Sunday, October 30, 2011


As part of our curriculum we are required to participate in projects that perform some sort of service to the community.  I was chosen to help the group that creates a pipeline from elementary school that eventually guides them to enroll in the university.  Our goal yesterday was to get the kids familiar with various health professionals and their roles.  My specific job was miscellaneous people directing, setting up tables for lunch, and otherwise doing what I'm told.  I was happily putting plastic table cloths on the tables when I was interrupted by the female student in charge, "No, those are for sitting."  I then proceeded to place the table cloths on the floor assuming she meant that the sixth graders will be taking their lunches on the floor.  A few minutes later she came by and exclaimed, "What are you doing?!"

"You said these were for sitting," I patiently explained.

"No, the tables, the tables are for sitting," she patiently explained to me.  "I'm not quite sure how literal I need to be with you, so can you move these tables to the other side of the room?"

Hmm, I think.  Being 'literal' was not her problem.  I think she meant 'ambiguous' concerning her less than specific pronoun, but I don't press the issue.  Funnily enough, we wound up putting table cloths on all the tables including the tables she originally told me not to cover, but I didn't survive this long in the world without knowing that bringing up that point would somehow be detrimental to my position.

Speaking of funny things that happen, S and I were sitting in Sacrament meeting trying to entertain C and I suddenly get a text.  Mom is usually the only person I know who texts me around that time so I look at it quickly.  I stifled a laugh as I read, "Hey so what's uppp and u should of come toe the dance it was funn [][]RaWr<3[][]." First of all, that's not Ally, that's not even...literate.

 Secondly, I am at church sitting next to my adorable wife and child and am really not interested in an extracurricular relationship right now.  Call it bad timing, but don't ever text back. :)  I've never received a text like that on my cell phone and I certainly don't give it out recklessly so when I got home I looked up the area code and traced it back to a place called Natrona, Wyoming.  Later that night, I got another text saying "Hey what's upp" with the same RaWr signature.  Shelli and I shared a pretty big laugh and she told me to text back and ask if it was Stephanie.  So I did and immediately got a text back saying, "No, brittany."  I hope I didn't crush her dreams of everlasting love, but I'm thinking she'll get over it soon.

Our anatomy block is over.  I passed Head and Neck with honors and I that makes me very happy.  To sum up my experience, I wanted to share some of my favorite Dr. Benninger quotes.  Dr. Benninger is a wonderful anatomist from England.  He is one of the editors of Netter's Atlas of Anatomy which is a standard textbook for all medical schools.  To date, he is also the best lecturer we've had.  He is submitting a proposal to the medical community to rename the twelve cranial nerves which have been doctrine for decades and he has sufficient clout that he may even succeed.  Because of him, my new favorite adjective is antisocial.

"Dr. Kuehn, you are a rockstar.  It's not all about looks now, is it?"
"When you receive a question like this, the only audible sound is that of puckering sphincters."
"We should return to the practice of a more civilized era when a student who gave me such a terrible answer would fall on his sword in shame."
"Vessels and nerves normally travel in threes with the nerve most superficial, then the vein, then the artery.  This is important to remember so when you do a nerve block you don't puncture the nerve.  That would be terribly antisocial."
"The lateral femoral cutaneous nerve is intimate with the psoas major, so those who do an antisocial number of situps might find tingling or starbursts in the skin it innervates."

Sunday, October 23, 2011

Help me my life

"Thanks, Daddy, for help me my life."  That is the thanks I receive these days when I help C get some crayons and paper out, or get her a drink of water, or help her into her car seat.  When she can't think of something specific to thank me for, that is her default thank-you phrase.  "Thanks, Daddy, help me my toys."  Not exactly sure where she learned the word life, but it is very endearing.  Her undying gratitude is a great accomplishment, but not nearly as big as watching C try to gig S (pretend her fingers are spiders  up a limb to clamp on the skin of the neck) during Stake Conference today (we don't encourage that behavior in Church, but it sure is funny when it happens).  "I'm gonna gig you!" she squeals delightedly as her fingers search for flesh around Shelli's neck.

I haven't seen much of S or C this week.  Most of my awake hours were spent at school getting ready for the final in Head and Neck on Monday.  I haven't kept an official tally, but I've probably put in around 70 hours at school this week.  S and C have been fantastic this week making all the other students jealous of my position.  S makes the best food I've every had for almost every meal of the day.  Not only does she make it, but often she'll bring dinner to campus and we'll spend a few minutes together while we eat and then she goes home so I can keep studying.  Some of my favorite things she makes are french dip sandwiches, peanut chicken on pasta, bbq chicken sandwiches with homemade rolls, enchiladas, rosemary potatoes, etc.

Speaking of how fantastic S is, while I was studying with my group, one of the members left the room to take a call.  She was gone for about twenty minutes and when she came back, she apologized and said she normally saved up the chore of dishes and her phone calls so she could knock out both at the same time.  She ended the soliloquy with a challenge that any of us could have time for dishes while we're in med school and against my better judgement I noted, "My wife does our dishes."  At that, she spouted about gender inequality issues that would have done credit to Virginia Woolf.  I was tempted to say, "It's a really good thing my wife isn't here, Morty.  She might say something truly inflammatory like, 'What's wrong with a woman wanting to make her husband happy?'"

On Tuesday we had the CEO and founder of an insurance company come and talk to us about ethics.  The most memorable thing he said was, "Don't believe everything you think, because 95% of what you think is made up.  Evaluate what you absolutely know is fact and then judge your opinions and assessments.  Ethics isn't deciding what is right and what is wrong, but deciding between what is right and what is right.  When we come up against two situationally conflicting values such as honesty (I will always tell the truth no matter what) and kindness (I will be kind no matter what) then you have an ethical dilemma when a friend or family member asks for your opinion on whether they look fat.  Most often we resolve the dilemma by impromptu adoption of the value of personal convenience although no one will explicitly tell you that is one of their core values."

Sunday, October 16, 2011

Smiles, Swallows, and Moose

Head and Neck is halfway through and we take the final next Monday.  Somehow it seems like I'm learning it better and faster than Gross Anatomy, but we'll reserve judgments till after the results of the final.  We learn some cool things and some less cool things.  The less cool things include the branches of the three divisions of the maxillary artery (we are learning 11 of the branches.)  The cool things are mythbuster things like how many muscles it really takes to smile and frown (I've heard between 17 and 26 to smile and 43 to 62 to frown.  I don't exactly know how the motivational speakers and demoticons gathered their information, but defining a smile as raising the corners of the mouth and the entire upper lip, it takes about 10 facial muscles and the corresponding frown with a pouting lip takes 6 (that's according to the pictures in Thieme's Atlas of Anatomy).

I wish I had known this back in high school so I could abandon my smile for a look of mild disappointment in order to conserve energy.  If, however, you define a smile or frown as simply raising or lowering the corners of the mouth, then you have a 4 and 4 tie. 

Also interesting is the anatomy of sword swallowing.  Somehow going to the Rennaisance Festival wasn't enough to convince me that the swords the performers were using weren't collapsible.  Some undoubtedly were, but I never asked myself why they extend their neck.  The anatomy behind it is rather straight forward.  Leaning the head back creates a straighter line between the oral cavity and the pharynx to the esophagus.  The performer tries to relax the upper esophageal sphincter and control the gag reflex, sneezing reflex, hiccoughing, coughing, or anything else that might tighten the body around the sword

Past the pharynx the sword passes into the rather flexible esophagus. The stomach, is normally at an oblique angle to the esophagus, but is brought into line as the sword enters through the cardiac sphincter. Some performers consume a large meal or drink water before performing to give the stomach a more vertical orientation, allowing for easier passage of the sword.  Most keep the sword down for only a few seconds since it is difficult to suppress the gag reflex for very long.  

Yesterday we played a friendly game of flag football. We had so many people come out that we had to split into four teams and then rotate opponents.  During a particularly fantastic play on my part (when I wasn't slipping on the sodden field) I let out a celebratory whoop.  Then during the lull before the next play, we all heard a big game animal that sounded suspiciously like my whoop.  Moral to the story is, it's all fun and games until a moose mistakes you for its mate.

Sunday, October 9, 2011

Coxsackie, Foot Binding, and Other Pathologies

The wet season is here.  I saw the sun peeking out of the clouds yesterday and C and I basked in its rays for a few minutes.  I hadn't seen it for about two weeks and I didn't realize how much I missed it until I saw it again.  C had a nasty coxsackivirus infection this week.  I'd never heard of such a thing, but during General Conference weekend she had a rather high fever and we didn't think much of it.  Then, over the next few days she developed swollen and inflamed gums that bled easily on top of a series of canker sores on her tongue.  She wouldn't eat hardly anything and brushing her teeth was impossible so she lived on milk and juice.  The only option was to let it run it's course and she is doing better now, but she was not her happy self while it was going on.

On a happier note, US Preventive Services Task Force released recommendations that abolish prostate screening exams (including digital) on healthy males.  This is an independent medical branch that receives government funding to discover which procedures prevent deaths and they have added prostate screenings to the same list as breast screenings with the statement, "In men younger than age 75 years, the USPSTF found inadequate evidence to determine whether treatment for prostate cancer detected by screening improves health outcomes compared with treatment after clinical detection."  That is a wonderful statement for a person like me who never wants to undergo something like that.

We finished Gross Anatomy and have moved on to Head and Neck.  I wound up passing GA which is a relief (a wonderful testament that I do belong here and that I can overcome impostor syndrome), and I hope to do well enough in HN to pass with honors.  I am sure it will be this way with every class, but it doesn't seem like a doctor can ever learn enough anatomy.

The professor for the lower limb anatomy was probably the most engaging and interesting lecturer we've had yet.  At the end of his lecture about the foot, he showed the x-ray below taken from a Chinese female who had had her feet bound.  It was a common practice for hundreds of years to repeatedly break the toes of 2-5 year old girls and then bind them tightly with cloth in a figure eight to force them to grow into the desirable, beautiful shape you see below.

You don't have to be an anatomist to realize that this would cause some serious pathology in a person.  Likely, the girls couldn't walk very far or stand for very long so it was probably a significant status symbol to marry a woman with feet like these.  The reason why he brought this up was to talk about self mutilation that goes on all the time in which people alter the structure of their bodies for the sake of status.

Again, you don't have to be a doctor to explain why this person's feet hurt.  They have essentially taken the arches of a bridge, suspended the bridge from the on ramp, and created a pillar.  This hyperextends the toes, hyperextends the knees (making the legs appear longer), forces the hips to increase rotation to accommodate the diminished toe off and heel strike, increases the curvature of the lumbar vertebrae (forcing the tupus and chest to become more prominent), and Shelli tells me it increases the sensation of pain from the belly button down. He also showed a picture from a cadaver  who must have worn high heels for decades.  Her big toe was sideways so nail was facing the other foot, the second toe was curled under toes three and four, her third toe was normal, her fourth toe was almost fused with her third toe, and her fifth toe was lying on top of toes three and four.  I can only show you pictures that are either public domain or mine so I can't post that one. I  I learned in my ethics class that I can't become an effective doctor unless I refrain from judging people for their self-destructive behavior so I can recommend a shoe change, administer pain relief or counseling, but I shouldn't laugh or roll my eyes.