Grand Rounds 4:09

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¡Bienvenidos a Guadalajara, Jalisco, México! I will be your host and guide through this week’s best of the medical blogosphere. This is the second time I have had the privilege of hosting, and for that I’d like to thank Dr. Nick Genes who has seen fit to give me the nod for this week’s edition and keeping the Grand Rounds tradition going. Without further delay, let us begin…

Thanksgiving is two days away in the USA. This will mark the 3rd Thanksgiving in a row that I am not home to spend with the rest of my family. Perhaps I’m just a little nostalgic for home right now, but I really wanted to incorporate the holiday here in a way besides references to turkey, pie, and football (Go Packers!). Victor Hugo said (translated), “Music expresses that which cannot be put into words and that which cannot remain silent,” and like the last time I hosted, it is to music I turn once again to express myself.

In the Thanksgiving spirit, all of today’s selections will highlight American composers. Since all links here are set to open in new windows (or tabs), you can read articles while leaving this window playing in the background. In all but one shorter case, the selections are about 8 minutes each; I hope you indulge my desire to share. Enjoy!

When Aaron Copland burst onto the musical scene in the 1920s, American music would never be the same. While there were several important composers before him–McDowell, Herbert, Sousa–Copland was arguably the first to truly musical codify what it was to be “American,” by drawing from folk songs, cowboy music and other “popular” sources. Everyone knows Rodeo (the last part used in the “Beef: It’s What’s For Dinner” campaign in the States), but there was far more to Copland than catchy tunes. Here is the 2nd movement of his third symphony. The expansive, colorful harmonies and driving rhythms are so distinctly American, one just feels it.

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Editor’s Choice:
Sid Schwab at Surgeonsblog has a great piece about people’s need for magical thinking, particularly as it relates to “alternative medicine” and new discoveries. The post builds up steam (both momentum and ire) and finally culminates in a challenge bordering on the ridiculous (the whole point) to those who want to cherry-pick common sense. In a similar vein, Dr. Val comments on an infuriating decision by Medicare to no longer cover expensive, necessary treatments to lymphoma patients while at the same time, government dollars are wasted trying to legitimize the spurious benefits of homeopathy with more research studies. Craziness.

Coming back from the Twilight Zone to the ER (some would say that’s just a few steps away ;) ), the truth always comes out eventually, as Bongi at Other things Amazni shares. It may not come via the patient nor the patient’s family or friends–it may require surveillance cameras to finally shed light on what’s going on. The delay, however, could be deadly.

And on the lighter side, Zac at Agraphia has a story about a particularly reptilian surgeon which had me belly laughing from a similar experience.

Mark O’Connor is of a newer breed of contemporary American composers. O’Connor draws his inspiration from the country and bluegrass aural traditions (handed down through playing, not written) and brings his formal training to transform it into something completely unique. O’Connor’s most famous piece is Appalachia Waltz, and O’Connor has arranged several versions, this one for solo cello. This is a slow, easy waltz, just like sitting on a porch looking at the mountains…

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Clinical Perspectives:
Here are two selections about burnout and emotional balance. Keith at Digital Doorway talks about having been all compassioned out. Third-year medical student Nick Gavin at NY Emergency Medicine has a post entitled Traumatic Disconnect where he explores the fact that empathy and connecting with patients don’t come automatically with the white coat.

Straight Talk from the Stanford ER‘s Sean Donahue writes a good summary of how an ideal stroke response plays out, from EMS to thrombolytic treatment.

Nancy Brown at Teen Health 411 writes with suggestions on how to ensure an inclusive, positive holiday season for the whole family. With so many families being “go-go-go,” just pausing long enough to communicate openly is probably more than half the solution.

Ever wonder why your psychiatrist doesn’t take your insurance assignment (especially if talk therapy is involved)? Dinah from Shrink Rap explains why.

Terry from Counting Sheep tells a touching story about how a frail, blind nonagenarian had the power to halt activity in a busy OR staging area–in a good way.

Clinical Cases and Images Blog comments on the Perioperative Ischemic Evaluation (POISE) trial and how it might affect perioperative beta-blocker usage.

Some patients just “get to you,” and some do so without you realizing it before they’re gone. About a Nurse talks about one such patient and her struggle to find balance when you can’t even grieve because there’s still work to be done.

In Emergiblog’s first-ever guest blogger post, an anonymous Army nurse writes a letter of thanks to her fellow military nurses who serve our country by helping manage the healthcare of detainees. It’s another world entirely when one is faced with a potential moral dilemma for every medication/intervention, every patient, every day.

Tara Gidus at The Diet Dish shares why she’s especially thankful this year.

How can one talk about American music and not include jazz? Well, 1) Ken Burns already covered that history at length, and 2) I am focusing on classical music. Nevertheless, jazz’ universal appeal influenced many composers from around the world, none more so than American composers. George Gershwin is probably most recognized for this, evidenced most popularly with his Rhapsody in Blue. However, the work I’m featuring is the Piano Concerto in F, an unmistakably American work but rooted in a more traditional form. In spite of feeling a distinct “swing” at times, it’s completely written out and is very strictly timed (as evidenced by the orchestra’s accompaniment–there are no free-form solos as in Rhapsody) Here is about 1/3 into the first movement to the end:

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Patient Perspectives:
November is Diabetes Awareness Month. In a special feature, Amy Tenderich at Diabetes Mine interviews musician Elliot Yamin, former American Idol finalist and Type I diabetic, on World Diabetes Day. Stories such as Elliot’s are clearly inspiring for any diabetic feeling imprisoned by their illness. However, this can have an unintended counter-effect, as Kerry Morrone shares at Six Until Me. Just because a person appears healthy doesn’t mean they are disease-free.

In The Power of the Flower, Own Your Own Health talks about how physicians who tailor their communications individually to their patients win them over in more ways than one.

In Sickness and in Health, a chronic pain sufferer, has a nice, short post about appreciating the small moments of being pain free.

Of all the many incredible pieces Samuel Barber wrote, his “Adagio” is far and away the most known. The “Adagio” was first penned as the slow movement for his first string quartet, but was arranged by Barber once for string orchestra (which is most played by far), and again for a capella 8-part choir. It is this infrequently performed second arrangement that I present here. The music is set to the words of Agnus Dei:

    Agnus Dei, qui tollis peccata mundi, miserere nobis.
    Agnus Dei, qui tollis peccata mundi, dona nobis pacem.

    Lamb of God, who taketh away the sins of the world, have mercy upon us.
    Lamb of God, who taketh away the sins of the world, grant us peace.

The seemingly endless, ever reaching melody passes among all the vocal parts, finally culminating in a climactic chord and sighing quietly to the end. The tonality is never really settled until the final major chord, making one feel that after all of the yearning, peace is found at last.

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Healthcare Business and Policy:
The Executive Physician gives his thoughts and concerns on the concept of “cultural competence” as mandated by Washington and New Jersey and offers a more generalized solution.

Regarding hospitals and their attempt to maintain an edge–or at least financial viability–two stories are presented here. ER Murse talks about interhospital turf wars over a trauma level designation. When things get really bad, as HealthBlawg describes, sometimes it may be best to just pull the plug.

David Williams from Health Business Blog interviews the founder of DoubleCheckMD, a free, public web-based medication service that checks interactions and utilizes natural language technology to correlate patients’ symptoms, in their own words, against drug data. I was skeptical given the marketingspeak from the interviewee, but I checked it out before including it here, and it is worth a look.

Toni Brayer at Everything Health laments the whole SCHIP fiasco. I never understood the argument that because certain adults and/or families above a certain income level might be newly eligible (and improperly so, say opponents) if passed, why that would be reason enough to deny coverage (a non-partisan fact) to so many children.

To send this edition off on an uplifting note, here is the finale of Howard Hanson‘s, second symphony. Hanson is practically synonymous with the Eastman School of Music in Rochester, NY. He also wrote this symphony at a time when most composers of his day saw romantic, melodic music as an anachronism, preferring instead to embrace the atonality that was emerging from Europe. Hanson, a consummate melodist, unapologetically subtitled this symphony “The Romantic.” While Hanson is not as universally known as Copland, his legacy also lives through all of the Eastman students who have carried some of his spirit with them.

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Culture and Media:
Christian at MedJournalWatch presents a absolutely fascinating case study in Africa about body image issues (!?!) and a surprising trend in the perception and desirability of body fat.

Jolie Bookspan at The Fitness Fixer shows how she performed martial arts movement analysis “old school” with high speed film years ago. Later, she returned to this area, except she was the model FOR a computer and even had her moves included in a video game. Cool stuff!

In the spirit of both Thanksgiving and the upcoming holiday season, Paul Levy of Running a Hospital shares his daughter’s essay on about fruitcake and family tradition. It’s an extra click from his post, but the Salon article is an excellent read and well worth the extra navigation.

Canadian Medicine talks about how Canada’s health department warned against using a Chinese preparation of caterpillar fungus. Gee, ya think? I wonder how those meetings went. “There’s a fungus among us!”

I hope you enjoyed this edition of Grand Rounds! I hope everyone has a safe and happy Thanksgiving. Regardless what country you’re reading from, I know there’s something to celebrate and be thankful for–after all, you’re alive and reading this, aren’t you? :)

Grand Rounds leaves Mexico from Puerto Vallarta a few hours away and sails for the Philippines, home of next next week’s host, Prudence, MD. ¡Adios y buen viaje!

  • By Paul Levy, November 20, 2007 @ 5:37 am

    Muchas gracias, Enrico. Bien hecho!

  • By Doctor Anonymous, November 20, 2007 @ 5:40 am

    I love the audio links. Well done!

  • By Paul Levy, November 20, 2007 @ 5:53 am

    P.S. Enrico, I’ve linked my blog to yours and given you an advertisement this morning.

  • By Bongi, November 20, 2007 @ 6:00 am

    masterfully done. well done!

  • By Dr. Val, November 20, 2007 @ 6:55 am

    This is a great Grand Rounds – nice categories, and great job weaving together posts on a very wide variety of subjects. Not easy to do! I really enjoyed the musical interludes. Thanks for including me. :)

  • By Terry at Counting Sheep, November 20, 2007 @ 7:25 am

    What a great edition of Grand Rounds – I just loved listening to your music selections while cozying up to some great reading and a hot cup of chai. Great way to spend my early morning. Thank you for my inclusion. And wishing you a warm holiday, too.

  • By rlbates, November 20, 2007 @ 8:08 am

    Wonderful edition Enrico!!!

  • By Sid Schwab, November 20, 2007 @ 10:24 am

    Enrico, if I wore a hat it would be in my hands, tipped toward you. South, that would be. I loved the musical selections, and the fact that they kept playing as I clicked away to the recommended posts. If I were there, I’d buy you a sangweech. And, having found it via this GR, I left a revealing — if imprudent and obscene — comment on a post regarding a “reptilian” surgeon and the greater implications.

    Once again, you set the standard for excellent (if I may say so) choices, perfect organization and summarization, and transcendent experience. Would that the world was filled only with musicians.

  • By Zagreus Ammon, November 20, 2007 @ 10:30 am

    Gracias Enrico por su travajo.

    But wait… no Phillip Glass?

  • By Barbara K., November 20, 2007 @ 10:30 am

    You did a super job! The audio adds an inspiring touch to the wonderful array of posts you chose. I am honored to be included. Happy holidays to you.

  • By travelingdoc2, November 20, 2007 @ 12:29 pm

    Enrico- This dazzles. I am still listening to the previous selections. The music shift shapes it all around. Great job of hosting.

  • By smalltowndoc, November 21, 2007 @ 6:04 am

    Enrico. i am very new to grand rounds and this is the second GR i have visited. It is fantastic. The way you have organised them into a continuous weave is fantastic. The back ground music is the topping that did it. Because of you i was able to meet so many different people from different field of life. All in all great. Keep it up.

  • By Prudence, November 23, 2007 @ 9:24 am

    Where did you get those songs anyway? Hehe. Thanks for linking to my blog. I’m excited for next week. I hope you do submit your article, too, for next week’s GR. I hope you had a nice Thanksgiving holiday! We don’t have it here so I’m rather curious as to how people celebrate Thanksgiving.


  • By TBTAM, November 25, 2007 @ 5:08 pm

    A technological masterpiece, I loved the musical interludes. Great posts, great commentary.


  • By Roy from Shrink Rap, November 27, 2007 @ 8:23 am

    Great GR! Clinkshrink will be honored that you renamed Shrink Rap after her :-) . Thanks for including us. [Sorry for typo; fixed. --ed]

  • By daniel silverstein, December 4, 2007 @ 7:29 am

    how are you? I enjoyed your blog. I am also interested in music as well as medicine.I think music is good for the soul, both the patient’s as well as the doctor’s. Keep up the good work.

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