A Monty Python Grand Rounds 3.08

Hello there! I am A Very Famous Historian and I welcome you to the Grand Rounds. From a field of over 60 submissions, 26 authors have been chosen to seek the Grail. It will be a dangerous journey full of peril and death may await with nasty big pointy teeth. We shall see if anyone makes it out of these woods….alive. Feel free to traipse past all quotes.

A point of disclosure: Kim has written a provocative piece about how a famous historian should edit Grand Rounds for quality and content and it has informed my every decision. I have decided to change the title to Two Bloggers, Two Voices, One Opinion. On second thought — she’s a witch and we should burn her! [everything in italics will have sound in a separate window]

Jarrad at Veritography takes a break from the living to dress like a zombie for a “Lurch” on Washington. “In an interview with heavy metal rocker Rob Zombie, I once read that when his parents asked him as a child what he wanted to be when he grew up, his answer was ‘a monster’. Now there’s a kid who really chased his dreams.” Jarrad goes on to describe “switching from George Romero shambling zombie mode to ’28 days later’ ultra fast zombie mode in order to avoid the speeding cars.” On the Virtues of Zombies is a fantastic read. Bring out your dead!

Woman: Who are the Britons?
Arthur: Well, we all are. We are all Britons, and I am your King.
Woman: I didn’t know we had a king. I thought we were an autonomous collective.

King Arthur may have benefited from a press release of some sort, but this week I’m learning that even that might not cut it. Diabetes Mine writes about The Death of the The Press Release as a tool for social (blog) marketing. Giants of the Blogosphere should take notice: the stiff, wordy offerings of old will have to go. But how should we replace them? Help Amy decide in the comments section.

Arthur: Look, you stupid bastard. You’ve got no arms left.
Black Knight: Yes I have.
Arthur: Look!
Black Knight: (looks at stumps) Just a flesh wound.

Imagine the Black Knight presenting at your hospital. Kal at Trauma Queen has no problem spotting a liar in Not As Green As the Uniform. For those of you that didn’t already know that “[b]lood smear occurs when an object contacts a body part that is already bleeding,” this post can be redeemed for CME credit. Further, the Black Knight is in for more trouble if he isn’t honest about his injuries. In the Incantations, InsureBlog relates a story of a man named “Monty” who gets caught between coverage without disclosing a procedure he had in the interim. Unfortunate stuff. For more help spotting a liar, Psychic Health has a post close to my heart. Watch out for the m00se.

I’m not entirely sure how to treat a man without any limbs (or what the Medical Coding would be) which means I’m turning to Dr. Google. This week, an article from the BMJ showed that within the first 30 results, Google catches a difficult diagnosis 58% of the time. Am I out of a job? Dr. Charles goes through the paper and runs the experiment himself revealing the limitations. Thanks, Dr. Charles, for reminding me that the study helped clinicians find the diagnosis which means (for the time being) I should keep studying. The story isn’t over, however, as Ves from Clinical Cases and Images writes that clinicians may be able to hand pick the information that Google returns for their own patients. And there was much rejoicing.

Father: Other kings said I was daft to build a castle on a swamp, but I built it all the same, just to show ’em. It sank in the swamp. So, I built a second one. That sank into the swamp. So I built a third one. That burned down, fell over, then sank into the swamp. But the fourth one… stayed up! And that’s what you’re gonna get, lad: the strongest castle in these islands.

I still believe that we can rebuild the cities hit by Hurricane Katrina to be the strongest in the land, but the pace is causing problems. Dr. Herbert writes this week in How Slow Can You Go that of the $7.5 billion in grants allotted to help build private homes, 18 requests have been approved. Jon Schnaars writes that just because they are ignored, Katrina’s Mental Health Woes Will Not Disappear. We are inviting a public and private health catastrophe when temporary trailer homes spend five months waiting for delivery and the acute problems of “depression, anxiety disorders, stress disorders, [and] addiction” are allowed to become chronic.

[And out of the blue an arrow strikes Concorde in the chest.]

Lancelot: Brave, brave Concorde, you shall not have died in vain!
Concorde: Uh, I’m — I’m not quite dead, sir.
Lancelot: Well, you shall not have been mortally wounded in vain!
Concorde: I- I- I think I cou- I could pull through, sir.
Lancelot: Oh, I see.

Time to call a MEDIC! The Angry Medic of Cambridge isn’t seeing as much gore as he’d like from his textbook prison and decides to take his education to the pitch where he receives a ball to the face, dips blood into his antiseptic and consoles the players that a large bandage will not effect “the number of female spectators yelling their names from the sidelines.” You could say he Comes of Age. I can identify with the itch to begin but Karen Little has set me straight. With 20/20 hindsight, she offers a painfully funny glimpse of our collective future in her Years as a Medical Student two-parter. The pictures alone are worth your visit.

It’s the time of year where several people are changing roles and interviewing for their lives. BadDoctor recounts an Interview With Wolves straight from the vault of medschool myths. “I probably would have been better off telling him that Perry Mason was a filthy commie…[h]e looked at me as if he would rather see me in his headlights than in his clinic as a student.” It ends well.

Of course, there are other important interviews to be had. Nurse Ratched-Zoot writes about the successful dating strategies of doctors and suggests that all psychiatrists start off by claiming to be undertakers, since this is initially preferable to your date being “more afraid of [you] getting inside their head than inside their pants.”

With all of the forward-looking, its important to remember why we’re doing any of this. This week, Doctor Anonymous writes a great story about counseling a difficult patient to undergo a stress test that may have saved his life. The Dinosaur counters with Sigh, Just…Sigh , a story about a patient that “…is not a clinical puzzle. This is something between somatization and hypochondriasis.” Her visit length is inverse to need. Hilarity ensues.

Knights of Ni: Ni! Ni!Ni! Ni! Ni!
Arthur: Who are you?
Head Knight: We are the Knights Who Say … “Ni”!
Random background Knights: Ni! Ni!Ni! Ni! Ni!
Arthur: No! Not the Knights Who Say Ni!
Head Knight: The same!

The Knights Who Say Ni are arguably the most bizarre part of this movie (no small task) and I’ve always wondered, “What would a clinician do with them?” Certainly we could chastise them for spraying their germs with each careless “Ni!” We could sit them down and make them watch a very funny video at BreathSpa outlining the correct sneezing/coughing etiquette (I think this video could prevent The Plague if people didn’t spread so many germs laughing at it). Or we might suspect something more serious. The Tundra PA recounts her experience with an epidemic of Whooping Cough that hit Southwest Alaska a short while ago in her post, The Hundred Day Cough. Of course it was handled expertly.

God: GET ON WITH IT!

Thanks to Sid Schwab, I’m reminded that medicine is moving forward. He writes this week in You Tube, I Tube, We Tube about his experience as a medical student placing NG tubes into his classmates. Sympathetic gagging ensues while we learn that many patients undergoing abdominal surgery are now spared this invasion. MyLifeMyPace writes about a different invasion: the miserable mores of Grey’s Anatomy tainting the pool of hopeful physicians. I actually stopped watching the show because of the example she cites in So Why Do You Want To Be a Doctor?

Monk: And Saint Attila raised the hand grenade up on high, saying, ‘O Lord, bless this thy hand grenade that with it thou mayest blow thine enemies to tiny bits, in thy mercy.’ And the Lord did grin, and the people did feast upon the lambs and sloths and carp and anchovies and orangutans and breakfast cereals and fruit bats…

Should the Holy Hand Grenade blow you to bits, you could do worse than to go to Susan Palwick’s version of Heaven. She’s a volunteer ED Chaplain that sees more than a few parallels between the afterlife and triage.

While all of this has been very silly, there are adventures that bring more than a bit of peril. Paul Auerbach writes in Pilgrims at High Altitude about the “silent” deaths of pilgrims attempting religious ascents but succumbing to mountain sickness. Several good links are included. Borneo Breezes has a great post about aid to Aboriginal children and that our good intentions may not always be appropriate. “Ivan Illich said, ‘Don’t come to change us or help us. Come because you are getting something out of it. Take pictures of our wild flowers, study the animals, climb the mountains if you like, but leave us alone. We want to make our own mistakes.’ ” His pictures tell half the story in How Children Play.

…And now for something completely different.

Every once in a while, Dr. Crippen of the NHS will throw his weight behind an excellent site. I am indebted to him for introducing me to Karen Little at Just Up The Dose (showcased today) and to Abby Lee at Girl With a One Track Mind. This week he writes about the NHS’ standardization of care and lack of appropriate resources for victims of sexual abuse. At the end, he recommends the site Survivors Can Thrive. “Dr Crippen strongly recommends [her sites] but, be warned, they are not comfortable reading.” I agree. In the same vein Nancy Brown writes about an alarming ruling that “consensual sex cannot become rape.” I ask you to read these articles and see if you agree.

Finally, Julie over at Medscape has written a piece about her fight with cancer that is so amazing and moving that I find myself rereading it. Her post is a shining example of how a well-written message bores deeper and deeper into the reader. I have saved her for last to spare anyone from trying to follow — it’s that good.

And so we end. The Holy Grail is a solid Grand Rounds read in a single sitting. I hope we found it and I invite all comments from the readers and authors alike. And with that I have been sacked. Join us next week as Dr. Anonymous hosts Grand Rounds 3.09.

Cheers, A Very Famous Historian.