Tuesday, August 30, 2011


Today I came across this article about how the people who eat the most chocolate on a regular basis reduce their relative risk for heart disease by one-third.

Now I am really picky about my chocolate. I don't like dark chocolate. I don't like milk chocolate in bar form. I don't like chocolate chips. I don't like chocolate ice cream. I do like brownies and chocolate cake as long as it's not too rich or decadent.

But now clearly I need to increase my chocolate intake. I need to have a chocolate bar with every meal. And chocolate milk as my drink. Then a chocolate cake for dessert. Then I need to buy an Oompa Loompa.


"...the studies reviewed in this report were observational -- that is, they looked at data based on what people ate. Clinical trials, where chocolate is pitted against a placebo, are needed to see if the effect of chocolate is real, Fonarow said."

I am honestly curious about how they're going to do a trial of chocolate vs. a placebo. And if so, I really, really wouldn't want to be one of the people eating the sham chocolate.

Monday, August 29, 2011

Patient Mix-ups

*Bonus points if you can figure out what this patient's medical problem actually was

Sunday, August 28, 2011

My experience with homebirth (i.e. how not to argue)

Back in May, I made a post on Mothers in Medicine about home vs. hospital birth. I have a few things to add to this, which may be controversial, so I will post here instead.

For starters, the reason I made the post in the first place was that a woman in an online pregnancy community that I'm part of posted some pro-homebirth propaganda. I didn't know how true the stats she gave were, but I hate obvious propaganda and it was hard for me to keep my mouth shut.

The thing is, I'm not an ob/gyn or a pediatrician. When I read this propaganda, I didn't know much about homebirth. All I knew was that when I rotated through L&D as a med student, I saw a few seemingly normal deliveries go south and it was a good thing the women were at a hospital. But I can't say I had a particularly strong opinion about homebirth aside from the fact that it was something I'd never do. It seemed like it was something that was probably okay for low risk women. But at the same time, I thought it was kind of insensitive to post propaganda scaring women into thinking that they were going to have a worse outcome with their hospital births, especially since many of them needed hospital births for medical reasons.

Like I said, I'm not an ob/gyn, pediatrician, midwife, doula, whatever. But I am a physician. I also did a research fellowship and have had multiple publications in peer-reviewed journals, so I've like to think I have some idea of how to interpret research. So when I get in a discussion with someone about homebirth, I can call bullshit on the following statement:

The fact that homebirth is safer is not even "controversial," as it is based on solid medical research.

That was said to me almost verbatim by more than one person. Let me tell you why this bothered me, in case it's not obvious:

1) No studies could be provided to me that in any way supported this. Every study I found myself showed the opposite.

2) Practically everything in medicine is controversial on some level. "Beta blockers should never be used in heart failure." "Oh wait, beta blockers are a good treatment for heart failure." To say that something that has never (and will never) be tested with a randomized trial isn't even controversial is just ridiculous. Especially when there are so many blogs arguing vehemently on both sides of the topic. Clearly it's a very controversial and emotional topic.

3) This statement was meant to imply that I could not argue further because the point I was arguing against was simply a fact, like the Earth being flat.

Before this argument, I had never heard of something called "birth trauma." I don't want to undermine the seriousness of birth trauma. But when every argument I made is shut down because it is triggering to people with birth trauma, that makes it hard to have a discussion. Especially if the other person refuses to stop making statements akin to "you will be butchered and raped in the hospital" around women about to give birth.

After participating in the most frustrating argument ever, in which I started even doubting my own name, I talked to a couple of the lovely women on MiM, who assured me that I wasn't crazy and that the official position of ACOG, based on what research is available, is that hospital birth is safer for both mom and baby.

I also discovered Dr. Amy's blog. I love this blog with all my heart. I wish I knew Dr. Amy so I could shake her hand. Every time I get irritated that a crunchy mom says that hospital birth will kill you, epidurals are the root of all evil, or vaccines/formula are poison, I read Dr. Amy's blog and her no-nonsense logic makes me smile. Pretty much any entry will do.

So that's the story of how I went from being pretty much neutral on the homebirth issue to being staunchly against it.

But the moral of the story isn't so much that I think homebirthing is a huge risk (although I do, sorry). Or that I'm going to go around telling random pregnant women not to have their babies at home (I won't). The moral of the story is something that has absolutely nothing to do with homebirth:

When you try to argue a point with someone, the goal is not to push them way to the opposite side.

Maybe this woman could have even convinced me that homebirth was a good option if she had:

1) Refrained from calling me names

2) Addressed my arguments instead of calling them all "triggers" or saying that the articles I cited had been refuted (and not saying where or how)

3) Provided me with actual links to articles instead of telling me they all got swallowed in some other comment she tried to write

Ultimately though, it was good because I learned a lot and discovered an awesome blog. (And had a non-traumatic hospital birth.)

Saturday, August 27, 2011

Weekly Whine: Typo Nazis

I find it kind of obnoxious when other people correct my spelling or grammar in the context of blog entries. I mean, it's a freaking blog. Usually I write the entry quickly and either proofread it quickly or not at all. So I don't find it helpful to have my typos pointed out, especially if it's obvious what I meant.

I find it even more obnoxious when someone acts like a typo was made out of stupidity rather than just typing carelessly. For example, when I was doing EMGs in residency, I made the mistake of calling the "median nerve" the "medial nerve" once in a written report.

Understand that like 90% of the EMGs we do are for carpal tunnel syndrome, so you can bet I know what the median nerve is and that it's not actually called the medial nerve. And my attending, who had been working with me for weeks on dozens of studies involving the median nerve, knew that I knew that. But I sure appreciate that he acted like I didn't.

Attending: "You know, there's no medial nerve. It's the median nerve."

Me: "Oh, did I write medial nerve?"

Attending: "Yes, I just thought I should let you know there's no medial nerve. It's the median nerve."

What an ass.

Friday, August 26, 2011

Tips for choosing an anatomy lab group

One of the most important decisions you will make in your first year of med school is who you pick for your anatomy lab group. I recommend including the following people:

1) Yourself: You must be a part of your own lab group. While this might be the person you’d most like to avoid, this one is pretty much a given. Sorry.

2) A funny person: While I’d recommend a person who is funny as in hilarious, any kind of funny is all right, such as funny looking or funny talking. Even funny as in strange can be okay, as long as they provide you with some kind of entertainment to break up the interminable hours of anatomy lab.

3) A hot person: Much like the Sirens in the Odyssey, a hot person will lure the professors and TAs to your table and get you out of lab much faster. Also, when you inevitably get drunk and bang your anatomy partner, at least you’ll have banged someone hot.

4) A smart person: You need someone to actually do the dissection, right? Anyone with glasses will probably do.

People you want to avoid having in your lab group:

--Anyone who uses the phrase “I’m not here to make friends.”
--Anyone who smells worse than your cadaver.
--Anyone who refuses to give the cadaver a hilarious nickname.
--Future dermatologists

Wednesday, August 24, 2011

Are you smarter than a med student?

Since every allopathic med student in this country must pass Step 1 in order to advance in their medical training, it stands to reason that the information tested on this exam must be somehow useful for being a doctor. Today I'd like to test that hypothesis by taking a few sample Step 1 questions I found online.

Believe it or not, I actually got a very respectable score on Step 1. I won't divulge my score, but it was good enough to warrant an email of congratulations from our dean, who also referred to it as a "respectable" score. So since I could do the questions back then, if the information were actually useful, it seems like I should be able to do the questions now... right?

OK, here we go, starting with biochem:

How many ATP are required to transform pyruvate into glucose?

A. 5
B. 6
C. 7
D. 8


OK, no idea about that one. But biochemistry wasn't my best subject. I was really good at anatomy. Let's try anatomy:

Which of the following is not a muscle identified in the rotator cuff?

A. Teres Major
B. Teres Minor
C. Infraspinatus
D. Supraspinatus

YES! I totally know this one. It's A. But then again, as a physiatrist, I damn well better know what makes up the rotator cuff.

All right, let's try physiology:

Which of the following is not an anterior pituitary gland secretion?

C. Vasopressin
D. Prolactin


Physiology isn't really all that practical though. Let's try microbiology:

Which of the following is the most important structure related to microbial attachment to cells?

A. Flagellum
B. Plasmid
C. Peptidoglycan
D. Glycocalix


All right, one more:

What cell type secrets surfactant?

A. Plasma cell
B. Type I alveolar cell
C. Type II alveolar cell
D. Type III alveolar cell

All right, enough of this.

My name is Dr. Fizzy and I am NOT smarter than a med student.

(Questions obtained from Test Prep Review)

Tuesday, August 23, 2011

Tales from Residency: ADD

I had one attending in residency who was very nice, but was also as distractible as my 2 year old child. It was literally like being supervised by a 2 year old.

One day I was doing EMGs in the afternoon, and he was over 40 minutes late getting back from lunch. I didn't know how to work his EMG machine that well so I was a little stuck. When he finally got back, I ran to his office, practically in tears: "I can't figure out how to enter the patient in the computer and he's been waiting there for half an hour!"

"Okay, I'll come help you right now," the attending said.

We started walking down the hallway to the EMG room, but then one of the other residents named Doug passed by us.

"Oh, was that Doug?" the attending asked me. "I need to tell him something really important."

"Uh, sure..."

The attending hurried down the hallway in the opposite direction after Doug. "Doug!" the attending said. "I was reading something you would be interested in."

"What?" Doug asked.

"In Korea," he said, "they made a new kind of machine that helps you tell apart genuine laughter from fake laughter. Isn't that interesting?" (Doug is Korean.)

I take it back. I think my daughter actually was LESS distractible than this attending.

Monday, August 22, 2011

My Pathology Final Exam

At the end of my first year of med student, we took a class called Pathology. I can't even say exactly what we learned in that class, but we spent a lot of time identifying organs and trying to determine if the white spot on the organ was due to ischemia or a tumor. I was correct about the white spot almost 50% of the time.

The practical portion of the pathology final exam was a multiple choice exam where we had to identify a bunch of organs and figure out what was wrong with them. It was a little like looking at an abstract art exhibit in that I had no freaking clue what anything was. I probably could have bubbled in the answers before walking into the room and gotten the same score.

The only saving grace was that I could tell from the blank (and terrified) looks on my classmates' faces that everyone was equally clueless.

At the end of the practical, there was an "extra credit" question. I remember looking at the organ and having absolutely zero idea what part of the body I was looking at, much less being able to hazzard a guess what was wrong with it. I remember exchanging baffled looks with the other students at the station with me and finally we all started snickering. "Good thing we have this extra credit," someone commented.

I attempted to find a photo online of that particular organ and I did find one that's a pretty good likeness. It's the wrong pathology, but I think it illustrates my point:

Yeah, what the hell is that thing?

Sunday, August 21, 2011


So in December of 2010, I submitted a study I wrote to a journal.

In August of 2011, the study was finally accepted for publication.

When will it be published? Their estimation is 2013.


Guest Cartoon:Prison

Cartoon contributed by Sydney Meurer at surgicaltechnologist.net

Saturday, August 20, 2011

Weekly Whine:Teen Idols are UGLY

Is it just me or are the male teen idols these days nowhere near as attractive as they used to be?

I accidentally saw a bit of that Disney TV show with the Jonas brothers recently. I know girls go crazy for the Jonas brothers, so I always assumed they were fairly hot. But when I saw the show, I was shocked. The Jonas brothers are NOT hot. They are the opposite of hot. They're totally dorky and not in a good way. I don't think Justin Bieber is particularly attractive either... at best, I think he could be a cute girl.

Am I out of touch? Are these guys actually wildly attractive in a way that my 30-something year old brain simply can't comprehend?

I really don't think so. I mean, hot is hot, right? I can find attractiveness in the teen idols of the past. For example, Paul McCartney was one of my mother's favorites:

He's cute, right? I'd like to give him a haircut, but he can totally pull that look off. And then there's a star from the 70s, like David Cassidy:

Again, desperately in need of a haircut, but I still think he's attractive. And moving into the 80s, we've got Kirk Cameron:

I could do without the mullet, but not bad, right? And then of course, from the 90s, when I was about the same age as the girls slobbering over the Jonas brothers, we've got Zack Morris from Saved By the Bell:

I know some girls preferred Slater, but Zack was always my favorite by a mile. I mean, what a cutie, right? Either way, Zack and Slater were two really hot guys.

And now compare with Nick Jonas:

I mean, seriously? Seriously?? Am I blind or something?

Friday, August 19, 2011

Most awesome 80 year old EVER

A few years ago, I did a consult on an 80 year old patient had a bleed in his head that was caused by a fall. I asked the son (who didn't speak perfect English) how his father had fallen.

Son: "It was one of those... those things you jump on..."
Me: "Huh?"
Son: "You know, for parties. You jump on it..."
Me: "A... trampoline?"
Son: "Yes, a trampoline."
Me: "Your father got hurt jumping on a trampoline??"

Thursday, August 18, 2011

Training with babies

When I was in med school, I had the following conversation with another student, who was studying medicine as a second career:

Classmate: "I still remember during Operation Desert Storm, my college roommate put up a sign on our window to protest."

Me: "I don't remember Operation Desert Storm very well. I was just in grade school then."

Classmate: "No, you weren't!" [thinks a minute] "Oh my god, you were! Oh god! That makes me feel so old!!!"

Of course, he was only in his late twenties, but I guess it's kind of weird to be 30-ish and training with students who are 22 and fresh out of college (like me). Personally, I think if situations were reversed, I would have been bothered by all the young whipper-snappers.

The average age in my class was 24, which was probably the median age as well. It definitely seemed like there was a disconnect between the students in their late 20s and the under 25 crowd. It seemed like the older students had their own group of friends. Although frankly, I thought we were the more mature ones, in many ways. I may not have known as much about the world as they did, but at least I never made obscene gestures with a banana during histology lab.

Wednesday, August 17, 2011

Let me eat!

I am the sort of person who gets super cranky if I don't eat when I'm hungry. I don't usually eat a lot in one sitting, so I'm sort of like a baby in that I need to eat more frequently. Usually by the time lunch rolls around, I'm really hungry and don't look kindly on things that keep me from eating.

While I was in residency, I had a clinic every Thursday morning that always, always ran late. Since the afternoon clinic started promptly at one, this was a source of major stress for me.

On one occasion, the Thursday clinic finished at about 12:45. I raced over to the cafeteria, got some lunch, and then raced back to clinic to eat. I figured bringing the food back to the clinic would give me a little more time to eat if the 1 o'clock patient was roomed late. Smart, right? Except not so much.

It was 12:55 and I just sat down to eat my lunch with a whopping five minutes to spare, when the nurse, who SAW me just bring my lunch into the resident room, came into the room bearing a chart.

"I know you just sat down to eat your food," she said, "but the one o'clock patient is here."

"OK, well, it's not one yet," I said. "I came back early. I shouldn't even be here now."

"Yes, but this patient came in a medical vehicle," she explained. "So if you don't see him right away, the vehicle is going to leave, and he'll have to call them to come back for him."

"The attending probably won't be back from lunch for another twenty or thirty minutes," I pointed out. "Plus the patient has a huge sore that we need to look at. This isn't going to be quick."

The nurse just stood there: "I know, but can you just see him now?"

"You know," I said, "even in prison, they're allowed to eat lunch."

(Yes, I really said that. And yes, I finished my lunch before seeing the patient.)

Anyway, as I was saying those words, I realized I had said something extremely profound. It's true. In prison, you're allowed to eat meals (of roughly the same quality as the cafeteria food, I suspect). As a resident, you're not. It was so profound and brilliant to me that I repeated that statement roughly half a dozen times over the next several weeks.

Also, I never again made the mistake of attempting to eat my lunch in the clinic.

Tuesday, August 16, 2011

Worst classes

Recently I was thinking about the worst classes I ever had to take during my schooling, which encompassed age 3 to age 25. On deep reflection, these are the five worst classes I've ever taken:

1) Med school Biochemistry: I actually didn't hate all of biochem, but there were portions of it that I hated with my very soul. Like metabolism. I really don't like memorizing pointless stuff and metabolism was the epitome of that.

2) History: I guess I should be more specific and say something like "AP American History" (and I could, because I really did hate AP American History), but I can't really remember any history classes I ever took that I didn't hate. I find history boring, and if that means I'm doomed to repeat it, then so be it. The best semester of high school was when instead of history, I got to take economics. And in college, I avoided it entirely. But you know what? Despite hating history, I'm glad I was forced to take it. Because if I hadn't, I never would have learned that stuff on my own, and knowing, for example, that Benjamin Franklin wasn't ever a President is the kind of stuff that occasionally makes you sound intelligent.

3) Alexander the Great: When I was in college, I had to take a class about Alexander the Great. No, that would have been too broad... it was actually about the art depicting Alexander the Great. I never knew what the hell to write about for the essays, and the final exam involved memorizing 200 slides. It was the kind of thing that I forced my brain to do, knowing it would expel the information an hour after the final. Except then the final got interrupted by a homeless guy who claimed he had a bomb and was going to kill us all. This actually happened.

4) High school biology: I know you're thinking, how could someone who hated biology so much end up going to med school? That sounds like a mistake. And you'd be right. Granted, I hated the plant biology most of all and I didn't become a botanist. I think part of the issue was that I was trying too hard, so I'd spend like two hours on the homework every night, and my only reward would be a check plus. And then I bombed my biology project because I refused to bring fruit flies home with me over spring break. Actually, the only science class that I enjoyed through all of high school and college was chemistry.

5) Expository writing in college: I was forced to take this class during the first semester of college. We were supposed to write essays about short stories, and despite the fact that I liked the short stories, I discovered that I really, really suck at expository writing. It was a rude awakening, especially after high school, when all you need to do to write a good essay is read the book and have good grammar.

Honorable mention goes to physiology, immunology, pulmonary... well, half of med school, basically.

Classes I liked: MATH

I also liked high school level English, Art (drawing not art history), and computer science. How does that equal "doctor"?

Monday, August 15, 2011

Are you a nerd??


<10: You are not a nerd. Except you sort of still are, since you're in med school.

11-25: You are a cool nerd. Like Harold and Kumar in Harold and Kumar Go to White Castle. Even though you're kind of nerdy, you can still get girls, get high, and make an epic journey to get those delicious tiny burgers.

26-40: You are an intellectual nerd. Other intellectual nerds include Al Gore or David Souter. You're super nerdy, but people still respect you enough to elect you Vice President of Neurology.

>40: You are an uber-nerd. Other uber-nerds include Mark Zuckerberg or those guys from Revenge of the Nerds. Although everyone always kind of made fun of you, not so much after you become the world's youngest billionaire.

Sunday, August 14, 2011

Weekly Whine: Breaking Leases

Back when I was just a little fourth year med student, my husband (then boyfriend) leased us a fairly pricey one bedroom apartment. It was a decent apartment in a nice area, and we weren't unhappy there.

However, the problem was: we signed a lease until the end of September. I was going to start residency in late June or early July and there were no residency programs in the area. All right, there was one program, but they wouldn't even interview me (snooty bastards). The next closest program was an hour's drive away.

Those of you who have been in internship know the problem. Being an hour's drive away from your hospital during internship is almost like a death sentence. At the end of a call, I could barely walk straight, much less weave my way through highway traffic.

So we talked to our landlady's son Gary about the situation around the Christmas holidays. (We never actually met our landlady, who lived in another city, but Gary was the go-to guy who managed all her properties.) Anyway, Gary said that if we wanted to get out of our lease early, it was no big deal and actually, it would be way easier for them to rent out the place at the beginning of the summer than at the end of the September, so we were kind of doing them a favor. Win win.

Fast forward to April:

We called Gary to remind him of our deal. He says he'll get back to us. We then get a phone call from the actual landlady, who we have never spoken to before in the seven months of having lived there. She outlined the following for us:

1) In all the many years she's been renting out apartments, nobody has ever left early on a lease.

2) We signed a contract in blood, so we better stick to it.

3) We are not allowed to sublet.

4) There was one couple once who tried to get out of lease early because the woman had a baby and there was no room for the baby in the apartment. And the landlady wouldn't let her out of the lease.

5) If we left early on this lease, we would never be able to rent an apartment ever again.

We really tried to negotiate. We offered to pay rent until they found someone new. We offered to pay half the remaining rent whether or not they found someone new. Anything to avoid paying a steep rent on a place we had moved out of months ago. But nothing was acceptable to them. Her other son finally got on the phone and told me, "If you get to leave, you'll be the first ones ever." (Just before that, he informed me I was "killing" his mother.)

Things got a little adversarial at that point. I started taking photos of things in the apartment and in the building that were unacceptable or dangerous and mailed the photos out with a letter detailing our complaints. They sent us back a letter that I thought admitted a little too much. Like you probably shouldn't write: "That live wiring covered in cobwebs that you photographed is too high up on the wall to be dangerous."

My husband got an email from someone at his school asking if anyone had a sublet available. Despite what it said in our lease, we decided to show them the apartment. Literally five minutes after the potential subletters left our place, we got a call from Gary saying, "You're not allowed to show the apartment to subletters." I was beyond creeped out.

At that point, I didn't care about the money or whatever trouble we'd be in. I just wanted out of that apartment. I didn't feel comfortable living there anymore.

We found a new apartment about five minutes away from my hospital. We rented a truck and quickly moved our stuff out on June 1. We cleaned the apartment, didn't give them any more rent money, and they kept our deposit. We were scared for a while of getting dragged to small claims court or something, but we never heard from them again.

The reason I write about this now is that I was talking to a friend who has a house in another state that she was renting out to a tenant. The tenant stopped paying the rent and continued living there. It took months for my friend to evict them. And even after evicting them, the law stated that she would have to pay herself for their belongings to be stored!

It just made me realize how much the law protects tenants and all that worry and aggravation was over nothing. In order to even attempt to get any money from us, they would have had to prove they attempted to rent out the apartment. And we could have countersued to get our deposit back. (And as my husband pointed out, then the crazy landlady would have been forced to make a court appearance.)

Of course, I was spooked enough by the whole thing not to write anything about it until I was sure the statute of limitations was up on the whole thing.

Saturday, August 13, 2011

My can opener

A woman who identified herself to my husband as "a neighbor living right next door" (very possible, since we don't know our neighbors) came by this morning to borrow a can opener. My husband handed it over and she said she'd bring it back. He didn't ask her which apartment she lived in.

It is now several hours later and the can opener has not been returned.

Do you think we will ever get it back?

I don't.

British speak

I've been reading a lot of British chick lit lately and I have to say, I really love the way those people talk. A few of my favorite British terms:

--Brilliant: Meaning something that's really great. Now I finally understand why Simon Cowell kept saying performances on Idol were "brilliant" because I really didn't think any of them were that smart.

--Chucked: Sounds so much better saying that your boyfriend chucked you than that you got dumped


--Mobile: Meaning your cell phone. You don't call someone's cell, you dial their mobile.

--Flat: This sounds like a really swank apartment, but I guess it's just a regular apartment.

--Tart: I think this is the equivalent of hussy. And they also say "tarted up," which I think is cute.



--Takeaway: Meaning takeout. Especially takeaway curry.

--Shattered: I think this means tired.

--Fancy: I fancy you.

Why couldn't I be British? I'd be so brilliant at it.

Friday, August 12, 2011

Guest Cartoon: Consanguinity

Contributed by Dr. Wonderland

The 3 A's

I was recently reading a post from Dr. Amy that reminded me of the well known saying that patients judge doctors by the three A's:


In that order.

That is so true. In the outpatient rehab clinic in my residency, there were two physicians who were basically beloved by all their patients. They were intelligent, but they hardly had an encyclopic knowledge base.... but the patients adored them because they were just SO NICE.

One of those attendings wasn't particularly charismatic or outgoing. In fact, he was downright nerdy. But he was still loved by his patients (and me), because he was a total sweetheart.

That inspires me as a physician. Because I'm not charismatic and I don't think I ever can be. You can't learn charisma. And as a new attending, my knowledge base is probably less than encyclopedic. But I can certainly be nice.

Thursday, August 11, 2011

Tales from Intern Year: More ER Stories

2000: I arrive at the hospital. The waiting room is so ridiculously crowded that some patients are forced to sit on each other's laps. Luckily, we're understaffed tonight.

2010: I'm assigned an OD patient. I'm supposed to do checks on her every 20 minutes. I do one and subsequently forget for the rest of the night. Eh, she's got nurses.

2030: I see a patient who is here for "rectal abscess", although she's placed in the hallway so I don't know how I'm supposed to look at it. It doesn't really matter though, because when I speak with this lady, she's clearly floridly psychotic. She keeps telling me she needs a penicillin shot for pneumonia. That was pretty much all I could understand, because she talked like Golem on meth.

I went back to my attending: "This woman is crazy. I can't understand a word she's saying."

Fortunately, after making her wait another hour, she left.

2050: Suicide attempt patient. Surprisingly, it wasn't me.

2120: I "get to" sew up the palm of this 15 year old kid who got his hand stabbed in a knife fight. I never want to sew up a palm again. It just wouldn't get numb and the skin kept breaking. Plus the kid was a complete wuss, considering he had just been in a knife fight. And his girlfriend kept leaning into my sterile field to see how I was fucking up. And his girlfriend looked about eight.

"Aw, is that your little sister?"

"Naw, that's my woman."


I sort of got it to stay together though. The attending looked at my work and thought it looked OK, but said I would have been better off using a mattress stitch. I was like, "I don't know how to do a mattress stitch... I'm a freakin medicine intern. I'm lucky I can do this at all."

Me: "So what was worse: getting stabbed or when I sewed it up?"

Pt: [no hesitation] "Getting sewed up."

2200: I slam my right ring finger in the bathroom door. For about two minutes, all I can do is hold my finger and mouth the word "Ow" over and over. Will I get back into the trenches despite my injury? Do I have a choice?

2230: Woman comes in smelling so strongly of alcohol, I feel like I'm getting drunk just talking to her. If only.

2300: I run into my arch-nemesis Jessica in the hallway, who I have discovered I have to spend my first ICU week with. I do the hardest thing I've had to do all night, which is I flash her a small, friendly smile. God, I hate her.

2330: If you really want to make a little kid scream, all you have to do is pull out a tongue depressor. I don't know why, but those things freak them out.

0010: My awesome attending brings in a guy with a forearm laceration just because she knows I want practice with the lacs. She doesn't realize I've gotten all jaded from the last lac. Fortunately, this is a nice straight cut and it goes swimmingly.

0030: One of the university hospital interns David gets snooty with me (again). He's decided to do his own blood draw, for reasons that completely escape me, and he's asking me where the tubes are and I don't know because no other doctors draw their own freakin blood. I don't know what is up with these university guys... they're all really cute and they're all really arrogant. There is nothing worse than a cute, arrogant male doctor. I wanted to smack David upside the head when he started lecturing me on the correct INR for a person with a valve replacement. I didn't, but next time I will. Watch out, David.

0100: Little boy with cerebral palsy having serial casting had cast placed today and it's too tight and needs to be removed. The attending saws it off, saying every five minutes: "I hate doing this" or "I almost never saw off casts" or my personal favorite, "I don't know what I'm doing."

0200: Patient in stretcher in hallway with no legs tries to get my attention:

Pt: "Nurse! Nurse! NURSE!"

[I ignore all cries of "nurse"]

Pt (looking right at me): "Are you a nurse?"

Me: "No."

Pt: "Do you work here?"

Me: "Yes."

Pt: "Can I have some Klonopin?"

0245: Guy with history of neck cancer comes in because he had dental surgery three days ago and ever since, that side of his face is really swollen and painful. The attending nearly gives him a heart attack when she tells him she thinks his obvious tooth infection may be a recurrence of the cancer. (We do a CT and it's negative.)

0300: Girl on suicide watch makes a break for it. I hear the door to the ED slam, a nurse yells "Shit!" and runs out after her. She's retrieved.

0330: I decide to take a break. Because I missed the food cart, I go upstairs and steal some crappy cookies from the on-call teams.

0400: Post-menopausal woman with vaginal bleeding. She's got every possible risk factor for endometrial cancer, like she got the textbook and was just reading it to me. I wish every patient were this easy: refer to GYN.

0440: "Do I really have to do a rectal exam on the demented nursing home patient in room 4?"

0500: I've got 2 hours left. Now the game is: how few patients can I get away with seeing in the next 2 hours?

0510: I see a 30 y.o. woman with symptoms of ovarian cyst, history of ovarian cysts, but for some reason, her mom thought she had appendicitis and got her all anxious. While I'm taking her history, I find out that she just started smoking three weeks ago. Because I'm in no hurry, I launch into a little lecture I call, "Smoking causes more than just lung cancer." She's nodding and saying that she'll try to quit.
Then I ask about drug history. She smokes crystal meth daily and apparently traded it for cigarettes 3 weeks ago. I suddenly feel really stupid for the cigarette lecture.

0530: I get out the ultrasound machine and attempt to visualize this alleged ovarian cyst. I've gotten to the point where I can turn the US machine on REALLY well, but that's about it.

Pt: (looking at screen) Oooh, is that my ovary?"

Me: "Uh........ yes."

Pt: "Does it look like there are cysts there?"

Me: "Uh.......... you know what? I don't really know how to use this machine."

A rare honest moment.

The attending comes in and does a really good US, rupturing the cyst in the process, causing the woman to have 10/10 excruciating pain. Go diagnostic medicine!

0550: IM morphine SUCKS. I am never giving it to anyone again. The shot hurts and it doesn't appear to relieve anyone's pain at all.

0600: Little girl with history of sore throat now have blood in her urine and puffy face. Oh fuck, is this glomerulonephritis? I've never seen that before and I know it has a really good prognosis, but I'd really rather not tell this woman I think her daughter might be in acute renal failure.

Mom: "So what do you think is wrong with her?"

Me: "Um.... it could be... a urinary tract infection."

Mom: "Oh, so--" [I've already run out of the room and am walking down the hall]

0650: The next shift begins to filter into the hospital.

Attending: "Well, it looks like we made it."

Wednesday, August 10, 2011

Bad Roommates (part 3)

So I've been writing about ways prior roommates have pissed me off, but this is one where I was 100% guilty and still feel kind of bad about it...

In college, I had a single during my junior year, but we had a locked hallway and I shared a bathroom with three other girls who I didn't really know. These girls were all orthodox Jewish and so on the sabbath, they weren't allowed to do things like turn lights on and off. So they asked that on Friday evening and Saturday morning, I leave the light in the bathroom on.

I never ever did it.

Not purposely. It's just this automatic thing where I always shut the lights off when leaving a bathroom. It was a really hard habit to break.

So I'd often pass by the bathroom on Friday night and see one of my hallmates using the bathroom with the light out. I'd feel so bad!

Tuesday, August 9, 2011

Tales from Residency: IVs

There was a rotation in residency where I did epidural injections under fluoroscopy every Friday. On my first day, the resident who was doing them the block before me was explaining to me and another resident what to do.

Resident: "So you take the patient into the examining room...."

Me: "Examining room... got it..."

Resident: "Have them sign the consent form..."

Me: "Consent form... okay..."

Resident: "Then you go ahead and get an IV started...."

Me: "You're kidding."

Resident: "What?"

Me: "Um, I don't know how to start an IV."

Other resident in room: "Me either."

Resident: "Well, you can give it a try."

Me: "Seriously, I've done it like, once. I could maybe draw blood if I had to, but there's no way I can start an IV."

Resident: "Actually, I don't really know how to do it either."

How many residents does it take to start an IV? Clearly more than 3.

I know it seems like residents should be able to start IVs, but there's really never any reason to do it when there's ancillary staff around. Nurses draw blood, insert Foleys, and start IVs. I just write, "Start IV." I'm really good at that part.

In fact, if I wanted to get good at IVs, it would have taken a lot of effort on my part. I would have had to show up early for surgeries or stalk nurses or something. So I didn't do that. And up until that day, it had never ever been a problem.

Monday, August 8, 2011


For years, whenever I heard anything about scoliosis, I thought about Deenie. Deenie is a book by Judy Blume about a beautiful 13 year old girl who is trying for a modeling career until it's discovered that she has scoliosis. As a result of this curvature of her spine, she must wear a Milwaukee brace going down from her neck to her hips for the rest of high school. This pretty much kills her modeling aspirations. Suddenly, she goes from being the prettiest girl in school to being given permission to take the bus for disabled kids.

This book definitely served to fill me with fear as a child. Every time the pediatrician told me to bend down and touch my toes, I knew what they were looking for. It was terrifying. I didn't want to end up like Deenie. Luckily, I did not have scoliosis and my modeling aspirations were realized. (Not really.)

Anyway, when I was rotating in pediatric orthopedics, we had a 13 year old female patient in our clinic who was absolutely gorgeous. She was so beautiful that the attending felt a need to comment on her looks no less than three times while we were in the room, and once straddled her in a way that was borderline inappropriate to demonstrate her scoliosis to her parents. And she knew she was hot. I could tell by the way she flipped her hair back after she stood up from touching her toes.

You couldn't tell from a few feet away, but she had a 35 degree scoliosis, which is pretty significant. It calls for bracing, especially in a female, where the curve is likely to progress.

But instead of being offered the life-ruining Milwaukee brace, she was given two different options. One was a Boston brace which she could wear 20 hours per day, taking it off only for some sports activities. The other was a Charleston brace, which she could wear just at night, while she slept. The attending said that most girls opted for the night brace.

Both the Boston and the Charleston braces are TLSO's, which only go up to the thoracic spine. The Milwaukee brace is a CTLSO, which goes all the way up to the cervical spine (neck). I had read that the Milwaukee is indicated for curvature at above the T8 level, which our patient's scoliosis most certainly was. So why wasn't she prescribed the Milwaukee?

My attending's answer: "Have you SEEN the Milwaukee brace??"

So apparently, in this day and age, they don't force hot teenager girls to wear cumbersome, life-ruining braces. Too bad Deenie wasn't 13 in the 21st century.

Saturday, August 6, 2011

Weekly Whine: Tips

It always bugs me when places that are self-serve have a place on the receipt for tips. It makes me feel guilty to write in $0, but at the same time, what would I be tipping for exactly? How am I supposed to judge this performance? That they successfully took my order? I already paid for my food. If I'm carrying the food to my table and carrying it to the garbage and getting my own drink from the fountain, I feel like I shouldn't have to tip. Or if it's a takeout order that I am picking up myself, what is the tip for then?

I guess there are some places where the receipts just come like that, with an space for a tip, and they don't expect anyone to actually tip. But yesterday, I was in a restaurant and at the cashier, there was both a place for tips on the receipt as well as a tip jar. So they clearly expected people to tip.

Except you picked up your order at the other side of the restaurant. So basically, you were expected to tip without having even received your food. My understanding is that tips are supposed to at least partially be based on service.... so how am I supposed to judge what tip to give when all they have done is take down my order? I didn't know at that point that they were going to fail to get me the exta plate I wanted or the butter I asked for. This makes a total mockery of meritocracy-based tipping! If we're supposed to tip based on nothing, then why not just increase the price of the food?

But like I said, I always feel like a total miser when I don't tip in those situations. What do you do?

Friday, August 5, 2011

Tales from Intern Year: The Eye Roll Test

When I was an intern, we had a lecture about methods of smoking cessation. One of the interns was an ex-smoker and tried hypnotism to quit. She started talking about hypnotism and she said that it doesn't work for everybody. The way you determine who it won't work for is something called the "Eye Rolling Test".

I swear to god, I thought the test was going to be that if you rolled your eyes at the idea of hypnosis, you couldn't be hypnotized. Which let me out.

Apparently, the test is that you have the person look skyward and record how much of their iris and cornea are visible. The more of the whites of their eyes you can see, the easier they are to hypnotize. She tried it on me and said that I was a 3, which is the cut-off for someone who might be hypnotizable.

Thursday, August 4, 2011

How to convert your PPD

A story I heard from an attending physician:

Back when he was an intern, there was an ICU nurse who began having fevers, weight loss, and was coughing up blood. Being a nurse, she diagnosed herself with lung cancer. Since there was no effective cure, she decided not to seek medical attention and continued to work at her job until the end of her life, which she assumed would be imminent. About six months later, she died as expected.

Shortly after her death, my attending (then an intern) received a letter that explained that an ICU nurse had recently died of disseminated tuberculosis and they were contacting everyone who had worked with her to tell them to get a PPD. Apparently, she had misdiagnosed herself. Not only did she have a disease that was treatable and her life could have been saved, but she also managed to spread TB germs to all the really sick ICU patients she worked with.

"... and that's how I converted my PPD."

Wednesday, August 3, 2011


I remember on my first day of third year of med school, I was completely stumped by the signout sheet I was handed:

68 y/o m c h/o ESRD on HD s/p cabg x 3....

I was like, "68 what what what what what on what what what?"

I basically had to have the sub-intern translate the entire thing for me word by word.

Eventually, I got to know the medicine abbreviations. Except then when I went to PM&R, there was a whole new set of abbreviations to learn. I'm guessing you're all familiar with the medicine abbreviations, but I'm curious how well my audience knows the standard rehab abbreviations. Here's a sample of ones I use very commonly, try your luck:

1. STE
2. HEP
3. FWW
4. BKA
5. ITB
6. SAH
7. ICP (I use this for two things)
8. BTP
9. AFO
10. LBP
11. ESI
12. WBAT
13. SCI
14. SLP
15. FIM
16. NCS
17. PVR
18. TTWB
19. TKA
20. SPC (I also use this for two things)

Tuesday, August 2, 2011

Dr. Goldilocks and the Three Patients with A-Fib

Once upon a time, there was a little doctor named Dr. Goldilocks. One beautiful summer day, she went for a walk in the hospital. Pretty soon, she came upon the rehabilitation unit. Her pager went off and she ventured inside.

At the entrance to the unit, there were three rooms, each with a patient inside. Dr. Goldilocks found her sign-out and discovered that each of these patients had atrial fibrillation and was being anti-coagulated with coumadin.

She checked the INR on the first patient. It was 1.6.

"This INR is too low!" she exclaimed.

So, she checked the INR on the second patient. It was 3.9.

"This INR is too high!" she cried.

She skipped off to the final room and checked the INR on her last patient. It was 2.1.

"Ahhh, this INR is just right," Dr. Goldilocks said happily and she curled up in a corner and fell fast asleep.