Note to Self [update 1]

No "disco dancing" while intubating. Or putting in lines or anything else. Especially if I ever have the opportunity to be using an extremely high powered drill that CUTS BONE while cutting bones in the face. Read more here: http://www.msnbc.msn.com/id/21599495.

The real issue here is what do/should doctors and other health professionals do if (read WHEN) they screw up. Clearly not do what this guy did. I'd write more about it, but it's late.

[update 1]: I fixed the broken link, in case any of the 3 people who read this actually wanted to read the stem article.

Hijack a Phone Number

Yesterday my wife called me. Instead of hearing her familiar sweet voice, I was greeted by Optimus Prime. He told me that the Decepticons are waging war in my own home state and that I was needed in the battle lines. He also warned me that one of my classmates may have joined the enemy as a Decepticon named Devastator. He then instructed me that I could help by purchasing the Transformers movie on DVD or HD-DVD.

What is super awesome about this call is that you can send it to anyone from this website. I'm sure it's totally against the terms of agreement, but you could potentially hijack anyone's cell phone number and send anyone else a message. You could even send it to two people's phones at the same time (if you have two windows open) and have them call each other at the exact same time.

Hugest Baby Ever

So I'm in the middle of studying for my Step 2 right now. Not nearly as hugely important in deciding the course of the rest of your life quite like Step 1, but it's still pretty important. So, I wasn't intending on blogging until after the test, which begins in 35 hours from now, but when I saw this I couldn't resist. A 17 pound 1 ounce baby. That's a really big baby.

Surprsingly, this little bundle of joy was born via C-section. I've seen my fair share of those and it's usually a pretty tight fit for a regular size baby to come out. I would have to guess they didn't go with a fanninsteil on this one.

Anyway, on further reading of the article lots of read flags went up. That's how they train us, you know. This was baby #12. Cheaper by the dozen, right? Apparently none of the other 11 babies came in under 10 pounds. And mom couldn't afford any fancy diet, so she just went with potatos (carbs), noodles (carbs), and tomatos (not-carbs). I thought pregnant women were supposed to get unsatiable odd cravings. The point is that this sounds like classic gestational diabetes. Insulin is an anabolic substance. Anabolic kinda like anabolic steroids, but not quite. That means it helps build tissue up. Mom's with diabetes are resistant to insulin's effects, which is why they start making too much. Babies, however, are not insulin resistant. So babies become overtly huge if gestational diabetes goes untreated. There can be other complications, but this is classic "macrosomia" (litterally translates to "ginormous body" in latin) that really is a red flag to look for Friday on my test. So this really was studying.

Believe

Imagine this. It's the year 2552 and the Earth is under assault by an alien race. It's a war on the human species, and we're definitely out-manned, out gunned, and on the verge of defeat. Except there's one man who manages to rally the troops and single handedly throw the war in our favor. Master Chief.

OK, so this isn't really going to happen and is based totally out of a video game. Perhaps the most hyped video game ever. So hyped that the makers, Bungie, have gone to the trouble of making quite the ad campaign out of it. They call it the "Believe" campaign, and through it have tried to make the Halo story more real by interposing live actors to talk about the war in a fictitiously created museum that honors "the Chief". I quite like the videos, but my wife thinks I'm a nerd for even being interested in them.

The first is a fly through of the center piece in this museum. It depicts the battle where the war was supposedly decided. I particularly like the piano music background and the dramatic details on the minatures' faces.




This second one is an account given by one of the soldiers who was in that battle talking about how they were able to stay in the fight and the hope that Master Chief brought them.




This third one made my wife laugh that someone would go to all the trouble of actually constructing this monument about a fake war that happens in a video game. And that they'd make a documentary about it like it really happened.




This one is an account given by another soldier that was there. He talks about some of the weapons and is asked a few questions about one the alien guns, the "Spiker", which is a new addition to Halo 3



This is the latest one of the commercials and is a soldier talking about hiding in the forest while the aliens were running around looking for humans. And all he could do was sit and wait for Master Chief.


So, yes, I am a nerd and I am excited for this game to come out tomorrow even though I know I won't be getting it for a while.

Et-AOK revisited [update 1]

Those of you who have been reading my blog since its previous address may remember my EtAOK post. Without reposting it, a quick summary is that despite its many ill effects and the huge cost it creates within society, alcohol (a.k.a. EtOH) is consistently and preferentially ignored throughout medical education. I like to therefore call it Et-AOK because despite the huge medical burden it places on society, since most doctors seem to enjoy drinking more than the average individual it is passed off as being totally OK, or EtAOK.

We all know smoking is bad. It causes cancer of many kinds. It causes significant decrease in lung function. It causes birth defects. It even carries a surgeon general's warning that using the product will cause these problems.

Alcohol can cause cancer, specifically hepatocellular cancer and stomach cancer. Alcohol can cause you to die from just about any organ system failing. Alcohol is the #1 cause in America of birth defects. Nobody seems to care.

Not only does alcohol cause all these things, it also causes a lot of trauma. You might remember my ER rotation posts "Life Lessons" and "Chief Complaint". A lot of those people also came in with pretty notably elevated blood alcohol levels. Anyway, the whole reason for me revisiting this post is I spotted this article in the news today. You might notice a few things about this guy. Like his use of a mixture of "stupid stuff" right before inserting the snake in his mouth. A poisonous western diamond back rattlesnake. Into his mouth. Because it was a "nice snake". Not that this one case report among many would change the fact that in medical school you will hear more about "the beneficial effects of drinking one glass of red wine daily" than anything other consequence of drinking alcohol.

Oh yeah, and this case is double awesome because it's anesthesia related because his tongue was so swollen as to totally occlude his airway requiring an emegency trach.

[update 1]: Who could ask for such luck in a single day?! Not just one story of inibriated madness, but two. This one is the story of a 54 year old drunk man who got in trouble with the law for throwing an onion at his 27 year old wife. I'm sure there's more than one story of "night's I can't remember" in that family. Your first clue might be that when the man was his wife's age she was but an embryo.

Poor Choice of Words

I like to read the weird news that comes across the AP wire. A great place to find it is at Yahoo's Oddly Enough. Tonight I noticed a rather poorly titled article ; "Cities Cracking Down on Sagging Pants". Very punny!

Combitube

Today I was given the opportunity to attend a lecture given by the man who invented the combitube. You might ask, "What exactly is a combitube, and why would I care?" Well, the combitube is an airway device that is blindly inserted into the esophagus which then occludes the esophagus and also occludes just above the opening to the trachea. Between the two ballons that you blow up, there are a bunch of holes that allow for ventilation. It's pretty useful especially for EMT's in emergency situations because it's supposedly very user friendly. You just shove it down the patient's throat and 95% of the time you're in the exact right place. Just to give you an idea of where exactly that tube is sitting, here is a cut away view.

There are several upsides to its use, including the apparent lack of the need for pre-anesthetic to tolerate its placement in extreme emergency as seen in the video below.

I especially like the look of panic on his face when he realizes he forgot to deflate the second balloon. You gotta love YouTube.

The Secret

Recently we were visiting with a friend who was telling us about this Oprah phenomenon - "The Secret". I say Oprah phenomenon because no one would have cared about it if Oprah hadn't mentioned it on her show. But since she did, we all have to live with people who actually believe in it.

So in case you didn't know, "The Secret" is that if you think and focus long enough on things that you will become some sort of powerful psychic energy beacon to the universe. The more of this energy to the universe, the more the universe will do to give you the very thing you are obsessing over, whether it be good or bad. So if you obsess over, say, a necklace from Tiffany's, then eventually that's exactly what you'll get. Or if you obsess over having bad health, then bad health you will have. Because the universe will give it to you for thinking about it.

I have a few observations about this so called secret. First, and foremost, I plan to make an official un-official psychic energy wave transmitting beacon; which will strengthen and amplify the signal your psychic brain waves give off. Here is a picture of them being modeled by two children.

Pretty soon everyone's going to be wearing them so you might as well just buy one now. After all, you are going to get tons of free stuff from the universe if you wear it. I mean even way more free stuff than people who don't.

Second, this phenomenon reminds me of the mindset of people that just drives me crazy. Entitlement. Getting something for nothing. Of course being in medical school, that means that there is more than one person I encounter regularly that just rubs me the wrong way. I digress. So the whole root of this philosophy is that you get stuff for just thinking about it. And it is well spelled out that it is not because you make any sort of plans because you obsessively are thinking about. The universe just magically gives you stuff because you think about it. I must be broken because there's lots of stuff that I've thought about that never happens. And I would never want the universe to grant my every thought.

However, sometimes you just have to wonder if maybe there is something to it. For example: this article. You'll have to excuse my callousness, but her name was "Debree" (pronounced the same as the word "debris"??). A sad story, but ironic nonetheless.

McMarketing

We've all seen those golden arches saying "Billions Served." I'd even venture to say that there is not one single person reading this that has never eaten at a McDonalds. Remember when you were a kid and your parents would strap you into the car and drive you to go play in the ball pit and eat a handful of chicken mcnuggets soaked through with McDonalds brand honey? Remember the TV ads with McBurgler and Grimace and Birdie and Mayor McCheese? Remember how often you begged to go to McDonalds?

Turns out McDonalds knew what they were doing, and now there is scientific proof. According to this study out of this month's Archive of Pediatric and Adolescent Medicine kids can taste a difference in food presented in McDonalds packaging. The authors had 63 kids from 5 different low SES day cares to whom they provided 5 different foods, including hamburgers, french fries, and carrots, which were identical in all aspects aside from their packaging. The results of the study are probably predictable to any parent. Four out of the 5 foods tested turned out to that kids thought the McDonalds branded food tasted better. The only one that came out being even was the hamburger. They did find some influencing factors. Kids who ate at McDonalds more frequently were more likely to prefer the McDonalds packaged food. Also, kids who live in homes with increasing number of television sets are increasingly more likely to prefer McDonalds wrapped foods.

So I guess the lessons learend here are that you should 1 - let your kids eat less at McDonalds 2 - get rid multiple television sets and 3 - if you want your kid to eat carrots, put them in a McDonalds french fry box.

Traumatic Brain Injury

Once upon a time there was a man. His name started with "H" and ended in "omer Simpson". When he was a boy he was playing with his crayons. And then he lost one after shoving it up his nose. Years later he had a strange neurological complaint and went to Dr. Hebert, who discovered the crayon on X-ray. When asked why he never noticed it before despite Homer's numerous trips to the hospital with head trauma, Dr. Hebert showed the Simpsons how he always missed it by the way he routinely held X-rays up to the light to see them.

After succesful removal of the foreign body, Homer had a dramatic recovery and even became extremely intelligent. The problem was that he had built a life that centered around him being an imbicile and he quickly began alienating all those around him. In his intellectual nirvana, he realized he would never truly be happy this way and elected to re-insert a crayon into his nose to try to regain what he had lost. And in true Simpsons fashion, all came full circle nice and neatly in 22 minutes.

The reason I make note of this now, is that a German woman has had a quite similar experience, at least to the first part of that story. When she was 4 years old, she tripped and managed to lose a pencil into her cheek. It, unlike Homer's case, was actually quickly diagnosed but went untreated due to the lack of today's sophistocated medical technology. And then at age 59 she finally had surgery to remove almost all of the pencil - 55 years later. Thanks to the skilled ENT, she has reportedly stopped having headaches and nosebleeds. The question is, in a year will she feel so isolated by her own intellectual prowess that she elects to reinsert it?

Strange Day

Today was perhaps one of the strangest day I've ever had on this rotation. It all started nice and early at 5 AM. I got to the hospital and rounded until 6 without ever seeing a resident. "That's weird," I thought.

At 630 at board checkout finally the residents showed up, a whole new set just because it was Thursday. Apparently the regularly scheduled residents all have clinic on Thursday and so the clinic residents come and take their place. We ran around the whole day with crosscover residents and a cross cover attending, on what was actually a pretty slow day, but somehow managed to not actually round on the patients at all. But back to my morning...

Then I went upstairs to see a baby born earlier. They told me I needed to see it for my education. So I get up there and the nurse says, "Oh, you want to see his malformations. Look here." And she takes off the diaper. I've seen ambigious genitalia before, but this was not ambiguous..definitely a boy. After trying to figure out what his problem was called, I found one single case report at pub med here. If the link is too medical mumbo jumbo for you, what it says is that this particular problem is where the scrotum is actually ABOVE the shaft. I didn't know what to think, and then the nurse says to look at his bottom. At which point I noticed his anus was way too high. It was posterior, just not low enough. The attending said he would never sit down to poo. Poor kid.

And then I met the mail-order bride. She was pregnant and not really having a problem but her husband was a complete nervous wreck. With way too much coffee. He kept checking the empty mug he brought in with himself in case magical coffee appeared in it again. And he never let her answer for herself. And asked a million and one irrelevant questions. "Why are you asking about that? Is something wrong? Is it bad that she is hurting like that? What should I do? Should she be taking her medicine more often? Is the baby a boy or girl? Is the cord wrapped around the neck? Is the baby too low? Where's her uterus?" 1) I can only answer 1 question at a time 2) I don't know the sex of a baby by asking about contraction pain 3) I don't have xray vision 4) I really wanted to find this guy some xanax just to shut him up so we could talk to his wife who actually knew what symptoms she was having.

At least it was interesting today.