Polite Dissent

On tonight’s episode of House, a famous jazz trumpeter who’s paralyzed from the waist down suffers sudden difficulty in breathing. He is rushed to the hospital where he is diagnosed with pneumonia in addition to his previous diagnosis of amyotrophic lateral sclerosis (better known as ALS or Lou Gehrig’s disease). House, of course, does not believe this is ALS. He settles on Wegener’s Granulomatosis (a disease primarily of the lungs and kidneys) as a culprit. When the musician develops an arm paralysis he believes it to be a stroke instead of a progression of the ALS (it’s his show, so he’s right, of course). Ultimately, the musician is found to have an arteriovenous malformation (AVM — an abnormal growth of blood vessels) pressing on the spine and causing his paralysis.

The show was a good character study and took a close look at Drs. House and Foreman, as well as Foreman’s previous physician supervisor. Foreman was offered a job in California and had to decide whether to stay with House or go west for higher pay and more perks (and less abuse).

While the character moments were good, the medicine was not particularly well done:

• ALS seems a reasonable diagnosis, given what was known of the musician’s history and symptoms.
• It would be quite a stretch for Wegener’s Granulomatosis to have affected both the lungs and spine without being detectable on an x-ray or CT scan.
• The AVM should have been visible on any previous blood vessel study (such as an MRA) despite being hidden by inflammation.
• There is only a very narrow window of time to give clot-busting drugs (such as tPA) after a stroke. The patient was well outside this window.
• House violates his own favorite Occam’s Law by deciding that the upper arm and lower extremity paralysis are caused by two separate diagnoses.
• Not only are the Young Gun doctors running labs and MRIs, but now they’re performing embolectomies by themselves — so apparently they’re trained interventional radiologists as well.

It’s that time again. Time to look at what searches brought people to the halls of Polite Dissent this month. My comments, when inappropriate, are in green.

The Department of Returning Favorites:
“the frogurt is also cursed”
Wormy, by Dave Tarmpier
bwana beast

The Department of New Favorites: Lots of hits for these oldies but goodies this month
Legion of Super-Heroes After School Special
Klingon Karbs

The Department of Medical Information:
Is shocking flatline wrong? No.
All medicine plants and thier[sic] functions?This would fill up books. There are thousands and thousands of medicinal (or at least allegedly medicinal) plants.
HIV from a sewing needle Unlikely. If HIV is going to be transmitted via needle, it is generally a hollow needle, not a solid needle.

The Department of Why Did They End Up Here?
10 % police supply laser guns
Books or articles by Debbie Boone about her childhood
Abraham Lincoln silhouette graphics
fake wedding dress

The Department of General Information
full of sound and fury signifying nothing
It’s from Macbeth, Act V, scene 5. Macbeth is speaking in a famous series of lines:

She should have died hereafter;
There would have been a time for such a word.
To-morrow, and to-morrow, and to-morrow,
Creeps in this petty pace from day to day
To the last syllable of recorded time,
And all our yesterdays have lighted fools
The way to dusty death. Out, out, brief candle!
Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more: it is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

The Department of Fanboys Gone Bad
nascar comics
zatanna naked

The Department of There Are Worse Things Than Being A Comic Book Fanboy
Dawn Holliday and Mack Wolfe fan fiction One West Waikiki fan fiction…and sadly I know there’s some out there.

The Department of Snark
Big words smart people use I like “bifurcation.” It sounds cool.
Mr Midshipman Hornblower summary character chapter background Read the book yourself. No Cliff Notes here!
Plot in Amazing Spider-Man #514 I’m still looking for it myself.
As a polite person if you want to smoke in a restaurant what should you do? Step outside.
Country singer matt rossi Is there something you’re not telling us, Matt?
Causes tongue tingling This is going to be my new byline: “Polite Dissent - cause tongue tingling”

Because we here at Polite Dissent will stop at nothing to help our readers, I recently obtained a loner copy of World Watch #1. I read through it and realized that I’ve never before read a professional comic that derivative, clumsy and all around painful to read.

Still, I know whatt you’re thinking: “What if this someday becomes known as a classic of Western Literature? How am I going to be able to face my kids and admit I’ve never read it?”

Don’t worry, we here at Polite Dissent have prepared this special Bowlderized version of World Watch #1 just for you. It’s twenty times shorter than the original, but still contains every important plot point.

(And yes, I can draw better than this, but I figured: Why bother?)

Editorial commenting by myself and the mrs.

Continuing our look at World Watch, this time moving on to issue #2.

Polite Dissent, “where we read bad comics so you don’t have to”

A final look at World Watch, this time focusing on issue #3. Pray for us.

The winner of the Quality Contest is David Oakes for his modern remake of the Russian poem Fop’s Blouse

The Fan’s Blouse/????? ????

I will sew myself black trousers
from the velvet of Don Ho’s voice.
And from three yards of sunset, a yellow blouse.
Along the world’s main street, along its glossy lanes, like a river
otter
I will saunter with the gait of David Oakes, a fan.

Let the earth, overripe and placid, cry out:
“You would rape the green Spring!”
I’ll yell at the sun with an impudent grin
“I prefer to prance on smooth asphalt,
and drink from a bottle of vodka!”

Isn’t it because the sky is blue,
And the earth is my lover in this spring cleaning,
that I give you verses fun as bi-bah-boh
and sharp and useful as an ice cream sandwich!

Women who love my flesh, and you,
Spiro Agnew , looking at me like a brother,
toss your smiles to me, the poet -
and I’ll sew them like sheaves of
The Annotated Alice in Wonderland
onto my fan’s blouse!

---

Gordon gets a Close Second Runner’s-Up award for his haiku epic poem:

RUSSIAN THROUGH TIME

Andre Milnakov,
Russian nobleman, eating
An ice cream sandwich.

The tsar’s enemy
Washes down his snack with a
Bottle of vodka.

A river otter
Swims playfully as Andre
Sharpens his sabre.

He plans to purloin
The most treasured of objects -
Tsar’s Faberge egg.

Seeking conspirators,
He travels through time to seek
Out Spiro Agnew.

The Vice-President
Tells Andre to go to hell;
Nixon sweats alone.

Another time jump,
Andre recruits Mr. Marx -
Alas, it’s Chico.

Men of history
Turn down the Russian’s offer
Of Corpulent Weath.

His only reward,
An invitation to golf
From Charlie Chaplin.

Sitting dejected,
No Faberge egg in hand
Andre plots again.

Something easier,
Which Andre contemplated,
A pure hole-in-one.

“Eureka!” he cried
As his next goal coalesced:
Ben Grimm’s underpants.

This story’s moral
For those who don’t comprehend:
Please get some fresh air.

---

David wins a copy of Nikolai Dante: The Romanov Dysnasty. Gordon will find himself in possession of a nice runner-up prize. Remember, all entrants in the Quality Contest are automatically entered in the Pure Luck Contest, so you may still win a copy of the book.

Tomorrow, the Quantity Contest results.

There will be no medical review of Strange #3 because there is precious little medicine in there.

There is precious little plot there as well.

And as a final small snarky note, the song title is “The Boxer“, by Simon and Garfunkle Garfunkel, not just “Boxer.” You’d think someone as wise and learned as the Ancient One would know that.

There were two strong entrants in the Quantity Contest. In this contest, people were asked to incorporate as many items off the big list as they could into the tale of a Russian Nobleman (or Woman).

The prolific David Oakes managed to use all 102 items in his poem “An Ode in Blessed Memory of Her Majesty the Empress Katrianna Wavevna on the Vitory Over Toto and K.I.T.T. and the Taking of Kamchatka, 2539” He gets a hearty congratulations, but he already won a copy of the Nikolai Dante trade paperback in last night’s Quality Contest.

The winner of the trade paperback is Tangognat who managed an impressive 85 items (by my count) in her “Svetlana and the Library of the Weird”

Tomorrow night: the winner of the Pure Luck Contest!

David’s Tale Tangognat’s Tale

Birds of Prey #78 “Hero Hunters, part three: Moondance” (cue Van Morrison)
Gail Simone, writer
Tom Derenick, penciller

There’s some interesting medicine in the latest issue of Birds of Prey. After a fight with the villain Harvest, Dinah Lance (Black Canary) has been mysteriously aged 20 years. The Huntress and Lady Blackhawk manage to get her back to the plane where Oracle (Barbara Gordon) runs some test on her.

Oracle: “Pupils, extra-ocular and accommodation are all good, and she aced the Romberg test.”
Oracle: “I can’t find anything wrong with you, Dinah.”
Black Canary: “Other than the fact that I aged twenty years for an hour, you mean?”
Oracle: “Other than that, yes.”

I’m assuming that Barbara ran more tests than the just the ones mentioned here because it would take more than a few neurological tests for me to declare a mysteriously aged patient healthy (even if she did return to her normal age fairly quickly). The conversation suggests that at least an hour has passed, so I suspect we’re just catching the tail end of the exam.

The pupillary exam looks at the pupils (duh), examining their size, shape, equality and behavior. The accommodation exam also looks at the pupils; they should constrict as a distant object moves nearer.

When a physician has you follow an object with your eyes without moving your head, he is checking your extraocular muscles. These are the muscles that control the movement of the eyes.

The Romberg test is easy way to test a patient’s sense of balance. The patient stands with their feet together and their arms at their sides. They then close their eyes. A positive Romberg test (which is a bad thing) means that the patient can’t keep their balance and is swaying or even falling over. Their can be many reasons for this including inner ear problems, certain brain tumors and strokes.

---

Later in the issue, Dinah reminisces about her training days with Ted Grant (Wildcat). She mentions how she once suffered boxer’s knuckle.

Boxer’s knuckle is an injury to the metacarpophalangeal joint (the big joint between the hand and finger), most commonly the index finger. Repetitive trauma is the most common cause, though it has been known to occur after a particularly damaging punch. The injury most commonly involves the extensor tendons of the joint, although it may also involve damage to the sagittal bands or the joint itself. Surgical repair followed by several weeks of splinting is the best treatment. There should be no boxing, martial arts or punching for six months following the injury (sorry Dinah).

Boxer’s knuckle is different than a boxer’s fracture, which is a break in the neck of the fifth metacarpal (here’s a good x-ray). According to DeLee and Drez’s Orthopaedic Sports Medicine (2nd ed), trained fighters tend to suffer boxer’s knuckles, while untrained fighters suffer boxer’s fractures. The fits perfectly with what I have seen in practice because I have yet to see a boxer’s knuckle (and I’ve never seen a professional fighter) but I see 2-3 boxer’s fractures a year, almost always from guys punching a wall or a home appliance (and losing).

For today’s episode of Lois Lane Friday, I present the most infamous Lois Lane story of all:

“I am Curious (Black)” the first story in Superman’s Girlfriend Lois Lane #106
Robert Kanigher, writer
Werner Roth, penciler

Lois is sent to get a story in Metropolis’s “Little Africa” but is unable to get anyone to talk to her. Little children run away from her and adults shut doors in her face. One old lady will talk to her, but only because she is blind and doesn’t realize Lois is white. She draws the particular ire of a fiery orator who uses her as an example of the enemy “whitey.”

Lois: He’s wrong about me…but right about so many others!

Frustrated, Lois convinces Superman to take her to his Fortress of Solitude and use the Kryptonian Transformoflux on her to turn her black for twenty four hours. Back in Metropolis, her usual cabby won’t stop for her because she’s black. She has to take the subway but is convinced that everybody is staring at her because of her skin color.

This time in Little Africa, people are happy to talk with her and help her. She meets Dave Stevens, the same firebrand she encountered before, but this time because she is black he talks to her and even hits on her. He sees some kids run into an alley to buy drugs and runs after them. He interrupts the drug deal but is shot by a pair of gangsters straight out of Guys and Dolls.

Superman, who was conveniently nearby keeping an eye on Lois, swoops in and takes them both to the nearest hospital. The doctor there informs Superman that the patient is fading and needs a blood transfusion.

Doctor: His blood type is O-negative!
Doctor: He needs a blood transfusion immediately!
Doctor: We don’t have enough funds for all types!
Superman: I can’t help! Even if I were that type…no needle could penetrate my skin!
Lois: I - I’m O-negative! Just like him!

It’s understandable that small hospitals would not be able to carry every blood type because it is very expensive to buy and store blood. However, blood type O-negative is the “universal donor” and in a hospital limited to only a few types of blood, O-negative would be the one blood type they would definitely stock

What’s with Superman? He’s donated blood before countless times, usually to Lois or Lana. It’s been established in the past that his blood is compatible with every blood type, and he’s been able to “rip open” his skin even though needles don’t work. Is this simply a continuity error for the sake of plot or is Superman a closet racist? (I assume it’s the former since Lois doesn’t bat an eye at Superman’s statements.)

Previously, we learned from Superman #125 that Lois has a “very rare blood type”, yet this comic tells us that she has blood type O-negative. Seven percent of the U.S. population is type O-negative, the most of any negative blood type, so while it may not be common it’s certainly not “very rare.” Common blood types vary quite a bit across the world, so what is common in the US is not necessarily common in other areas. Given the globalization of today’s world, this is slowly changing as populations mix.

At the end of the story, Stevens realizes that Lois was white and yet donated blood to save his life. He smiles at her and they shake hands.

So here we have another “blood transfusion redeems racist” storyline. This story is a bit schizophrenic though. The individual racist — in this case a black man — is redeemed. However the societal prejudice against blacks — the supposed point of the entire story — is glossed over and barely mentioned.

OK, I’m not being entirely fair to the story. Lois does confront Superman about whether he would ever marry a black woman, but he never has the chance to answer fully. Dave Stevens is a complex character as he is both a racist and the best hope for his neighborhood. Still, I felt that the ending went for the easy way out and missed the big picture.

The winner of the third Nikolai Dante: The Romanov Dynasty trade paperback is: Heather Buchanan.

Congratulations to all the winners, and thanks to everyone who participated. We’ll do this again next time a book captures my imagination.

Several interesting medical stories from around the country.

• Several of the St. Louis Rams have come down with infections from MRSA (methicillin resistant Staphylococcus aureus), a particularly nasty and persistant germ. According to the article, some less-than-sanitary hygiene habits may be partially to blame. Catch the story over at Kevin, M.D.
• A Florida doctor injected himself, his girlfriend and two other people with botulinum toxin — not Botox, but the unadulterated full-strength toxin, and they are all now paralyzed in critical condition. Recently, there’s been concern that the firm in Arizona that supplied the toxin (ostensibly for research purposes) may have known what was going on all along. Symtym has a concise rundown on the entire story.
• Another vaccine success story with deaths from Chicken Pox dropping to their lowest level ever. Additionally, the number of Chicken Pox infections has dropped from 4 million cases per year to under 100,000 cases. These changes have all taken place in the nine years since the Varicella (i.e. Chicken Pox) vaccine has been available. The full story is available here.

“Topsy Turvy” in The Batman featured the return of the Joker. I really like the Joker’s initial appearance in the series; it was the first time I’ve ever seen the villain truly seem psychotic and homicidal, not just goofy. This time around, it was a pretty generic Joker story with nothing particularly homicidal or maniacal about it. A gun that turns people into playing cards? Sounds like a leftover prop from the Adam West series.

The Teen Titans “Birthmark” was a set-up episode. Slade is back, but this time he’s doing prep work for another big baddy (Trigon, presumably). It all centers on Raven, but she’s being tight-lipped as usual. Some decent action, but it’s mostly exposition, foreshadowing and people getting knocked into walls. What is is with the giant gears in this series? Also, I just don’t see Slade calling someone else “master.” He’s too much of an egotist for that, even if they did bring him back from the dead.

“The Cat and the Canary” was the Justice League Unlimited episode this week. Between Black Canary and Supergirl, Green Arrow seems to be the go-to guy for non-League problems. Must be the Robin Hood hat. Girls dig the hat… The episode was OK, but not great — and with that cast it should have bean unforgettable. I thought Dennis Farina was great as Wildcat and Morena Baccarin (Inara from Firefly) was a good Black Canary, and it was fun trying to name the villains*. (Roulette is the newest comic book villain I’ve seen yet; she’s only been around about three years or so.) Still, with that ending, it was basically Amok Time, JLU style.

And I definitely feel cheated by Canary’s scream.

* I saw Sports Master, Tracer, Atomic Skull, Electrocutioner, Hellgrammite, Roulette, Bloodsport and Evil Star

Now I’m not a lawyer, but I sometimes see plot points in comics that perplex me from a legal point of view (Identity Crisis #7, for example). Today, I’m wondering about serving people — in the legal sense, not in the Twilight Zone “To Serve Man“ sense.

What are the limits to serving someone with legal papers/subpoenas? If someone is being served with papers from an Indiana court, can he be served if he’s in Illinois? Can he be served if he’s outside the country (vacationing in Bermuda, for instance)? Can he be served if he’s in outer space?

Why yes, I was reading Manhunter #6.

I wish Bob Ingersoll were still answering questions like this.

I’ve spent most of the past three days playing Sid Meier’s Pirates!.

The original Pirates! was my favorite computer game of the CGA/EGA era. I first discovered it my freshman year in college, and it quickly became an obsession.

A few years later VGA debuted and Pirates! GOLD was released. It was a graphically enhanced version of the original. It never played as well, mostly because of the counter-intuitive use of the mouse. The graphics weren’t that much better, really. The same menus as before but now over a static pirate-esque picture instead of the previous blue background.

There have been several attempts at pirate games since then and none have been particularly good. So is it any surprise really that Pirates! was retooled and re-released recently?

The gameplay is as good as the original. That is the game’s single greatest asset, as well as its single greatest drawback. Players start out as a young pirate on the Spanish Main. They start with a few men and a single ship and sail the Main looking for other ships to capture or cities to raid. Along the way, the character hunts down wanted criminals, romances beautiful (and busty) women and searches for buried treasure. There is no official end to the game. At some point, the player retires his pirate and the game is over. There are no stated goals or objectives to meet; it is open ended game.

This was fine in the original, but that was back in the day of the 8086. Nowadays I expect to see more story. The original could be included as “Pirates! Classic,” but throw in some goal-driven scenarios as well.

There are some small changes. Land battles are now fought through an arduous and time consuming move-and-shoot method. Still, it’s better than the original’s murky land battles. The romance angle is better thought out as well, with a dancing mini-game simulating romance. Don’t worry if you’re not good at the dancing, there are items later on that will drastically enhance your character’s ability. I don’t like the new buried treasure system. I preferred the original version where you had to dig for treasure and hope you had chosen the right place instead of the glowing red marker in the new version.

The graphics are much improved in this version, though this highlights their repetitiveness as well.

This is a very good and fun game. I recommend it to anyone, particularly those who enjoyed the original. However, due to the limited nature of its gameplay, I think $49.99 is a little high, so I would wait until it reaches $20-$25.

Is there a more reviled cliche anywhere? This represents the worst in unbelievable and lazy storytelling in comics (and soap operas.)

I couldn’t believe my eyes when Mark Waid pulled out this hoary chestnut to explain the villain Cobalt Blue in his otherwise excellent run on The Flash. It dragged the whole storyline down from there. (Poor Barry, he’s had more questionable things done to him since dying than before.)

That’s not to say it can’t be reworked succesfully. Peter David did a good job with what has elements of an “evil twin” tale in Madrox. Personally, I would love to see Luorno Durgo with one of herselves evil — that would be a good evil twin (or triplicate, really) story.

This was the first episode of House with an unhappy ending. The medical mystery was fairly involved and several personal mysteries were thrown in as well. Why is the homeless patient seizing and photophobic? Why does Dr. Foreman detest the homeless? Why does Dr. Wilson go out of his way to help them? All the mysteries were answered — except for the one about Dr. Foreman, which was dropped halfway through the show and never picked up again (even though it was the driving force of the first half-hour).

The ultimate solution to the medical mystery was good and bad with the one-two punch of an abdominal tuberculoma and rabies. Abdominal tuberculomas are uncommon, but there have been several well documented cases. It was a bizarre presentation for rabies, both in the patient and Dr. Foreman, so I’m suspicious of the diagnosis with the information presented.

There some other mistakes (medical and otherwise) that caught my eye on tonight’s show:

• The show was right that Iron Dextran is infamous for causing allergic reactions. However, contrary to what the script said, the “banana bag” was still infusing in the patient and not the iron dextran when she had the allergic reaction. In case you’re wondering, a banana bag is an intravenous multivitamin formulation that is nearly neon yellow in color.
• Why was the epinephrine injected intramuscularly when there was a perfectly good IV site? IV administration gives faster and more reliable results — very important in a code situation. Foreman remembered the IV site when he had to give the patient Haldol several scenes later.
• CA-125 is a tumor marker that is useful for following a patient diagnosed with ovarian cancer; it is not useful as a screening tool. It’s very expensive too, so I find it hard to believe that any physician would use it as a first-line general screening test.

It wasn’t all bad. There was some good medicine in the episode too. Serotonin syndrome and paraneoplastic syndrome were likely diagnoses and adenosine is an appropriate drug for a supraventricular tachycardia.

Once again, the Young Gun doctors were performing every test themselves. Dr. Chase performed the abdominal ultrasound and Dr. Foreman performed the biopsy on the ovarian mass. He’s a neurologist so I’m surprised he even know here the ovary is.

I give this episode a B+ for the mystery (the score would have been a great deal higher if they hadn’t forgotten the plot point involving Foreman), a C for the eventual solution, and a C- for the medicine (the episode lost lots of points for perpetuating the CA-125 screening myth).

Dies the Fire is set in the Pacific Northwest after a mysterious catastrophe has wiped out almost all technology. Electronic equipment no longer functions. Gunpowder to no longer works. Steam engines can’t build up enough pressure.

Juniper Mackenzie and her fellow Wiccans escape the chaos of the city and set up a colony in her family’s old mountain cabin. Their group is prosperous and attracts more and more people to their land.

Meanwhile, Mike Havel is an ex-Marine and a pilot for a small charter airline. When the “Change’ hits, he was flying the Larsson family over Idaho. He manages to bring the plane down safely (mostly) and does his best to lead the family to safety. Along the way, the group picks up more and more people and ends up becoming a formidable cavalry war band.

Not everyone has taken the change so well. Many people go mad and many more revert to savagery. In Portland, a self-styled king has set up a brutal fiefdom that is rapidly expanding into the surrounding countryside. It’s not long before his minions come into contact with both Juniper’s people and Mike’s war band.

Dies the Fire is projected to ne the first book of a trilogy. It has a definite ending, although enough plot threads are left for further books. This novel is loosely connected to Stirling’s “Nantucket” series. In those books, the island of Nantucket is thrown back to prehistoric times. This novel tells what happens to the rest of the world after that incident. Some of the character’s last names are familiar, so I wonder if they are supposed to be related?

As to be expected from S.M. Stirling, this is a very good book. It shares the “self reliant men and women surviving and even prospering in a world gone mad” theme common to many of his novels. While I don’t think it is as good as Conquistador or The Peshawar Lancers, it is still much better than most books out there and I recommend it without reservation.

---

One of the acknowledgements in the beginning of the book was to Heather Alexander, one of my favorite filk/folk singers. Several of her songs can be found in novel.

---

Links:

• S.M. Stirling’s site
• Heather Alexander’s site

One of the biggest differences between military medicine and civilian medicine is the chain of command. In the military, there was always somebody over you telling you what to do. Frequently, it seemed that the higher in rank a person became, the more out of touch they were. I had a number of excellent commanders when I was in the Air Force, but I also suffered through more than my share of bad ones.

One day, the word came down from on high. “The Colonel wants everyone to see six patients an hour,” my commander said. I had the misfortune of being acting clinic chief at the time.

“Six? That’s probably feasible for sick call, but there’s no way it’s going to work otherwise. Ten minutes per patient is not enough time.”

“I know,” my commander agreed. “But it seems Colonel M- has been getting some grief from his superiors about the number of patients seen here per day. He’s decided the best way to salvage this is to have the Family Practice, Pediatrics and Medicine Clinics increase the number of patients they see.”

“We already see more than the rest of the clinics combined. Wouldn’t it be easier to have the specialty clinics actually work a full day instead?” I wondered, with a trace of bitterness. While the primary care physicians worked nine hour days, the specialists came in late and left early. She just shook her head

With the blessing of our squadron commander, the major and I tried our best to point out the flaws in the Colonel’s plan. While the numbers of patients seen would rise, complaints would skyrocket and morale in the primary care clinics (already low at that point) would plummet. He refused to believe that anything could be wrong with his decision and the new rules stuck.

A few weeks later, Colonel M- decided that he needed to get in touch with his roots. Before becoming a flight surgeon, it seems he had been a Family Practice physician. He asked our commander if he could spend a few hours working in the Family Practice clinic. She agreed, and assigned him a block of my patients one morning.

The first patient was a well-controlled diabetic patient in for a regular check-up. The colonel went in to see the patient and I waited. And waited and waited.

Forty minutes later, he came out of the room, finally finished.

“That went well,” he said.

“Sir, you realize it took you forty minutes to see that patient?”

“Good medicine takes time,” he replied smugly.

“You’re now three patients behind,” I pointed out.

“How can that be?” he asked.

“As per your orders, we’re required to see patients every ten minutes, sir.”

He looked puzzled. I honestly think he could not see the irony in the fact that it took him forty minutes to do what he expected us to do in ten. It was a complete disconnect. He looked at the stack of charts waiting for him then quickly glanced at his watch.

“I’m late for a meeting,” he said as he abruptly left the clinic.

The six-patients-per-hour rule stayed and he never asked to work in the clinic again. When he was sent to Korea in an abrupt change of command a few months later, no one was sorry to see him go.

How many times have we seen this? A hero or group of heroes is fighting a super-villain, usually one with some sort of energy draining or absorbing power.

“If we can just overload him, we’ll win” the lead hero declares confidently.
Following his lead, all the heroes max out their powers on the villain. There’s Super Nova flares, Gekigan punches and Screams that shatter glass. It’s too much to handle, and the villain collapses, defeated.

If you think about it, that’s a pretty risky move. Almost always, it’s a villain the heroes have never seen before and certainly one they’ve never had time to study. Still, they’er confident enough to risk everything. If they’re wrong, they’re going to be totally depleted while the bad guy will be stronger than ever. Yet the trick never fails and seems to turn up in comics and cartoons at least once a month.

Just once, I’d like to see the villain shrug it off, laugh, and wipe the floor with the good guys.

So you want to be a star comic book writer but you just can’t think up any good titles? No need to fret, for we here at Polite Dissent have created S.I.N.S. (Scott’s Incredible Naming System). With this simple system, now you too can create the title of the next multi-issue storyline, crossover or event comic.

Simply choose a word from Column A and a second word from Column B. Combine them, and — voila! — a title as good as anything out there!

Column A	Column B
Cosmic	Angel
Strange	Death
White	Storm
New	Shadow
Faded	Flag
Impossible	Mystery
Long	Flame
Young	Monkey
Intimate	War
Savage	Power
Lonely	Arrow
Last	Knight
Red	Dream
Evil	Family
Ultimate	Quest
Hidden	Fate
Total	Fear
Fallen	Love
Secret	Sin
Dark	Crisis

Advanced techniques:

1. Go for a longer title using multiple words. A good pattern to follow is: (Column B) of the (Column A)(Column B).
   Using this method, you can create such outstanding titles as Death of the Lonely Fear or Shadow of the Dark Monkey – now there’s a book I would buy!
2. Many multi-part epics have seperate chapter titles. A could chapter title could either just be a word from Column B, or another Column A-Column B combination. For example: Lonely Knight, chapter 1: War and Lonely Knight, chapter 2: Secret Love
3. Combine two words from Column B, such as Death Angel, Family Sin or War Monkey.
4. For a good name of a group, just take a word from Column A. You may need to add an “s”. Now we have the Fallen, the Ultimates and the Intimates…
5. A similar system could be applied to manga books, but more flowery language would need to be substituted.

Very harsh day in the hospital today so I’m just going to take a night off. “Lois Lane Friday” will be back next week. In the meantime enjoy this classic medical comic-book cover.

On Monday, a call came into the office from a local employer.

“Did the doctor write a medical excuse for J-T-?”
The nurse checked the chart. J-T- was a patient I’d seen towards the end of the previous week. I treated a nasty bronchitis and wrote him a note excusing him from work through the 4th (last Friday).
“Yes, he did,” she replied.
“Was it for the 4th or 7th?”

It seems the note J-T- handed in at work had the 4 in “4 Feb 2005″ crossed out and a 7 written in place of it.

The work excuses we use at the clinic are pre-printed — we just fill in the appropriate blanks — and two pages. The patient keeps the top copy and a duplicate bottom copy is filed in the medical chart.

If I change a work note, I almost always fill out a new one so there’s no question. On the rare occasions that I do change the original note, I’ll cross out and rewrite the whole phrase, not just the number, and I’ll initial and date any alterations.

“The note the doctor wrote was for the 4th,’ the nurse said, reading off the duplicate in the chart.
“That’s what we thought.”

So now this guy has his employers mad at him (rightfully so) and one of our nurses mad at him (even worse). The sad thing is that this never had to happen. I’m a soft touch when it comes to work excuses; all he had to do was the call the office and tell me he was still feeling sick and I would have written him a new note with no questions asked.

For most of my time in the Air Force, I worked at the Mike O’Callaghan Federal Hospital Family Practice Clinic. Our clinic was divided into ten “teams” of two providers: a physician and a physician’s assistant. Each team also had two nurses, four medical assistants and a receptionist. The system worked well and each team had a great deal of autonomy.

One day, our receptionist fielded an angry phone call from a bank downtown. They demanded to know why we had excused a particular patient from work for two weeks. Well, we hadn’t. She had never been seen in our clinic — ever. Apparently someone had stolen a stack of our work excuse notes and handed them out.

Doug, the physician’s assistant, was livid. As far as he was concerned, his reputation was on the line because it was his name that was “signed” on the bottom of the forged note. He spent all morning trying to figure out who had stolen the notes. Unfortunately, we never did find out who stole the notes so to this day Doug’s thirst for vengeance remains unquenched.

We started keeping the forms under lock and key after that. We also added a line that said not valid unless signed and stamped (military physicians have an ink stamp they use for official forms). We never had problems again, so it seems our changes worked.

Of course, the work notes we used in our office were just something I had put together quickly in Microsoft Word, so anyone could create a realistic looking note on their own in seconds without having to resort to outright theft

Joining in on Mike’s Meme, here are “100 Things I Love About Comics”. There may be a theme here…

1. Donald Blake
2. Cardiac
3. Doc Samson
4. Dr. Bong
5. Dr. Death
6. Dr. Decibel
7. Dr. Druid
8. Dr. Faustus
9. Dr. Gym’ll
10. Dr. Harleen Quinzel
11. Dr. Maxilla Yale
12. Beth Chapel
13. Charles McNider
14. Pieter Cross
15. Dr. Polaris
16. Dr. Reinstein
17. Stephen Strange
18. Dr. Sugarman
19. Murmur
20. Celia Reyes
21. Michael Two Youngman
22. Bruce Banner
23. Victor Von Doom
24. Dr. Light
25. Kimiyo Hoshi
26. Dr. Manhattan
27. Dr. Octopus
28. Dr. Phosphorus
29. Dr. Solar
30. Ray Palmer
31. Reed Richards
32. Jason Woodrue
33. Phillip Sylvian
34. Dr. Mirage
35. Curt Connor
36. Dr. Alchemy
37. Dr. Demonicus
38. Dr. Denton
39. Dr. Spectrum
40. Kirk Langstrom
41. Will Magnus
42. Henry McCoy
43. Hank Pym
44. Bruce Gordon
45. Dr. Nathan Appolyon
46. Valeria Cooper
47. Peter Corbeau
48. Doctor 13
49. Dr. Messiah
50. Dr. Craupad
51. Dr. Destiny
52. Doctor Diehard
53. Doc Horror
54. Doc Noble
55. Dr. Bedlam
56. Dr. Cyber
57. Dr. Minerva
58. Dr. Mist
59. Dr. Moon
60. Dr. Nowhere
61. Princess Maru
62. Dr. Psycho
63. Dr. Regulus
64. Moira MacTaggert
65. Dr. Fate
66. Dr. Occult
67. Dr. Spectro
68. Dr. Strangefate
69. Dr. Thirteen
70. Dr. Tzin-Tzin
71. Dr. Tyme
72. Dr. Vortex
73. Doc Savage
74. Dr. Kildare
75. Ben Casey
76. Doctor Fu Manchu
77. Doctor Who
78. Doctor Tomorrow
79. Doctor Graves
80. Phantom Witch Doctor
81. Emergency Doctor
82. Dr. Spektor
83. The Adventures of Young Dr. Masters
84. Dr. Brent, Young Intern
85. Dr. Weird
86. Dr. Swineheart
87. Dr. Radium
88. Doc Stearn
89. Thomas Elliot
90. Sikorsky
91. Doctor Love
92. Hector Hall
93. Linda Strauss
94. Inza Nelson
95. Doctor Zodiac
96. Jane Foster
97. Doctor Chaos
98. Dr. Cyborg
99. Dr. Bromwell
100. Anton Arcane

Designed to keep several sets of fanboys happy!

Snit’s Revenge was the first Tom Wham game I ever encountered, and remains one of my favorites. This is the sequel to Snit Smashing, the game that H posted about last month. In this game, the Snits have had enough of the Bolotomi and attack en masse, sneaking inside and booting their internal organs about.

A friend of mine picked up another game of his, Awful Green Things From Outer Space, and loved it so much that he was moved to created his own “Advanced Awful Green Things: The Roleplaying Game.” Yes, he is gainfully employed nowadays — he’s actually a lawyer — why do you ask?

I subscribed to Dragon Magazine for most of junior high and high school. It was always a cause for celebration whenever a new Tom Wham game would be published. While there was always something to recommend about every game of his, my favorites were File 13 and King of the Tabletop. File 13 was a game about getting games published; the game play was very straightforward (and a little too random for my current tastes) but the humor was perfect (I’ll see if I can find the names of the games you were supposed to sell, they were hilarious). King of the Tabletop was a game where you had to marshal your resources, build your army and the wipe the other players out one by one. Looking back, it was in some ways a precursor of Magic the Gathering. Each player had certain terrain tiles and was could only form his army from creatures native to the terrain he owned. This was my gaming group’s favorite game through most of high school. Mayfair published this game later as Kings & Things*.

Two of Wham’s games are contained in the boxed set The Best of Dragon Magazine Games, which is usually available on e-Bay. Kings & Things* can be found on e-Bay quite a bit too, although usually it’s the German edition.

Links:
Tom Wham’s web site

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*This is not a footnote. Kings &Things* is the actual name of the game.

UPDATE:
Here is the list of the game pieces from File 13.

This episode of House looked at two separate medical issues. The first was a case of hemolytic anemia in a high school student. The second issue was Dr. House’s use of narcotic painkillers.

Various reasons for the patient to have hemolytic anemia were considered, including cancer, lupus and hepatitis E. Ultimately, it was determined to be liver toxicity from naphthalene secreted from an enormous colony of termites. Naphthalene is the chemical found in mothballs, and one would think the distinctive odor would be noticeable at a level high enough to cause symptoms. Still, it was an intriguing case and diagnosis (and it’s true that some termites do secrete naphthalene).

I was not as impressed by the handling of Dr. House’s use of narcotic painkillers. Dependence and addiction were treated as if they were the same thing when they are two different, though related, conditions. Dependence means that the body is habituated to the drug and the patient will suffer withdrawal symptoms if the drug is stopped. The patient may become tolerant to the medication and need higher levels to achieve the same effect. Dependence is not limited to narcotics, but can be seen in many other drugs including alcohol and such over the counter medications such as acetaminophen and nasal sprays. It is a physical diagnosis, not a psychological one (though there is also psychological dependence, but that’s another issue).

Addiction is a maladaptive behavioral change. Basically, a person is dependent on a medication, it interferes with their life, and they do things they know are wrong to get it or take it (such as stealing, lying, skipping work or school, and do on). While physical dependence is a part of the condition, addiction is more of a psychological condition than a physical one.

Just to confuse issues, House may also be suffering from pseudo-addiction. This occurs when a patient has inadequately treated pain and behaves in a way that leads people to believe they are addicted when all they really want is better pain control.

House is certainly dependent on his painkillers. He’s been using them for years and has needed increasing doses to kill the pain. However, I don’t see much evidence that he’s addicted. He’s unpleasant and unlikable, but I get the feeling he’s always been that way (despite what Dr. Wilson’s last minute speech would have us believe). He doesn’t do things that he knows are wrong in order to get his medication. His problem is more one of dependence (and pseudo-addiction) than addiction.

I give this episode an A for the mystery, a B+ for the result, and a B for the medicine (A- for the hemolytic anemia and D for House’s “addiction”.)

It’s been a while since I updated the Hawk and Dove Chronology (actually, at this point it’s just the Hawk chronology since Dove perished during Crisis on Infinite Earths).

When last seen, Hawk was fighting Cheshire alongside Wondergirl, Flash, Aqualad, Robin and Speedy in New Teen Titans #19-21. As you recall, the other characters — both hero and villain — made sure that the reader knew that Hawk had gone insane since his brother died.

Hawk returns in New Teen Titans #24 (October 1986), but just long enough
A) to quit the Titans,
B) for the reader to be told once again that Hawk is crazy.

The rest of the issue deals with the introduction of the Hybrid, a super-powered team developed by Steve Dayton (you want to see somebody nuts, look at Mento, not at Hawk) to defeat the Titans.

Looking back at Wolfman’s New Teen Titans, it doesn’t take long to realize how incredibly well-written most of the issues are (any one with Deathstroke or the H.I.V.E. in particular), but I’m also struck by how many issues seem to consist almost entirely of exposition.

Y: The Last Man #30 “Ring of Truth, chapter four”
Brian K. Vaughan, writer
Pia Guerra, penciler

One of the secrets of the plague is revealed in Y: The Last Man #30. Dr. Mann has discovered that the monkey Ampersand, for some as yet unrevealed reason, is immune to the disease. Furthermore, his stool carries some plague proteins that have allowed Yorrick to remain protected.

At this point, Dr. Mann goes into a long spiel of technobabble that would make a Trekkie proud. Unfortunately, this technobabble obscures the science so it unclear whether Dr. Mann is talking about passive immunity or active immunity. In passive immunity, a patient is given antibodies from someone else. This has the benefit of kicking in quickly, but the protection only last for a few months. In active immunity, the patient is exposed to a small amount of protein from a particular germ and develops their own antibodies. This process takes longer to occur, but lasts years, if not forever. Active immunity is the basis of vaccination.

• Is Dr. Mann saying that Yorrick has absorbed protective antibodies from Ampersand? If this is the case then Yorrick’s protection is only temporary since passive immunity only lasts for about three months. Antibodies can be given orally, but the success rate has never been very high. It seems to work best for gastrointestinal diseases.
• Is Dr. Mann saying that Ampersand is secreting a plague protein that Yorrick has made an antibody against, and this is what has protected him from the plague? This makes a little more sense because this would be active immunity, like a vaccine. Immunity of this kind would last much longer — and may even be permanent — because Yorrick is making his own antibodies against the plague. (But then you’d think Dr. Mann would have been able to detect these antibodies). There are several oral vaccines available including oral polio vaccine (OPV) and oral typhoid, so the success of vaccination by this route is well established. Bear in mind that this would mean that not only is Ampersand protected against the plague, but that he is producing some plague proteins as well.

The medicine and science are sound and I’m eager to see what future issues will reveal about the nature of the plague.

Check out the 2nd Skeptics’ Circle, hosted this time around by Orac.

The Skeptic’s Circle is a blog “carnival” designed to stress science over pseudoscience, reason over quackery, and facts over misinformation. Be sure and check it out.

(The 1st Skeptics’ Circle from two weeks ago can be found here)

A college-age patient came in complaining of large white spots on both of his arms. He told me that there had been white spots like these on his arms for years. They had actually been worse when he was younger, but he was going on a trip to Mexico so wanted to get them cleared up before Spring Break. The spots were present year round and did not get worse during any particular season. They itched, and he had tried various over the counter treatment without success.

On exam, the patient had several irregularly-shaped hypopigmented macules* on the upper and lower arms. The lesions were 1-2 centimeters in diameter and had a fairly diffuse border. They were not inflamed and there was no flaking or scaling.

The most common cause of light-colored spots in my clinic is tinea versicolor (TV). TV is caused by an overgrowth of a fungus that commonly grows on the skin. It worsens in warm conditions, and is most common in tropical climates and during the summer months. By my experience, the lesions are usually found on the shoulders and upper trunk. Sometimes they itch, but they usually do not. The spots have a well defined border and are often slightly flaky. Under a Wood Lamp (black light) the lesions will fluoresce, and skin scrapings treated with potassium hydroxide (KOH) have a definitive spaghetti-and-meatballs appearance under the microscope. Topical medications are the best treatment for TV.

This patient, however, did not have TV. His lesions did not have well-defined borders, but instead blended in with the normal skin so that it was hard to tell the exact spot where the lesion started. They also appeared much lower on the arms than versicolor usually does. They did not light up under a Wood lamp and the KOH examination was negative.

This patient has a condition known as pityriasis alba. The cause is unclear, though some dermatologists believe it may be a related to eczema. Itching, although uncommon, has been known to occur. Pityriasis alba occurs most commonly in children and goes away on its own as the patient gets older. It is extremely rare after age 25. Time is the best treatment, though there have been some successes with mild topical steroids and light therapy.

The patient was happy that I was able to diagnose his condition, but disheartened by the fact that there are no good medical treatments. We decided to try some 1% hydrocortisone cream and hopefully he’ll have good results before he heads south for Spring Break.

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*Psst! Here’s a secret for all you non-medically inclined readers. Hypopigmented means that a rash has less pigment than normal skin and is lighter in color. Macule refers to a flat lesion (like a freckle). Don’t let the other doctor know I told you…

I finished reading Batman: Detective #27 last night. It was one of the more enjoyable Elseworlds I’ve read in recent memory. Writer Michael Uslan does a good job weaving historical individuals such as Theodore Roosevelt, Allan Pikerton, Gregor Mendel and even Sigmund Freud into the tale (though the Babe Ruth moment seemed a little forced). The mystery was well done with some clever red herrings and a satisfying last minute reveal.

I’ll do a post in a few days looking more in depth at the villains’ plans, particulary at their use of toxic plants. (Posionous plants have always been an interest of mine. Before deciding to attend medical school, plant molecular biology was my main area of interest and research, though I worked with barley — which isn’t really a poisonous plant unless you count cheap beer).

A funny post on blogs and bloggers over at IMAO. I especially like the line comparing Aquaman to the recent Eason Jordan brouhaha:

In a fight between blogs and Aquaman, blogs would keep hounding Aquaman about supposed statements he made at Davos about U.S. troops deliberately targeting fish until he was forced to resign from his job at CNN.

It’s Friday, so that means it is Lois Lane Day here at Polite Dissent. Because I missed last week’s installment, I have a doozy of a Silver Age tale for everyone today.

“Tomorrow I Die!” - Second story from Superman’s Girlfriend Lois Lane #98 (January, 1970)
Robert Kanigher, writer
Curt Swan, penciler

Lois is celebrating her 1000th shift as a volunteer nurse at the hospital. She is assigned a special patient — a Nobel laureate — who has cancer and needs “radium therapy.” Meanwhile, Superman flies her to an asteroid to celebrate her nursing milestone. While there, they munch on the local flora (“This blue flower’s nectar is fantastic!” says Lois).

The next day, after giving another radium treatment, she goes into the supply closet and notices that she’s glowing. Poring over medical textbooks, she deduces that she’s got radium poisoning and has only days to live.

Leaving her awards banquet in tears, she decides to get the scoop of her life by interviewing the Hermit of Haunted Mountain, who conveniently lives in a cave just outside Metropolis. In the cave, she is confronted by a giant mutant rattlesnake, but it seems scared of her and leaves her alone. She finds the hermit, but he is dead of a rattlesnake bite. So much for that Pulitzer-winning scoop.

Next, she decides that if she is going to die then she wants to do it on an island beach. She convinces her stewardess sister Lucy to get her a plane ride to the island. Of course, the plane is hijacked by a bomb-wielding maniac. When Lois tries to intervene, he throws the bomb at her, but it malfunctions and stops working.

Superman arrives, arrests the hijacker and then flies Lois to his Fortress of Solitude. He shows her a “honeymoon cottage” he built for her. She is touched that he cared enough about her to build this cottage, but sad that she will not live to enjoy it. Suddenly, a giant lizard that escaped from Superman’s Kryptonian zoo attacks the pair. Superman is powerless to stop it, but a mysterious Kryptonian steps out of the shadows and subdues the beast. It turns out that he was a criminal sentenced to the Phantom Zone. A mysterious rupture appeared in the zone and he was able to leave just in time to save Superman. Docilely, he returns to the zone to serve out the rest of his sentence. Superman reveals to Lois that she does not have ra