Dream a Dream

Evidently, television coverage of the "Tea Party" on tax day was pre-empted by another story. Since I've given up using the television for acquiring my news in any form other than presented on Comedy Central or in live broadcasts (debates, live speeches, CSPAN and the lot), I didn't catch this other story until it was echoed in the morning newspapers. Yesterday, a 47-year-old Scot performed a rendition of "I Dreamed a Dream" from "Les Miserables" on the UK's equivalent of American Idol and brought down the house. Much rubbish was made of her frumpy appearance, older age and romantic status in advance of (and after) the performance. Which reminds me that our current day conception of talent is inectricably linked to looks and social status. I'm glad that the show (titled "Britain's got Talent") actually brought out the talent it advertises. Especially if it drowned out some of the shouting about the illogical Tea Party. I actually enjoyed sending in my check this year. But then again I like the idea of the government funding science, cleaning the air, caring for the poor sick and lame, building roads and even defending freedom. I think the rich conservative broadcasters who orchestrated this Tea Party are celebrating a la David Horsey...

I've not embedded the clip because YouTube has restricted it and because if you are visiting my front page, you still get to hear the "Imperial March" in the background. Wondering why? Read this. Then watch Susan Boyle live a dream.

Imperial Battle Cruiser

On and off for the past 7 weeks, I've been working at the Seattle Veterans Affairs hospital. Many medical students spend part of their time at VA hospitals, but I was not assigned to one until last month. (I completed my geriatrics rotation and part of my radiology clerkship there.) But as with a lot of things these days, the day has come that I will not return to this place for a while.

The reason I am sharing this is to share a funny (if strange) phenomenon I experienced every day on my morning walk from the bus stop or the parking lot. By the time I approached the entry, I had started humming The Imperial March. It didn't matter if I was reading a book on my way in, listening to music or news radio. In the meters approaching the door, I had moved from the well recognized drumbeat to that catchy progression.

I cannot explain this. I mean, it's not like the hospital looks like an Imperial battle cruiser or anything.Or does it...

If your bandwidth is low, you may experience jumpiness in the music.

In Case You've Not Seen It...

This video has surfaced at several of the blogs I read. In case YOU haven't seen it, this is worth a few minutes of your time...



There's really no reason for me to post this here except that I tend to post things that I think are interesting...

Straight from the Medical Record

Sometimes information in medical records cracks me up. Take for example these excerpts from a note for a patient I helped care for:

Interval History:
Had a good day, with an especially lucid morning. Enjoyed throwing rubber chicken into sink. Family pleased with progress.

Exam:
NEURO: Continues tremulousness, is mostly non-verbal (per family, is exhausted and getting cranky after busy morning). Throws rubber chicken onto attending physician and into sink.

ATTENDING STATEMENT:
I personally saw and evaluated the patient. She did seem to enjoy throwing a rubber chicken at me and into the sink. I discussed the patient with Dr. XXX. I agree with the findings and plan as documented in his note.

The moral? Rubber chickens never fail to amuse.

Critical and identifying information has been changed to protect this patient's privacy.

Toast

Want one for yourself? Go to Obamicon.me.

A Big Burly Joke

A few weeks ago, I came up with what I thought was a great riddle. After none of my hand-picked readers figured it out, my wife suggested I rephrase it in the form of a joke. One intrepid reader offered a good guess (Burl Ives Trio) that was not what I was looking for.

So for those of you reading this for the first time, here is an (improved?) version of the joke:

A surgeon, a pathologist and an oncologist are hiking through forest when they encounter a burly tree (shown at left). Curious by nature, they sit down to ponder their discovery. Of course, the surgeon proposes to cut open one burl. The pathologist thinks that's a good idea; she whips out her pocket microscope to examine it. The oncologist goes on about a two-hit hypothesis and proposes dumping toxic chemicals onto the tree's base. What do you call this conclave of MDs which also happens to be a name for the piece of wood being examined by the pathologist?









A Tumor Board!



I tried to tell this riddle/joke at a recent party I held at my house when I realized that a few years ago, I had actually sliced up a small burl with the intent to make a set of coasters out of them. (The slices warped, and will need additional work to make them functional.) I got some laughs, but not because of the joke. Mostly, my guests thought something about the back-story was hilarious.

This group of mostly medical professionals proceeded to hypothesize the origins of burls. We all decided burls are some sort of tumor. Perhaps it's caused by a genetic cancer, but also perhaps by insects, fungus or viral disease. (Viruses cause tumors in humans, too!) That burls often congregate in groves could support a genetic or infectious cause. But the tendency for burls to form on golf courses and orchards speaks to a traumatic origin. Maybe the burls I saw in Alaska are residual from moose antler scraping behaviors or aborted assaults by beaver?

For those out there who have never heard of the second meaning of "tumor board," you will probably not think this as funny as I did (and still do, by the way). At most hospitals, there is a special meeting of specialists every week that serves to discuss the new, complex or complicated cancer diagnoses. Since every cancer is a little bit different, and every patient is different, you can imagine there could be a very large number of approaches to cancer therapy. In an effort to provide the best care, pathologists (who have the final word on diagnosis), surgeons (who provide the important skills to remove some tumors) and oncologists (typically the doctor in most contact with the patient) all meet to present and deliberate information. This meeting is called a tumor board.

Much Needed

As I type this entry, I am sitting under a thatched beach umbrella in Ixtapa, Mexico. My hotel's wireless internet extends all the way to the breakers, so I can take in the sea and salty air with my feet in the sand, a limonada con gas in one hand, the internets at my fingertips and my head in the shade. (For added fun, try mixing the phrases above... head in sand etc.)

I'll be back to Seattle and to life as a fourth year medical student in a few days.

Clue

Activity on this blog been down of late, mostly 'cuz I've been busy finishing my Ob/Gyn clerkship. Well, then there's that pesky truth that I mostly write for myself.

But I thought I might get one guess for my previous riddle. Yes, it was complicated and as my first blog riddle, maybe too hard. My wife suggested I turn the puzzle into a joke. So here's your first clue:

A surgeon, a pathologist and an oncologist are on a hike in the forest when they encounter a burly tree (See the recent post for a picture). Curious, they sit down to ponder their discovery. The surgeon proposes they cut open the burl. The pathologist thinks that's a good idea; she whips out her pocket microscope to examine it. The oncologist goes on about a two-hit hypothesis and proposes dumping toxic chemicals onto the tree's base. What do you call this conclave of MDs?

And your clue is this: the answer is the same as one of the items in the pathologist's possession.

A Woodland Riddle

Anyone out there up for a riddle?

When I was in Fairbanks for my obstetrics and gynecology rotation, I was fortunate to have a few days off so I could get out and experience the Alaskan landscape. Alaska is so big that it is impossible to make generalizations about the land. The people, the flora, the geology, the weather - it's difficult to write about the place without over-generalization.

One thing about interior Alaska that is hard not to notice is the trees. Having lived in the Pacific Northwest for several years, I've rediscovered a connection with the colossal organisms that define the landscapes here. Evergreens are, after all, the reason Seattle can claim the title of Emerald City. It isn't surprising that one of the first things I noticed after landing in Fairbanks was the diminutive stature of the area's trees. Black and white spruce, paper birch, alder and poplar are the main species there. And none of them grow much taller than 40 feet! Old growth forest consists of tree trunks less than a foot in diameter. The short growing season conspires with the extreme winter cold to limit tree height and diameter.

There is something else peculiar about interior Alaska's trees. There is a much higher frequency of burl formation there than any place I've been. Woodworkers know burls to be valuable sources of figured wood. Laminates, sculptures, and bowls derived from burls are things of beauty. Hikers and orcharders know burls to be those funny bulbous growths along the trunk, roots and limbs of trees. One of the more affected trees I encountered on a hike is shown at the left.

The strangest thing about burls is that no one really knows what causes them. Theories range from insect infestation, mechanical damage, genetics, fungus and soil contents. What I know is that when a medical student who has been a biomedical researcher and is an amateur woodworker encounters these misshapen trees in the forest, the first thing he thinks of is a riddle. That's right, the trees speak to me! This one said:

You doctors, you searchers, you cutters of flesh;
You sawyers, you sculptors, you dry aesthetes:
Gather together to crack my mystery.

So then, my witty readers... What do you think it all means? What was this telling me? How and when might we be able to figure the etiology of this I'll put up what I think it was telling me next week, and provide grades on your responses. I hope some brave readers will offer solutions to this mystery, first.

Butting Heads

All evening, I've felt like I'm butting heads with this manuscript I'm trying to rewrite for resubmission. Now that it's midnight where I am, it's too late to finish everything to my satisfaction. It's also too late for me to strap on my antlers. When I return to this paper tomorrow night, it better be ready... ready, that is, to butt heads with CaribouTom!

No caribou were harmed in the filming of this post.

Arms

My experiences in the Ob/Gyn clerkship these past weeks have revealed to me that being up in arms about something is very different than being up to your arms with something. Or up to your elbows. Whatever. I'm going to keep the field at arm's length.

Google Me!

Just to be clear: I, Thomas Robey am neither a senior vice president of investor relations for Time Warner nor an otolaryngologist in Milwaukee, WI. Nor am I a Khoros computer language programmer or a Rotten Tomatoes film reviewer. As fun as those things all sound, I'm happy with who I am and what I'm doing now.

Ella Ella Eh Eh Eh

This week has been busy, if a little disorienting. I do not think I'll get used to the daylight round the clock. It will make it easier to stay up all night if I am so called. For the next few days, I'll probably be humming Rihanna's Umbrella tune. Not because it was raining yesterday, but because of this. (Warning: if you're not familiar with this pop song, watching this video could be really painful.)



Didn't know the words to this song in the first place? Now you can sing along about the microbes you don't want to get...

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!

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.

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.

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...

20,000

Today - March 26, 2008 - at 4:18:48 PM local time, an unsuspecting web surfer entered the Hope for Pandora website. This visitor hails from Melbourne, Australia, uses the Safari browser on Mac OSX, and accessed the internet through an Australian provider called TPG. Evidently, Hope for Pandora is traded on the virtual stock market called Blog$hares. I'm not sure how this works and don't have time to figure it out. This is from the What is BlogShares panel on their site:

BlogShares is a fantasy stock market where weblogs are the companies. Players invest fictional dollars on shares in blogs. Blogs are valued by their incoming links and add value to other blogs by linking to them. Prices can go up or down based on trading and the underlying value of the blog.

I hope my stock is rising. Judging though from the amount of time (not very much!) I've had to make posts recently, I'd bet the value is holding steady or dropping. Some blogs I read have 20,000 readers in one day. It took me ten months.

Looking Over Your Shoulder

As a medical student, everything you say and do is noticed. This is important when you talk about patient information. For some, it's a reminder to not slip up in potentially evaluative settings. Others treat evaluation as an additional motivation to be your very best. A rare number of students don't care. Take for example an experience I had today:

I finished my work on Harborview's wards early today so was able to leave before the sun went down. My wife is on call tonight at the VA hospital. In my quest to be the best husband in town, I paged her to propose a dinner datein between admitting patients. She was happy to let me head over to the International District to pick up some Chinese takeout, and I was thrilled for the opportunity to sit in the hospital lobby eating delicious food with her.

When we first started our clerkships together, no one knew that we were married. Since we were both MD/PhDs, it probably seemed natural that we knew each other and chatted more than with other students. For an example, read this post from November.

One of the students from our first rotation together last fall happens to be rotating at the VA with my wife. We don't mind telling people any more, especially since we're more comfortable with both our career choices and our positions in what I've recently taken to calling the medico-educational complex. Anyway, we sat just to the side of the main entrance of Seattle's VA hospital. As I finished my minimally Americanized food, I got a strange feeling like I was being watched. Was it my wife's intern? Our classmate? When I turned around, I was surprised to see, not more than a foot from my face, this exact sight:

This very photo - larger than life - was there smirking at me. His head was about 16 inches across. Just hanging on the wall. Looking over all I was doing. Listening to every word from my mouth.

You never know who's listening to you in the hospital.

LOL Zygotes

I'z got 2 faces
I zgot 2 faces
1 zygot, 2 faces
1 zygote, 2 faces

And no, I didn't do any Photoshopping on this one. Read all about it!