Something rotten in the state of those lungs

A funny thing happened last week: I enjoyed a histology prac. In fact, not only did I enjoy it, I learned something!

You may recall, if you are an avid reader, that the last time I wrote about histology I clearly had no idea what I was talking about, or looking at for that matter. Since then I have somehow learned something without realizing it, since the prac last week came as a complete surprise to me.

The pathologist running the prac told me to look at the slide and note that there was an eosinophilic infiltration - and I did! He told me to note the thickened basement membrane - and I did! He told me to observe the non-necrotizing epithelioid granulomas - so I did! And then he told me to find where the ciliated epithelium had been replaced by the keratinizing squamous metaplasia - and I could! It was all a bit eerie, as if I had gone to sleep and woken up knowing a lot more stuff than I had the night before. Perhaps sleeping with my head on those textbooks every day in the library is really starting to pay off.

The other surprising thing to me is that I enjoyed the prac. This is partly from not being completely lost like I have been in the past. It also helps to sit closer to the front of the room so that my aged ears can hear what the pathologist is saying, rather than the fascinating gossip concerning my fellow students' social lives which is all I can hear if I sit up the back with the Cool Kids.

But mainly I think I enjoyed it because pathologists have fantastic vocabularies so it's very entertaining to listen to them. They use words like fulminant, nodular, and serpiginous. And they compare things to food like cheese, porridge and rind just to make it a bit more earthy. It's like listening to Shakespearean dialogue. I can understand what they are talking about but I would be unable to create anything like it myself.

Words, words, words...

Ow my leg!

I spent yesterday morning being a patient for the 3rd years for their practise clinical examinations. I had to lie on a bed and pretend to have a DVT and they had to take a brief history from me and examine my leg in just 5 minutes. The task was actually pretty straightforward and most people did fine, but I could tell that they were pretty nervous about it.

The interesting part for me was to be on the other side of the stethoscope and be able to watch how they conducted themselves. I learned that little things in what doctors do can make a huge difference to the patient's perception of them. I knew this before of course, but seeing 12 people do the same task in different ways in one morning really emphasizes the point.

Weird things that people did that I found really off-putting included:

• not introducing themselves to me,
  
• having their hands jammed in their pockets while talking to me,
• leaning against a wall or chair while talking to me,
• not warning me beforehand when squeezing my supposedly painful leg,
• not looking me in the face when squeezing my supposedly painful leg and hence missing my NIDA inspired grimaces of agony,
• looking up at the roof and saying, "ummm, what else?" when they were stuck for a moment (everyone got stuck at some point - the good people just didn't talk about it out loud)

Since DVTs cause the affected leg to get hot, I was supplied with a heat pack which I applied to my leg before the students came in to examine me. Most of them checked my legs for differences in temperature, but since they knew I was just pretending, they didn't expect to actually find any physical signs, so only one student all morning noticed that one of my legs was hot. (Actually I think both of my legs are hot, though perhaps a little hairy.) He looked up at me in surprise and said, "I don't know how you've done this, it's very clever, but the affected leg is much warmer to touch". Everyone else just skated past it, saying that both legs were the same temperature. The examiner would ask them at the end to go back and check my legs again - it wasn't until they were specifically directed to compare temperatures (obviously indicating that something was going on) that they noticed it. Then they would get all quizzical and I would say, "ha-HA!" like a stage magician and show them the heat pack that I had thrown under the bed as they walked in. To their credit, they all laughed.

I certainly learned a few lessons of what not to do, which I will hopefully be able to put to good use next week, when I have to do a respiratory examination on a standardized patient of my own. It's hard to imagine someone deliberately filling their lungs up with fluid just to trick us, but at least now I'm aware that I need to report what I find, not what I expect to find. Good bit of learning, that.

Spare me the purple prose

If you are very observant, you may have noticed that I am currently reading "The Memory Room" by Christopher Koch. He's a great writer and I am enjoying the book but there's one thing about it that I am a bit iffy about. It relies heavily on diary extracts as a narrative device, and to this day I think the only book I have ever read which portrayed diaries at all accurately was (tragically) "The Secret Diary Of Adrian Mole, Aged 13 and 3/4".

One of the great (perhaps the only great) diary-based books is (in my mind at least) Bram Stoker's "Bram Stoker's Dracula". (It's actually just called Dracula, but have you noticed that people always call it "Bram Stoker's Dracula"?) I think Stoker pulled off this stunt because it is Gothic horror, and it just seems plausible that in the face of such soul-chilling evil that the protagonists would keep detailed diaries in order to preserve their own sanities. But also, in the time in which the novel was set (and written for that matter), people actually did things like write each other long letters that lasted several pages!

The problem with translating this to a modern novel is that people just aren't like that any more. No-one sits down and carefully crafts beautiful descriptions of the weather and scenery and the ambient sounds and smells in the course of documenting their everyday life. It seems to me, as I sit here in the dim light of my computer as it whines faintly, half-drowned out even by the distant midnight traffic noises from the nearby roadworks that throw up a fine dust that settles on one's bedclothes during the day and inks the sky vermillion every evening, that no-one in their right mind could be bothered to do it because it's incredibly time consuming and pretentious and I have to get up early tomorrow to get a good park at uni and it's already a quarter to one.

I think James Elroy could probably write a good diary-novel. "Got up at noon. Sheets were scorched from cigarette butts again. Too drunk to write more." And so forth. Hmm - sounds like a blog. Maybe not such a good idea...

Self-portrait

One of the only blogs I read on a regular basis is Michelle Au's startlingly named The Underwear Drawer. The reason I started reading it is because of this cartoon about medical students, which still makes me laugh.

And so, as a blatant rip-off of her latest post, I present my own cartoon self-portrait, produced by Face Your Manga:

He's a good man but...

Oddly enough, I don't think anyone has ever asked me where the name of this blog comes from. It's possible that it's so ridiculous that they just don't want to mention it to save me the shame. It's also possible that it is so catchy and full of winnage that they just assumed that I made it up because that's the kind of thing that a guy with my vim, zeal and elan does.

Alas, the truth is that I stole the phrase from a cartoon that was published in the New Yorker. I liked the cartoon because I thought it could very well have been written about me personally, and my ego just loooooves that kind of thing. I liked it so much that I ripped it out and stuck it to my fridge for a year until the fateful day when I decided to start this blog and realized that I needed a name. Thank you Robert Mankoff.

Closing ceremony

I watched the closing ceremony of the Olympics just now. Man - what's in the water over there in Beijing? That was some freaky stuff going on. People flying around on giant drums? Men bouncing on their back on portable trampolines? There was a real Dr Seuss quality to the whole thing, but without the catchy rhymes. I kept expecting elephants wearing tutus and balancing bowls of goldfish on their heads to ride in on tiny little bicycles, but it didn't happen.

My favourite part of the ceremony was the speech by the Chinese President, Hu Jintao. Mr Hu spoke in Mandarin, but I was fortunate enough to be able to bring you this translation from the Australian Athletic Team's un-official translator for the Games:

Hu Jintao
(translation from Mandarin by Sally McLellan)

Oh my god! Is this for real? Did we just run the Olympics? Did you see it? I told China to host the Olympics and they did and we won lots of medals! Did you see me at the opening ceremony? I was so pumped! I have never been so pumped in my life! The torch got lit up and I just thought "Go for it! You're running the country! Do it!" and I did! Shit! I finally ran the Olympics! Oh my God!

Invention

I'd like a longer stethoscope please. The tube bit on mine is about 40 or 50 centimeters, which is fine for most purposes. But because I am slightly taller than average, I sometimes have to stoop a bit, especially when listening to (or "auscultating", if you're a medical person, because God knows we wouldn't like the rest of the world to understand anything that important) a particularly flat patient. But worse still, when doing a respiratory examination, the patient has to breathe in and out deeply while we listen to their lungs, which typically involves getting mouth-breathed-on quite vigorously. This doesn't really appeal to me that much.

It's not that I don't like people. I do. In fact, some of my best friends are people. It's just that mouth-breaths are so moist and warm and often carry strange food-like odors. I get enough of that kind of thing at home from my cat.

Apparently the stethoscope was originally invented by a guy who didn't like pressing his ear against the chests of his patients with tuberculosis. Bravo! I'd like to stake a claim to the invention of the bihomostethoscope, which requires two men to operate. It's basically a really long stethoscope. One person presses the listening end to the patient's chest and gets breathed on, and the other (more senior) person stands 5 or 6 feet away listening to the lung sounds.

You heard it here first!

Let's not get our lethal Bird-Women confused

I was eating dinner in a Burmese restaurant over the weekend. The candle-light was just right, the hi-fi was in the background, and the wine was delicious. One of my Dining Companions commented that the Burmese classical music sounded "harp-y". I remarked that perhaps we had all better lash ourselves to the mast. Not only did no-one laugh, I had to explain what I meant to everyone present. And here I was thinking it was some of my best work!

To add insult to injury, when I returned home I realized that I had confused Harpies with Sirens. Isn't that always the way?

Crimes against nerdity

I just can't take it any more! The time has come for me to take a stand, to right a wrong, to speak out where there has been silence. Criminals are a cowardly and superstitious lot. In brightest day, in blackest night etc etc. I can no longer stand by while my lecturers describe curves as "exponential" when they merely have a positive second derivative. I know you're with me on this one.

Today it happened again. That makes twice this semester, and at least twice last semester. Today's curve described the ventilation/perfusion ratio of the lung. We were shown a graph of ventilation (litres per minute) versus distance from the base of the lung. The graph was a linear one, so y1 = ax+b. On the same graph was shown perfusion, again of the form y2 = cx+d. The ventilation/perfusion ratio was then shown and was described as being exponentially increasing. But if you let x = (z-d)/c, it's easy to see that (ax+b)/(cx+d) = a/c + (b - ad/c)/z, which is clearly a hyperbola! Outrageous!

If you think it's unimportant, consider the difference in the two cases as the size of your lungs approaches infinity!

Similarly, we were previously shown another example which was two linear curves multiplied together. Thus, it was simply a polynomial rather than exponential! How would you feel if you were a patient lying in hospital struggling for breath and you heard one of your treating physicians so egregiously confuse his high-school mathematics?

Every time it happens I feel like sticking my hand up and correcting them but part of my brain (I'm guessing the right hemisphere) tells me to be quiet. It is innate knowledge amongst medical students that any consultant that is corrected by a student would tear that student limb from stinking limb and I have no desire to be dismembered just yet. Nevertheless, ignorance breeds where wise men say nothing. If you are reading this I place upon you a most solemn duty. The next time a lecturer describes a curve as "exponential", you must raise your hand and enquire whether the gradient of the curve is proportional to its height or if it merely curves upward. And don't tell them I sent you.

Olympics

Aaaargh! The Olympics are here!!! Noooooooo!!!

I have very mixed feelings about the Olympics. When I was a kid, the Olympics were on in Los Angeles. My school ran a competition to design a poster for an Olympic sport, and the prize was this special book all about the Olympics, with lots of glossy photos. I so wanted that book. I think I must have been bouncing around the house being all obsessed with Olympic stuff, because a couple of days later my mother gave me a copy of that same book! Oddly, I was kind of disappointed, because I had wanted to win it rather than be given it. I think that reflects positively on my moral character, don't you? My disappointment only lasted about 10 minutes though, because it was an awesome book and now it was mine! I learned everything I have ever needed to know about the Modern Pentathlon from that book. I can still remember a picture of Glynnis Nunn throwing the javelin as part of the Heptathlon. She had this crazy muscle popping out of the side of her neck, that I now know to be the sternocleidomastoid muscle. In my next set of exams I can inform the examiner that the sternocleidomastoid muscle is not on an accessory muscle of respiration, but can be used to hurl javelins! Bonus marks!!

Anyway, mixed feelings for the Olympics. I love esoteric sports. I spent six weeks in Canada a while back. Spent most of it watching curling on tv. Awesome! The Olympics is a great time for me because for a short time it seems like there are enough sports in the world that everyone can win a gold medal for something.

But there's a downside to that too - some of those "sports" are pretty lame. I mean come on, trampolining? And I'm not big on swimming, which is a shame because Australia tends to do well at swimming so every single damn race gets shown. Face up to it people - every race looks the same. You can't tell the swimmers apart in all that splashing. I think they're showing us the same race over and over again and just changing the commentary. And a quick aside: there was a swimmer on tonight (bald of course) whose surname was Nederpelt. This made me laugh because to me, "Nederpelt" sounds like it might mean "Hairless" in Dutch. Maybe his name used to be Grossepelt before he shaved his head.

And then there's the drugs. (I'm talking about the athletes, not me.) I'd like to see the Olympics re-formatted so that drugs are no longer feasible. It would run like a military draft. Everyone in the world would have their name put inside a ping-pong ball (one ping-pong ball per name, not all names in the same ball) and they'd all go inside this big biscuit barrel and be drawn out at random by a minor celebrity, event by event. And then helicopters would go out and grab those people and they would have one week (say) to train for their event, just to eliminate the most fearfully gumby performances, and then - the Olympics!

Because the odds of being chosen at random to compete for your country would be so small, it just wouldn't be worthwhile taking performance enhancing drugs in advance. So you'd get people competing in a real state of nature. I personally would pay big money to watch a bunch of obese Americans plummet from the 10-metre board in the synchronized diving. And every now and then, maybe once per games, you'd get someone who actually knew what they were doing and put on a good show.

Memo to the IOC: you heard it here first!

Sometimes I doubt my sanity

I was just doing some reading for my tute tomorrow, so that if someone happens to ask me, "Did you do any work at all this week?", I can truthfully answer, "Yes I did!" and get all self-righteous on them.

So I'm flipping around through a big fat book reading about croup:

PTR
Wow! Croup is real!

Smaller Half
Of course croup is real. What are you talking about?

PTR
I always thought it was just a word that old nannas used to describe sick babies. Like colic.

Smaller Half
Colic is real. Colic refers to a specific type of pain.

PTR
Not colic then. You know what I mean though - a kind of old-wives word for an entirely non-specific set of symptoms that don't really exist. Like lumbago.

Smaller Half
Lumbago is real too.

PTR
Aaaaargh!

I seem to have developed the idea that any disease with a short or old-fashioned-sounding name doesn't really exist. Isn't that strange?

Get out of jail free?

Last week we (my Smaller Half and I) were chatting to a friend who is also studying medicine at This Fine Institution. He is in his third year, so he's two years ahead of me. I find it really useful to talk to people in the years ahead from time to time because they can speak authoritatively about what I'm going through. They know what is hard, what's easy, what's important, what is not. In general they tend to say that first year is pretty cushy and not to get too worked up about it.

This is great because it really puts things in perspective and calms me down. It's unfortunate that the perspective is due to the enormous increase in work as you progress through the later years of the course. It's a bit like being told, "No, that headache you have now is nothing compared to how you'll feel by lunchtime tomorrow". Nevertheless, it is of some short-term benefit.

We were discussing the sheer vastness of the landscape of health and illness knowledge that we're expected to acquire and how overwhelming it can seem, when our friend said something like this:

Knowledgable Friend
My supervisor said that in the end, there are four things that will kill the patient in the next five minutes, and that's all you really have to know. Everything else gives you time to duck around the corner and look it up in a book or google it.

PTR
Wow, that's encouraging - makes it seem a lot more manageable. What are the four things that you do need to know?

Knowledgable Friend
He didn't say.

PTR
Oh.

I guess I don't get to go straight to third year after all...

Anything but that

Went to the markets as usual this morning to shop. I was very disappointed that nobody stopped me to ask for advice on what to buy or how to cook it like they did the last two times. I complained of this to my Smaller Half, and she said, "It's because you're unshaven and you look like a thug. And your eyes are too close together too." Great - I'm married to a phrenologist (see the comment section below regarding this). It's true though that I am a bit bristly, and it's possible that I had a stern look on my face because my shopping trolley fell apart on me so I had to wrestle this big bag of food back to the car without the benefit of wheels. It was like shopping in the Paleolithic.

Nevertheless I did get to do some quality eavesdropping on my fellow customers. My favourite was the suave man with a charming French accent and his young son who I queued behind at the Italian deli. Once the guy had finished buying his stuff he said to the boy, who was about 5, "Would you like to choose some sausages? You can choose whatever you like, zey are for you." The boy considered his options and tapped on the glass in front of want he wanted. His papa recoiled visibly and said, "Ze English sausages? Oh! Perhaps you would like to choose somezing else? Ze Continental sausage perhaps?".

I can't say I blame him. The English sausages were pale and smooth and limp looking.
They actually looked like they were made out of English people. The Continental sausages, on the other hand, were coarse and meaty and fiery. Viva la salsiccia!!