Friday, December 25, 2009

Winery Refinery


As a long time drinker and new found wine connoisseur (which I think is French for "drinker"), I have recently figured out an algorithm for purchasing a quality wine.  

My first step is to peruse the aisles and try to choose a country's vineyard that I would like to try.  Generally I stick with Australians and French wines because those are the physically closest sections to the entrance. 

Next, I choose a grape.  Traditionally, red's go with more full meats and white's find the palate better with fish or chicken, but let me emphasize that a white needs to be chilled and isn't chilled at most wine distributors, whereas a red is ready to rock right out of the bag.  Among the reds, I'm a fan of the thicker, fuller, volumetrically larger bottles and tend to go with those.

The final step is, unfortunately, really more of an art than a science, and although I can describe the basic formula, some of the inputs require significant practice.  Essentially, I take a look at the name of the winery, and then of the particular label of that wine, I take the hilarity of either (or both, if it's a really good wine, like Benzinger's Moose Shoot) and multiply* that by the inverse of the price.  High score wins. 

*Note: There is no real math involved.  I mostly go, "Moose Shoot?  That's pretty funny.  11 bucks?  That's pretty cheap.  Donzos".



Wednesday, December 23, 2009

Excelling at psychiatry

The question we are taught to ask to assess depression and psychiatric risks is, "Have you ever thought about hurting yourself or others?"  But I don't think that is sensitive enough, there is a high potential for false positives.  To better screen for those who are truly in trouble, I think it should be reworded as follows: "Have you ever thought about hurting yourself or others, not including while driving in heavy traffic or when trying to format a document in Excel?"

Monday, December 21, 2009

ID thief

The guy at the liquor store rang me up and didn't ask for my ID.  He then asked, "debit or credit" and when I chose credit, asked to see my ID.  So despite my Ninja Turtles shirt and my purchasing of wine with names like, "Great Grapes" and "Smooth Operator", he took a look at me and thought, "this guy is more likely to be stealing someone's identity than to be under 21"?  What a dick.  I can't wait to steal his identity.

Saturday, December 19, 2009

Case of SOBs

I'm finishing up my preclinical book work and heading to the clinics in a month and things are so much fun.  Now we've done all the organ systems and so when we get these case presentations to work on, it's much more like having an actual patient.

23 y/o (year old) male presents with SOB (shortness of breath), fever, and cough.

PE (physical exam): Febrile (fever), dyspnic (pain on breathing), tachypnic (having really tacky pnics)
ABG (arterial blood gas): 7.48/55/98/22

"Now what's the differential diagnosis"  This is the most fun part.  Everyone knows what this is.  Everyone has seen a medical show of some kind and this is the part where they start to list diseases, each of the students saying a disease in turn at a fast clip, followed quickly by the head attending agreeing or another resident going, "Yes, but it's an acute presentation.  We must be missing something" (because they are always missing something, usually something they can find in 22 minutes plus commercials). The attending tells them to do something procedural sounding, the word, "stat" gets thrown around, a montage of hustling and needles begins, it's pretty special.  This is not at all how our sessions go.

We stare blankly for a solid 20 minutes until an MD/PhD who has done extensive research on ARDS raises her hand and says something really brilliant like, "asthma?"
"Great!"
We all congratulate her, exchange some high fives and start to pack up..."but the fever and blood gas don't really indicate asthma".
Ok now we are in a bind.  21 young doctors in training have a fake SOB with a fever, and if we don't do something fast this patient is going to die.  Or live.  Or whatever has already been written out for him in the rest of the case that none of us have read ahead of time.  Then someone looks at the title of the workshop, "Pneumonia".
"Could it be Pneumonia?"
"Brilliant!"  The doctor says something else, but he is drowned out by the thunderous sound of high fives.  When they die down, he follows up, "Now what do we want to do for the patient?".  Aww shit, it's one of those patients.  Fine. 

I got this one.  Earlier today, I was texting and rudely interrupted by the lecturer turning the lights out so we could see a CXR(Chest X-Ray), I'm gonna go with the recency effect:
"Chest X-Ray?"

"Exactly!"  My hand becomes inflamed and erythematous (hurts) from the high fives.  So we get a Chest X-Ray. Put in the order, take the patient to radiology, set the patient up, help the tech out, get the films on disk, bring them back to the doctor.  See?  I watch medical shows too.  I actually have no fucking clue how you get a CXR.  For our cases we just turn the page and there is a picture of lobar pneumonia from our patient, who according to the picture records, was lying about his age since the CXR was taken in the 80s and suddenly has breast tissue.  And this is how cases go.  Did I mention that in a month I'm supposed to be doing this with real people?

Friday, December 18, 2009

"Let's go bro, you got this!"

The deepest voice a male can make is the voice that is used to ask another male for a spot at the gym.

Thursday, December 17, 2009

Graphic

Surprisingly accurate

Damn dude, check out that abscissa!

Note: My friend pointed out that it looks like a woman giving birth.  I'm not sure what to make of that.  I think he's sexist since the head is null set.

Tuesday, December 15, 2009

Monday, December 14, 2009

Singing the Blues


When you say you like the blue M&Ms best, what you really mean is, you like blue best.

Thursday, December 10, 2009

Affective dial

On my speed dial (because I use a dial so much now) are my best friends, my family, my landlord and that one friend who really knows when to use "affect" and when to use "effect".  Messing that up could really effect my future.

Wednesday, December 9, 2009

Let's talk about H-P-V, let's talk about you and me.

We had a doctor tell us that you spend about 3 times the amount of time in a room explaining a finding of an abnormal pap smear than you do explaining a finding of full blown cervical cancer.  This is my response to a friend asking about HPV:

HPV, the kind you are referring to, is a virus that affects certain kinds of mucosa (internal goey tissue).  It can infect other kinds of tissue and give common hand warts and other stuff, but unfortunately for everyone, the kinds of HPV people care about basically just enjoy the genital mucosa and anal mucosa.  I mean, who doesn't. Anyway, there are a whole lot of different kinds (like 130) and there are 4 that people mostly care about.  2 that cause most of the genital warts (6 and 11).  By definition, they aren't really a problem. Ugly, but not really a problem.  By  the very fact that they are causing a wart, that means they are being harmless. 

The real problem is a few other strains that like to bury themselves into DNA (because it's soft and warm and there's candy in there) and hang out causing bad changes in genital and anal tissues, with types 16 and 18 causing most of the trouble.  They can, although seldom, cause cancer (cervical and anal). 

Now it's only certain strains, mostly 16 and 18, and they only bury themselves sometimes (in general, sexually active people have a 50% lifetime risk of exposure to the bad kinds, 75% lifetime risk of all kinds), and from there, only rarely do they actually cause cancer (1.3% lifetime risk of invasive cancer).  And, the great part for us is, they only ever do so in a very predictable fashion.  That is, they move from burying themselves, to a sort of abnormal, precancerous tissue, to full blown invasive, bad cancer.  Many cancers just pop in, full blown, no warning, totally uninvited.  Cervical and Anal at least have the decency to bring a bottle of wine.

So, a pap smear checks for the presence of these precancerous tissues, and a polyposcopy (or colposcopy) is an examination (scope) of the vaginal cavity and cervix (polyp and colpos respectively.  I'm kidding, not that medical terms are that far off from the ridiculous, but if the latin term for vagina were polyp, it would give a whole different meaning to certain nasal issues) looking for abnormal tissues and polyps to sample and evaluate to see what sort of stage they at in the progression of HPV, if any.  Basically it's the next step after an abnormal pap smear.

The beauty to all this is that, when caught early, it's super duper treatable.  That's why they do pap smears.  Death rates from cervical cancer have plummeted since the pap caught on (first tried as a follow up to the macarena, then realized to be a far more potent test than dance move, particularly because of the part in the dance when the vagina is swabbed.  Went fine in Europe, didn't catch on in the US.  Americans are prude). And with the guardasil vaccine, things are expected to really turn the corner.

Tuesday, December 8, 2009

my bike ride home(less)

Some student group was raising money for the homeless and as I rode by on my bike, this guy goes, "With each turn of your bike pedal, another person goes homeless, what are you going to do about that?"  I got off my bike and walked. Boom, eat that shit declining economy.

Sunday, December 6, 2009

Reboot and rally

Updates have finished installing. Would you like to restart your computer now, while you are working on important unsaved documents and you left to make a sandwich? Or later when you would naturally turn your computer off? You have 6 seconds.

Thursday, December 3, 2009

;)

If you are ever looking to make an email request turn passive aggressive, just remind me to do something and then end it with a smiley face.  When you get a chance, can you go fuck yourself :)

Bears and Futures


While texting someone a message to make them feel better about our group's performance, I accidentally typed "whatever, I think we'll do better in the bear future" instead of "near future", but decided not to fix it, because frankly, I hope we do fare better in the bear future, that shit is gonna be rough.

Wednesday, November 25, 2009

Nightmare on Elm and any other street I happen to live on

There are really only two kinds of people that truly scare me.  First, the people who can look at a car and instantly figure out what's going on, they could skin a sheep if they had to, they just sort of clap and fire appears.  These are the people who will survive when the whole world goes to shit.  They have the skills possessed by our ancestor's ancestor's buddy who could fix shit real good.  They are survivors and their superiority intimidates me.  I'm always concerned that one day they are going to take me camping, ask to borrow my phone, crush it with their steel toed boot, and then hunt me.

The other kind of person is the one who, when the linking page to our lecture material site goes down, sends out that email that is like, "Hey guys, so I guess we can't access lectures through our main encryption node, I went through the trojan door and took down the source code.  I attached a zip file with the links on it.  Just copy the link and paste it into a media player with matrix access.  Should work just fine.  Skype me if you have any problems, I'll be on the space station".  These are the people who will survive as the world goes to its current state of shit. They have the skills that my kid's kid's virtual bully will have as he creates a dragon on the mainframe to steal my grandkid's space basketball trading cards.  I'm always concerned that one day they are going to take me camping, ask to borrow my phone, turn it into some kind of giant mechanical dinosaur, and then hunt me.

Sunday, November 22, 2009

Cookie monster

Sometimes I'll come home from drinking and, with inhibitions down and hunger high, just ravage my roommates food.  I'll wake up the next morning to their box of cookies out and a whole sleeve missing. I'm always sorry and real disappointed in myself. I make sure to apologize and clean up. I also make sure to grab one more cookie

Thursday, November 19, 2009

Lecture notes

When I'm taking notes, and you end up saying something different than what I was expecting, I'm making my note fit. I refuse to scratch out my perfectly worded intro to your point. "Stroke is the number 1 cause of death...or would be if the number 1 and 2 causes, which are obviously heart disease and cancer, were fairy tales."

There once was a man from Nantucket, his atherosclerosis was so long...

Tuesday, November 17, 2009

False Blood*

I don't get the people that just go home. There are only 3 points in a night that I am aware of, the point when I'm hooking up, the point when they turn the lights on and all the darkseekers run, or the "alright, dan, maybe it's time you went to bed. No, everyplace is closed. No you can't walk home, you will get in this cab. Give me your phone. No, give me your phone. Dan, do not text her, it's 3:30 and she has the bar exam tomorrow. Get in the cab". Who are these people leaving at 1130 when they get "tired"? They exist, I know it, hiding among us, like social vampires, sucking fun away.

*that's a True Blood joke.  I clarify because I came back to edit this and was like, "False blood?  what the hell am I talking about?" 

Thursday, November 5, 2009

I'd call it Godbook, but I think we already have one of those

I bet heaven is just like a big facebook, but there are no privacy settings and there are an infinite number of posted pictures and videos. Sarah, why did you break up with me in 8th grade? Creating and checking an album called "Cheating"...you did make out with Andy! I fucking knew it! When you get to heaven, I'm gonna post on your Heaven Wall that you stuffed your bra.

Scientific Achievements

I realize that modern medicine has failed us with a cure for a hangover, and I just want you guys to know how hard I'm working on a solution. Just this weekend, I conducted a scientific experiment in which I sat on the couch and ate Chunky Monkey while watching BET and it worked (p<.05). Next week I'm going to try watching the Game Show Network and see if I can't tease apart where the magic is.

Skinny jeans

"This is really good, what's in it?"
"Red pepper, lemon juice, spices, and uh..."
Cucumbers. I can see them in there. The last ingredient you want to say is cucumbers. Just fucking say it Hippie Waiter.
"Uh"
Stop staring off into space, stop day dreaming about indie music and skinny jeans, get back to earth and say the fucking word cucumber.
"Uh, cucumbers"
God you do an impressive amount of drugs.

Saturday, May 16, 2009

paternashizm!

There is a big push in modern medicine to stop being so paternalistic. Doctors don't always know what is in a patient's best interest and we can't force them to do or not do anything. This principle gets harped on over and over and is the topic of many pop medicine articles. However, apparently there is one exception; heroin addicts: There is a new drug for treating heroin addiction called Suboxone. It contains Buprenorphine which prevents heroin from working, prevents withdrawal, comes in an easy to take pill, and only causes a fraction of the effect of heroin. It also contains Naloxone, which does nothing whatsoever when taken in the pill form. So why give Naloxone? Because when you get all antsy, try to crush your pills up, melt them down, and inject them, Naloxone becomes active and does the exact opposite of heroin, i.e. an immediate and intense heroin withdrawal. "That way, they'll only try that once!" Oh yeah, that sounds good. I mean it's the exact same thing we said about my dog and her electric dog collar, but whatever.

cheater part 3

On my walk home I pass house after house of the these undergrad frat guys, theater kids, athletes. Every time the temperature warms up a degree, the beer pong tables are out, grills light up, bubble dresses get sported. They always take up the whole sidewalk and it's like come on, some of us are PLEASE! Please ask me if I want a beer! I do! I do want a beer! Let me have a game. Fuck it, one throw, just one throw. I'm imprisoned in the real world, can't you see it on my face?!? I'm crying out for help here. One beer. Please...please

In the library, I was looking at big board of student ads and stumbled upon this poster (verbatim), "Build-your own STD bake sale!"...what? Wait, I...what? What am I building? How are baked goods involved? Is it like a choose your own adventure for STDs? "You have chosen Sarah. You now have herpes. Would you like to A) See a doctor B) Reenter the party C) Respond to another Craig's List ad." I'm going to have so many questions when I show up drunk.

During a sex lecture, someone in my class asked what douching was. I'll take this one Doc. Afflicting "adult" males, douching symptoms include popping one's collar, calling another human, "bro", and wearing a body spray of any kind. Although rarely fatal, Douche Flu can be severe and lead to aggressive behavior followed by hugs ("but not the gay kind"), a poorly used gym membership, and a bunch of friends who don't really like them anymore. Suspected individuals should be quarantined and told that a fraternity is not really forever.

I think 8 hours of work can best be characterized by the punctuated equilibrium model. Massive stretches of meandering, half-work punctuated by 15 minute bursts of intense productivity, quickly followed by several more hours of facebook and gchat. Don't fight it, it's evolution.

"To treat sleep disorders, one large component is to improve sleep hygiene. This includes using the bed only for sleep and sex. Exercise helps too, which of course includes sex. I think I'm going to be the leading prescriber of sex. "To be taken twice daily. Once upon waking and once before bed. Taken either orally or through direct injection. Rectal administration is neither indicated, nor contraindicated. Side effects include feelings of awesomeness and babies. If sex lasts for more than four hours, consult your physician for high fives."

Coffee lowers your risk of Parkinson's disease, contains the most anti-oxidants per volume of any food or drink, and can improve performance and alertness. Not to mention the acute health improvements associated with me not punching you in the face. I'm tired and I'm late, stop texting and move the fuck out of my way.

"Hey there are bagels in the back room if you're hungry!" Nope. I just went back there. There are no bagels. There is cream cheese. There are knives. And then there is a giant bag of round fluffy breaded things with goo swirled all around, diseased with raisins, pulsating with cinnamon-raisin flavored disappointment. Don't fuck with me, Leader of Meeting that Just Ended, I will stab you with a plastic smearing utensil.

Time for a pep talk, Body. We fell asleep in class today. 3 times. Once in small group. There were 6 other people in that room. I'm willing to overlook that, but then last night, we were in bed for like 2.5 hours just lying there, trying to fall asleep. And did you let us fall asleep? No, you kept jumping awake with a start. We just simply can't have that, Body, can we? This hurts you as much as it hurts me, but I'm going to have to drown you with alcohol this weekend. Ok? I'm sorry. I hate to be the bad guy. We cool?

When you name a formula, an disease, or a psychological phenomenon after yourself you are imprinting your name in the history books forever. You are also guaranteeing that every single student who has to memorize your stupid fucking name will hate you forever.

I keep learning about diseases and thinking things like, "Hey, Kenny's sister has Lupus! I should totally text him!" No. No I shouldn't text him about how much I know about his sister's devastating illness. I should sit here quietly and continue to learn about Lupus.

The other day I got to suture fake brain layers using a multi-million dollar surgical robot. When I was a kid I wanted to grow up to be a firetruck. Ding-ding, Fire!

From that first college final to that last annual report before retirement, it is the right of every man to display stress in his life by growing facial hair. Fuck off, Mach-3, I've got a deadline!

Hey Brain, how's it going? You doin' ok? You sure? You want a soda? No, you don't want a soda? Good, great, because if we ever spend 2 hours memorizing 25 different bacteria and their 6 important features, only to come back from lunch not remembering a single goddamn one, I will stab you with a fucking Q-tip. I'm not kidding, I will mess you up, you son of a bitch.

Feet, if you are going to be freezing, then Armpits, you cannot be sweating. You may choose one or the other, but not both. You have 5 minutes to decide.

"Diarrheal illnesses are often spread through fecal-oral transmission" ...Um, could you elaborate on that a little further? I get the fecal part, and the oral makes sense, it's the dash that I'm a bit curious about.

cheater part 2

It's hard to make small talk in med school. "So done with class...I guess probably since I'm also done with class. Uh, what are you working on..Besides the only subject we have. What do you think of the Bears' draft pick...I don't really have time to follow either. Boy this weather is nice...or it looks that way from the one window at the back of class. Anyway! Talk to you later I'm heading this way...and you are too. Because we are both going to the library."

Med school does not lend itself to studying in public spaces. I get really into what I'm trying to learn, and because it's on the body, I'm often the best demonstration. So as I try to figure out the dermatomal sensory distribution of the ulnar nerve, I end up looking up 30 seconds later as the entire library has stopped to watch me slam my elbow down on my desk trying to hit just the right spot to recreate the knocked out nerve.

In Guatemala, they were selling something called, "Fun Station". It looked like a playstation, but it was not. It came with one cartridge and advertised 9,999,999 games. Apparently it has small variations in each game, like game speed, that they count as a whole new game. Not a single house we went to in the entire area even has a tv. Now I'm not one to fuss over marketing, but I think this team of expert advertisers may have missed their mark.

I went hiking in Guatemala recently and our guide was a Mayan 26 year old with two kids, 13 years of paramilitary experience and just enough Spanish to communicate with our shitty Spanish. My hope for the world rests in the fact that he found our farts as funny as we did.

I was walking past a girl in the library who had something written on the back of her shirt that said, "You can always retake a test, but..." I walked past too fast to see what the rest said, but I liked where this was going.

It really bugs me when I meet someone busier than me. "Oh sorry, I can't do Monday, how about Tuesday?" "Oh really? Because I'm an attending neurosurgeon, my triplets are having their birthday this week and my NIH grants proposals are due this weekend. You sure you can't make time Monday?" "Well I guess I could just watch Heroes on nbc.com. It's actually just a rerun. Yeah Monday sounds fine John Storm MD PhD MPH JD".

A study following 1000s of people for 2 years determined, with complex statistical analysis, that the best indicator of future suicide, is past suicide attempts. That's brilliant. Thank you. The scientific community can sleep soundly knowing you all figured that conundrum out.

There are experiments where they hook an animal up to an IV and allow them to push a lever that will administer cocaine. If you allow the animal to self administer the cocaine whenever it wants, it will stop mating, stop eating, stop drinking, and push that lever until death in 2 days. It will take 2 days to seizure out and kill itself... Fucking best 2 days of his life! Whoo, Vegas, here we come! ...No, seriously, don't do drugs. Scrambled egg and all that.

So in a move of scientific brilliance, chemists decided that since pot causes appetite increase, if they could create a molecule that does the exact opposite of pot, it could reduce appetite and be a diet drug. It worked. Oh, except for the fact that the exact opposite effect of pot is severe, severe depression. Probably should have seen that one coming.

I'm not going to steal medical supplies. I'm not going to write scripts for myself. I'm not going to discuss my patients tooth to tatoo ratio. But the instant I learn how, I'm going to hook my ass up to an IV to cure a hangover.

Great, so now oral sex can spread STDs. Can't a hedonistic brother get a break? Is there anything fun that doesn't cause STDs or cancer? I'm gonna be stuck with hand-jobs and "runners high" for the next 60 years until I hit 80, then fuck it, someone get me some heroin.

cheater part 1

This is super cheap, but in lieu of posting a real entry, I'm going to post everything from ruminations.com that is medical related or even school related and a few that I never posted on there because they were just rampant medical masturbation (that's a real disorder, it has to do with a defective G-protein or something. I wouldn't bother fact checking that and just trust me).

"Staphylococcus aureus (pronounced /ˌstæfɨləˈkɒkəs ˈɔriəs/)" Oh, that's how to pronounce it? Thanks Wikipedia. If it weren't for you I would have gotten up in front of my class and looked like a total idiot. I probably would have pronounced it exactly how it looks. I would have been so embarrassed when someone pointed out that it is pronounced like a string of fucking gibberish.

I see you in the hallway, we kind of know each other. I nod. You nod and follow with a, "Hey". I follow with a reflex, "How's it goin?" I'm like 20 feet past you by now. You fucking answer, "Pretty good!" Cool, fantastic, I'm glad you are doing well. Pause. "How are you?" Oh come on! I've opened the door. My jacket is zipped. Do I have to answer? I just put my hat on..."Good". I keep walking. Pause. "How was your weekend?" I don't even know your fucking name, you one-upping son of a bitch!

They say that the way to a man’s heart is through his stomach, but I just took anatomy and that is totally wrong. I would go through the chest. The chest is probably the best way.

If you don't have a Wikipedia article, I don't totally trust that you are a real thing.

One time I was reading a scientific paper and the words “matastable” and “susceptible” were close enough together that I thought it said “mustachable”. I thought I was about to read about the most exciting modern medical breakthrough. Turned out it was about stupid cancer. I hate cancer.

My parents came to visit recently and they were driving me and two of my friends around. I was showing them the sites around my house and kept referring to things as, “…best food truck in West Philly”, or “…busiest street in West Philly.” At some point my dad goes, “Why does everyone say West Philly, you can’t say West Philadelphia?” to which, without skipping a beat, all three of us replied, "...Born and raised. The playground is where I spent most of my days, chillin out max and relaxin all cool, shootin’ some b-ball outside of school...

All I really want to learn in school is the name of that disease where you can read two full pages worth of material only to realize you didn’t process a single fucking word. Because I definitely have that.

When there is free food offered at an event, people are always disappointed when it’s pizza. How can people hate freedom so much?

Coffee just makes me more alert while I procrastinate.

I’ve heard that we are the ADD generation and I totally believe that because about 25% of the time I call someone, by the time they answer, a mere 30 seconds later, I’ve forgotten who I’ve called and have to make awkward coughing noises while I look at my phone to see who I dialed before I end up saying “whats up, motherfucker?” to my grandma.

Sometimes, when I’m trying to get work done, I will offer myself a reward of distraction. For example, if I finish the intro section of the project I’m working on, I might reward myself with some YouTube. The problem is that the task takes 4 min. and the reward will go ahead and finish out the hour. I am bordering on doing a completely different task. At this point, my distraction is my project.

Sunday, February 15, 2009

sowwies

This was such a good idea...until I actually got to med school and haven't posted a fucking thing. I promise that I will post stuff sometime, but it turns out that med school is hard. Who knew. And I've overextended myself and don't have time for something like this, so sorry if you came here looking for something worthwhile. I don't have it.

Sowwies! Soon, totally soon, I promise.

Meat