Grow Your Pea-Sized Brain

I’m sitting in Thursday’s Tumor Board and the new radiation oncologist is waxing eloquent about radiosurgery, gamma knife, cyberknife and fractionated external beam radiation. He projects an MRI image of a T1-weighted contrast enhancing parietal lobe mass and then launches into a soliloquy about his treatment plan based on the volume of this metastatic lesion, hoping to spare the speech center. He then challenges the audience by asking “Does anyone know how to calculate the volume of a sphere?” I survey the room for the fourth year medical students thinking they are closer to geometry than anyone else, but they are mute. The other physicians in the room are silent. Perhaps they thought it was golden. Then I recall past drainage procedures and my own IR geometry kicks in. Since no-one was answering, from the cheap seats I blurt out “4/3 pi r cubed.” The oncologist chuckles, acknowledges the correct answer and proceeds with his discussion. OK, end of the cute story, right? I thought so, but then my interest is piqued in the next few days when serendipity connects two seemingly unrelated events.

It’s Monday morning, just four days after Tumor Board and I’m discussing a peer review case with a colleague. I remind him that when we render an opinion different from the prospective reader, we need to take some sort of action to address the discordance; perhaps an addendum, perhaps a phone call. Something needs to be done to make sure our clinical colleagues realize what is happening.

The patient has to be properly taken care of and not slip through the cracks. “I know, I know,” is the standard reply. “Keep reminding me until I get it into my pea-sized brain.” Of course it was just a quip made in jest. No big deal. I just laughed and said “Well then drink a bunch of water and maybe it will swell to the size of a grape.” We both laughed and then the conversation was over. End of story, I thought. Not so much.

Fast forward to the following Thursday, now just a week following the previous Tumor Board. Now I get an e-mail from our respected neonatologist who writes “…I've been meaning to ask you about this for some time, and it keeps falling out of my pea brain.”  Since she is a great colleague and since we serve together on committees, I figure I can have a little fun. I replied with a carefully crafted e-mail response that may have universal application.

I explained that she was my second colleague in the past week that said they had a pea-sized brain. I told her “…Just drink a bunch of water and because of Brownian motion, your brain will swell to the size of a grape. Assuming the average pea is 5 mm in diameter and the average grape is 16 mm in diameter, that will increase the volume of your brain more than three times. Imagine that. All from just drinking water. Come to think of it, since we are talking about grapes, perhaps it would be even better if we were drinking wine.”

So I got to thinking. Maybe we should all be drinking wine occasionally. The literature and evidence-based guidelines would support this recommendation.

C'est la vie.