Marbles

I was in a dreadful antique store today.  In fact it wasn't really an antique store, it was a "bric-a-brac" store.  "Bric-a-brac" seems to be shopkeeper code for "collections of horrid teacups and twee little bits of quilting".  As such, when drawn into bric-a-brac stores I usually jam my hands into my pockets, stare at the ceiling, and enter my own private world while humming Freddie Mercury songs to myself.

But today I was relieved of the tedium when I spotted a bowl of marbles for sale for 20 cents each.  Deluxe!  These were good marbles too.  Normally when you see marbles for sale they are just digs or catseyes.  But these were a good range of glassies, onions, bananas and snakies.  I bought a couple of digs and catseyes too, since just going for the high-end marbles seems a bit snobbish.

Rolling my newly bought marbles around in my hands brought back a lot of childhood memories.  Fads would sweep through the quadrangle at school every few months.  Most were never to return, but marbles came back every year.  I don't know where our actual marbles came from (as opposed to the marble fad itself, not that I know where that came from either), because with one exception I was never aware of them ever being bought from a store.  I must have pinched some from my older siblings, because otherwise I can't imagine how I ever got any.

The one exception to marbles not being bought I remember happened when some kind blessed spirit possessed my Aged Mother and she bought for us a small mesh bag of bananas and black bananas, mostly quarters but a few halves.  For about a week I was living large at school, being newly rich in marble wealth.  Of course, I was pretty crap at marbles so I pretty quickly lost mine to my less sensitive and more athletically gifted classmates.

A typical example was one time when I was playing a kid who caught the same bus as me.  I'm pretty sure I had put up a couple of banana halves for a snakey quarter.  I thought I was a good chance but he kept accusing me of fudging and awarding himself two shots.  I can remember thinking that this was unbelievable, and that this country was stuffed.  I attempted to call him on it but he threatened my physical integrity so I conceded.

A few words of clarification: we played proper marbles, not the stupid version that seems to be depicted in British children's books and TV programs.  In pommy marbles the objective seems to have been to knock marbles out of a circle with your own marble shot from a distance.  This is plainly absurd and pathetic and no fun at all.  Our marbles was more like golf.  We dug a hole in the ground and, starting about 3 metres away, we would alternate shots to get our marble into the hole first.  Whoever won the game kept the marbles which had been pre-agreed as the stake.  You didn't have to shoot with the marble up for grabs though - hence you could choose a marble appropriate for the terrain.

Of course, all sorts of shenanigans can and did happen, usually leading to disputes, thumpings, tears and shouting.  But that's what childhood is all about.  Buy some marbles for your kids today, then give them a thumping.  One day those will be cherished memories.

Finally, do not under any circumstances submit comments about "losing your marbles".  I will find you and destroy you.

Man-bag

[Fire typography for the picture stolen from Nir Tobir]

I've got mixed feelings about my man-bag.  Partly it's to do with the name: "man-bag" has a certain scrotality to it that I'm not entirely comfortable with.  Also, although it is a genuine man-bag purchased from the Men's Accessories section of a wanky store, it was bought by my Smaller Half for her own use.  She used it for two years and I have only started using it this year because she doesn't really need to lug books around any more.  So a certain air of femininity lingers on despite its rugged brown leather construction and spartan style.

I've had a couple of my Esteemed Colleagues say to me, "Nice man-bag!", which is encouraging.  But they said it in a slightly over-enthusiastic way that makes me wonder if they were mocking me.

But the worst insult happened just today.  I was sitting in with an orthopaedic surgeon (and we all know that they're the real macho men).  My man-bag was on the floor under my seat, innocently minding its own business in its understated masculine way.  He saw it there just as the patient was leaving the room and said to her, "Oh Mrs MacGillicuddy!  Is that your handbag?"

"Oh no", she said, "It's HIS!" and she pointed right at me.  Oh how I burned with shame.

Mock OSCE

We had a mock OSCE on Wednesday night.  (An OSCE is a oral exam where you interact with either actors playing patients or real patients and you have to be the doctor.)  There were only five active stations and two rest stations, but the organisers had structured it so that it was excellent preparation for the real OSCE at the end of the year.  Here's an overview of what each station was testing.

Station 1: Panic
The first OSCE skill to master is panic.  If you go into your first station and you don't panic, the patient and the examiner will know that you are a clueless noob.  For this reason, getting a good panic on for the first station is essential.  Some things that may help are to drink too much coffee, imagine how your life will be wrecked unless you perform perfectly, and to glance at advanced textbooks immediately before the start of the OSCE to ensure that you are fully aware of how much you don't know.  If, despite your preparation, you find yourself unnaturally calm and relaxed, you could try hyperventilating to induce lightheadedness.  Alternatively, try bluffing your way through by moistening your palms and brow with water to give others the impression of fear.

Station 2: Disorganisation
This skill is most usefully displayed during a station which combines history taking and examination.  You should immediately commence examination, and if possible arrive at a firm diagnosis immediately.  This allows you to suggest management, preferably something which would be contraindicated by common conditions with similar presentations.  Thus, you then are compelled to ask a few history questions which then trigger something in your mind to test by examination, and thus the cycle begins again.  It would be good if, from time to time, you then leap back to history taking by asking some general systems questions.  The effect you're looking for is something like this: "The patient is tachycardic, it's almost certainly a pulmonary embolus, I'd recommend thrombolytics, oh wait, maybe it's blood loss, have you noticed any change in your bowel habits?  The abdomen is tender in the right iliac fossa, how are you sleeping?  And your parents, do they have any history of epilepsy?"

Station 3: Time mismanagement
After station 2 you will realize that you need to be more thorough.  Thus, station 3 is the one where you can delve step by step into the minutiae of the patient's condition.  With any luck, you'll still be only halfway through taking a history when the bell rings for the end of the station.  A good place to get bogged down is when asking about medications - few patients can remember the correct names and doses of their tablets, so this gives you the opportunity to spend a long time trying to pin them down.  "Are you sure it was atenolol?  Not metoprolol?  Or nebivolol?  Or carvedilol?  What colour is the tablet?"  Alternatively, a good chunk of time can be burned up by an inquisitorial style when asking about smoking and alcohol.  Believe nothing that the patient tells you and scold them for not telling you the truth.  With luck you'll not only waste time but antagonise them so much that the rest of the station is complete disaster.

Station 4: Compensatory euphoria
By this stage of the OSCE you're past the halfway mark.  Soon it will all be over, so it's traditional at this point to relax a little and lapse into compensatory euphoria.  Thus, the fourth station is there to test your ability to urge the patient to make sweeping lifestyle changes while assuring them how great the results will be with just a little willpower, and babble at great length in order to show the examiner how wonderful your interpersonal skills are. A useful technique is enthusiastically agree with everything the patient says and then continue talking as if they hadn't said anything.  Another good trick is to dump on the patient all of the detailed pathophysiology that you learned in first and second year.  This will baffle them into stunned silence and ensure you have maximum talking time.  Again, hyperventilating while reading the instructions on the door before you enter the station can be invaluable in getting you into the right frame of mind!

Station 5: Exhausted confusion
This is one of the easiest OSCE skills to master once you know the right approach.  The key step is to begin preparing early on.  Don't eat anything since the night before.  Sleep badly.  If you have any notepaper to write on, keep notes for all stations on the same piece of paper.  Make sure you don't write any names or other identifying material.  This will allow you to keep asking, "What's your name again?", and, "I know I've asked you this before, but where is the pain?"  Hopefully you will have performed terribly on each of the previous stations so you'll be tired, demoralized and sick to death of the whole thing.  Sigh deeply.  Stare down at your notes and shake your head.  From time to time, glance despairingly at the examiner as if begging for help.  If you are unfortunate enough to have to recommend management, try being unable to recall the names of drugs, or unable to pronounce them properly.

So that's how you do a mock OSCE!  If you practise these skills at every opportunity, you'll be ready to savour the full richness of the real OSCE at the end of the year.  Of course it's hard to extrapolate from just 5 stations to the full 20, but keep in mind that these techniques can be used not only in isolation but in combination.  When you're first starting out it's advisable to master them one by one.  By November, however, I expect you'll be able to use these notes to play a beautiful symphony of underperformance in the key of F.

I just wanted to say good luck, and we're all counting on you.

Start low, go slow

We had an excellent tutorial from a cardiologist yesterday.  It was mostly about the various drugs that are used to treat people with heart failure.  One group of drugs, beta-blockers, work very well despite their effect seemingly being contrary to what you think you should be aiming for.  In heart failure, the heart is weak and is really struggling to get blood to where it is needed in the body.  Beta-blockers work by slowing the heart down and making it pump more weakly.  This sounds dumb, but it is good for the patient as their heart is less likely to damage itself by trying too hard.  Problem is, when you first start giving beta-blockers to these patients, it makes them feel terrible.  So the advice is to start them on very small doses and increase the dose very slowly.  The way to remember this is, "Start low, go slow".

I think that this is sound advice for many areas of medicine, and is one that I'll be offering for many common presentations.

An elderly woman presents with dizziness and fainting when getting out of bed in the morning?  "Start low, go slow".

A traveller newly returned from an overseas holiday presents with chronic diarrhoea?  "Start low, go slow".

A couple presents with difficulty conceiving?  "Start low, go slow".

It seems to work for every situation!

Forgot to type in this box

I was offered the chance to see a great big haemorrhoid incised and the trapped clot taken out.  How could I resist?  Of course, once you're there, it's all hands on deck.  My job was to grab hold of the buttocks and pull them apart far enough so that it was easy to get the needle and scalpel in there without difficulty.  I ended up standing on the opposite side of the patient's bed, using both hands to hold on, and leaning back like a sailor hiking out on the trapeze when the boat starts to heel.

Nevertheless, I was able to get a good view by craning my neck. As a med student, it's normal for me to get excited at things like this.  It was great to see the incision made and to see the enormous clot of blood plop out onto the bed.  Very satisfying, like seeing a boil burst.  To my surprise, the clot looked much bigger than the haemorrhoid itself, probably a couple of metric teaspoons or so.  A bit more came out when the doctor rummaged around inside the haemorrhoid with the forceps.

"Oooh, that's a good one!" I said, like some kind of desperate haemorrhoid groupie.  The doctor then asked if the patient wanted to see it, which I thought was a little odd.  Perhaps, just maybe, possibly later when he's up and dressed.  But not now.  Indeed, the patient gracefully declined the kind offer to examine the clot at close range.  But the doctor's enthusiasm got the better of his empathy, and he thrust the bloodstained gauze with the clot on it over the patient's shoulder, right under his nose.

Doctor

Look at that!

Patient

Eurgh.

[Recoils and starts to go a pale shade of green]

Doctor

And that's not even half of it!  There's plenty more!

Patient

Eurghhh

I don't see how I can possibly fail this year.

Evolution

And since it's 11:57 pm here, this'll be quick.

Vote in my new poll so I can mock your deepest convictions.  Go on, you know you want to.

Epistemology

My blog seems to have attracted a frightening new class of intellectual comments.  One person even used the word "epistemology".  It's freaking me out.  And since I know I am heaps more smarter than you, I just knew I would have to explain it to you.  So bear with me while I turn up the dial on intellectualishness today.

It's a little known fact that the word "epistemology" has two meanings.  The more widely known, or "street" meaning, is "theory of knowledge", from the Greek episteme: "knowledge"; and logia: "study of".  It's the area of theory and conjecture about how it is that we know certain things. To help you remember this, here's a little dialogue:

Dullard

You epistemologists are a bunch of know-it-alls!

Epistemologist

Takes one to know one.

The other (medical) meaning is derived from the Greek epi-: "around"; STEMI: an abbreviation for ST-segment elevated myocardial infarction; and logia: "study of".  Thus, epistemology is the study of things that happen around heart attacks.  It includes, but is not limited to, the study of:

• screaming,
• ineffectual pounding of the chest for just a few seconds,
• utterance of phrases such as, "Fight damn you! FIIIIGHT!!!"
• injection of adrenaline straight into the heart by gonzo stoner drug dealers, and
• promises to love someone as they truly deserve, if only they'll wake up.

Obviously the clinical study of such phenomena is only undertaken by the most callous of researchers.  They have been known to induce heart attacks in innocent victims by handing out forged lottery-winning tickets, seducing spouses, and scoring goals against the run of play in Serie A.  So the next time your friendly neighborhood philosopher mentions his special interest in epistemology, stop and think.  Maybe he's one of them.

Medical reformation

Got some feedback from one of my GP supervisors today.  He pointed out that when I'm unsure of the truth of what I'm saying, I tend to get very quiet.  It's true - although I'm quite happy to bullshit patients, because they're not going to remember 99% of the science anyway, when there's a doctor watching me I get that uncomfortable feeling of being up at the board in a tutorial when you haven't really done your work and you know that one of your Esteemed Colleagues did their honours in what you're about to make up.  Psychologically, I deal with this by speaking in a very faint voice in order to simulate me being a long way away, just in case someone wants to hurt me.

I said this to him (in not so many words) and his response was, "Well, Martin Luther said, 'Sin boldly', so just try that."

Gee I laughed.

Transcendental numbers and you

Thanks to all 13 of you who completed my online personality quiz, a.k.a. the poll, "What's your favourite transcendental number?"  Here I present some feedback, based on the answer you chose:

e. You are a middle-aged, middle-class, moderately intelligent nobody, probably working in the finance department of a middle-size corporation.  You vaguely remember something about e from your commerce degree in the 80's, or was it high school mathematics?  Regardless, you knew it was smarter to choose this than pi, but didn't want to choose something too outlandish in case you got caught faking it and ended up being thrown out of the liberal party.

pi. You have a vivid memory of grade 6, mainly because you're still in it.  Wow!  A number that's so long you can't ever write it down!  You're unsure why 22/7 is so much more complex than 23/7, but maybe you'll find out in grade 7.

ln(2). You are a geek.  You always think in powers of two because you spend your life talking to computers, so ln(2) appealed to you because that's how you know how many megabytes you need for your Java blog mainframe uplink.

Chaitin's constant. You are a try-hard.  You went to look this up on wikipedia and what you read was baffling but you thought it would impress other people because it sounded so complicated.  Think again.

4. You are a moron.  You had to look up transcendental numbers on wikipedia, and you accidentally went to the page on transcendental meditation.  That didn't seem to have anything to do with numbers so you just chose 4 because you know it's a number and the other ones are letters or words.

Highlander

So maybe we can't agree on science/religion, or as I like to call it, religious science.  But we can all agree on one thing: Highlander is the most awesome film ever.  Fact.

Take Sean Connery and that French guy who played Tarzan as well as that big dude from Highlander - no wait, that's the film I'm talking about, anyway he's been in some other films - and give them all swords and let them just whale away at each other and cut off heads and drive cars down the footpath and stick safety pins in their necks and machine-gun Nazis and add the most kick-arse soundtrack EVER by none other than Queen.  How many films are there this great?

There can be only one!  HeeeeeyaaAAAGH!!!!

Belief

There's been a lot of hubbub about Richard Dawkins recently, and it's got me thinking, so this post is loooong, self-indulgent, potentially boring, and definitely opinionated.  I'm really only typing it up as an aide to clarify my own thoughts.  I'm no philosopher - the arguments and observations here are probably incredibly naive and easily knocked down.  If so, please feel free to comment with a rebuttal.  Otherwise, feel free to skip it or read on as you please.

Back to Dawkins: a lot of people enjoyed watching him club the baby seal that is Steve Fielding when the two of them were on QandA recently on the ABC here in Australia.  It was sickeningly brutal but I couldn't look away.  I wouldn't go so far as to agree with Dawkins that Fielding is "dumber than an earthworm" but I do think that he's way out of his depth in Parliament and is doing himself and our country an injustice by being there.

While I love to see Fielding taking the hurt, I find Richard Dawkins an incredibly difficult person to watch.  He makes very strong arguments but does so in a way that I find personally objectionable.  On QandA I think he got carried away.  He became more and more smug, more and more mocking, and more and more contemptuous of his fellow panelists as the evening went on.  It's kind of unfair for a person who makes a profession out of attacking religion to get stuck into people who are not in the business of defending religion.  I think he made Tony Burke look uninformed and unprepared, but in return Tony Burke made him look like an arsehole.  When Burke called Dawkins out on his smugness, Dawkins attempted to deny any such thing, and I don't think the incident reflected well on him.  Tony Burke 1 - Richard Dawkins 0.

To be honest, I don't understand why (some) scientists seem to get so much pleasure out of attacking religion.  I do understand the frustration and desire to retaliate when ill-informed religious leaders seek to inject religion into science. But to retaliate by denigrating all religion ends up (in my humble opinion) not only missing the point of the argument but actually bolstering the credibility of the opposition by accepting the role of antagonist.

What I have difficulty sympathizing with is Dawkins' position, which seems to be that because science works, all religion is thus stupid and only a fool would subscribe to the religious viewpoint. Science and religion beating up on each other seems to make as much sense as mechanics and ballet dancers beating up on each other.  And while beating up ballet dancers may be fun and make you feel like a big man, I don't think it's either necessary or excuseable, despite that fact that in the real world, until quite recently, the ballet dancers have been beating up the mechanics for hundreds if not thousands of years.

Let's be clear about where I stand - I'm agnostic.  And proud of it.  Hmmm, maybe "proud" is not the word - I'm not "proud" of being blue-eyed either - it's more that I refused to be ashamed of it because it's an honest description of me. Many people seem to shrink from the label as if it reveals some kind of moral weakness, like how the term "liberal" in the USA is often used sneeringly.  But I'm agnostic because I have no idea whether there is any kind of God or not.  I think that's a rational position.  There's no evidence that I'm aware of that God exists, in whatever form you care to conceptualize him. Absence of evidence, however, is not evidence of absence. Recognising that, atheism seems to me to be just as much of a leap of faith as religion.  I can't put my hand on my hand and say that I think there is no God.  But why am I this way?

One thing I have come to believe over time is that we don't choose our beliefs.  I think I'm agnostic in the same way that I'm introverted, modest and devastatingly handsome.  It's the way I'm put together.  Sure, if I'd been raised in a deeply religious family I'd be different.  But I wasn't so I'm not.  I used to have (mostly) friendly arguments with a colleague at work when he would urge me to reconsider my lack of faith and would present all sorts of well-informed theological arguments to try to persuade me to Believe.  To my mind the best theological argument is Pascal's: if I believe and I'm right, I get an infinite reward.  If I disbelieve and I'm wrong, I get an infinite punishment.  Anything else and meh.  Given that equation, you'd be a fool not to believe.  I find this argument immensely compelling, and it genuinely makes me frightened and makes me wish that I believed.  But my stumbling block is this: I do not believe.  And I don't know how to choose to believe something.

Sure, I could act as if I believed, and hope that over time I just kind of came to Believe, in the same way as you might drink only sarsaparilla cordial for a month during summer to try to train yourself to like it (which is how I taught myself to like sarsaparilla, just to see if it would work).  But that seems incredibly insincere and phony to me.  I'm about to say something ridiculous here: if I was God, I'd prefer people to stick to their honest beliefs and try to live good, productive, fulfilling, generous lives, rather than force themselves to pretend to be something they aren't.  I'm aware that that is an absurdly presumptuous thing to say so I'll pre-empt Godwin's law myself - just because Adolf Hitler, if he was God, would have done some seriously bad stuff to a lot more people than he was able to anyway, doesn't mean that the real God agrees with him - thank God.  Nevertheless, I think the underlying point is a valid one: regulating actions is more reasonable than regulating beliefs, because people have more control over their actions than over their beliefs.  (Even if free will doesn't exist I think this is still true - perhaps that's a future post...)

But back to Richard Dawkins, again.  He likes to talk about rationality.  Science is rational, religion is irrational, etc etc.  I think he overestimates the rationality of science.  Sure, the idealized process of science is rational, even if the practise of it isn't.  And science works: 747's can indeed fly and VX gas does indeed kill you very quickly. Obviously, one of the great things about science is that it seems to work regardless of whether you believe in it or not.  But very few people obtain scientific knowledge by the scientific method. I know heaps and heaps of "sciencey stuff" that I use to make decisions all the time about my own life and indeed the lives of others that I've encountered in a medical context.  Ultimately though, I have almost zero scientific basis for that knowledge because I have simply accepted it carte blanche.  I subscribe to a whole slew of beliefs about scientific knowledge because they come pre-approved by the Powers That Be.  My actual direct exercise of rationality though is pretty much limited to seeing people put bananas into a box and then take some out again, and being able to deduce how many are left.  (Yes, I like to hang around fruit shops.  And zoos.)

I'm not denying that there are people out there who have direct experience of certain areas of science because of their work.  But it's probably quite rare.  Several hundred years ago, the work that scientists did was so grounded in their direct sensory experience that to even consider that there was some kind faith involved would probably have been borderline psychotic.  But now it's a different matter.  I listen to patients describe symptoms to me, which I interpret in terms of explanations of physiology (although I have never seen 99% of it with my own eyes) and I recommend treatment to them in terms of pharmacology (of which I have never seen 100%) and I fully expect that it will work.  I take all this information out of books and just assume that it's right.  Why?  Partly because most of the time it is self-consistent and seems to work, but mostly because That's Just How You Do Things.

So when Richard Dawkins sneers at religious people, it gets my hackles up.  His arrogance diminishes him, it diminished his arguments and it diminishes me as a believer in science and as an agnostic as well.  I think his hostility is unnecessarily because religion and science aren't playing for the same cup, and science is almost as much of a religion as religion is.

Right - so that's science v. religion resolved.  Next up: MP3 v. vinyl.  Then mechanics v. ballet dancers.

Sound advice

Words of wisdom from a senior consultant today, on the topic of cautious prescribing:

"You don't want to kill the patient on the first day that they're taking their new medication - that would be silly."

Speak to me in a language I can hear

Doctors and patients speak different languages.  Often a patient's answers don't match what the doctor is asking.

The doctor asks, "Do you have regular bowel actions?"  And the patient replies, "Oh, all the time!"  Because the patient thinks that regular = frequent.

The doctor asks, "Do you have trouble with your heart?"  And the patient replies, "No."  Because ever since they had that coronary artery bypass graft last year, they've felt great.

The doctor asks, "How bad is the pain?"  And the patient says, "It's really acute".  Because they think acute = severe.  Except for the people who say, "It's really chronic".

But it does happen to us students too.  It happened to me today.  The doctor said, "The interesting thing is that the optico-anal nerve in murines gets blocked because of the sympathomimetic conjugation of transisocarboxylase inhibitor under the modulation of clubbing factor."  And I said, "Hmm, that's really interesting".  Because I had no freaking idea what he was talking about.

Weeeowwwm! Shkkkktt!

I spent the morning with a sonographer today.  She was doing echocardiograms, which is where you use ultrasound to take pictures of the heart and make all sorts of measurements to make a report so that a much more highly paid cardiologist can glance at it later on in order to completely agree with it.  It was good fun.

Normally I can't read ultrasound scans for sh!t.  On Monday I was sitting in with a gynaecologist and one of the patients brought in some scans of her uterus in case he wanted to see them. For some reason he wasn't interested so I grabbed them.  I held them up to the light and decided to pop them right back into that big ol' envelope they came in.  Absolutely incomprehensible.

I understand the u/s (that's "ultrasound" for you non-medical types - feel the power!) scans that are in textbooks because they have labels and arrows all over the pictures.  In fact, if you removed the pictures I'd probably understand them even better.  But real scans don't have this stuff.  They have a few labels, but the labels say things like "A-A" and "B-B" which makes me think that perhaps they are origami instructions rather than u/s scans.  "Look mum, I made a uterus!"  "Oh honey, I'm so proud of you!" *hugs*

But the great thing about today was that we were looking at the heart and I was right there looking at the screen of the machine rather than puzzling over pictures in a book.  I was able to devise a fiendishly clever technique for analysing the scans: if things moved, they were "heart"; if they didn't move, they weren't.  It was also made heaps easier by the lovely sonographer doing the scans who was happy to talk me through every step of what she was doing for every patient who came in, while simultaneously answering my ignorant questions that I was firing at her.  She is my new hero, the wind beneath my wings.

At the end, she even let me have a go at doing it.  I got to hold the transducer-thing and fiddle around getting different views of a very patient patient's heart.  The patient and the sonographer both looked a bit alarmed when I started making lightsaber noises, but I defy anybody to not do that.  It's a handle that shoots out a magic beam, for crying out loud!

But the best thing about the day was that I learned a bit more about how to learn stuff.  After one patient I felt stupid.  After two I felt puzzled - in medicine aren't you supposed to see one, do one, teach one?  Why didn't I get this yet?  After three I felt educated - this was starting to make sense.  After four I felt bored and wanted to leave, but stayed because I couldn't think of a diplomatic way of walking out.  After five I felt equivocal - perhaps there's more to this than I thought.  And after the sixth and last, I felt reinvigorated - there's a lot of stuff I don't know yet but now at least I knew more than I did when I woke up this morning.  And today is the first day I've felt like that for a while.

Gazumped!

Terry Gilliam, the mad-scientist animator of Monty Python and director of bizarro films like Time Bandits, had this to say about my favourite author:

"For everyone lost in the endlessly multiplicating realities of the modern world, remember: Philip K. Dick got there first".

The reason I bring it up is because (yet again) it's just happened to me.  Loyal readers will know that I have just completed a protracted series of dubiously humorous puns about Ernest Hemingway and his novels, and so I chose to unwind by reading PKD's book Galactic Pot-Healer.  On page 13 I came across references to several works by Serious Constricting-Path, including The Male Offspring In Addition Gets Out Of Bed, and Those For Which The Male Homosexual Exacts Transit Tax.  His Hemingway references weren't intended to be funny, just puzzling, but I did find it incredibly surprising that they were there at all.

Galactic Pot-Healer is a very strange book.  It concerns the fate of Joe Fernwright, a professional repairer of ceramic pots, who is recruited by a vastly powerful alien being that plans to raise a sunken cathedral from the floor of an alien ocean and needs someone to fix the smashed up plates.  Shortly before I went to sleep I came to a part describing how Joe meets face to face underwater with his own rotting corpse.  That generates some crazy dreams, let me tell you.  I woke up in the middle of the night thinking I was an old man trapped in a hospital.  I careened around the room looking for the way out, and when I eventually flicked on the light and realized who and where I was, I laughed with relief.  Which didn't exactly endear me to my Smaller Half.

Good book though.

Cooking tips

• Basil leaves should always be torn rather than cut in order to avoid bruising the leaves.
• Onions should be peeled underwater to avoid the pungent fumes stinging your eyes.
• A frying pan with a copper bottom will make your kitchen look more European.
• To make better chips, only use potato slices from the side with the most eyes - this is the sweeter side of the potato.
• Storing your celery in an atomsphere of pure ozone will keep it crisp twenty percent longer.
• If your electric stove-top won't turn down low enough to maintain a bare simmer, a sub-critical disc of  enriched uranium may be what you need to stop your stews from sticking.
• Mayonnaise and salad dressing should always be mixed in zero gravity to ensure optimum emulsification.
• Garlic should never be sliced - rather, it should be crushed by Talos, a triple-iron golem.

Baked egg challenge

At the moment my Smaller Half is working on a paediatrics ward.  Like all wards, there's a big board on the wall listing all the patients and the reason for their admission.  While looking at it, she noticed that one kid was admitted for "baked egg challenge".

When she told me this, my first thought was that this kid had been dared to swallow an egg whole and in doing so had ruptured his oesophagus, which actually happened to a friend of mine (by which I mean I just made that up but it sounds like it could happen).  But then I realized that the board would just say, "ruptured oesophagus", not "baked egg challenge".

My next thought was that maybe he'd won some kind of competition, the baked egg challenge!  Why that would lead to him being hospitalized is not obvious.  Maybe the runner-up clocked him with the trophy or something.  It brought to mind my salad days as a newly minted graduate in the public service when I had nothing better to do (apart from defending the nation) that initiate themed punning competitions with my peers over email.  After one spectacular run on the theme of bread, I anointed myself the Inaugural Baked Grain Challenge Cup Holder and proudly put the title in my email signature for the next few months.  Apparently it caused a bit of amusement in some of the other organizations that I would email from time to time.  However, the likelihood of this kid's own Baked Egg Challenge victory ending up on the medical status board seemed pretty slim, and if it did it would "annoying twerp" rather than "baked egg challenge".

It turns out (as my Smaller Half so kindly let me know after I had explained my previous theories to her) that he is allergic to egg.  He's been admitted to hospital so that he can be provoked with an egg (an interesting notion in itself) under medical supervision in order to find out just how bad his allergy is.

Which is interesting, but not as interesting as it could have been if I was king.

How to annoy a doctor

PTR
The left tonsil is enlarged. My left, I mean.

Doctor
The left tonsil is enlarged or it isn't. There is no "my left".

Nephrotoxins!

I had to give a presentation today on nephrotoxins to the head of the renal unit at the Big Hospital (ie: Mr Kidney-Guy).  There are two ways such a task can be approached: with diligence or with flair.  I chose flair (also known as laxity).

Partly this is because I really dislike watching presentations which are just endless bullet-pointed lists.  But mostly it's because I only started preparing it last night at 10.30 pm so I knew that diligence really wasn't to work out for me.

I think it went fairly well.  I got a few laughs, Mr Kidney-Guy didn't seem too upset, and I learned some lessons along the way about the true value of friendship.  Here's my first slide - all the pictures came whizzing in from the side in exciting Powerpoint animation.  You can only imagine the spectacle of it all!

Feel free to guess the relevance of the pictures.  But no, I had no good reason to use Ernest Hemingway's picture - I just did it to amuse myself...

Two today!

And before I forget, I'd like to wish a happy birthday to this blog.  Two years old today.

A portrait of the blogger as a young man

The most recent poll, "Am I old?", is finished.  41% of you said "yes" and 58% of you said "no", leaving exactly 1% of you who seem to have been destroyed by the rounding error of Blogger's poll gadget.  Since only 17 people actually answered the poll, each person thus contributing 5.88% of the total vote, this means that one of you has lost almost a fifth of your body mass.  This would be roughly equivalent to both arms.  Perhaps Ernest Hemingway voted!  That would be exciting.

Anyway, 41% of you thought I was old.  In a pseudo-scientific attempt to find out what this means, I first took the life expectancy of an Australian male: 78.7 years.  I then used the magic of arithmetic to find 41% of 78.7, which is just over 32 years.  This is actually reasonably close to my age and is, I think, either an odd coincidence or a nice example of the Delphi method.

Finally, if I was female, as many of you seem to think, the adjusted age estimate would be 34.2 years - even closer to my real age.  Egad!

Greek dessert or medical ailment?

1. Leukonychia
2. Loukomades
3. Galaktoboureko
4. Galactorrhea
5. Bougatsa
6. Baragnosis
7. Soutzoukos
8. Saccharopinuria
9. Visceroptosis
10. Vasilopita

Greek dessert: 2,3,5,7,10
Medical ailment: 1,4,6,8,9

(Inspiration from quizzes at McSweeney's Internet Tendency cheerfully acknowledged.)

Fear

In a comment to my previous post, the ever-prolific Anonymous wondered if there was some part of the brain that could be deactivated to turn off the fearful anticipation of asking medical supervisors for help.  And I am here with good news, o my friends!

It's well known amongst nerdy science types that fear, especially fear of senior doctors, is mediated by a small structure deep in the brain called the amygdala.  Interestingly, amygdala is Latin for almond.  A favourite dish of the Romans at orgies was the almond-stuffed amygdala extracted from gladiators.  Originally the amygdala was taken from dead gladiators, since they were in ready supply.  However, under Emperor Clavdivs the Veeth, extraction of the amygdala from live gladiators became more popular.  This not only meant that the amygdala was fresher and more delicious, it also had the beneficial side effect of driving the gladiators nuts.

An anamygdalic gladiator knew no fear.  He would pick up his weapons and run to the nearest hospital, force his way into the operating theatres, and begin his grisly work.  Thus was the ancient discipline of surgery born.

So if, like me, you quail at the thought of injecting yourself into a medical procedure, why not inquire with your GP about having your amygdala removed?  A procedure in the clinic under local anaesthetic will see you become bold, fearless, eager to try out new barbarities on helpless patients, totally oblivious to the results of your social brutality, and climbing the ladder of success rung by rung every day!

Brain training

My abs are killing me.  I went to a kicky-punchy class on Tuesday night and it ended with us all doing crunches on those giant fitballs.  It looks stupid and it really hurts, so it's not my favourite thing.  But I accept that part of getting fit is that you're going to be uncomfortable from time to time.

So why is it so hard for me to push my boundaries when it comes to getting my brain into shape?  I'm happy to sit there and try to learn stuff from books.  I'm used to both the feeling of ignorance and the feeling of overcoming it, so it's not scary for me.  But for some reason when it comes to making myself stick my neck out to learn hands on skills, I am a giant fraidy-cat.

I know, intellectually, that it's good for me to do things to get the practise.  And I know, intellectually, that getting that practise will involve asking someone who is about to do it themselves if I can do it instead.  But I find that very, very hard to do.  If they offer, I am all like yesssss!  I will have a go at anything.  But why am I so reticent to put myself out there, even if I know I can do it?

At least part of it is the feeling of uncertainty as to the other person's reaction.  Another part is the knowledge that if I try but fail I will feel bad about myself afterwards.  When we're learning, isn't it crazy how harshly we judge ourselves when things go wrong, and how elated we feel at getting the smallest things right?

I remember I used to be scared of gyms.  That was before I had ever been to one.  I was worried that I wouldn't know what to do.  I was worried that I would drop the weights on my head or foot.  I was worried that the muscleheads would laugh at the tiny little weights I was struggling with.  But these days I am fine.  I'm still aware that any of those tragic situations may occur, but it doesn't bother me because I am more at home in that environment now and I know that, in reality, it's not such a big deal.  Plus now I am ripped as, bro.

It only occurred to me yesterday that I am at least part of the way along the road to feeling more comfortable in a clinical environment, and hence I am approaching the day when I won't freak out quite so much about asking to be shown how to do something or asking to have a go at something.  Even though my brain knows it already, my heart has yet to learn the lesson, but its time will come.

In the mean time, I'm going to just keep on turning up every day and freaking myself out.  Eventually I'll burn out all the adrenaline receptors in my body and then I'll be too cool for school, I'll have the skills to pay the bills, and my brain will be ripped as, bro.

Writers

While discussing the Adelaide Writers' Festival tonight with my Aged Mother and Smaller Half:

PTR
It seems to me that most writers are either over-educated prats with too much time on their hands or disaffected minorities with an axe to grind.

Aged Mother
That's an absolutely outrageous thing to say!

Smaller Half
You fit pretty well into the first category.

Tip for the day

Feeling glum?

Try pouring your morning coffee into a glass rather than a mug, for a touch of European glamour at your breakfast table!

Dead reckoning

I really haven't been myself recently.  I wonder who I have been?

Perhaps I've been you.  You've been reading my blog, so my thoughts have been swirling around in your head, at least briefly.  So in a sense, you've been me.  So someone must have been you.  Maybe it was me.  I must say I don't care for it.

Some of you have blogs that I read.  I must have been you for some of the time when I was reading them.  But it seems unlikely that we were reading each other's blogs at the same time.  I haven't noticed that I've had any absent spells after publishing blog posts when it seems likely that you'd have been reading them.  So during that time when you were me, but I wasn't being you, I must have been a third party.  I wonder what happened to them?

It seems most unlikely to me that this mass transfer of consciousness is somehow magically transitive like a game of musical chairs where nobody loses.  That would require detailed record keeping and would be fraught with coordination problems.

No, the most likely explanation seems to be that during the time when you are reading my blog and hence are being me, I am being inhabited by the spirits of the dead, who have no requirement to be elsewhere urgently.  This is alarming.  If I get too many blog readers, I won't be myself for much of the day.  Hopefully the dead who possess me will have been doctors in real life so I will be able to continue to carry out my daily duties.

Alternatively, how about we all agree that you don't read my blog except between midnight and 6.30am South Australia time, when I am usually in bed.  Sleeping like the dead.