Slightly frazzled update

To the bullet-points of lazy hastiness!

• I rode Zeus last night, Lear having been sent off for vacation. Zeus is new to our class, a strange copper-colored animal who looks like a QH from the chest back and a scrawny Morgan otherwise. He's very forward-striding, which makes him good on trail (I'm told) but once at any kind of speed in the ring he does. Not. STOP. When I asked for the canter I got several laps of hand gallop; eventually I had to spiral him into a circle to get him to come back down. More to the point, oh my God he does not bend to the right. At all. EVER. It was like riding a close-paren, and after a few minutes I felt like I'd been cranking a mower from the effort it took to keep him from collapsing in half to the left. The barn assigned him to the class "because he needs dressage," the way stiff office workers need yoga, and truer words et cetera. But riding him is exhausting work, like teaching spelling to a four-year-old who's breakfasted on Chocolate-Frosted Sugar Bombs. This pony needs less grain and a lot more work. And also not to step on my foot argh argh argh ya bastard move argh.
  
• C'est fini the mini-med course. The final presentation was on reconstructive plastic surgery after breast cancer, and the presenter was kind of an asshole. First off, he apologized for the "adult" material, which consisted of before-and-after neck-to-hip naked shots of women who got the surgeries. If you're lecturing on breast cancer, trust me, we know. Boobs. Gotcha. We've all seen 'em. Second, he implied that all surgeons should ask small-breasted women whether they've ever thought about implants, because when you're dealing with a disease that attacks a major part of your appearance, what you really want is someone implying that you weren't so hot even before the cancer diagnosis. Finally, he made some snarky remarks about feminists thinking his work isn't important. Started, comma, do not get me. True, the presentation involved some useful intels, like that you should consult a plastic surgeon before going in for general breast surgery, because that'll get you better cosmetic results, but he ruined what could've been an excellent lecture by being condescending and a little creepy.
  
• Wanda reported back on the Arizona round-up: dusty, understaffed, and fun, with an all-girl ground team to pin the calves (up to 300-pounders, aka all hands on deck cow) while Alex handled the branding. Aw. She got to ride a barrels horse who by the sound of it could've done the cattle work without a rider: "Coalie would spin on a dime and roar off after a cow that cut off where she shouldn't be, and he was completely unafraid of their horns and their bawling...all I had to do was keep him from running over Cynthia! When the calves were finally done and let go, he put his nose down to move along the little ones; it was sorta cute, no way to have a nice picture of that." Jealousy gnaweth my entrails.
  
• I'm trying to get back into C25K. Last year I'd worked up to half an hour's running at a stretch, then let it lapse entirely, so it's back to square one. I find it hard to be disciplined about running programs, but I'm trying to do this (again) because I still have dreams where I find myself running and it's easy, and I think, "Oh. How silly not to have realized," but then I wake up. So I'm trying to bridge the gap. But...
• Mexico! High altitude! Long scheduled workdays! Oh well. Rockninja and I fly out Tuesday, while those in command arrive on Wednesday. We're all a-flurry with trying to plan things, and I'm channeling my nerves into wardrobe angst and stress about my rusty Spanish. But there is balm in Gilead: One of our partners is coming up from Argentina and called with an important question: "Apart from dulce de leche and alfajores, what should I be bringing you?" Oh man. MAN. I will be worse than Zeus.
  

Structuring the week

Monday: The painful yoga class. I've now gone to four in a row, enough to see what bits remain consistent from week to week (the 20-minute sun salutations warmup; the agony of abs work just when I start to think it's quittin' time) and what changes (the lunges, the balances, the perverse forms the abs stuff takes). I don't participate in the oms that start and end the class, but if I did I'd be hard-pressed not to faff around singing in thirds just to be perverse. Better to stand in silence.

Tuesday: Mini-med! It's back! Aaand Georgetown fail: every single presenter on the roster is a guy. Bring back the goddess of the shiny knife! The first lecture, on obesity and whether it is or should be considered a disease, was full of neurochemical goodness. Human adenovirus-36, you interest me strangely. The second, on drug development, was a disappointment; the speaker covered maybe 12 of his 40 pages, and noncontinuously at that. The Elder Gods reserve special torments for presenters who flip around in their PowerPoints. He covered some of the development process and discussed a couple of things he's working on, including a bizarre but potentially lucrative product that would fluoresce when it reached target cells, so clearly he knew his stuff, but he didn't do a very good job of presenting it. He also got on my nerves by claiming that Viagra was originally developed as an anti-allergy med; it was in fact an anti-hypertensive (and is still sometimes prescribed as such).

Wednesday: Well, we all know about the standing date with Lear or some four-footed facsimile. Last night I got Lear after he'd been worked in a kids' class, so he was less of a fruitcake than usual. We worked on cantering large circles, rather than the full ring, an exercise that forces the horses to balance themselves more precisely; Lear promptly lost track of all his feet. He did, however, do a perfect haunches-in, good turns on the fore, and stretches down for the bit, and he's getting more consistent about collecting himself, so we had progress. Pat has decided to spring for a blood test to find out whether he's incompletely gelded; I await the findings with interest.

Thursday: Pilates, or possibly Chisel, if I can get up the nerve to spend an hour doing what I'm told are many squats. This is followed by going out with Teal for crepes, because balance is very important, and because the thought of Nutella may sustain me through the fitnessing process.

Friday: Watching Dollhouse. Cooking. Passing out.

This whole structured-schedule thing is all very well and good, but how the hell does anyone fit in basic chores, let alone extemporaneous fun, during the week?

Invisibul nitting needul

I woke up at some wee hour of Wednesday morning feeling as though someone had rammed a dowel rod straight through my left ocular ridge and out the back of my head. In such moments do we learn whether we've taught ourselves to open the child-proofed analgesics bottle without even turning on the light. I knocked back some naproxen sodium and went back to sleep, hoping that the merry elves who live in the pills would do the job while I snoozed. Alas, either the little buggers were on vacation or the Campaign for Equal Heights had declared a work stoppage.

A hot shower proved useless for pain relief, and I made it through all of two hours of work before deciding that what I really needed was to spend some quality time in a dark room, whining softly from beneath a cold washcloth (or...GENIUS! one of those chilled gel eyemasks, the invention of which should have earned someone a Nobel). Five hours of quality nappage later, I felt closer to human than to hemicranial shish kabob, but it was still painful enough that I canceled on my riding class. Call me a wimp, but I want all my brainy parts working when I'm around large animals. Instead I watched the Obama infomercial, swapped reactions with IE via text, and went to bed early. Life is mo' boring when there are no horses.

Ordinarily I would've written this off as a regular migraine, but in catching up on the webs today I learn otherwise; clearly it was my body's reaction to the BBC's horrible news. Nooooo, they be stealin mah Tennant!

Disambiguation

Whenever it comes to problems with the hip area, me and mine seem doomed to encounter GPs who have no idea how to deal with physical mechanics. Apparently most general practitioners are all about chem and bio, which is fine and dandy except when the problem is mechanical rather than infectious. Lately it's Seesterperson who's been struck down with sciatica-induced agony, probably related to roller derby's determination to have skaters always going widdershins (step 1 to becoming a goddess of the rink: figure out which way widdershins actually is) in a squatting pose. Her GP and a surprising number of online resources are in fits debating whether it's really sciatica if the pain descends below the knee. Here's my feeling: if the pain is related to the (follow the logic closely here) sciatic nerve, the question of whether or not it goes below the point of the nerve's bifurcation is moot, a semantic debate that has nothing to do with the actual mode of treatment, and you shouldn't hassle your poor patient about the fine points of the definition. You won't end up looking any better, because your first fix won't work, and your patient will be uncomfortable for longer. Also her relatives will think about handing you an "ass/elbow: disambiguation" wiki and then smacking you on the noggin.

Ahem. Got a little spleen on the monitor here, excuse the mess. Anyway, in hopefully distracting conversations over the weekend, Seesterperson and I were talking about Neil Gaiman's professed guilty feelings at how much work it took to build a zeppelin pirate ship that collects lightning bolts, relative to the ease of just writing one into Stardust because it sounded cool. Which of course it does and is, it's hard to argue with that, and the screen ship was worth the work (though if they'd tossed De Niro overboard early on, I would have been better pleased). Not before time, someone's actually come up with music for it. You just know that this is how it sounds inside Cory Doctorow's head whenever he writes about steampunk. Especially the propeller.

A little knowledge

The last of the mini-med seminars finally came and went. We are now unleashed upon the world as mini-doctors, capable of exposing slightly more advanced ignorance in future conversations with medical professionals.

I was looking forward to the oncology lecture, but it was a bit of a letdown. In retrospect, the topic was maybe a little too broad to fit into two hours—or, actually, an hour forty, since we had a mini-graduation ceremony that was cute but completely unnecessary. The oncological basics were pretty much what most of us already know, although the statistics on diagnosis and remission rates were good wonk fodder. The doc skimmed over conventional chemotherapy and wouldn't have talked about radiation at all had it not been for a question from the audience; instead he focused on explaining how antibody therapy and some of the new small-molecule drugs work. I hadn't heard the stats on Gleevec/STI571 before—90+% remission in CML patients, 75% in gastrointestinal stromal tumors (translation: life for the dying, in Novartis' hands lying)—or understood how long drugs and antibodies stay in the system, nor was I familiar with some of the survival data for other novel therapies. It's sobering to hear that progress in the past 25 years means that expected survival time for patients with colon cancer has doubled...to two years. Yikes. But cure rates are improving overall, and most neoplasms aren't as resistant as colon or pancreatic cancers. Oh, and he explained how PET scans work. Radioactive sugar uptake! Truly we live in an age of wonders.

The exciting, for very stats-happy values of the term, news was that the school's cancer center is starting a database of molecular information on every patient they treat. Ultimately, they hope to be able to mine the data to develop targeted regimens that will have the best results at the lowest cost (physically, not fiscally, which is another and slimier kettle of fish) to the patient.

It was also a kick to learn that the school's cancer center is going to join the ranks of facilities offering long-term follow-up care. The follow-up issue has finally gotten some attention in the last 15 years or so, as pediatric patients in particular are generally surviving long enough to have their health concerns tracked on a broader scale. Unfortunately, without a coordinated follow-up program, there's no guarantee that they'll hear about what tests they should be getting or what long-term side effects they should look out for. Even those who do hear the news are often stuck being their own advocates for care, dealing with physicians who may not know the likely ramifications of a drug regimen given 20 years ago. (In these cases, a handful of PubMed abstracts is a very useful thing. Snapping, "It's not my fault that you haven't kept up with this research," when confronted with obstruction, however, will not make friends. Not that I would ever do such a thing and find it so cathartic that I practically needed a cigarette afterward. At least not more than once.) Integrated survivorship programs are more likely to know the long-term nasties, understand what's normal for someone who's had their innards irradiated, and keep all the test results in one place. They're also usually more helpful in coordinating schedules for tests, because it's easier for a customer to spend a day or two getting poked and scanned than it is for him or her to schedule five different appointments with various departments over two weeks, only to find that nobody knows to whom the results have gone. CAT scans are unpleasant enough; there's no reason to erect further barriers to compliance.

Con su flor en la boca and my 10 blade in his trachea

Gala Theater's "Blood Wedding" was such a fun trip back to halcyon days of minoring in la bella lengua. You absolutely cannot accuse Federico of ever having been too subtle, what with Leonardo riding his great big sweating horse hither and yon in search of stolen moments with La Novia, while the chilly Luna keens about how she wishes she were able to warm her hands in the hot blood of a human heart, and Gala didn't try to minimize any of the fantasy in the interests of realism. The flamenco trio who performed in the first half almost overshadowed the rest of the production—bring back the guitarist! more stamping!—but were balanced out by a great arrangement of the woodcutters' song in the second act, where three peripheral characters sing a lament to the moon, asking her to leave some shadows where the lovers can hide. She doesn't. It ends badly.

Continuing the cantata in the key of goooooore, this week's mini-med course was on non-cardiac thoracic surgery. I've always heard that surgeons are the fighter pilots of the medical world, all ego and strut and absolutely bugger-all in terms of personal skills, and mostly I haven't been able to argue. This week's presenter clearly loved, oh but I mean LOVED, her job, but she was also weirdly charismatic (and gorgeous and raising twins on her own and a fine arts grad and able to do plumbing work on her 1865 house during her residency and oh God I've wasted my life). She explained how open-chest surgery became possible with the development of the ventilator, then she kind of took a sharp left turn and from then on we were all sitting in stunned silence as she ran us through at least five different major operations, including tracheal reductions, bronchial lobectomies, arterial reconstructions, esophageal reconstructions, and tumor excisions, complete with CT scans (which she made comprehensible, a neat trick), graphic photos, a couple of videos. I especially liked one video—an esophageal operation, maybe—where she could clearly be heard snapping, "I don't care, I don't care." She looked a bit embarrassed and said, "I only care about important things when I'm doing surgery." Other memorable lines included, "The aorta is tough, like kevlar. The pulmonary artery, though, it's like American cheese. Rips if you look at it," and of course, "Wow, I wish I could go on Letterman for this one. I can sever a trachea at the neck, extract it from below, and reach up to wave at you through the hiatal space." Surgeon humor.

The biggest surprise for me personally was that I could watch the slides at all. Blood and lymph and exposed innards, no thanks, usually, but she had the gift of showing all the squishy bits as structures. I was fascinated by the engineering of certain neat surgical tricks, like how to remove a giant tumor during a laparoscopic operation: You detach it from the surrounding structures, put it in a ziplocky bag inside the body cavity, then snip the mass into bits, seal the bag, and ooze the whole thing out like a sausage. How sneaky! How clever! How I hope I never need that myself! And oh sweet God that teratoma is going to eat my dreams. She wrapped up with a look at the seriously dire fall in the number of cardiothoracic fellows; it's one of the few specialties that's experiencing negative growth, and part of the problem is the hours and the difficulty of training people in such potentially serious areas. She's working with the med students to use her ingenious plaster/bovine/banana-prophylactic models to introduce basic surgeries, but since they won't be fully grown surgeons for 10 (!) more years, there are going to be some very lean years. We may've come out of the class starry-eyed and thinking that surgery looks like, OMG, super fun, but I doubt anyone really wants me trying to figure out how to use a rib spreader.

"Don't buy this gum, it tastes like rubber"

More to come on last night's mini-med lecture, which was fantastic and fun and strangely sexy in a "wow I want to be a pilot because I just saw 'Top Gun'" sort of way, but I want to mention the absolute zenith, which was a series of photos of the practice version of an aortic valve replacement our presenter had MacGyver'd up out of a plaster cast, a cow's pulmonary artery, and a banana-flavored condom.

Ayurveda to rumble?

Last night's mini-med lecture was the one I was most unsure about, because while cellular processes and chemical reactions are fun and games, is complementary and alternative medicine really science? Despite my yoga-doin', massage-gittin', biofeedback-slightly-creditin' ways, stuff like reiki and homeopathy still gets the full eyebrow of dubiousness.

But the woman who presented the lecture is used to getting a similar look from med students throughout a full semester, so she was undaunted. After covering the history of the NCCAM (shriek about your tax dollars if you wish, but Americans spend about $27 billion on CAM each year; a little investigation into whether any of it actually works wouldn't hurt), she ran through short descriptions of a bunch of different modalities, including homeopathy, naturopathy, traditional Chinese medicine, acupuncture distinct from TCM, the forms of yoga that aren't asanas, ayurveda, and traditional Greek "take two humors and call me in the morning" medicine. The proselytizing I was half expecting never materialized; she simply described each discipline and a bit of its history, then moved on, apologizing occasionally that condensing a semester's worth of material into two hours meant giving some questions short shrift. In the last 10 minutes, she presented some of her preliminary statistical results on using homeopathic saw palmetto to treat prostate cancer and on mind-body treatments for stress among med students, both tentatively positive.

I'm not convinced that understanding what throws the yellow bile upon the black is likely to provide major medical breakthroughs, or that homeopathy is anything but the placebo effect in expensive action. Still, encouraging a focus on prevention, on treating people rather than symptoms, and on making it easier for everyone to take an active role in managing their health could stand to be integrated into the medical culture. The world would be a happier place if more of us got massages covered by insurance.

In the taste confounds the appetite

Last night's class was presented by another first-time mini-med speaker. Unlike last week's presenter, however, this one stuck pretty well to the order of slides as distributed in the class packet (thank you, sir) and had left himself enough time to get through all the material and still have a decent Q&A. He also seemed more at ease, connecting with the audience and answering questions without being brusque. If his manner during the class is indicative of his interactions with patients, his practice must do well.

God knows it's probably growing, because he's an endocrinologist specializing in diabetes, the topic of last night's lecture and an, er, expanding field in its own right. The doc covered the clinical and therapeutic differences between Type 1 and Type 2 diabetes (the first involving complete and apparently spontaneous failure of the insulin-producing beta cells; the second, once known as adult-onset diabetes, involving a slower progression from insulin resistance to complete beta-cell failure, and strongly statistically correlated with weight gain), the definitions of prediabetes versus full diabetes, how the disease rates have changed over time, what therapies are available, and how regimens have been adapted to cope with shifting disease patterns. He emphasized that most of the increase in Type 2 is lifestyle driven, and although I was a smidge disappointed that he didn't mention our borked-up food distribution system, which IMO is responsible for many of our dysfunctional eating patterns, he did advocate much wider access to gyms and nutritional counseling. Questions from the audience included whether Lipitor is associated with weight gain, because everyone in the questioner's family who has taken it has also put on pounds (response: sorry, this is a case where correlation != causality); why some physicians worry that insulin is associated with cardiovascular disease (response: incorrect data were presented by a high-profile physician, and although the numbers have since been refuted, not everybody got the news); and why fatty fat fatties don't just stop being so fat (from, of course, That One Guy, who needs to shut up so hard; formal response: it takes a lot of work and commitment that many of us find difficult to maintain).

My only quibble, come to think, is that the presenter was so pleasant and positive that the scale of the problem may not have come through. Unless our health care system, food network, and overall cultural attitude toward exercise change drastically, the number of people with diabetes is going to continue to rise. Pharma companies can make stupid money off treating diabetes—it is largely a disease of wealthy societies, after all, although genetic predisposition plays a significant role—so while we may see increased funding for medicating diabetes, coordinating efforts for preventing the disease from ever developing are tricky. It's a lot easier to fund a drug than it is to make a city's layout safe and accessible for bicyclists and pedestrians and to make fresh food more affordable and appealing than preservative-laden packaged stuff.

It was a cool spring night when we stepped out of class, so I walked the two miles back to Dupont rather than waiting for a bus. Truncal obesity begone! Integrating exercise into daily life, yay! Today my hip registers a protest at all that strolling in nonsupportive shoes. Damn, it's always something.

Does what it says on the tin

This morning the dermatologist swapped me a little dermis for two tiny stitches and a warning not to lift heavy objects or twist around too much for the next few days. Hoisting weighty things in a torque-wise manner is probably out, putting paid to the idea of tacking up a horse tonight or tomorrow. I could always ask someone else to do the pregame work, but then there's mounting up and the near-certainty that something would go wrong in a way that called for twisting, so after a little inner struggle I gave up and canceled my lessons for the week. I am grumpy but lack the nerve to face down the RN if I were to bust a suture by, say, wrestling with Okie's right-turn issues. So, apologies: no horse gossip this week. To make up for it, here are a few objects of coveting. Secret Santa presentations cheerfully considered.

Last night's mini-med presentation on NSAIDs was a general disappointment. The presenter was new to the program and hadn't planned the lecture very well, so we spent a lot of time flipping back and forth in the enormous packet of slides and being given tantalizing glimpses of information there wasn't time to address. Some of the presentation was borderline insulting, including the reading aloud of a printed list of NSAIDs on the market, and some was overly technical given the audience. Not quite nul points, because she included some interesting material on why the COX-2 inhibitors were put on the market (and why they're being pulled) and some fascinating data showing that the pain relief from opiate-NSAID combos is inferior to that of some prescription NSAIDs alone, but overall it was a little scattershot and not the best use of two hours. My favorite Q&A moment involved someone demanding to know why the pain-relieving effect of leech bites had not been discussed. Was it because the FDA hasn't approved them for use and the medical institution is biased against alternative therapies? The presenter just looked at her blankly for a second and said, "No, it's because they're not NSAIDs." Hee! (Pedantic NB: Leeches are, in fact, approved for use in U.S. medical facilities, although not specifically as analgesics, and were the first live-critter medical devices approved by the FDA. Maggots were the second. Disgusting medical knowledge, heyah, GETcher disgusting medical knowledge.)

Information gradients

Mini-med is back from its brief hiatus, hurrah. Ooh, and it brought lemon squares. Digression ahoy: Patch clued me in to the fact that the best coffee in DC is to be found at Illy, an easy stroll from my office and oh-so-conveniently on the way to G-town. It's criminal that I've been drinking Starbucks froth when I could've been indulging in Illy's luscious crema. The only downer is that the artisanal steaming process takes forever, so you have to just stand there and think wistful thoughts of how much you would enjoy bathing in a vat of the stuff.

So this week's class actually was about drugs, or more generally the science of pharmacology, and since I'm not expected to do the calculus for titrating doses to correct maintenance levels over time, it was perfectly fascinatin'. We got a zoom-through of the basic principles of pharmacology: all drugs are poisons (if poison is defined as something affecting a system's function), there is no single-effect drug, the definition of the main effect versus the side effect can depend on what you're treating (for instance, morphine can be given for pain relief, with nausea and constipation as side effects; to stop diarrhea, in which case the buzz and nausea are the side effects; or to induce vomiting, in which case I'm betting you've already got the picture), the therapeutic window must be defined and sustained fairly carefully, et cetera. There was also a massive tasty infodump about normal neuron function, how lethality is defined relative to effectiveness, delivery mechanisms, the history of drug regulation, interactions between drugs, and the function of the most addictive drugs. Kids! Take your meds on time! Follow directions! Nicotine is bad! Cocaine is worse! Chewing coca leaves with ash enhances the buccal membrane's uptake of the good stuff! And so forth.

The downside of the classes is that some of the attendees use the Q&A periods to air grievances—"I had to show ID to buy Sudafed!" "Drugs are too expensive!" "My cat's breath smells like cat food!"—that don't add value. But other students ask short topical questions, such as how to set up a schedule for maintaining a certain minimum drug level if you don't want it to fall to zero before the next dose. Those people were also smart enough to sharrup and listen to the answers (which, for that question, is to use a loading dose: a large amount of the drug to start, followed by smaller maintenance doses). The information gradient is denser around the person with the laser pointer than it is around you, Mr. "I read in the New York Tiiiiimes that antidepressants have a substantial placebo effect and I'm going to imply that people who need Prozac are whiners and I'm going to talk over your answer because it sure seems like you should agree with me so that's my question." Is there a real-world way to rickroll someone without bystander casualties? God, it would be so handy.

Match It for Pratchett

Terry Pratchett, as has been mentioned here before, has been diagnosed with Alzheimer's. It's horrible to think about someone like him having his mind eroded piecemeal, but it's a shitty diagnosis for anyone. Pratchett has donated $1,000,000 to Alzheimer's research, saying that he would eat the arse out of a dead mole if it would give him a fighting chance, and no sooner had the news hit the papers than fans set up Match It for Pratchett to make it an even million quid. You can stop by and make a simple donation, buy a t-shirt, or, if you're feeling flush, check out some of the online auctions (I hear tell that the Luggage, full of autographed copies of all the Discworld books, is available). Then maybe head over to one of the US Alzheimer's funds and give them something as well. To quote the Omnians, we are here, and this is now. Go do a good thing.

The girl in the bubble

Last night's lecture at mini-med school was supposed to be on drug mechanisms, including those of Prozac, booze, nicotine, and cocaine, and I was quite looking forward to hearing about all that fun stuff and why it's dreadfully bad for you and/or therapeutic. But schedules change and interest rates fluctuate, so instead we got a lecture about microorganisms, presented by a guy with a British accent and a professed love of "House" (although, quoth'a, on the show you never do see lab technicians; instead the poor team do all their tests themselves).

You know, I'm not going to go into details about this lecture, because it ended up giving me a bad case of the squeams. I am grateful that the poor transition from color version to xeroxed black and white slides in the packet means that the horrific picture of a newborn suffering from one of the nastier side effects of C. difficile infection isn't clear enough to cause flashbacks. "You'll not sleep tonight," the cheery presenter had told us at the beginning of class; hell with sleeping, though, I didn't think I'd ever manage to eat again. Also, while it's sort of interesting to see an infected GI tract with hundreds of neatly aligned colonies of bacteria, it's not at all comforting to hear that the air around you is probably aswarm with those self-same nosocomial spores. The line for the women's room after was longer than normal, because everyone was frantically scrubbing down.

Please forgive any typos. I'm experimenting with typing this from inside a protective dome of Saran Wrap. May we all live like Boiled in Lead: "Caffeine, sugar, and THC/ Is all the doctors are gonna find in me/ When they do the autopsy./ The microorganism won't get me."

Now 'scuse, I must go wash my hands again some more.

You've got to love heme, and kiss heme, and squeeze heme

Short review of the first mini-med lecture: Loved it, learned a bunch, came away excited and thinky and, oh yes, grateful for my little hemoglobin molecules for working the way they're supposed to. Smooches, you guys! Keep up the oxygen binding and releasing!

Longer version: The first IQ test was finding the classroom, which I managed eventually. Reward for being such a good mouse? Free cookies. We all settled in, flipped our arm desks into place (agh, college flashback, agh), and looked attentive while the chair of the program introduced the series. He explained that the course is part of the medical school's initiative to reach out to the community, described the program's structure—four sessions on the science behind various disorders and four on clinical applications—mildly upsold us by pointing out that the autumn series includes lectures on gross anatomy ("That's when we can get the cadavers"; you know, we never think about the seasonal variation in available corpses, my dear Dr. Maturin), and introduced the first speaker. Meanwhile I was flipping through the presentation booklet and suppressing a little apprehension; page after page of molecular chains, diagrams of protein structures, and incomprehensible graphs full of actual Greek, oh dear. I limbered up my pennin' hand and hoped for the best.

Which best is actually pretty much what we all got. After we weathered the inevitable shrieky mike probs, it was on to the equally unavoidable PowerPoints, the hallmark of modern science. The speaker spent 45 minutes whipping us through slides on the basic molecular biochemistry of a functional hemoglobin molecule, from amino acid chain to the actual mechanics of action, with brief discussions of how altitude affects the molecule's ability to pick up and release oxygen, how carbon monoxide binds to hemoglobin's receptors, and how the proton/oxygen exchange works. After a short break, he dove into how a single amino acid change affects Hb's function in sickle cell disease (Hb! yeah, we're such good friends, I use the nickname), how sickling occurs, how SCD affects tissues other than red blood cells, what the positive side of the mutation is for carriers who do not express the disease, what DNA tests are used to diagnose SCD in a fetus, what the current treatment protocols are, and what's currently in development.

It was both awesome and a little boggling that the guy got us through so much information, some quite technical, so quickly, and that, based on the follow-up questions, people appeared to have followed almost all of it. Kudos to him for being so clear and for so effectively taking my mind off the primaries, to the uni for hosting such an interesting event for so little baksheesh, and to the local buses for getting me home before I turned into a squash. Backpats for all (except Texas).