Polite Dissent

It’s July 1st, the day the new interns start in hospitals across the country. It’s their first day of being a “real doctor.” In honor of them — and remembering my first days on the job — here are 5 quick important lessons. Some of these were mentioned in medical school, but those were the lectures you probably slept through. These apply mostly to primary care doctors, but are skills every doctor should have.

1. Learn to Give Shots
   A quick skill to learn that will pay back dividends many times over. This is a key skill if you’re going to be a deployed military physician or plan on going on any humanitarian missions.
2. Learn to Give Bad News
   Don’t hesitate or hem and haw, just say it directly and simply. Don’t have the nurse call a patient’s family with bad news, do it yourself. The family (and the nurse) will be grateful.
3. Learn to Talk about Sex
   Again, don’t hesitate or hem and haw, just say it directly and simply. If the patient wants to use strict anatomical terminology, stick with thatbut I find that most patients are more comfortable using slang. The patients with the most questions about sex seem to be adolescents and late middle age men and women.
4. Trust Your Instincts
   I was once taught that if “even the thought of an LP crosses your mind, it means the patient needs one.” If something doesn’t feel right, it probably isn’t.
5. Save Time for Yourself
   Keeping yourself sane is always important.

The Tour started off well for the Americans in general and Dave Zabriskie and Lance Armstrong in particular.

Today’s first stage was a 19 km (12 mile) individual time trial. In individual time trials, riders start one minute apart and race for the best time. Dave Zabriskie won the stage with a time of 20:51 and Lance Armstrong finished second, just 2 seconds behind. Lance looked strong and had a great race. He managed to catch — and pass — his main rival Jan Ullrich at the 15 Km point (this is key in time trial stages because it means Armstrong was able to make up the minute time difference). That puts Ullrich 1:06 behind Armstrong, but will be an even bigger blow to the ego, particularly this early in the event.

Overall, Americans (racing for 3 different teams) took 4 of the top 6 places.

Tomorrow is a 181.5 Km (112.5 mile) mostly flat stage.

Whatever happened to Tyler Hamilton? He was another big name in American racing. He had a bad Tour last year, and ended up dropping out. A few months ago, he was accused of blood doping (a charge he denies). I didn’t see his name as one of this year’s participant in the Tour, so I wonder what happened.
Read more…

A straightforward day of racing in France with not too many surprises. At 26km into the 181.5km stage, four riders staged a breakaway from the main peloton that lasted until the last 6km. As one of the breakaway riders, Thomas Voeckler won a masterful race up the only major climb in the stage to be the first to wear the red polka-dot King of the Mountain jersey. In terms of the Green Jersey (the sprinters jersey), Tom Boonen of Belgium won the final sprint of the day to the finish line and he gets to wear the green jersey tomorrow.
Dave Zabriskie keeps the overall lead and the yellow jersey.

There was only minimal changes in the standings since almost every rider finished in the main peloton, which all receive the same time. Some of the position changes are due to the wear and tear of the Tour, but most are because of the sprints (which award a time bonus for succesfully winning a sprint). That’s why George Hincapie “fell” to fifth without losing any time; Hungarian Laszlo Bodrogi won enough sprints to gain a twelve-second time bonus and jumped up to third.

Tomorrow’s Stage 3 is another flat road course, 212.5 km (132 miles) this time. There will be sprints and probably a breakway or two, but most riders will be saving their strength for the following day: the Team Time Trial.
Read more…

Come the end of August, the Polite Wife and I will be moving down to the St. Louis area. Though I like the small town where we are, the Polite Wife grew up in a bigger town (Las Vegas, to be exact) and misses some of the opportunities (and most of the shopping) available in larger cities. We’re actually moving to my hometown, so we already have a bunch of friends (and source of cheap labor) there.

We have already bought a nice house there, though I’d feel a whole lot better if we could sell this one (and soon). Because we’re in the process of selling this house, we’re finally getting around to doing all the household repairs we’ve been meaning to do for the two years we’ve lived here (fix the plaster, re-prime and paint the porch, etc. etc.)

I have a nice new job lined up — Family Practice, of course. It’s in a larger office, and it’s outpatient only - no hospital patients. While I enjoy seeing patients in the hospital, it takes up a tremendous amount of family time and all my less-than-pleasant experiences over the past few years have all involved hospital patients — so I really won’t be sorry to see it go. The job opportunities should be much better for the Polite Wife (she’s already seen more elementary teaching openings in one month down there than in two-plus years here).

Polite Dissent will continue unabated — even during our already scheduled Hawaiian vacation. That week I’ll be posting Flashback Week II and a look at the Death of Superman.

Since we’re moving, I’m putting up a lot of items on eBay over the next day or so. There will be some comics, anime, manga and a great deal of RPG goodies, including some hard to find D&D complete boxed sets. (My eBay items)

The final issue of the Hawk & Dove mini-series starts with the origin of the new Dove. Dawn Granger was in London during the time of the “red skies” (i.e. the Crisis on Infinite Earths). Her mother was held hostage by a group of terrorists who had taken over the American Embassy. Desperate for a way to save her, Dawn hears voices that promise her the power to restore order (or should that be Order?) when she says the word “Dove.” Changing into Dove, she captures the terrorists and rescues the hostages. She then decides to return to America to find Hawk. Ultimately, Dawn is able to link Hawk and Hank Hall and enrolls at Georgetown to track him down.

As Dawn and Hank are sitting in Hank’s apartment talking, his parents let themselves in. They of course immediately assume that their little Hank has found himself a girlfriend. Despite the protestations to the contrary, the Halls invite Hank – and Dawn – to dinner at their house the following evening.

It turns out that the Halls weren’t the only one who barged in on Hank and Dawn; one of Kestrel’s demons was listening and threatens Hank’s parents if Hawk and Dove don’t show up at the same warehouse where they first met.

The pair arrives at the warehouse but find it empty. Hawk discovers a mysterious door in the wall that Dove can’t see at all. They enter the doorway and find themselves in the Chaos realm. Dove’s order-based powers are weaker there and she is having problems concentrating. Hawk, on the other hand, finds himself strengthened. They’re not alone in the Chaos realm — Kestrel is there as well. He taunts both Hawk and Dove, but finds particular delight in harassing Dove. She manages to lead Kestrel directly into Hawk’s path, but the chaos has so enraged Hawk that he is as willing to fight Dove as Kestrel. Trying to convince Hawk that he’d be better off without Dove, Kestrel tells him that he and Hawk would make better partners; that they’d be “blood brothers.” This reference to “brothers” reminds Hawk of his brother Don and this immediately calms him down. Finally realizing and admitting that Dove is his partner, Hawk and Dove agree to take down Kestrel once and for all. At this point, the Lords of Chaos realize that Kestrel has failed – he was unable to tempt Hawk to Chaos. The Chaos realm collapses around Hawk and Dove and they find themselves back at Hank’s apartment.

That evening at the Hall’s house as she is talking to Hank’s mother, Dawn realizes that she received her powers before Don died, and she begins to wonder if he died because she was given his powers. She wonders if maybe there was some truth to the “experiment” Kestrel had been ranting about. On the walk home, Hank does his best to reassure her. They encounter Ren, who finally gets Hank to agree to take her out on a date. The series ends as Hawk and Dove chase after a mugger with Ren exhorting them to be careful and make sure they’re back by Friday.

This issue is a fitting end to the mini-series. It establishes the new Hawk and Dove status quo but leaves questions open for exploration later. The Order/Chaos dichotomy is handled well. Dove is weaker in the Chaos realm and is unable even to see the door that leads to it. Hawk becomes stronger when exposed to Chaos – a point that will be revisited in the second year of the subsequent series when the definitive origins of both Hawk and Dove are given (and Kestrel returns).

There are other nice touches as well. The interactions with the parents are handled perfectly, and this continues into the following Hawk & Dove regular series. Crisis on Infinite Earths is referenced, but never explicitly mentioned. This allows new readers to enjoy the story without missing a beat, but allows us old time DC readers a smile. I like the fact that Kestrel remembers how Dove fights and tries to use that against her. Dove, however, anticipates his anticipation and leads him into a trap. For all the time the same heroes and villains fight in comics, you think you’d see more of this recognition of style.

Today’s third stage was a long mostly flat day, like Stage 2. There were a few climbs, and that allowed Erik Dekker of the Netherlands to claim the King of the Mountains jersey (though we’re still over a week from any real mountains).

Belgium’s Tom Boonen won today’s stage (he won yesterday’s as well) and holds on to the Sprinter’s green jersey.

The Overall Point Leader’s yellow jersey continues to be worn by American Dave Zabriskie.

Most of the teams took it fairly easy, resting up for tomorrow’s Team Time Trial (you’ll notice that the highest finishing member of the Discovery Channel Team was 82nd, nearly halfway back).

As mentioned, tomorrow’s Stage 4 is the Team Time Trial, where Lance Armstrong’s Discovery Channel Team is expected to win — though other teams have been beefing up their time trial skills. Expect a change in point standings after the time trial, though there wasn’t much of one today – just a few changes due mostly to attrition or the time bonuses given to sprint winners and stage winners.
Read more…

The 41st edition of Grand Rounds, the best of Medical Blogging, can be seen this week at Medical Conenctivity Consulting. Check it out!

The Discovery Channel Team won the Team Time Trial today, letting Lance Armstrong take the overall points lead and the yellow jersey. Their main rivals, Team CSC, finished just 2 seconds behind, but Dave Zabriskie — who had the points lead going into the day — crashed and finished over a minute behind the rest of his team.

Now that Armstrong has the yellow jersey, the question is whether or not the Discovery Channel Team will fight to keep it this early on, or let another team take it for a few stages, then attempt to reclaim it in the mountains. I suspect the latter, because it takes a lot of energy to fight to keep the jersey this early on.

Tomorrow’s Stage 5 is another mostly flat stage favoring the sprinters.
Read more…

Another mostly flat stage that ended in an all out sprint, with several wicked turns thrown in the last few kilometers to shake the riders up. Australian Robbie McEwan won the stage, though he remains out of contention for the Sprinter’s green jersey (he lost a great deal of points when the judges dropped him to last place after stage 3 for making contact with another racer during the final sprint). Lance Armstrong retains the leader’s yellow jersey, and since the entire peloton is scored with the same finish time, there were no time losses this stage. There were a few shuffles in overall standing due to the sprinter’s time bonuses for winning sprints (and some minor attrition).

Tomorrow there are a few more hills, but for the most part it’s another long flat stage.
Read more…

Between their 1988 mini-series and their 1989 regular series, Hawk and Dove made an appearance in the DC crossover event Invasion! (No, I’m not using an exclamation point because I was excited they were in it. I’m using the exclamation point because that’s the name of the mini-series: Invasion!) After Crisis, DC seemed to have some sort of big event every year or so. Legends, Millennium, Invasion! and others. Most of them were forgettable, some were downright embarrassing. Invasion! was actually fairly entertaining, and did shake up some things in the DC Universe, rearranging the powers of several heroes.

Hawk and Dove appeared in the second issue of Invasion! in the Invasion, Book Two: Battleground Earth. Despite the name, we never actually got to see Hawk and Dove engage in any battle. Frankly, we barely saw them at all.

They first show up in a big Where’s Waldo? scene that’a reminiscent of one of the first shots in the first episode of Justice League Unlimited. See if you can spot Hawk and Dove — I promise you, they’re in the shot. (Click on the image for a larger view.) While your at it, see if you can find the favorites of some other bloggers including Swamp Thing, Wild Cat*, Blue Beetle, and Aquaman. I think that’s Booster Gold behind Ambush Bug and Ice, but it’s hard to tell. And tell me that’s not Spider-Man hiding behind Killowog. It was sure nice of him to help the DC heroes out, wasn’t it?

A portion of the same crowd scene shows up two panels later, this time colored darker to suggest shadow and depth, but since it’s clearly the same pencils, I’m not really counting that as a Hawk appearance.

A few pages later, Dove shows up alongside Hawkman, Guy Gardner and a pre-Atom Smasher Nuklon. She even gets a word balloon, though it’s rather colloquial for someone so grammatically correct: “So we’re gonna fight?” That doesn’t sound like Dove; it sounds more like Hawk, or a second-grader.

That’s it. Those two (and a half) panels are the sum total of Hawk and Dove’s contribution to Invasion! Of course, they remember it a bit different in their own title, but you’ll just have to wait until I review Hawk & Dove #1 to get the low-down on their memories of the invasion.

*OK, it’s the Yoland Montez Wildcat II, but it’s still a Wildcat

Manhunter #11 “Manhunted, part 2: Chasing the Dragon”
Marc Andreyko, writer
Diego Olmos, penciler

Manhunter Kirk Depaul is lured into a fight with a villain named Dumas. At a key point in the fight, Dumas stabs Depaul in the arm with a syringe.

DEPAUL: A hypodermic? Filled with what? Succinyl chloride? Arsenic? Cyanide? It’ll take more than any of that to kill me! Or didn’t you know that I have a healing factor?
DUMAS: Oh, I knew…that’s whay I injected you with an air bubble. The massive stroke you’re having right now should kill you — albeit painfully — in a few minutes.

The question before us today is whether a syringe-full of air injected into the arm could cause a stroke. The answer: very, very doubtful.

First, it’s unlikely that Dumas would be able to inject the air directly into a blood vessel. He’s just blindly stabbing the syringe into the upper arm — and through Depaul’s shirt, at that. It can be tricky to find a blood vessel even when you’re looking for one (as anyone who’s given blood knows), so the odds of Dumas finding one while stabbing blindly during a fight is very low. In addition, Dumas is pushing the syringe straight in – so even if he does find a blood vessel, he’ll probably go right through it and into the muscle.

Dumas will most likely just inject the air into the arm muscles. It’ll be painful for Depaul, but not deadly, and it wouldn’t lead to a stroke.

There’s a small chance that Dumas could inject the air into an artery. Even this wouldn’t cause a stroke. The air bubble would travel with the blood flow down the arm, but become trapped as the arteries get narrower and narrower. Depaul would end up with a blocked artery in the arm, stopping the blood flow from reaching a finger or two, or maybe even the entire hand. This would be extremely painful and render the hand useless, but it wouldn’t be deadly.

It’s also possible that Dumas might manage to inject the air into a vein. In this case, the air bubble would travel with the blood flow back to the right side of the heart and then out into the lungs. The air bubble would become trapped and block the pulmonary circulation. This is a type of pulmonary embolus, which is very painful and quite often deadly.

None of these situations would lead to a stroke in Depaul. That’s not to say that air bubbles can’t cause strokes: there are some very rare and specific circumstances where an air bubble can lead to a stroke. Air injected directly into the carotid artery would cause a stroke. Additionally, just like in a glass of soda, air bubbles have a tendency to rise. In the body, the flow of the blood keeps most bubbles from rising. Studies on SCUBA divers suggest that small bubbles (think soda again) have the greatest chance to fight the current and rise up to the brain and cause a series of small strokes. At the opposite extreme, a large air bubble can entirely block the pulmonary circulation, which would cause the blood to back up and increase the pressure on the right side of the heart. If the pressure builds up enough, and if a person has a small hole between the two sides of their heart, then this increased pressure can send the air bubble from the right side of the heart to the left side of the heart and then into the arterial circulation and the brain. Bear in mind that holes in the heart like this are uncommon and this situation requires an air bubble of at least 50cc.

Dumas would have been better off using poison.

Final thoughts:

• It looks like Dumas is using a 20cc syringe.
• Succinyl Choline is a paralyzing agent. Arsenic and Cyanide are both infamous (and deadly) poisons.
• There are no pain sensors within the brain, so despite what Dumas says, strokes aren’t painful.
• If Depaul is having a stroke, why is he clutching his chest?
• I suspect that Dumas managed to inject the air bubble into a vein, which led to Depaul developing a large pulmonary embolus. The art supports this, with Depaul clearly grabbing his chest in pain.
• Here’s a nice page for teenagers that deals with air bubbles in the blood.

A long rainy day with another spectacular crash at the end that wiped out several sprinters and France’s favorite son. Alexandre Vinokourov finished well, gaining a time bonus which pushed him up to 3rd overall. Meanwhile, Americal Dave Zabriske — who at one point wore the yellow jersey — fell far behind. His crash two days ago must have hurt him more than he let on. Lane Armstrong continues to hold the lead.

Tomorrow: Long and mostly flat, but a few hills. Rain is likely.
Read more…

Another wet long day dominated by the sprinters. Lance keeps the yellow jersey and poor Dave Zabriskie keeps falling farther and farther behind. The rest of the positions and times among Americans and Discovery Channel Team members are virtually unchanged.

Read more…

Yes, I know all super-heroes are fictional, bear with me here.

What are the favorite super-heroes of fictional characters? Not super-heroes that you and I read, but ones that were specifically created for the stories in question.

Here’s the ones that I can think of off the top of my head, but there have to be more:

The Fearless Ferret from Kim Possible
Radioactive Man fromThe Simpsons

The first mountain stage of the Tour, and not very mountainous at that. Still, it shook things up quite a bit in the standings. Lance continues to hold a minute lead on his nearest rivals, but the rest of his Discovery Channel Team did not do as well — a fact that he made sure to mention in his interview after the race.

I don’t think they did that poorly — they finished in the next two groups — and today’s positions probably more accurately reflect their actual ability, instead of a position artificially raised by a good Team Time Trial. Lance has a point though: strategy is an important part of the mountain stages, and he needs his team at his side to help him win.

Tomorrow holds more mountains, then a rest day, then the real event: the Alps.
Read more…

The second day of mountains (and the first real mountain stage) has definitely changed the tour. One time leader Dave Zabriskie has dropped out and Lance Armstrong has given up the leader’s yellow jersey. This is really not a surprise; Zabriskie was injured more than he let on in his crash during the Team Time Trial and the Discovery Channel Team has been trying to give up the yellow jersey for the past several days. It takes a great deal of effort to hold on to the yellow jersey, and Armstrong would rather regain it in the coming Alp stages than spend the entire week wearing himself out defending it. I’m confident he’ll have regained it by the last day in Paris, the only stage that really counts. I am surprised by how poorly Noval and Padrnos did today, both losing 65 places overall.

Tomorrow is a rest day followed by a week of Alpine days.
Read more…

Some of the more interesting searches that led to Polite Dissent in June, divided into easy-to-understand categories:

You should be studying this rather than looking it up on Google:

• What are the different medicine in the Philippines give the kinds and their uses
• Location and organs served by aorta artery

You People Are Sick!

• Real graphic pictures and images of patients bleeding out because of the Ebola virus
• Batgirl Catwoman tentacle
• Comics about sexual diseases

Good Questions

• What does the medical term foosh mean? My nurse accuses me of making up the word whenever I use it, but FOOSH is a legitimate medical acronym. It stands for Fall On Out-Stretched Hand.
• How does Robin fit all his gadgets in his belt from Teen Titans? Um, unstable molecules?
• Polite weight comments. I don’t think there really are any.
• On Teen Titans are Terra and Slade related? No, and in the original comic book it could be inferred that they were sleeping together, and not in the platonic way (personally, I don’t read it that way – I think Terra just liked to play dress up and Slade pretty much ignored her, but I can see how people could get the idea there was something going on).

Not So Good Questions

• Alternative medicine to cure infection in amputated finger. I’m assuming you want to treat an infection in the finger stump, and not the amputated finger itself, because it’s pretty much beyond help by now. Anyway, I’d recommend you see a real doctor for real medicine. Don’t mess around with alternative medicines for infections; they simply don’t work as well as the real thing (if they work at all).
• Value of Spiro Agnew wrist watch? Before or after taxes (chuckle).
• Is their going to be more movies of the original Batman from the 1960s? No. And you do know that’s not the original Batman, right?

TV

• Boy Meets World episode skiing or broken or leg. I remember that one: Cory sprains his leg while skiing, and stays back at the lodge hitting on the hired help instead of spending time on the slopes with his girlfriend Topanga. It was the first of a two-parter and I’m ashamed I actually knew all that off the top of my head.
• Daria DVD box sets Sadly no. I would pay good money for this.

??

• a rh negative and extraterrestial blood
• polite toilet signs

---

There’s been way too many sites hot-linking to my images lately. I’m not quite at the point of messing around with the htaccess file (because the last time I tried, I ended up banning everybody from the site), but I’m almost there. For the time being, I’ll be replacing the stolen images/bandwidth with pictures of the Iraqi Information Minister. So if you see his picture out of context on another site, there’s a good chance it’s replacing a hot-linked image.

Amazing Spider-Man #521 “Unintended Consequences”
J. Michael Straczynski, writer
Mike Deodato, penciler

Towards the end of the issue, the Hydra leader reveals his dastardly plot:

In a state of the art facility elsewhere in this complex, a half ton of genetically enhanced bacilli of anthrax, typhus and botulism toxins are being readied for delivery.

He goes on blabbing for a while (as villains are wont to do), then finally gets to the heart of the matter.

Half a ton of Anthrax, typhus and botulinum toxins deposited into the Ogallala Aquifer will render it poisonous to all plant, animal and human life.

The Ogallala Aquifer is much as the Hydra leader describes it.

The use of Anthrax as a biological weapon makes sense. It has name recognition and that certain lunatic cachet. While Anthrax is most common as a skin or lung infection, it can also cause a very nasty gastrointestinal infection upon consumption of contaminated meat, so using an enhanced version of Anthrax in the water supply makes a certain amount of sense.

Typhus is a different story. The term typhus encompasses several different diseases that are passed to humans from rodents by lice and fleas. Luckily, these diseases are rare in the more industrialized nations. There is no evidence that drinking water contaminated with typhus-causing bacteria will actually lead to typhus. I have to wonder if Straczynski meant “typhoid” instead of typhus – they are two entirely different diseases and unlike typhus, typhoid is caused by contaminated food and water. Anyway, Straczynski can always claim that drinking contaminated water can cause infection with the “genetically enhanced” type of typhus.

The use of Botulinum Toxin also makes sense as a biological weapon in this scenario. As regular readers of this site already know, it is an extremely potent and deadly toxin; just over half a pound of botulinum toxin is enough to kill everyone on Earth. As an aside, Botulism must be the comic book disease of the year, this is its third mention in a mainstream book in the past six months.

Anthrax, Typhus and Botulism are all animal (and human) diseases. They would have no effect upon plants, so I am uncertain how these agents would render water toxic to “all plant life.” It could be that “genetically enhanced” loophole again, but I have to wonder how botulinum toxin – which affects the nerve/muscle junction – could affect plants which have neither nerves nor muscles…

A note to any Homeland Security Agents, FBI Agents or other government officials who stumble across this site, and specifically this post: I am reviewing a comic book plot involving a make-believe terrorist organization. It is entirely fiction. I do not condone mass poisonings of any sort, though I do find “botulinum toxin” a neat phrase to say.

Lance Armstrong took back the yellow jersey in a decisive first day in the Alps. Most of his serious challengers are now five minutes, or more, back. The Discovery Channel Team showed it strength today when the peloton started up the second mountain climb. They drove faster and faster up the mountain and other riders were soon dropping back left and right. This slowly wore out most of the Discovery riders, but frankly that’s what they’re there for: to provide support for Lance (who won second in the stage and took back the overall lead).

Tomorrow is the second Alp stage, and it will be interesting to see how many riders wore themselves out on the first one.
Read more…

Discussing anthrax yesterday reminded me of my experience with anthrax while in the Air Force, or more correctly, the lack of anthrax…

A few years back, when the anthrax scare was going strong, I was a family physician in the Air Force. One day, a young Airman came in convinced that she had been exposed to Anthrax because her gas bill had powder in the envelope. She made it clear that she wanted to be tested for anthrax. She was completely healthy and had absolutely no symptoms that could be remotely considered similar to anthrax. When I informed her of this fact, she dug in her purse and pulled out a zip-loc bag containing the gas bill in question. She thrust it at me.

“Then how do you explain this?” she demanded.

I looked closely at the bill. It was printed on perforated paper and the “powder” she was pointing at was nothing more than the little bits of paper debris from the perforations. I pointed this out to her, but she was adamant that it must be anthrax sent to her by terrorists. I was tempted to ask why terrorists would target an 18 year-old Airman for their evil plots instead of a general – or at least a colonel – but for once I decided to keep my mouth shut. I simply once again pointed out that she had no symptoms of anthrax and the “powder” in her envelope bore no resemblance to anthrax. I also explained that the anthrax test was expensive and very unpleasant. I then sent her on her way.

About a half-hour later the commander of our clinic stopped by and told me that the hospital chief of staff had called him. Apparently, this Airman had complained to her sergeant that I had not run the anthrax test, and he had called the chief of staff in a huff. The chief of staff was now commanding me to order the test.

“Let me get this straight,” I said to the clinic commander. “Our chief of staff, a plastic surgeon, who has never once laid eyes on this patient has determined that she needs an anthrax test based on the say-so of a non-medically trained sergeant?”

He nodded.

“This is despite the fact that she is symptom free and was exposed to nothing more than perforations?”

He nodded.

“Never mind the fact that the Air Force paid for me to attend medical school and never mind the fact that the Air Force sent me to a special workshop on biological/chemical weapons, they’re going to take the word of some yahoo off the street over my clinical judgment.”

Again, he nodded, then patted me on the shoulder and walked away. Unsurprisingly, her test came back negative for Anthrax.

This to me was always the greatest annoyance about military medicine: there is always someone above you telling you what to do. I understand the military has a definitive chain of command. That’s fine for military concerns, but it breaks down in medical areas when different specialties are involved. I don’t mind people who know what they are talking about advising me, but I become very frustrated when people without the proper training and experience stick their nose into my business. This was probably the biggest factor that drove me out of the military and into civilian medicine.

Alexandre Vinokourov won the second Alp stage of the Tour today; this allowed him to recoup about a minute and a half of the time he lost on yesterday’s stage. Of course, that still leaves him a whopping four and a half minutes behind Lance Armstrong, who retains the overall lead. Other than that, there were few surprises today, with most riders behaving fairly conservatively.

Tomorrow is a hilly stage followed by a flat stage on Friday. On Saturday, the Tour returns to the mountains — this time to the Pyrenees. Don’t expect much excitment or drama until then.
Read more…

Hawk & Dove #1 is a set-up issue. Sure, there’s some action, but mainly it exists to re-introduce the characters from the Hawk & Dove mini-series and to provide hints of upcoming threats.

The issue begins with Hank and Dawn recalling their part in defending the Earth during Invasion! As you may recall, they appeared only briefly (and that’s being generous) in issue #2 of the mini-series. Hank and Dawn have more grandiose memories of their participation: Hank tells Ren that Hawk himself led the charge against the aliens in Australia. Dove, on the other hand, skimps over the action and instead remembers being hit on by both Guy Gardner and Booster Gold. I’m sure something could be made of the fact that Hawk remembers action while Dove remembers sexual harassment, but you won’t read it here. Nope.

The Kesels manage to include some very telling moments in the Invasion! flashback. Dove runs to rescue some children from a falling wall — the same way the original Dove died — and Hawk rushes over to rescue her, repeating “Not again! Not gonna let this happen again.” Dove, however, has managed to rescue herself. Later when the aliens drop the “Gene Bomb,” Hank and Dawn are not affected in the least and still retain their super-powers as Hawk and Dove. This proves that their abilities are not based on the meta-gene (DC’s answer to Marvel’s mutant gene), but are due to some other yet unexplained factor.

After the reminiscing, Ren, Hank and Dawn catch up with Donna and Kyle at the local pub. Meanwhile, our favorite cops, Captain Arsala and Wolfson, are trying to figure out what happened to Kestrel and whether Hawk killed him. “All I’m saying is that Hawk’s capable of doin’ it, Captain. More capable than most super-heroes, it you ask me.” They also skim over some cases that turn out to be most of the villains Hawk and Dove will encounter in their first year: “Explosion in Alexandria…No trace of bomb or natural causes. Unidentified man killed by an extremely high dose of snake venom. Bank in Richmond robbed by Dillinger, Bonnie & Clyde”

The real action of the story starts when a strange robot teleports into a DC jewelry store and starts stealing all of the gold. Hank and Dawn happen to be passing by and they rush in, change to Hawk and Dove, and confront the robot. A great deal of property damage is done, and in the end Hawk manages to decapitate the robot. In our second of three foreshadowing episodes, the robot teleports away but tells Hawk: “Name’s Gauntlet…Remember it…Got friends…We’ll be back.”

In our final bit of foreshadowing, Hawk and Dove’s appearance in the jewelry store catches the eye of a mysterious observer named Barter who deduces that the pair are some form of mystical conduit. He decides that they’ll be just perfect for his upcoming plans.

Writers Karl and Barbara Kesel manage to convey a great deal of information in this issue, and all in an entertaining fashion. Readers are re-introduced to Hawk/Hank and Dove/Dawn as well as their friends Ren, Kyle and Donna. The Washington D.C. SCU cops are re-introduced as well, and their antagonism towards Hawk, yet grudging acceptance of Dove, is demonstrated. After creating Kestrel, the evil reflection of Hawk and Dove, the Kesel’s create their second great villain in Barter. I’m truly surprised that no other writer has used him since.

The art by Greg Guler and Scott Hanna is well done. Comparing issue #1 to later issues, it’s apparent that Guler is still developing his skill at drawing the duo, but he’s already better than most. His action scenes, while not as explosive as Liefeld’s, show a stronger sense of composition and flow. He also shows that he’s better at drawing facial expression, especially humorous ones.

---

So our connection to the internet at work went out for most of the afternoon, and all I could think was “Damn that Joe Quesada, this is all his fault!”

As I predicted, there were no changes in the leaderboard in today’s rather pedestrian stage at the Tour. Given that it was Bastille Day, it is fitting that a Frenchman, David Moncoutie, won today’s stage. Look for much of the same on tomorrow’s flat road course. The Tour returns to the mountains on Saturday.

Notes of Interest:

• Green Jersey (Sprinter’s Jersey) leader Tom Boonen dropped out of the Tour after injuring his knee in a crash the day before. Norwegian Thor Hushovd now holds the Green Jersey.
• Discovery Team Channel member Manual Beltran was forced to drop out of the Tour today. He was in a crash where he may have lost consciousness; he definitely suffered some amnesia afterwards. These are signs of a concussion, and the race doctor made the right choice by forcing him to withdraw. Concussions and sports can be a bad mix.

Read more…

In honor of Bastille Day, here’s the cover to Justice League Europe #6 — the funniest comic ever to take place in France.

Captain Atom has decided that in order to better connect with their host country, the members of the JLE need to learn French. Therefore, he signs everybody up for a night class in French. Meanwhile, Major Disaster has decided that his Injustice League need to learn French as well, and unwittingly signs them up for the same class.

With the combination of Captain Atom, Guy Gardner, Flash, Power Girl, Metamorpho, Major Disaster, Cluemaster, the Mighty Bruce, Big Sir, Multi-Man and Clock King — plus an extrememly strict French teacher — how could this not be fun?

There are certain artists whose pencils just never works for me on a certain title, no matter how much I love their art elsewhere. Similarly, there are some artists whose art I’m not particularly fond of who seem to shine on one certain title.

Only rarely have I been able to figure out why it works or doesn’t work on that particular title; most of the time I have no idea. It’s just one of those personal likes/dislikes things, I guess.

Here’s a partial list:

Paul Smith: I never liked his take on the X-Men. Golden Age and Leave It to Chance are phenomenal, and he is one of the best Dr. Strange artists (he draws the definitive Clea, in my humble opinion). I have to note that I am enjoying his art on the latest Kitty Pryde mini-series.

Greg LaRoque: His art on Flash never worked for me, but his Legion of Super-Hero pencils were great.

Bart Sears: His art on Justice League Europe? Perfect. Pretty much everything else? Not working for me.

Ale Garza: All his characters look pretty much the same (vaguely Asian versions of recognizable characters), but this seems to really works on Batgirl.

A flat sprinter’s stage today. Minimal change in the overall standings with Lance Armstrong retaining the overall points lead and yellow jersey. Tomorrow will be an exiciting stage as the Tour returns to the mountains.

If Lance Armstrong is going to lose the Tour, it will be in the next two days. Armstrong’s Discovery Channel Team lost one of its best climbers when Manual Beltran dropped out, and Alexandre Vinokourov (one of Armstrong’s strongest rivals) has publicly stated he plans on going on an early offensive in the mountains.
Read more…

A very exciting stage of the Tour today. The T-Mobile team, lead by some of Lance Armstrong’s biggest Rivals (Jan Ulrich, Andreas Kloden and Alexander Vinokourov) made a surprise early surge, catching the Discovery Channel Team off guard. Lance was able to keep up, as were some other big names including Floyd Landis and Ivan Basso. This group battled up the first mountain, down its other side, and up the tallest peak of the day. Armstrong, Ulrich and Basso were the strongest and by the end they were the only ones left from the breakaway. Less than half a mile from the finish, Ulrich slowed, leaving Basso and Armstrong to fight it out. Armstrong surged ahead and beat Basso to the line.

OK, technically Armstrong took second because the lone rider remaining from the very first breakaway (Georg Totschnig), was ahead by a little under a minute — but it was an impressive day as Armstrong showed that even without his team behind him he was able to outlast his rivals.

Tomorrow is said to be the hardest day of the Tour. I can only assume that the rest of the Discovery Channel Team will feel like they have something to prove.
Read more…

Once again, Lance Armstrong battled JanUllrich and Ivan Basso up the mountains. As in Stage 14, Ullrich gave out before the finish and Armstrong and Basso finished together. Armstrong managed to put more time on every one of his rivals except Basso, who took second place. The battle now is really for the third “podium spot,” with Armstong and Basso having all but locked up the first two places.

Today’s stage belonged to American George Hincapie. He was one of the riders who broke away early, and he managed to hold out and make it to the finish line first, winning the day’s stage — his first Tour stage win ever. Hincapie is Armstrong’s most trusted lieutenant and it’s great to see him have his day.

Monday is a rest day followed by the final mountain stage of this year’s Tour de France.
Read more…

Batman: Legends of the Dark Knight #192 “Snow, p1 of 5: Drift”
J. H. Williams III and Dan Curtis Johnson, writers
Seth Fisher, penciler

Victor and Nora Fries are featured in the latest issue of Batman: Legends of the Dark Knight. Victor (better known as Mr. Freeze) and Nora are one of the most tragic love stories in comic book history. It wasn’t always this way: For most of the forty-six years since his first appearance, Mr. Freeze (originally Mr. Zero) had been just another villain from Batman’s rogue’s gallery. It wasn’t until Batman: The Animated Series that his unfortunate wife, Nora, was introduced. She had an incurable fatal disease, and Freeze had her frozen in suspended animation until a cure could be found. It was this love of a dying wife, and hope of her resuscitation, that drove him to commit his crimes. This version of Freeze was a fan favorite, and worked its way from TV into the main comic book continuity.

This latest story finally explains what disease Nora Fries developed, and it’s a doozy: Huntington’s Disease. Huntington’s Disease (also known as Huntington’s Chorea) is a devastating degenerative brain disorder. In this condition, key parts of the brain begin breaking down. Affected individuals develop uncontrolled movements and lose their ability to control their emotions and think. Dementia is common and as the disease progresses, the individual will lose the ability to care for themselves at all. Death generally occurs 10-20 years after the onset of symptoms.

A particularly unfortunate aspect of the disease is that it strikes people in their 30s and 40s. By this time, most of these people have already had children and unknowingly passed the disease on to them. Because Huntington’s is inherited in an autosomal dominant fashion, half of these children will go on to develop Huntington’s Disease themselves in the future.

There is no cure for Huntington’s disease. With medication, some of the symptoms can be lessened, but the disease is still ultimately fatal.

Huntington’s Disease is an inspired choice for Nora; the writers clearly did their research. The disease not only affects Nora, but also affects Victor and Nora’s hope for healthy children. One can easily imagine how Victor Fries would do anything to protect the perfect life he and Nora had constructed for themselves.

The writers and artists do an excellent job in this comic. The story does a nice job contrasting the relatively new-on-the-scene Batman and the Frieses. At some point in the story, both Bruce and Nora find themselves in hospital beds, though for vastly different reasons and with vastly different outcomes. As for the art, I particularly like Nora’s diaphanous 1950s housewife look; it is the perfect compliment to her personality.

The creators do take a few medical liberties with the story. First, while early Huntington’s Disease causes abnormal movements, they’re more on the order of an uncontrollable twitch than a tremor. Also, Huntington’s doesn’t show up on an X-Ray (or MRI) as black splotches on the temporal lobe. I’m inclined to explain these mistakes away as artistic license because the rest of the story was so well done (though I would like to know where I can get an X-Ray machine that takes pictures like that).

So while writing about Nora Fries in that last post, I began thinking about my favorite fictional Nora. That would be, of course, Nora Charles from The Thin Man (and subsequent movies).

I think a remake starring Mr. Freeze in the role of Nick Charles, former P.I. turned married playboy, would be masterful. I can just see him sitting there in his swanky New York hotel room — glass dome over his head — sipping martinis by the dozen and exchanging bon mots with his wife Nora:

Mr. Freeze: I’m a hero. I was shot 2 times in the Tribune.
Nora Fries: I read where you were shot 5 times in the tabloids.
Mr. Freeze: It’s not true. He didn’t come anywhere near my tabloids.

That would be great! (And if you haven’t seen The Thin Man, watch it as soon as possible. It is the original detective comedy and holds it’s age well. I’m sure NetFlix has it.)

The last of the true mountain stages, there was little change in the standings today. Lance Armstrong retains a 2:49 lead over his nearest rival, Ivan Basso.

Tomorrow’s stage is the longest stage, and while flatter than the past few days, still has some good peaks. While the battle for the yellow jersey is for all intents and purposes over, keep an eye on the battle over the green jersey (the sprinter’s jersey) and the polka-dot jersey (the king of the mountains) because there’s still life in those fights (particularly among the sprinters. The green jersey probably won’t be decided until the last day on the ride into Paris).

Other than the sprinters’ battles, the Tour will be fairly quiet untilSaturday, the second-to-last day (Stage 20). It’s the final individual time trial and will be the last chance Basso has at defeating Armstrong (unlikely), but keep an eye on 4th place Jan Ullrich who is a powerful time trial-er and wants third place very badly.
Read more…

As a preview of tomorrow’s discussion of Hawk & Dove #2 and #3, here is the opening splash page from Hawk & Dove #2. The scene is the interior of Barter’s shop where Barter (the mustachioed gentleman) is talking to Child, a Lord of Chaos.

Look around at the sheer number of items Barter is offering for trade. Think of this as one of those magazine scavenger hunts, like the ones in the Highlight magazines in your doctor’s waiting room when you were a kid. How many artifacts from comics or other media can you find in the shop?

My list, undoubtedly incomplete, is below.

 

My List: Daredevil costume (of the original Daredevil - not the spiked belt), upper left. Captain America’s shield, lower left Green Lantern, on left shelf Night Owl statuette (from Watchmen), on left shelf Idol from the beginning of Raiders of the Lost Ark, behind Night Owl Abnormal Brain (from Young Frankenstein), below the green lantern Batarang, bottom of shelf on left Mad-Hatter’s Hat (though a later panel suggests that it’s really the Ringmaster’s hat), front shelf.

Rest in peace, James Doohan.

Scotty was always my favorite Star Trek character, in part because he was shared the same name (more or less, it was his last name and my first name). I was raised in a Star Trek house. My father loved the show and passed the love on the show on to me. It was fuuny that we’d each remember the show differently. I’d remember the episodes by the title and plot, while he was more knowledgable about the guest stars. I’d mention “Metamorphosis”, and he’d give me a puzzled look. Then I’d describe the plot and he’s say “Wasn’t that the one with Glenn Corbett?”

One thing we both agreed on that Scotty was our favorite character. When my father was teaching at Virginia Tech (around 1978 or 1979), Doohan came to the university to give a lecture. My father took the whole family and it was great. Doohan spoke for two hours or so about everything — he talked about Scotty and other roles, he talked about Canada, and he talked about his time in the military. Then they showed 3 Star Trek episodes (remember, this was before 100+ channel TV and DVD, so seeing an episode was a big deal). I was delighted that “The Trouble With Tribbles” was one of the episodes, because that was my favorite at that point. I wish that I remembered more of Doohan’s lecture, but two parts in particular stick in my mind:
1. He told a great story about flying slalom between telephone poles in his plane while in the military.
2. His comment to the crowd about the (then) recently released Star Trek Enterprise Blueprints. “Some of you may have noticed that there were no bathrooms on the blueprints. Just remember, we did have our phasers…”

When we moved to the St. Louis area in the 1980s, St. Louis still had an excellent annual Star Trek convention. My father and I went almost every year, and everytime we went, Doohan was there. My father has always had great skill at talking to celebrities. He would mention how much he liked them in some of their lesser know roles, and then they would spend the next fifteen or so minutes reminsicing about bad movies and TV shows. It was always great to watch and would love to develop that easy going charm my father has. I’m sure Doohan remembered my father, because each time we went, they’d spend longer and longer talking. Sadly, in the mid-80s, the convention closed down and we never got another chance to meet James Doohan in person.

So this is my long-winded way of saying James Doohan, requiescat in pace.

Paolo Savoldeli, Discovery Channel Team rider and teammate of Lance Armstrong won today’s stage of the Tour. Other than that, there was minimal shifting in the standings as riders prepare for tomorrow’s slightly mountainous ride and Saturday’s final Time Trial.
Read more…

The storyline starts with the enigmatic Barter weaseling some information out of the Lord of Chaos Child. He’s trying to find out more about Hawk and Dove and how they tie into Order and Chaos.

Meanwhile, the Grangers are hosting a housewarming party. Dawn and her mother are out shopping for party supplies when they are accosted by a disheveled young woman. She seems obsessed with a blue pin that Mrs. Granger is wearing and manages to follow the pair home. Waiting until the party has started, she breaks into the house and starts searching through Mrs. Granger’s dresser. She finds the pin and it transforms her nto Huitzilopochtli, the Aztec god (or in this case, goddess) of war.

At first, Dove battles Huitzilopochtli alone. The goddess is a tough combatant; in addition to enhanced strength and agility, she can fly and has the ability to transform ordinary objects into Aztec weapons and artifacts. For example, a letter opener becomes a knife, a lamp becomes a spear, and a dresser becomes a heavy carved stone. Dove and Huitzilopochtli crash through the wall of the Granger’s house and take the battle to the street. Dove is injured preventing a heavy stone block (that was once a car) from crashing into innocent bystanders.

The Washington SCU arrives but they have no more success than Dove. Hawk finally appears and takes out Huitzilopochtli by swatting her with a telephone pole. She’s only stunned and manages to subdue Hawk when he’s not paying attention. Dove tackles the goddess, pushing Hawk out of the way, allowing the SCU to open up with a barrage of heavy artillery. Huitzilopochtli is down, but not out. She grabs the SCU medic and flies off into the night.

Hawk and Dove track Huitzilopochtli and her hostage to the Washington Monument. The pair climbs up the monument and catch Huitzilopochtli by surprise before she can sacrifice the medic. Hawk throws the Aztec goddess off the Monument, but then Dove takes up the battle while Hawk rescues the hostage. This may seem backwards at first, but the fight is more a battle of wits than power. Dove tricks the goddess into giving up her powers and the SCU takes the weakened deity into custody. (But don’t fret, she’ll reappear in the War of the Gods crossover.)

Elsewhere in the story:

• More future plot points are foreshadowed, and they all directly or indirectly involve Donna and Kyle. First, Donna and Kyle tell Dawn that they’re going to set her up with “Brian,” a storyline that continues until the end of the series. Later, Donna mentions an upcoming tennis match with Bette Kane (of Bat-Girl and Flamebird fame) and Kyle receives a mysterious postcard with a hidden message (Though not a very subtle one. See if you can figure it out: Customer, the Rug yoU ordered will be readt nexT montH.).
• Dawn’s father, a top scientist at the Washington branch of S.T.A.R. Labs, is introduced. He will appear in one or two more issues, most notably Annual #1.
• Hank mentions that he has lived in Washington DC his whole life. This is a definite retcon, as previous stories have him growing up in Eldon, Oregon. This change explains what Judge Hall is doing in DC, but doesn’t make much sense when you remember that Hank and Don were members of Titans West, not Titans DC.
• Ren makes a classic appearance, showing up just as Dr. and Mrs. Granger are wondering where Dawn is. She babbles a mostly incoherent story prompting Mrs. Granger to ask: “Who are you?” While Dr. Granger merely states: “You must be Ren.”
• Hank joins the Georgetown wrestling team.
• Issue #3 ends with Donna, Kyle and Ren caught in the middle of bank robbery — a robbery conducted by thieves dressed as Dillinger, Bonnie and Clyde.

Counting down the top ten doctors in comic books who actually practice medicine. There’s an awful lot of doctors, but few are ever seen using their medical skills. This is a countdown of those doctors who truly aspire to the profession.

#10 - Tom Brent

Dr. Tom Brent, Young Intern was the star of the Charleston comic book of the same name. The book lasted for five issues, from February to October 1963. As the title suggests, the series followed the trials and tribulations of a young physician, fresh out of medical school. It was published when such stories were popular, both on TV and in comics (Dr. Kildare and Ben Casey were both TV shows and comic books, for example).

You have to wonder about the title. Is that how he introduced himself to patients: “Hi, I’m Doctor Tom Brent, Young Intern.” That can’t fill them with much confidence. Personally, I always tried to suggest experience when I introduced myself to patients. I’d use the term “doctor” and skip the “intern” part entirely. No patient wants to hear that.

And what about now? Is he Dr. Tom Brent, Over-the-Hill Doctor?

This series is not to be confused with Young Dr. Masters, a similar title published by Archie. Masters doesn’t rate the top ten as his comic only lasted 2 issues and nobody remembers him anymore.

This list celebrated doctors who are actually shown working as physicians in comic books; those rare individuals who aren’t just doctors in name only.

#9 - Cecilia Reyes

Cecilia Reyes is doctor who briefly – and reluctantly — joined the X-Men (on more than one occasion, actually). I always thought that whining was her mutant power, but more knowledgeable people inform me that she can project a protective force field (Which, frankly, is redundant. What good is a non-protective force field?).

Cecilia was initially described as an Emergeny Department physician, but then in that comic book miracle of all-doctors-can-do-anything-medical, she turned into a surgeon. Though I’m not fond of the character, she has been shown functioning as a physician on several occasions, so Cecelia Reyes is number nine on the Top Ten Comic Book Doctors list.