I’m working on making living arrangements for next year. It’s funny, I thought this would feel all grown-up and real-life responsible, but it doesn’t. It feels like a big game of play-house, where the grown-ups decided to join in and collaborate in the game. I can’t believe I’m really going to have a house on my own, and take care of all the furniture, and cleaning, and cooking, and bills and all. Actually, bottom line, I can’t grasp the idea of getting a regular paycheck. I’m much more interested in the fun of acquiring and decorating a place to live, than internship itself. I’m sure that will change in June, but right now I’m nesting without anyone to nest for. Tsk.

I also discovered the library’s two-volume complete Sherlock Holmes books. I just finished the first story, A Study in Scarlet. I’ve been noticing Watson’s behavior more, in his character as a doctor, and Doyle’s medical training. After the criminal is captured, Watson puts his hand on the man’s chest, and feels a continuous loud thrill, which causes him to agree that the man has a severe aortic aneurysm, and is liable to die soon. (They attribute this aneurysm to a long period of wandering in the desert several years before, though; hmph.)

I love this paragraph from Holmes’ concluding oration; it summarizes what I’ve often tried to explain to pre-med and first-year medical students about how medicine is different from all the other sciences.

In solving a problem of this sort, the grand thing is to be able to reason backwards. That is a very useful accomplishment, and a very easy one, but people do not practice it much. In the everyday affairs of life it is more useful to reason forward, and so the other comes to be neglected. There are fifty who can reason synthetically for one who can reason analytically. . .
Most people, if you describe a train of events to them, will tell you what the result would be. They can put those events together in their minds, and argue from them that something will come to pass.
There are few people, however, who, if you told them a result [ie, a patient’s presenting symptoms], would be able to evolve from their own inner consciousness what the steps were which led up to that result [ie, the underlying pathology]. This power is what I mean when I talk of reasoning backward, or analytically.

And the fun part is that, although I’m definitely not very good at this yet, especially as related to more obscure conclusions, I can do this. I can think in a way I could hardly imagine when I started medical school. I don’t know whether it’s good or bad to think this way, but I do a little of the detection business too with everyone I see: I can tell by looking (don’t need to smell) whether a person smokes, whether they have certain neurological conditions, whether they’re likely to have thyroid problems, whether they’re on blood thinners (at least, high dose), whether they have diabetes, or will in a few years, and of course whether they’re actively schizophrenic, or have been on anti-psychotics for a long time. (I don’t think I’ll start a detective business yet, though; I can’t deduce everybody’s occupation on sight, as Holmes does.)

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