The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.
In 2012, more than 61,000 babies in the U.S. were conceived with the help of IVF, the Society for Assisted Reproductive Technology reported Monday.
That means IVF babies made up 1.5 percent of the 3.9 million births in the U.S, the agency wrote on its website. And it makes 2012 the biggest year for IVF on record: Doctors performed the most procedures and delivered the most IVF babies.
Over the past decade, the number of IVF treatments has been rising. Doctors performed about 113,000 cycles back in 2003. That number jumped by nearly 50 percent to about 165,000 in 2012.
Video: A new instrument, called an Embryoscope, allows fertility doctors to watch the embryo develop after in vitro fertilization. In the video, you can see the embryo go from the first cell division to the blastocyst stage when the cells move to the outside. The time-lapse video takes about five to six days in real time.
More than a decade of research on children raised in institutions shows that “neglect is awful for the brain,” says Charles Nelson, a professor of pediatrics at Harvard Medical School and Boston Children’s Hospital. Without someone who is a reliable source of attention, affection and stimulation, he says, “the wiring of the brain goes awry.” The result can be long-term mental and emotional problems.
A lot of what scientists know about parental bonding and the brain comes from studies of children who spent time in Romanian orphanages during the 1980s and 1990s. Children likeIzidor Ruckel, who wrote a book about his experiences.
When Ruckel was 6 months old, he got polio. His parents left him at a hospital and never returned. And Ruckel ended up in an institution for “irrecoverable” children.
But Ruckel was luckier than many Romanian orphans. A worker at the orphanage “cared for me as if she was my mother,” he says. “She was probably the most loving, the most kindest person I had ever met.”
Then, when Ruckel was 5 or 6, his surrogate mother was electrocuted trying to heat bath water for the children in her care. Ruckel ended up in an institution for “irrecoverable” children, a place where beatings, neglect, and boredom were the norm.
Researchers began studying the children in Romanian orphanages after the nation’s brutal and repressive government was overthrown in 1989. At the time, there were more than 100,000 children in government institutions. And it soon became clear that many of them had stunted growth and a range of mental and emotional problems.
When Nelson first visited the orphanages in 1999, he saw children in cribs rocking back and forth as if they had autism. He also saw toddlers desperate for attention.
"They’d reach their arms out as though they’re saying to you, ‘Please pick me up,’ " Nelson says. "So you’d pick them up and they’d hug you. But then they’d push you away and they’d want to get down. And then the minute they got down they’d want to be picked up again. It’s a very disorganized way of interacting with somebody."
The odd behaviors, delayed language and a range of other symptoms suggested problems with brain development, Nelson says. So he and other researchers began studying the children using a technology known as electroencephalography (EEG), which measures electrical activity in the brain.
Many of the orphans had disturbingly low levels of brain activity. “Instead of a 100-watt light bulb, it was a 40-watt light bulb,” Nelson says.
As the children grew older, the researchers were able to use MRI to study the anatomy of their brains. And once again, the results were troubling. “We found a dramatic reduction in what’s referred to as gray matter and in white matter,” Nelson says. “In other words, their brains were actually physically smaller.”
The scientists realized the cause wasn’t anything as simple as malnutrition. It was a different kind of deprivation — the lack of a parent, or someone who acted like a parent.
Top photo: Izidor Ruckel, shown here at age 11 with his adoptive father Danny Ruckel in San Diego, Calif., says he found it hard to respond to his adoptive parents’ love. (Barry Gutierrez for NPR)
Middle photo: In the Institute for the Unsalvageable in Sighetu Marmatiei, Romania, shown here in 1992, children were left in cribs for days on end. (Tom Szalay)
Bottom: Izidor Ruckel dons a hat of a style common in his birthplace, Romania. He now lives in Denver. (Barry Gutierrez for NPR)
The Morphology of Human Blood Cells (1956)
Dorothy Sturm’s beautiful watercolors are difficult to distinguish from an actual microphotograph (except perhapsthey are clearer and more detailed than a micrograph, and certainly superior to images from the 1950’s). Sturm’s watercolor on paper illustrations, drawn directly from Wright-stained smears prepared by [microbiologists], depicted normal, pathological and infectious hematology with a clarity, detail and beauty that photomicrography of the 1950’s simply couldn’t approach. JAMA, in a review of the first edition, even called her work “of exceptional quality.”
 This table showing hematopoiesis (as it was understood in 1956) was the frontispiece of the first edition of Diggs’ The Morphology of Human Blood Cells. Here’s the key to this illustration.
 Cell types found in smears of peripheral blood from normal individuals
 Blood parasites
 Fat cells
 Megakarocytes and thrombocytes
A intussuception as seen on CT
An intussusception is a medical condition in which a part of the intestine has invaginated into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another.This can often result in an obstruction. The part that prolapses into the other is called the intussusceptum, and the part that receives it is called the intussuscipiens.Early symptoms can include nausea, vomiting (sometimes bile stained [green color]), pulling legs to the chest area, and intermittent moderate to severe cramping abdominal pain. Pain is intermittent not because the intussusception temporarily resolves, but because the intussuscepted bowel segment transiently stops contracting. Later signs include rectal bleeding, often with “red currant jelly” stool (stool mixed with blood and mucus), and lethargy. Physical examination may reveal a “sausage-shaped” mass felt upon palpation of the abdomen.
Texas A&M Health Science Center College of Medicine second year students embark on a nostalgic journey, reliving their first year of medical school in a dream world where Queen’s Bohemian Rhapsody becomes…MED SCHOOL RHAPSODY
Trying to introduce the study of the brain to a bunch of students, I said: “If everything we needed to know the brain about a mile … how far have we walked in this mile?” I got answers [like] 3/4 of a mile… half a mile… quarter mile. And I said, “I think about 3 inches.”
When it comes to the nervous system, there are a large number of diseases where the only real sign that there’s something wrong is the outward manifestation of the disease — the person is acting crazy, or they don’t seem to learn very well, or their movements are disordered in some way. But if you look at the brain with most of the techniques we have, there’s nothing to see.
You’ve gotta see the wires — just have to see where they come from, where they go, what they connect with…
National Geographic looks at the wiring of the brain in exquisite 3D renderings of every synapse, exploring how parts of the brain communicate with each other and animate us.
Lung in a box. Very cool.
To extend the time an organ can last before it’s transplanted into a recipient, engineers have developed the Organ Care System — which is essentially a box pumping blood and oxygen to the lung.
As Gizmodo explains:
What’s especially neat about the OCS is that they can actually be used to improve imperfect donor lungs by flushing it with antibiotics and nutrients. Like refurbishing a lung, sort of. Putting donor lungs through the OCS helps increase and improve the number of potential donor lungs. Not every donor lung is usable, donor lungs that go through the OCS may be.
Go into almost any hospital these days and you’ll hear a constant stream of beeps and boops. To most people it sounds like medical Muzak.
But to doctors and nurses, it’s not just sonic wallpaper. Those incessant beeps contain important coded messages.
"The three-burst is a crisis alarm," systems engineer James Piepenbrink of Boston Medical Center explains on a tour of 7 North, the hospital’s cardiac care unit. That might signal that a patient’s heart has gone into a potentially fatal arrhythmia or even stopped altogether.
"Two tones is a warning," he says. That can mean something ominous — or nothing worth worrying about.
Alarms are good and necessary things in hospital care, except when there are so many of them that caregivers can’t keep track of the ones that signal a crisis that requires immediate attention. Then it may be that less technology can actually be more effective.
In the case of Boston Medical Center, an analysis found that 7 North was experiencing 12,000 alarms a day, on average. That kind of cacophony was producing a growing problem known as “alarm fatigue.”
"Alarm fatigue is when there are so many noises on the unit that it actually desensitizes the staff," says Deborah Whalen, a clinical nurse manager at the Boston hospital. "If you have multiple, multiple alarms going off with varying frequencies, you just don’t hear them."
That can be dangerous. Patients can die when an important alarm is missed, or an electrode on a patient’s chest comes unstuck, or a monitor’s battery goes dead.
Boston Medical Center hasn’t recorded any patient deaths because of alarm failure, but, Whalen says, “we were lucky.” A Boston Globe investigation in 2011 found more than 200 deaths nationally related to alarm problems. Last year, the Joint Commission, a national quality-control group, warned of 98 alarm-related instances of patient harm, including 80 deaths and 13 cases of permanent disability.
The known alarm-related problems are just the tip of an iceberg, according to Dr. Ana McKee, the Joint Commission’s chief medical officer, because such cases are seriously underreported.
"It is pervasive in almost any accident that occurs in a hospital," McKee says. "If you look carefully, you will most likely find that there was an alarm as a contributing factor."
That’s why the Joint Commission has put alarm problems at the top of its current list of issues that hospitals are expected to tackle.
Photo: Amanda Gerety, a staff nurse at Boston Medical Center, checks monitors that track patients’ vital signs. Fewer beeps means crisis warnings are easier to hear, she says. (Richard Knox/NPR)
Before Syria’s civil war, there was no real need for a clinic that could teach the disabled how to walk on artificial legs. Now there’s huge demand, not only for the legs, but also for training.
Photo: Deborah Amos/NPR
[Johns Hopkins neuroscientist Michael] Yassa’s research team gave people 100 to 300 milligrams of caffeine after looking at some images. The next day, those who got 200 or 300 milligrams of caffeine remembered the images better than people who took a placebo. “We report for the first time a specific effect of caffeine on reducing forgetting over 24 hours,” Yassa said. “We conclude that caffeine enhances consolidation of long-term memories in humans.”
Scientists find that in addition to sharpening short-term attention and alertness, caffeine can improve long-term memory consolidation. There is, however, a tipping point – go over a certain dosage (200 mg, or the equivalent of one strong cup of coffee) and you might experience “some unfortunate side effects.”explore-blog)
Primary care physicians report that anxiety is one of the most frequent complaints driving patients to their offices — more frequent, by some accounts, than the common cold.
Few people today would dispute that chronic stress is a hallmark of our times or that anxiety has become a kind of cultural condition of modernity.
December is supposed to be the time of year filled with family gatherings and holiday good cheer. For medical residents, quite the opposite is true.
There are no school breaks during residency. Being a medical resident is a real job, and a stressful one at that. Residents work long shifts, even with caps that max out at 16 hours for the newbies and up to 28 hours for those beyond the first year.
For many of our trainees — especially those fresh out of medical— this will be the first holiday season without time off.
I remember lamenting my first December having to work straight through. A wise mentor helped me reframe my self-pity.
"It’s a privilege to work on Christmas," he told me. "Our patients count on us. You may not want to be in the hospital, but think of what they’re going through." He smiled, as if he were welcoming me to a special club, one that I wasn’t wholeheartedly ready to join. "Your mere presence helps reduce each patient’s sense of loss."
I was rotating in intensive care, where the outlook for patients can be quite grim on any day, regardless of the season.
A 30-something patient I’ll call Will was brought in after paramedics found him unconscious on the street.
He was in a coma. We didn’t know the cause, but set to work trying to give him every opportunity to arise from the slumber of his critical illness.
I was on the rotation with two other interns. We took turns spending nights in the hospital — each of us taking every third night on call. The first night, my buddy Paul spent the night at Will’s bedside trying to figure out a way to replenish his body with fluid, given the massive output that was draining into his urine bag.
Will had suffered a brain injury. One effect was diabetes insipidus, a condition that meant his kidneys couldn’t hold onto his body’s water. The result can be rapid dehydration and death.
Illustration by Katherine Streeter for NPR