Medicine is a science, and yet countless writers throughout the ages have referred to it as an art. And the truth is, it’s both. Often there is a strict protocol to follow in dealing with various circumstances, but the art comes in learning when or equally important, when not to apply it.

You know what other field is eerily similar in its dual art and scienceability? Cooking. That’s right, I think the same instincts that make great chefs have a lot in common with the instincts that make great doctors. And given that one of my hobbies is the culinary arts, as you may have noticed from the cooking with almost Dr J posts…it got me to wondering…what other similarities are there between doctors and chefs?

1. We both have white coats and funny hats that identify us to the general public.

2. Both require intensive training for years with a clear hierarchy of ascent.

3. Skill with sharp instruments is necessary for both professions-at least if you are in surgery.

4. We both work long hours, including nights and weekends.

5. If we both do our jobs right, our clients walk out feeling better than when they walk in.

6. Classic texts: We have Harrisons, they have Lourousse Gastronomique.

7. We have to be able to work quickly and do many things at once.

8.We have to have good instincts (from tons of experience) about when to add medications/ingredients, take things away, or let something stay as is

9. We have to be able to design a plan of action meticulously and carry it out flawlessly, timing and all, but also solve problems on our feet, quickly, and move on to a totally different plan if necessary.

10. Our work is often physically, mentally, and emotionally exhausting because we work with our hands, arms, legs, and backs as well as our minds and hearts.

Then again, while cooking is my hobby, medicine is my career, and there are many aspects of the career that dont quite transfer over:

1.Doctors should not take care of family members, but chefs should (and do) cook at home

2. They don’t have to worry about malpractice.

3. They cause food poisoning, we cure it.

4. Americas Next Top Doctor? Nah, it’d never fly…

5. We have lots of food comparisons (“A fibroid the size of a grapefruit”), they dont have medical comparisons ( a steak as good as a benign tumor).

6. We call a thymus a thymus. They call it sweetbreads.

7. We call it fatty liver disease and treat it with a low fat diet and exercise. They call it Fois gras and treat it like a delicacy.

8. We dont get tips, even when our service is outstanding

9. If a doctor does his job right, you’ll never see him again. If a chef does his job right, you’ll see him every week.

10. Let’s see…Clients leaving restaurants pay a $20 co-pay and their dining out insurance picks up 80% of the reasonable and customary cost of their meal? Hmm…

When you cook for others, you become an intimate part of their lives, even if only for a few hours. Remembering that personal connection is what separates the good from the great.

Almost Dr J

Its funny what pop culture images our psyche holds on to. How we differentiate what is just mindless entertainment versus what has special meaning to us.

I eat breathe and sleep pop culture. Not as much now as when I was younger, but I pride myself on being at the forefront of new hot tv shows, internet memes, movies, jokes…providing me a rich mental imagery of conversational gags and interpretations for any occasion.

But every so often, I realize one or two of these images has somehow managed to stick with me and take on personal significance

One such image is in disney’s The Lion King, when a grown simba meets again the aging baboon rafiki.

Adult Simba: I know what I have to do. But going back will mean facing my past. I’ve been running from it for so long.
[Rafiki hits Simba on the head with his stick]
Adult Simba: Ow! Jeez, what was that for?
Rafiki: It doesn’t matter. It’s in the past.
[laughs]
Adult Simba: Yeah, but it still hurts.
Rafiki: Oh yes, the past can hurt. But the way I see it, you can either run from it, or… learn from it.
[swings his stick at Simba again who ducks out of the way]
Rafiki: Ha. You See? So what are you going to do?

Now I am not going through any particular troubles at the moment, but every so often that scene plays out in my head, a reminder to me not to get too caught up in my worries…

so what movies/songs are significant for you?

My friend snowbird recently had car trouble. As in she was driving along, minding her own business, when all of a sudden smoke started coming out of her car, and her check engine light came on. Well that could only mean one thing obviously…there was a ninja hiding in her car who needed to make a quick getaway. Unfortunately he flipped out killed a bunch of stuff in her car. Cause ninjas do that.

I started to make the comment to her and then stopped myself. Because it has been my experience that most of the witty “oh you broke your car” commentary comes from people who drive wussy pissant cars like saturns or hondas (me). Whereas my motorcycle or porshce owning friends are more like “ha ha that’s nothing, you should have seen the time I had to replace not only my engine, but my LEFT LEG!”

Some other random thoughts today I jotted down while my brain was melting from studying…

Who the hell came up with the phrase “more fun than a barrel of monkeys?” At what point in human history were we storing monkeys in barrels? And why multiple monkeys in a barrel? As close as I can determine -One monkey arouses a great deal of amusement. Two or more then double the…amusement. If one were to release a barrelful, we must suppose that their antics would become hilariously comical

I find the idea of midget zombies to be particularly terrifying. I would rather have my brains than my knees eaten, that would just be creepy.

What if Macgyver was in the saw movies. “Hello Angus, all your life you have eschewed brawns over brain, and in your path left hundreds of…wait a second did you just turn break out of my deathtrap using a swiss army knife and some duct tape?” “Yep” “shit.”

For the first time in 5 years, i will be returning to West Hollywood for Halloween to party. Anyone who wants to meet up, leave a comment

Listening to the debate tonight, I really enjoyed the phrase moral turpitude. What is it?

Moral turpitude is a legal concept in the United States that refers to “conduct that is considered contrary to community standards of justice, honesty, or good morals”. It is of great importance for immigration purposes, as only those offenses which are defined as involving moral turpitude are considered bars to immigration into the U.S

Okay, you say to yourself, but what exactly is an act of moral turpitude?
Crimes of Fraud and evil intent: arson, blackmail bribery counterfeiting, forgery, child abandonment, and lewdness, and the like.

I was doing well up until lewdness and pandering.

See politics can be fun! So remember remember the 4th of november, and then…don’t vote. unless you care about…

While studying in borders today, I was struck by how my thought patterns have changed. It happened so gradually I didnt even notice it, but I feel like I have finally begun thinking like a doctor.

Allow me to clarify. The first year of medical school my thought process was pretty much the same as it had been all through college. That is to say, data A leads to fact B in what was basically a memorization process. 2nd year, as you really begin to review pathology and organ systems, your entire neural network reconstructs from a linear memorization to a pattern recognition.

An example:
Year 1: bacteria==>sickness
Year 2: streptococcus s a gram positive cocci, found in chains or pairs
* causes Pharyngitis (strep throat), Cellulitis Impetigo, Scarlet Fever, and Pneumonia, among others
* can not be prevented with a vaccine, but penicillin and macrolides will treat it
* produces Pyrogenic Toxins that stimulate T cells
* produces F proteins that facilitate adhesion to tissues, Capsules that prevent phagocytosis
* produces streptolysins that destroy red and white blood cells
* produces M protein that prevents complement activation

but of course that is not how a patient presents to you. People come in with symptoms and it is up to the doctors to tease out clues like some kind of medical sherlock holmes and from there solve the mystery of the disease.

To continue my example
Year 3: sore throat…history of sneezing, coughing, fever…physical findings of inflamed tonsils…lab resutls rapid strep test positive with increased wbc count…most likely culprit…strep

So while the beginning of my third year i had all this knowledge, I really had no clue of what to do with it. It was just taking up space. But now I have learned to seek the patterns within the presentation, and tie it back to knowledge that I sometimes didnt even know I had. My studying consists of reading through case files…where a classic presentation of some condition is given and you are asked the condition, the diagnostic test, and the next best step for therapy. And now, a lot of those cases seem simple.

Dont get me wrong…real patients almost never present classically, as diseases dont read textbooks. BUt the point is I have finally learned the right kind of questions to ask the patient to tease out the clues i need to figure out a diagnosis. And once I have the clues…I actually have an idea of different treatments or tests that i need to further perform. And to me, that’s pretty amazing.

It totally makes sense to me now why doctors call what they do “practice” It’s because while everyone continues to improve at this pattern recognition process, there is so much information out there that it can never really be perfected, but the longer you practice in any one area, the better you get and the fewer clues you need to figure out the next step, or the whodunit.

To complete my detective analogy I began third year needing a smoking gun and bloody glove to figure out the murderer…now I have my forensics team and a single strand of hair may not be enough to solve the case, but it is enough for me to pin down the usual suspects.

On an unrelated note…I probably wont be doing to many neuro stories as I have way to much to do right now…but the reason I dont care for neuro (coz grrsh asked) is that my attending for neuro manages to combine two of my biggest pet peeves in one person: she is disorganized/scatterbrained and a micromanager.

I have reached a point in my training where i still need to be supervised, but not swaddled. Sitting in a room and watching the attending interview someone does not further my education in any way shape or form. I would much rather be told to go do something, and then evaluated on what was done right, wrong, or other techniques. But if you keep me idle, and keep me late in the hospital on top of it, well i get frustrated. And since neurology seems to be a whole lot of diagnosing the patient and not much else, well, it is not the field for me. I want to figure out what someone has and make an attempt to treat or control it, not tell a family, yup your father/sister/aunt/wife had a stroke in my expert opinion, and my work is done. Maybe it is different for other people but to me it appears that in neuro, you make the diagnosis, and then the patient is shit out of luck with the exception of a few cases. And that is not the experience i want out of medicine. I need to feel like i am making a difference, however pretentious it may seem.

On another tangent, though an important one, I need to begin writing my personal statement for residency applications. As someone applying for an early match residency (which will be the subject of another post later) I really need to have my business all taken care of by mid july, august at the latest. That said, I will be posting several rough drafts of the personal statement here on the site for you, my loyal followers to peruse, and i strongly request as much feedback as you all can give me on it, because this is probably the most important essay of my career, and it needs to be well written and interesting, and I am hoping that you folks out there in internetland who come to my site do so because my general writing matches those criteria at least a little, and you can help me in improving it. And then you can all pat yourselves on the back for your part in helping me become a doctor ;-P

So first and foremost, allow me to congratulate waterfallphilosophies, who despite reading my plethora of ob/gyn posts, decided to go ahead and have a baby anyway. He is adorable, and you should go here to see him, and I am going to harass both of them mercilessly when i go to california in the summer.

Next, some really interesting pathology today in peds clinic. Perhaps the most interesting thing to me was that most of the pathology I saw was as a result of incidental findings

Example 1: Cute little baby Rodolfo has been constipated for a couple days along with a fever, and mom brought him in to make sure he was alright. Fairly standard case of acute viral gastroenteritis, aka tummy bug. So I start doing a full physical because 1)hey, why not and 2) I am supposed to do a full physical in this type of setting.

While sifting through his curly hair to check fontanelles, i look down and lo and behold, he has a hemangioma on his head

Of course the pic above is not him , as his was more centrally located and not quite as large. This is a strawberry hemangioma (thanks, google image search!) and should give you a rough idea of the color and size. It is a benign tumor and he had had it since birth, but hey, its still good to know  about. As Dr Zaret says, the eyes can’t see what the mind doesnt know.

Example 2: Pixie like toddler girl sarai was here for a follow up appointment for a mild case of bronchiolitis. No new diagnoses needed to be made, she was basically here to confirm that her illness was resolving which it was. But after taking a fairly simple history, i decided to do a focused physical and just check the heart and lungs since she had no other symptoms in other organ systems.When lifting up her shirt to listen to her lungs, i noticed two moderately sized black/blue spots on her back. Which instantly screams “abuse!”…

If you dont know about mongolian spots, that is. These are basically birthmarks, or “stork bites” that represent a concentration of melanocytes and is totally benign. But had i just listened through the shirt, i would never have seen them. You cant see what you dont look for. Maybe there IS something to that complete physical exam thing the attendings keep harping on about ;-P

Example 3: The attending leans out the doorway and yells, “hey students come here” in a heavy indian accent. I walk in the doorway and he asks me, “look at this baby…normal or abnormal?” I respond abnormal. “Why?” he follows up. And I dont quite know, but the baby doesnt look right. Not the classic features of downs, and a fairly chubby baby, but on first glance, something was simply not quite right. Then the attending lifts the baby up, and the baby cant support the weight of his own head as it lolls back like a rag doll. This is NOT a normal finding. He puts the baby down and NOW i notice the baby has its fists tightly balled up and they have been so since i entered the room, highly unusal. The baby was clearly hypotonic. But once the attending demonstrated ankle clonus, the diagnoses narrowed significantly. “Cerebral Palsy” he said. “Is that what he’s here for?” I ask, amazed to have seen the condition diagnosed firsthand. “Oh no, we knew that already, he is here for a cold.”

The physical exam is like a game of hide and seek, or detective work. You have to do each part the same and do it every time, because you never know what you might find, even incidentally.

And now for something completely different:
THANK
YOU FOR CONVERTING TO THE DARK SIDE. DRIVE THROUGH AND PICK UP YOUR
COMPLIMENTARY COOKIES-N’-EVIL-OVERLORD-LIST GIFT BASKET AT THE WINDOW!

REMEMBER TO CLEAR YOUR SCHEDULE FOR THE “IT’S A VILLIANOUS WORLD”
CONFERENCE NEXT MONTH. TOPICS INCLUDE: “SHOULD SUPERVILLIANS GO
GREEN?”, “EVIL OVERLORDS FOR THE NEXT GENERATION: HOW TO EDUCATE ONE’S
OFFSPRING IN THE WAYS OF DARKNESS WITHOUT PUSHING TOO HARD(AND
PREVENTING INCONVENIENT AND EMBARRASSING ‘SUDDEN, INEVITABLE
BETRAYALS’)” AND “MAD SCIENTIST PARENTS: WHEN THE EXPERIMENT GOES
WRONG. HOW DO YOU COPE WHEN YOUR KID’S IS MORE OF A FREAK THAN USUAL?”.

BYE!

Posted by elven pirate lady over on LJ. Reposted here because I find the idea of supervillian business conferences funny.

I just saw an advertisement for The Forbidden Kingdom, the new Jet Li Vs Jackie Chan Movie. Heck, I would see a movie called Jet Li versus Jackie Chan.

*My guilty pleasure was watching a full episode of step it up and dance. It was a train wreck of a show, and i couldnt stop watching. I had an ex-girlfriend who was a dance major, and i had to watch some goodness-awful movies, and now i am just sort of hooked on those spontaneous dance competitions.

why do so many people doubt that a murder mystery party would be fun

*sigh* back to work

F.decorate(_ge(‘button_bar’), F._photo_button_bar).bar_go_go_go(977159315, 0);

	Awesome pic. Also, I am bored

It is approximately 3:00 in the afternoon and I am already sitting at home in my pajamas. There are a few reasons for this

reason the first: I have no more clinical duties for psychiatry. Yesterday was technically my last day, but I had to return today to get my evaluations from the attending  and resident. Which on the whole were good. who knows i may have a shot at an A in this clerkship yet. One of the patients I have been following the whole 6 weeks was discharged to a social rehabilitation program today, and it was his opinion that I helped him a lot and I am “good people” Which is always nice to hear, although we are constantly warned about letting our self esteem get tied up in our patients opinions of us. So I guess, i am done with work.

of course this doesnt explain why i am in my pajamas (they are a sock monkey pattern in light blue, in case you are wondering)

reason the 2nd: It is snowing something fierce in illinoise right now. As in 12-14 inches expected today with more possibly over the weekend. Ergo, having safely made the drive home from work, i have no further reason to be leaving my apartment with the weather outside so frightful. And my jammies so delightful. And since I’ve no place to go. Let it snow, let it snow, let it stop by friday when my shelf exam is. Yes, doesnt have quite the same rhyme scheme too it, but trust me it would make me much happier

I also am wearing a garbage pail kids tshirt. You all remember the garbage pail kids, right? If not, i am sadly older than you. The one i am wearing is “sloshed josh” and he is stuck in a coke bottle. A friend picked up the shirt for me at some garage sale i am thinking, and it is tremendously comfortable. So. inclement weather

reason the 3rd: still sick. though feeling better than the previous two days, and holding out hope that by friday i will be fully recovered so i can go out and do more things that will probably not make me feel very well. I seem to have some kind of flu/cold. I dont care enough to listen to my own heart and lungs to get any more details. So as rainy wondered, what do doctors do when they are sick?

this one sleeps much more than usual, and drinks a substantial amount of green tea, cocoa, and watches movies when work does not call. I also enjoy a variety of tasty soups, one of which i will try and post in another “cooking with almost dr j” segment soon.

I have no other reasons, and sadly for you, no more funny psych stories. Though it was certainly a laid back, easygoing rotation, i dont feel psych would have been right for me, as my constant need to be doing SOMETHING ANYTHING is a little too high intensity, energy for this field. Despite that, i learned some valuable lessons about communicating and listening to the patient, something i fear we all too often as physicians dont have or take the time to do with a lot of our patients

Thursday is my day off to study or more likely, catch up on sleep and feeling better, and friday the shelf exam. The following monday its back to an inner city hospital to learn about the inner workings of the female in OB/GYN. It will be…interesting…

Hmm… what to begin with. I know. how about the return of AMERICAN FREAKING GLADIATORS!!!

Seriously, best show of my childhood bar none. Now some of you may recall I tried out for this show a few months ago when i heard it was returning. Clearly, I didnt make it but that’s not important because winners on american gladiators get a chance to BECOME american gladiators!

So i can hold on to hope. Hmm…what would be a better gladiator name…Plasma, or Zombie?

Oh well. The show has done something amazing with its return. What is that you ask? Well, it actually remembered what made the original show so great and recreated it without trying to improve it..except for one or two minor errors i will discuss later. It brought back several of the classic events

1.Powerball
2. Hang Tough
3. ASSAULT (the nerf ball one)
4. The eliminator (the end one)
5. Mother effing- JOUST (the giant Qtips!…how long til we can make this toy for sale?)
6.Whatever the rock wall was called

It also added a few new ones, which on the whole i am not impressed with, except for the hanging in the air wrestling thing…that is like ufc.

Another point in favor of this new show…the old show had gladiators who were clearly ‘roid monkeys with names like Nitro, Blaze, and Gemini (my favorite then). The new show has brought back more roid monkeys with names like Titan, Crush, and Wolf (my current favorite)

Except for mayhem…he is a fuckup of a gladiator…who disqualifies themself twice? on the same event? which involves basically NOT moving. dumbass. And poor sportmanship too…the guy who mocked him for losing was a douchebag, but shoving the contestant off a platform after he had won? well that was funny, but still poor sportmanship.

As to the idea that the show is “staged”. I dont care. as long as it entertains me it doesnt have to be real. That never took any of the fun out of pro-wrestling back in the days of hulk hogan…who was a great choice for host.

On a tangential note (hmm, perhaps i have a formal thought disorder ) I know it’s supposed to mean no sugar added, but i keep seeing “NSA” and thinking there is some sort of National Security Agency flavored ice cream. Which I don’t even want to think about what that would taste like. Probably a combination of Mint Chocolate Chip-in your head and Rocky Road to justice

Hmmm…i should probably mention something about medicine, I am on my psych rotation. Today I saw ECT performed for the first time. ECT, meaning electroconvulsive therapy

Yeah, it’s kinda like that, but nowhere near as scary. Basically, for people who are very depressed, or bipolar, or suicidal, or refractory to drugs, or pregnant, or really there are practically* no contra-indications* to ECT

*Practically, because there are a few, and I need to remember to cover my tukkus from a legal standpoint. thanks, medical school

*Contraindications are really good reasons to NOT do a procedure, or give a drug, as in, penicillin is a contraindicated treatment for someone with a pencillin allergy, because bad things will happen

Anyway, The procedure is actually fairly simple. The patient came in and laid down on the bed. Electrodes are places either bilaterally or unilaterally on the scalp, depending on condition and physician preference, followed by heart monitors. Patients are then given an anesthetic to put them to sleep (with a blood pressure cuff around one foot acting as a tourniquet), followed by a muscle relaxant meant to temporarily paralyze you for the duration of the procedure. Finally, a prespecified amount of electricity is delivered to the patient via electrodes

The cuff is so at least one foot is prevented from receiving the muscle relaxant…this allows us to actually monitor the seizure on an additional level. (i.e. muscle spasm while current being delivered to otherwise paralyzed muscles)

The seizure induced lasts no more than 20-30 seconds, and then the patient comes too shortly after as the drugs wear off. The main complaint of most of them? A bit of a headache for the rest of the day, and a slight retrograde amnesia for a couple of hours at most. Good stuff.