Saturday, April 30, 2011

Weekly Whine: If it smells like a gunner....

I hope this is an antiquated practice now, but back when I was a little wide-eyed first year, our histology lectures were recorded on tape. Then to study, we'd go to someone's house who had a VCR and watch them over and over and over until our eyes would bleed.

It was horrible.

Anyway, I was at one of these "histology parties" in my second term of med school at a friend's house. One of the people present was a young guy named Angelo, who was one of those people you look at and think, "He seems really cool." He was funny, always seemed to have a lot of girlfriends, and on his way in to the histology party, had accidentally gone to my friend's landlady's apartment and after declaring her a "MILF," claimed he considered ditching the party and staying with her.

Anyway, somewhere in the middle of watching tapes, Angelo spoke up, "Hey, what did everyone get on the practical portion of the anatomy final?"

Nobody volunteered a score, so Angelo said, "I got three wrong. I'm just wondering because I think I may have gotten the highest score in the class."

Immediately, I thought, "Wow, that was obnoxious. What a total gunner."

But later, my friend (who was also Angelo's lab partner) told me that Angelo "wasn't like that." That he was just genuinely curious about whether he got the highest score in the class. And that if he got a low score, he would have asked around to see if he got the lowest score in the class. At the time, I totally bought it.

A couple of years later, my roommate who was on a rotation with Angelo told me that he was the biggest brown-noser she had ever seen. She came home every day with ten stories that made her want to strangle him. Then he was junior AOA.

So the moral is, if someone acts like a gunner and talks like a gunner, don't kid yourself. You're looking at a gunner.

Friday, April 29, 2011

Med school experience

I didn't have the energy to turn this into a cartoon.....

I propose that all pre-meds, as part of their coursework undergo a class entitled "The Med School Experience." These will be the components of the class:

Overview of the Med School Experience:

1) Students will be forced to take a full courseload in addition to this course

2) Students will carry a pager with them at all times and will receive no less than 20 pages in any given evening, at least 25% of which will be during dinner hours and the other 25% during sleep.

3) Pages will by made by teaching assistants, who will be asking permission when they want to eat, go to the bathroom, or go to sleep. If the teaching assistants wake up during the night, they must page the students for permission to go back to sleep. If any injury is sustained, such as a papercut, the students must go to the teaching assistant's room to evaluate it.

4) Students will wake up every morning at 4AM and have to report to a designated location by 4:30AM, where they will have to stand in one place holding a metal object for 5 to 6 hours. If they move at all, they will be berated for several minutes, sent out of the room to wash their hands 100 times, then come back and continue holding the metal object.

5) During regular daily courses and sections, students must remain standing at all times.

6) Every four nights, students will stay awake all night. Every few hours, the student will be paged and an angry, smelly, drunken man will read them a page from the encyclopedia, which they must memorize. At noon the next day, the students will be quizzed extensively on the pages from the encyclopedia in front of a group of their peers.

7) Every day or so, a student will be paged to speak to a parent of a teaching assistant who will yell at them continuously for about 20 minutes for all the problems they've had with their child over the years.

8) If for any reason, a student is sick and cannot fulfill his duties, he must pass on his pager to another student, who must take on double responsibilities for that night.

9) All meals must be finished in ten minutes or less.

10) Students will have two opportunities during the day to go to the bathroom. Before going, students must ask the permission of a teaching assistant. On their way to the bathroom and while inside the bathroom, they will be paged repeatedly. If they don't return those pages within one minute, they will be in danger of failing the course.

11) There will be only four days off per month. One of those days will be the first day of the month and one will be the last, so they will otherwise work 14 days in a row.

12) At some point during the course, students will be dumped by their significant other or undergo some other personal tragedy. At that time, their grades in all their other course will automatically drop to 65 and they will require at least an 80 average on their next set of exams in order to keep from repeating the entire year.

13) Every day, students will give foot massages to the members of whatever athletic team has been playing the longest, sweatiest game that day.

Thursday, April 28, 2011

Ode to Green Day

When I was doing a fourth year med school elective in a sleep clinic, we had this 15 year old patient who said that he lay in bed for five hours every night, trying to fall asleep.

Attending: "So what do you do when you're trying to fall asleep?"

Kid: "I usually listen to some music."

Attending: "What kind of music?"

Kid: "Well, I try to listen to classical--"

Attending: "I didn't ask what you try to listen to. What do you actually listen to?"

Kid: "Umm..."

Attending: "Well, what did you listen to last night?"

Kid: "Um... Green Day."

Everyone in the room bust out laughing. (For those of you living in a soundproof booth, Green Day is not really what you'd call good music to sleep by.) I was amused on two levels though. When I was 15 years old, Green Day was MY favorite band. It blew me away that ten years later, teenagers were still listening to the band that I liked so much when I was that age. I mean, Green Day?? Who knew that a band who named their first two albums (Kerplunk, Dookie) after the passage of fecal matter into the toilet could maintain popularity for so long? I remember my boyfriend in high school used to tease me that they only played three chords all time. True, but Billie Joe was hot.

I was a teenager in the 90s and therefore liked all the alternative bands that were popular back then (e.g. Nirvana, The Cranberries, Weezer, No Doubt, Bush, Hole, etc). But Green Day was my absolute favorite. The first time I heard a Green Day song on MTV circa 1994, it was like a voice in my ear telling me to dye my hair blue, buy ripped jeans, smoke pot, and have lots of angsty relationships with guys. Of course, I was a huge nerd, so I didn't do any of these things except of course for the ripped jeans. And I listened to Dookie about a million times.

I'm not sure how Green Day evolved into a mainstream band. When they were singing Basket Case, I never dreamed there would be a Green Day song played during my brother's high school graduation years later. But I distinctly remember when I was playing Green Day's American Idiot album in the car in 2004, my husband commented, "Wow, is this Green Day? This song is actually melodic!" So I guess they evolved.

It was a sobering moment in my life when my husband and I got tickets to a Green Day concert when I was an intern. I was only 26, but it was obvious the audience they were pandering to was much younger than I was. In fact, we were probably the oldest people there who were not parents of someone else there. It was then that I realized that I had grown too old for my favorite high school band.

Wednesday, April 27, 2011

Photographic evidence: Acupuncture

As part of my residency training, I did acupuncture. This particular acupuncture model always made me giggle a little bit:

Because, you know, there's a pole up the model's butt. That's one of our leading treatments for back pain, you know.

Here's an acupuncture needle:

OK, nobody drink from this cup:

Tuesday, April 26, 2011

Tales from Med School: Schizophrenic?

During my psychiatry rotation in med school, on some mornings, we would have patients come into our sitdown rounds and attendings would interview them. This was actually very interesting (and also awesome because I got to sit down).

One of the patients I will never forget was a college age kid named Riley who was presented as having his first schizophrenic break. He had been admitted a few days earlier and the med student sitting next to me (Jason) had taken him as a patient.

Riley was a skinny kid of about 20 years old with dyed black hair who had recently dropped out of college. He didn't seem particularly happy to be there, but he didn't seem particularly schizophrenic either. But what did I know?

At one point, the attending said to Riley, "When did you start hearing voices?"

Riley frowned and said, "I don't hear voices."

At the end of the interview, the attending sent Riley back to his room and stated that he would "bet anything" that the kid was hearing voices. The attending highlighted the fact that Riley couldn't tell us what his parents did for a living as particularly odd and strong proof of his schizophrenia.

At that point, Jason (the med student who was following Riley as a patient) nudged me and pointed to something he had written on his notepad in big capital letters: "GAY"

Jason's theory, he later told me, was that Riley wasn't schizophrenic at all and was actually just struggling with sexuality conflicts.

I can't say I ever found out the truth about Riley. But I did later read about a study where some "normal" people were admitted to a psychiatric ward and subsequently just acted like themselves.... and the psychiatrists would explain all their "normal" behavior in terms of psychiatric disorders. Like when the subjects were taking notes on their experience, the psychiatrics observed "compulsive notetaking."

Monday, April 25, 2011

The Oregon Trail

My husband and I were discussing computer games that used to be available when we were kids. He had Nintendo, but I had nothing, so the only games I got to play were on the computers at school.

A game they always let us play with was Oregon Trail. If you were a kid in the 80s, you must remember this game. It's a "learning game", supposed to teach us about pioneer life, so that's why we got to play it in school. I remember the goal was to lead our wagon and ox from some starting point to, presumably, Oregon. Except I never understood why the pioneers were going to Oregon. Why Oregon? Oregon sucks. Why not go to California to get gold or whatever?

(See American flag in drawing, which teaches us that the Oregon Trail was in the US, not in like France or something.)

At the beginning of the game, you went to a store and bought a bunch of crap that you were supposed to need for your journey, like food and ox and bullets. (The game was always talking about oxen and it was only years later that I realized that oxen was the plural of ox. I was always like, "What is this weird animal called oxen?") Then you were off on your journey.

Things that could happen to you on the Oregon trail included losing half your food in a river, getting sick and losing time, or I guess other things could happen. I don't really remember. I never got very far.

Above and beyond, the best part of the game was going hunting. You got to stand in a little field with your tiny gun and use the arrow keys and space bar to shoot at animals scurrying through the field. And any animal you shot, you got to keep for food. The highlight was shooting one of those big buffalo.

In all my years of playing the Oregon Trail, I don't think I ever once finished the game. I guess it takes a long time to get to Oregon from... wherever the starting point was. There was some kind of scoring system, but since I never actually finished, I never learned how that worked or cared.

The other game we played a lot was Where in the World is Carmen Sandiego? I don't remember much about that game, other than the fact that it required you to know geography, therefore I sucked at it. Also, it was a TV show, and this kid from my class got to be on it and lost really badly.

When my father finally got a computer, my first game was this text-based game based on The Hobbit. I think it was called The Hobbit. Between me and my father, neither of us could figure out how to play. There was this whole dictionary of words you were allowed to use, but the only command I could get the game to understand was "Kill Gandolf". And once Gandolf was dead, you had no one to help you so the game was pretty much over. I'm not even sure why the game let you kill him. I guess computer games have come a long way since then.

Saturday, April 23, 2011

Weekly Whine: Med School = JHS?

Sometimes in med school, it takes a little bit of time to find your niche, to find a group of friends that you click with. I had some friends I made in med school that I absolutely loved. But before that happened, I made “friends” with two girls named Tina and Roberta (not quite their real names).

I’m not sure how I made friends with them, other that we were all in the same place at the same time and struck up a conversation. Tina was one of those genuinely sweet girls who was very hard not to like. Roberta’s favorite saying was, “I’m not here to make friends.” So basically, she was the reality show bitch. Although at the same time, she complained that she always hung out with the same people (me and Tina) and it was lame and she wanted other friends. But she was intelligent and I respected that, and I’m not that outgoing, so it was easier to just be friends with them.

Tina and Roberta had a special bond though that they formed because Tina didn’t have a car at first, so Roberta chauffeured her around everywhere. Also, they both had long distance boyfriends in the same city. It was very obvious that they were extremely tight, and I was just a third person who hung out with them.

The three of us were lab partners, plus one other guy. Tina was having roommate issues, in that her roommates were the “popular” kids in the class (does this sound like junior high school yet?) and they were constantly making plans with each other and not inviting her, and basically making her feel unwanted in her own house. Ironically, she would then turn around and make plans to study with Roberta right in front of me, and not invite me.

I remember one particular night when Tina told me she was thinking about going to the anatomy lab on a Saturday night to study right before an exam. I told her if she did that, she should give me a call and we’d go together. She eagerly agreed. As it turned out, she never called me, then on Monday, she mentioned that she had been studying at the anatomy lab on Saturday night with Roberta. I felt kind of hurt about that. But I’m not into confrontations, so I didn’t say anything.

After I got past the initial couple of months of being overwhelmed by med school, I realized I needed to make new friends. Luckily, as I said, there were other nice people in my class. And the new friends I made were way more fun than a girl whose motto is she’s not in med school to make friends.

However, our “friendship” couldn’t just dissolve quietly. It had to explode in a really public way.

One weekend right before a big anatomy exam, Tina and Roberta made plans to meet up with a TA named Maria to go over material in the lab. I think I was standing there so they were forced to tell me about it and invite me. I remember prior to going over to the lab, I called them to ask if they wanted to go over together since Roberta was in the same dorm as me, and Roberta told me that she was waiting for Maria to call her (for some reason).

Anyway, it was getting late, so I eventually went over to the lab by myself. After entering the lab and getting gloved up, I noticed Maria was already there. She was in the middle of teaching a bunch of other med students and I kind of tagged along for the remaining 20-30 minutes she was there. Then Maria said she had to be somewhere and she left.

Over an hour later, Roberta and Tina showed up at the lab and Roberta was LIVID. “You knew we were waiting for Maria to call us!” she said accusingly. “Why didn’t you call me to let me know she was here?”

I suppose it was a reasonable question, but I didn’t have a cell phone (this was back in the olden days and I was always a few years behind on technology) and I was already dirty from the lab and I didn’t even know her number offhand. So it wasn’t like it was easy for me to call her. I just assumed they would be heading to the lab soon, like I did. It was Maria's responsibility to call them, not mine. Roberta didn't even want to invite me along in the first place and now she was pissed that I hadn't gone out of my way for her.

At first, I tried to apologize and explain that I didn’t have a cell phone, but Roberta pointed out that there was some public phone I could have used in the med student lounge. She basically told me it was really bitchy that I hadn’t called them.

Finally, I said, “Well, how come you didn’t call me that night you two were studying in the lab?”

Tina got this “oh god” look on her face, but Roberta shot back with, “What does that have to do with this? Why are you bringing that up now??”

Anyway, I don’t do well with confrontations. So long story short, I left the anatomy lab crying.

Tina ran out after me. She finally confessed that Roberta had been explicitly telling her not to invite me to study sessions for the last two months because she didn’t like studying with me. I guess she assumed that I intentionally tried to ditch her since she had been doing the same to me.

Things were kind of awkward after that. We all apologized and were back on speaking terms, but I wasn’t friends with Roberta after that. I sort of remained friends with Tina, because I do think she was a nice person, but it was really never the same. And now, ten years later, I get a bad taste in my mouth when I think about either of them.

Friday, April 22, 2011

Respiratory Rate

I got this lecture in med school where the professor/attending told us that the normal respiratory rate for an adult is about 12. And when nurses record 18-20, which they usually do, that actually represents a HIGH respiratory rate.

I just recorded my respiratory rate and it was 12. So I guess he had something there. That or I've OD'd on benzos again. (Kidding!)

He was also right that nurses ALWAYS record the respiratory rate as 18 or 20 (per minute). I have worked at tons of hospitals in several different parts of the country and that seems to be universally true. I'm not even sure what the point is of recording a number, since nobody actually stands there and counts respirations for a minute (or even 15 or 30 seconds). Clearly, this number is always made up.

The one that always baffles me is when they record the respiratory rate as 19. How do they come up with that one?

Wednesday, April 20, 2011

2 Penis Stories

Like me, my father is a physician. He did his residency many years ago, back in the days when residents were real cowboys, who worked ungodly hours and without ancillary services.

But he generally doesn't tell me any stories about his hard work or any miraculous lives saved. Mostly the stories he tells me are about penises. At least, the ones I remember.

He told me a story about a patient he had who was a hard stick, but they really needed blood. They tried getting blood from both arms and even the feet. No luck. So where did they get finally blood from? The dorsal vein of the penis.

Moral: Don't blow all your veins because the consequences are HORRIBLE.

He had another story about how he was putting a Foley in a patient during a call, and forgot to pull down the foreskin again when he was done. The patient got a terrible rash and he felt really bad about it.

Moral: If you're an uncircumcized male, request an uncircumcized male to put in your Foley. Or alternately, a woman experienced with such men.

Tuesday, April 19, 2011

Book Club, Part 2

So I posted a bit ago about a book club that I joined. Our first book ended up being The Gargoyle, which was actually one of my suggestions based on the advice of one of the commenters on this blog (Liz). (We did consider Water For Elephants, but someone had read it already.)

I loved The Gargoyle. It was entertaining, disturbing, romantic, and even relevant to me as a rehab physician. I thoroughly enjoyed reading it. Thanks for the suggestion, Liz!

Next week we're going to discuss the book and decide on a book for next time. One of the women is into Oprah's book club inspirational stuff, and suggested reading Three Cups of Tea. I read a couple of pages of it on Amazon and boy, did it look boring. The reviews said that while it was inspiring, it wasn't very well written, and anyway, I hate books that are supposed to be good because they're inspiring. And furthermore, it turns out it may be a pack of lies.

Anyway, I'm open to suggestions for the next book. Basically, I don't want to read anything inspiring, nothing that's so new it will be hard for me to get from the library, and it has to be relatively easy to read. I mean, I'm not illiterate, but I don't feel like digging through dense prose in my free time.

Monday, April 18, 2011

The 9 Types of Medical Student Bloggers

Back in the olden days, I used to read a LOT of med student blogs. I noticed that much like physician blogs, they fall into a few different categories....

Sunday, April 17, 2011

Tales from Intern Year

Resident: "I'm concerned with this patient's symptoms, she might have a pulmonary embolism."

Me: "I got an EKG and it showed sinus tach."

Annoying medical student: "Did you look for the S1Q3T3?"

Me: "Shut the fuck up, med student."

(OK, I didn't really say that. But I thought it really hard.)

Saturday, April 16, 2011

Procedure list

My last entry got me thinking about procedures I wanted to learn how to do real well in med school. And if I actually managed to be able to do any of them....

My list:

1) Phlebotomy -- Actually got halfway decent at it during 3rd year because one of our private hospitals didn't have great ancillary services, but since it's not something that you EVER do in most hospitals, I probably would have trouble doing it now.

2) Start an IV -- Tried this a few times during med school, never successfully. I finally learned how to do it when I was doing epidural steroid injections at a really ghetto hospital when we had to place our own IVs. But since I never actually ran anything through any of those IVs, I'm not entirely sure they were functional. Eh, I'm sure they were.

3) Put in a Foley catheter -- Got very good at this during surgery, but since (once again) the nurses do this, I discovered it was a useless skill.

4) Suture -- See yesterday's entry.

5) Pap smear -- I was terrible at these coming out of med school, having only done a handful. Finally I did a GYN rotation during intern year where I did like a million of them.

6) Lumbar puncture -- Well, this was more on my "wish list." I got to do around 4-5 in med school. I did more during internship, but not enough to really feel comfortable.

Looking back at this list... um, what the hell did I do during med school? I never even removed any staples until like May of my third year... and removing staples is half of what med students do.

Friday, April 15, 2011

The Suturing Story

One of the skills I really wanted to learn in med school was how to suture. It’s just one of those things that I felt like you’re supposed to know if you’re a doctor. How can you be a doctor if you don’t know how to suture?

Anyway, by fourth year of med school, I had totally failed at my goal. I had already done a surgery rotation, but while I was really, really good at cutting sutures that other people had already tied, I couldn’t really tie them on my own.

Moreover, some of my classmates were really experienced. My housemate, a future ER doc, would breeze home from his EM rotation, talking about all the lacs he sewed up that night and also how he reached into some guy’s chest and massaged his heart or something. Meanwhile, I was watching pregnant women deliver babies from the far corner of the room. I don’t think I was aggressive enough.

When I got to my Emergency Med rotation during fourth year, I thought to myself, “FINALLY, I am going to learn how to suture!”

Except again, I was thwarted. I did my EM rotation at a hospital where no lacs were seen in the main ER, only in fast track. And I was only allowed to do two shifts total in fast track. And there were never any lacs. The second I’d leave, apparently five would come in all at once, but it’s like the patients knew to avoid the clueless med student who wanted to stick a needle in them.

On my last day, I got a patient who had sliced his hand with a propeller from a plane and he was totally down with letting me suture him up. I was so psyched. I would love to tell you that I did a fantastic job and was met with glowing adulation, but the truth was that it took me like twenty minutes to put in one stitch before the PA insisted on taking over, and ended up undoing the one stitch I managed to put in.

And that was kind of it for med school.

For the longest time, I was embarrassed to tell this story. I had graduated from med school without learning how to suture. That’s like… graduating from high school without learning how to read (sort of). Luckily, I got to do another EM rotation early in my intern year.

I still remember my first patient with a laceration, who was listed as the victim of domestic violence. I felt a little bad practicing on a domestic violence victim, until I saw the varsity football player whose girlfriend had sliced him up because she caught him cheating on her. I was totally fine with practicing on that guy.

Let me give you a tip: the key to doing something in medicine that you don’t really know how to do is to act totally confident and don’t say things like, “oops” or “whoops” or “uh oh” (you get the idea). The first few stitches took me an eternity to put in, but I continued to act like I wasn’t dropping every stitch, and the guy didn’t seem like he was in a rush. He was just lying there, looking unhappy about the events of the night, so I just took my time. And eventually, I finished sewing him up.

Then on my next shift, I had a patient who had the skin on his hands sliced to shreds by a band saw. It took me two hours, but by the end of that, I felt like a freaking expert at suturing. (And the patient was grateful. After I finished bandaging his fingers up, he told me that his hand looked like “a beautiful flower.”)

So that’s my suturing story. It’s kind of a disgrace that I didn’t learn the skill in med school, but at least I learned it eventually. And then likely forgot it in the subsequent five years, since I was never once asked to suture again.

Wednesday, April 13, 2011

Med school vs. being a dog

The real challenge is probably to find one reason why it's better to be a med student than a dog.

Tuesday, April 12, 2011

Guest Cartoon: Stages of Getting Stuck in the Stairwell

In case you thought getting trapped in the stairs was something that only happened to idiots like me, this is a guest cartoon from Dr. Wonderland:

Monday, April 11, 2011

Tales From Intern Year: Mosh Pit

When I was doing my ER rotation in internship, I noticed that often nights would seem to have a "theme." When they put patients up on the board, there are always a couple of words to describe their chief complaint. One night, there were a couple of patients with the chief complaint "mosh pit victim". Apparently, at this My Chemical Romance concert, someone had knocked someone over in the mosh pit and it just got out of hand and lots of people were injured. Not too badly though, fortunately.

However, our attending, who was a religious Muslim woman, didn't understand what a mosh pit was. The PA was trying to explain it to her.

PA: "It's this area that forms during concerts where people jump around and fall into it and basically throw around their weight."

Attending: [horrified] "Do they have this at every concert or just heavy metal type concerts?"

PA: "Well, every concert that young people would be going to."

Attending: "Does a mosh pit just break out or...?"

PA: "No, it's actually an organized group at every concert."

Attending: "Where is it? Is there just one or are they scattered?"

PA: "It's in the large area right in front of the stage and there's only one."

Attending: "How do you wind up in a mosh pit?"

PA: "Well, you have to choose to go into it. I mean, it's not like you're walking down the street and suddenly you're in a mosh pit."

The PA then told us about how he worked at a Pearl Jam concert a number of years ago and within like TEN MINUTES of the music starting, there was already a humerus fracture and a forehead laceration. The concert had JUST STARTED and already there were all these injuries.

Sunday, April 10, 2011

Tales from Residency: Income

This is a conversation I wrote down that I had with a senior resident prior to the 2008 elections:

Resident: "Hey, if Obama gets elected, he's going to raise taxes on people with incomes over $250,000."

Me: "Wah wah."

Resident: "That's going to affect doctors."

Me: "I doubt it's going to affect me any time soon."

Resident: "It probably will. It's combined income and starting salary for a physiatrist is $190,000."

Me: "Yeah, except I only want to work part-time, so I don't think I'd get that high."

Resident: "You might."

Me: "Well, if I do, I should shut the hell up because I'll be making $250,000."

Saturday, April 9, 2011

Weekly Whine: Bedside manner

I've been to a lot of different doctors.

I don't have that many medical problems, but I'm a woman and I think women go to doctors more than men. We're supposed to have annual exams and are obligated to keep up with that, on threat of losing birth control. And since I move practically yearly, that's resulted in my having seen a lot of different doctors. Being pregnant resulted in a lot of doctor's appointments and a few times my own OB wasn't around, so I saw another doctor. Then joining an HMO insurance meant I had to have a primary too, so that was more doctor's appointments. And I've had scattered other medical issues here and there, so those sometimes warranted appointments. So anyway, I've been to a lot of doctors.

I've liked the vast majority of these doctors. Sometimes I like them so much, I feel bad about myself that I can't be more like them. But occasionally, I get one who has a really awful bedside manner.

I remember in med school, I was at a doctor for my annual exam and I told him I was feeling stressed out. He told me he didn't get why med students always felt stressed out, because he found med school really easy. Thanks.

Recently I had an encounter at a doctor that I was very unhappy with. Not to go into specific details, but I was scheduled for a (painful) test at the office and I said I wanted to speak to a doctor for a minute before I did it.

The tech doing the test acted really put out by the whole thing, but finally agreed. A few minutes later, they located a doctor who was between patients.

The doctor (who I had never met) came over to me with a really pissed off expression her face. She was angry before I even opened my mouth, because she had to take 60 seconds out of her schedule to speak to me. I told her I was a physician and tried to quickly explain my concerns, how I had researched the test and felt that it wasn't necessary for my specific situation (I didn't physically bring any articles because I thought that would be obnoxious). She (angrily) repeated some mantra about the test, which indicated that she was looking only at a number and nothing else. When I explained my concerns further, she said, "Well, I'm documenting that you're refusing!" And she stormed off.

I work with a lot of patients who refuse things, mostly lovenox shots. I would really hope that I don't act that way around them. I know how hard it is to paste a smile on your face when a patient is inconveniencing you, but I try to do it. If she had been nicer, I probably would have done the test. But after that encounter, all I wanted to do was leave that office and cry.

And for the record, when I later talked to my own doctor, he 100% agreed that it would have been overkill for me to do that test.

Thursday, April 7, 2011

Tales from Residency: Unsatisfied patient

It can be frustrating (both for us and the patient) when a patient comes to clinic and they only want to be treated for one thing, despite the fact that it's not what your clinic is for.

During my residency, I had an elderly male patient who was being seen in our musculoskeletal clinic for neck pain, but all he cared about was the fact that he was constipated. I told my attending that I've never heard a patient say the word "constipated" that many times in a clinic visit. At least not since my intern year.

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

Patient: "Well, I've been constipated for the past six months or so...."

Me: "Yes, but you were sent here for neck pain. You're having neck pain?"

Patient: "Oh. Yes."

Me: "How bad is your neck pain on a scale of 1 to 10?"

Patient: "Oh, the constipation is pretty bad."

Me: "Yes, but on a scale of 1 to 10, where 10 is the worst pain ever, what is your NECK PAIN?"

Patient: "Thirty percent."

Me: "Uh, okay."

Patient: "And this constipation has really been bothering me."

Me: "Are you taking any medications for pain?"

Patient: [reaches into his pocket] "Well, I'm taking this medication here. It's for constipation but it hasn't been working that well."

Me: "Listen to me, sir: I understand that you're having constipation issues, but all we deal with in this clinic is pain. We don't treat constipation here. You're going to have to make an appointment with your primary care physician if you want to discuss your constipation. Today we're JUST going to talk about your neck pain. Do you understand?"

Patient: "I understand."

Me: "Okay, can you show me where your neck hurts?"

Patient: "So who do I talk to about the constipation?"

When I brought the attending into the room, I was hoping he had gotten all his constipation issues out of his system (figuratively). But after we spent a couple of minutes on his neck pain, he was right back to constipation again.

Attending: "So we'll make a referral for you to get physical therapy."

Patient: "I can only remember three things at once and you're giving me too many things to remember. What should I do about my constipation?"

Attending: "As the resident just told you, we don't treat constipation in this clinic."

Patient: "Well, I'm pretty unsatisfied with this visit. You didn't do anything to help my constipation."

Tuesday, April 5, 2011

Photographic evidence

In this post, I talked about the sorts of things you might find in a typical short white coat. Somehow I don't have any short white coat photos of myself, but I did track down two from residency.

This first one is from intern year:

And this one is from PGY3 year, two years later:

Of course, the real question is: why did I keep taking pictures of myself in the bathroom?

Dr. Fizzy in the Media

In case you're looking for something to do today, a few places where my writing and cartoons can be found in the last week:

I wrote an article for my friend's blog, Kids Play the Darndest Things, about The Educational Checklist for kids' TV shows. Check it out!

Atrium Magazine has reprinted my How to be a Gunner cartoons and some others.

Kevin MD reprinted my cartoon about medical bloggers. Thanks, Kevin MD!

I also have a post up on Mothers in Medicine about my obscene cholesterol. No, I won't tell you what it is. You must read the post.

Also, I've got my own post planned for today that has PHOTOS! "Fizzy, don't you have a job anymore?" I think the answer is obviously no. (Just kidding, I'm still gainfully employed.)

Sunday, April 3, 2011

Weekly Whine: Cigarettes

When I rotated at the VA, it seemed like 9 out of 10 patients reeked of cigarette smoke. Now I'm not a primary care doctor and the last thing I want to do is to lecture a patient on the dangers of smoking. So I don't. They can smoke all the cigarettes they want and eat a dozen Big Macs for all I care.

But if you're going to be shut in a room with a patient who just was outside smoking, you may as well go hang out in a smoky bar because it's just as bad. I'm not allergic to cigarette smoke or anything, but it still makes my throat scratchy and my eyes burn. And I come out of the room smelling like I was smoking. And the room stinks for the next hour.

I'm not a smoker (obviously) so I really don't know: do people who smoke think about the fact that the person they're going to be trapped in a room for the next half hour with someone who likely isn't going to appreciate the smell of smoke? I think it's obnoxious. I mean, when I eat something garlicky for lunch, I always eat a mint after for the benefit of others.

I'm not a militant anti-smoker by any means. In college, I used to occasionally have a cigarette when I was out drinking. In fact, I remember once when I was about twenty, I was sharing a cigarette with a friend on a street corner at like 11PM between bars (ahh, crazy youth) and some woman came all the way down the block to yell at us that the smoke was bothering her. So I feel a little bit of sympathy for the plight of smokers. But at the same time, I really don't like smoke, especially when I'm already sick (which is always, these days) and my eyes are already irritated from lack of sleep (which is also always).

In fact, I know that even many smokers don't like smoke. When I was a kid, I got stuck in the smoking section during an international flight (due to poor planning) and people kept coming back from the non-smoking section to smoke. When my dad challenged some guy about it, he said he didn't like sitting in smoke.

I remember in med school, there was a rotation where my attending used to always go out and have a smoke right before our team meetings. She was often like 5-10 minutes late to the meeting and would breeze in stinking very strongly of smoke. We were in this tiny room, so it was unpleasant anywhere you sat, but especially unpleasant if I ended up sitting right next to her. So I'd actually scheme to figure out where she was going to sit so I could sit somewhere else.

I never entirely understood how a doctor who routinely treated patients with serious complications that were at least in part from smoking could still smoke. I felt sort of bad for her too, because that's surely what everyone else was thinking too. I guess nicotine is pretty addictive.

Saturday, April 2, 2011

A fascinating historical tidbit

Something I read in an article today:

You may or may not know that a "Hangman's Fracture", referring to a bilateral pedicle fracture of the C2 vertebrae, is thusly named because it commonly resulted when prisoners were hanged.

Most people who were hanged didn't suffer much damage to their spinal cord, because the neural canal is quite wide at this level. Most of them choked to death. However, if a hanging was done properly, a so-called "good hanging", then the spinal cord was severed and this was the means of death rather than strangulation.

So how do you (the executioner) know if you've achieved a "good hanging"? If the spinal cord was severed, the sympathetic tracts going down to the lower body would be severed as well, leaving only the parasympathetic system. For those of you who don't remember the autonomic nervous system, sympathetic is "fight or flight" (dilates your eyes, makes your heart race) and parasympathetic is "rest and recuperation." One of the things that the parasympathetic system does is the male erection.

Therefore, if a male prisoner's spinal cord was severed, leaving only the parasympathetic in charge, he would develop an erection as he died. That's how you knew the man was "well hung".