Viraj's Weblog

I picked up a cool external storage device called a Drobo. It's marketed as a 'storage robot', but there are no robotics involved. They use a proprietary RAID-like scheme that typically gives you more storage than the various RAID levels. The price is reasonable too: $499.

Are there any problems? Well the only issue I have is with the noise. That thread does not exaggerate at all; this thing sounds like a blowdryer/jet engine when the fan kicks into high, which is almost random. For what I'm using it for, in a home theatre setup, it's really unacceptable. So I took advice from one the posters on that thread and decided to open it up and replace the fan with something quieter. It turns out the fan in the unit is a Sunon PMD1208PTB3-A and is 3900 RPM, 49 CFM, and 42 dBA! That is ridiculously loud. I bought a Vantec SF8025L from Fry's which is rated at 2050 RPM, 27 CFM, and 21 dBA. The Drobo was rather cumbersome to take apart, but not too bad. I had to splice in the fan cables because it had a non-standard fan connector, but once it was in it worked pretty well. It's much more quieter now. Of course it's a lot less airflow, but I honestly don't care. It was simply unbearable in its previous state.

Now I hope my place doesn't catch on fire . The drives are hot, but not exceedingly.

This past weekend I took a trip to Baltimore to attend a friend's wedding. It's the first time I've been in Baltimore, and I enjoyed it. I went to the famous seaquarium and the amazing Walters Art Museum. They've recently made it free admission, and I highly recommend it if you like museums. The wedding was fun, and I sure drank alot of Russian vodka!

Here's a good interview with Michael Moore on his new movie Sicko.

I've been a big fan of Atul Gawande, and loved his book Complications. It was one of the books that inspired me during my premed studies.

I had a chance to attend a talk he gave at Google, and as is usual for such talks, got a free copy of his book Better: A Surgeon's Notes on Performance. He writes with real honesty and detail which makes a fascinating read if you are into anything medical. Better is about, just as it sounds, improving and gauging the performance of physicians. Right now there is really no good way the public can know how well their doctor performs. Hospitals don't even report mortality to the public, so we can't even know how good a hospital is.

My favorite chapter has to be The Score, where he discusses childbirth and the Apgar score. This simplistic scoring system revolutionized the way obstetricians could quantify how well they were doing relative to others. It created a drive for physicians to do better, to get a higher score. The chapter interweaves a story of a woman determined to have a completely natural childbirth, but complication after complication results in her questioning whether she wants to go through the pain. It also talks about childbirth itself, the various positions babies can be born in, and what doctors must do in such cases. It turns out the methods for getting babies out were really invented and honed by midwives, who received little credit for their work.

He also talks about the efficiency of the Walter Reed medical facility and Iraq casualties. This is medical performance taken to an extreme, where patients enter stages of treatment in an assembly-line like fashion. The doctors on the forefront do only what is necessary to get the patient stable, perhaps leaving their bodies completely opened up, and then flying them to a hospital in another country. Doctors there do more work on the patient, perhaps stabilizing him/her even more, then off to another location. Throughout the whole process doctors keep impeccable reports on the patient so everyone is tightly in the loop. It's all perfected to reduce mortality, and it works.

But there is a problem here, and it is hinted at only slightly in the book. True, the mortality rate of injured soldiers from this war going through the medical facilities is possibly the lowest ever, but what does this truly mean? People can come back with all limbs removed. This person has not died. He does not contribute to the mortality number. But what about this person's quality of life thereafter, as a veteran with his body torn apart? Will he/she have a happy life in such a state?

This I feel is the real problem with hospitals trying to reduce 'mortality.' It sets the stage for doctors doing everything possible to keep a human alive, with little concern for the future of that patient. As long as the patient is out the door alive, things are all wonderful. It gets the doctors a high score, and makes the hospital look good. But what about the patient's quality of life? Is the technology to keep the soldier with all limbs blown off alive a blessing or a curse?