Month: October 2018

Humanities scholars these days make the news for only the following reasons:

• their efforts to suppress views with which they disagree
• their hatred of Donald Trump
• their passion on behalf of the gender-nonconforming

The Celtic World, a 24-lecture class from The Great Courses, will restore your faith in this corner of the U.S. education industry. The lecturer is Jennifer Paxton, a professor at Catholic University, and she wears her expertise lightly. She uses modern idioms and plain language when appropriate and then drags out her Latiin or Gaelic as necessary.

One learns a lot about the Romans in this class as they were the big power in the region and the authors of most of the primary sources.

Highlly recommended for listening in the car (available on Audible).

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I was down in Bethesda, Maryland over the weekend, technically home to Georgetown Prep (actually located, since 1919, in what we Native Bethesdans would have called “Rockville”) and its weekly official gang rape parties (organized by Brett Kavanaugh, according to Julie Swetnick). None of these parties were on the calendar for Saturday night at my parents’ retirement fortress, so we were able to enjoy a quiet family dinner (cooked and served by immigrants to the pro-immigration elderly Democrats (nearly all had retired from careers, e.g., civil service, medicine, or law, that depended on Big Government becoming Yet Bigger)).

A grandson who is a local high school junior joined. I asked “Are you partying like a Kavanaugh?”

I’m hoping that this can become a new meme to replace “Party like a Rock Star”.

[I posted this on Facebook. It was #NotFunny and #TooSoon. A woman who manages an anti-development non-profit org:

Really? You mean like, get drunk, assault women, black out, and don’t remember a thing the next day. You seriously think that’s funny?

to which I responded

All the more reason to ask!

A self-employed carpenter and contractor whom I know commented

I only hope he turns out that smart. Remember also “he, who is without sin, cast the first stone”

He’s 70 years old and, for 55 years, has been getting up at 5 am every morning, 6 days per week, to work. It is possible that he interpreted my post literally as he is not a close friend nor a close reader. A woman who went to an elite high school then two elite universities before settling into a cushy university desk job, resonded to him and men in general:

It sounds like you may have things on your conscience. That’s ok, we are not judging you (at least not until you run for a public office). Let me give you this advice. Just come clean and apologize. You will be forgiven.

If Jesus were alive today, he would be a liberal!

I can see the aggrieved male privilege getting up at arms about “politically correct” taking away the last bits of “boys will be boys” fun you were able to have (at our expense too!). Please pardon me if my heart is not breaking for you. I cannot feel guilty or bad that it is no longer ok to drink until you are liberated enough to force yourself on another human being. Please figure out how to bond with other guys and have fun some other way.

Is it reasonable for a woman with an elaborate list of educational credentials and a highly paid desk job that starts at 10:00 am (or later!) to say that a man who gets up at 0500 to work with his hands has “privilege” compared to her? (They both appear to be white, but their respective photos have not been evaluated by official government race-identifiers.) Could billionaire Sheryl Sandberg, for example, say that her immigrant landscapers are “privileged” if they happen to identify as male? If not, where is the line over which a female can cross into the land of “more privileged than a blue-collar guy”?]

For the record, though I was a high school student in Bethesda in the late 1970s, right in the middle of the Jimmy Carter Malaise and a core non-woke period of “rape culture”, I did not hear about any rapes at parties or otherwise (maybe Walt Whitman (public) High School kids were not cool enough for these?). Teenagers back then were terrible gossips and keeping secrets was more or less impossible. The most common sex-related scandal was a pregnancy (this, despite the extensive contraception education provided by Montgomery County officialdom). A few Catholic girls got married as a result of unintended pregnancies. The happy new couple would move into a walk-out basement belonging to one set of parents (our neighborhood was called “Mohican Hills” (maybe Elizabeth Warren lives there now?) and nearly all of the houses were on a slope). The new moms would take a couple of months off school and then hand the resulting baby to their 40-something parents. At the time, a 17-year-old giving birth was considered unfortunate. This was before the advent of child support guidelines (history) that made single motherhood a financially sensible lifestyle choice and every pregnant girl either married the father or had an abortion (legal since 1968 in Maryland).

(Teenage motherhood still seems to be something for people to condemn. I spoke with an anesthesiologist the other day. She remarked negatively on having recently assisted with a birth at which four generations were present: baby, mother, grandmother, and great-grandmother. “The oldest family member in the room was 39. Nobody had a male partner or a job.” (i.e., each child had been born to a 13-year-old mom) In her view, this fecundity was due to our welfare system. “What this country needs is more hunger. You don’t see people in China having babies so that they can then live in public housing.” She’s a frequent business traveler to China so this is based on first-hand knowledge. I was shocked by her statements because typical Boston-area academic physicians are just as liberal as you’d expect given that more than 50 percent of their income comes from the government (Medicare, Medicaid, etc.). It is odd that Americans want to condemn something that they also vote to fund and enable!)

Update: “Kavanaugh Was Questioned by Police After Bar Fight in 1985” (nytimes), which says “As an undergraduate student at Yale, Brett M. Kavanaugh was involved in an altercation at a local bar during which he was accused of throwing ice on another patron, according to a police report.” Compare to students in the 18th century (Daily Mail): “duelling with swords; getting loudly and raucously drunk and getting kicked out of taverns … Trapping a servant girl in their rooms and scaring her; … Getting drunk and arguing with a lecturer…”

Related:

• “How Anti-Poverty Programs Marginalize Fathers” (Atlantic) explains why today’s 17-year-old mom might not want to marry the dad: “Cohabitating with a boyfriend who is not biologically related to any of the household’s children is the most advantageous setup in most states.”

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From our anonymous insider…

Exam week: two one-hour clinical standardized patient (SP) encounters, a 4-hour NBME-style 200-question exam, a 2-hour case-based exam, and a 2-hour clinical multiple choice exam over four days.

My first SP is 50-year-old nonobese non-smoking female with a two-month history of radiating back pain. She describes pain beginning in her lower left back, traveling down her buttocks to her feet like a bolt of lightning. She denies urinary incontinence or retention, denies headaches or visual changes. She reports difficulty walking. Physical exam reveals weakness in plantar flexion of the right foot decrease in station over the lateral aspect of the foot. She is unable to walk on heels. She has 2+ pulses in distal extremity. Positive straight leg raise while supine. I diagnosed her with a disc herniation spinal stenosis causing a L5 or S1 radiculopathy. One mistake: I forgot to do sensation testing of the distal lower extremities (feet).

My second SP is a 40-year-old nonobese nonsmoking female presenting for right-side hearing loss and one-hour episodes of dizziness over the past several days. I conduct the Rinne test (tuning fork is placed next to the ear and then on the mastoid bone. If conduction loss, the patient can hear better when fork is placed on the bone) I then do the Weber test (tuning fork is placed on the midline skull, and localizes to the affected ear if conduction loss)

Good news: I have ruled out a problem with mechanical conduction and therefore her hearing issue is due to a sensorineural cause. Bad News: I did not read up on sensorineural hearing loss. Although we are not supposed to discuss the cases (others will see the same patients later in the week), Jane and I overhear the correct answer in the line at Starbucks: Ménière’s disease. Neither Jane nor I had ever heard of this, let alone how to diagnose or treat this disease.

The clinical multiple-choice exam tests ophthalmology, suture technique, lumbar puncture technique, and psychiatric cases. Several questions showed images where we had to identify the correct diagnosis: for example, a cherry red spot in the macula (pigmented area near the center of the retina) suggests a retinal artery occlusion or Tay-Sachs disease. How is it possible to test suture technique with multiple choices? Example: “What suture size and needle type should be used to close a face laceration? What technique is depicted with this diagram?”

Students led by Type-A Anita swarm the clinical director because one of the questions had the wrong units attached to an optic ultrasound measuring the optic sheath diameter. It had calipers measuring the optic nerve diameter at 3 mm distal to the retina. The multiple choice questions all were in cm instead of mm.

The case-based exam covers five patients, each starting with a two-paragraph description of a patient’s presentation. We are then asked open-ended questions about what tests we would order and other symptoms to ask about. The exam for this block covers neurological diagnoses, endocrine diagnostic workups, musculoskeletal fractures, dislocations and malignancies. Neurology questions asked what other symptoms is most likely in a description of a Huntington’s disease patient and localize the lesion for stroke symptoms (e.g,. right anterior cerebral artery for left-sided leg weakness). Endocrine questions dealt with determining if an endocrine pathology is primary (disorder of the endocrine gland itself) or secondary (exogenous or pathologic dysfunction of the pituitary). For example, a patient with low thyroxine hormone and high TSH suggests a primary thyroid disorder; a patient with low thyroxine hormone and low TSH suggests a secondary cause of hypothyroidism. Pinterest Penelope complained about a lifelong smoker with Cushing syndrome (excess cortisol) and high ACTH (adrenal corticotropin hormone, hormone released by the pituitary gland to stimulate the cortisol release from the adrenal cortex). We had to determine if this was a ACTH-secreting pituitary adenoma or paraneoplastic syndrome from an underlying small cell lung carcinoma. “How were we supposed to know what is more likely?”

Jane and I look at the sample question bank on UWorld the night before to prepare for our final NBME block exam. These will be retired Step 1 questions from the National Board of Medical Examiners. I ask Jane about drugs for the treatment of bipolar disorder. She responds, “First Aid says mood stabilizers. lithium and valproic acid.” I look at my own copy of this book: “On page 545, First Aid says you can also use antiepileptics like carbamazepine and lamotrigine.” Jane exclaims, “What!?! Those are sodium channel blockers for seizures.” I add, “I understand why doctors order psych consults and call it a day. We cannot go into psychiatry.”

The Thursday NBME block exam was our toughest so far. Type-A Anita claims to have “blacked out” for the last 15 minutes: “I do not remember anything.” Pinterest Penelope: “Where was the biochem, where was the actual neuro on the test? There was nothing of yield.” Mischievous Mary adds: “I am glad I do not go to lecture because I’ve heard not much was represented on the exam.”

The renal questions required differentiating different types of chronic renal disease. Some questions you could answer using the patient demographics, e.g., African Americans are more likely to get focal segmental glomerulosclerosis (FSGS), whereas whites and hepatitis B/C patients get membranous nephropathy. Others started with black-and-white scanning electron microscopy images and asked about the immune complex deposition pattern. Anita was not happy: “There is nothing to memorize. It’s like learning a new organ system every single question.” Her mood was not lifted by a genetics counseling question concerning the probability that a couple’s potential children will develop an autosomal recessive disorder. The husband has a sibling afflicted with the disease, which has a 1 in 40,000 prevalence in the general population. “I did not go to medical school to do math!” Anita exclaims. Answer: assuming Hardy-Weinberg equilibrium, 1 in 100 individuals are carriers of the disease. The husband’s parents must both be carriers for a sibling to have inherited two affected genes and therefore the spouse has a 2/3rds chance of being a carrier (he doesn’t have the disease so 1/4 of the sample space is removed). Thus the probability of an affected child is wife’s risk of being a carrier times husband’s risk times child’s risk of receiving two carrier genes: 1/100 * 2/3 * 1/4 (1 in 600).

[Editor: In most states, any child born during a marriage will entitle the parent who can obtain custody to child support, regardless of actual paternity. So the wife could have sex with a genetically-clean neighbor and in the event that the husband ever does find out, she can still count on child support profits for 18-23 years (depending on the state).]

After exams, Jane, our class VP, and I help Lanky Luke and Sarcastic Samantha move into their new house. Luke and I rent a U-Haul trailer for his F-150 pickup. While driving, Luke informed us that his uncle has autosomal recessive polycystic kidney disease. “I thought the question Anita was complaining about was a great question. My father is an engineer, but has no idea about medicine. He told us he debated having children out of fear his children would inherit the disease.” He continued, “Just like in that question, the doctor informed my parents it would be very unlikely.” We googled ARPKD — a prevalence of 1 in 20,000 puts the carrier frequency at about 1 in 70. Based on the uncle’s phenotype, there is a 0.24 percent chance of his children getting the disease. Luke continued: “People overestimate certain risks. That’s about the same likelihood as a typical couple having someone with Down syndrome. When you put it in that perspective, you wouldn’t change your whole plans based upon that risk.”

We drink some craft beer on their new porch overlooking a small creek as their dog and cat explore their new home. With exams over, campaigning for the six student admissions committee representatives (from M3 and M4) has begun. Geezer George sets off a firestorm by texting the class GroupMe:

Hey all, I know it’s a little early, but I’d like to throw my hat into the ring for the Medical school admissions committee. If you think I would be good for the job, and if one of your better friends isn’t running, I’d love your support!”

Buff Brad responds:

I would also like to throw my hat into the ring for a spot on the Medical School Admissions Committee. I have been working hard to promote the vision of our school to both incoming applicants and current undergrads. I believe that being elected as a committee member would allow me to really make an impact.

Type-A Anita grills the two men: “What are your strategies for getting more girls at our school?” Our class and M1 are both over 50 percent female, but nobody asks Anita to clarify her question with a target percentage. Instead, Fashionable Fiona announces her candidacy:

… Being a women (@Anita) I will ensure we will have equal representation of genders and as a minority I will ensure we have a diverse class. Let me know if you have any questions! I’d love your support!

Optho Annie, an aspiring opthamologist with a family heritage from the Indian subcontinent::

To piggyback off of Anita’s question, I’m also interested in being on the Admissions Committee and have thought about increasing both female enrollment and enrollment of people of color and minorities, something we severely lack. I think the answer comes down to increasing visibility and outreach through different endeavors to show we host an environment where every student can flourish and feel safe. Happy to talk to anyone in person about my ideas, and would appreciate your support if you think I’d be a fair and just committee member!

Our school was awarded a diversity award by the LCME. What was lacking from Annie’s point of view?

… In general, diversity to me means a community or group of people that are of different races, religions, cultures, which can all help expand their peers’ world views. However, that’s the more obvious form and not all of what diversity means to me. I also think people of different socioeconomic backgrounds, hailing from different geographic areas , and also people on different sides of the political spectrum can contribute to and enhance diversity. …

… our class is pretty diverse when it comes to a lot of things like socioeconomic background, geographic background, and even culture and religion. However, I do think we are lacking in minority enrollment as well as female enrollment. We historically have had very few black, Hispanic, and Native American students. Also, over 50% of medical school students are now women but our class percentages do not always reflect this.

It turns out that one of Annie’s prime motivations was hearing about a class several years ago that was 50/50 female/male rather than adhering to the national trend of majority female. Neither of the two closeted conservatives whom I know in our class offer to sit down with her and share their perspective from their Trump-tainted side of the political spectrum!

Adrenaline Andrew, an aspiring ED physician whose family is from Kurdistan:

I would also like to be considered! I think it’s important we present ourselves as inclusive and well-rounded. I really enjoy talking to future students and believe I can represent our school as such. I am huge advocate of diversity and ensuring minority students feel welcomed in our city (and increasing awareness within our school). This a very exciting position! I would love your support and welcome any advice you have for me.

After an extensive exchange of messages, it turns out that nobody wants to promote diversity of undergraduate majors, age, or any other characteristic other than gender and race ID. No white males come forward (Geezer George and Buff Brad can qualify as persons of color).

Sarcastic Samantha, who currently identifies as “white,” cracks up as

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