The Haversian Canal

I'm looking for my roommate from the Naval Academy, Daniel Lane Miller. Dan Miller graduated a Fort Lauderdale highschool in 1994 and graduated from the US Naval Academy in 1998 having selected submarine warfare. He was one of my groomsmen at my wedding but I have since lost his address. If anyone has any information on Dan, please let me know.

A hit-and-run driver killed Toby Beaugh, probably intentionally, over Mardi Gras. Please keep reading. This is a letter from a friend of the family, soliciting information. Here is a link to recent news stories Google has found about it. The reporting has been relatively scant, perhaps due to the press focus on Mardi Gras that week. If you have any information, please call Crimestoppers (504-822-1111) or e-mail Kim Tracey.

Hello everyone,

I am emailing this information to see if anyone can help us out.

Toby Beaugh, a very close friend of Ryan and mine died this past week. He was killed, deliberately, by a hit-and-run driver on Magazine Street.

He was recently married to Melissa Vanderbrook Beaugh. Many of you saw this tragic incident on the news already, but for those who have not heard about it, please read the attached document which includes the Times Picayune article. I've also included a photo of Toby. Many of you may remember him since he ushered at our 2002 wedding.

The hit-and-run driver of the black pick-up truck (with tinted windows)has NOT been found. We do not want this person to get away with the murder of our friend. Due to Mardi Gras, this did NOT get much publicity with the media, so we are now taking our own actions to help catch this person.

Here is how we NEED help. First, we are taking donations through Crimestoppers for a reward. (Information on how to give is below). We also need donations to pay for the advertising of the reward. This can all be done through Crimestoppers.

Secondly, we need volunteers to help distribute fliers to advertise the reward & incident information. Volunteers are also needed to fax local body shops and car dealerships, so that we may find the car (in case it was turned in for repair or sold). If you have a home or work fax, please let me know if you can fax 5, 10, 20 whatever!

Lastly, we are looking for anyone to assist with getting this advertised. If you have a contact with a print shop/copy shop (to make copies of fliers) OR any contacts with local media (newspaper, billboards, radio, TV, etc.) or media in Texas, Baton Rouge, or Mississippi, please let me know. Also, if you know any politicians that may be able to assist with our efforts, please let me know. We also need contact information for any reporters that may be able to give us "free" advertising through an article regarding our efforts.

For those out-of-town, I sent this to you as well since this person may have fled to your state. I would appreciate it if everyone could send this information out to everyone they know so that there is more awareness of this incident. We need everyone to be on the lookout for this possibly damaged black truck. This was a murder, not an accident, and it unfortunately was not well-publicized. We hope to catch this person with the combined efforts of the NOPD and Melissa and Toby's dedicated friends.

Thanks, in advance, for any help you can give us. Please feel free to email me with any suggestions, contacts, etc. or ways in which you can help us.

Sincerely,

Cherie

REWARD DONATION INFO: Crimestoppers is a New Orleans organization which supports the NOPD in gathering crime-related tips. This reward money may be given to any person providing tips leading to an indictment. Melissa's friend, Kim Tracey, is organizing the various pledges for Crimestoppers. Please contact Kim if you or your business would like to assist: ktracey@burglass.com, or you can contact Crimestoppers directly at 504-822-1111.

72 points = 96 pixels = 13 characters = 1 inch

Microsoft is wrong about the layout rules for their own flagship program, Excel. Their conversions between points, pixels and characters boil down to this:

72 points = 96 pixels = 13 characters = 1 inch

13 characters.... what? 13 capital letters in 10 point Arial fit nicely in a 96-pixel-wide column. If the column width is in characters, then one would think Excel would change the character count with font size, but it doesn't. Well, it will if one changes the default font size (Tools/Options, yada yada, and restart Excel) but then a 22 point default font gives a default column width of 8.47 (136 pixels), and the apparant cell width accomodates fewer than 7 characters and just about 4 em dashes. I still don't understand how the character count is calculated, however, this seems quite solid for height and width:

At 100% print scale 72 points = 96 pixels = 1 inch

Of course, the down side of that is one can't draw a rule thinner than .0138" without zooming the print scale and thereby suffering serious typographic layout inconveniences.

Technorati-ing gmail leads to a rash of bloggers torqued about gmail being down. Apparently at least one account has disappeared. I deleted all my cookies just to see if Google was having a conflict with my computer, and that was not the case. Starting to get concerned here. Anyone else having problems?

Came back up sometime between 6:45 and 7:30. So maybe down for an hour or two.

Fran Simon has an article in Tulane's New Wave rag about Dr Donal Ricardson's upcoming appearance on ABC's Miracle Workers: Calming a Storm in the Brain. The episode will air on 13 March at 9 pm Central time. He will be implanting a deep brain stimulator in Emily Bresler, who has Tourette syndrome. Since childhood she has "jerked and jumped with involuntary motion, making guttural noises and uttering curse words." Emedicine has an article about this that indicates the problem lies with dopaminergic cells in the ventral striatum, which is what we're studying right now, so this isn't complete procrastination. Yay, me.

Dear Students:

I've always felt, in light of what we've experienced over the last few
months, that this year's commencement will be a special one. Just how
special was made plain this week when George H. W. Bush, 41st President
of the United States, and William J. Clinton, 42nd President of the
United States, agreed to be the keynote speakers at Commencement 2006.

As you know, Presidents Bush and Clinton first joined forces to raise
funds for the victims of the 2004 south Asian tsunami. Then, in the
aftermath of Hurricane Katrina, they formed the Bush-Clinton Katrina
Fund, which has raised more than $100 million to date, some $30 million
of which has been dedicated to 33 higher educational institutions in the
Gulf region, including Tulane.

The whole world has admired how these two leaders have risen above their
political differences, harnessed their formidable skills and galvanized
the generosity of the American people. Their partnership provides a
lesson for all of us.

Please join me as we welcome our two former presidents and salute the
graduates of this historic class, May 13 at 9:30 a.m. in the New Orleans
Arena. For a full schedule of Commencement 2006 events visit
http://www.grads.tulane.edu/.

Have a great weekend,

President Cowen

At least, here's how I took these. The camera body doesn't matter. Any camera body can fire a flash and take pictures at a 1/100 second shutter speed. I've got fifty year-old double-reflex cameras that can do that. A bounce flash with a high guide number was the moneymaker on these. In this case a Nikon SB-22s, guide number adjustable up to 92. I was manually controlling exposure by adjusting the amount of light the flash put out and rotating the flash head up and down. I pointed the head up, or in some cases up and slightly forward. The basic idea was to bounce the light off the ceiling, which was thankfully white. The lens was on f4, the sensitivity of the CCD was ISO 1600, and the flash was set to ISO 1600/f32. That is, if the flash head was pointed straight forward, I could have taken these pictures at f32. Instead I was taking pictures at f4 because the ceiling was high, so there was a lot of dispersion on the way up, I lost a stop as the light bounced off the ceiling, and then it dispersed more on the way down. I was literally sending 32 times more light out with each picture than I would need if the flash was straight. Don't be confused by f32 and 32 times. The 32 times comes from 2⁶, or 6 stops of exposure value difference between my lens and my flash (f4-f5.6-f8-f11-f16-f22-f32). The two occurances of 32 are coincidental. The advantage of all that dispersion and bouncing was using the entire ceiling as a huge soft light source, so the shadows are soft, instead of harsh, there's no red-eye, blown out highlights, any of the stuff most people expect from flash photography. A medium telephoto zoom, in this case a Nikon 70-210mm/f4 was also helpful to get through the mess of microphone stands and speakers, and control the messy background by only selecting a small amount of it.

From: The People’s Hurricane Relief Fund and Doctors Without Hospitals

Place: OUTSIDE Charity Hospital in downtown New Orleans (Map)

Speakers:
1. James Moises, MD, Charity Hospital emergency room physician
2. Jeff Wiese, MD, chief of medical service at Charity Hospital
3. John Dreyfous, grandson of Charity Hospital’s original architect
4. Brad Ott, Charity Hospital patient
5. James Carter, attorney and candidate for council district C

On March 25, 2006, at 2 p.m. CST, several hundred doctors, residents, medical students, nurses, hospital employees, politicians, and political activists will be meeting outside Charity Hospital in New Orleans, Louisiana to protest the closure of this esteemed public hospital. Considered the oldest continuously running public hospital in the country, Charity has cared for millions of members of the New Orleans community for two centuries. These New Orleans residents are now largely without access to healthcare and forced to rely entirely on understaffed emergency rooms for basic health needs, such as monthly prescriptions and routine medical complaints. This shift has caused a healthcare catastrophe in the New Orleans metropolitan area and will be the focus of this rally, along with a discussion of the future of Charity Hospital and the fate of this city’s uninsured.

18 March: Hospital Leaders: System Cracking (WBRZ)
17 March: Closure of Charity strains Jeff Hospitals (Times-Picayune)
15 March: New Orleans Hospitals in Critical Condition (ABC News)

I recently got an e-mail from a friend who was just accepted to medical school. Congratulations to him! In his e-mail he asked if I had any recommendations on what he could do before starting. Here's my answer, refined:

Yeah! Start producing study aids now that will help review the week, or weekend before the test. Don't, don't, don't take notes on a laptop. Use 8.5x11 or notecards. Preread means skim, and then, from the time you're in lecture on, all 'studying' should be focused on creating a product you will use to review for the week before the tests, like a big stack of notecards, diagrams, that sort of thing. Handwrite and draw it all. The tactile and visual feedback is rich input to your brain.

Physio and Biochem are straight notecard and diagram. Biochem, get Lehninger (all other biochem texts plagarize this guy) and start drawing glycolysis, kreb's cycle, electron transport chain, gluconeogenesis, glycogen synthesis, structures of the sugars (glucose, galactose, ribose, heparin, heparan sulfate, amylose, amylopectin, collagen, etc). Draw the twenty amino acids and the nucleic acids. Put all these on flashcards. If they're to big (glycolysis, Kreb's cycle, etc) draw them on 8.5x11. Over and over.

Physio: a big smludge of stuff. Kidney tubule. Learn the transporters inside and out. Same for myocardium. If you don't understand a synapse yet, that's about as priority one as it gets.

Neuroscience: Haines is the the textbook to get, but they all go into to much detail. You can start administering these quizzes to yourself (you have to click around a bit, but they're there). The site is awesome. Find the quizzes. Learn all the structures in the quizzes. Even if your prof swears you don't need to know it. If you try to not learn, you'll waste time and brain cells thinking "I don't need to know this that I'm not supposed to know. But I know it. Dammit". I found it a long time ago, then our neuro prof was using it independently for some of the videos. I suggested it to the students at A&M; now their prof is using it too. Also, Harvard Whole Brain Atlas.

Histology - too complex to draw. Find images on Google Images (you'll find the high-yield sites as you go) and compile them in powerpoint. Slide with the image, next slide has the same image, but with various structures identified. Every cell type you can imagine. Repitition, repitition, repitition.

For Anatomy, get Netter's Atlas of Human Anatomy, 3rd Ed, and quiz yourself by placing your hands over all the names of structures, and try to identify them. Every single one of them. They will all be on the test. You think I'm kidding or exaggerating, but I'm not. Don't worry though, there's a fair amount of repitition. You'll see how this works once you get the book. Don't get a textbook of anatomy until the prof tells you which one to get. They all suck. Bad. I own most of them. That's not a joke. I have been collecting, for years, virtually every anatomy text and atlas, every book on surgery. I've got first editions of Brodel illustrations. The textbooks are vacuous except maybe the highlighted 'clinical correlations' boxes, or whatever they call them in whatever text. You can be sure that stuff (torticollis, claw hand, whatever) will be on the test. Along those lines, don't get more books than necessary. You've got to much to learn to read anything twice. Make the study guides. If you run into something you need a second source on, go to Google. Repitition, repitition, repitition. If anything you're doing takes a lot of time, stop. Computer drawing programs (OneNote, Illustrator, etc) are a good example of this. I can draw a perfect circle in Illustrator faster than I can with a pencil. But I don't need a perfect circle. I only need a 80%, 90% circle. I can do that with a pencil in one stroke.

Most people in any organization pass on the same lore and legends one year to the next. It's all fluff. The smart ones lie because they don't want to spend time helping the people who are struggling. The strugglers lie because they don't want to let on they're sucking. The professors lie because they are taking gentle vengence on you for whatever they went through in graduate school. If you stop and listen you'll be amazed at how much fluff is presented as deep insight. It's really just the same lore and legend. They'll all talk about the ease of learning the brachial plexus once you figure it out. They'll all ask you five times about which nerve root is sensory, which is motor. They'll all tell you about freshman's nerve (a tendon), the rise of antibiotics, anesthesia, and how they revolutionized surgery. Blah, blah, blah. Learn what's going to be on the test. Cold. By repitition.

If you can, seriously consider just listening to the audio if they provide it. Listen to it at 1.5 times speed with the prof's powerpoint slides (most of them provide these through a website somewhere), at home. I'm the one that does the recording for our school, so I haven't tried this much. Because I always go to lecture, so I can record it. If this works, cool. Otherwise, go to lecture and don't take a laptop. At least, don't use a laptop while you're in lecture.

Read the medical education posts on this blog if you want some more stuff.

People will give you lots of study tips. Like this. If it doesn't match what you've been doing, be highly suspect. If you got As without group study, don't start now. If you got As without a computer, don't start now. If you eat seven pieces of Lindt chocolate when you study every night, don't stop.

For the non-traditional students: be especially suspect of advise from the professors. They spend most of their time advising the 80% who are between 22 and 24 years old. Nothing against 22. I was 22 once. I wish I was 22 when I went to medical school. I really do.

So, in my last post, I wrote gobs about what to do for each class. This will be more about how to plan and carry out the plan on a day to day basis. There's two schedules that you have to mesh: the class-centric schedule and the your-time-centric schedule. This is how I think of it: you've got a morning, afternoon and evening in each day. Some of those are weekday periods, some are weekend periods, some are at the beginning, some are in the middle, and some are just before the test. Within these blocks of time you have to take care of yourself (laundry, fitness, the bills, family, leisure, etc), class, and studying. Even though the topic of class is presumably the same as the topic of study time, it is inherently different in that you can't control it.

Let me take a moment about this 'fog of confusion' graph. What kind of goofball crap is that, Niels? Sounds like something out of a get-rich-quick-scheme book. Well, it's based on Clauswitz's fog of war. During war, and especially during an engagment, no one knows everything that's going on or everything that will happen. Uncertainty about the future is one thing, knowing that you don't know what you will soon need to know is something different. In war this is exemplified by time delays: a forward commander calls in an airstrike which is delivered on target, but the enemy got away under cover of darkness and no one knows it, and this will effect the projected number of bullets that need to be delivered through the supply chain, but the quartermaster already dispatched the projected number of bullets needed. Now resources have to be diverted to provide the bullets, the bullets are promised but redirected again in response to an even greater emergency so when contact with the enemy is made again, the promised bullets aren't on hand, grenades are used, which weren't budgeted for, and quickly no one really feels like they know what is going on.

Similarly, in learning, you're responsible for budgeting your time to learn the things you need to know, but sometimes it's not obvious what is going to require more time to learn. Worse, sometimes you underestimate the time required and spend it on something else, like writing a blog entry called "Further Thinking about Medical Education" and start falling behind, even though YOU THINK YOU'RE AHEAD OF THE GAME. Oh, Niels, this is simply poor planning on your part. I'm not talking about me. No one knows what the future holds, and when time is a scarce resource that must be allocated among competing interests, errors of allocation are bound to occur. The trick is to reduce them by as much as possible. And this why bosses are always 'looking for visibility' on something. They're trying to pull up and away enough to see the bigger picture, see where the resource could be best allocated. This is what schedules, budgets, and other planning documents are for. There are no consequences for violating what was written in the plan, per se. The planning documents are thought exercises to figure out how to allocate resources in response to various branches and sequels leading away from the current decision point. Planning documents are drawn up when things are safe and happy, with the expectation that when the time to make a decision comes, there will not be enough time then to work out the various planning alternatives.

If you want the luxury of considering alternatives, branches and sequels, you will have had to work them out in the plan ahead of time. A plan is not I will do A, B, and C. A plan is part descriptive and part proscriptive. Descriptive planning is budgetting: you assume you will earn so much money this year. Based on that, you allocate the fixed requirements, like rent, then set caps various other categories, like dining out, and minimums on others, like savings.Descriptive planning doesn't normally lead to back-up plans. Emergency plans are typically more proscriptive. If the mayor of New Orleans advises everyone to evacuate the city, then we will always, always, go to my parents house. Proscriptive plans are where you start getting into back-up plans: if my parents are out of town, we will visit some relatives in Tennessee.

Anyway, so how does this all relate to planning for the next block in medical school? Have a generic template plan, and fill it in each time as you go. I recommend the above as a good, generic form to customize during the first weekend before the beginning of a block. During that first weekend, you'll see it calls for a preview. As I've said before, produce something. So previewing doesn't just mean flipping through the book, it means laying out before you, within eyespan, what you need to do. In addition to my schedule, I also prepare these two column preview sheets, one sheet per class (don't worry, I'm taking more than two classes). The are the lectures, numbered, with the reading assignments in the margins. Every time I write a flashcard for that lecture, I will note the class, the block, lecture number, and page number in the lower left corner of the question side; if a figure needs to be referenced, I'll note it on the answer side. For example, the lower left corner of a block three physiology notecard from today lecture reads "P3-37-L22" P = physiology, 3 = block three, 37 = 37th lecture, L = Levitzky's textbook, 22 is the page number.

So how do these allow me to allocate time to favor the branches and sequels I prefer? Remember those three uses of time? Yourself, class, and studying? Well, what if my daughter falls out of a car, bounces her face off the curb, as happened earlier this year? Of course I'm going to go home if something like that happens, but for me, that means driving two hours each way, and probably staying the night. I'll need to leave the recording equipment at the apartment in Houston, and, while I'm in the car, I need to call someone to record the lectures. Using that time in the car and planning to spend some of my time later listening to the lectures I miss. Which lectures will I miss? How do I best decide when to go back? There will surely be earlier and later alternatives. If I'm missing five lectures the next day, as I would see on my schedule (not shown - I use Palm Desktop), maybe I'll try to get back earlier, even wake up the next morning at 4 am to get back. And when I review for the test, the absence of notecards for, say lecture 41, will remind me that I didn't go tot that lecture, so I need to allocate some time to go over that material in more detail.

Volume 2, Number 26

Further evidence that PowerPoint slides are not a good source of information from which to study comes from Dr Levitzky, our pulmonary physiology professor, and the author of the book: "In lecture, the slides are mainly for the professor to remember what they're supposed to talk about. This way they look cool because they're not using notecards."

Texas has a bright, harsh, washed out, hot atmosphere except when it's bright, harsh, washed out, and cold. Except for the rare spring day when a cold front has covered the sky with a roll of cloudy gray. Gray with an a. Younger and brighter than grey with an e. For a few hours everything takes its full range of color. Tree bark is every shade of brown except for the deepest black crevice and the lichens, which are white, or almost so. The lawns and leaves are every shade of green that's bright. People walk through portrait light. Friends look just like the ideal images of them you carry in your mind when it's harsh, washed out, and hot, or cold.

What lessons have you learned that you think people ought to know?

Revel in the suckiness: it will be over sooner than you know it and five or ten years from now you'll regret it if you don't record things. Write. Take pictures. Paint. Compose. Something. I really wish I had some pictures of me and the English professor, Charlie Whisky, with our Chinese friends in Ecuador buying $3000 hats for $50 in Monte Cristo while frozen shrimp, which we'd gotten from the fish warehouse an hour inland, which was guarded by men with automatic weapons, thawed in the bed of the pickup. At the time I was just really hot and the entire port city of Manta, where we'd come from, where my ship was, smelled of rotting tuna due to the transportation strike. Which is why we needed the owner of the Chinese restaurant to drive us to Monte Cristo, and why we were willing to help him load and unload shrimp.

Fresh produce in West Bank grocery stores is usually picked over early in the morning. Go shopping at 6:30 am.

Restaurants on the West Bank have two hour waits. Every day.

There are apparently no soda machines in the new medical school building yet. Should we set up an honor-system pay-as-you-go gedunk room?

Be flexible. Revel in the suckiness.

I'll think of more later. If you know any tidbits like this, please post them in the comments, e-mail me, something. I'll post them in the body of this entry, with due credit.

Yes, you anglophiles, the NHS Blog Doctor is hosting the weekly round-up of the medical blogosphere's best: Volume 2, Number 27.

Too cool.

The Journal of Neurosurgery and Neurosurgery are considered the best journals for those interested. All my neurosugery links are on del.icio.us, including all the names dropped at the neurosugery interest group meeting on 29 March.

U.S. News and World Report ranked Tulane's medical school 50th among the nation’s top research schools. There around 150 medical schools (MD and DO) in the US.

Personally, I don't put to much stock in the rankings, but a little competitive spirit is healthy.