The Tulane School of Medicine reunited today in the lecture hall of one of it's most prestigious graduates: Dr Michael E DeBakey, class of 1932. The DeBakey building, the original building of the Baylor College of Medicine in Houston, sits directly across from the medical library where I'm composing this. There were photographers and cameramen, reflections on recent events, some teary eyes and a general sense of history in the making. As a privately funded institution, Tulane's very existance is on the line, but there is no doubt the school will play a critical role in rebuilding New Orleans and we may be in for the education of the century. If you want to apply to the Tulane School of Medicine, we're looking for those with a desire to serve, a vision to build, and a desire to make a difference.

Noone knows when we'll return, but there was some good news on the condition of the higher stories of our downtown New Orleans buildings: the financial aid folks were able to recover documents from their 12th floor offices in the Tidewater building, so that may not have been overcome by molds and fungi. Similarly, the university's IT department has a generator set up on top of 1555 Poydras (the medical school was due to move into our new digs there on the day Katrina hit) and the computers are running, including the web.

I haven't studied the back or arm since we evacuated. I did the entire head and neck dissection at Texas A&M, but have done little more than a few flash cards and mental exercises on the arm and back. Now it's almost 9, I've got a few more things to do just to be ready to go to class tomorrow. Gotta go.

Grand Rounds

Volume 2 Issue 2

Case Studies

Subcutaneous Emphysema, by GruntDoc. Wow.

Buy That Man a Wheelbarrow, by Dr Bard Parker. Still haven't made his blogroll, but I have to admit Dr Parker serves up some of the meatiest posts in the blogosphere, with a particular emphasis on case studies (students like me love case studies, particularly surgical case studies). So here's his most recent, a wicked hernia. [An editor's pick, not submitted by the author.]

Disaster Response, Part II, by me. I was the team leader for twenty Texas A&M medical students at a special needs shelter in College Station during Rita. The first draft was written within 24 hours of turning over to the next crew.

Clinical Correlations

Applying Single-Disease Guidelines to Patients with Multiple Diseases by Dr James Gaulte of Retired Doc's Thoughts. Dr Gaulte is a graduate of the Tulane School of Medicine and did his residency at Charity Hospital.

Doctors Telling Bad News and How to Tell Bad News by Dr Maurice Bernstein at Bioethics Discussion. Starting from a post by Dr Greg P at Information is Free, Dr Bernstein expands on the topic of giving bad news.

News and Commentary

The Nobel Prize in Medicine goes to Barry J Marshall and J Robin Warren for their association of helicobacter pylori to stomach ulcers, from DB's Medical Rants.

The Liar's Brain, by Dr Emer. Dr Emer comments on an original article from the British Journal of Psychiatry on structural differences in the brains of pathological liars. PS: Gruntdoc also commented on this article.

BBC Invents New Germ: the E. coli "virus", also* by GruntDoc. Comments are short, but I think both of GruntDoc's BBC links raise a much larger issue: the BBC is substantially rewriting articles after going to press?! Journalists are supposed to get it right. Period. What is going on at the BBC that they allow anything short of retractions, which involve an admission of error?

Where Should Donations Go?, by Elisa Camahort of HealthyConcerns. Ms Camahort provides two alternative ways to dispose of excess monies generated by a charitable campaign. What other alternatives can you think of? How would they play out? I'm particularly interested as I added a donation button to my blog.

Drug Approved to Help Alcoholics Also Effective Against Tinnitus by Joseph at Corpus Callosum. The title is introduction enough.

Harvesting Brains Without Consent. Ironman, of Political Calculations, provides a synopsis of this case against the King County Medical Examiner's Office, which sold brains of mentally ill patients to a research foundation in Maryland.

I Will Name My Anger Scowly McGrimace And He Wrote This, Not Me, by the Jerry at the Cosmic Watercooler. Jerry takes issue with Morley Safer's softball treatment of Robert Oxnam's new book.

Group Doctor Visits: on the rise? from Hospital Impact. The blogger reviews group therapy, particularly for Kaiser Permanente's obstetric patients.

Stealing Endoscopes and Colonoscopes, by the Interested Participant. Who steals colonoscopes? Funny I should know this, but an essentially identical device is used for diagnostics on turbine engines and other equipment with very high, very fast internal rotating forces (pumps, engines, etc).

Clowns in the OR, by Aggravated DocSurg. Uh, yeah.

Late Addition

National Depression Screening Day is 6 October. Thanks to Dr Serani for this notice.

Perspective

Within These Hands, by the Cheerful Oncologist. Compare this to They Sent Me Here, by Dr Danielle Ofri, editor of the Bellevue Literary Review.

Running Through My Mind, by Shrinkette. Editor's pick, not submitted by author.

The Ghost of Influenza Season Future, by Dr Charles. Dr Charles' fictional piece has the feel of The Minority Report, except this is possible. As we saw with Katrina, horrific scenarios need this sort of thinking before they happen. Loaded with facts and, at the bottom, helpful references.

Identifying a Pill by Dr Mic Agbayani. How many times has this refrain been repeated? No matter, it bears repeating again. Rather than a possible horrific scenario, this one plays out, surely, millions of times every day.

Becoming a patient by Jen SN. An editor's selection, not submitted by the author.

There's a Reason They Call Nature a Mother by Josh Cohen of Multiple Mentality. Josh continues to his weight-loss struggle while recording his observations, almost as though he is leaving breadcrumbs for himself and others.

"When You Look Up", by Geena at Codeblog. Geena's submission is, in her words "a silly little post". Well, maybe, but nerdy students like me actually go study up on spinal traction after reading.

Teaching Compassion, by the Red State Moron. Some of Harvard's material mentioned in the article is now posted (free) at the New England Journal of Medicine.

Behind the Mask by the Difficult Patient. DP continues to struggle with her most distressing physician encounter.

Correspondence

Another writer questions JAMA’s Scientific Integrity, by Dr R W Donnell. Dr Donnel comments on one Dr Hanson's comment on another author's comment on a JAMA article. [Ed: Dig deep on this one and you'll find Regulation, a publication the Cato Institute, the neo-conservative think tank.]

Blogger of Gloom and Doom by David Williams. Mr Williams offers planning advise to people looking at retirement.

A Little Criticism Directed Orac's Way by Orac at Respectful Insolence. Orac slogs through the hinterlands of logic searching for lost souls to invite to the hearth of science. In this post he does battle with some of his more vocal critics. Pay attention - he discusses a few clinical biases that caregivers do need to gaurd against in their own practices.

Communication

Ed: A quirky category where these all seemed to fit.

Communication Skills by MSSPNexus.

Why Connect Medical Devices, by Tim Gee. Inspired by a reader, the connectologist struggles with the fundamental problem in medical technology: so what's this data good for? [Ed: this also comes up in the military, particularly in the tech heavy Navy's combat information centers aboard ships where shoot-don't-shoot decisions are made without ever seeing the attacker. Life-and-death decisions are intimately tied to the information the decision-maker has at the time. Anything that enters that relationship between the decision-maker and their information is bound to be caught up in the painful struggle).

Make the Largest Encyclopedia in the World Better, by Clinical Cases. If you haven't actually contributed to the Wikipedia yet, it's a win-win: you get to share what you know; we get to learn.

Book Reviews

Jill Quadagno's One Nation, Uninsured, by Dr Stern of Insureblog.

Editor's Picks

Paul Starr's The Social Transfomation of American Medicine. This is a must read for the health insurance debate; it won the Pulitzer Prize in 1984 and remains highly relevant. Nothing has taken it's place.

Edward Tufte's The Visual Display of Quantitative Information. A visually stunning book, Tufte's work will make you a better presenter, a better communicator. One of Amazon's 100 best non-fiction books of the 20th century.

George Lakoff's Don't Think of an Elephant!. It's much shorter than his seminal (and less partisan) Metaphors We Live By. If you want to understand politics, you've got to read one of his books.

Nota Bene

The Pulmonary Roundtable is loaded with case studies.

Assassins, by the first year Texas A&M medical students. What a novel use of a blog [Ed: Cheryl got me].

Insert Clever Title Here by a New Orleans family doc and the wife of a classmate.

Liveblogging Katrina Relief in New Orleans, by Enoch Choi at Medmusings. Dr Choi is being housed in Kenner, a bit west of the city, and working — where, I'm not exactly sure.

Push Fluids, by three MDs, is notable because it's still here, having survived the shift of the three authors from students to MDs, and the incumbent moving around the country.

Kent Bottles Interviews Intueri's Maria. Possibly the best new addition to the medical blogosphere interviews one of the best.

End Matter

Finally, this is from Dr Gary McCord, a radiologist and the dean of student affairs at Texas A&M. I'll save the details for another post, but I will never be able to repay the debt of gratitude I owe the Aggies.

The waiting room for our Pediatrics clinic where I trained was a large open area. Kids played in the middle and the parents sat around the periphery with the secretary's desk at one end. This day it became quickly evident that one 8 year old was terrorizing all of the other kids while waiting to be seen. Periodically, Johnny's mom would get up, attempt to remain calm, and quietly talk in his ear, telling him to calm down. Little Johnny got louder and louder over time, and his mom got more and more embarrassed, but seemed unable to help him gain control. After 10 minutes of this, he pushed another child to the floor. Mom bolted over to where he was and exploded. She picked up Johnny by the shoulders, carried him over to the secretary's desk, and slammed him down into a sitting position on top of the desk. She proceeded to read him the riot act, while the whole waiting room got very quiet, all eyes fixated on what this kid might do next.

After her diatribe, and having been slammed down on top of the desk, Johnny announced in a voice that all could hear, "Now you've gone and done it! You went and smashed both my balls!"

Mom was mortified. Some of the other parents started snickering, while others shook their heads as if to say, "But for the grace of God go I..."

Then Johnny hopped off the desk, reached into his back pockets, and plucked out a smashed ping pong ball from each.

Next week's Grand Rounds will be hosted by Doulicia

The entry before Grand Rounds? Ditto.

An interesting e-mail not to be lost:

From: Dr. Peter G. Traber [mailto:notestothepresident@bcm.tmc.edu]
Sent: Mon 9/26/2005 4:07 PM
To: BCM-ALL@LISTSERV.BCM.TMC.EDU
Subject: Post-Hurricane Summary

September 26, 2005

Dear Members of the BCM Family:

I hope that this message finds all of you and your families safe following the landfall of Hurricane Rita. Houston was fortunate to have experienced much less damage than those cities to the east of us. I know that many of you evacuated your homes and I hope that upon your return you found everything safe and intact. Baylor College of Medicine was well prepared for this hurricane thanks to the dedication of a number of individuals in multiple areas.

Following the devastating flooding of Tropical Storm Allison four years ago, BCM evaluated how to protect the College from flood waters and implemented those plans. Our Facilities team was essential in activating those plans last week.

They installed flood gates and film coverings on vulnerable windows that provided protection from Category 5 hurricane winds up to 180 mph. They also ran all the pumps to ensure they were functioning properly in the event water came into the building. It is interesting to note that our pumps have the capacity to remove the equivalent of one tractor-trailer load full of water each minute.

In addition to their work on the main BCM campus, they also worked with facilities crews at other institutions where we have space including SLEH for the Baylor Clinic; TMC for the McGovern Building; TMH for Neurosensory, Smith and Scurlock; and the crews at Greenway Plaza and the Baylor Family Medicine office building. This enabled us to do as much as we could to protect the College's investments in all locations.

In addition to the Facilities team, we also had teams from the Office of Research to coordinate the shut down of labs and work with scientists; the Center for Comparative Medicine to care for research animals; the Office of Environmental Safety to prevent or deal with hazardous products; Information Technology to back up and secure our electronic information systems; and Security to assure that people and property were protected throughout the process.

All together, approximately 140 people devoted their time to prepare BCM for this storm. On Friday evening, 82 of them joined me in spending the night at the campus in the event there was building damage that required immediate attention. Please join me in thanking these dedicated members of the BCM Family who sacrificed being with their own families in order to be at the College as members of the Emergency Operations Team.

Peter G. Traber, M.D.

This was sent out before Rita arrived.

-----Original Message-----
From: Dr. Peter G. Traber [mailto:notestothepresident@bcm.tmc.edu]
Sent: Thu 9/22/2005 10:56 PM
To: BCM-ALL@LISTSERV.BCM.TMC.EDU
Subject: Thanks to the BCM Community

September 22, 2005
5:00 pm

We have just finished the final preparation for hurricane Rita and are confident that the College is well protected and ready for this storm. We owe this confidence in very large part to the faculty, staff and trainees who vacated the College gracefully and on time and did an outstanding job of preparing their labs and offices. The Emergency Operations Team visited every lab and office on the main campus to assure that the emergency power was used properly and that dangerous chemicals were contained. We found only a few problems that were easy to correct.

In order to assure constant protection of the College during and after the landfall of Hurricane Rita, we have approximately 100 people on site, from Facilities, Comparative Medicine, Research, Environmental Safety, Information Technology and Security to assure the continued protection of the College.

As we look to the next few days which may bring some difficulties, I want to thank you for your help and cooperation. It makes a remarkable difference in our ability to respond to these sorts of emergencies.

I hope you and your families are safe and I look forward to seeing you once we have accomplished our recovery process.

Peter G. Traber, M.D.

The Houston Chronicle on Saturday's historic reunion of the Tulane School of Medicine.

Oh, my head.

Gross Anatomy tests are written and practical. That means part of the test is walking around to the cadavers and identifying muscles, nerves, veins, bones, etc, that have pins stuck in them. A little index card next to the body will have something like "Name the nerve that innervates the pinned muscle". So if the biceps is pinned, the correct answer would be the musculocutaneous nerve. Most schools (I can speak from experience on this one now!) hold practice practicals before the real practical exams, so the students have some sense of what might actually be pinned, and what those pins look like, how the cadavers are presented, that sort of thing. Oh, and it's timed. I think one minute per structure is standard. So we took our practice practical after our second lecture back from the "holiday".

Ouch.

Now we're all studying like mad. Groups are forming and dissolving, people were in lab yesterday until 2 am. God only knows how the test is going to go. I'm feeling pretty stupid right now, though. Gotta go.

Enoch Choi has been blogging his experiences in New Orleans, St Bernard's Parrish, particularly. It is a little disturbing that people are still lined up outside FEMA tents, now 6 weeks on. The patients sound very similar to those I saw at St Anthony's. I'll be going in next weekend.

Well, everything this semester is pass—fail (RangelMD would be pleased), but that first anatomy test hurt (and I hear they only get worse). Maybe it was Katrina. Maybe it was Rita, which delayed the test a week after I'd already volunteered to host Grand Rounds, thinking I could edit Grand Rounds the day after the test. Maybe it's my own damn fault: I suppose I could have studied more. Not that I did anything else, except call home, set up yet a third living space (this time a living room stocked from WalMart), make plans to retrieve my car from New Orleans (attempted theft three days before Katrina, towed to the shop. Katrina demolish shop around the car, car just looks like it got a power-wash, finally repaired and ready for delivery, but... how do I get there?), remembering how to study, spend a few hours with my wife and kids and parents on Sunday for dinner, etc, etc, etc. I'm pretty sure I passed, but it ain't over till Dr Vigh sings.

Grand Rounds Vol 2, No 3 is up.

Ever do something with electronics that the manufacturer advises against? What about when there's no advice, like replacing the battery on a Dell laptop running on AC power.

Why would one do such a thing? My scenario, which is oh so painfully common for me, is taking electronic notes. This wasn't a big deal at Tulane because I was always able to get close to a power supply. At Texas A&M and now Baylor, that's not always the case. Sometimes we might have, say, a three hour histology session with a break in the middle. If I'm not so lucky as to have gotten access to an outlet during the first hour and a half (and I do come early for that specific purpose), then I'm low on battery and need to switch batteries, but I may not have time to shut down the computer (due to other things that need to be done on the break) and reboot. So it would be nice to plug in momentarily to change batteries and then go back to my no-plug seat. Plus, once I get home I may very well have two dead batteries and my time is still valuable, so I'd rather not shut down the computer just to change the battery. Well, Gateway says you can change the battery on a running laptop if it's plugged into AC power, so I just tried it. Pause for dramatic effect. And my computer is fine.

I also disregarded manufacturer instruction on my Nikon D100 and cleaned the CCD myself using the Copperhill method. Now that felt like open heart surgery.

antedeluvian: before the flood. Specifically: 1) Before Noah's Ark purportedly floated: 2) before Katrina.

I passed all my tested. I dare say I even did well! Nothing like the risk of public humiliation as a motivator!

For whatever reason the Baylor students and Tulane students really haven't mingled that much yet, at least not in the first year class, despite occupying the same building, the same labs, and having two mixers already. I think this has to do with a few things, not the least of which is that the Astros are in the playoffs, so the Baylor folks are a little preoccupied during their free time right now. And the faculty worked really hard to make sure there was no overlap between the two classes. Their initially smooth two week schedule is on it's last lecture (shouldn't I be paying attention?) so we'll see if there's more overlap later.

Going in to New Orleans with, along with every other Tulane student this weekend. Hopefully I can get into the school to get my books out of my locker.

They tried to steal my car. Four days antedeluvian they tried to steal my car. A standard steering column defeat job that failed. But succeeded on the next car they tried. That poor lady, a state employee, had been parking in that garage for 10 years, driving the same car as mine for the last, well, since it was new (they found hers gutted and burned three days later). It took three tow trucks to get mine out of the sixth floor of the parking garage. Then the shop had to figure out how to defeat the anti-theft circuitry (the thieves broke into the vehicle, removed the steering column plastic, and then the car disabled the ignition circuit). Then it was Saturday and Katrina was coming. The shop was demolished around my car! The car just looked like it got a power wash! The shopowner called a couple of weeks ago and said he could have it fixed by last Wednesday, and my neighbor went and picked it up and delivered it to my house (I'm in Houston).

So I was in the back seat of my friends' car as three of us drove back into New Orleans on Friday night. I was getting a ride to get my truck, and they were getting a truck to haul stuff back to Houston. At 10 pm we were on a 25 mile long swamp bridge (a roadway standing about 20 feet off the ground) when we came to a skreeching stop. Cars skidding onto the shoulder, the whole bit. About 20 minutes later one of our classmates, Dan, calls Van, sitting in the passanger seat, and reports the accident is near the end of the bridge: a car fire; Dan saw the gas tank explode out the side, stopped to help and then drove. Emergency services responded fairly quickly and I could see the flashing lights behind us but they weren't getting any closer: the cars weren't moving to let them through. So I ran about a quarter mile back to them and started directing cars to clear a path, which I did until about a quarter mile ahead of our car where someone else took over the path-clearing job. Then more emergency vehicles were trying to get through, man, that's a lot ambulances for one car fire. Why aren't they moving? Awwww! People had driven back into their lanes, again blocking the ambulances! Mental note: if there's a wreck, and a path is made for emergency vehicles, keep the path clear until traffic starts to move again!

As I was clearing cars (again!) some of the drivers (many independent reports relayed over CB) said there was another accident: a semi, still up ahead, had driven over six cars! Oh. That's why there's more emergency vehicles. So after the path was clear I explained the situation to everyone and advised them to turn their cars off as we might be here for a while. Then I went back to our car. Van was just getting out of the car saying to someone on her cell phone "Oh my God, are you okay?" The driver, Bart, was asleep and she didn't want to disturb him, but that got cleared up really fast. Two of our classmates, Kelly and Kam, were in the wreck with the semi!

Turns out the trucker was at a complete stop in the traffic jam caused by the car fire and decided to back up. Into the three cars behind him. And then slam forward into 13 more! Kelly was driving a car that belonged to her exchange family (she's from New Guinea), a Honda Prelude. A bit of context—Kelly's exchange family lives in Lake Charles (incidentally the hometown of Michael E DeBakey). After she evacuated New Orleans for Katrina, Kelly's exchange family lost all their property in Rita, except two cars, one of which just got smashed by a semi. Kelly and Kam were standing outside the car, near the driver's side door stretching their legs and waiting for the burned car to be cleared out when the cars started slamming into each other behind them. Kelly basically stood there counting the violence approach, wanting, I'm sure, to believe that this couldn't possibly be happening, until Kam grabbed her, yelling "Run!" Good thing because the Honda started moving before they were actually clear of it and was ultimately slammed into the median siderail. Six inches of concrete away from the swamp! They would have been pinned if they hadn't run.

I learned most of that later. When Van told Bart and I that Kam and Kelly were in the accident Bart and I agreed I'd run ahead and meet them, and Bart and Van would meet us once we disposed of the wrecked Prelude. Luckily, Kam's family is in with the Louisiana state police so we were able to drive the Prelude (with smashed bumpers, a smashed left side, and soft steering) thirty miles to the state police headquarters and wait for Bart and Van. We got there about 3 am. Have you every tried to take a cat-nap in a Honda Prelude? Bart and Van got to us about 4:20 and we got to Van's house in the Uptown neighborhood of New Orleans about 5:30. We all passed out. I got a phone call at 8 and couldn't go back to sleep.

Other than that it was a usual weekend spent salvaging our lives out of the largest national disaster in American history.

Grand Rounds is up!

The New England Journal of Medicine will presumably keep these perspective articles on line, but there are a couple of links I want to hold on to:

Field Operations Guide for Disaster Assessment and Response. At 378 pages this needs to be a longer term reading project.

The Sphere Project's minimum standards for disaster response. This seems a little pie-in-the-sky to me, sort of setting every future response effort up for failure, but that's what they did.

Because he's such a good writer and makes so much sense. Here's his speech to the Harvard Medical graduating class of 2005.

Here is a very nice analysis, both in terms of mathematical analysis and visual presentation. Both components are vital parts of it's over-all quality.

I just read an article about search engines and decided to search the engines for me. Most of them came up with links for me in respond to the search string niels olson. AltaVista came up with Charlene Olson, who apparently paints small knick-nacks, mainly to hang in your kitchen. I understand someone named Joe Smith who never uses e-mail not finding himself as the first return in a search engine. But how did AltaVista think someone looking for Niels Olson would rather find Charlene Olson?

One of our faculty, a retired pediatric general surgeon, came in from New Orleans this week, having spent the last six weeks with the New Orleans Police Department. He said there had not been a single rape, armed robbery, or murder in the city since the storm. This is in a city that used to have a murder a day.

My first patient. My first standardized patient. My first standardized, scripted, done-this-chest-pain-script-so-many-times-he-can-improv, patient. Sweet. There's three of us students. Sure, I'll go first.

Hello, Mr Lake? [Mr Lake has his back to me... I'll walk around!]

Hello, Mr Lake? I'm Niels Olson, a medical student at Tulane. Do you mind if I ask you a few questions? [Do I ask if I can have a seat? Does my doctor ask that? It's not his hospital... Look at that, I'm sitting!]

So, what seems to be bothering you?

And how often do you have this chest pain?

It feels like pressure... And does it radiate? From you back to your stomach... [Why does he have an insulin pump? Is that part of the bit? Man, wouldn't that kind of complicate chest pain? We haven't even cracked the chest on the cadaver. It must not be part of the shtick, ignore the insulin pump.]

[Ignore the insulin pump]

[IGNORE THE INSULIN PUMP! THAT ONE! RIGHT THERE! THAT LOOKS LIKE MY OLD CELL PHONE! IGNORE IT!]

And how long does the pain last? Thirty or forty seconds, great. [It's not great! What the hell was that?! Great....]

You seem tense. [Note the lack of follow-up here...]

So, do you have any past hospitalizations? [My classmates are sitting there, so safe. I want to sit over there, watching the fool trying to interview the standardized patient...]

Blah

Blah

Blah

Okay, well that about raps it up, thanks for your time Mr Lake. I'll go brief your attending and we'll see what we can do to help.

———Next student———

Blah, blah, blah

Other student: "You seem tense. Would you like to talk about that? Is something troubling you, Mr Lake?"

Mr Lake: "Yes, yes, the stress is killing me! We just moved into this house, our dream house, that we built, and one night two weeks ago a thief came out of the bushes and beat me over the back and stole my wife's purse! And the economy's in a downturn and I've had to lay people off at my architectural firm, and my 18-year-old daughter stays out late, and I've got these skin cancers on my hands, ohhh, it's so horrible! I don't know what I'm going to do! I can't even sleep in my own home!"

[Hmmmmm..... should've followed up on that tense thing....]

Here's a story from Texas A&M's medical school, which has been unbelievably kind to my family and I.

COLLEGE STATION, Texas (October 4, 2005) – When asked where he's from, Niels Olson simply replies, "All over the place". He attended the U.S. Naval Academy in Maryland and was stationed in San Diego with the Navy for several years before settling in New Orleans with his wife and children. Olson started medical school at Tulane University School of Medicine August 9, just 20 days before Hurricane Katrina would devastate the Central Gulf Coast. Luckily for Olson and his family, his parents had moved into their new home in College Station just three days before they evacuated New Orleans on Saturday, August 27.

As the storm approached, Olson and his wife Brooke had two choices when deciding where to evacuate their family: her aunt and uncle in Tennessee or his parents in Texas. As fate would have it, evacuees could only go south from their section of the city. That sent them packing for College Station, where there just happened to be a medical school in the form of The Texas A&M Health Science Center College of Medicine.

"I had a big test coming up that next Monday (August 29), so I decided to go study over at the Medical Sciences Library on campus," Olson remembers. "Then on Monday, the levees broke and I thought, ‘There goes my school.' Bad news does not age well, so I started talking to Casey Huckaby in the Student Affairs office to start coming up with a plan."

Olson spent the week studying in the library until administrators at the college were able to get him set up for classes. His first day as an "Aggie medical student" also happened to fall on the first day of the head and neck block of gross anatomy. Olson fell in with A&M's first-year class, also taking biochemistry and Becoming a Clinician courses.

In all, Olson spent a month at the College of Medicine while Tulane officials planned their next move. After deciding to resume classes in late September on the Baylor College of Medicine campus in Houston, Tulane students and leaders experienced another setback with the arrival of Hurricane Rita. Eventually, Tulane students were able to have orientation Saturday, October 1 and started classes yesterday.

Olson looks forward to returning to his studies with his Tulane classmates, but is grateful for the help he received at the A&M College of Medicine.

"They just asked me what I needed and helped me work out a plan," Olson says. "Everyone was unbelievably supportive and helpful. Other people in the community have also been great, as they helped my wife get a job and my daughter into school. Everybody really thought outside the box in helping us get our feet back on the ground. After being here a month, I think I know more A&M students than Tulane students."

Olson's home in Jefferson parish was relatively untouched by Hurricanes Katrina and Rita with the exception of minor wind damage, but he doesn't plan to move his family back until the school opens back up in New Orleans.

"Right now my mom is taking care of my kids, my wife has a job and I'm living with two other students in Houston while I take classes, so we're set," Olson says. "There couldn't have been a better place to evacuate than College Station, because the people at the College of Medicine really made everything possible. Dr. (Christopher) Colenda and Dr. (Gary) McCord really did so much, and I owe them gargantuan thanks."

To keep track of Olson, visit his blog, "The Haversian Canal", at: http://nielsolson.us/Haversian/, where he is hosting Grand Rounds Tuesday, October 4.

We're going to be in Houston through May. Needless to say a lot of people aren't happy with that. Apparently the cincher was the lack of clinical opportunities for third and fourth year students, which both the deans and the LCME agreed on. Could the first and second year students go back? Maybe, but that would stretch a thin administration even further. Personally, it's not that bad for me. If I'd stayed as a line officer in the Navy I'd be at sea all week every work week during the training cycle anyway, and if I wasn't in the training cycle I'd be on a six month deployment. My parents are helping my wife with the kids, my daughter is in school, my wife has a sense of occupation at her job, my mom could have kept up with her PhD program but was able to defer and wouldn't trade the time with her grandkids for anything. My dad has a full house to go home to, and my kids have lots of loving attention, far more than they probably got in New Orleans. They're not in daycare, which means we're saving on that, and we've been able to make our house in New Orleans available to some folks who lost everything. I've been told my living conditions are below what most of the other students came into, but it's still a lot better than I'll have on a ship (which may still be in my future once I graduate) and it's really close to school, so I can bike, which saves gas.

The nephrologist at Kidney Notes has posted Grand Rounds, Volume 2, No 6. Check out the knitted digestive system (I'm not linking: click yourself over there!)