Thursday, October 30, 2014

Malignant

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

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

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

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


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

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

Wednesday, October 29, 2014

Anthology

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

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

Tuesday, October 28, 2014

Medical Humor Writing Contest WINNER

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


Standardized Patients


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monday, October 27, 2014

What physiatrists do

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

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

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

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


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

Saturday, October 25, 2014

Ebola

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

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

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

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

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

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

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

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

Weekly Whine: Been there, done that

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

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

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

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

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

Thursday, October 23, 2014

It's easy to be a jerk

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

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

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

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

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

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

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

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

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

Tuesday, October 21, 2014

Dr. Orthochick: The Hoarder

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

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

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

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

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

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

Monday, October 20, 2014

The Inevitable



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

Saturday, October 18, 2014

Weekly Whine: Me

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thursday, October 16, 2014

Doctor Finder

A little while ago, I was calling to arrange a patient cardiology follow-up after her discharge. (Yes, my job is very glamorous.) I called the hospital she had come from and the operator informed me that there were no cardiologists on staff there, and anyone who had seen her had just popped in for a consult.

Me: "so how am I supposed to get her seen by cardiology?"

Operator: "well, I could put you through to Dr. Finder."

Me: "he's a cardiologist?"

Operator: "…"

Me: "sorry… Is that a she?"

A minute later, the operator had put me through to Doctor Finder, a service for helping you find a doctor. Talk about feeling dumb …

Wednesday, October 15, 2014

Choice

I recently wrote a post about the interventions that should or should not be done on elderly people. One complaint a lot of people had is that they didn't want the decision to be taken out of the hands of the patient or the family. I would like to share a personal story about why I think it should.

When my favorite grandmother turned 80, she started to develop dementia. It happened very quickly. In a matter of months, she went from the woman who used to make me all my favorite foods and discuss books with me to having weird delusions and hallucinations. She was not pleasantly demented. She became very confused, agitated, and emotionally labile.

Eventually, my mother had to put her in a nursing home because she could not be left alone anymore. She didn't receive horrible treatment, but she never seemed very happy, which was probably due to the many small infarcts that caused her dementia. Every time I talked to her she would start crying.

About four years later, she suffered a massive hemorrhagic stroke. The doctor told my mother that on the scan of her brain, "there was more blood than brain."

For reasons beyond my control, she had been made full code. The doctors told my mother and my uncle that there was essentially a zero chance of any sort of meaningful recovery. But because they had the option, she had a craniotomy to remove some of the blood from her brain followed by a tracheostomy and feeding tube placement.

She never again regained consciousness and died on a ventilator a few months later.

My mother knew that there was no chance of her recovery. The doctor knew it, I knew it, everyone knew it. But because she was given the option to keep her mother alive, she felt she had to do it. I couldn't talk her out of it.

Meanwhile, I feel like my grandmother was robbed of the dignity of a quick death from a stroke.

Why are people given a choice of a procedure that has essentially no chance of working? At least in her case she was unconscious through the whole thing, but plenty of people spend the rest of their short life in agony due to treatments they never should have been offered.

Some people may say it's heartless, but I think sometimes the most humane thing is taking away that choice. Of course, nobody likes feeling that their choices have been taken away. So I propose a system where the patient can choose to act in their own best interest:

I think when people get to a certain age (75?), they should be offered an option for a quality-of-life based healthcare insurance. The insurance would not pay for an ICU stay, being intubated, CPR, major surgeries that are high-risk and expensive, cancer treatments that are not palliative… You get the idea. Instead, the insurance would provide services that would improve quality-of-life, such as extended hospice services or nursing services to come to the patient's home (this exists now, but isnt good enough yet to keep many people out of nursing homes). Considering how much money is spent (wasted) on extending the life of elderly people for short periods of time, I think the insurance companies would jump at the chance to do this. Plus it would keep people out of nursing homes, which I genuinely think most elderly people fear even more than death.

Then when it comes to those risky procedures, that choice is gone, and you were able to use your health insurance for things that actually made your life better.


Tuesday, October 14, 2014

Contest Deadline TOMORROW

I know people in medicine love to cut things down to the wire. Entries for the First Annual Medical Humor Writing Contest are due tomorrow! I will allow submissions until midnight tomorrow, in whatever time zone you live in.

Dr. Orthochick: Back surgery

Dr. X paged me while I was operating so I called him back after I was done.

Dr. X: I have this patient in room 321, I did a [spinal] fusion on him the other week. He fell and now he can't move his legs. We got a CT scan and it showed a T3 fracture. So I want to extend his fusion. I need you to explain to him and his mother, who's an idiot but she's his legal guardian, that he may have a spinal cord injury and could be paraplegic and then I need you to get consent for the surgery. Oh, and make sure they hold his heparin tomorrow.

Oh. OK.

Just to recap, that means I need to go talk to some patient who I've never met and know nothing about and tell him that he may be paralyzed for life. Then I need to explain to him that he needs more surgery. I need to convince him and his mother. I've never met this guy before. I don't really understand what's going on. I have nothing to do with any of this.

Seriously people, do your own damn dirty work.

So I went to talk to the patient. He seemed a little slow in that he was having a conversation with the phone while it was ringing, but he definitely understood what I was telling him. As in, I walked in and asked him how he was, he said he was terrible because he couldn't move or feel his legs, I said we wanted to do surgery to fix the broken bone in his back and he said "Oh G-d no, not more surgery. I'll do anything but that." Then he started crying. Because I have no tact, I pushed forward and I said we wanted to also look at his spinal cord while we were operating because there was a chance that whatever it was that was causing his paraplegia could be reversed. The thing is though, that's probably not all that accurate. So I had to say that there was a good chance if he was paraplegic now, he would always be paraplegic. I think my exact words were "It's likely that you will spend the rest of your life in a wheelchair."

He understood that.

Then, because his mother was his power of attorney, I had to call her to get permission for the surgery. She understood what was going on after I told her that he might never walk again. She said 'it sounds like he might not be able to walk again even if he has the surgery." I said that was true. She said she was still OK with him having the surgery. So I got consent, called the primary team to tell them the plan, and made sure he was appropriately pre-opped. The whole thing took about an hour.

See, this really does not sit well with me and I was actually pretty pissed about the whole thing. I know I tend to be more anal than most people when getting consent because i don't want a surgeon who can't sit down with me for two minutes and explain the surgery and the risks and benefits and I get that not everyone is like that and it's fine, but I really think it's inappropriate to have someone else deliver bad news to your patient. I mean, I don't think anyone enjoys telling people that they'll never walk again (and this is my second time in a week and really, the experience has not improved with time) but I feel like if you're the one who has the relationship with the patient, you should be the one to tell him. I don't think it's fair to the patient or to me to stick me in this position. I don't know anything about the patient or his history, so I really can't answer any questions. He doesn't know anything about me, so why would he trust my opinion on anything?

The patient said "I wish I'd never had the first back surgery." It was hard to argue with that logic so I slunk out of the room while he and his mother cried together over the phone.

It's really hard being a surgeon sometimes.

Monday, October 13, 2014

Die at 75

I was recently reading an article written by a guy who said he wanted to die at 75 years old.

I thought for sure I was going to disagree with every bit of the article. There were definitely parts that I didn't agree with, such as foregoing some basic cancer screening. (I think I would do anything to keep from dying of colon cancer.) I don't agree with the basic philosophy, that once you slow down significantly, life is not worth living. Plenty of people over 75 have wonderful and worthwhile lives, even if they can't do with they could do when they were 30.

That said, with the aging population, I do think medical treatment to people over 75 (to set an arbitrary cut off) should be limited.

I do think the elderly should have access to antibiotics, flu shots, and medications, and should see physicians frequently. But nobody in their 80s should be allowed to be full code. It just doesn't make any sense in terms of expected recovery. Furthermore, I think cancer treatment should be palliative only at that point. Any major surgeries, such as a bypass surgery, should be avoided. Nobody over that age should be allowed to have a trach or feeding tube. The chances of recovering and having a reasonable quality of life after these interventions is just not high enough to justify it. Frankly, I think it's just cruel to the patients, in addition to being a waste of medical resources.

The most important thing is that the decision ought to be taken out of the hands of the patient or family members. It feels so ridiculous when we ask a 90-year-old if they want to be full code. A lot of the time, the patient or family will say yes, because they just don't understand what it means. They think not being full code means we won't treat their family member, but what it really likely means is it their family member will not have to die on a ventilator. Or alternately, they do understand what it means, but feel guilty making any other decision. I am still angry with my mother for putting my grandmother through a "life prolonging" surgery instead of withdrawing care when the doctor essentially told her there was no chance of recovery, but she said she felt guilty doing anything else.

For starters, I think everybody over the age of 80 should automatically be DNR. And we should seriously consider what other medical interventions should be offered to people who most likely won't benefit from it.

Saturday, October 11, 2014

Weekly Whine: Short Season

Lately, my husband and I have been watching some new TV shows. A couple of the shows that we really like are Nathan For You and the IT Crowd.(Well, I like the latter. I'm always a sucker for an Irish accent.)

When you start watching a show and you think that there are four seasons to watch, it makes you think that there are lots and lots of episodes. But somehow, in these shows, the seasons are only five or six episodes long. It's kind of a cheat.

Seriously, how is it possible to have a show with only six episode in the entire season every single season?

Thursday, October 9, 2014

A doll that poops!

I would have thought this was a joke, except I saw it in a commercial on television:



Basically, you give the doll water to drink, and then it poops out a charm in its diaper. And then you wear the charm around your wrist.

Because as everyone knows, little girls are dying to wear poop bracelets just like their mommies.

Wednesday, October 8, 2014

There's still time!

For those of you who have been procrastinating, there is only ONE WEEK left to submit an entry to the First Annual Medical Humor Writing Contest. The $25 Amazon gift card is still up for grabs!

Tuesday, October 7, 2014

Dr. Orthochick: You are fat

The government is into preventative medicine or something like that these days, so if you go to your friendly local orthopod's office, they have to ask you about your most recent mammogram, your sexual history, and your vaccination status. Technically they don't, but the way funding is set up, they get reimbursed more if it looks like they care about the patient as a whole. In addition, we are now giving out what we refer to as the "you are fat" handout. The "you are fat" handout goes to anyone with a BMI>25, which is technically overweight going by the BMI calculator (as in, not taking muscle mass into account, etc) but it's not fat. Or at least, it doesn't have to be. Not only that, but you have to give it to a patient each time he/she comes to your office. I guess to make sure they know they're still fat. There's a second "you are fat" handout that you get if your BMI is over 30, which I believe is "obese" if we use the BMI scale. Your office gets reimbursed more if you show you're giving out the "you are fat" handout so we're all doing it these days.

For obvious reasons, I am not a fan of the "you are fat" handout. I mean, I feel like I wouldn't go back to a doctor if the first thing he did was give me the "you are fat" handout. From what I hear, I am not alone in this regard. Apparently there was a 20 year old who started crying hysterically upon being presented with the "you are fat" handout. They haven't seen her since. Also, most of the attendings are really not all that thin. Dr. Orthoking Jr probably weight around 300lbs, so I can't imagine anyone would take the "you are fat" handout seriously if it came from him. He's probably the fattest, but there's a whole pile of them who really aren't so thin. So I'm not sure how seriously I would take the "you are fat" handout if it was coming from someone who was, uh, fat.

Also, the "you are fat" handout is causing me some distress and I haven't even gotten it. The other day in the OR, Dr. Chatterbox was talking about it and he said "I bet everyone in this room has a BMI over 25!" That seems like the wrong thing to say in a room full of women. He then said 'I think everyone in my office has a BMI over 25...well...maybe not the new girl." So I had to calculate my BMI after the case to see if I was, in fact, over 25. I am not. I calculated what my weight would have to be for me to be 25 and I am below that by a wide enough margin that I could go to the all you can eat buffet tonight and then I could still be under 25 tomorrow morning. (I do not think I could do that more than once, however) But still, I don't want my attending to think I need the "you are fat" handout because, like I said, I'm a little bit touchy about it.

Today the "you are fat" handout was mentioned again and I said I had calculated my BMI and I was definitely not over 25 and Dr. Chatterbox said "oh, so what are you? #?"

...and...I got a great evaluation today in the OR. And it has nothing to do with Dr. Chatterbox feeling bad about overestimating my weight by the time I was done. I totally deserved all those "excellents."

Monday, October 6, 2014

Saturday, October 4, 2014

Weekly Whine: Surveys

I really hate people who call you on the phone to do surveys.

I used to feel sorry for those people. I mean, what a crappy job. So one day, when I had a little bit of time, I agreed to do the survey.

I felt that my goodwill was completely taken advantage of. I answered a few questions, but the questions wouldn't stop. It was getting to the point where my answers were completely irrelevant because the questions were stupid and I was so angry at that point.(The questions involved my rating movie after movie after movie, most of which I had never even seen.)

What was worse is that after I finally told the person, as politely as I could, that I was not going to participate anymore, the number of calls I got seemed to triple. Like I got put on some sort of sucker list.

I insist on having a landline for emergencies, but the only calls we get on the landline are from telemarketers or people doing surveys, despite being on a no call list. We eventually just turned the ringer off. They have basically rendered our phone nearly useless. I hate those people.

Thursday, October 2, 2014

Med students are people too

As a med student on surgery, I had to go to this lecture after my seven straight hours of ambulatory. I was exhausted, my neck was killing me, and the only thing I had eaten all day was a couple of handfuls of peanuts. Still, I went to this lecture.

Only when I got there, it was in this small classroom and there were no available seats. There was this resident sitting in the back and I tried to ask him if there was a seat next to him, but he was unresponsive.

Then another surgery person came in and the resident actually got up to give that guy his seat, still pretending that I didn't exist. I was more than irritated at this point, but I couldn't leave, so I sat down on the floor. The resident had left his coat in the room and as he was reaching to get it, something fell out of his pocket and landed behind my back. I didn't know what it was, but I quickly moved backwards so that he wouldn't be able to retrieve it without asking me to move.

The resident disappeared for a minute and I checked what he had dropped. It looked like a laser pointer. I stuffed it into my pocket. Subsequently, another female medical student came in and had to sit on the floor also.

Then the resident returned with a chair! I thought, "How nice, is he trying to get us chairs?" But no, he just brought the chair for himself.

And I got to watch the bastard searching through his pockets for his laser pointer when the lecturer called on him to read a CT. Yesss! It was a drug company laser pointer anyway, the sellout.


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For those of you who have been procrastinating, there are only two weeks left to submit an entry to the First Annual Medical Humor Writing Contest. The $25 Amazon gift card is still up for grabs!

Wednesday, October 1, 2014

Stress

Lately I've noticed that more and more, I feel like crap. I almost never feel completely good physically. If I don't have a cold that lasts forever, then I pulled a muscle somewhere, or there's some other physical ailment bothering me. I mentioned this to my husband the other day and he said it was probably because I was stressed out.

That may be the case, but what am I supposed to do about it? Everyone says to meditate, but you know what? Meditation is boring. It seems to take tremendous discipline to do, and I don't think I have that kind of discipline.

Exercise is probably another option, but aside from not really having time for it, every time I start to launch an exercise routine, I come down with some sort of flu or sprain my ankle. Then I start to get stressed out that I can't exercise.

Honestly, I am starting to see how people become addicted to sedatives.