Recently, @sandnsurf at Life in the Fast Lane rolled out their version of Problogger's 7 link challenge, and I thought I'd have a crack. True to form, it was good fun trawling through the last few years of posts...

1. My first post;

Game on. I started this blog one Sunday at work. I wasn't playing regular sport because, in addition to Med School, was working 30+ hrs a week. It took me a while, but the question remained pertinent; "What do I want out of this?"

2. A post I enjoyed writing the most;

Medicine and Travel combined for a dream-like premier experience in My First Surgery. Reading the post made that night flood back, even the smells. There's really something special about the first one you do.

3. A post which had a great discussion;

Why I'm Against Pharmacist Prescribing. An oft discussed topic in pharmacy circles, this post was designed as a caution to over-zealous, ivory-tower, Pharmacists. The comments have also revealed some interesting public perceptions about prescribing and the value we place on diagnosis vs prescriptions.

4. A post on someone else’s blog that I wish I’d written;

@sixyearmed - Where the water is. I stumbled across sixyearmed when I was compiling Grand Rounds in July 2009. The rawness of this post just grabbed me, confounded me. An inspirational, honest writer and a pediatrician, Danielle is now the number one feed in my reader.

@precordialthump - Brainstem rules of 4 at Life in the Fast Lane. This post taught me more about clinical neuroanatomy than medical school has. Plus, it's logical, memorable and has wee follow-up self-tests. More than once, I've printed a copy and handed it to a confused colleague on their neurology/internal med rotation.

5. A post with a title that I'm proud of;

The Clinical Creep is a post about a truly awful Clinical Coach we suffered through in first year, before he was fired from the MedSchool. I like the name because, well, it's just him.

6. A post that I wish more people had read;

Failure. Medical Students don't talk about it enough. I don't mean the catastrophic, university-career-ending, multiple sunject failures. I mean the once-offs, the 'I didn't get this rotation/subject/idea' kind of fail that is much, much, much more common than the Medical Student Community will admit to. In the words of my little sister, "It's good to know that becoming a doctor is hard."

7. My most visited post ever;

Pseudoseizures: Not Funny. This post continues to recieve a large number of angry comments that I moderate, thanks to its prominence in Google Searches for 'pseudoseizures'. The message, without a breath of sarcasm, is in the title - pseudoseizures are not funny. The post aims to provide a rational and caring viewpoint about the condition.

These posts, I think, represent this blog as a whole. Evolving, honest, rational and questioning. Feel free to have a chop through the archives on the side...

Welcome to another edition of Grand Rounds! This week, Grand Rounds 6:43 pays tribute to our friends, with a little help from Messrs Lennon and McCartney (with Ringo on vocals...)


# ACP Hospitalist's Dr Manning tops the bill with a tale of hell on call, complete with a technically absent colleague. A scary and frustrating look at a night with THE pager.



# Medical Resident extends the hand of friendship (not just medical care) to a patient with Brugada Syndrome, in this insightful and well-written post.


# Delia O'Hara over at Birth Story applauds the Pioneering women in Medicine at Johns Hopkins, in this informative look at few of the Medical Schools benefactors.

# OBCookie (great name), puts a loving, and practically educational, touch on her sumptous looking Chicken Roulades. Yum!

# Dr Val and Better Health submitted a recent guest post from Dr Alan Dappen about Canaries and the Primary Care Crisis. Just 'cos it's chirping doesn't mean you're there to hear it...


# Mental Notes looks at an interesting manuscript about Anxiety and Religious Zealots, highlighting that it's essential to solve the concrete issues first. Great post!

# How to Cope with Pain Blog suggests Why You Should Try A Pain Support Group, and not be all alone, because...


# Recently named as the Nicest Person on the Internet, Dr Ramona Bates adds to her vocabulary after renewing her friendship with folderol.

# Happy Hospitalist floats the genius notion of Open Source H&P, to reduce duplicity in medicalcare; friends and colleagues (?lovers), we should all work together.

# Will Meek's discussion of the time-honoured Interpersonal Circles model could help to both win friends or hold foes at bay.


# Highlight Health celebrates 50 years of birth control, in this well referenced post, complete with fantastic infographic.

# Inside Surgery remembers Kit Carson, frontiersman and self-trained surgeon. He even helped with an amputation aged sixteen - talk about a fast-track residency!


# Bongi's writing often gives me pins and needles, and is true to form in his ever-eloquent post, Silence.

# In my submission for this edition, darkness adds a bit more risk to a situation, as I was reminded in Getting Back.


# The Good Samaritan Laws are about being good (and legally protected) friends, as Dr Ed Pullen writes, citing two memorable experiences.

# The UK health system is looking to cut bureaucracy, InsureBlog reports, and notes that it's by no means a bad thing.

# Health Blawg celebrates and explores the new definition Meaningful Use as applied to EHRs.


# Health AGEnda honours visionary geriatrician Dr Bob Butler, pulitzer-prizer winner and first director of the National Institute on Aging.

# GlassHospital draws a touching obituary for Harvey Pekar, comic writer, clerk and Cleveland hero.


# Is Medical School a Hostile Environment? Not Withstanding Blog poses the question of educational institutions and anti-harrassment laws.

# Dr Rich, at Covert Rationing Blog, observes with great interest the debate between those who want to change the guidelines, and those who believe that changing the guidelines would be the greatest of travesties, in this excellent post about rosuvastatin.

# Louise at Colorado Health Insider, puts forward an Economist's view of midwifery.

Thanks again to Billy Shears and especially Dr Nick Genes and Dr Val for running the Grand Rounds travelling carnival; Next week, Grand Rounds is hosted at Inside Surgery, see y'all there!

It was dark. Stupidly dark. And I had no lights. E and I had summited the 1600m climb some twenty minutes earlier as the sun dropped behind the ridgeline. And now, half way down the road, it was dark in the open and pitch black in the trees. I was, frankly, terrified.

The road, on the way up, had been shaky at best. Less than ideal for climbing, and a challenging descent, even in daylight. Wanton golf-ball rocks were strewn across a cracked and undulating bitumen tongue, each threatening a catastrophic puncture or fall from the route as it snaked its way up the Col, two gravel fords and eighteen hairpins climbing 1200m in 12km. The descent should have been quick but challenging.

Despite starting at relatively reasonable time, a wrong turn or two had put us at the bottom of the climb about half an hour longer than expected. The col, too, took another twenty minutes longer that we'd planned. And now, in the last remaining light, there were no better options.

The other option, of course, was to walk. It was getting cold, and all food and water had been consumed to recover at the summit. Walking would take four or five times as long, without walking shoes, and would increase the odds of getting hit by a car going up or down the narrow road.

So we rolled on down, hands hard on the breaks, careful not to snatch a handful of lever and send ourselves sprawling. Eyes reaching, squinting to seek out the cracks and rocks that only an hour ago had been as plain as the day. As the trees enveloped the road, only a wisp of road was visible, punctuated by a grey hairpin, open to the sliver of light and treacherously sharp, followed by a long, steep straight of black and nothing, road somewhere beneath skinny tyres.

It occured to me that the same thinking would, one day, be necessary in a medical situation. The situation is less than ideal. Everyone's in the dark and uncertain of the fastest, safest solution. There's blame to be had. Something must be done. So the options are weighed and the least risky, with best result is chosen. Textbook stuff, really.

But it doesn't make the journey any easier, nor safer. Just a heightened awareness of the risk, that, over time, changes with the situation. There's no sense dwelling on how you got there, just choose the remedy and make it happen.

At the bottom, I took a deep breath, lesson learned. E took a photo;

He looked to be in his late sixties, and was probably ten years younger. His face lined with life, worry, nicotine and grit, he sat quietly watching television.

Aside from the hacking productive cough, which emptied his airways and filled his handkerchief, he didn't say much.

Every fifteen minutes, he would limp to the threshold, suck back a smoke and return to his seat. On occasion, crutches in hand, he'd festinate away for a few gulps of red wine, returning with a glazed, sad look and stained teeth.

As Wawrinka lost to Federer, he said "Those boys used to train around here." And we talked about where he was from; locals don't often stay in Youth Hostels, I thought.

He was a local. He'd fallen and injured himself, and lost his apartment. Now he had nowhere to go, no money, nothing. He was lodging at the Hostel, at the expense of his health insurance, sharing a four-bed dorm with an endless parade of rowdy travellers and the odd drunk teenager.

He sat watching the tennis. Coughing. Homeless.