Friday, June 14, 2013

Finals That Violate the Terms of the Geneva Convention

what I probably looked like on Wednesday

The Sports Sociology final was a breeze, but I was so agitated about the final that was to follow it that I really didn't have the opportunity to enjoy it or to savor its ease.  It was a combination of multiple choice (few enough that it wasn't worth bothering with a scantron), fill-in-the blank, short answer, and short essay. Nothing on it should have stymied anyone who had either done half the reading and/or had shown up for most sessions of the class.

The Physics and Mechanics of Fractures was every bit the grizzly bear of a final that I had feared it might be, but I had covered the material thoroughly. I don't see how anyone who isn't either a certified genius or at least slightly OCD or both gets through classes like The Physics and Mechanics of Fractures. We walked into a classroom with every lighted surface posting an xray of a bone of some sort, most of which had been fractured in some way or another. Most of the test -- and the most heavily weighted portion -- involved identifying the form of fracture and elaborating on how each might have occurred. The remainder of the test was a short section of single-sentence answers and five short essay questions.

I did the single-sentence answer questions and the short essays first, assuming that those were the most likely to trip me up, and it made sense to tackle them while the test preparation I had done was most fresh in my mind, since they were simply single-anser, right-or-wrong questions. I did those with relative ease, reserving time to review them at the end to ensure I hadn't made any careless or stupid errors.

I was  doing fine with the xray identificaton/elaboration questions in both a practical and in a psychological sense until the next- to-last question, at which point I felt as though I had given this professor all I had to give and needed to quit before I could no longer resist the urge to climb to the writing surface of  my desk and scream at the top of my lungs.  I possibly could have quit the exam at that point and still aced it, or at least the course probably aced the course,  but it would have been cutting things entirely too close, and I had worked too hard to give anything up over a momentary lapse of sanity.  Moreover, I felt that none of  thought my classmates -- even the ones of whom I'm not all that fond-- deserved the disruption that such behavior would have created.

I looked at the clock, saw that I still had fifty-eight minutes to finish, so I put my head on my desk. (The professor approached and stood next to me but said nothing. I don't know if he was concerned for my well-being or thought I might be engaging in a creative form of cheating. I breathed slowly and deeply for about two minutes. I then went on to answer the two final questions, the first  of which was about a torsion or spiral fracure, which occurs when torque or twist is applied, typically to one or more of the body's longer bones. Because the twist is applied to part of the bone, compressive forces are naturally occurring on the remainder of the bone.  (If the entire bone twisted, what would likely result would be a dislocation, which, while painful, heals much more quickly than does a spiral fracture.)  This contrast is what causes the fracture. The bone featured in the xray was a child's bone. A child's spiral or torsion fracture is a red flag for child abuse, but other causes may exist, including certain sports injuries. (We saw one X-ray in class in which a child playing centerfield in baseball jumped for a high fly ball; on descent, the prongs or whatever one might call the things sticking out on the surgace  of his cleat were caught in the chain link fence. The boy fell with his front toward the ground, creating the torsion fracture. That was one nasty fracture. The fracture in this particular x-ray we saw on the exam was of the lower two bones in the arm - the radius and the ulna.  This one raised immediate red flags, but abuse shouldn't be an automatic conclusion. A child's arm could be caught in something, or another child could have done the twisting; peer-against-peer, it's assault or a silly bit hazardous childhood accident, but not child abuse.  My guess was that it was a gymnastics or cheerleading injury. (Cheerleading starts early now, which you know if you watch many of the "reality" series on TLC.)  It looked as though the child's hand was planted firmly on a surface that wouldn't allow the fingers and hand to rotate with the arm when the child either rotated her own body or her body was rotated by someone else.  I explained my hypothesis on that particular xray and went on to attack the final question.

The final xray question was one of the easiest questions on the test for anyone who looked closely. For those who did not look closely, the xray resembled an earlier MRI in which a bone was not broken but severe soft-tissue damage was present. In the case of this xray, the soft tissue (ligament and tendon) damage was also present, but a closer look revealed that the ligament had pulled off a decent-sized portion of the lower fibula, which is the outside bone of the lower leg.  When torsion or twist of an ankle is sufficiently strong, part of the bone may be pulled off as well. This is known as an avulsion fracture.  Many people will tel you that a sprain is actually worse than a fracure. While I'm not downplaying the potential severity of a sprain, a fracture is very often accompanied by soft tissue damage, i.e. a sprain. Thus, breaking a bone does not necessarily in any way protect a person from soft  tissue injury. (What does happen with the avulsion fracture, however, is that it is treated more aggressively, i.e. complete immobilization, depending upon the size of the piece of bone pulled away, and non-use of the injured body part. If all sprains were treated so aggressively, all but the most severe would heal thoroughly without further intervention or trouble.) In the case of this particular xray, the  fibula was broken entirely through, and mild displacement occurred. Had the patient been a child, most likely surgery would have been indicated, as a growth plate was involved. Since it was an adult, the disfigurement would have been considered mild enough to avoid surgery. In would have been anesthetized and pushed into place as close as could be done manually, then casted temporarily until swelling went down, then recasted tightly with a more permanent (six-to-eight-week) cast.

One short essay question concerned the difference between a green-stick fracture and a hairline fracture.  I couldn't even understand why this would have been on the test, but in speaking with classmates after the test, some were confused about the distinction.  A hairline fracture is a crack of a bone. It's not a complete break. Sometimes it goes through the bone, and sometimes it merely affects a portion of the bone's diameter. A green stick fracture, on the other hand,  is something that happens most typically to children.  Children's bones are often supple, like green sticks or limbs on a tree in the spring, You can take a green stick and bend it;  while one side is broken, the other side, usually the underside, remains intact. A hairline fracture is detectable only in an xray. a greenstick fracture is obvious to anyone, as the two ends of the bone stick up, making it appear almost as a joint where there is not one. (A compound or open fracture can occur with a greenstick fracture, greatly complicating matters.) The treatment for a non-compound greenstick fracture involves applying local anesthetic or drugging the patient with narcotics or even a light general anesthetic, then basically physically forcing the bone back into place, applying a temporary cast, and applying a tight cast as soon as most of the welling has gone down.  The two kinds of fractures -- hairline and greenstick -- have very little in common.

I finished the final two essay questions with twelve minutes to spare, which gave me ample time to go over the short answer and fill-in-the-blank portions of the test to double-check for careless mistakes, of which there were none.

However much the final distressed me, I was calm compared to many of my classmates. In fairness, many had more at stake than I did. Some were master's degree candidates who were obtaining master's degrees because they didn't get into medical schools on their initial tries and were hoping that the master's degrees would give them the necessary boost to enable them to gain admission.  Some young women were crying during the exam. The males were less emotional, but I did see a great deal more persiration than would have been seen in a typical class session. When I mentioned to a few of them my desire to climb atop my desk and scream at the top of my lungs, eveyone there said either that they could relate or that they wish I would have done so because it might have bought them additional time while the prof was calling campus security so that the men in white coats could come to cart me away in a straightjacket.

I was too jittery to drive home, so I jogged the distance, which is about two miles. I was dressed and wearing appropriate shoes for the jog, as finals are no place to be worried about making a fashion statement, although running home after the last final exam was the furthest thing from my mind when I dressed myself that morning.  Once I got inside the door, I essentially collapsed in the entryway. my family is used to theatrics, so no one contemplated calling 9-1-1 or any such thing. My dad did walk over and check me out to ensure that my heart was beating and that I was breathing.  He put me in a recliner because he said breathing is easier if one's chest is elevated slightly. I eventually found sufficient energy to climb the stairs, get into the shower (I would never place my sweaty body on my precious bedding. My family's furniture is one thing, but my own bedding is another matter entirely.) I threw on the first nightgown I could reach in my closet and crawled into bed with wet hair.

That's the last clear memory I have. At various points, one or the other parent came into my room, presumably to ensure I was still alive and to give me drinks of water, lemonade, or 7-up.  All my plans of debaucherous beach parties went right down my shower drain unless the parties were held without me. Frankly, if they went on in my absence, I was and still am too tired to give a rip. someone must have driven to campus to retrieve my car, because I noticed it in the garage this morning. At a few pointsI woke up just enough to reply to interesting posts, but then went right back to sleep.

Maybe tomorrow I'll be up to going to the beach, but as for today, I'll walk no further than the mini-refrigerator in my room, which contains only drinks. (I'm roach-phobic.) If I eat anything, it will be because someone brings it upstairs to me or piggybacks me downstairs.

My body feels as though I ran a full marathon with no preparation whatsoever. My dad says it's temporary and I will eventually return to normal. This is not his area of specialty, but then again, I've never heard of anyone becoming permanently disabled from a difficult final exam, so he's probably correct in this instance.

I'm reasonably certain that if I had to take a class as intense as The Physics and Mechanics of Fractures every quarter, Lindsay Lohan and I would eventually end up as roommates in one rehab facility or another. I don't know what my substance of abuse of choice would be, but I'm confident there would be one to which I was addicted, and it wouldn't be orange juice or Skittles.

I'm not feeling quite like sleeping again yet, so I may take on  another ASK ALEXIS column.  The response from my first column was so overwhelming that it would be morally wrong for me to ignore the masses who are in such desperate need of up-to-the-minute information on the topic of sex. [Note: there isn't a font that denotes irony.]

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