Thursday, October 30, 2014

Malignant

The place where I did my residency had a really horrible urology program. It was extremely malignant due to the program director, who was apparently always threatening to put residents on probation. A friend of mine, who I will call Angela, was having an especially horrible experience.

When Angela was in her R2 year, she was put on probation... she couldn't even write tylenol without calling an attending for approval. So she'd get called at home for a temp and she has to come in, evaluate, and then call the attending at home to find out if it's okay to write for tylenol. The rest of us could give a verbal order for tylenol and maybe some pan cultures and that's it. She had to drive to the hospital.

What happened was angela was presenting a patient and said something about the patient's code status. The director was the attending doing rounds and he went on a huge speech about how R2s don't understand code status and how they shouldn't be dealing with it, and she never finished presenting this patient. So what happened is the director never heard about the patient's primary diagnosis of a fistula because he wouldn't let her finish presenting.

So later on in the day when something came up regarding that patient he ended up looking like a fool cuz he didn't know the patient had a fistula. He went ballistic, called the R2 an inaccurate and messy doctor who presents inaccurate information. She got angry and started to talk back, and he yelled at her and said she needed to understand her place. And she was so angry that she started to tear a little, and he told her she obviously had some psychiatric disturbances cuz she obviously couldn't handle stress. He told her she'd have to undergo a psych eval and she dug in her heels and it went on like that.


And then he announced she'd have to be in remediation, and then put her on probation. Indefinitely. And then after he did that to her, he kept saying he wasn't going to renew her contract, and that she'd better contemplate not being there the next year.

That's so unbelievable to me that a person could go through all those years of schooling and hard work, just to have it ruined by one asshole.

Wednesday, October 29, 2014

Anthology

As you can see from the winning entry posted yesterday, I received some amazing entries to the humor writing contest. I have just barely enough to put together a little anthology of the best of them, pending permission from the authors.

If you didn't make the deadline for the contest but would like to be included in the anthology, please email me a submission. The more the better!

Tuesday, October 28, 2014

Medical Humor Writing Contest WINNER

Congratulations to Laura, general surgery resident, on her hilarious winning entry, posted in its entirety below. And thanks to Dr. Grumpy for the help in judging!


Standardized Patients


When I was 16, I got a job as a “standardized patient”. My neighbor worked for a medical school, and they needed standardized patients for their medical student to practice talking to. Because apparently you can make it through 4 years of undergraduate, a rigorous medical school application process, and, you know, normal life experiences, but still require formalized practice in speaking with other actual humans.

So I showed up for training, and was assigned my patient role. I was hoping for a TV-medical-show mystery type patient… some vague symptoms combined with a fascinating and intriguing back story. I expected this to be my dramatic acting debut, complete with genuine tears of pain and suffering when recounting my medical symptoms.

Instead, I was told that I was a slut. Apparently, their medical students were not comfortable talking to young teenage girls about their sexual escapades. So I was there to be a big-ole slut.

My character profile was a real gem. I worked at Taco Bell after school, and I started sleeping with my manager. He was 23 and had a motorcycle. We had unprotected sex because he didn’t like condoms. So I was looking for birth control pills. I was supposed to act embarrassed and shy, and evasive and reluctant in answering questions. The young doctors-to-be were supposed to recognize that I was at risk for STD’s and domestic violence and set me on a better path.

It was awkward. It was beyond awkward. Awkward was a dead fly on our rear view mirror. I would’ve killed for it to just be “awkward”. I had to pretend I was there for a headache, because I was too embarrassed to come out and say I needed to talk about sex. So the medical student would start on a rigorous course of questioning about my headaches to which I infuriatingly answered “I don’t know” to every questions. This charade continued until finally, exacerbated after wasting 12 of their 15 minutes on my obvious non-headache, they would ask, “So what are you really here for?!”

I got more frustrated than they did with the “headache” prologue. Sometimes I would try to make my own transition…. They would ask “Does anything seem to make the headache better?” and I’d say “Yes, having unprotected, crazy, statutory rape sex.” The doctor-teacher sitting on the other side of the one-way glass did not like that.

The other awkward part was the physical exam. In the real world, a teenager at risk for genital warts and cervical cancer would get at least a glance-over of her down-there-ness from a doctor about to prescribe birth control. But the medical school did not want their fumbling mini-doctors poking around my junk. Probably because paying a 16-year-old to let people repeatedly perform pelvic exams qualifies as a child sex crime.

But the medical students didn’t know whether they were supposed to exam me or not. In an attempt to make up for the awkwardness of the encounter up until they point, they would charge confidently ahead in stating that I needed a pelvic exam. I was supposed to tell them I was on my period, and about 80% of them got the point and backed down. Another 19% got the hint when I said I was really uncomfortable with having an exam, but promised to come back next week for an exam. Then there was 1% of medical students who still persisted. They thought the “I’m on my period” bit was like the “I have headaches” ruse, and they were too smart to fall for that twice. They were going to exam me whether I liked it or not.

Here’s a tip for medical students- if an standardized patient encounter ends with a 16 year old girl yelling to get your hands off of her, then you have failed.

All that being said, being a standardized patient was the best job you can possibly give a teenage girl. I literally got paid $30 per hour to be lectured about having safe sex. At 16 years old, I knew more about syphilis, HPV and how teenage pregnancy would ruin my life than any other virgin ever.

Once I was in medical school, it was my turn to awkwardly harass pretend-patients. One night, we had a special, after hours, standardized patient session. Instead of the usual daytime, on campus session- this one was on a Thursday night at a ‘special venue’. They even fed us dinner beforehand. Like a naïve school girl, I missed all the hints… late night, dinner prelude… things were about to get inappropriately intimate.

It started with pelvic exams. The women who volunteered to be standardized patients for fumbling medical student to learn pelvic exams on them are… um, well… interesting. One was a midwife, who was so used to seeing lady bits that she believed her own were no more personal than her bony elbows. Another was the owner of the local sex shop. She taught weekly classes like “Oral Sex 101” and “G Spot Roadmap”. She had an overly aggressive style of grabbing our hands and repositioning them while saying something vaguely sexual like, “Now twist like this, move in, push up and yes, that’s my cervix, right there!”

Male medical students were the worst. We had a very simple script were we supposed to follow while we did the exam, “OK, we’re going to get started now. This is my hand on your leg. You’re going to feel a little pressure now. Alright great, everything feels normal and healthy. We are all done.” But somehow the awkward males would manage to turn every phrase into a pseudo-sexual come-on. “I’m going in now. Oh, that feels good. I’m about to finish.” My vagina clamped down like a steel trap just listening to them fumble through it.

I can’t say that the female medical students fared much better when the tables were turned. It was fairly obvious which ladies had never seen an uncircumcised member before, as they fuddled with the extra cloaking. Do we pull it back? Do we peek inside? Is there a zipper somewhere? And how long can one spend feeling the testicles for lumps and bumps before it seems like foreplay?

The last event of the night was prostate exams, aka finger up the butt. For some reason, this was where our teachers drew the line about what it was appropriate to have the standardized patients do. So instead of feeling real prostates, they lined up a series of plastic models to practice on. Inside each butt-hole model was some different variant of a prostate, so we could learn what normal felt like, and how to recognize a cancer. The act of guessing what something is based on how it feels while jammed inside someone’s butt has never been, and will never be anything but hilarious. It’s fun for all ages!

I recently went to dinner with the attending surgeons of the colorectal surgery division. We hadn’t even received our appetizers before the conversation turned into a sparing match of who had found the craziest thing in a patient’s butt. This scenario is international, and it transcends cultures. I truly believe I could travel to rural Ethiopia, meet with a surgeon, and start showing off x-rays of things-stuck-in-colons and we would bond instantly. However, stories about things stuck in butts are like stories of the fish that got away- greatly exaggerated in every direction and conveniently never witnessed by a second party.

Monday, October 27, 2014

What physiatrists do

I had an experience in ortho clinic as a resident that was kind of a metaphor for what being a rehab doctor is all about.

In the new specialty clinic building, all the patient examining rooms had computers with printers. Apparently, all the ortho docs had been trying for months to get these printers to print out patient films, but without success. However, on my one day in the clinic, I got a patient's hip X-ray to print out. Everyone was super impressed.

How did I do it? Instead of printing from the actual radiology program like all the ortho docs were doing, I pressed PrntScrn, then I pasted it into Word and printed the Word doc. A cheap solution, but it worked.

And that's kind of what we're about. In ortho, when a bone is broken, they fix it. Orthopedic surgeons fix things that are broken. Physiatrists take things that are broken and can't be fixed, but find a way to make them work anyway. It's a worthy cause, I think.


FYI: The winner of the humor writing contest will be posted tomorrow in its entirety!

Saturday, October 25, 2014

Ebola

It's sort of hard to read so much about ebola without making a post about it.

Right now, Ebola is pretty low down on the list of things I am worried about. Hell, the flu kills more people every year than ebola has ever killed ever. It doesn't seem incredibly contagious and it doesn't seem like any Americans have died from it yet, making its mortality rate in Americans somewhat less than 70%.

That said, when I heard about how Dr. Spencer, the physician who treated ebola patients in Africa, went around the city doing his thing for over a week before he was diagnosed with Ebola, it did make me angry. If you have a clear exposure to sick patients, why wouldn't you want to be quarantined? It's clear that the doctor who went to Africa to help these people is a hero and cares about people a lot, so why wouldn't he automatically take this precaution?

Yes, I do understand that a three-week quarantine is probably difficult. But at least he could've avoided going on the subway or going bowling. He could've just gone out for completely necessary things.

And yes, I know that ebola is supposedly not contagious until the patient starts to show symptoms. But what if he is contagious an hour or two before the fever is noticed? How many people could be exposed in that period of time if he is going on the subway and not taking any precautions?

It seems like we go from being completely hysterical and overcautious to completely throwing caution to the wind. That medical correspondent Nancy Snyderman was given shit and put on mandatory quarantine after running out to grab a bite to eat when she hadn't even been caring for any sick patients, yet they allowed a nurse who cared for an ebola patient to fly on a plane when she was running a fever.

Aid groups are arguing that a mandatory quarantine would cut medical personnel volunteering in Africa by three quarters. Is that really true? Dr. Spencer was in Africa for two years. Would he really not have gone if he knew he was going to have to be in quarantine for three weeks afterwards? People going to treat Ebola in Africa are risking their lives. Are these people fine with risking their lives, but wouldn't be able to handle a three-week quarantine to prevent risking more lives?

So yes, I am in favor of a mandatory quarantine if there is clear contact with someone sick. But feel free to convince me otherwise.

Weekly Whine: Been there, done that

I can't tell you how many times I have gotten an amazing idea for a blog entry. I get really excited about it, because my goal is to entertain you guys, and I'm happy when I get a really good idea.

Then I do a quick search of my blog, and it turns out I already wrote about that topic. Like, three years ago.

I have had this blog now for about five years. I have written about a lot of topics that are important to me. Most of the things that I feel strongly about are things I have already written about. Often more than once.

Obviously, new things are always happening to me and there are situations at work that are frustrating, funny, or interesting. But I am really careful not to write about anything actually happening at my job. I feel that is just asking to be burned. Usually when I say something happened to me yesterday, I mean yesterday six years ago.

So it can be a big challenge to come up with new content for this blog that isn't just same old, same old. I hope the effort is appreciated, whether or not it's entirely successful.

Thursday, October 23, 2014

It's easy to be a jerk

I was recently reading an article on why doctors can be such jerks.

I wouldn't describe any physicians that I currently work with that way but I've certainly worked with plenty of jerks in the past. There are jerks everywhere, but it does seem like the percentage of doctors that are jerks is maybe somewhat higher than average.

This article talks about why doctors are jerks. The two reasons are first that doctors become arrogant and look down on their patients, and second that doctors become jerks when they're frightened or stressed out, which is obviously common in medicine.

I think part of the problem is that it's often easier to be a jerk then not to be a jerk.

For example, I was recently trying to reach a doctor at another hospital with a question on a patient. I had been waiting an hour for them to call back, and when they did, a random nurse picked up the phone, and told them that nobody was trying to reach them and then hung up, without even asking around.

I was so angry, rightfully so, I believe. It would've been so easy to snip at that nurse for what she had done wrong, and I'm sure I would've gotten away with it, considering what she had done had compromised patient care. It was much harder to take a few deep breaths and calmly explain the situation to the nurse, and then go through the process of reaching that doctor again.

Or to give a less obvious example, often when I walk onto the ward, immediately everyone descends on me with questions, before I've had a chance to catch my breath or get my bearings. It can be very tempting to snap at everyone that they need to step back and give me a minute.

Taking care of patients can be really frustrating, and it is actually really hard to calm yourself down and continue to be kind to the people around you. The staff on my unit call me the "nice doctor" because I try so hard to be nice and approachable, no matter how frustrated I am, no matter how much I feel like if somebody asks me one more thing, I'm going to punch a wall. I monitor every word that comes out of my mouth, to make sure that is not something that would hurt another person's feelings.

You'd think that would be easy. And some days it is. But many days, it is a real challenge.

Tuesday, October 21, 2014

Dr. Orthochick: The Hoarder

The nurse walked over to me and said "just to warn you, the woman spells like cat pee and human pee and the house they found her in looked like it was out of Hoarders. And we don't know why she's here, even though her son is with her and he lives with her. I think she might have fallen."

This 75 year old lady actually did smell like many different types of pee. I'm not sure which species were represented, but i'm pretty sure half of the domesticable animal population had left their scent on her. In addition, there seemed to be a few days' worth of human pee as well. Because that's not gross enough, when I asked her to roll to the side so I could listen to her back, I discovered her back was covered in dirt. And little twigs. And dead leaves. As far as I could tell, she had been lying in filth for days. I asked her what happened but she told me to mind my own business. Then she said she was at walmart that morning. I asked the son if she had, in fact, gone to walmart that morning, but he said he didn't know. So I decided to try and get the story from him.

me: OK, so what happened?
Son: What?
Me: I heard that your mother fell?
Son: Did she?
Me: Do you live with her?
Son: Yes
Me: So what happened?
Son: I don't know.
Me: Why did you come to the emergency department?
Son: What?
Me: WHY ARE YOU HERE?
Son: I don't know
Me: OK, let's talk about this morning. Why did you call an ambulance?
Son: I was going to take her to a checkup but the ambulance brought her here.
Me: Why were you going to bring her in an ambulance? Is she not able to walk?
Son: She says she can walk
Me: Can she?
Son: I don't know
Me: Well...don't you live with her?
Son: Yes
Me: So...do you see her walking?
Son: I don't know.
Me: OK, when was the last time you saw your mother before this morning?
Son: I think it was a week ago. I don't know.

I gave up, did a full trauma exam on the woman, which probably exposed me to every pathogen present in pee (and yes, I know pee is sterile, but that's only when it's in the bladder. On its way out the urethra it gets exposed to a ton of bacteria) and also got dirt all over my hands and stethoscope. She had bedsores on her hips and she couldn't raise her arms above her head or lift her feet off the bed. (The son said "she's pretty strong" after observing his mother's inability to lift her legs) She looked pretty dehydrated. So we ordered the standard "patient fell" workup (pelvic and femur x-rays, chest x-ray, head CT, EKG, bloodwork) and called internal med to admit her.

My attending also ordered carbon monoxide levels on her after hearing about the level of acuity demonstrated by the son.

I don't really know what's going on, but this looks like elder abuse. Or, at the very least, elder neglect. I'm not saying it's intentional because the son didn't seem to have two brain cells to rub together, but it's a little scary how people can fall through the cracks like that. I tried calling the last PCP she had and he said he hadn't seen her since 2005. I found an ER report from December in a different city where they noticed her appearance and filed a complaint with adult protective services, but that means that there's a good chance this woman hasn't been out in public for 5 years. Clearly she doesn't have a competent caretaker, and I'm guessing she hasn't been getting her meds since neither she nor the son could tell me what they were. And I didn't see the house she was living in, but judging from her appearance, it should be condemned. So you have her and the son living together in squalor and no one else knows/cares and so no one gets her (them?) help.

Monday, October 20, 2014

The Inevitable



I have a couple more, but they're pretty silly/NSFW. I can't decide if I should post them or not.

Saturday, October 18, 2014

Weekly Whine: Me

Some of you may or may not remember my story where I got into a fight at Kmart over a pair of sunglasses that took me half an hour to buy. This is part two.

About a week after the Kmart situation, Mel and I went to the Painted Penguin chain. It's one of those stores where they have pottery that you can paint. It's one of her favorite places to go and we had a little time alone together, so I took her there.

The pottery is organized on the wall by price. You can pay anything ranging from about $10-$30. Considering I knew the pottery would either end up in a drawer or broken by her baby sister, I told her to pick something from the $10 wall.

After some deliberation, Mel picked out some Pokémon pottery. We went to pay for it, and it rang up about five dollars more than I thought it would. I thought it was probably some sort of surcharge they had added, so I casually asked about it.

Cashier: "this pottery came from the $15 wall."

Me: "no it didn't. We got it from the $10 wall."

Cashier: "well, maybe somebody put it back in the wrong place. But it's a $15 pottery."

Me: "but it was on the $10 wall."

Cashier: "I don't know what to tell you."

Obviously, I don't care about an extra five dollars. I had been perfectly willing to pay it when I thought it was a surcharge. But the whole thing pissed me off because I had gotten it in the right place and it was their fault that it wasn't where it should've been. It's their responsibility to make sure pottery gets put back in the right place. What's the point of the walls if they mean nothing?

I told Mel that we were going to pick out a different piece. I mean, it's not like that stupid Pokémon pottery was so wonderful. But apparently it was, because she started to cry. So I had to suck it up and buy it.

I couldn't resist saying to the cashier, "you know, this sucks. The pottery was in the wrong place and now my kid is crying, so what am I supposed to do?"

But I was pretty much talking to hear myself speak at that point.

Anyway I got over it, and Mel painted her Pokémon. Then afterwards, we went to the supermarket. They had a little bin of beanie babies, which were marked down from $8 to $2.

Mel asked if she could get one, and I told her she could. And I figured we had to get one for her sister too, otherwise there would be major jealousy. So we took two beanie babies and went to pay for them at the self checkout.

Naturally, the second beanie baby rang up as eight dollars.

But here's the reason I'm writing about this. The second I saw the beanie baby ring up as eight dollars and commented on it, Mel said to me, "mommy, please don't get angry!"

And that made me feel really bad. I mean, I don't think I was wrong in either of those situations, but I hate to think that I'm getting worked up enough that it's upsetting my daughter.

Yet at the same time, I'm not just going to sit there with a smile when I'm getting shitty customer service.

(In case you were curious, I called customer service over and ended up getting the second beanie baby for free for some reason.)