Saturday, June 30, 2007

Welcome to Residency

For most of the U.S., July 1st just means that a holiday is 3 days away.

For a minority of the population, July 1st marks the beginning, progression, or end of residency training.

At some programs, the interns started this past week. They're excited. Nervous. Bravely stepping into the unknown.

People say that July is a bad month to get sick. What with all the newbies in the hospital. The flip side is that if you do get sick in July, you'll have the freshest, most energetic group of people taking care of you than you'll ever have for the rest of the year.

Plus, it's kind of cute to see them wandering the halls with the crisp white coats and the "I don't know what I'm doing but am trying to pretend like I do" look. They look so young.

Welcome, new interns. We're glad you're here.

photo credit
photo credit 2

Tuesday, June 26, 2007

Welcome to Grand Rounds!

Grand Rounds:
Things That Inspire Us

S Palwick, N Brown, Emergiblog, S Rap, S Nurse, V Jones, A Driver, L Edwards, Anonymous, K Morrone, P Auerbach, Bongi, R Schwab, S Schwab, Kal, M Knife, E DNA, J Leow, Emer, JC Jones, A Tenderich, J Schwimmer, J Bookspan, C Bachmann, AADT, H Stern, Keagirl, ER Nursey, A Gruntdoc, Rachel, Louise, AJ Cann, B Mesko, B Ecology, V Dimov, D Williams, W Visitor*


Welcome to Grand Rounds!

The theme this week is “Things that Inspire Us.” Every week Grand Rounds presents interesting articles from different authors. Our interests vary. Our writing styles vary. But we all share this weekly interest.

My wish was to use this week’s forum as an opportunity to “get to know” each other – what better way than to catch a glimpse of that which inspires us? And the hope is that perhaps one, or more, of the articles found here, having inspired a lone author, may go on to share that inspiration with others.


All posts that were received before the submission deadline were included in this edition. If more than one submission was received from the same author, one post was chosen for inclusion. Exclusion criteria included most submissions after the deadline and blatant advertising “posts.” Posts that followed the theme were placed higher than those that did not, and posts within the theme that were most interesting were given the highest placement possible.


39 posts were received for submission. 29 of these followed the proposed theme. 10 (25%) did not. 3 (8%) authors submitted early (more than one week prior to deadline). 21 people (54%) submitted during the Tuesday to Friday before the deadline. 13 (33%) submitted the weekend prior to the deadline. 2 (5%) submitted after the deadline.

Posts that followed the spirit of the theme:

Susan, a volunteer ER chaplain, writes about how her time in the hospital and at the bedside of the dying has shown her the love that exists among us, if we take the time to look for it.

Nancy from Healthline writes about her source of inspiration. She states that “doing things for others, and acknowledging that we are part of a community, is what parenting is all about. If we slow down and prioritize the people we interact with every day, we will be inspired - and peaceful - which will also infect people around us with a sense of well-being.” Although she uses parenting as the example, her words are applicable to everyone who have been guilty of getting caught up in things and forgetting what truly matters. Beautifully written.

Roy, Dinah, and Clink from Shrink Rap each write about the different things that inspire them. The list is long and diverse, from cannibals and disagreement and ants (yikes!) to the more mundane sunsets and food, family and friends. (phew!) Check it out.

Kim from Emergiblog , finds that inspiration is all around us, and all we need to do is take the time to look for it. It is in Donna, and Derek, and Sam. And we’re surrounded by Donnas, Dereks, and Sams.

There were several recurring themes that inspired the authors:


A special welcome to Someday… Nurse, who’s submitting to Grand Rounds for the first time. She finds inspiration in our blogging community – give yourselves a pat on the back!

Val from Revolution Health finds her co-authors inspirational. They work to save lives, make a difference in the third world, work to convert to electronic medical records, balance family and career, and give back to the community.

Ambulance Driver writes a moving story about his partner, who heroically tries to save a drowning victim. It’s inspiring that there are still people like Partner.

Laurie from A Chronic Dose writes about her ultimate inspiration – Dad. Some of his words of wisdom: “You can’t always get the answers you need to pursue the dreams you have. Sometimes you just have to make a decision that might not make complete sense now and grow into it. It’s a risk, yes, but there are very few certainties in this world.” Dr. Anonymous also shares some memories of his father.

Kerri from Six Until Me blogs about struggling with diabetes and a mother’s love.

Dr. Auerbach from Healthline shares a tragic story of a young man’s death. He found inspiration in the boy’s father, who suggested that others should learn from Derek and “not live their lives in a box.” How can one find meaning in freak accidents like these? Mayhaps they sober us and teach us to be grateful for what we have, the here, the now. And never take tomorrow for granted.


Bongi , a general surgeon in the South African province of Mpumalanga finds inspiration from Kruger Park, a park with an area purported to be about as large as England where the wild things roam. Sounds amazing.

Rita from MSSP Nexus finds inspiration in the beautiful glass exhibit at the Phipps Conservatory and Botanical Gardens. What gorgeous works of art!


Dr. Schwab recently posted a nine-part series on what it's like, in detail, to be operating in the OR: the sights, the sounds, the smells, the thoughts. Here is the first of the nine posts. He says “If that's not something that inspires me, I don't know what is.” Well said for a general surgeon.

Meanwhile, Kal shares the great feeling when one realizes we’re part of something larger. If you ever have a hankering for EMT/ambulance drama – you now know where to go!

Midwife with a Knife shares how she ended up getting paid for delivering babies

EyeOnDNA says “I’m going to be a total geek and send you a post about DNA, since it inspires me day in and day out.” My friends, that is dedication to work. I guess we could have guessed that from the blog name!

Jeffrey, an aspiring surgeon, blogs about what inspires him. He includes a “gentle reminder to never underestimate the power of every word and action. A simple thank-you, a gentle pat on the back, a word of encouragement, can sometimes be all it takes.”


Dr. Emer shares a heart-breaking picture and posts about how helping others includes “giving hope and opportunity to those whose lives have been demonized with constant pessimism.” Let’s not forget that.

JC Jones from Healthline posts on the sad situation in Somalia, and hopes that we too can be inspired to help out our distant brethren.

Amy from Diabetes Mine shares a few pictures of “a little something that moved her” while on vacation in Europe. What’s up with the dreadlocked sheep?

Dr. Schwimmer, shares with us a “mindmap, which he’s found inspiring and incredibly helpful in taking better care of patients and himself.” Looks complicated…

Christian Bachmann , who works as a science and medical writer and editor finds his blogging inspiration from “the facts and findings of medical research..” He comments on the relationship between famine and weight loss.

Jolie from Healthline is inspired by bones. She states that “In life you literally shape your health”, and she would like this post to “inspire people so that they can improve their health.”

Jon from Anxiety, Addiction, and Depression Treatments responds to a recent article on prescription drug abuse, “one of several issues that inspires the multiple authors at the AADT blog.”

Henry from InsureBlog, states that one of the primary reasons he blogs is to help people solve problems with their health insurance.

Those marching to their own tune:

Keagirl weighs in on men’s focus on all things penis. Ever wonder what some people worry about? Check this out. Or, if you take yourself too seriously, better not.

ER Nursey shares a patient encounter that will sadden even the most jaded practioner.

Allen from Gruntdoc writes about why ER medicine is like practicing medicine in 1972.

Rachel from Tales of My Thirties documents a cute discussion between her Metformin and her glucometer.

Enoch writes about trying to lose two dozen pounds. Go Enoch, go!

Louise from Colorado Health Insurance Insider blogs about how spending money on obesity prevention could help the healthcare economy.

Dr. Cann sent an interesting article that proposes a link between obesity and bacteria, viruses, and prions. Interesting, but I'm still a skeptic. It’s hard to argue with calories in – calories burned = weight gain.

Bertalan from ScienceRoll posts about Second Life, an “educational island for genetics.”

Matt from Behavioral Ecology believes that “having a bad attitude won’t kill you.” (So you can survive longer as a grouch... just kidding!)

Clinical Cases and Images wanted to share Britain’s Got Talent Video – XXX

David from Health Business Blog discusses how he believes technology may be of help in medical diagnoses.


Compiling posts from the last week was a constant work in progress. One of the most surprising findings (although not that surprising when one thinks about it) was that the word “inspiration” means vastly different things to different people. And that which inspires us cannot be simplified into one thing or a group of things. Rather, our authors finds inspiration from the most unexpected sources – from those closest to the heart to those thousands of miles away. From cannibalism to wielding a blade.

In addition, it was interesting to see the range of responses to the proposed theme. There were people who tried to write with the theme in mind, those that marched to their own tune, and those that wanted to submit a particular post AND get more hits, so made up a good story about how the contents of the post were, although not inspirational in the general sense, very inspirational to them and thus, circuitously, they too “followed the theme.” (You know who you are... >:D)

But none of this matters. As we gather here to read this collection, let’s marvel at the diversity of the members of the Grand Rounds, learn the many _other_ meanings of the word “inspiration,” and hopefully, use this to expand the breadth of things that inspire us, so that we too can learn to find inspiration everywhere we turn.


This concludes another edition of Grand Rounds.

WV would like to thank Nick and all the authors. Send your latest submissions to Over My Med Body (link, who is hosting next week.


WV has no relevant financial interests to disclose.
Reprint requests: Wandering Visitor


I didn't prune submissions for Grand Rounds - everyone is included. If you don't see your submission here, something over the internet must have ate it! Please resubmit your post if you like - I'll add it in.

* The way the author names were put together at the beginning: if your full name can be found on your blog, I included it in the author listing. If only your first name could be found, that was sometimes used. If your blog name was shorter, that was sometimes used. And sometimes, a combination of the above was used (hey, trying to keep it interesting!) If you have very strong feelings about how your name/blog was (mis)represented, let me know and I’ll change it. Also, while some people may be miffed that their titles were left out of the authorship, it was done because I don’t know everyone’s degree, and I don’t think degree(s) really matter for the current edition. Sorry if you’re one of the few that is miffed.


What's with the rainbows? They're circumhorizon arcs. They're here to remind us that, if you think you know our world, just look a little closer. You'll learn things you never knew. Inspiration is everywhere.

photo credit 1
photo credit 2
photo credit 3
photo credit 4

Sunday, June 17, 2007

Grand Rounds

Grand Rounds will be hosted here next week, June 26th. The theme is:

"Things that inspire you."

My wish is to use next week’s forum as an opportunity to “get to know” each other – what better way than to catch a glimpse of that which inspires each of us? And the hope is that perhaps one, or more, of the articles found here, having inspired a lone author, may go on to inspire countless others.

All posts received by the deadline will be included. You don't have to use the given theme, although posts within the theme will have preferred placement ;)

Send your submissions to wanderingvisitor607 {aT} yahoo. Deadline is Sunday 6/24/07.

Happy posting!

photo credit

Random Musings

Couple of interesting points that came up in the last week:

* Experiences that we go through can't change the fundamentals of who we are, unless we let them. But they do teach us another vantage point from which to admire the world.

* Was wave watching this weekend - the crest of a wave looks so very different from the trough, but they're essentially the same thing. Both part of a much larger, more magnificent whole. The quick impermanence of both "extremes" in waves reminds us of this fact. But we're not so different. Except that our lives are a bit longer than that of a wavelet. Am I making sense? Words can't do this justice.

* Sometimes your joy is the source of your smile, but sometimes your smile is the source of your joy. (I believe this was a quote from Ellie's blog)


To end this string of rambling thoughts, here's a great quote from a favorite movie:

In the world, I am insignificant, but what in the world is not of me?

It's such a beautiful line, and here's one of my favorite interpretations (those that have lost loved ones may share this sentiment) -

Even though loved ones are gone, they live on in the things they did, the people they loved, the places they've been. We all affect each other - hurting others is like hurting our loved ones, hurting ourselves. Loving others is the same as loving ourself.


Here's a call to spread a little love this week - it'll make your world brighter!

photo credit

Monday, June 04, 2007

Musings on a Life Well Lived

One of my first patients today was a real live horse whisperer. This was our second and final appointment, and at the end of the appointment, he said - I'm really glad to have met you. You know, I'm a horse guy, and with horses, they read a lot into nonverbal cues. You gotta work to gain their trust, but once they trust you, they trust you. Well doc, just though you might wanna know that you give off good nonverbal cues and I fully trust you.

That made my morning.


Am taking care of a nursing home patient who, at the end of our visit today, shared a website that he had written for prior to his becoming debilitated. Intrigued, I looked up the website and found out that said patient had been very well traveled and had a highly successful career. In addition, patient's wife was a very famous RN in her day.

Reading about them was very moving - they are two of the most down to earth, humble people, and in just meeting them, one would never be able to guess at the amount of life experience accumulated between the two of them. Or perhaps, it is because of the life experiences that they are who they are today. People like them are so inspiring.

This -- is why I love what I do.

Sometimes when the department politics get out of control, or when the paperwork or bureaucracy takes away from valuable patient care time, I wonder if I made the wrong career choice. Maybe I should have become a chaplain. I love to listen to patient stories - their struggles, their triumphs. I want to learn from their experiences and absorb their wisdom. I want to sit with them, and by the virtue of my presence as another human being, validate their life experiences. I want to be at the bedside of the terminally ill and of those for whom the silliness of the material world no longer matters, and I want to hear about what they still believe, and think, and value.

Days like today remind that one does not need a different job to make a difference. And they remind that it is a blessing to be working so closely with fellow souls...


Sister is now starting out in her first job. She makes great money but has been surprised at how tedious the daily work grind is. She's thinking about switching to banking, because it "sounds more interesting." My only advice? That the day to day of every job will eventually become routine, mundane, and even "boring." The first surgery that one does is great, the second, just as great, but ask someone who's done ten thousand of them what they think of that procedure - "mundane" at best. But perhaps the key to staying interested in a job or a career is less the details of what one does, but the meaning one draws out of doing such a job. For me, the opportunity to work with and learn from patients far outweighs the negatives in medicine. Would that I never forget this. I hope that it continues to mean as much to me at the end of my career.

If so, it will have been a "career" well lived.

Saturday, June 02, 2007

Killer Boy and His Hog

Did you hear about this joker?

Jamison Stone is an 11 year old sixth grader in Pickensville, Alabama. His fifteen minutes of fame came from telling the world that he killed a large "wild" boar. "I feels really good," says Jamison Stone. "It's a good accomplishment. I probably won't ever kill anything else that big."

Turns out the "wild hog" he massacred had been raised as someone else's family pet. He killed something that couldn't speak and likely didn't even know to run from him, since killer boy looked a lot like the people who raised him. This is what the "hunt" consisted of: the boar was hunted inside a large, low-fence enclosure and fired upon 16 times by Stone, who struck the animal nearly a half-dozen times during the three-hour "hunt."

What the heck is an eleven year old boy doing with a gun, why the h*$! does he think it's OK to kill living things, and why did he torture the poor thing for three hours before killing it? How brave is it to shoot a defenseless animal that is trapped inside an enclosure? What kind of parents encourage this kind of behavior?!

Friday, June 01, 2007

Do You Have a Small Penis?

Penis size: Do you have a little one or big one?

Saw a great post at Keagirl's place. Apparently a couple of urologists from England reviewed "small penis syndrome" and the medical literature on penis size in the latest issue of the British Journal of Urology. They note that the average erect penis is about 5.5 to 6.2 inches long and 4.7 to 5.1 inches in circumference at midshaft.

Actually, in doing a PubMed search to find this article, there is a whole literature on penis size. Here are some of the studies: Treatment of men complaining of short penis (Urology 2005). Penile length in the flaccid and erect states: guidelines for penile augmentation. (J Urology). Can shoe size predict penile length? (BJU 2002). Can physique and gluteal size predict penile length in adult Nigerian men? ( West Afr J Med. 2006). Should the definition of micropenis vary according to ethnicity? Mean penile length and diameter are slightly but significantly smaller in newborns of Chinese origin compared to newborns of Caucasian and East-Indian origins. ( Horm Res. 2001). Interesting, unable to find an article on African penile length, but there were several documenting smaller Asian sizes.

Sheesh. Can men be more preoccupied about a body part that is totally hidden from daily view? You don't have a whole literature on breast size (at least not that I'm aware of) and those are actually seen under clothing!


We see a lot of private parts because of full body skin examinations for changing moles and skin cancers. When you see a lot of penises, seeing another one doesn't phase you - usually. But I think one can tell a lot about a person by how they are when they're naked. Get your mind out of the gutter! I mean, naked in a medical examination room. There's the group of young pubertal boys that are aghast that you are looking at them *down there.* There are the group of men who are uncomfortable, but understand that it's part of the visit. There is the group that knows the drill and are quite comfortable with or without their clothes on. There's the group that LOVE having their clothes off and will keep their pants down until you specifically ask them to "please cover up, the exam was over a LONG time ago" a group which overlaps somewhat with the minority of perverts that get off on showing your their "goods." Anyways, I digress.

Keagirl's post got me to thinking that given the number of penises we see, the usual penis doesn't even warrant a second look. However, there are a few situations when you do (subtly) look again:

1) TINY. Like "we see a lot of penises incidentally and wow, that is small"

2) Abnormally large. Like "you are a tiny thin old man, and that is one big dangly doo."

3) First case of Fordyce's angiokeratoma. like "what the h*#! is on your scrotum, man!"