I had to come to this area to see...

What follows is probably of more interest to the medical types in and out of the fam:

Today we were looking at a CT of the brain with a radiology resident from Penn. He is GREAT in that he is used to being prompt, accurate and communicating findings to us in person, a welcome change from what can appear as passive aggression on the part of the department. True I should and am getting used to the SOP here but to have some one like him is huge. Today we were looking the CT from a guy with HIV and a CD-4 count in negative numbers. There were many white matter lesions all over the place and the radiology resident was a little hesitant to give a definitive call. Up pipes Kathleen (a fourth year student), "Looks like PML!"

That's Progressive Mulitfocal Leukoencephalopathy, a rare disease process of the brain white matter, somewhat like multiple sclerosis, seen more commonly in HIV. But very rare. After I picked my jaw off the floor and all of us exchanged looks of "well I'll be" we agreed that she was probably right on the money. An unfortunate diagnosis for the patient to be sure but, wow, made by a med student.

The uncommon is so frequent here. Today I saw a classic case of milary tb on CXR. They see this so often that it wasn't any big thing, except to me. And this afternoon witnessed an echocardiogram on a 30y/o with HIV cardiomyopathy and an EF=40%. This damn disease can kill you in so many ways.

I continue to be blown out of the water by the pathology. I'm a better diagnostician, but I hope I never lose the "wow gee-whizz" side of things here.