HIV and ID Observations

Plaster anatomic head, 1900.

If you’re an ID doctor, there’s a lot to be grouchy about these days. This. This. THIS! The list is long — and growing. Longtime readers with an interest in ID: I ask that you please contact your members of Congress to convey the harmful impacts of the workforce cuts at the CDC, NIH, VA, and other agencies. Thank you.

Now, on to the topic of today’s post — a break from the news but maintaining the grouchy mood to discuss some words or phrases I deeply dislike. We’ll come to a new one in a minute, but first a review of a few others already in my penalty box:

1. HAART. I sense this one is vanishing, especially among us ID and HIV specialists — either that or people are afraid to say it in front of me. Seems that ART, standing for “antiretroviral therapy,” has finally triumphed. Hooray! Whether my campaign against HAART has anything to do with its demise is unknown, but I’m happy to take credit. In fact, I’ll add that to my CV now.
2. Thanks in advance. As a reminder, I vastly prefer (even welcome!) a simple “Thank you” or “Thanks” when a person asks for something. My wife thinks this pet peeve of mine is beyond petty, saying “You want people to thank you and be appreciative, but at the same time you don’t approve their way of doing so. That’s not fair.” Good point — but a Thanks in advance innocently placed at the bottom of an email reminding me to complete my annual HealthStream modules, or a request for 3 learning objectives for an upcoming talk, still rankles. Oh well.
3. Quick question. It’s possible every ID doctor gets hives when they hear this one, since the range of complexity in these “quick questions” is vast — and truly unknowable when someone starts out by greeting you with Can I ask you a quick question? I shared this distaste for the “quick question” prelude with an experienced (and excellent) nurse, and she told me I have misinterpreted the intent of the “quick” — it’s not to meant to demean the knowledge of the queried person (me), but to soften the impact of the curbside to follow. She’s no doubt right — people are trying to be nice! — so I’ve become much more tolerant of this one. Preemptive antihistamines are no longer required to prevent the hives.

But this is just a partial list. So today I’m bringing back the Language Grouch to introduce another unfavorite phrase — and this time it’s a common request:

Can I pick your brain?

Every time I see this one, I immediately think about what it means literally. This would involve cracking open someone’s skull, rooting around inside, and then using a sharp tool to pick at what most people consider the most important organ in the body. The fact that neurosurgeons do this routinely is still unfathomable to me, all these decades of being a doctor later.

But, as the saying famously goes, I’m no neurosurgeon (or rocket scientist), which puts me with roughly 99.999% of the population. And for us non-neurosurgeons, being an active brain picker would not only be inappropriate — it would also get us arrested. Don’t do it.

But of course the request is metaphorical — people who say, Can I pick your brain? aren’t asking to perform a craniotomy. What they’re after is information, not chipping away at your white or gray matter. I know this because I distinctly remember the first time I got the request, which occurred way back in my senior year of college, and no doubt explains my distaste for it. Pull up a chair, here’s the story:

I was taking a wonderful history of music course, the kind of broad survey that completely changes your life by introducing you to something you never really understood. It was the second semester, and we were on to some of the heavy hitters — Mozart, Beethoven, Mendelssohn, Schubert, Chopin, Brahms. The standard classical music canon.

Our “homework,” if you could call it that, consisted of going to the music library and listening to the greatest music of Western civilization in the listening lab, along with an annotated score. Homework! I distinctly recall listening to the opening notes of Beethoven’s Fourth piano concerto as one of my assignments, heard through the special headphones they gave us when we checked out the recordings. Hearing those gentle notes, then the early key change from the orchestra right after the opening, and reading along in the score — it literally gave me chills!

For some context, the early 20-something me had mostly been listening to Led Zeppelin, Blondie, Steely Dan, Elvis Costello, and The Pretenders — Genesis and Yes were the closest I’d come to classical music. Discovering these 19th century great works of music was a revelation.  To call me an enthusiastic student barely begins to describe how happy this class made me. I couldn’t get to the lectures fast enough.

The course also had weekly small sections, taught by a fun and funny graduate student memorably named “Fla.” (It must have stood for something. I wonder where he is now. Definitely not picking brains.) I was the kind of student who, if you’re not really into this music stuff, you’d find annoying. In our weekly small teaching sections, I sat at the front of the class and actively engaged with Fla, absorbing his every word.

In the same class was a (sort of) friend of mine, who I’ll call Brian to protect his identity. I’m not saying his large size and ability to push people around and knock them over while wearing pads and a helmet helped him get into college, but just sharing that “talent” of his shows that I have my suspicions.

Not only was Brian indifferent to the charms of the music course, but he also teased me about what he considered my very teacher’s pet-like behavior. Most of the teasing happened in our dorm’s dining hall because he stopped going to the small sections early in the course.

But when it came to prepare for our final exam, Brian reached out to me because there was simply no way to cram the listening assignments into the time he had remaining before the test. Listening to music takes time — you can’t speed it up, they’re not digital podcasts.

Not only that, one of the goals of the small sections was to highlight the most important material, always a harbinger of what was to be on the tests. And Brian had only attended a tenth of the classes — and I’m being generous with that estimate. Fla held no charms for him.

So here’s what Brian said (he was a last-name-first user):

Hey Sax — can I come over sometime and pick your brain about the key material for the music final?

How would you have responded?

Take it away, Ludwig. This music still gives me chills.

The views and opinions expressed in this blog do not represent those of NEJM Journal Watch, NEJM Group, or the Massachusetts Medical Society.