The last day

Today is the last day of my vacation. Tomorrow I'll be saddled with the call pager all day. Just thinking about it spikes my blood pressure.

But on the plus side, I've enjoyed some great entertainment the past couple of days. On Friday night, I saw The Departed. Wow. If you put practically any other crime movie in history up against it, The Departed would kick the crap out of it. With steel-toed boots on. And then it would stomp on the other movie and do that heel-twist thing, leaving little tread marks all over the place.

So it's good -- you should see it.

I also just watched Walking Tall on cable, which of course after watching The Departed is like washing down a 25 year old single malt scotch with Boone's Farm kiwi-strawberry flavored wine. But it was still entertaining.

And last but not...well, yeah, last and least I watched this week's episode of Grey's Anatomy, entitled "Sometimes a Fantasy." I had taken a hiatus from watching this show, and in the meanwhile it appears that the show is even more about sex and less about medicine. Thanks to this show the American public now thinks that interns are not the least bit overworked, but significantly oversexed. Oh, and internship continues in perpetuity, apparently -- these folks started their intern year when I was still a fourth year student, and now that I'm well into my second year of residency they're still slogging through intern year. Gotta love T.V. time.

Really there wasn't all that much of medical substance to comment on here. Yes, there is such a thing as congenital absence of pain, as the little girl Megan suffered in this episode. Typically these patients end up with severe problems with their eyes, their mouths, and their joints. Think about all the times you've bitten your tongue or your cheek and then rebitten it again, and again, and again...despite the fact that it's excruciating. If you felt no pain, you'd basically just end up biting things off, remodeling the inside of your mouth to make room for those terrible gnashing teeth. Besides that, every little thing that got in your eye would stay in there, causing corneal ulcers and consequent visual problems. As far as orthopaedic injuries are concerned, these patients typically develop what's called Charcot joints -- eponymous lesions characterized by destruction of the joint space due to ongoing, severe trauma. So I suppose what I'm getting at here is that such a child would not present with a cut on the shin; she would have presented for medical care long before, even if she was in foster care.

Oh, and putting your hands in a bucket of ice water is a crappy way to assess pain sensation. Such a stimulus would hurt initially, but the pain would subside over time as the cold temperature exerts an inhibitory effect on nerve conduction -- completely backwards from the way the test was demonstrated in the show.

On the neurosurgery side of things, Dr. Burke performed a corpus callosotomy on a patient with refractory seizures. This sort of procedure has historically found some utility in treating patients with severe seizure syndromes such as Lennox-Gastaut; such patients can suffer atonic seizures known as "drop attacks" during which they fall, hit their heads, etc. The procedure does not abort seizures, but it helps keep the seizure focus lateralized to one hemisphere so that it does not spread and cause loss of muscle tone on both sides of the body. However, corpus callosotomy carries with it many attendant side effects, including disconnection syndromes (this was alluded to in the show when the patient exhibited word finding difficulties). Because of this morbidity, corpus callosotomy has in recent years been superceded by a variety of less invasive surgical techniques which I won't belabor. Suffice it to say that the show fails the reality check in that the patient seemed a little too highly functional to proceed straight to corpus callosotomy as his first surgical procedure. And honestly any good surgeon would have explained to the wife that the patient might have speech difficulties -- so she likely wouldn't end up screaming at him to say the name of their baby. That was a bit of prime time melodrama.

All in all the producers of the show seem to be targeting the Desperate Housewives audience more so than the ER crowd, with their constant parade of overwrought sexuality. Whatever works, I guess. It's just a shame that the program creates such misconceptions about the nature of surgical training.