Natural Selection

I'm definitely not the first person to opine that the growth of our medical technology has somehow subverted natural selection. With our medications, people with formerly debilitating environmental adaptations (e.g. allergies, autoimmune disorders) have been able to live productive lives and pass their genes on to their offspring. If we have defeated natural selection, is humanity getting weaker? Not to fret: The internet and simple human stupidity have become our new barometer of environmental pressure.

We all know about Jenny McCarthy and her ilk using pseudoscience and superstition to increase the burden of preventable communicable disease on our society's children with their anti-vaccination religion. But apparently, there's a new trend coming out:

Parents are refusing Vitamin K shots for their newborns 

http://www.usatoday.com/story/news/nation/2013/08/30/babies-suffer-bleeding-disorder-after-parents-refuse-shots-/2750023/

I refuse to link to a woman so irresponsible that she would advocate for opting out, so here's a blog from another doctor who is willing to show you how clueless these people are:

http://www.skepticalob.com/2013/08/i-didnt-manage-to-kill-my-first-baby-by-withholding-vitamin-k-maybe-i-can-kill-my-second.html

As long as people keep convincing themselves not to use the available technology, we'll have this problem whipped within a couple generations. Not the actual medical issues, mind you. Just the genetically based idiocy that causes these irrational beliefs.

A couple ideas on Surgical Education for medical students

It's been a long time since I was a medical student. I still have miles left to go before I reach the coveted land of Attendings and join my classmates who went into medicine. But as I reflect upon my own education and the education the medical students undergo at this program, I've started to think about how I can maximize the training of my future charges.

As it appears to me now, the students sit through an occasional lecture here and there during their third year rotation, tag along with their interns and residents during morning rounds (if they're interested), and otherwise observe surgeries for the rest of the day - though they mysteriously disappear in the afternoons and between cases. We'll quiz them here and there ("pimping") -- trying to keep them engaged at some level, point out interesting structures and anatomy. I think I can do better. I think we all can do better.


My ideas that follow aren't that complex - a lot of them come from the better clinical educators I've had, in all disciplines of medicine. And the ultimate effect is this: my medical students will spend less time in the OR, but more time seeing patients.

In addition to the traditional set-up of having the students "own" the patients whose procedures they witnessed on a daily basis, I want my students to have the extra step of trying to make the initial diagnosis. Thus, rather than shadowing the interns, who are busy enough with the scutwork, they'd spend a lot more time with the consult residents. On the more basic diagnoses (cholecystitis, appendicitis, hernias), I want the medical student to be actively involved in obtaining the H&P and lab tests - the caveat being, no CT/radiology/imaging -- and then have the student present the patient to me to discuss the differential diagnosis and plan. Of course, the resident would be required to get the imaging as appropriate. I'm hoping that this activity will improve their physical examination skills, an apparently dying art. This is not to say that the students will be out of the OR completely - I want this to be a once or twice a week exercise that augments time otherwise not spent in the OR.

Afternoon downtime will be spent by the chief resident of the service sitting down with the entire team - students and the available residents and interns - to go over didactic topics in diagnosis and patient care, at the very minimum. This would be a great forum to discuss complications and issues that arose during the day in the post-op patients, and a nice little summary of possible events the intern should be wary of overnight.

Pretty Young Thing

In terms of recent events, I went to a Haunted House at a world famous Southern California-based theme park, then a couple days later, I felt compelled to listen to a playlist featuring a recently deceased musician while doing my work in lab. By a couple days later, I meant yesterday. And by recently deceased musician, I meant Michael Jackson. And, if you happened to have forgetten, that is a sweet playlist, especially the older stuff.

Returning home that night, I started flipping through the channels - and by that, I mean "cycling through my favorites so I can avoid turning to Fox News inadvertently" - and all of the sudden I saw "P.Y.T." being covered by the wheelchair dude and the Asian guy on "Glee."

This can only mean one thing: A certain someone's ghost followed me home from the Haunted House. I think he may think that I somehow know how to perform cosmetic surgery on the spiritual level. Or that I have access to ethereal propofol. I hope he runs into the ghost of William Halsted so that he can explain what our different specialties have evolved to do. Well, that, or they can get hooked onto the same crazy ass mind-altering substance they have in the afterlife.

Yea, I went there - and by "there," I'm referring to the late Dr. Halsted's personal demons.

Short-Cut Gourmet: Starting over

Restarting an old hobby: the Short-Cut Gourmet returns

Enchilada Hot Wings

8 frozen buffalo wings
Trader Joe's Enchilada Sauce
Sriracha (the bottle with the green cap with a chicken logo)

1. Preheat oven to 400F.
2. Arrange frozen wings on a baking sheet.
3. Layer enchilada sauce over wings individually. Drizzle sriracha over wings.
4. Cook for 25-27 minutes.
5. Cool for 5 minutes on top of stove. Put on serving dish. Add extra enchilada sauce, sriracha to flavor and desired heat.

About Manning

Maybe the DNI/CIA/NSA guys should have been taking their tips from the National Football League the whole time.

As the corners and safeties have figured out, intercepting packages meant for receivers by people named Manning (Eli and Peyton) has become somewhat routine over the last couple weeks. Since Tom Brady threw his last pick, the Manning brothers have compiled 39 INTs between them.

Since the Brady Bill was passed, Bradley Manning was found to have leaked secrets to a foreign national running a massive security leak masquerading as a website.

What we need is better pass protection in our national intelligence structure.

What's on my mind?

I've noticed that people have a habit of asking me what I'm thinking about. Questions about what's on my mind, or just comments that I seem to be lost in thought.

When they ask me, I always wonder if they know what they're getting themselves into.
In that vein, random thoughts I've had today:

1. In the plastic world that mannequins occupy, is it really cold? Or are they aroused all the time? If that's the case, how do they procreate?

2. Superman is a fascist, but is Batman that much better?

3. Why does it always happen that the people who are most willing to tell other people what to do in a group responsibility are the ones who are least likely to do it themselves when their turn comes up?

4. Surgeons are about 2 psychological steps away from being serial killers.

5. Do people who want to take social services away from the poor ever wonder about self-preservation before they run their mouths? Desperate poor + violent revolution = dead rich people.

Dented fingernails

As I sat at my desk, staring at corner where the unplugged LCD monitor that I saved from the trash bin resides (one that, coincidentally, isn't connected to any other electronic device at this time either), I began to wonder what the other scientists on the floor thought about in their down time. Do they ponder their chosen object of scrutiny, their tiny molecule that defines their focus of academic worth? Do they reflect upon their degrees, their theses, the extra letters that they've placed at the end of their names? Or perhaps they just stare out of the window, wallowing in their self-acknowledged greatness as they occupy the corner of their laboratory at one of the world's most excellent universities - one so "excellent" that they even have an Institute for Excellence?

Today, while my biochemical interactions stewed away, my great downtime observation was this:
I have dented fingernails.

Not all of them, mind you - just the ones on my thumbs. Two little indentations roughly 1/3 of the distance from the proximal edge, bilaterally. One of the beauties of the human body is that we're kind of bilateral, at least on the outside, so that you can generally find that if something appears odd on both sides equally, it may just be normal. Or bilaterally odd.