Today's lesson

I really need to learn to stop logging onto facebook on Saturday morning. There are too many idiotic postings glorifying various football teams, and almost all of them betray what are seemingly intelligent people. It's a game folks. Say Go Team X all you want, that doesn't bother me. What bugs me is "proud to be a (Insert Mascot)," or "I hate team X," Etc, etc, etc. None of them has ever stepped foot on an athletic field. Get a life!

I will admit I'm a bit sensitive to this issue right now after the Penn State sexual abuse scandal. All of that done in the name of football just makes my blood boil. If Jerry Sandusky had been my neighbor down the street, he would have been in jail years ago, and it would not have been allowed to go on for two decades. Ok, rant over!

I'm off to the lake to hide for a bit longer. I have no internet there, which makes me more productive!

I'm kvetching...

I sometimes get incredibly weary about the Catch 22 to which doctors and medical students are treated. An INCREDIBLY tense and stressful load is placed upon us, requiring us to shut ourselves off in the interests of completing the tasks and self-preservation. We then get ridiculed for being withdrawn and inhumane and are instructed to be more personable and expected to function socially in the same manner as someone with half the work load. In many cases people are forced to be superfluous to our existence, but our existence IS people--our patients! My fellow students are only so much help because I am embarrassed to be associated with many of them, and we see so much of each other anyway. Just get away from me. I want somebody who doesn't remind me of school.

It can be incredibly isolating, and it seems like no matter what you do you're pissing off somebody. It's draining and sometimes more than I want to take. It sounds like whining, I know. Sometimes it just gets to be so much that even something as benign and useless as a dumbass posting on an internet forum  hurts your feelings or makes you angry. It's the stupidest thing in the world to get upset about, but it's easier to get mad at something trivial because there's little consequence--I believe the term is displacement. Case in point, I simply do not appreciate being told I'm wrong about something I wasn't even discussing. Ordinarily I would just laugh and move on, because I'm a nameless and faceless individual on the forum, as is the boob who apparently didn't get my point. But right now I just want somebody to understand me, dammit. I thought I was using only factual information--because God forbid your opinion actually mean something--and attempted to rephrase my position, but that only made it worse. Although, on the flipside, if some of what I've posted on a stupid thread about the Las Vegas airport and gambling towns is the most questionable thing someone has ever read, I am tempted to question how widely a user reads...

And right now I feel like a lot of people know WHAT I'm doing, but they understand very little about it. I'm tired of doing nothing but reading. I'm tired of giving up everything for nothing. I am just plain tired of being tired. I am tired of being asked the same stupid questions, and my parents are the worst offenders:
"What'd you study today?" -- Waterhouse-Friderichsen Syndrome and thiazolidinediones Mom, ever heard of 'em? Yeah me neither...
"Are you getting enough done?" -- well I wasn't aware of it until you pointed it out for the second time today. I'm stressed to the max and now I have to be reminded I'm running behind, thankyousomuch.
"Is there anything I can do for you?"-- Yes! SHUT.UP! STOP IT! Stop walking around me like I'm on eggshells or a piece of fragile glass that is going to break. Stop reminding me that I'm studying and have a test coming up soon. Like I could forget? I set the date. I paid almost one thousand dollars to register for it. I'm well aware! Stop asking me what happens after this! The answer hasn't changed, because THIS hasn't happened yet! I have been asked the same five bloody questions for the past four months...and the never NEVER changes. How hard is it to grasp "When I know something, I'LL EFFING TELL YOU!" Even more frustrating is I am obliged to dumb down my answers (remember, they are always the same) because very few people even understand enough to know what I'm studying, much less what it means. The fact that it's not really something they should know doesn't make it any less annoying. Rattle off the generic of something as ubiquitous as Tylenol or the clinical term for high blood pressure and many people either look at you either like you've lapsed into Swedish or they think you're trying to make them look stupid by using big words. Sorry, I didn't make up the word! I'm just responsible for knowing what it means...

And most of all...I'm so annoyed that I cannot even see straight over the fact that Hallmark Channel has taken The Golden Girls off the air completely until January. I have watched The Golden Girls as I fall asleep for over a decade...This is totally screwing with my mojo.

Was that whiney enough for every body? Right now I'm three years old.

And we spent how much money in Afghanistan...

Stories like this just make me shake my head and go WTF! We spent how much money in "liberating" Afghanis from the terrible Taliban regime, only to replace it with a government that imposes many of the same laws. I want a refund! I have no problem with the Afghanis implementing the style of government of their choosing, but I DO have a problem subsidizing a zero-sum transition.

Last Dance with Mary Jane...

I have been hearing this song on an almost daily basis the last few months, on different radio stations in different cities in different states. Perhaps we have a generation of stoners reminiscing??
Also, was it impossible for Tom Petty and the Heartbreakers to make a video in the early 1990's that wasn't batsh*t crazy??

Mary Jane's Last Dance

Oh the Humana-ty!

In between my study time I've turned the TV on a few times, and without fail during at least one commercial break is a commercial for the Humana health insurance company. I tend to be wary and skeptical any time I hear someone bang on about their beneficial program, especially in the last few years with the Health Care Insurance...erm...stuff. These Humana commercials look like something my middle school AV squad came up with...yes please take responsibility for my health care even though you're too cheap to make a proper commercial...that gives me confidence! Either that or they're preying on the uneducated and/or stupid. Perhaps it's a play for the "good ole boys" to say, "well lookathere, what a no nonsense commercial. These people must be honest. They're not some giant, slick corporation."


The best part of it all is in one of the commercials they use blocks of Swiss Cheese to demonstrate the difference between different plans and supplements. Paraphrase: "Policy X leaves this HUGE hole right here, and many others. Policy Y has a smaller hole, but it's still there. With Humana that big hole is gone!" As he says this he holds up a piece of Swiss cheese that is still riddled with holes and says, "With Humana there are far fewer holes in your plan!" So let me get this straight, you fill what you claim is one really big hole, but I'm still buying a hunk of hole-riddled Swiss Cheese?? So there are still holes in my coverage?? This is right after you tell me how broad in scope and effective your plan is. Have you got two mouths or are you just talking out of both sides of only one?

Who wants to move like Jagger...

I do not like this song. It is stupid. It makes no sense. I just.do.not.get.it. Neither Adam Levine nor Christina Aguilera move like Mick Jagger. And quite frankly who finds that sexy?? I just picture Jack Skellington when I see Mick Jagger moving, pouting like Tina Turner and singing (or trying to, anyway). The idiotic idea and the reality juxtapose. Also...why is that a good idea?? SOMEBODY EXPLAIN THIS TO ME!!!

Just a thought...

Make note...whoever you are...Rush hour is not the time to put your Kentucky Derby Hat on, the top of your 3-series down...and take a leisurely stroll at 50 mph in the left-most lane of I-85

Slip of the tongue

"...lots of things can cause inflammation of the cervix...excuse me...cervical lymph nodes"

Thank you Captain Obvious…

 “…abdominal aortic aneurysms can cause death, which can be problematic…” Really? I must have my priorities out of line…

17 November 2011

Looking at all these EKGs today reminds me of a bozo PA that I was rotated through in South Florida. Contrary to everything else I had been told about PAs operating in the State of Florida this guy was effectively operating a one-man show. Disturbing, eh? He claimed his father-in-law was the physician he practiced with, but his FIL was retired…so in other words he just signed everything willy nilly. Doesn’t that make you feel warm and fuzzy? Notsomuch. According to what I’ve been told, Physicians Assistants by law aren’t permitted to sign orders or write scripts. The Physician must sign all scripts and co-sign anything the PA signs. Annnnyway, for two days I just sat there astonished at the sheer amount of incorrect information this guy was trying to tell us. This is just a sample:

1.     Attempting to tell us that when reading an EKG you go 300, 150, 100, 90, 75, 60, 50…Um, where’d you get NINETY pendejo? The best way to count an EKG heart rate (and that’s how it’s usually taught…) is to start with 300 at the big line and divide 300/1, 300/2, 300/3…etc etc etc. No integer will yield 90. I verified it with four texts when I got home that night. Yes I have that many useless medical texts lying around my house.


2.     THEN we got into heart blocks. I don’t even know where to begin, or how any of it makes sense. He began with stating that because this woman’s EKG showed a dropped QRS complex (the prominent pointy thing on an EKG) he had diagnosed her with a first degree AV block. Ummm, the entire definition of a first-degree block is predicated by the (albeit prolonged) PRESENCE of a QRS complex. He proceeded to discuss Wenkebach diagnoses and identified them as a Type II Mobitz, incorrectly describing them as a constant length QRS, with random QRS drop. Ugh, where do I start? First of all, he got the Mobitz Type II part right, but it’s not a Wenkebach. Wenkebach is a TYPE ONE Mobitz. There's even a song about it. Watch it and try to get the “AV Type I Mobitz” out of your head before tomorrow. Secondly, how can a First and Second degree both have dropped QRS complexes?  None of this would bother me as much if the guy hadn’t claimed to be a cardiac specialist.


3.     Acetazolamide. A classic carbonic anhydrase inhibitor. It prevents bicarb, HCO₃ from being reabsorbed by the kidneys. For those not in the know this is a diuretic, and it results in the basic compound of bicarbonate being eliminated via the urine. Bicarbonate is one of the most rudimentary (I would say “basic” but basic has two definitions in this case) buffers in the body. A loss of a basic substance means that the blood is going to become more acidic, and as such the pH will DECREASE. PA Bozo made the assertions that metabolic alkalosis (ie basic blood) will ensue and the pH will INCREASE. Ugh. Strike three pal, you’re out. I realize my degree in chemistry gives me a slight advantage when it comes to dealing with subjects such as acids and bases, but c’mon, anybody who has a master’s degree (which is what PAs have) much less BE a PA should be able to grasp that concept. Even if that’s too much, they should at least know what the hell the drug they’re giving a patient does!!!!!!!! ***

4.     As if all that wasn’t enough, we get to metformin. I’ll make it short and sweet. He stated that metformin works by getting the pancreas to secrete insulin. Head. Wall. Now! One of the advantages of metformin is that it works independently of a functioning pancreas (quite common in diabetes obviously). There are indeed drugs that function by stimulating the pancreas to release insulin, and they do so by closing K+ channels. Metformin mostly works by inhibiting gluconeogenesis, which is a liver function. To make sure I hadn’t confused a drug (let’s face it that can happen), I asked him “what about gluconeogenesis?” He said he didn’t know anything about that and had never seen a drug that worked that way. Ok, I’m out. Either this guy’s a complete moron and DANGEROUS for patients, or everything I thought I learned in medical school is incorrect. I’ll form a committee to decide... I tuned out for the rest of the day and alternated my concentration between stifling laughter to quelling fits of rage.

My main problem with this guy who doesn't know squat is he is effectively seeing patients with NO accountability. And on top of that most of his patients were poor immigrants who spoke little to no English. A Spanish-speaking PCP is not hard to find in South Florida, but people in this group tend to believe the first Spanish-speaking voice they hear. My main goal out of all of this is to not develop a prejudice toward Physicians Assistants. I’m working on it.

**Foot note: I’ve noticed that we chemists tend to be more persnickety about balanced statements and making one and one add up to two than our biology colleagues. That isn’t a slam, it’s just an observation. We are taught that if it goes into the system, then it’s gotta come out, and must be accounted for. In biology, a process, reaction, or an equation if you will, is rarely taught to be balanced or quantified. ATP comes flying in from I-don’t-know where. True, we are taught that each molecule of glucose ultimately yields ~32 ATP, but frankly that’s just oh gee wiz fare for the student when one considers that there are 3.012 x 10^23 molecules of glucose in a mole of sucrose (table sugar). A mole of table sugar off the top of my head is about 340g, or roughly a six pack of soda. Yeah, you do the math. I’ll pass unless I can fish out my TI-83 Plus, but I haven’t seen that thing in over three years. Some amino acid just randomly appears. That enzyme just happens to already be there chilling. All of this stuff has been quantified (usually by chemists or physicists with a biological focus by the way), but it doesn’t seem to be stressed. I totally get it, and do not begrudge the field at all. Were all that to be quantified and taught to students as such, four years wouldn’t be enough to finish what is taught in the first year of biology. It is so much more complex and intertwined. It’s so much more integrated than chemistry or physics. Chemists, on the other hand, have the benefit of observing a great deal of our processes as an isolated system, controlled and mostly free from exogenous influence. Balance is taught to be paramount, and the end product is frequently known, and often irrelevant to the study.

I have often thought that chemists would make excellent accountants, and vice versa, simply because we are taught from Day One to take into account things such as molar equivalents, quantifiable energy, etc etc from start to finish. Were we asked to take into account all that other STUFF and then quantify it, we’d never get done either. So, to me, the two fields have done a beautiful job of simplifying their subject, but in different ways. Biology has done away with accounting and in many cases mechanism on a large scale in favor of studying process and integration. For instance, biology on the “molecular” level usually stops with DNA, which drives me nuts because as a chemist I know that a septiquadrilion little molecules make up that big molecule of DNA. Little mention is neither made about what actually makes Enzyme A convert Product A to Product B and why Inhibitor Q prevents said miracle, BUT, you can see the whole process at once. Chemistry has done away with integration of the process as a whole in favor of accounting and individual mechanisms, and in many cases the outcome is already known and incidental. It’s the how much and how that matters most. For instance, in the spoon-bending-minds-required abstract field of Physical Chemistry we spent hours modeling the structures of molecules we had known for years, such as ethanol. The biologist would in many cases be happy with the outcome simply being ethanol. The chemist in many cases already knew it was going to be ethanol, and wants to know why it’s shaped that way and precisely why it was allowed to be made in the first place. Biochemistry manages to integrate the two, but on a limited scale, and to study biochemistry you have to already know your fundamentals of chemistry and many of the fundamentals of biology. And we all wonder why these two ideologically juxtaposed fields get into interdepartmental fights??

Now back to your regularly scheduled programming…

Today's Microbes

F. Ingbullox

I. Amsickofthismalarky

U.Rencyclopaedic

N.Omoremicrobesplease

H.Ellnawiwillnotrememberthis

S.Hootmeplease

16 November 2011

It really aggravates me when I am trying to study and actually read the review answers and I get something like this horse squeeze:

“Laboratory tests are ordered for two hospitalized patients. During the phlebotomy procedure, the Vacutainer tubes drawn from these patients are mislabeled. One of the patients receives a blood transfusion later that day. Within 1 hour after the transfusion of RBCs begins, the patient becomes tachycardic and hypotensive and passes pink-colored urine. Which of the following statements best describes how this reaction is mediated?”

I had it narrowed down between:

B) Antibody-dependent cellular cytotoxicity by natural killer cells

D) Complement-mediated lysis of RBCs

Needless to say I got it wrong, and chose B, but that’s not what aggravates me, because I usually LEARN from answering questions incorrectly. I proceed to the explanations and this is what I get RE: answer B:

“…Natural killer cell lysis is seen with antibody-mediated diseases.” You don’t say, Sherlock! Obviously I should have known that the process was complement-mediated, but I thought differently. C’est la vie, I can get over that. I’m kvetching because that is a completely USELESS statement. Yeah I’m making something out of nothing, but it’s these “DUH!” circular statements that make me wonder how much the schmucks who wrote this got paid…

A real gem...right??

The SRY gene encodes for testes determining factor. As in “SoRrY” ladies, I gotta make testes. Without this a fetus will automatically undergo development as a female. So all the men who think they’re something special just because they’re a man…well, just think, your body is perfectly capable of being a female, and was certainly plumbed for it when you were conceived. Look no further than your nipples.

15 November 2011

Hiding at the lake for a few days, posts will be retrospective.

Just made a run into Laketown for some caffeine. Also decided to supplement the nutritious benefits of Coca Cola Classic with a pint of Ben & Jerry’s Half Baked. Oh, and that all-important generic CVS Ibuprofen. For some reason, and it might be the incoming weather front, the top of my head and behind my forehead has been hurting since late last night. The medical student in me freaks out that I’m having a subdural hematoma by way of aneurysm…but two days the later the medical student in me says that I would be dead by now if that were the case, or at least have some sort of motor impairment. Right?

Coming back from town I was reminded why I don’t live here anymore: the drivers would give me the aneurysm I was concerned about if I had to drive here full time again. HIYA Lady stops at a green light because I don’t know why, and then she doesn’t pull to the right when an ambulance is coming…DUMBASS! = YOU. Then I get behind an astutely clever gal whose probably-perpetually confused expression I could see in her side view mirror. She proceeds to put her turn indicator on and slow down to 30 mph almost a mile before her turn (and there were no other turns on the road)…and as if that wasn’t enough, comes to a complete stop in order to make a ninety-degree turn (with no other car for miles…other than me that is). Ugh, I swear people need to take an idiot test before being allowed to drive or reproduce.

A typical day of studying right now is looking like this.

I do my best to get up before 8am, some days I’m more successful than others. No later than 10 I want to be plugging away. I learned a long time ago that I’m not good for much more than one solid hour of studying at a time, and then I need at least a half hour to let all that information process and sort (through the Papez circuit thank you very much) itself out. Then I go again. And it continues like this until either I’m so frustrated with a concept I cannot see straight, or I get through the daily allotment. 

QOTD

 "Meningitis will kill you a lot quicker than ghonnorhea." Thanks...but I'll pass on both...


In reference to distinguishing N. meningitidis from N. gonnorhoeae. They cause completely different diseases (meningitis and ghonnorhea, I'll let you figure out which one does what...). And N. meningitidis ferments maltose. Think "Maltose" = "m"...profound, I know.

Total Scooby Doo "eerrghhh???" moment

"Selection bias: A questionnaire of risk factors for MI is sent out to survivors of MI --> what about those that did not survive the MI?"....Let me know how many responses from non-MI-survivors are received...

Today's rambling rant

I know I'm supposed to be learning how to care for people and all that...but sometimes I wonder if people like Jerry Sandusky should just be shot on sight...how do you rehabilitate somebody like that??? And what's even worse are the people who tried to sweep this cesspool under the rug in exchange for monetary benefit. All because of damned football. And my father wonders why sports fanatics piss me off into an unknown oblivion...

Absolutely hysterical...but I can't remember where I stole it from

How to improve your gaydar: You walk down a busy street and look for a really hot guy walking the same direction as you .... you follow him ...( the next bit is the tricky part) instead of focussing on him , pay attention to the guys coming the other way, watch out for the ones whose eyes do a quick flick as he walks past (if they turn around for a second look as he passes all the better) try this for a few weeks and your gaydar will improve ( although you may walk into a few lampposts/rubbish bins/ sandwich boards along the way) .

Unforgettable patient

I was doing a 12 hour shift in a South Florida ER, lucky me right? Being South Florida, and the neighborhood this hospital was located in, 99.999999999999999% of the patients were Latino, and consequently the ER functioned using Spanish, except written records. I often wonder how many times some of the nurses who spoke less-than-perfect English flubbed written instructions, but whatever.

At some point during the evening a woman arrived in the ER. I heard her before I saw her and I my head snapped around because after hours of speaking Spanish, hearing English grabbed my attention. But it wasn't just any English, nay nay. This woman talked like Larry the Cable Guy and Loretta Lynn had a red-headed bastard. The attending was  perfectly bilingual, but couldn't understand a word this woman said. I, however, must claim that I understand Hick, Hillbilly, and Redneck beautifully and can transition between the three with little effort. No, I'm not overly proud of that, but hey, roots is roots y'all. My grandmother left Small Mountain Town in the late 40's, but never dropped her Hillbilly speak. For instance, "7" is pronounced "sevum," 11 becomes "elevum." Nancy becomes NAIN-cee. Jennifer becomes "GINNNNiferrrr." Michael becomes "Mahkahl." And so on and so forth. I'm not making fun of her, just stating facts. So, to make a long story short, I had little difficulty deciphering this lady's obviously mountain accent. The doctor did, however, and there are no words to describe the look of relief when I translated and then took over the interview. He also decided that the stench from her cigarettes was also more than he could bear. The remainder of the conversation went something like this:

Me: Well, ma'am, let's see what we can do for you. -- transliteration "whale maham, let's seeah whut we can do fer you." (Damn! Was that me talking just now???? STOP IT!). Apparently I speak like that around my grandmother. Oh.god.

I proceeded with my interview and examination. She quivered and giggled when I examined the LLQ and LRQ. Would anybody mind if I wretched??
PMH: A whole bunch of stuff I wish I could elaborate on...but won't because of HIPPA, and a procedure she described as..."They took out all mah toys!"...And this affects me how?....
Social: from Western part of State X where there are many mountains. Ahah!!! Paydirt!. Came to South Florida (Flerdy as she pronounced it...) to have a procedure. Had a gay roommate, not sexually active. Are the two statements mutually exclusive? Nevermind. I don't want to know.  She also felt the need to tell me what her children did for a living. So, because you're dying to know: her daughter is an, ahem, exotic dancer, and bears a striking resemblance to Ann Margaret. Thanks for telling me? Doesn't drink, but smokes what she says aren't cigarettes but aren't cigars but are kinda like both of them. Thanks, that helps. She smokes them because they only cost $1/pack. Ahhh, that would explain why my eyes are watery and I'm getting a migraine. (I'm very sensitive to tobacco smoke). She also admitted to smoking a rock of crack the day before her symptoms started. Ugggh! Greeaattttttt! Lady, you've just insured you'll be here at least two extra hours. Can't wait. At the end of everything she said "I like you! You're nice and got a grayt smahl." Oh goody! Thankfully that concluded our interview....

BUT...nobody else in the ER could understand her. So guess who got tracked down if she needed something...yubba, yours truly. It would go something like this:

FOB-y Cuban nurse: Esa mujer en 9, no puedo entenderle! Habla con la puta! -- I can't understand that woman in 9. Go talk to the bitch.


Me: Uhhh, ok, algo mas? -- Um, sure, anything else?


FOB-y: No! La puta solamente!!! No! Just go talk to the bitch!

The type of humor only a medical student would get

We indentured servants, er, Medical Students, over time develop our own, ahem, unique sense of humor. Some of it is derived out of necessity, because more often than not if we didn't laugh we'd be giving ourselves lobotomies. Some of it develops naturally, because who else is going to find something like the following funny:

(Playing Words with Friends, and as such using the little chat feature, when I probably should have been studying um, something).

Me: oh you needed vowels...I had four os.....(intending to type O's, but it just didn't work out that way)
Me again: and if I get even one cervix or uterus joke I will kill you...

Opponent (also a medical student): lol, hahaHa (verbatim what he said). Sidenote...why do we type lol....and then HAHAHA??? I do it myself, and ask myself why even as I type it. I still send it, though.

Click here if you need to know what an "os" is... No it's not some pretentious pronunciation of the word "ass," as my brother asked...

Studying Gems...

‎"Picture 7.3 shows a woman with a white forelock and bilateral hearing loss"...um...thanks? now I know what a deaf woman looks like...


Really bugging me that the TV series Homeland is showing it's protagonist as taking clozapine without a script...I'm pretty sure I remember a little British lady banging on about clozapine and consequential agranulocytosis for about an hour...Bad psychiatrist! Bad psychiatrist!


‎"people who are appropriate for using psychoanalysis and related therapies " should be among other things "intelligent and not psychotic"...are those mutually inclusive???? If so that's a very short list!


Although women attempt suicide three times as frequently as men...men are three times better at it...gotta love behavioral...


‎"Markers in many chromosomes including 1,2,5,6,7,8,11,13,15,17,18,19,22, and the X chromosome have been associated with schizophrenia." -- gee, that narrows it down for me!


A: Why am I so tired? And It's only 10!!
B: our telomeres are getting shorter...


I had a dream that half of my tooth fell out, and I woke up to find it burning like it was in the dream. My own personal somatiform disorder??


Don't ever ask me "what's new"...I'm just going to tell you c/lambda


Whoever came up with words like "disinhibition" needs to be strung up by their toes...


"A 4-month old boy presents with frequent episodes of weakness, accompanied by sweating and feelings of dizziness".........I just want to know how a 4-month old feels dizzy in the first place, and then is capable of relaying that bit of information...


this conversation happened:
"Hey what are you doing?"
"I'm reading about um, lemme see what I'm reading about..."

Studying the GI tract is really crappy