Rumors of my death have been greatly exaggerated

It seems that every so often, life beats me down with a spiked club enough so that I disappear to all but my closest friends and family, sometimes even to some of them. The last 2-3 weeks have been one of those times. Honestly, it’s not that I’ve had nothing to write about or even that I was too depressed or whatever to write, it was just that I’ve been living day-to-day and have been unable to make sense of why I’m so out of sorts and out of time. It can also be attributed to three things, specifically:

1. Living with a newborn and all the changes involved
2. Classes themselves (academic)
3. Delusional classmates that unfortuately have chosen me most recently as an outlet for their love of conflict and misery

It seems weird to say that adjusting to a newborn (now 3 months and doing great) is a lot harder than I thought (“Well duh!”), but I still didn’t think it would be this hard, especially with the piercing cries that often penetrate earplugs from across the house. Don’t get me wrong–I looooove spending time w/my daughter, but there are times I need to focus, and I’m so distractable, most especially to noise. You can flash a strobe light in front of me before I’d start to get affected, but the slightest non-conducive sound derails my mental train…it’s almost like the cartoon mouse scaring the elephant in the ridiculousness of the disproportion.

School is kicking my ass. And I don’t mean difficult, I mean Hebrew-slave-in-the-time-of-Pharoh hard work. I’d say easily 75% of this feeling comes from neurosciences. How I hate that class with the heat of a thousand suns. To quote Melville:

…to the last I grapple with thee; from hell’s heart I stab at thee; for hate’s sake I spit my last breath at thee.

Yes, that’s also from Star Trek II:Wrath of Khan, for those complaining I’m not giving true credit where it’s due. I’m not chasing neuro as my white whale, trust me–I’m trying to run the hell away. We’ve had a wonderful visiting professor from UT Houston for neurophysiology that has given us great lectures and exceptional class materials used @UTH, but the best instruction in this subject still leaves me in a fetal position in the corner after studying it for a few hours. As if I were made of Teflon, the information doesn’t stick and slides right off me. It’s not a subject that lends itself to flash cards or easy forms of brute-force memorization, so I’m trudging through. Slowly.

Lastly, there has been a lot of upheaval at my school. Just as I thought things were dying down from the Grand Rounds “bad press” I gave, one particular student decided to decided to complain once again about things in the class, only this time mail was sent anonymously. Since I manage the email lists and have had many run-ins with this individual (as well as a low tolerance for bullshit in general), I decided to publicly expose this attempt to anonymously cause trouble while simultaneously sending ingratiating emails to the student body publicly. Oh. My. God. What a firestorm this caused, and in true mentally unbalanced fashion, this person proceeded to become unhinged more and more, causing more and more problems. I could have left well enough alone, but part of me was stupid and didn’t, and part of me was obligated to reply when said individual would accuse me of things that were patently false.

To make matters worse, there was an incident involving a successful attempt to steal questions from an exam of a visiting professor via a fake email. As a class officer, I was somewhat involved, then fully involved because of my IT background. I don’t know where it’s going to go, but attorneys at both school are involved dealing with both theft of intellectual property and fraud. Academic honesty/honor code is the least of this person’s worries. I won’t go into more detail, but said unstable student now says I had something to do with it with no evidence whatsoever. I feel like I’m in junior high. It scares the living hell out of me that people this unstable and disconnected from reality will actually be in a position to tangibly affect people’s physical lives in less than 2 years. I truly hope this person grows up, gets psychiatric help, or chooses another career–whatever it takes.

So that’s the short verison of what’s been going on. For those who have emailed me privately without a reply, please don’t think I’ve ignored you…I promise to reply soon. After my neurophysiology exam on Monday, we move on to neuropharm, and my life will be a bit better for a while (pharm is so much more my cup of tea). I’ll be more communicative after the weekend, I promise.

As I’m writing this, I’m listening to an interesting recording of Mozart’s Requiem that I downloaded (more of an “early music” interpretation with thinner orchestration and faster tempos), and I already feel better. Even ending with a driving in a fugue in a minor key, my spirits are lifted along with the prayers sung in the text. Thanks Wolfie.

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UPDATE: I decided to finally upload the flash music player plugin to allow me to share music clips, like I tried to do more crudely w/Grand Rounds. So, to inagurate this, I’ll share the clip I referred to above, except this is the Kyrie that appears earlier, but musically it’s identical; the only difference is the text–Kyrie eleison/Christe eleison (Lord have mercy/Christ have mercy) in this section as opposed to cum sanctis tuis in aeternum, que pius es. (…with thy saints forever, for thou art merciful). Enjoy!

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

“Be silent, woman!” instructs Baptists

A Sunday school teacher of 54 years is dismissed by a Rev. Timothy LaBouf, who also is a city councilman in Watertown NY. The reason? She is a woman and, as a woman, has no business teaching men in spiritual matters. Don’t believe me? Read the article:

The First Baptist Church dismissed Mary Lambert on August 9 with a letter explaining that the church had adopted an interpretation that prohibits women from teaching men. She had taught there for 54 years.

The letter quoted the first epistle to Timothy: “I do not permit a woman to teach or to have authority over a man; she must be silent.”

In a rare show of egalitarian sensitivity, Rev. LaBouf did concede that a woman can fulfill whatever responsibility she desires, but “outside the church.” Perhaps he said these things because, irony of ironies, the good reverend’s boss in the city government is a woman.

Every city council meeting, Rev. Neanderthal must be wishing he could say things like “Fie thee, Whore of Babylon! Speak not with thy forked tongue, lest the wrath of the Almighty smite thee asunder!” but he probably slinks back in his chair like the sad, cowardly man that he is when he’s not behind the pulpit.

Udon bowl

I’m a total foodie. By that I mean I not only love food, but I love the process, the cooking, the variation, the art behind the scenes, the meticulous attention to detail that can go into a dish. I married a good cook too, so that doesn’t hurt, but as she’ll tell you, I bump her out whenever I have the chance. Having an adventerous palate also means that I’ll go to an Asian grocery and buy things without knowing exactly what they are, relying mainly on the pictures.

I prepared an udon noodle bowl that I bought at just such a market before coming down here, and I wanted to look at the ingredients. I was met with some Engrish like “wel shonion” and “sea tangle.” I had no idea what the first was, but “sea tangle” sounds like it deserves some respect lest I hurt myself, so I decided to Google it. Since I figured I was going to blog about all of this w/pictures, when I found this entry reviewing my very same noodle bowl, the project came to a halt, my thunder stolen. (on the upside, it saved me some time)

See the pinwheel seafood bits? Tasty, but not as tasty as the brown, amorphous blobs. The non-meat look about them is because they are small fried seafood cakes, made soft and squishy of course because of the boiling water. I added some sesame oil and some Sriracha sauce and chowed down. Mmmm…mmm….

If anybody knows Korean, can you please translate? Just curious to see if it says anything different than the obvious.

After Grand Rounds, Part 2: Backlash

I promise this is my last post about anything having to do with my Grand Rounds’ hosting experience. I would have posted this last Thurs/Fri when it was most applicable, but I had a heinous neuroanatomy exam and surgery class early this last week, which given no sleep the night before, I spent the next couple of days recovering and fuming. This weekend, I’m back in the saddle. Here goes…

Not to be immodest, but I thought my GR was a great success. I got LOTS of good feedback, almost all positive, and some even gave me some private feedback on some things they thought could make it even better, and I took it to heart. It makes me feel good to not only get positive feedback, but also to give back to the blogging community that generously reads my writings and gives me some motivation to keep doing this in spite of my time constraints. So before I continue, let me thank all my regular readers and visitors from GR once again.

Unfortunately, not all my feedback was positive. Some was downright negative. You see, there are those that are affiliated (directly and indirectly) with my school who felt that in my bio writings (both here and especially in the Medscape pre-rounds article) 1) showed Mexican physicians in a negative light, 2) put down my school, and 3) in general, showed unprofessionalism by saying anything negative about the country in which I am currently living and the school I’m attending, since both are so graciously providing me with an education–an education, which they believe, I was not able to get in the states.

OK, so after fuming for a bit incredulously, I objectively looked at what I wrote and I have to say that, yes, there are things I said which were negative towards a minority of Mexican physicians and certain aspects of the Mexican medical system. I am not going to exhaustively quote paragraph-for-paragraph my writings here to justify my points; I totally assume my readers are astute and open-minded enough to draw their own conclusions, which I respect even if different from my own– provided they have some basis in reality or fact. It bothers the living shit out of me when people fire off at the mouth, assuming this or that incorrectly about something that was clearly not the case in my writings. When these people comment on things they didn’t bother to read–words that I spent a LOT of time carefully composing–it’s insulting, as it renders all that consideration wasted due to their laziness.

Let me quote some of the emails and comments that I’ve received (anonymously, out of respect for the authors since I did not get permission):

The statements about Mexican physicians and your professors are truly insulting. Respect for an instution that is giving you an education (excellent, good, or bad), despite all of it’s problems, [is a sign of professionalism]. Communicating experiences can be a very dangerous thing! Words that you think are benign can translate into very deep offences. The reality you see about Mexican Medical system is very narrow, you haven’t been exposed to its totallity, and what is sad is that you dare to make such a dangerous opinion about a system you don’t know at all.

Jeez, where to begin? The person that wrote this is someone who I respect a lot, seriously. However, as a Mexican physician, there are too many differences between us to see eye-to-eye that are ingrained on a cultural level. Culturally, it is much less acceptable here to question authority. Position and a title mean so much here, so much so, that our medical school has several departments of one person, just so they can have the commensurate title and respect among others in the department and/or medical school. People from the states, particularly those from the East coast and/or self-assured, type-A individuals such as myself, look at some of the “rules” and say, “Oh, HELL no.” It didn’t come through in the Medscape piece but it’s elsewhere on my blog that we as non-Mexicans attend UAG through the International Program which is 100% different from the “Latino” program for Mexican nationals. One the stark differences between med school in the US and in almost everywhere else in the world is that everywhere else, including Mexico, med students start at 18 right out of high school. Many professors, even though we tend to be separate because of English instruction, still have this holdover where they tend to forget we aren’t little kidlets that need to be reminded of this and that. After a while, it tends to be insulting, even for the 24-year-olds. Now imagine us 30-somethings who are married, had careers, own homes and cars before coming here, etc. and you’re going to tell me how and when I can use the bathroom? F*ck off.

I can write pages and pages of things that are bad about this school, but I choose not to, first and foremost not because of “honor,” but because it takes energy–negative energy–to be in a place to rant, bitch and vent all the time, and I’d rather use that energy elsewhere. I’m not always successful at putting things behind me, but trust me when I say that I censor myself A LOT when talking about my school. UAG would never, ever, ever, under the most generous of days meet the requirements for LCME certification, and the professors (speaking only about basic science curriculum for first 2 years), with a handful of exceptions, should be embarrassed how bad their class materials are…yellowed acetate transparencies that haven’t changed in 10 years, you know the kind. Some of the “most esteemed” of the professors offer no materials or at all, making you feel like you should be grateful they even give you their time. They spend the in-lecture time talking about the school itself, like we should be so lucky to attend “Guadalaharvard,” (my term, not theirs) or they simply talk about themselves and everything the school is doing to make our lives better. When they do teach, it often consists of drawing cartoons of anatomical or other figures as things randomly come into their mind, never to be seen again as the wipeboard or transparency machine is wiped clean.

But for those who think that I wield such power to affect public opinion on this school, I remind those (after avoiding my spitting coffee at the screen) that none of anything I said was offered to be anything but my own personal opinions and experiences. Anybody with half a brain reading this site would see I’m a 2nd year student, so I’m not exactly the voice of authority here. As the article states, “I tell it like it is”….to me, and only me. I did not “put down” UAG and I didn’t talk it up. I didn’t say living in Mexico was awesome, nor did I say it sucked. Mine was a dose of simple reality (from my perspective) and nothing more. I made a choice to come here–a choice I do not regret for a second–but until I get a paycheck from the university, I’m not obligated to speak favorably of the school regardless of circumstance. I am thankful for UAG giving me the opportunity to come to school here where other schools did not, but my debt to UAG is paid by doing well, graduating, and showing that yet another successful physician came out of here. But make no mistake–I pay good money for my education, it’s not on loan to me from the school; as such, I say what I want, when I want, how I want. Period.

Finally, to give another shining example of the kind of correspondence I get from the increased visibility of having had some of my work published, I offer this gem:

I would never write about how bad I feel because I am fat or how I dont like my own school. I am just not that kind of person that likes people to feel pity for me because I have problems relating to people, I smell bad or because I sweat too much. This is just “pathetic” my friend.

Yeah. Right. Give a kid an easy target (weight), and he’ll take it every time. Some maladjusted individuals even make things up in their frenzy (that, or I need to go take a shower ). Folks, regardless of medical school, there are those who shouldn’t try to become physicians–this path isn’t for everyone. A warning to those American students struggling to get into US programs considering a foreign medical school: a foreign school *is* a viable alternative, but since you aren’t dealing with the “cream of the crop,” (witness the profound statements above), expect to deal with a lot of behaviors from people that you’d think you would have left behind in high school. Add to that, the culture clash of the country in which you go to school, and it’s can make for a stressful mix–all of which, unfortunately, detracts from studying and applying yourself to your task at hand. Be prepared.

In the end, however, for those of us that persevere, graduate and move on to successful residencies, no one will ever be able to question our hearts and the desire to become physicians.

After Grand Rounds, Part 1: Advice

It was a couple of days for me to post again earlier this week…the non-sleep of compiling Grand Rounds plus having a microbiology exam that same morning plus a clinical skills exam the following day (which I forgot about when I signed up — (bad Palm!)) meant bad mojo for me. If I had to do it all over again, I certainly would, but I’d make a few changes. Here are some small tips and warnings for future Grand Rounds hosts:

• No matter how much you beg and plead, you will get the bulk of the posts within 24h of the deadline. Accept this. It’s understandable, because people want to see if they post anything else worthwhile, people haven’t yet posted their magnum opus of the week, or, they are just simply intractable procrastinators.
• Themes are nice, but they definitely make things harder to compile, assuming you have any desire to make things flow. Unless you set a draconian deadline two days prior, you have but hours to complete your edition. As posts stream in, your concept of what you might want to do may change. Again, accept this.
• Fight very, very hard not to be judgmental about posts with which you disagree or have no interest in. Personally, I can’t stand the business end of healthcare. If I partner w/someone at all later, let it be an MD/MBA, because while someone waxes poetic about profit margins and price-for-performance, I’m probably thinking something about science or medicine instead. Or food. But, when I read a story about these topics, I have to evaluate it based on objective criteria (as much as possible) and consider including it because there are readers who want it. More power to ‘em.
• Don’t be afraid to not include a post. Posts with little or no original content have no business in Grand Rounds; that should go without saying. Posts which mentioned a news story, added a blockquote from the same, then added a 2-3 sentence pithy comment lasted about 5 seconds in my inbox.
• Most importantly, the URLs of the submissions you are considering including (not the final list by any means) should get placed in your editor properly, with title/desc, and place these in your web editor as a simple, carriage-returned list, with the title of the article submission, linked, followed by a few words as a “teaser” to remember which post it is. Do not worry about the final text to use, since this “flow” is what will be determined towards the end after all the submissions are in. This way, you can move the links around in the order you think works best based on the linked content before you start worrying about composing the rest and complicating the problem. I so wish I had done this as I would have saved nearly 6 hours of futile writer’s block on how to even begin.
• If at all possible, have some posts queued up for posting the after Grand Rounds. You’ll be tired and not feeling quite original, so write a couple of posts in advance while you’re in writing mode. Also, as Dr. Marcucci pointed out to me last week, your readership will peak on Tuesday, but stay elevated for a while. Remember that GR is what brings ppl to your site, but you have to offer something other than that for you to be blogrolled, added to their news aggregator, etc.
• It’s hard to forget this is supposed to be fun. As soon as you become really stressed, stop, breathe deep, and go do something else.

Several people in their submissions commented how amazed they were that I, as a med student, had time to do this. While true, I don’t have a lot of free time with studies and all, my schedule is still somewhat flexible. If I wanted to stay up all night and be a zombie the next day, I certainly could. If I were already a resident or practicing physician, that option would be crazy given the responsibility I’d have to patients. So I give mad props to the medical professionals out there who have to get this done STAT and still make sure all ducks are in a row to continue the next day w/o ill effect.

Finally, here is a scary look at the internals of my thought processes: I not only wanted to have more music featured combined with some sort of visual artwork, but I originally planned to also feature the edition in English as well as Spanish, just because. I know. Commit me now for even thinking it. This proves that while I certainly CAN be methodical, hyper-focused, etc. it’s only good for short (relatively) bursts of activity. I’m an incredibly intense individual but it’s usually reserved for the beginning of something, not throughout. What kind of specialty does that lend itself to…EM? surgery (seeing each individual case in terms of definite start-stop points)? Anesthesiology? I think we can all agree that slow, long-term management like heme/onc is right out. What do you think?

Dads suffer post-partum depression too

I knew it!! I knew there had to be a connection between birth and depression in fathers as well, and a new study confirms this. Of course, what dad goes through doesn’t hold a candle to the hormonal and physical changes in the mother, but the alteration of lifestyle, sleep, shifts in priority, etc. can take its toll if the father is already dysthymic or otherwise borderline for a major depressive episode. (this assumes, of course, that the father gives a damn, which is unfortunately not always a given)

However, I found this odd:

In general, the study found, mothers who scored above this threshold reported less interaction with their babies — reading to them or playing games less often than non-depressed mothers did. [...] Depressed fathers reported less play with their infants as well. And women whose husbands were depressed read to their baby less often than other mothers did — pointing to the potential effects a spouse’s depression can have on the other parent.

Ok, I’m convinced my child’s mental capacity will exceed mine; she’s already showing certain development well outpacing where she should be on paper at the moment. But even my daughter’s preparation for world domination does not include the ability to comprehend or otherwise benefit from story reading at 11 weeks. I play and talk to her all the time, but break out a children’s book and read? I think that’s a bit much, but then again, what do I know…peds sure isn’t my area.

New “Change of Shift”

The new edition is up at Intellinurse2b’s site, “It’s a Nursing Thing.”

To Grandpa

Your name was Roberto Mosqueda (mo-skeh-duh), but I just called you “grandpa.” I didn’t call you “Grandpa Robert” really, because I didn’t have any other grandfather; my mom’s dad died of a sudden heart attack when she was in her teens, so you are the only grandpa I ever knew (not counting great-grandparents). You were enough for two or three, which is why I’m writing this. The other day would have been your birthday, and I’ve been thinking about you lately, especially after reading this post by Kim…it described so many things about you to a tee. I never heard you complain about anything. Ever. You had so much pride, it sometimes worked against you–you often needed help and refused to ask–but you wouldn’t have it any other way.

People think it’s really cool that your dad actually was a gunrunner who ran with Gregorio Cortez around the time of the Mexican Revolution (1910). Being one of your older siblings, you actually remember your dad sleeping with a gun under his pillow, never knowing who was going to come by the house and exact some sort of revenge. How my life might have been different if things continued down this path for you, but “Papa Juan” miraculously found Jesus and renounced his criminal ways, concentrating on his family and building his future church, eventually becoming a Baptist minister. Like Saul on his way to Damascus, your dad’s life was changed instantly. I thank God that this is the man you grew up with, because I know that’s what forged you to be the upstanding man I always knew.

You faked your papers to go to World War II a year before you were legally able as many other brave classmates of yours did. It was a time when fighting for your country meant both the honor of potentially making the supreme sacrifice and knowing it was an enemy that presented a clear and present danger. You didn’t want to go into the infantry, you elected instead to join the more elite paratroopers, dropped into harms way where it was too dangerous to go in by normal means. You didn’t have the benefit of infrared goggles and other modern devices to allow for night-time jumps; jumping from a plane meant becoming a slow-moving aerial target for the enemy before you could land and finish your objective. One ill-fated day in 1942, the spray of artillery over some part of the Japanese islands was your welcoming committee and a deadly course of tuberculosis your final souvenir from the Land of the Rising Sun.

It still amazes me an Army hospital here in the US actually removed your entire left lung. I would think given the complications of TB in the 1940s, wartime medicine and its often inherent lack of resources, it would have been a more dismal assessment and plan. Perhaps God sent you a female surgeon (that’s right ladies–in 1942, a totally in-charge cardiothoracic surgeon) who felt that she had more to prove–I don’t care, I’m just glad you survived. It amazes me still that you lived as long as you did without it, to the point where I didn’t even know any of this until shortly before you passed away.

That’s because you never complained, you never had anything negative to say about a given situation. If really provoked, you could get angry, but it was very short lived and probably well-deserved. I couldn’t image a person ever having anything negative to say about you. In my eagerness to learn about World War II, I never forget an afternoon on day at your house. I was asking question after question. It was a subject you didn’t seem to want to talk about, but as always, you indulged me. Like a kid given an inch and trying to take a mile, I was probably tiring you with questions, but your reaction when I mentioned if you had seen the atomic blast at Hiroshima never left me. Your look of mild indulgence left, your eyes got glassy and intense, you looked at me while putting your hand on my shoulder and said, “Son, you don’t want to know what war looks like. There’s metal twisted every which way, and what the people look like afterwards are worse. I pray you never have to see what I saw.” And with that, you left somberly down the hall. I was young but I had enough sense to leave you alone at that point. Later, I’d know that you wasn’t there for the A-bombs; you were recounting what you saw with conventional warfare. And that was bad enough.
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Grand Rounds Vol 2, No. 46

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.

Prologue
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.

HomeSchooledMedStudent 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.”)

Summary
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.

Epilogue
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.

Team Hoyt

I’m not one to be easily emotionally affected by things, but this really got to me. It’s a video of a father who, though not a runner, got in shape to eventually compete in triathalons so his quadriplegic son can feel free, if only temporarily, from the wheelchair that imprisons him.

To see this and then think of all the stir and controversy and conspiracy theories about Landis’ alleged testosterone doping makes one feel even more cheated. This is what sport, what courage, what heart is all about. I’ll pay to see these two race if they’re the last ones to come in before I’d give a nickel for most athletes out there. Inspiring.