Teratoma

Quick: What's your favorite tumor?

Hands down, mine is a teratoma. I think they are really neat, and really satisfying. This thing isn't just a bunch of disordered cells with 92 chromosomes. These are crazy suckers that grow ordered human tissue in places it isn't supposed to be. How is that not awesome?!

I often wonder how it would be if the teratoma had nervous tissue. Obviously, you'd be unlikely to get a whole brain, but it wouldn't take a lot to get a squirrel worth of white matter. What if it had a brain and vocal cords and kept shouting things? What if it was kind of a chauvanist? It might make sexist jokes from inside your gut. You can't tell me that would be an easy tumor to deal with.

Maybe it's a violin virtuoso that can't control any hands. That would be unlucky. For the tumor.


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Monday Morning

Tomorrow is Monday. The Monday after a golden weekend.

Actually, in fairness, having the golden weekend off really does help as far as recharging one's batteries goes. The hardest days to get up are after you've had to work through a weekend... maybe the Wednesday after or so. By day 9 or 10 of 12 consecutive days on, I am no longer feeling bright-eyed and/or bushy-tailed.

One of the staff at my hospital was musing in conference about the dearth of new general surgeons. People are picking other fields. I don't think it's hard to see why. At some point, quality of life does matter. You wonder why people like fields like Derm, Gas, and Rads more than Gen Surg? It's not really about the money - we'll be able to do fine no matter what the field. It's about the sleep, the going home, and the ability to have a life independent of your work.

That shit is priceless.


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One Sweet World

We do really a lot of education. Lots.

I recently had the horrible experience of taking a step back and thinking about it. Really, I'm just doing a whole, solid education - folding it over - and then doing it again. Twice. Like some bizarre Teletubby ritual. At the moment, I feel very 'marathoned'. That being the quality of having a marathon upon oneself.

I find it useful to remember two things (these being the same two things from the album by Dave Matthews, I believe). First, that life doesn't stop just because you are in school - this is frosting. Second, coal miners have a way worse deal.

They have to go into the ground! For coal! And I'm pretty sure they wake up just as early.


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Coda

I was given an iPad.

Well, not 'given', exactly. It was included with the tuition. I was given a $40,000 iPad.

Like that paperclip that keeps asking me if I'm writing a letter, the iPad has some specific suggestions about how I should sign-off my e-mails. I'm not against suggestions; no judgment in brainstorming, but I would like it if it had a slightly larger repertoire.

Either that, or maybe it's more of a security feature. Sent from MY iPad. The one that I own. If you sent from it, you'd be legally obligated to amend it to say, "Sent from a stolen iPad".

But that's probably not what it's for.


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Suture

I am currently a medical person. This is how I self-describe - most recently at a drive-thru when asked if I was a doctor ("Not yet; just a medical person.") But in my previous life, I was an education person.

There is an education guy named Vygotsky who talked a lot about the 'Zone of Proximal Development'. It's the idea that learning happens best when you keep the task just barely above the comfort range of your learner. Let 'em get a few right, then they get one wrong, you help them fix it, and then the task gets a little harder and repeat. Gradually, the learner gets better.

One of the nice aspects of surgical education is the tight nature of the teacher/student thing. I start sewing, I'm holding the needle backhand - "flip that" - and I'm standing wrong - "turn your body". Put a few in, then how do I...? - "needle in subcuticular, bring it through the skin, and tie the knot". I like it, it works. I feel a lot of the time like a toddler of surgery, but I'm getting a little bit less hopeless every day.

In any case, the fact that I have that scaffold is pretty key - because left to my own devices, everything would be too frustrating to do.


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Here There Be Zebras

There is some little tricks to responding to pimp questions. Ideally, you know the right answer and you state it with conviction. The other 90% of the time, your best bet is to offer some useful knowledge that shows a reasonable chain of logic. Failing that, your best bet is to tell the questioner "I don't know" directly.

The worst possible option is to mess up the second option and give an unreasonable chain of logic that draws randomly from your fund of knowledge. It is possible to use basic science to support the correct answer; it is generally not possible to derive the correct answer, a priori, from the basic sciences.

Some medical students master these rules quickly. Some, to the chagrin of everyone around them, do not. It becomes very painful to be one of the other medical students in the room...


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Winter is Coming

I do a lot of reading. By necessity. In the past few minutes, I have had to look up Goodsall's rule, Gadolinium contrast use in pregnancy, and what Kocher won the Nobel prize for. This is not a joke; I was asked about each of these today, and I didn't know. Maybe if he had won the prize in the last century or so, I would have had a shot...

As a matter of pride, however, I am also trying to do a certain amount of non-academic reading. It somehow feels like a defeat to do 100% UpToDate reading over the course of a week. So I've been reading a little bit of George RR Martin - the guy popularized by HBOs 'Game of Thrones'. They're long books that are kind of like Lord of the Rings but with more realistic wound progression... and also boobs.

In any case, the whole thing makes me glad to live in a society that has no kings, indoor plumbing, and polymerase chain reaction syphilis detection. Don't take that shit for granted.


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Reality Recap

I recently had the privilege of taking (or 'sitting for', if you prefer the formal style) the NBME shelf test for medicine. This gave me the privilege of doing (or 'suffering') about 1200 USMLE World questions in medicine to try to get prepared for that test. It may have kinda worked - results are outstanding as of right now.

I like UWorld, but she is a fickle mistress. You need to be in the right mindset to deal with it. There is a pretty dastardly mix of questions that are 1/2 hard, 1/4 easy, and 1/4 tricky (which look like easy questions right up until you get them wrong). And there are certain keywords that pretty much guarantee a widowmaker steeped in apocrypha.

Maybe there are immigrant orphan IV drug users that get better than 18th century medical care - they are not heavily represented in the Q-banks.


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ESPN Legal

Today 06:45 - Surgery Orientation.

Today, Now - Trying to avoid accidentally napping to avoid screwing up sleep schedule for tonight/tomorrow morning. Moderate success.

As I'm sitting here avoiding the accidental nap, I've been watching the 24 hour shouting sport heads (not to be confused with the shouting political heads on the other channels). I feel like ESPN is a hair's breadth away from starting up a legal sister network to just cover things like NCAA violations, union lockouts, and shooting oneself in the leg. I would watch it. I basically am now.

Next up, Mike Wilbon and Harvard Professor Emeritus of Constitutional Law Eugine Glick...


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