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Showing posts from 2018

Erotomania = delusional love

The holidays are the perfect time to rewatch some guilty pleasures, including Love Actually  (2003), which has been hilariously ruined (or remedied) by this article, and Á la folie, pas du tout (He Loves Me, He Loves Me Not, 2002), starring Audrey Tautou.

The latter's not at all what you'd expect--certainly no Amelie. It's psychological drama that makes your blood run cold halfway through the runtime because nothing is what you thought it was, à la The Sixth Sense, Gone Girl or Hot Fuzz.

The title references how people (who think they're) in love pick daisies and recite the eternal multiple-choice question while destroying delicate petals: S/He loves me--
1) a little (un peu)
2) a lot (beaucoup)
3) madly (à la folie)
4) not at all (pas du tout).

In the beginning of the movie, Married Man seems to love Audrey Tautou a little, if love can be measured by a single, pink rose. Maybe a lot, because he's seeing her even though his wife is pregnant. Perhaps to the point of…


Triangles are everywhere: psychology, sociology, math, art, Bermuda.
First up for scrutiny is Maslow's hierarchy of needs, which theorizes that each lower level of the pyramid must be fulfilled in order for the individual to progress to a higher level, which may make sense in terms of architecture and gravity, but in application to real human beings becomes presumptuous.

Many of us still must function without sufficient rest (tier 1), or do not feel secure or safe in our environment (tier 2), yet we carry on with achieving our potential/creative activities (tier 5) even with problematic self esteem (tier 4). Also, if one is in immediate danger (burning building, possible death by water), physiological needs are obviously not the most urgent concern (well, maybe oxygen). And not every high-achieving person has the good fortune to find love or feel a sense of belonging in their relationships.

Speaking of failures of intimacy, Robert Sternberg took it on himself to describe all the k…

3.17. Carbuncle = carpooling furuncles

I Tiresias, old man with wrinkled dugs
Perceived the scene, and foretold the rest—
I too awaited the expected guest.
He, the young man carbuncular, arrives.
(T.S. Eliot, The Waste Land 228-232)

Our nursing instructor briefly referred to carbuncles as carpooling furuncles and we nearly died laughing, because at this point in the semester everything is hilarious, like this horse with an open fracture of the leg.

Start of semester: We're going to the ICU! We're going to be in codes, do chest compressions, save people's lives! We're going to maintain the hell out of the central lines and chemoports we weren't allowed to touch before, and it's going to be awesome! We will hold teeny tiny preemies, be moved to the core by beautiful, sick but stoic children, who will change our lives forever, and we will connect with awesome patients and families. We will do all the study guide questions, make our own study guides by personally reading every damn page of that Iggy book…

3.16. Tx = treatment

There's always a few individuals in the workplace who are so shady, negative, or incompetent that they are like cancer within the business, institution, or organization. How do we treat these malignant-tumor-type individuals? Surgery, chemo, radiation, immunotherapy, palliative care, and mixed metaphors.

Surgery: cut those people out. Fire them; remove their questionable work and policies as much as possible from the institution (or nation?) to prevent further damage. Everything they have touched, as far as possible, must go--this is termed negative margin. Successful removal of all cancerous tissue amounts to a cure.

Chemo: deliver a heightened level of law & punishment to the entire organization, with the goal of pronouncing the worst offenders guilty and forcing them to go. Multiple approaches may be enforced, making it impossible for the tumor to carry on. The toxicity/strictness of chemotherapies have been specifically designed to target the offending cancer, so while some …

3.15. SIM = simulation

Some days every patient I've ever had, including my mother and all the mannequins and simulations in skills lab, all blend together into one, genderless/all-gender, ageless patient with every disease process possible.

The patient needs mechanical ventilation to breathe, has a nasogastric tube and a gastric tube, a colostomy bag on the left abdomen, a urostomy bag on the right, has a central line in the jugular and in the femoral vein and four peripheral IV lines connecting to six different IV and drip pumps containing propofol & fentanyl (for sedation), insulin, two kinds of antibiotics, and fluids with potassium. Every line except for milky-white propofol is labeled and tagged to prevent confusion in the spectacular nest of tangled tubing that surrounds the bed.

The patient has a history of COPD, heart failure, type II diabetes, coronary heart disease, stroke, preterm labor, cancer, epileptic seizures, lower extremity amputation, hepatitis, liver and renal failure. The patien…

3.14. Metaphorsis

Like a butterfly goes through four stages in complete metamorphosis, registered nursing students go through (at least) four semesters. It's a torturous journey, filled with trips to the underworld, no looking back (or you'll turn into a 1000 ml bag of 0.9% normal saline), slogging away in hopes of a better life ahead.

I. Egg, first semester.
You are a round lump. Circle or oval, an ineffective, three-dimensional, zero. You know nothing. Everything you knew up until now is probably wrong. Apparently vitamin C is more abundant in broccoli than in fruit. Pharmacology makes you wish you were never born. You tumble along, from modern hospital to nursing home to rural hospital. Good thing Mom is there to help, because you are sleepless and starved and cannot survive without support. If you don't make it through this semester, you don't get a second chance.

II. Caterpillar, second semester.
You are a worm. Pathetic, wriggling along on the floor, waiting for someone to stick a…

3.13. NOTES = natural orifice transluminal endoscopic surgery

How would you like your infected gallbladder, which you are quite done with, to be removed and pulled out of your mouth, ! or * ?

Today's medical science has made this possible.

Back in the day, surgeries involved opening up patients on the table so surgeons could see and access target tissue. Now, many such procedures have been replaced with minimally invasive, "laparoscopic" surgeries that involve inserting a tiny, lighted camera and other instruments through small cuts in the body to perform the surgery. An even newer technique involving fewer cuts/holes is natural orifice transluminal endoscopic surgery (NOTES).

In NOTES, a surgeon puts the robot snake with a camera for an eye up or down the natural orifice (mouth, anus, rectum) of choice, and with the guidance of the camera, small incisions are made to reach a target organ. After ligation with a hot instrument, the part (gallbladder, for instance) can be gently retrieved and pulled along the snake's path, until …

3.12. MBPS = Munchausen by proxy syndrome

While many of us will try every wikihow home remedy before visiting a doctor, some patients make themselves sick or fabricate symptoms just because.

A Munchausen's patient may self-medicate to create symptoms due to a desire to be seen as ill or injured. The patient might even undergo risky procedures and surgeries in order to receive the full experience of serious illness.

Nowadays called "factitious disorder," this mental illness was named after the fictional Baron van Munchausen, an 18th century German nobleman known for embellishing the stories of his life and experiences. Tall tales of symptoms, induced or made-up, send doctors on a wild goose chase for differential diagnoses. Factitious disorder may be self-imposed or imposed on others. The latter's a terrifying syndrome, "Munchausen by proxy," made somewhat famous by the entertainment industry.

In Munchausen by proxy, a caregiver or parent causes symptoms in a child through medication, poisoning, or …

3.11. Sign = objective evidence of disease

According to Saussure, a "sign" is a combination of signifier (what we perceive) and signified (the meaning we make of what's perceived).
In medicine, a "sign" is objective evidence of a disease (blood pressure 150/100 mmHg) as opposed to a "symptom," (headache) only perceivable by the patient. The signs & symptoms indicate a disease process or differential diagnosis.
Here are some signs that may or may not come in handy one day.

Auspitz sign: if you pick off a patch of your own scaly skin (why?) and see pin point bleeding underneath, it's psoriasis.
Brudzinski's sign: when my mother was dying from meningitis and someone pushed on her neck to bend it upwards, her knees would bend too, helping confirm the diagnosis.

Blumbergs sign: tender pain after a doctor presses on the abdomen then lets go. Possible peritonitis.
Cardinal signs of choking: inability to speak, cyanosis, & collapse. (If you ask, "Are you choking?" and there's…

3.10. Crisis = time-limited, disruptive, challenge

Are you in a crisis? According to Erik Erikson, we all are. Erikson divides psychosocial development into eight stages. Each period comes with its own "crisis," which once resolved, yields an appropriate "virtue."

0-1.5 years: Baby learns to trust, or mistrust the world. The former yields hope; the latter does not. Seems like many of us are still working on this one.
1.5-3 years: Toddler's crisis (or rather, Toddler's parents' crisis) involves a battle between autonomy v. shame & doubt. Making it through this stage confirms the child's (free) will. No, _____, this does not mean you always get your way.
3-5 years: The Preschooler may struggle with initiative v. guilt, but "purpose" emerges as a way to make sense of it all (hence the Why? why? Whyyyyyyy? WHHHYYY?s). A little bit of guilt here and there is fine for the developing ego and superego.
5-12 years: The School-age Child feels anxious about industry v. inferiority, ideally striv…

3.9. Pain = pieces of hurt

The Pieces of Hurt Pain Tool asks subjects 5 years old and up to, "stack pieces of hurt," to indicate their level of pain.
The logic behind using gambling paraphernalia with pediatric patients is beyond the scope of this discussion, but the the idea of turning pain into something as concrete and mundane as plastic chips, and stacking them to show the additive nature of "hurt," is nothing short of poetry. It also serves as a reminder that while pain cannot be seen, whatever the patient feels is real, and the causes of pain may not always be visible or physical.

Somatic pain arises from deep body structures such as muscles and bone. Visceral pain involves sensations that arise from internal organs. There's also neuropathic pain involving damage to nerves. Most interesting, however, is psychosomatic pain.

Contrary to popular misconception, psychosomatic does not mean something is not real. It means the cause of an issue or pain arises from psychological factors su…

3.8. CHD = congenital heart disease

Some hearts come with mistakes.

Some are missing parts or have extra holes in them. Some are boot-shaped. Some have arteries connected to the wrong side, so that each side of the heart/circulation keeps its own blood, and once the connections that shunt blood between them close there is no more oxygenated blood available to the body.

Hearts may not literally break, but they can fail, or stop.

Inside Mom's body, Baby receives free oxygenated blood that moves through extra, functional holes and blood vessels, but once born, the umbilical cord (with its artery and two veins) is clamped and it's up to Baby's new lungs to breathe in oxygen and Baby's heart to deliver that oxygen (in blood) to every part of a tiny new body.

After birth, the hole between atria should close within hours, while the duct between major arteries turns into a ligament in a few weeks. Ideally, all the walls are walls (no Pyramus and Thisbe action) and valves are not sealed shut or prolapsed. Otherwi…

3.7. LE = life expectancy

According to the World Health Organization, women outlive men in every country in the world. Why is that, when women face a wider variety of stressors, are more likely to be victims of sexual violence, and experience more chronic diseases, depression and anxiety? In addition, women today (for less pay) share the same financial pressures, long hours at the office, and potentially unhealthy diet and habits (drinking and smoking) as men. Some scientists attempt to explain the 3-7 year difference between male and female life expectancy with biology.
In general, women experience chronic diseases like cardiovascular issues and diabetes later in life than men, and with less severe complications. Hormones may be partially responsible for this difference. Estrogen lowers harmful cholesterol and increases good cholesterol. Testosterone does the exact opposite for men, increasing their risk of high blood pressure, heart disease and stroke. Once diagnosed with chronic diseases, women also score h…

3.6. Chromosomes = genetic material

Some genetic and chromosomal diseases are serious, and lethal. In fact, most chromosomal anomalies result in spontaneous loss of the pregnancy, because human beings need to have more or less the same bits and functions to survive, even in utero.
With autosomal dominant diseases like Huntington's disease or Marfan's syndrome, children of the affected parents have 50% chance of developing loss of control over motion and cognition, or having Rachmaninoff-sized hands and eventually dying from a tear in a weakened aorta. 
The recessive diseases require both parents to be carriers, and when two carriers meet and fall in love and statistically (this is just statistics--obviously this is an all-or-nothing event) 25% of their children get the little "a"s instead of big "A"s in the punnet square, where complications like cystic fibrosis, PKU, Tay-Sachs, and sickle cell can happen.
Conditions associated with the X chromosome appear more often in men because they only…

3.5. Dentis = teeth

Teeth are one of our most primal weapons. When push comes to shove, the last thing one can do is bite.

Humans have 32 teeth; snails have tens of thousands, lined up on their tongues. (But humans still win because they mash up snails and make them into face cream.)
Narwhals, the unicorns of the sea, have one long tooth for a horn. The teeth of living rabbits, squirrels and other rodents never stop growing.

Teeth can be removed (not with ease) and worn around the neck as a warning to enemies, or hidden in a dollhouse as a souvenir.

Dermoid cysts can grow on any part of the body, and occasionally sprout hair or teeth. Several cultures have myths of the vagina dentata, ranging from literal, fish-down-there, to metaphorical.The horror movie Teeth provides a literal, visceral interpretation.

Sometimes an editor says of a manuscript, "The writing has no teeth. It needs teeth."

Insect may not have teeth, but they can certainly "bite," with effects ranging from annoying to …

3.4. Infection = invasion

Fungi can hijack ant brains and turn them into zombies; humans have found Botfly larvae in their balls and Aspergillus (fungus) in breast implants. Infections may come from bacteria, viruses, fungi, or parasites. Human minds can also be afflicted, if not infected, by anxiety, fear, stress, trauma, and even romantic obsession.

People are normally covered in bacteria but do just fine thanks to their immune systems. However, particularly powerful strains reside in the hospital: Methicillin resistant Staph aureus (MRSA), Vancomycin resistant enterococci (VRE), and C. diff (what's left--and keeps coming out--after too many antibiotics kill the good gut flora.)
Bacterial meningitis is much worse than viral meningitis, though they're both bad news. Viruses can wait on surfaces for hours, days, or weeks until a sucker picks them up and lets them in.
Yeast can grow in the mouth, or down there (a "superinfection"--oh no!) Athlete's foot doesn't always stay on the foot …

3.3. Cardiac = of the heart

A heart beating through the chest can be visible, not just in cartoons.

1: verb. to omit sounds from a word.
2: verb. to lose consciousness.

Heart palpitations aren't always abby normal. Everybody gets butterflies once in a while. Racing, skipping, or pounding heart beats may come from nervousness, sleep deprivation, caffeine, alcohol, or tobacco. Rule out possible heart failure and thyroid issues.

Auscultation is a type of auditory consultation between a medical professional and specific parts of a patient's body, mediated by thoughtfully pre-warmed instruments. Tell me the truth, the stethoscope whispers, and the heart acquiesces.

Cardiac tamponade is about as bad as it sounds. Excess fluid must be drained, not plugged.
Lubb: S1, the long, low sounds of tricuspid and mitral valves closing during contraction of the heart.
Dubb: S2, the short, high sounds of aortic and pulmonic valves closing during relaxation. Also: a musical genre.

The stuttering "b"s above…

3.2. ABO = blood type

In parts of Asia, people don't just consult the zodiac, star signs, and the eight numbers of one's birth (八字). There's an entire culture of personality decoding based on blood type. It all started in 1927 when Takeji Furukawa, a professor at Tokyo Women’s Teacher’s School, shared his research connecting personality traits with blood type. Since then, friends and romantic interests ask if one's A, B, AB, or O, and in Japan, people reportedly get discriminated against at school and work based on their blood type.

Correlation of personality with one's A, B, AB, or O blood has not been supported by many credible studies, but some people take this very seriously. If you know your blood type (and you really should), see if the traits below sound about right.

A: Contrary to the Western concept of a "type A personality," people with type A blood (and antigens) can take a long time doing something when they're not motivated, or finish the same task in a jiffy …

3.1. 灰 = Gray

The Chinese character, 灰, has multiple meanings: mortar, ash, gray, and loss of hope.

Californian skies have been gray for most of summer, thick with particles, true to the image of dust to dust, ashes to ashes, and the general feeling of it being the end of the world. The elderly, the young, the asthmatic, and respiratory patients were encouraged to stay indoors. In fact, everyone should have been wearing masks, like a scene in some post-apocalyptic sci-fi flick.

There are endless shades of gray, certainly more than fifty, especially in real life and not fiction. No judgment either way--that's the point. The continuum is horizontal, rather than vertical (from heaven to hell).

From now on, nursing school will be more and more gray, our new instructor says. She's referring to gray area, non-black-and-white-ness, no absolute good or bad, but things sitting somewhere on the spectrum. Possibly, she's also talking about the gray hairs sprouting from our scalps with each fluid an…

hepatic = everything liver

Like a starfish or lizard, the liver can regenerate. A severed liver won't grow itself a whole new human, but as long as 25% of it is still there, a healthy quarter-liver can grow back to its original size. 
Ancient Greek physicians talked about yellow and black bile, respectively associated with fire and earth, passion and prudence.
Chinese medicine associates the liver with the element of wood, the emotion of anger, and ying chi.
The liver may not be imbued with emotions in these anthropomorphic manners, but when it falls ill, blood won't clot, skin turns yellow, the body swells from water retention, and the brain's poisoned with ammonia.
This sleek, brown sponge separates specific compounds from blood in the body, filtering hormones, alcohol, and drugs. To the best of its abilities, it does a first pass of everything we take in, the therapeutic and toxic. 
Like a moist, leather satchel, the liver also stores important molecules: glycogen; vitamins A, D, E, K, B12; iron…

TKD = taekwondo

We interrupt our regular programming of blood, guts and babies to talk about taekwondo, a traditional Korean martial arts form.

Tae = kick/strike with the foot.
The foot as a blade, as hammer, as hook, the blow that knocks someone out, a broom sweeping the enemy down, pushing an intruder to the ground.

Kwon = punch/strike with the hands.
The hands, fist or palm, can be knives, blocks for poles, a punch to the solar plexus, bladed support when one rolls or falls, or a friendly hand to help a competitor back up from the mat.

Do = the art, the way of life.
Like any relationship, one's journey in martial arts has ups and downs. There's a honeymoon period, initial excitement--passion or obsession, even. That may not last, but commitment does. There are milestones but also little bumps, minor or major injuries. Things get in the way of training, but some amazing people also support one along the way. Sometimes one learns to find fun in dressing in full storm-trooper sparring gear on a …

ROS = reactive oxygen series; free radicals

You don't have to know or remember organic chemistry to know what a free radical is--simply understand that they are needy motherf-ers that steal energy (electrons) from others and make them miserable. Those that were stolen from in turn steal electrons from yet others, leading to an energy-vampire chain of misery. End result: oxidative stress and damage to cells and DNA, often associated with cancer, heart disease, autoimmune diseases and neurodegenerative disorders.

Free radicals come in many forms; most of them sound like moans (•OH, NO, ONOO-). They appear in the body through exposure to environmental pollutants, toxins, infection, radiation/UV rays, deep-fried foods (sadness), and normal metabolism.

Thankfully, a healthy diet rich in antioxidants can help combat oxidative stress and keep cells healthy, because antioxidants donate electrons to free radicals so they shut up and leave other molecules alone.

Fruits with rich hues such as blueberries, blackberries, cherries, and p…

Nonmaleficence = do no harm

No one wants to be Maleficent. The Hippocratic Oath, Florence Nightingale Pledge, medical ethics, nonmaleficence--a rose (with thorns) by any other name. Bottom line: do no harm. This also proves a handy guideline for teaching, parenting, friendship, taekwondo sparring, and other interpersonal interactions or activities.
Is somebody going to get hurt? Then no. Or, if hurt is inevitable, what option will do the least amount of damage while providing maximum benefit? Vancomycin may leave an elderly patient's hearing and kidney function in ruins, but at least the patient will still live to buy hearing aids and go through dialysis. Some bleeding risk from anticoagulant medications outweighs the risk of a massive heart attack--bleeding can be stopped, whereas dead heart muscle can no longer be convinced to do its job.

Just like beauty in math is defined by minimal complexity and maximal applicability, nonmaleficence means minimal harm and maximal benefits. However, there is one other, …

ABCDE = melanoma screening

Skin cancer is one of the most commonly diagnosed cancers in the U.S.. The #1 way to prevent skin cancer is to use sunscreen and avoid sun exposure. Early detection is also key to good long-term prognosis.

Melanocytes are tiny, pigment-producing cells responsible for a whole lot of prejudice in human history as well as possible cancerous mutations in the form of melanoma. Thankfully, one can recognize early signs of melanoma through the ABCDE screening method, which coincidentally describes a number of family/relationship issues.

A for Asymmetry: asymmetrical moles can be cause for concern, as can any kind of favoritism among children, or someone loving another much more than one is loved back (if at all).

B for Boundaries: smooth and even borders to a mole are good; scalloped or blurred lines are not. Children will ceaselessly test boundaries, and discontent significant others will push the limits until they break.

C for Color: even coloring in a mole is good; several shades of red, bro…

CA = cancer

Our understanding of time breaks down at extremes. If the Big Bang happened, what came before it? And what, then, came before that?

We think time has a beginning and end because our lives have a beginning and end. Like most creatures on earth, our DNA comes with telomere caps, and as we run out of telomeres, our bodies age and die. However, if cellular regulation goes wrong, cancer cells can divide indefinitely and "live" forever, as HeLa cells do.

Ironically, DNA mutations that can lead to our demise also have the potential to make us immortal: in laboratory petri dishes across the world, in people's memories, through art and words.

There're a few things wrong with cancer cells, however.

They are anaplastic, having nonspecific appearances, so that under a microscope many different types of cancer look alike. Like cartoon characters with exaggerated eyes, they have giant nuclei. These cells have no function. They adhere loosely, break off, travel and spread (metastas…

Attachment = bidirectional bonding & trust

Children need family, not just for nutrition and safety, but also psychosocial needs like attachment, socialization and a sense of belonging.

Compared to our fellow denizens of Earth with their feathered wings or webbed toes, humans lavish a great deal of attention on relatively few offspring, and those offspring need every bit of that care for a long period of time. We don't kick fledglings out of the nest 21 days after birth, or go MIA long before fertilized eggs become tadpoles. Evolutionarily speaking, humans have babies when they do because it's the sweet spot of fetal growth v. maternal ability to provide growth requirements (& give birth safely). Though baby's brain (about 40% of an adult's) still needs years more to develop, baby is born when it's safe and relies on parents or guardians to protect, feed, and nurture baby until that brain matures sufficiently (arguably not until baby turns 30...)

Skin-to-skin bonding helps babies regulate their temperatu…

Rule of Nines: quick method to assess burns

If clothing or skin catches fire, stop, drop, and roll.

Writers must develop thick skin to survive. Where the skin is thinnest more damage occurs from burns: face, hands, perineum, feet, the skin of the elderly.
The Rule of Nines divides the body into multiples of nine to quickly approximate the extent of burns. Head 9%, each arm 9%, each side of each leg 9%, the trunk 18%, privates 1%.
Burns may be classified by cause or degree.
Dry heat injuries: open flames, explosions. Moist heat injuries: hot pot of red bean soup, steam from rice cooker. Contact burns: contact with hot pan, chicken grease, lard. Chemical burns: drain cleaner, oven cleaner, sulfuric acid, a particularly caustic rejection letter. Electrical burns: electrical current passing through body. Thermal burns: clothing on fire. Flash (arch) burns: contact with electrical current traveling through air, from one conductor to another. Conductive electrical injury: from touching electrical equipment. Radiation burns: therapeutic treatme…

ACS = acute compartment syndrome

Psychologically, the ability to compartmentalize one's roles in different aspects of life can be a sign of successful coping, but communication between and integration of various compartments are also necessary for a healthy psyche. Excessive stress in one compartment can lead to maladjustment, just as excessive pressure in one section of a limb can lead to severe complications.

"Compartment syndrome" sounds claustrophobic, like your tiny studio apartment or condo's about to spontaneously combust, and the condition is just that--a compartment of the body choking to death from lack of blood/oxygen.

In our bodies, there are "compartments" of muscle, nerve, blood vessels, encased in strong, connective tissue. If stress or injury leads to inflammation, edema and excessive pressure in a compartment, poor blood flow due to pressure on the vessels can lead to the 5 Ps: pain, paresthesia (altered sensation), pallor, paralysis, and pulselessness. If the pressure is …

Matrescence = a woman's transition into parenthood

The term, "matrescence," coined by anthropologist Dana Raphael in the 1970s, describes the process of becoming a mother, just as adolescence indicates one's passage into adulthood. Incidentally, a woman's breasts are not fully developed until pregnancy (I'll take my not-fully-developed ones backanytime).

Of course, there's "patrescence" as well, and there are stages the expectant father and new father go through, such as announcement, moratorium, focusing, engrossment, etc., but that is simply not the same as having your body stretched out, all systems taxed for 9-10 months, several hours to days of labor, having your vagina ripped open (sometimes all the way to the anus, in a fourth degree tear), and after all that maybe still having your belly sliced open like a watermelon in an emergency C section that leaves you debilitated for days, though that in no way excuses you from taking care of the baby 24-7.
The baby is waiting for you to be a full tim…

Fallophobia = fear of falling

Not all people like heights. The fear of falling is possibly related to fear of unknown depths. There's a risk of drowning, getting lost, flailing, crashing into a hundred pieces. Few of us would voluntarily walk off a plank, whether it's in a water park, on a pirate ship, or at the precipice of a major life decision that changes everything.

For the elderly, the concern of falling is real, and practical. Many medical charts of old folks at skilled nursing facilities begin with, "admit date: [ten years ago]; reason for admission: patient fell at home." All it takes is loss of balance, not landing right, and not being to get up, not being able to reach a phone. It's okay to fall, but only so long as there's people to help one get up, and proper care for fractures to heal.

Bones, like hearts, can be broken every which way. A greenstick fracture, a break on just one side, usually happens in children because their bones are resilient enough to only half-break. Whi…

2.18. PNA = pneumonia

Pneumonia, like jam, comes in many flavors--all of them bad. Mucus coughed up can be creamy yellow (Staphylococcal pneumonia), green (Pseudomonas), rusty (Pneumococcal), currant jelly (Klebsiella), or pink and frothy (not just pneumonia, but pulmonary edema.) A sputum culture can be done to identify the offending organism.

One can get this infection of the lungs out in the world (community-acquired pneumonia) or from a hospital (nosocomial pneumonia). There's also "walking pneumonia" (Mycoplasma pneumoniae), and ventilator-acquired or aspiration pneumonia.
That doesn't mean one must pick one of these poisons. Flu shots are better than nothing (pneumonia often follows a flu), and anyone older than 65 without contraindications might consider the pneumococcal vaccine (sepsis from S. pneumoniae was the main thing that did my mom in at the age of 63--maybe they should lower the recommended age).

Patients present with fever, chills, flushed face, sweating, shortness of bre…

2.17. Sphincter of Oddi = a weird sphincter

Ampulla of Vater: not Luke's father. Rather, the exciting Y where two ducts converge in a yellow wood and move into the duodenum (small intestine, part I), never to be heard from again.

Angle of His: reads like a typo, possible religious reference, or place where cats hiss and snakes bite. Possible compliment re: his jawline, or the acute angle formed as his esophagus enters his stomach (so hot).

Circle of Willis: not going to say this out loud for fear of Freudian-mispronouncing it, when it's merely a circular arterial complex at the base of the brain.

Duct of Wirsung: this duck ain't flying nowhere, with wind or wing nor song, because it's the pancreatic duct.

Golgi apparatus: sounds Rube Goldbergian, and looks it--tiny, convoluted complexes in the cell involved in transport of protein, etc.

Islets of Langerhans: possible vacation spot (on a drug holiday!), aka part of the pancreas that produces the insulin that keeps most of us nondiabetic and also, alive.

Loop of Henle: