Grand Rounds Vol 2, No. 46

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Welcome to Grand Rounds Vol. 2 No. 46! For the first time, Grand Rounds comes to you from Mexico. I hope you find your stay pleasant — current weather here in Guadalajara will range from 58°F to 78°F (14°C to 25°C) with afternoon thundershowers. For all you suffering in the U.S. heat wave, come on down and enjoy some mountain air.

My first love was music, and growing up as a classical pianist, I never let the serious study of music stop, even though I can’t play nearly as much as I’d like to these days. To that end, this edition will feature musical interludes which will highlight different cultural, national, and musical motifs. Clicking on a musical selection will bring up a pop-up window which hopefully your browser should play without any additional fuss. The idea is that you can read this edition, the links it sends you to while having some background music to accompany your reading. Feel free to download the selections for your personal enjoyment. (I guess one of the benefits of living in Mexico is there is no RIAA to worry about, but honestly, who is going to complain about a work from the 15th century…come on.)

Culture Convergence
The main theme for this edition is “Culture Convergence” and the idea, being that I’m an American medical student studying in a foreign country, is that opportunities for learning new ideas, experiencing new ways of doing things–good and bad–are all a part of daily life. For the top spot in cultural exchanges this week, Traveling Doc pays tribute to her mentor in a post entitled Remembering Don–a story about a truly remarkable man who dedicated his career to providing healthcare to underserved populations across the world.

A funny and insightful post at My Life, My Pace illustrates how the Chinese inherent distrust of Western medicine can make for understandable misunderstanding. Also breaking with Western medicine, Tundra PA shares a post about Yupik Eskimo Home Remedies. I can relate, since teas from the local yerberia (herb store (no, not that kind)) are still widely utilized here in Mexico, if for no other reason than it’s vastly cheaper to boil herbal tea than buy a proton pump inhibitor.

Musical Interlude No. 1: Empress of the Pagodas

This is a piece from the “Mother Goose” suite by French composer Maurice Ravel evoking a Chinese setting. Originally written for piano duet, it is transcribed here for guitar; I think the transcription works very well.

Speaking of Mexican medical economics, while Unbounded Medicine shows different ways to assess hemoperitoneum, the other salient feature is the disparity between the “haves” and “have nots” in terms of private practice vs. public/charity medicine. I’ve seen both, and as scary/antiquated as the latter seems to be, one does learn quite a bit as a trainee forced to improvise and get the job done in spite of not having top-notch equipment/supplies.

Anxiety, Addiction and Depression Treatments shares its view of body image and popular culture in Body Dysmorphic Disorder and the Cult of Celebrity. Hollywood has it’s own culture altogether.

Musical Interlude No. 2: Rondo alla Turca

Mozart’s famous “Turkish March” was written when Turkish fashion was storming central Europe in the mid-late 1700s as trade with the East increased. Finger cymbals, drums, and flutes were characteristic Turkish additions to dance rhythms. In spite of this, Mozart’s true crystalline, transparent writing is still predominant.

In Imagine Bright Futures, Amanda writes several vignettes about patients/families with whom she’s communicated who have liver/biliary disease like her niece. Story Number 5 specifically deals with a cultural difference in how an illness is perceived. It’s hard for us to accept a different view that would cause a potential loss of life, but short of cases involving outright negligence, we must struggle not to judge.

As I said in my original post, a joining of two cultures can be a temporal relationship as well as an interpersonal one. Kim at Emergiblog shares a tribute to her great-grandmother who was pivotal in her decision to become a nurse, reconnecting through her memories of an era long past.

On a hot day and the end of the month when your financial net worth is defined by the change jingling in your pocket, Digital Doorway shows that there’s nothing a little Eskimolito can’t make better.

Sometimes these differences can be funny, as illustrated by Gruntdoc’s hilarious recollection of events while in Japan and eating what looked familiar without checking. I think an Eskimolito could have helped at the time, actually.

Vitum Medicinus shares a time where he went to Nigeria and saw a different side of medicine that might have turned a lesser-motivated student away.

Dr. Lisa Marcucci of Inside Surgery, last week’s Grand Rounds host, offers her views on what’s really wrong with Castro.

Musical Interlude No. 3: Sephardic Jewish Music

Sephardic Jews are primarily from Spain, Portugal and Northern Africa and have a distinct lineage from Ashkenazi Jews. Their language, Ladino, is a Hebrew-Spanish mix, more heavily leaning towards Spanish. The song here is titled “Los gayos empasan a cantar” (“The roosters begin to crow”)

The Doctor-Patient Relationship
Carol at Ain’t Chicken shares a story about good doctoring that doesn’t involve a prescription pad or more testing.

The “BEST” communication model pointed out by Clinical Cases and Images Blog definitely seems to be the best way to get one’s point across. I know that if I were on the receiving end, I certainly would appreciate all these points.

Want to go on a date with your doctor? MSSP Nexus suggests doing just that to test the waters. Nothing unethical, but no strings attached either. Now the question is do you go dutch or not? Sounds like the patient shouldn’t foot the whole bill. Dr. Cheapskate could at least pay for something. Hmph.

Difficult Patient writes a poignant post about facing her son’s illnesses, calling up more strength than she knew she had, and the power of simple supportive words that can affect someone in unexpected ways.

Snapshots, Stories
Dr. Jordan Grumet of In My Humble Opinion shares an incredible story sequence ending in death, letting go, and a life well lived but I think it’s worth it to read from the beginning, personally.

Part Three of Dr. Sidney Schwab’s “Memorable Patients” at SurgeonsBlog tells of a precarious operative situation with a schizophrenic patient with multiple self-inflicted stab wounds and a Korean dry cleaner who discovered a graphic secret.

Musical Interlude No. 4: Russian Male Chorus

Listening to this all-male Russian vocal ensemble will give you chills. I promise the basses you hear are real and unedited; it’s one thing to sing low but quite another to sing that low and still project. This piece is entitled “Nine sili nebesniye” (“Rejoice now heavenly powers”) by Alexander Sheremetiev.

Paper Cranes is a story by Six Until Me about how sympathy and understanding are found in the most unlikely places.

recounts a very busy night on her OB rotation as she participated in a surgical delivery of premie twins which almost ended in tragedy.

If one is looking for the presence of the divine in a hospital, one usually does not follow the signs in the hallway leading to the Emergency Department, yet Susan of Rickety Contrivances of Doing Good, a volunteer chaplain, routinely finds God in the ER.

If you could find out for sure you were going to get Alzheimer’s Disease, would you want to subject yourself to the screening? That’s the quandary Moof presents with rather emotional responses from her readers.

Confirming our suspicions that Some Nurses Eat Their Young, kt living takes us through a change of heart (if not appetite) about a co-worker when she understands that her tough demeanor also applies to how much she’s willing to work for her patients.

Medical News and Views
Dr. Tara Smith at Aetiology writes about an ominous cessation of the National Children’s Heath Study, a huge cross-populational study to focus on multiple factors that possibly lead to disease states later in life.

Across the pond, Dr. Jest laments the fact that “the talk” about DN[A]Rs is being mandated by factors other than when medical personnel believe it’s the appropriate time, especially since they are used a lot less in the UK.

Musical Interlude No. 5: Spanish-Arabic Fusion

For the only non-classical piece here, I include a favorite of mine: Arabic music deriving from the Iberian peninsula and Northern Africa. This region underwent multiple changes of Spanish and Moorish rule, and the gypsy culture is a strong influence as well. The group here is Alabina and the song is titled “Habibi de mis Amores.” Habibi is Arabic for “darling,” and the rest of the title is Spanish for “of my loves.” The whole song switches back and forth from Arabic to Spanish.

Trisha at Ideas For Women posts about Women with HIV/AIDS which is more complex than the title suggests. We forget that the freedom women have in the West/developed countries is not the case in all the world, yet AIDS is a worldwide problem.

Dr. Deborah Serani helps explain the Science Behind Deja Vu and why the quote “It’s deja vu all over again” actually has some validity when you consider different parts of you brain will look at the same situation asynchronously!

Ever consider what the logistic process is of female inmates giving birth? Navelgazing Midwife shares an interesting opinion piece about having to shackle laboring inmates and why the common “inhumane” reaction may not necessarily be the most appropriate one.

All Bleeding Stops (aka Movin’ Meat), discusses a recent order by Ah-nold in California that essentially removes any power physicians had in negotiating reimbursement rates (also creating limitless financial liability to the disadvantaged patient). To quote, “I paid more for a plumber to unclog my toilet the other day than I will get paid for taking care of a three-day-old [in the ER] with a fever last night.” Sobering.

ChronicBabe posts very practical advice about managing a career while dealing with a chronic illness.

Do you consider the act of childbirth sexual? Midwife student Myra thinks so.

The first-ever global survey of medical blogs is now open at Envisioning 2.0 and requesting participants. The survey’s results will be prominently featured at the first Healthcare Blogging Summit this December. Please consider donating a few minutes of your time to help out.

Musical Interlude No. 6: Latin-American Symphonic

I couldn’t let you go without something from Latin America! Here is “Malambo,” a frenetic dance in alternating 3/4+6/8 rhythm typical of Argentine composer Alberto Ginastera. If this doesn’t get you out to start your day, nothing will! (things have gotten more upbeat on purpose. ;) If you want to be really adventurous, you can also listen to Sensemayá by Mexican composer Silvestre Revueltas. It depicts a pagan snake ritual and is far more musically “graphic.”)

Next week’s host will be Hospital Impact. Thanks to Dr.2 Nick Genes for allowing me to host, and thank you for reading and listening. It has truly been a pleasure being your host.


I want to dedicate this Grand Rounds edition to my Grandpa Robert whose birthday is today. He passed away in January of 2002, but ever since I read this post on Emergiblog I have been thinking of him. I have a post written, but right now I want Grand Rounds to stand on its own. Since today is his birthday, though, I thought I’d simply mention it and invite you to return in the next couple of days to read the post at your leisure. Happy Birthday Grandpa.

  • By Fard Johnmar, August 8, 2006 @ 7:00 am


    Fantastic edition of Grand Rounds! Also, thanks so much for highlighting the survey! Your support is greatly appreciated!

  • By difficultpt, August 8, 2006 @ 7:21 am

    Fantastic–thanks for hosting!

  • By Jenni Prokopy, August 8, 2006 @ 8:16 am

    love love love it! what a great take on the grand rounds idea and execution of a theme – the musical interludes are excellent. way to go!

  • By That Girl, August 8, 2006 @ 8:36 am

    Thanks! The links for “surgical delivery of premie twins” and “would you want to subject yourself to screening” go to different posts than those described – posts which appear later in the “Round”. Just fyi.

  • By Fat Doctor, August 8, 2006 @ 8:46 am

    Brilliant! I’m listening to the last piece of music as I type this comment. Will need to wait for it to end before I head back over to my blog to link to GR for this week. The music is giving me chills. Outstanding job! Hope the baby is doing well. :)

  • By Borneo Breezes, August 8, 2006 @ 8:53 am

    The musical interludes are wonderful and the matching to the sections cleverly done. I have just figured out hyperlinks and now have something else to work on. What a great job you have done. Thanks so much. I also checked out those Soviet posters and loved them.

  • By Dr. Deb, August 8, 2006 @ 9:01 am

    I was classically trained in music as well as a young girl. It ontinues to be such an important part of my life. However, I could not access the music :(

    I will try again though.

  • By enrico, August 8, 2006 @ 9:05 am

    That Girl: I was already in the process of fixing Moof’s link, but thanks for the heads up on the other one. After a while, everything gets a blur after hours of looking at tons of HTML. Thanks again!

    Dr. Deb: It’s almost certainly a browser issue, because I composed everything on my Mac, used 3 browsers there then went to my PC laptop and tried it w/Internet Explorer 6 (XP) and Firefox. Email me privately if you need more help. (I have a solution for you, regardless. )   Also make sure you give it time to load; it’s not instantaneous as I don’t have a streaming server.  If you see an hourglass, it’s still coming through.

  • By The Tundra PA, August 8, 2006 @ 9:54 am

    Outstanding job! The music is excellent and adds such a delightful additional sensory experience to GR. I can only imagine how much extra effort that required of you. Thanks so much for hosting; you’ve raised the bar another notch.

  • By ipanema, August 8, 2006 @ 10:35 am

    Very neat! I love the music interludes too. My fave is #5. :)

  • By mylifemypace, August 8, 2006 @ 11:09 am

    Great Grand Rounds (esp the music)! Thanks for including my post. I just want to point out that my blog is called My Life, My Pace (not Place). It’s a common mistake (guess I should have thought harder about the name). Thanks! :)

  • By Sid Schwab, August 8, 2006 @ 11:25 am

    Surpasses the brilliance I expected from you. Amazing work. By the way, my dad loved to listen to the Don Kossacks, and said (don’t know where he got the info) that they did those amazing low notes by inhaling rather than exhaling: try it. You can get quite low, although personally I can’t control it like they do.

  • By Jon Mikel, M.D., August 8, 2006 @ 11:26 am

    Nice musical edition! Let me bring my coffee!

    Thanks for hosting, dear Enrico

  • By Carrie (NeoNurseChic), August 8, 2006 @ 12:12 pm

    Nicely done! I enjoy reading through all the links each week. I really love the music here! Before I became a nurse, I actually got a degree in piano performance…so I especially love the music. :) Don’t ever let go of the musician inside of you – I was just discussing this with my patho teacher yesterday as he is a violinist….musicians are a “different” sort – in all the best ways!! :)

    And for some more cultural music, have you checked out Debussy’s “Estampes”? The first one, “Pagodes” is such a beautiful piece of music… I played that work on my junior piano recital but loved it so much I’m almost considering re-learning it now. :)

  • By Happystance, August 8, 2006 @ 12:59 pm

    Excellent selection of music with some fascinating transcriptions that worked so well.

    Thanks for all the work involved in putting this together.

    Best Wishes – Tony

  • By Kerri., August 8, 2006 @ 2:21 pm

    Fantastic job hosting! And thank you very much for including my piece.

  • By Kim, August 8, 2006 @ 3:06 pm

    Oh….this will be great! I will read when I come home from work – it will be like blogging at Starbucks with the satellite radio only coming right out of my computer! LOL! Better selections, too! Looking forward to it!

    Thanks for including Emergiblog…… : )

  • By AmandaM, August 8, 2006 @ 9:47 pm

    A job well done, with music to boot. Loved the soundtrack….and laughed till I cried over the…um…avocado. :)

  • By Wendy, August 9, 2006 @ 10:56 am

    You did a great job with this week’s Grand Rounds! I love the diverse music selection!

  • By d, August 9, 2006 @ 4:47 pm

    Awesome edition of Grand Rounds! I actually got through it all in one sitting!

  • By intelinurse2b, August 9, 2006 @ 9:32 pm

    Great edition. Very diverse selections. The music was wonderful. My husband kept looking at me with peaked interest while I played another piece of music. Yours is an iPod I would love to browse through.

  • By Sharoda, August 10, 2006 @ 9:31 am

    Great edition of Grand Rounds! Loved the music. Can you tell me where I can find Alabina’s music (band in No. 5)?

  • By drcharles, August 10, 2006 @ 6:07 pm

    wow, i am thoroughly impressed. this was very well done. thank you for all the time and effort you put into it. happy birthday to grandpa robert!

  • By Sumer Sethi, August 18, 2006 @ 12:02 pm

    great work..

Other Links to this Post

  1. GruntDoc — August 8, 2006 @ 7:04 am

  2. First Carnival » Grand Rounds 2.46 — August 8, 2006 @ 9:22 am

  3. grand rounds 2.46 at My Life, My Pace — August 8, 2006 @ 11:12 am

  4. Grand Rounds 2:46 at Unbounded Medicine — August 8, 2006 @ 11:42 am

  5. Es Redondos Magnificos: It’s Grand Rounds! // Emergiblog — August 8, 2006 @ 3:46 pm

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