" /> Toads-in-the-Hole: June 2006 Archives

« May 2006 | Main | July 2006 »

June 30, 2006

Lampyridae

As this website is, beneath and within its function as a means of keeping family and friends abreast of our doings, a personal journal, it is worth noting that this has been an excellent summer for fireflies in Vermillion. For the past several weeks we've been routinely enchanted (paradoxical though it sounds) by the local glowing chorus line on our evening walks. Two nights ago we didn't have to walk far, as our entire backyard was filled with lightning bugs, causing the usually squalid weed-lot to resemble a pre-CGI special effect for fairy dust.

Most of the fireflies swooped around a few feet above the lawn, but a few daring or confused bugs spiraled high up into the air where they were (probably) welcomed warmly by several bats.

Thunderstorms, fireflies, and bats are three things that make me love summer in Vermillion.

June 20, 2006

The Red Leg

As far as flesh-eating bacteria goes, I exaggerated somewhat in my previous entry (before our unfortunate case of blog-jacking [no, Mom, we’re not going back to France this year, damn the luck]). It wasn’t the flesh-eating bacteria of the tabloid headlines. In fact, it was as innocuous a wound as you can imagine. The patient presented in our clinic with a small scrape on the knee with a wide ring of reddened skin around the abrasion, extending down to the mid-shin. My attending looked at me expectantly. “Looks like it’s infected,” I stated the obvious cautiously. The doctor nodded slowly and smiled encouragingly as you would to a toddler telling a story. Emboldened, I added, “Probably that ‘scalded-skin syndrome’ caused by Staph. aureus.” The patient had a fever and so the doctor admitted them to the hospital. I was surprised. It was, after all, just a little knee scrape, the kind of thing you might get playing soccer or falling off a bike.

My attending’s caution was well-founded, for by the time we visited the patient that evening the hot and red area had crept far past the border we had marked with a permanent marker down to the patient’s ankle, and the calf was visibly swollen. “We’ve started you on intravenous vancomycin,” my doctor told the patient, “which is an antibiotic that almost always works against the infection we think you have. Unfortunately you can only take it through an I.V., so we have to keep you here until we know what the bug is and what other medicine can deal with it.”

The patient seemed depressed by this news. It was just the beginning of summer, the weather had become reliably fine, and they had a long list of things they were looking forward to doing. Their hospital room quickly filled with family and friends, however, and something close to a continuous (and mostly sober) party reigned in the room for the next two days while we waited for the patient’s culture to grow. The vancomycin quickly reigned in the infection, and before the culture results came back the bright red leg dwindled to a bright red knee. Throughout, the patient reported only very mild pain. “It makes me limp a little, is all. Do I really have to stay here?”

We explained, while erring on the side of smiling reassurance, that if the infection spread it could quickly short-circuit the immune system and drive them into shock, or form a chronic and intractable infection in the bone. The lab finally reported that the cultures of the patient’s wounds’ ooze had grown out Staph. aureus, along with a list of the various antibiotics that had been thrown at the bacterial colony and their efficacy. The litany was chilling. The bug was resistant to all of the newer penicillins and cephalosporins, the usual antibiotics patients are sent home with, as well as most of the alternatives: the quinolones. One drug (other than vancomycin) had worked well: levofloxacin (a newer cousin to the well-known Cipro), which can be taken orally, allowing us to finally send the patient home. “Three days in the hospital because of a scraped-up knee,” the patient teased us as we helped organize the great mound of gifts, toys, and food their friends had brought in. “Remind me not to really cut myself on your watch.”

We said goodbye and hurried back to the clinic to continue our day, discussing the result all the while. I said, “So our antibiotics are weakening. Our vaccines sometimes fail (we were having outbreaks of measles and whooping cough among our well-vaccinated population])….”
“And we have to hospitalize people when they scrape their knees,” my attending finished. “This is what your generation gets to deal with.”
“It doesn’t seem fair,” I tried for a joking tone. “What did your generation have to face that was so tough?”
“Managed care plans and insurance companies,” my attending growled back. “Which I guess you’ll get, too.”

June 15, 2006

Joelus Mironus


"France? I love France!"

June 13, 2006

A Blast of Liquid Nitrogen!

A Day in the Life of a Medical Student At-Large

For the past four weeks I’ve been working at the final assignment of my second year of medical school: the family practice preceptorship. Designed as a relatively low-risk buffer between the incredibly cerebral, all book-learnin’-and-no-patient-pokin’ initial two years of school and the more free-wheeling third year wherein students are called upon to actually have a hand in patient care, therapy, and (for all I know) kidney transplants, (this is a pretty long dependent clause, you may want to check back to the beginning and orient yourself to where all this is going) the family practice preceptorship subjects students to an intensive trial by fire of the everyday afflictions that bring the general public in to see their doctors, i.e. sinusitis, allergies, and the sniffles. But, in my case, nasal congestion, mild cough, and occasional sinus headache turned out to be merely the tip of the iceberg. Underneath the water lurked a hidden mass of warts, flesh-eating bacteria, and prostatitis. Ew.

To speak of the first, I’ve had my share of warts. My verrucae vulgaris tended to spring up on my fingers, and while I was never terribly afflicted, I remember being pretty embarrassed somewhere around age 12 when I had three warts simultaneously on my left hand. I would periodically go in to our family doctor to have them taken off. He was always happy to see me, and his enthusiasm for wart removal verged on glee when he demonstrated his new electro-cautery gun. The stench of burning hair would sear my nose as he torched the affected area. “Got any more?” he’d grin hugely, making his little gun go Zzzt-zzt. “I’ll take 'em off for free!”

In the clinic here in Vermillion, we use a liquid nitrogen spray to freeze skin lesions. Rather than disappearing in a cloud of foul-smelling smoke, they blister up and then peel away, leaving behind normal-ish skin. I carefully watched my attending doctor freeze a pre-cancerous lesion on a patient’s nose, so I was ready when she handed me the sprayer and said, “Now get the spot on her arm.” The patient winced as I carefully sprayed the area. To make us all feel better I said to the patient, “Here, you can get even with me, spray this wart on my thumb.”

sort of like our sprayer

She declined, but afterward my doctor smiled and said, “That’s a good idea, you should know how it feels for the patients to be sprayed.”

“So I can gain a sense of empathy with the patient?” I asked.

“Right, empathize with what they’re going through,” my attending replied.

As it happened, later that day a middle-school-aged kid I knew came in to have his warts frozen. He seemed pretty anxious about the process, so I repeated the offer I’d made to the previous patient. The young man happily grabbed the sprayer. “Just point the nozzle at my wart and pull back on this lever,” I said, ready to set everybody at ease with my relaxed and stoic demonstration of how to take liquid nitrogen like a man.

Sshht, went the sprayer. Shhht-shhht.

“Okay,” I said. Sshht. “Hmm. Um… ow. Ow!Shshshhht "OWW! Oh man, Oh MAN that stings. Oo! That’s enough, that’s plenty!”

My young patient, looking even paler than when he’d walked in, nonetheless managed to sit still as I got my revenge on him. Our friendship now on somewhat shaky ground, I walked out of the examination room with him, carrying the sprayer. “See you later, buddy,” I said as cheerfully as I could through gritted teeth, and, for some reason, waved goodbye with the hand that was holding the sprayer.

FWOOOSH went the sprayer as the lid came partially off, directing a thick stream of nitrogen down onto my hand. My attending leapt backward, the young patient reflexively went into a defensive crouch, and a patient from across the hall stuck his head out the door and asked, “Everybody okay?”

A large blister began to form on my hand. I looked at it, then at my attending, and said, “I feel very empathetic.”

June 12, 2006

Answers

Here at last are the answers to our young fiction book quiz:

1) “Where’s Papa going with that ax?” said Fern to her mother as were setting the table for breakfast.
Charlotte’s Web by E. B. White

2) On rocky islands gulls woke.
Johnny Tremain by Esther Forbes

3) From the pleasant village of Mayenfeld a path leads through green fields, richly covered with trees, to the foot of the mountain, which from this side overhangs the valley with grave and solemn aspect.
Heidi by Johanna Spyri

4) All children, except one, grow up.
Peter Pan by J. M. Barrie

5) Alice was beginning to get very tired of sitting by her sister on the bank, having nothing to do: once or twice she had peeped into the book her sister was reading, but it had no pictures or conversations in it, “and what is the use of a book,” thought Alice, “without pictures or conversations?”
Alice in Wonderland by Lewis Carroll

6) Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin.
Winnie-the-Pooh by A. A. Milne

7) The night Max wore his wolf suit and made mischief of one kind and another his mother called him “Wild Thing!” Where the Wild Things Are by Maurice Sendak

8) If you want to find Cherry-Tree Lane all you have to do is ask the policeman at the crossroads.
Mary Poppins by P. L. Travers

9) Once when I was six years old I saw a magnificent picture in a book, called True Stories from Nature, about the primeval forest.
The Little Prince by Antoine de Saint-Exupéry

10) I write this sitting in the kitchen sink.
I Capture the Castle by Dodie Smith

11) Lyra and her dæmon moved through the darkening hall.
The Golden Compass by Philip Pullman

12) In an old house in Paris that was covered with vines lived twelve little girls in two straight lines.
Madeline by Ludwig Bemelmans

13) It was nearing midnight and the Prime Minister was sitting alone in his office, reading a long memo that was slipping through his brain without leaving the slightest trace of meaning behind.
Harry Potter and the Half-Blood Prince by J. K. Rowling

14) It’s a funny thing about mothers and fathers.
Matilda by Roald Dahl

15) The Mole had been working very hard all the morning, spring-cleaning his little house.
The Wind in the Willows by Kenneth Grahame

16) It was seven o’ clock of a very warm evening in the Seeonee hills when Father Wolf woke up from his day’s rest, scratched himself, yawned, and spread out his paws one after the other to get rid of the sleepy feeling in the tips.
The Jungle Book by Rudyard Kipling

17) Claudia knew that she could never pull off the old-fashioned kind of running away.
From the Mixed-Up Files of Mrs. Basil E. Frankweiler by E. L. Konigsberg

18) Once there were four children whose names were Peter, Susan, Edmund, and Lucy.
The Lion, the Witch, and the Wardrobe by C. S. Lewis

19) Buck did not read the newspapers, or he would have known that trouble was brewing, not alone for himself, but for every tide-water dog, strong of muscle and with warm, long hair, from Puget Sound to San Diego.
Call of the Wild by Jack London

20) Big A little a What begins with A?
Dr. Seuss’s ABC by Dr. Seuss

21) It was difficult to think of a time when Betsy and Tacy had not been friends.
Betsy-Tacy by Maud Hart Lovelace

22) Once upon a time there were three children, and their names were Carey, Charles, and Paul.
Bed-Knob and Broomstick by Mary Norton

23) Ramona Quimby hoped her parents would forget to give her a little talking-to.
Ramona Quimby, Age 8 by Beverly Cleary

24) Once upon a time, sixty years ago, a little girl lived in the Big Woods of Wisconsin, in a little gray house made of logs.
Little House in the Big Woods by Laura Ingalls Wilder

25) “Tom!” No answer.
Tom Sawyer by Mark Twain

26) Mrs. Rachel Lynde lived just where the Avonlea main road dipped down into a little hollow, fringed with alders and ladies’ eardrops and traversed by a brook that had its source away back in the woods of the old Cuthbert place.
Anne of Green Gables by Lucy Maud Montgomery

27) Ba-room, ba-room, ba-room, baripity, baripity, baripity, baripity – Good.
Bridge to Terabithia by Katherine Paterson

28) There is no lake at Camp Green Lake.
Holes by Louis Sachar

29) Andrew Marcus wanted freckles.
Freckle Juice by Judy Blume

30) It was a quiet morning, the town covered over with darkness and at ease in bed.
Dandelion Wine by Ray Bradbury

Congratulations to Lisa, for answering the most correct (and being mostly correct on several), you win the prize! Somewhat at random, we're awarding you a new copy of a book you didn't know the first line of: Matilda by Roald Dahl.
matilda.jpg

Please allow six-to-eight weeks for delivery. Or possibly more.

A big thanks to our other official competitors, Lynn and Andy. From various emails, phone calls, and parking lot conversations I know quite a few people played along in their heads, but you two stepped up and contributed.

Thanks finally to JD, who hosted the original version of this game (or is it a meme?) a few years ago.

June 8, 2006

Summer Reading List

A comment from our amis at chez Briscoe on our most recent entry put us in mind of a contest that was played out on our host Jd’s website back in 2003: a list of the first lines from famous literary works appeared at foldedspace, sans author or title, and Jd queried, “How many can you name?” The scramble ensued, with the assistance of memory, nearby friends, and the public library (As I recall visits to Amazon and Google were not encouraged).

In the spirit of that brilliant contest, we at Toads offer you:

Famous First Lines from Children’s and Young Adult Literature


1) “Where’s Papa going with that ax?” said Fern to her mother as were setting the table for breakfast.
2) On rocky islands gulls woke.
3) From the pleasant village of Mayenfeld a path leads through green fields, richly covered with trees, to the foot of the mountain, which from this side overhangs the valley with grave and solemn aspect.
4) All children, except one, grow up.
5) Alice was beginning to get very tired of sitting by her sister on the bank, having nothing to do: once or twice she had peeped into the book her sister was reading, but it had no pictures or conversations in it, “and what is the use of a book,” thought Alice, “without pictures or conversations?”
6) Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin.
7) The night Max wore his wolf suit and made mischief of one kind and another his mother called him “Wild Thing!”
8) If you want to find Cherry-Tree Lane all you have to do is ask the policeman at the crossroads.
9) Once when I was six years old I saw a magnificent picture in a book, called True Stories from Nature, about the primeval forest.
10) I write this sitting in the kitchen sink.
11) Lyra and her dæmon moved through the darkening hall.
12) In an old house in Paris that was covered with vines lived twelve little girls in two straight lines.
13) It was nearing midnight and the Prime Minister was sitting alone in his office, reading a long memo that was slipping through his brain without leaving the slightest trace of meaning behind.
14) It’s a funny thing about mothers and fathers.
15) The Mole had been working very hard all the morning, spring-cleaning his little house.
16) It was seven o’ clock of a very warm evening in the Seeonee hills when Father Wolf woke up from his day’s rest, scratched himself, yawned, and spread out his paws one after the other to get rid of the sleepy feeling in the tips.
17) Claudia knew that she could never pull off the old-fashioned kind of running away.
18) Once there were four children whose names were Peter, Susan, Edmund, and Lucy.
19) Buck did not read the newspapers, or he would have known that trouble was brewing, not alone for himself, but for every tide-water dog, strong of muscle and with warm, long hair, from Puget Sound to San Diego.
20) Big A little a What begins with A?
21) It was difficult to think of a time when Betsy and Tacy had not been friends.
22) Once upon a time there were three children, and their names were Carey, Charles, and Paul.
23) Ramona Quimby hoped her parents would forget to give her a little talking-to.
24) Once upon a time, sixty years ago, a little girl lived in the Big Woods of Wisconsin, in a little gray house made of logs.
25) “Tom!” No answer.
26) Mrs. Rachel Lynde lived just where the Avonlea main road dipped down into a little hollow, fringed with alders and ladies’ eardrops and traversed by a brook that had its source away back in the woods of the old Cuthbert place.
27) Ba-room, ba-room, ba-room, baripity, baripity, baripity, baripity – Good.
28) There is no lake at Camp Green Lake.
29) Andrew Marcus wanted freckles.
30) It was a quiet morning, the town covered over with darkness and at ease in bed.

June 7, 2006

Basics

Reading.

Where's Papa goin' with that axe?

Listening.

What do you think will happen next?

Good story.

June 5, 2006

Road Trip

On Thursday afternoon, Joel, Adelaide, and I packed up the Taurus and headed north to St. Cloud, Minnesota for a lively weekend of baby showers, family reunions, and meet-and-greets.

Snug-as-a-Baby-Tightly-Packed-into-a-Carseat

All said and done, we’ve decided that Adelaide is an intrepid traveler, braving the packed-to-the-gills backseat with a cheery disposition. Moreover, during the eleven hours we spent en route this weekend, Adelaide happily snuggled down into her seat and chose to snooze instead of complain about the state of things. She even seemed to enjoy an obligatory rest stop at the Dairy Queen, even though she wasn't allowed to taste a Mister Misty or Blizzard.

Yum, Dairy Queen! (Although, Adelaide seems somewhat outraged at not receiving her own DQ treat)

And the trip wasn't totally uneventful. The drive home to South Dakota marked a milestone in Adelaide’s development: somewhere between Willmar and Lake Benton, Minnesota, Adelaide found her hands.

Clap your hands!