Polite Dissent

Well, here we go: one more blog. There’s a good mix here, involving comic books, medicine, and a heaping serving of politics as well. Special attention will be focused on the rare instances where these combine.

I’ve been a blog troller for quite a while, enjoying what I’ve read (even when I didn’t always agree — which was quite common). I’d been thinking about blogging for a while, but a couple things finally pushed me into action, but more about those later.

Make no mistake about it, Pat Tillman was a hero.

He was not a hero because of how he died — well no more so than any other American who has died for his (or her) country.
He was a hero because of how he lived. He chose to live his life by a following his principles. He chose these principles time and time again over money and materialism. Loyalty to team, loyalty to country. This is what makes him a hero.

There should be more like him.

Look at this…my first day of blogging, and already the comics and political worlds are colliding. Micah Ian Wright, writer of Stormwatch: Team Achilles, had published a book wherein he “re-worked” some old WWI and WWII propaganda posters into anti-Bush, anti-Iraq War screeds. Admittedly, some of them were fairly clever.

He claimed, quite loudly at times, to have been an U.S. Army Ranger who saw combat in the Panama invasion. As you’ve no doubt figured out, the key word is “claimed.” He never was an Army Ranger, never saw combat, and even dropped out of ROTC.

Whether you are a conservative or liberal, or Republican or Democrat, you should find his actions wrong. It’s wrong to lie about your credentials, period. It’s even worse to do so in an attempt to gain the moral high ground. And it’s entirely reprehensible to have claimed to be in the military, much less in combat, when it’s not true. People are risking their lives for their country, and even dying, and Mich Wright didn’t have the guts to even finish ROTC.

He deserves all the scorn heaped upon him. He deserves having his second book canceled. And he has no one to blame but himself and his lies. I love seeing liars, and resume padders, brought low, so I shall enjoy every minute of this.

I just wonder what his parents think. They had to have known he wrote a book claiming to have been in the Rangers, and they had to have known the truth. Are they proud that he wrote a book? Or ashamed by his lies? I assume the latter.

Michele at A Small Victory [ed. note: sadly, this site is now defunt] has the best information on this, better than I could ever aspire to. Also check out the report at Comic Book Resources, and the words of Greyhawk at the Mudville Gazette.

As for his comics, I can’t say that I ever read Stormwatch: Team Achilles. I did pick up Coup d’Etat: Stormwatch (both covers actualy – damn those multiple covers) and all I can say is ehh. Not the worst part of the mini-series (that would be the pointless Coup d’Etat: Wildcats), and not the best (Coup d’Etat: Sleeper - which was still pretty mediocre), but in the middle. So it was the mediocre-est of a mediocre series. Not exactly a ringing endorsement…
I was looking forward to the new Vigilante series (but didn’t know he was involved)

The Micah Ian Wright fallout continues. No new information, per se, but their are some interesting comments in the blogosphere. Grim, at Fanboy Rampage, sums up the Mark Millar (shameless master of self-promotion that he is) reaction well. The comments make for some good reading too.

Kevin at Thought Balloons has another nice summation here. (I don’t know if he coined the term Rangergate, but I like it). His original posts on the subject are here and here.

Four years ago, CrossGen comics started out with a bang, but now they seem to be ending with a whimper. They generated their share of controversy, first by attempting to change the comic employment status quo for the better , and then (ironically enough) by failing to follow-through on payments to some of their artists. Along the way, they put out quite a few good comics, and some not as good. Their visual appeal was always excellent, with quality art (except maybe in The First) and high quality production. In the past several months, they’ve cancelled their trade paperback reprints, and cancelled many of their monthly comics outright. Although they still put out comic books, each week seems to add another nail in the coffin of CrossGen.

This entry is not an attempt to dissect what went wrong at CrossGen or surmise what their future may hold. Others elsewhere are doing that (see any given Newsarama, the Pulse, or Lying in the Gutters). Instead, this is going to be a brief look at each of the comics that they produced (in rough order of their publication) starting with their four launch titles: Scion, Mystic, Sigil, and Meridian.

All four of these books shared some common themes. None were super-hero books, but all dealt with heroes with incredible powers. In each title, the main character was granted special abilities and marked with a yin-yang appearing tattoo – the “sigil.” In some books (Meridian, Scion), the primary antagonist also had powers granted by a sigil. Each sigil bearer also had a guide, a “higher being” of some sort, who appeared in disguise and guided the character. While each book was independant and could be read on its own, the idea of a “shared sigil universe” clearly scared some early readers away. This “shared universe” was never really a problem however, as the books remained independant until the very end of their run, when some cross-overs did occur.

Read more…

Just a quick note to office staff and hospital personnel: If you need my signature, ask for my John Hancock, not my John Henry.

I am many things, but not a “steel-drivin’ man”…

I now continue looking at the books put out by the failing CrossGen comics. After the initial releases, CrossGen added more titles to their “shared sigil universe” including Brath, Crux, The First, Negation, Route 666, Ruse, and Sojourn. Most of these seemed more two-dimensional concepts than well-composed titles. Today, I’ll look at the first three “Second Generation” books:

(Yes, I know I missed the CrossGen Chronicles as one of the first releases, but frankly, it was hit or miss and almost always a miss. I can’t recall a single good story from the series…)

Read more…

As it is the fourth of the month, I went through Mile High Comic’s list of upcoming comics (July releases) and updated my pull list. Just looking at the new #1’s coming out, here are the ones that struck my fancy, or totally disinterested me. There are other #1’s, but they didn’t inspire the heights (or depths) of feelings these did.

Good:

• Kabuki and Powers. Two good books come to Marvel’s new Icon Line
• Starjammers. Somebody finally must have written a decent Starjammers book. No really. Please. (And I think it’s the height of hyperbole to call artist Ale Garza a superstar…OK he did Gen 13, Vol. 2 — but that wasn’t nearly superstar material.)
• Batman: Order of the Beasts. By Eddie Campbell. Sounds promising.
• Doom Patrol. Not long after the demise after the last title of the same name. Sigh, I’ll give Byrne a try…One. Last. Time.
• Books of Magick: Life During Wartime. A new Tim Hunter storyline (even if it is an alternate timeline). And co-written by Gaiman. Count me in.
• Noble Causes. A new Noble Causes mini-series. Always a fun read.

Bad:

• Catwoman: The Movie. A movie title, count me out.
• Guardian. Just does not intrigue me. The title and concept remind me of Guardians of the Galaxy, an overated title.
• Loki. The Asgard mythos needs a Stan Lee (or at least a Walt Simonson) to be interesting. This has the hit-or-miss Rodi instead. Pass.
• Man-Thing. Another movie title. This time a ‘prequel.’ Nope.

Guilty admission: I ordered the Cloak and Dagger busts. Damn. I’ve always been a sucker for those characters…

Make no mistake about it, there is medical malpractice crisis coming. Medical liability insurance companies (the companies that provide malpractice insurance to doctors) are either raising their rates dramatically (500% or more, annually) or pulling out of states entirely. Some states have been hit harder than others; for instance, when I was living in Las Vegas 2 years ago, the only level 1 trauma center was shut down for several weeks, and no obstretricians in town were accepting new patients — you had to drive to Lake Havasu (more than an hour away) if you wanted to have a baby.

Now why is there a crisis? It depends on who you ask: the doctors, lawyers, or insurance companies. One undeniable fact is that many Americans are sue happy, and seemingly will sue anyone at the drop of a hat. It was repeatedly told to us in Medical School that no matter how good a physician we were, we could expect to be sued at least twice. The doctors for the most part blame the trial lawyers for filing frivolous lawsuits. The lawyers blame the insurance companies, saying that they are raising their rates due to failed investments. The insurance companies blame the lawyers again.

This round table blame game serves little purpose. While everyone is arguing about who is to blame, doctors are quietly closing up shop and retiring early or moving to friendlier states. Sooner than we realize, it will be harder than ever to find a good doctor, an inexpensive doctor, one who can fit you in to be seen, because soon there won’t be many doctors left. I’m not crying wolf here, I personally know several doctors who have closed up shop, or severely restricted their practice in both Nevada and Illinois (where I live now). I know more who are starting to consider it.

Now you might expect me to espouse a malpractice damage awards cap, and I do — but I don’t like them. I don’t think malpractice caps solve the main problem. It’s true that malpractice caps will limit the damages awarded in the lawsuits that come to trial, but that’s not where the issue really is. The main problem is that many physicians who are sued have NOT committed malpractice. The plantiffs and their lawyers know this, the insurance and their lawyers know this, too. The physician certainly know this, and wants to go to trial to clear his or her name. However, the insurance company decides to settle prior to court, figuring it is cheaper to settle than defend a lawsuit (even one they will likely win). Malpractice caps do not solve this problem, as insurance companies will have no reason to act any differently.

I also have a concern that damage caps will fail the patient who was truly injured and will require lots of money to survive, period. Medical care for the chronically ill/injured is extremely expensive.

The only long term solution is Tort reform. Not just medical malpractice law, but all law. It will be difficult, but necessary. We need to block frivolous suits, but be careful not to favor big business or to prevent the “little guy” from suing when appropriate. Unfortunately, I don’t see tort reform happening anytime soon.

Sadly, that brings us back to malpractice caps. They may be a poor “band-aid”, but the only one quickly available. They do drop the insurance rates, and ease the malpractice crisis. I stand by my statement that I do not like them, but unfortunately I see them as a necessary evil if we want to fix our current mess.

A minor crisis (well, a distraction) in the Polite Dissent household tonight. I will resume the CrossGen blogging tomorrow.

My wife was kind enough to let me assist in two ways for our wedding: I could choose the cake topper, and I could pick the music for before the ceremony and the processional. She knew my interests and my sense of humor, so she knew what she’d be sacrificing.

For the music, I stayed with the normal Barouqe music common to weddings. I did add a few songs into the mix: the Princess Bride, the theme from Lost in Space (the movie, not the TV show…bad movie, but good music), and the theme from the Incredible Hulk TV show. It sounds weird, but all the pieces fit in perfectly with the traditional music. Unless you knew what my additions were, you’d just think it was regular wedding music. You could see people give a smile when they recognized what I added, but it wasn’t many. Last but not least, I had the Planet of Krypton (from Superman the Movie) as the bridesmaids, groomsmen, and groom were introduced. It’s the best short dramatic piece, ever.
I let my bride keep the traditional music for her grand entrance. I’m not stupid.
Read more…

You can find Part 1 here and Part 2 here.

Ruse
Ruse followed the adventures of a Sherlock Holmes-like character, Simon Archard, and his female Watson, Emma. It was set during a Victorian Age in an Earth very similar to ours. It was heavily promoted by CrossGen as it was the first title written by Mark Waid since they lured him from Marvel and DC. Ironically, it was also the last CrossGen title he wrote before returning to Marvel and DC. The series had great potential — especially due to the perfectly fitting artof Guice — but that potential was never realized. This was for several reasons. First, we learn that superpowers exist on this world, and that Emma possesses some, but wants to hide that fact from Archard. This simple idea — and deus ex machina — ruins much of the atmosphere so carefully created as it doesn’t match the setting, except as a tie into the “shared sigil universe.” Second, the comic is rife with pseudo-science. If there’s going to be magic, fine, call it magic and be done with it. Don’t try and explain it away in pseudo-scientific terms that evan a grade schooler can tell are utter nonsense. i.e. “Their minds were controlled by metal filings in their snuff which, when inhaled, were aligned in such a way…” More technobabble than Star Trek. Third, unlike the other CrossGen books, Ruse had no real guiding theme. Sure, a mystic diamond would occasionally pop up and Archard would hunt it, but it was more like a series of random adventures. As I said, potential, but that’s about it.

Read more…

Fridays are always the slowest days in the clinic; I guess patients don’t want to come in the day before the weekend. Conversely, Monday is the busiest day, and we always end up being over-scheduled. This week has also had the nicest weather so far this year, so I think a lot of patients are outside playing (not that I blame them). I’ll just catch up on some Social Security and Disability paperwork for patients, and cruise the web.

I am a board certified Family Practice physician. That means that after medical school, I finished a residency in Family Practice and then passed the certification exam. I chose Family Practice because I like the variety of patients and ailments that we see, plus I like the concept of being able to treat the the whole family, not just individual patients. After residency, I served in the Air Force as a physician for the next four years. Most of my time was spent at Nellis Air Force Base, though I was deployed to both Haiti and the Middle East. I finished my time with the USAF last summer, and took a position as a second physician in a small practice in a central Illinois town. I’m from Southern Illinois originally, but this is close enough. I love being back in the midwest, but my Nevada-bred wife is taking some time to adjust.

I’ve collected comics since I was 10. The first I remember were the X-Men, Avengers, and Fantastic Four I read of my cousins one Thanksgiving. The X-Men issues were those at the waning end of the Claremont/Byrne run – #139, 140, 141, 142. The stories were the Nightcrawler/Wolverine/Alpha-Flight vs. Wendigo story, plus “Days of Future Past” — still some of my favorite comics ever.. I started collecting comics myself shortly thereafter, and haven’t looked back. While I am a sucker for super-hero comics (well, good ones) I don’t restict my reading; I read all varieties from any publisher, no matter how small or obscure.

I’ve been considering the medicine/comic theme for a while now. Most comics have appallingly bad medicine in them, or bad science, or both. I’ve been working on building a website that covers this ground for about a year now (I know, I’m slow), and I hope to actually put in online someday soon…

Politically, I tend to be moderate with leftward leanings. I also have strong pro-Defense and libertarian streaks. I preferto consider each issue individually, and not buy any party platform as a whole.

Hope that answers some questions (or raises more…)

In this final installment of my recap of CrossGen titles, I touch on two mini-series in the “sigil-verse”, and two non-sigil continuing stories. The remarks are very brief this time out.
Part 1 can be found here, part 2 here, and part 3 here.
Read more…

I hope everyone had a nice Mother’s Day. My wife and I met my parents up at Starved Rock State Park in north-central Illinois, and had a nice day of hiking and climbing. There was an excellent dinner at a small Italian restaurant in Peru (Illinois, that is, not South America), then a night at a bed & breakfast in Utica, Landers House (we has the “Log Cabin” Room). Finally, a little more hiking, then a big Mother’s Day brunch at the Starved Rock Lodge (mmmm, Belgian Waffles…). A very nice relaxing weekend.
Normal blogging to resume tomorrow.

JSA #60 “Redemption Lost, Part 1″
Geoff Johns, writer
Tom Mandrake & Don Kramer, pencilers

The JSA is the only group that not only has a doctor, but actually has him practice medicine. This issue shows Dr. Mid-Nite (Pieter Cross) and one of his assistants operating on a bullet wound victim in the back of his clinic. Pieter is also recalling the first life he was unable to save: his mother’s.

The medicine is this issue is mostly well done, with a handful of nit-picks. Johns also earns extra-points for bringing up a rare tropical disease.

First, the operating room staff is definitely minimalist: just Pieter doing surgery and his assistant administering anesthesia and watching the monitors. While I doubt this would meet quality of care guidelines, it is an emergency situation. By OSHA rules, his assistant needs a mask and eye protection. The sterile technique also leaves a little to be desired, with Pieter wiping his brow with his bloody hand (a definite no-no; do that while scrubbed in and the surgeon will smack you. Plus, Pieter’s in his costume — so what good is wiping his brow going to do anyway?).

His assistant warns Pieter that some flutter is occurring. Ventricular flutter rapidly degenerates into venticular fibrillation, a dangerous and fatal rhythm. Pieter says the heart was injured, which can certainly lead to ventricular flutter and fibrillation. My nitpick is that the rhythm shown on the monitor, and the rhythm just before he flatlines, is not a flutter (nor a fibrillation rhythm), but looks instead like a normal heart rhythm.

Pieter reveals that his mother contracted Chagas disease while on a seminar with him in Brazil. Chagas disease is a parasitic infection transmitted by the bite of the Reduviid bug, also known as the assasin bug. If caught early, it is treatable, but in most cases a chronic infection develops that causes serious heart and gastrointestinal problems many years later. At this point, the infection is not curable, and the symptoms alone must be treated. It’s certainly possible that his mother caught Chagas on a trip to Brazil, it is common there, but that would have had to have been at least 10-20 years ago…so how long has Pieter been a doctor?

One last thought: In the Doctor Mid-Nite mini-series, we learn that Pieter has had his medical license revoked. When did he get it back? Or is he practicing medicine without a license?

Elektra #32, #33, and #34 “Fever, Parts 1-3″
Rob Rodi, writer
Steven Cummings, penciler

I was worried when I started reading the first issue and found a major mistake on the second page. Luckily the rest of the story arc was fine from a medical point of view. (The story was too thin for a three-parter, and all the chararacters — especially the male characters — looked a little too cartoony…but the medical facts were good).

Elektra, recently back from a mission to Southeast Asia has picked up an influenza virus. Will it interfere with her mission to kill a Russian mobster? (Spoiler: yes, but of course she succeeds.)

The first issue is mostly set up, while the second and third issue show Elektra under the effects of the virus: weakened, febrile, hallucinating.

The influenza virus is correctly shown to be a serious infection. Influenza is a particularly nasty virus, one that we in the US do not take as seriously as we should. Fever and chills are common with influenza. However, as influenza is a respiratory virus, I would have expected Elektra to show more respiratory symptoms (cough, for instance). She is shown gasping for breath in one scene, and shortness of breath is a common symptom of influenza.

The mistake on page 2? The radio in the background of Elektra’s room: “In international news, reports of a virulent new strain of flue virus that’s seemingly resistant to all existing varieties of penicillin…”

Influenza is a virus. Penicillin is an antibiotic – that means that it works on bacteria, not viruses. All strains of influenza, in fact all viruses, are immune to pencillin. This may be a common mistake (see recent Avengers issues, and many Batman issues dealing with the “Clench” virus), but still one that shows a misunderstanding of one of the basic principles of modern medicine.

I’m not sure whether I should be amused or concerned that the malpractice crisis in Illinois is the lead story in this week’s syndicated News of the Weird

As reported on CNN.com [editor's note: link now closed], a recent study looked at several “herbal viagras” available online or advertised in magazines. Some of these “natural medicines” contained actual Viagra (sildafenil), or its close cousin Cialis (tadalafil). These are drugs that are not safe for everyone to take, and drugs that are illegal to prescribe without a medical license. The other preparations contained some combination of yohimbine, ginseng, and/or gingko biloba. These herbs have some definite side effects themselves, and they have no positive effect on erectile tissues. In fact, we were specifically taught in medical school that yohimbine only works because people thinks it works; it has no physical effects on erection.

This study demonstates one of the main problems with herbal and natural medicines: purity. Study after study has shown that herbal preparations rarely contain what they clain too. Some contain too little herb, some too much. And some don’t contain the herb in question at all. Say what you will about conventional medicines, purity is something a patient does not need to woory about. 500 milligrams of amoxicillin, name-brand or generic, contains 500 milligrams of amoxicillin. This is clearly not a claim that can be made about natural/herbal medicines.

Just remember these studies next time you visit a doctor or decide a condition or illness requires treatment. Caveat emptor - buyer beware.

Two recent storylines in Marvel comics have looked at biological warfare. How accurate was the science and medicine? Surprisingly good.

In the “Red Zone” (Avengers #65-70), the Avengers face the devastation occuring after a cloud of bacteria is released from a secret government lab under Mount Rushmore. The disease is determined to be necrotizing fasciitis. The story by Geoff Johns and the haunting art by Olivier Copiel do an excellent job of showing the destruction even a small biological attack could cause.

The medicine is sound. The story correctly identifies Group A Streptococcus as being the main bacteria responsible for necrotizing fasciitis. Under normal circumstances, the disease spreads unbelievably quickly, so the speed of the genetically modified version is entirely possible. Airborne dissemination would be likely, as indicated in the story.

There were a couple small medical nit-picks: First, on at least one occasion, the bacterium is identified as a virus. Second, the characters and narration refer to necrotizing fasciitis as the name of the bacterium; it isn’t – it is the name of a disease that can be caused by several different bacteria (the most common, and the one ultimately identified in the comic, is Group A Streptococcus ). Finally, it surprises me that never once are antibiotics discussed. There’s a great deal of talk about using “enzymes.” While there’s no reason an enzyme wouldn’t work, why not stick with the tried and true treatment: an antibiotic effective against Group A Strep. Overall: A good well-written story with sound science. The art by Copiel fits the mood well.

In “Tinker, Tailor, Soldier, Spy” (Mystique #7-10), Mystique is sent to retrieve a vial of a genetically-modified smallpox vaccine. While on her mission, she encounters the Host, a mutant who controls viruses. Not as deep or as scary a story as the Red Zone; more of a caper-flick really.

The medicine is well thought out. The writer (Brian Vaughan) has clearly done his research. Vaccinia is correctly identified as the virus used for smallpox vaccination (not variola, the smallpox virus itself). Ebola is noted to be a hemorrhagic fever. He is correct in stating who has had smallpox vaccinations: most people born before 1970, military members, and some healthcare personnel. Vaughan also earns extra points for bringing up Murray Valley Encephalitis, a rare mosquito-borne virus found only in certain parts of Australia, New Zealand, and New Guinea. My only nit-pick is the symptoms of the virus itself: while described as being Ebola-like, it shared few symptoms with Ebola (or smallpox). Overall, another good story. Mystique has surprised by being more readable than I anticipated, with captivating stories and good art.

E-Bay has certainly changed the way I buy my back-issue comics. I used to prowl around the dimly lit back rooms of dusty, forsaken comic shops looking for my back issues. That works fine, assuming you live in a big enough city to support multiple comic shops. It also works well when looking for a broad range of issues, but is pretty much luck-of-the-draw when looking for elusive individual issues. On the plus side, the condition of the comic is easy to determine for yourself.

Now, I buy most of my back-issues on e-Bay. I can sit at home and search e-Bay for what I want. If it’s not there, I can always search again in a few days, or few weeks. I’ve never not found what I’m looking for; it may take awhile, but it’ll show up (admittedly, I’m not looking for super-rare Silver or Golden Age comics — that’s what auctions or dealers are for).

There are certainly some downsides to using e-Bay. First, money is sent before you get the merchandise, so there’s always the risk of not getting what you paid for. The best bet here is to buy from established sellers with good feedback — don’t just check the number, read the actual feedback to get a feel of how business is done. Always look back to last few negatives to see if the complaints seemed valid. I’m not worried about 1 or 2 negatives; sell to enough people, and somebody will be unhappy. I get concerned when I see a lot of negatives or neutrals, or a few with a low overall score. Along the same lines, I think twice before buying from someone using private feedback.

On e-Bay, condition cannot be verified before you buy. I find that almost everyone overgrades their comics, so I always assume a slightly lower grade than advertised. Again, buying from an established dealer or someone with a good feedback profile will help here. If grade is a big concern, you can always buy CGC graded comics; they’re easy to find on e-Bay. I don’t do this because the high grades always end up overpriced (I don’t care if it is a 10.0 book, U.S. 1 is still a worthless comic, and not worth 50 cents, let alone $100), and I actually like to read the comics I own, and that invalidates the CGC grade.

My biggest personal problem on e-Bay is doubles. Most e-Bay comics are sold in sets or lots. So I often end up buying 2 or 3 more comics more than the specific issue I want, and up with 2, 3, 0r even more copies of certain issues. Not a big deal, because I can sell the doubles myself on e-Bay, but just a hassle.

As I’ve both bought and sold comics regularly on e-Bay, here are some annoyances I’ve encountered, and pointers to both buyers and sellers:

• A lot implies many comics (alot of comics, duh), not just 2 or 3. “Witchblade lot” suggests you are offering more than just a handful of comics
• If you advertise a run of comics (i.e. Amazing Spider-Man #310-330), this should mean that you are offering all of that run. In the body of item, it should not say: issues 310, 312, 324-325, 330. If it’s not a complete run, indicate that in the title.
• Along the same line, if you are offering a run of comics in Trade Paperback format instead of individual comics, be specific about it. Don’t lead off with “100 Bullets, issues #1-15” and then hide the fact that the run consists of trade paperbacks at the bottom of the listing.
• Reserve prices are annoying. I hate winning a bid for an item, only to discover that it’s still below the reserve price. Be up front with the pricing. If you don’t want to sell it for under a certain amount, then make that the starting price.
• If it’s not CGC graded, don’t give it a number grade as if it were. Don’t call it “apparent 9.8″, or “certain 9.6″ or such nonsense. Call it “near mint” or “good” or whatever.
• Be up front about shipping & handling charges; don’t try to make up money on a cheap auction by charging for exorbitant S&H fees.
• However, remember that it is shipping and handling. I charge slightly more than shipping alone (usually by 25-50 cents, depending on the size of the item) because I package securely, and that costs money. If I ship at just postage alone, I lose money.
• Media mail is fine, but ship promptly. I pay quickly and expect the same courtesy. I expect to see the item on my doorstep within 2-3 weeks. Even Media Mail is faster than this (but according to Comic Buyer’s Guide, there are some questions as to whether or not comics are eligible for Media Mail as they contain advertisements).
• Leave feedback promptly. Sellers should leave feedback when the payment has been received (or cleared the bank, if a check). Don’t play “feedback extortion” by waiting until I give you feedback before you give me my feedback. As buyer, my job is to pay for items, and as soon as I’ve done this I deserve my feedback. That is my policy when I’m selling.
• Finally, remember that annoying smart-alecs like myself will be reading your listing, so make sure of your facts. For example, the infamous DC Implosion occurred in 1978, long after the demise of The Hawk and the Dove.

Recently, a certain CBG commentator has had some negative things to say about the comic blogosphere. Comic Treadmill sums it all up nicely.
Tired of the negativity (though I’ve contributed my share), I hearby present Ten Reasons that Comic Blogs are Superior:

1. Speed: Opinions and views can be expressed almost instaneously. No need to wait for weekly or monthly publications.
2. Discussion: The communication is not one-sided, like most periodicals. There are interactions between the bloggers and people leaving comments, and between the bloggers themselves. With blogs, you can have posts on various blogs build and expand on each other.
3. Variety: With hundreds (if not more) of comic-blogs to choose from, if you don’t like one person, you can easily find ten or fifteen you will like. Whether you like professional blogs, semi-professional blogs, or totally non-professional blogs: all are available. I’m not paying a subscription; I’m not limited to 3 or 4 columnists.
4. Dedication: Bloggers are posting because they enjoy and are dedicated to their interests. It’s not our job; we’re not paid to do this. The hours we spend, after work, after family, are our contribution to the comics community.
5. Specificity: If there’s a particular comic-book interest, chances are that a blog covers it. Graeme covers the highlights of the message boards in Fanboy Rampage, so I don’t have to read them all; Laura is the source for all things Aqua; this blog (generally) presents the medical aspect of comics. Other interests have their own blogs as well.
6. Peers: I don’t necessarily care what John Q. Professional cares about the latest comic. I’m more interested in what average readers like myself think about the comics. Did everyone think “Iron Fist” sucked as much as I did? Was everyone else enthusiastic about “Monolith”? I can get advice on books to try from people with similar opinions.
7. Community Support: Comic bloggers support the comic community, especially the smaller publishers, more than any professional publication. How many bloggers brought attention to the recent “Demo” contest? How many helped Fantagraphics with their recent concerns? How many push smaller, less well-know books?
8. Democracy: Anyone can blog. This is not a negative; it’s a positive. I can find information from anyone about anything. It’s not a secret club. Anyone can join for little, if any, cost (other than time). There are comics blogs from teachers, lawyers, students, doctors, housewives, secretaries. If I don’t like what I see, I don’t have to read it. What matters is not who you are, but what you say and how you write.
9. Cross-Overs: You’ll never see George Will write an article about comics, but more mainstream and political bloggers will frequently write about comics. Michele of A Small Victory makes no secret of her love of comics, and Meryl Yourish writes some hilarious Hulk dialogue (here’s a good one), and her Superhero Dating Ratings are hilarious.
10. Honesty: I’m not worried about conflicts of interest in comic blogs. There have been always been rumors of biases in the “professional” internet comic news sites (i.e. “The Pulse in is CrossGen’s pocket”, “Marvel gets preferential treatment from Newsarama”, etc.). To some extent these are tue because these sites have to worry about not offending publishers, writers, artists or they may not be given their next big story. These worries don’t exist in the comic blogosphere. If it’s below average, we’ll say so.

This one’s good for a chuckle. From Fox News, Japan Lawmakers Scolded for Reading Comics. The senior member of one of the political parties scolded the younger members of his party for reading comics in full view of the Prime Minister. Now, he was scolding them because they were being impolite, not just because they were reading comics.

One of the last sentences of the article was quite telling:

Comic books, often with adult themes, are common reading material for middle-aged men.

If only this statement held true in the West!

When a comic company publishes a series, is that a promise? Are they telling their readers that they will continue this series no matter what? No, of course not. A comic publisher is first and foremost a company. They need to make a profit. Unprofitable series are subject to cancellation.

For a standard episodic series, cancellation is regrettable, but understandable. There aren’t many, if any, loose threads to tie up.

What about a mini-series? Starting a series is a promise. It’s a promise to the reader that the mini-series will be finished. Certainly, sometimes bad finances rear their ugly head and a mini-series has to be shortened. Regrettable, but understandable. But what about when the company simply does not deliver? Is it the writer? The artist? The publisher? Certainly a comic company should not start a series unless it knows it can finish it. Yes, I’m talking to you Marvel Comics and Kevin Smith. This was a broken promise.

Then there are the series that have an underlying concept. These series have too many loose threads to simply end abruptly. Would it have been right to have ended Sandman in the middle of A Dolls House? Sojourn was one of these books with such a theme: Arywn was searching for the magic arrow with which to slay Mordath. It was not a perfect book, by any stretch of the imagination (as I stated earlier). It was a fun read, however. Those of us who started the series in the beginning have been following Arwyn’s adventures every step of the way. Now comes the news that Sojourn will be ending prematurely. Issue #34 will be the final issue (although it has been solicited through #37). This is a broken promise. There was an understanding from the beginning that Arwyn would finish her quest, one way or another. It may not have been put in writing, but it was a promise understood by both sides. If the series had to end early, they owed us a real conclusion, not some clich頦amp;#8220;to be continues?”. Hell, Arwyn doesn’t even appear in the final issue.

I’m tired of broken promises and I’m making a stand. I’m voting with my dollars. I will not support CrossGen anymore. Before I buy any new Marvel mini-series, I will be sure that the creative talent can actually complete it. I will not support Kevin Smith projects anymore.

Today, we’ll look at a classic: Strange Tales #115, “The Origin of Dr. Strange”, by Stan Lee and Steve Ditko.

For those of you who don’t know the story behind the Master of the Mystic Arts: originally a brilliant and arrogant surgeon, Dr. Stephen Strange’s hands are severely injured in a car accident. Told that he will never operate again, he refuses offers of assistance and charity and turns to the bottle becoming an alcoholic bum. Eventually, he overhears someone talking about the mystic “Ancient One” and he journeys to the Himalayas to persuade this wizard to heal him. No spoilers here, you’ll have to finish the tale yourself. (Try Marvel Masterworks: Dr. Strange or The Essential Dr. Strange)

Let’s look in on the scene where the doctor is talking to Strange after his car wreck…

Doctor looking at X-Rays: I don’t know how to tell you this…
Strange: Speak up, man! I can take it! What do the X-Rays show?
Doctor: Although your hands seem to be all right. The nerves have been severely damaged!

There’s a major problem here. X-Rays are good for looking at bones, lungs, and certain other organs and masses. They do not show nerves.
You’d need an MRI for that.

In fairness to Lee and Ditko, MRIs did not become common until the mid-1980’s, long after Strange Tales #115 was published. Frankly, I’m not even sure today’s MRIs would be able to show the fine motor nerves that Strange injured; you’d probably need a nreve conduction study. Regardless, an X-Ray wouldn’t help. Now I’ll stop picking on Dr Strange before Neilalien sends the Hoary Hosts of Hoggoth after me…

What exactly is Dr. Doom a doctor of?
As I recall, he got expelled from college, so when did he receive his bachelor’s degree, let alone an advanced degree? Of course, being ruler of your own country comes with perks, so he’s probably got more honorary degree from LIT (the Latverian Institute of Technology) and Lat State. But somehow Dr. (honorary) Doom doesn’t quite have the same ring to it…

UPDATE (16 May 2004, 0112): University links are up and working.

It’s a beautiful day in central Illinois. The sun is out, a nice breeze is blowing, and not a storm cloud in sight. I just returned from a nice bike ride, from Pekin to Groveland to Morton and back by some mostly deserted country roads. Passed a group on tandem bikes. I could never feel comfortable on a tandem, sure you go faster, but I never entirely trust the other person to steer. There were a few recumbent tandem bikes too. I’ve never seen those before — they just don’t look comfortable.

Today is day for housekeeping, both literal and figurative. I need to file and put away this month’s shipment of comics, plus do some yard work. I also want to play with some of the WordPress CSS files and spruce up this site a little.

In the meantime, here are some good weekend blog-o-bits:
Laura at Bloggity-Blog-Blog-Blog waxes rhapsodic about Aquaman #18, and particularly some very nice interior art. Makes we want to run out and read the issue now; unfortunately it won’t be in my shipment until next month (sigh…)

Johanna at Cognitive Dissonance continues her weekly “chick check” (Marvel here, Mature DC here ), with results that are slightly less dismal than usual…so far. As she cautions, regular DCU titles still have to be totaled.

Michele at A Small Victory reports that children’s book writer extraordinaire Syd Hoff is dead and writes an elegant eulogy. Rest in Peace, Mr. Hoff.

H at The Comic Treadmill takes a hard look back at the Outsiders Special #1 and issue #28. His closing dialogue between the JLA and Geo-Force is a must read. (H, you’ve got to get a longer name so that links to you are easier to see. Just one more letter, please. How about “Ha”, or “Hi”, or “He”?)

In Anime news, the series Full Metal Alchemist has secured a US release in October of this year. I understand the Cartoon Network will be showing it as well. I saw several episodes of this at Millennicon this year and it was excellent. (I watched a subbed version, so the dubbed voices in the trailers seem a little off to me…). This series bears no relation to Full Metal Panic, another highly recommended anime series.
UPDATE: Watch Trailer 2 (as it explains the story better), then Trailer 1.

UPDATE: I see I’m having some sort of problem with the archives and calendar. I’d like to point out that this was happening before I started changed the CSS. Oh well, I’ll see if I can find a fix tomorrow… UPDATED UPDATE: Fixed the archives, temporarily, by upping the number of posts per page.

In the June 2004 issue of Wizard (#152), there is a Question and Answer session with Editor-In-Chief of Marvel Comics, Joe Quesada. After he’s done with comics, Quesada should move to politics. He would be a great politician; what he says is always interesting, and he usually manages to say something stupid at least once.

As I read the article, there were a couple of times where his responses to questions caught my attention. First, when asked who was more important to Marvel, Mark Millar of Brian Michael Bendis:

You’ re asking me to split the baby in half in a very Solomoesque way at which point I’d have to say, it is Mark Bendis.

Quesada has his biblical metaphors confused here. Solomon was presented with a dilemma in which two women both claimed to be the mother of an infant. Solomon had to give the baby to the right woman. In this situation, there was a definite right answer and a definite wrong answer – the trick was in figuring out which was which.

Quesada, on the other hand, is saying that he cannot choose between Millar and Bendis – that is there is no right answer. This is a very different situation than that of Solomon. His answer – though wishy-washy – is fine, stating that he really cannot pick one over the other. But I don’t think that “Solomonesque” is even a word.

After his biblical wisdom, Quesada goes on to discuss not only Millar and Bendis, but also Joe Straczynski, and Neil Gaiman:

These guys [Millar, Bendis, Straczynski] and Neil Gaiman with 1602, are creators that have brought in so much revenue or have created new franchises that never existed before, like 1602 and Supreme Power.

Later, in the same paragraph:

We value all our creators, but there are guys who are just full on revenue-makers. Also important to us are up-and-coming money-makers like Brian Vaughan.

I understand that a comic book publisher is a company and needs to make money. But it is disheartening to hear the Editor-in-Chief, a creator himself, talking about his headlining staff solely in terms of revenue production. Never once does he mention talent, creativity, or ability.

This is the kind of thinking that can only hurt the industry. At this point, anybody could write the X-Men and make money. But a bad writer will eventually drive the fans away, even from a well-known franchise. On the other hand, a talented creator will bring fans to a book. How many people read Gaiman’s Sandman in the beginning? How many by the end? Quesada needs to focus not only on revenue, but talent as well. He needs to let the creators know, and the fans know, that money is not the only issue.

As an aside, the Squadron Supreme is not a new franchise, and has existed for a long time. I first ran across them in an old issue of Defenders, and they were around before that.

When asked about Chuck Austen, “one of the most criticized writers in comics,” Quesada responds:

His books still sell…Look, if I ran my business through what the message boards and the Internet wanted, I would have been out of business. A perfect example is the ‘Net’s reaction to Ultimate Spider-Man. It was horrifically negative…If I would’ve followed the ‘Net, I’d be out of a job.

In defense of Chuck Austen, Quesada says that his books make money. As I said above, anyone could make money on the X-Men. The trick is bringing new readers to the book and keeping them. This is where “revenue-generation” isn’t enough.

In terms of not listening the buzz on the Internet, he brings up how the ‘Net was wrong about Ultimate Spider-Man. While this may be true (I honestly don’t know), it’s a bit disingenuous. Quesada is like a “psychic” here; remembering only the hits, conveniently forgetting the misses. The ‘Net may have been wrong about Ultimate Spider-Man, but it’s right more often then it’s wrong – Marville, and X-Men: Phoenix ring a bell?

In fairness, Quesada is the EIC, and he’s being paid well for his knowledge and expertise. The decisions are his to make, but he would be wise to listen to all his sources of information.

When questioned about recent continuity lapses, Quesada states that continuity was much easier in Stan Lee’s time, when Marvel wasn’t putting out so many titles. He goes on to state that he doesn’t believe that continuity is that important, and ends with:

For me, that’s the key; is a continuity glitch going to keep a writer from writing an incredible story? If it is, then to hell with the continuity – just go and write the great story; we’ll fix the rest later.

Quesada presents continuity as if it were an either-or situation: either tell a good story or follow continuity. But it’s not an either-or choice. It is possible to tell a great story within continuity. It may take a little more effort, but that’s all. Take a little more time and make sure the continuity is correct. It’s not like Marvel is known for putting comics out on time (the Ultimates, NYX…). Just utilize the Assistant Editors.

Continuity cannot be “fixed later”, just ask DC Comics, home of the Crisis on Infinite Earths and Zero Hour.

Overall, I do think that Quesada is doing a good job as Editor-in-Chief. He has certainly revitalized Marvel Comics. I just think that he needs to avoid developing “revenue” tunnel vision and push the creativity and talent.

Green Lantern #153
Judd Winick, writer
Dale Eaglesham, penciler
“You Can Never, Never, Never Go Home Again…”

While high school reunions have always been the perfect setting for tension and drama, they are also a perfect set-up for comedy. Why else would they be so common in movies, TV sitcoms, and reality shows?
In this issue Kyle and Jen go back to California for Kyle’s high school reunion. The cliche characters are all present and the issue is a run light read, before Winick’s change to a heavy-handed style for the remainder of his run.

I’ve never understood how Kyle could keep his identity secret…
Earl: Hey, there’s Kyle Rayner with his girlfriend, that ex-model Jennie-Lynn Hayden. Man’s she’s hot!
Howie: Earl, she’s green.
Earl: So? She’s a photographer now, think she’ll take my picture?
Howie: Isn’t she that super-hero Jade?
Earl: You sure?
Howie: Yeah…look, she’s green too and looks just like her. Jade lives in New York, just like Kyle and Jennie-Lynn.
Earl: Doesn’t Jade always hang out with that Green Lantern guy?
Howie: Yeah.
Earl and Howie: You don’t suppose…

Attention Laura:
Just to add my two cents worth. It’s simply not an Aquaman comic without Tusky.
–Scott
charter member, S.P.L.A.SH.
(Society for the Preservation of Large Aquatic Super-Heroes)

Kinetic #1 (“Superzero”), #2 (“Crash”)
Kelley Puckett, writer
Warren Pleece, artist

In Kinetic, we meet Tom Morrell, a high-school senior who suffers from “over a dozen major syndromes.” His mother reminds him that he has hemophilia, diabetes, and monmyelic amotrophy, before scolding him and injecting him with a large shot. Tom has difficulty in school, getting picked on by both teachers (indirectly), and students (directly). Because he walks a pretty girl home and misses his “shots”, he has some sort of spell and passes out, requiring his admission to the hospital. He then resolves to kill himself. Issue #2 continues where issue #1 left off, with Tom trying to kill himself. It also includes a great deal of back story and flashbacks, but not much new medically.

I can find no medical references to “Monomyelic Amyotrophy“. So either writer Puckett has made up a disease (which I have no problem with), or it is a typo for Monomelic Amyotrophy. I suspect the latter because Tom exhibits the symptoms of this condition: a weakness and wasting of the muscles of a single limb. It is most common in males between 15 and 25, so that fits as well.

Tom also suffers from Hemophilia, a genetic disorder where the body is missing one of the proteins that allows blood to clot. Therefore, people with hemophilia are prone to bleeding much more than a normal individual, and even a small cut can prove significant. Tom’s mother was right to worry when he was considering shaving. Hemophilia A is treated with an IV medicine called desmopressin (DDAVP), Hemophilia B is treated with an infusion of clotting factor (either genetically engineered or from human blood donors), and Hemophilia C requires infusion of plasma to stop bleeding.

Diabetes is the third condition that Tom suffers from. Summed up quickly, diabetes occurs when a person cannot utilize the sugar and other carbohydrates they ingest, and the sugars build up to high levels in their blood. There is Type I Diabetes (otherwise known as Juvenile Onset or Insulin Requiring Diabetes) that occurs when a person’s pancreas stops making insulin. It must be treated with insulin injections. Type II Diabetes (also known as Adult Onset or Non Insulin Requiring Diabetes) occurs when a person becomes resistant to the insulin that their body produces. It can generally be treated with oral medication, but may ultimately require insulin. Given Tom’s age and thin appearance, it is most likely that he suffers from Type I diabetes. This requires insulin injection to treat.

Insulin syringes are small slender syringes, either ½ or 1 cc in size. His mother appears to be holding about a 5 cc syringe, but it could be one of the newer multiple-injection syringes which are larger than the traditional insulin syringes. Insulin injection is done subcutaneously — not deep like a flu shot, but just under the surface of the skin. Insulin can be injected in the outer arms, abdomen, thighs, or buttocks, but the injection site needs to be rotated regularly. If Tom were my patient, I’d expect him to be injecting his own insulin by this age, but clearly there are some messed up Mother-Son dynamics here.

I’m not quite sure what sort of spell Tom has while walking home. Most likely he is developing Diabetic Ketoacidosis (DKA). When Type I diabetics develop an extremely high blood sugar, they can become deathly ill and even die. It usually results from stress, infection, poor diet, and/or not taking their insulin. Vomiting is common sign of DKA. However, incontinence does not occur with DKA (just the opposite actually — dehydration). While he did apparently miss his afternoon insulin injection, it’s too soon for DKA to set in as it usually takes a couple of days for the sugar to build up to a high enough level. Of course, his spell could be because of one his nine other unnamed syndromes.

In the hospital, Tom is hooked up to several wires and tubes. There are two leads going to the heart monitor (there should be 4 leads), and a tube in his nose. This tube could be nasal canula (to supply oxygen) — but in that case, it should be in both nostrils — or is could be a nasogastric tube, used to drain the stomach contents or provide liquid to the stomach. He also has an IV line in place, so it makes no sense for the nurse to inject the medicine directly into his arm, the IV would have been much easier and faster.

Overall, it is clear that a great deal of research went into Kinetic. The only concerns I saw were minor, and took place almost exclusively in the hospital setting (we can probably blame those on the artist, not the writer). I am also interested whether Puckett meant Monomelic Amyotrophy, or made up his own disease Monomyelic Amyotrophy.

In reality (such as it is in comics), Tom’s biggest issues appear not so much to be medical, as maternal.

Everyone is familiar with the Golden Age and the Silver Age of comics. There are those who also speak of a pre-Golden Age “Platinum Age” and a post-Silver Age “Bronze Age“. I would like to propose an age of my own. I refer to the age of gimmick covers, multiple covers, and the rise of Image Comics. I speak of the boom and bust speculator days of the early to mid-90’s.

I suggest we call this age the Silicon Age.

Why?

• Silicon keeps with the mineral/element theme previously started (alright, I know bronze is an alloy, but close enough!)
• This is when computers really started playing a noticable role in comics (Batman: Digital Justice was published in 1990)
• This was the beginning of the good girl/bad girl art and pin-up pose era…and those busts just are not natural…hence the Silicon Age.

A couple of interesting medical articles across the newswire today. The first deals with dangerous new diseases, and the second with prevention — or more correctly, when to stop prevention.

CDC Watching for Next Worrisome Outbreak [editor's note: link now dead] discusses concerns about new and deadly diseases such as SARS, Avian Flu, and Monkeypox. It also talks about dangerous diseases like Rift Fever and Influenza. With the world becoming more and more connected by air travel, it’s easy for what once was a rare disease to spread quickly across the world. Watch for this to happen more and more frequently. This is a good article, and not too “science-y”. (This also ties in to my medical review of Elektra #32-34)

The second article, When To Quit Medical Tests Remains Murky [editor's note: link now dead], discusses a difficult question. When do we stop testing people for cancer and other diseases? There are definite rules for when to start mammograms, prostate checks, Pap smears, and other early detection tests. But there’s no clear rules for when to stop ordering them. There’s no arguing theat these tests have dramatically increased the detection of cancer, and its survivability. But ho important is that to a 90 year old? With people living longer and longer today, this is no longer an academic question. Cervical and prostate cancer are very slow diseases, we can detect a cancer decades before it’s a real risk — so how late in life should we test? This article addresses that. Interesting, if a little dry.

Strangers in Paradise #61, 62, 63 “David’s Story”
Terry Moore, writer/artist
Yousaka Takahashi picks a fight with David Qin, and beats him nearly to death. Actually, he did beat him to death. As Yousaka puts it himself later: “I beat a kid with asthma and acute arrhythmia and told him that the world hated him. After that he went home, laid [sic] down and died.”

After the fight, when David is lying bleeding in the street, his sister brings him an inhaler because of his asthma. Physical activity can certainly cause an asthma attack, as can extreme stress (such as being jumped by a gang of guys). Lying down is not the best way to use an inhaler, but David’s not exactly in good shape at the end of the fight, so I’ll let it pass.

An arrhythmia is an abnormal heart rhythm. There are many kinds of arrhythmia, some are dangerous, but many are not. For instance, the way the heart speeds up and slows down with breathing is known as “sinus arrhythmia”, and is completely normal. Some arrhythmias can last for years; others just a few seconds or minutes.

Stating that David has an “acute arrhythmia” is somewhat confusing. If he has a constant irregular heart rate, then it is a “chronic arrhythmia”, not an acute one. A chronic arrhythmia wouldn’t cause death in this scenario.

On the other hand, David could have a rare condition known as Wolffe-Parkinson-White (WPW) syndrome. In this condition, the heart has an extra conduction pathway that can lead to an arrhythmia. These irregular rhythms almost always involve the atria (the top of the heart), not the ventricles (the bottom of the heart), and are more annoying than dangerous. Physical exertion is one trigger for arrhythmias in WPW, and in very rare cases they can degenerate into a fatal rhythm.

However, I suspect that what Yousaka means is that David died of an acute arrhythmia caused by the injuries he received in the fight itself, not because of a pre-existing rhythm problem. In a myocardial contusion, the heart itself is bruised, and this can lead to fatal arrhythmias. Usually, it takes a severe blow — such as a steering wheel impact in a motor vehicle accident — but there are recorded cases of it happening after a direct blow. This is the most likely cause of David Qin’s death, though WPW Syndrome is a possibility too.

In the sidebar, Newsarama reports that Jeffrey Moy’s Video Game Girls will finally see the light of the day in Shooting Star Comics Anthology #4, on stands this week. Jeff did great art for Legionnaires, though I haven’t seen anything recently. I was pleasantly suprised when I saw he was on Artists Alley at the Mid-Ohio Conn 2 years ago. We had a pleasant chat, and he was one of the nicest, most down-to-earth, least-ego driven creatosr that I have ever met. He was quite excited about his Video Game Girl characters, and showed me many intriguing sketches and drawings. He came up with a nice sketch of Ayla Ranzz for me, too (to my wife’s dismay). If you like his art at all, I’d advise you to check this book out. (I missed it unfortunately since I order my books in advance from an online retailer. Sigh. Now, I’ll have to venture into the frighteningly unsanitary local shop…ewww…it had better be there!)

This weekend, I’ll be taking an in-depth medical look at certain X-titles by Mssrs. Claremont and Austen. In terms of the X-Treme X-Men, I’ll look at the tunnel rescue scene in #24, and the ER scene (i.e. the entire issue) in #18. The point will be made that Claremont seems to have gained his emergency medicine knowledge from the overdose scene in Pulp Fiction.
For the Uncanny X-Men, a brief stop will be made in the sickbay scene in issue #413, and an long look will be made into Austen’s assertion that religion is worse than cancer (the issue number escapes me, but it’s the issue where some of the students are crucified on the front lawn).
Dig out your copies now…

There have been several excellent discussions going on around the comics blogs recently.

1. Over at the Howling Curmudgeons there has been an intriguing discussion of John Byrne’s run on the Fantastic Four, concentrating on the “Trial of Reed Richards”. I have read a handful of Byrne’s issues, had enjoyed them, and was planning on picking up more on e-Bay. Now I may need to reconsider. Marc brings up many excellent points, especially about Byrne tearing down the work of other creators.

I never read the “Trial of Reed Richards”, so I can’t comment on that. I did read “Terror in a Tiny Town”, but wasn’t very fond of it because the whole plot seemed rather telegraphed. Also the retelling of the first Dr. Doom story with Herbie the robot in it instead of the Human Torch pretty much ruined the entire isue for me. Byrne’s best issue was #240, when Attilan was relocated to the Blue Side of the Moon. The scene where the landing city buried forever the place where Phoenix died was poignant, or did I miss one of Byrne’s digs at Claremont? The fact that the first child born on the moon (to Crystal and Pietro) ended up being human was clever. Though now that I think about it, why was Reed Richards delivering the baby in the first place? He’s a physician now, too? Dammit, now I’ll have to take a look at that issue again.

2. John Jakala and his commenters have some great thoughts on the whole concept of reviews and reviewing. John raises some excellent points, and I agree with all the comments, even the ones that contradict each other. Each one I read makes perfect sense and I nod agreeing, then go on to the next comment, and start agreeing again. Every one raises good points; it’s just a tough subject.

To me, a review is a persuasive piece; it is an argument for or against buying the comic. Any good review needs two things:

• First, an opinion on the worth of the comic. Should I buy it? Burn it?
• Second, reasons why this decision was reached. Don’t just tell me it was great or it sucked; let me know why. Then I can determine whether or not I agree with your reasoning. To one person, the lettering could make or break an issue, while another person may not care as long as it’s legible.

The reviews of Brian Hibbs at the Savage Critic are good examples. In just a few lines, he tells you whether he thinks the books is worth reading, and why he feelsthat way. You may not agree with him, but you know how he reached his decision. On the other hand, H at the Comic Treadmill has recently gone over several JSA stories. These posts were more his thoughts about the comics, than an actual review.

3. Matt Rossi has an extremely insightful post on the Legion of Super Heroes. He makes excellent points made about Superboy and Supergirl’s importance to the Legion that had not occurred to me before. Certainly the various reboots of the Legion suffered from their absence. Using Valor as a 20th century super-hero never made much sense to me, and using the L.E.G.I.O.N. as an inspiration was an even more asinine attempt to make up for the lack of Superboy. John Byrne comes off as a villain here too, due to certain repercussions of his reboot of the Man of Steel. I’ll plead ignorance here, being mostly unfamiliar with the details of this.

Unlike most people, my favorite LOSH series by far was the infamous “Five Years Later” series. Many people seem to have a predilection for the bubble-gum happy Legion. I always preferred the darker incarnations. I’ve always liked stories with dystopian futures, and the Legion fit surprisingly well in this setting. Sometime next week, I see I’ll have to write a post explaining the brilliance of “Five Years Later” to all you heretics…

In X-Treme X-Men #24, Sam Guthrie (Cannonball) is assisting in the rescue effort after the terrorist attack in the Chunnel. The panels discussed are reproduced below, in the “more” section.

Things to remember: The role of the first responder is to stabilize the patient and transfer them to definitive medical care. The priorities are the ABCs (Airway, Breathing, and Circulation — in that order). In trauma care, time is crucial, and every second counts.

Sam comes out of the rubble carrying a victim in his arms. He really should be providing more neck support. Even if he couldn’t fit a cervical collar on the her, he should provide more support for her head (look at it just lolling there — ouch!)

In the next panel, the medic calls for a “line of ringers, line of plasma”. Ringer’s lactate is an IV fluid commonly used for fluid resuscitation, so that’s good. However, plasma is only used in patients who have clotting problems; it is never used for fluid resuscitation. Additionally, plasma is a blood product, and blood products are not carried into the field due to stringent storage requirements.

No pulse can be detected in the patient (but remember Sam has just said he was talking to her). The medic says to start an Ambu-bag, which is used for rescue breathing. He never checked her airway (remember A B C), but maybe someone else on the team did. An Ambu-bag makes good sense, but sooner or later, this patient is going to need to be intubated (i.e. have a breathing tube put down her throat).

Next he says to inject “Atropine, 1mg, direct to the heart!” Bad, bad idea. First, atropine is probably not the right medicine. It is used in some pulseless situations, but not most, and no one has stopped to check why the patient has no pulse. There are many reasons: her heart may have totally stopped beating or have a bad rhythm, her heart may be injured, or maybe she’s bleeding so much out that no pulse can be detected (remember, Sam says he’s covered in blood). Before injecting any medicine, her heart rhythm needs to be determined. They have a defibrillator, and those have heart leads attached, so it will take only a few seconds to check her rhythm. Second, atropine is not supposed to be injected into the heart. Only a few medicines, such as epinephrine, can be injected into the heart (a la Pulp Fiction), but not atropine. It’s never been approved for that, and a search of the medical showed no reports of atropine ever being used that way. Finally, and most importantly, injecting a medicine into the heart is dangerous, and only used as a very last resort. It can irritate the heart, tear the heart muscle, or sever a coronary artery – causing a heart attack. Two IV lines have already been started, just use those to deliver the medicine. So again, atropine into the heart: wrong, wrong, wrong.

200 Joules is the appropriate starting level for defibrillation. But whether or not defibrillation is the right thing to do depends on why there is no pulse. Certain rhythms require immediate defibrillation, while others warrant medication first, then defibrillation. No amount of shocking is going to help a severely injured heart, and she still needs plenty of fluids. Plus, if has no pulse, then someone needs to be doing chest compressions while waiting for medicines/paddles.

Overall, the emergency medical care shown here is very poor. It may look exciting, but it’s also borderline negligent. Sam is right to be worried about her care.

Read more…

Make sure your children get their vaccinations. We are spoiled here in the US with our good health care system. Most of us have never seen measles, diptheria, or whooping cough. Infants are rarely born deformed with congenital rubella. No one remembers iron lungs. We have become complacent about the importance immunizations.

I understand some people have philosophical difficulties with vaccines. I think these people are misinformed or misguided, and I will do my best to change their views. But if they are making a bad decision, at least they have a reason behind it.

What I absolutely cannot stand is when people are just too lazy to get their children immunized. Now it is a year and a half later, and he is paying the price. I think he’ll be fine. I’ll do what I can, we all will, but I wish you had been this concerned about his health then.
</soapbox>

The Polite-Wife and I just returned from a matinee of Shrek 2. Definitely a movie worth seeing. The main characters are back in the sequel, and new characters abound, such as Fiona’s parents, her Fairy Godmother, Prince Charming, and Puss-in-Boots. The animation again is unbeatable. The voice talent is superb; the stand-out is Antonio Banderas as Puss-in-Boots, who steals almost every scene he is in. The overall theme of the movie is similar to the first one: be true to yourself, but no less charming for the re-telling. Like the original Shrek, there are many in-jokes and background gags (hint: look at all the store names) that will take repeated viewings to catch. Our favorite scene was the Cops parody: Knights. ROTFL. The only negative (and a slight one) was that the music didn’t seem to mesh as clearly this time. The cover of Bowie’s Changes struck me as particularly jarring (I think the original would have worked better), but the “Livin’ La Vida Loca” duet at the end was worth it.

No Spider-Man 2 preview (sigh), but The Incredibles preview looked great. I was less impressed by the Shark Tales preview.

Part 1 of this review deals with more statistical and philosphical arguments than usual. The standard medical review of Uncanny X-Men #423 can be found in part 2.

Uncanny X-Men #423 starts out with this bold assertion: More people have died in the name of religion than have ever died of cancer.

I’m not an overly religious person, but that struck me as a very inflammatory statement. Certainly, a great number of wars and deaths can be blamed on religion. But more deaths than cancer? That’s hard to believe.

I’d be very interested in knowing where Chuck Austen came up with his information. I’ve certainly found nothing to support it.

It’s not always easy to determine what qualifies as death due to religion. The Holocaust certainly counted. What about ethnic cleansing in Africa and the Baltic? What about war between the Ancient Greek city-states? The Inqusition? What about terrorists?

Satistics are better regarding cancer, but still incomplete. It is one of the top killers today, world over. Cancer has been around since before organized religion. Certainly cancer cases have increased over the past century, but that’s mostly due to improved detection and better health overall (people now routinely live long enough to develop cancer). Cancer has always been around.

Total cancer deaths in 2000, excluding skin cancer, were 6.9 million. There was no statistic for religious deaths, so I chose to use “Armed Conflict” deaths to represent religious deaths. I suspect that it overstates the number of religious deaths, since many wars are not caused by religion, but it will allow me to capture the non-armed conflict religious deaths. For the year 2000, there were 310,000 deaths due to armed conflict. Thus, for every one person who died in an armed conflict in 2000, over 20 died from cancer. Statistics were obtained from the CDC and WHO databases.

There were 191 million deaths due to armed conflict in the 20th century. I was unable to find a total for deaths due to cancer, but here’s an interesting fact: 300 million – 500 million people died from smallpox in the 20th century (and there were few, if any, cases 1980-2000).

The statistics are coarse, but they seem to support my assertion that cancer deaths are more numerous than religious deaths. As the saying goes: extraordinary claims demand extraordinary proof. Austen has made an extraordinary claim. I’d like to see his proof.

Uncanny X-Men #423, Holy War, part 1writer, Chuck Austen
artist, Ron Garney

The X-Men return home to find some of the other mutant residents of the Xavier Institute crucified (6 or 7, the number of injured seems to change during the issue). Utilizing Archangel’s healing powers, Nurse Annie tends to the wounded. Meanwhile, the other X-Men go off in search of the perpetrators, the Church of Humanity.

My main concern was with Austen’s statement about religion and cancer, but I covered that in part 1. Other than that, this issue contains only a few minor medical errors (and these seem to be more art errors, than writing errors):

1. Archangel’s blood is being transfused into the wounded mutants, but the art shows bubbles coming up into the blood bag. How is air getting in? This is not like getting a glass of water from the water cooler, there should be no bubbles. It’s a closed system.
2. A nasal canula is shown in Jubilee’s nose, but that’s not how nasal canulas look. The one pictured would keep falling out.
3. Finally, the patients are shown hooked up to breathing machines by face mask. Crucifixion kills by suffocation. They are going to need more help breathing than a simple mask can provide, they are going to need intubated (breathing tubes placed down the trachea).

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I never liked Sundays.

I had planned on doing a nice long 2-3 hour bike ride along the country roads in central Illinois today, even had a new toy to play with (at much, much less than MSRP) so I wouldn’t get lost. But guess what happened? Rain. Lots of rain. Pouring rain. Oh yeah, a tornado warning, too.

Bleah! Set me in kind of a funk all day; just sitting around, reading an occasional comic, playing a videogame, playing Knarly Mazes, or watching the History Channel. Sigh. I did some minor tweaking on the Polite Dissent template — I hope it works for everyone. Stupid rain. I’ll never get ready for the Ride Across Indiana this way…

I’ll post the remaining two X-Men medical reviews (X-Treme X-Men #18 and Uncanny X-Men #413) tomorrow.

Sunday Blog-o-Bits:
First Laura spoke up, and now Ilyka has some choice words regarding Dan Brown and the Da Vinci Code. I haven’t read it, and based on a reading of its prequel Angels & Demons on a recent plane trip, I doubt I will.

All this recent talk of Dan Brown and the Da Vinci Code brings us to today’s topic: books and book series you’re embarrased to admit that you read. These are books that are poorly written, poorly conceived, improbably plotted, and more. These are books that would cause you unending shame if your friends, or God forbid your English teacher, caught you reading them. Yet, you still keep reading these books.

Of course, many of these books end up on the best-seller list.

I actually keep a stack of books in my room that I call the “Guilty Pleasure Pile.” I’ll read these books on long airline trips or dreary rainy days. Currently, the pile contains books from the following series:

Tom Clancy’s Net Force series.. Of course it’s not written by Clancy, it’s his “idea.” It was even turned into a made-for-TV-movie (or started out as a movie, it’s unclear), so that should tell you something about the series’s quality. The characters are all two-dimensional, and the villains inconsistent: an evil genius one book, rampaging rednecks the next. Still, it’s an addictive read.

Clive Cussler’s Dirk Pitt books. The best poorly written books available. These adventures follow the heroic marine salvager/scientist Dirk Pitt and his motley band of friends as they face various evils throughout the world. The best are To Raise the Titanic, Cyclops, Treasure, and Sahara. All of Cussler’s books, somewhere in the story, contain some variant of this long cliched line: “If only he had known what was about to happen, he never would have…”. My dad and I both read these books, and will call each other chuckling as soon as we spot this line in his latest book.

Xanth books. Jumped the shark so long ago. Would you feel comfortable in an airport reading a book called The Color of her Panties?

Robert Adams’s Horseclans series. This started wonderfully with an intriguing future setting, exciting — if two-dimesnsional characters, and non-stop well-plotted action. The series quickly degenerated into cardboard characters, redundant action sequences, and an “all but the kitchen sink” approach. Oh yeah, and incest.

John Norman’s Gor series.. Started out as a decent pastiche of ERB’s Barsoom series, but quickly degenerated into a misogynistic mish-mash. Think no man can have more issues with women than Dave Sims? Read John Norman. Actually physically painful to read by the end.

Robert Parker’s Spenser books. These are actually more of a pleasure than a guilty pleasure, as Parker writes well in his pulp noir style. The character are believable, and the mysteries generally quite good. It’s in the “guilty pleasure pile” because I pick them up in airport bookstores, so they end up in the same pile. (In terms of the TV version, I prefer Joe Mantegna as Spenser over Robert Urich, but Avery Brooks made the best Hawk, hands down).

Uncanny X-Men #413 Annie’s Moving Story
writer, Chuck Austen
penciler, Sean Phillips

In Uncanny X-Men #413, the X-Men return to the mansion after a battle with Black Tom. Iceman refuses to let anyone but Professor X sew up his wound. Which is a shame, because Professor X makes several mistakes:

1. No gloves. This is a big infection control no-no. For the sake of both Prof X and Iceman, gloves should be worn. Sure, mutants cannot get AIDS (and was that ever stated before this issue), but there’s still Hepatitis C and other bloodborne diseases. (And did he wash his hands and clean the wound?)
2. Straight needle and thread. Straight needles that require threading have not been used in surgery for years. Tissue is hard enough to sew through without worrying about the thread falling off. Straight needles are also very hard to sew tight sutures with. Nowdays, sutures come pre-packaged attached to a curved needle.

These errors should probably be attributed to the artist and not the writer.

For those unfamiliar with what suture looks like, click on more for pictures.

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X-Treme X-Men #18 Day of the Dead
Chris Claremont, writer
Salvador Larocca, penciler

This is the book that made me realize what a horrible job comics do of portraying medical care. I threw it across the room several times in disgust before finishing it. It is especially sad because Claremont thanks an actual nurse for helping him with the medical part. I hope he didn’t pay her too much.

Play by play is in black, my comments are in red. This is a long one, so buckle your seatbelts and let’s get started.

The issue begins in an Army MASH unit (Claremont calls it a M*A*S*H. Hollywood added the asterixes; the real Army just calls it a MASH — and does the Army even use that term anymore? I was an Air Force doc, not an Army one). In typical Claremontian fashion, the doctor then proceeds to explain to his experienced triage team exactly what triage is. There are a lot of bearded doctors in this Army hospital, which makes no sense. Military men do not wear beards and civilians would not be in a battlefield MASH (see endnote).

As the Avengers bring the wounded X-Men in, medical babble is going on in the background:
A “type and cross match” is called for. Type and cross is too slow for trauma work; if blood is needed Type O is given.
Plasma is called for. Plasma is not used for trauma, just for clotting disorders.
Ringers and Normal Saline IVs are started. Good.

Everything goes to hell when Storm is brought inside in cardiac arrest. Her vitals are crashing, so they start CPR (though Claremont, in his usual wordy fashion, calls it “CPR – chest compressions”). First, they need to remember the ABCs – Airway, Breathing, and then Circulation. Second, CPR is reserved for patients without a pulse, and Storm has one, albeit a weak one.
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The Polite-Wife is back in Las Vegas this week visiting her family, while I’m stuck here in Illinois with a manic kitten, a pissed older cat, and the tornado warning sirens at midnight.

Since she was in Vegas, she agreed to stop by Alternate Reality, my favorite comic shop. Like H at The Comic Treadmill, I’ve been intrigued by all the buzz about Demo, and she was able to pick up issues #1-4, plus the new X-Men Academy: New Mutants #1, which I had failed to preorder. Ralph, the proprietor, recognized her as soon as she walked in, and helped her get what she (well, I) wanted.

I haven’t been able to find a good shop out here, so I’m currently using an online “subscription club”. It’s not bad, but I miss the ambiance of a well run comic store.

So thanks to Ralph at Alternate Reality for running such a great shop, and thanks to the Polite Wife for stopping by and picking up my goodies.

As a child, comic books held a sense of wonder for me. They were 22 pages of action, art, and escape. As an adult reader, I notice that I haven’t felt that wonder and awe in quite a while. I’ve matured and lost some of my childhood innocence, that’s true. But comic have changed, too. I enjoy the variety of titles available, but I look at today’s video-game playing youth and contemplate how we can get them to experience the wonders that are comics.

When I was younger, comics were easily available. I would run down the block to the corner drugstore once every couple of weeks to buy some comics to read. I would scan the racks, and pick-up the comics with the most exciting and enticing covers first. The stories were easily accessible. I could tell what was going on even if I had never read the title before. The stories also had action; not necessarily fights, but there was a definite sense of story progression from the start to the end of the issue. An occasional cliff-hanger was fine, but most stories were self contained. I would read and re-read them until the books were on the verge of falling apart. The price was right; with a couple of crumpled dollar bills, I could buy at least four comics.

A definite effort needs to be made to attract new readers. Today’s new readers are tomorrow’s collectors that will keep the industry going. With the plethora of comic book movies today, attracting new readers should be easy, but experience has shown otherwise. What is needed is not a complex plan, but simply more attention to the basics so that this sense wonder we felt as children can be passed on to the next generation.

1. Availability: Thanks to large national chains, many small local retailers are gone. Most that remain do not carry comics due to poor profit margins. While there are excellent comic book shops out there, but they tend to cater to those established collectors, not to the new or occasional reader.
   There needs to be a way of getting comics out to the general public. Spinner racks at bookstores are a good start. Trade paperback collections make a nice start to reading comics, but there’s something special about the classic comic style. Publishers are starting to sell their comics at some of the large chain stores. This is a good idea, and should be expanded. The publishers and distributors also need to look at getting comics back to the smaller retailers. Once comics are readily available, then advertising becomes a more tenable concept.
2. Covers: Covers need to return to the eye-catching wonders they once were. They should portray an idea of what’s going on in the story, and in as dramatic a way as possible. Recognizable characters should be on the cover, and the title, issue number, and price should be readily evident. Looking over the past month’s comics, the only cover that really attracted my attention wasFlash #209, with Flash racing Superman.
3. Stories: The story lines need to be tightened. I’m not saying there’s not a place for slower paced or less action filled comics. There are, but these are not the best titles for new readers. There are too many comics today that contain issue after issue of “middle”, with a two- or three-part story stretched out into 5 or 6 parts. Long arcs can still be told with individual stories. Look at the “Dark Phoenix Saga”. There was definitely an overarching theme to those issues, but each story stood on its own (with the occasional cliff-hanger).
   Collecting issues for trades is a fine idea, but who says trades have to consist of just one long storyline? I would be just as happy with a trade of 5 or 6 individual stories.
4. Affordability: Price is a major issue. In the twenty (and more) years I’ve been collecting, comics have gone from 40 cents to $2.99, an increase of over 7 times. However, I doubt that kids’ allowances have increased this same amount. Sure, the paper is better quality today, and the art better reproduced, but that doesn’t matter if you can’t afford the comic. Trades are cheaper, some say, because it brings the individual price-per-issue down. True, but they still cost at least $9, and a kid who can’t afford $2.99 can’t afford $9. Sure, you can try to explain savings to kids, but it won’t work, they want a quicker gratification. Marvel tried some cheaper “unplugged” comics a few years ago, but they didn’t work out. They were perfect for the new reader, yet marketed to the established reader. If these books could be released again, but targeted for a wider audience they would have a better chance of success.

While the collector in me may cringe at the sight of my old comics, dog-eared and torn from repeated readings, this is just what the industry needs. We need comics that grab new readers’ attentions and don’t let go. Comics that turn a new reader into an occasional reader, and an occasional reader into a regular reader. The publishers need to look at it as an investment: an investment in the future of the industry.

There’s a healthy discussion of my Sense of Wonder post over at Thought Balloons, and I look forward to Shane’s thoughts when he promises to join the discussion this weekend.

I think there are some people who are missing the point of my post, however. While to some extent I am bemoaning the loss of the wonder I once felt, the post is more about the future. What can we do to get today’s kids to feel that same sense of wonder? What changes need to be made?

I’m not suggesting ways to “save” the comic book industry as a whole, but instead speculating on the best way to bring young new readers to the hobby.

Yes, I’d love to feel that sense of wonder again. A very few books (both super-hero and non-super-hero) bring back some of that feeling. I accept that times have changed; I’m not the kid I was 20 (or more, ahem ahem) years ago. I would just like my nephews and nieces and their friends to grow up loving comics like I did.

Med School and Residency are certainly trying times. Not as bad as they were during the time of House of God, but real life never adequately prepares you for the challenging and bizarre years that make up medical school, internship, and residency.

The Underwear Drawer is fun and insightful blog by a New York pediatric resident. Make it a point to check out her Scutmonkey Comics.

Has there ever been a good mind-control story?

It has always been one of my least favorite story clich鳮 I’ve never seen it carried off very well. Either the explanation for the power control is poor (Ruse), or it seems like little thought has gone into the story itself. Often it seems to be done because the writer needs a quick explanation for a plot hook or needs to explain someone acting out of character (“I was mind controlled! No, really!”).

It still occurs up regularly (in the last year alone: Scion, JLA, X-Treme X-Men, and Alias, just to name a few off the top of my head).

Brian Michael Bendis pulled it off better than most in the the last story arc in Alias. He certainly put some thought into the villain’s motivations. It showed a seamier side to mind-control powers that I’m sure most of them would indulge in (because, well, they’re evil). While it showed some nice back-story of Jessica, and explained some of her psyche, I still thought it was one of the weaker Alias stories. Especially the ending, which was far too deus ex machina for my taste.

The worst recent story was the first story arc in Ruse: mind-controlling magnetic snuff. The less said about this the better.

How about it? Can anyone name a good mind-control story, or have a particularly favorite bad one?

Doctor Mid-Nite (Pieter Cross) is a fascinating character, mainly because he is one of the few superhero “doctors” who actually practices medicine. He is an accomplished surgeon, but also is proficient in primary care medicine. Generally, Matt Wagner and Geoff Johns/David Goyer have done a good job writing the medical aspects of the character. There are a few medical-legal issues that have gone unresolved, however.

1. In the Doctor Mid-Nite #1, Pieter Cross is injected with a dangerous and experimental steroid. As a result, he crashes his car, killing an innocent woman. After the crash, his medical license is revoked by the AMA (American Medical Association). However, the AMA does not have the power to issue or revoke licenses; it is strictly a professional organization. Each state has a medical board that issues (and revokes) medical licenses for that state.
   Did he ever get his license reinstated, or is he practicing medicine without a license? Does he have a license for every state, or how does he get by practicing medicine wherever the JSA takes him?

2. In JSA #17, Pieter is on a dinner date with Black Canary when they are attacked by Count Vertigo. Pieter injects Canary with diazepam (Valium), and meclizine (Antivert) to stop the dizziness. Both of these medicines are excellent choices for vertigo, however diazepam is a class IV controlled substance. Superhero or not, it looks mighty suspicious that he injected his dinner date with this addictive medicine, and without a prescription, too.
3. Again, in JSA: All Stars #6, Dr. Mid-Nite runs afoul of controlled substance laws. Happening across a pregnant woman in a crashed subway train, he offers her both meperidine (Demerol) and butorphanol (Stadol). Both of these are narcotics and controlled substances. Once again, Pieter is handing out addictive medications to people he barely knows. This is especially true of meperidine, which is a class II controlled substance and highly regulated. (As a medical note, narcotics are avoided whenever possible in labor because they sedate the infant as well as the mother.)
   How does he legally get away with carrying all these controlled drugs — does he have special permission? Exactly how many drugs does he carry with him? (Does he have Mid-Nite-utility belt?)

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I was down in the operating suite helping the anesthesiologist prep a patient for surgery. It was the middle of my third year in medical school, and I was halfway through my general surgery rotation in the downtown VA Hospital. Just as we got the patient sedated, intubated, and hooked up the ventilator, two older nurses walked in.

VA nurses are a distinct breed; they are capable nurses who have chosen not to pursue the higher pay and higher acuity at better hospitals, but instead to reign in comfort in the federal system. Almost uniformly, they are old, big, and tough. You learn quickly not to cross a VA nurse.

I’m almost out the door as they walk up to the patient. They look at me, look at each other, then share a wicked smile. The anesthesiologist quickly leaves.

“Hold it there,” the older nurse says. “This patient needs a Foley catheter.” She hands me a Foley catheter kit. Foley catheters are soft rubber tubes that are placed up into the bladder to drain the urine during surgery. To place a Foley in women, it takes a little lube and a deft twist of the wrist. In men on the other hand, it takes a lot more lube, a firm grip, and some honest effort.

“I’ve never put one in before,” I said.

“We’ll tell you how,” she said as she handed me a pair of gloves. As I put them on, some other nurses came in the room to watch. The first nurse handed me the catheter, the tip dripping with lube.

“Hold the Foley in one hand,” she said. “Now, take that other hand and just choke that chicken, son. Just choke that chicken!” All the other nurses joined in, laughing, “Choke that chicken! Choke that chicken!”

I placed the catheter, made sure it was working, and left the OR as quickly as I could, the nurses still cackling behind me. I hoped nobody else been watching; I also prayed that for his sake, the patient was deeply asleep.

From that day on, I made sure I was out of the OR long before the nurses came in.

Sorry for the light blogging this weekend. My redneck roots are showing, and I’m settling in for a long weekend of watching auto racing — plus grilling some memorable ribs.

The Polite-wife is back from visiting her family in Las Vegas, and she comes bearing Demo #1-4, plus some other comics to read.

I’ve got some interesting medical/comic stuff in the works, and should have time during the race(s) tomorrow to compose my thoughts. In the meantime, I’ve posted some blink-and-you’ll-miss-them mini-medical reviews.

Also, if you blinked and missed them in the past, enjoy these Saturday Funnies:
Latverian State University
Latverian Institute of Technology
S.P.L.A.SH. (Society for the Preservation of Large Aquatic Super-Heroes)

Here are a few quick recent medical nit-picks in comic books:

Flash #199 Blitz, part 2
Geoff Johns, writer
Scott Kolins, penciler

In the midst of a memorable battle, Zoom informs Flash that his wife, Linda Park-West, has miscarried.
If Linda has miscarried, then why are the fetal monitors still showing a heartrate?

NYX #2 Wannabe, part 2
Joe Quesada, writer
Joshua Middleton, penciler

Empty pill bottles reading “Vicodin 100mg” are scattered across the apartment of Kiden’s teacher. Vicodin does not come in a strength of 100mg. It is a combination drug consisting of acetaminophen (i.e. Tylenol) and hydrocodone, a narcotic. The doses of both drugs are listed on the prescription (for instance 5/500 or 7.5/500). 100mg is a uselessly low dose of acetaminophen, and a lethal dose of hydrocodone

JSA #54 Virtue, Vice and Pumpkin Pie
Geoff Johns, writer
Don Kramer, penciler

In an awkward converation with Black Canary, Dr. Midnight states, “Anthroscopy, triple bypass. I can heal the human body with my eyes closed — but relationships…I’m not very good at fixing those.”
There is no such thing as “Anthroscopy“. It appears to be a typo for “arthroscopy” – a form of joint surgery utilizing a small camera. There are some scattered anthroscopy references around, but on closer exam they all are typos too (OCR — can’t live with it, can’t live without a proofreader).

Well, the Indianapolis 500 is currently on rain delay, and from the looks of things it will have to be postponed until tomorrow. The last time the Indy 500 was postponed was in 1997, and I hapened to be finishing up my internship at Methodist Hospital in Indianapolis, doing my ER rotation at the time. I lived about 1 mile from the Speedway, and about 7 miles from the hospital. I left my apartment about 1:30, figuring that would give me plenty of time to get gas for the car and fast food for me prior to my ER shift at 3pm. Guess again! That race traffic was incredible, and the crowd was only worse at the hospital. We had a computerized “waiting list” for the ER that normally held 20-30 patients. That evening it held at least 200 patients, and most complaints were alcohol related one way or another (”nausea”, “alcohol posioning”, or “cut with beer bottle” the most common). I must have sutured up 7 or 8 people that night, and didn’t have to use much anesthetic at all.

The grilled ribs were good, a little fatty, but quite tasty. Tonight, we’re having some friends over to watch the NASCAR Coca-Cola 600 and have swiss and then chocolate fondue. I may be a redneck, but I do it in style.

I read Astonishing X-Men last night, and thought it was quite good overall. It seems that Kitty is going to be the reference character. Whedon showed her reminiscing back about her time at the X-Mansion, particularly when leaving for Emma Frost’s Academy (UXM #151), when she was angry at Professor X for demoting her to New Mutant status (UXM #168), and when she was kissing Piotr one Christmas (issue ??, Paul Smith run, I think). I thought that it was interesting that she did not have a flashback towhen she joined the X-Men (circa UXM #139), just later memories.

The scripting was good, and Kitty, Hank and Emma had the best lines. Kitty’s verbal sparring with Emma was good, “I’m sorry, I was busy remembering to put on all my clothes.” She also had the trademark Whedon pop culture bon mots: “Did I miss the sorting hat?” Emma got her digs in too, though.

The characterizations were well done, including the fight between Scott and Logan (and from a psychological/medical point of view, I liked Logan’s reference to Kubler-Ross’s 5 stages of loss: “…Which stage of grieving is this? Denial?”) I’m hoping Whedon will write Scott to be an interesting character because I haven’t found him to be interesting since…well, ever.

Cassaday’s art was fitting, but those are some ugly costumes. Wolverine’s and Emma’s are fine, but Kitty’s is generic X-Men. Cyclops looks like he’s channeling Steve Rude’s Nexus, and Beast’s just looks plain silly. Add two suspenders and he’s an Osh Kosh B’gosh. Also, why is Scott always wearing his visor, even in bed? What happened to those ruby red glasses of his?

On a side note, I think Whedon’s name has the potential to bring some readers to the series, particularly female ones. Both the Polite-wife and my sister have asked about reading The Astonishing X-Men.

Sunday Blog-o-bits (and thank you’s):
1. Thanks to Mag at The Comic Treadmill for confirming that the Army does not use MASH units any more, instead they use Forward Surgical Teams (FST). This is in reference to my medical review of X-Treme X-Men #18.
2. Thanks to Matthew Rossi for pointing out “The Houseplants of Gor”, a hilarious (and spot-on) parody of John Norman’s Gor series, one of my guilty pleasure book series.
3. Michelle at The Underwear Drawer blog, has some good advice for medical interns

I first caught this show when my nephews were watching it at my in-law’s house. It caught my interest, and I’ve been watching it ever since. It’s shown daily on the Disney Channel, and Saturday mornings on ABC.

Kim Possible is a high schooler who is also what is best described as a freelance secret agent. With her best friend Ron Stoppable (and his pet naked mole-rat Rufus), they travel the world fighting crime. Her arch foe is mad scientist Dr. Drakken and his sidekick Shego. Other memorable villains include Señor Senior Sr. (voiced by Ricardo Montalban), his goofy son Señor Senior Jr, and Lord Monkey Fist.

The art is stylistic but well done. The voice work is also good, and includes such notable voices as Patrick Warburton (Seinfeld, The Tick), Jean Smart (Designing Women), Gary Cole (Brady Bunch the Movie, Office Space), and Will Friedle (Boy Meets World, Batman Beyond). The humor can be childish as times, but rarely immature. There are frequent bits of adult humor thrown in as well.

There are several connections to comic books. Will Friedle, who voices sidekick Ron Stoppable, was the voice of Terry McGinnis on Batman Beyond.

In the second season, the episode “The Fearless Ferret” is a clever homage to both Batman Beyond and the old 1960’s Batman TV show. There is also a parody of the infamous upside down kiss from Spiderman. Adam West supplies the voice of the Fearless Ferret.

The episode “Go Team Go“, also in the second season, is a deft parody of super-hero teams, super-villians, and secret origins (“A multi-colored meteorite fell from the sky…”).

A fun show that’s well worth the time to watch.

Detective Comics #793 Surrogate, part 3: Deliverance
Andersen Gabrych, writer
Pete Woods, penciler

Batman and Dr. Leslie Thompkins are trapped in a collapsed building along with superstar L’Shea and her pregnant daughter Neisha. Neisha has been severely injured and Batman and Dr. Thompkins perform an emergency Caesarean section to deliver her baby and hopefully save Neisha’s life as well.

The intricacies and history of the c-section are well explained, as are the two different surgical approaches. Dr. Thompkins chooses to perform an LTCS (Lower Transverse C-Section, a horizontal incision at the bikini line) instead of the classic c-section (a vertical incision from the bottom of the breastbone to the top of the pubic bone) as it “less traumatic for the mother.” This is true. Almost all modern c-sections are done by LTCS, not because of trauma, but because it provides a smaller scar and allows for the chance of a standard delivery at the next pregnancy. The classical incision leaves a very prominent scar and any further deliveries mandate repeat c-sections. On the other hand, the vertical incision in much faster and is the best choice for emergency situations, and should probably have been used in this case.

The umbilical cord is cut with poor technique. If performed the way illustrated, blood would spray everywhere, and the infant would lose blood as well. Proper technique is to clamp the cord in two places, and cut the cord between the clamps. Less blood spraying, no blood loss.

The CPR scene was well done, with good hand position and technique by Batman.

Despite my nit-picks, the medical content of this issue were well done, particularly in regards to the c-section scene.

I hope everyone had a good holiday and took a moment to reflect on the concept behind Memorial Day. I was graced with a rare week day off (well, I was on call, but it was quiet), so spent the day catching up on important reading (comic books, not medical journals) and watching American Hot Rod and American Chopper on the Discovery Channel. I am amazed by the workmanship and skill of those guys. There are times I think I would be perfectly happy being able to do hands-on work like that for a living (but definitely not under Paul, Sr.).

The Indy was a bit disappointing as it was rain shortened, but still a good race. The Coca-Cola 600 was an excellent race, and I was happy to see Jimmy Johnson win. Unfortunately, Bobby Labonte crashed on the last lap. At least, he still managed to pull off a 13th place finish, and moved up to 6th overall in points.

This week shouldn’t be too bad. Only four days and no call! Now, if only the weather will stay nice so I can get some bike rides in.

There are several problems with the presentation of Sgt. Patrick Mancini, as shown in Phantom Jack issue #2, pages 9-11. I find it distressing that the drawings of the sergeant’s uniform were so poorly done. Not only were there multiple mistakes regarding the uniform itself, but there were multiple continuity mistakes.

I can understand missing some of the finer points regarding military uniforms; I get confused at times, and I had to wear one. However, the more blatant errors are hard to ignore. Artists use references for drawing all the time, why not use a reference for drawing the Army uniform? I was able to turn up multiple reference photos/illustrations in only a few minutes of internet searching. Even worse than the uniform mistakes are the multiple continuity mistakes between panels, even panels on the same page.

Uniform mistakes:
1. Military members do not wear hats indoors.
2. The US Army Class A Uniform coat has two sets of pockets, one upper and one lower.
3. There is no name tag.
4. He is missing rank patches/insignia.
5. Other insignia/devices are missing.

Continuity errors:
Page 9, panel 1: Ribbons, no medals, no arm patches.
Page 9, panel 3: Stripes clearly evident on left epaulet
Page 9, panel 4: Ribbons, and now medals too!
Page 10, panel 4: Ribbons, no medals. Left epaulet now sporting pins instead of stripes. Left arm patch now present. Shirt collar out.
Page 11, panel 1: Ribbons, medals may be present (obscured by word balloon), shirt collar in, no arm patch, back to stripe on epaulet.
Page 11, panel 3: And Lo — there shall come a tie tack! Ribbons, no medals, and now no pockets.
Page 11, panel 5: Ribbons, no medals. Pockets are back though.

My first rotation in the third year of medical school was obstetrics/gynecology. I had started with a month of gynecological surgery at St. Johns Mercy Hospital, and now I was doing two weeks of high-risk obstetrics at St. Mary’s Medical Center. St. John’s was busy, but relatively cushy. On the other hand, St. Mary’s was not as busy, but we ended up working at least twice as hard.

A classic tonight! To get ready for Spider-Man 2, I’m going to dip into the back issue bin, and take a look at The Amazing Spider-Man #3, containing the first appearance and origin of Doctor Octopus!

Otto Octavious was a brilliant atomic researcher who experimented on dangerous radioactive materials using special metal arms of his own design. A lab explosion one day exposed him to high doses of radiation, causing brain damage and fusing his arms to him.

Hospital doctor at bedside: The X-Rays show an uncertain amount of brain damage! I’m afraid his mind has been permanently damaged!

An X-Ray is useful for showing structures (such as the bones and lungs), but will not show brain damage. While some brain damage is detectable by fancier tests — like MRIs and CT scans — many kinds of brain damage do not show up at all on radiological studies. A series of nerve and neuropsychological tests would be the best way to detect and diagnose brain damage.

It is way to early for the doctor to predict permanent brain damage “in the hours that follow [the explosion].” Because of the radiation, there would be a great deal of swelling in the brain. But this swelling is only short-term, and the brain would improve as it resolves. Long-term prognosis is better predicted by looking for chronic brain changes, not just short-term ones.

In fairness to Stan Lee and Steve Ditko, the CT scan wan’t used until the mid-1970s, and the MRI until the mid-1980s, long after The Amazing Spider-Man #3 (July 1963). Brain damage in those days would need to be diagnosed by neurological testing, not x-rays.

But the brain of Dr. Octopus — the brain which has been damaged by radiation — reacts in a bitter way…

Radiation can certainly cause brain damage. Shortly after exposure, fluid can collect in the brain, causing headaches, nausea, vomiting, sleepiness and confusion. This usually goes away on its own.

Long term brain damage from radiation can occur months or years after exposure, and consists of memory loss, progressively worsening dementia, and difficulty thinking. It can also include flawed perceptions and personality changes.

These results are all from studies of radiation levels used during treatment of brain tumors. What high-dose radiation exposure (like what Dr. Octopus was exposed to) will do to the brain has not been well studied.

I found this while searching the web for some obscure medical information. From the “There Are Always People With Stranger Obsessions Than Yours” Pile:
List of Films about Possesed Body Parts

Shane at Near Mint Heroes (finally!) brings his own thoughts to my Lost Sense of Wonder post, and brings up an excellent point that I had completely failed to recognize (but not failed to be irritated by).

This should be a good time for Fantastic Four fans as there are three different series about the FF (not counting the Human Torch series). First, there is Mark Waid’s and Mike Wieringo’s run on the Fantastic Four, highly anticipated and highly publicized. There was even a successful letter-writing campaign to bring them back after an apparently premature termination. Next came the Ultimate Fantastic Four by Brian Michael Bendis, Mark Millar, and Adam Kubert. This series brought the FF into the Ultimate universe. Finally, there is the Marvel Knights 4, by Robert Aguirre-Sacasa and Steve McNiven. Compared to the other two series, this one has seen much less praise and press.

Unfortunately, only one of the series really shines. The others are just unimpressive Fantastic Four tales or weak attempts to retell a good story.

As much as I looked forward to Waid’s run on the Fantastic Four, I haven’t found it anything remarkable. The revision of Dr. Doom from a man of science to a man of magic was clever, but the rest of that arc was a rather standard Doom story, just with “magic” substituted for “technology”. Too many of the recent stories have been dealing with the dangers of technology, and Reed is clearly the focus of Waid’s tales. Everyone else, even Doom, just acts as a foil for him. We understand that it’s Reed Richards, flawed and guilt-stricken hero, but enough already. Move on. At least Ben and Johnny get some time in the spotlight, Sue just seems to exist just to be Wife-to-Reed and Mother-to-Franklin-and-Val. I was totally unmoved by the recent trip to the afterlife and meeting with the “creator.” The peril all seemed superficial: Ben can’t get through the door to Heaven because you built it Reed! Wieringo’s art is good, but sometimes the characters look too child-like. This series does have the best covers, as they are action covers, not poster covers.

The Ultimate Fantastic Four is just a weak re-hash of the original, reminding me way too much of the “Heroes Reborn” Fantastic Four. No one has yet improved upon the original Fantastic Four origin. Reed and Sue as teen prodigies trying to open a channel to the Negative Zone just doesn’t have the visceral thrill of the tragic space flight. Reed and Ben come off the best here. Johnny is pretty much a typical tag-along comic-book style teenager. Sue is the least member of this team, too, existing solely to be rescued by the others. The de-condensed story telling works against this title, dragging out a thin story too long until it’s even weaker. And as for changing Doom’s last name? Now I can’t think of him without a picturing a certain Belgian B-movie actor. The covers are way too poster-ific.

On the other hand, I find that the least anticipated series stands head and shoulders above the others. Over at Marvel Knights 4, we have a more plausible scenario of the Fantastic Four losing their millions and having to join the workforce than in Waid’s Fantastic Four. These aren’t action-laden stories by any stretch; instead they’re character studies of each individual as they have to go out into the “real world” and face what normal non-super powered people must deal with every day. Aguirre-Sacasa has a better grasp of the characters than Waid does. The stories have been well written and every character gets a chance to shine equally here. The art by McNiven has been nice as well. The covers, while poster-styled, are better than most of Marvel’s poster covers.

So my recommendations are to pick up Marvel Knights 4, ignore Ultimate Fantastic Four, and substitute any of the Fantastic Four Essentials volumes for the currrent Fantastic Four.

It was a late fall Monday, during my third year of medical school. I had just finished a horrifically boring month of Geriatric Psychiatry at the VA hospital, and now was doing a month of Adult Psychiatry at the local psychiatric hospital. It was a locked ward, and every day we had to be buzzed in to the unit, and be buzzed out at the end of the day.

The frailty of Peter Parker’s Aunt May was legendary back in the Silver Age. But just how sick was she? Is it true she couldn’t enter a hospital without receiving an operation – even if it was just to pay her bill?

To kick off this weekend’s celebration of the medical excitement of the early Amazing Spider-Man issues, let’s look at the illnesses suffered by Aunt May in the first 3 ½ years of the comic (this covers Amazing Spider-Man issues #1-43, and annuals #1-3 – coincidentally, these are the same issues reprinted in The Essential Spider Man, Volumes 1 and 2, for those of you who want to play along at home).

The following list sums it all up nicely (my notes are in red. ASM stands for Amazing Spider-Man):

To sum up, Aunt May was in the hospital 3 times: issues #9-10, issue #17, and issues #31-34. She also received 3 operations, in issue #9, around issue #17, and between issues #33 and #34. That’s 3 operations in 3 hospital visits, quite an average!

In 46 issues, she had 3 operations. That’s 1 operation every 15.3 issues. She was in the hospital for a total of 7 issues, or 15.2% of the time. At this rate, by the time Amazing Spider-Man had reached issue #500, she would have had 33 surgeries, and been in the hospital for a total 75 issues…

In Amazing Spider-Man #10 (March 1964), Aunt May is recuperating in the hospital after undergoing surgery in the previous issue. Peter Parker comes to visit her after the surgery. He meets with the doctor, who tells him:

Your aunt is doing as well as can be expected, son, after her operation…but she does need a blood transfusion! What is your blood type?

Peter hesitates, afraid of causing problems for Aunt May with his radioactive spider-tainted blood, but ultimately relents and provides blood for a transfusion.

Why does the doctor need blood from Peter for a transfusion? Aunt May is a relative by marriage, not blood, so Peter has no better chance of matching her blood type than a random person off the street. Furthermore, blood banks had been established in the United States starting in 1937. By 1962, there were 4,400 hospital blood banks, 123 community blood centers, and 55 American Red Cross blood centers in the United States. Certainly a hospital in New York City would have a blood bank – or at least access to a community blood bank — and they shouldn’t need Peter’s blood at all (except as a plot point).

Before the transfusion, Peter’s blood is tested:

Lucky for me my blood checked out okay! The tests didn’t reveal my super qualities!

The hospital only checked for blood type, so of course the tests wouldn’t show any spider qualities.

The physician then proceeds to transfuse Peter’s blood directly into Aunt May. This is unusual because even directly donated blood is purified and concentrated so that only the needed portions (in this case the red blood cells) are transfused. Otherwise, fluid overload may result — especially in frail elderly ladies.

Finally, the hospital is using glass bottles to hold the blood, which was anachronistic even in 1964. Plastic bags for storage and transfusion of blood had been developed in 1950 and gone into widespread use almost immediately. I would strongly recommend that Aunt May find a better hospital next time.

Returning to Peter, as he was donating blood, he was worried about his powers:

If my strength comes from my blood, which was affected by the spider’s bite, how will this transfusion affect me? I’ll probably be weakened for a while, until the blood cells can replenish themselves!

He is right to be concerned. After a blood donation, no strenuous activity or heavy lifting is recommended for 24 hours. While it takes less than one day for a person to replenish the fluid lost in donation, it takes 4-6 weeks to replenish all the red blood cells donated.

The following day, despite his doctor’s advice to rest, Spider-Man fights the Enforcers:

Getting weak! Doctor told me to take it easy for a while! My body hasn’t yet replenished the spider blood cells which I lost in transfusion!

He has to run away from the battle to recover (but don’t worry, he manages to catch them all the next day).

Peter is mistaken in thinking that his body has spider blood cells. First of all, spider blood is very different from human blood (it’s blue, for starters) and has only a very few cells. They have no red blood cells. Second, non-human blood cells cause serious antibody reactions in humans. Spider-Man may get his power from his blood, but it isn’t due to any spider blood cells. Peter’s a talented scientist and knows better, so I assume he was just speaking metaphorically…

Interesting sources:

1. The Blood Book. An very thorough site concerning blood and blood transfusions.
2. Two sites with good information on the biology of spiders.
3. How sick is Aunt May?

In Amazing Spider-Man #39 (August 1966), Peter Parker has a bad head cold and goes to visit the doctor. Dr. Bromwell examines him and states:

You have a whopper of a cold son – but some anti-histamine pills and a B-12 shot will have you as good as new again!

First, Dr. Bromwell recognizes that Peter just has a cold, so does not give him any antibiotics. They would not do any good, as a cold is a viral infection and not caused by bacteria.

Anti-histamines are effective against certain cold symptoms, such as sneezing and runny noses. They don’t work against every cold or every symptom. Since Peter is complaining of sneezing, anti-histamines are a good choice (they were prescription-only drugs in the 1960s). A decongestant would be another good choice, and better for his nasal congestion, though it wouldn’t do much for the sneezing.

B-12 shots are useful for people who have a Vitamin B-12 deficiency. The shots do not have any significant affect on individuals with normal B-12 levels. While many patients believe that B-12 injections will give them more energy, there is no good evidence to support this. There is some weak evidence showing B-12 injections will help certain medical conditions such as Chronic Fatigue Syndrome, but a B-12 shot will do absolutely nothing for a cold. Giving a B-12 injection to Peter would do nothing other than give him a sore arm and a thinner wallet. However, in defense of Dr. Bromwell, he is following standard medical practices of the 1960s, so judged in that light he is correct in his choice of giving Peter a B12 injection.

Finally got that long bike ride today the weather has denied me the past few weeks. It went well for the most part, but those last ten miles were killer (and the headwind was no help). Came home and crashed, and have been mostly zombie-fied the remainder of the day.

The parents came up from St Louis yesterday. My mother and the Polite-wife went shopping for lawn furniture and arts & crafts supplies, while my father and I went hiking at a couple of obscure central Illinois sites. First we went to Dickson Mounds, a state museum about mound-building Native Americans, and the Mississipian culture in general. Next, we went to the Gleason Sand Prairie nature preserve where there is about 4 square-miles of sand dunes and unusual plants and animals in the center of Illinois. There were hillsides of prickly pears in bloom, and we saw over 15 lizards and skinks in a ten minute period. Also saw a couple of deer ticks (Ixodes scapularis), but managed to get them off before they bit (no Lyme disease here!). We returned home, and all cooked a nice meal together (salad, sesame chicken, and gyoza) before they returned home.

All in all a nice relaxing and sunny weekend. Next weekend: I’m on call again (sigh).

Sunday Blog-o-bits:
1. Matt Rossi presents us with some comic stories he would like to write. The first one, concerning Tony Stark, is particularly good. I’m always up for pulp-style action, plus he references Robert E. Howard as a bonus. His second idea seems very complex and convoluted (but no more than certain Legion of Super-Hero stories and ret-cons), and while I like the idea of tying the origins of several extraterrestial races (including the Martians, Kryptonians, and Daxamites), I’ve never seen in pulled off well. Remember that issue of Star Trek: the Next Generation where it turns out the humans, Klingons, Vulcans, Romulans, etc. all had a common ancestor. It should have been graoundbreaking, but was never referenced or mentioned again (A Mopee, as Mr. Silver Age would say). His third story raises some interesting consideration as well. Well worth reading.

2. One month to the Tour de France!

3. Bible inspired diets [editor's note: link now dead] are on the rise. This is the third article I’ve seen in last two weeks. I don’t care how religious you are, this is not a good idea. Remember, most people before the Industrial Revolution (and that includes Biblical times), were significantly less healthy than we are, and they died early (and were shorter!) due in large part to poor nutrition.

4. Finally, good news this week: cancer rates are down.

After a blood transfusion from Peter Parker in Amazing Spider-Man #10, Aunt May was exposed to “radioactive particles” and became very ill by Amazing Spider-Man #29 and nearly died. Her symptoms of fatigue, fainting and bleeding were consistent with radiation poisoning. Mortality is at least 50% at the amount of radiation she absorbed (and higher still in the elderly).

Damage from radiation depends on several things: the dose, the amount of time exposed, and the distance from the source. Some radiation poisoning symptoms can occur immediately, but most symptoms take longer to develop. Certain symptoms do not occur until years later.

Depending on the dose, immediate symptoms of radiation poisoning include nausea and vomiting, headache, fever, and diarrhea. Higher doses may cause a loss of consciousness, and it is theorized that very high doses (greater than 8000 rads) will kill immediately. Radiation burns generally appear on the skin within hours to weeks.

Delayed symptoms can include fatigue, infection, easy bleeding, hair loss, and skin lesions. The amount of time before these symptoms appear also depends on the dose of radiation; higher doses cause symptoms to appear sooner. In high doses shock, coma, and death can occur within days to weeks.

Individuals exposed to high amounts of radiation who survive the immediate and delayed symptoms have significantly higher cancer rates ten or more years later.

Aunt May received a transfusion from Peter in issue #10. Her first symptoms were noted in issue #29. In the bizarre world of comic-book time, it’s hard to know for certain how many months of radiation exposure she actually had.

Her radiation dose was undoubtedly a very tiny amount. However, because these “radioactive particles” were circulating in her blood (from issue #10 until they are neutralized in issue #33), she had a very long exposure time. She started with an extremely low initial exposure since she did not develop any immediate symptoms. Over time, her exposure increased from the “mild” level to the “moderate” level based on her symptoms. Mild symptoms include fatigue and fainting. There is no mortality at this level. At the moderate level, fatigue and fainting continue. Increased infections occur, and bleeding is very common. Mortality at this level is 50% at 6-8 weeks. Given Aunt May’s general debilitated state and ever increasing radiation exposure, it is no surprise that she went from mild to moderate to potentially lethal very quickly.

Treatment includes IV fluids, antibiotics, blood transfusion, and bone marrow transplantation. However, Aunt May was lucky and received the miraculous serum ISO-36 and recovered completely (or as completely as Aunt May ever recovers).

Yes, I know it’s a bastardization of several superior Japanese anime series, but this was the one of first cartoons that caught my fancy and inspired my imagination (the other being Battle of the Planets). The local TV station in Virginia showed it every day, and my friends and I would run home after school to watch it. Even 20+ years later, I can still sing the theme song (much to my wife’s dismay).
I have the first season on DVD, and cringe at some of the plot points and characterizations that I loved as a kid. The animation is dated and the stories are cliche (but this series originated some of those cliches), and the science laughable (Mars is light years away from Earth?). Still, it’s engrossing to watch, and I’ll sit through the series at least once a year.

As part of our Obstetrics/Gynecology rotation, we had to finish a 10 station practical exam the final week (this was in addition to the 3-hour written exam). You had 10 minutes at each station, and received a score of 1-10. The ten scores were added together to give a final score of 10-100. The tests included ultrasound reading, patient counseling, laboratory interpretation, online medical reference searches, and several stations dedicated to physical exam skills.

I was 40 minutes into the exam and felt confident. I had been able to pinpoint the placenta on the ultrasound. Online research was a snap. Talking to the patient on the phone had been relaxed and natural. Then I came to the Pap smear practical.

This station consisted of a plastic mannequin of a female pelvis and an OB resident sitting next to it. I was supposed to pretend the resident was my patient, and talk to her, but perform the exam on the mannequin. I knew the resident well as we had been on call together several nights. It was a little awkward pretending someone I knew was my patient, but I learned to cope quickly. I explained what I was doing and answered her questions. I finished the basic exam and then moved on to the Pap smear itself.

Unfortunately, plastic mannequins have a property real people don’t: elasticity. As soon as my brush touched the mannequin, it flexed, and the instrument shot out of my hand, over the heads of several incredulous students, and bounced off the far wall. Newton’s Third Law had never been demonstrated better.

The resident was trying so hard not to laugh; tears were rolling down her cheeks. Calmly and matter-of-factly I told her, “On a real patient, that would never have happened.” I then picked up a replacement brush and finished the exam without incident.

She must have believed me, because I scored a 9 on that station, and a 93 overall.

Being a history buff, I enjoyed reading H’s review of Batman Family #1 so much, I just had to track down my own copy. Batgirl (the original — no wait, the second if you count Bette Kane’s Bat-Girl) and Robin (the original) against Benedict Arnold. Benedict Arnold! Perfect — I had to read this. So thanks to e-Bay, I now am the proud possesor of an inexpensive copy of the issue in question.

First impression: I like the Mike Grell artwork. He has always been a favorite of mine – I have the entire run of Warlord, and his Green Arrow was the definitive one. Here his art is good, not as polished as he is on later books, but still good. He does seem to have an issue with drawing bizarrely triangular anatomy on Barbara, though.

The story is a riot and needs to be read to be believed. The Devil has all the denizens of Hell, and the best villain he can come up with is Benedict Arnold? Sure, it was the Bicentennial, but I didn’t think the Devil would have the Spirit of ’76. (Now that’s a bad movie. Anyone else see David Cassidy and Olivia d’Abo in The Spirit of ’76? Ugh.)

As can be expected, the story is a mish-mash of historical accuracy. Barbara’s retelling of the history of Benedict Arnold left out most of the reasons he turned traitor, such as repeated politically-based court martials, serious debt, and a socially ambitious Loyalist wife. I expected better from a librarian turned Congresswoman. Admittedly, she was filming a public service announcement, so she’d be lucky if anyone actually watched it.

The anachronisms were thick. I was struck by Arnold’s understanding of modern (well, modern in 1976) media. He not only knows what cameras and film are, but knows what the “airwaves” are. They get TV down in Hell now? Plus, how did he know who Stonewall Jackson was?

At the battle of Saratoga, Arnold suffered a serious injury in his left leg, leaving him lame. Yet he’s walking and running fine in this comic. I’m sure the Devil fixed him right up, but I would have asked him to do something about that pot belly as well.

Don’t get me wrong: despite all my nit-picking, I thoroughly enjoyed the story. The premise alone is worth the price of admission.

The rest of the stories are a mixed bag. The Alfred story was a lightweight one from back in the days when he was more of a bumbling character. I prefer him the clever, quiet and somewhat condescending character he is now.

I can’t add much to H’s critique of the Commissioner Gordon story except to say that Robin’s dialogue is particularly painful. Remember that scene in Better Off Dead where Lane’s father is trying to talk “hip” to him? It’s like that, but even worse. Adults should not try to write trendy teenage dialogue. Period.

I enjoyed the Man-Bat story. I had never read it before, and always liked the character. Neal Adams and Dick Giordano present us with some beautiful and appropriately moody art. In terms of the story, I did find it interesting that Batman welcomed the new “hero” with open arms, as opposed to his “get the hell out of my Gotham” attitude nowadays.

Inhumans #11 and 12 No Matter the Cost, parts 3 and 4
Sean McKeever, writer
David Ross, penciler

The beginning of Inhumans #11 is well done. Through a series of sepia-toned memories and family pictures, the back story of Terry Halley Jr., the antagonist of the tale, is told.

His brother William dies at age 8 from an aortic aneurysm. It is very unusual for a child to die of an aortic aneurysm unless it was caused by blunt trauma (which this wasn’t). Most aortic aneurysms are due to bad arteriosclerosis (hardening of the arteries) and occur in older individuals. Some childhood aneurysms are caused by Marfan’s Syndrome, a genetic disorder that has a definite look to it — tall and thin (think Abraham Lincoln; there is some speculation that he had Marfan’s). About 2% of other aortic aneurysms are congenital, and this is probably what his brother had. McKeever is right that a ruptured aortic aneurysm will kill instantly.

His father dies at age 52 from “complications due to liver failure.” The main cause of liver failure is alcohol abuse. Sure enough, if you look at the three family pictures of Terry Haller Sr., he is always holding a drink, and looking more and more disheveled in each picture. Clever.

Both his mother and wife die of “accidental overdoses” of medicines. I suspect his mother’s was a suicide (so soon after the death of his father), and his wife’s probably was too. Most overdoses of antidepressants are.

His son is born with an unnamed genetic condition. Terry tries everything to cure his son including gene therapy, holistic medicine, shamans, and psychics but nothing works.

Gene therapy is a fascinating concept. Basically, in a genetic disorder where we know which exact gene is wrong, is there a way we can correct it? Muscular dystrophy, cystic fibrosis and sickle cell anemia are all good candidates for this therapy because we know precisely which gene is incorrect. The problems lie in getting the good gene into the right place in the correct cell without causing more problems. Not an easy task and no good solutions have been found…yet. Watch for gene therapy to advance dramatically in the next decade.

Nitpick time.

1. In issue #11 and #12, Terry Haller’s son is shown in a hospital bed with what looks like a large wire going to his left chest. I assume this is supposed to be the lead to his cardiac monitor, but monitors require 4 small leads, not one large one.
2. His nasal canula (oxygen tubing) in issue #12 is wrong as well. I’ve covered this before (with pictures!) so I won’t go into depth here.
3. Finally, at the end of Inhumans #12, Nahrees is reunited with her “boyfriend” Damon, who she believed had been killed. In issue #10, Damon is shot in the back and falls about 1 foot to land on the grass. Yet in the hospital he is shown with his head swathed in bandages, and his hair shaved as if he had brain surgery. It’s not clear how he went from shot in the back to a head wound. Maybe the bad guy ran him over with the car as he left?

While children are fairly common in comics, pregnancy has only rarely been shown. The following is an informal list of pregnancies that have been shown, or *may have been shown* in comics. The list is entirely from memory, and so ommissions and mistakes are probably quite common. I am striving for a list not of characters who have been pregnant, but whose pregnancy has been shown in comics.
I would appreciate any additions.
This list does deal primarily with super-hero comics because that is what I am most familiar with, but I welcome non-super-hero suggestions as well.

Heroes:
AQUAMAN
Dolphin and Garth (Tempest) recently had their son Cerridan. I missed a bunch of Aquaman, so I don’t know if they ever showed the pregnancy.

FANTASTIC FOUR
Sue Richards lost her first pregnancy, but then had Franklin with her second. A magical/time-stream induced third pregnancy recently gave the Richards a daughter, Valeria.
Lyja Storm, as I recall, was pregnant and gave birth to an egg(?)

INCREDIBLE HULK
Betty Banner was pregnant, but miscarried.

FLASH
Iris was pregnant with twins at the time that the silver age Flash (Barry Allen) died.
Linda West lost twins recently in the current Flash.

INFINITY INC.
Hippolyta Hall was pregnant a *long* time, and ultimately gave birth to Daniel.

ANIMAL MAN
Annie was pregnant and gave birth in the last issues of the series.

JSA
Hawkgirl was pregnant as a teenager, but this was presented after the fact, so probably shouldn’t be on this list.

STARMAN
Jack fathered children with the Mist (see below) and his significant other, Sadie.

LOSH (1)
Garth Ranzz (Lightning Lad) and Irma Ranz (Saturn Girl) had twins. Now, twins are the usual on Winath, Garth’s home planet; however, Irma come from Titan. Plus are the twins fraternal or paternal? Both have been shown on Winath in the series.

LOSH (2)
In the “five years later” Legion, Night Girl was not only married to Cosmic Boy, but also pregnant.
Also Laurel Gand had a child.

LOSH (3)
Apparition (Tinya Wazzo) and Ultra Boy (Jo Nah – you talk about bad puns, his name was ‘Jo Nah’ and he was swallowed by an outer space whale) have married and had a child (Cub).

L.E.G.I.O.N.
Stealth had a child by Vril Dox.

AVENGERS
Wasn’t Ms. Marvel impregnated by some extraterrestrial being at one point?

TEAM TITANS
Donna Troy was pregnant at the beginning of this series.
Wasn’t Mirage pregnant at the end?

X-MEN
Madelynne was pregnant with Scott Summer’s child (and gave birth to him) in the X-Men.

Villains:
Punch & Jewlee
They showed up in Hawk & Dove toting a toddler, but I don’t know if the pregnancy was ever mentioned or shown in Suicide Squad or elsewhere.

Chesire
Gave birth to Lianne, fathered by Speedy/Arsenal (Roy Harper), but I don’t know if the pregnancy was shown.

Mist
Had a child by Jack (Starman). Do not recall if the pregnancy was shown.

Non-Super-Hero:
STRANGERS in PARADISE: Francine recently miscarried.

In my junior year at college, my hardest class was Physics 197. This was the second semester of general physics for science majors. It was harder than the first semester, because it dealt with more abstract concepts such as optics, electromagnetic waves, and quantum mechanics. It was taught by Dr. Bender, a Harvard-trained quantum physicist who liked to inject a little history into his lectures.

Dr. Bender had just finished up a particularly dense discussion of some of the finer points of quantum electrodynamics. He then started brought up some of the scientists who had made the field famous including Albert Einstein, Richard Feynman, and Freeman Dyson.

Looking around the large lecture hall, he asked if anyone had ever heard of Dyson.

Without thinking, I raised my hand. Surely if I had heard of him, lots of other students would know him as well. When the girl next to me nudged me in the ribs, I was mortified to discover I was the only one with my hand in the air.

“How have you heard of Dyson?” Professor Bender asked.

“Dyson spheres*,” I replied, my voice echoing in the still air.

He looked at me closely for a second, then nodded and said, “Very impressive.” Turning back to the chalk board, he resumed the lecture as the rest of the class glared at me.

I didn’t have the heart to tell him I only knew about Dyson spheres from reading about them in a comic book. Who knew all those years ago that New Mutants Annual #1 would make me seem smart to a university physicist? A dollar well spent.

*This was several years before the Dyson Sphere/Scotty returns episode of Star Trek: The Next Generation.

I’ve just finished the third issue of the new She-Hulk, and find myself quite enamored of the series. The story and art combine well to make a compelling read.

The art by Juan Bobillo is good in the way that it is deceptively simple, yet conveys the story well. There have been some complaints that his She-Hulk/Jen looks too much like a kewpie doll, or too young. While I agree that she is somewhat “kewpie” looking, I don’t think she looks too young. The art is emphasizing the waif-ness of Jen, and the simplicity of the She-Hulk (if she can’t smash it she doesn’t know want to deal with it). Each character is distinct, and his backgrounds are well drawn. The man absolutely cannot draw the Thing though.

Dan Slott does a good job with stories that highlight both sides with the Jen Walters/She-Hulk dichotomy. She-Hulk was shown as a wild party girl in the first issue, but that fit with her past portrayals. In the recent Avengers, Geoff Johns has shown her to be all business, but it’s always been well established that she has constantly favored her She-Hulk side and the freedom it represents. She’s always been a bit of a wild card, too. Remember that when she first joined the Avengers, she knocked Hawkeye’s taxi upside down, then picked up her own convertible, hoisted it on her shoulder, and carried it to the mansion.

I appreciate the fact that the stories play up Jen’s native intelligence and abilities. It’s been a long time since plain Jen Walters had a chance to shine. It was Jen who won the court case in issue #3, not the hot-shot lawyer. It’s clear that she’s realizing the importance her long forgotten human self just as she is beginning to understand that She-Hulk is just being used, particularly by the aforementioned lawyer.

The court cases shown in issues #2 and #3 are cleverly conceived. Both deal with situations that could logically arise in a super-hero universe. Both cases are concluded capably. Dr. Strange also makes supporting (consulting, really) appearances in both issues, but I don’t remember him being as omniscient as he is portrayed here though.

There is some enjoyable subtle humor in the issues as well. When Jen’s new neighbor is attacked by the Avenger’s security system of “super-strong carbonadium alloy”, he accuses her of just making up words. A few panels later, Jarvis shows up wielding a baseball bat and wearing a pan on his head; the pan he assures Jen, is made of “forbushion alloy.” Finally, in court, the Infinity Gauntlet is referred to as “Thanos v the Universe”, as if it were a court case.

Last but not least, I appreciate all the single-issue stories. While each issue builds on the previous one, each story is entire in itself. This is a nice change from the decompressed storylines in vogue now.

The Goblin Reservation, by Clifford D. Simak, tells the story of Professor Peter Maxwell. In the not too far future, humanity has rediscovered all the creatures of legend – elves, trolls, goblins, banshees, and so on. All of the supernatural creatures have been accounted for except the dragon. Maxwell, a professor of Supernatural at the University, has made it his life’s work to find a dragon.

As the story begins, Maxwell arrives back on Earth by matter transporter after spending several fruitless weeks searching a distant star system for rumors of a dragon. His transmitter beam was hijacked on his way to Earth, and he found himself a guest on a mysterious crystal planet for several days. While there, he was asked to share the immense knowledge of this mysterious planet with Earth.

He finally returns home to discover that his transmitter beam was not hijacked, but duplicated. Another Peter Maxwell returned two weeks before and died in a mysterious “accident.” Maxwell’s attempts to re-establish his life are complicated. His apartment has been leased to a new tenant – a graduate student with a pet saber-toothed tiger. His teaching job no longer exists. His friends want him to pay back the money they spent on his funeral wreath.

Meanwhile, he is trying to figure out what to do with this knowledge he has been asked to share. He is approached by a group of mysterious aliens, the Wheelers (who look like giant pill bugs on wheels), and who seem to know too much and wish to purchase this knowledge from him. How can he reconcile his own loyalties, return to his previously happy life, and fulfill his appointed duties wisely?

The book showcases the common Simak themes. The first is the search for knowledge. As a former newspaper reporter, Simak injects this into almost all of his characters, many of whom are reporters themselves. In The Goblin Reservation, the character Ghost represents this quest in its most basic sense. He knows that he is someone’s ghost, but he can’t remember whose. Peter Maxwell represents this idea turned on its end. Maxwell has the knowledge – but doesn’t know what to do with it. Who is he supposed to give the knowledge to, and how? The quests of both the Ghost and Maxwell are an integral part of the novel’s ultimate outcome.

Simak’s stories commonly show the struggle between the urban and rural ways of life. This is often shown as conflict between technology and the “simple life”. His characters are generally unassuming individuals thrust into some technological conundrum. In this novel, the Wheelers represent the technological aspect while Maxwell himself represents the uncomplicated rural lifestyle. Both his caveman friend, Alley Oop, and his goblin friends represent the ideal of the pastoral life; another concept common in Simak’s novels.

All of Clifford Simak’s science fiction novels are unreservedly recommended. He was a not a multiple award winner (Nebulas and several Hugos) by accident. His stories, originally written in the 1960s and 70s, still ring true today.

The Goblin Reservation is more light-hearted than most of Simak’s other novels. It is a near-perfect blend of action, humor, and conscience and has my highest recommendation.
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Rashes are fascinating. They are one of my favorite diagnoses to see in the office. It is amazing that the skin, a single organ, can respond in so many entirely different ways to a limited number of causes. Rashes can be red, blue, purple, red, white, brown or almost any other color of the rainbow. There are hundreds of textures, including bumpy, solid, flaky, or even slimy. There can be no pattern, a ring pattern, a swirl pattern, a Christmas tree pattern, or any of hundreds of other patterns.

Rash identification breaks down into three possibilities, all fairly equally spread. This gives us Scott’s Rule of Rashes:

1. One-third of the time I know exactly what it is. (“Why, that’s pityriasis rosea“)
2. One-third of the time I have a general idea of what it is, and a good idea of how to treat it. (“That looks like some kind of irritant dermatitis. We should be able to calm it down with a steroid cream.”
3. One-third of the time I have no idea.

I first formulated my rule of rashes when I started my career as an Air Force physician. As I’ve gotten more experienced and entered private practice, I find that the rule still holds true for the most part, although there’s less category 3 and more category 2 now.

I should have known from the start that it was going to be a bad day. I woke up late, which is unusual for me, so I didn’t have time to shave before I had to leave for my OB rotation at St. John’s Mercy Medical Center. My overnight kit was in the student call room, so I knew I’d be able to shave at the hospital before rounds started.

As I was walking into the OB ward, a couple of the nurses I passed mentioned that I was looking pretty pale. I just smiled and said, “I’m always pale.” Not until I was shaving did I realize that I really did look pale. I had given blood the day before, so that probably explained most of it. I wasn’t worried; our routine was always the same: pre-rounds on the OB patients with the residents, a leisurely breakfast, then full rounds with the attending physician. I would have plenty of time to rehydrate and get a good breakfast.

Unfortunately, things didn’t work out that smoothly that morning. In the middle of our pre-rounds, an emergency C-section came in. The attending grabbed the two residents and me, and we all scrubbed in to the surgery.

The surgery went well, and the infant was delivered quickly and without any difficulty. The attending turned to the youngest resident. “Steve, have you ever sewed up a C-section?”

“No, sir,” he said.

“It’s all yours,” the attending replied, removed his gloves and gown, and stepped out of the room.

The trick to a C-section is that there are many different layers involved (OK, the real trick is to get the baby out – that’s definitely first). You need to sew up the uterus, the peritoneum, and then the skin itself. Sometimes multiple layers of suture are placed in the uterus or the skin. An experienced physician can do this quickly, and sew up all the layers in no more than 5 minutes. She will usually staple the skin layers, as staples heal well, and are fast to put in and easy to take out.

Steve, however, was anything but experienced. Slowly, very slowly, he began to examine every square inch of the uterus. He took the needle holder and suture and made a very small, precise stitch. He looked closely, and then took another stitch. This laborious process was repeated for the sixty tiny stitches he used to close the inner layer of the uterus. He then started on the outer layer, using a slightly bigger suture, but the same slow routine. By the time he was finished with the uterus and started on the peritoneum, we had been in the OR for over an hour.

I started to get very sweaty. The gown, mask, and cap that everyone has to wear in the operating room are always very warm, but this was worse than usual. I developed a cold sweat and then began to feel a little nauseous as well. I took a deep breath to clear my head, and took a firm grip of the table to steady myself.

Meanwhile, Steve continued his slow, precise suturing.

My sweats got worse. I started to shake and get a little light-headed. I gripped the table tighter, and concentrated on what Steve was doing.

He had finally finished repairing the peritoneum and moved on to closing the skin. Please, I prayed, use the stapler. Instead he picked up more suture and carefully measured the incision before he started in with another tiny stitch. He took a second stitch then stopped, eyed the incision critically, and pulled both stitches out.

Sweat was pouring down my face and my vision was blurring. I was feeling dizzy but I was determined to make it through the C-section. Steve had started again and placed three stitches in the incision. He stopped, measured, and placed two more stitches. Another pause, then another stitch. He stopped again and ripped the last stitch out before starting again. He had repaired barely one inch of the eight-inch incision.

At this point, it was taking all my effort to stand upright. I had visions collapsing face first into the operating field. I stepped away from the table, ripped off my surgical mask, gown, and gloves and bolted from the room. I stumbled down to the doctor’s lounge and collapsed on the couch.

After five minutes, I got up and crawled to the fridge. Opening it, I found a can of Coke and quickly drank it down. After another half-hour and another Coke, I felt strong enough to leave the lounge. I returned to the ward, where Scott had just finished the C-section. I walked up to him and apologized for breaking scrub and leaving the OR.

“You left?” was his puzzled reply. He was so intent on suturing that he had never even noticed that I had left. He teased me about leaving the OR for the rest of the rotation.

I should have kept my mouth shut.

I love video games. I have been playing video games for close to two decades now, and own a few (ahem) game systems. As I get older, however, I find that fewer and fewer games are appealing to me.

In some cases, the subject matter itself, or the way it is portrayed, is offensive. Some genres and titles just don’t interest me (football games, for example). Most of the problem is that I’m just not getting my money’s worth out of games anymore. Ironically, it’s not because they’re too short, but instead they are too long. When I was in school, or even residency, I had a lot more free time. When I was off duty, I was free. No “home call”, no family, no house to take care of. Then, I could spend 90+ hours finishing Final Fantasy VII. Now, that’s no longer practical. I need games that don’t go on forever. Games that don’t require a hint book. Games that I can finish before I lose interest.

The industry needs to pay more attention to the desires of mature gamers. We need games that are playable, fun, and finishable. Mature gamers may not be as numerous as younger gamers, but I suspect we have a great deal more money.

I would like to see games that:

• Can be finished in a few good weekends (around 30 hours of gameplay).
• Have a gentle learning curve and a logical control scheme.
• Are replayable (hidden areas, power-ups, etc.)
• Have good graphics and a good storyline.
• Are divided into manageable areas and have a good save system.

True, some companies make “budget games” that are shorter, but they generally are of shoddy quality all around. I want to see big budget games that can be enjoyed by people with limited time (and in some cases, limited abilities).

The two Ratchet & Clank games are good games. The basic game takes just about 20-30 hours, but there are many areas to go back and explore after the game itself is finished. Saves are logical, and finishing a level is a good nights play. The graphics are good, the voice acting excellent, and the story line in engrossing with lots of humor.

Primal is also a contender. The game is longer, but allows you to save anywhere. The graphics are excellent, and it has the best voice acting I’ve ever heard. The captivating story is easy to follow yet captivating.

The new Pitfall games does not come close. The control scheme is awkward and the save game scheme poorly thought out. The levels vary from simplistic to near-impossible-to-figure-out-what-the-designer-had-in-mind. The story and graphics are childish.

The score…. Ratchet & Clank 1 & 2: good. Primal: good. Pitfall: Bad. A game industry that listens to mature players: Important and needed.

Another dreary Sunday in Illinois, so the long bike ride gets put off again. I managed to get a moderately-long very-fast ride in yesterday, so all is not lost, but I was looking forward to a nice long ride today. On the bright side, the rain gives me an excuse for not mowing the lawn.

The Polite-wife and I went to see Harry Potter and the Prisoner of Azkaban last night. It was excellent and enjoyable from start to finish. This was the best of the Harry Potter moviesso far, and the new director gives it a much more cinematic feel than the previous movies. I particularly liked his subtle way of showing the seasons changing by focusing on the Whomping Willow without having to explicitly state “It’s fall now.” The acting was superb. I think this is one of the fist movies I’ve seen with Gary Oldman where (spoiler warning) he was not the bad guy.(end spoiler). David Thewlis (who played Professor Lupin) was also good — I know I’ve seen him somewhere before but I’m sure where, and IMDB did not help this time. In terms of cameo roles, I liked seeing Dawn French (of French & Saunders and Vicar of Dibley fame) as one of the paintings, and Peterson from Red Dwarf as Ron’s Father.

Michelle at the Underwear Drawer has some excellent thoughts on medicine, a life in medicine, and medical blogging. If you have any interest in medicine, go read it (the comments too). The Dr. J quote is wonderful. There are certainly days when I wonder whether a life of clinical medicine was the right choice, but then I realize that there’s absolutely nothing I would rather be doing. So, right choice! It’s certainly true that some physicians make a great deal of money, but I can guarantee that none of those doctors are primary care doctors (family practice, internal medicine, pediatrics). No one goes into primary care for money, but rather for the enjoyment of the job.

Other Sunday Blog-o-bits:
1. Three weeks until the Tour de France!! (Go Lance!)
2. The Food Whore. An enjoyable blog by a caterer. A fun read, particularly if you’ve ever worked in catering or the restaurant business (I had to pay for college somehow!). Thanks to Ilyka for the link.

Fantastic Four #73 (Third Series) 5th Wheel, part 2
Mark Waid, writer
Casey Jones, artist

In Fantastic Four #73 (or #502, depending on which numbering system you use), Reed Richards and Johnny Storm traveled back in time and cut a sample of hair from Victor von Doom’s head. Reed then uses the DNA from this sample to make armbands protective against Castle Doom’s defenses in Fantastic Four #74.

The problem is that hair is composed of protein molecules and not cells and has no DNA. Hair samples can have DNA if they are pulled out or fall out, as most of these hairs still have the follicle attached, which does have cells and DNA.

However, Reed cut a hunk of Doom’s hair off with a laser – leaving no follicles, and no DNA. (Now maybe Doom had bad dandruff, so some scalp flakes were in the hair sample allowing Reed to get the DNA he needed. This bad dandruff would have led to awkward teenage years and rejection after rejection from the girls. His self-esteem plummeting, Doom had no choice but to flee Latveria for schooling in the U.S. Furthermore, the teen angst he experienced due to his bad dandruff could have been the spark that led him to seek revenge and world domination. And to think that Dr. Doom’s megalomania could have been cured by a bottle of Selsun Blue…)

As Dr. Midnight’s associate Nite-Lite gives Hourman and Wildcat a tour of the Cross Medical Clinic, he explains why they have a room full of high-tech equipment:

Last year, a self-aware strain of Camel Pox callin’ itself the seeing plague blinded three-hundred people in Portsmouth…Doc says we gotta be prepared with more than a pair of eye scissors and aspirin.

Camel Pox is a real disease caused by a virus closely related to Smallpox. It causes fever and mouth sores on camels. There have been no cases of Camel Pox infecting humans. There is some concern that it is close enough to Smallpox to have the potential to infect humans if it mutates (or is mutated) the wrong way.

A cluster of infection from a mutated Camel Pox virus is well within the realm of possibility. I would expect symptoms similar to its effects in camels, but with a self-aware virus, I guess anything is possible. (But why does a virus calling itself “The Seeing Plague” cause blindness?)

The Adventures of Pete & Pete was a great half-hour comedy that used to be shown on Nickelodeon (and now sometimes appears on Noggin). It follows the adventures of two brothers both named Pete. The older Pete is in high school and a reluctant conformist, while the younger Pete is in junior high and a serious rebel. Their parents were pretty much the typical clueless sit-com parents, but each brother also had their own group of friends – and enemies. The older Pete’s best friend was Ellen, and his enemy “Endless” Mike. The younger Pete has best friend Nona (played by Michelle Trachtenberg…better known as Buffy’s sister, Dawn), and a group of adversaries including Pit-Stain and Hair-Net.

The show had a definite surreal quality about it, and never took anything seriously. Show subjects included turtles, curfew, dating, adult jobs (ugh!), bowling, fishing, lawn care, ice cream, and tricycle racing.

Guest stars were common. Adam West had a recurring role as the junior high principle and Steve Buscemi played Ellen’s father. Other guest shots included Michael Stipe, Debbie Harry, Iggy Pop, Janeane Garofalo, Bebe Neuwirth, Syd Straw, LL Cool J, Frank Gifford and even Hunter S. Thompson.

Some of the best episodes include “Time Tunnel” (using Daylight Savings Time as a means for time travel), “35 Hours” (Dad and Mom go on vacation; Pete and Pete sell the house), and “Last Laugh” (Pete is determined to pull an April Fool’s Day prank on the Principal).

Ostensibly a children’s show, there was a great deal of mature humor and clever cameo roles. If any show is deserving of the DVD treatment, this is it!

JSA All-Stars #5 An Hour at a Time
Geoff Johns and David Goyer, writers
Adam DeKraker, penciler

This this issue focuses on Rick Tyler, the current Hourman and son of the original Hourman. While there is some decent medicine in the story, there is an abundance of bad medicine, plus some serious logical errors as well.

Rick is talking to his mother about his reformulation of the drug Miraclo, which gives him his “hour of power”:

It’s a homeopathic solution now. Delivered through a transdermal patch in my glove.

The fact that Miraclo is “homeopathic” makes no sense. Based on an 18th century medical theory, homeopathic medicines follow two basic principles: the Law of Similars, and the Law of Infintessimals. According to the Law of Similars, to treat a particular symptom a substance that causes similar symptoms is used (for instance, you’d use a substance that causes a fever to treat a fever). The Law of Infintessimals states the more dilute a solution is, the stronger its effect. Homeopathic solutions are diluted by orders of magnitude to such an extent that it is statistically unlikely that even one molecule of the original substance is left in the final preparation.

Leaving aside the scientifically dubious claims of homeopathy, let’s focus only on the Law of Similars. Super-powers are not a symptom. How can you “treat” super-powers by using another substance to cause them? I suspect the writers are using “homeopathic” to mean natural, or non-synthetic, but the terms are not interchangeable (they mean very different things). As it stands, Rick’s comment is technobabble at its worst.

Transdermal administration of Miraclo is a possibility. Many drug preparations are available now that are absorbed through patches on the skin. However, the absorption of medicines through the skin tends to be a slow process, and is best for long term steady-state drugs (like hormone replacement or pain killers). It wouldn’t be fast enough to give Rick his power when he needed it.

Next, in the middle of lunch, Rick has a premonition that a man is going to commit suicide by jumping from the top of a nearby skyscraper. He rushes to stop the man.

After racing to the top of the building, Rick has a sudden realization that he has an addictive personality. This makes sense. There are certainly people who have problems with addiction after addiction. It makes since that Rick, who was once a drug addict, now gets his kicks from the adrenalin rush of being a hero.

Speaking of Rick racing up to the top of the building, why did it take so long? It took him over 50 minutes to get from the 1st floor to the roof (80 flights of steps). It took me 47 seconds to climb 5 stories (10 flights) of steps at the hospital this morning. At that rate, it should take 12:32 to reach the top of an 80-story building. Admittedly, this calculation does not take fatigue into account, but 1) I walking briskly, not running; and 2) I didn’t have Miraclo surging through my body. It should not have taken Rick that long to get to the roof.

The numbers make even less sense when they are broken down further:

It took nearly two minutes per floor for the first six, but only six-seconds per floor for the last 22. It seems that I was right about transdermal being slow, and it took over 50 minutes for the drug to kick in.

Finally, let me point out the “count-down clock” in the issue is not counting down Rick’s hour of power, but instead the amount of time until the man jumped to his death. Rick’s hour started at least a minute and 16 seconds later. The whole ending, where Rick runs out of power just as the man jumps, is contrived. He still had at least a minute of power left.

After picking on Hourman in JSA All Stars #5 last night, I now turn my attention to JSA All Stars #6, where I get to pick on one of my favorites, Dr. Mid-Nite.

JSA All-Stars #6 Out of the Shadows
Geoff Johns and David Goyer, writer
Stephen Sadowski, penciller

In the prologue to the story, the Spectre states that Dr. Mid-Nite (Pieter Cross) “lost his residency after exposing an insurance scandal”. Assuming Dr Mid-Nite is practicing medicine legally, he must have completed at least his first year of residency training, as this is required to obtain a medical license (some state require two years). Addendum: According to the Washington State Department of Health, two years of residency are required for a full medical license if the physician graduated after 1985. Foreign medical graduates face extra requirements. Pieter mentions that he was born in Norway, but it has not been explicitly stated when he came to the U.S.

Exploring the scene of a gas main explosion, Pieter finds a pregnant woman trapped in a subway car. Carrie, the pregnant patient, informs Pieter that she cannot move because her water just broke. In other words, the membrane holding the amniotic fluid which surrounds the infant has ruptured. Generally, delivery comes shortly (but not immediately) after the rupture, but this is quite variable. Note that Carrie says nothing about contractions, or “being in labor”; other than the rupture of the amniotic membrane, there is nothing more to suggest that delivery is imminent. It would be a good idea to move her to a safer location prior to childbirth.

Dr. Mid-Nite uses his ultrasonic vision to check out the infant. His ultrasound is extremely detailed, much more than current technology, but then he has always been ahead of the curve. There seems to be quite a bit of amniotic fluid surrounding the infant for a mother whose water just broke.

Next, Pieter uses a spray to sterilize everything around them. How necessary is this? Opinions vary. Childbirth is an inherently messy and non-sterile situation. Certainly, extra precautions and cleanliness never hurt. The most important thing (particularly for the mother) is for the doctor to have clean hands during the delivery. However, Dr. Mid-Nite never washes or sterilizes his hands, despite handling debris, skin, and clothes before delivering the baby.

Pieter offers Carrie the narcotics meperidine (Demerol) or butorphanol (Stadol) for the pain, which she declines. Meperidine is not used much in the U.S. for pain control during childbirth, but butorphanol is still common. Generally, narcotic drugs are avoided because they have the potential of slowing the infant’s respiratory drive. As noted in a previous post, offering narcotics to this patient is legally questionable.

Dr. Mid-Nite successfully delivers an infant girl. Umm, where’s the umbilical cord?

After the delivery, Dr. Mid-Nite escorts Carrie and her new daughter to medical help:

The child’s fine. But the mother has a fractured ankle. Minor lacerations. And they both need oxygen stat.

If the infant is fine, then why does she need “oxygen stat.” Same for the mother; if she only has a fractured ankle and minor lacerations, why does she need oxygen.

Maybe they both suffered smoke inhalation, in which case oxygen is an appropriate therapy…but then the infant wouldn’t be “fine”, and Dr. Mid-Nite should have mentioned smoke inhalation in his report to the medics.

To end on a good note, Pieter did swaddle the infant, keeping it warm. This is very important in newborns, as they have poor temperature regulation.

I was sitting at my table in the hospital tent early one Wednesday evening, typing on my laptop, and trying not to think about the 120 degree heat we were experiencing on our deployment in the Arabian Peninsula.

The tent door opened, and Gene, one of the vehicle maintenance sergeants, came in.

“Doc,” he said. “Something funny’s going on with my right eye.”

“What’s that?”

“I haven’t been able to see well out of it for the last couple of days. There’s one spot where I can’t see at all.”

I beckoned him over to sit down on the cot and looked closely at his eye.

“Did you injure your eye? Or get anything in it?”

“I don’t think so.”

I did a quick exam, and both eyes moved and responded normally. I got out my ophthalmoscope, and looked at his retinas. This is a difficult exam to do under the best of circumstances, and in a bright hot tent it was particularly difficult. Both retinas looked pretty normal, though there seemed to be a slightly pale spot on the right.

I did a confrontation exam, which revealed that he had a fairly significant blind spot in the upper outer quadrant of his right eye.

Read more…

Less than a week after my postive review of She-Hulk, the latest All the Rage column suggests that Paul Pelletier will be taking over as penciller. I understand that many people are turned off by the current artist Juan Bobillo. I like his waif-ish drawings, and think they compliment the intellectual/lawyer side of the character well, but I can see that they are an acquired taste.

While I am sorry to see him go, Pelletier has shown that he can draw a good She-Hulk (in Incredible Hulk #412, for instance). He’s great at the action shots, but I’ll be interested to see how he does with the courtroom scenes. On the other hand, much of The Negation was characters sitting around and talking, so it can’t be much different than that.

Good luck to Bobillo, I’ll keep an eye out for him, and welcome to Pelletier.

My medical review of issues #1 and #2 of Kinetic can be found here.

Kinetic #2 Stupid Pretty
Kelley Puckett, writer
Warren Pleece, artist

This issue starts out with Tom in the hospital after having suffered what seems to be some kind of seizure at the end of issue #2. The doctors refer to Tom as having suffered a grand mal seizure. A grand mal (or gran mal) seizure is also known as a generalized tonic-clonic seizure or a major motor seizure. It is what most people think of when they think of seizures, with the patient suffering rigidity and then jerking of the whole body. Tongue biting, loss of postural control, and incontinence are common.

However, Tom is showing no evidence of the muscle activity associated with a grand mal seizure. He instead seems to be having a petit mal seizure. This is also known as an absence seizure, and is characterized by a prolonged staring spell with a vacant expression. Like a grand mal seizure, loss of body tone and incontinence are common.

If he was having a grand mal seizure, I’m impressed that the nurses were able to place an IV; it can be challenging enough on a quiet patient, let alone one who is jerking and thrashing.

Seizure patients are extremely tired for hours after a seizure, but Tom doesn’t seem to be experiencing this post-seizure tiredness, and is actually rather garrulous.

Overall, the book proceeded along at a pace that can be generously referred to as glacial. By the end of the third issue, Tom is just beginning to realize that he has some sort of poorly defined superpowers.

I’m also a little puzzled by his mother’s attitude. For the first two issues, she was clinging to Tom, and not letting him have any freedom. Suddenly – the day after a seizure requiring a trip to the hospital – she’s leaving him alone.

I’m enjoying the comic. It has a complex character in Tom, and it’s interesting seeing him come to terms with the changes in his life. The art, especially the coloring, is bland with a very limited palate, but I suspect that’s intentional to show the bleakness of Tom’s life. I look forward to reading more issues of Kinetic, but I worry that its slow pace will not allow it to build enough of an audience to continue.

Medical errors show up commonly in hospital scenes. Tubes and wires running to and from the patient look impressive, but most are drawn incorrectly and probably not needed at all. Patients are commonly shown receiving oxygen, either by a face masks or nasal tubes known as nasal canulas.

This first lesson is going to focus on supplemental oxygen delivered by nasal canula because it is seen commonly in comics, and almost always wrong.

First, does the patient need to be on oxygen at all?
1. Do they have a lung condition (asthma, emphysema, pneumonia)
2. Do they have a heart condition (angina, heart attack, congestive heart failure)
3. Did they just undergo extensive surgery (especially if they were weak or sick to begin with)?
4. Is the patient a pregnant trauma patient?
If then answer to all these questions is “no”, then the patient probably does not need extra oxygen.
As a side note, a nasal canula can only provide up to 45% oxygen. Anyone who needs more oxygen then that will need a special face mask. Nasal canulas will not help someone who cannot breathe on their own; those people need to be intubated and placed on a mechanical ventilator.

Second, is the nasal canula shown correctly?
It needs to provide oxygen to both nostrils. It should be looped behind the ears (like a pair of glasses), then down the neck. The main reasons for this are comfort and mobility. Nasal canulas are already uncomfortable; they shouldn’t be pinching the nose or requiring tape to be held in place. It’s also important for the cannula to stay in place as the patient moves around in bed, or walks around.

Examples:
1. District X #1 – Officer Kucharsky suffered a grazing head wound. His lungs and heart are fine. He does not need to be on oxygen. Additionally, his nasal canula is drawn wrong as well, only providing oxygen to one nostril.

2. Daredevil #58, 59 (current series)– Daredevil was beaten up, but probably does not need oxygen (unless he suffered a pulmonary contusion or broken ribs and is not breathing deeply enough). The canula, while it goes in both nostrils, would not be comfortable and would fall off if he moved.

3. X-Treme X-Men #31 – The patient has a dual pronged nasal canula, but it is not looped around correctly and is taped in place. (And why is there a thick tube going to the eye socket? Ewww!)

4. The Dreaming #9 – Bridget is in a coma, and is hooked up to oxygen (but by very uncomfortable looking dual nasal canulas taped in place). I doubt she even needs oxygen: sShe’s not pregnant, and has no heart or lung problems.

5. Gen 13 (second series) #2 – Kudos to Chris Claremont and Ale Garza here (though I’ve picked on both of them before). Hamza is in a coma, but is correctly shown to not need supplemental oxygen.

When I started collecting comics, there were two titles that I collected religiously: The X-Men, and The Micronauts. The Micronauts started out as a line of science fiction toys with interchangeable parts, but soon became a comic published by Marvel. I was a big fan of the toys, but the star-faring tales in the comic really fired my imagination. The comic related stories of the Micronauts, heroes from another dimension (the Microverse), who traveled to Earth where they were only six inches tall. It may sound silly in retrospect, but it was handled very well (and I was only eleven at the time).

The Micronauts consisted of: Commander Rann, their leader and possessor of the psychic “Enigma Force”; Marionette, princess of Homeworld and lover of Rann; Acroyear, King of the warrior planet of Sparta; Cecilia, Acroyear’s queen; Bug, insect-like warrior from the planet Kalikak; and the robots Microtron and Biotron.

Since defeating the evil Baron Karza in issue #11, they had been exploring Earth in their ship, the Endeavor.

The series reached its creative peak in issues #26, 27, 28, which featured the Micronauts and S.H.I.E.L.D. battling the combined forces of Hydra and Baron Karza.

In Micronauts #26, the Micronauts travel to the S.H.I.E.L.D. Helicarrier and find themselves in the middle of a Hydra assault. Acroyear and Cecilia aid S.H.I.E.L.D. in combat against Hydra. Bug gets lost in the Helicarrier, and discovers a laboratory devoted to the Microverse. Inside, he discovers Dagon, another Acroyear warrior, and revives him from suspended animation.

Commander Rann and Marionette look for the S.H.I.E.L.D. psychics, who seem to be the root of the disturbance. They find more than they bargain for when they discover that Baron Karza has returned from the dead. Marionette is apparently killed by Karza, but actually returns to the Microverse where she takes command of the rebel forces there.

In Micronauts #27, Baron Karza explains his plans, but Shaitan — Acroyear’s evil brother — is not happy that he is being excluded. S.H.I.E.L.D. and the Micronauts determine that Karza’s and Hydra’s plans hinge upon a certain world famous amusement park in Orlando, Florida. They travel there to confront them.

As Acroyear, Cecilia, and Bug aid S.H.I.E.L.D. in fighting Hydra, Commander Rann flies off in search of Baron Karza. Dagon, Microtron and Biotron stay behind guard the ship, but Biotron is slain — apparently by some of Karza’s dog soldiers. Rann confronts Karza, only to be defeated and have the Enigma force ripped from his mind.

In Micronauts #28, S.H.I.E.L.D. and the remaining Micronauts make their last stand against Hydra. At the last moment, Shaitan betrays Karza, allowing the rebel fleet from the Microverse to arrive on Earth and save S.H.I.E.L.D. Acroyear confronts Karza, but is not powerful enough to defeat him. He summons the Worldmind, the soul of his planet of Spartak. This act, while granting him great power, also causes the destruction of Spartak. Esmera, queen of the planet Kalikak, attacks Karza with her “suicide sting”, allowing Acroyear an opening to defeat him. The Micronauts and S.H.I.E.L.D. win, but at a high cost: Commander Rann is in a coma, Queen Esmera is dead, and Spartak has been destroyed.

The writing by Bill Mantlo is exciting and action packed. Smaller stories that have been building for over a year are successfully merged to form a powerful narrative. The characters are larger than life, but then, so is the conflict. The dialogue is overly dramatic at times, but since when has Nick Fury every talked in a normal manner? The art by Pat Broderick is sometimes busy and the inking can be muddy, but it conveys the excitement and action well.

The covers are thrilling and eye-catching, especially compared to today’s flat poster-like covers. The cover to #26 shows Nick Fury grappling with a Hydra agent in front of a large Hydra Symbol. The Micronauts rush to assist in the foreground, while Baron Karza, eyes glowing red, stands powerfully in the back.

The cover of issue #27 shows Commander Rann and baron Karza locked in combat, with a psychedelic red background that seems to have been drawn on a Spirograph.

Finally, issue #28’s cover shows Karza and Acroyear in combat while the rest of the Micronauts look on. The type on the cover is dramatic as well: This issue: Rann – Doomed! Karza – Defeated! The Planet Spartak Destroyed! Be There!

In addition to the stunning stories and covers, there are some classic ads in these comics. There ads for joke products and magic tricks are well represented, as are the Hostess mini-comic ads; the ones in these issues feature Daredevil and the Human Torch. Charles Atlas has an ad, of course, as does PEZ. On the back covers are ads for Monogram models, LEGO expert sets, “132 Roman Soldiers just $2.98”, and who can forget that you could make money by selling America’s favorite paper: Grit.The in-house ads are for Roger Stern and Frank Miller’s Doctor Strange, and two new comics: Captain Universe, and Dazzler!

Rereading these comics twenty-plus years later, they still hold up well, and are as exciting now as they were then. The.Micronauts had some good stories after this (and more mediocre one), but never again reached the level of epic greatness these issues represented.

I finally got around to updating the blogroll. I added a bunch more Comic Blogs (or mostly- or frequently-comics blogs). One, I had to abbreviate (and you know who you are), because the name seems to be a paragraph in and of itself. The sites on my blogroll are those that I visit daily. If your name’s not up there, it probably means that I haven’t stumbled across your site yet. I have yet to find a comic blog that I actively dislike (or even passively dislike).

The sites listed under Political Blogs I read daily as well. Some I frequently do not agree with, but they are always well written and give me something to think about. Life would be boring if we all thought alike.

I haven’t added anyone new to the Medical Blog list yet because I am extremely picky in this area. There are many good sites out there, but too many seem to espouse medical views (as opposed to political views) I do not agree with and cannot condone, or have some obvious agenda. So for now, just enjoy Michelle’s blog for your medical-entertainment blogging (besides this one, of course!)

I may not have as much search-term excitement as Grotesque Anatomy, Peiratikos, or Progressive Ruin, but due to the medical/comic nature of this blog, some interesting search terms do show up. Some also seem to show up that seem to have nothing to do with either medicine or comics.

I hope those who stumbled across my site looking for actual medical advice found a good site (I recommend FamilyDoctor.org), and maybe decided to pick up a comic book along the way.

Here are some of my favorites so far (search terms in bold, my comments in italics):

• super pubic catheter I assume they’re looking for “suprapubic catheter”, though “super catheter” does bring to mind rubber tubing wearing spandex and a cape
• pityriasis rosea caused by vicodin use well then, don’t use the vicodin (but don’t worry…it doesn’t cause PR)
• e-bay empty narcotic bottles is this even legal?
• shrek godmother incest I got nothing to add to this
• classic philosphical arguments how this got directed to my site, I have no idea
• batman catheter rubber suit this one stands on its own
• dr doom degree I’ll proudly claim this one
• tusky the walrus I’ll claim this one too
• multiple hairs coming from human follicles feels like wire looks like worm I hope they found some help

First off, HAPPY FATHER’S DAY!!

It’s been a busy weekend. I was on call again (and next weekend too!) as the partner is on vacation. The landscapers came on Friday and re-seeded our front and side lawns, and totally redid the back yard. So the Polite-wife and I have been running out every 15-minutes for the past two days moving sprinklers.

Yesterday was our front-desk receptionist’s wedding. It was a nice smalltown-midwest wedding, which means lots of beer at the reception (not me, I was on call). The rest of the office gang was there too (except the big boss, who is on vacation), and a nice time was had by all. No Jordan Almonds, though. What’s a wedding without Jordan Almonds?

Only one Blog-o-Bit this week (been busy tracking mud in the house):
1. Two weeks until the Tour de France! Interesting news this week, with a book being published suggesting Lance was blood doping with Epogen (a drug that increases red blood count and thus oxygenation of the blood), and Lance threatening to sue the publisher for slander. Between him and Marion Jones, it should be an interesting summer for drug testing…

I am really getting sick of “decompressed” storylines. First of all, what does decompressed mean? Were the previous stories compressed? I suspect it’s just a fancy way of saying “padded out for at least three extra issues.”

I have nothing against multi-part storylines. Suddenly, however, every mainstream comic seems to be churning out stories in five- and six-part story arcs. The trouble is that the storylines can’t support that long an arc. What would have been a great two- or three-part story is stretched and padded so much that the readers lose their interest part way through. I find it hard to justify spending my hard-earned money on books that go nowhere fast.

Some books can handle the longer arcs better. Sandman could pull it off, and Fables handles it well. Most other books don’t.

I’ve been getting more and more irritated about these long storylines, but what brought it to a head was Supreme Power #10. It took 22 pages and $2.99 to say “Princess leaves cave, goes to Hyperion. Doctor Spectrum wakes up in cocoon, talks to naked finned woman; then he leaves.” Three bucks for that? There was more story between commercials in Babylon 5! Sure, there was some nice art in the issue (and lots of fan service) by Gary Frank, but that still comes nowhere close to salvaging the issue. My money and I are going elsewhere.

Sean at Attentiondeficitdisorder Too Flat, and his missus at Lexapropriate Ramblings (and I have to say that I love that name) are hosting a contest to determine which comic their cat likes best.

Unfortunately (or fortunately), I have minimal artistic skill, so I have no hope of winning their contest. However, I will match my cats (and their reading habits) against their cat.

WARNING: Gratuitous cat photos follow
Read more…

The House of God is an autobiographical “novel” of a physician’s intern year at a large New York City hospital. It was written in the 1970s when all residents, regardless of their specialty, shared a common first year. An intern would routinely (and legally) work 100 hours/week at that time and carry a heavy patient load.

Things had improved by my residency in the 90s, and have improved even more today. Don’t misunderstand me, the intern year is still the hardest year of any physician’s life, but it’s at least a little easier today than it was thirty years ago.

Still, the House of God is a terrific read. Portions of the book are scary, some are haunting, many are hilarious, and several are heart-breaking. It stands as a testament of what it took to be a doctor in the 1970s, and what it still takes today.

Plus, it’s very funny.

One of the banes of my existence as a medical student was the type of student known as a gunner. “Gunner” was the term for the medical student who sat in the front row and never missed a class. They used at least three different colors of ink to take notes, and their text books had more highlighting than text. They lived in the library going over their notes time and again. These were the students who would ask question to make themselves look good.

Some teachers loved gunners, some hated them, but most just put up with them. Remember, all of our teachers were medical students once themselves, so they know what being a gunner meant.

We had close to fifteen gunners in my class. Most of them were easy enough to ignore. One gunner, however, earned the enmity of our entire class. Her name was Becky. Socially, she was a very nice person. Put her in a classroom though, and she lost all of her social skills and became obsessively focused on the lecture and her grade. What set her apart from the other gunners was how she dragged the whole class down with her.

A perfect example of this was Gross Anatomy (the class, not the movie). After our first Anatomy exam, she told the professor that his questions were “too easy.” Take it from me, they weren’t too easy. I passed the test, and did modestly well, but it took all my meager skills to pull it off.

Becky’s comment offended Dr Y-, the Anatomy professor. He had been teaching Anatomy for thirty years, and was originally going to retire before my class started. No other professor could be found who was willing to teach anatomy though, so he stayed on to teach my class. He had this huge database of thousands of anatomy exam questions, each rated 1-5 (with 1 being easy and 5 being incredibly hard). A normal test was mostly questions rated 3, with some others thrown in for color. After Becky’s comments, the test questions went from an average of 3 to an average of 4 to 5. The class score dropped by over fifteen points. Thanks a lot Becky!

Sometimes, the teacher got the last laugh. One of our Histology exams had three “E: none of the above” answers in a row. After the test, Becky stormed up to the teacher and complained that the test was “educationally invalid” because of all the none of the above answers. The teacher merely nodded and smiled.

The next Histology exam featured two full pages of none of the above answers.

One of the concluding ideas of the Hush storyline in Batman was that the Riddler knew that Bruce Wayne was Batman, but that it didn’t really matter because nobody would believe him because he was the Riddler.

Barely a year later, the Joker is saving the Riddler’s life in Batman: Gotham Knights because he wants to find out from the Riddler who killed his wife. Clearly he believes what the Riddler will tell him about this, so why wouldn’t he believe him about Batman?

It seems to me that Loeb just wrote himself into a corner in Batman, then decided it didn’t matter and went for the easy way out.

Speaking of the current Gotham Knight storyline. It’s trying to make Hush into a more fearsome villain, and for the most part it’s succeeding, but Hush still has a long, long way to go. I have to ask: why bother? Hush offers nothing other villains with more style don’t already offer. Sure, he’s better then Benedict Arnold, but just barely (and Arnold’s a snappier dresser). Again, it seems that DC has painted itself into a corner by promoting Hush, and is now trying to prove (to us, and to themselves) that he is a good villain. Please don’t. Just stop now. Please!

As anyone reading my last post can surmise, I was not a big fan of the Hush storyline in Batman. It was overwrought, underdrawn, and padded in terms of both characters and storyline. Sure, Jim Lee can draw. But remember when he used to draw action instead of pin-ups? Remember when characters were added to the story to add substance, not to give the artist another character to draw (and DC Direct another statue to sell)? Sigh.

Still, I would have loved to be a fly on the wall when Jeph Loeb was pitching the story to Paul Levitz, President of DC…

Jeph: Paul. I’ve got this great idea for a new Batman villain…Hush!
Paul (whispering): What’s his name?
Jeph: Hush!
Paul (still whispering): I’m being as quiet as I can!
Jeph: No, Hush is his name!
Paul: Oh. What are his powers?
Jeph: He’s a neurosurgeon!
Paul: A neurosurgeon?
Jeph: He’s the best damned neurosurgeon in the whole world!
Paul: Oh. Who is he?
Jeph: I’m going to introduce Bruce Wayne’s best friend from childhood in the first issue. That’s who Hush will be! I’ll fool everyone!
Paul: So you’re going to fool everyone by having him be the obvious choice?
Jeph: Exactly!
Paul: Oh. And what sort of costume will he have?
Jeph: It’s brilliant in its simplicity and originality: He’ll wear a trench coat and have bandages around his head!
Paul: So Batman’s new villain will look like the Unknown Soldier.
Jeph: And I’ll have Two-Face seek redemption by getting plastic surgery!
Paul: Didn’t Frank Miller already do that in Dark Knight Returns?
Jeph: No, he copied me.
Paul: What?
Jeph: You see, Dark Knight Returns is set in the future, and therefore will happen after my story. Thus, Miller copied me!
Paul: I don’t think that-
Jeph: And I’ll have Catwoman, Superman, and Krypto. And there’ll be Poison Ivy, Harlequin, the Joker, Clayface, Huntress, and Killer Croc! I’m even thinking about bringing back Signalman! And Benedict Arnold!
Paul: Jeph, how are you going to get people to buy this alleged “masterpiece.”
Jeph: I’ll have Jim Lee do the art.
Paul: Well, OK then. Sounds good.

In the comments to yesterday’s post on the Riddler and Hush, Dave Lawson brings up the point that the Riddler is keeping quiet because of the threat of Ra’s Al Ghul, not because other villains wouldn’t believe him. Dave is right, in Batman #619, Batman does threaten the Riddler with the League of Assassins.

However, the exchange I was referring to occurs on the page before that, where Batman confronts the Riddler about knowing his identity. Batman tells the Riddler that he knows he won’t tell others because “a riddle is worthless if everyone knows the answer.”

Umm…I guess that’s true. But:
1) The Riddler already told Thomas Elliot. What’s one or two more? I’m sure Batman’s identity is worth some big money to the right people.
2) Batman’s identity is a secret, not a riddle. The two are not the same thing.

In terms of Ra’s and the League if Assassins:
1) Surely Batman’s villains have figured out his “no kill” clause by now. Wouldn’t this lessen Batman’s threat (because telling Ra’s would be essentially the same as killing the Riddler)
2) Thanks to Death and the Maidens, Ra’s is now dead…

Clearly, I misinterpreted the end of Hush and parts of my original post were wrong. Batman has no fear that the Riddler will expose his identity — not because no one will believe him (as I originally thought), but because Batman believes the Riddler will tell no one. (And if he does, he’ll tell Ra’s who was using his Lazarus pit).

The rest of my post still stands. The ending of Hush is still indicative of Loeb taking the easy way out, and this ending is even more full of holes than what I thought originally. My concern with Batman: Gotham Knights still exists. If Batman’s identity is a riddle, then so is the identity of the Joker’s wife’s killers, and he would be as loathe to share it.

Dave does bring up another good point: what happened to Jason Todd’s body?

I have been thoroughly enjoying the discussion of the Greatest Villains at the Howling Curmudgeons (and Shane’s list as well at Near Mint Heroes). As usual with these discussions, I find that I agree with almost everyone, but I do have to come out on the Anti-Anti-Monitor side of the debate. And the pro-Deathstroke side.

There is one thing that I feel makes a great villain that I find missing from the list. Different posters and commentators have come close to it, or hinted about it, but I don’t think anyone has stated it explicitly: Motivation.

Why the super-villain is doing his deeds is as important to me as what he is doing, and how. Generally speaking, the better the motivation, the better the villain. Certainly motivation is not the only criteria of a great-villain, but it is one of the most important ones.

A few scatter-shot examples of Good Motivation:

1. Dr Doom wants to rule the world, sure, but more than anything else, he wants to defeat Reed Richards, the only man who may be his better.
2. Magneto wants to make the world safe for mutant-kind (and if without the Homo sapiens, all the better).
3. Deathstroke may have started out as a standard killer-for-hire, but then became more complex. There were his two sons (one good, one evil) he had to kill, and his love/hate relationship with his ex-wife. All excellent motivations for his activities.
4. Kestrel wants to kill Dove because she represents everything he isn’t, and he believes that he and Hawk would be inseperable as brothers without her.
5. Zoom in the recent Flash storyline wants Flash to experience the pain of losing someone important to him, so he’ll understand where Hunter is coming from.

Posting will be on the light side this week as my partner is off on vacation and I find myself covering not only our hospitalized patients but also an overloaded clinic schedule. And did I forget to mention all the letters, lab results, and X-rays? Sigh…

I’ll still post at least something every day, it’ll just be less in-depth than usual (well, as in-depth as I get anyway). I plan on having some more Medical Reviews and True Tales up this weekend.

Plus, I’ve got to finish my squid story for John…

I have been watching anime for many years. When I first was shopping for anime, there weren’t many choices available: Bubblegum Crisis, Kimagure Orange Road, Vampire Hunter D, and not much else. VHS was the only option, and you had to choose between subbed or dubbed. They always came in these real bulky plastic packages, too.

Thankfully, things have changed. There are hundreds of titles available now, and with DVD you can have subbed and dubbed (at the same time if you want – and that’s always fun, because the translations rarely agree). The voice acting is much better now as well.

One thing hasn’t changed for me. In my mind, one of the most important parts of the anime experience to is the opening credits. This can make or break a show for me.

What makes a good opening? A near perfect combination of music and graphics is important. Important aspects of the show should be shown, but not much plot given away.

A good opening will make me stop the DVD and re-play the credits. I will want to watch the “clean” opening and closing in the extras. God help me, I’ll sometimes watch the previews of that anime just to hear the music.

Here are my favorite openings in alphabetical order:
• Big O – The silhouette graphics over the psychedelic backgrounds are eye-catching. The theme music (sounding suspiciously like Queen) is hard not to sing along with.
• Full Metal Panic – Light music, but easy to sing along to, even if your Japanese is poor or non-existent. Clean graphics introducing the crew, villains, and robots (of course!). The opening animation changes in the later episodes, but the music stayed the same. Both animations are good, but I prefer the original.
• Gunsmith Cats – Jazz music with a simple color palette. Girls, guns, cars, and explosives – what’s not to like? The explosive kiss and firing range heart are nice touches too.
• Martian Successor Nadesico – Another classic opening done right. Upbeat music, introduction of the crew, and of course – robots!
• Star Blazers – What can I say, I’m a sucker for this show. I can still sing the entire lyrics twenty-five years later.
• Witch Hunter Robin – The rock chords are a nice change from the usual upbeat themes, and the graphics hint at some of the mysteries of the show.

Runners up:
• Neon Genesis Evangelion
• Vision of Escaflowne
• Gasaraki

In the first issue of Batman: City of Light, an innocent bystander is critically injured while Batman skirmishes with thugs. Batman becomes haunted and obsessed by the injured bystander.

In issue #2, while riding the subway, Bruce Wayne is recalling the injured patient in the hospital room. The patient’s head is bandaged and he’s wearing a cervical collar and an oxygen mask. An electrocardiogram (EKG) tracing is superimposed over the picture.

Given the patient’s traumatic crush injury, a bandaged head makes sense, as does a cervical collar, as he probably has a broken neck. If he sustained rib fractures or pulmonary contusions, oxygen would be important, so the mask makes sense. The EKG tracing is nonsense. A traumatic crush injury can certainly injure the heart, giving an abnormal EKG, but the one shown makes no sense at all. It’s no more than a random collection of lines.

In the beginning issue #3, Batman visits the patient in the hospital. While the patient’s head is still wrapped in bandages, he no longer is wearing the cervical collar. In fact, his neck appears to be bent at a pretty steep angle in the first panel. Apparently his broken neck is all better now. He also has no oxygen mask.

There is a cardiac monitor at his bedside, but I see no leads running to the patient. The heart rhythm pictured is still bizarre, but an improvement over the previous issue.

At the end of the issue, Batman visits the hospital again. This time the patient has a nasal cannula delivering oxygen (but drawn incorrectly) and the oxygen tubing appears to be coming down from the ceiling. His oxygen requirements appear to vary wildly, from full mask to nothing to nasal cannula.

As Batman watches, the patient’s heart stops. “No” says Batman, and hits the wall in frustration. (“Wham!” says the wall).

In one of my favorite butchered medical cliché the doctor runs in and says: “Oh my God, he’s red-lined.” No, he’s flat-lined. Red-lining is something you so to a very fast car or motorcycle. There’s a big difference.

At no point does anyone attempt CPR or any form of resuscitation on the patient. The patient is young and should stand a good chance of survival. It’s bad medicine not to attempt to revive the patient. Batman, and certainly the doctors and nurses, should know better.

Looking more like the movie Scotty than the TV show Scotty?

Having a wardrobe malfunction?

The answer to your prayers is here: Klingon Karbs

I apologize for the dearth of posting yesterday and today, I seem to have fallen a bit under the weather. (And yes, I am aware of the irony of a doctor being sick. You can stop giggling now, Polite-Wife.)

In the meantime, as Spider-Man 2 is opening Wednesday, take a look back at some of my Spider-Man columns (if you missed them the first time around)…

• Amazing Spider-Man #3: A Medical Review (the origin and first appearance of Dr. Octopus)
• Amazing Spider-Man #10: A Medical Review
• Amazing Spider-Man #39: A Medical Review
• Aunt May’s Radiation Sickness
• Just How Frail is Aunt May?

As I was putting away comics today, I ran across Avengers #81 (current series), the “climax” of the Lionheart of Avalon storyline.
For those of you who need to be reminded of the story (the pain! the pain!): in this scene, the Scarlet Witch and the new Captain Britain are being attacked by the Black Knight and Morgan le Fey while attempting to rescue Brian Braddock.

Another cloudy cold Sunday in central Illinois. Apparetnly, there’s a law of nature that Sundays in this area can’t be nice days. No big deal this week, as I’ve got a great deal of reading to catch up on, and I’d just as soon lounge on the comfortable couch in the den.

Good news! Our new grass has finally started to grow. The backyard now looks like a giant Chia-Pet.
Better News! My partner comes back tomorrow! No call for 2 weeks!!

Sunday Blog-o-Bits:

1. Just over 1 week until the Tour de France!
2. I know I mentioned my concern about Bible-inspired diets a few weeks ago. Now comes news that the academic credentials of author Jordan Rubin are all from non-accredited correspondance “diploma mills” (third item down). This is not the first time this has happened, John Gray, author of all those “Men are from Mars, Women are from Venus” books also has mail-order academic credentials.
3. From the Hypnosis in Media site is a look at hypnosis and mind-control involving comic books and comic book characters. Other comics are discussed here. A very thorough listing that seems to be accurate as far as I can tell. Maybe I’ll be able to find a good mind-control story after all.
4. Finally, for all you war-gamers, or those interested in military history, check out the Armchair General. In addition to good historical articles, it also offers readers the chance to find out what would have happened if they had been in charge in famous battles (I fare…poorly).

As this coming week marks the celebration of the birth of our nation, I thought it would be a good time for a slight change of pace. This week, I’ll take a look back at some of the classic medical comic books from the 1950s and 1960s.

So, climb in your time machine … push Malcolm McDowell out of the way … turn left at Sherman and Mr. Peabody … sneak past Homer and his time machine/toaster … zoom past the TARDIS (wave at Adric, Teegan, and Nyssa — mmm, Nyssa) … and starting tomorrow: FLASHBACK WEEK!

I would like to thank John Jakala at Grotesque Anatomy for naming my story, Untrue Tales of Medical School: The Squid, as one of the winners in the Street Angel Squid Contest.

If you haven’t been following along from the beginning, you’ve been missing some great art and stories. Initial post is here, and follow-ups are here, here and here.

My favorites have been Graeme McMillan’s Kirby-esque “Cosmic Sky-Skating Street Angel vs. The Space Squid”, Ed Cunard’s Rap Battle, Steve Mohundro’s Wally Wood-pencilled story, and Libby’s (slightly) Hentai story.

After Fredric Wertham’s infamous Seduction of the Innocent and the subsequent congressional inquisition, Entertaining Comics (EC) had to regroup. They could no longer publish the comics such as Tales from the Crypt and The Vault of Horror. Instead, they introduced a “new direction” in their comics. One of these titles was M.D. First published in 1955, it lasted for 5 issues.

The initial page of the first issue discusses the philosophy of the new series:

It is dedicated to Mankind’s Tireless and unceasing battle against disease, and to the man who fights that never-ending battle day after day after day…your Family Doctor…your M.D.

It goes on to state:

This, then, is the theme of “M.D.” It will contain stories of people…people who are helped by their Family Doctor and his associates in the Medical Profession. It will deal frankly and honestly with the diseases and misfortunes that beset people. It will deal graphically and candidly with the treatment they receive. At times, the stories will be poignant…at times they will be sad…at times they will be grim. But at all times, they will be true to life!

[All punctuation is verbatim].
A copy of the Hippocratic Oath closes out the first page.

The opening story, The Fight for Life, is a sweeping history of disease and medicine from prehistoric times until the modern age (well, 1955). Full of hyperbole and generalizations, the story nevertheless works because of the intricate and eye-catching art.

The next three stories each deal with a patient with a different medical condition. The particular condition and its required treatment are highlighted at the start of each story.

The first of these stories is Janie Some Day, which tells the story of Janie, an orphan who has a congenital bone infection in both of her legs. She’s been in heavy plaster casts for her whole life. Dr. Kendall is able to cure her left leg, but is unable to save her right leg which has to be amputated. Of course, the kindly doctor never tells Jenny that she’s going to need an artificial leg; he leads her to believe somehow her original leg will grow back. When she finds out the truth, she is heartbroken. But then Dr. Kendall shows her that she will not need an ungainly wooden leg, but instead an ungainly plastic pink one. She lives happily after ever, and Dr. Kendall and his nurse exit the scene with tears of happiness in their eyes.

The next story, To Fill the Bill, concerns the Saunders. Mr. and Mrs. Saunders are having some financial difficulties, and have been unable to pay their doctor’s bill. Mrs. Saunders begs her husband to pay the doctor at least a small amount, but her husband states that the phone bill is more important. She asks him how he would like it if his company paid their phone bill instead of paying him? He laughs and brushes it off saying, “Don’t be crazy! I belong to a union! We get paid first! Or else! You think I’m nuts?! You think I’d sweat over a machine all day, and get paid off in promises…!” Apparently irony is lost on Mr. Saunders.

In the midst of this argument, their daughter interrupts, saying that their son has swallowed a safety pin. Panicked, the husband realized that he must call the doctor for help. Upon receiving their telephone call, Dr. Bennett grabs his bag and runs from his office to the Saunders’s house, telling a passerby to call an ambulance. Upon arriving at the house, Dr. Bennett finds little Bobby unable to breathe and turning blue. He performs an emergency tracheotomy on the kitchen table and then fishes the pin out with a pair of tweezers. As Bobby is taken off to the hospital, Mr. Saunders sheepishly hands a check to Dr. Bennett and apologizes for not paying the bill. Dr. Bennett refuses the check, telling Mr. Saunders that helping Bobby is all the payment he really needs, and he knows Mr. Saunders will pay when he can. The story ends with the neighborhood cop saying, “I always say ‘You can never really pay ‘em enough!’ ”

The final story, The Antidote, while featuring a patient with acute appendicitis, is actually focused on Dr. Anders. As the doctor returns home after a long day, a patient accosts him, saying that the doctor must help his sick son. Dr. Anders replies that he has a consulting neurosurgeon flying into town that he must meet with, but he allows the patient to drag him along to examine his son. He finds the child in the throes of acute appendicitis. He sends the patient to the hospital and sets up an operation with a top surgeon, but the family insists that he attend the surgery as well. Reluctantly, Dr. Anders agrees, and scrubs in. The surgery goes well, and he goes to tell the family the good news. The father insists that he stay at the patient’s bedside through the night, but the doctor begs off, saying that he must meet with the neurosurgeon. The father accuses Dr. Anders of having no emotions as he leaves for his appointment. Dr. Anders realizes that the father is hysterical due to the stress of his son being sick, and tries not to let his words get to him. In final panels of the story, as Dr. Anders finally meets with the neurosurgeon, we find out the patient the specialist is in town to see is the doctor’s sick wife.

In addition to the stories, there is also a one-page text feature giving the history of Dr. William Morton, the dentist who discovered the effectiveness of ether as an anesthetic.

The art is what is to be expected from EC comics: intricate and highly detailed art with typed lettering.

The stories are designed to tug on the heartstrings. The first with the story of the poor crippled orphan girl. The second story has the selfless doctor who runs through the city to save the life of a child, not caring that his parents haven’t paid their bill. The last story tells of another selfless doctor, arranging the best care for a patient, all the while delaying his meeting with the specialist in town to save the doctor’s wife’s life.

The narratives tend to be unrealistically didactic at times. Dr. Kendall explains to six-year old Jenny that she needs to exercise her leg because the muscles “ need to re-attach themselves as distally as possible. ” As Dr. Bennett is saving young Bobby’s life, he’s explaining the anatomy of the trachea to his mother.

Overall, the stories hold up pleasantly well for a nearly fifty year-old comic.

This post covers the medical aspect of the first issue of M.D., published in 1955 by EC. A summary of the comic itself can be found in my previous post.

For the most part, the medicine in this comic holds up very well fifty years later. Technologies and medications have certainly improved since 1955, but I refuse to hold that against the writers and artists.

The first story about the history of disease and medicine is fairly light and inconsequential. I take issue with the statement: “As soon as man developed enough intelligence to distinguish metabolic disease from parasitic infection…the practice of medicine began in its crudest form…” The practice of medicine began long before we could tell metabolic disease from parasitic disease. We still have trouble differentiating the two sometimes even now. Malaria wasn’t proven to be parasitic until 1897, and only recently has Lyme Disease been shown to be parasitic in nature.

The second story, Janie Some Day, is the one I have the most problems with. First, I am not sure what “congenital osteomyelitis” refers to. Osteomyelitis is a bone infection, and congenital means that the patient was born with it, but I can find no references in the medical literature to “congenital osteomyelitis”. Admittedly, my resources do not go back as far as 1955, and it may have been common terminology then. At one point, Dr. Kendall refers to Janie’s condition as an infection of the bone by tuberculosis. Certainly, tuberculosis can infect bones – usually the spine, but leg bones can be infected too. Tuberculosis can also very rarely (300 cases, ever) be transmitted congenitally. So, Janie could have had this tuberculosis passed from her mother that infected her leg bones, but I suspect the writer is referring to something else.

I am more concerned about Dr. Kendall’s treatment of Janie. He has her leg amputated, and misleads her into thinking she won’t need an artificial leg. Another time, he knows her left leg is healed, but keeps the cast on two extra months just to be “absolutely sure”. At best, Dr. Kendall is misguided, at worst he is a cruel and sadistic man. Either way, I’d suggest the orphanage needs to find a better doctor.

The third story where little Bobby chokes on a safety pin could happen as written today, but I suspect the parents would call 911 long before they’d call the doctor. Note: If your child is choking, please call 911 before calling my office.

The last story is fine. The treatment of acute appendicitis remains an emergent operation. Anesthesiology has advanced remarkably since the 1950s, and we no longer use “ether dripped onto the large gauze pad over the patient’s nose and mouth.”

It is fascinating noting the changes in medicine in the fifty years since this comic was published. Anesthesiology and medications have improved, but the basic procedures remain the same. Two of the three medical stories deal with doctors making house calls, a unlikely occurrence in today’s society. There is also no mention of insurance or HMO anywhere. Hmmm…

As much as I enjoy the respect that is shown to my profession, the comic’s fawning adoration of the Family Doctor is almost creepy. I fully expected the doctors to turn water to wine the way the stories nearly deify them.

Except for poor little Janie, I was pleasantly surprised to find how well the stories hold up medically today, almost fifty years they were first published.

One of my favorite obscure singers is Tom Smith, the self-described “World’s Faster Filker.” I first ran across his music six years ago while looking for some Heather Alexander CDs at a small Sci-Fi convention. I have since acquired all of his CDs and listened to him in concert at three different conventions, and my appreciationfor his music has only grown.

His work is mostly humorous, though he does write some serious songs. Many of his best works are parodies. All his songs are easy to sing along to, and feature incredibly clever word play and occasionally painful puns. His topics generally include Sci-Fi, fantasy, comic books, movies, and fandom in general. He has also written the official song of Talk Like a Pirate Day.

My favorite songs are Superman Sex Life Boogie, 500 Hats (a song that manages to cover nearly every Dr. Seuss book. Sung to the tune of 500 Miles, by the Redeemer), Five Years (the entire Babylon Five plot, to the tune of Barenaked Ladies One Week), Rocket Ride (about old classic SF/fantasy/comics versus their shallow modern versions), and I Want to be Peter Lorre. All three of his albums available on CD (Debasement Tapes, Plugged, and Tom Smith and his Digital Acoustic Compilation) are highly recommended and available at hissite.

Last night in the wee hours of the morning, Samantha, our “main cat”, awoke us by sitting outside our bedroom door and yowling. Cat owners will tell you that cats have several different vocalizations, each with a different meaning (such as “feed me”, “look what I caught”, or “pay attention to me!”). This was not a sound we’d heard before.

We sprang from bed to make sure she wasn’t injured. As soon as she saw us, she bagan purring and wrapping herself around our legs. We petted her and comforted her until she calmed down and went to sleep. We went back to bed, puzzled by her behavior.

This morning we discover there was a small earthquake in our area last night. Coincidence? I don’t think so.

The Dr. Kildare comic was published by Dell sporadically from 1962 to 1965. It was based on the television series starring Richard Chamberlain as Dr. James Kildare, an Internal Medicine resident at Blair General Hospital. Dr. Kildare #7 has a 12¢ cover price, and is dated Sept-Nov 1963. It has a photo-cover of star “Dick” Chamberlain and is titled “Emergency, Dr. Kildare…The Shipyards are Engulfed in Flame!” It offers 32 pages of four-color excitement, with the only ads being on the back cover.

The medicine in the story is quite accurate. The opening scenes do a good job showing how different state-of-the-art medical care was forty years ago. The writing is good, but the story tends to be overdramatic in parts, with Dr. Kildare always being in the middle of the action, even the firefighting sequences. The art is above average, with the main characters always looking like their television counterparts. The color choices are a little off, with Kildare’s hair always a bright blond, despite the fact that the photo-cover shows him to have brown hair. Additionally, his scrubs always stay a bleached white, despite running around burning buildings filled with ash and smoke.

The main story is a 27-page story titled “Trial By Fire“. In the opening scene, Dr. Kildare examines a man who fell off a building and injured his head, ribs and leg. A depressed skull fracture is seen on the x-ray, which suggests that their may be some brain damage as well. To determine whether there is any bleeding around the brain, a lumbar puncture (spinal tap) is performed. The spinal fluid shows blood, so an intracranial operation is performed to stop the bleeding in the skull.

Today, we don’t rely on skull x-rays and spinal taps to determine brain injuries. CT scans of the head (which were not available in 1963) show brain damage and any bleeding. Utilizing special medications and tiny clips, many intracranial bleeds are able to be stopped without invasive operations.

Next, Dr. Kildare is called to the waterfront, where a tanker boat and some buildings are on fire. Impetuously, Kildare rushes into a burning apartment with the firemen to save a girl and her father. They are able to rescue the girl, but her father has passed away. “The father was dead before we left the room,” laments Kildare. “Heart failure.” This is a bold call – not that the patient is dead, I assume he would be able to recognize that, but that he is able to determine the patient died of “heart failure” after only a cursory exam.

Next, Kildare joins several firemen as they cross a boom and spray down the burning tanker with water. One of the firemen falls off the boom, but Kildare treats his wounds successfully. Tired, he returns to the hospital only to hear that the tanker fire has flared up again with some of the firefighters trapped inside. Returning to the waterfront, Kildare dons an asbestos suit (this was before asbestosis was recognized as a disease) and goes inside the burning tanker. A firefighter is pinned by a metal beam that has fallen, crushing his hand. Ultimately, Kildare has to amputate the fireman’s two crushed fingers. Kildare returns to the hospital more desperate than ever for a vacation.

The comic contains more than just the Dr. Kildare story. The inside cover contains two brief “Little Medics” vignettes showcasing children and first aid. The first strip has two Boy Scouts hiking when one is bitten by a rattlesnake. The other scout places a tourniquet on the wounded limb, cuts a cross over the bite, and squeezes out the venom. Next, he runs to the nearest house and calls the zoo, as they are most likely to have “anti-venom serum”.

This treatment, or the more commonly taught treatment of sucking the poison out of a snake bite, was the recommended first aid treatment for many years. I suspect this was only because no reliable authority actually looked at what the Boy Scouts and other outdoorsmen were teaching. Over the past several years the recommendations have changed. The tourniquet is appropriate, but cutting, squeezing, or sucking the wound are all counterproductive. Intricate field treatment is not necessary; simply get the injured person to the ER as soon as possible. In the early 1960s, our modern emergency room system was not in place, so zoos were the most likely places to carry antivenin.

The second Little Medic vignette deals with a boy who breaks his leg while biking. His sister makes a splint for him out of available materials. Good advice both then and now.

There is a text feature, Lady Doctor, about Sally, a young woman who wants to be a doctor. There is a small amount of sex bias in the story, but overall it is a well written story that would be encouraging to any young woman desiring to become a physician.

The last story is “Jungle Doctor: Dangerous Waters”, about a doctor and his assistant deep in the heart of Africa. It is more of an adventure tale than a medical strip. The story is formulaic, and you wonder why African natives are screaming for help in English. It also ends abruptly, as if the artist suddenly realized he was on the last panel.

The medicine shown in the Dr. Kildare #7 is all well researched and accurate for the era. We treat head trauma and snake bites differently today, but the illustrated treatments were state-of-the-art in 1963.

Daily, we have pharmaceutical representatives (hereafter called “drug reps”) stop by our office to talk to my partner or me. Their job is to convince us that their drug is best, and we should prescribe it above all others (a tough job, as I almost always prescribe time-tested and trusted generics).

They also bring samples of their medication for us to hand out. This is important, especially for our low-income or elderly patients.

To convince us to use their drugs, they will bring out charts and reports and studies to prove their point. Unfortunately, I find that many of these studies and reports are flawed, biased, or both.

I don’t blame the drug reps for the bad data (because it’s provided by their home office), but I will take the time to make them sweat and squirm about it.

I simply cannot stand misleading statistics. I find it unethical and immoral to intentionally mislead people. Most individuals, even educated ones, are surprisingly naﶥ about statistics, and don’t realize how easy it is for them to be misled. It’s not just physicians who need to be wary of bad data, but the public as well. Most of these studies also show up in television and print ads for the medications.

Here are some common situations:

1. Unequal Comparisons: Yesterday, a rep pulled out a graph showing 10 mg of his statin (a type of cholesterol drug) compared to 10 mg of all the other statins. According to the chart, his drug was far above the rest. Impressive? Not really, because the comparison was very misleading. 10 mg of his drug is its standard dose, but 10 mg of the other drugs are only half-strength or quarter-strength doses, so of course his drug came out on top. It’s like taking a full shot of Jack Daniels, a watered-down shot of Jim Beam and a watered-down shot of Wild Turkey and asking which is stronger.
   Unfortunately this is a very common tactic: studies that compare a high dose of one drug against weaker doses of its competitors.
2. Differing Definitions: There are three main osteoporosis drugs. Each one claims that they are the best, but each drug measures “best” differently – one measures bone density, one measures hip fractures, and one measures spinal compression fractures. It’s nearly impossible to effectively compare drugs when each company defines the solution to best fit their specific product. Which is best? It’s not clear, but I have my suspicions.
3. Anecdotal Evidence: One of the drug reps loves to use anecdotal evidence provided by a local cardiologist. “Dr. McE- put this patient on our drug and their cholesterol dropped by one-hundred points!”
   Anecdotal evidence is fine to illustrate a point, but it carries very little weight. It is the weakest type of evidence; it is the statistical equivalent of a story your cousin’s neighbor’s hairdresser’s son told. Drug reps know this, yet some continue to present anecdotal evidence as if it were better than real scientific studies. (Note that this is the same trick most weight loss drug/diet ads use, with the small-print disclaimer “results not typical”.)

Let it be stated that I like the drug reps individually and socially; I’m just not fond of their job and the tricks some use.

Ben Casey was published by Dell from 1962 to 1965. There were 10 issues total, all with a 12¢ price and a photo-cover. The comics were based on the Ben Casey television show that aired on ABC from 1961 to 1966. Ben Casey #9, titled “Crisis at 59 West!!!”, has a date of October-December 1964 and contains 32-pages of story. The writing and art are mediocre. The regular characters are drawn and written well, but the other characters seem more two-dimensional caricatures than anything else.

As the story begins, Dr. Zorba persuades Dr Casey to come for a ride in his new sports car. As they are driving, another car nearly runs them over and then crashes into a tree. Casey and Zorba drag the unconscious driver out of his car and transport him to the hospital. As they arrive at the hospital, Casey tells his co-worker that he suspects the patient is suffering from a case of paroxysmal cerebral dysrhythmia.

It turns out the patient is Junior Van Cleve, the son of rich and arrogant Cassius Van Cleve, a major hospital donor. Mr. Van Cleve arrives and immediately begins to throw his weight around. Soon he and Casey butt heads, and Casey finds himself forced off the case, or the hospital won’t get its annual donation check from the Van Cleves.

Meanwhile, the tests Casey has ordered come back and prove that he was right about Junior’s diagnosis. Of course, he and his fellow physicians can’t come right out and tell the patient what the diagnosis is. Instead, they throw around a succession of medical terms that were already archaic forty years ago.

Rich Mr. Van Cleve accuses Casey and the medical staff of making things up because they have diagnosed his son with 1) paroxysmal cerebral dysrhythmia, 2) recurrent disturbance of brain rhythm, 3) psychomotor seizures, and 4) psychic variant seizures. Of course all these terms mean the same thing: Junior has epilepsy.

Mr. Van Cleve refuses to believe this because “everyone knows it only effects [sic] half-wits and criminals!”

Incensed, Van Cleve decides to transfer his son to another hospital, but as they are leaving the hospital Junior suffers another seizure and Casey saves him. Van Cleve’s personal physician finally arrives and tells Mr. Van Cleve to back off, that Casey had the right diagnosis and treatment all along.

In the end, Mr. Van Cleve comes around and even offers Casey a position as Junior’s personal physician. Casey thanks Van Cleve, but says he’d rather stay where he is. “Hmmm,” says Mr. Van Cleve. “Until I locked horns with that Casey character, I thought the younger generation couldn’t even spell grit and determination! But he…You’ll have my check in the morning!”

This comic is more of a character story than a medical story. Most of the narrative concerns the conflict between Ben Casey and Mr. Van Cleve. What little medicine is shown is a mixed bag. The epilepsy is diagnosed correctly. While Casey and his co-workers use a great deal of technically correct terminology, most of it is horribly out-of-date, even for the 1960s (but this is done to set up a plot point). In terms of negatives, I’m surprised that Casey would drag the unconscious patient from the car without supporting his neck; he should know better considering that he is a neurosurgeon. Speaking of neurosurgeons, why is a patient with seizures being treated by a surgeon instead of a neurologist?

Finally, take a second and look back at Mr. Van Cleve’s last statement, where he praises Casey’s grit. Could this be it? The first of the grim and gritty comics? My vote is yes.

Excelsior!
‘Nuff Said.

I’m upset and depressed. One of my original comic pages has turned up missing. On the walls in each of my exam room, I had a framed Air Force commendation, a super-hero calendar, and a framed page of original comic art.

Today I noticed that a Silvestri-signed X-Men page is gone.

I don’t think a patient took it, as it’s rather bulky — maybe the cleaning staff? Regardless, it’s gone. I think I’ll have to take the other pages home too.

The areas where I have seen the biggest influence of prescription drug advertisements has been in arthritis pain medications and stomach/heartburn medications. Both of these diagnoses cause significant pain, so it’s easy to understand why patients would want quick relief and why advertisements would catch their eye. In both these cases, however, there are over-the-counter (OTC) or generic drugs that work just as well, if not better. These are also some very expensive drugs. Insurance companies provide limited formularies, with only one or two of these expensive drugs on them, and even then you have to jump through hoops to prescribe them. I have to routinely tell patients who want a particular arthritis pain medication that they must first have tried, and failed, two other pain medications before they can get the ones they want. That’s two months of waiting, and most patients are very unhappy with that.

I have a fair number of patients who come in seeking allergy relief after seeing ads. Again, prescription allergy medications are expensive drugs. In this case though, there are no really good OTC or generic equivalents. There are still insurance restrictions, but not as strict as those for arthritis and stomach medications.

Occasionally, I’ll see a patient who comes in inquiring about an anti-depressant after seeing advertisements. This is the area where I actually see some benefit from ads. Many people have depression, but don’t realize they have it, aren’t sure it can be treated, or are embarrassed to admit that they are depressed. The ads help reassure patients and remove some of the stigma of being on anti-depressants.

Finally, I have seen absolutely no changes in my practice due to advertisements for high blood pressure or cholesterol medications. This makes perfect sense. Neither high blood pressure of high cholesterol have specific symptoms, so patient are not going to go out of their way to seek treatment.

In a given week, about 10-15% of my patients are clearly influenced by advertisements, while at least another 30-50% show are familiar with the ads. I generally dislike the idea of having prescription drugs advertised nationally, with the possible exception of anti-depressants. However, I prefer well-regulated prescription drug advertisements to the misleading and sometimes dangerous advertisements and infomercials for “nutritional supplements”, alternative “medications” and diet aids. But that is a rant for another day.

Here’s the page that was stolen (only full sized and black and white). It is page 8 from Uncanny X-Men #243, art by Mark Silvestri and Hilary Barta. There is a blue ballpoint-pen signature from Silvestri on the bottom, and a black ink signature that says “Barta ‘90″ from the inker.

click on graphic for a larger image

If anyone sees it in person or for sale, please let me know. A suitable reward will be offered for all assisting in its return.

The second issue of M.D. is a lot darker than the first issue. Only one of the four stories can really be considered to have a traditional happy ending. The art continues in the intricate style E.C. comics were known for, and the lettering has the familiar blocky look.

The cover shows two doctors assisting a victim at a car crash, a scene that never appears in the comic. M.D. #2 is dated June-July 1955 and had the cover price of 10?.

The first story, “The Balance”, is about Bobby, a young boy who develops leukemia. Since the story was written before chemotherapy was available, treatment options were limited. Bobby is admitted to the hospital and given injections of cortisone to suppress the white blood cells and transfusions to build up his number of red blood cells. He does well at first, but then his symptoms return and worsen. He slips in and out of a coma and eventually dies. When the doctor tells his parents the sad news, his pregnant mother panics and runs down the hall, slipping and injuring herself. She is taken for an immediate c-section, and ultimately delivers a healthy set of twins. Looking at his new children, Bobby’s father remarks: “It’s strange, isn’t it doc…how things work out? Twins! A boy…to take the place of the one we…we lost…and the girl we’ve wanted for so long.”

The type of leukemia Bobby has is never stated, but is most likely Acute Lymphocytic Leukemia (ALL). It is a cancer of precursor white blood cells, which grow so dramatically that they choke out all the other blood cells. The treatment of leukemia has dramatically improved in the past fifty years, and the diagnosis is no longer the death sentence it once was. Hospital conditions and policies have improved as well. Family is considered important, and Bobby would not have had to die all alone.

This story does show a fair amount of sexism with the mother repeatedly referred to as “frail” based on nothing more than the fact she was female and pregnant. The father’s last line and the thought repeated by the doctor that a dead child can be “replaced” is misguided and strikes me personally as somewhat repugnant.

Herbie, a child with cerebral palsy, is the focus of the second story “Different”. Feeling that his family would be better off without him, Herbie runs away. He knows his mother will miss him, but he doubts his brothers will even notice he is gone because they always make fun of him. His father mostly ignores him, and just the other day forbade him from going outside so the neighbors wouldn’t know he had an “idiot child.” Herbie is found by a kindly policeman and taken to a wise family doctor. The parents are brought in to see the physician who lectures them sternly about Herbie: “If Herbie were an idiot, he wouldn’t have been hurt by the things you said about him and did to him! Your son, Mr. Struthers, is a bright, sensitive, intelligent boy!” Chagrinned, the parents ask for help. The doctor informs them that there is no surgery or medicine that can cure Herbie, but with intensive therapy, he can lead a more normal life. The parents agree and Herbie starts therapy, improving a little each day.

This story is a good narrative about cerebral palsy, both then and now. The treatment remains essentially the same today, and the prejudice faced by people with cerebral palsy continues.

In “A Case for the Books”, the third story, the elderly cabinetmaker Gustaff suddenly loses most of the vison in his right eye. He goes to see the local Family Doctor, who sends him on to an eye specialist in the city. The specialist tells Gustaff that he has ocular hypertension and that the high pressure in his eye is damaging the optic nerve and could lead to permanent blindness. An operation is required to reduce the pressure. Gustaff agrees, and a small hole is drilled in his eye to reduce the pressure. The operation is successful and Gustaff regains his vision. Instead of money, the doctor asks for a handmade bookshelf in payment.

The term ocular hypertension fell out of favor in the 1970s because it was vague and meant different things to different people. Today it refers to someone who has elevated eye pressure but no other symptoms. Gustaff had progressed beyond this to a severe case of glaucoma. Caught early enough, glaucoma can be treated with eye drops. If it progresses too far, an operation is required. Modern glaucoma operations are similar to the one Gustaff had, though lasers are used.

In the final story, “Even For a While”, Augie has constant severe headaches, nausea, and visual changes. The local doctor suspects he had a brain tumor, and sends him to a specialist at the hospital. The specialist runs a battery of tests and confirms that Augie has a tumor. An operation is performed, and the cancer removed successfully. After recovering from his surgery, Augie thanks everyone for caring so much about him, especially considering the fact that he is a murderer set to die in the electric chair in a few weeks.

Our diagnostic tests are better today, so the several days of tests Augie went through would not be required. The ethical issue raised by this story is left up to you.

In addition to the four stories, there are also two text pieces in the comic. The first one, “Fever Fighter”, tells of an American army physician named William Gorgas who served during the Spanish-American War and while the Panama Canal was being constructed. Gorgas was the first to realize that yellow fever was spread by mosquitoes. He was one of the first to realize that malaria was also spread by mosquitoes. He was ultimately named Surgeon General of the Army.

The second text piece tells of Edward Jenner and how he discovered smallpox vaccination. This story has always fascinated me, not just because the eradication of smallpox is one our greatest accomplishments, but because of some of the ethical issues involved in Jenner’s original experiment. His subject was an eight-year old boy who was first injected with cowpox, then smallpox. How ethical is it to experiment on a child? Did they, and could they, give consent? What if Jenner had been wrong?

The stories in this issue are not nearly as wordy as those in the first issue were. In fact, the story on leukemia and the one on ocular hypertension could have used more explanations. The mix of medical conditions this issue is good because it shows that no matter how much medicine changes over the years (leukemia, glaucoma), much of it stays the same (cerebral palsy).

For someone who complains so much about not getting a vacation, Dr. James Kildare manages to take one in both issue #8 and issue #9 of his comic. Both issues feature photo-covers and a 12? cover price. 32-pages of story are provided, but there are no Jungle Doctor back-up stories or text pieces. The inside front cover is taken up with advertisements, not the “Little Medics” vignettes seen in Dr. Kildare #7.

In Dr. Kildare #8 (October – December, 1964), James Kildare takes a week of vacation at his friend’s beach house. He gets in a little surfing, but then the weather turns poor, so he relaxes inside. He meets Stacy, a spoiled rich girl who nearly runs him over with her expensive boat. She repeatedly hits on him, but he rebuffs her, thinking that she is simply too irresponsible. Going into town, he meets two fishermen, Captain Bob and his son Joey. Kildare and Bob get along well, but Joe dislikes Kildare because he’s sweet on Stacy himself. “My boy Joe’s crazy about her, but she won’t give him a tumble,” Captain Bob says, hopefully meaning something different than I read into his comment.

After being turned down by Kildare yet again, Stacy goes off in a huff, ignoring his warning about a thick fog. Lost in the fog, she steers erratically and causes Captain Bob’s fishing boat to crash onto the dangerous shoals. Joe is trapped in the boat’s hold, his legs crushed by a fallen beam. Stacy jumps in her boat and goes to get Kildare. He comes out to the fishing boat to help Joe. He, Bob, and Stacy can’t move the beam off Joe’s legs, so Stacy goes to get help from the Coast Guard. Finally, just as the tide has risen so high that Joe’s life is in danger, the Coast Guard arrives and helps lift the heavy beam off his legs. James diagnoses Joe with two broken legs and sends him to the hospital. Stacy apologizes for her wild ways and helps Captain Bob buy a new boat.

Not a great story by any means. Kildare is in the story, but more as a bit player than a main character. He reacts, he doesn’t act. The only medicine is the diagnosis of two broken legs, and almost anyone could have done that. The art is fair. Kildare is drawn to resemble his television counterpart most of the time, but in several panels he bears an uncanny resemblance to Fred Gwynne. Once again his hair is a bright blond, despite a photo-cover showing “Dick” Chamberlain’s brown hair.

In Dr. Kildare #9 (April – June, 1965), James Kildare and two other residents head up to the mountains for a weekend of skiing. Once on the mountain, a blizzard sets in, closing the roads. A bus has gotten stuck down near the city, so James and the others ski off to help anyone who might be hurt. On their way, they are met by a group of rescue workers who tell them of two injured skiers trapped high on the mountain in an unheated cabin. Kildare tells his associates he’ll go with the rescue team to the cabin and they should continue on to help the bus.

Kildare does his best to keep pace ascending the mountain, but falls behind. One of the rescue crew stays to help him, but they get lost in the blizzard. Helping each other up a steep slope, Kildare slips, but his companion manages to grab him. In the process, he wrenches his shoulder, but Kildare diagnosis it as only a sprain and puts the arm in a sling. They hurry on to the cabin where they meet the other rescuers. One of the skiers is fine, but the other has a broken leg. Kildare splints the leg, and the team hauls the injured skier down the mountain on a sled.

When Kildare, the rescue crew and the skiers arrive back at the lodge, they discover his friends aren’t back from the bus yet. They hurry off to help them, and discovers the bus almost completely buried by an avalanche. He and the others manage to dig out the bus and rescue the people inside, but only just in time as another avalanche sweeps the bus away. Kildare and his friends return to the hospital the next morning, uninjured, but exhausted from their “vacation.”

Again, there was not much medicine in this story: a sprained shoulder and a broken leg. Kildare was a main character this time, not just a bit player. The art is similar to issue #8 in that most of the characters look like their TV counterparts, but every once in a while, Kildare sports Gwynne’s unmistakable chin.

These two issues were some nice light reading, but not the medical adventures I had hoped to find. Nonetheless, they make a good way to close out Flashback Week (and now I need a vacation!).

Fred Gwynne and Dr. James Kildare: Separated at birth?

I’m off to St. Louis for the weekend (fun! fair! fireworks! family!), but should return on Sunday. I hope everyone else has a fun holiday weekend.
Please remember these important safety tips:

1. Do not put fireworks in any holes where they do not belong.
2. Poison ivy should not be used as toilet paper.
3. Do not pet the snakes.
4. Do not feed the bears, raccoons, or Rob Liefeld.
5. Do not drive if you’ve had more than 2 beers, and do not even attempt to stand if you’ve had any of Aunt Betty’s special fruit punch.
6. Do not play “God Bless the USA” more than two times in a row (there are plenty of better patriotic songs available, so please choose one that does not butcher the English language) (and that does not include Toby Keith’s abhorrent “Courtesy of the Red White and Blue“).

The Polite-wide and I had a nice time in St. Louis with my parents. It was their anniversary, so we took them out to dinner at one of their favorite restaurants, The Blue Water Grill, and had an excellent meal. My mother and wife split this enormous chocolate-sampler dessert, and both reported that they could not eat another bite of chocolate (which is one of the signs of the Apocalypse, I believe). We returned to my folk’s house after dinner and caught the end of the NASCAR Pepsi-Cola 400. It was a surprisingly good race. I’ve never been a fan of the restrictor plate races (Daytona, Talladega), because the tracks seem to favor pure chance over skill. The new aero packages and smaller gas tanks seemed have allowed skill and strategy to return, and the race was exciting to watch (plus Bobby Labonte finished in the top 10, keeping him near the top overall).

Managed to stop into a comic shop near my parents yesterday. I was pleased and disappointed. I was pleased that they were plainly offering the FCBD comics (well, the gold ones) — plus what seemed to be some left over from last year. I was disappointed by their selection of comics overall. They had Marvel, DC, Dark Horse and Image. Not much else. Their idea of an independant was Thundercats. I asked for Demo #7, because I didn’t see it on the shelves. I had to patiently explain what it was and who published it. And no, they didn’t have it, because (and I quote here): “Those artsy books don’t sell.” Well, if you don’t offer them, they won’t sell! Buying comics off the internet doesn’t seem so bad now.

This morning, I got up before the crack of dawn and drove to the St. Louis waterfront to run a 10K (6.2 mile) race. It was the fourth 10K I’ve run in downtown St. Louis, and every one has followed a different route. I was pleased with my effort, and my (nearly) daily runs seem to be paying off. Not once during this race did I my usual “Now why did I think this was a good idea?” thought cross my mind. All participants received a commemorative medal too, which was a nice touch.

We drove back to central Illinois tonight, and have been watching the city foreworks from our porch for the last 45 minutes. I can hear them outside the window and they’re still going on now. Pretty good fireworks for such a small town.

Sunday Blog-o-Bits:

1. Check out the CDC’s infectious disease trading cards. (Brought to my attention by the Steve Jackson Games’s Daily Illuminator, the source for interesting links of all sorts.)
2. There is an excellent new illustrated Solomon Kane book out. It collects all of Robert E. Howard’s Kane stories, plus it contains some material I’ve never seen before, such as an alternate version of Solomon Kane’s Homecoming. If you are a Solomon Kane fan, a Howard fan, or just interested in classic pulp fiction, you need to check this book out.
3. It’s Independence Day. When’s the last time you watched 1776?
   My favorite line from the movie: “I have come to the conclusion that one useless man is called a disgrace; that two are called a law firm, and that three or more become a Congress! “

Detective Comics #795 Monsters of Rot, part 2: Knee Deep
Andersen Gabrych, writer
Pete Woods, penciler

In Detective Comics #795, Batman and the Tarantula are investigating a particularly nasty disease known as the mugre. Batman ultimately determines that it is a bacterial infection from the rainforests of Central/South America.

To treat the Tarantula for an exposure to the infection, he injects her with Cipro. He also gives some of the same drug to Commissioner Akins to administer to any sanitation plant employee who may have come into contact with the disease.

Cipro (generic name: ciprofloxacin) is a potent antibiotic and is effective against a wide variety of bacterial infections.

However, I am concerned that:

1. Batman administers it by intramuscular injection. Ciprofloxacin is only supposed to be administered orally or by IV, not by injecting it into a muscle.
2. Batman only used one dose. Bacterial infections need several days of antibiotics to clear up.

The Polite-wife and I went for lunch today at one of my favorite casual restaurants: Buffalo Wild Wings. This was on eof my favorite places in Indianapolis when I was in residency, the they opened up one in Las Vegas that we went to at least once or twice a week. Now they’ve opened up one in Peoria. It’s a twnety minute drive, but worth it.

They have twelve different sauces of varying flavors and intensities. I recommend the “Caribbean Jerk” and the “Smoky Southwest”, although the new Captain Morgan flavored sauce is quite good as well.

What more is there to want? Good food, good drinks, multiple TV screens, and NTN trivia?

mmmm…hot wings…

One of the most important aspects of medicines and one that is frequently shown incorrectly in comics, TV shows and movies is how the medication is given to the patient. The most common ways of administering medication are orally (by the mouth), intramuscularly (injected into muscles), or intravenously (injected into veins).

Medicine taken by mouth takes about 30 minutes to work. It has to be digested in the stomach or small intestine, enter the bloodstream, and then reach its target organ.

Intramuscular (IM) injections place the medications into muscles (similar to a vaccination) where they are absorbed into the bloodstream. These medications generally work faster than oral medications, but slower than intravenous drugs. On average, an IM injection takes about fifteen minutes to work.

Intravenous (IV) medications are injected directly into the bloodstream. They work quickly with effects in 5-10 minutes. Usually, these medications are injected through IV lines already in place, though skilled individuals can inject medications directly into the veins.

Not every medication can be given every way. Some medications can only be given one way, though most have several different means of administration. Additionally, oral doses usually need to be much higher than IV or IM doses due to digestive and metabolic effects.

In addition to the common methods of administering medicine, there are other less common ones including inhalation and trans-dermal.

Some medications can be inhaled. Inhalation is quick, with the medicine traveling from the lungs to the bloodstream in a matter of minutes. Very few medications can be used this way, and it’s hard to get a consistent dose with inhaled medications.

Some medications can be given transdermally, or through the skin. This is usually done with patches, but can also be done with gels or creams. Skin absorption is a slow process, and works best for slow drugs with a steady level, like hormones or medications for chronic pain.

There are several other methods of giving medication that are only used in certain circumstances and will not be covered here (except to again point out that atropine should never never be injected directly into the heart).

Case Studies:

1. Oral: Hourman (Rex Tyler). Miraclo would not be the instantaneous drug it is supposed to be
2. Intramuscular: GOOD: In Amazing Spider-Man #508, Ezekiel injects Peter with a neuromuscular agent. It takes several minutes for it to take effect, and Peter grows weaker as it the drug takes effect. BAD: In Detective Comics #795, Batman injects the Tarantula with Cipro, a drug that should not be given intramuscularly. In JSA #17, the medications Dr. Mid-Nite injects inot Black Canary take effect immediately.
3. IV: Usually shown in hospital situations, it has been shown (among others) in recent issues of Hellblazer. No exemplary (or terrible) examples.
4. Inhalation: Batman gases a Checkmate agent in Batman: Gotham Knights #40, and in Avengers #69 the Red Skull uses a narcotic gas to knock everyone out. In real life, the Moscow police used a narcotic gas to subdue the terrorists holding theater patrons hostage about 2 years ago. The results were mixed.
5. Transdermal: Hourman II (Rick Tyler). Miraclo would work even slower as a patch than as a pill. No “hour of power” here.

Imagine that two kids walk into a toy store. The first is a spoiled brat; his parents will buy him whatever he wants. He gets toy after toy after toy, not because he necessarily wants them, but because they’re cool and he wants what the other kids have. A month later, the toys are scattered over the floor of his room, broken and forgotten.

The second kid chooses just one toy. Probably not the fanciest or most expensive, but it’s the one that he wants. He cherishes it and plays with it every day. It might wear out eventually, but even then he’ll repair it and keep playing with it.

The Batman titles have become home of the spoiled kids. Every writer wants all the toys, but doesn’t play with them well. First in Batman was Hush, where Loeb and Lee brought out every character they could get their hands on. Immediately after that was Broken City, where Azzarello and Risso, not to be outdone, trotted out an impressive list of villains themselves. Switch over to the current storyline in Gotham Knights current storyline, and once again villain after villain is being added to the storyline. That’s three storylines in one year that feature most of the heavy-hitters from Batman’s rouge’s gallery.

Isn’t it about time that the Batman writers and editors realize that quality is better than quantity?

Bring back the second kid; the one who cares about his toys.

As I’ve mentioned repeatedly in previous posts, I have been unimpressed by recent storylines in the Batman titles. Wouldn’t it be nice to know beforehand exactly how bad a particular story arc is going to be?

I hereby introduce S.C.R.U.B.S. (Scoring Concerning the Readabilty/Unreadabilty of Batman Storylines). It is a scoring system designed to give a quick determination of whether a particular Batman title storyline is going to be particularly bad. It is not designed to identify good storylines, just highlight the ones likely to be bad.

Scoring is easy, consisting of 4 areas of considerationsfor Basic SCRUBS (length of storyline, identity of Batman, side-kicks/guest stars and villains). Special modifiers are added in Advanced SCRUBS. The Basic SCRUBS score can be figured out from advance solicitations and no significant advance knowledge is needed. The Advanced system is more accurate, but requires more in-depth knowledge of the storyline. Once the Basic or Advanced score is determined, the Final Score table will show whether the storyline is worth reading. Scores are also comparable to one another: a storyline with a score of 14 is worse than one with a score of 7, and a storyline scoring 31 will be much worse than either of them.

Examples:

• In Knight Moves in Batman: Gotham Knights (#38-40), a 3-part storyline where Batman and the Huntress fight Checkmate before the Huntress ultimately agrees to join the organization. This would score 10 points: 3 points for number of issues, 2 points for the Huntress (as she was a major character ), and 5 points for her acting out of character.
• Batman: City of Lights would score 18 points. 4 points for being an 8 issue limited series, +3 for Batgirl (as she is a main character), +4 for a new villain, +2 for the death of a minor character, and +5 for Batman acting out of character.
• I don’t even want to calculate the score from Hush

With just a little work, this system could be adjusted to fit other super-hero titles as well. Reading Previews will give us enough for Basic SCRUB scores, and reviewers could put Advanced SCRUB scores in their reviews. With the use of SCRUBS, bad Batman storylines can be avoided!
(I admit this is tounge in cheek — mostly — but I still think it could work.)

When I interviewed at Saint Louis University School of Medicine, one of the things that most impressed me was this enormous room filled with a variety of anatomical mannequins. I had been worried about learning how to draw blood and perform other procedures on frail old ladies, but clearly this room was the answer to my concern: we would learn on mannequins.

Of course, I was wrong. We only used that room once, and then just for the OB practical exam. On the other hand, we didn’t have to learn to draw blood on little old ladies; we learned on each other.

In the middle of our second year of medical school, it was time for us to learn to draw blood. A full six-hour Glucose Tolerance Test was to be run on every student, and we were going to draw the blood for the test ourselves. A glucose tolerance test is an older test used to diagnose diabetes or similar problems with sugar metabolism. It is used most commonly in pregnant women in their second trimester to test for gestational diabetes. A standard sugar load is ingested and then the blood sugar level determined at regular intervals afterwards.

The class was divided into thirds; the first third went Monday, the second, Tuesday, and the third on Wednesday. As usual, I ended up in the first group.

Early Monday morning we showed up at the second floor histology lab. We were given a glass of Glucola to drink based on our weight. Glucola is this sickly sweet syrupy beverage that gives a specific sugar load. Ours was this cloying root beer flavor and was one of the most disgusting things I’ve ever had to drink. It took all my effort not to gag, but I managed to get it down.

An hour later, and then every half-hour after that, we had a tube of blood drawn. We would take turns and draw blood from each other. Watching the other students, you quickly learned who you wanted, or more importantly did not want, to draw your blood.

The first draws were the hardest. My classmate would rest their arm on the table, and I’d wrap a rubber tourniquet around the upper arm. They’d pump their fist a few times to make the arm veins stand out. I’d poke around with my finger to make sure I found a good vein that wouldn’t move or roll on me. I’d swipe the skin with an alcohol swab to kill any germs. Taking a needle and a vial, I’d carefully slide the needle into the vein and pop the vial onto the back of the needle. Once the blood was flowing well, I removed the tourniquet so they wouldn’t get a large hematoma when the needle was withdrawn. After the tube of blood was full, I carefully pulled the needle out. The needle is razor sharp and can cut the skin fairly deeply if it’s pulled out at the wrong angle. A bandage was applied, the vial was labeled and turned in, and then it was my turn to grit my teeth and be the patient.

The blood draws at the end of the day were easier because I could follow the previous needle marks — just like runway lights — and find the vein easily.

Six hours and eleven blood draws later we were done. We had learned how to draw blood, and would learn the next day whether any of us were diabetic (nope). As I climbed in my car for the drive to my apartment I prayed that no cop would pull me over, because he’d never believe my story about the needle marks up and down both arms.

Drawing blood is not a skill I use frequently. There are trained medical technicians and phlebotomists who do the job much better and quicker. However, there have been situations when labs were needed immediately or when I was the only one available that have made me glad that it’s a skill I possess.

The United States Postal Service team handily won the team time trial today at the fourth stage of the Tour de France, catapulting Lance Armstrong into the lead and the coveted yellow jersey. Former teammate (and now competitor) Tyler Hamilton also did well, but Jans Ullrich fell far behind for this early in the Tour.

There are still several stages left that favor sprinters before the mountain stages begin, so Armstrong will probably lose the lead in the next day or two. Baring catastrophe, he should be able to regain the lead on the mountain stages.

This is a good beginning to the Tour for Armstrong and the rest of the Postal Service team.

Since I have some vacation I have to use before the end of August, the Polite-wife and I have decided to attend the Wizard World Chicago convention in August (well, I decided to go and she — for some reason — has decided to accompany me).

I attended the Chicago Comic-con several times in the ealy-90s, but no big conventions since then, so it should be an interesting change experience.

If anyone else is planning to attend, let me know…

Please note: Using big words does not make you seem smarter, especially if you put them together in an apparently random fashion. This applies not only to reporters, fiction writers, (probably some bloggers), but also to game designers.

This particular passage from last month’s issue of Dungeon (#112) caught my eye:

The entire room is dark gray, and the walls and ceiling seem almost to loom with an oddly latent malignancy.

Does this description make sense to anyone? Malignancy I can understand, but what makes it latent? And then, if it is a latent malignancy, what makes it so odd? I would consider all latent malignancies odd, but apparently that’s not the case.

Laura’s experience with blood draws is a common experience.

There are some abilities in the medical field that are more art than skill in the hands of an expert. Blood drawing is one of those abilities.

Some people are simply horrible and cannot draw blood. It’s clearly a skill they lack. I admire their persistence, but please find another job that doesn’t inflict as much pain on innocent people. On one occasion, I’ve had to stop the phlebotomist at the blood drive (With a “You know there’s a nerve down there, too?” spoken between gritted teeth) and place the needle myself.

Others people are experts, and could probably get blood out of a turnip. In my experience, the best individuals at drawing blood are anesthesiologists and pediatric nurses, especially those from the nursery. However, the best phlebotomist I’ve ever seen in action was a secretary.

There was an elderly gentleman on the floor. He was having a rough night and I desperately needed to draw blood from him. He had just lost his IV, and none of the nurses could get a blood sample or place the IV. Expert nurses from the ER and pediatric floor were called, but their luck was no better. Anesthesiology tried and failed. I was at the front desk discussing the possibility of a central line with the nurse and anesthesiologist when the floor secretary got up, washed her hands and walked into the patient’s room. Two minutes later she came out with two tubes of blood and told us his IV had been replaced. As we all stared at her in open-mouthed shock, she nonchalantly resumed typing orders into the computer.

I never did figure out her secret.

JSA #62 Redemption Lost, part 3
Geoff Johns, writer
Don Kramer and Tom Mandrake, pencilers

After a battle with the Spirit King, Mr. Terrific collapses and stops breathing. Dr. Mid-Nite and Hourman rush him into the nearby medical clinic.

Hourman: Is he–?
Dr. Mid-Nite: Breathing again. His pulse is fluttering. He’s having a heart attack.

There appears to be a common misconception here. Heart attacks and cardiac arrhythmias (bad heart rhythms) are two entirely different things. A heart attack is caused by the death of part of the heart muscle, and an arrhythmia is caused by a problem in the conduction of the heartbeat itself. Both can be fatal. Bad heart rhythms don’t cause heart attacks, but heart attacks can sometimes cause bad rhythms.

Dr. Mid-Nite pulls out the defibrillator and shocks Mr. Terrific’s heart back into a normal rhythm, but this does nothing for the underlying heart attack. Other than placing Mr. Terrific on oxygen, Dr. Mid-Nite never treats the heart attack itself (no aspirin, no nitrates, no beta-blockers, and no “clot-buster” drugs). Ideally, Dr. Mid-Nite should be treating both the arrhythmia and the heart attack.

Lingering concerns:

1. If his “pulse is fluttering”, why is the heart monitor showing a flatline? Any rhythm strong enough to create a pulse would be visible on the monitor.
2. The nasal cannula is drawn much better than normal (almost correctly).
3. I’m unclear on why Mr. Terrific was having a heart attack in the first place. He was attacked by the Spirit King (using the Flash’s body), but he managed to get his own licks in at the end of the fight. The Spectre intervenes, and suddenly Mr. Terrific is unconscious in Hourman’s arms. Was there a clot? Was it the trauma? He did receive a solid blow to the upper chest, could this have ruptured some coronary arteries? Or was it John’s incorrect assertion that a cardiac arrhythmia (most likely caused by trauma) caused aheart attack?
4. I hope the JSA has good health insurance. Mr. Terrific is the second member to suffer a heart attack. Dr. Mid-Nite himself experienced one in JSA #19 after looking into Johnny Sorrow’s face. At least they both healed quickly.

On the non-medical side, I felt this issue was a bit of a let down. The two issues leading up this had been strong, and the zombie attack was (of course) great. Having the Spirit King possess Jay Garrick again and then attacking the new Mr. Terrific was a stroke of genius. Then the issue ends with a deus ex machina courtesy of the Spectre. I’m not fond of deus ex machina in my comics, but if it’s going to happen, it should be because of someone on the team, not a visiting player. Ultimately, the JSA served no purpose in the story arc other than getting themselves beat up.

After realizing that both Mr. Terrific and Dr. Mid-Nite had suffered heart attacks, I began to wonder exactly how many injuries JSA members had suffered. Digging through my comic boxes, I dug out my issues and added up the totals.

My research showed what I suspected; it is very dangerous to be a member of the JSA (especially Wildcat, who seems to be a magnet for injury). Maybe not as dangerous as being a red shirt aboard the Enterprise, but close. It’s also dangerous just being an associate of the JSA.

This list covers JSA issues #1-62, JSA Annual #1, JSA: Our World at War, and Hawkman #23-25 (the Black Reign crossover). Main characters are in bold, associated characters are in italics.

Sorry for the late ramble today. A quick and nasty thunderstorm blew in and knocked out our power for much of the afternoon. Most of the weekend has gone toward outdoor tasks. I’ve been working on building a butterfly garden in the backyard. When we moved in late last summer, the air was thick with Viceroy butterflies. I hope to entice them back by builing a nice garden for them. I’ve ordered some native plants especially for butterflies from the Missouri Wildflowers Nursery. I got the garden laid out and hand tilled most of the soil yesterday. Today, I dug out the rest of the ground and started placing the edging. Then the rains came. Hopefully it’ll be dry enough tomorrow for me to finish the edging and start laying in some top soil.

Sunday Blog-o-Bits:
1. The Tour de France continues. Lance Armstrong maintains sixth place, 9 minutes and 35 seconds back, but watch for his comeback once the Tour hits the mountains. OLN did move their daily coverage back and hour ’til 8PM central….arrgh!!

2.A nice brawl in NASCAR today. In all my years of NASCAR watching, this is the first actual baseball worthy bench-clearing brawl I’ve seen. An occasional tantrum, punch, or scuffle, but never a full brawl.

What’s wrong with this picture? (Cropped from the cover to Emma Frost #10, art by Greg Horn)

I was reading this month’s Dungeon Magazine (#113) where I noticed they had poster map of the new D&D campaign world, Eberron . What little I’ve read of Eberron sounds intriguing. Then I saw the name of the continent on the map: Khorvaire.

Khorvaire? What’s the other continent? Edsel? Pinto?

I can only assume it’s unsafe at any speed…

(I’m not really showing my age here; our next door neighbors had a Corvair when I was growing up in the 80s. I actually thought it was a pretty cool car. This was long before I had ever heard of Ralph Nader and his original claim to fame.)

Batman: Gotham Knights #53
A. J. Lieberman, writer
Al Barrionuevo, penciler

In this issue, Hush joins Dr. Mid-Nite as one of the few physicians portrayed in comics who are actually shown practicing medicine.

Hush travels to Star City, where he rescues Prometheus from a battle with Green Arrow. Green Arrow had shot Prometheus 3 times: once in each shoulder and once in the thigh.

In a hotel room, Hush initially has Prometheus icing his shoulder, and then encases his whole body in bags of ice. An IV is placed and running some sort of fluid. Hush removes the arrows and sews up the incisions. He injects Prometheus with morphine to kill the pain.

First, Hush has good suturing skills. He gives an excellent demonstration of vertical mattress sutures.

Sutures come in two main varieties: running and interrupted. In a running suture, a knot is tied at one end of the incision, enough stitches are placed to close the wound, and then a second knot is placed at the far end. Running sutures are fast and not as irritating to the body as interrupted sutures (there are fewer knots). Therefore they are good when speed is an issue, or internally when fewer knots are better. On the other hand, running sutures aren’t as forgiving, and one break will re-open the entire wound.

In interrupted sutures, each stitch is tied and knotted separately. Interrupted sutures are easier to line up and give better cosmetic results. They are slower to tie, but sturdier because one stitch can break without affecting the others.

Hush is using a special type of interrupted suture known as a vertical mattress suture. These are good for closing gaping wounds without putting undue pressure on the incision (note that the knots are not over the incision). They can leave a bigger scar sometimes and can be a pain to take out, but are a good choice in this instance.

I’m unsure what the purpose the ice is serving. There is anecdotal evidence that lowering a patient’s temperature slows bleeding, but if it is lowered too much the bleeding worsens. The temperature must be tightly controlled, not like it is here. More importantly, individuals who have lost a great deal of blood are at increased risk for hypothermia, so icing Prometheus is not a good call.

Finally, it would be a lot easier on Hush if he’d just inject the morphine in the IV already there, rather than trying to inject the vein.

A childhood love, but still one of my favorite candies. Large amounts of caffeine and Smarties helped me survive my ER night shifts during residency. I keep a jar of these around the house to stave off the occasional hunger pain.

As any true Smarties afficionado will tell you, you have to eat them in the proper order. I prefer white-orange-yellow-green-purple-red.

A note to European readers: Smarties here in the U.S. are much different from the European candy-covered-chocolate treat of the same name.

My most common diagnosis of the past two weeks has been poison ivy. I didn’t see much of it when I was stationed with the Air Force in Nevada (which makes sense, because “poison ivy” and “desert” don’t exactly go together). But here in Illinois I’ve been seeing a lot of it. At least 2 or 3 patients a day for the past two weeks.

Most people just have a few spots, but some have severe rashes. I’ve seen poison ivy in the eyes, nose, mouth, and less pleasant-to-mention places.

Treatment is straightforward and easy, but I still itch for at least an hour after seeing each patient.

Prevention is the key word. “Leaves of three, let it be” is still good advice. If you get some of the sap on your skin, wash it off with lots of soap and warm water. Pay special attention to under the fingernails, and wash the clothes in hot water because the sap can remain on the clothes for days.

As part of the third year of medical school, each student had to take a 3-month Surgery rotation. There were 3 choices for your Surgery rotation. You could choose Group A (the “I know I want to be a surgeon” group), Group B (the “I may want to be a surgeon” group) or Group C (the “no way in Hell am I going to be a surgeon” group). I was the poster child for Group C.

My 3-month rotation was made up of one month of Pediatric Surgery, one month of General Surgery at the VA hospital, and two weeks each of Vascular Surgery and ENT Surgery. The Pediatric Surgery was intense, but at least we were not expected to take call. The residents were fun to work with and the attending physicians instructive. The VA rotation was easily the most miserable month of my life. Unfriendly residents, unpleasant physicians and a grueling call schedule. I found Vascular Surgery interesting, and the surgeons were friendly and helpful. I was able to do my first stitching of a real patient during this rotation. The ENT rotation also went smoothly. I had bartended the ENT Christmas party the year before, so I knew all the residents and instructors (and how much they drank).

In addition to the surgeries and routine patient care, there were daily lectur