DocAMAZING

The Uterus

2005-12-15T07:04:00.000-06:00

My doc told me today that the uterus is like a fancy sportscar. Women love to have it but can't stand how often it causes problems and it's constant maintenance. They are relieved when it is gone. This was right after we left a room where a patient actually did a little dance saying "no more periods!" after discussing her surgical history. Thank god for the unassuming prostate.

Here's to you, Drug Rep!

2005-12-14T00:25:00.000-06:00

Let's hear it for the hard working men and women of the drug companies. While most people entering a doctor's clinic sit quietly in the waiting room, you walk in uninvited through the side door with your pull cart full of pens and drug branded picture frames ready to engage each staff member avoiding eye contact with droll conversation. Certainly, none of your visits are complete without a "isn't that how it always is", "don't work too hard", or a peal of canned laughter.

When drug companies try to market an old antihistamine with new packaging and a new indication for something silly like "night allergies" or "insomnia complicated by hives", you step up to the plate and swing like mad. Sure, some would say it is just as effective high-dose Benadryl, but Benadryl doesn't have an FDA approved study stating it has no negative effects on prostate health. Take THAT nay-sayers!

Even though most doctors would just prefer a package of drug samples being dropped off at the front desk monthly, you continue to bring five or six samples to the office every week to add that personal touch. But just when they are about to tell you that they are too busy to talk "for the very last time" you bring a box of sugar cookies from the supermarket bakery as if to say "I know your price."

When the big drug companies made the Pharma agreement that prevented you from taking doctors and their spouses out to dinner you shrugged and said "sorry doc, but the cost of wining and dining doctors is making it tough to keep costs down for elderly people who need their blood pressure meds." You keep the doctors from thinking about how the Pharma agreement came about around the time drug companies were launching multi-million dollar ad campaigns for their wares. But you don't worry about that, because if doctors could think independently your job would be completely obsolete.

So kick back and enjoy the limelight drug rep! Each of you are an indespensible part of the medical team: the laundering tag on the quilt of America's health care system. Even while the ranks of reps swell with more hot women and ugly guys who know about golf, rest easy knowing as long as you have free stuff to give away our clinic doors will be open.

Rice Water Logorrhea

2005-11-22T21:52:00.000-06:00

"So tell me why you think this guy is a good candidate for Lipitor."

"Well, HMG CoA reductase inhibitors have a good lipid profile of lowering LDL cholesterol and raising HDL. While some may choose niacin for it's HDL improving properties, it needs to be increased slowly over weeks to prevent overwhelming niacin flush, and this patient does not have very good compliance. However, in the future, two-drug therapy of a statin and niacin may be needed to blah blah blah..."

I've come to cherish nights like this. I'm enjoying the sweet, sweet sound of boy-band pop wafting up from our downstairs neighbor on the shoulders of a carton-worth of Lucky Strike smoke. It's all so very American. Unfortunately I haven't had the chance to introduce myself to them as they spend so much of their time procuring the 'sweet leaf' and running out to their respective Audis in the morning. I once dropped a bag of groceries outside their door, and while picking them up the neighbor I lovingly refer to as "YellowGrin" rushed out the front door grimacing with a pen in her teeth. It was as though she was in an old western, about to get an arrowhead removed from her shoulder after a raid on the moonshine silo. That is the most I've seen of her.

"Okay, so what do we do about..."

"... not that it is that common any more, but one must really be aware of niacin deficiency. Pellagra. That's what it is called. The classic triad is dermatitis, diarrhea, and dementia. Some would include 'death' as the fourth 'd', but it is in poor taste as no respectable triads have four items. It would be a quad... no, make that a tetrad. Plus death is not really a blah blah blah... "

Anyway, I've just finished a night of loading up on raw information for my Family Practice rotation. I spent the first night of the rotation learning everything about cholesterol, diabetes, high blood pressure, and asthma. I've never cared for expanding my mind or helping patients, but now, after my first day of FP, I've cornered myself into a endless spiral of helping and learning.

"Yes, but what about his..."

"... spent days observing patients with significant neural damage and defects and would occasionally stroke their feet with his reflex hammer. Those with upper motor damage would extend and fan their toes in response to this stimulation. The medical community named this reflex after this physician. This man: Joseph Jules François Félix Babinski. Now you know.. the rest of the story..."

But most importantly, FP covers more than just diabetes, hypertension, hypercholesterolemia, and asthma... no really, it does. It covers 75% of every other specialty as well. This has forced the usually unflappable and well versed DocAmazing to confront his tremendous ignorance in the management of just about everything. I can only be described in this context as unwell versed and flapped.

"...while the onion simmers in the bacon fat. You may be tempted to stir the onions, but the light browning is best achieved by leaving them alone. Start the milk simmering on low to medium heat and add the cubed blah blah blah..."

So now I've resorted to unleashing volumes of information each time diabetes, hypertension, hypercholesterolemia, or asthma comes up - frequently referring to any trivia slightly related to those four diseases. My doctor is currently afraid to even make eye contact with me for fear that I may spout off the diagnostic criteria for moderate persistent asthma. But, even I know this can not last.

"...it wasn't long after that I realized that that was neither the time or the place to make thrusting motions at the rabbi. However, the rest of the bris went along with out a hitch, and several phone calls later I blah blah blah..."

I'm hoping this will hold him at bay until I discover different ways to treat infections rather than following the DocAmazing law of: If the head and lungs be illin', give Amoxicillin, and everything else is done in by a dose of ciprofloxacin.

My ward has 3 Jesuses and an FBI secret agent

2005-11-06T12:56:00.000-06:00

I WANT TO BELIEVE
I like psych. This bothers me because I've got too many preconceived notions about psychiatry and psychiatrists to unlearn. But as time goes on I'm finding that the docs actually know stuff about internal medicine and are pretty thoughtful, and that many of these patients would be pretty destructive to themselves and others without treatment. Furthermore, many treatments, including electro-convulsive therapy, actually seem to work without dulling the patients' personality.

DAMMIT!

Much of psychiatric treatment is more palliative than curative, and many 'successful' patients must be on medications for the rest of their lives. I don't know how I'd feel about getting into a profession where most people are never 'healed'. But regardless, against all of my previous rants, psychiatry is on my list of possible professions.

My feelings could also just be delerium from having to commute 3 hours a day. I will definitely enjoy my next rotation, where the clinic is just ten minutes from my house. Maybe then I'll actually get back to meaningful weekly posting.

Mia Listo Sekreto

2005-10-19T20:48:00.000-05:00

Of all of the thousands of little 'insignificant' syndromes, tests, and signs we are taught in the first two years of medical school, there are a multitude of syndromes you don't plan on seeing. I plan on not seeing (or diagnosing) sarcoma botryoides, frotteurism, or scientology. They are all too uncommon to be seen by me, especially if I'm looking to go into pain management. There are several more on the list, but they are a secret. (secret=forgotten)

One of those things I thought I'd never see is Broca's aphasia. It's a syndrome where there is damage to the "outgoing communication" center of the brain, usually from a stroke, which leaves the patient unable to form words. They can still understand what is being said to them, unlike the very tragic Wernicke's aphasia. Well, one of our patients came in for treatment of shoulder pain and had symptoms of a somewhat resolved Broca's aphasia from a previous stroke. WHOA! Broca's! Here! As soon as that synapse connected in my brain the rest of my brain was engaged in inhibiting my excitement from causing me to blurt out "BROCA" several times in a Tourette's type manner.

Twenty painfully long minutes later the patient left the room and I struck an aloof pose on the side of the doorway, looked at my cuticles, and breezily told the doctor, "that was a pretty textbook case of Broca's if I've ever seen one." I'm not sure whether the phrase "if I've ever seen one" is a valid one if you've only seen one and there was no "if" about it, but I tossed it in to accentuate how aloof I was in the face of such a brilliant discovery. The discovery was, of course, that medicine includes things other than hypertension, high cholesterol, allergies, and low back pain - it includes those things we missed test questions about.
The doctor looked at me as though I'd just spoken in Esperonto.

"Broca's aphasia", I clarified.

His head tilted slightly to the side.

"From the stroke, affecting her speech", I stammered.

I wasn't sure whether he didn't understand or if Broca was a stupor inducing trigger like in Manchurian Candidate. Before drool started to gather at the corner of his mouth I went ahead and explained the condition. Deflated, I continued the rest of the day, deftly caring for hypertension, high cholesterol, allergies, and low back pain.

I apparently discovered something that was on his secret list.

Idealism returns like the herp

2005-10-12T23:05:00.000-05:00

Manipulative medicine is taking more out of DocAMAZING than first expected. My clinic’s operating hours are 9 to 5, give or take the sum of those two numbers. So, except for one odd day out, I’ve been in clinic until 6 o’clock or, like today, 7:20. Tack on an hour’s drive home, forty minute workout, dinner #2, meaningful chatter with the missus, checking the latest dirt on my favorite BDSM anime forums, and bedtime snack and there’s not much time for working on the paper that is due at the end of the rotation. Yes, a paper is due at the end of the rotation. It feels very high school-like, such as when a teacher realizes that watching Tombstone for three class periods was not entirely justifiable and bookends the last day with a paper due comparing Doc Holliday’s motives with those of The Outsiders protagonist Pony Boy.

This rotation has been piquing my idealism in medicine again, though. It may be the actual patient contact that’s doing it. I actually switched with another person for this doctor because of his gentle, more focused, osteopathic manipulative technique. My first doc was known for what he called the “good ol’ fashioned osteopathy” of whipping joints at high velocity counter to other joints in positions that can only be likened to techniques seen in the “good ol’ fashioned Spanish Inquisition”. I feel that the ‘joint cracking’ that I thought was so cool the first year may sound and look effective, but they do little to reduce the ‘gamma gain’ that caused the lesion in the first place. In other words, I think it doesn’t really help the problem. It’s kinda like that three-pack of azithromycin you got last winter for the sniffles.

--------

On a side note, I've got good news for smokers that comes directly from one of my lunchtime study sessions: It turns out that smoking is protective against ulcerative colitis. Smokers are only a third as likely to get the dysentery and ulcerous rectum of UC than the rest of us non-smoking suckers. However, smokers are twice more likely to get the intestinal blockage and gastrointestinal fistulas of Crohn’s disease than us non-smoking smarties. But if you work it out mathematically I think smokers are still ahead of us in avoiding debilitating GI tract disorders by sixty-six something-or-others. Euros, I think. So smokers everywhere can hack a large wad of relief as their intestines remain the envy of us, the ignorant white-toothed masses, while their lungs turn the texture of Bea Arthur’s elbow skin. (covered in tar, natch)

The internet is TEEMING with people!

2005-10-03T20:04:00.000-05:00

It's a momentous time in this blog's history. Now that it gets about 52 hits per week, other DocAmazings are coming out of the woodwork. I just recently received a 'cease and desist' post from another DocAmazing, asking me not to 'flood the market'. I assume this was meant to either close the blog or change the name (probably the latter). This is one of the problems with the 'internet'. The internet is full of people. Chock full. There are people pouring out of the seams. At least a million of them.

In this melange of people there is bound to be some name overlap. Go to any forum and there is a NiteShadow, but I doubt these are all the same NiteShadow. One could be a 13 year old boy posting about how cool Insane Clown Posse is, and another could be a 14 year old boy posting about how "teh r0xorZ!!11!" Insane Clown Posse is. You could get dizzy trying to work out the implications of such a split personality until you realize that the internet is just damned full of people. You can't miss em'. At least a hundred thousand of them.

However, in respect for the name DocAmazing, I will include a little disclaimer that this Doc is not the craigslist or the netherotarecords Doc. My internet sphere is much smaller and, frankly, better decorated. I think I'll stay here.

----------------
For an update on NiteShadow:
NiteShadow races Honda hatchbacks
NiteShadow has animated girls melting in his hands
NiteShadow is Death
NiteShadow hasn't sat on any good Goethe books lately
NiteShadow feels Mexican spices are below him
NiteShadow writes Melissa Joan-Hart for spiritual guidance

My white coat is one blueberry pie stain away from starring in a detergent ad

2005-09-24T20:13:00.000-05:00

Yeah, it is time for my biannual white coat wash. Featured stains include: grease from the inside of my car door, a coffee slosh up the right arm, pen marks around the left pocket, something dark brown near said pen marks, ring around the collar, AND a brown ‘ring’ stain where the stethoscope diaphragm rests.

Well, OBGyn ended with a fizzle. The last two weeks were in the clinic where, due to the director’s decision, medical students never see a patient alone. You just follow a resident into the room, stand between the sink and the biohazard trash and nod appropriately when she makes comments about weight loss, smoking cessation, or the importance of Pap smears. The best residents don’t even introduce you to the patient so you might not even get eye contact during the entire process of patient care. It’s very good training for pathologists – bad training for DocAMAZING.

I did learn about the importance of the Spanish language, or, for my Spanish-speaking readers, la lingua de Dios. There were four Spanish speaking residents in the program, and getting linked with them led to a day of (A) being a wallflower per usual, and (B) being a wallflower that had no effing clue what was being said. I had minimal on the job training in Spanish, and all of it was in labor and delivery. So unless I needed to start yelling, “Puje, senora! Puje puje puje puje puje pujepujepujepujepujepuje, PUJE MAS MAS MAS MAS MAS MAS MASMASMASMASMASMASMAAAAASSSSSS… BUENO”, then I was more worthless than the otoscopes on the wall. Really. OBGyns are baffled by otoscopes.

So, I had three days at home without any responsibilities, except for making up for twenty-six months without my wife. Needless to say I was fulfilling my husbandly duties! *wink* You know what I mean? Yeah?! Well, if you don’t, it means opening relish jars and walking down the stairwell first to collect spider web strands before my arachnophobic wife descends. Arachnophobia is the fear of spiders, but the relative eased state of mind when a loved one is flailing in the midst of the remnants of last night’s spider silk cotillion.

I’m getting prepped for Monday, the start of my manipulative medicine rotation. I hear the there is a lot of student interaction on this rotation, so maybe my blog will shrivel up and die from lack of cynical content. If so, dear reader, I’ll make sure to continue with the ever so popular copied-lyric-blog, or the Blogspot favorite: list-blogs.

Ten little sins I don’t tell anybody about this week

1. I put peanut butter on BOTH sides of my PBJ!
2. I left my shopping cart right NEXT to the cart corral, not IN!
3. I threw a bottle at a homeless man!
4. …

I better stop now before I ruin my next post…

Wasn't placenta #6 delivered? Of course not!

2005-09-16T20:36:00.000-05:00

That's right. Count 'em. Six. They're clearly labeled to the right.

I've been straining to find anything to write about this week, but there is nothing to write about except the nothing that is occuring here... er, or the nothing that is NOT occuring here. Wait. Nothing isn't occuring here never. "Nothing" is the occurance. Goddammit.

My wife says I have a deficiency in the area of double negtives. It pains someone like me to hear this as it is like having someone say, "you are clearly not able to stop breathing when submerged under water." The mechanism for double negatives seem simple enough: when a sentence has two negatives, ignore them. When the sentence has three negatives, take a deep breath, squint, then repeat the question back to the asker, hoping for a clarification using less cirmlocution or a complete topic change. The latter is used most often by my wife in between wiping the drool off my chin.

This is difficult enough for a person who has never memorized his multiplication tables nor his own age. Each time I'm confronted with either of these situations the Etch-A-Sketch of my weak cognition is shaken and the monkeys get to work tossing numbers at the wall until something sticks like white on rice (luckily, my mastery of metaphor amalgamation is not hindered by this).

"What's my age? Uhm..." I was born in 1980. It is currently 2005. 2005-1980=25, but my birthday has not occured yet this year, therefore 25-1=24. I am 24. "I am 24, Your Honor." *Self-satisfied swagger*

But then my wife tosses the wrench in the bathwater. She will ask me a question with one or more negatives, but then switch the rules of multiples of negatives! The gall! God has allowed one man to rewrite the rules of grammar and pronunciation like this and I'll be damned if we make a mockery of his office. Here's an example:

"Don't you think this new top is cute?"

At this point marriage has injured my thinking enough to translate 'hot' to 'cute' (two terms which used to be miles separate in my mind), and thinking that the top IS cute I answer truthfully: "No". Do I NOT think the top is cute? Of course I don't think it is not cute!

I quickly learn that Wife does not share my understanding of The Rules. Hours later, when my vision returns, I fail to convince her about the proper usage of "not". And I refuse to play the "ignore the not" game. Now I'm relegated to answering questions with recitation:

"Don't you think this new top is cute?"
"The top is cute."

"Didn't you like the salad?"
"I like salad. Specifically this salad."

"Wouldn't you rather watch Shakespeare in Love before Elizabeth?"
"I would prefer to not see Gweneth Paltrow at all, whatever the circumstance."

Ah, sweet middle ground.

Placenta #5!

2005-09-11T20:13:00.000-05:00

I'm a mad placenta-delivering machine, sent back through time to change the future for a handful of lucky uteruses.

Today I was on call with a cool resident and a cool attending, both of whom made it a point for me to deliver a baby. However, I was confounded on both deliveries.

Lady #1 decided to all but launch the baby before we entered the room. We were at the L&D nurses' desk when we heard her scream, and when we entered the baby's head was already out. By the time I got my gloves on the thing was 4/5 the way out. I could have told the attending, "I'll take it from here", and extract the feet, but that would be tantamount to 'taking over' cleaning the kitchen for my wife right before she pushes the start button on the dishwasher.

Lady #2 was at only 5cm cervical dilation (full dilation is 10cm). I went to go sonogram another lady for 10 minutes, and when I returned the woman had delivered. God himself rewrote the laws of biology and tissue expandability solely for this woman. Maybe he did it because of my using his name in vain last weekend when this exact situation first happened. Or maybe it was for picking my nose in church. I perpetrated both offenses several times.

I also have a beef to pick with all women who choose to not get an epidural:YOU ALL MAKE ME SICKIt's true. ALL OF YOU. I can't stand being in the same room with you. I get PHYSICALLY SICK!

You must understand: I am a card-carrying candy-ass. Each time one of you starts moaning, crying, and writhing with contractions you transmit that pain through thin air into my own abdomen. I get a mixture of that feeling you get when the airplane drops altitude too fast and that feeling you get when you are being attacked with a claw hammer. I usually have to sit down when I leave the room to get my abdomen to release the evil pain mojo. I'm getting that feeling again even as I type about it! I wish there was some way for you all to understand the pain it makes me feel. Sigh. I guess that is just a wish I'll never see realized.

It turns out I am a little TOO Fair and Balanced

2005-09-08T20:18:00.000-05:00

One of the benefits of having an OBGyn rotation in OilTown is that you get to room with two other guys. It has all of the charm of a college dorm room without the annoyances of cleanliness or frequent interpersonal communication. Everybody you room with has to be up at 6am and study until 8:30pm, with occasional microbursts of complaining about the residents and talking about sports. I could write a whole post about me trying to talk about sports in any ‘meaningful’ fashion, but this is not that day. Nor that post.

The biggest plus about this apartment is the cable. I don’t have cable at home. I have four channels: CBS, FOX, UPN, and WB. Therefore my usual choice of entertainment is CSI: [city of population >500,000], When Buildings Explode, You Go Girlfriend, and Blind Date reruns. But now I have 50+ channels to provide background noise while I plug away at soduko puzzles.

This background-noise habit of mine led to an awkward exchange with one of my ‘roomies’ (read: roommate) a few days ago. He left the apartment one evening to pick up some dinner as I sat placidly in the living room reading blogs between bouts of soduko. I didn’t have the gumption to crawl over to the loveseat to grasp the remote and switch the channel from FOXNews to something more satisfying like Futurama or Reno 911. While this may seem silly to most, my laptop becomes a pivot point when it is in my lap and all of my motions are made from an Indian-style position until nature calls or my lap gets too sweaty from the Chernobyl-level heat emanated from my Dell.

The next twenty minutes were an award winning display of ignoring Sheperd Smith’s comparing New Orleans to Hiroshima (yes, he really did that). Soon, Roomie returns and says, “So you’re a good ol’ Southern boy too!”

I looked up and tried to make the connection between reading updates about the new iPod and “Southern boy” status.

Roomie, being connected to me through similar location status, picks up on this and points to the television, “FOXNews.”

After another moment of me pursing my lips and squinting at him, Roomie starts on how much he likes nutty ol’ Shep and his fair and balanced news. I feel uncomfortable that my Southern status test turned up a false positive and I think that I should stop Roomie before he starts telling me Southern boy trade secrets or puts me on any mailing lists.

I stop him with, “I actually just left the TV on the station when you left.” Not knowing better I also add, “I usually watch CNN or MSNBC.”

Roomie looks as though he has just lost a new brother. “Oh. You know, I thought you were a Democrat.” … It all starts making sense: Southern boy = FOXNews watcher = Republican. Likewise: CNN/MSNBC watcher = Democrat = bastard heartbreaker. And from the look on his face I could also figure: Republican > Democrat.

I try to salve his pain by saying that I’m not Democrat or Republican, but rather, I vote only for candidates that I have researched well enough to support. This leaves Roomie in a quandary. Die-hards for either side of the political line work only with absolutes, much like the Sith. Roomie stares at the “Republican Friend” and “Democrat Enemy” tags in his hands and still doesn’t know which to place on my ear.

“Are you Pro-Life or Pro-Choice?” he asks.

I realize that he is not interested in nuance and a deeper conversation about extreme cases. So I decide the best way to diffuse this situation is with a poorly delivered joke. “Neither,” I say, “I’m just Anti-Life.”

“What does that mean?!”

Fie on his literalism! I explain that my answer was a joke on how the names for each side insinuate that the other side are against life or choice. “You know? Pro-Lifers are not against choice and Pro-choicers aren’t against life.”

Roomie’s half nod inform me that I am wrong about both counts. Two minutes of silence pass like an ileus. I cough nervously. O’Reilly cuts off someone’s mic on the TV. I finally awkwardly break the silence once more.

“I’m not really Anti-Life.”

…I don’t remember who switched the TV station to ESPN, but things returned to normal after someone’s helmet flew off during a tackle. Thank God for the simple joys of sports injuries.

PolitiPost:: Brought to you by the number 12 and the letters A, C, L and U.

2005-09-02T09:36:00.000-05:00

There is a clear difference between 'looters' and 'finders' in New Orleans:
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If there's any justice, FEMA Under Secretary Brown will go to jail for this guy's 'crime'.
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This is not political but Taylor Dent's serve has straightened up since he has 'let the darkness take over'.
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America, protecting our natives for over two centuries.
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The best explanation yet about why ID is a joke with scientists.

No placenta is safe

2005-08-30T23:06:00.000-05:00

Make sure you are sitting down, you are in the presence of something special. Uterine contractions quiver at the sound of my name. Heavily gravid women panting on the once-dry hospital sheets reach to touch the back of my coat for a chance to cease the abdominal gripping that occurs every two to three minutes. My mere presence sends fetuses scrambling back into the womb. I, DocAMAZING, am a human tocolytic. No babies breathe free air on MY watch.

At least, my tocolytic effects last just long enough for an intern to walk into Labor & Delivery, at which point babies launch from their respective uteruses into fumbling hands. I post about this special ability now because it took me nine days to even see a vaginal delivery.

At the beginning of my Sunday shift, two women were brought into L&D for induction. Paydirt! Two women, both at term, without complications, were coming to my floor to have their babies chemically encouraged to squeeze out into my gloved and gowned arms. It’s really as poetic as it sounds. To accentuate my dorky over-excitement at getting a chance to deliver, I donned a pair of paper boot covers that stayed on my feet for the rest of the afternoon. These paper boot covers are called “Personal Protective Gear” because they (A) protect your tennis shoe laces from bodily fluids and they (B) protect the soles of your shoes from dangerous “traction” with the floor. I've learned about both of these uses personally.

Unfortunately, medical students get demoted to the level of ‘dust ruffle’ the second a first-year resident enters the room. They have few responsibilities when they get to the residency program except for writing most of the patient histories, tying knots, and delivering babies. This makes them pretty unwieldy in a clinic or hospital setting, so when a chief resident finds one of these tasks for the intern she unloads it upon him in an attempt to keep him busy.

At this point the student’s job is to observe the first-year performing said tasks – a weighty task worthy of someone with six or more years of higher education. In this case, the intern arrived thirty minutes before both women delivered and I did my best 'keen observer' bit, natch.

So, like so many students who rotate with interns early in the educational year, I’ve learned that I’ve got to go where the interns are not.

But until then…

I am king of the placenta delivery. I OWN that placenta. After the baby is out, it is show time. Over the past six days I’ve learned to deftly massage the uterine fundus with my right hand while carefully maneuvering the umbilical cord with the left, all the while never ashing my cigarette. Once that fleshy bag ‘plop’s into the placenta bucket, I don’t even have to examine it to know that I didn’t leave a piece behind. (I NEVER leave a piece behind) In one swift move my gown is off and I strut out the door yelling, “THANK YOU FIVE-CENTRAL! I LOVE YOU! GOODNIGHT!” amidst thunderous applause.

Stay tuned as I aim for a fifth placenta!

Wow them with your next PowerPoint presentation! --PART 2--

2005-08-26T18:08:00.000-05:00

So I lied. I said I’d have this out BEFORE Friday conference, but, as you can see, this is published decidedly AFTER Friday conference. I give half-hearted apologies to the residents who read Part 1 and had only backgrounds, animations and sounds for their slideshow today. The good news, though, is that I picked up a few more tips to add to my sixth element of MSPP. Rejoice!

4. Image THIS
Before ‘pixels hit the paper’, as they say, pick out which of MSPP’s limited clipart pictures you want to use. Then, later, add the clipart and conform the title to the picture.
Come up with your own bright ideas!
(These just come to me. A special gift, I know.)
Don’t forget that your audience is in the medical field and therefore must be constantly ‘softened up’ with smarmy images. Good image breaks include comic strips (preferably the Far Side or a Rube Goldberg contraption) or pictures of your children in adult clothing or covered in spaghettios.
Feel the magic

5. Content Schmontent
Text: the icing of the PowerPoint cake. This is where the proverbial men are separated from the proverbial boys, proverbially. The factor that separates the two is this: pure unaltered volume of text and information. A medical textbook is best likened to, and best read as, an epic novel with recurring themes of suffering, illness and dysdiadochokinesia. We, as medical practitioners, are not expected to slice into the text, tease out the pertinent items and dissect extraneous or harmful text. In fact, I cannot think of a single physician with any experience or qualifications in such practice.

Some hacks who present themselves as ‘professional speakers’ would mangle this following paragraph:

Traditionally, inflammation of the liver capsule has been attributed to direct bacterial infection. Organisms were thought to travel from the genital area via the fallopian tubes and the paracolic gutters to the liver capsule. Some evidence supports this: Holm-Nielsen et al1 demonstrated that peritoneal fluid is propelled from the pelvis to the diaphragm, where it is preferentially absorbed on the right side. The association between recent insertion of an IUD and Fitz-Hugh-Curtis syndrome also supports the hypothesis of intraperitoneal spread of organisms. While direct spread may occur in some cases, several factors suggest an alternate etiology. Bacteria have only rarely been isolated from the liver surface or surrounding ascites in patients with Fitz-Hugh-Curtis syndrome.

into this:

One hypothesis for FHC is direct spread from the pelvis

Do you feel as dissatisfied as I do? Where is the heart? The meat?! I’m starving for character arc and drama. That molestation of the text is like removing the scene where Juliet stabs Romeo from Shakespeare’s play - the name of which escapes me at the moment.

6. Present 'till it hurts. Bad.
Presentation time. You’ve been waiting for this all morning, since you probably finished around three or four in the AM. You’ve got your most comfortable shoes on for nervously shifting weight from foot to foot. You did your lat and triceps stretching preparing to clasp the remote with both hands in front of your stomach like a Dell-branded infrared emitting umbilical cord. All you need is a few last reminders to make your presentation top-notch.

Let the laser be your sheepdog – Without a laser point constantly moving under each word you read aloud who knows where your audience’s attention is!? Don’t trust in medical professionals’ ability to follow what you are reading by sheer linguistic acumen. Lead them through the information with the comforting guiding-hand of trillions of photons. Remember to circle madly each diagram you are referring to.

Dump the red laser– Through the miracle of applied physics and filling needs that never existed, manufacturing has made available a new brighter green laser for use with your presentations. These babies are a cheap $119 apiece since the US military stopped using them for guiding laser missiles for the reason: “too strong for military use”. Not only can these sweet pointers be seen from 1.2 miles, 80% of their luminosity is returned to the viewing audience off of the semi reflective projection screen. Your audience is certain to remember the points you made, as a mish-mash of purple trails will be left in their vision for thirty minutes afterward. Their retina’s inability to restore visual pigments to their receptive state after a photo optic assault is to your benefit.

Read directly from the slides – Since you have gone through the trouble of cutting and pasting large amounts of unformatted text haphazardly, do your audience the favor of reading directly from the slides. They didn’t come to hear summaries, opinions, or new corroborating information that is not on the slide – they got enough of that crap in college.

You now have the tools that will fill in the holes in your personal communication skills. Be assured that people will be talking about your presentation for days.
*applause*

PolitiPost: God bless The Onion!

2005-08-23T17:36:00.000-05:00

You've already heard everybody's opinion on this topic, so I won't waste your time with mine.

Evangelical Scientists Refute Gravity With New 'Intelligent Falling' Theory

On allowing Kansas students to make an informed decision from all sides of the issue:

Dear Kansas School Board...

In response to Dr. Hovind's $250,000 evolution challenge...

Wow them with your next PowerPoint presentation! --PART 1--

2005-08-21T22:01:00.000-05:00

Yesterday, I was schooled in that fine art of PowerPoint presentations. It is only fair that I share this information to give med school hopefuls and other PowerPoint neophytes a running start at the fun and furious world of audio-visual presentations. Jump on it!

So, you're about to do a medical presentation and have decided to enlist the aid of Microsoft PowerPoint. Let me be the first to welcome you to the exciting world of adding color and pictures to your presentation. PowerPoint (MSPP) can not only improve a mediocre or even gut-wrenchingly bad presentation, but it can do so moderately well! However, before you start copying large amounts of extraneous unformatted text onto your first slideshow there are a few tricks of the trade that will help you turn that snooze of a lecture into a visually engaging one.

1. Background check
The quickest way to lose an audience is with an unexciting background. Who wants to watch yet another presentation with a muted blue-black gradient that draws your attention only to the text? At least 60% of the screen space should be accentuated with background graphics. MSPP has a poor selection of quality backgrounds, consisting of the 'notebook' and 'fireworks', both of which only use about 40% of the screen (if formatted correctly). If you don't have time to find better, more ostentatious, background you can make up for the aesthetic weakness with tips 2, 3, and 4. If you do have time, here's two winners I know will fill the projection screen with character:
Got a recipe to share in your next presentation?
Even Frank Lloyd Wright knows a good background!

2. Animation Station
There are two types of animation to choose from for your MSPP presentation: tasteful, appropriate animations and AWESOME animations. There are three pillars of animation - no wait, make that three keystones of MSPP animation: slide transitions, text animation, and looping.

Slide Transitions: In a normal slideshow, slides are changed without any of the necessary transition. This rough transition is as abrupt as an eye blink and just as unnatural. You would much rather have the interim thought between two slides be "Hey, we're going to open the curtain onto the next slide" (blinds vertical transition) or "Newsflash! Let's go to a new slide" (newsflash transition), than "SMACK!" (no transition). The previous leads to contented grins and lowered blood pressure while the latter leads to weeping and rending of clothing. Also, keep it fresh and use a different transition for each slide.

Text Animation: Do you remember the last book you read? Of course you don’t! Words in books are what scientists call “static” or non-interesting. Their value lies completely in their meaning, but luckily your words do not have to – your words can spin and then change color. Don’t rely solely on fade in or left to right sweep like an amateur. If you have MSPP 2003 you can allow your text the same expansive freedom afforded only to Americans and feral cats by linking several text animations in a row. My personal favorite is floating the text in from the bottom, fading it out, fading it back in, expanding it 200%, spinning 720 degrees, then changing the color to bright red. I call this animation “The Widowmaker”.

Unleash the torrent of mouse clicks: It goes without saying that you do not want to let any of the animations start on their own. Once you let the slideshow take control you have already lost. Make sure that all animations start ‘on click’ so that each slide is slowly unveiled like the antagonist’s motives in a suspense novel. You may not be able to write a lyrically as Dan Brown, but at least you can tug on people’s waning attention like he does.

Behold The Widowmaker

3. Sounds and the Fury
Let’s take a moment to discuss the layout of a good movie. It starts with the Exposition, then the Building Action, which is followed by the Climax, and then wound up with the Denouement. Sounds are the artistic glue that holds all of these elements together.

Exposition: (1 minute) Self-introduction and reading all of the information off of the title slide. {sounds: your own quavering voice}

Building Action: (30 seconds) Pregnant silence as you fiddle with the mouse and try to figure out how to get rid of the pop-up right-click menu you just brought up. Add an additional 30 seconds if you advance two slides forward by accident and have to restart the whole show to get back to slide 2. {sounds: your own nervous laughter, scribbling on paper as people start writing notes to each other, your own voice saying “it’s never done this before”}

Climax: (45 minutes) Ah, the 45 minute climax. Slides #2 through the next to last slide. Here lies the majority of your MSPP sounds. {sounds: ‘drumroll’ at the beginning of slide #2, ‘whoosh’ anytime a word flies onto the screen, ‘laser’ for any and all bulleted text, ‘cash register’ whenever insurance or worker’s compensation is mentioned ,‘typewriter’ on the bibliography page, etc}

Denouement: (1 minute) The last slide, if not a picture of a Caribbean island beach, should say “Thank You” and have the applause sound. Failing to do this is like having a slide that says “I verily do NOT thank you” with the sound of a high-pitched baby scream. {sounds: ‘applause’, or ‘high-pitched baby scream’}

Once you get enough experience you can start adding your own sounds like ‘rusty can opener’ or ‘ovulation’… you’ll know when those sounds are appropriate.

---------------------------------------------------------
Stay tuned for the exciting conclusion before your own Friday conference!

Next week we will be presented with transcripts of books on tape...

2005-08-20T17:47:00.000-05:00

I just had my first Friday grand rounds of my OBGyn rotation. If there is a god in heaven all of the conference rooms at the hospital will spontaneously fill with concrete and rebar next Thursday evening. It turns out that presentations by the residents are actually word-for-word transcripts of our textbooks in a timed audio visual format. That’s right: we read a book then get to have residents read the exact same paragraphs off of a projection screen. For four hours. I won’t even say they regurgitated information straight from the book because that would imply some amount of digestion took place.

In more positive news I got to see three cesarean sections this week. I have to say I’ve mastered the subtle art of holding retractors, snipping sutures, and suctioning smoke from the electrocautery gun. Keep your fingers crossed that I'll get to see at least one vaginal delivery in my last week in labor & delivery.

Medicine: old school

2005-08-17T14:21:00.000-05:00

All doctors that teach medical students, at some point or another, will squint their eyes and speak wistfully of the good ol’ days when medical students slept three times a week and got humiliated frequently in front of patients and staff. It truly is a sad testament to modern medical education that it is the doctor who gets in trouble when he open hand slaps a student for omitting vital signs in a progress note!

Today, was supposed to my day off after twenty-four hours at the hospital. But before I left I noticed there was a surgical procedure that I wanted to watch, so, figuring that I wouldn’t have many more chances to see it, I scrubbed in anyway. After four hours the surgery was over and I changed back into my clinical attire to go home. At which point Dr. Pettigrew asked, “You going to a conference?”

“No,” I replied handsomely, “I’m off today and am going home to catch up on studying and sleep.”

“Oh.”

Dr. Pettigrew then turned to the resident and reminisced about when he was in medical school and didn’t have the option to go home after a night of call. He then looked at me and nodded expectantly. “I couldn’t agree more,” I said, “we’re all a buncha pussies.”

Actually, I know better than to make such a comment in front of an obstetrician unless I can back it up.

What I really did was give the furrowed-brow-head-bob, as if to say, “Your opinion is full of consequence to me.” Then I looked at my analogue watch suddenly as though it had suddenly started shrieking and told then that I’d see them tomorrow after an afternoon and nighttime full of sweet sweet slumber. I believe that is the correct etiquette for having been called inadequate.

"Welcome to my blog! It is full of random thoughts! I hope you enjoy blah blah blah...."

2005-08-17T13:51:00.000-05:00

I spent an hour today trying to figure out the “first post”, and figured the test post I published a week ago sums up everything well enough.

Splendid!

2005-08-11T23:34:00.000-05:00

excalibur!