Monday, December 31, 2012

Spam

I just want to say that I hope you people appreciate how much spam I've had to wade through since I got rid of captchas so you could comment more easily.

I just deleted an ad for "ejaculation trainer reviews." Not even just an ejaculation trainer, but reviews for ejaculation trainers. Because there are apparently more than one of these horrible things (whatever they are--don't want to know), and people need to see multiple reviews to make an informed decision of which ejaculation trainer is best for them.

So yes, you're welcome.

Seating Rank Order


Sunday, December 30, 2012

How was your holiday?

One really annoying thing from coming back from a holiday or even a weekend is that everyone asks how your holiday/weekend was. It's another of those pleasantries that I find really ridiculous. Nobody cares how my weekend or holiday was. And now I have to figure out a way to answer that question without being boring.

And god forbid I don't ask someone how their weekend or holiday was. That would be really rude of me.

I propose we all stop asking questions that we don't care to know the answer to. Starting...... now.

Gone too far....

Me: "Do you think my posts sound like 'me'?"

Husband: "I dunno. Maybe a little too whiny."

Me: "Gasp! Are you implying I'm too whiny??"

Husband: "Well you do have a weekly whine. Plus a lot of daily whines too."

Me: "I guess I should be grateful you don't think I'm whiny in real life."

Husband: "I just assume you are whining to yourself all the time."

Me: "Secretly?"

Husband: "Yeah, like in your head."

Me: Well, I'm thinking of whines to put on the blog."

Husband: "But you have so many that sometimes you have a whine that isn't a weekly whine."

Me: "I know. It's out of control."

Husband: "I just think it's really funny how my purposely offensive post for you was the least offensive one."

And then he insisted that I write a whine about HIMYM and how it's so annoying that he still hasn't met the mother. Because seriously.

Types of Primary Care Patients


Saturday, December 29, 2012

Weekly Whine: Pager walkaways

You know what really grinds my gears? When someone pages you and then walks away from the phone.

It annoys me to no end when I try to promptly return a page, only to be met with endless ringing on the other line. When you page someone, you have to give them a grace period to answer the page. We can argue how long that grace period should be, but at least sixty seconds.

Yesterday I was waiting all afternoon to get a callback from a surgeon's office on my pager. When I finally got the page, at like 4:30, I quickly ran to a phone to return the page. The person who paged me was on the phone. I hung up and called back, this time getting a message that they had left for the day.

Friday, December 28, 2012

Presents

I have to be honest, I am not into presents.

I don't buy any presents. I don't receive any presents. I don't send any cards or Christmas letters or any of that.

Last year, I brought a plate of brownies to work for the holiday, but I subsequently realized that there are so many treats around now, when people bring in one more, the staff makes little vomiting gestures. So I figure I'll bring it after the holiday, when people might actually enjoy it.

When I was younger, like a teenager, I used to buy presents for my friends. But at some point, I became vehemently anti-present. And this is why:

I feel like presents, except those given to small children, are rarely appreciated. It's usually something you don't even want.

Furthermore, presents make other people feel left out. Every time I considered buying a present for someone I worked with, I realized that I'd have to give it to them in secret to keep everyone else I work with from being offended. Plus they wouldn't have gotten me something, so that would be awkward.

We got a Christmas card this year from the staff in our building. There are like eight of them. I said to my husband, "Are we supposed to give them all something?" I didn't even know who half the names were. But if I got something for one or two of them that we deal with, I'm sure the others would be insulted and, like, we'd have no heat this winter or something unexpected like that.

Same problem with daycare. There are probably like five or six float teachers that take care of my kids, plus their usual teachers, plus the directors. I knew that whatever I did, I'd probably leave someone out and make them feel slighted. Finally, I brought in three separate plates of cookies for each floor.

Describe Your Headache


Thursday, December 27, 2012

H/H

Is there any particular reason we always report the hemoglobin and hematocrit, consider they're almost always equivalent tests? What do we gain by listing both or calling it h/h or any of that?

Heart Conditions


Wednesday, December 26, 2012

Trendy Names

I am totally judgmental about how parents name their kids. Naming your child is a great privilege and sets the tone for their entire life. Maybe some parents freak out under this awesome responsibility, I don't know. But man, there are some terrible names out there.

I gave my kids The Best Names Ever. Obviously. But seriously, I'm pretty happy with them. One is a name that's persistently ranked around 80-100 in the top 100 names for the last half a century, meaning it's a well known name but one that isn't super common. The other is a very classic, timeless name that's common, but will likely never be dated. Of course, there are lots of great names out there, and most parents don't seem to screw it up.

What I don't approve of:

1) Giving your kid a non-name. Like naming them after a fruit, an article of clothing, a dishwashing detergent, or a feminine hygiene product. That's just wrong.

2) Trendy names.

I'm sure I'll take flak for #2 since by definition a lot of you have probably given your kids trendy names. I've said this before, but I just feel like the trendy names of today are going to be the old-fashioned names of tomorrow.

For example, would you name your kid Melvin? Probably not. But in 80 years, Mason is going to sound to the people of the 2090's exactly like Melvin does to us now. You are essentially naming your child Melvin. Think about it.

Furthermore, I've noticed another disturbing trend. It seems like a lot of recent popular boys names have evolved into girls names. For example, Jordan seems to have made a transition, and I'm noticing more and more little girls named Aiden and Riley (but spelled Rylee). How long before we start to have girl Masons out there?

So, essentially, when you name your child a trendy boys name, you may as well just name him Kelly or Ashley (both initially boys names!).

Stages of Needing to Pee


Tuesday, December 25, 2012

Weakly Whine: Being Skinny*

Recently one of my loyal commenters joked that I should write about how "Being Skinny Rocks". Except everyone already knows (or thinks they know) how being a skinny woman "rocks"-- basically, you get more attention from men. So instead I'm going to tell you why being skinny can really suck. Don't believe me? Read on...

1) I mentioned this in previous posts, but other people (especially heavier people) are constantly remarking on my eating habits. Half of them imply that I must be secretly anorexic. The other half see me eat some oreos or donuts after a lunch at McDonald's and assume I must be secretly bulimic! Sorry, but you're wrong on both counts. I eat a reasonable portion size, and sometimes I enjoy a small treat after my meal. There's no big secret here; I've found that if you practice some basic self-control it is easy to eat a satisfying meal while maintaining a very healthy BMI. Even if the wild accusations of others are just jealousy, it can really get to you
(Don't get me wrong-- there are obviously some people who struggle with obesity whose problems are not some simple moralistic "lack of willpower". For example, some of my bed-ridden patients who simply cannot get around like us able-bodied folks.)

2) Claims that my being skinny will somehow scar my kids-- it is totally inappropriate for someone to bring your kids into an argument like that. I'm proud to be a skinny mother of two. As a mother, it's important to set a good example for my kids, and as a doctor, I strive to set a good example for my patients. You could definitely argue the opposite point, actually. Overweight or obese parents set a terrible example for a young child, teaching them that an unhealthy weight is "normal". It's also unfair to the children who will (statistically) lose those parents early to heart disease or stroke.

3) The attention from men ain't all it's cracked up to be-- I don't want to blow this out of proportion, because I'm NOT trying to accuse any guys I know of sexually harassing me or creating a hostile environment. Mostly, I've just noticed that a lot of men tend to be a lot friendlier and more helpful to me and the other women around who are a healthy body weight. And I suppose that's just how men are. But frankly, I'm happily married and have two beautiful children. I'm not keeping my slim figure for their benefit, and I'm past the point in my life where I need to constantly be flirting with men. And look, I get that this attention is not fair to the heavier women. But it's not my FAULT either. The animosity displayed to me by those other women is what really creates a hostile environment for me. (It goes without saying that whatever great advantage they think I'm getting from this attention is all in their head; being skinny didn't get me Christmas off to spend with my kids!)

4) Finding clothes that fit-- I live in the United States, where the average clothing store mostly caters to the size of the average American. 'nuff said.

Skinny readers, feel free to add to my list in the comments.



*This satirical post was actually written by Mr. McFizz, who is on vacation now and clearly has too much time on his hands. He isn't skinny, but actually lost 40 pounds recently which I think is pretty great for him (his health at least... I'm totally into overweight guys). He said I would never post this, but clearly he doesn't know me very well. But I may take it down quickly if a firestorm results.

Tips for Step 1


Monday, December 24, 2012

Why Working Holidays Rocks

Aside from the annoyance of having to deal with childcare issues, I really like working on holiday weeks. It's like the funnest time to be working because:

1) There is so much food and treats everywhere. Yum.

2) Everyone is in a cheerful mood.

3) No traffic.

4) No trouble parking.

5) Generally tends to be easier, quieter days, at least where I work.

6) Excuse for any relative who complains that I'm not visiting: "Oh, sorry, I have to work!"

How long will you live?


Sunday, December 23, 2012

How to cut a surgical knot


Holiday Repeats

Well, it's Christmas week, which means everyone is either away on holiday or pissed off that they're not away on holiday or pissed off that they have to see their stupid family. In summary, everyone is either away or pissed off.

So I decided that I'm going to spend this holiday period reposting some of my favorite cartoons from the history of this blog with possible occasional new content.

Enjoy!

(Or else get further pissed off about the lack of new content.)

Saturday, December 22, 2012

Weekly Whine: Defriending

In the modern world, it seems like de-friending people on Facebook, Twitter, or whatever is really common. People will agonize over why so and so dropped them as a friend. Did I do something wrong? Were the ten billion photos of my newborn child one too many?

Probably, yes.

I'm on Facebook, but I've never dropped anyone as a friend. Partially because I don't know how. But also, I'm pretty sure that on any social media site, I can block things I don't want to read. In all honesty, there were a few people on my friends list who went a little overboard with the babies updates and I just couldn't take it anymore and so removed them from my feed. It was easy and they never knew!

I say we end this random "defriending" of people. It's fine if you defriend someone who's a stalker or doing something really reprehensible, but if you have to think about it, I say don't defriend. Why hurt someone's feelings?

Friday, December 21, 2012

Code Blue is not funny!

Yesterday I heard something that I had never heard before: the person announcing the code blue overhead started laughing.

I was in the bathroom when I heard the familiar beeping overhead and a woman announcing: "Code blue on 3 center, room 318."

A brief pause, then: "Whoops!" The announcer started giggling and said, "I mean, room 380. Code blue on 3 center, room 380. Hee hee."

Whoops!

Thursday, December 20, 2012

Defensive

In the ER, as an intern:

Me: "How much alcohol do you drink?

Patient: "I drink beer at night."

Me: "How many beers?"

Patient: "You know, a couple."

Me: "Well, how many? Like 2 or 3? 3 or 4?"

Patient: "Um, I'm not sure..."

Me: "If you had to take a guess though... how many beers a night?"

Patient: "Maybe 5 or 6."

Me: "Okay. Have you ever wanted to cut down?"

Patient: "You know, these questions are a violation of privacy."

Me: "Excuse me?"

Patient: "I mean, you're asking me 2 or 3, 3 or 4 beers... I feel like this is rehashing prohibition."

Me: "Prohibition?"

Patient: "Well, I guess you don't know much about American history. Prohibition was... look, I don't mean to lecture you. It just feels like... you know, there are some questions that are private that you're not supposed to ask."

Me: "I don't want you to feel like I'm singling you out. I have to ask everyone about their alcohol use. It's on the form and I have to fill something in. I don't want you to feel like I'm attacking you."

Pt: "No, I'm sorry... I just... I feel like some things ought to be private, you know?"

Me: "Yes, of course."

I wrote on his history: Patient became very defensive when asked about alcohol use.

Wednesday, December 19, 2012

Moms are always right

What is it about becoming a mother than means that suddenly you know everything about everything, and you are always right?

Because somehow this seems to be a magical process that happens to many women. They squeeze a baby out of their body and suddenly they become an expert on many things that they weren't an expert on just months previously. (And as I understand it, if the baby is squeezed specifically out of your vagina, that adds even more expertise.)

About a year ago, I wrote a post on Mothers in Medicine how at times, I am just a giant ball of stress, notably during the process of picking my kids up and getting them home. I wrote:

"I don't like stress. Stress stresses me out. While I adore my kids more than anything, it would be so nice to be able to take one shower without someone busting in on me and asking when I'll be done. It would be nice to spend a whole day in bed getting to do whatever I want to do. Something like that feels selfish, even decadent, to me now."

The responses, in general, were pretty supportive. But naturally, moms know best. So I got a couple that weren't quite as supportive with some "helpful advice." Such as, "Can't you use a bit of discipline? It sounds like she's spoiled."

Actually, I think my daughter being upset because every single day for the last two years, I've had a snack for her on the way home and this time I've failed to provide one is a pretty reasonable response for a small child. But thanks for that helpful advice, mama.

But my absolute favorite was this one: "Just an FYI, the baby shouldn't be wearing a coat at all in the car seat. You can't get it tight enough with the coat on."

CLEARLY, when you're stressed to the breaking point, the answer is to take all your kids' coats off in the freezing snow before buckling them in. That is something that obviously every mother does and it's not totally insane at all. Great, helpful advice that I was obviously just asking for. Thanks, mama.

Recently, a woman was publicly criticizing me online for my response to that particular comment to that post. She wrote:

"...She wrote about how difficult it was to buckle her daughter into the carseat because the daughter’s winter coat was so huge. Someone pointed out that it’s unsafe to buckle a carseat over a jacket and she’d solve her problem and keep her daughter safe by taking the jacket off.

She went ballistic.

I then posted a comment about how the carseat info was correct and I was shocked she responded with such vitriol. My comment was deleted."


First, for the record, I'm not a moderator for Mothers in Medicine, so I can't delete comments there and I'm innocent of that offense (it likely had links in it that got it filtered as spam). Second, I didn't write about "how difficult it was to buckle [my] daughter into the carseat because the daughter’s winter coat was so huge." I wrote about how my life is stressful. But certain mothers felt that they knew best and just had to weigh in, no matter how obnoxious it made them sound. No, I wasn't nice in my response. But I just freaking warned everyone in my post that I was really stressed out. If someone puts up a sign saying there are lions behind this door, you probably shouldn't open the door and tell the lions they're buckling their kids in wrong.

When I pointed out to this women how her comment made me feel, her response was, "I understand having a rotten day. But, please don't let your rotten day put your children in danger."

Because clearly, it's not about being right. It's that she was just sooooo worried about my poor little kids. People who give unwanted advice to other parents are really just compassionate souls worried about the poor kids.

Not that it's anyone's business, but my daughter has a compressible jacket that's "carseat safe." I told her this and she kindly retracted her comments and announced to the website where she'd been bashing me, "She assures me that her children are safe in special car seat safe jackets."

And everyone was so relieved. Because now Fizzy's kids are safe. Which is what everyone was just terrified about. Shit, they probably couldn't even sleep at night. It wasn't about being right at all. Or else nobody commented or cared.

I'm a mom so that means I apparently know everything. So here's some really wise advice:

Do not give other mothers unwanted advice about their kids just because you think you know better than they do. Ever. That's right, ever. They are doing a good job raising their kids. Your advice isn't going to do anything except raise their blood pressure.

Tuesday, December 18, 2012

Monday, December 17, 2012

Why Being a Doctor Rocks

I've written before about the downside of medicine, the limitations, why medicine is a crappy career for a mom, etc. I'm sort of getting the feeling y'all think I'm quite a Debbie Downer, and maybe I deserve that. I guess I just feel like so many people desperately want to go to med school and think of being a doctor as this amazing thing, so I'm just trying to keep it real (yo). I'm trying to honestly present the other side, because I don't think it's something people see a lot. People have thanked me for my honesty and told me that it's refreshing.

That said, there are a lot of great things about being a doctor. I mean, DUH. Still, I feel it needs to be said on this blog. So I'm going to slip from character and write a really positive post about some things I genuinely love about medicine:

1) There are few greater feelings in the world than when a patient profusely thanks you for helping them and changing their life. It happens more than you think.

2) The intellectual challenge of medicine is really fun, such as interpreting a tricky EMG (my fav) or trying to figure out the best way to treat a patient.

3) Being sick is really rough, and I love trying to be the compassionate person who treats my patients the way I hope to be treated in that situation.

4) I do get respect, sometimes more than I feel I deserve!

5) My kids are proud of me. My daughter thinks what I do is so neat. I got to give the doctor talk to her class one day and all the kids wrote me a thank you card.

6) I get to spend much of my day walking around and not crammed behind a desk.

7) This might not be true of everyone, but I love working with my hands, and medicine gives me tons of opportunities to do so.

8) The pay... well, it's pretty great. There, I said it.

9) Lots of job security in this economy.

10) A lot of physician jobs do give you the flexibility to work part-time. And because the compensation is so good, you can afford to work part-time.

11) There are so many options within medicine: you can be a teacher, you can do research, you can work with patients, you can be an administrator... or all of the above.

12) The privilege to get to do and see things that most people never get to do or see. I mean, I've seen an open heart surgery, dissected a dead body, counseled patients at the end of their life, administered life support, and I'm just a rehab doc. Seriously, how amazing is that?

13) The stories. I love a great story, and I love getting to know new patients and hear their stories. I feel like I could practically write a book about every single patient I meet. They're all fascinating in their own way. Especially in my field.

Just because I try to present the other side of a field that sometimes gets over-glorified, that absolutely doesn't mean I don't think being a doctor can be a rewarding career.

Tomorrow: Why having lots of money rocks.

Sunday, December 16, 2012

Don't take it seriously

Somehow I feel like this needs to be said:

The only things that truly matter to me are the health and welfare of my family, especially in scary times like these.

I write Weekly Whine posts to entertain you guys, as a distraction from the real world and real problems. Some people enjoy them, some not so much. But don't for even a second think that any of the issues I write about are ones that I feel vehemently about. Please believe me, I am not devoting any brain space to worrying about 3-D movies or kids with hyphenated last names. The things I truly worry about are not things I would ever write about on a public cartoon blog.

I'm not bothered by serving sizes any more than Jerry Seinfeld is bothered by the little black box on the plane.* Those posts are meant to be lighthearted and entertaining. But if it truly angers you so much to read the Weekly Whines, maybe you should avoid them for the sake of your own sanity. No hard feelings.


*Seriously, why don't they make the whole plane out of the little black box??

Ask a patient recently put on Elavil

Me: "Is the Motrin you're taking helping your back pain at all?"

Pt: "I guess so. But I don't like it because lately it makes me too sleepy at night."

Me: "I've never heard of Motrin doing that. That might be from the Elavil you recently started."

Pt: "The Motrin also makes my mouth really dry and cottony."

Me: "That's probably from the Elavil too."

Several minutes later, attending comes into room:

Attending: "So is the Motrin helping you?"

Pt: "It helps, but it makes me tired and it dries out my mouth."

Saturday, December 15, 2012

Weekly Whine: I love my job!

If you don't want to piss me off, don't say to me, "I love my job!"

Maybe it's just that I know too many people in medicine, but it seems like only people in medicine seem to say this. Notably, I remember on one OB call in med school, the intern was running around like a crazy person all night delivering babies, definitely getting zero sleep, and at one point she said completely earnestly and to my complete befuddlement, "I love my job!"

(My private response: "Is that why you act like a bitch all the time?")

Most people don't really love their jobs. That's why it's called a job. You might like it. You might love some aspects of a job. But I feel like "love" is an emotion that should be reserved for people, not a place where you are obligated to go 5+ days a week.

There were times in the past when I said I loved my residency. But I didn't really. I mostly felt peer-pressured by all those job-loving liars out there. Plus it was so much less awful than my internship, it didn't feel like a total lie to say I loved it. Comparatively, I loved it because I didn't hate it with every fiber of my being.

So yes, I suspect a lot of the time when people say they love their jobs (or med school or residency), it's disingenuous. Either they're trying to convince themselves or they're trying to feel superior to other people who hate their jobs. But even if that's not the case, it's still an obnoxious thing to say, considering most people don't love their jobs. It would be like saying how much you love being a mother in a room full of infertile women. Or me blogging about how much I love being skinny, which I know would really piss off one or two of you in particular.

And if you still insist that you love your job... well, maybe you and your job should get a room.

Friday, December 14, 2012

Physiatrist vs. Psychiatrist

Psychiatrist: "Somehow patients always manage to get their Viagra. Their blood pressure meds, whatever... but they always take the Viagra."

My attending: "That makes sense."

Psychiatrist: "Viagra is really big in the gay male community, you know. It increases libido. Although I really don't think they need it. I mean, they're already having so much sex."

Attending: "Uh..."

Psychiatrist: "Even if you think you have a lot of sex, you can't even conceive of how much gay men have sex. You have no idea."

Atttending: "..."

Psychiatrist: "I had one patient who would go to these bathhouses and he told me he'd have sex like 12 or 13 times in one night!"

Me: "With different people?"

Psychiatrist: "Yeah!"

Me: "Wow."

Psychiatrist: "I don't know what it is about me. It seems like patients just ALWAYS want to share their sexual history with me. I don't think most doctors have this problem."

Attending: "Well, you're a psychiatrist and I'm in rehab. Patients just want to tell me about their speech problems or their knee pain."

Psychiatrist: "The only way I get to hear about knee pain is if it happened during sex."

Thursday, December 13, 2012

Swayback

Me: "So you're here for back pain?"

Patient: "I don't really have any back pain. I'd like a back brace."

Me: "Uh, why?" Because back braces are cool?

Patient: "For my swayback."

Me: "What's swayback?"

Patient: [incredulous] "You don't know what swayback is??"

Me: "No..."

Patient: "It's a well known condition!"

Me: "Uh."

Patient: "Here, look!" [shows me totally normal-appearing back]

Me: "Uh. How long have you had it?"

Patient: "I was born with it, of course! I can't believe you don't know what swayback is."

Me: "Do you mean scoliosis?"

Patient: "No, but I also have scoliosis."


Later:

Me: "The patient said she has... swayback."

Attending: "What's swayback?"

Me: "Oh my god, that's what I said!"

Attending: [googles "swayback"]

Apparently, swayback is excessive lumbar lordosis. It's also a rock band with the feel-good hit of the summer.

Wednesday, December 12, 2012

Perfect Christmas Gift

OMG, Christmas is right around the corner! And you haven't bought any presents yet! What are you going to dooooooo??????

Never fear, you can always buy your loved ones a copy of A Cartoon Guide:



You know how it's totally annoying I never post cartoons anymore? Doesn't that piss you off? Well, now you can get all those cartoons I never post in one handy book!

Buy it from Amazon or Lulu just in time for Christmas! And if you get two-day shipping, you can still make it for the last day of Hanukkah, in lieu of yet another dreidel! Yay!

Why we cut back

About a year and a half ago, there was an op-ed piece of the New York Times called Don't Quit This Day Job by Dr. Karen Sibert about how women in medicine have an obligation to work full time, and an obligation to take on the same workload that men generally take on. I've been thinking about this lately, and why mothers increasingly do not make that decision. I'd like to present an entirely plausible scenario to you:

Mary is a physician and a mother of two children, ages 2 and 4. Her husband is also a physician, and she learns in September that he will have to be on call for the upcoming Christmas. The daycare that her children uses will be closed on Christmas and Mary has no family in the area. The babysitter she usually uses will be out of town. So she requests to her boss that she have Christmas off this year, hoping to get priority given her predicament, even though several other people have also requested it off. She receives one or all of the following replies:

“If you work in the medical field you should realize that you will be working holidays and it's presumptive to assume people without kids should work holidays just because it's hard to find child care.”

“Your inability to find childcare does not mean I should be forced to take second pick at holidays.”

“Well, kids are expensive and stressful. Didn't you know that before you had them? I don't feel bad AT ALL for doctors who have kids during training and then discover that childcare is expensive and inconvenient.”

“If you can't pull your weight and do your fair share due to your situation, then you need to leave.”

“You chose to have children. Parents who both work in professions that work on holidays chose to do so.”

“Not wanting to leave [your kids] with a stranger is not an acceptable reason for someone to cover you.”

“If you want holidays off get a new job and stop bitching.”

“But bottom line is that reproduction and child rearing is, at the core, a choice we make as human adults. I never once said that it's easy or painless to have an abortion or give a child up for adoption, only that those are choices available to women who are not ready to deal with child rearing and the stress/hardship/etc that it entails.”

“If someone decides to have kids then they need to bear the brunt of what ensues and not expect other single or childless colleagues to sacrifice just because.”

“Sorry, Mom, you cannot have your cake and eat it too.”

“If you want to make the big bucks you have to do what it takes to prove to the employer that you are worth those big bucks.”

“You may see your time with your kids as a priority, don't expect others to do the same.”

“You may see that as selfish, but my 'me time' takes priority over other people's kids.”

“A good Christian is one who deals with their own problems like childcare without complaint or burden to others. They are your children, dear. Not mine.”

“You chose to have kids. You chose a profession that requires you to work holidays. Get a backbone and deal with the consequences of your choices and stop trying to make the rest of us who made good life choices or are happy with them suffer for your decisions.”

“If you feel your very young children need to be watched that carefully, why work at all?”

“One of the major responsibilities of being a parent is having adequate childcare, which includes backup and backup for your backup. “

“The fact of the matter is that the decision to have kids is a personal one. Once you make that decision don't expect everyone to plan their lives around yours. People who are really concerned about having holidays off become teachers or find office government jobs. “

If these comments sound familiar, it's because they all appeared when I suggested on this blog that someone in Mary's predicament have priority.

And maybe all of you are right. Maybe she shouldn't have priority. But if anyone is wondering why women cut back on medicine and even leave the field after having kids, now you have a taste of what we face. Can you really blame us? And just to hammer the point home, here are a few other comments that will give you a flavor of what we mothers in medicine go through:

“At times childcare falls through, and I'm forced to rely on the goodwill of others.”

“How many babies go to daycare and end up with a febrile illness within 3 weeks of starting? Practically all.”

“My sister has three kids and hasn't had a Thanksgiving with her family in 20 years.”

“Then I had a kid. So I moved to a field where I do not have to work any holidays or weekends unless I want to.”

“When I had to work in a remote hospital thirty minutes away, I arranged for my childcare to spend the night and went there to stay in a hotel so I could make the 8 am frozen sections."

“Our state would expect an emergency worker to respond, including physicians. our employer, and state, expects you to have appropriate emergency coverage for children in the event of a disaster.”

Just food for thought.

Tuesday, December 11, 2012

Highly Recommended

Thank you for the book recommendations from the other day. When there's not one specific genre that you really love, that makes it much harder to find books to read. As fun as it is to be engrossed in a book I really love, it's equally frustrating to try to read book after book that I just can't connect with. I have to say though, I'm a little baffled by some of the recommendations to read books that were specifically what I said I didn't like to read.

All this reminds me of something...

When I was in grade school, I was also a really avid reader. I read much more then than I do now, because I had actual free time. I can't really remember what I used to read, but I liked some of the girlier mysteries (Mary Higgins Clark) as well as medical mysteries (Robin Cook) and a little bit of Stephen King and that sort of stuff thrown in.

We had to keep a journal of every book we read with a little summary of the book. My teacher Mrs. Hanson collected my journal, and after she saw my reading list, she made a recommendation to me:

"You should read Jeffrey Archer," she said. "Try A Matter of Honor. You'll love it."

And since I was a huge teacher's pet, I immediately rushed to Barnes and Noble to purchase A Matter of Honor.

You guys, I hated it. I found it unbelievably boring. It had all this political intrigue and foreign affairs and stuff that I was totally, utterly uninterested in.

I was pissed off, in a ten year old kind of way. Why did Mrs. Hanson recommend this horrible book to me? Obviously, she didn't really understand what I liked. The book was just something she liked, and without any regard for my own taste, she recommended it to me. I expected better from my teacher.

This is why when I ask people for a recommendation, I always try to make it clear what kind of books I like. Because one person telling me they personally liked a book doesn't really help. I mean, I could go on Amazon and find strangers who like just about any book. I prefer it when someone says, "Well, if you liked Twenties Girl, you would just love...."

Sunday, December 9, 2012

Reading Suggestions

I posted about this on Facebook, but I am searching for new books to read.

You can look at my reading list to see what sorts of books I'm interested in.

Basically, I like books that are easy to read and interesting. Things I don't like:

1) Pure fantasy.. I can handle the Hunger Games, but nothing too out there

2) Overly flowery or complex language

3) Non-fiction

Depressing Sundays

I figured this was an appropriate Sunday post...

When I was in residency, I would get two emails every Sunday night:

One was a reminder email to go online and log my duty hours.

One was an email from the chief resident with a list of all the cross-coverage for the week.

It was just about the most depressing thing to get these two emails every Sunday night. It always signified the end of the weekend, and reminded me of all the crap I had to do that week. (And the cross coverage schedule was often a depressing nightmare.)

If only I filled out my duty hours on Friday night, I could have avoided one of these emails. But somehow I never ever did in the entire three years.

Saturday, December 8, 2012

Weekly Whine: PMNR

It bothers me to no end that people constantly call PM&R "PMNR".

I mean, it's not like Linens 'N Things. Or Toys R Us.

I get that people in other fields have no idea what PM&R is, so it doesn't surprise me that they don't know what it's called. But what really bothers me is when someone is applying to PM&R, and they still think it's called PMNR. It sort of shows you didn't research the field very well.

For example, I got an email from a reader of this blog, telling me that he was interested in going into "PMNR" so that he could become a "pyschiatrist", and he wanted advice. My advice was, first and foremost, learn what the field is called.

That might sound a little mean, but my program director told me that when he got an inquiry from a resident or med student interested in "PMNR", it was already like two strikes against them.

Friday, December 7, 2012

Pay Attention!

Note to patients: when your doctor comes into the room, it's time to PUT DOWN THE KNITTING.

Seriously, this woman I saw in clinic last week would not stop knitting the whole time I was interviewing her. It was really distracting.

And then this week, I had a patient who was flipping through a magazine the entire time I was talking to her. The best part was when she finally got to the end of the magazine she was flipping through, she picked up a new one and started flipping through that.

I have to ask: is talking to me really that boring??

No, don't tell me.

Thursday, December 6, 2012

Highlighter gone mad

One weird thing about me is that I was never into highlighters in med school. Everyone else was. One day some drug company gave out these pens that had highlighters at the other end, and many of the students were almost salivating.

One day when I was studying with friends during third year, I noticed that the student next to me was highlighting stuff from the peds textbook. I glanced over at the page he was reading and I saw that he had highlighted every single line on the entire page with a single exception. I looked over and read out loud the single sentence that he had not highlighted:

"H. influenzae type b cellulitis is now very rarely seen."

Wednesday, December 5, 2012

Easier than it looks

The new Yahoo CEO Marissa Mayer recently had a baby and got some widespread criticism over her comment: "The thing that surprised me is that the job is really fun…and the baby's been easy. The baby's been way easier than everyone made it out to be. I've been really lucky that way."

This comment pissed people off. Why? Because you are not allowed to say that your baby is easy. There's a little vein in my temple that starts pulsing whenever a woman says that.

I was in a conversation with two other women a little while ago about our kids. One of the other women was exchanging stories with me about mischievous things our kids had done. When we turned to the other woman and asked her about her son, she just shook her head and said, "Oh, no, David is just an angel."

And I was like, really? You can't think of one act of mischief that your three year old child has ever gotten into? Seriously, you've got to have one story in your pocket.

The thing is, I think my kids are pretty good. But there are always going to be times they drive me totally nuts because that's what kids do. That's what they specialize in.

I've noticed that the definition of "an easy baby" varies widely from person to person. My cousin informed me that his eight month old son was a "really easy baby." I later discovered that this really easy baby was still waking up like four times a night. I guess if you have a stay at home wife who does all the work, that counts for you as a really easy baby.

I wonder what Marissa Mayer considers "an easy baby." This is a woman who went back to Yahoo with the umbilical cord still hanging out of her. Her definition of "easy" is probably way, way different from mine. Also, depending on whether you have someone watching your baby all day and helping at night, it seems like most babies would be pretty easy under those circumstances.

In any case, I don't think we should vilify Mayer for saying what she said. After all, she's a brand new mother. She's not privy yet to all the ways we jump on each other.

Tuesday, December 4, 2012

Dr. Wikipedia

I remember during residency, one of our most arrogant attendings was finishing up with a patient himself. When he came out of the room, he handed the resident a huge stack of papers that he had printed from the internet on fibromyalgia.

"I gave a copy of this to the patient," he said. "Put it in the dictation."

"It's from Wikipedia," she said, baffled.

"Yeah, so?" he said. "I love Wikipedia."

Sometimes words fail you.


Sunday, December 2, 2012

Liar Liar

No, this post isn't about that mediocre Jim Carrey movie from 1997. It's about the lies we tell to our kids during the holidays.

My husband and I can't quite agree on the whole Santa thing. Right now, our six year old thinks Santa is probably real. I've been encouraging this. We're even doing the elf on the shelf this year. (Our elf is a girl and she is named Elfa.) I did accidentally terrify my daughter into thinking that the elf was going to trash our home while we slept, but then I convinced her the elf was good and she didn't have to sleep with her bedroom door locked.

My husband is very much not on board with the whole "pretending Santa is real" thing. He feels it's wrong to lie to your kids and they'll eventually find out the truth and think you're a liar. I disagree. I believe I'm just making the holidays more magical for her.

I don't really have a frame of reference on this, because I was never taught to believe in Santa Claus. Also, I was never allowed to trick or treat. (Damn traumatic childhood.)

What do you think? Does pretending Santa is real make the holidays more magical or does it make you a dirty liar?

Saturday, December 1, 2012

Weekly Whine: Serving Size

I'm just wondering how people who make products determine serving size, because I seriously don't understand it.

I feel like anything that's individually wrapped ought to be ONE serving. Like if you buy a muffin, why is a serving size 1/2 muffin. Does anyone buy a muffin for the purpose of eating half a muffin??

And the other day, I was looking at a package of ramen, and one serving was half a package (yet still had like 100% of the day's salt allotment). How is that possible? A package of ramen is like nothing.

Basically, this is all a trick to make people think foods have less calories than they actually do.

Friday, November 30, 2012

Visuospatial

I have terrible visuospatial skills. It's why I could never be a general surgeon or a gastroenterologist, or any field where you need to work a camera in more than two dimensions.

Believe it or not, good visuospatial skills are required for interventional pain medicine. I did a rotation in Pain Medicine as a resident where I spent a lot of time in the fluoroscopy suite doing injections. And I was terrible at it.

One day when I was working with an attending named Dr. Contrast, I spent practically the whole day in the OR and the whole time was extremely frustrated that I never knew which way to move the needle. We were using fluoroscopy to look at the course of the needle into the spine and based on what we saw, used tricks to redirect it. But I just. Didn't. Get it.

Finally, I 'fessed up to Dr. Contrast:

Me: "I don't get it."

Dr. Contrast: "Yeah, I can see that."

Me: "How do you decide what direction to move the needle in?"

Dr. Contrast, bless his heart, launched into a big explanation of how to move the needle, equipped with drawings. I understood about 50% of what he was saying. I was just having trouble visualizing it.

Me: "Man, I wish I had played more video games as a kid. I'm good at math, but my visuospatial skills suck."

Dr. Contrast: "I know. I thanked my parents for letting me play video games as a kid."

It's true: when I attempt to play 3D games, I'm so bad at them, it's actually hilarious to the people watching. When I held the camera during surgery, the surgeon kept telling me they were going vomit (but maybe they say that to all the med students). And my husband won't play 3D Wii games with me, because he says I'm giving him a headache.

So kids, that's what you need to tell your parents when they tell you to stop playing those video games. Don't they want you to be a doctor someday??

Thursday, November 29, 2012

What's my but for?

In my daughter's kindergarten class, they are learning to read and write new words. I caught a glimpse of one of her recent assignments from class:


(Answer: It's for pooping.)

Wednesday, November 28, 2012

The TOMM

I work closely with neuropsychologists, so one day, I asked one of them to go over some of the tests they do. I thought it might have been fun to actually get tested, although I'm too worried I'd do badly and they'd lose respect.

Anyway, one of the tests they do is called the TOMM: Test Of Memory Malingering. It's an "effort measure," which is basically a really easy test that even demented patients can do well on, so if the patient fails it, they're likely not making an effort to do well.

The neuropsychologist told me that she tries to cover up the name of the test, the TOMM, so the patient doesn't go home and Google it. I made a suggestion that she could tell them that the test is named after the guy who authored it, whose first name is Tom. But it turned it, the guy who authored it really is named Tom. And actually, it turned out the guy's last name is Tombaugh.

So in summary, the test is called the TOMM, developed by Tom N. Tombaugh.

Is it just me, or is that funny?

Tuesday, November 27, 2012

Too many jackets

Chief complaint: Neck pain

I walk into the room and see patient is wearing a heavy sweater, covered by a light jacket, covered by a second, heavier jacket. She's also wearing a silk scarf. Even though a gown has clearly been provided for her, it is lying unused on the examining table. For the record, it's really not that cold out.

I finish taking the history, then say to the patient: "I'm going to examine your neck. Can you please remove your jacket?"

Patient: [removes ONE jacket]

Me: "Can you please remove your other jacket."

Patient: [reluctantly removes second jacket] "Do you want me to take off my scarf too?"

Me: "Yes, that would be wonderful."

Monday, November 26, 2012

Healthy babies are worth the wait

When I was 36 weeks pregnant, I was just done. My feet hurt, I was waking up every hour to pee, and my back was killing me. I didn't want to be pregnant for a second longer.

During my OB appointment, I told my doctor how miserable I was feeling. "Next week I'll be full term," I pointed out. "Can you induce me then just so I can get this pregnancy over with?"

"Absolutely!" she said. "I'll put you down to be induced at 37 weeks, so you'll be full term."

She put me down on the calendar and I went in to be induced at the hospital at 37 weeks. My baby was a little on the small side, but she was fine.

Or........ none of that actually happened.

What really happened? At 39 weeks, I felt like my baby was never coming out. I asked my OB if she'd consider inducing if I made it to 41 weeks so I wouldn't spend my entire maternity leave pregnant. She reluctantly said she'd consider it, but my cervix didn't look favorable so we'd talk about it then. (Fortunately, my water broke two days later.)

I'm honestly baffled by the March of Dimes campaign that says "healthy babies are worth the wait" that strives to eliminate non-medically indicated (elective) deliveries before 39 weeks. I just saw a commercial for it on TV where they were trying to convince pregnant women to wait till 40 weeks. Who are all these women who are being induced prior to 40 weeks??? I don't know one woman who was induced before 40 weeks. I had to BEG for an induction at 41 weeks!

I've asked a couple of OBs and they seem equally baffled by this campaign. Who is it aimed at anyway? It's not like you can just go the mall and get an induction. The OB has to be on board with it too, and from what I've seen, most OBs wouldn't want to induce too early for no medical reason and risk a complication.

Can someone please explain this to me?

Sunday, November 25, 2012

FOO fighters

When I was an intern, one of our ICU attendings was very distrustful of the ortho service. He had two acronyms he liked to use: FOO and FOOBA.

FOO = Found On Ortho

FOOBA = Found On Ortho Barely Alive

(I don’t think he thought much better of PM&R though. He was also quoted as saying, “Being on the rehab service is kind of like a death sentence.”)

Still, FOO and FOOBA remain two of my favorite acronyms. What are yours?

Saturday, November 24, 2012

Weekly Whine: Don't be a doctor if....

I had another whine scheduled for today, but in light of that delightful Thanksgiving discussion, I decided to write something else that's been on my mind.

I made a post about covering holidays and stated the opinion that I thought parents of young children should have priority for holidays. It got one or two comments, as you can see. Truthfully, I'm not passionate either way. I don't usually care much about taking holidays off because my husband has a very flexible job, so I try my best to be flexible to help others who actually need it for whatever reason. However, I felt it would be more entertaining for you (and me) if I took a side and you got to argue with me (or yell at me, in some cases).

One thing I found particularly interesting is that in refuting my statements, multiple people commented, "If you aren't willing to work holidays, you shouldn't become a doctor."

In all honesty, that's an excellent point. What kind of idiot would become a doctor if they don't want to work on weekends/holidays/etc?

Here's the thing:

Many people *raises hand* are 22 years old and single when they start medical school, with zero obligations beyond getting yourself clothed and fed. And maybe you've even heard that medicine is a good career for a mother because it pays well and you can work part-time. As a little fresh-faced med student, it's difficult to even contemplate what it will be like in the future when (if!) you get married and have children. All you know is that you can manage it all now.

Then it's ten years later. Everyone expects you to put your job before your kids, even though you love your kids more than anything. And when you take maternity leave people give you dirty looks. When you return, they say in a snarky voice, "Did you have a nice vacation?" And you can't take any actual vacation for another year and have to make up missed calls, even though your baby is still waking up twice every night and you're so tired, you could just die. And when people visit your house, they make disparaging comments about how cluttered it is because you don't have time to clean. And people on a blog will write over a hundred comments, furious at your sense of entitlement for hoping to get Christmas off when your nanny is gone so that your baby won't have to be cared for by a stranger that day. And how dare you take a day off because your grandmother died, after you left early last week because your kid was vomiting? After all, having children was a choice you made, so don't expect anyone to help you. You are just another unreliable parent, using your kid as an excuse. For Christ's sake, why did you go into medicine if you can't handle the lifestyle?

I consider myself very fortunate in that both my husband and I have a lot of flexibility in our jobs. But that's actually very rare in medicine. I don't think I appreciated when I was 22 years old how much of a challenge it is to work in medicine or to be a mother, both of which are obligations that expect you to give practically all of yourself. If someone had warned me, I probably wouldn't have listened. I would have figured they were trying to scare me or they were just weak.

When I was 22 years old, I truly thought I could do it all. It's only as I got older that I realized that not only couldn't I do it all, I didn't want to. But by that point, it's too late for most of us.

Premeds and med students: Be warned.

In any case, my follow-up question is: why can't medicine be a field that's more friendly to parents? Must it be the case that becoming a physician dooms you to spend 20 Thanksgivings in a row away from your family (as one commenter stated). And that we should be furious with people who don't want to do this? Maybe instead of being angry at a mom who just wants to spend a holiday with her baby (how dare she??), we should be working toward ways for doctors who want a normal lifestyle to have one. Perhaps hiring per diems to cover holidays or calls in exchange for a slight dip in salary? I don't know. But I believe there is a solution, and it isn't going to be achieved by calling parents selfish because they want to spend time with their kids.

Fifty years ago, they said to exhausted residents who were working three days in a row, "This is how it is. Deal with it." Now we realize how crazy that was, and we let residents work normal human hours. Will the medicine attending lifestyle similarly change in the future, and will we look back with disbelief on people who mocked physicians for daring to want to spend Christmas with their families?

Friday, November 23, 2012

Positive U/A

(And now for something a little less controversial. Unlike my last post, I expect significantly less than 100 comments.)

A page I got at 1AM:

Nurse: "I'm calling to let you know that the urinalysis on Mrs. Burns is positive. There are a lot of white blood cells."

Granted, I'd never been paged before urgently with the results of a urinalysis, but the patient had a mild fever earlier so it didn't seem unreasonable.

Me: "Oh..." [groggily trying to decide what med to start her on or to wait till morning] "Is the patient on any antibiotics right now?"

Nurse: "No."

Me: "Any allergies?"

Nurse: "No. There's also trace leukocyte esterase in the urine."

Me: [finally waking up] "Trace? Wait, can you read me the full results of the urinalysis?"

Nurse: "Protein negative, ketones negative, trace leukocyte esterase, nitrite negative, 0-3 red blood cells, and 3-5 white blood cells...."

Me: "Three to five white blood cells???"

I made her repeat that number twice to make sure I heard right. I can't believe I got woken up in the middle of the night about three white blood cells in a patient's urine. That was like the least remarkable urinalysis ever.

Thursday, November 22, 2012

Humanitarian

Happy Thanksgiving everyone!

I figured there aren't going to be many people online today, what with all the turkey making. So I decided to take a break from my usual stories and post something that I found... interesting. I figure I won't get bombed with comments since it's a holiday and all.

I made a post on Mothers in Medicine yesterday about whether people with small kids should get preference for having specific holidays off in jobs that require people to work holidays. My argument was yes, mostly because you can just as easily see family or friends on Jan 25 as you can on Dec 25, but there's less flexibility when it comes to schools or daycares being closed and people with kids having to scramble for reliable childcare.

Just to be clear, I absolutely wasn't trying to say that a parent should get every holiday off and a non-parent should work every holiday or anything close to that... but if everyone gets, say, three holidays off and the parent says they really need Christmas off due to not being able to find anyone to help watch their child, that should receive preference. I'd feel the same way if someone was caring for an elderly or disabled relative. As a society, I think we should try to provide flexibility for these people who need it, or else risk driving them out of the workforce entirely.

However, putting all that aside for a minute... one person argued that while you could see family and friends on any day, if you want to go to the Christmas church services, that can only be done ON CHRISTMAS. And that is just as legitimate an excuse as having nobody to watch your kid that day.

This argument struck me more than anything. I respect people who value religion and find comfort in their faith. But at the same time, don't most churches teach you to be a humanitarian? Maybe I'm wrong, I don't know. But would you really feel worse about yourself if you had to miss church than if you, say, forced a single mom to have to scramble for childcare for her small children because you were in church? Is a good Christian someone who goes to church on Christmas or helps a parent be with their small children during Christmas?

I feel like an attitude like this is all about following some kind of mantra and not about caring for your fellow human beings. It's like politicians who restrict abortions and at the same time, cut off funding to poor, single mothers. I think you should practice what you preach.

Wednesday, November 21, 2012

Doctors are human too

Through interactions with my husband, I've gradually come to the realization that many civilians (i.e. non-physicians) don't appreciate that doctors are, in fact, human.

For example, a while ago, we were at our pediatrician, and he had told us he'd get us some information sheet before we left. After a significant amount of time, nobody had returned with the sheet for us. I said, "He probably forgot."

Husband: "No. I'm sure it will be here soon."

Me: "I'm sure he forgot."

Husband: "He didn't forget."

I finally went to check. Guess what? He forgot.

Totally understandable. He's human and humans forget to give out information sheets when they're seeing five patients at once. That's why I was so quick to think he probably forgot.

On another occasion, my husband had some lab test done, and got a call from his doctor in the late afternoon same day about an out of range result, and she asked him to repeat it. He repeated the lab the next day, and then was super upset that she didn't call him again about the result being either normal or abnormal (despite the fact that it would available online the next day).

Husband: "How come she didn't call? That's pretty obnoxious."

Me: "Why would she call you same day about either a normal or unsurprising lab result that you're not going to do anything about right away anyway?"

Husband: "Well, she called yesterday."

Me: "That's because she wanted you to repeat it. And she might have had a break in her schedule."

Husband: "I think she should have called."

Me: "Maybe she's in clinic the whole afternoon with patients. Maybe she doesn't have time to be calling every patient back about non-urgent lab results."

Husband: "Okay, okay..."

I think that as doctors, we have a much better understanding of what's humanly possible for a physician. Non-physicians don't quite seem to understand that.

Tuesday, November 20, 2012

Things you learn about in med school (that probably aren't as funny as they sound)




*Urachal fistula: Connecting fistula between bladder and belly button

Cremaster reflex: Elicited by lightly stroking the inner part of the thigh, resulting in elevation of the scrotum and testis on the side stroked.

Maple syrup urine disease: An autosomal recessive metabolic disorder that gets its name from the distinctive sweet odor of affected infants' urine.

Monday, November 19, 2012

How to be competitive

Ever since I made my post about why I didn't do dermatology, I've gotten responses reprimanding me for implying that dermatologists are all terrible people.

They're not. Back in the old days, it was much easier to match in derm. And I'm sure the people who trained back then are nice people. Just the new ones are terrible.

(I'm joking.)

(Or am I?)

One of the responses got me thinking about my own classmates who matched in derm. There weren't many of them, and yes, they were very very competitive. They were the ones who fought to have every exam postponed, who showed horrible behavior during clerkships that made everyone hate them. Future dermatologists: if you want people to stop saying you're terrible, stop doing things to make us hate you! (But you can't, because then you won't match in derm...)

Then I got to thinking about the people in my class who were junior AOA.

For those of you not in the field, AOA is the medical honor society. In most schools, a few people get elected early to AOA due to just being totally awesome. And these people are called "junior AOA."

In my class, there were five. Four of them were incredibly competitive, very cutthroat students. They actually had a fair amount of charisma as well, which meant that they weren't quite as hated as maybe they could have been. But believe me, if you were on a rotation with any of these students, you got to dislike them. Or possibly even refer to them as "the devil incarnate."

Those four matched in ortho, plastics, derm, and rad onc. Coincidentally, none of them had their interest sparked by peds or family medicine.

The fifth junior AOA member, the only female, was a little different. She was a little quieter and more studious. I never heard any horrible stories about her behavior on clerkships. And then when match came along, she failed to match in the surgical subspecialty of her choice and had to settle for general surgery.

Five students. All very smart. All very good at studying and getting high grades. Four matched in highly competitive specialties, one didn't. Apparently, being smart and studious isn't enough. Being a huge competitive jerk is requisite to getting what you want.

Sunday, November 18, 2012

Sliding pain scale

Back pain clinic can get very repetitive, so you kind of appreciate it when a patient does something that's unique.

For example, there are many patients who have been having back pain that started before I was born. This guy I saw last week? He had back pain since before my parents were born.

And then I asked him for his pain score (on a scale of 1 to 10). Sometimes patients will say something like 3-4 out of 10, which is kind of annoying because I want to just write down one number. But this guy was, again, totally unique.

Me: "What is your pain level on a scale of one to ten?"

Patient: "Oh, it's two-three-four." [Pause] "Five, six."

Um, did he think I just asked him to count to six?

Saturday, November 17, 2012

Weekly Whine: Hyphenated Names

I think that parents who given their children a hyphenated last name are doing them a great injustice.

First, it's hard to put a hyphenated last name on forms. And what do you do as a kid? You spend half your time filling out forms. Even these days, when you may not be dealing with scantrons, it's still got to be a pain in the ass.

Second, think about what happens when you give your last name for an appointment or whatever. Nobody ever knows how to spell it, so you have to spell it out. Then you have to tell them there's a hyphen. Then you have to spell the second name. Think about doing that your whole life.

And if you do this to a boy, what happens when they get married? Does the wife drop her own name and taken on both her husband's parents' names? I wouldn't be thrilled about doing that. And what if she wants to hyphenate? Will she now have three names? And what if her name is hyphenated? Will her new hyphenated name now have four parts?? And what about the children? Will they each have four hyphenated names???

I think it's selfish to hyphenate. To me, it means that neither parent was willing to compromise their precious last name in order not to saddle their child with that burden. Especially when the two names sound awful together. Like I knew this guy whose last name was O'Malley-Goldstein. Seriously??

Options that I think are okay:

--Making one parent's last name the child's middle name

--Alternating which child gets which parent's last name

--Creating some new last name that's one word but somehow a fusion of both names

--Anything that doesn't involve a freaking hyphen!

And don't get me started on hyphenated first names, Mark-Paul Gosselaar.

Friday, November 16, 2012

Pleasant

Attending: "Are you ready to present your patient?"

Resident: "Oh sure. This was a.... very pleasant 46 year old man--"

Me: "Very pleasant. Wow."

This particular resident always gave a little commentary on how pleasant the patient was as part of his presentation. Admittedly, I usually made a remark to that effect, muttering under my breath about how the patient was either a nightmare who drove me nuts or a generally nice person. But I never made it part of my presentation.

In my dictations, I used to put in little judgments about the patients' personality in my physical. "The patient was a [pleasant/anxious/rancid], well developed, well nourished man in no apparent distress." These days I just say everyone was pleasant. Unless they were really an asshole.

Thursday, November 15, 2012

All accounted for

Usually in residency I was fairly busy, but there were also times when my schedule was pretty light.

For example, there was one afternoon when I was covering EMGs and consults, but there was only one EMG scheduled and only two consults.

After I saw and staffed the two consults, I got an email from my EMG attending, saying, "What were you doing all afternoon? We have to document your time."

What?

Apparently, all our time had to be "accounted for". We can be doing admissions, consults, clinic, or even "directed reading", but we can't be, like, out skateboarding in the parking lot, I guess.

The email kind of irritated me because much of the time, the days were long, and if I were to somehow luck out and not have anything scheduled for the afternoon, why couldn't I go skateboarding in the parking lot? Or better yet, spend a little quality time with my daughter. No, that's crazy talk.

Wednesday, November 14, 2012

Ticketed

One day during residency, on my way to the VA for lecture, I saw one of my co-residents standing outside his car, flanked by two very serious-looking police officers. This particular resident was always a little on the sketchy side, so I was pretty much dying of curiosity. Maybe the cops caught on to his, like, drug trafficking side business or something.

But it was nothing so exciting. Apparently, he got pulled over for speeding in the VA parking lot. Got a $200 ticket.

Someone later told me that they did this constantly on the VA hospital campus. Lots of doctors received tickets for going FIVE miles over the speed limit (which was like 10 MPH). I'd imagine patients get pulled over a lot too. Considering how behind we always get in clinics and how long patients have to wait, is it really a good idea to start pulling over doctors just as they're getting to work and making them wait 20 minutes for you to write out a ticket? Or patients who are already probably running late to their appointments?

Me: "I can't believe they pulled you over when you were wearing your white coat!"

Resident: "Yeah, they don't care."

Me: "You should have told them you were, like, on your way to deliver a baby."

Resident: "At the VA???"

Me: "Oh. Maybe not."

Tuesday, November 13, 2012

Confessions of a Curly Girl

I am a curly girl.

Having curly hair is probably the most distinctive thing about me. Like, if someone were to describe me from afar, that’s probably the first thing they’d say, “That doctor with the curly hair.” (Or they might say “the skinny doctor” but I know that would offend some of you.)

I always hated having curly hair. When I was a little girl, I had blond curls, and I wished I had straight brown hair like my best friend. My mother says I used to stand in front of the mirror, staring at my tight ringlets, saying, “I think it’s getting straighter.” It wasn’t.

Actually, things were fine when I had that great baby-fine hair. But as soon as I got to pre-adolescence and my hair took on a normal texture, it became uncontrollable. Sort of like this:


And the really rough part is that I inherited the curls from my father, who just cut his hair short and had no idea how to control them. And if you’re an eight year old girl with wild, curly hair, all any adult wants to do is brush it out. But that just makes the situation worse. Like this:


Rule #1 of curly hair:

Do not brush it.

By the time I was ten, I gave up on my hair. I was sick of the tangles, getting teased, and generally just being embarrassed by my curls. So I started just wearing my hair in a braid.

Every time I went to get my hair cut, I’d ask the salon if they had any tips for curly hair. They’d always sell me some expensive product that didn’t work. It’s like nobody actually has any idea how to deal with curly hair. I mean, there are only two kinds of hair: curly or straight, so it seems like if your job is hair, you ought to know this. That’s like, being a general practitioner and not knowing how to treat, like, women.

When I got to high school, I was still wearing my hair up all the time. Except I looked really young already so wearing my hair in braids wasn’t doing me any favors. Finally, when I was 15, I hacked it all off, short enough that I couldn’t physically pull it back anymore.

This started an era of trying a wide range of products to control my hair. I usually used gel, but that was no good—I needed too much of it and it made my hair crunchy. That was my biggest problem, that my hair was so thick, any product often wasn’t enough. A pea sized amount? No way. And putting a bunch of sticky gel in my hair meant that I couldn’t follow Rule #2 of curly hair:

You can’t wash your hair every day.

By the end of college, I had sort of figured things out. I still hated my hair, but oddly enough, I used to get constant compliments about it. At least a few times a week, some complete stranger would tell me they liked my hair. That wasn’t what I wanted though—I just wanted to get control over my hair so that I could blend in.

I found a book called Curly Girl: The Handbook which was technically an advice book but just as much a support book. The women pictured in the book look really great, but then again, they’re models and actresses who have probably had their hair professionally done. It teaches you to identify your curl type and teaches you never, ever to shampoo your hair. Instead, you’re supposed to use something called “no-poo”. You can’t make this stuff up.

Ultimately, as a mother of two kids, I don’t have time to spend hours making my hair look awesome. I have a very short, layered cut, and I’m mostly focused on not letting my hair get too wild. I just use Frizz-Ease mousse, adjust a few curls manually, and I’m usually good to go. Or good enough. Like this:


(Actually, I don't think I've ever had a hair day quite that good.)

I don't usually get compliments anymore, but that's fine. Better than fine.

There are times when I’ve been tempted to try straightening it, just to see what would happen. But I can’t do it to my kids. My children love my curly hair in ways that I never could. My older daughter is constantly talking about “mama’s curly hair.” And every night before bed, she has to touch it. Literally. She runs out of her bedroom, comes to me and strokes my hair for a minute, then runs back to bed.

So I guess I’m stuck as a curly girl.

Monday, November 12, 2012

Good residents vs. med students

When I was a resident, we'd often have med students rotating with us, notably students who wanted to match with us. If the student was working with me, the program director or chief would usually ask me about them and whether I thought they'd make a good resident.

Often, I wasn't sure what to say. Even though sometimes they were kind of annoying, I wasn't sure if I should just chalk that up to wanting to make a good impression (but not knowing how).

It made me wonder about how (or if) the qualities of a good med student differ from the qualities of a good resident. I believe that there IS a difference.

For example, I think that a good med student is someone who is there to support the resident they work with. They are someone who is eager but can also sense when the resident is too busy to deal with them. They are somewhat knowledgeable, but more importantly, remember information you taught them and are able to apply it. If you give them a task to do, they do it without complaining or asking a hundred follow-up questions. Also, they're courteous to their fellow med students and don't make an effort to make them look bad.

In contrast, a good resident is someone who is diligent, independent, eager, knowledgeable, and dependable. They don't dump work on their fellow residents and are willing to pitch in for help when it's needed.

I think the main difference is that it's hard (and rare) for a resident to be overeager. I haven't experienced much in the way of "resident gunners," but maybe that's just me. I think the main two qualities that make a resident bad are:

1) Poor patient care (which includes anything from not following up labs to poor documentation/signout)

2) Dumping work on fellow residents

What do you think are desirable qualities in a resident vs. a medical student?

Sunday, November 11, 2012

Weekly Whine: Children's clothing

Why the hell is children's clothing so expensive? This bugs me to no end.

When I went out to buy my daughter her first pair of shoes, I found a pair at some crappy Marshall's type store that fit her okay. And they were $30. $30! For shoes for a kid that could barely walk! That she would outgrow in like two minutes.

That's my big argument. When it comes to my own clothing, I'm okay for spending a little more for an outfit I really like because I know I'll be able to wear it for a long time. (I'm still wearing shirts I bought for medical school.) But for an older kid, the best you'll get is maybe a year of wear. And for a baby, it's more like a few months.

Yet there are still tons of outfits for babies/toddlers that are like $20+. Stuff that the kid will probably only have occasion to wear once before it is outgrown. And it's not like I shop at high end stores. These are the prices at, like, Target. I'm sure a nice shirt for a one year old is $40-50 is a good store.

Who is paying these prices?? Don't you people know there's a recession??? This is why you can't afford your mortgage... because you've spent it all on baby clothes!!

Friday, November 9, 2012

Not alone....

Resident: "Are you like the rest of us and regret going to medical school?"

Me: "Huh?"

Resident: "Me and [senior resident] are always talking about how much we regret going to med school. What a mistake that was, right? Do you regret it too?"

Me: [glances at our attending, who is sitting right next to us] "Uh, no?"

Thursday, November 8, 2012

Time = value

One thing that's nice about being an attending is that my time now has some amount of value. In residency, that's less true.

When I was an intern, I came into an attending's office to present some consults to her. She was on the phone and waved me to sit down.

That attending stayed on the phone for thirty minutes while I sat there, staring at the wall, waiting to talk to her.

Finally she got off the phone. I started presenting my patients, and then someone else called. She then spent another ten minutes on the phone with that person. By the time she hung up, I was almost shaking with anger.

What struck me about it was that how, if situations were reversed, she wouldn't wait for me even thirty seconds, much less nearly an hour.

Wednesday, November 7, 2012

Failed lab

When I was in college, I did a summer in a research lab doing something with mice. What, I don't remember. All I know is that by the end of the summer, my hands were covered in little mouse bites. Probably because when they were under anesthesia, I'd cuddle with them in my hands and not be vigilant enough of when they were waking up.

One of my coworkers was a 25 year old graduate student named Elaine. She got engaged that summer and was totally excited about it. At the time she seemed really old, but in retrospect, she seems really young.

Another of my coworkers was a 30-ish post-doc named John. (At the time he seemed really old, but in retrospect, he seems really young.) He was not super happy there, mostly for monetary reasons.

During that fateful summer, two things happened:

Elaine quit her grad program to get a job teaching science at a high school.

John quit his post-doc to get a job "in industry" that paid twice as much.

It never occurred to me that this was a little bit odd that two people quit a lab in one summer. I mean, maybe it isn't odd, I don't know. Maybe people quit grad school and post-docs all the time? The lab itself wasn't particularly horrible. The boss was pretty nice. I found it really boring working there, but I had no idea what I was doing.

Tuesday, November 6, 2012

Side Effects

As an intern, I saw a guy in urgent care with seizures who was on Tegretol. The attending asked me, "What are the main bad side effects of Tegretol?"

"Agranulocytosis," I said. (One of the few things I remembered from med school pharm class)

"Right, what's the other side effect?"

"Um..." She's pretty much reached the limits of what I know about the side effects of Tegretol. "Nausea? Dizziness?"

"Look it up."

I went into epocrates and I get the list of common adverse reactions. I read it to her: "Agranulocytosis, syncope, dizziness, nausea, vomiting, hyponatremia, anemia, thrombocytopenia, elevated liver enzymes, photosensitivity, pruritis, edema, arrhythmias, urinary retention, uh... it's kind of a big list. Which one were you thinking of?"

"Elevated liver enzymes."

"Oh."

So somehow my guesses from the list was less correct than her selection from the list. It's nice to be an attending and always get to be right.

Monday, November 5, 2012

Chlorophyll

When I was doing a pediatric brain injury unit, I noticed that the attending had put several of the patients on chlorophyll tablets. About half the kids on the unit were getting chlorophyll.

Without cheating and looking it up, do you know why this might be?

Hint: It wasn't because they weren't eating and he was hoping they'd start making their own food.

(Answer will appear in the comments by the end of the day.)

Sunday, November 4, 2012

RS3PE

One day in EMG clinic, we had a patient with wrist pain and intermittent wrist swelling. His workup for rheumatological disease was negative and his EMG only showed mild carpal tunnel.

Attending: "So do you think he has RS3PE?"

Me: [thinking: "Am I supposed to know what that is??"] "Uhhh...."

Attending: "That's Remitting Seronegative Symmetrical Synovitis with Pitting Edema."

Me: "Um."

Attending: [points to bulletin board, where article is pinned up] "We saw a really interesting case of it last week. I'll bet that's what he has. Was his sed rate elevated?"

Me: "No."

Attending: "Maybe that's because he got prednisone."

Me: "It was normal before the prednisone."

Attending: "Well, it could still be RS3PE! We should put that diagnosis in our report!"

Me: [thinking] "Just because you have an article about something on the wall, that doesn't mean every patient has it."

I guess the diagnosis is possible. I love the fact that instead of calling it RSSSPE, they call it RS3PE.

Saturday, November 3, 2012

Weekly Whine: Tootsie Rolls

My kids went Trick or Treating this week. What did they dress up as? They were both Rapunzel. Oh, the humanity!

They collected a fair amount of candy, a significant portion of which was tootsie rolls. Observe:


After the kids were asleep, my husband started yanking them out of the candy basket in a fit of anger, ranting about how tootsie rolls are the absolutely worst candy, nobody likes tootsie rolls, and why do they even bother to make this disgusting candy anymore?

Then he made me take a photo of the tootsie rolls and insisted I make it a weekly whine.

I sort of agree. I think tootsie rolls aren't that great (although I do like the new fruit-flavored ones), but I don't think they're the absolute worst candy. I think the worst candy is probably Snickers. Objectively. I only say that because when people bring in their Halloween candy on November 1st, it's always the Snickers that are left over at the end of the day. I'd definitely eat a tootsie roll over a Snickers bar.

Friday, November 2, 2012

Rugged masculinity

I was reading the note on a patient I was going to see in clinic tomorrow and this is how the orthopod described him:

The patient is a "pleasant gentleman standing 5'11" and weighing 175 pounds who has a muscular, rugged, mesomorphic body build. He appears to be in excellent general medical condition and has well-developed muscles throughout his entire body."

I thought that sounded kind of funny. I mean, it almost sounds like a description from some romance novel. Sort of. Anyway, the guy sounds hot.

Thursday, November 1, 2012

Names and transcription

I suspect every transcription service handles patients' names differently.

For example, in my current transcription, I always start my transcriptions by saying, "Mr. Smith is a 45 year old man..." and then when I read over the transcript, it's always been changed to "The patient is a 45 year old man..." I have no idea why this is.

At another clinic where I worked, I would always spell out the entire name before transcribing, since I thought the transcriber might not have the patient's name automatically available, so having the spelling might help.

One day, I found out differently:

The patient's last name was really long. Like, a long name hyphenated to another long name. So long that in the printout, the patient's first name, Catherine, got cut off. So it looked like:

NAME: Longname-Secondlongname, Catheri

Then all through the dictation, every time I referred to Catherine, it was written as Catheri:

Catheri is a 12 year old girl with a history of....

So obviously the transcriber does not care that I spelled out CATHERINE and even said it during the dictation. They just took whatever first name was printed out for them and inserted it into their transcription.

Good to know.

Wednesday, October 31, 2012

Signs

Recently on my drive home from picking up my kids, I see these people standing on the street, holding up signs saying, essentially, "Gay marriage is evil."

It angers me on a daily basis. I want to honk at that people, but that's a sign of support, so I can't do that. Is there a way to anti-honk?

Instead, I've been turning it into a lesson for my daughter about intolerance. Every day I point the people out to her and explain that there are some people who don't believe that two people of the same gender who love each other should be allowed to marry, and isn't that awful? She agrees, although to be fair, I could probably convince her of just about anything.

Monday, October 29, 2012

VA Receptionists

I spent a lot of time at the VA during my training. I think there are a lot of great things about the VA. But one thing that has been consistent is that every receptionist I've worked with has been terrible.

The main receptionist in our residency outpatient clinic, Lucy, was the absolute worst. She would constantly tie up the phone line with personal calls, show up late, leave early, and she didn't know how to do anything. On the days she didn't come in, we'd just sign the patients in ourselves and it honestly wasn't any harder.

She didn't room patients or keep exam rooms tidy. That was the residents' job. One time an exam room ran out of disposable paper for the tables, and she showed me where I could find more, but refused to do me a favor and help me change the roll, considering I was very pregnant and having trouble with bending. "That's not my job," she said. So it's mine? I'm in training to learn how to change paper rolls?

In fact, she passive-aggressively refused to do even one little thing to make our lives easier. For example:

Me: "I'm going to another floor to see a consult. Can you please page me if any patients shows up?"

Lucy: "Okay, I'll do that."

Me: [stops halfway down hallway and turns back] "By the way, do you have my pager number?"

Lucy: "No."

I mean, WTF? Clearly she had no intention of paging me.

There was one time when that exact situation happened with another resident, she failed to page him, and the patient sat in the waiting room for like an hour. The attending came to check on the clinic, found out the patient had been waiting a long time and the resident was absent, and he lost his shit at the resident.

Finally, Lucy confirmed the resident's story that he had asked her to page him and she didn't do it. Apparently, Lucy got reamed, which was satisfying for all of us.

Sunday, October 28, 2012

Playing smart

There was a resident I worked with who would always ask some hyper-intellectual question during lecture. Like: "You say that Intervention X didn't work, but a study done in 1998 showed that Intervention X was effective in at least three quarters of men over age 50."

And you're like, "Guh?" And you're all impressed that he could just randomly recite studies on seemingly any topic. You think he's definitely the most knowledgeable of all the residents.

However, if you asked him a directed question where there is one right answer, you discover that he actually didn't know some extremely basic things.

It's amazing how good some people are pretending to be smart.

Saturday, October 27, 2012

Weekly Whine: Wood chips

I'm sure the non-parents reading this will have no idea what I'm talking about, but I've become incredibly frustrated recently that every single park in my area is now paved with wood chips.

In my day, they used foamy cushions to line a playground. Or they just used regular pavement, I guess. Obviously, I don't want my kid to fall on hard pavement and break an arm, but I really really hate those wood chips.

Aside from the fact that if your kid takes off their shoes, they are guaranteed to get a splinter, if you have a kid under two who is still in that oral phase, you are guaranteed to spend your entire time at the park grabbing wood chips away from your child seconds before she swallows them.

Friday, October 26, 2012

Wash your hands!

In residency, I once watched an attending performing urodynamics on a patient.

The attending did a rectal exam on the patient, and after it was over, he didn't change his gloves. So he was using the same glove, smeared with poo and lube to touch other things, including the computer monitor.

When he smeared poo and lube all over the computer screen, I nearly lost it.

And then at the end of the procedure, he patted me on the shoulder with that same hand (thankfully, he had removed the glove, but not washed up). I had to go sterilize myself after.

Thursday, October 25, 2012

Irregardless

Lately I've been noticing more and more people using the word "irregardless," and every time I hear it, I want to raise my hand and be like, "Oooh, Oooh, Mr. Kotter, that's not a word!!!"

(Except I don't because I know how totally obnoxious that would be.)

In any case, when people use the word "irregardless" they usually mean "regardless." Adding the extra negative modifier doesn't change the word.

Then again, the people I hear using it are generally very intelligent people. So you'd think people like that wouldn't use a word that was so blatantly wrong. So maybe "irregardless" has been used incorrectly so many times that it's now correct. Just like "flammable" and "inflammable" now mean the same thing and are both correct.

I checked Wikipedia, the source of all knowledge, and they seem to say that it's controversial whether "irregardless" is a word. Irregardless, it seems that people use it a lot.