Monday, June 19, 2017

Stress Reduction

My new goal in life is stress reduction.

Correction: There's no way to actually reduce stress.  Life is stressful.  In my line of work, I see people every day who are dealing with much more stressful situations than me.  I could say that once my kids are a little older, things will be easier, but there's no guarantee of that.  From everything I've heard, dealing with teenagers isn't a walk in the park.  The job I took that was supposed to be part time and low stress has evolved into something that's not really part time and somewhat stressful.

So my goal is to improve the way I deal with stress.

A little background:

I'm someone who tends to somaticize my stress.  This has manifested itself in many different ways throughout my life.  In my mid thirties, it's mostly been musculoskeletal.  For a while, I was doing well, but a recent big stress caused everything to get worse. Lately, I've had constant tightness in my upper traps that I can't seem to get rid of. When I'm feeling good, I can ignore a little muscle tightness, but when I start focusing on it, it becomes this terrible pain that takes over my whole life.  As a physiatrist, I know and use every modality there is, but I recognize that a large part of it is psychological.

My problem is that I'm not a spiritual person.  The idea of sitting and meditating is very, very hard for me.  I've tried countless times with little success.

How can I achieve my goal of stress reduction? Has anyone been successful with this? I'm determined to do this, because I see myself going down a path that frightens me.

Monday, June 12, 2017


I'm going to go out on a limb here and say that I think firefighters are heroes.

I recently was trying to fill out some disability paperwork for a firefighter who was injured in the course of his job.  It was a specific form just for firefighters.  Unfortunately, one of the most important Yes/No questions about how the injury pertained to the job was The Most Confusingly Worded Question Ever.  I think it had a triple negative.

I wanted to help the firefighter by getting him the disability benefits he deserved, but I could not figure out how to answer this question in his favor.  I showed the question to three other physicians and NONE of us could figure it out.  I finally picked one, because I had to.

It turned out to be the wrong answer.  (We were able to redo it, fortunately.)

I'd just like to thank whoever developed that paperwork to help deprive heroes of the benefits they deserve.  I hope you sleep very well at night.

Thursday, June 8, 2017

The Hard Questions

I get asked questions in the course of my day that can be hard to answer.

"Will I ever be able to walk again?"

"Will I have another stroke?"

"Can you fix my back pain?"

So sometimes it can be a relief to hear a medical question that I absolutely can answer:

"Mommy, since you're a doctor, can you tell me.... is a thumb a finger?"

"YES.  It is."

"Mommy says it is!!  I told you so!"

Monday, June 5, 2017

My dear friend

Does anyone else refer to patients as "friends"?

I'm not saying that you are actually friends.  I'm not suggesting anyone takes their ICU patient out for a beer.  But I feel like I hear things like this:

Nurse: "Our friend in room 305 is asking for more morphine again."

In writing this post, I'm realizing that we tend to use the word "friend" to refer more to difficult patients.

With that in mind, it worries me a little that the teachers at my kids' daycare refer to all the kids as "friends."

Friday, June 2, 2017

Glitter is worse than herpes

I’ve got a terrible case of glitter today.

Don’t laugh. Glitter is a very real affliction. More people’s lives are affected by glitter than by stroke and heart disease combined.

Glitter is just like herpes. It’s not dangerous or deadly, but it’s super annoying. You think it’s just in one place, but then it spreads to other places. Most of the time, you’re not even sure where it came from. But once you’ve got it, it’s nearly impossible to get rid of. And you can give it to anyone you have contact with. Even if you just touch them. So really, it’s worse than herpes.

I mean, not that I’ve ever had herpes or anything. But I’ve heard stories. You know.

With a little girl in the house, we’re always in danger of a glitter attack. On one occasion, Leah must have stuffed some glitter in one of her pockets, because when I did the laundry, all of our clothing was covered in glitter. I remember my husband holding up one of his white dress shirts for work with a horrified look on his face when he saw it was covered in shiny specks. I can’t go to work dressed like Beyonce!

This morning, I know exactly how I contracted my case of glitter. Leah brought home a baggie of glitter from preschool, and she decided to do a project with it in the wee hours of the morning. By the time I discovered what was going on, there was glitter all over the floor of her room. I attempted to clean it up, but I was already dressed for work, so not only did I barely make a dent in our glitter infestation, I ended up catching glitter.

So during my entire drive to work, I’m busy brushing glitter off my slacks. To the point where I nearly crash my car dealing with this stupid glitter. Seriously, it is freaking everywhere. This is the worst.

When I get into the elevator, I give George the Elevator Guy an enthusiastic hello. George nods in my direction, looking critically at my glitter-stained clothing. I should have changed my clothes while I still had a chance.

As we approach the sixth floor, George looks down at the ground where I was standing. He frowns at me. “You got glitter all over the floor.”

I look down. He’s right. There must have been a glitter pocket trapped in the sole of my shoe, because there’s now glitter all over the floor of the elevator. I’m telling you—worse than herpes.

“Sorry,” I mumble.

He raises his eyebrows at me. “Aren’t you going to clean that up?”

We reach the sixth floor and the doors to the elevator open up. This is my floor, but George is still staring at me expectantly. Does he really think I’m going to clean the floor of the elevator? I mean, I don’t want to sound like a diva or anything, but is he kidding me? I work here as a doctor.

Maybe George doesn’t realize I’m a doctor. Even though I do walk around with an ID badge that says “PHYSICIAN” in big black block letters. Maybe he thinks I have some sort of housekeeping job at the hospital.

“You know, I’m a doctor,” I tell him.

George just keeps glaring at me. I don’t think I made the situation better.

I’m not cleaning up this glitter. Even if I wanted to clean it up, I’m not even sure how I’d do it. Does he expect me to find a janitor and borrow a mop?

Maybe he does.

“Sorry,” I say quickly. “I actually have a patient right now, but… I can call housekeeping, okay?”

George frowns at me.

“Is that okay?” I say again, more timidly.

“I guess it’ll have to be,” he says with a shrug.

I practically run out of the elevator. As the doors close, I check the soles of my shoes, which are absolutely covered in glitter. Oh God, it’s probably all over the floor of my car. Worse—I probably tracked it into the daycare and now Mila’s never going to let me hear the end of it. And the worst part is that it’s still all over my clothing.

I walk into Primary Care C, where Dr. Kirschstein is standing there in his white coat with a patient chart in hand. He looks down at the floor where I’m still somehow depositing glitter everywhere I walk.

“Sorry, Dr. Kirschstein,” I mumble. “My daughter… there was glitter in her room and…”

He frowns at me. I’m scared that I really am somehow going to get court marshaled for this. “I’m bringing you my wife’s book on child management,” he says.

“Oh,” I say. “Um, thanks.”

“This time I won’t forget,” he says. “I think you could benefit from it, Doctor.”

I stand by my original assertion—glitter is worse than herpes.

(But it’s better than play-doh.)

This was an excerpt from my new book, The Devil You Know.  Buy a copy on Amazon today for only $2.99!

Wednesday, May 31, 2017

New Book!!!!

It's been nearly four years.

Four years ago, I published my first novel, The Devil Wears Scrubs.  Now, after four years, here is the sequel, which takes place about 12 years after the original, when Dr. Jane McGill is married with a kid:

Buy it now on Amazon on the Kindle or Paperback!

Dr. Jane McGill is in heaven.

She’s got a great job at a VA Hospital, an adorable daughter, and a loving husband. Granted, it would be wonderful if her preschooler wouldn’t wake her up at three in the morning, and it would be a miracle if her husband would change the toilet paper roll once every millennium. Still, in most ways, she has the ideal life she’d always imagined.

Then Jane discovers that Dr. Ryan Reilly is the VA’s newest vascular surgeon. Dr. Ryan Reilly, a.k.a. Sexy Surgeon, a.k.a. the biggest jerk she ever loved.

A decade ago, Jane broke up with the Sexy Surgeon to marry the Nice Software Engineer, but as cracks and crevices appear in her marriage, she can’t help but wonder what life would have been like if she’d made a different choice. Or if it isn’t too late to change her mind…

Buy it now on Amazon on the Kindle or Paperback!

Thursday, May 25, 2017

My census

At the end of my first month of intern year, I kept a pile of signout cards with all my patients' diagnoses on it.  This was my list of diagnoses for a month at a county hospital:

1) new onset DM
2) Trisomy 18 with aspiration pna
3) pancreatitis
4) alcoholic cirrhosis
5) inflammatory colitis
6) ascites and alcoholic cirrhosis
8) abscesses
9) pyelonephritis
10) UGIB
11) cardiomyopathy
12) gangrenous finger
13) CAD, here for PTCA
14) SOB/CP
15) diplopia
16) GB cancer
17) SOB
18) TIA
19) LLL pneumonia and UTI
20) CP and melena
21) pancreatitis
22) CP
23) CHF exacerbation
24) TIA and gout attack
25) UC exacerbation
26) gastroenteritis
27) N/V
28) herpes zoster. 

(Note that no non-standard abbreviations are used above :)

Monday, May 22, 2017

4 days

During my Medicine rotations during med school and also during my Medicine intern year, we had four days off per month.  I believe that's the minimum that residencies are forced to provide.

Maybe this makes me a delicate little snowflake, but I think 4 days off per month is nowhere near enough.  Especially when the other 26-27 days of the month, you are waking up super early, leaving super late, and sometimes spending the night in the hospital.  I remember one resident said she got a simple cold and it lasted for two months because she was so overworked that she couldn't shake it.

Is it any wonder residents are so burned out?

There was one month during internship when I was feeling really depressed and burned out, and I was going into a stretch of working nearly two weeks nonstop with two overnights wedged in there.  I asked my lovely (not) senior resident if there was any way I could have even a half day off in there.  In retrospect, I'm embarrassed I asked because the answer was so obviously no.  She let me have it: "If you get a day off, that means someone else has to cover for you!"  

The solution, in my mind, is that we need to train more physicians so the ones we have aren't so overworked and miserable.  Yet I doubt that the four days off per month policy will ever change.

Tuesday, May 16, 2017


One of the hard things about going from my pre-clinical years in med school to working on the wards was getting used to all the freaking abbreviations.  I remember my first medicine signout sheet looked like gibberish to me.

These days, I'd like to think I know MOST medical abbreviations.  But sometimes I'll get a discharge summary on a patient that makes me think that whoever dictated it got a little too abbreviation-happy.

These are all from a recent discharge summary:


I literally had no idea what any of these things meant.  Is it just me?

Friday, May 12, 2017

Dictation errors

From a recent dictation:

"He hasn't had a left thigh laceration which were featured by ophthalmology."

Really?  I understand that Dragon isn't the greatest, but if you're going to produce notes that say things like that, what's the point of even writing a note?