Tuesday, May 26, 2015

Dr. Orthochick: Zinger

Patient: What should i do about this rash on my back?

Dr. Douche: I recommend you start showering.

Zing!

Saturday, May 23, 2015

Weekly Whine: Annoying pregnant women

I'm not saying that all pregnant women are annoying. It's just that I've noticed women who are already annoying tend to become orders of magnitude worse when they become pregnant.

For example, someone I know was saying that she invited a pregnant friend of hers to a party, and the friend wrote back, "is the fetus in my belly also invited?" (The appropriate response would be, "No, you must get an abortion if you would like to come to my party.")

I don't know what it is about pregnancy that brings out the annoyingness in certain women. It's like having an extra person inside them makes them feel entitled to be completely obnoxious without any boundaries.

And don't get me started on television pregnancies. I recently finished watching the last season of the Mindy Project (which will be the last season, because apparently, I'm not the only one who grew to hate it with a passion). In this season, Mindy (who is already annoying, but it's okay because her life is so imperfect), becomes pregnant and then suddenly becomes unacceptably annoying. Anytime anyone asks her a question, the answer always somehow involves her being pregnant. She has weird food cravings, bemoans her weight gain, all the stereotypical pregnancy stuff. And she's got a boyfriend who is always saying stupid sentimental stuff about the baby and putting his hand protectively on her belly. *Vomit* At some point, a sassy black woman comes in to make her feel more confident about herself. Just... enough already. Please.

If you are pregnant, you are only allowed to talk about it if somebody specifically asks about it. Or I guess it's okay to mention it if your water broke and you have to leave.

Thursday, May 21, 2015

Dollar

My husband was recently trying to use a dollar on a vending machine, and it refused to take his money. When he looked at the dollar bill, it looked like this:



I'm actually surprised that was enough for the machine to reject the dollar.

Husband: "I can't believe I never thought of doing that before."

Wednesday, May 20, 2015

Typos

In looking through the reviews on Amazon for my newest book, Baby City, two of the reviewers pointed out that there were a few typos, and one said that they gave it a lower rating because of that.

I'd just like to say that one of the readers was kind enough to email me the typos (there were 5 of them in 400 pages) and they have all been corrected.

I apologize if anyone was annoyed by typos. I did pay an editor, but I think it would be difficult for any human being to not miss a few typos out of almost 90,000 words. I'm sure the publishing companies have multiple editors go through books and I still frequently find typos in books published by large publishing houses. I also frequently find formatting errors in the Kindle conversion, especially for older books. I actually found a ridiculous number of errors in the Hunger Games sequels, to the point where I wrote Amazon to complain.

In any case, the typos are all fixed, so if you feel that those five small errors will disrupt your enjoyment the book, please feel free to download a new copy (you can do this for free).

Tuesday, May 19, 2015

Dr. Orthochick: Hip dislocation

I was supposed to have a "research day" yesterday, which would have been really nice since Dr. Jewish emailed me to inform me that my whole "summary" section for my paper sucked and i had to redo it since it did not "emphasize the points of this paper or convince the orthopaedic surgeon that this paper is in any way useful or relevent." He also asked me if I wanted to help him with a project, which means I have 3 projects going and potentially 2 more starting soon. So yeah, a research day would have been nice and I would have actually used it to get research done, thankyouverymuch.

As luck would have it, I had to cover a Dr. Grandpa case. It looked like a cool case, it was a hip replacement but the lady had a really deformed hip socket so it was going to be done a special way. The advantage to this is that it's a cool case, the disadvantage is that I don't get to do much. but i like hip replacements so OK, I'm cool with the whole thing. The surgery went fine and I ordered a postoperative xray to be done in the recovery room because that's Dr. Grandpa's MO. By that point it was around 10:30AM so I figured I could stick around and wait for the xray results and the results of the patient's hemoglobin and then head out to get some research work done.

I got paged by the xray tech who said "I'm not sure, but the hip looks dislocated."

If you think a hip looks dislocated, it probably is. It's one of those radiographic findings that's pretty hard to screw up. I'm pretty sure if you showed the xray to a bunch of laymen standing in Times Square, they could probably identify a hip dislocation. So I pulled up the xray and not only was the hip dislocated, but the whole hip socket had been ripped away from the rest of the pelvis.

If your hip dislocates, you can just do a closed reduction. If your hip socket gets pulled out of your pelvis, that's a bigger issue. So I frantically called Dr. Grandpa to tell him, left him a voicemail saying to call me back ASAP, sent him a text to call me back ASAP, tried calling him again, and finally established connection 20 minutes later. I also sent him a picture of the xray, he said he was driving back to the hospital now and to please tell the patient.

Great.

The patient was surprisingly nice about it, I told her what happened, she said "shit," and I said "yeah, that's pretty much what I said." Her daughter and husband were not quite as understanding, so I figured the learning experience in all this was to only deliver bad news when people are waking up from general anesthesia. I showed them the xray, they demanded to know how this happened. Um, good question. They also demanded to know what we would do if the revision didn't work. Um, equally good question. I would say try Plan C, but they would probably ask me what that was and I didn't really have a great answer. I could probably make up something and use enough scientific terminology that they wouldn't question it, but that seemed a tad unethical.

Dr. Grandpa showed up an hour later and we took the patient back to the OR to start the surgery.

The problem was, when we got in there and discovered there was a huge chunk missing from the hip socket, Dr. Grandpa decided to use trabecular augment. Which is not the wrong thing to do in that situation, except we don't keep trabecular augment at this hospital. We don't even keep it in this city. So the patient got an extra hour of general anesthesia and Dr. Grandpa and i played 6 games of tic-tac-toe with the sterile pen. (all ties) Then the scrub tech and i played hangman with the sterile pen until the sterile pen ran out of ink and we thumb wrestled in sterile gloves. Then Dr. Grandpa told us to knock it off so we stood there and stared at each other until someone put the radio on.

So yeah, the whole day went a lot longer than expected. but at least the patient had her surgery and she seemed to be doing OK this morning. So fingers crossed this works, because if not, well, I guess we have to come up with a plan C.

Monday, May 18, 2015

Guest post: Why are OB/GYNs terrible people who deserve to die?

Bitterness and Ob/Gyn, alas, does seem to go hand-in-hand. I believe that, first and foremost, it is an incredibly important, busy, special, and stressful job. True, most of our patients are healthy, but when they get sick, they can get sick quickly, and when healthy young women or babies get sick, injured, or die on our watch? That's especially devastating.

I can't think of a single person that went into Ob/Gyn as a bitter person who hated women, but at the end 4 years of constant sleep deprivation, sometimes another pregnant woman in labor is no longer a miracle, it just means more time spent away from fulfilling basic human needs like using the bathroom, or eating, or, most elusive of all, sleep! It is also seeing women, not only at their best but at their very worst, hours of staring at monitor strips, worrying about when to pull the trigger on a cesarean delivery, wondering, if it is too early that we will be blamed for "unnecessary surgery" and trying to get to our golf game or (God forbid) home for dinner, or, if too late, we will, much worse, have a sick or damaged baby (and possibly be sued for everything we have).

Women can be very difficult patients, who require a lot of communication, not a problem for patients who are willing to return to discuss issues, more of a problem for people who wish to stuff a year's worth of problems into a 10 minute annual exam. It's persistent 36 hour shifts, often skipping breakfast and/or lunch, and 72 hour weekends. It's adrenaline burn-out, hours of nothing followed by a harrowing roller coaster. It's constantly being second-guessed, by our partners, other physicians, the L&D nurses, the patients, the internet, the media, ourselves, even when we *know* we are practicing to the *standard of care* for our profession.

It's the malpractice, multi-million dollar coverage premiums to pay yearly, the threat of lawsuits for up to 18 years after the fact, shrinking reimbursement (universal for all physicians), trying to pay our staff and our overhead, having to fit more patients into the same hours in the day, trying to be a good doctor for them, trying to at least support our family since we can seldom be there to see them. It's medicine, surgery, primary care, and caring for two patients all rolled into one, and sometimes it eats at your humanity.

Sometimes, you come home at the end of the day so emotionally exhausted that you have little to give to the rest of your family. Sometimes the sadness of discussing a cancer diagnosis, or miscarriage, or fetal death lasts for weeks or days. Sometimes it is impossible to *not* take your work home with you. Sometimes we care *too* much, causing us to start separating ourselves from our patients, building a wall, becoming callous, so the better to protect ourselves.

Sometimes we deal with the stress in inappropriate ways: too much wine, snarky humor, or snappish answers. Likely, many of us are clinically depressed. Many of us have little time to exercise. Because women Ob/Gyns are women too, and usually mothers and wives, who feel guilty when we are at work and guilty when we are at home, just like other working mothers. Because, despite how much it sucks, we still really love our jobs, think pregnancy and birth is amazing, and wouldn't do anything else (even if we wish we could); because we care about mothers, women, and babies.

Kelley Stoddard is the co-author of Baby City, and a practicing OB/GYN.

A version of this article was initially posted in Mothers in Medicine.

P.S. If you read and enjoyed Baby City, please consider leaving a positive review on Amazon. We would truly appreciate it!

Saturday, May 16, 2015

Whole Foods is expensive yo

I was at Whole Foods today, and while I was at the checkout line, I grabbed one of those impulse purchases: a little single serving caramel, about an inch in diameter.

Then they rang it up. And that tiny little caramel cost a dollar.

Me: "oh my God, I can't believe that cost a dollar."

Cashier: "why? Did you think it would be more or less?"

Me: "I thought it would be about five dollars."

Cashier: "really??"

Me: "no! I thought it would be like a quarter."

Seriously though, a bite of food should not cost a dollar unless it is caviar.

Thursday, May 14, 2015

Top 10 bands of the 90s

One summer when I was in college, I was working at a job doing research, in which a large chunk of my time waiting for an experiment to run, i.e. twiddling my thumbs. So me and three of my friends from college decided to undertake a momentous task:

We decide to read the top 10 alternative bands of the 1990s.

We took this task incredibly seriously. No less then three dozen long detailed emails were passed between us. Finally, we came up with a definitive list in no particular order:

REM
Red Hot Chili Peppers
Green Day
Smashing Pumpkins
Nine Inch Nails
Stone Temple Pilots
Nirvana
The Cranberries
The Offspring
Pearl Jam

And then we decide to do bands 11-20:

Soundgarden
Alanis Morisette
Garbage
Beck
No Doubt
Bush
Oasis
Live
The Foo Fighters
Alice in Chains

Tuesday, May 12, 2015

Dr. Orthochick: Algebra

I was heading out last night so I decided to do some quick postop rounds before i left and make sure no one had a compartment syndrome or something. The nurse told me one of my patients wanted to see me, so I figured he had some questions about the surgery since it was a 4 hour reconstruction of the foot and ankle. I went in an his wife and son were in there.

Me: Hi! [The nurse] said you wanted to talk to me?
Son: Yeah. What's (a+b)^2?
Me: (a^2)+2ab+(b^2)
Wife: See!? I told you she would know that! She's a doctor!
Son: S***. I really thought she was going to say (a+b)^2.

And that's the second time this year I've used math on the job.

Apparently the wife and son were having some sort of lively debate on how useful Algebra 2 was exactly and whether or not you actually needed it in daily life. Not sure how I got dragged into this one, but for the record, yes, I passed algebra 2 back in the day. Haven't used it since, but I did do pretty good in it junior year of high school, if I recall correctly. So I'm going to side with the son that no, I do not need it in my daily life, but I guess I wound up supporting the wife's argument because she figured if I remembered it, I must use it.

(I don't. Every now and then I need to add things, the forms in clinic only give you the patient's date of birth and not age so I need to subtract on a regular basis, I've done some multiplication for things like prescriptions...but I don't even remember the last time I divided two numbers.)

Monday, May 11, 2015

Baby City

There are only three things in this world that are certain: death, taxes, and babies.

Nobody knows this truth better than Emily McCoy, a third year resident working in Baby City, the affectionate nickname for the busy Labor and Delivery unit at a New York City hospital. On a typical day in Baby City, Emily delivers more babies than the number of hours of sleep she manages to squeeze in that night. And definitely more than the number of dates she's been on since she started her training in OB/GYN two years earlier.

As Emily works tirelessly to safely herald baby after baby after baby (after baby) into the world, she becomes well acquainted with the three hard facts of Baby City:

1) Babies never come when you want them to.

2) Babies always come when you don't want them to.

3) You don't know who your true friends are until your baby is sliding down the birth canal.




Baby City was a joint effort, written by myself and Dr. Whoo of OB/GYN Kenobi. Do you remember the wonderful Dr. Whoo? She was a really funny OB/GYN blogger who stopped blogging when life inevitably got busy. Well, now she's back… in book form! This book is all about the real events that take place on a labor and delivery unit. It's an inside look that few people get to experience.

And if you're about to start your third year of medical school, this book totally counts as studying.

Buy Baby City today on Amazon!

Read a preview

Side note: Special thanks to Dr. Amy of the Skeptical OB for her help in creating an incredibly realistic scene about homebirth gone wrong. Dr. Amy has been a tireless crusader for safe childbirth, and she's also got some really intelligent things to say about medicine in general (including vaccination). In her honor, we are donating 25% of the profits from the book to the fistula foundation, a nonprofit organization that does great things for women in Third World countries.