其實在好一陣子之前就有接觸到這種風格的簡報,第一次應該是在Taiwan 2.0的這篇以 OpenOffice.org Impress 實作「Lessig/Hardt/高橋」風格簡報看到的。所謂Lessig/Hardt/高橋風格簡報,如同文章內所述,是運用單一的文字或圖片作為視覺輔助,幫助聽眾把注意力放在講者的內容上。我非常建議大家可以看看範例,尤其是Dick Hardt的演講。我第一次看見這種簡報方式,佩服地五體投地,居然有人可以把簡報做到如此精彩。

自從認識了這個風格,心裡常存著一個念頭,想要逮到機會來實際試試看。最近在外科有許多運用簡報軟體的機會,我也趁機練習了設計投影片範本。昨天林子忻醫師指導的ATLS討論,我們組負責Shock的這一章,休克的基本概念大家都還算熟悉,我只要稍微喚醒大家的記憶,順便補充個幾點就好。於是運用這個機會,設計了一組簡報,共有110頁(有興趣的話可以下載來看)。經過幾次練習、修改,也對簡報的流暢度比較有信心一點。

想說可能是史來第一次有人在醫院用這樣的方式簡報,所以請poligen幫我錄影下來。感謝小泉的簡報筆,讓換頁可以如此順暢。



整體而言還算成功,但如同前晚排練時佑樺給的建議,老師也說中間穿插幾張圖片效果會更好。這種方式拿來傳達一個概念可能比較成功,當所述包含一些瑣碎的資訊時比較使不上力。看了影片才知道原來自己轉頭看螢幕這麼嚴重,會有點打斷報告的感覺,理想中最好前方還是能有個小顯示幕知道現在進行到哪裡。

在醫學院常常受到各種冗長簡報的轟炸,因此看見關於如何做好簡報的文章總會稍加留意。醫學院不比人文學院,上課沒辦法只靠說明理論就解決,不過仍然有好聽易懂的課和不知所云的課。有一些資源可以幫助你,像是這本「簡報藝術2.0」(小泉上禮拜有帶來)或是它的網站,還有一些好笑的影片教學檔案。祝大家簡報順利!

監測血糖的刺青

在網路上看到新聞,有一家公司研發出可以監測血糖的刺青!MIT的Technology Review也有一篇報導。

對於糖尿病患者而言,監測血糖濃度是必要但很辛苦的工作。目前的作法是在指尖上扎一個傷口流血,再用機器讀取血糖值。雖然說被扎一下是不會有什麼嚴重後果,但沒有人想要一天被針刺三次吧?要是能夠有這樣方便的監測方式,病人願意追蹤血糖的意願就會比較高。

根據這篇報導,皮下的染料含有許多奈米顆粒球,裡頭有三個部份:偵測葡萄糖的分子、可以變色的染料、以及一個擬葡萄糖的分子,這些分子在會球中跑來跑去。如果染料抓到真的葡萄糖,在紅外線下會變成黃色的;血糖濃度低時會抓到擬葡萄糖,呈現紫色。正常的血糖值看起來是「怪怪的橘色(funny orange)」。這個系統每幾毫秒就能夠偵測一次血糖濃度,比起現行系統迅速許多,也大大降低疼痛。

但是皮下組織的葡萄糖濃度,不見得可以反應血糖的濃度;有些研究指出皮膚葡萄糖濃度的改變甚至可以比血液的改變慢上20分鐘。另外植入奈米染料可能會引起免疫反應,而巨噬細胞又會改變局部的葡萄糖濃度,都是值得考慮的問題。雖然如此,血糖的改變方向仍然是個很好的指標。

這項科技目前還在實驗階段,即將開始動物實驗,實際運用到病人身上至少要兩年後囉。


這個細胞中注入了偵測鈉染料,發出紅色的螢光。

不過話說回來,你會願意去刺青呢,還是寧願一天扎三下手指?

The Tennis Partner

以下敘述可能提到部份劇情,但我相信不影響您閱讀時的樂趣。

The Tennis Partner的圖像
The Tennis Partner
Abraham Verghese

當初只是看了書名一時衝動借了這本書,開始閱讀之後卻有相見恨晚的感覺。如果你也對醫學有熱忱,推薦你看這本書;對網球有興趣者,也會喜歡這本書。以醫學作為畢生志向,又認定網球是一生離不開的牽絆的人,你有百分之兩百的理由看這本書!

網球在一個人的心中,究竟可以發揮多大的影響力?

堅叔曾經跟我們講過,生活中其實只有三件事情:學業、網球、愛情。我想他的意思是,生活中不見得只有這三件事情,但是這三者可以是我們生命的支柱,在挫折時支持我們。假設我們能夠努力紮實打下三個基礎,當重大的挫折不可避免到來時,就能藉由另外兩者定位自己的價值,而不至對自己完全失望。

當戀情分解碎為萬片時,過去的自己及過去的價值觀也隨之崩壞。現在的我到底剩什麼?過去的一切都是徒勞,所有的努力都是白費,想像的未來已經從掌心飄走。自己什麼都沒有,什麼都不剩,好像本來就不該存在這個世界。很多人在這時候會轉變成工作狂,因為那是唯一剩下抓住自己的機會。但我們更幸運:我們還有網球。

I sensed that he reached for the tennis the way I did, looked forward to our twice-a-week dates. This kind of tennis was healing, the rhythm of our to-and-fro drill perhaps as salutary as the church service he had missed. (P168)

Abraham是新到這個地方任教的內科教授。身為印度裔,來到一個新的地方,身為「外來」的感覺總是特別鮮明。與David的網球帶給他一股安定,一個期待下禮拜到來的理由。
Tennis was so much more than a game. What you saw—four people, a ball, and lines that determined whether a ball was in or out—was but an illusion. (P27)

Abraham用同樣的熱情擁抱醫學與網球,也在這兩個領域中發現神似之處。他在網球日記本中塗寫著網球的筆記,卻也是生活的紀錄,是他定義自己的一個方法。醫學與網球,在他的心中交纏。
At Wimbledon, they used white balls for the longest time.
The white ball was difficult to see on television. At times, during a point, your eyes lost it completely. Still, when that happened, your mind projected ahead, gave the ball a position in space based on the location of the player, the speed of the swing, the tilt of the racket face at contact, the sound of the ball coming off the strings, and the shape of the follow-through. But you could never define exactly where it was. [...]
What relief then when the ball, after this disappearance of a few milliseconds, appeared again. [...] I loved this separation-and-reunion feeling. It reminded me of what I loved about medicine: how a patient's words and the clues the body gave you were coordinates for a disease lurking below. The art of diagnosis was to plot the trajectory of the invisible disease and then, like a mongoose, feint, coax the serpent into striking, sidestep the fangs, and seize it behind the head, where it could do no more damage. (P37)

對我而言網球與生活之間的相似之處越來越多,而且大部份是在網球場上(更多是網球場邊)學到的再運用到生活上。在醫學上也有些突然間的領悟,然後才發現從 前怎麼這麼無知。一個好選手,應該要把自己的能力都整理好,而且準備好一整套的應對流程;碰上底線來回的對手該怎麼因應、上網型選手要怎麼對付、對手心態改變時該如何。這與醫師的養成是極度相像的:碰上發燒的病人該怎麼想,注意哪些事情,並且比病程更早預料到下一步的發展。

也許,醫學和網球之間,真的有些特別的關聯。
Keep the ball in play. Keep your eye on the ball. Follow through. These were admonitions for both tennis and life, and they spilled over from the one into the other. (P92)

一本好小說應該讓讀者起共鳴。我在書中不停不停地看到自己的影子;在Abraham身上、在David身上,看到腦中曾經盤繞過熟悉的想法在書中出現,總是讓我心頭一震。看到自己的形象在故事裡出現,讓我笑翻了天。
The two third-year students had no particular reason to be tense, but they had picked up the mood of their seniors, as if this were the right posture to adopt. So far the students' only introduction to clinical medicine had been a physical diagnosis course in Lubbock; for practice they had, for the most part, examined one another. [...] Now here they were with brand-new coats, their pockets stuffed with flashlights, stethoscopes, reflex hammers, and little "peripheral brains"--condensed versions of the bigger tomes they were supposed to read at night. They looked much like first-time skiers who had managed to get onto the ski lift, but now, as the crest of the mountain appeared, still had to figure out how to get off and not fall flat on their asses. (P66)

引起共鳴的不只網球選手與醫學生,還有「朋友」的角色。故事的後半兩人都遭逢生活上的變故,雖非生離死別,但都是精神上的一大打擊。作為一個「人」所面臨的抉擇、掙扎,我閱讀時心有戚戚焉。
"Within your secrets likes your sickness." (P341)

當意識到朋友正在往一條毀滅性的道路走去,該如何反應?我們對於朋友究竟有多少的影響力?歲月的歷練真的讓我們更懂得處理這些抉擇嗎?身為David的搭檔,同時也是教授的Abraham,在細微處已瞟見徵像。David不想進入內科,而嚮往急診、外科快速而刺激的生活,但Abraham心裡清楚那種充滿壓力的生活只會讓他的毒癮再犯。身為教授,能夠干涉他的選擇嗎?David的感情生活主宰了他的情緒,但性格上的缺陷卻使他在感情上不停受挫,吸毒又讓惡性循環繼續下去。這個事實對Abraham來說再清楚不過,David卻渾然不知。作為搭擋和一個朋友,他是否應該要努力拉他一把?朋友的權限有多大,應該可以影響到什麼層面?
Abraham自己的生活也非完美,那他有資格來「矯正」David嗎?
"He isn't exactly innocent, Mickie," I said. "You know that, don't you?"
"Ah, but he is, Abraham. He isn't innocent about the world. In fact, he knows too much about the world. Yet he knows nothing about himself." (P232)

最後Abraham選擇不介入,因為對David有信心,放手讓他自己決定。靜靜地看著他在外科的影響下變得疲累;和女朋友的關係時好時壞。終於大家害怕的,卻又無可避免的錯誤出現了:他又用了毒品。一組不同的問題又浮現:既是朋友又是師長,要不要舉發他?尤其是在醫院裏人命關天的地方。但他也很清楚,這已經是David的第二次機會,他不會再有下次機會了。
If I was ever going to turn him in, the moment for that had passed. The fact that I was debating what to do, engaging in a dialogue with him, gave me away: I had already capitulated. It was surprising now to realize that being his senior in the medical-school hierachy really meant nothing. When the heat was on, as it was now, the role that we had both slipped into, that defined us, was that of friends, equals. His superiority on the tennis court or mine in the hospital were superflouous. It was because I was his friend that he had replied honestly when I'd asked him if he had used.

不論你扮演什麼角色,人生是一場掙扎。我們面對許多紛擾,外界的驟變、內心的洶湧、離開的戀人與不能抗拒的命運。人生需要一個錨,一個恆定不改變的元素。可惜世上真正不改變的東西少得可憐:親人伸出的愛、朋友間堅定的手臂,還有底線間來回的網球,一次、一次、又一次。


 

Copyright 2006| Blogger Templates by GeckoandFly modified and converted to Blogger Beta by Blogcrowds.