Resurrecting the dying blog

At last, I have finished moving my unfathomably large mass of totally worthless belongings from my apartment. Sure, the task required most hours of the day for several consecutive days, but I suppose it was worth it if it meant saving a box of old 1st and 2nd year med school exams, college course notes, the boxes that once housed my speakers, stereo receiver, computer, and DVD player (you never know when you might need all that perfectly molded styrofoam and form-fitting cardboard again), five year old cleaning supplies, etc. I think that someone my age should have no difficulty filling a 10X10 storage room to the brim. It's perfectly normal.

On the other hand, I might just suffer from the particularly intractable hoarding variant of OCD, in which sufferers cannot for all the world bring themselves to part with even the most trifling trinket. Oh well, I'm sure OCD actually becomes more an asset than a liability in the world of neurosurgery, so my psychopathology should serve me well.

(Okay, okay, so in my defense I did throw out about 100lbs of "trash" from my apartment, including some items that many people would consider useful and worth saving. In all cases I had to squelch the little voice in my head that clamored for recognition, the Cassandraesque crier predicting in no uncertain terms the calamity that will surely befall the world if that rust-encrusted set of old forks and spoons reaches the garbage bin. It's going to be okay, right? Yes?)

Gathering no moss

I spent most of today gradually trying to pack the remaining items in my apartment and clean some of the mounds of trash I have accumulated over the years. It appears that I have succumbed to the genetic tendency in my family of hoarding every single item in my possession, regardless of its significance, until all available space in my living quarters has been obliterated. Thankfully, with the help of my girlfriend playing the part of the voice of reason, I managed to lighten the load at least nominally today, though I still have about 99% more junk than any 28 year old should reasonably possess.

I'm tired. As for blogging, it seems that all I have to offer are thoughts of a dry brain in a dry season. There I go pointlessly quoting people of infinitely greater writing ability than my own, meaning that once again it's time to step away from the keyboard and call it a night. Hopefully this coming week holds the promise of better blogging efforts.

Busy, busy, busy

I've found myself occupied by a never-ceasing list of chores this week, which has significantly impinged upon my efforts to relax. Doesn't the rest of the world know that I still need some time to recover from the last four years of med school effort? Anyhow I keep having to dash about town doing this or that, and tomorrow I need to move out of my apartment -- always one of my favorite pastimes.

I did, however, find time to locate this interesting website. It appears that the city in which I live is the base of operations for a large zombie-fighting syndicate. Consequently, this should be one of the safest places on earth in the event of a zombie apocalypse -- so I've got that going for me, which is nice. I think I'll go pop 28 Days Later into the DVD player and fall asleep to the sounds of rage-infected corpses marauding London.

Ian in the House

I finally watched the show House, M.D. tonight on Fox. I was impressed -- it was a quality drama, certainly more engaging than Grey's Anatomy. The characters actually seem to have some depth, and one gets the impression that the script might actually have been written with the consultation of a real life M.D. That's not to say that the show accurately depicts the workings of a hospital, as it too falls victim to the universal TV medical drama fallacy that any single doctor can and will care for every type of patient and disease that walks through the door. It appears that TV scriptwriters skirt the issue of specialization as an expedient for limiting the number of characters in the show while still allowing for breadth in subject matter, a dramatic contrivance for which I can't say I blame them. Nonetheless, most disease entities presented in House actually exist, and the on-screen presentation fortunately does not completely do away with verisimilitude. The 'mystery' format also makes for fun watching from the standpoint of a medically trained individual, as it provides the opportunity to guess the diagnosis ahead of the revelation in the show (for instance, I called the upper lobe lung cancer and the Lambert Eaton Myasthenic Syndrome in the pregnant patient in tonight's episode).

Of course, I could nit-pick every detail and tell you that small cell lung cancers occur much more commonly close to the lung hilum, rather than the periphery; that any doctor who suggests the diagnosis of myasthenia would also recognize that eyelid weakness is the first and most sensitive manifestation; and that nobody walks into the OR without a mask, as Dr. House did during the emergency thrombectomy; etc. But frankly I'm more inclined to be charitable towards this show than towards Grey's Anatomy. At least this show won't lead my future patients to think that I'm just another surgical intern like the ones on 'that TV show,' and hence must be a blundering fool. Oh well.

A little thing called a personal statement

I don't feel like writing anything new or readable tonight, so I'll once again pull from some obscure folder on my computer's desktop a sample of writing from ages past...

Oh, this will serve the purpose. When we apply to residency, we must submit as part of our application the quintessence of self-aggrandizement known as the Personal Statement. I, of course, wrote mine about neurosurgery. So here, for your mirthful perusal, is the personal statement I submitted to 30 residency programs across this great nation of ours. If you read it, WOW! If not, I don't blame you. At least I can cheaply subvert the otherwise ineluctable advance of blogger's guilt this way -- no complicity required on your part.

NS Personal Statement

Unbeknownst to me at the time, when as a teenager I first raced around a track, I began to lay the foundation that would ultimately prepare me for a career in Neurological Surgery. Throughout high school and college, competitive distance running remained an essential component of my life. And though my running career was far from illustrious, marred by injuries and studded by failures, I learned a great deal about myself and gained an uncommon level of perseverance. When I began running I was not especially talented, but over time I developed my endurance by running at times over 90 miles per week. Eventually, I successfully walked on to a top collegiate track and cross country team, in the process learning well that that I could not dictate the innate capacity of my heart to pump or my legs to move, but that I could devote myself wholly to my training, and then run with such abandon as to extract every trace of potential from my genetics. This diligence and dauntlessness has come to characterize my approach to all the endeavors in my life, and will serve as an important asset for embarking upon a career in neurosurgery.

Another lesson I learned from running that prepared me to enter the field of neurosurgery is the importance of teamwork. The runners on a cross country team run for an individual place, and the sum total of their places becomes the team’s overall score; thus each member must perform his absolute best in order that the team as a whole may succeed. Additionally, racing and training have their own team tactics, the most important of which involve simply encouraging and supporting each other in a difficult endeavor. By becoming a dependable team member and supporting my teammates as we all strove for a shared goal, I feel that I learned many skills that will make me a valuable neurosurgery resident.

Thus I feel that my running helped to develop my incipient potential to become a neurosurgeon. Since then, I have honed that potential by becoming a leader in my medical school community, serving as the president of my class for all four years. In this capacity I have often gathered my colleagues together into a cohesive unit to accomplish a shared vision. Perhaps my most successful – and enjoyable – leadership endeavor has been to rally my classmates together to create and perform two “class shows” that gained renown within the medical school. With these activities and others, I believe I have developed leadership skills that will make me a successful neurosurgery resident, and ultimately a contributor to the advancement of the field.

While these past experiences will serve as a foundation for neurosurgery training, the strong interest I possess in the field will serve as my continuing motivation for success. Nothing else in medicine strikes me as more compelling; perhaps that is because, among all the systems of the body, only the nervous system serves as a springboard for philosophy, and contains those essential elements which make us human. Further, the fact that the brain is insuperable from an individual’s personhood makes caring for patients with neurological problems a tremendous responsibility, towards which I feel an innate attraction.

During my 4th year sub-internship on Neurosurgery, I had a particular patient encounter that illustrates my attraction to the gravity of neurosurgery. He was a very young gentleman – in his early 30’s – whose career as a professional athlete had been hampered of late by pronounced headaches affecting him daily. As the days passed the headaches grew worse, so he finally sought care; the MRI that followed from his workup revealed a large right frontal ring-enhancing lesion. After he came to our service and had his lesion resected, the pathology report confirmed what we all feared: he suffered from a glioblastoma. In some people’s eyes, this young man’s example could illustrate the futility of some cases in neurosurgery – performing an operation that at this stage remains essentially palliative in nature, and, as one of my classmates so unceremoniously put it, akin to “polishing the brass on the Titanic.” I, however, look at it differently. This was a man in the prime of his life, who suddenly saw his entire world abolished in a matter of days – and who, were it not for his surgery, would likely have died within weeks. The resection of his tumor clearly did not cure him, but it undoubtedly extended his life by several months, likely even a year or more. Related to this point, Wilder Penfield once explained in a letter to Harvey Cushing, at a time when his sister was dying from an oligodendroglioma he had previously resected, “Simply to postpone death is very much worthwhile, for life when we measure it by weeks and months becomes a very precious thing” (J Neurosurg 95:148-61, 2001). The surgery on this unfortunate young gentleman had similarly given him and his family the gift of precious weeks and months to reconcile his previous worldview with his new reality. Perhaps we were just “polishing the brass” with that operation – but I recognize the nobility of the polishing, the beauty of the shine, and the great privilege associated with maintaining the luster to the very end. Clearly this man had a worse prognosis than many patients treated by a neurosurgeon, but the fact remains that neurosurgeons treat some of the sickest and most vulnerable patients, and thus they participate in not only some of the most painful defeats, but also the most uplifting successes in all of medicine. To help patients at their time of greatest need seems to me to epitomize what it means to be a surgeon, and it remains my primary reason for entering neurosurgery.

Grey's Anatomy -- "No Man's Land"

I returned home just in time to grab some dinner and watch Grey's Anatomy. This episode, entitled "No Man's Land," had the following plot synopsis gleaned from the abc.com website:

Cristina's encounter with a former nurse, now a patient at Seattle Grace, changes her forever; Derek and Meredith treat a construction worker who has miraculously survived an injury but is now faced with tough decisions about his future; and a patient recognizes Izzie from a lingerie ad, which makes her the subject of hospital gossip.


This turned out to be a fairly entertaining episode, though the writers continue to take significant liberties with their presentation of the world of surgery. I present to you this week's list of gripes:

1) Interns do not all arrive at the hospital at the same time and don their scrubs to the accompaniment of the morning's motivational speech, compliments of the chief resident. Actually, interns will arrive at the hospital at varying hours depending upon the particular demands of the surgical service to which they happen to be assigned at the time. Also, 4:30am is typically not a time for loquacity; even if the chief resident were naturally inclined to speak at length about the day, her natural volubility would likely wane significantly at such an early hour.

2) Patients do not come to the surgical service to die. Even an ex-scrub nurse would likely receive admission to a standard medicine floor, though her status at the hospital might earn her a single-bed room.

3) I admit, words spoken through a surgical mask lose some of their impact, without the listener able to observe snarling lips and defiant clenchings of the jaw. Nonetheless, nobody removes a surgical mask in the middle of a procedure just to make a point; doing so compromises sterility, and it's a great way to find yourself kicked out of the room post-haste.

4) Sandra Oh's character, Cristina Yang, remains a hideously distorted caricature of the heartless surgeon in training. In this episode we watched her try to save a DNR (Do Not Resuscitate) patient who had come to the hospital to die; somehow, we are led to believe that this surgical cyborg had formed such a bond with her patient -- though no evidence of said bond ever became apparent in their interactions -- that she was pushed by a flood of emotion to forgo reason and sense in the interest of saving the patient's life at all costs. Well, I suppose that notwithstanding the problems of plausibility with this exchange, we can hold out hope that the writers might use this "epiphany" as a door through which to inject some semblance of humanity into a character who is otherwise as cold and sterile as the scalpel she aspires to wield.

5) I realize that essentially any injury -- conceivable or not -- can befall a person, and that practically everything -- including a head-full of nails accidentally incurrred -- has probably happened at some point in the history of medicine. However, falling down the stairs with a nail gun would more likely splinter the torso and legs with nails, rather than the top of the head, due to inherent limitations in the length of the arms and the standard manner with which one holds a nailgun (i.e. with the index finger on the trigger and the tip of the gun pointing away from the hand, a position from which it would be impossible to put a nail in the top of the head). Nonetheless, for the sake of argument let's assume that such a nail-ridden skull could result from a fall. These nails pierced the skull and entered the brain along its convexity, pointing inwards radially; although an optic nerve injury could result, as the show alluded to, most likely the patient would not escape without some damage to the motor or primary somatosensory cortex. The nails plunged right through these areas, judging by the head CT depicted. So "Jorge" would likely have had difficulty with movement or sensation of his face or his arms. As it turned out, the nails caused him essentially no harm, but a hypothalamic tumor caused his fall down the stairs. I didn't get the best look at the MRI showing the tumor, but operating too aggressively on a tumor in and around the hypothalamus can, indeed, lead to significant changes in memory and even personality.

6) Oh, one more thing -- any neurosurgery attending who has to have his interns perform a literature search in order to inform him that the risks of surgery include bleeding & infection, and that surgical outcomes are better when the procedure takes less time, really has no business cutting into somebody's brain in the first place.

Well, that's all I have for tonight. I could say much more, but I'm beginning to bore even myself, so I think it wiser for me to sign off for now.

I go to encounter for the millionth time the reality of experience and to forge in the smithy of my soul the uncreated conscience of my race

Or maybe I'll just go to a wedding.

I'm heading out of town early tomorrow morning, destination Louisville, KY, to serve as a groomsman in my friend's wedding. I shall return Sunday night -- in time, of course, to watch Grey's Anatomy and post my comments here. I hope everyone has a great weekend!

Bloggedly blogless

I have no inspiration for tonight, so I will resort once again to posting some online quiz results for your delectation.


What Monty Python Character are you?
brought to you by Quizilla

Missed House

Well, I had the best of intentions as I began the evening: I was to grab a quick Del Taco dinner, then nestle down on the couch just in time to watch House on Fox. Mmmm... I miscalculated slightly, departing for Del Taco right around 8:00pm Central time, which just happened to be when House began. I caught the last five minutes of the show, which seemed interesting; unfortunately, though, due to my disorganization, I have too little fodder to comment on House this week. I hold out hope that next week, when my girlfriend returns and provides some semblance of structure to my disheveled life, I'll finally see House and add it to the list of medical shows which I shall review on this blog.

In an effort to salvage the evening, a friend and I watched Sin City at the theater. It was pretty good, a mix of Quentin Tarantino-style violence, film noir mystery, and good old fashioned sexual allure. I have a feeling that it will require a second viewing at least to collect the myriad connections between the delicatedly interwoven plotlines.

In other news, a touch of irony. I first learned the word untonsured in the opening chapter of Ulysses; now, after having employed the word in one of my blog post titles, I have jumped to the #1 "untonsured" search rank on Google. The next three search results quote the passage from Ulysses from which I gleaned the word in the first place. It's funny how that works.


ADDENDUM (5:54PM, 4/13): penis

Grey's Anatomy posts

It now appears that the primary source of search traffic leading to my blog (aside from the occasional "bifid penis" or "severed penis" search -- why did I ever have to mention the word penis?) relates to Grey's Anatomy. In the interest of increasing my blog's navigability, therefore, I have added a little drop-down menu just beneath my profile box on this main page that links to all of my Grey's Anatomy posts. As always, I aim to please.

Also, I stumbled upon a local Seattle blog that offers some insight into the dubious geography of the show, as well as other Seattle-related info.

Back in town just in time to catch Grey's Anatomy

I spent Saturday and the better part of today in Chicago for my friend's bachelor party. I learned two things: 1) Having a Super Bowl ring, as my friend's soon-to-be brother-in-law wears on his left index finger, opens more doors than you can imagine. People with Super Bowl rings do not wait in line. I must set about procuring a Super Bowl ring for myself as soon as humanly possible -- hopefully the gym is still open at this hour, and I can pound out a couple of sets of bench press. 2) Strip clubs make my skin crawl. When I have a bachelor party of my own, I think I'll insist upon all of us spending the day opening doors, pulling out chairs, throwing our coats over puddles, and otherwise engaging in chivalric behaviors as symbolic atonement for all the mischief and debauchery of bachelor parties throughout human history.

Anyways, the party overall was a lot of fun, and I got to see and experience my friend become increasingly bellicose as the night wore on, culminating with him sucker-punching me -- unprovoked -- in the right kidney. But hey, at least I have two of them, right?

So I returned home just in time to run a few miles, eat, and sit down for a full episode of Grey's Anatomy. As I've previously mentioned, I have voluntarily assumed the role of the paladin of medical truth who shall combat the evil misinformation proffered forth by ABC with this drama. Today I was actually surprised to find relatively little (in comparison with earlier episodes) with which to quarrel insofar as actual medical information is concerned, though situational and character realism remains quite a deficit in this program. Major points, in no particular order:

1) I really expected them to royally screw up the brain death issue. However, I think the writers sneaked in a consult from a real life person who knows something about medicine! In fact, patients with demonstrably absent brain activity and corneal reflexes undergo an observation period of six hours -- assuming that corroborative tests, such as an EEG, have been performed -- prior to the pronouncement of brain death. Interestingly -- and it's too bad the show writers didn't work this one into the storyline just for kicks -- brain dead individuals can actually exhibit a particular spinal reflex, aptly titled the "Lazarus reflex," involving the patient sitting up in bed . Oh well, that was a missed opportunity for dramatic sensationalism.

2) Based on this show, you would think that the only way any organs ever get donated is via surgical interns having the bright idea, "Hey, this guy's brain is dead, but his body isn't! We can donate his organs and save a few lives, but more importantly, WE CAN SCRUB IN ON AN ORGAN DONATION CASE! SWEET!" Nah, it doesn't work like that. Most hospitals have firmly established policies and procedures to ensure smooth harvesting and distribution of available organs, provided the family agrees and/or the patient's wish to donate was known in advance.

3) Donation matching isn't quite as quick and easy as checking the blood type. Most major organs, aside from the heart, are also typed according to major histocompatibility antigen proteins in order to reduce the risk of transplant rejection -- although newer anti-rejection drugs have made this increasingly less of an issue.

4) Most interns know how to speak to family members better than the character Cristina, who has all the tact and compassion of a yam.

5) Most interns don't scream, yell, and gesticulate while watching television, prompting you to suspect that perhaps the Super Bowl is on (and I'm playing WR, earning my ring), when in fact all they are watching are some old tapes of operative procedures. Enthusiasm is good; too much enthusiasm is pathologic.

6) A patient whose peritoneum has been punctured by nails (or whatever those metal foreign objects were that protruded from the belly of "Viper") does not present the next day with a wound dehiscence (i.e. wound falls apart)and an evisceration (i.e. bowel contents pouring out); the rent in the connective tissue would not be large enough. Rather, his peritoneum would simply become infected, and he would more likely return to the ED in septic shock. But sepsis is less exciting than bowels falling out, and with sepsis we don't get to see Ellen Pompeo (Dr. Meredith Grey) mounted up on top of the patient in some sort of medical heroics that also serves double duty as sexual innuendo.

7) Interns are busy. Repeat: interns are busy. Just in case you missed it, INTERNS ARE BUSY. They don't sit around in the E.D. waiting to cherry-pick the best patients, they don't spend all day and night in a brain dead patient's room, they don't observe every case that rolls through the O.R., and they don't somehow manage all to appear in the same place in the same time. In actuality, they find work constantly thrown upon them, in all the far reaches of the hospital, and generally make themselves scarce in all places but the patient floors where they have five thousand chores to complete before evening rounds. Watcing Grey's Anatomy, I almost begin to believe that my intern year will be easy easy easy. Apparently, it's all glamorous romance, subversive machinations (such as every time somebody defies Dr. Burke, who in reality would probably scalp somebody by now), and heroic holding of bowels in place! I can't wait for the fun to begin.

I love VH1

vh1_love_90s
Originally uploaded by Ian D..

Say what you want about VH1's surfeit of "I love the (insert favorite decade here)" and "Best Week Ever" shows -- I'll still keep coming back for more. It's perfect television for those with a limited attention span: brief, catchy segments, peppered with comedy, that highlight the most newsworthy events of...whenever. These shows bundle humor and nostalgia into one potent combination pill. Most importantly, these VH1 masterpieces encourage me to plant my arse on the couch and budge only to feed and eliminate. What could be better?

In other news, it turns out that the majority of the searches that yield my blog these days relate to Grey's Anatomy. So, I hereby appoint myself to the position of Grey's Anatomy Misinformation Filter; be sure to check back every week for the latest update on all that is false and misleading on the new ABC drama.

I have not, alas, seen the show House. Maybe I'll check it out sometime soon -- provided it doesn't conflict with "I Love the 90's Part Deux."

Astounding productivity

Please allow me to allocate space on my blog for the list of things I accomplished yesterday (i.e. the current day, as I have not yet retired for a night of sleep):










Okay, thanks for reading!

(I'm about as useless as an ordure-caked wad of toilet paper; sorry for the gross-out.)

This week's gripes about Grey's Anatomy

Okay, so I missed the first half hour of the show again (I seem to have begun a pattern here), but nonetheless I'll take my stab at dispelling Grey's Anatomy - induced misconceptions.

1) Most hospitals have places to store severed penises. Those places do not include the trustworthy hands of surgical interns. Nevermind the fact that ice evinces an inherent proclivity to melt, and that after just a few hours the severed penis would be floating in lukewarm bloody water; unless, of course, the surgical intern devoted much of her already limited time to opening her little red and white cooler, dumping the broth from the penis soup contained therein, and re-packing the cooler with ice. Anyhow, the take-home-message is that severed penises are kept in special severed bodypart refrigeration devices, and are not carried around ad nauseum by surgical interns.

2) At an academic medical institution, the chief of surgery typically does not hand-pick his successor. Rather, the hospital board makes the decision, generally at the behest of a cadre of executive faculty members (i.e. multiple chiefs of other services in the hospital). This actual scenario provides much less drama and interpersonal competition, however.

3) Yes, indeed, surgical interns sometimes scrub into cases and find themselves merely holding a retractor. However, this task generally finds its way into the category of "things I hate about internship," and does not cause ejaculations of joy and awe as we once again saw from Dr. Grey in this episode. The girl is seriously going to lose her sh*@ when she actually gets to make an incision or close a wound.

4) Every newborn baby has its blood oxygen content checked via pulse oximetry. Cyanotic heart conditions such as Tetralogy of Fallot generally do not just 'slip by,' waiting for the gallant surgical intern to swoop in and save the day.

Well, that's about enough. If I had watched the whole show, I might have had more. And by the way, if my fault-finding becomes annoying, feel free to send me a nasty email or berate me mercilessly in my comments.


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In other news, this and this are pretty cool. It appears the scene in Star Wars in which Luke's severed hand (a lot of talk of severed body parts today, I know) is replaced with a robotic hand may become more fact than fancy in coming years.

What happens when people spend too much time in a dark room

Every once in a while I stumble upon a medical discovery that renews my hope that one day, we might through our astounding ingenuity finally conquer all human disease and suffering. Indeed, today I feel warmed by the promise of a field of medicine that can teach us that, in fact, the penis assumes a boomerang shape during coitus. Here is the study, in PDF format. May you bask in the radiance of its intellectual triumph.

(Click on the "Begin manual download" button in the center of the screen if the study does not appear.)

Add to that list untonsured

By the way, I am not only fat and ugly, but my hair is getting out of control. I already have an enormous head, but when I let it become overgrown with a thick matte of sandy-blonde, sprouting profusion, I begin to look rather ridiculous. For those of you who have ever played Goldeneye on Nintendo 64, and who have had the pleasure of entering that code that gives all the characters ultra-large heads, well -- you know just what I look like.

Anyhow, I have had a rather good day as I finally lit upon something about which I actually feel motivated to write -- not for my blog, but for real-life writing. I'm revisiting my college days, when I ran cross country and track and measured my life in weekly miles and pairs of worn out running shoes. I find it quite mentally liberating to re-live my running days in fiction, as my own running career came to a premature end due to injury. Watching fictional characters face the same challenges you did -- and then steering them either to safety or catastrophe -- can be a serviceable antidote for regret.

In other news, interest rates continue to rise, and the very real possibility exists that I will not be able to purchase the house I had decided upon as my home for the next seven years of residency. Ahh, disappointment.

But I'm fat, I'm ugly, I'm unkempt, and things have nowhere to look but up.