Sunday, January 29, 2012


This week was more of the same. The immune system works this way with cancer, it works this way in graft rejection, it works this way with viruses, this way with bacteria, and it doesn't work when (blank) cells are dysfunctional. (Blank) bacteria invades tissue via (blank) factor, it evades the immune system via (blank) mechanisms, you can identify the strain via (blank) laboratory tests, etc. You learn one, you learn 'em all - except the names change. 

S's mom left on Friday so we have been left to our own devices to sink or swim with the new adjustments. Saturday night, C came into our room around 3 am asking for a drink of water. Then she came in at 4:30 complaining that her tummy hurts and right as she got to our bed, she began puking everywhere. Between N feeding and having to cleaning C every few minutes, Shelli got maybe an hour of sleep and I fared only slightly better. Good practice for a residency in surgery, right?

In the arena of world news, the cruise company who tipped the liner over in the Mediterranean is offering all non-injured passengers $14,460 as an enticement to not sue. The cruise company is taking advantage of a horribly inefficient Italian Courts system betting that the passengers will take the quick settlement rather than brave the courts.. Attorneys are convinced they can get closer to $164,000 per non-injured passenger and that's 3,206 people.

Everybody stay calm, Schettino is NOT driving.

Monday, January 23, 2012

Floods, Flips, and Flotsam

We took our first test in Disease, Immunology, and Therapeutics this week. It was one of those tests that I felt confident going into, but coming out I felt fortunate to pass. As it was I scored around average at 83%. Since the test we have been focusing more on individual microorganisms such as Staphylococcus aureus, Streptococcus pyogenes, Neisseria meningitidis, etc. You might recognize the diseases they cause. S. aureus causes staph infection (among other things), S. pyogenes causes strep throat, and N. meningitidis  causes meningitis.The idea is to differentiate them from each other and to understand the virulence factors - what it is about each organism that makes them able to not only survive but thrive within a host.

  If you look closely enough, I think the guy has a leash and is taking his fish for a ... swim.

Why did the fish cross the road?

This has also been an interesting week for Italy. Just when I thought the public opinion of the international presence was on the upswing, (winning the World Cup in 2006, hosting the 2006 Winter Olympics, ousting a corrupt Prime Minister Berlusconi, replacing Silvio with Mario Monti to implement austerity measures) they go and do something like this:

The captain of the ship violated the guiding Italian principle - 

Chi va piano       (He who moves slowly)
Va sano             (Goes healthily)
E va lontano.      (And goes far.)

Never mind that that they had their credit rating reduced three notches by Moody's - America and 12 other European nations have this year. The tragedy would be comical if it weren't for the loss of life of at least 14 people. For a country that closes down for the entire month of August in addition to the fifteen or so national holidays, when something like this happens I would first question the work ethic of captain and crew. The captain's explanation of what happened makes clear that the problem is more deep than a simple work ethic problem. The defense sounds more like a Monty-Python skit.

This is my favorite part.

Schettino, who is currently under house arrest, is under investigation for potentially causing the wreck by steering into the rocks and then abandoning the panicked passengers for a lifeboat as the ship plunged over on its side. In recorded radio transmissions released Tuesday, Schettino is heard telling Italian Port Authority officials he and other officers abandoned ship.

"And with 100 people still on board, you abandon ship? [expletive]," the Port Authority officer says in response.
Schettino appears to correct himself, saying, "I didn't abandon any ship... because the ship turned on its side quickly and we were catapulted into the water."

Tuesday, January 17, 2012

Stuff I Think About

(Stuff I Think About? Maybe it's Stuff I Think about? Last words in titles get capitalized, right? Prepositions don't get capitalized, right? What if your title ends in a preposition? Can you do that? Latin can't. Hence the English rule that-isn't-a-rule.  Good thing I'm not an English major. That's not fun to think about.  Shoot I just did it again.)

I read this article and it made me happy I didn't choose a career in law. How can a person claim jurisdiction where none has ever been established? In a world with no borders how do you know which of the 196 countries' laws apply to you? Turning a rhetorical question into a literal question sounds like a job for Chuck Norris.

I read this article and it made me happy I didn't choose politics. Who would want to sort through the complex relationships between voters and politicians and align an entire working life based on polls and opinions? My favorite part is the example. "The Obama campaign once held a press conference arguing that Hillary Clinton was unfit to be commander in chief because she had embellished a story about landing under gunfire in Bosnia. What was once an irredeemable flaw was forgotten when Obama made her his secretary of state." Names and parties change, but the humor is always there.

Then I saw this and it hit close to home.  The last article I read was this one and it made me wonder if the lines between professions are as clear as I had imagined.  When I was shadowing doctors in Provo, I never had to bring a lunch because there was always a drug representative representing or a specialist seeking referrals. Business is all about getting a foot in the door, and the food from these guys is a fantastic way to get a foot in the door. With a stroke of the pen, both state and federal governments can change the scope of practice of medical specialties, mandate pro bono work, and set income caps (limiting Medicare payments is a poor example, I know, but it's been in the news and is the best I could come up with).

Becoming a professional is hard enough. Becoming five professionals is truly daunting. No wonder doctors are going broke and leaving private practice.

(I do more than read articles during med school. This is what I do to stay current because I'd really hate to graduate and find myself legislated out of a job.)

Sunday, January 15, 2012

Megatron and Emergency Medicine

We have our first and most heavily weighted test for IDIT on Tuesday.  Luckily, MLK gave us Monday off.   The class leans heavily toward bacteria with only an hour dedicated to protazoa, fungi, and worms.  It is difficult to come up with cool real life applications for drugs and microbes like I did for anatomy.  I consider sword swallowing, foot binding, high heels, and screw-drivers cool real life applications in anatomy.  Knowing that Candida albicans causes yeast infections in women and diaper rash on babies only has limited appeal.  Knowing that biceps brachii functions to flex the forearm only when the hand is supinated (the reason curl-ups are easier than pull-ups) and that it is a powerful supinator (the reason why the threads of screws are designed to turn the way they do into wood) is more interesting to learn about and probably more interesting for you to read about. 

We have a professor from I don't know where, but his last name has 16 letters in it and it's pronounced  like....Megatron.  As in, "All hail Megatron!"  

Dr. Megatron
I've been thinking quite a bit about residencies and what I want to specialize in.  Gifted Hands (Dr. Ben Carson), Magnificent Obsession (Lloyd C. Douglas), and also television shows like Body of Proof indicate that quite a few people think of neurosurgery as the pinnacle of medicine.  I did love my neuroscience classes in undergrad and I'm excited for the upcoming neuroanatomy class we start in February, but the aspects that I like seem to be more radiology related than surgery related.  Vocology is a sub-specialty offshoot of otolaryngology (ear, nose, and throat) that deals with singers, public speakers, and vocal health.  Vocology sounds interesting because I'd be able to keep a potential summer home in the music world.  Physiatry is an area of physical therapy that helps people become as functional and pain-free as possible.  Most of what we do with osteopathic manipulation helps restore function to joints and relieve pain.  So far we have been trained to treat basic head-aches, neck, back, and shoulder pain - all without meds or expensive diagnostic equipment.

The following gem is a quote from a science fiction author contemporaneous with Isaac Asimov.

-A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.
-Robert A. Heinlein
Sounds like emergency medicine is the winner.  I can do 8 of those 21.

Sunday, January 8, 2012

Learning Something from Everything

This week we started Introduction to Disease, Infection, and Therapeutics (IDIT).  This course covers concepts in microbiology, pharmacology, and immunity.  I took an introductory microbiology class in undergrad, but that's really the only exposure I've had to some of this information.  For MCBM, I'd taken biochemistry, genetics, and molecular biology.  Not only had I taken those courses, but those principles were taught in almost every undergrad class I had.  We learned biochemistry in endocrinology and neuroscience.  We learned genetics and molecular biology in cell biology.  We learned cell biology in organic chemistry.  Then we learned everything all over again in physiology.  The concepts in MCBM were not new, so this is the first time in med school that I'm learning material for the first time and that's an uneasy feeling.

Luckily, The Princess Bride taught me everything I need to know about studying effectively.  "All I have to do is divine from what I know of you..."

All I have to do is divine from what I know of you...
Realizing how well you know what you do know is an important skill in knowing what to study.  For various reasons some people don't know what they don't know - the teacher could be unclear on the objectives, the student could be unfocused or trying unsuccessfully to sift relevant from irrelevant.  Fortunately, I have avoided the academic mire that the following individual has found himself in.

N is sleeping well at night.  In fact, she's only awake for about 5 minutes a day.  Somehow she even does most of her eating asleep.  C is the perennial sleepless problem.  She arises at 3 am, turns into the creature of elbows and knees, and expects to share someone's bed.  "I wanna sleep mamma's bed!"  I put her back down at 3:30, 4:00, 5:00 and then at 6:00 am she decides she is ready start the day.  "I wan' bekfast. Wanna pay my toys, Daddy? Wan' some water, Daddy."  She's been doing this since September, but I'm sure she'll grow out of it soon.  If not, I might need to slip some benadryl in her water.

Sunday, January 1, 2012

Buon Anno

We had a rather quiet New Year's Eve this year.  I don't think security allows firecrackers into the hospital and the nurses wouldn't let bubbly in the maternity ward.  I took C home at around 6 pm for bath, bed, and beyond.  She doesn't like it much at the hospital.  None of the rooms are toddler friendly and the rain has been savage the last few days so it was no fun visiting the fish at the hospital garden.  Every New Year's Eve since Naples has been a little anticlimactic.  The year I was there, one of our good friends from the Spanish Quarters said it had been a quiet year because they didn't blow up any buildings.  They know how to do it right in Napoli because they collectively understand that what you lack in coordination, professionals, and safety can definitely be made up for by applying the law of large numbers.

This video doesn't really do justice to the real thing.  You can't hear all the car alarms going off, you can't feel the 'big ones' disintegrating entire dumpsters and the cars on either side of them, and you don't feel the danger of standing out on a rooftop while someone higher up the hill throws firecrackers down on top of you.  

N and S were discharged from the hospital Sunday at about 1 pm.  The doctor warned us that the biggest safety hazard to N is C.  She doesn't realize exactly how fragile her baby sister is and she didn't take it very well when we told her N couldn't sleep in her bed.  She'd love her to death - literally. Whenever I let C lay down next to us, she somehow turns into a creature of all knees and elbows.

N is so calm and sedate that except for her squeaks and grunts you can almost forget you are holding anything at all.  She hasn't woken up once by herself to eat and her eyes mostly loll when they are opened so I'm not sure she has been entirely awake since I met her.  

I go back to school on Tuesday.  When the break started I meant to get a head start on our next class which covers immunology, pharmacology, microbiology, and pathology.  I also wanted to start reviewing anatomy to solidify that for COMLEX 1 at the end of year two, but I didn't.  I spent my time cooking, cleaning, laundering, entertaining C, preparing for N, and relaxing when I had the time.  I can't wait to go back to school so I can rest.