The BackRow Ballers are no longer lowly medical students, blogging about the daily grind. They are now doctors, who will continue to bring light, joy, sunshine to their readers' lives with their blogs. You're welcome.

Monday, May 24, 2010

Fixing the Finale of Lost

Lost left a lot to be desired in the series finale. Mariam invested 6 years watching the show and tried to convince me that the ending was touching and appropriate. I only invested 6 months in the show and hated that the last season was about the death of only one character who I didn't even like that much! Maybe I am more cavalier about dismissing the show entirely because I didn't invest 6 years in it, but still it was about 120 hours of television. I could have gone to the gym instead and burnt at least 120,000 calories! I know the writers want to leave the ending open to interpretation, but it is poor form to end a show about a lot of interesting mysteries and character interactions on an island completely removed from the island and its mysteries. I suppose the lost writers and die hard fans can keep their lame ending, but for people who just want straightforward resolution they should include a highlight reel of character events after Jack's death, much like the end of any teenager coming of age movie. Imagine the song Don't You (forget about me) by Simple Minds playing as screenshots come forward with a few sentences updating us on how things turned out. Here's how I picture things turning out.

PEOPLE WHO WERE ALREADY DEAD
Jack: Enough about Jack, no update needed.
Juliet: She goes on to marry Sawyer in afterlife part 2. She runs into Jacob one night at a Sushi restaurant. After some saki bombs, he reveals he wouldn't let woman have babies on the island because his own mother died after childbirth. Juliet slaps him.
Locke: Locke opens a walkabout company in afterlife part 2. Nightly boar feast and luau included in cost of package if you buy right now!
Sun and Jin: Live together in afterlife part 2 where they never speak Korean again. They sell oxygen tanks for submarines specifically designed for unconscious people.
Sayid: Lives a slightly fulfilling life with Shannon. They live in the suburbs of afterlife part 2 and join a really WASPy country club.
Charlie: Afterlife 2 treats him well. He has 4 kids with Claire, and teaches music classes.
Shannon: Eventually dies of an asthma attack and ends up in afterlife part 3.
Boone: Wanders around awkwardly, smiling and giving everybody hugs. Sometimes he sleeps with Shannon.
Alex: Stays in afterlife part 2 until she eventually finds Karl. They date for a while, but grow apart after she leaves for college at Brown. She eventually meets Detective Miles and totally hits that.
Rousseau: Marries Dr. Linus and cooks him french food in afterlife part 1. They have adopt a baby named Pierre. They abandon him after Rousseau and Alex remember the island and they move on to afterlife part 2.
Daniel Faraday: Wins over Charlotte with his super awesome muzak.

PEOPLE WHO MAYBE NEVER EXISTED
David (Jack and Juliet's son): Gets abandoned by his dad and mom mysteriously one day after his grandfathers funeral. He has a lot of issues about it until he crashes on a strange island with a group of strangers (including Sayid's niece and nephew!).

PEOPLE WHO DIED IN THE FUTURE
Kate: Escapes on the Ajira jet, and helps Claire raise Aaron. Dies in a tragic run away ferris wheel accident.
Sawyer: Starts a blog called Nickname. It is epically successful for its one liner wit.
Miles: Finds a bag of diamonds in his pocket after landing on the Ajira flight. He becomes CEO of Oceanic airlines, but is removed after a duct tape repair scandal.
Claire: Runs a decorating company specializing in goth themed baby furniture in Beverly Hills.
Desmond: Escapes successfully from the Hugo-run island after Hugo decides to install a Star Trek-like transporter with his island magic. Lives happily with Penny and his son.
Richard: Sells eyeliner for men.
Lapidus: Works in Vegas as a Kenny Loggins impersonator, and writes a weekly conspiracy theory newsletter.
Walt: Uses his angst from his parents absence to start very promising acting career as a vampire on the CW. His strange magic powers that scared his stepdad in the first season really help him in his role.
Aaron: The dire warnings about him not being raised by his mother turn out to be wrong. He becomes a very successful marine biologist and is rumored to be dating Walt from the CW.
Ji Yeon: She channels her angst over her parents death into becoming the first female leader of the Korean mob. Think O-Ren Ishii in Kill Bill, Part 1.
Ben: Makes a lot of number 2 jokes with Hugo, especially after finding out from Desmond that the island is just a big clogged toilet.
Hugo: Hugo acts as the island protector until 2537. He is eventually replaced by Jar Jar Binks in an even more upsetting finale.

--By Farrah, who is 26 tomorrow

Wednesday, May 12, 2010

TV Doctors never write Medical Notes

There are only two doctor shows I can stand to watch on TV - House and Scrubs. Both of these shows were better in their earlier seasons, but after getting involved in the character stories I just watch out of inertia. Scrubs is probably more realistic, but House tends to have more interesting cases with entertaining Sherlock Holmes-type medical mysteries. The most annoying unrealistic thing about House is that the multiple overqualified MDs are in a never ending internship disguised as a fellowship for a specialty which does not exist. These docs can run any test in the hospital - MRI scans, cardiac catheterization, exploratory laparotomy, neurosurgery, genetic assays, autopsies, bacterial culture, breaking and entering. Every mundane test is run with the personal attention of doctors in perfectly tailored white coats without the help of any nurses or techs. The only mundane task these doctors are almost never seen, even miming, is the act of writing a medical note. Since my last month of medical school is flex time, I spend my time painting, playing guitar, and watching TV online. As I watched an episode of House in a feeble effort to exercise my already atrophying medical knowledge, I started to wonder what the medical chart would even look for an episode of house. In an exercise of pure boredom, here is what the chart would look like for the House episode "Brave Heart."

History & Physical
History: 39 year old male presenting with trauma, fell 30 feet from building
Family: Father, paternal grandfather, paternal great grandfather - death in 4os from heart disease
Social: Detective, Reckless because he thinks he's gonna die at age 40 like his relatives, unmarried, no children
Physical: 2 broken bones, severe concussion, collapsed lung
Assessment: Trauma stabilized, but unknown cardiac condition warrants an inpatient work up. Differential Diagnosis includes familial hypercholesterolemia, marfan syndrome, brugada syndrome, idiopathic
Plan: Admit to diagnostic medicine service, EKG, cardiac catheterization, genetic testing, routine labs

Progress Note
Tests: Negative
Assessment: Um... still probably genetic
Plan: Will get consent to exhume bodies of relatives (would insurance EVER cover this, put it on credit card, he's gonna die at 40 anyway!)

Progress Note
Interim History: Patient's ex-girlfriend presented to hospital revealing patient has a son.
Pathology on relatives bodies: Negative
Assessment: Um... still probably genetic
Plan: Get fresh pure squeaky clean bone marrow biopsy for genetic analysis (a little painful, but what's the pain of a child compared to cinching a farfetched diagnosis!)

Progress Note
Son's Bone Marrow Biopsy: normal
Assessment: Probably faking it = idiopathic, Will give patient imaginary diagnosis of Ortoli Syndrome, a rare cardiac disease treated with pills
Plan: Give patient sugar pills, discharge home

Autopsy Note
History: Patient collapsed 4 hours after discharge. Found in laundry room of apartment building by landlord. Pronounced dead on arrival by EMTs
Procedure: Post-mortem incision at midline of sternum revealed active bleeding. Patient comes back to life coughing and screaming in distress
Assessment: Not dead yet. Extreme Bradycardia. Differential Diagnosis includes sick sinus syndrome, metabolic disease, isolated anti-ro antibody
Plan: Transfer to ICU, start steroid treatment

Progress Note
Interim History: Jaw and tooth pain, patient pulled out own tooth with forceps from cart in room. Dentist analysis of tooth revealed normal tooth
Assessment: Source of pain could be bone cancer with paraneoplastic syndrome. Li fraumeni syndrome
Plan: Gamma survey to look for tumors

Progress Note
Gamma survey: normal
Assessment: Source of pain could be related to nervous system - hereditary sensory autonomic neuropathy type 1
Plan: Carbamazepine

Progress Note
Interim history: patient with continued pain and urinary incontinence
Assessment: Wilson's disease (is there a single episode where this isn't in the differential? seriously writers, it's just like Lost's obsession with dural sac rupture)
Plan: Penicillamine (why diagnose? just start treatment!)

Progress Note
Interim History: Dr. House heard the word "button" triggering the concept of heart attack button leading to the obvious next diagnosis of intracranial berry aneurysm pressing on brainstem
Assessment: Intracranial Berry Aneurysm
Plan: Neurosurgery for both father and son, then heartfelt reunion!

Good lord this show is stupid laid out like this! But inertia is terribly powerful so I will likely keep watching.

--By Farrah, who spent the last 5 days babysitting her 2 year old nephew and who never knew she could pull off the unkempt mom look so well, several people told her to have a happy mother's day