. Gawande points out that “skill and confidence are learned through experience.” (18) This is evident with surgeons as the young resident Gawande is wary of what the plan should be to take the screw out of a patient’s foot. Likewise, Gawande is constantly asking questions and is unsure about the steps for putting in a central line. He needs much more practice to gain the confidence to perform simpler tasks such as these. I find a lot of similarities here with my own life. It is very hard for me to be firmly confident in anything, unless I am very experienced. For example, this past year I began skiing in the terrain park where all the jumps and rails exist. At first, I was very timid. I would ski into the jumps too slowly and not commit myself to the tricks because of my lack of confidence. Eventually, after many days of practice, it all clicked and I was skiing as though I’ve been in the park for years. Those days of practice were not easy, however. Failure can be frustrating to the point of giving up, but those with the “willingness to engage in sustained training” (20) will rise to the top. This is similar to Gawande’s struggle with putting in central lines as one day he just gets it, and he remains confident from then on. But he had the willingness to push through his misery of failing time and time again. Gawande says, “Conscious learning becomes unconscious knowledge.” (21) If enough practice is put in, it is inevitable that confidence will come due to the experiential learning. Once that knowledge and skill is achieved, the door of improvement is wide open because the confidence to push forward is now instilled.
However, setbacks to that new confidence can occur along the way due to the fear of being wrong. If one lets that fear consume them, all confidence is lost and the task at hand becomes much more difficult than it should be. Gawande elaborates on this when he mentions a saying about surgeons: “Sometimes wrong; never in doubt.” (15) This saying’s purpose is precisely to keep out the fear of being wrong. Because that fear takes away the confidence to perform optimally, for surgeons it can possibly mean taking away someone’s life. They need to proceed with full confidence whether they know it is absolutely correct or not. Although someone else’s life is not at stake with skiers, it is imperative for them to block out the fear of failure, just like surgeons, in order to ski at their highest level. When skiing, it is easy to have bad form by constantly bracing for a fall, and usually when a fall is expected, a fall happens. Those who can ski with the confidence that they will not fall make it through alright. Because they are able to commit to the run, they can learn from their mistakes immediately. The ones who are timid take much longer to progress. Besides, it is much more enjoyable to ski a difficult run successfully rather than falling often. It is also necessary for resident surgeons to progress quickly. By committing to their work as if they know exactly how to do it, they will learn more than if they are unsure. Although sometimes they will be wrong, never having doubt will erase the fear that complicates tasks. If they allow the fear to be present, it is inevitable that they will focus on that negativity instead of the next step.
Another way people can obtain confidence is by witnessing someone else’s failure rather than focusing on their own. People do not feel as bad failing at something if they know someone else already has. Appearing inadequate in a friend’s eyes is one thing that certainly no one wants. This is evident with Gawande as he again is struggling with a central line, and to his embarrassment, a more experienced resident has to step in. But much to Gawande’s relief, putting the central line in was not very easy for that surgeon either. “It took him several minutes and two or three sticks to find the vein himself and that made me feel better” (19) Gawande says after watching the more experienced resident. Once again, this same concept is present on the slopes. A couple years ago I was preparing for my first ski race ever. As nervous as I was, oddly enough many of the nerves came from the fear that I would be the worst of all my friends. Luckily, I was not the first to race so I had the opportunity to watch the racers before me. After witnessing one person fall, and another not place so well, I felt a huge wave of relief. I believe I did much better in this more relaxed state compared to how I would have done with all the built up nerves. Although Gawande did not instantly become perfect at putting in central lines after seeing the other resident fail, I still believe it was a big step for him to realize that no one is perfect at it. Just realizing that others are imperfect is enough to allow people to relax and regain the confidence to proceed without hesitation.
Surgeons as well as professional skiers are experts at what they do for a reason. It is because they had the will to practice until they achieved enough experience to be confident with their respective specialties. It is natural for people to have more confidence after more experience. That is why we can trust the best doctors to be the ones with the most practice, just as we know the best skiers undoubtedly spent the most time on the slopes. My own confidence with skiing has increased over the years as I have spent much more time practicing. Every time I find myself above a steep slope atop a mountain I still feel the butterflies in my stomach, but now I embrace that feeling and attack the mountain with confidence.
Confidence is essential to perform to the best of one’s ability, yet it is difficult to find that confidence without having the necessary skills. Gawande points out that “skill and confidence are learned through experience.” (18) This is evident with surgeons as the young resident Gawande is wary of what the plan should be to take the screw out of a patient’s foot. Likewise, Gawande is constantly asking questions and is unsure about the steps for putting in a central line. He needs much more practice to gain the confidence to perform simpler tasks such as these. I find a lot of similarities here with my own life. It is very hard for me to be firmly confident in anything, unless I am very experienced. For example, this past year I began skiing in the terrain park where all the jumps and rails exist. At first, I was very timid. I would ski into the jumps too slowly and not commit myself to the tricks because of my lack of confidence. Eventually, after many days of practice, it all clicked and I was skiing as though I’ve been in the park for years. Those days of practice were not easy, however. Failure can be frustrating to the point of giving up, but those with the “willingness to engage in sustained training” (20) will rise to the top. This is similar to Gawande’s struggle with putting in central lines as one day he just gets it, and he remains confident from then on. But he had the willingness to push through his misery of failing time and time again. Gawande says, “Conscious learning becomes unconscious knowledge.” (21) If enough practice is put in, it is inevitable that confidence will come due to the experiential learning. Once that knowledge and skill is achieved, the door of improvement is wide open because the confidence to push forward is now instilled.
However, setbacks to that new confidence can occur along the way due to the fear of being wrong. If one lets that fear consume them, all confidence is lost and the task at hand becomes much more difficult than it should be. Gawande elaborates on this when he mentions a saying about surgeons: “Sometimes wrong; never in doubt.” (15) This saying’s purpose is precisely to keep out the fear of being wrong. Because that fear takes away the confidence to perform optimally, for surgeons it can possibly mean taking away someone’s life. They need to proceed with full confidence whether they know it is absolutely correct or not. Although someone else’s life is not at stake with skiers, it is imperative for them to block out the fear of failure, just like surgeons, in order to ski at their highest level. When skiing, it is easy to have bad form by constantly bracing for a fall, and usually when a fall is expected, a fall happens. Those who can ski with the confidence that they will not fall make it through alright. Because they are able to commit to the run, they can learn from their mistakes immediately. The ones who are timid take much longer to progress. Besides, it is much more enjoyable to ski a difficult run successfully rather than falling often. It is also necessary for resident surgeons to progress quickly. By committing to their work as if they know exactly how to do it, they will learn more than if they are unsure. Although sometimes they will be wrong, never having doubt will erase the fear that complicates tasks. If they allow the fear to be present, it is inevitable that they will focus on that negativity instead of the next step.
Another way people can obtain confidence is by witnessing someone else’s failure rather than focusing on their own. People do not feel as bad failing at something if they know someone else already has. Appearing inadequate in a friend’s eyes is one thing that certainly no one wants. This is evident with Gawande as he again is struggling with a central line, and to his embarrassment, a more experienced resident has to step in. But much to Gawande’s relief, putting the central line in was not very easy for that surgeon either. “It took him several minutes and two or three sticks to find the vein himself and that made me feel better” (19) Gawande says after watching the more experienced resident. Once again, this same concept is present on the slopes. A couple years ago I was preparing for my first ski race ever. As nervous as I was, oddly enough many of the nerves came from the fear that I would be the worst of all my friends. Luckily, I was not the first to race so I had the opportunity to watch the racers before me. After witnessing one person fall, and another not place so well, I felt a huge wave of relief. I believe I did much better in this more relaxed state compared to how I would have done with all the built up nerves. Although Gawande did not instantly become perfect at putting in central lines after seeing the other resident fail, I still believe it was a big step for him to realize that no one is perfect at it. Just realizing that others are imperfect is enough to allow people to relax and regain the confidence to proceed without hesitation.
Surgeons as well as professional skiers are experts at what they do for a reason. It is because they had the will to practice until they achieved enough experience to be confident with their respective specialties. It is natural for people to have more confidence after more experience. That is why we can trust the best doctors to be the ones with the most practice, just as we know the best skiers undoubtedly spent the most time on the slopes. My own confidence with skiing has increased over the years as I have spent much more time practicing. Every time I find myself above a steep slope atop a mountain I still feel the butterflies in my stomach, but now I embrace that feeling and attack the mountain with confidence.
Wednesday, August 27, 2008
Split-Second Decisions
Injuries can be the outcome of split second decisions. This was the case last winter when my friend, we'll call him Mike, got injured while skiing at Mammoth Mountain. Mike is a very good skier who was spending most of the season learning the terrain park. Skiing the jumps in the park is all about having confidence. Mike did not have enough confidence for a particular jump, but a friend at the very last second convinced him to brave it. He did not take it with nearly enough speed and proceeded to land on the flat part of the jump. Two broken heels and a torn wrist ligament later, Mike found himself in Mammoth hospital about to have surgery. Mike is a tough kid, but he became uncharacteristically emotional as he was realizing how long it would be before he could walk again. That was when it hit me how such a quick decision on the mountain, could produce such an effect on someone's life. I truly got a glimpse at how delicate life is.
The next couple weeks in the hospital with Mike helped me realize another important thing about injuries; that they truly bring out who your closest friends are. A few of us spent a lot of time with Mike in the hospital and the weeks of rehab afterwards. We packed up all his gear and brought it and his car back to USC. At school, one friend who had a similar class schedule as him pushed his wheelchair between classes for about a month. And all of us helped him move all of his stuff into a new, wheelchair accessible room and take him to multiple, follow up hospital visits. He never had to ask for any of this, we just did it. Before the accident, we all were good acquaintances. Now we are all best of friends and many of us live together. Without that split second decision on the mountain, we probably would not be as good of friends as we are now.
Mike is completely healed now, besides having weak calves as a result of not using them for 3 months. We are all a lot more learned about surgery as well. If there is a learning experience to take away from an injury, it is that true friends will arise and help you through the struggle. And in a split second decision, so much of your life can be changed.
The next couple weeks in the hospital with Mike helped me realize another important thing about injuries; that they truly bring out who your closest friends are. A few of us spent a lot of time with Mike in the hospital and the weeks of rehab afterwards. We packed up all his gear and brought it and his car back to USC. At school, one friend who had a similar class schedule as him pushed his wheelchair between classes for about a month. And all of us helped him move all of his stuff into a new, wheelchair accessible room and take him to multiple, follow up hospital visits. He never had to ask for any of this, we just did it. Before the accident, we all were good acquaintances. Now we are all best of friends and many of us live together. Without that split second decision on the mountain, we probably would not be as good of friends as we are now.
Mike is completely healed now, besides having weak calves as a result of not using them for 3 months. We are all a lot more learned about surgery as well. If there is a learning experience to take away from an injury, it is that true friends will arise and help you through the struggle. And in a split second decision, so much of your life can be changed.
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