Mars is closer than it will ever be (in our lifetime, at least).

Kevin Kling of NPR gives a highly accurate recollection of a marathon experience (RealAudio).

Today is the 56th anniversary of India’s Independence from Britain. Interestingly, Google’s top results for “indian independence day” are not very informative - mostly just greeting card sites.

The power finally came back on at around 7:20 PM tonight. I was sitting on my futon trying as hard as I could not to sweat, when I heard a loud cheer from the courtyard and saw that the lights had gone on in the apartments outside my window.

It’s been a weird couple of days. The power went out around 4:15 PM yesterday while I was looking up some labs in the preceptor’s room. The A/C had been on full-blast, so we all thought that it was just an overloaded circuit, but soon we got word that nearby buildings were affected and everyone went smoothly into disaster-mode. Take care of any urgent patient needs and encourage everyone else to go home. No staff leaves until we know what’s going on. Around 6:30, we got the word that whoever was within walking distance could go home, provided that they be back first thing in the morning. I figured 4 miles is walking-distance, so I left. From the 80’s to around 63rd St, 2nd Avenue was packed with cars trying in vain to get to the Queensboro bridge. Traffic lights were off, but it didn’t seem to matter since the cars weren’t moving anyway. Civilians were trying to direct traffic with varying success. The cars obeyed, but pedestrians were on their own schedule. From the Queensboro down to the 40’s, pedestrians replaced the cars and swarmed over the street.

I got to my neighborhood around 8ish. Most of the local shops were out of flashlights and running low on water. I swear the people at the counter were just making up prices as they went along, but no one really seemed to care. After getting settled at home, I went for a short walk outside around 10PM. I was shocked at how dark New York was without any lights. You could clearly see the stars in the sky. It was dangerous to walk around without a flashlight because there would be people just sitting on the sidewalk waiting to be tripped over.

But everything is back to normal now and the only casualty is my uptime

Update:

• Satellite pics via Badgertronics
• Lots of more interesting stories via BoingBoing

Girish has put up some pics from the Seattle trip and other family events.

An article in the NY Times claims that ‘6 degrees of separation’ is an exaggeration. They tested it by asking people to forward emails to people that they knew in hopes that the chain would eventually lead to 1 of the researchers' destinations. I know that I delete any chain mail that I get, so I’m not sure that the study’s results are valid.

Let me provide an anecdotal rebuttal. I went to Subha and Archana’s wedding in Chicago last weekend and I’m guessing there were 400 people there. I met about 20 people whom I hadn’t met before. Of those, 2 had links to me through people who had nothing to do with the wedding. One was a cousin of Sushil, my good buddy from Boston. The other one is a little more convoluted. My cousin Deepu was the inspiration for the name of a musical group when he was at Wash U in St. Louis. Deepu has since moved on to San Fran, so the group has changed its name. A person I met at the wedding is currently a member of that group and has always wanted to meet the infamous Deepu, whose name is plastered over the other members' instruments.

Now, does being connected through a band’s name count as a degree of separation?

Another interesting article in the Times today. Lo and behold, the annual physical exam is useless. Shocking, huh? Well, no - not really. The first questions about the annual physical cropped up 20 years ago and recent studies have only confirmed these initial doubts.

So, do I perform annual physicals? Yup. Why? A few reasons…. As a relatively young doc, I think it’s important to examine LOTS and LOTS of normal patients in order to get a firm sense of what’s normal and what’s abnormal. And even if I were 100% confident in my physical exam, I would still want to keep those exam skills sharp.

The annual physical is also a great time, if not the only time, to discuss preventive care with patients. Acute care visits are already rushed and sick patients aren’t the most receptive listeners.

Patients in my community are underserved as it stands - getting rid of annual physicals would only contribute to patients getting lost in the system.

Finally, and most importantly, performing annual physicals makes me look like a doctor. Patients expect annual physicals and I’d look like a quack if I didn’t perform them, regardless of how much science is backing me up. This is one of those classic “Art of Medicine/Science of Medicine” intersections. In order to be able to practice the Science of Medicine effectively, we need to compromise on the scientific purity a bit, for the sake of the Art of Medicine.

“I still listen to everyone’s heart,” said Dr. Stewart Rogers, an internist at Moses Cone Hospital in Greensboro, N.C. “Why pick that fight? Why try to explain 10 years of evidence-based medicine so the patient will understand why I didn’t do that test? The reason to listen to hearts is that it establishes our priestly majesty when you tell them about smoke alarms.”

That being said, I do try to explain to patients that not all tests are necessary and can in fact be harmful, but I’m not dogmatic about it.

It was pouring, monsoon-style here in NYC today, but I went running anyway. When it’s raining, no one else is out, so I get the path to myself. And jumping over (or through) the puddles makes me feel like a tough guy. I swear I can hear the Rocky theme song when I run in the rain. The only bad thing about running in the rain is that the always-stunning midtown skyline gets obscured by the clouds.

I haven’t run outside since July 13th when my knee started hurting. I’ve run on the treadmill a couple times this week and my knee felt fine, so I decided to hit the pavement today. I ran to the East River and all the way down to the South Street Seaport. About 8 miles in 90 minutes. My knee was a little sore at the end but it feels fine now.

A young guy came in as a walk-in with some mild shortness of breath on exertion and associated chest pain. He was the last patient that I saw during a long, busy day and his symptoms were very mild. I was thinking that maybe he had mild asthma or a respiratory infection, but he didn’t look sick at all. Then I listened to his heart. A loud holosystolic murmur throughout with a fixed split S2. Wait, wait. I know this one…. (sounds of my mind clunking along) ASD - Atrial Septal Defect (Patient Information).

He had his echocardiogram today which confirmed that he had a large ASD (We don’t need no stinking echo!). He’ll be going to Bellevue for repair and most likely will do very well. I explained everything to him (in Spanish “un agujero in su corazón”). It’s times like these that make me glad that I get to do what I do.

We went whitewater rafting in Pennsylvania in 2000, sea-kayaking in North Carolina in 2001, and death-marching (er… hiking) in the Grand Canyon in 2002. This year, we chose kayaking and hiking in Seattle.

We went kayaking near the San Juan Islands on Thursday. It was a great upper body workout and our guide Martine was a fountain of information. We saw some harbor seals close up and a bald eagle from afar. We (well some of us) were really hoping to see whales, but unfortunately, they didn’t cooperate.

On Friday, we drove south to Mt. Rainier. The skies were overcast in Seattle but they conveniently cleared up just as we neared the park. The views were breath-taking (or was that the hiking?). We trekked around Paradise (yup that’s what it’s called) along a path that Manu picked out. It was challenging, but we wouldn’t have it any other way. One of the climbs took us to the top of the cliff where Manu warned Noel, “If you fall, Anita won’t let you join us next year!” After a quick well-deserved soak in the hotel’s outdoor jacuzzi, we finished the night with some amazing sushi at Shiro. Everything was great but I could’ve done without the Uni (sea urchin) - those who didn’t eat it seemed to enjoy it the most.

On Saturday morning, we played our annual basketball game. Because of some logistical details, I had the fortune of playing on the young-guys team in game 1 and the old-guys team in game 2. My team lost both games, thus graciously providing both the oldies and the kiddies with bragging rights. I took a few movies - Harish making a shot, Girish with a tough shot, and Dilu with some fancy dribbling.

After basketball, we ate brunch at the Space Needle and took in the great views of Seattle and Mt. Rainier in the background. Saturday was a day to relax and take in the city without exercising too many muscles.

I’m skipping over a lot of details, but the bottom line is that I had an amazing time. It’s always more fun than I imagine it could ever be. I can’t wait til next year.

See Manu’s site for some more pictures.