Joseph F. Clark, Ph.D.

Remember My Graduate Education will be published on my blog starting August 15th just in time for going back to school. Please keep reading my blog so you do not miss a chapter.

Here is the table of contents:
Introduction
Foreword
Chapter 1 – My Career as an Athletic Trainer
Chapter 2 – The Cost of a Broken Door
Chapter 3 – Road Trip
Chapter 4 – Reverse Road Trip
Chapter 5 – Research to Help People with Graduate School
Chapter 6 – Jock Strapping and Ship Jumping
Chapter 7 – Duties of a Graduate Research Assistant
Chapter 8 – First Date
Chapter 9 – Research: Data Are Plural
Chapter 10 – Moving In
Chapter 11 – The Challenge of the Comprehensives
Chapter 12 – My First Scientific Meeting
Chapter 13 – Planning a Future and Making a Discovery
Chapter 14 – Meeting Her Family
Chapter 15 – My Future Boss Visits Michigan
Chapter 16 – My Data Go Primetime
Chapter 17 – Two More Weddings and a Tragic Death
Chapter 18 – The Lighter Side of Being a Graduate Student
Chapter 19 – Leaving on a Jet Plane

So as many of you know I write a lot for this blog, for my work, books, text books etc. Much of this writing requires contracts, copyright, waivers, certifications, attribution, financial disclosures etc etc. I have about 100 peer reviewed articles, about 50 other articles, 4 different books, book chapters, blogs, podcasts all out there in the public domain. I also write a tremendous number of grants that are submitted to various funding agencies. That is a lot of writing.

With all this writing and publishing I have a bit of experience looking at publishing contracts. Recently one came to me with an interesting indemnification clause. Indemnification “As a legal concept … it means to compensate another party to a contract for any loss that such other party may suffer during the performance of the contract” (Wikipedia). If something in a contract screws up and it is my fault I guess I should be responsible. But indemnification in a publishing contract can have results that are quite broad.

For example, if I were to sign a publishing contract for a medical article, where I agree to indemnify the publisher for a liable suit, I would have to pay for damages to someone who randomly decides to sue. Remember anyone could sue any other person for any reason. Say in this medical article, I use fake medical scenarios with fake patients; but a person with a disease reads it and thinks a hypothetical patient reflects them and they sue me and the publisher. I will fight the suit because the scenario is made up. But if I signed an indemnification clause in a publishing contract, the publisher could unilaterally decide to plead guilty, settle the case and pay any damages. It makes no difference to them, I’m paying. By signing the indemnification clause, I am basically writing the publisher a blank check.

What astonishes me is that publishers, in a difficult publishing market, put such things into contracts and call them, “standard” contracts. When I write an article, accepting no payment, while trying to educate medical professionals in saving lives; I should not be expected to take on an unlimited financial liability. I guess some people sign off on them, but I will not. It is pretty much caveat emptor.

I received a heart breaking email recently. Frankly it made me cry. There are a lot of patient confidentiality details I must withhold but it is worth expressing this story.

A care giver emailed me concerning a loved one he/she is taking care of (for ease of reading, this person will be female and the patient; her daughter). She had read about some research I published several years ago that might be used to treat her daughter. The clinical case she presented was in line with the research I am doing and that research had progressed a long way in the last few years. The key question this mother had was did we have a treatment yet.

Well the answer is difficult. I have a compound that I know (am positive) will work but it is not ready for patients. I dare not give false hope to this woman but there are absolutely no treatments. She knows her daughter is not going to recover without treatment so there is desperation for her. The compound I have is experimental and not approved for humans with this condition. We do not know what dose will work or what side effects to watch out for. So we are not ready to go to clinical trials.

This is very sad.

Please remember I’ve blogged about some people experimenting on patients too soon, and I’m opposed to doing that here, but what do I tell this woman? By the time my research is ready for her daughter; it will be much too late. Doing nothing to help her is tearing me apart too. But if I were to say treat with compound X there are many questions I could not answer like: how much, for how long, what do we watch for, when will we know if it will work, how much will it cost and all the things people expect from a drug; but we do not know yet. Answering those questions is the life of a researcher like me but it does not help this woman.

I know this is hurting her and it is affecting me too. But I’m stuck. I can’t tell her about what we are studying but I also do not want to ignore her. I’m left with telling her that there is hope on the horizon, but it is not ready yet. I really do not know when it will be ready, but it will not likely be ready for her daughter. That is going to be hard to say.

Oh and did I mention that I have applied to the NIH 3 times to develop this treatment for patients and it has been rejected every time? I’m trying to get companies to work with us on this too, but right now we are funding this on our own. This woman’s email convinces me even more to push forward with this work if not for her for the next passionate mother.

For the fans of big bang theory here is a note to make you miss the show more until next season.  

  
I firmly believe that the show’s characters are believable and may be based on real characters, some of whom I have known and worked with. My back-story here is I lived and worked in Oxford University in the Department of Biochemistry. I did Nuclear Magnetic Resonance research and worked with some brilliant minds – several modeled in the Big Bang Theory. Below I will discuss Leonard, Sheldon, Raj and Howard, as well as Leslie Winkle and how my Oxford friends match them.

Let’s just start with Sheldon. If anyone thinks that Sheldon’s character is extreme think again. I can assure you that a person with a genius intellect, likely child prodigy or savant, could most definitely be SO socially inappropriate. I knew a physicist who worked in Chemistry in Oxford University and claimed, “life started at the Schrödinger’s Equation” for him and he meant it. If a person said she raised rabbits as pets he would extol the virtues of hasenpfeffer saying rabbits were tasty and tender; being inconsiderate and insensitive but not trying to be mean. He had Sheldon like neuroses concerning driving and would never take a hand off the steering wheel – gripping it like a toddler hanging on to mom’s fingers. He would go the speed limit exactly maintaining that speed until he was much too close to the car in front of him relenting to slow down only at the last minute by slamming on the breaks; claiming it best to maintain speed and only slow when necessary. He had an identic memory and could recite movie lines often completing casual sentences with the movie lines of random movies he happened to recall fit those lines in the conversation. So I would be talking to him and string three words together that may have come from Aliens and he would then continue those lines from the movie. Truthfully, I think he did it as an excuse to shut me up. This guy was about 6 foot tall, 90 pounds, long hair down to the middle of his back and finger nails each a minimum of one inch long. The nails were clean and pristine because he constantly was cleaning them. He would type using the tips of his finger nails and loved to make as much noise as possible on the keys. This is a real person I had to dinner at my place on numerous occasions. He was serious entertainment in small doses.

 
Okay how about Raj. Poor Raj with selective mutism being unable to talk to females without drinking. I had another colleague in Oxford who was just like that. He was a centerpiece in all the guy activities and a wall flower when females were around. The one and only time I know of that he asked a woman out on a date, she was sitting next to him in the computer lab and he sent her an email asking her to the pub. She said yes and they were married about a year later. It was a lovely wedding.

   
Howard is almost too easy because his awkward desire to meet and be with women is typical of too many of us. Sad to admit it, but yes. Anyway, my personal friend who most reminds me of Howard is a guy I used to play soccer with in Oxford. He was a gifted engineer and, like Howard making the space toilet, could make anything from the most random bits of lab “junk”. Us guys would go to the pub and he would buy drinks for the American Tourists trying to impress the women by flexing his brain muscles. Also, like Howard, he was a masters student amongst Ph.Ds. Like Howard he felt somewhat inferior because of that, but he did eventually enter the Ph.D. program and obtained his doctorate. Interestingly the degree never changed the dynamics amongst us. My Howard analogy would also make comments to woman about what he thought of the “size” of his friends’ anatomy. Showering after a soccer game with him most of us just would face the wall to avoid being judged a grow-er or a show-er.

    
Let me mention Sara Gilbert’s character, Leslie Winkle. Again, my personal analogy is even more extreme than Leslie on the show. My friend and colleague was a senior Ph.D. candidate in Oxford when I met her. She was in a position of power and authority in the system for multiple very valid reasons. This woman was competent and confident in many ways. Her behavior towards men matches if not exceeds the interactions of Leslie and Leonard. My colleague had a very well known “friends with benefits” relationship with another student her junior. He told me it was a bizarre situation, in that she propositioned him with a list of pragmatic conditions that he could accept or reject – non negotiable. He accepted and they pursued it until he entered in traditional and monogamous romantic relationship. The friends with benefits ended between them with no emotional ties, but with the door was left open to reengage if the opportunity should arise. I was told she moved on to someone else.

    
Leonard! Leonard is who all of us geeks want to be. He is pretty much the best we can hope for. His awkward relationship with Penny is a reflection of how many of us interact with “normal” people. To be blunt, for a geek; Leonard is too good to be true. He has his feet in both worlds and that is very hard to do. Usually we are like fish in the fishbowl looking out at the big ol’ world but we’re stuck in this microcosm of science and technology. If more of us could be like Leonard, we would not need to go to scientific meetings and socialize with people from other fishbowls. So regarding Leonard there is a little bit of Leonard in all of us. We more or less know we are different, wish we were not so different and try little forays into the land of Penny. Usually those are unsuccessful.

Yeah, I wish I could be more like Leonard.

On July 25th 2005 my siblings and I were called to my father’s hospital bed. He had had complications from a surgical procedure and summoned us all there. So per his request, Dad’s live in girlfriend Deb call us. He was dying. We were scattered over three states: New York, Michigan and Ohio. We drove and flew to him as quickly as possible. Within hours of the call we were all at his bedside. He was conscious and alert but in obvious distress. I’ll skip the medical details but his condition was serious. My sister brought her kids too; to see their grandfather. I could tell that he was happy to see his grandchildren. While young and scared they were very mature and comforting to my father.

I’m the only one in the family with medical training and I acted to communicate with the hospital and the family. I also communicated with some of my colleagues from work about the right care. The care at that time was supportive and appropriate for the situation, but he was failing.

Dad could communicate with a little effort and he tried to comfort us. We spent quite a bit of time with him in the intensive care unit. In consultation with Deb, my family I made our wishes known clearly to the medical personnel to ensure care and endorsed resuscitative efforts as he was not DNR (do not resuscitate). We wanted dad to pull through this.

Visiting hours were over so that dad could get some sleep and we were advised to go to dinner and return later. I told dad our plans and the family all said goodbye. I was the last one to leave my father’s side. I was holding his hand, kissed him, said I love you and said goodbye. He held my hand tightly for a few moments, said goodbye and as I looked into his eyes I knew. This was the last goodbye.

Somewhat in a fog I went to the hall with the family and tried as delicately as I could to say that I thought dad was saying goodbye to us as a last goodbye. He wanted to see us and he was ready to go. I’m not sure if they got the impression I had, but the plan was to go home and let dad get some rest, which we did.

About an hour later the phone rang at the house and the doctor asked for me. According to the doctor, Dad had gone into cardiac arrest almost immediately after we left. They did what I told them to do to resuscitate him and those attempts were not successful. The doctor wanted to know if we were going to come back to the hospital and say goodbye again and I said yes. I now needed to break it to the family.

Breaking the bad news sucks. But that is what I did. I had seen many families be told of the loss of a loved one and it sucks to watch and it hurts horrendously to be part of it. It may have been those years on the ambulance where I’ve seen patients give up and effectively know when it is over, like what dad did. I think my brother was not too surprised because he could read my face fairly well when I got off the phone – we are 15 months apart in age so you kind of get to reading one another. My sister is 3 years younger and both she and Deb were surprised that dad had gone so quickly. I did not give them the detail that he was probably in cardiac arrest when we were still in the parking lot.

We took some time to grieve and put ourselves together. My sister and brother-in-law told their kids. We piled back in the car and went to the hospital to say goodbye to dad.

I was the first one to dad’s ICU room and pretty shocked that he was not cleaned up from the resuscitation efforts. He still had an IV and breathing tube etc in. I stopped the family from entering and told the nurses I did not want the family to see him that way. I was kind of upset because, in my years of doing medical and EMS work, I had cleaned up several people after dying so that the family could visit in a somewhat dignified way. Dad looked like they had just abandoned what they were doing and walked away. Miffed I made it clear to the nurse to clean him up or myself and my lawyer brother were doing it now.

Sorry, yeah I pulled rank, but there is no excuse for that. It is insensitive in the extreme to abandon a corps in such a state knowing family with kids were coming. Yes, I know I just referred to my father’s body as a “corps” but that is how they were treating him.

The rest of the family, Deb included, said goodbye in groups or alone. My sister let her kids decide what they wanted to do and they all said goodbye.

We signed the papers etc for tissue donation and various documents that the hospital shoved in front of us. That is where my brother the Michigan law grad comes in handy.

In a haze and stoic silence we piled back in the car to head home. The house seemed larger and lonelier now. I took on the task of calling our mother to tell her. Mom and Dad had divorced several years ago. On the phone mom was supportive and told me that us kids were great at supporting each other, which is correct. Her voice started to crackle and she asked me if I knew what day it was and I said yes, it would have been my parent’s 45th anniversary.

When I was alone in bed thinking about the tragic events of the day. I was literally walking to work when I got the phone call. The last news I had was talking to dad saying his procedure went well and was going home that day. His discharge day became his last day on earth. Alone and to myself if finally cried. I cried at the loss of my father and that there was nothing I could do. I spent every day of my life for 25 years, working to save lives, and my father dies of a simple complication from a routine procedure. Every ounce of logic in my body knows that it should not happen ever but it happens all too often. The medical system boasts some of the best minds in the world but the simple things can take or save lives. My research will save thousands of lives, but it did no good for my father. All that damn knowledge I have about serious complications killing people does no good if the people working on patients don’t do the right thing. Sometimes I am so proud of the system I work in and sometimes it makes me sick. July 25th 2005, was an example of the latter.

The federal government is spending a lot of time and effort on a federal bailout or stimulus package. Some of this stimulus package money is going to medical research. Over ten billion dollars is allotted to the national institutes of health to fund medical research projects. This money is grant funding that is being done by individuals who spend their lives working to help people. This is not corporate America driven by profit, but some of this work will save lives and almost all of it is for improving the health of Americans.

Why is it that the funding comes with more strings attached and oversight than banks and companies like AIG, or GM? There are no multi billion dollar bonuses for the scientists who make the next cancer drug. However the person designing the latest methods for preventing leukemia will spend half their time trying to get less money than a bank executive’s bonus. To put it simply the salary for GM’s CEO could be given to a quality researcher today and they will discover a way to save your child’s life tomorrow.

The smartest people in the world used to be rocket scientists or brain surgeons. But if you look at the best and brightest in American universities now, what they are going to do is move money around to put money in their pockets. If you want to know why we are in the financial situation we find ourselves in now it is because of a culture of greed. We rewarded greed and that bred mutual reinforcing of more greed by others. Meanwhile we can’t find good people to train to be the next generation of researchers and technology developers. We have money transfer experts.

Mr. President, if you want to stimulate the economy, save the intellectual base of America or the technology sector for the world economy will be moving off shore and we will need the Chinese federal governments permission to buy their guidance systems for our national defense.

I just submitted what is likely the most difficult grant application of my career; it nearly killed me. It was not the biggest grant, but it was a pain in the keester. Now, please – please – please understand that when I say “I” submitted a grant application that means I am part of a team of individuals who put together a research proposal and submitted it to the funding agency as a grant application. This grant had 5 major research projects within it, four faculty members as the core team, 7 other faculty team members and a host of students and support staff. Several of the support staff went above and beyond the call of duty to help get this in. The total amount requested for funding was about 7.5 million dollars and is scheduled to last 3 to 4 years.

Let me bore you with some more random details. The Departments of Neurology, Emergency Medicine, Neurosurgery, Biomedical Engineering and Engineering are all involved. We engaged artists and designers in our proposal and the grant has been submitted to the US Army for research funding. What we are proposing is to get the funding to make and test a star trek type of tricorder. This will detect if a soldier who has been exposed to an IED (improvised explosive device) might have had a brain injury. The device would work without the need for x-rays.

As I hope you know, I worked for over 7 years in emergency services. I remember very distinctly kneeling in the mud and rain next to a severely injured patient saying to myself, “My equipment is no good in these conditions. This sucks.” I can assure every EMS person out there in the field, if I develop a technology and say it will work in the field, I mean all conditions. I refuse to be the genesis of anyone else’s, “this sucks” sentiment.

So the summary is that I, with help of others, worked my butt off, metaphorically killing myself, to submit a research grant to save lives. While I think “it sucks” that I need to kill myself to save others, this is one case where the end justifies the means. I just hope the Army gives us the means to get to that end.

I have two blogs written and queued up ready to post on line. They are about things that will be happening in the near future. I am waiting for “official” okay to announce what is coming but have to contain myself for now. Nonetheless, I’ve got two new gigs in the works and can hardly wait to get moving on them. Please keep checking back to see what things are coming along, how they are going and when things will be happening. Never a dull moment.

I cannot believe I got taken for a ride by a Tokyo taxi driver.
I’m in Tokyo after a conference and have some meetings and lectures scheduled. I’ve been to Tokyo numerous times, I think about 15, and feel comfortable getting around by metro, walking and taxi as needed. I am scheduled to meet a colleague for dinner at a restaurant at 7:00 PM and have a clear plan on how to get there with a good idea of how long it takes to get there.

From my hotel I walk to the metro station and get on the right train for the restaurant. Unfortunately I misjudged how packed the streets were and it took me a lot longer to walk to the metro station than I thought. So I was running a little late. I arrived at the station near the restaurant at 7:05. I was assured that it was a 5 minute walk to the restaurant, but I was stressed about being late and did not feel I had time to find landmarks to find my way to the hotel. So I hopped in a cab next to the Akihabara metro station. I had a map in Japanese and English with the name and address of the restaurant on it. I showed it to the taxi driver and he said yes – hai in Japanese. I asked in Japanese if he understood and he assured me yes.

I estimate that one minute walking is at most 5 blocks and when the taxi driver went past 5 blocks I’m worried. I get on the phone to call my colleague. I tell him I am in a taxi and think the guy has no idea where we are going. I have the taxi driver stop and give him the phone. He listens for a few moments, hangs up and hands me the phone. He again says he understands and turns around.

It takes 30 minutes driving to get where I am supposed to go. My colleague meets me and the taxi driver and I’m complaining that I should not have to pay for a 30 minute fare. The directions were clear. My colleague and taxi driver argue. This is all occurring through the window because the taxi driver will not unlock the doors!!! I’m stuck in the taxi and getting real mad. I pay the extortionate fare which is over 2070 Yen when it should have been 700.

I get a receipt, which has the taxi id on it and finally I’m released from taxi purgatory. My colleague says the taxi driver was confused despite the map in Japanese and that he cannot change the fare; it is all electronic. Basically I was taken for a ride and arrived 35 minutes late for a dinner that at most I should have been 10 minutes late. The taxi driver never even apologized which makes me even more sure he rolled me intentionally.

I acknowledge that my role in this fiasco is that I should have just called the people at the restaurant to get walking directions and I had thought of that. But I also thought their answer might have been just take a taxi because they knew the map I had; they gave it to me. The bottom line I handed the guy a map and got screwed. By the way, it is not the fare that is most annoying but the time lost and being embarrassed in front of my friends.

http://www.emsresponder.com/readingroom/

Or the direct link:

http://www.emsresponder.com/web/online/Reading-Room/QandA-with-Joseph-F-Clark–PhD/55$13359 
will take you to EMSresponder.com where My Ambulance Education is featured along with some other EMS books. It includes a full chapter excerpt and an interview with me.