Sunday, February 1, 2015

Suicide Med

I signed up for expanded distribution of my newest book Suicide Med, which I've been reluctant to do because it meant I would have to increase the paperback price, but I'm not selling that many paperback copies anyway (Focusing mainly on Kindle), so I figured it was worth it.  The price will probably come down again eventually as Amazon readjusts, but I don't know when that will happen. So if you've been postponing getting a paperback copy of the book, this is a good time to take a chance.

I haven't done as much to push this newest book, mainly because I haven't felt as confident about it. My first one was basically a fictionalized autobiography, sort of an extension of my blog, but Suicide Med is more difficult to characterize and involves a little bit more creativity.  So it's hard for me to go around telling people to read it when I don't feel confident about it.


Saturday, January 31, 2015

Weekly Whine: Rude

I make a lot of calls to doctors offices in the course of my job, and it surprises me how many receptionist answering phones are blatantly rude. Like, before I've even opened my mouth to say hello.

I understand that everyone has bad days and everyone can't be a bundle of personality, but if your job is to communicate with people, maybe it's better not to sound outright angry when you pick up the phone. Maybe you hate your job, but at least try not to sound like you hate the person who is calling. If you have the sort of personality where you cannot be pleasant to strangers, then you should not have a job where you have to communicate with people so frequently.

Why would anyone hire a receptionist who is so unpleasant anyway?

Thursday, January 29, 2015

Grease, the tater tot

I bought some tater tots the other day at our hospital cafeteria. They don't have the best tater tots, but they are usually passable. Usually I eat a few of them and then bring the rest home for my kids as a snack for the car.

A few days ago, I got some tater tots and after eating one, I had to spit it out. It was so greasy! I complained about this to a friend at work.

"Aren't tater tots supposed to be greasy?" she asked.

I then took one tater tot and rubbed it in a paper napkin. Below shows the amount of grease that came out of a single tater tot. I think that's too much grease for one tater tot.

Tuesday, January 27, 2015

Dr. Orthochick: Dispo

On Wednesday when I was operating with Dr. Anal he admitted our last hand job patient of the day. She was an 88 year old lady who had fallen and fractured her patella as well as her distal radius, the patella was being treated non-operatively and she was allowed to weightbear as tolerated as long as she was in her brace, but the radius needed surgery. Dr. Anal had spoken to her for a while and decided she would benefit from being in the hospital overnight so that she could get placement in a nursing home and so she could get a formal consult for her depression. Normally distal radius is an outpatient surgery.

In theory, Dr. Anal is a great guy for understanding that the patient really did need to be in a nursing home right now because she couldn't take care of herself and that she was suffering from depression.

The reality is a little different.

So the patient was admitted around 11:00AM on Wednesday. The hospitalist saw her later on that day and started her on Zoloft before calling a psych consult. By 11:00AM Thursday, discharge planning still hadn't seen the patient. Psych then saw her and decided she wasn't suffering from depression and stopped the Zoloft. They then called a geriatric assessment, who determined that she was at a high risk for falls and should be in a nursing home temporarily. They also ordered physical and occupational therapy. Social work saw the patient at 16:00 and asked her about nursing homes before faxing a couple of referrals.

Fast forward to today, the patient has been in the hospital for 3 days and because she wasn't really admitted for anything legitimate, medicare isn't going to cover her hospital stay and even if they did, they wouldn't cover anything over three days. Which means it comes out of pocket, and these consults aren't cheap. And since it's Friday night and she still doesn't have placement in a nursing home, she's going to be here all weekend. Also, if anyone had talked to the patient for any length of time, they would have figured out that the reason she was depressed was because her husband of 65 years had died 2 weeks ago. Correct me if I'm wrong, but bereavement is a pretty normal thing and doesn't require medication, especially since most of the psych medications cause drowsiness, which increases the number of falls in the elderly. Speaking of which, I really don't think we needed a geriatric assessment to tell us that this 88 year old lady with a broken patella and a broken wrist is a fall risk. And when you're in a long-arm cast, it's hard to do physical therapy on your wrist.

I'm not trying to sound callous, but now the family is mad because they have to pay for this pointless hospitalization, the patient is mad because things have grinded to a standstill and she'll be here all weekend, Dr. Anal is mad that she's not in a nursing home already, psych is mad about the crap consult, and really, what the hell was everyone expecting? It's a hospital. By this point even I have figured out that simple things become big, long, drawn-out processes in a hospital. (if you don't believe me, try ordering FFP, STAT. Oy vey.) I tried telling Dr. Anal that I thought his plan was a bad idea since the patient wasn't suffering from depression and it takes longer than 12 hours to get a spot in a nursing home, but since he's my attending, I tried to be subtle and tactful about mentioning that. By which I mean, he said "admit her overnight and consult discharge planning for nursing home placement and consult the hospitalists for depression and discharge her tomorrow morning when that's all done" and I said "OK." In retrospect, I can see why he misinterpreted my answer and thought I was agreeing with him.

Monday, January 26, 2015

Personal statement

I recently dug up a copy of the personal statement I wrote when I was applying to residency. I've said before that I think these personal statements aren't worth much. But somehow, I now feel compelled to prove it by ripping apart my own personal statement. So here we go:

It was the same situation that I had been in dozens of times.


Well, not really. I mean, I was only a third year medical student on my second rotation. Dozens = Possibly more than once before. But by the time I wrote this, I was already an expert at pretending I had done something many more times than I'd actually done it.

I was on night call during my medicine clerkship and was sent to the emergency room to see a possible new admission to our team.

Everyone else on the team had something better to do and they were sick of babysitting me.

The patient was a man in his forties with severe abdominal pain who had first been seen by the Surgery and GI services and judged to not have an acute abdomen.

The guy had just been dumped on us.

By the time I saw this gentleman, he had been in the emergency room hallway on a stretcher for over fourteen hours, in terrible pain. In my short white coat and clutching my notebook of H&P’s and progress notes, I tentatively approached him.

This was my poetic way of saying that I knew I was going to annoy him and I assumed he was going to get pissed off.

I could see the dread on his face, and it was very clear he had no desire to have me ask the same questions he had been asked repeatedly by people who were unable to give him any answers.

"Are you kidding me?" the guy snapped at me. "Now they're sending a high school student to ask me more of the same questions? Don't you people know what you're doing?"

While I tried to think of what I could say that would not upset him further, I knew that I, as a medical student, had fewer answers than anyone.

"Um," I said. "Can you tell me when your belly pain started?"

The guy stared at me a second, then rolled his head away and refused to look at me.

I consulted my little notebook. "What makes the pain better?"

"When you go away and leave me alone."

I managed to take his history that evening

It was brief.

and I followed him while he was on the medical service. His abdominal pain turned out to be benign,


"Sorry," I told him. "We're still not sure what's causing your abdominal pain but we don't think it's anything serious."

"Why am I not surprised?" he retorted.

but his labs were suggestive of Type 2 Diabetes. We started him on an insulin regimen with scheduled follow-up appointments as per routine.

We spent $20,000 of hospital bills to diagnose him with something his primary care doctor should have diagnosed him with in one office visit.

Also, in retrospect, why were we giving him insulin for early type two diabetes?

On the day of his discharge, I came to his room to ask if he had any questions, but instead of asking me questions, he thanked me. He said that he had been ready to walk out of the emergency room when I had arrived. He brought tears to my eyes when he said that my attention made him feel that someone really cared and was working to get him better.

That part really happened.

But I never actually explained the cause of the patient's abdominal pain aside from saying that it was benign.

One morning during the patient's hospitalization, I walked into his room and he was smiling. "My belly pain is gone," he told me.

"That's wonderful!" I said.

His wife, who was by his bed, told me, "I went to the store and I bought this laxative, because I remembered the night before he got sick, he ate a lot of steak and I thought maybe he was backed up."

"I pooped so much last night," the patient informed me.

"The toilet was clogged when I came in here this morning," the wife added.

"And now I feel completely better," he said.

"That's… great!"

In summary, my personal statement was about a patient who had a $20,000 work up for constipation, which was only cured by his wife bringing him a laxative from the local drugstore.

And that's why I want to be a doctor.

Saturday, January 24, 2015

Weekly Whine: Fat Shaming

A bit ago, I made a post about how some women can be very hostile towards other women just for being skinny, even if they are not at all obsessed with looks. I'm probably asking for trouble here, but there's more I'd like to say on the topic.

First of all, I want to apologize if I did not seem sensitive enough. I genuinely think women look good at any size, unless they are at some extreme, and I would never in a million years consider making a negative comment to another woman about her weight and I can't imagine the mindset of a person who would, so perhaps I don't realize how much crap overweight women have to endure. In that sense, when I make posts like these, it is eye-opening for me. Some people accuse me of always thinking I am right because I don't immediately change my opinion when someone disagrees with me, but I do genuinely listen to everything people on here have to say.

For example, one woman told about how she underwent chemotherapy and experienced severe nausea. She said, "for a while, I couldn't eat much without getting nauseous. I had that condition for over a year. It sucked. But would take that over the easy weight gain any time. Hands down. Not even a close call." It is definitely a commentary on how obnoxious people must be to overweight women if someone would rather lose weight from being horribly nauseated from cancer therapy than be healthy and overweight. Of course, women do unhealthy things to lose weight all the time. The commentor then went on to say that she "cried with joy", not because of a cure for her illness, but because she lost weight.

That sort of attitude, valuing pants size over health, speaks volumes about how difficult it must be to be an overweight female. Although I genuinely hope most women would not rather be sick than overweight. If they did, there are a few hot dog carts in New York that I think would be getting a lot more business.

The truth is, I think women are always going to judge other women (as a mother, I have received a very large amount of unsolicited judgment and critique on my parenting), and weight is something that is very visible, and easy to critique people on since it seems like it should be changeable, although any intelligent person would realize that that's not often the case. I don't know if society can change how we think about weight, or be less judgmental. However, I feel strongly that we should help women to realize that is never acceptable to make an unsolicited comment on another woman's body. (Or her parenting, for that matter.)

Tuesday, January 20, 2015

Dr. Orthochick: Miss Boobs

Me: You know what I like about you? You're one of the few scrub nurses around here who doesn't remind me that everything blue is sterile every time I walk into the operating room.
Scrub Tech: You know what i like about you?
Me: No, what?
Scrub Tech: Your boobs.

The next 4 years have potential to be awkward.

Also, I was in clinic with Dr. Sportsfem and we walked into the [female] patient's room together and the patient said to Dr. Sportsfem, "wow! Look at her boobs! Can I call her 'Miss Boobs?'"

...and that is why Dr. Sportsfem and I will never be friends. Because she said that was fine.

Monday, January 19, 2015

MLK

At preschool:

Me: "Aren't you happy that you get to have Monday off for Martin Luther King Day?"

Four-year-old child: "You mean Dr. Martin Luther King day."

Sheesh.

Relations

One thing I have learned is that if you see a patient with a family member, never assume any sort of relationship, no matter how much the family member looks like their wife, son, whatever. Always ask how the person is related, so you can avoid interactions like this:

Nurse: "Wow, your mother looks young for her age and in pretty good shape."

Patient: "She's my wife!"