Saturday, March 31, 2012

Lottery jackpot

Nurse: "I'm going to go out and buy some lottery tickets for our pool. Do you want to chip in?"

Me: "No, I don't play the lottery."

Nurse: "Well, it's a really big jackpot."

Me: "I'm just worried that if I give you a dollar, you might get hit by an asteroid on the way to buy the tickets."

Nurse: "..."

Me: "Because that's more likely than winning the lottery."

Nurse: "Yeah, I figured out you meant that."

Me: [to another nurse] "Boy, I'll feel pretty dumb if they win."

Then the nurse told me she'd read Shirley Jackson's The Lottery for tips on how to win, although it ended up not having any practical tips and was actually just a chilling tale of conformity gone mad.

So no, I don't partake in the lottery. And I'm pretty sure our unit pool didn't win. The odds of winning are just so small that it's basically like throwing your money away.

So long, you're wonderful

When I was in fellowship, we had residents rotate through our EMG lab every month. On one particular resident's last day, I noticed he was reading a handwritten note on a scrap of paper. "What's that?" I asked him.

"The EMG tech wrote it to me," he said.

The note said: You are a wonderful person. It's been a pleasure and a privilege to work with you. God bless you.

"Holy shit," I said. "That's like the nicest note I've ever seen. Why did he write that to you?"

"Because it's my last day," he said.

Let me tell you, I've had a LOT of "last days" and nobody has EVER written me a note like that. I mean, WTF?

(Although the tech did bake me a cake on my last day, which was also pretty nice. He was a good guy.)

Friday, March 30, 2012

Weekly Whine: 10 Completely Irrelevant Pieces of Crap

A few days ago, I got an email that said the following:

Hi Fizzy,

We would love to share with you an article that we just posted on our own blog! “10 Completely Irrelevant Pieces of Crap” (link) would be an interesting story for your readers to check out and discuss on your blog, so we hope you will consider sharing it!


This pisses me off far more than emails asking me to help some rich guy in Africa transfer his money, because it's so personal. They mention my name and it seems like they didn't just write a program to create the spam. I could be wrong, but sometimes they mention very specific details about my blog in clear English that leads me to believe that a real human actually spent some time and effort composing the email.

I don't know why it irritates me so much more than other spam. Maybe it's because I feel like they're using friendliness and fake flattery to try to get me to advertise for them for free. Maybe it's because I feel like they're taking me for an idiot that I'd ever do something like that.

In any case, if you think my readers might be interested in your article "10 Completely Irrelevant Pieces of Crap", let me save you some time: they're not.

Wednesday, March 28, 2012

Dougie Howser

Me: "So how did you hurt your back?"

Patient: "Well, I was just walking and--"

Me: "Oh my god, you have the same birthday as me!"

Patient: "Oh, wow."

Me: "Happy birthday."

Patient: "You too. I just turned 3 to the 4th power."

Me: "I just turned 2 to the 4th power."

Patient: "..."

Me: "Wait, that's not right."

Tuesday, March 27, 2012

Ode to iPhone

Recently I got an iPhone and I LOVE it. Prior to that, I had a stupidphone and I was very resistant to getting a smartphone, maybe because I didn't want a phone that was smarter than me. Also, I didn't want a phone where I'd be really upset if I dropped it in the toilet (like my husband did a week after he got his $300 phone).

But it had to happen. I think the final straw was when our 16 year old babysitter sent me an email "From my iPhone" and I just felt like a big fat loser.

Things that I love about my phone:

1) Has epocrates and other medical stuff on it, so I can be competent at work

2) I can check email on my phone!

3) Calendar with alarms helps keep me from feeling like I'm juggling ten million things in my head

4) Can make lists of what I need before I go shopping. So I don't go to Meijer to buy Valentine's Day cards for my daughter's class, then buy a few things, and realize when I get home, I forgot to buy the damn cards. Not that this happened to me. Twice.

My main worry was that I'd spend all my time playing games, so I kept from downloading any games. That's just what I need, right? I had to ask my husband to delete games from my palm pilot back in the day. Damn addictive Drug Wars.

Monday, March 26, 2012

Tales from Residency: How to present a patient

Attending #1: "Okay, who's your patient?"

Me: "This patient is a 58 year old man with 5 years of axial lower back pain who--"

Attending #1: "Any past medical history?"

Me: "He has a past medical history of hypertension and asthma."

Attending #1: "Okay, so you should say, 'Patient is a 58 year old man with a history of hypertension and asthma with 5 years of axial lower back pain.'"

Me: "Okay, sorry."

Later that day....

Attending #2: "Okay, present your patient."

Me: "This patient is a 49 year old man with a history of hypertension, arthritis in his shoulders, and vicodin abuse--"

Attending #2: "Okay, stop. What's he here for?? You should say that part first."

You know, it's not that hard to present a patient. Unless you have to do it slightly differently to comply with the personal preferences of every single attending in the clinic. And even when you include every pertinent detail in the presentation, he'll ask you, "Has she tried NSAIDs for pain?" And then shake his head accusingly because you left out such an important detail, even though you actually mentioned that the patient had been taking ibuprofen but the attending just wasn't listening.

Sunday, March 25, 2012

Weekly Whine: Music

Back when I was a teenager, if I liked a song I heard on the radio, I'd do the following:

I'd turn on the radio on my boom box and stick a blank cassette tape inside. I'd then camp out listening to music all day. When the song came on, I'd race over to my boom box and hit record.

Clearly, this was less than ideal. So if I liked a song enough and especially if I liked more than one song by an artist, I'd go out and buy the album.

Kids these days don't have to do that. If they like a song, they just go to iTunes and download it. In a way, it's great. I mean, how many crappy albums did I have to buy in order to get one song? Let me tell you, I did not need to own 14 tracks by Superdrag, that's all I have to say.

Yet I can't help but think the kids are missing out too. If you just get the songs that are on the radio, you're missing out on some other tracks that are amazing but maybe not as commercial. How many albums do you own where your favorite track isn't one of the ones from the radio?

Obviously, kids can still download an entire album (and probably cheaper than back in my day). But will they do it if they can easily get the tracks they like for cheaper? I think it's kind of sad that all these non-radio songs are getting missed out on.

Saturday, March 24, 2012

Fired for Blogging

After my post last week about Dooce, I can't help but get creeped out about people who get fired for blogging.

Then again, blogging is not necessarily a fireable offense. After all, people like Michelle Au and Kevin Pho blog under their real names, and are fairly well respected. I don't write about anything that happened in the last two years or anyone I currently work with. (When I say "recently," that usually means "two years ago".)

If you were my boss and someone forwarded you the URL of this blog and said it belonged to Fizzy McFizz, what would you say?

a) You're fired, Fizzy!

b) You're not fired, but we need you to take the blog down.

c) Wait... Fizzy McFizz... who's that? Oh, that little redheaded girl. OK, whatever, who cares.

d) Is there anything about me on the blog?? No?? Why not?! I'm hilarious!

e) Hey, this is actually funny. It surprises me, coming from someone who's such a bitch at work. I think I like her a little better now. Maybe I'll give her a raise!

f) Other

Tales from Residency: Balanced breakfast

Attending: "You need to eat healthier."

Kid: "I eat healthy."

Attending: "What do you have for breakfast?"

Kid: "Frosted flakes."

Attending: "Well, instead of frosted flakes, you should have bran cereal. Or if not bran cereal, then you should have Oreos for breakfast."

Kid: [looks shocked]

Me: "Do you mean... Cheerios?"

Attending: "Oh. Right."

Friday, March 23, 2012

Dealing with Cruel Residents

I’m sure you all think that I was a meek little intern who was constantly terrorized by the cruel senior resident Jessica and never spoke up for myself. But that’s not entirely the case. I'm actually a little more vocal than people think I am.

About halfway through my first month of internship, I decided that I was sick of hating Jessica. It had gotten to the point where I felt like I couldn't even be in the same room with her. I looked forward to her day off like they were my days off.

So basically, I told on her. I had a talk with our program director about my Jessica issues. The program director listened to my gripes and then launched into a crusade to get me to talk to her about my issues with her. He went on and on about it until I promised that I would talk to her. He gave me this example:

A professor teaching a lecture notices that Stacy is 10 minutes late to class. He is slightly irritated by her late entrance and starts thinking to himself that she's been late a lot lately. In fact, he thinks that her work in the class has been sub-par and she hasn't put much thought into her assignments. Stacy obviously doesn't care about the class. The professor decides to fail Stacy.

However, if he had asked Stacy why she was late to class, she would have told him that she was at a national conference down south over the weekend. And her mother who lives down there also happened to be ill and needed help around the house. However, she set her mother up with her sister and caught the redeye back to school just in order to make that class, because it was that important to her.

A little ridiculous, but fine, I could see his point.

Anyway, I did talk to Jessica. I told her that I valued her feedback, but I hoped she would give me a little more POSITIVE feedback in the future. Because I was an intern just starting out and still just learning... plus I'm sensitive.

I thought the talk went well. She was really nice about the whole thing. It was definitely a much better thing to do than go behind her back and report her to the chief residents or something. I felt like I was actually doing something about my problem, rather than just being a sleaze.

And after that, she was much nicer to me. For maybe... 24 hours. Then she immediately went back to being a huge bitch again. And then we later were in the ICU together for a week and I started hating her more than I ever thought it was possible to hate another person.

So the moral is: when someone is being cruel to you, talking to them about it doesn't do jack shit.

Wednesday, March 21, 2012

Playing healthy

A friend of mine once wisely said, "It's easy to act drunk when you're drunk."

I find the opposite is true of being sick. I find that I can be sick as a dog, yet still give a very convincing picture of someone who is completely healthy.

Recently, I had a cold. It wasn't one of those colds where I was sniffling or coughing, but I felt congested deep in my chest, had bad sinus pressure, and even felt slightly feverish. Yet every time I walked into a patient's room, I said perkily, "Hi, I'm Dr. Fizzy! How are you today!" Nobody was the wiser. And my germs were thus disseminated.

Like other doctors, I don't like to give the impression of ever being sick. So I'm going to act well, no matter how crappy I'm feeling.

The downside of this, which unfortunately is what happened to me, is that when you're sick with "that thing that's going around," so are other people. So you can be sick as a dog, planning to get your work done and get yourself the hell out, and then you get the call:

"Dr. SoAndSo is going home sick. Can you cover?"

And all you can think to yourself is, "But I'M sick too!" Except you came to work and you have been pretending not to be sick all day, so it doesn't sound terribly convincing. And damn it, you don't want to admit to being sick.

Guess I'll be covering.

Tuesday, March 20, 2012

The high schooler

A while ago, I came to work and one of the attendings Dr. Kenalog had a young man standing next to her. I initially thought was a new fellow or resident, but then decided he looked awfully young for that. I mean, I know residents all look really young, but this guy looked just a little too young.

Dr. Kenalog: "Dr. Fizzy, I'd like you to meet John, he's a high school student who's doing research in the neurology department."

Me: "Hi, John."

John: "Actually, it's Tom."

Me: "Oh. Hi, Tom."

Dr. Kenalog: "Right, so Tom is very enthusiastic. He's only 13 and he's already in 10th grade. Isn't that amazing? He skipped two grades. Which two grades did you skip?"

Tom: "Kindergarten and 5th grade."

Dr. Kenalog: "Also, he's never been to summer camp. He always works!"

Me: "Wow."

Dr. Kenalog: "Tom wants to be a neurologist, right?"

Tom: "Actually, I want to be a geriatric psychiatrist."

Me: "Gosh, that's awfully specific."

Tom: "Yeah."

Me: "You know, there's a really great geriatric psychiatrist who works here."

Tom: "Oh."

Me: "He might be able to talk to you about the field, if you're interested."

Tom: "Oh."

Dr. Kenalog: "Tom, I don't think we have any other patients right now. Do you want me to find you a computer to work on?"

Tom: "No, that's okay."

Me: "Do you have any questions you'd like to ask me? I recently finished training, so I could talk to you about getting into med school and how to prepare. Do you have questions?"

Tom: "No."

Me: "So I guess you're pretty confident about getting in, huh?"

Tom: "Yep."

Geez, I just wanted to smack the kid by the end. I mean, show a teensy bit of interest or enthusiasm or humility or SOMETHING. Dr. Kenalog and I were talking about him later... she thought he was way overconfident and I thought he was maybe a little shy. I've hypothesized that nobody who has skipped more than one grade can possibly be normal.

Monday, March 19, 2012

Nerd Fetish

One night when I was 14 years old, I was on the phone with my friend Kathy talking about... what else? Boys! Kathy and I spent about two hours on the phone discussing every boy we knew and how incredibly... smart he was.

No, really.

The conversation went kind of like this:

Kathy: "Oh my god, Rob is SO SMART. Do you know what he got on the last math team competition? He got a perfect score."

Me: "Oh, wow. But you know, John has the highest overall score on all the competitions."

Kathy: "So who do you think is better in math? Rob or John?"

Me: "I don't know. I mean, they're both really, really good. I don't know who I'd pick."

I'm not even kidding. I probably wouldn't have even thought of it or be retelling this story years later, except that my mother was in the room with me, and later declared it "the funniest thing" she'd ever heard. Because we were gushing about boys, except instead of talking about how hot they were, we were talking about how good they were in math.

Realistically, I could never have dated a guy who wasn't really smart. I had crushes on guys who were not the brightest, but ultimately it couldn't have gone any further than that. Intelligence was just that important to me. I've never dated a guy who got less than 800 in math on the SAT's. (Sorry, but my definition of smart is being good at math and science. You may disagree, but a brilliant fiction writer just won't do it for me.)

Yes, things like looks and sense of humor and compatibility are also important. But nothing is more attractive to me than intelligence.

Fast forward to today.

I've been noticing that when I do research for one of my journal articles, I often come across a few names of men who did the a large chunk of the scientific research in that field. Some guy's name will come up over and over again, and clearly he's a big authority in the field. And as I'm reading and outlining these articles, I can't help but having the very odd thought, "Gee, I wonder if he's hot..."

(Answer: Probably not.)

Sunday, March 18, 2012

Residency stories: Scared peeless

Attending: "I can't remember, what is the innervation of the bladder? S1? S2?"

Resident: "I don't know."

Me: "It's S2-4 for parasympathetic and voluntarily control, but the sympathetic control comes from T10-12." (I had just been studying for the boards.)

Attending: "Oh. And what does the sympathetic part do? Does that make the bladder relax?"

Me: "Sympathetic is for storage, parasympathetic is for peeing."

Attending: "Oh wow, I think you just helped me pass my PM&R recertification exam."

Resident: "So if that's true, how come when someone gets scared, they pee in their pants?"

Me: "Uh... I don't know..."

Resident: "Because being scared elicits a sympathetic response, right?"

Me: "I don't know. Let's google it."

Attending: "You think it's on google?"

Me: "Yeah, it's autocompleting for 'why do you pee when scared'."

We actually never figured it out. Google was surprisingly unhelpful.

Saturday, March 17, 2012

Weekly Whine: Dooce

I don't get Dooce. Maybe someone can explain it to me.

I go to dooce.com and some of the things I see:

1) About fifty advertisements.

2) Under "Daily Photo", a big photo of her daughter. Which is nice, I guess, but.... um, why do I care about a photo of this random woman's daughter? I barely care about the photos of my friends' kids on Facebook.

3) A story about her daughter liking... I don't know, I can't get through it. Something about a puzzle.

4) Some tweets she likes.

5) A sponsored post.

I just don't get it. I'm sorry, I don't. I know she has that photo shoot of her belly every two weeks during her pregnancy that's kind of popular, but you know who else can do something like that? Any other woman on the planet. So I don't really understand why Dooce is better than any other mommy blog out there. To me, it just looks like a whole lot of ads and rambling by someone who has a little too much time on her hands.

Friday, March 16, 2012

You might be crazy (or not)

A valuable lesson that I've learned is just because a patient acts crazy (or possibly IS crazy), you can't discount what they say. I offer two memorable examples:

When I was rotating in the ER as a med student, there was an old woman who had this crazy story about being locked in a basement by her family. The story involved tin foil hanging from the ceiling and all the things you'd associate with someone who was psychotic. But I later found out that when social services checked out the lady's house, apparently everything she said was true. It was a case of elder abuse.

The second story is one I heard from another physician. She said she had this schizophrenic patient who one day said that he couldn't walk anymore because there were "animals eating away his back." The guy was floridly psychotic and everyone kind of wrote him off.

Finally, they managed to get him in an MRI machine. Metastatic cancer to the spine.

Thursday, March 15, 2012

Birth control... huh?

I've made no secret of the fact that I think birth control is a good thing. I don't think this is a terribly radical viewpoint. Frankly, I'm a little confused. It's the 21st century and we're arguing about birth control? Really? Did I accidentally go back in time and now there's a chance my mother might fall in love with me, irradicating my own existance? Is this something I need to worry about??

But anyway, assuming it's still 2012, here's what I really don't get:

Everyone says that most of the people who are against birth control are men. And if men could get pregnant, this wouldn't be an issue. It's all about punishing women for having sex. Except....

Don't men like sex?

In fact, it could be argued that they like it more than women. A lot more. I mean, rapists... they're almost all men, right? Prostitutes might be mostly women, but the ones who are willing to actually pay money for sex are almost all men. The women are just trying to make a living. And those jokes about married couples... isn't it the woman who usually has the headache and tries to get out of sex? Is there really any indication that women are these sex-starved creatures that men are fighting off with a stick?

So why is it a bad thing that your wife/girlfriend has birth control and can have sex with you more often?

And on the procreation issue, the same thing applies. Do men give squeals of pleasure when they hold a tiny newborn baby? Do men walk through the baby aisle in a department store and have to touch all the tiny little baby clothes? Do men get "plucky" and jealous of their expecting friends? Do men want babies THAT BAD?

To be honest, in most married couples I know, the men were the driving force behind waiting to procreate. Yes, the woman has to carry the baby for nine months. But after that, both parents get to be woken up at 3AM by a crying baby. And have to pay all the related expenses.

So, um, WHY do men think birth control is bad again?

Obviously, any career-minded woman should support legislation that makes it easier for us to get birth control. And you know who else should support it? Men who like having sex.

Guest Cartoon: It's not a tumor


See more cartoons by this author at Paradoxical Syncope

(Submitted by Hali Vanderburg)

Wednesday, March 14, 2012

Feedback

About a week and a half into my first month of internship, Jessica the Horrible said that it was time to do FEEDBACK. I was really looking forward to this, as you can imagine. And we did it while on call, which made it like twice as painful.

Anyway, I knew she wasn't going to say anything that great, because she'd been so nasty to me all along. She acted like she'd been doing this feedback bullshit her whole life, instead of this being her very first time. She started off by saying to me, "Well, how do YOU think you're doing?"

I said very honestly that this was the first inpatient rotation I'd done since my sub-I a year ago (yes, I took it easy fourth year and had no regrets) and it was a bit of an adjustment. I'd forgotten a lot and I had to get used to a new hospital where I’d never worked. I also had to get used to dealing with 30 hour calls and living far away from my family and friends. But I said I thought I was getting the hang of it now.

She nodded and agreed with everything I said. Then we had this patronizing discussion about what was I doing to improve this or that. Let's not forget that one month ago, she was a freakin intern too. She did this really irritating thing that my brother does. He always says, "No offense, but..." then says something really, really offensive. She said that she felt my knowledge wasn't much better than a sub-I. I was like, "Yeah, no fucking kidding, I just TOLD you I haven't taken an inpatient rotation since my sub-I." Considering I had just told her that, I thought what she said was needlessly hurtful (and a crappy thing to say in the middle of a 30 hour call). Besides, even though my practical skills were a little rusty and undeveloped, I knew my knowledge base was fairly good because I had great board scores and I would hope there's at least some correlation. (I didn't say that, maybe I should have.)

My biggest problem was probably lacking confidence in the field, and she just killed what little confidence I had. What I really wanted to say was that one way you gain knowledge is by asking questions and she made me completely intimidated to ask any questions.

Over the course of intern year, I got feedback from many, many other senior residents. And every single one of them ended our session by asking for my feedback on them. Interestingly, Jessica was the one resident who didn’t ask me for any feedback on her. I wonder why she didn’t do that. Did she forget? Did she think she was so perfect that she didn’t require feedback? Did she think I sucked so much that I couldn’t possibly have anything relevant to say to someone as wonderful as her? If I had given her feedback, it would have been to say that she should try to remember what it was like two weeks into residency at a new hospital when you don't know everything yet.

Anyway, I basically stormed off to my next patient and didn't speak to her again until I absolutely had to.

Tuesday, March 13, 2012

Rancho Los Amigos

This is another of those entries where there's a chance you might learn something about PM&R. But don't worry, you won't learn much.

Physiatrists (i.e. specialists in PM&R) can sometimes work with traumatic brain injury (TBI). During my rotations in TBI, being a mother as well, it was hard not to make comparisons between brain injured patients and small children.

We use a scale called Rancho Los Amigos to describe the stages of recovery of cognitive functioning following a severe brain injury. Conversation from six years ago, on my first day of residency:

Attending: "What is this patient's Rancho Los Amigos level?"

Me: [laughs]

Attending: "What's so funny?"

Me: "Oh, you were serious?"

So yes, that's actually what it's called. It's not, like, some restaurant that serves Mexican style food and flavors. At least, it's not just a Mexican restaurant.

Anyway, there are 8 Rancho levels and each one corresponds to the age of a child:

Rancho I: No Response
--appears to be in a deep sleep, completely unresponsive to stimuli

That would be, like, I don't know, when you're an embryo. OK, this comparison isn't perfect. Just stay with me.

Rancho II: Generalized Response (vegetative state)
--reacts inconsistently and non-purposefully to stimuli in a non-specific manner
--responses may be physiological changes, gross body movements, and/or vocalization

Fetus maybe? I promise, it gets better.

Rancho III: Localized Response (minimally conscious state)
--reacts specifically, but inconsistently, to stimuli
--responses are directly related to the type of stimulus presented, as in turning head toward a sound or focusing on an object presented
--may also show a vague awareness of self and body by responding to discomfort

That is totally a newborn, right?

Rancho IV: Confused/Agitated
--heightened state of activity
--behavior is frequently bizarre and non-purposeful relative to his immediate environment
--may cry out or scream
--unable to cooperate
--verbalization is frequently incoherent and/or inappropriate
--unable to perform self-care (feeding, dressing) without maximum assistance

Hello, terrible 2's.

Rancho V: Confused, Inappropriate Non-Agitated
--able to respond to simple commands fairly consistently
--may show agitated behavior as a result of external stimuli
--has gross attention to the environment, but is highly distractible and lacks ability to focus attention to a specific task without frequent re-direction back to it
--confabulation
--can usually perform self-care activities, with assistance
--may wander off, either randomly or with vague intentions

I'd say this pretty well describes a 3 or 4 year old.

Rancho VI: Confused, Appropriate
--goal-directed behavior, but is dependent on external input for direction
--response to discomfort is appropriate and he is able to tolerate unpleasant stimuli when need is explained
--follows simple directions consistently and shows carry-over for tasks
--no longer wanders and is inconsistently oriented to time and place

I'd say this would be a 5 or 6 year old.

Rancho VII: Automatic, Appropriate
--goes through daily routine automatically
--decreased judgment and problem-solving and lacks realistic planning for his future
--carry-over for new learning
--requires at least minimal supervision for learning and for safety purposes
--independent in self-care activities and supervised in home and community skills for safety
--initiates tasks such as social or recreational activities
--judgment remains impaired, such that he is unable to drive a car

OK, I don't have any kids this age, but this probably describes a 7-10 year old.

Rancho VIII: Purposeful, Appropriate
--alert and oriented, is able to recall and integrate past and recent events, and is aware of, and responsive to, his culture
--needs no supervision once activities are learned
--independent in home and community skills, including driving
--somewhat impaired abstract reasoning, tolerance for stress, and judgment

Does this sound like a teenager? I think so.

And now you know a little bit more about traumatic brain injury. And why I sometimes treat my TBI patients like they're my babies.

Sunday, March 11, 2012

Weekly Whine: Jennifer Weiner

*Note: This whine may contain spoilers*

This is perhaps slightly more esoteric than previous weekly whines, but I'd say that Jennifer Weiner has some degree of fame, usually claiming at least one spot on the bestseller list. And her book In Her Shoes was a movie with Cameron Diaz. Anyway, it's my blog and I want to whine about Jennifer Weiner.

Everyone always recommends JW books to me because I read similar authors. But for some reason, I can't stand JW. I first read Good In Bed several years ago on the recommendation of several people. I liked the premise: overweight woman dumps her boyfriend who subsequently writes a column about her weight issues. But somehow, I got stuck about a hundred pages in. I finally finished it and was pretty disappointed.

A few things bothered me about her book:

1) Her treatment of "real" issues felt cliched and dull. How many books are there about women with weight issues? How many about women with daddy issues? I felt like she didn't have anything new to give us.

2) I can suspend disbelief for a novel, but it's got to be consistent within its own universe. I have no problem with a book about teenagers being forced to fight to the death, but I do have a problem with a "realistic" book where a reporter randomly runs into the celebrity who canceled an interview in the bathroom, then suddenly they become BFFs and the celebrity wants to star in her unpublished movie script. I mean, come on.

3) The book was not funny. Not every book has to be funny, but nothing bothers me more than when an author is trying to be funny, but just isn't.

Frankly, I expect more from an author whose last name means penis.

Saturday, March 10, 2012

Interview stories

From an interview at a residency program:

Me: "Are the residents happy here?"

Chief resident: "No, of course they're not happy. They cry every day."

Me: "They cry every day?"

Chief: "Yeah, well, that's pretty typical for residency. You just get so tired and frustrated."

Me: "So they cry out of frustration more than unhappiness?"

Chief: "Pretty much. I mean, when I did my sub-I here, the intern on my team cried on every post-call day. She was so tired."

Me: "But the call is only Q6 here... so that means she only cried every six days, right? That's not so bad."

Chief: "Yeah, but it was Q5 back then."

(I didn't end up ranking that program.)

Friday, March 9, 2012

Evolution of the med student



Note: I originally drew this cartoon for our humor magazine in med school and found it recently on a trip to my parents' house. I'm not entirely sure it's funny.

Note #2: You can tell which are my old cartoons cuz all the people in it look like Archie Andrews (or Betty/Veronica). I spent most of 3rd grade drawing cartoons of Betty and Veronica. That's why I don't know the multiplication tables.

Note #3: What do you think: Betty or Veronica?

Thursday, March 8, 2012

Do it right the first time

A really good piece of advice I got from an attending during my first week of intern year is that it saves you a lot of time if you write your orders correctly the first time. That way the nurses don't have to call you on it.

I know it seems obvious, but early in intern year, you're constantly making stupid mistakes when writing orders, like leaving out the "PO" or forgetting to sign them or leaving out the date and time. Spending an extra five seconds making sure you did everything right can ultimately save a lot of time.

Unfortunately, sometimes during residency, you have no choice but to write an order you know with 100% certainty you'll get called on.

Attending: "Can you write for the patient to get 12.5mg of trazodone?"

Me: "It comes in 50mg tablets."

Attending: "Oh. Well, maybe you can cut it in quarters?"

Me: "I doubt it."

Attending: "How big are the tablets?"

Nurse: "They're really small."

Attending: "Well, write for it anyway. If the pharmacy calls you about it, you can change it."

Me: [grumbles curses under breath]

Naturally, I wrote the order and the pharmacy paged me half an hour later to tell me that the pills couldn't be divided that way, so I had to rewrite it. All in all, it was like 10 minutes of wasted time.

Wednesday, March 7, 2012

On call frustrations

From several years ago:

8AM:

Nurse: "I'm paging you to tell you know that you need to write a prescription for this patient to have meds to take with him to go home for a day tomorrow."

Me: "My patient upstairs is having chest pain. I'll do it later, okay?"

Nurse: "Okay."

Me: "But I don't know that patient, so have the medications available so I know what to write for."


An hour later:

Nurse: "I'm paging you to tell you know that you need to write a prescription for this patient to have meds to take with him to go home for a day tomorrow."

Me: "I didn't forget, but I'm in the middle of something. Do you need me to come down right now?"

Nurse: "No, just don't forget. You have to do this today."

Me: "I'll be down in half an hour."


Half an hour later:

Me: "Here I am! Hi, Nurse, what do I need to fill out?"

Nurse: "Hi, I'm glad you're here." (Hands me chart, which contains no helpful info)

Me: "What do I do with this? I don't know this patient and I've never worked on this floor before... what medications does he need? Where's the form to order the medications?"

Nurse: "I don't know the answer to any of those questions."

Me: "You paged me twice to come down here... and you don't have ANYTHING ready for me to fill out?"

Nurse: "Why don't you sit here and twiddle your thumbs for fifteen minutes while I try to figure it out."

Tuesday, March 6, 2012

Transgender

One day on weekend cross cover a few years ago, I was rounding on an elderly trans-gender patient. Male to female. I went into the room to meet the patient, and if the resident hadn't told me she was transgender, I would have definitely thought it was a man. She had a deep voice, a stubble, and only slightly longish hair.

Anyway, as I was leaving the room, I said, "It was nice meeting you, sir." Then I quickly added, "Er, ma'am."

I was SO embarrassed. What's annoying is that I usually didn't even say "sir." I don't know why I felt compelled to add it with the one transgender patient I've ever had.

On Monday, I told the primary resident about it, and said I felt really bad. She said it happens all the time, which only made me feel slightly less guilty.

Monday, March 5, 2012

Guest Cartoon: You say tomato


See more cartoons by this author at Paradoxical Syncope

(Submitted by Hali Vanderburg)

Sunday, March 4, 2012

Goodreads

So this morning I signed up for Goodreads. Because reading is good.

I don't quite understand how to use it or what the point is, but somehow it's supposed to recommend books to me, although I don't know exactly how it's supposed to work. Um, does anyone know?

Anyway, if you're on goodreads, you can add me as a friend. Or not.

Tales from Residency: Evening decubs

This is a story about an attending I once had named Dr. Decub and a falling out she had with a resident (not me).

The falling out was apparently a big deal and I was curious for a while to find out what happened. I thought it was going to be something like he wasn't updating the pre-printed notes frequently enough, or something. But no.

Apparently, some patient had a wound that needed a dressing change by the surgery service on a daily basis. For some reason, they did this dressing change every evening at 7PM. Even though this wound was pretty much status quo, Dr. Decub insisted this resident be there every single day to observe the dressing change. Every single day at 7PM.

The resident went a few times, but then stopped going. When she pushed him, he outright refused. And who could blame him? Who would want to stay at the hospital every single night until 7? Even surgery residents get to leave earlier than that some nights.

Saturday, March 3, 2012

Weekly Whine: Under the Bus

I really hate the phrase "under the bus" as in, I "threw him under the bus." This story is the reason why:

When I was a resident, I was assigned to a clinic rotation with an attending named Dr. Brown. Usually the clinic had two residents, but about halfway through, the second resident got pulled to do something else. Therefore, I was Dr. Brown's lone resident.

Dr. Brown was very unhappy about this. He wanted the consult resident Alyssa to be pulled to cover his clinic. But the consult resident was busy doing (you'll never guess) consults. But Dr. Brown kept asking if consults were light, maybe Alyssa could help out.

I didn't particularly care. I didn't like having to deal with a pissed off attending, but I was going on vacation in a week, so... you know, whatever.

Anyway, one day I was on the phone dictating, and Dr. Brown approached me. "Where's Alyssa?" he asked.

"I don't know," I said (reportedly). And I continued dictating.

Another resident named Peter was in the room and said, "She's doing consults."

This seemed like a totally unremarkable interaction to me. But it was enough to cause Peter to go up to Alyssa behind my back and tell her that I was "throwing her under the bus" and acting like she wasn't where she was supposed to be.

Let me tell you, that was 100% not my intention. Why did I say that I didn't know where she was, rather than saying she was doing consults? I don't even entirely remember the interaction and was only reminded of it because it ended up being such a big deal, but here are a few theories:

1) Maybe I thought he was asking specifically where in the hospital she was

2) Maybe I thought she was in a meeting, because the consult resident does go to some meetings

3) I was mid-sentence in a dictation and didn't want to get involved in a huge discussion

4) Maybe I didn't realize that the weight of the universe rested on my answer

It's a little sad because I really liked Alyssa. There were so few residents with kids and she was one of them, and even though she realized (I hope) that I didn't mean to "throw her under the bus," the drama that resulted from this situation put a permanent wedge in our friendship.

Immediately after, I approached Peter about having gone behind my back to talk to Alyssa. He said that saying "I don't know" wasn't resident-friendly. You ALWAYS cover for residents when attendings ask where they are. By not doing so, I wasn't a team player.

Except there was one recent time when I told Peter quietly that I had a doctor's appointment at 4:30 and even though it should be no problem since our last patient was at 2, I was wondering if it somehow came down to the wire, if he'd mind seeing the last patient that day. Peter said, "No problem!" Then he immediately went to Dr. Brown and told him I had a doctor's appointment and had to leave early.

I asked Peter if he had a problem with me, if he thought I was a slacker or something, and that's why he went behind my back. He said he didn't and I was crying too hard to press him and start naming other incidents where he seemed like he was out to get me.

Peter and I didn't speak for a long time after that. I was really angry at him and I probably always will be. I think Alyssa also realized he was kind of an ass when he asked her why she was so tired because she'd just come back from vacation (i.e. maternity leave).

Friday, March 2, 2012

Disallowed abbreviations

We all know (or should know) the medical abbreviations you're never supposed to use:

-- u
-- QD, QOD
-- trailing zero
-- MS, MSO4, or MgSO4

However, there are a few additional abbreviations that we're supposed to avoid because they might be confusing:

-- cc
-- @
-- ug
-- greater than or less than symbols

I actually was informed by a nurse once that I had to rewrite an order because I wasn't allowed to write "straight cath for volume > 300 ml". Apparently, this could have been mistaken for "straight cath for volume 7300 ml. Because that's a totally reasonable mistake that someone could make. Please straight cath patient if their bladder has 10 times more urine than a normal bladder can hold.

Of course, if your handwriting is crap, it doesn't really matter what abbreviations you use. When I was rotating through the ED, I got yelled at by an attending for writing an order to give a diabetic patient D5 NS. What did I actually write? 0.5L NS.

Thursday, March 1, 2012

What the hell is PM&R, Part 2

When I was studying for the PM&R boards, they had some practice questions online. It's bad enough that nobody outside of my field seems to know what a physiatrist does, but after doing some of these questions, I was no longer certain what I do.

Some examples:

A 24-year-old man with T6 complete paraplegia whose injury occurred 16 weeks ago. He is concerned he can no longer reach down to put on and tie his right shoe. Upon evaluation, he has significant loss of range of motion in the right hip with mild warmth at the hip. There is no swelling at the knee, lower leg, ankle, or foot. What is the most likely diagnosis?

OK, this is a reasonable question. We deal with spinal cord injury, so this makes sense.

What is the most common reason for prescribing a plastic leaf-spring ankle-foot orthosis?

Also very reasonable, since we deal a lot with bracing.

Which of the brain tumors listed is a benign tumor?

OK, this question makes less sense, but I guess sometimes we get a brain tumor patient on our brain injury unit. And somehow we wouldn't be able to figure out that information from the person who diagnosed the tumor.

A 47-year-old man with human immunodeficiency virus (HIV) presents with fever, headache, and memory loss. What is the most likely diagnosis?

This question makes no sense to me. I mean, I can come up with an answer based on my med school and internship training, but we very rarely deal with HIV. I suppose we could have a patients now and then with HIV so we should be able to manage complications, but I think I would call medicine or ID in that sort of situation. (That wasn't an option in the answers.)

A 70-year-old man underwent a 2-vessel coronary artery bypass graft and mechanical mitral valve replacement five days ago. You note that he is presently taking Coumadin (warfarin). What is the primary reason to put this patient on Coumadin after this procedure?

I give up. I really don't know what we do if we're somehow supposed to be deciding whether a patient should get coumadin right after cabg. I mean, why not just copy and paste the Medicine boards into our board exam and call it a day.