"Finger pads" in Spanish?
Ahora sabemos.

M. H. Graham just sent me a complimentary copy of her Ahora Hablo! Medical Edition, a handy paperback of Spanish terms useful for medical professionals.

It seems useful and relatively error-free (there's the odd typo, but no big deal). Had I seen it in a store, I would have bought it - it's only ten dollars. The most important feature of the book is that the words and phrases it includes are used nearly every day by many healthcare workers -- fun conversation starters like What color is your stool? and Do you have asthma? My Spanish is fluent (though not native) and I can testify that I've already learned a number of words from this book I didn't know before.


On the wrong side?

I realized just this year, perhaps later than everyone else, that I have been misunderstanding the entire* story in Genesis about the massacre at Shechem by Shimeon and Levi occasioned by the rape** of Dinah. I have always taken it as obvious that Shimeon and Levi did the wrong thing - that Jacob scolded them, and that their answer ("Is our sister to be treated like a harlot?") is self-righteous indignation. For the first time, I realize that the Chumash* does not disapprove of the actions of Shimeon and Levi. The reason Jacob says nothing after Shimeon and Levi's response is that he has lost the argument. The reason the Chumash does not disapprove is that God is on the side, here, of those who massacre the unclean.

*Putting aside for a moment the multi-authored nature of the Chumash, which I think is evident.
**If you think "rape" is the right translation - open to question.


The Lonesome Death of Max von Pettenkofer
From the American Journal of Epidemiology.
In the mid-19th century, the German hygienist Max von Pettenkofer viewed cholera as resulting from the interaction between a postulated cholera germ and the characteristics of soils. In order to cause cholera, the cholera germ had to become a cholera miasma, but this transformation required prolonged contact of the germ with dry and porous soils when groundwater levels were low. This hypothetical germ-environment interaction explained more observations than did contagion alone. Despite its attraction, von Pettenkofer's postulate also implied that cholera-patient quarantine or water filtration was useless to prevent and/or control cholera epidemics. The disastrous consequences of the lack of water filtration during the massive outbreak of cholera in the German town of Hamburg in 1892 tarnished von Pettenkofer's reputation and marked thereafter the course of his life. von Pettenkofer's complex mode of thinking sank into oblivion even though, in hindsight, germ-environment interactions are more appropriate than is bacteriology alone for explaining the occurrence of cholera epidemics in populations. Revisiting the fate of von Pettenkofer's theory with modern lenses can benefit today's quest for deciphering the causes of complex associations.


Trauma in the slot
Notes in and out of the ER.

Oh hell.

I put down whatever I'm doing, sometimes spilling it/surprising the patient/abandoning my computer orders uncompleted, and quick lope across the hall to the Trauma Slot (it's a room with space for several trauma victims), where I put on a disposable gown. Then I am supposed to shear off the victim's clothes and stick an IV in their arm. He (they're generally hes) is lowing, often drunk or otherwise substance-addled, but definitely in pain. I don't move fast during this ritual, nor in general, so a few minutes into the slot I'm standing uselessly at the side of the room, waiting for some signal from a superior to go get more work done inside the ER.

Back in the ER desperation on all sides: patients ask when you're going to see them, families wonder what's going on, why hasn't the X-ray been read/glass of water brought/IV taken out of arm/broken bone been set. Nurses are busy doing something else. Senior residents drift from corner to corner of the ER, occasionally assuming a stance ten feet or so away from the patient board on your end, with a look of quizzical impatience: why aren't things moving faster? Why hasn't N, with the abdominal pain, been seen yet?

Rounds punctuate. Someone is admitted - off our hands. Someone is waiting for dispo - a test, for example, to decide whether they'll stay or go. Attendings talk about patients right in front of them, in the third person.

But nevertheless (despite all these initiation rituals that I thought I left behind with intern year, but now as a second year resident I am submerged in again, on this my ER rotation) I am seeing pathologies I never laid eyes on before: the dinner-plate eyes of cocaine, the writhing appendicitis, the horrible pain of a cancer patient that knows (or doesn't yet) that it will never go away completely.

Always the crush of patients to muddle through (primary care medicine in the Bush era), always the disappointed person who hoped that their months-long back pain would be cured by a 4 am visit to the ER. And always, in the middle of all this, the cursed interruption: Trauma in the slot!