A Journey of a Biomedical Engineer

I was excited to prepare for a seminar at the Biological Engineering Department at the University of Minnesota. It has been 30 years since I began my journey in the field of biomedical engineering when I enrolled in Shanghai Jiaotong University in 1987.

At that time, I did not know any other biomedical engineer in my life. I was attracted by the description of “biomedical engineering”. Solving medical problems with the knowledge of biology and tools of engineering appealed to me as a promising field. Biomedical Engineering was a newly created department at Chinese Universities. We went to many other departments on-campus or off-campus for classes. We rubbed shoulders with other students in electrical engineering and mechanical engineering classes. We rode bikes to anatomy and physiology classes at a nearby medical college. Our own professors taught us computer programming, ultrasound and medical instrumentation.

By the end of the four-year college in 1991, most of us got jobs in the instrumentation department at a hospital or at a few medical companies in China which manufactured x-rays and other medical equipment. Many graduates of my college had left China to study abroad. The opportunities for admission to a US university and obtaining a student visa were rare in the early 90s in China. For many, it was a path to a bright future.

I was admitted to the University of California, San Diego. The Bioengineering program at UCSD was founded by Professor YC Fung, and chaired by Shu Chien at the time. Professor Fung initiated the field of research on biomechanics, which studies tissue properties of muscles and circulation. In an outing with new students, Professor Fung recalled how he got his start in biomedical engineering. He had been an aeronautics professor at Caltech. When he found that his mother was developing an acute glaucoma, he began to immerse himself in the medical literature to learn about it, and sent his notes to his mom’s physician in China. The intense learning led him to a close collaboration with a medical doctor, and later, with many other physicians in areas of heart and lung mechanics.  Professor Fung no longer taught classes in the department, but told me the first real-life story of a biomedical engineer.

Dr. Chien took me into his laboratory research in cell mechanics. I studied the aggregation of red blood cells, a phenomenon that occurs in life but with little understanding of why and how. I spent countless hours in a dark room with a powerful electron microscope, but was unable to find what bound these cells together. To this day, I still remember what Dr. Chien said, “You are going to be a scientist. You want to learn everything there is to learn on your project.”

My learning continued at the University of Utah, where I decided to pursue a PhD in its Bioengineering Department. My growing interests in the electrical system of the heart found a home with two mentors at the Cardiovascular Research and Training Institute. Bruno Taccardi was studying how heart muscles affected electrical wave propagation in each heartbeat. He devised systems with hundreds of electrodes that placed directly in a beating heart to measure electrical field during propagation. Rob MacLeod, my PhD advisor, had developed computer programs for visualization and simulation of these complex systems based on some of Bruno’s measurements.

Bruno was in his late 60s at the time. He “retired” from his institute in Parma Italy, where he was the director, and came to Utah to continue his research. Bruno wanted to know everything about electrical propagation in the heart.  He only wrote a few papers in his career, but one of them was read by nearly every researcher in the field. Rob MacLeod was a young faculty member and I was lucky to be his first student. I could not have asked for a better mentor. Rob recognized my challenges with scientific writing. He gave me a list of classic papers on cardiac electrophysiology, and critiqued my review summary of each paper. The exercise went on for a few years, and ended with our first paper together on interpolation of electrical potentials in the heart.  After six years, I finished my PhD in biomedical engineering. I was ready and anxious to solve problems in the real-world.

It was an exciting time in implanted device industry with recent introduction of cardiac resynchronization therapy, a new therapy for patients with heart failure due to an electrical conduction problem in the heart. I was impressed by the enthusiasm of scientists I met during the interview with Guidant Corporation, one of the three companies that manufactured cardiac pacemakers and defibrillators. I decided to join them after the interview and hoped one day to work on a new therapy myself.

I was open to work on any problems. The first problem I worked on was a condition called chronotropic incompetence. With aging, many of us lose the ability to regulate heart rate with increasing metabolic demand, for example, during exercise. In traditional cardiac pacemakers, an algorithm increased heart rate based on body motion detected by an accelerometer sensor. This had limitations, for example, an accelerometer would not determine the different metabolic demand between climb upstairs versus downstairs. I started with a project to measure respiration using an implanted respiration sensor in a cardiac pacemaker. This was a new feature in the pacemaker to provide heart rate support during patients’ exercise. The pacemaker can sense the increase of respiration with an impedance sensor and changes of motion with an accelerometer. The combined information would improve the algorithm to regulate heart rate with the metabolic demand during the exercise.

The ability to monitor respiration in an implanted device soon led me to a discovery that many cardiac pacemaker patients stopped breathing frequently during sleep, a disorder called obstructive sleep apnea. In a collaborative study with a cardiac electrophysiologist doctor and a pulmonary doctor in Pittsburgh, we found nearly half of his VA pacemaker patients had undiagnosed sleep apnea. We formed a new team in 2001, the apnea team, which included original team members of Kent Lee, Jess Hartley and Jeff Stahmann. Our goal was to detect and monitor sleep apnea with a cardiac pacemaker and explore new treatment options. Boston Scientific, which bought Guidant, now produces pacemakers that can monitor sleep apnea status every night for this chronic condition based on our original work.

Once diagnosed, sleep apnea treatment is another major clinical challenge. The standard of care is positive airway pressure delivered by a mask placed over the nose and mouth during sleep. I made a good effort trying the treatment myself for two weeks and I had a very hard time to get to sleep. So it was not a surprise that nearly half of the patients with sleep apnea do not use any treatment.

My opportunity to work on a solution for sleep apnea treatment came in 2008. Tim Herbert, Mark Christopherson and others had worked on an implanted neuromodulation approach for treating sleep apnea while at Medtronic in the 1990’s. The idea was based on the finding that tongue relaxation during sleep was causing airway obstruction, and the tongue could be controlled via the hypoglossal nerve. The Medtronic team developed an implanted device to stimulate this nerve, and demonstrated in a small study that hypoglossal nerve stimulation would stiffen and move the tongue forward and could resolve upper airway obstruction. Medtronic did not continue this project, as it was not in their core therapy areas. In 2007, as a true entrepreneur, Tim quit his job in Medtronic, licensed the technology from them, and recruited Mark to join him to start Inspire Medical Systems, whose singular goal would be to develop and commercialize a neurostimulation therapy for obstructive sleep apnea. During one of our conversations before joining them, I asked Tim what made him believe they could accomplish what Medtronic could not in developing this new therapy. Tim put a children’s book in front of me, and asked if I remembered reading A Little Engine that Could. I told Tim that I grew up in China and had not heard of the book. After finding the book at a bookstore, I liked the attitude of “I think I can”.

In April 2008, I left my job at Boston Scientific and joined the Inspire team and began the next chapter of my journey as a biomedical engineer in finding a solution to help people sleep better.

Letter to Congressman Paulsen on Immigration

Dear Congressman Paulsen

You visited us when we were a company of 10 people in a small office in Brooklyn Park, Minnesota. Inspire Medical Systems was just spun out of Medtronic in our mission to develop a new treatment for sleep apnea. You asked us why we felt we could accomplish what Medtronic had given up. I jumped on like a good student who felt I had the best answer. That was the same question that I asked our CEO, Tim Herbert, during the job interview a few months earlier. Tim pulled out a little book with the title of “The Little Engine that Could”, and asked me if I knew the book. I told him that I grew up in China, and had not read children’s books for some time. The story of “I think I can” from the book impressed me so much, I signed on shortly after. So I responded to you, “Congressman, have you ever read a book called The Little Engine that Could?”  

“I think I can” is my story as an immigrant American. I left China in 1991 right after finishing college with the fresh memory of the student movement in 1989. My search for a better life was blessed by an opportunity to study in America, and the help from a caring sister, who was studying in California. My mentors in graduate schools shaped my skills as a biomedical engineer. They also formed my desire to improve lives. My job in the medical device industry is fulfilling as reflected in one of my employers’ motto “When you have the power to save lives, share it”. After eight years in America, I received one of the most treasured privileges in my life, a green card, the right to live in America permanently. I became a US citizen after 18 years in this country. I was attracted by our democracy and kindness and fairness of our people. I wanted to participate as a citizen.  

Our recent immigration policy changes related to travel ban make me think about my fellow immigrant Americans. I think about my friend from Egypt. He is a VA doctor, who received the Chief of Staff Clinical Excellence award last year. I think about a collaborator in Detroit, who grew up in Syria and trained in the US. He is one of the most respected doctors in sleep medicine today. I think about a young surgeon, who was born in Iran. He lost his Dad last year, who worked until his last day in Minnesota, as a family doctor. I hear the story of a fellow engineer, who grew up in Ethiopia, and came to America when he was young. He tells me the fear of watching what happens after the recent policy and wondering his belonging.

The task of fighting terrorists is as hard as fighting other violent crimes. We need to be resolute and be determined. We cannot, however, harm innocent people in our response. Over the last two hundred years, people came to this country to search for better lives. It was not an easy journey for most of us, including the separation from the home country often with families behind. We travel back when there is a parent who needs care, or when there is a niece who gets married. The travel ban harms immigrants from the seven countries included. It also affected me because of the concern of our policy maker's willingness to overlook the harm for fellow immigrants. We cannot have policies that erode the principle of our country of immigrants.

When I am reflecting today on who we are, and what I want to be, I am reminded by a former coworker who told me to choose work that is life giving. I am reminded by my CEO, and his mentor, the late Dr. Glen Nelson, who told us to put patient first. I am reminded by our celebration of 1,200 treated lives at the recent holiday party of our company now of 80 employees, where Dr. Nelson’s widow, Marilyn Carlson Nelson told us to do work that is good and to help people. I am reminded by what my Dad taught us at his 80th birthday, to be kind, be sincere, be informed and think independently.

Congressman Paulsen, you have a great responsibility representing Minnesotans in Washington. There are complex issues about which you will make decisions that will impact lives in the coming days, months and years. I hope you will represent us with kindness to others, support work that to be life giving, be informed and think independently.

Quan Ni

An Immigrant American

"You are not perfect, you have flaws."

I found out from Gale today that my first dental cleaning from her was 16 years ago. 

I marveled, "Your kids were babies then". Gale became a grandma last year. 

"They are still babies."

I chuckled after a few seconds. Gale was not happy with my response. 

"It took you that long!"

Gale and I have bonded over the last 16 years in keeping my teeth. I have a unique set of teeth from the overuse of tetracycline and the lack of dental care growing up. Back in the 70s’ China, tetracycline was a go-to antibiotic for every bacterial infection including common cold, gonorrhea, which I had plenty. The “tetracycline teeth” kids, as many of us being called while growing up, would not like to show the jarring teeth in dark and brown color when take selfies today.

Gale was protective of the bond, after my initial dental exam. She always apologized after the first exam of each new dentist in the office we broke in together over the years.

“I am sorry you have to go through that, Quan, but you are unique.”

After examining the dental x-rays today, Gale was seemly satisfied. Then she added,

"But you are not perfect, you have flaws,".

Feeling my dental homework un-appreciated, I responded, 

"I do floss." 

Nashville and the New Year Resolution

On my way to Nashville, I recalled a passenger I met a few years ago on a long haul flight to Shanghai. He grew up a surf boy in San Diego, and later found home in Nashville. He owned a company making hunting gears. Using his product catalog, he proudly showed me hundreds of different shooting targets that he designed. He was fit, even though he seemed to be chewing tobacco during the entire trip. After several hours of friendly conversations, he told me to stay away from the dessert. “No sugar, my friend”. Finally, I decided to put less sugar on the resolution for the new year.   

The Uber driver who picked me up in the Nashville airport was also from California. He followed his children and their mom here after the divorce. After learning this was my first trip to Nashville, he got excited. “Are you ready for some honky-tonk, my friend?”. Honky-tonk? I had to google it quickly, and was excited too. New adventure and new learning every day, that is the second resolution on the new year list. 

My colleague told me he would have a surprise for me in Nashville. After searching what was around the hotel that he recommended in the Gulch neighborhood, I found that the Station Inn seemed to be the place to be for live Bluegrass music. I felt sorry that I apparently ruined his surprise. The Bluegrass musicians played in the Station Inn were surprisingly good. The Tuesday night band was a collection of professional and amateur musicians. The two guitar players took turn at the mic. One of the young guitar player looked like about 15. Later on, he had to leave early for school tomorrow. We sit close to the fiddle player. He just kept blown us away. The bass player was the proprietor of the place in the last four decades. Then there were mandolin, banjo, and Dobro.

Dobro is a guitar with a metal plate which creates amazing resonant sound. I found more about it on youtube by Jerry Douglas, the best Dobro player according to my friend.

The players took turns for a half step up to do their highlight of a song. The rest of the band would look him on, nodding in support. They were having a good time. We were having a good time. It was a harmony of collaboration, inclusion, appreciation, patience and calm. Those, of course, are the rest of the new year resolution for 2017.

Relection after the Election

Disbelief, sadness, escape and reflection.

Those are my reaction since Donald Trump winning the 2016 presidential election on November 8th.

When the network TVs called Florida for Donald Trump, who had already won most of the mid-western states, I turned off the TV and went to bed. It was hard to fall asleep. The victory of Hillary Clinton had been imminent right before the election day as predicted by various national polls. My own vote for Hillary was full of confidence.

The wave of sadness flushed in the next morning on Wednesday. The result was final. The social media around me were filled with raw emotions. I had to go to work.

Work was the best way to escape. Our colleagues mostly leaned towards republican as others who work in the medical device industry. I felt relieved and respected during the morning staff meeting when everyone clearly felt the gravity of loss on my face and several others. In the next few days, I finished everything on my to-do list, talked to family and friends, and played table tennis like every other week, trying to escape from the sense of loss.

Family and friends are much more important than politics.

It is time to reflect on what I saw and what I missed in this election.

My voting came from my belief in collaboration over competition. I saw that with Hillary a continuation of policies to help those in needs, to collaborate to achieve peace and to slow down climate change. In contrast, I saw Donald Trump a bully who put himself above everyone else, and who could ignore anything to advance his own agenda.

But I must have also ignored much what 60,072,551 American have voted for Donald Trump.

Americans wanted a change agent during recent elections. The choices of Bush over Gore in 2000, Obama over McCain in 2008, and now Trump over Clinton in 2016 all found someone brought fresh perspectives and agenda for change. The directions for change were not the same in each election, but the idea of we can do better was the same motivation in the past, was probably the same for 2016.

There were also 60,467,601 American have voted for Hillary Clinton. This election result could not reflect what is right or wrong. Like a lyric from one of my favorite song writers “what you say right now is just your courage at this moment”, this election reflected the current sentiment of the country.

Nobody should leave America, because this is our country.

Our beautiful democracy has protected us from chaos or wars that would have occurred in many other places after a divisive election like this one. I want to give change a chance. The republican party has an amazing chance to get something done in the next few years. It would be a big beautiful thing if politicians spend more time with their constituents than with lobbyists and donors.

I don’t think Donald Trump will be able to mess up too badly.  I believe there are more Americans will stand up to bigotry towards women and prejudice against minorities. The next election cycle is in two years.

We will look back this election in 2034 and remember the Supermoon this weekend. The moon is the closest full moon to Earth since 1948. I will go out into the dark night and enjoy the brightness of being.

My Vote as an Immigrant American

In the early days after arriving in the US, I was often asked when I would go back. Not all of the inquiries were unwelcoming, but I understood that not everyone would like to have immigrants in their country.

It was not easy to stay in America. After graduation, it is difficult for a foreign student to work in the US legally unless you can find an employer that sponsors the H-1 visa. I was very fortunate to receive the permanent residency, a green card, through the national interest waiver program because of my research work and gracious support from many colleagues. The road to citizenship took seven years after I received the green card.

I have chosen to stay because I love America. I left China after the 1989 student movement. I saw on TV how a government sent tanks to crush peaceful student protests. I realized how important that people should have voices in deciding their leaders. It was here that I cast my first vote as a citizen in the general election in 2012. My own vote, which I do not take for granted, is the most important right that I treasure as being an American.

I love American workplace. After finishing school, I found a scientist position with a medical device company. Before long, I started to work on a product that can help millions of people with sleep apnea, a chronic condition that affects sleep and causes heart problems. America has the most competitive medical device companies in the world. I am always proud to tell people here and abroad about my work because we have the most innovative products to help improve and extend lives around the world.

I love America because of its generosity. My graduate education and research were funded by government grants. I am happy to see taxes I pay and so do many others make possible these federal programs, such as the national institutes of health and national science foundation. I appreciate my local city and state governments are obsessive about keeping the roads free of pot holes after each long winter of Minnesota. 

When I cast my vote this time, I reflected on my journey as a Chinese American. I benefited from an immigration policy that allowed me to use my talent to work on medical devices that can help millions. I understand the struggle of immigrants, and their desire to improve the life of their families. I love the non-profit organization Children's HeartLink, which I volunteer my time. Its mission to improve access to congenital heart disease care helps countless families and fosters friendships in partner sites in China, India, Brazil and Vietnam. What I have learned from the experience is that it is richly rewarding from collaboration and help others. I appreciate my teachers, neighbors, and friends who showed me how to value diversity, respect the environment and treasure our independence. These are the values that I have based on to cast my vote this year. And this is why I am proud to vote for Hillary Clinton.

Indian Leadership in American Business

A friend shared several articles on the rise of Indian in large US companies on Wechat, a popular social media in China. Sundar Pichai at Google and Satya Nadella at Microsoft are impressive successes of Indian immigrants in America. The rising wave also includes the recent appointed dean of Harvard Business School (Nitin Nohria), University of Chicago Booth School of Business (Sunil Kumar), and several other large US corporations and institution.

These articles from the Chinese media consider the following factors:

1. Strong network within the community: many Indians help each other in the workplace, such as job interviews, promotions etc.
2. Focused on relationship in leadership: the tradition of apprenticeship makes Indian leaders more likely to participate and build strong relationship and loyalty with subordinates.
   
3. Others: IIT as the ultimate elite school has produced half of the top Indian leadership; strong language skills; and early exposure to the American culture.

Some of these summaries came from the vantage point of comparing with the experience with recent Chinese immigrants in America. Indeed, the background of these Indian leaders are very similar to mine, and many of the technical immigrants from China in their mid-career. We grew up in places were poorly developed, went to good universities, came to the US to pursue postgraduate education, and stayed.

The focus on relationship in their leadership was an interesting observation, but makes sense after thinking about my own experience with friends and coworkers from India. My own observation to add:

1. Continue to pursue the next career goal: I know more Indian co workers than Chinese who completed an MBA in early career. I attribute this to the Chinese philosophy of “Zhi Zhu Chang Lie”, knowing having enough makes one happy. Many Chinese become technical expert and stop. My Indian friends more often have eyes on the top spot of the company
   
2. Strong family and community: this observation is very superficial, but it is often breathtaking to participate in the Indian family and friend gathering, weddings and other ceremonies. Community is a salient part of the Indian culture. My most awe experience is the best table tennis club in the US is not by Chinese, who dominate the sport, but hosted by the Indian Community Center in the bay area (http://www.indiacc.org/tabletennis). These communities can often serve as the backbone for strong leadership. The individual pursuit of excellence or happiness is different from taking everyone with you to pursue a common goal.
   

Alas, I congratulate my Indian friends for their rise in American Businesses, the diversity will be good for all.