Ew Esse Em Elle Ee

Dr Ana and I worked almost 4 hours today and really worked hard and successfully. We spent 1' 3" on one question. We only did one other but we learned the lesson of that one question very well. We had fun today, laughing at our wrong answers, that we knew, but couldn't quite put our finger on in time. "Motherfucker" is Dr. Ana's go-to term of frustration in those moments. "FUCK ME!" is mine. And we high-fived and I hugged her when we blind hogs rootled out the truffle.

We have been on neurology for the past couple weeks and one of the early questions asked us to make a diagnosis on an infant who presented with a constellation of symptoms that perplexed doctors for some time: injuries, a subdural hematoma, rib fractures and retinal hemorrhages, that were "inconsistent" with the mother's account that the child had "fallen out of bed."🙄

I knew the answer right away, it was Shaken Baby Syndrome, and told Ana the answer. She hesitated a split second and then clicked on my correct suggestion, and looked at me wide-eyed. "How did you know?"

l then told her that 30 years ago I had had one of the first Shaken Baby Syndrome homicides in Miami-Dade County and told her the details of the case: the "shearing" of the blood vessels over the dura from the rapid acceleration-deceleration forces caused by the vigorous, murderous shaking when the neck muscles of the baby are too undeveloped and weak to stabilize the head during the catastrophic shaking, how the caregiver grabs the baby around the trunk and squeezes malevolently hard, causing rib fractures, about the build-up of pressure in the head caused by the intense squeezing which causes the retinal hemorrhages--that trial lasted months and I spent tens of hours down at Miami Children's Hospital getting got a crash but thorough course in the Syndrome.

Today ana told me that she had told her Brazilian USMLE chat group friends, "Guys, David knew all about Shaken Baby Syndrome!" She said one of them in sober reverence pronounced me a "genius."🤣 Wait till they find out that I also know where the U.S. Midwest is, the chief locale for the Histoplasma capsulatum fungus! 😂 It was a fun day of learning.