Queen Square Patella Hammers

As promised, the experience of my final medicine OSCE deserves a blog post. Or rather, my SOSCE, which stands for Subjective Objective Structured Clinical Examination. We all got gussied up in our suits, struggling to find a place to lodge those Queen Square Patella Hammers, stethoscopes and penlights without looking like we were construction workers with massive utility belts. Honestly, there is no justification for the design of these patella hammers. There is NO good way to carry them around apart from poking a hole in your pocket and having them protrude ridiculously from it. Hence the phenomenon of doctors checking reflexes with stethoscopes.

We all sighed with relief with the announcement that funduscopy would not be required. Come to think of it, I would rather have used my ophthalmoscope with the eyes not dilated in broad daylight using the largest diameter setting than my Queen Square Patella Hammer. Which says a lot. May Gordon Holmes turn over in his grave (did you know he was Irish?). Here is another interesting pre-exam fact which Brian Hayes pointed out to me. Apparently Abraham Colles, of RCSI and Colles Fracture fame, was succeeded by Smith, who, apart from describing the opposite fracture, also performed Colles autopsy. Also, thanks Brian for pointing out that the glabellar tap is performed by percussion whereas the jaw jerk is performed with the patellar hammer.

clustr map

I am excited to have a clustr map on my myspace.

I was looking for people on myspace who live in far away and exotic places to add to my map, and I am disappointed most of you people who say you live in Greenland or Antarctica or Madagascar or the South Georgia Islands don't actually live there...if you know anyone who does, tell em to view my profile so I can get a dot from there.

According to Myspace there are 2308 inhabitants of South Georgia and the South Sandwich Islands between ages 18 and 100. I find that interesting considering that the South Georgia Islands and South Sandwich Islands (SGSSI) (further to the south-east) are a UK overseas territory see website. Continuous UK administration has been in place since 1908. At the height of the whaling period some 2,000 people lived on the island. Now there no permanent residents - but there are two British Antarctic Research Stations (Bird Island and King Edward Point), two Museum Curators and a Marine Officer and his wife.

Here is what it looks like ...

The Heard and McDonald Islands are also very far south... see website

If you are one of the 2039 estimated myspace residents of these places, you are just demonstrative of everything wrong with american culture. it's not an island so you can make a joke about big macs... currently there is no permanent resident population, and there are no ports or harbors... here is what really happened there: In the five years following the discovery of Heard Island in 1853, and of its reporting in newspapers around the world, more than 50 visits were made to land gangs on the island to kill elephant seals and render their oil.

Doesn't sound so cool anymore does it....

The killing and rendering of elephant seals at Heard Island commenced in 1854/55 and oil production peaked in 1857/58.

Following the near destruction of seals on the island by 1859, oil production continued until 1877. Up to this time more than 40 vessels, almost all from the north-eastern United States of America, had made over 100 voyages to the island.

The poor weather conditions at Heard Island and the lack of sheltered harbours along its coast meant that many vessels ran aground at the island, occasionally sinking in view of the sealing gangs that awaited their return.

There are few details of brief, sporadic visits to Heard Island by sealers and whalers in the early 20th century, and no records of sealing activities occurring on the McDonald Islands.

Now here is a little information about Christmas Island for the more than 3000 myspace residents of that Island who think it is a joke to say they are santa and live on Christmas Island (courtesy of wikipedia)

Since the late 1980s or early 1990s Christmas Island periodically received boatloads of refugees, mostly from Indonesia. These, and the occasional illegal fishing boat, were never a large issue, often welcomed by locals who looked forward to the exploding of the boats once the "boat people" had been processed. During 2001, Christmas Island received a large number of asylum seekers travelling by boat, most of them from the Middle East and intending to apply for asylum in Australia. The arrival of the Norwegian cargo vessel MV Tampa, which had rescued people from the sinking Indonesian fishing-boat Palapa in international waters nearby, precipitated a diplomatic standoff between Australia, Norway, and Indonesia. The vessel held 420 asylum seekers from Afghanistan, 13 from Sri Lanka, and five from Indonesia. The standoff eventually led to the asylum seekers being transported to Nauru for processing. Another boatload of asylum seekers was taken from Christmas Island to Papua New Guinea for processing, after it was claimed that many of the adult asylum seekers threw their children into the water, apparently in protest at being turned away. This was later proven to be false.

John Howard, the Australian Prime Minister, later passed legislation through the Australian Parliament which excised Christmas Island from Australia's migration zone, meaning that asylum seekers arriving there could not automatically apply for refugee status, allowing the Australian navy to relocate them to other countries as part of the Pacific Solution. As of 2005, the Department of Immigration has begun construction of an "Immigration Reception and Processing Centre", due for completion in late 2006. The facility is estimated to cost $210 million, and will contain 800 beds.

I don't think that's very cool.

As for the 1801 myspace residents of the Marshall Islands, I can only wonder why they want to live on a nuclear testing site.

Did you know that as of Dec 31 2005 there were more than 1.3 million US military personnel deployed in more than 100 countries? When you compare that to the estimated 10 million undocumented persons living in the US, I think it is silly to say for the US to say that there is a problem with undocumented people. I mean, for every armed American who is prepared to die to defend freedom and our way of life, there are 10 people who are living peacefully and just going about their business, living free in the USA. What's wrong with that? Just give em citizenship. Heck, give the whole world US citizenship. Why not. Whoever wants it should be able to get it, whoever doesn't want it doesn't have to have it.

I mean, seriously, if people on myspace can live wherever they want what's the big deal with a few immigrants?

Besides, most of the stuff we use in the USA is made somewhere else...

baby names and google

names

apparently it is all that to name your kid funky names. gwyneth paltrow and apple, the new cruise kid suri, grier from brooke shields. and who ever heard of pilot inspektor for a kids name.

ok but although according to freakonomics your name has no impact on your life, in google suggest this is not the case. Try it and see what your "Google Suggest Number" is...



http://www.jerrykindall.com/2004/12/10_google_suggest_number.asp

http://www.google.com/webhp?complete=1&hl=en

apparently there is even a google suggest alphabet, which on launch day was:

a: amazon
b: best buy
c: cnn
d: dictionary
e: ebay
f: firefox
g: games
h: hotmail
i: ikea
j: jokes
k: kazaa
l: lyrics
m: mapquest
n: news
o: online dictionary
p: paris hilton
q: quotes
r: recipes
s: spybot
t: tara reid
u: ups
v: verizon
w: weather
x: xbox
y: yahoo
z: zip codes

census

Sunday the 23rd is the Irish census. I filled out my section. According to it, I am Irish American, it asked me how far I travel to work and how, what my level of education is and if I volunteer. Quite comprehensive. And apparently you can be fined a substantial sum for refusing to participate. I wonder what happens if you tick the boxes wrong. Do the census police come after you?

The last push

It is late April. Where did the time go? I thought it would never go this fast. I have had a busy few months, obviously, since February 1st. I knew I was not going to match on Match Day due to the impressively "unresponsive to my pleas" errors of my medical school and the ECFMG. So, I ended up flying to New York City to participate in the Scramble. I negotiated the Scramble from my laptop computer inside a Kinko's on the Avenue of the Americas. I used my SKYPE phone to make phone calls, all from my computer. Then, when I finally got my c.v. through to some programs, being on the ground in the city enabled me to interview in person for a position. I lucked out being there, but since most of the unfilled programs were in NYC, it was a good strategy move in retrospect. I would have regretted not going.

One highlight of my visit was getting to see my grandmother. For a woman in her 90's she gets on remarkably well, continuing to drive! To think that the state doesn't enforce a night driving restriction on her, she only does that herself, makes you realize just why they were the greatest generation. How many younger people would voluntarily restrain their activities like that?

After coming back to Dublin, it was time for more study in preparation for finals and Step 2 CK. When I took this exam, some of the questions were just very tiring. It seemed like every question told you the patient's BMI and a whole slough of useless information, where you had to read the stem for the one significant clue. Several gems of questions focused on AMS people being brought in by concerned spouses and significant others. It was so formulaic it was ridiculous, but I really had to giggle at one question in which I was asked to discriminate the toxidrome of the munchies to determine what drug of abuse the significant other who had recently run out of an illicit substance, and had been avoiding work had been using.

I took USMLE Step 2 CK in London, got a chance to sit on the footsteps of St.Paul's and think about the last twelve years since I sat there last. When I was there last time it was 1994, I was 19, and just there for a year of study abroad. Now I am almost done with school, and it made me think, being there sitting outside that cathedral. Cathedrals take a lifetime to build, they are impressive in that way. Similar in many ways to professional education. Yet, I hardly feel like a cathedral.

Ah well. Also got a chance to pop over to the British Museum and have a look at the drawings of Michelangelo. He was pretty good at representing anatomy, apparently he wanted to publish his own drawings as he did dissections (but never ended up doing so) to make sure he represented the muscles correctly. As I was looking at his sketches that he did for the sistine chapel and for other works such as David and the Pieta, I began to realize that he had to do several sketches in advance, to get the perspective and points of view right. It became interesting to me when I thought about it, very similar to reading an x ray or CT in terms of visualizing in 3 dimensions. He would do sketches from points of view never visible from the viewers perspective, just to get the dimensions and sculpture right. It was interesting.

Here are Michelangelo's thoughts before he died. He was a fascinating figure. While I was in the British Museum, I had a peek at the Rosetta stone. It was a stone which enabled translation of ancient hieroglyphics. Fascinatingly, it only came into the possession of the British through military conquest. Speaking of military conquest, apparently things don't change much. I saw several exhibits of the Assyrians and other civilizations in Iraq in the British Museum. One of the exhibits displays a bas relief of some soldiers in a conquest in Iraq. The caption is telling, things don't change much. I just saw in the news that SIX retired generals have come out stating that Rumsfeld should resign due to his mismanagement of the war in Iraq. One of the interesting points I saw in the argument was that the civilian control of the military remains paramount to our democracy, but perhaps is very irksome to the retired generals who view his conduct as arrogant. Interesting, because as Republicans arrogantly state big government is bad, and the role of the government should be limited, this obviously doesnt apply to the way they run things, from Cheney shooting hunters to Rumsfeld's micromanagement.

One last note. Recently two commercial airliners were diverted from landing in the Irish Republic due to bomb threats. British RAF Tornado jets were scrambled to escort the planes to landing facilities in the UK. I find it somewhat interesting that in 2006, 90 years after the uprising in Dublin in 1916, the sight of RAF jets over Irish airspace is handled so well by the public. Particularly in view of the recent Dublin riots and the military parade on Easter Sunday. Yet after talking about it with my Irish friends, I realize the Irish Air Force has NO fighter jets. It is inconceivable to many Americans to live in a country without that. But, looking at the Irish Air Force, they really don't boast too much apart from the only Learjets in Europe.

Back in Dublin

Ok So I am back in Dublin and I have been back for like three weeks. It's nice being back in the hospitals, mostly, as in this picture, we medical students run around trying to find tutorials and read books and attend lectures that only half the time occur when or where they are suppposed to. Basically, its pretty stressful because you go in every day and you never know whether you are going to learn a lot or not. Some days you just want to stay at home and read, especially when you go in one day and only half your lecturers show up and half of the ones that do show up are a pile of crap. We are supposedly attached to teams but everyone is so busy that we dont really have any real responsibilities on the team. Its a pile of crap and its difficult to keep a good attitude. Anyways, apart from that, I met this girl on myspace who came to Dublin and she's pretty neat, I like her a lot, she lives in New York and I have been talking to her on skype, she's cool.

Back from Saginaw

Went to Saginaw Michigan for an interview, stopped in Grand Rapids to say hello to my cousin Marie Claire and Victor. Saginaw is the home of Dow Chemical... and not too much else. But the interview was cool, I had a chance to sing the fight song of UC Davis, of which all I know is the first line, which is "We are sons of California...", and all the campuses use the same song, but I think there are some particular Aggie/Mustang lyrics in there. Thats random, but I have never been asked to sing a song in an interview before. The other thing I was asked was who my favorite superhero was. I did some research the night before and I was going to say Finn Mc Cool who ate the Salmon of Knowledge, but figured what with the toxicity of the Saginaw River I didn't want to go there.

The Saginaw ED is cool, they have a great program run by the president elect of CORD, and their ED is on the cover of ED Design Guide put out by AAEM. They even have a toy train in the pediatric procedure room, and each pediatric room has a fish tank! Not Level 1 Trauma, but they do have most every specialty, and one of the hospitals does site directed TPA for stroke. Seems like a good place to learn.

Drove across from Wisconsin via Chicago, Michigan is an empty state. Lots of flags at half mast, still, since I was there a month ago in Detroit, apparently this is because there are a lot of troops serving from Michigan who are quite young.

A New Year

This is a list of notable new books by the New York Times for 2005, it is clear that I am home early on my New Year's Eve! It's still OK, because the Chinese New Year isn't till January 29th, and 2006 is the Year of the Dog!

Detroit

Two weeks ago I went to Detroit to interview for a residency position there. Motor City is an interesting town. It's sprawled out like LA, but the traffic is nowhere near as bad. There are a lot of liquor stores on the inner city street corners, and not much happening. Despite the fact that the Super Bowl is coming this year, it's a shell of a city. Why can't US automakers start making small cars that are fuel efficient and make the city thrive? At the very least, the Saturn Sky looks promising!

On a completely unrelated note, I was at Wayne State for the interview, and had a chance to go down to the Shiffman medical library there. Upon entering, I noticed a plaque on the door, and was quite surprised to see my great grandfather's name on it. So, since I was there, I looked up some of my great grandfather's work in the bowels of this library that looks like a nuclear bomb shelter. As I sat there leafing through the pages of the journal that he edited for some time, the Journal of the Michigan State Medical Society, I had the chance to see another era of US medicine. In those post World War I years and into the Second World War, there was a definite fear of socialized medicine. The fear was that the US Public Health Service would take over the profession, leading to poor quality, and the erosion of physician independence to make decisions for patient care. At the time, Blue Cross and Blue Shield were started as prepaid health plans, some of the first ones in existence. It is interesting to see how this situation has changed over the years. Looking at the NHS in the UK, it is fair to say our health care in the US is of higher quality. However, one thing I notice about the US is that people get left behind. In the NHS, and in Ireland (a separate system), there is a safety net. At some stage here in the US, we will need to establish a safety net, and whether it is prepaid, or paid by the government matters not.

After my visit to the library, I wandered past the Detroit Insitute of the Arts, and paused in fronth of Rodin's Thinker. Actually, one of many. As it turns out, there are copies of this statue around the world,and the original is in Paris. I don't know why, but I have bad museum karma. Every time I visit a city with a cool museum, I end up going on the day it is closed! So, if you don't like museums, travel on Tuesdays, you are sure to find the museums closed...

Minnesota

I have been here in Minnesota for three weeks now, doing an elective at the Mayo Clinic. It's pretty cold here, but it's Christmas Day today and the snow is starting to melt! Anyways, the place is huge, it's like a factory town for medicine, with the clinic being pretty much the only thing here. That said, it's an efficient well oiled machine for getting things done! Here I am sitting next to the Brothers Mayo on the steps.

There is an interesting professional ethos around here, something I haven't seen elsewhere, not even at Scripps Clinic in San Diego. Maybe it is the Mayo Model of Care, which I found engraved in the museum here. Certainly there is a lot of history around the place.

results are in

Got the word today, passed peds, obs and psych. Had the ex-president of the Irish Medical Council in my Peds exam, and faced both external examiners in the Obs exam, one from Trinity and one from Dundee, so it means something to have passed these last ones, not easy were they (couldn't have said it better if I was Yoda). Now just have to pack the old bags and am off to Minnesota for an elective in Critical Care, with trips to Michigan for interviews. Called round to Mick's gaff tonight and saw his pics of him laying the wreath at his grand-uncle Patrick Kavanagh's grave in Monaghan, very feckin cool. Heard interesting stories from Daran about the Jameson Distillery where he is now working, evidently they allow a free bottle of the stuff every two weeks. If a bottle of whiskey is 30 units of alcohol, that just about does it for your alcohol for life if you work there. Today was World AIDS day, so I guess my post about the condoms previously should be taken to heart! Went to an HIV/AIDS conference earlier this year sponsored by Bill Powderley in the Mater and it was staggering to hear what the global burden of this epidemic is, particularly in Africa.

Christmas in Dublin

Christmas Time!I managed to catch this shot of some buskers playing some music at the top of Grafton Street, with the Christmas Tree.

Then, while walking to my favorite cycle shop to pick up my bike with the broken spokes, I ran into a strange man who was promoting the idea that condoms are not what they seem to be. Rightly so, I suppose, as there was a recent condom scare in Dublin, in which several thousand fake condoms were distributed and sold in shops! More information available at Irish Medicines Board. Anyways, I escaped unscathed and the bike shop didn't even charge me for the repair! I think this is because I called my favorite Spanish bike mechanic "The Man", and he said not even his mother called him that. That made my day. Anyways, the exam results from peds, obs and psych come out tomorrow. Man I am sweating it! Ran into two people from the class walking across town, evidently the day to be out shopping for Christmas! Which reminds me...

Back from Sligo: Without a Fridge Named Saoirse

Spent the last two weeks commuting back and forth from here to Sligo, on a psych attachment there. Sligo is a small little place, made liveable by the Sligo Higher Institute of Technology, affectionately known as SHIT. At least it's not shite! Lovely little roads to run around on leading to just about nowhere. Apparently however, a nice day in Sligo is a day it doesn't rain, as I was told it's a lovely day on two consecutive cloudy overcast gray days, which evidently were lovely by Sligo standards. It's all relative I suppose. And not to complain, but I am a little curious about the trains in Ireland. What is the story with a return fare costing the same as a single? And just what does the money go for? Is it the classy carriages? Why couldn't they put in some doors that you don't have to stick your hand outside the window to open? It makes me think I am in the wild west gettin off a train in Ireland, goin back 50 years to 1950... This is a little off topic, but my trip to Sligo did have two very interesting revelations about Ireland and roads.

First, I found out the meaning of the song about the N17. For those of you who haven't spent any time in an Irish country disco, the song says, wish I was on the N seventeen, etc etc. Now why would anyone write a song about a road? Well, turns out it's the road from Galway to Shannon, and it's a bit of an emigration anthem... ahem.

The second revelation came as I was gettin my hair cut by a barber on North Earl Street in Dublin, so not technically a Sligo based revelation. In any case, he was telling me about the emergency, during world war II. The government was so concerned about Germans landing here that all the road signs were taken down. Nowhere, anywhere had road signs, you simply had to know where you were going. This might explain why these days it is so bloody hard to find a road sign. I thought it was something to do with the U2 song "where the streets have no name"but it was all about the emergency in world war II.

Also finally found a place to live, nice place by the sea in Portmarnock. Will ride in to city, only 45 minutes cycle... All the looking around though. Spent ages on daft.ie... it really is daft. Got lost looking for a place in Beaumont area, some place called Ardmore with an housing estate with like five streets named Ardmore Drive, Place, Park, Grove, and Close. Of course, I have to walk down every single one because they are poorly signposted, and only three of the five have actual signposts... And this is an estate built post 1950, so the whole world war II explanation doesn't cut much slack for this oversight in roadway nomenclature. Speaking of which, I will have to devote another blog to the phenomenon of the Irish housing estate!

Video Blog

Introducing the author of the post, check out my video (it's clean)...

Bluetooth

Well, finally came into the 21st century and got a laptop, and even taught it to talk to my phone... This is all based on a technology which is named interestingly, after a Viking called Bluetooth, who was pretty sophisticated in his own time... I think he might have coined some money. So this whole bluetooth thing is very Monaaay!!!

The interesting part of all this is that now I can take photos with th e phone, which I have done, and some are here! If only I could figure out the panorama feature! The one above I took on a hike in Howth during September, when it was still warm enough to wear shorts. Some ladies were out riding their horses, and the flowers are nice. And the next one is of the view looking across Dublin bay towards Dun Laoghaire and Bray Head.

Stephen's Green

First Post

This is the first post to John's Journal of Irish living in Dublin etc. It is Wednesday Sept. 28th. This blog was inspired by Toby's blog about India. It will hopefully be better than my previous attempts.