"I should've brought you a sedative." -- Medicine in the Sherlock Holmes: A Game of Shadows

Holmes and Moriarty meet in person for the first time.
A good scene.

[SPOILER ALERTS]

My holiday break just started and naturally the first holiday movie I saw this season was Sherlock Holmes: A Game of Shadows.  This is the sequel to the 2009 film Sherlock Holmes with Robert Downey, Jr. and Jude Law, certainly one of my top pair of actors to play Holmes and Watson.  The story is based partially on Doyle's The Final Problem which ends with Holmes and Moriarty falling over Reichenbach Falls.  This was a highly enjoyable movie and a great way to start my break.

That being said, medical fact, as usual, takes a backseat in Hollywood.  Nothing major in this film.  Only that Holmes drinks formaldehyde, a pretty significant poison.  According to the Agency for Toxic Substances & Disease Registry, as little as 1 oz. of a 37% solution of formaldehyde is lethal.  The chemically affluent Holmes would have known that.

Holmes also has a cardiac arrest in the movie, although I am not sure why.  He was injured and ran through a German forest while under a lot of heavy fire but he didn't bleed out that much.  Nevertheless, it was fortunate that Watson had Holmes' wedding present, a shot of adrenal gland extract.

Overall, neither of these events in the movie were that significant.  As before, the film paid a lot of respect to Doyle's stories while bringing a fresh take that is lead in large by Downey's interpretation of the character.  Also, Stephen Fry as Mycroft Holmes was a definite plus.        

The Physician's Library: 2011 in Review

2011 has been a very medical year for me.  For the first time in a long time I have seen myself grown a lot as I transistioned from my first year to second year of medical school.  Here's a bit of the year in review in some of the best medically-related things that I encountered this year:

Medcine in fiction: The Citadel by A.J. Cronin. 
This year, I gained a new literary hero in A.J. Cronin who I imagine will be largely unknown to American audiences.  I have written about Cronin before and cannot encourage my colleagues enough to read this book.  Cronin is not only writes with great artistry but touches on issues that I am sure he observed in medicine as a doctor, himself.  Many of those issues still exist today, almost 90 years since the novel was written.

Medicine in non-fiction: Every Patient Tells a Story by Dr. Lisa Sanders

Again, this is another book I have written about previously and another highly recommended book for medical students.  There are plenty of reasons medicine can be enjoyable but Sanders' top reason is very much my own: the detective work of medicine that leads to diagnosis.  In a series of real life cases of difficult diagnoses, Sanders illustrates how important history taking, technology, and the physical exam all generate key data that lead to a final conclusion. 









Medicine in TV: The first of half of Season 7 of House, MD

Honestly, it's been difficult for me to get through the second half of Season 7 (post-break-up with Cuddy) because House has regressed a lot, negating the personal progress that was nice to see in Season 6.  The medicine in some of the first episodes of Season 7 was decent, too. 













Medical Teacher: Dr. Edward F. Goljan

People will tell you different things when it comes to USMLE Step 1 Prep but there are two constants: First Aid for the USMLE Step 1 by Dr. Tao Le, et al. and, my personal favorite, Rapid Review: Pathology by Dr. Edward Goljan.  Not only is Dr. Goljan's book great but so are his audio lectures.  Dr. Goljan is every medical student's dream professor not because he is an easy tester (probably far from it) but because he tries to get his students to think like doctors and integrate multiple facets of medicine into pathological concepts. 



Person in Medicine: Dr. Atul Gawande

I have had the great opportunity to listen to Dr. Gawande lecuture twice this year.  If you follow my blog you will know that I have posted a lot on his work, which I have enjoyed a lot since discovering it a few years ago.  Dr. Gawande is the de facto voice of reason in medicine today.  He has no political agenda or advocates for any position other than "this is what evidence is showing might work - let's try it." 

Doyle Syndrome

Today, I had the fortune of meeting a patient with Marfan's syndrome.  The disease is officially named after the French physician Antoine Marfan but almost a decade earlier Sir Arthur Conan Doyle had created a villain who was very likely to have the condition in his very first Sherlock Holmes story, A Study in Scarlet.  Doyle, through the voice of Watson, described the character of Jefferson Hope as a tall man in his late thirties who an aortic aneurysm.   These are common features seen in Marfan's syndrome which is now known to be a connective tissue disorder.  As Doyle was a physician, himself, he frequently had very clinical descriptions of characters (probably the most accurate in all of fiction) and it is likely he had made an association between very tall, slender individuals and aortic aneurysms.    

"Ventricular Tachycardia. Digitalis"

I am currently in the middle of my cardiology module at school and digitalis shows up a lot.  I wrote previously about digitalis in a post about an episode of The X-files.  I just remembered that digitalis poisoning showed up much more accuratley portrayed in Casino Royale.  Bond manages to induce some vomitting but at that point some of the drug has started affecting his heart.  He ends up with ventricular tachycardia and is defibrillated in time with the help of Vesper Lynd.  This was a change from the novel where Bond was under threat of getting shot with a cane gun.