And now for some erudite interests: a song from a horror videogame (Room of Angel)

This is the opening/main theme song from the Japanese horror videogame Silent Hill 4: The Room:

A long time ago, I read a review that very succinctly and accurately summarized this game's plot: hell has invaded some poor bastard's bathroom. 

The Man from U.N.C.L.E: it exceeded my admittedly low expectations

I don't go to the movies often. Part of it is my general dislike of going outside; another part is my reluctance to spend money on anything that isn't legible or edible, and the rest is just laziness. I know that seeing a film on the big screen, especially an action or sci fi film, can be incredibly satisfying. But actually getting to the theater can be such a hassle.

Last weekend, I wanted to celebrate finishing my odious rotation in the ER. I also wanted to catch up with an old friend who asked that I pick between this movie, some new Mission Impossible nonsense, and a videogame film. The choice was obvious.

I could analyze this flick in terms of plot, characterization, pacing, costume, score, social context, history, etc., but I think the best way to summarize its quality is much simpler. My friend and I were both in a sour mood when we sat down at the theater, and we both left smiling and joking.

Verdict: this is a movie worth watching.

I do have more to add, though. The three leads had great chemistry and they were all relatable, insofar as action film wish-fulfillment characters can be. Gabby stayed within the constraints of an action film damsel in distress (I didn't claim this movie is trying to be progressive), but at least she had her own agenda in the plot, and was allowed to make choices to achieve that agenda. She spent the last act of the movie as a hostage, and her agenda did revolve around a man (her father), but still. At least she's someone I'd like to go for lunch with.

The most surprising part of the film was Henry Cavill, who played the suave American spy Napoleon Solo. The only other film of his I've seen is the tragedy that was Man of Steel. I walked out of that movie convinced that this gentleman was no more than a pretty face with the charisma of a soggy napkin, but it looks like the director of Man of Steel is to blame for that travesty.

Henry Cavill was charming throughout the movie. He managed to make utterly ridiculous scenes (like the one where he eats a sandwich while his partner spy is gunned down by armed boats) seem more fun than silly. Though he portrayed the character as a flirt who robbed old ladies blind, I never got the feeling he was sleazy. Whoever directed this allowed him to make facial expressions that conveyed more than mild constipation. Good for him.

The Russian spy was played by Armie Hammer, who Google informs me is some American actor who's been trying to make it in Hollywood for some years. I have no way to asses the accuracy of his "Russian" accent, but I can report that he was also a fairly likable character. His anger issues and "emotional disturbance" were shoved in the audience's face with a shameless lack of subtlety (the ever original shaking hand thing), but Hammer managed to imbue his supposed brute with plenty of depth and vulnerability.

All in all, I recommend the movie. It seems to have earned itself a respectable fandom that's producing lots of cool material to keep people entertained. More of that in this tumblr.

Outlining; personal pros and cons

I didn't outline at all for the first story I tried to write, and it was a disaster. I messed up in the beginning and lost control of the pacing probably by chapter two. At one point, I tried that snowflake method, and I got so caught up on details before getting to the writing that I didn't actually write anything.

I wasn't sure what to do. From what little I could glean, writers fell into two camps: the plotters who spent as much, if not more time plotting than writing, and the pantsers who just sat in front of their computer and let a story flow out their fingertips. It seemed like I didn't fit into either category.

Then for my current WIP, I tried something I consider "new", but I'm sure that writers have been doing since . . . forever. I tried for a very flexible, evolving outline. First, I wrote down my loose concept and broke it up into twelve "chapters". At this point, I didn't concern myself too much with plot twists, rising arcs, or characterization. I just wanted to know what the story was going to be about. I let my rough outline sit for a couple of days, then came back to fill in more specific events and tried to break up the "chapters" into loose "episodes".

And I was ready to write.

I've just finished chapter five of my WIP, and I'm satisfied with my progress. I realized right away that I couldn't follow my outline to the letter. Instead of panicking, I simply revised after every chapter. This way, I could reassure myself that I was making progress while reminding myself of my endgame. I also gave up on keeping the chapters as chapters, hence my continued use of quotation marks for the word in this post.

I haven't tried to outline my characterization at all. I hate to sound like an artiste (I don't like the idea that characters have a mind of their own; they don't exist outside my imagination and I am my imagination). I have learned that characterization is probably best when it flows organically. Plots tend to be mechanic, but characters are hopefully always unique.

Personal lesson learned: outline what needs to be outlined, and improvise what needs to be improvised.

Social Media is Bullshit by B. J. Mendelson - a funny title to recommend on a blog

As I've complained before, I'm not the most social person in the world. Not even in the online word. Yet common wisdom tells me that I must have a robust social media presence if I want anyone ever to notice my writing, hence why I'm trucking along in this here blog. I picked up the following title hoping to get some pats in the back about the rather . . . inadequate effort I'm putting into gaining a following.

It's been an interesting read, though it's yet to offer me the get-out-of-marketing card I'd hoped for. Marketing is important, and the internet is one of the few places where a person can take a stab at it without a massive budget.

Of course, the massive budget would be immensely helpful, and that's one of the points Mendelson makes. It's very unlikely that I (or anyone) will "make it" with the help of a plucky blog/facebook/twitter/youtube account without help. Even if we have a high quality product.

What did I learn from this book?

• How famous social media successes (ex. Justin Beiber) actually happened.
• How rich corporations can afford to sink time and money into social media advertising that a solo artist like me couldn't afford if I sold my soul to Satan.
• How facebook is as evil as I've always suspected.
• That face-to-face marketing is still the most important (though ew).
• How not to be obnoxious to other solo bloggers/artists online in a shallow attempt to drive traffic to my lonely blog.
• How I should focus all my attentions on one blog/website rather than spread myself thin on every social media platform on the net.
• Hopefully, how to spot scammers preying on artists and/or small business owners with promises of social media magic.
• That first and foremost, I need to be offering something worthwhile if I have any hope of ever building a "base".
• To chill out and try to have fun with this blogging thing!

So I would highly recommend this book. It's an interesting, level-headed perspective on social media and marketing.

Amazon

Muscle cramps

I've always gotten them in my calves, and usually at night. Back when I exercised regularly, they used to happen three-four times a week. "Stretching" never seemed to help that much. Anyway, I've gotten pretty good at recognizing when they're coming: I begin stretching, extending my knees, and I feel the superior aspect of my calves tense up.

It's peculiar. I know what's about to happen, and I know it's going to be painful. I'd probably cry if it lasted more than a minute. Though I know it can't be stopped, I still try to think of a way. Lately, I've started quickly flexing my knees back and forth. It still hurts, but I like to think the pain passes faster. Not really, though. Without fail, the burning pain shoots up my thighs and down my legs, like a huge boulder fallen in the middle of the ocean, causing two waves in opposite directions.

When the cramps are bad enough, I know I'll be sore for hours after, though those waves of severe pain will last less than a minute. More exercise seems to help, except for one time when I was teen when I tried to exercise going up and down some steps in the park near my house, and my thighs were sore and weak for a month.

I haven't exercised at all this month, unless you count the hours running to and fro in the ER exercise. The pedometer on my phone claims I'm consistently walking at least ten thousand steps a day, but I know it doesn't have much going for it in the way of accuracy.

ER shifts are making me discombobulated. Being in that relatively narrow strip of hospital, with no windows and a constant stream of patients, can be disorienting. My diet, sleep, and exercise schedules are a disaster. I haven't gotten much of a chance to read pathology, or write. Or go to the gym. Switching from day shifts to night shifts is making me confused about what day it is constantly.

At least, I'm getting lots of perspective of how an ER in a busy hospital works, which should help for the scenes in my novel that happen in a busy ER. The most important aspect of the atmosphere will be constant noise.

Somehow, I always know when the sun is out. It must have something to do with the atmospheric pressure.

Histology for Pathologists - My first post-post graduate textbook

When I asked my mentors about which textbook is absolutely essential for a pathologist in training, the recommended this glorious tome. It's so expensive it took me forever to buy . . . but it's for my career, and I've always been the type of student who prefers to have a paper copy of whatever I'm reading. 

This book is 1300+ words, which even with the appendix included is pretty intimidating. Another mentor of mine said he'd been practicing pathology for thirty years, yet he feels like he's only scratched the surface of what's known about the subject. Never mind what isn't known. 

My current goal is read or review at least one section of this book a day. I know my own limitations. I will not be able to learn much by studying once a week, or a month before each of the many tests I will have to take. 

On the bright side, I find all this so freaking cool that I'm more excited than intimidated right now. I've started reading tonight and already reminded myself of something I probably already knew and learned something I'm probably going to babble about tomorrow.

Eh, I'll babble about it right now. I got the image bank so now I get to share awesome pictures.

 

On the right are Toker cells (Figure 1.3 from Histology for Pathologists). 

If I was a cool blogger, I could probably use one of the arrow thingies to point them out. They are the "clear cells with pyknotic nuclei with a clear halo, surrounded by a narrow rim of cytoplasm". Two of them on the left corner sort of look like they're the eyes of a sad owl?

Anyway. They're important because they's a normal variant of cells, often found around the nipple, which can be mistaken for Paget's disease. Actually, there's apparently question of how benign they are, or if they're precursors of Paget's disease, but that's out of my league. 

Paget's disease is a commonish disorder that I should probably know more about, but I don't. There are so many Paget's diseases. Of bone. Of breast. Of other stuff, probably.

On the left is a picture of extra-mammary Paget's disease (see, I told you there was a lot of stuff about Paget). (Figure 1.4 from Histology for Pathologists)

I think I see what the text is telling me about the difference between Paget cells and Toker cells. The nuclei are pleomorphic (fancy way to say they have lots of weird shapes). The textbook tells me that there's more intense staining of the chromatin, but I don't actually see what they mean by that yet. I need more practice.

I do think the Paget cells look "uglier" than the Toker cells. A principle of pathology I've picked up is that normal tissue = pretty, organized while diseased tissue = ugly, messy. That's not always the case. I've seen some visually stunning cancers.  

Gomer blog, the site I must resist ripping off everyday

Like the Onion, but for healthcare workers. Featuring news articles such as:

Intern Shocked to Discover TV Residency and Real Residency Vastly Different

Anesthesiologists Compare Arm Tans While Surgeon Repairs Penetrating Aortic Injury

Personal favorites:

Tired Critical Care Fellow Accidentally Intubates Patient's Rectum

Devious MRSA Spider Bites Yet Another Antecubital Fossa; Remains at Large

After Another Horrid Shift, Doctor Calls Palliative Care on Self, Goes Home on Hospice

Pathology Duty Pager Goes Off Overnight

This can be called research, right? If you're ever writing a medical drama, this is the kind of humor your doctor characters are dying at.

Flash fiction - Seven Deaths

One

The baby was born too soon, so soon it could barely be called a baby, and the thin skin over his ribs stretched almost translucent every time he tried to take a breath. His mother cried the only time she came to see him, then asked if the transparent skin that made up the corners of his nostrils hurt. He died without a name.

Two

She was going home from college on Mother’s Day when a drunk driver T-boned her on the driver’s side. She got three bags of fluid on the way to the hospital, then died in the operating room while an exhausted trauma surgeon tried to find the source of internal bleeding. Later, the forensic pathologist explained that it was a routine case of exsanguination into the pelvis.

Three

The man had some kind of tumor wrapped around his heart. Though he’d tried not to listen when the grey-haired doctor with hundreds of fancy words explained it to him, he knew they couldn’t operate because his trapped, agonized, strangulated heart wouldn’t be able to pump through the fog of general anesthesia. Every single one of his heartbeats was a diffuse stab trying to claw its way out of his chest, including his last.

Four

The woman chased down too many Tylenol with vodka shots, and it ate away her liver. Her mother brought her to the ED once she started hallucinating insects crawling all over her skin, biting and biting until they drew blood, and she bled inside and out while her mother tried to convince the transplant board that her her daughter wasn’t a drunk.

Five

The doctors were always saying he was about to die, and they were always wrong. It hurt to breathe, true; which was why he needed to get out of the hospital and blow someone for a little hit. Just one more . . . just one more. It was his last thought before the clot broke off his heart valve and got stuck in some important artery or other on the way to his brain.

Six

She was going her own way, and not neat and soft like the women in novels, or like the statistics on suicides said she should. She walked into the emergency room and said she was planning to kill herself, only pulling the gun out when they called for the bitch shrink in the crisis unit. They were the ones who said they couldn’t cure her brain tumor, so they would be the ones to clean her brains off the floor.

Seven

He was a ninety-year-old smoker with a mass eating out of his lung and a heart that barely pumped any blood, but his daughter loved him. She was with him in the ICU when the monitors got louder, and she yelled that she’d sue every last doctor in the hospital if they let her father die. No one paid much attention to her, but the ICU did what the ICU does, and the last time she saw her father, a kid in blue scrubs and a short white coat was suctioning lung pieces out of his mouth.

Rhabdomyolysis - is it too geeky/technical for a fiction story?

As I keep telling anyone who'll listen, I'm writing a sci fi/speculative fiction novel about a magic disease that gives an extreme minority of patients superpowers. In the spirit of originality, one of those superpowers will be super strength. How the super strength will work is irrelevant because . . . you know, magic, but I know how skeletal muscle destruction looks. Or I should know anyway. There's too much stuff to memorize in medical school.

So! My review of rhabdomyolysis (rhabdo = something like "rod-shaped" in Latin, a reference to the structure of skeletal muscle cells; myo = something to do with muscle; lysis = breaking; I think of it as tearing cellular membranes apart). Which, like everyone in the hospital, I'm going to shorten to "rhabdo" from now on.

Imagine you wake up one day feeling weak. Your body hurts, especially around the shoulders, thighs, and calves, though rarely to the point where you can't move. But you do feel crappy as you head to the bathroom, and by chance you look down at the toilet before flushing your morning urine -- and your urine's brown!!!

The textbooks say "tea-colored" urine, but patients are usually freaking out because my piss turned black (or red!!!!) holy shit, do something!!! Though if they're screaming, it was a mild case and they'll probably be fine.

Why is the urine dark/"tea-colored"/black/red? Because skeletal muscle cells have lysed, releasing myoglobin into the bloodstream, which then deposits in the renal tubules. Picture time:


This is acute tubular necrosis of the kidney following rhabdo in nineteen year old marathon runner.

The early damage is caused by constriction of the afferent arteriole, the blood vessel that feeds the glomerulus (kidney's functional unit). This leads to ischemia and acidity in the kidney. There's also deposition of myoglobin in the renal tubules, which can only be seen with special stains.

Myoglobin is related to hemoglobin, the protein that carries oxygen in the blood. Interestingly, heme proteins in blood do not seem to cause renal injury in the absence of aciduria and hypovolemia (we always have hemoglobin after all), both of which tend to caused or be caused by rhabdo.

Oh and there's also the hyperkalemia. Like all cells, skeletal muscle cells have a lot of potassium, and if it makes it into the blood, it can cause a heart attack. (I believe the USA uses or used potassium chloride in the lethal injection cocktail).

Duolingo and Portuguese

I just noticed today that I'm down to the last few Portuguese lessons on the wonderful free app Duolingo. I started the "course" a little less than a year ago, and my Portuguese is good enough that I can communicate with Brazilian patients. I'm obviously better at understanding it than speaking it, but understanding is enough for my purposes.

Once I finish the course, I plan to read Veronika Decide Morir in the original Portuguese (can't put the accent in that o, grrr).

Link to Duolingo for anyone interested in a new language.

Judith Ivory's "The Proposition": One of my favorite Romance novels

This is one of those books I go back to once or twice a year to reread my favorite chapters/scenes. Its plot is nothing earth shattering: an upper class, "ugly duckling" spinster living in genteel "poverty" teaches a chimney sweep/rat catcher how to act like an upper class gentleman. This all happens because a pair of d-bags make a bet that some street rat can't learn to be upper class or whatever, and of course there's some intrigue where the street rat is secretly a noble all along, but whatever. That's not what stuck out to me about this story.

Both leads are really likable and well developed. They both have their moments of vulnerability and strength. The female lead might be well-educated and upper class, but she's still a woman. Her business teaching other ugly ducklings of high society how to behave at dinner parties will be destroyed if she's caught "living" with a street rat. Mick might be a man, and big and strong, but he will pretty much be killed if he's caught fooling the upper classes at one of their parties, especially if he's caught "seducing an innocent". 

And I do like the opening quite a bit:

The most highborn lady Mick had ever been with - the wife of a sitting member of the House of Lords, as it turned out - told him that the French had a name for what she felt for him, a name that put words to her wanting his "lionhearted virility" - he liked the phrase and remembered it.

"A yearning for the mud," she told him. "That's what the French called it."  

Amazon

Forensic pathology textbook

I've downloaded a copy of Knight's Forensic Pathology textbook. It's a 2004 edition, but it’s free!!! I have some reading for any down time during tonight's ED shift.

So excited.

Flash fiction: How To Demoralize Your ER Doctor in Ten Easy Steps

1. What you read online is true: if you say you have chest pain, someone in the ER will usher you right in for an ECG. So make sure to say your chest hurts! Bonus: use the words “pressure” and “crushing” to describe this pain.
2. After you’re through the door, sneak away to get a Coke from one of the bending machines.
3. Do not, under any circumstances, cooperate with the tech trying to get you that ECG for your chest pain.
4. Inhale some of that Coke while telling your doctor your chest pain has passed, and now your stomach hurts.
5. Say your pain is 100/10 as you play with your phone. We all understand nothing on this Earth could be worse than not knowing what all your Facebook friends are posting at all times.
6. If your doctor abruptly walks away from you while you mumble something about the runs, it wasn’t because the patient on the bed next to you started seizing. Threaten to sue her when she remembers to get back to you.
7. By this point, it should be clear that no one’s offering you anything for your pain. You need to take some initiative. Tell everyone you’re allergic to morphine, Advil, Tylenol, Tramadol, aspirin, and ibuprofen, but your doctor gave you some drug you don’t remember . . . the one that starts with a ‘D’, and it works just fine. Dilutid? Delucid? It goes in the vein.
8. Dilaudid! It was Dilaudid. Gosh, you’re so glad you managed to remember the name!
9. Throw your soda at the doctor when she refuses to give you some Dilaudid. Even if she dodges, which she probably will unless you’re at the tail end of her shift, you’ll still be sending a message.
10. Be calm and collected by the time the police arrives to relieve the orderlies you’ve been verbally abusing for the last ten minutes. 

(I'm doing shifts in the ER this month.) 

"That's great!" Mary said happily . . .

I will probably always hesitate to give any specific advice on sentence structure and word use, even if ever reach a level of success/notoriety that anyone might ask me for any. As a new writer, I've found a lot of the nitty-gritty advice in random blogs . . . less than helpful. For example, my blog's attempt at a clever name comes from something I've seen more than once:

A new writer asks for their work to be critiqued. They're excited, nervous, etc. They want to know if they have an interesting idea, if their characters are engaging, if they can keep anyone reading . . . and somewhere in their prose, they've put something along the lines of "That's great!" Mary said happily. They do not yet know this is a writing faux pas.

A more experienced writer comes along and strikes out the word 'happily'. They could explain that in this particular case, happily is unnecessary because "That's great!", specially with the exclamation point, is pretty clearly a happy statement. The adverb here is belaboring an unnecessary point and feels intrusive. It's not enhancing the scene.

But that's a lot of words, and the more experienced writer has things to do. So they just write something short and simple like "adverbs are for amateur/clumsy/lazy writers; let the dialogue speak for itself". Which is less words, but if you noticed, doesn't actually explain anything.

The new writer's probably mortified by this point. They want to eliminate that adverb ASAP. They may have to look up what an adverb is, then somehow arrive at the conclusion that an adverb is anything that ends with -ly. Possibly from writing blogs. Then they train themselves to search and destroy those -ly word . . . and replace them with adverbial statements.

"That's great!" Mary said happily becomes "That's great!" Mary said in a happy tone.

Our new writer goes off, proud that they're now less new. When it's their turn to help out a new writer, they might sagely give the advice that -ly words are clumsy and amateurish, and they should describe the characters' tone of voice instead.