A word of advice

In a recent comment on my post regarding pain scores, the indefatigable Lumpage asked, "Uhoh, I set my pain scale between 0 and 10. Am I doing it wrong?"

No, Dr Lumpage, you're not doing it wrong.  You're just doing it different.  Which is my way of saying you're doing it wrong.  Stop - collaborate and listen.

You see, I don't offer the patient the option of a pain score of zero, for the following three reasons:

1. I have already asked them if they have any pain.  And I only ask them for a pain score if they actually have pain.  If they told me that they were in pain, and then told me that their pain score was zero, I think my brain would haemorrhage from sheer frustration. The medical history is a battle of wits.  Patients will delight in flummoxing you at every opportunity.  You must learn to close off every avenue of potential nonsense, building up your innate feel for these types of simple traps so you can conserve your energy for the real battle ahead: presenting the patient to your boss.
2. Having a pain score of 0 to 10 is actually an 11 point scale.  This sort of thing works well for humorous effect in rock 'n' roll mockumentaries, but isn't very practical when it comes to taking medical histories from patients at 4am when neither of you can think good.  Say the person's pain score improves from 10 to 5 after 4mg of IV morphine.  In my system that is a 50% reduction in pain.  In your system that is 5/11 or a 45.4% reduction in pain.  Which is frankly absurd. Especially since if the pain drops again by another 5 points to zero, that's another 45.4% drop, for a total of 90.8%, and they are now pain free.  What the fuck? Where did the other 9.2% of their pain go?
3. Is the patient alive? Then they are in pain.  Life is pain. Only the dead feel no pain. Or people that you've put a really good ring block in - you can just rip their nails out using haemostats and they don't feel a thing.  It's full on.  But aside from them, everyone else feels the exquisite pain of living, every waking moment, swimming in the agony of existence until they can swim no longer.

So, yeah, you're doing it wrong. 1 to 10, my friend. 1 to 10.

I did it for you

youTube.com is an amazing site.  Not only does it contain hilarious videos of cats, it also enables you to see children falling off bicycles.  Before youTube I used to have to fling cats at children on bicycles, but no longer.  It's win/Win/WIN!  Part of its genius is the name - it starts with "you" so it makes everyone feels like it's relevant.  The principle could be used to start up a bunch of other websites which I think could end up being just as big.  Here's a partial list - feel free to register and develop them yourself - I just don't have the time to give them all that they deserve.

youThyroid.com - This site would be handy for people to upload pictures of their goitres or of their Mel Brooks googly eyes.  They could trade stories about their pretibial mixoedema, and swap tips on how to use the internet effectively despite a severe tremor and a heart rate of 160.

youVolaemia.com - This site would be dedicated to enabling people to share hints, tips and tricks to do with their fluid balance.  How to best assess your jugular venous pressure.  The controversy over mucus membranes.  Skin turgor and the elderly.  The osmolality conspiracy.

youRopeanUnion.com - A fan site for European communalists of all stripes!

youClideanGeometry.com - Do your external angles sum to 360 degrees?  This could be the site for you!  Or perhaps that's just hyperbole.

youKaryote.com - Too long have plants and fungi been excluded from the internet.  This site would serve as a portal for all organisms with nuclei.

youPhemism.com - This site would have a lot of the you-know-what, eh!  Eh!  Especially for you-know-who!

youLersNameIsPronouncedOilerNotYoulerSoThisJokeDoesntWork.com - A site for looking up the names of dead mathematicians and the mispronunciations thereof.

Modern primitive strikes back

The Hatchling doesn't really understand equivalence relations in set theory. She's so cute that way. Still, I hope it's something that she overcomes soon or she's really going to struggle when I start reviewing topology with her next year.

This all came to light during bath-time. I asked her what colour her little turtle was, and she quite rightly responded, "Green!". I then held up a green cup and asked her what colour it was, and she said, very confidently, "Purple!"

I had to explain to her that since the turtle was green, and since the cup was clearly the same colour as the turtle, that the cup must also be green. She was gracious enough to admit her mistake in this instance but didn't seem to be convinced by the more general principle.

Note to self: Hothouse not hot enough. Make more flashcards.

Holiday inequalities

walking > bussing
trains > planes
exploring > touring
breakfast > lunch
galleries > museums
trees > lamp-posts
towns > cities
relaxing > bustling
sun > rain
history > glamour
Europeans > Americans
coffee > beer
free > charged
bathroom > wifi
soup > pudding

Awesomeness knocks

No time to post properly, but check out this comment someone left recently.  It's epic!  As I noted in my response, I can't figure out if it is a madman raving incoherently, or a mathematician ... errr, raving incoherently.

And they spelled Kolmogorov wrong, but let he who is without sin cast the first stone.

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!

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.