Day 1 - A&E

Slightly erratic at the start, but things got better later in the day. With almost zero-experience, the tiniest case admitted sparked my interest and caught me feeling inquisitive. The first case witnessed involved (today's theme: poisoning):

Organophosphate poisoning-malathion, I believe
Ah, chemical warfare. I think the doctor mentioned this was a suicidal attempt (quite obviously), and being cautious of the possibility of chemical aging (I presume the patient had delayed admission), atropine alone solved the problem. He did mention the clear parasympathetic symptoms, bronchorrhea (hypersecretion with excessive ACh), and an exception, sweating (excessive neurotransmitters).

Gastric lavage followed by administration of activated charcoal via nasogastric tube. The following case observed was similar, anti-psychotic poisoning-believed to be lamotrigine.

Major take-home lesson: Methods of dealing with poisoning and observing the common symptoms of these two types belonging to the umbrella theme.

The Bhutanese bloke doing his masters in EM also elaborated on an ECG showing lateral ischaemia, and mentioned other cardiac markers such as CKMB and troponin levels as possible diagnostic tests. He introduced aortic dissection to me and explained the possible appearance of an X-ray scan showing widening of the mediastinum and hints of pleural effusion as well as the plausible obliteration of the aortic knob.

That's hardly anything, but I'm certain there's more to come and that I'll learn more. Hardly did much besides cleaning up some emesis remains and giving the patient a change of clothes.

Voila, so I finally had my law interview yesterday night.

And what can I derive from the 30-ish minute conversation? I can't do law. I should just stick to medicine. =)

For keepsake, this is the brief case we discussed over the interview:

"Z, who is 16, conceives a child as the result of aone-night-stand. She keeps the pregnancy a secret. She wants to give the child up for adoption immediately after birth and therefore contacts the local authority. Neither the father nor her parents know anything about the pregnancy.

Article 8(1) of the European Convention on Human Rights states the following:

Everyone has the right to respect for his private and family life, his home and his correspondence.

In the light of this provision, should the local authority have a duty to identify and inform the father and/or the Z's parents?"

Please read the question carefully. (end)

The interviewer rang 12 minutes after I received the email, and the torment began

Nevertheless, it was great fun. Haven't used my brain that much in so long.

Written test/assessment up soon (apparently it's just an informal exercise). I don't expect it to be any easier than what I faced yesterday.

On a positive note, at least it isn't a scientific essay! I've written an incalculable amount of science-y essays since I embarked on the medical course. At last, something different.

I'm determined to only spend 10 minutes on this.

I've revamped my music playlist and it is this list that has been supporting me through the uphill battle of a certain examination we call Tripos, which makes me wonder really about the effects music exerts in our lives, what with the widely acclaimed Mozart effect, and something I stumbled upon more recently, the Beethoven effect.

To be honest, I don't really understand how music taps into our health; a possibility of establishing synchrony with brainwaves subsequently altering our attention span and ability to concentrate, somewhat similar to how the thalamus and ascending arousal neurotransmitter systems regulate our sleep-wake cycle. If that is true, this is bound to have physiological effects, perhaps observed changes in our breathing and heart rates considering their connections with the autonomic nervous system. But this really is too fuzzy for my liking. Nevertheless, there isn't much to lose by believing in this, bearing in mind the potential placebo effect like how complementary medicine most certainly produces its results.

Having said that, it is also heavily dependent on your choice of music, which then again relies on the different social groups, early exposure and upbringing. Some people find relief in suicidal music, and some in techno. Unfortunately, I fail to understand where they are coming from as I never shared their interest in music of those genres.

And then we come to the popular belief (with fairly solid scientific ground) that Mozart makes your children smart or more intelligent (really, semantics). Putting aside the flaws in assessing one's IQ, and assuming we all subscribe to the Stanford-Binet IQ test, surely researchers have to consider the other existing factors contributing to the results they are obtaining.

Temporarily enhanced spatial-temporal reasoning. hmmm. Perhaps certain pre-existing neurons fire in response to specific frequencies played, and perhaps this corresponds to the region responsible for this momentary spike. Mozart's pieces , if I remember correctly often revolve around a certain frequency range, I wonder if this would explain why a wide range of his pieces, and only his compositions would have triggered the observed response.

I suspect these enhancements may be an artifact-maybe generated from enjoyment arousal. Somewhat like a spillover effect of enjoying your environment? I shouldn't even attempt to challenge this really. Oliver Sacks discovered the association between music and Parkinson's, quoting several examples and citing that even mental rehearsal of a particular piece by patients who are music-enthusiasts creates a temporary effect of being 'released' from Parkinson's. I find that rather interesting, and possibly exploitable. Enhanced performance in the presence of something you enjoy. Projections to the substantia nigra from regions such as the amygdala and orbitofrontal cortex (?, I really am not too sure about this), and efferent connections to the thalamus. And if that's true, what will happen if we play music patients do not appreciate, or children do not enjoy? Will similar results still surface?

An interesting study on epileptics I once read mentioned that besides Mozart's K.448 and Piano Concerto No. 23, only Yanni's Standing in Motion had a similar effect of reduced seizures. Rhythm, tempo and predicatability are possibly the shared factors. I wonder at times if these effects will be produced if Asian contemporary music was used. One has to admit that these are not sufficiently researched upon, and we may be far from realising its potential.

Mozart has certainly received a lot of attention. Beethoven is however easily forgotten, probably because of his temperamental, dramatic style. I am rather ignorant with regards to this effect, but I'm certain it has to do with vibroacoustics, and this will probably come in handy in disabled individuals ie channeling music therapy even to those who are deaf. The proposition that the subtle vibration exuded from Beethoven's composition (especially the celebrated 5th Symphony) can be delivered into and throughout the body, affecting the cells (TOO vague, I know). Disruption of unhealthy cells through resonance? No clue.

Alright, so I spent 20 minutes, and produced trash. That's what I do. It's time to hit the sack and pray I wake up in time to fetch my sawo from the airport. Meanwhile, enjoy the music and my apologies for the K-pop dominance in this updated series.