Wednesday, October 17, 2012

Nobody looks at the phone when it rings

This is utterly, totally off-topic, apropos of nothing. As both of my readers probably know, I'm a movie enthusiast. One of my pet peeves in movies is that when a phone rings, the character or characters in the scene turn to look at the telephone.

In real life, noboby looks at the phone when it rings. Of course, these days we do look at our cell phone screens to see who's calling, but when the cell phone rings on the corner table, we don't turn to look at it. Especially not landlines.

I realize that turning to look at the phone with a concerned expression is dramatically compelling. It's an effect. But when we're expecting an important call, the reality is, we'll just frown, jump up, or sigh heavily, or roll our eyes, depending on the nature of the expected call. But we don't turn to look at the phone.

Same thing with the doorbell. We don't turn to look at the door. Looking at the telephone or door serves no purpose, and we just don't do it. Think about it. You don't do it. When the characters in movies do it, it always breaks suspension of disbelief for me. I wish they would stop doing that.

Thursday, December 15, 2011

Update nr 2 on Ariel Sharon's brain

Some years ago I wrote about the futile attempt to rescue former Israeli PM Ariel Sharon back to a meaningful life. Here are the links to the previous posts.


I suspected they would turn him into a vegetable. Well, they did:

"Sharon remained in the long-term care center following 6 November 2006.[61] Medical experts indicated that Sharon's cognitive abilities were destroyed by the stroke, and that he is in a persistent vegetative state with slim chances of regaining consciousness.[62]"

"In October 2011, Sharon's son Gilad claimed that he was responsive and alluded that he was sometimes awake. In a telephone interview, Gilad claimed that when his father is awake, he "looks out with a penetrating stare" and moves his fingers when asked."

[source: wikipedia]

Technically not exactly a vegetable if we are to believe he is at least a tiny bit responsive, which may or may not be true. But nevertheless, after 5 years, an 83-year old man is bedridden, possibly occasionally somewhat awake and able to move his fingers.

Maybe he is trying to sign "please let me go". That's what I'd be doing.

Tuesday, December 07, 2010

"Dr." Mercola, enemy of children

Every now and then something comes up that nearly destroys my usual optimism. I had the misfortune of stumbling upon a website by an apparently popular alternative medicine guru, Joseph Mercola.

To put it mildly, the website depressed me. This person makes money by feeding on the paranoia of the uneducated. His advice probably causes a great deal of death and sickness. For instance, he advises parents against vaccinating their children. At the same time he advocates mutilation of baby boys, also called circumcision.

He's one of those salesmen who will say anything as long as his books and snake oil products keep selling. He only cares about money. Except maybe religion. Maybe he's jewish (I don't know, and I don't really care), so he advocates ancient, unnecessary and painful practices such as circumcision, or maybe he is funded by the circumcision lobby. Probably just the money talking.

Vaccines are possibly the greatest achievement of medicine and public health. Vaccines have saved and continue to save millions of lives. Feeding on irrational fears and picking out some rare cases of (mostly uncertain) association between vaccination and some neurological or other complication. Of course, complications occur but the benefits far outweigh the risks.

And in case you don't know what circumcision is, find out here:

http://20.fi/2905


Quacks like Joseph Mercola are enemies of civilization. One idiot born every minute, as they say. Too bad a lot people actually believe in his crap.

Monday, January 05, 2009

So, why not kill yourself?

Although I haven't updated this blog recently, and definitely would not like to continue the suicide theme, there's no escaping the fact the original suicide post still gathers some attention, and new comments keep appearing, 90 comments already that make for interesting and at times harrowing reading.

The reason I brought this up now is that I saw something that has a connection with all this, and while it may not turn your life around, it will most certainly give you some new perspective and, if you're not made of stone, you will find yourself moved. Link below.

http://20.fi/1803

Monday, November 13, 2006

Of Denmark, Humanity, War and Sci-Fi Movies

I was visiting Copenhagen for a neurosurgical conference, and had some time to kill in town. I fell in love with Copenhagen. This is a beautiful city, inhabited by some of the friendliest people you'll ever meet. I read somewhere that the Danes are the happiest people in Europe. But something is rotten in the state of Denmark: the Danes are among the heaviest opioid users in Europe, and have the highest rate of consumption of anti-depressants (maybe that explains why they are so happy?).

I was walking around town, doing some shopping, visited the Bang and Olufsen store (could not afford to buy anything but they sure looked pretty and sounded good), and popped in to a record shop that had movie DVDs on sale. I collected some random titles, among them the 1998 Sci-Fi number Soldier, starring Kurt Russell, directed by Paul Anderson and written by none other than David Webb Peoples (Blade Runner, Unforgiven).

I am a huge fan of science fiction. But science fiction films are few and far between, and good sci-fi films are truly scarce. All we get is 5 too many Star Wars films, and that's not even science fiction, it's more fantasy.

"Soldier" was a major flop and received some of the harshest critique in recent memory. The Rotten Tomatoes website gives it a stinking rotten 5% score, with only one favorable review. Needless to say, I wasn't expecting much, but at €1.99 the DVD was worth picking up anyway.

I was in for a surprise. "Soldier" is up there among some of the boldest, most sincere sci-fi films I have seen.

This is a thinking man's sci-fi film that resonates with the themes in Blade Runner, the greatest sci-fi film ever made. Granted, it's a B-ish movie, but it has heart, and raises some important questions about our times, about technology, war, and the core values of humanity.

It has some decent action, too. It lacks the ironic and satiric humor of such genre films as Robocop, but why should every movie be humorous? This is a sincere effort by the filmmakers, and Kurt Russell achieves the improbable as Sergeant Todd: suspending disbelief against all odds, in a very tough role.

The film has some powerful images that linger in mind long after the end credits have rolled. Desire; the golden hair and sensuous lips of Sandra, played by the beautiful Connie Nielsen, awakening some unfathomable force deep in the soul of sergeant Todd, rendering him vulnerable like no enemy could ever do. Destiny; the fate of Todd's nemesis, Cane 607 (Jason Scott Lee) in the hands of sergeant Todd, a moment of killing in the rain, in a piece of brilliant moviemaking capturing the inevitability of death, a soldier submitting to his fate, much like pvt Stanley Mellish in Spielberg's Saving Private Ryan. Cane 607 dies like Roy Batty in Blade Runner - "All those moments will be lost in time like tears in rain".

I actually teared up a little when somewhere in the middle of the film Russell's character, exiled by his newly found community of marooned outcasts, was caught unawares by his own tears, finally recognizing his human nature and coming to terms with his stolen childhood and realizing that he had been denied the one thing that ultimately makes us human: Love.

I was also pleasantly surprised by my ability to be moved by a simple, action and sci-fi B-movie. Hell, maybe I'm not that old yet. Maybe there is some juice left in me.

But the most important question remains unanswered: Where can I find Blade Runner on DVD?

Thursday, June 29, 2006

Unmanned Brain

I just read something fantastic. Scientists at the University of Florida cultured 25,000 brain cells from a rat on a plate, connected the squishware to a flight simulator, and what do you know, it learned how to control the airplane and return it to straight-and-level flight. This was in 2004. I'm stunned. I would have thought such a finding would have caused a major philosophical and scientific debate, and shaken the very foundations of the current understanding of technology. Even I hadn't heard about it until I read this piece of news .

Mark my words: future computers will be biological. I can't even imagine what will happen when these neural networks computers achieve high levels of consciousness. Of course, this has been a favorite topic of science fiction writers. As always, it's worth reading science fiction to see what the world will be like in the future.

Thursday, May 25, 2006

The Karma of the Brain

They say we only use 5% of our brain at any given time. I believe this to mean that we are consciously utilizing about 5% of our neurons while making our everyday decisions. The rest of the brain is active subconsciously. This has led many people to think that we should seek ways to directly influence our (or someone else's) subconscious mind, by way of meditation, yoga, specific exercises, or marketing techniques. The subconscious, or unconscious, mind has been widely studied by psychologists and psychoanalysts such as Freud, but it escapes definition, and is surrounded by myth and mystery.

To me, the subconscious mind is a far more concrete phenomenon. Intuition resides in the subconscious mind, and intuition is shaped by the things we learn, and by the decisions we make based on the knowledge thus learned. A doctor makes decisions based on hard fact, but often these facts are not conclusive and intuition plays a significant role in decision-making. It's not just a hunch - it's more than that. When I see a patient for the first time, I may get an intuitive feeling of the probable diagnosis, based on the templates of hundreds and hundreds of patients and their illnessess in my subconscious mind. If I make the right diagnosis, the synapses that link a certain attribute to a certain diagnosis or outcome will strengthen and more synapses will grow to connect the tried and true associations in my brain. Next time I see a similar attribute in a case, it will be even more likely that I arrive at the right conclusion intuitively. This is intuition shaped by experience.

I was thinking about this the other day, and it occurred to me that this must be the true nature of Karma. Say we are consciously using just 5% of our brain in everyday decision-making. Just like the development of intuition, the decisions we make become part of the 95% which in turn will shape our future decisions. This means that the decisions we make today will, by molding the very structure of our brain, shape our thinking and decision-making in the future. Our conscious mind does have the final say in making the decision, so by making wise decisions we can shape our unconscious mind and prepare it to drive us to making better decisions in the future. This way we can exercise free will. The decisions we make today will have a meta-effect on the decisions we make tomorrow. In some cultures this is called Karma. Call it what you will, knowledge of these processes helps in regaining control of one's own thought processes.

Our morals and ethics are shaped by our actions, more than the other way around. By doing the right thing today, we are hard-wiring our brain to do the right thing tomorrow, and good things come to those who do the right thing. This is Karma. It's in our brain, in our synapses. It's who we are.

Wednesday, May 24, 2006

Back in Black

Did the quiz on Blogthings. Here's the result. I like it. I love to listen to AC/DC when I'm operating.

Your Theme Song is Back in Black by AC/DC

"Back in black, I hit the sack,
I've been too long, I'm glad to be back"

Friday, March 17, 2006

The Thing That Speaks For Itself

Both of my readers have suggested that I should try and update my blog more frequently. You've asked for it - please note that all negative comments will be deleted.

Quoting Frank Vertosick again, for inspiration:

--
"Operating on the wrong patient or doing the wrong side of the body makes for a very bad day...It means a malpractice case in which the error is so obvious that even a non-expert can see that a fuckup has occurred. A patient falls off the OR table. You cut off the left leg when it's the right one that's gangrenous....A patient bursts into flames during defibrillation....[it's] checkbook time. Just write in a string of zeroes."
--

When you board a commercial airliner, you have about a 1 in 8,000,000 chance of dying in a crash. When you enter a hospital (as a patient), you have about a 1 in 200 chance of dying due to an adverse event, out of which 50% are medical errors deemed easily preventable. You can take comfort in the fact that staying in the hospital is still considered safer than parachute jumping per hour of exposure.

Things could be worse. Consider the tragic case of Jenny:

"Four-month-old Jenny was hit by a car in August 2002. As a California-based malpractice attorney tells it, Jenny's doctor put a cast on her broken leg, assuring her family he had X-rayed the fracture first to make sure everything was in the right place. But after six weeks, a follow-up X-ray brought some ugly revelations: no fusion between the bones, a developing infection -- and the doctor's admission that he'd never actually taken that first X-ray. After getting second and third opinions, Jenny's family decided on amputation. Her condition, however, continued to deteriorate, and she was euthanized."

An attorney with a malpractice law firm in Portland, Oregon, comments on the risks of medical error:

"You do a surgery and there are always going to be risks, but if you have to get your leg amputated and they cut off the wrong leg, that's below the standard of care"

-The Washington Post, Sunday, September 26, 2004 (adapted)


Jenny was a light-brown pit bull mix by the way.
 

Wednesday, February 22, 2006

A Hundred Thousand Years

The comments on the Suicide Blog post build up..someone wrote about childhood, and I started thinking about how times goes by so fast now, and how childhood seemed to last forever. Let me quote a paragraph from Catch 22 by Joseph Heller:

"A second ago you were stepping into college with your lungs full of fresh air. Today you're an old man /../ A half minute before that you were stepping into high school, and an unhooked brassiere was as close as you ever hoped to get to Paradise. Only a fifth of a second before that you were a small kid with a ten-week summer vacation that lasted a hundred thousand years and still ended too soon."

That's just so amazingly powerful writing that I always get chills when I read it.
 

Sunday, February 19, 2006

Defenseless Doctors

Original photo by Stuart

This post was inspired by a post on Richard Winters' blog.

A famous person was admitted. She had a major bleed in the brain. Initially, she had no pulse and was not breathing. She was succesfully resuscitated, and admitted to the neurosurgery ICU. A cerebral aneurysm was found, and operated succesfully. After 2 weeks of intensive care, she regained consciousness, and was discharged from the ICU after 3 weeks. She had almost total amnesia for the first few weeks, and slowly started recovering. She went through extensive rehabilitation and was finally discharged from the hospital after several months.

She recovered extremely well. In fact, she recovered so well that she was able to return to her high-profile work, and she gave several interviews on TV and in magazines. In the interviews, she told the harrowing tale of how she was treated inhumanly in the hospital, how she was forced to lay in a bed with her hands tied down, how she was asked the same questions over and over, and how no one ever explained to her what was wrong with her and what her illness was. How the hospitals are horrible, cold places where patients are stripped of their humanity, how the doctors are cold cynical people who are not sympathetic to the suffering of their patients.

Looking at her interview on TV, we were stumped. Having worked very very hard indeed to bring her back, practically from the dead, then to see her in such good health and at the same time putting us down like that, it was mixed feelings to say the least.

Fact is, she was so demented during the first weeks, and confused for a month or two, that she had to have her hands tied at times so as to prevent her from pulling out her breathing tube or iv's and from injuring herself. Her illness was explained to her every day, often several times a day during that time by nurses and doctors with infinite patience.

Her comments initiated a public discussion (again) of the miserable state of health care, when she was in fact a success story.

And how did we defend ourselves? We didn't. We can't. We are bound by doctor-patient privilege and cannot make any public comment on such matters. We never can. The discussion is always one sided. Doctors and nurses do their job, then shut up and take the heat, move on.

New in the blogosphere: Ask the Doctor Forum

Sleep of the Just


It's not always easy being a neurosurgical fellow...just ask this guy.
 

Monday, February 13, 2006

The Great Fly-Swatter of God

More than a year has passed since the Tsunami. I'm reminded of a patient of mine who lost her whole family in the disaster. I mentioned God's fly-swatter in a previous post, and I tell you, God's been having at it again. For not only did she lose her husband and two children in the Wave, she was later diagnosed with a malignant brain tumor, which means she will join her family within months. And not only that, but she had been treated at our clinic for a difficult chronic pain syndrome for the past 10 years.

Tell me everything has a meaning.

Saturday, January 21, 2006

Update on Ariel Sharon

Well, it looks like Ariel's doctors are determined to turn him into a vegetable. He's been unconscious for more than 2 weeks now, and they're considering now to get him off the ventilator. Reports have it he "may have opened" his eyes once, and his breathing has "improved".

He is an old man with a fatal illness, and should be allowed a graceful death, not lie in the hospital in a vegetative state waiting for that pneumonia or embolism that will eventually kill him, probably within a few weeks.

That's the problem with treating famous and important people. When they seem to receive extra special treatment, what they are in fact receiving is treatment that's not based on medical decision-making, i.e. inappropriate treatment.
 

Friday, January 06, 2006

Ariel Sharon's Brain

I think George Bush should consider some better use for his time than praying for Sharon's recovery.

The reports indicate that Sharon had two brain infarctions, the latter of which was "massive" and hemorrhagic (i.e. bleeding). The doctors operated for 7 hours, "to try and stop the bleeding". This does not make much sense, and I wonder who's doing the operating because 7 hours is an awfully long time to operate. They need to hire a faster neurosurgeon. The longer the operation takes, the more problems you run into. Say someone has a spontaneous bleed in the brain. It should take the 5th year resident about 1.5-2 hours to remove. If there's a hemorrhagic stroke, surgery is not usually a viable option, unless there is massive swelling, in which case you could do decompressive surgery, which basically means removing a huge chunk of bone from the side of the stroke to give the brain more space. Even that's usually reserved for relatively young patients with good chances of recovery.

If you do operate a hemorrhagic infarction, what you end up doing is removing a lot of brain tissue, and battling with endless little bleeds, and chances are the brain is going to look just the same or worse after the operation. It looks like this is exactly what happened, and Sharon was "rushed" back to the OR again friday morning. Another 4 hours of operating ensued. OK, 11 hours of operating I'd accept if they had done bypass surgery, i.e. trying to recover the blood flow by a demanding procedure in which a skin artery is connected to the an artery that supplies the brain tissue.

The reports do not state which side of the brain the stroke has affected. They didn't mention what his level of consciousness was at the time of admission, either. If he was it's the left side, he'll probably never speak again. In any case he'll never walk again. If he was unconscious at the time of admission, he'll never be coming off the ventilator again.

Based on the information available, I'd wager this guy is as good as dead.

Looks like the local neurosurgeons have been doing a lot of futile work on a 77-year old obese man just because he's the PM. I I guess the politicians need something to occupy the public's mind while they're trying to figure out what the hell they're going to do next...

New link on the blog block: Ask the Doc
 

Wednesday, October 12, 2005

Set Your Zappers to Kill

I'm back from what I've come to call my Autumn Limbo where I reside every September-November, until there is at least the slightest promise that the dark fall will turn into bright snowy winter, and Christmas is coming and the days will get longer again.

So, upon the audience's request (both of them), here's my first post in a long time. It's irrelevant, dumb, poorly written, has no informational value, so it's right at home here in the Broken Brain Blog!

Last summer, I was visiting a friend's summer house and discovered a pink device (no, it's not what you think...read on..) which looked quite like a racquetball raqcuet but in place of the string bed there was a shiny metal mesh. There was also an on-off switch on the handle. When I turned the thing on, it made a whining noise. I could think of only one purpose for such a device. They had finally invented the electronic fly-zapper.

It was payback time.

Within an hour I had zapped all the flies in the house and, I admit, a couple dozen in the garden. Hey, I had to get it out of my system. But the best was to come: Imagine the satisfaction of zapping to fiery death the fly that keeps waking you up by buzzing around your head in the morning.

A word of warning though: that thing packs a punch. I had to stick my finger in it, just to see what it was like. I figured, it's only got a couple of 1.5V batteries, how much harm can it do? I mean, you can check the charge on a 4.5V battery with your tongue, right? Well, I forgot some of your basic electronics. The thing is a capacitor. My finger still bears the mark of that painful burn. It was a spectacular way to ridicule myself in front of my friends, though.
 

Monday, June 27, 2005

The Job(s) of Dreams

Inspired by a recent discussion, "Of Dreams and Yo-Yo Diets", on the Not Rocket Science blog, I thought I'd share with you all something pretty amazing. Check it out here. Maybe it will not change your life, but if it did, it would be no bad thing. 

Friday, June 24, 2005

That's the way I wanna go


Last night, on call, I invented a new medical term: Exitus poeticus. Here's the story.

An old lady was admitted in the afternoon. She had always been in very good health, and was celebrating her 90th birthday with her friends and family. She was standing there among her loved ones, holding a glass of champagne. Suddenly, without warning, she collapsed. Someone called an ambulance, and she was rushed to the ER. Upon admission, she was not reacting to pain, and her blood pressure was low. I did a CT scan: a massive brain hemorrhage. Her closest ones came in to see her, and held her hand while she passed away peacefully.

What better way?
 

Friday, May 27, 2005

Russian Radiation Makes Smarter Kids?

In a recent post, Boing Boing refers to the so-called news that children who grew up in the radiation-affected areas in Chernobyl are smarter and healthier than their counterparts. As their scientific source, they quote - the tabloid newspaper The Sun! The original piece is here. (See Below for Cory Doctorow's comment on my post)

Hey, it's even in the Pravda, so it must be true! Pravda, after all, means "The Truth". Here's what it says about living close to the radioactive wreckages of strategic bombers: "Local residents collect metal scrap there, hunt for hares and pick mushrooms. Children enjoy playing on the territory behind barbed wire." Idyllic! Here's what the Pravda says about the Chernobyl children: "They have better reactions; their brain activity is more active as well." They quote one Professor Vladimir Mikhalev from Bryansk University. Sounds like Good Old CCCP propaganda - in the old days, Vlad would be on his way to receive the coveted Hero Of The Soviet Union medal, I'm sure.

This is all, of course, complete horseshit. We know that radiation damages the brain, especially the young, developing brain. Even relatively small doses of radiation (say, repeated CT scans) can cause a drop in the cognitive abilities of children, see BMJ article.

Because this happened in Russia, facts are hard to find. We know that after the Chernobyl incident, 300,000 people were relocated, and the incidence of thyroid cancer in children has increased, see Radiation Research.

PS. Looking at what's happening in Russia right now, and considering Putin's popularity, sometimes it seems the Russians are trapped in some sort of Soviet nostalgia. They are erecting statues of Stalin again, hey he only exterminated what, 50 million people, they refuse to acknowledge let alone apologize for the WWII atrocities they were guilty of (can you say Baltic countries, East Germany..). All they do is celebrate their greatness. Look at Germany - that's a nation come to grips with its past, and they've earned due respect for that.

Updated Jun-01: I got an email from Cory Doctorow, one of the editors of Boing Boing, he clarified that he did not think the above to be true, but considered it interesting from a science-fiction-writer point of view. I couldn't agree more!

Saturday, May 21, 2005

The Suicide Blog




This will hopefully be my last post on the subject matter (no, this is not a suicide note...)

As I mentioned in a previous post, my blog has inadvertently become something of a target for people looking for ways to kill themselves. I logged in on my website statistics page, and found out that most of my traffic came from google searches such as "how do I kill myself" and variations thereof. The phenomenon was even featured on the New Links daily linkage web site.

It's nice to have some traffic, but it makes me feel kind of creepy to think that as I write, these very entries are being read by desperate people all over the world who are determined to end their lives. It also makes me sad. So I figured I'd try and gather from my readers a collection of reasons why these people shouldn't kill themselves. The catch: I don't have that many readers, and most of them want to kill themselves anyway, so my collection hasn't exactly exploded into a treasury of reasons to cherish life.

Now I'm starting to fear that this blog is becoming so depressing that sooner or later the rest of my readers will want to kill themselves, too.

I wouldn't want to be remembered as the blogger who caused a mass suicide.

So here is my collection of reasons not to kill yourself. All three entries. Thank you mmChronic and Ian for your contributions. The first entry is by me.

Reasons Not To Kill Yourself:

Consider this: If you've reached the point where you are determined to die by your own hand, you have nothing left to lose. So I ask you to do just one thing: Talk to someone first. A friend, a neighbor, a doctor -- if you feel you don't have anyone, just call someone you've known in the past. If someone's hurt you, call them and let them know how you feel. If you're feeling guilty and dirty, confess to someone. We all have our secrets, our shortcomings. You may think you're a dirty, failed person, but in fact you're probably just average in that respect. If you're in pain, talk to a doctor. Pain can be treated. So: talk to someone. The internet is not a substitute for a living, breathing human being.

The decision to kill oneself is sometimes vindictive. A means of revenge, a malicious act, aimed at hurting others. The realization of a selfish, desperate need to have power over others. That power is fleeting: As Ian pointed out, suicide leads to nothing but a reeking corpse and oblivion. Instead of achieving the ultimate victory, you will suffer the ultimate defeat.

Finally, to expand on the pragmatic approach I took in a previous post on this blog:

We have the power to end our own lives at any given time. Therefore, if we choose not to do it now, we will always have that option later. We can take comfort in that -- no one can take that option away from us, and therefore it's not absolutely necessary to do it right now. We can always postpone it, and still keep that option. So - don't do it now, because it's final. If you're certain you've exhausted all the other options, it just might be worth waiting a little longer to see what happens. You have had happier times - life happens in cycles, and you will see better times again.

-Stuart


Why not? Because millions of people throughout history have died fighting to earn or defend the rights and prosperity we seemingly have thrust upon us, and which we often take for granted.

Also -- another reason not to kill yourself is because suicide is often wrongly romanticized. For instance Kurt Cobain or Hunter S. Thompson did it, and so the people who idolized them in life begin to idolize their death as well. But we have to take death for what it is -- a cold, bloody extinction that leaves a rank odor of decomposition in its wake. Try this: if you can go to the library and read about the Spanish Inquisition, the Holocaust, the Cambodian Killing Fields, the Rwandan Genocide, etc. and think to yourself, "Wow, that's glamorous! I would love to die like those millions of poor saps!," then, perhaps, your death wish carries some credence. But if you're like the other 99.9999% of people suffering suicidal ideation, you'll see the horror of such historical atrocities, and that deep-seated revulsion towards death will provide you the answer to whether or not killing oneself is a viable option.

-Ian


Though totally frivolous the fact there's new gaming hardware like Xbox 360 and the PS3 are just around the corner shoud be enough to keep a gaming freak from suicide for a few months yet. ;)

Oh and it's spring - yay!

-mmChronic
 

Thursday, May 19, 2005

Upgrading to Tiger - How To

Mac OS X 10.4 Tiger upgrading instructions for idiots. (Hey, it worked for me!)







Very much off-topic here, so if you're a PC user, do skip this post and read about nasty brain injuries and such elsewhere in the blog -- but if (like me) you are hooked on your Mac, and (like me) completely dependent on it, if (like me) you have your whole life organized by iCal and (like me) make all your presentations with Keynote, you'll appreciate the gravity of this topic. And, if (like me) you don't actually know what you're doing, you'll need some really simple instructions.

Here's a how-to-upgrade-to-Tiger-and-suffer-only-minor-stress-related-brain-injury guide, courtesy of The Broken Brain

1. Spend hours and hours surfing the web in search of foolproof instructions.
2. Spend more hours wondering whether it's worth the risk.
3. Waste another couple of hours wondering if you're actually going to do it. Wasted hours, because resistance if futile. Of course you are.

Alternatively, you can skip the above mentioned steps, because I've already done all of that for you.
I have a G4 12" iBook, and a LaCie 160 GB external firewire hard drive, and I wanted an "erase and install" because that's supposedly the way to get the best results, and because the Tiger installation program will give you the option of restoring all your programs, users, settings, documents, etc from your backed-up system after the install, and after the installation and restoration, my Mac looks and feels exactly the same except that it runs Tiger now with all its new features. So this is what I did:

Before you start, you may want to check some other pages written by guys who know what they're talking about:
No such thing as clean install?
TUAW on upgrading

WARNING: Do make sure your backup works, make several, do whatever you need to do but make sure your important files are definitely backed up, bombproof like, totally securely backed up, on DVD, CD, written down, engraved in stone, whatever. Because after a clean install everything will be lost from your machine's internal hard drive. Also - I can't guarantee this works for you. I can only say it worked for me.

1. Make a backup of your system first, start by downloading Carbon Copy Cloner.
2. If you don't have a firewire external hard drive, go buy one. If you can't afford one, ask a friend over for a beer and exploit the situation by using his/her Mac as an external drive, connected by firewire. Then make a partition which is at least the size of your internal hard drive. Name that partition "Panther" for clarity.
3. Format the partition using MacOS Disk Utility (Applications->Utilities). Select the "Panther" volume, and choose "Erase". Choose the option "Mac OS Extended (Journaled)".
4. Now, select the "Panther" volume on your external hard disk, and CTRL-click it, then select "Get Info". Look at the bottom. Make sure the box called "Ignore Ownership on This Volume" is NOT CHECKED. If it is, uncheck it of course.
5. Use Disk Utility to "Repair Permissions" on your internal hard drive.
6. Safe-boot your Mac (restart and hold SHIFT key). After that's done, do a normal restart.
7. Start Carbon Copy Cloner and make a clone of your system to the external hard drive volume "Panther". Follow the Carbon Copy Cloner instructions, and make sure you check the "Make bootable" option.
8. When that's finished, boot your system from the external drive. You can achieve this by holding the "alt" key while restarting and then selecting the appropriate volume.
9. If your machine looks and feels completely normal when booted from the external drive, you have succeeded.
10. Restart normally, boot from internal drive.
11. Insert Tiger installation DVD. Choose the Erase and Install option.
12. After that's done, choose the Restore From Another Mac option. You have another Mac - that's the backup of your Panther on your external drive. Choose restore from there and let the setup program work its magic. Takes a long time so go out and look at the sunrise because "you never saw the morning 'till you stayed up all night" (Tom Waits).
13. Once it's finished, that's it! You should have a Mac that looks and feels just like your own Mac, files, programs, users, Network preferences and all, just running Mac OS X 10.4
14. Go to "about this Mac" to admire the version number. Then hit "software update" and upgrade to 10.4.1.

Good luck,
Stuart
 

Tuesday, May 17, 2005

Why Shouldn't I Just Kill Myself?

I logged in to my web site statistics counter, and was mildly shocked to learn how people have found my blog recently. Most folks find their way here via a google search, and by far the most popular search was something along the lines of "how to kill yourself". Here's a list of some searches that led people to the Broken Brain:

"best way to kill yourself" -USA
"how to kill yourself" -Britain
"suicide how not to kill yourself" -USA
"how to kill yourself with a shotgun" -USA
"ways to kill yourself" - Canada
"shotgun brain alive" -USA
"how to kill yourself with medicine" -Japan
"how to kill yourself with alcohol" -USA
"cool ways to kill yourself" -USA
"succesful ways to kill yourself" -USA

..and there are lots more. But, I mean, COOL ways to kill yourself? Hell, I guess if you're gonna go, might as well go in style, right?

On a more serious note, it's not the sort of publicity I was hoping for, but it's there, and it's relevant to the title of my blog, and I've decided to take some action. I want to make a permanent link visible near the top of this page to address the issue. I want to link it to a post which will hopefully include many good reasons NOT to kill oneself. For this, I need your help, and I ask to you contribute by leaving a comment to this post, and tell us why we should choose to keep on living. To get the thought process going, you can start by reading a related previous post called Analyze This.

So, question of the day: Why should I not kill myself?

Well, don't just sit there! Get typing!

Sunday, April 17, 2005

Cutting Away The Anxiety

Greetings from the snowy mountains. I could have stayed forever.


I promised to write a bit about self-mutilation so here goes.

As a surgeon, I'm no stranger to cutting, but I try not to cut myself. OK, so I've removed a mole from my skin under cognac-swig anesthesia, and sutured a wound or two, but that's about it.

I remember a young woman who came to see me when I was working as a GP in a public clinic. She had cut herself with a kitchen knife, just superficial cuts, in the wrists, and stomach area as well. Dozens of cuts. This was no suicide attempt; suicide by self-cutting just doesn't happen that much, with the exception of the Japanese. She told me she was under tremendous stress. After listening to her story, I almost started cutting myself.

She had lived in Africa for the past three years, working for an aid organization. There she had fallen in love with a local man, and they had decided to adopt an orphan child. The child had HIV. They brought the kid home with them, and had only returned from Africa a few months ago. The HIV disease of their child had progressed to the point where he had to get treatment, and both parents were unemployed at the time, and it was hard for them to make ends meet. What do you know, as soon as he gets resident status, the guy takes off. He found another woman and moved in with her. My patient was left alone, unemployed, living in a small, cheap apartment, unemployed, with a child who had AIDS.

I've often wondered what goes on in the head of someone who decides to commit suicide. The anxiety must be so strong, it becomes unbearable just to exist from one second to the next. At that point, when existence itself becomes the problem, it seems only reasonable to want to cease to exist - there's no choice, really. This is a medical emergency, and if there is no help available stat, the result is suicide.

My patient wanted to live. She had severe anxiety, and had tried to alleviate it with medication, psychotherapy and hypnotherapist. She found a way to ease the anxiety. She found that physical pain worked as a diversion. She started cutting herself - as long as there was physical pain, she found it possible for her to keep existing. It came to the point where she had to cut herself constantly. That's when she decided she needed to talk to a doctor. She told me all this in a perfectly calm voice and reasonable manner, and her actions, to me, seemed quite logical, and there was no evidence of psychotic thought processes or anything like that. I believed her. I gave her a good dose of Valium and arranged a psych consult. She seemed immensely relieved just to have someone else take the responsibility (or maybe it was the Valium).

It's not easy being homo sapiens sapiens. Too much cortex.

Monday, March 21, 2005

Broken Brain Maintenance

Time to take this ol' brain out to get some fresh air. I'm going skiing, will be back Apr. 7th, check back then for more posts. Meanwhile, take care of your brains

Cheers,
Stuart

Wednesday, March 16, 2005

Analyze This

Self-cutting is next, promise. But this is more pressing: I just had a long tete-a-tete with a patient of mine who's had suicidal thoughts lately. He's an ex-athlete, ex-alcoholic, who's suffering from, among other things, a bad case of depression. What can I do about it, other than start him on antidepressants? Nothing much. He needs serious treatment right now, but the only way to get the psych department interested would be to convince them he's gone completely bonkers and thinks he's the President of Romania or something. Well, you know, he's just a guy who's depressed. I tentatively asked him whether he might entertain the notion that he's the President of Romania, to which he suggested that I should go see someone myself. I think he's probably right. Know any good shrinks?

He said he's come this close to doing the deed a couple of times, but that his love for his family keeps him from doing it, for now. So we made a deal: If he does decide to chuck up the sponge, he will call me on my cell first, just to let me know he's going for it. He gave me his word, we shook hands on it, and I think he's the kind of guy who will not go through the embarrassment, even posthumously, of not having kept his word.

Another thing I usually tell my suicidal patients: We have the power to end our own lives at any given time. Therefore, if we choose not to do it now, we will always have that option later. We can take comfort in that -- no one can take that option away from us, and therefore it's not absolutely necessary to do it right now. We can always postpone it, and still keep that option. So - don't do it now, because it's final, and you should definitely look at the other options first.

Of course, the rational approach often fails, especially when the depression is so deep that it's beyond the reach of any rational thought. But a couple of times I've found I've managed to get my point through.

I'm no shrink, and I wouldn't mind some more ammunition for these encounters. So help me out: What would you tell someone who's contemplating suicide?
 

Tuesday, March 15, 2005

How NOT to Kill Yourself


I'm in one of my disillusioned moods again, so if you do choose to read this, be warned: it's cynical. This is stuff you don't need to know. This is the kind of talk doctors engage in when they've had an overdose of psych patients...

Before proceeding to read this, check the instructions on how NOT to kill yourself with a shotgun, look here. If you're still interested, read on..

There are various ways to kill yourself that I wouldn't personally recommend. For instance, dousing yourself with gasoline and setting yourself aflame is generally a bad idea. Chances are you'll survive, but lose most of your skin, and end up looking really freaky, after a couple of months of extensive surgery and intensive care.

If cordless bungee jumping is your idea of a cool exit, do make sure you do it from at least the fifth floor. Second floor is just not high enough. Again, with surgery and intensive care, you'll be discharged in a couple of months, a cripple with brain damage.

Valium is the classic suicide attempt drug -- with an emphasis on the word "attempt". I haven't seen any successful Valium suicides. You'll end up sleeping real sound, and eventually taken to the ER, where a world-weary doctor, rolling his eyes, will stuff charcoal into your brand new stomach tube. You'll be discharged after a psych consult. As an emergency medicine teacher once told me in medical school, the only way to kill yourself with valium is to stuff so much in your mouth that you choke on it. However, successful cash-ins have been made with a mix of Valium, alcohol, and perhaps some antidepressants thrown in for good measure.

Throwing your house of dust in front of a moving vehicle will not guarantee a one-way ticket to eternity. More often than not, what you get instead is a round trip to the OR and intensive care again, and go home to an even more miserable life than before.

[edit] Added 2009-08-09: Before you take any drastic action, please see this if it's the last thing you do:
http://www.youtube.com/watch?v=XnuAyFCZjdA

Coming up in The Broken Brain: Self-Cutting. Stay tuned, but only if you really want to read about it..
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Tuesday, March 08, 2005

Kills the Body First


Today I told a lady that she will die, but first she will waste away. I gave her the news that she has ALS. Also known as amyotrophic lateral sclerosis or motor neuron disease, this is a major bummer of a diagnosis: On average, the patient will have 3-5 years to live, during which time she will lose her ability to move. Her mind, however, will stay clear. Eventually, she will lose control of the muscles that she uses for breathing, and unless she has a tracheotomy done and put on a ventilator, she will die. She told me straight off she'd rather be killed than dependent on machines. I said nothing. As I've said before, all of medicine is about probabilities, not absolutes, so I can't tell her when she will die. Some die within a year. Some, like Stephen Hawking, continue to lead very productive lives for decades. Prof. Hawking is, of course, a rarity in many respects.

ALS kills the body first. The ALS Society of Canada has launched a public service ad campaign, entitled "What would you do, if you still could?". Check out the video clips. Then, ask yourself that question. Rephrase it: What will you do, while you still can? I think we all need to ask ourselves that question - every morning.

Again, a reference to cinema: In Saving Private Ryan, Capt. Miller, dying, tells Ryan: "Earn this." Miller and most of his men gave their lives to rescue this man, and he tells private Ryan to make it worthwile. What will you do to make your life worthwile?
 

Friday, March 04, 2005

Rules of Neurosurgery

Excerpt from When the Air Hits Your Brain by Frank Vertosick:


"Rule number one: You ain't never the same when the air hits your brain. Yes, the good Lord bricked that sucker in pretty good, and for a reason. We're not supposed to play with it. The brain is sorta like a '66 cadillac. You had to drop the engine in that thing just to change all eight spark plugs. It was built for performance, not for easy servicing."

"Rule number two: The only minor operation is one that someone else is doing. If you're doing it, it's major. Never forget that."

"Rule number three applies equally well to the brain patients and to the spinal disc patients: If the patient isn't dead, you can always make him worse if you try hard enough. I've seen guys who have had two discs taken out of their backs and begged us for a third operation, saying that they had nothing to lose since they can't possibly be any worse than they are. So we do a third discectomy and prove them wrong."

"Rule four: One look at the patient is better than a thousand phone calls from a nurse when you're trying to figure out why someone is going to shit. A corollary: When dealing with the staff guy after a patient goes sour, a terrible mistake made at the bedside will be better received than the most expert management rendered from the on-call-room bed or the residents' TV room."

"Rule five: Operating on the wrong patient or doing the wrong side of the body makes for a very bad day...otherwise it's a res ipsa...short for res ipsa loquitur, or 'the thing which speaks for itself'. It means a malpractice case in which the error is so obvious that even a non-expert can see that a fuckup has occurred. A patient falls off the OR table. You cut off the left leg when it's the right one that's gangrenous....A patient bursts into flames during defibrillation....Res ipsa is checkbook time. Just write in a string of zeroes."
 

Wednesday, March 02, 2005

On the Button

The Broken Brain now has its own button:
You can use this button for linking to my blog if you wish. Thanks again to the boys at New Links for help, and to Brilliant Button Maker for the utility.

Tuesday, March 01, 2005

Pain Treatment With Benefits


Sometimes a treatment may have unexpected effects. This month's award goes to the young woman who was referred to us because of her chronic pain syndrome. This is one hell of a condition, it frequently drives people to the brink of suicide --and many take the big leap.

One of the treatment options for chronic pain is spinal cord stimulation. An electode is placed against the spinal cord and a small current is applied to stimulate the fibers in the spinal cord that mediate signals of pain. A pacemaker is then implanted under the skin to generate the electrical current. The patient may then turn the current up or down with an external remote control device. About half of the patients benefit from this treatment.

Not all benefit as much as this young lady. She came in for a follow-up and was quite happy with the pain relief. Blushing a little, she said that there is another effect, which she hadn't mentioned to anyone before. The effect was this: Every time she turned on the device, she experienced repeated orgasms. We concluded that things could be worse and decided not to change anything - after all, the stimulator eased her pain considerably so the treatment was a success.

She was our first patient to experience this, but a literature search did reveal reports of similar cases. Outside of medical literature, ABC News Houston ran a related story last september. Sound like just the thing for you or your girl? Volunteers wanted.

I was immediately reminded of the 1970's Woody Allen movie, Sleeper, where the Orgasmatron was first introduced. A rather clumsy device, that, like a phone booth. The famed Australian high-tech industry has developed a budget version.

I've thought about orgasms a lot (haven't we all). Specifically, about the neurobiology of orgasms. I find it intriguing that we have a built-in neurochemical mechanism to produce the ultimate high, the biggest rush of all. Without using any recreational chemicals, we can produce a storm of endorphins to match and surpass the effects of even the strongest drugs. The biggest kicks from drugs are often compared to orgasms. The implication is this: Since we have this inherent ability, it follows that we are capable of producing the effects of the strongest painkillers, and possibly other medicines as well.


 

Brainy Icon for Technorati Users

Our friends at New Links have dreamed up this brain icon, tailor-made for The Broken Brain. You are free to use it, visit New Links for instructions.

Cheers,
Stuart

Thursday, February 24, 2005

Sins of the Mind



I saw this movie on TV when it was released, in 1997. One of those utterly forgettable made-for-television-films. However, two years ago there was a case which brought this movie back to mind. A young woman, with a large aneurysm, very difficult to treat. The aneurysm had ruptured twice, and it seemed likely it was going to bleed again. Every time a brain aneurysm bleeds, there is a 50% chance of instant death. So something had to be done. She underwent three operations, the aneurysm was approached from both sides, and finally it was successfully clipped. Unfortunately, the procedure resulted in damage to both of her temporal lobes.

As a result, the young lady started behaving oddly during rounds. She started exhibiting uninhibited sexual behavior, speaking in a suggestive and seductive manner, as well as touching and grabbing male doctors. I started dreading the morning rounds because it was always an awkard situation. How to respond? Getting angry or reprimanding her was useless, because she did not consciously think she was doing anything wrong. Nonchalance was the only way to deal with it, and that seemed to work reasonably well.

She was suffering from Kluver-Bucy syndrome, a condition caused by bilateral (both sides) temporal lobe injury. She was eventually discharged from our unit and transferred to another hospital for rehabilitation, but to this day I don't know how she recovered. It would be interesting to know whether she was finally discharged and returned to normal life, and whether the hypersexuality persisted, and how she manages with it. Now that I think about it, I'll try to find out, and if I do, I'll let you know.

Cheers,
Stuart

 

Kids

Continuing on the topic of internet, check this out. For more information, read this article.


No surgery today, but a big presentation tomorrow, and you know how it is, haven't even started working on it yet. Must be a universal law: Presentations cannot be prepared until the night before..

Cheers,
Stuart

Wednesday, February 23, 2005

Revolution, finally

An off topic entry in my electronic diary, but I've noticed recently that the internet is finally changing for the better. I've been using the internet since 1990 or so, and although I'm only semi-literate when it comes to computers, I've kept myself somewhat up-to-date on what's going on.

Some years back the WWW started going downhill big time. At first, when Google appeared it was a great thing - but these days, the first 20 or so results are not what you need but commercial sites that exploit the way google works.

Now this: blogs. The world wide web is exploding, and it's becoming again what it was originally intended to be: A web of freely flowing information, where everyone has an equal opportunity to publish. The result? Blessed anarchy. The commercial powers are losing the game. People are linked to people, individuals are expressing themselves, and finding each other. And what creativity, so much talent!

And the search engines? Google is still great for finding the most relevant sites, if you know which keywords to use and which ones to avoid. But Google is not up-to-date. Many blogs (even Blogger blogs) are not found by google at all! And niche sites with few references to them are hard to find. Yahoo search is much better for bypassing the google-optimized commercial sites, and also for finding new stuff, recently published blogs, etc. Then there's Technorati of course, a great search tool for bloggers and their readers.

Having said that, Google scores big time with a new innovation again. I just got a gmail account, thanks to Dan. My first impression: this is how e-mail should be. I hope it will become available to everyone soon.

The commercial powers are looking to dominate the blogosphere, for sure. But I have a feeling we are making history now. The world of information is changing, and bloggers are the pioneers.

I know that all of this is probably yesterday's news to any hard-core bloggers out there, and that the whole phenomenon has already been analyzed to death by greater minds, probably sprouted a few Ph.D. dissertations, too, but I felt like writing this down anyway.

P.S. Thanks to New Links for the Technorati icons.

Tuesday, February 22, 2005

Breaking the Taboo

Breaking the Taboo


I'm feeling pretty good today, so for a change I reward what possible readers this blog might have with a post they won't have to cringe at..

Most people (including most neurologists) think of the brain as untouchable. We neurosurgeons don't claim to comprehend the inner workings of the brain (here's where you turn to the neurologists and psychiatrists) -- but we are manual workers, and for us the brain is accessible. We know that the brain is modular. We know that we can touch the brain, even remove parts of it, and we have a pretty good idea what it will mean to the patient. By modular I mean that the brain is not some complex neural network where everything is interconnected and nothing can be touched without damaging the whole network. For instance, if I remove someone's occipital lobe, I know that the person will suffer from partial loss of vision, but otherwise he will be the same as before. If I remove a cancerous tumor from the motor region representing the left hand, I know that there is a risk of paralysis of the left hand, but that's it - the person will be the same otherwise. I know that I can remove a part of the frontal lobe without any noticeable changes in the individual's personality or physical performance. This is what makes brain surgery possible. We know what will happen to the patient if some part of the brain is damaged, and we know what will not happen. And with modern techniques, such as microsurgery, we can access any part of the brain causing minimal or no damage.

Certain regions of the brain are especially important to daily living. We call these the "eloquent" brain areas. These include the speech, motor, and visual areas. If there is even the slightest damage to eloquent brain tissue, the results can be disastrous to the quality of life of the individual. We think twice before operating in these areas. Other regions of the brain are more redundant. Take the anterior (front) part of the temporal lobe, for instance. Removing nearly the entire temporal lobe on one side will cause no harm to the patient. Not even a skilled neuropsychologist can detect any changes after a succesful temporal lobe removal.

The ancient motto of the medical profession is "Primum non nocere", which means: First, do no harm. This is the ultimate test for the neurosurgeon: Often we need to do harm in order to heal. We must decide whether the benefits are greater than the harm done. There are great risks involved in brain surgery, and the difference between success and disaster is literally microscopic.

Inevitably, great failures happen. The most difficult part of being a neurosurgeon is learning to live with one's failures. When a disastrous complication occurs, and they do, the burden is great. The patient was in my hands, and whatever happened was the direct consequence of my actions, and the responsibility is mine alone. The way I've learned to live with it is by the realization that all of medicine is about probabilities, not about absolutes. There is always a certain inherent element of failure and misjudgment, which can never be eliminated.


 

Sunday, February 20, 2005

Assorted Objects in the Brain


174golf1
Originally uploaded by Ressler.
Never mess with a golfer who's had a subpar day. This unfortunate fellow has had a 9-iron introduced to his brain.

People tend to be imaginative when it comes to dealing injury and death. One of my patients presented with a crossbow arrow shot through the eye. By a jealous boyfriend, what else is new. Another one was unexpectedly hit with a large axe in the back of the head, by an unknown person, just randomly. We did operate and he lived through the first week but the damage was too great in the end. Another one refused to offer a cigarette to a stranger and was rewarded 15 minutes later by a baseball bat in the head. The attacker had walked into a store and stolen the bat, then returned to deal punishment.

That cheer you up? If not, here's a wonderful story. There was a man who according to our hospital records attempted suicide 18 times. He wasn't very good at it. On his 12th or so attempt, he was hospitalized and admitted to a ward, which is located on the 12th floor. Like a true pro he immediately saw the unique opportunity and jumped out of the window, only to have his leg caught in the balcony railing right below. The leg was badly mangled and he spent another couple of months recovering from extensive surgery. Then, a couple of years later, someone pointed out that he hadn't been admitted recently. To this day there has been no sign of him so he must have finally succeeded.

Okay, I promise I'll try and post something more uplifting soon....

 

Saturday, February 19, 2005

Knife in the Brain


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Originally uploaded by Ressler.
The image here is from the internet. I'm not posting scans of my own patients - even without the identification removed it might violate their rights somehow. Anyway - I've seen a case almost like this one, but my patient had a knife through the eye. Her boyfriend had pushed a very large bread knife into her head while she was sleeping. All the way up to the handle. She was brought into the ER with a knife handle protruding from her eye. We took her in the operating room and did a craniotomy, i.e. opened the skull, pulled the brain aside a bit, and retracted the knife while making sure that the blade didn't damage any blood vessels or the sensitive cranial nerves such as the optic nerve. The operation was a success, and she recovered very well.

A colleague of mine had to go to court to testify. He came back extremely pissed at the defense attorneys demanding to know whether my colleague could say for 100% sure that the man hadn't had second thoughts while pushing the knife and eased on the pressure feeling remorse, which they felt he had done and therefore the court should show lenience. Load of crap if you ask me.

We doctors are generally reluctant to go to court to testify, because the lawyers seem to ask trick questions all the time and it seems they exist in some other reality compared to that which we see in our line of work.

 

Monday, February 14, 2005

Dead or Alive? part II

A handy reminder that your days are numbered: Deathclock

For instructions on how NOT to kill yourself with a shotgun, look here.

A couple of anecdotes that you may or may not find amusing:

When a doctor is on call, he is from time to time required to go to the ward to determine death. A med school buddy of mine was doing just this in the middle of the night, when the patient suddenly sat up and demanded to know what the hell was going on. The good doctor had walked into the wrong room. It's also a good idea to double check that you've got the right patient file when you write down the time of death. There's nothing quite as embarrassing as discharging an officially dead person who's feeling just fine.

You may encounter surprising technical difficulties: Another classmate from med school was on call in a rural hospital, and was paged to go down to the morgue to determine death and to do a cursory forensic examination. They'd already placed the corpse in the refrigeration unit. You know the type, with the end-opening drawers. Well, he pulled out the container, which was located at shoulder-height, and, as it happened, the body was that of a very obese woman, and what do you know, the body rolled off the tray and fell on the floor. As an intern, he was too embarrassed to call for help, so he spent a good part of the night wrestling the ample cadaver back onto the tray.

My own morgue-at-night story is rather less amusing (it would be, wouldn't it). I was on call, years ago, in a small hospital up north. It was September. I remember that, because it was moose hunting season, and that's integral to this story. Word came that a woman had been shot. She went straight downstairs (that's where the morgue was), D.O.A., or should I say S.T.H.O.A. (Shot To Hell On Arrival). I unzipped the black body bag and, oddly enough, the smell of strawberry yogurt was the first thing I noticed. Pretty soon after that I noticed that there was a gaping hole in the woman's chest. There was a yogurty substance splattered all over, amidst the blood. She had a neat hole in the back. The next thing I noticed was that she was one of our nurses. According to her husband (whom I saw right afterwards), he'd been cleaning his rifle when suddenly it discharged and the round hit his wife who'd been baking in the kitchen. No mention of yogurt. I didn't buy his story. He said he was a skilled marksman (so it seemed) and had killed four moose that day (and one wife, I didn't add). He had alcohol in his blood. The police took him for questioning, and he was later tried for manslaughter. He walked.

This case will stay with me for the rest of my life, because I like to eat yogurt. Smell is a powerful reminder.
 

Dead or alive?

The boundaries that divide Life from Death are at best shadowy and vague.
Edgar Allan Poe: Premature Burial (1844)

According to this article, a hundred billion people have been born. Out of those, about a hundred billion have died. We the living are here but for a fleeting moment, mere links in the great chain of human existence.

I'm still in a morbid mood. So this is going to be another one of my more-or-less existential posts.

One of my patients joined the Air Force last night. Good for her, given the circumstances. She was in her eighties, paralyzed and couldn't talk. She was barely conscious, with no hope of recovery. Another one is silently waiting for death. He won the Jackpot this year: metastasized pancreatic cancer plus a massive stroke. I've been giving him as much morphine as the nurses can carry. Finally this morning he seemed free of pain. I was happy about it. The morphine will expedite his vacating the runway, but he's had the clearance from Heavenly Air Traffic Control for some time now anyway.

Ever wondered how you can tell for sure whether someone is dead or alive? It's not always easy, you know. If the head is separated from the body, it's a pretty straightforward diagnosis. Sometimes it can be tricky though, and for laymen I imagine it might not always be obvious. Generally, the dead do not breathe, they do not have a pulse, and they don't react to anything at all. If you find someone who fulfills these criteria, chances are they've cashed in their chips. Should you start CPR, then? If you see a person collapsing and then find out that they don't breathe or have a pulse, go for it. But if you find your 90-year-old grandmother in said state, you'd be wasting your time. If you notice signs of rigor mortis, meaning the body is rigid, they've been dead for several hours and beyond the reach of any Earthly medicine.

Speaking of the Beyond, there is something called the "Lazarus phenomenon". That's when CPR (resuscitation) is deemed unsuccesful and therefore ceased, and after a while the patient gets spontaneous circulation and starts breathing. It's very rare, but it happens. When a patient is brain dead and moves spontaneously (due to spinal cord reflexes), that's called a Lazarus sign. We see that sometimes in the neuro ICU. Another tricky situation is hypothermia. There's a medical adage, "nobody is dead until they're warm and dead". Which is to say, severely hypothermic patients may recover after surprisingly long periods of apparent death, once warmed up. So maybe Mr. Poe was right.

I've seen many deaths. It doesn't bother me much anymore. We doctors builds a huge defensive psychological wall around ourselves, and the most terrible things can bounce off our psyche like rubber balls. It has its disadvantages, though. Sometimes we may appear "cynical" when we really are not, it's just a mechanism of preserving our own mental health. Someone's death or suffering still affects those caring for them, and sometimes the defensive bubble is filled from the inside, and when it overflows, I sit down and write a new morbid post in my blog.

Death can be a good thing, like for the patients that I mentioned above. Sometimes though, it's terrible. The death of a child is always hard to take, and accidental deaths involving several family members are the worst. The Tsunami, of course, was the ultimate random death-dealer. I treated some of the victims, and talked to their close ones. Was not fun at all.

Things happen so randomly. An orderly gets squeezed to death by a trash can in the elevator, a child drowns in knee-deep water, a youngster gets killed by snow falling from a roof. Never know what's gonna happen, and to whom it's gonna happen. I call it the Great Fly-Swatter of God.

Right now I'm acutely aware of my own mortality (writing this post sure didn't help). When will I kick the bucket, buy the farm, throw in the towel? These euphemisms bring to mind my personal favorite, translated from another language, "throw the spoon in the corner". It's absurd. Just like life and death.

So it goes.
 

Saturday, February 12, 2005

Deadeye Dick

A man walked into the ER. Complaint: Headache. Nil else of note. Well, you walk in through this door, you're gonna get scanned. Here's a surprise finding: a bullet in the brain. A large one, too. This one requires a closer look. Measurements: 7.62 mm x 39 mm. I've done my military service, and I know what THAT means. Time to interview the fellow a bit. Yes, by the way, I was shot in the head in Somalia a few years back. It seems there had been some kind of riot, and this man had been doing some shopping in the marketplace when he was suddenly hit by a round. The entry point was at the very top of his skull, and the CT scan showed that the bullet was located in a fluid compartment in the back of the brain, sharp end pointing straight downwards. A shot in the air amidst the riot, the gravitational parabola, a chance in a million, and this guy gets it straight in the head. Other than dropping his bananas, he had seemed fine. No brain could survive a direct encounter with the business end of an AK-47 assault rifle, but this particular round had taken the high road. I'm secretly a geek, and I get fascinated by stuff like this. So I made some calculations. Based on the conservation of energy principle, a bullet like this shot straight up would climb to 24,500 m (80,000 ft), and come back down at the original muzzle velocity, 700 m/s (2300 f.p.s.). But that's not true because air resistance slows it down both ways. It seems the Army geeks have been puzzled enough by this and conducted some experiments, and found out that the actual downward velocity of a similar bullet would be about 90 m/s (300 f.p.s.). It seems that's enough to pierce the skull, but the energy is low enough to make survival possible.

Headshots are nasty. Often there's just a neat little hole on the outside, but on the inside, it's a mess. We see quite a bit of them here. Some murders, some of them execution-like, but mostly self-inflicted, with a .22 caliber pistol. The problem with the .22 is that the energy is low, and the victims often survive initially, and as a result are operated on and spend days or weeks in the intensive care unit. Eventually most of them die (which is generally the intended outcome when one chooses to shoot himself in the head), but some survive to find their lives even more miserable than before. Sometimes it seems kind of futile to desperately try to save them, since they didn't want to live anyway. I wonder if anyone has ever sued their doctor for saving their lives after a suicide attempt? Wouldn't be surprised, really. Damned if you do, darned if you don't, right?

Shotgun is a more drastic weapon of choice for relieving oneself of earthly worries. Done correctly, it's a sure way to go. But carelessly performed, all you get is a terrible mess. Let me explain. Now, if you put the shotgun muzzle in your mouth, point the weapon horizontally, straight back, NOT upward, and squeeze the trigger, you're all set for a permanent vacation. But based on what I've seen, here's how NOT to do it: tilt your head back, press the muzzle against the underside of your chin, then squeeze the trigger. Bad idea! You'll blow off your face, but you'll live. After extensive plastic surgery, you'll go home looking real ugly, and possibly blind. It's embarrassing, really.

To end this rather grim post on a positive note, I remember a young lady who was shot in the head, point-blank range, by her jealous husband, and had a severe injury but survived, was heroically operated on several times, recovered, and visited us, wearing a nice dress, and while she had a mild paralysis, she seemed like an interesting and attractive woman, which means that the best part of her brain was saved.
 

Friday, February 11, 2005

The Drugs Don't Work

Discharge! Today's victory. The dentist with the headache. She is gone. Doctor Pain was on his way up in the elevator, but I made sure the patient went down the stairs. She has a strong jaw, and frowns constantly. The jaw muscles are strong because she has bruxism - she grinds and clenches her teeth. The frown is from the migraines. She is repeatedly admitted because of her headaches. Nothing works for it, we've tried every trick in the book. She is a Pain Patient. They are never happy. They are always in pain. "Now the drugs don't work, they just make you worse, you know I'll see your face again". She'll be back, but she looked fine in the morning. I don't think she had any headache this morning, but she frowned anyway, and I hate that. I wish she would just stop frowning. I wrote her a prescription, said "you want some rest. I'm glad you came to see me to get this off your chest. Come back and see me later, *ping*, next patient, please, send in another victim of industrial disease!"
 

Doctors

Every night I lie awake
And every day I lie abed
And hear the doctors, Pain and Death,
Confering at my head.

They speak in scientific tones,
Professional and low—
One argues for a speedy cure,
The other, sure and slow.

To one so humble as myself
It should be matter for some pride
To have such noted fellows here,
Conferring at my side.

Sara Teasdale (1884-1933)