Path of the day: Hep C cirrhosis

I'm alive! Just really busy.

Here's a portal triad (artery, vein, and bile duct) with significant fibrosis and chronic interface inflammation, the hallmark of chronic Hep C infection. 

Tumor of the day: squamous cell carcinoma

Keratin pearl

Skin is made up stratified, keratinizing squamous epithelium. Normally, basal cells are basaloid, with nuclei and other organelles.  These nuclei and organelles, specially the nuclei, are bluish (basophilic). Their job is to create keratin that will act as a protective layer over the topmost layer of skin. As the epithelium matures, the cells migrate into higher levels and begin to lose their organelles and nuclei, becoming pinker and pinker (more eosinophilic) all the while.

So finding well-differentiated squamous cells carcinoma is a matter of finding a loss of that specific organization. The way I think of it is "look for pink where it's not supposed to be". Dysplastic cells start making keratin and maturing way faster than they should, or they refuse to mature as they rise into higher epithelial levels. Or both. Or maybe I just don't know enough about the process yet. 

Regardless, the most obvious examples of well-differentiated have islands of keratin coated with immature, dysplastic cells. They look very pretty, and old pathologists probably would agree with me because they're called "keratin pearls".

World of Final Fantasy: awesome, or are my standards too low by now?

Buy here.

Against my better judgment, I purchased a full-price copy of World of Final Fantasy shortly after it came out. Most Square Enix games I've played in the last few years have been crushing disappointments, but I guess old habits die hard. For better or for worse, my hindbrain associates Square with games I enjoy. I briefly considered buying Deus Ex: Manking Divided even though I know it's not the kind of game I like to play. It was published by Square Enix, apparently.

The only logical, if unflattering, explanation is that I'm not as immune to bitter brand loyalty as I like to pretend I am. For now, I'll console myself with the fact that, at least in the case of World of Final Fantasy, brand loyalty didn't lead me astray. I've not had this much fun playing a videogame since Fire Emblem: Awakening. And considering Awakening is one of my favorite games ever (Chris, I'm still gonna harass you into buying a 3DS and playing this game), that's saying something.

Much like Persona Q, World of Final Fantasy is a blatant play for long-time fans' wallets. And much like Persona Q, I was floored by how much the developers seem to have cared about making a fun game even though name alone was going to move copies.

You play as a pair of twins that. . . honestly, who cares? They travel from dungeon to dungeon, meet heroes from previous Final Fantasies, while catching classic Final Fantasy monsters like they're Pokemon. I can't even pretend to be able to judge this game with any objectivity because did you read that description? 

That being said, I'm going to try.

Tumor of the day: GIST

My job makes me wish I was a better artist because things like these are worthy of watercolors, no matter how tragic they may be:

The detail never looks quite right outside a microscope

You can see a bit of gastric epithelium in the bottom part, at the center. This is a low-power view of a GIST (gastrointestinal stromal tumor), spindle pattern. It's a sarcoma of the gastrointestinal tract, originating from the interstitial cells of Cajal, which are the pacemakers of the gastrointestinal tract. At high power, they look this:

GIST, spindle cell pattern

These cells stain with DOG1 (discovered on GIST) and CD117, and other stuff I'm not remembering off the top of my head.

The Sociopath Next Door: A psychologist's thoughts on the nature of evil

Buy on Amazon.

I don't remember if I ever mentioned it, but I have a psychology baccalaureate. At the time I chose my major, I thought it would be useful for a doctor to know as much as possible. And I also found the subject inherently interesting, though even back in the dark ages of 2007, people were warning my that a psychology baccalaureate would only prepare me to work as a cashier at Rite Aid.

I don't much use my psychology degree these days, unless you count the times I tell myself to be patient at work because we're all under a lot of stress. Mostly, I like to tell myself that I use what I learned about psychology in my writing hobby to help me with characterization. It's how I justified buying The Sociopath Next Door instead of putting an extra $12 towards my student loans payment, anyway.

Someday, if I become the next JK Rowling, I will have this book to thank for helping me write the most compelling sociopath imaginable. After all, Dr. Stout herself states that:

Conventional wisdom has it that dangerous people are attractive, and when we are drawn to sociopaths, we tend to prove out this cliché.

That being said, I very much doubt that any realistic fictional sociopath would be all that popular, at least not if they're realistic in the way this book describes. Not just because the chances of me becoming the next JK Rowling are astronomically low, but because Dr. Martha Stout writes about real people with Antisocial Personality Disorder, not the idealized Hannibal Lecters of the fictional world.

Devil May Cry and $8.00 USD cranberry juice

It's been a busy month for me, to put it mildly. Cancer hasn't let up, although I've been pretty lucky autopsy-wise. Only two this month, and one was neuro-only. But I've had at least one presentation a week and, during the first half of the month, had to deal with at least one colon cancer a week. I've gone out with friends only once all month, and though I had fun, I'm still bitter that I an NYC bar charged me eight dollars for cranberry juice. And not even good cranberry juice. At one point, I had a whole post ranting about it, but that was at least a week ago.

Anyway, I think I wrote a post about getting a PS4 and Final Fantasy Type-0. . . wait. Looks like I did. Mild update: Type-0's story is an abomination that hinders a promising battle system and an open map that at least tries to be engaging, unlike some other Final Fantasy games I could name. I gave up after two chapters, too many days ago to remember all the complaints I had for a blog post dedicated to the whole mess. Suffice it to say that my cautious optimism for Final Fantasy XV is more cautious than ever. 

Moving on to better news, I'm really loving this game so far:

Apparently fans complained about it when it came out?

Back to Final Fantasy because I guess I don't love myself

Not when it comes to this franchise. These last two weeks, I've been ruining my recent decimation of my credit card debt by setting up what I'm calling a home entertainment system. By which I mean, I bought myself a Roku TV and a PS4:

Yes, they're both on a couch

By the way, that couch is part of this number I got at IKEA. It's supposed to be attached to the couch where I sit all the time, but my mother (who claims to be a weak old women) ripped it off its hinges. It's now the world's crappiest stand. Anyway, I already pre-ordered the premium edition of Persona 5 at Amazon. They're promising an artbook, and probably a soundtrack, but I mostly want that book bag. Since Atlus' shameless lunge for my money, Persona Q, turned out to be awesome, my expectations for Persona 5 are off the charts.

Square Enix, on the other hand. . .

Bomba X 2

The grace period on my student loans will end in forty-three days. Though my monthly payments will be relatively low since I qualify for income-based repayment, I plan to pay at least double that every month. And I owe a lot of money. A lot. I've been enjoying the last few months of no payments, by which I mean climbing out of the hole I was in during the penniless period between finishing medical school and starting residency. I paid off my lonely credit card, bought new clothes, a new winter jacket, and even a new pair of sneakers. Living that doctor life and all.

In all fairness, I've made enough that I also got to see plenty of movies at the theater. I've gone out to eat with friends and family fairly often, and most of the time I even bought desert. Usually, I default to the warmed-up chocolate cake with vanilla ice cream option, but yesterday I went for a fancy passion fruit gelato with white chocolate:

Enough ice cream for four people right there. $8.00 USD

It was good, but certainly not worth as much as I paid for it. The tangy edge to the gelato totally overwhelmed the white chocolate crust, and since there was no warm portion to the desert, I lost an entire dimension of sensation. If that makes sense. I suppose there's something to be said about the price of information. This restaurant is right down my block, and now I know that I don't think their fancy "Italian" treat is worth it. I tried their tres leches a couple of weeks back, and it didn't compare with the tres leches from another restaurant further down the block.

In a move that I'm sure any restaurant owner would appreciate, I will share some pictures of menstruating/very late secretory endometrium under the cut, though the desert and period blood are in no way connected.

The Magnificent Seven: exceeded expectations

Last week, no particular movie caught my eye. I got conservative with my money and decided to save the $1 dollars for the ticket, and also went to hang out with my brother and his wife. Morgan originally caught my eye, but I'm not fond of the actress in the preview (the one who played the invisible woman in the new, atrocious Fantastic Four movie). She makes me not want to watch stuff she's in for some irrational reason.

The poster for The Magnificent Seven is like the opposite of that actor's face:

It was Chris Pratt's face that did it

This is not quite the image I mean. When I went to see Kubo and the Two Strings at Times Square movie theater, there was a cardboard, 3D poster that almost looked tough enough to take a few people's weight a server as a bench. It had an outline of the Old West town around it. I was about to use it as a bench myself, then noticed a much cheaper cardboard sign at it's base that said something like Warning: Not a bench; will not take your weight. Since the palate of the film is so brown, that cardboard sign almost looked like a part of the proper poster. I laughed because I'd almost made a fool out of myself. Somehow, that cemented the movie in my head. 

Fire Emblem play-through number I lost count

I'd planned to go to the hospital to get some work done today, but I forgot it's 9/11 and I live close enough to NYC that I saw the towers fall from my seventh grade English class. It appears there's going to be some march or parade today, and the main road to the hospital is closed. I could've gone via an alternate route, but traffic is about to get horrid, so I just went back to my basement. Since I don't have the equipment necessary in said basement, I grabbed for my DS and opened up another file for Fire Emblem: Fates.

I could've chosen to play either the Nohr or Hoshido route, especially since my DS thinks I haven't played either since this debacle, but the truth is that both those routes are depressing as hell. I like the royal siblings, and don't want to see any of them die. So back to Revelations it is, even though I won't have enough room to get everyone married without significant grinding. I've said it before (probably), but this game would have been so much better if instead of the multiple routes gimmick, they had just created one long, integrated story line.

I chose to play as male Corrin because I didn't like the voice acting for female Corrin. Unfortunately, I'd forgotten how much I dislike this particular voice:

It's the breathyness that gets me

I'll keep updates on the dumb pairings I select this time.
  

IVF and surrogates according to Hollywood

Yesterday, I made the mistake of going to see the 10:10 pm showing of When The Bough Breaks. That kind of behavior is out of my life henceforth because I was exhausted by the time I was driving home. I'm up by 5:30 AM most days to get to work by seven, so by the end of the movie I'd been awake for eighteen hours. Which may not sound that bad, but I couldn't even go to dinner afterwards, and in fact should not have been driving. At red lights, some of which I almost missed, I tried to take mini-naps. Many people do that, I know, but I'm not one of them. In fact, I take the bust to work because I don't want to risk having to drive when I'm post call. I've seen too many horrific accidents to not be a very cautious driver.

Anyway, the movie. Very few people seem to have reviewed it, but I can't tell if that's because no one went to see it, or because of some critics embargo. Somehow, I doubt it was the latter. This movie didn't strike me as having delusions of grandeur:

This is the rare trailer that lets me know exactly what kind of movie this will be without spoiling every little thing that happens, though that might be because When the Bough Breaks makes no attempts to be deep or controversial despite its premise. Still, I'm surprised that it has a 0% on RottenTomatoes. The leads are charming enough, and the first two acts build excellent suspense. That should be enough to earn it some praise, even though the third act is a severe disappointment. 

Don't Breathe. . . while this movie those that with cooking appliances

It's like a Goosebumps poster

Last weekend, I went to see Don't Breathe like a woman in a desert, by which I mean I'm desperate for something that isn't a superhero movie. I hate to be one of Those People bemoaning the death cinema because all anyone seems to care about is men in tights. . . but hot damn, you can't step into a theater these days without drowning in some superhero or other bemoaning that they can't be normal, or that the government is trying to tell them what to do and infringe on their rights or whatever. So Don't Breathe looked intriguing.

I would share the trailer, but the one I watched goes right ahead and spoils one of the movie's twists. Though perhaps it's more accurate to call it a plot point, since it happens relatively early in the movie and it's only one of several satisfying twists and turns. Still, it is a spoiler, so instead I will share this ridiculous commercial I keep seeing at the movies with "real" people, "not" actors:

What are you doing Chevy? Literally no one cares about cars this much, in this way. Even car buffs don't care about silly awards (I assume), and if they do, I highly doubt they're talking about it like that. Come on. You sell somewhat affordable cars for suburban people, not BMWs. 

Anyway. The movie.

August in review (so far)

I used to think I had little free time in medical school, but clearly I'd forgotten what it's like to have a real job with a fixed schedule. This month, I haven't had time to do much outside work, except try to maintain my skeletal social life with a couple of friends, one of them from work. I'm more-or-less satisfied, but I can't imagine what residency would do to someone more outgoing than myself. Or someone married with kids.

Anyway, since this blog has an audience of maybe ten people, I'm keeping it as a project for my future self. It's something for sixty-year-old me (hopefully I make it that long to peruse if she wonders what her twenty-something self was doing. So here goes:

1. Work: lots of cancer, and becoming more independent. Three autopsies so far. Learning to recognize simple things under the microscope:

Epithelial inclusion cyst of the ovary; from before I worked out how to use the microscope camera

Hyperplastic polyp of the colon, after my picture-taking skills improved

Ghostbusters: how watching some dumb movie became a political statement

I didn't watch the original Ghostbusters. Not the movies, the cartoon, or any of the other stuff that was apparently a huge part of so many people's childhood. Apparently. I don't now if it's because I'm too young, or because I wasn't in the US during the nineties. Either way, the new Ghostbusters movie didn't mean much to me. I was vaguely aware of some hoopla going on online because the new movie has women on it, and that's like destroying the original film with feminism and social justice. Or perhaps attacking men and boys with. . . something. I learned long ago not to pay too much attention to any random thing the internet decides is significant.

Still, as I sat at the theater, musing about the ridiculous internet flamewars about this film, I couldn't help but remember that one of our many mass shooters attacked a movie theater during a genre film. For a moment, I considered leaving the theater to sneak into Star Trek, a film that I hadn't heard any "controversy" about. I didn't do that, but at the second I had to exercise a degree of courage to sit down and watch a dumb movie. I don't know when we got to this point as a nation, but it depresses me.

Anyway, Ghostbusters. The trailer. . . well, it starts with the thirty years ago Ghostbusters thing that I don't care about:

Worst, I didn't laugh once. For something that's trying to be a comedy, that's a pretty bad sign. So why did I watch it?

Because Chris Hemsworth is hot. I wish I could say that I was making some kind of feminist political statement, but the truth really is that simple. He's my favorite Avenger. Because he's hot. He had like one shot in the trailer and didn't get to say anything, and he's probably the least cool part of this poster:

But he's still what caught my eye

First week as a doctor + a tiny example of what I do

JD from scrub said that a medical resident works 80+ hours a week, is hundreds of thousands of dollars in debt, and makes as much as a waiter. I don't know if I was planning to go to medical school when I first watched that episode, but somehow it didn't steer me away from the career. And finally, July 1st of 2016, I started my residency. I make much more than a waiter, though I only ever waited tables at run-of-the-mill restaurants that were just a step above fast food. Maybe JD was talking about fancy restaurants.

The first week went well, I think. I didn't make any egregious mistakes that I can remember, though I almost forgot to order a special stain for a case. I was assigned one autopsy, which I did with a chief resident's help. I had a nice mix of routine and esoteric cases on my plate, though I got very little of it, in all honesty. It's a good thing I don't make any real decisions yet. The greatest relief is that I'm loving my job so far. It shouldn't be a surprise since my first consideration when choosing a specialty was "am I going to enjoy doing this for hopefully 30+ years?", but it's still a big weight of my shoulders that I'm not panicking at the thought of spending the rest of my life reading slides and handling autopsies.

That being said, I will have to change how I study if I want to do it effectively. Now that I have a job besides passing the never-ending barrage of standardized tests the NBME throws at me, I can't take as much time studying as I used to. Up until now, I use hard copies or relevant print-outs of textbooks, then take notes and organize them as necessary. Perhaps it's because I didn't have access to computers until the second half of my childhood, unlike the rest of my peers, but I can't seem to absorb PDFs or ebooks. Typing my notes doesn't work either. For example, these are my notes for the normal histology of the cornea:

My art has not improved at all this year

I never gave it much thought before, but since I work from 7:30 AM to 5-8 PM, I wish I could work faster.

Mr. Robot and abyss of social media "connections"

These promotional posters must be seen to be believed

This last couple of weeks, I've been watching Mr. Robot with my friend Chris. It's the first TV show I've re-watched from beginning to end in a long time. Probably the first one ever, actually. I can barely get myself to get through a whole season of TV once (still haven't finished the second season of Daredevil).

I've noticed several things about Mr. Robot the second time around, some of them big and some of them small. Darlene's early behavior doesn't seem so invasive in context, for example. Talking about the show with another person has also changed my mind about certain some of the show's themes. Most significantly, I'm not sure Mr. Robot's central premise about the loneliness of modern life, and the oppressive nature of its false choices, is as shallow and juvenile as I first thought.

Though I still think that Elliot is over the top with his multiple speeches about how the world sucks because everyone is always drowning in pop culture and posturing in social media, I've had time to consider that my reaction might not be so objective. I don't disagree with Elliot's conclusion that getting caught up with presenting a perfect, always-interesting face on social media generates anxiety, loneliness, and isolation, but I also believe that engaging in social media to that degree is a choice. So I couldn't fully sympathize with his anxiety because I felt like he was choosing to judge people sole through what they post on Facebook/Instagram/etc.

Seven Deadly Sins anime: weird in an unfunny way

I was browsing through Netflix and noticed the following:

And I was like. . . Netflix is doing original anime?

It turns out that Netflix is just licensing and dubbing certain anime now. I like me some anime, so even though I'd never heard of this series, I decided to give it a shot. To this day, I've never looked up its history, so my knowledge is limited to the few dubbed episodes I watched before deciding it wasn't for me. I gathered that the story is set in generic anime fantasy Europe/Britain, where a squad of super powerful knights (that were also government officials?) called "The Seven Deadly Sins" plotted to take over the kingdom, and were then defeated by other super powerful "Holy Knights".

The story starts when a princess with a breathy voice (at least in the dub) stumbles into the main character's bar (the short blond guy on the banner above). Holy Knights are chasing her because they suspect that she's one of the Seven Deadly Sins, but it turns out that she's not. In fact, the short blond guy is actually Meliodas, The Dragon's Sin of Wrath and former captain of The Seven Deadly Sins. There's also this talking pig thing, a giant flying/travelling? turtle of some kind, and this weird Holy Knight who seems to have some backstory with both Meliodas and the princess with the breathy voice.

As I said earlier, I only watched a few episodes of this before calling it quits. The story line obviously didn't grab me as I have trouble recalling basic details, the female lead's voice grated on my nerves, and I was put off by the weird interactions between the female and male leads.

Rapture in Death: Eve Dallas vs mind-controlling virtual reality videogames

Buy on Amazon

Eve Dallas married Irish prince charming last book, after defeating the evil villain with the magic anti-aging drug that kills users. This book starts when a young engineer with no history of depression or suicidality hangs himself in his room at Roarke's outer space resort, where Eve and Roarke are finishing their honeymoon. I think this might be the first time I read this installment because I remembered nothing of the plot. Except for one subplot I will get to in a minute, I quite enjoyed this book from beginning to end.

Since this series is set Twenty Minutes Into the Future but publication began in 1995, earlier installments have a decidedly retro-future feel to them. Most of the time, it's odd blips like state-of-the-art, futuristic computers running on "discs", or people remarking about how only certain professionals have "links" (cell phones) with them at all times. Other times, Robb includes moral dilemmas about "new" technologies and/or scientific advancements that hinge on outdated theories.

In this installment, Roberts tackles the controversy about "nature vs nurture" through the lens of "genetics vs. environment". I wouldn't say that this conflict has been settled already, but Rapture in Death was published in 1996 and the Human Genome Project was declared complete in 2003. The doctor that argues in favor of the genetics side of the debate in this book espouses ideas that would only be entertained in some weird neo-Nazi "scientific magazine" today. I'll let this quote speak for itself:

Not that Reeanna is an actual neo-Nazi, it's just that the scientific concensus today is that the relationship between genes and the environment is more complicated than "genes --> behavior"

Over-filtering, do we even recognize it anymore?

I went to Connecticut this weekend to catch up with some of the more affluent members of my family. It was pretty fun. We went to a. . . semi-private? beach. It's hard to explain. I think only people who own houses and/or live in the area are accepted into the beach, so it was fairly clean. Best of all, it wasn't crowded at all. From what I understand, you can have barbecues in these types of little islets:

If you own a boat, of course.

Then we drove around the neighborhood to admire all the beach houses that my family members can't afford. (They own property about five minutes from the beach. I'd have asked how much it cost, but it would've been tacky. It's cool, though. One of my aunts asked and it was around 600k. Ten years ago).

Anyway, in all the talk about pretty things, my mother aunt started talking about a beautiful cousin I have who posts artsy pictures of herself on Facebook. I was only half-listening, but my ears perked up when one of my aunts lamented that my cousin looks way more beautiful in pictures than in real life. I didn't join in, but of course she does.

It's obvious that my cousin expends a lot of time on her pictures. I'm not knocking her. They're beautiful pictures. I wouldn't know how to make myself look like that even with filters and photoshop. But I wonder how she must feel like in person. Does she worry that her Facebook and Instagram posts set up a standard that she can never meet in real life? Does she enjoy posting those pictures even though she must know that people make snide comments about how they're "fake"?

The Purge: entertaining, but fails on multiple levels

I found trailers of The Purge: Election Year just intriguing enough to rent The Purge on Amazon. The tagline "Keep America Great" was just unsubtle enough to work on me, I guess.

Yeah, this trailer would not have been enough to get me to watch The Purge. For what it's worth, the movie itself is better than this, especially the first hour or so. Unfortunately, it does little to change that this movie's premise is fundamentally broken. Even if we accept that people will just start murdering each other en masse if only murder were legal (which I'm not sure I do), the financial implications of such a policy for a society are hard to enumerate. America loses significant money when people call in sick for work because of the flu, for God's sake.

But it's the movie any good if you just stop thinking and enjoy the spectacle?