Looking For Medical Student Blogs

Has anyone out there encountered a medical student blog written by a first or second year, or by a recently accepted student? Perhaps you read it, perhaps you write it. Either way, I'd like to add good ones to my blog reader...

Thanks for your help.

Asked To Be Super, But Not Up To The Task

This one goes out to ScienceBlogs readers.

Last month, I received emails from two different science bloggers inviting me to be a ScienceBlogs "Super Reader." Since I read several of Seed's ScienceBlogs and think that blogging is a good way to diversify the conversation about science, I agreed to be a reader. So what does a Super Reader do? Basically, Seed wanted to present a more qualitative metric by which a 'best of' list could be compiled. In the large ScienceBlogs venue, some of the most thoughtful writing may not be the most emailed or the most commented on; the former often are funny or cleverly sarcastic, while the latter are usually posts by PZ Meyers.

In a nutshell, Super Readers are tasked to post at most 3 entries a week to a del.icio.us account that the Seed blog editors have access to. This information is fed into a sidebar that indicates the readers' picks. This way, when I only have 15 minutes to surf the net, I can rely on well-informed readers to clue me into the most interesting posts. I imagine each blogger is allowed 2 super readers so that every blog is given a fair shot at making the hot list. While the "Most Active" feature is like the populist House of Representatives, the "Readers Choice" list is like the Senate - equal representation from each blog.

Some bloggers posted invitations for their readers to apply. I was solicited by folks who know I am a regular reader and commenter. The funny thing is, after I received the invitations and replied that I was willing to do a little bit of Seed's legwork for them (see the comment in this post), I haven't heard a thing.

Now comes the part of the post that presents fanciful theories. I am surely in the minority of folks who have been critical of how, well, overtly atheist the ScienceBlog community is. Often, I wish that folks like Rob Knop were still around to stir the pot. Perhaps knowledge of my minority view is why the Seed editors have not replied to my emails 'accepting' the role of SuperReader, but I doubt it. I bet there are some bloggers over there with religious beliefs from the East or West, old and new who see the conflict between science and religion as either constructed or impertinent to their mission as writer bloggers. Maybe I got the wrong email address in my response accepting the invitation. Or maybe, the Borg (a lovingly pejorative term for the ScienceBlog community) somehow knows that I only read 15 of the blogs over there. But in the end, there are already too many crackpot conspiracy theories out there about the blog collective than are reasonable. I have the sense that good things make for big targets, and rather than continue to assail, I'd rather contribute. My emails were probably and simply lost. (Update: this last theory is the correct one!)

I'm still happy to participate - It's not very hard to click a button when something you read is interesting! And I do think that participating in a community of commentators such as exists at ScienceBlogs is important. And if I don't fit into the Borg's demographic as an enthusiastic unpaid volunteer, that's fine. It would have been nice to have been told as such.

After sending another email and posting this mini-rant, I'm ready to move on.

Thanks for listening.

Read This

Today, Francisco Ayala was featured in a NYTimes story. When it comes to the science and religion 'conflict,' this guy is one of my role models. I recommend you read the article.

Pigeon Brained

This takes the urban naturescape to a whole new level.

According to the Seattle Times, someone has been shooting pigeons with a blow gun. Given that most pigeons have pigeon brains, a shot to the head seems not to be fatal in several instances. The pigeon above was alive and a

quite athletic, good flier.

I have trouble approving of or denouncing this activity without additional facts. Does the shooter intend to eat the pigeon? (Probably not.) Is this part of a larger pigeon eradication effort? (Again, not so likely.) Is the problem with this the sport itself or the failure to quickly kill? (PETA probably thinks both, but I lean more heavily on the latter.) Is the pigeon from Capitol Hill or the University District, where piercing such as this would immediately elevate himto higher social circles? (Actully, the injured birds have been found downtown at Third and Union.) Wait a minute, Third and Union is awfully close to Benaroya Hall and the Seattle Art Museum. Is this some kind of sick urban art project? Hmmm... Where can you get a metal dart blow gun?

Image from Franziska Edwards and PETA

Getting Along Just Fine

This photograph taken in the Seattle backyard of two of my dear friends provides evidence of a harmony between species that some might say is impossible. These two people have a way of making the unimaginable real. They also got married yesterday!

Congratulations A & C!

Dealing with Death (& Medicine)

I have two recent articles over at Medscape's The Differential about my recent personal experience of losing a family member while in the midst of medical school's third year.
Too long for a single article, the story is broken into two pieces. There's "When the Stride Becomes a Stumble" and "Picking Up the Pieces."

As usual, writing offered me great therapy for this issue. I hope this story speaks to you.

Cult Fiction Meme

Bikemonkey assailed me with another meme. This one demands the admission of guilt in reading cult fiction titles as determined by the British Telegraph newspaper. They define cult fiction as:

books often found in the pockets of murderers; books that you take very seriously when you are 17; books whose readers can be identified to all with the formula " whacko"; books our children just won’t get…

If I've read the title, it's listed in bold. If I started but gave up, it's in italics. Unfortunately, memes don't go very far beyond me. None of the bloggers I ever tag ever put anything up, so I'm not going to try sending this one on. But since I like to read, here's my list. Does anyone think I should definitely read a title that I haven't touched?

• Slaughterhouse-Five by Kurt Vonnegut (1969)
• The Alexandria Quartet by Lawrence Durrell (1957-60)
• A Rebours by JK Huysmans (1884)
• Baby and Child Care by Dr Benjamin Spock (1946)
• The Beauty Myth by Naomi Wolf (1991)
• The Bell Jar by Sylvia Plath (1963)
• Catch-22 by Joseph Heller (1961)
• The Catcher in the Rye by JD Salinger (1951)
• The Celestine Prophecy by James Redfield (1993)
• The Dice Man by Luke Rhinehart (1971)
• Chariots of the Gods: Was God An Astronaut? by Erich Von Däniken (1968)
• A Confederacy of Dunces by John Kennedy Toole (1980)
• Confessions by Jean-Jacques Rousseau (1782)
• The Private Memoirs and Confessions of a Justified Sinner by James Hogg (1824)
• Dianetics: the Modern Science of Mental Health by L Ron Hubbard (1950)
• The Doors of Perception by Aldous Huxley (1954)
• Dune by Frank Herbert (1965)
• The Hitchhiker’s Guide to the Galaxy by Douglas Adams (1979)
• The Electric Kool-Aid Acid Test by Tom Wolfe (1968)
• Fear of Flying by Erica Jong (1973)
• The Female Eunuch by Germaine Greer (1970)
• The Fountainhead by Ayn Rand (1943)
• Gödel, Escher, Bach: an Eternal Golden Braid by Douglas R Hofstadter (1979)
• Gravity’s Rainbow by Thomas Pynchon (1973)
• The Holy Blood and the Holy Grail by Michael Baigent, Richard Leigh and Henry Lincoln (1982)
• I Capture the Castle by Dodie Smith (1948)
• If on a Winter’s Night a Traveller by Italo Calvino (1979)
• Iron John: a Book About Men by Robert Bly (1990)
• Jonathan Livingston Seagull by Richard Bach and Russell Munson (1970)
• The Magus by John Fowles (1966)
• Labyrinths by Jorge Luis Borges (1962)
• The Leopard by Giuseppe di Lampedusa (1958)
• The Master and Margarita by Mikhail Bulgakov (1967)
• No Logo by Naomi Klein (2000)
• On The Road by Jack Kerouac (1957)
• Fear and Loathing in Las Vegas by Hunter S Thompson (1971)
• The Outsider by Colin Wilson (1956)
• The Prophet by Kahlil Gibran (1923)
• The Ragged Trousered Philanthropists by Robert Tressell (1914)
• The Rubáiyát of Omar Khayyám tr by Edward FitzGerald (1859)
• The Road to Oxiana by Robert Byron (1937)
• Siddhartha by Hermann Hesse (1922)
• The Sorrows of Young Werther by Johann Wolfgang von Goethe (1774)
• Story of O by Pauline Réage (1954)
• The Stranger by Albert Camus (1942)
• The Teachings of Don Juan: a Yaqui Way of Knowledge by Carlos Castaneda (1968)
• Testament of Youth by Vera Brittain (1933)
• Thus Spoke Zarathustra by Friedrich Wilhelm Nietzsche (1883-85)
• To Kill a Mockingbird by Harper Lee (1960)
• Zen and the Art of Motorcycle Maintenance: an Inquiry into Values by Robert M Pirsig (1974)

That puts me at reading 13 and for some reason, not finishing 4. Okay, enough of that. On to studying inflammatory bowel disease.

Incarcerated!

And I'm not talking about the potentially very bad outcome from an abdominal hernia.

The U.S. has less than 5 percent of the world’s population but almost a quarter of its prisoners.

Sheesh.

April X Begets May Y

If April showers bring May flowers, what do April flurries bring?

Curries?
Worries?
Slurries?

This message brought to you by a man and his duck.

Duck Curries, that is.

The Green Service

I'd encourage you to consider taking a little time this week to read some of the articles in the New York Times' Green Issue that they've published in honor of Earth Day. In the interest of mixing things up a bit, I've taken the liberty to arrange some of my favorite articles and features into the structure of a church service.

Where I go to church, the service starts with singing. In churchgoer lingo worship is a way to transition from the business of the week or the day and focus on the time you plan to spend meditating, learning, reflecting and challenging the ideas that will come of the service. Worship can be just song, but could also include projected artwork, dramatic readings, instrumental expression or even dance. The online version of the green issue includes a funky tribute to the sculptures used as headings throughout the article.

Every church service features a scripture reading, whether it be from a pre-determined yearly schedule or selected by that day's service leaders. In most Christian traditions, this includes readings from the Old and New Testaments. It was reading some of the entries in the ACT/ EAT/ INVENT/ LEARN/ LIVE/ MOVE/ BUILD sections that I though of this theme. Scripture readings are small snippets from the Bible that can then offer digestible ideas for study or contemplation. Of these, I recommend the LIVE and INVENT sections.

For the personal testimony, head over to Pasadena, CA where the Dervaes family has gone 'off the grid.' As my wife listened to the video report with me, she pointed out, "Those people used to be called Hippies." Maybe so, but these days, there's a lot more hip to what they are doing. Contrast their strategy with the way rich folks go green a la Bill Nye.

The sermon, tucked in toward the end of the service, centers on the motivation, justification, and implementation of individual efforts to curb fossil fuel consumption and carbon emission. The garden is rich with metaphor. The seed and sower have a long tradition in secular and religious texts. Michael Pollan provides a fresh take on the garden as a social force for lessening climate change.

Finally, for the benediction, I quote Rabbi Julian Sinclair:

“The environmental movement has been overwhelmingly secular for 40 years and has achieved amazing things,” he says, “but it hasn’t yet figured out how to move people on a massive scale because it isn’t telling the right story.’ Sinclair says he believes that the “doom-laden apocalyptic narrative” favored by the mainstream environmental movement can paralyze rather than motivate necessary lifestyle adjustments. Conversely, he says religion — which has been “in the behavioral-change business for 3,000 years” — offers a distinct message of hope and boasts an impressive track record of moral persuasion: “There have been watershed moments when religion has barged into public life, blown away the windbaggery of politics-as-usual and declared with irresistible force, ‘This must change now!’ ”

Trauma Call Makes The News

Recently I experienced something a bit unsettling about working in a regional trauma center.

I was on trauma call. At my current hospital, the surgeon on call assumes the role of quarterback when a trauma case comes in the door. He (all of the attendings here are male) meets the patient and collects pertinent information from the emergency transport staff as they come through the door, does the initial Airway Breathing Circulation Deficit Exposure (ABCDE) evaluation and orders the requisite next tests and treatments. If two folks come in, he must asses them simultaneously and enlist the help of the ER docs to stabilize the patient(s). This is exciting to watch; in these situations, I just try to keep up with the decision making process. When patient are already stable as was the case this time, the best I could do to help was to collect supplies needed for exam or treatment.

This case was my first interaction with the outcome of a motor vehicle accident (MVA in ER lingo). The specifics of the case are interesting; some of the passengers died at the scene, so it is expected that there were serious injuries involved. There are two elements of this situation I had not expected.

First, (and this is not the unsettling part) the hospital's chaplain provided an amazing service to the patients. He was able to respond to their emotional state. Whether the patient wanted to begin acknowledging the loss of their loved ones or to wait to hear about the situation, he was able to support them. No one else in the ER was able to forge this needed connection - we were all concerned with placing lines, reading films, and preparing for surgery or transfer. What I learned about telling patients that their loved ones had died was to:

• Be prepared to report accurate account of what is known about the accident and fatalities. Names, ages and relationships are very important to discern. If this requires calling the state patrol, so be it.
  
• Patients know something bad has happened. But they may not be ready to hear the words until some of the physical shock has worn off. They may tell you this. When they say they are ready, then see above.
• If the information is kept from them, it will not be for long. News travels fast in hospitals. The ICU nurses, anesthesia techs and other docs will know snippets of the story. If the doctor caring for the patient does not tell the whole story, this could erode trust needed to best provide care.

This last part brings me to the unsettling part of the MVA trauma experience: news reports. News of this accident undoubtedly makes it into the local newspaper. Full names, hometown and hospital condition are always reported. When I came across the story of the trauma case I participated in, I imagined the patients' personal concerns, complaints, fear, and humor. I also remember digging glass out of a neck laceration in the operating room and then washing the wound with 3 liters of saline. There is always so much more behind the police report oriented news release.

The news reports are so cold. It's the truth underneath the report that is hot: exciting, heart wrenching, fast paced, uplifting - all with little room for error. That part of the story is tucked away in the confines of the physician-patient relationship. It's a privilege to be a part of that.

What's The Deal?

Someone recently said some Americans were "bitter" over the economy and chose to "cling to guns or religion or antipathy to people who aren’t like them" as a result.

Could someone please help me understand what's wrong with this assessment?

Thanks in advance.

Diagnose This!

You're a student on rotation at an academic medical center's walk-in clinic. A new patient presents with a one week history of pruritic 1-2 mm diameter vesicles and evidence of excoriation on the extensor surface of both hands that is most prominent between the metacarpophalangeal joint and the dorsal crease of the wrist. There are also some lesions at the proximal nail fold and distal phalanges. The interphalangeal skin and finger webbing is largely spared, except for the area surrounding the left 4th digit. There is no palmar rash. Upon closer inspection, the lesions have a diverse morphology, ranging from non-erythemetic fluid-filled indurated vesicles to bright red papules with a 3 mm diameter border to small salmon colored macules with crusted centers. A thorough skin inspection yields no other rashes. Complete physical exam is unremarkable except for dark circles under his eyes. The skin finding is shown below.

Further questioning reveals that this patient has developed irregular sleep habits over the past several months and has several other new stressors in his life, including physical relocation, new responsibilities at work, looming deadlines, personal grief, and a perception that his future depends on every daily task. He does report several adaptive behaviors to help manage this stress, including creative outlets that use all ten fingers... The rash has been refractory to cortisone and triamcinolone, and Actifed helps a little bit with the itching. He seems resigned to this condition, stating that his position will change in about a month.

After consulting your attending, you recommend which of the following therapies:
A) Bed Rest
B) Solar Therapy (Specifically In Zihuatanejo)
C) Desoximetasone Baths
D) Cutting Back On The Alcohol

Oh, I almost forgot: What's your diagnosis doctor?

Expelled

I was going to go to the Expelled movie this weekend to write a review for this blog. But it turns out that Expelled is more about Ben Stein flunking than getting expelled. For more information, please consult with TUIB Guy.

We now return to our regularly scheduled programming.

Trauma And Sore Throats

For those keeping track, I'm back in Spokane and in my surgery clerkship. On Saturday, I took call. Whenever a patient comes in to one of Spokane's ERs and needs surgery, they call the doc I'm working with to do it. In addition, today that surgeon was also on trauma call. After we rounded on the practice's patients on the floors, I could have gone home to study or wait for calls. (And the calls would come, a this is the first warm weekend of the year.) Instead of being unproductive at home, I hung out in the ER where the trauma cases would go. It happens to be the same ER I worked in previously as an internal medicine student, so I knew the staff and my way around. From noon to midnight, I managed the following problems:

• Torus fracture of the radius in a ten year old
• Sore throat
• Tooth pain
• Hypotensive emergency
• Strep throat vs. mono vs. peritonsilar abscess
• Bleeding in a 6 week pregnancy
  
• Altered mental status
• Wallpaper induced migrane
• Alcohol + ATV = Badness
  

Technically, the only trauma case was the last one. For that, I put in a chest tube to treat a pneumothorax. But that doesn't mean I only did one procedure. I also:

• Wrapped a soft splint
• Took throat cultures
• Placed an IV line
  
• Did pelvic and bimanual exams and ultrasound
• Inserted a nasogastric tube
• Spoke several times with a social worker

Even though only one actual trauma case came through (so far! I'm on call from home until 7AM), today was great. It's because I was in the emergency room. I'm comfortable enough there that I know where stuff is and can contribute as a team member. And that's what I like about medicine.

Open Access UpToDate

Yesterday I commented on how members of the University of Washington community were shocked to hear of the subscription cancellation of the UpToDate reference. Read this to get up to speed. The basic story is that UpToDate wanted to charge the UW a fee that amounts to 60% of the Health Sciences Library's budget. To that, the UW said no.

My peer group (medical students) were surprised, appalled, outraged, and saddened by the news.

I say, "eh..." Let me tell you why.

UpToDate is an extremely easy way to learn about the consensus understanding and treatments for a large number of diseases and medical conditions. Maybe it's too easy. For many years, it has been the one stop shop for clinical pearls, research and both general and specific information. The company knows this. Now is the time to cash in. For many students, it's the ONLY place they go for information. For some, it's just the first place. (Every article has extensive reference lists that lead back to the primary data.) What we (myself included) have fallen into is a reliance on an information monopoly. The funny thing is that this is a monopoly of convenience. Part of me thinks that UpToDate is within its rights to charge whatever they want for their well organized service - this is a free market, after all. The rest of me is repulsed by the price this company is charging for what amounts to information that is already in the medical literature.

So Duke, Johns Hopkins and now the University of Washington have said, "No, thanks" to a convenient tool. These aren't poor backwoods places. I have not heard much ideology behind these decisions; today our dean restated the financial motivation for canceling the subscription. Why might a few giants making this choice be good for medical education? Here are three reasons:

1. Intellectual Laziness. In a response to my article yesterday, one UW professor lamented that third year medical students no longer scoured medical literature, medicine textbooks and other information sources when researching their patients' conditions. I know that as a student, I very much appreciate the ease of using one resource for all of my inquiries. It leaves more time for patient care. BUT, UpToDate articles are authored by one or two people, and believe it or not, medicine is rarely definitive. It could be useful to know different opinions when relevant. There's a good chance that relevant professional societies (take the American Academy of Pediatrics, for example) already publish recommendations, and make them freely available. The problem is that you have to know where all of this information is. The benefit of knowing the location of all this information is that you are actually closer to the basic decisions that affect care. Here is where a web resource portal comes in handy. Health sciences libraries need portals like this one to help care providers find the information they need. UW's HealthLinks page is a good start, but in the post-UpToDate age, will need much improvement.
   
2. Conservation of Resources. I am guessing that residency programs, departments, and even medical schools may cough up the money needed for their trainees to access this resource. As I understand it, every single person with UW network access could use UpToDate. Because of the UW's size and far-reaching extent, this could be on the order of 100,000 people. The people that need the kind of rapid access to information that UpToDate offers are students and trainees who are pressed for time in the context of 80 hour work weeks. (and who are used to the convenience of a single information source). If the medical school pays for this smaller number of subscriptions, then the health sciences library can order more subscriptions to basic and applied sciences journals that researchers crave.
3. Open Access. For me, this is the elephant in the room, and one that I hinted to earlier. My premise here is that this information is not new. It's a repackaging of basic and clinical science that is already out there. I think there is a legitimate mechanism by which UpToDate-styled reviews could be published free. After all, how much do UpToDate's authors get paid? I hope it's a pretty penny given what they are charging universities. In other academic spheres, if academic publishing is a for-profit venture, it's the publishers who profit. The authors get paid in the currency of academia: peer reviewed articles. "Open access" is a system where authors subsidize the costs of making their work available so that any reader can access it. This is an important trend in academia. The ivory tower is being disassembled and reconstructed into a public works project. But wait, if UpToDate doesn't pay their authors much (this is an assumption that I have not verified), why does it cost so much? I think the company would argue that their easy to use platform is worth something, as is the verification of the information as legitimate. In basic, clinical and applied sciences, this is done through the volunteer system of peer review. I am guessing UpToDate pays people to verify the information. Even so, I do not see why this needs to be for-profit. Why not use an open access model for these review articles? Open access works for 3,314 other journals. There are very well established mechanisms for running such systems, including the Public Library of Science family of journals. I would imagine that an UpToDate-styled review could fetch the prestige among clinicians as a Nature paper does for basic sciences. If the academic currency of publishing these clinical review articles could balance their widespread utility, why inject large sums of money into the system?

In the end, I think there are good theoretical reasons for abandoning expensive subscriptions to clinical review literature. The information is already out there. With a little help from librarians, we'll be able to keep providing the quality of care that the UW, Johns Hopkins and Duke are all known for. Who knows! Maybe the system will come out better in the end.

UpToDate OutOfDate

Where do most academic medicine providers get their information about the latest understanding of disease and treatment?

A web search engine called UpToDate. This service provides review articles of the medical literature that range from pretty good to excellent.

Imagine the horror medical students, residents and providers across the University of Washington system experienced today when they read this email:

"As a result of extraordinary price increases to provide UpToDate access for our distributed community of UW Health Sciences students, faculty and staff across the Pacific Northwest Region I have had to make the painful decision to cancel this heavily used resource. In spite of extensive negotiations with the publisher over the past two years we simply were unable to negotiate a price that our Health Sciences Libraries budget could afford. The price for UW is much higher than for other institutions, in large part, because we are a regional health sciences center with regular faculty and students across Washington State as well as in other states throughout the WWAMI region. This means that simple onsite access as provided by some Health Sciences Libraries (e.g. walk into the Health Sciences Library physically and access the resource) will not work for many of our students and faculty who would need to get into a car to come here or worse, fly for several hours!"

For more details about the specifics of this situation at the University of Washington, visit the UW UpToDate alert page. As a medical student spending the majority of his third year outside of Seattle, I am particularly aware of the crux of this issue. What I want to know is how they can charge so much money for what is basically a bunch of review articles. Just how much are their writers being paid? Do the authors get paid per hit? I kindof doubt it. The last time I checked, basic science professors don't get paid jack for writing review articles. (Actually, I just (this evening) reviewed the preprint proofs for a review article I was the first author on. Far from being paid, we had to pay the journal because we include color plates...)

Johns Hopkins refused to subscribe last year, and now the UW. As of July 1, 2008, UW students, residents and faculty will no longer have access to the most used resource for medical decision-making. In a way it is too bad, because the articles on UpToDate were the best annotated and easiest to read of any online medical resource. Because I am a (small potatoes) employee of WebMD, I've done a little bit of research in to the reference services provided by that company. So far, I haven't been able to use it for comprehensive reference information as seamlessly as UpToDate, but I think that will have to change. And, the WebMD portfolio includes a large amount of other cool information that is more media-friendly than UpToDate. Other services available to providers in the UW system include:

MDConsult (WebMD's healthcare provider page)
Cline-guide
DynaMed
AccessMedicine

If you are logged into your browser with your UW password, these links will send you directly to all of the subscription services.

Despite the inconvenience it will be for me not to have an UpToDate subscription, I am glad that UW just said no to big publishing. This info should be open access, anyway!

Anyone out there have tips for an UpToDate-free world?

As I discover tips, I'll try to post them under the tag, OutOfDate. But that reminds me, I've got a series about presidential health care politics I was going to write, too...

Coming Out Of The Closet

"I’m going into emergency medicine."

Head over to The Differential to discover how every medical student must come out - in a way - during the third year of med school.


I don't mean to diminish the stress and anguish involved with the GLBT meaning of the term. I do think it is a valid metaphor. Read the whole article to see what I mean.

One Week Of...

What a whirlwind my last week has been!

I think I know my way around three of Spokane's operating rooms; more importantly, I know where each OR's supply of non-powdered, size 9 sterile gloves is. One important (faculty-endorsed) location is my car's glove compartment - one of the hospitals doesn't have non-powdereds that large!

Boy am I glad I am outside of Seattle for my surgery clerkship! I'm not sure I'd be getting this much exposure to hands-on learning anywhere else... This week, I have:

• laparoscopically extracted a gall stone from the common bile duct during a gall bladder removal
  
• removed one appendix
• held countless retractors (more on that in a later post)
• clipped thyroid arteries in a parathyroidectomy
• learned 3 new knots and 5 new stitches
• sewn a colon into the skin
• coined a new term for a certain kind bowel adhesions and was subsequently pimped about said term ("fatty fibrosis" - another story for later)
• sewn large and small bowel together (using a really fancy stapler)
• imagined numerous uses for retractors and then seen them used that way...
• removed pounds of necrotic skin, fat and muscle off one person's shoulders only to have the infection spread to the heart.
• developed some annoying atopic dermatitis on my hands.
  
• eaten much more fiber than usual. Fiber can head off sooooo many bad things.

Did I mention that I am getting very familiar with retractors? I'm sure my fling with surgery will actually be an affair with retractors. Just in time for me to move on to OB/GYN (I hear they have retractors, too!!!), it will be my wife who picks up an affinity for those ubiquitously med student driven tools.

Meeting Bloggers in Real Life

I just realized tonight that on my list of things to do when visiting certain cities is meeting my favorite bloggers who happen to live in said city. The South Bay, Chicago, Minneapolis, Vancouver, San Diego, Charlottesville, Atlanta...

Is this silly?

Heston's Fingers

I think that we can finally pry that gun from his cold, dead fingers.

Unfortunately, gun control is not so much of an issue in the current political environment. I'll still have to learn how to treat gunshot wounds...

This One Just Fits

Bikemonkey tagged me with the song chart meme. As retribution, I present this:
I'm not sure if it really satisfies the rules of the meme, but it's what came to mind. I'm tagging Bunnies With Sharp Teeth, Dear Science, Dogs Bark At Night and Lid Upon My Head. If you are dying to figure this one out, take a minute and think about what Sarah said.

An Instance When John McCain Rightly Decides To Distance Himself From George Bush And His Wars

McCain may not be a Warmonger, and he is right to make this statement, but he has miles to go before I would agree with his position on the wars we're fighting. Check out other David Horsey cartoons. (Click on the image above to see a larger version.)

No Foolin': NIH to Cater to Young Scientists

Given this notice of a structural overhaul at the NIH, perhaps I should rethink my decision to pass on setting up a basic science lab in favor of the lucrative opportunities available to young scientists. With the champions of scientific humanities bowing to external pressures, I may need to discard my dreams of a career spanning the two cultures...