P.S.A.

I'd just like to call everyone's attention to my new sidebar element: Currently Reading.

I'm going to update this with whatever book I'm reading right now. So if you've read the book and like it, you can be like, "OMG, that's such a good book!" And I'll be like, "I know, right?" Or maybe, "What are you talking about? This book sucks. Your taste in books is total crap."

It will be awesome.

What to do if you're sick

Women stronger than men?

On my travels on the internet recently, I came across an article about how men may have a weaker immune response which is why they're bigger babies when they get sick.

I can't say that's true in this household. I think these days, I get sick more than anyone, certainly more than my husband. And I don't get rid of it fast. When my daughter first started daycare, I came down with every bug known to man. I had to be on antibiotics for something called tracheitis (my trachea hurt).

I do think I have a fairly high pain threshold though, as evidenced by the fact that on multiple occasions, I've voluntarily gotten hairs ripped out of my skin with hot wax. I also stayed at work for about five hours while having labor contractions, so there's that.

What's in a (first) name?

Yesterday I was talking to a very nice physical therapist at work named Elaine. Elaine is around my age, and I noticed that she was calling me "Dr. McFizz." This seemed a little weird because I call her by her first name and I basically consider us equals.

"Hey," I said to her. "You don't have to call me Dr. McFizz. You can just call me Fizzy."

Elaine laughed. "A few of the doctors have said that to me, but I'll be honest, I just can't do it."

I looked at her in surprise and she added, "You should take it as a compliment. It's a sign of respect."

I'm glad we had this exchange because now I've confirmed that I'm wasting my time telling people to call me Fizzy. I suppose I understand this, although I'm not sure how to feel about it. When I was in residency, there were attendings who used to say something like "Hey, it's Mike" when I'd return their pages, but I just couldn't call them by their first names. I just couldn't.

Annoying med student stories

When I was a resident, I had a med student named Gloria who had this thing she did where she tried to guess where people were from. I saw her do it no less than three times per day. She did it to everyone and they LOVED it, especially when she was right.

Especially men.

Medicine Attending: "Hi, I'm Dr. K."

Gloria: "Is that Israeli?"

Attending: "Why, yes it is!"

Me: "So, um, my patient's lungs are drowning... how much--"

Gloria: "You know, I went to Israel last year."

Attending: "Really? Will you marry me?"

I remember one day an intern came by from surgery. He was totally adorable and nice in a way that only an intern in his first week of residency could possibly be. And he had this thick Southern drawl.

Gloria: "Are you from Georgia?"

Intern: [drawls] "No, I'm from North Carolina."

Gloria: [disappointed] "Oh."

Intern: [drawls] "Georgia is the deep South. If I went to Georgia, they wouldn't even think I had a Southern accent. They'd be like, 'Are you from Connecticut?'"

For some reason, I thought that was hilarious.

Then when we were talking to some therapists, Gloria randomly says to one of them, "Are you an Aries?"

Therapist: [surprised] "Yes, I am!"

Gloria said that this therapist reminded her of all the Aries she knew. She told me she wouldn't date Pisces anymore because her ex-husband was a Pisces. Then I had to pretend like I didn't think that astrology is the dumbest thing in the universe. I'm a Leo though and we're skeptics. (Actually, I just made that up.)

The Fly

My mother has the weirdest strategy ever for killing flies.

What she does is she heats up some water to boiling, then tries to scald the fly by hurling the water at it. She claims this works really well. Except somehow last night, it all went wrong.

Apparently while throwing the boiling water at the fly, she instead hit the remote control, completely destroying it. She had to order a new remote.

And to add insult to injury, the fly survived the scalding and was seen in the living room today. Now my mother is trying to lure it into an ice cream trap, and I strongly suspect this second venture will also be unsuccessful.

First job not what you thought?

I just received an email from a recruiter that said the following:

Dr. Fizzy,

The promises made to you during your initial recruitment aren't quite coming to fruition. The call schedule is way more severe than you thought. The productivity incentive bonus you thought you were going to get didn't really amount to much or didn't appear at all. The type of practice you do on a daily basis isn't what you were told and isn't what you went to medical school for. You took the position out of training because you were nearing graduation and it sounded decent at the time. Does this sound familiar?


To be honest, not really. But ending up with a horrible job was one of my big fears. Horrible meaning Internship 2. I had been waiting through my entire residency to spend more time with my daughter, so the last thing I wanted was some nightmare job to take me away from her.

One of my first job interviews was for an academic attending position at a large rehab facility. Through the entire interview, I got this bad vibe that was making me almost ill. I remember the following exchange:

Me: "Do the attendings come in to round on weekends?"

Interviewer: "No, but we're trying to start that up."

Okayyyy......

I talked to an attending at my program who had been a resident there, and he told me that my bad vibe had been correct. The job was open because nobody wanted it.

I wonder how many people end up in truly horrible jobs because they were duped during the interview process?

Weekly Whine: Baby Shower

When I was pregnant, I never had a baby shower. Am I bitter? A little. But that's what happens when you just moved a thousand miles away from your friends and family. Also, I don't have a sister. Maybe if I had a sister, I would have gotten a baby shower.

As I said, there were times when I felt bad about it. When I was seven months pregnant, a baby shower was thrown during our Team Meeting for an OT who was six months pregnant. It made me feel a tad awkward, but I told myself that she had worked there for several years and knew everyone much better than I did, so it made sense.

This, however, was unacceptable to me:

I got pregnant during my PGY2 year. And like I said, no baby shower. Then during my PGY3 year, another girl in my class, let's call her Miranda, got pregnant.

When she was about 5-6 months pregnant, Miranda was working with a female attending named Dr. Green. Coincidentally, I also was working with Dr. Green at that same time during my pregnancy. Anyway, Dr. Green took a PGY2 named Rita aside and told her that she wanted to plan a baby shower for Miranda for all the attendings and residents to go to. Rita then told me about this and asked if I wanted to be involved with the planning.

I. Was. Livid.

First, I was angry because Dr. Green thought to plan a shower for Miranda and not me. Second, Miranda had tons of family in the area and I'm positive she already had a shower being thrown for her. Third, Miranda was not well-liked by the other residents because she had a reputation for calling in sick a lot on Fridays.

I told Rita that I refused to attend the baby shower. I wasn't going to take Miranda out to dinner and I wasn't going to buy her a present, because nobody did any of those things for me when I was in the exact same situation a year earlier. Rita asked me to reconsider and I again refused. I personally had nothing against Miranda, but it was a matter of principle. I would have felt humiliated attending that baby shower.

Anyway, the next time Dr. Green called Rita over to plan the shower and asked her what she thought they should do, Rita replied, "I don't know. What did you do for Fizzy's shower?"

And that ended the plans for Miranda's baby shower.

My issues

I consider myself to be the kind of person who is fairly accepting of other people's points of view. I get that everyone doesn't think exactly the same way I do and I'm okay with that. I don't care if you want to sleep with all five of your children in bed with you, breastfeed till they're 18. I don't care if you voted for Obama, McCain, a chimpanzee, or whatever.

That said, there are a few issues I do feel really passionately about:

1) Vaccination. If you don't vaccinate your kids, you're selfish. You're worried about taking a risk with your precious babies, but the only reason your kids have a chance of escaping horrible disease is because the rest of us comply with vaccinations.

2) Homebirth. I've decided not to argue about this anymore because it's too frustrating, but suffice to say, I can't believe anyone would take that kind of risk with their baby.

3) Gay marriage. It's mind boggling to me that anyone would want to deny rights to two human beings who love each other. I hope one day people look back on this and wonder how people were so intolerant.

4) "Abortion." I can honestly understand why someone would be morally against abortion, especially late term, so that's not something I have a problem with. I put "abortion" in quotes because what I have a problem with is people who are against abortion in cases where it's medically necessary to save the life of the mother. Or against birth control or Plan B. Or against aborting a fetus that is essentially dead, like one with anencephaly.

So yes, I'm pretty judgmental about people who disagree with me on the above issues. But then again, everyone is judgmental about some things, right?

A conversation from med school

Me: "What are you on?" (the prototypical third year question)

Friend: "Psych."

Me: "Nice."

Friend: "So I had this one patient... she was thin with red hair..."

Me: "Yeah...?"

Friend: "She was also very artistic. She was always drawing."

Me: "Uh huh..."

Friend: "She was very open about telling us about the voices in her head and stuff. She was really good at explaining it to us. She was really cool."

Me: "Really..."

Friend: "Yeah, so."

Me: "Is that the whole story?"

Friend: "No, no. I mean, the thing was, this girl really reminded me of someone, like in her looks, her attitude, her everything."

Me: "Really? Who?"

Friend: "You."

Me: "Whoa."

Friend: "Like she told us the voices she heard would always comment on what she was doing. So say she was drawing a picture, the voices would tell her, 'Nice picture.' I can totally see you saying something like that. If you heard voices, that is."

Me: "Hey, how old was this girl?"

Friend: "She was twenty."

Me: "OK, good, I'm older than her. I'd just like to confirm I'm not heading in that direction."

Apple pie

I done made a pie:

Unfortunately, by the time you read this, the pie will have been consumed.

Tales From Residency: Trying to sleep

One night during my residency, I was on home call and ending up having a busy night at the hospital. By the time I was done taking care of my patients, it was 3AM and I had to round at 7AM the next morning. So I figured there was no point in going home. (Ah, the joys of home call.)

I asked a nurse if I could sleep in an empty patient's room, since the ward wasn't that full. I figured I could get in about four hours and feel at least somewhat rested. I thought maybe I'd even sleep better at the hospital, since there was no baby.

Uh, wrong.

First off, I had one of those pressure-control beds. So every time I shifted, the mattress would whir to life and start inflating in different areas. Very distracting. I finally had to look for the controls and shut the damn thing off.

Then I noticed there was this loud rhythmic noise in the room, like a dripping noise. I tried to sleep through it, but I couldn't. I got some toilet paper from the bathroom and stuffed my ears and put the blanket over my head, but no luck.

Finally, I went to investigate the noise. I went over to the sink to see if it was leaking. It wasn't. But I noticed there was a large clock on the wall over the sink that was ticking. I grabbed a chair and pulled the clock off the wall, hoping to find an "off" switch. No off switch, but I managed to yank out the battery.

I expected quiet after that, but lo and behold, there was a SECOND clock in the room! I had to deactivate that one as well. Finally, silence!

Except for this damn bird that kept chirping right outside the window. I almost felt like someone was playing a joke on me, putting me in this room.

Luckily, I had another patient code at about 5AM, so I had to get up again anyway.

Killing patients

I have never killed a patient.

I've had patients die on me many, many times, but I've never been involved in a situation where I felt that I did something (or didn't do something) that caused premature death. Every time I cross covered the hospital as an intern, I would pray to get through the night without harming anyone. I know a lot of doctors who haven't been so lucky though. Recently, another doctor was telling me about how in residency he gave a little old lady 2 mg of Ativan and she never woke up, and he felt guilty about it all the time.

They say that there are 2 kinds of doctors: those who have killed a patient and those who will kill a patient. (I think I heard that on Scrubs.)

I'm hoping that as a physiatrist, it won't happen to me. Now that residency is over, I actively try to avoid situations where I could end up being responsible for a death. Yet another reason why I couldn't have become an OB/GYN: how could you deliver a dead baby (inevitable) and not blame yourself for the rest of your life?

I've heard a lot of stories of doctors who felt responsible for the death of a patient and subsequently ended their career. When I did pediatrics, I heard about an attending who missed a case of appendicitis and the child died. The pediatrician quit medicine, even though the mother didn't blame him and continued sending her other kids to the practice.

It's a hard job. Please don't tell us we're overpaid.

Pressure ulcer dressing options

Back in residency, one of my patients has a pressure ulcer on his bottom that was keeping him in bed. He came up with the following solution: "Why don't you just duct tape it up??"

"What?" I said.

"Just put a piece of duct tape over it. Then it'll be fine."

I know men think they can duct tape everything to fix it, but it's probably not the best pressure ulcer dressing.

After we talked him out of the duct tape, he gave it a little more thought and then suggested that we put cow balm on it.

What's cow balm, you ask? It's some sort of balm that they apparently use to heal wounds on cows. I'm not kidding. He claimed that stuff is a miracle and that it works just as well on people as it does on cows. He also said that instead of the expensive IV Zosyn (a type of penicillin) we're giving him, he could just get a huge bottle of penicillin for cows that will cost like ten bucks.

"Don't tell me it's not the same medication!" he said.

Weekly Whine: Cell Phones

I definitely appreciate cell phones and am glad to have mine. I can't even imagine how much more awesome high school would have been if I lived in a world where I had my own cell phone. And it provides a lot of convenience for doctors. I was recently watching an episode of Cheers where Frasier got paged and had to go find a payphone to return the page. We're lucky.

That said, there have been dozens of times when I want to wrench the cell phone out of a patient's hand and throw it out the nearest window.

OK, I get it that you don't want to turn your phone off in the doctor's office. I don't either. Or even that you don't want to switch it to vibrate. Now that I have a phone, I feel antsy if I turn it off.

However, I would never actually answer the phone unless I honestly thought the call was a true emergency. If my children's daycare was calling, that I would have to answer. Anything else, I would ignore. However, a lot of patients don't feel that way. They often answer their phone and occasionally even have prolonged conversations right in front of me!

I don't answer my cell phone when I'm examining a patient. I feel like the least they can do is pay me the same courtesy.

Yuck!

I went to the doctor the other day and I saw the following handwritten note posted on one of the patient rooms: "There are little worms all around the patient area. Who should we call about this?"

Isn't that totally what you want to see when you come to the doctor? A giant sign saying that the office is infested with worms?

The 7 Types of Physician Bad Handwriting

Lately I've been noticing that it isn't just that doctors have bad handwriting. There are actually many different ways that doctors can have bad handwriting:

Fun with cross cover

Nurse: "Doctor, there's an order for a medication that needs to be renewed."

Me: "Okay." (signs renewal)

Ten minutes later:

Nurse: "Doctor, that order you just renewed... that medication had already been discontinued two days ago."

Me: "Oh, then why did you make me renew it?"

Nurse: "The pharmacy told me to. Can you write an order to d/c it now?"

More fun with abbreviations

So these are a few abbreviations that I became very, very familiar with while working at the VA with recently deployed soldiers. I was just curious how commonly known these are:

1) OEF

2) OIF

3) RPG

4) IED

5) CPRS

Photographic evidence

My quartet of pagers from residency:



OK, the last one wasn't exactly mine...

Weekly Whine: I'm too short

According to some random website I googled, the average height for an adult female in America is 5'4". I won't get into numbers, but suffice to say, I'm shorter than that.

During residency, we took a photo of all the residents together. When the picture was sent out, I was shocked to discover that I was the shortest resident. I had no idea. There were residents who I had thought were about the same height as me, but were clearly taller in the photo. Granted, I was wearing flat shoes, but still.

I had several attendings in residency who were quite tall, like well over six feet. It seems odd that a very small person and a very tall person could even be of the same species. I felt like if I somehow mated with these tall men, we'd produce offspring that were sterile or something. And when I worked with them, especially since they were supervising me, I always felt very childlike. Maybe it's a holdover from childhood, but I often feel like someone who is taller than me must therefore know more than I do.

I wonder if taller women are more successful than shorter women. CNN says yes. Plus, taller women don't have to pay like ten bucks each to get all their pants legs hemmed. That said, at least I've never had to date a guy who was shorter than me (a fate worse than death).

For some reason, my kids are really tall though, both in the 90+%tile for height. When my daughter was two years old, I was rotating with a pediatric orthopedic surgeon who had a chart to calculate adult height for females based on height at two years old. Her projected height was 5'11"! Yikes.

Buh dum bum

Attending: "True story: I knew these four cardiologists who bought a boat together. And since they were cardiologists, they named it systole. Then later, they sold the boat to two pathologists, who added one letter to rename the boat asystole."

Resident: "I think all six of them need to get a life."

The Bone Doctor

In med school, we had this ethics class where we were separated into small discussion groups led by a physician preceptor. My preceptor was an orthopedic surgeon who always called himself a “bone doctor.” As in, “What do I know? I’m just a bone doctor.”

However, the guy clearly very much enjoyed being a bone doctor, because when he took us out to lunch at the end of the semester, he systematically belittled each of our future specialty choices:

Me: "I want to go into peds." (Yes, I used to want to do peds.)
Bone doctor: "You know, being a pediatrician is kind of like being a veterinarian."
Me: "Perfect. I love baby animals."

Girl: "I want to be a psychiatrist."
Bone doctor: "The thing about psychiatrists is they're all crazy."
Other girl: "Hey, my dad's a psychiatrist!"

Guy: "I want to do neurology."
Bone doctor: "Neurology is a great field. You can find out exactly what is wrong with the patient's brain that is causing their symptoms. Then you can't do anything to help them."
Guy: "No, but that's changing! Neurology has lagged behind other fields, but there are going to be big advances in curing neurological ailments in the next thirty years!"
(I think that guy ended up becoming an ENT, but I can't remember. Anyway, definitely not a neurologist.)

Girl #2: "I want to be a pediatric cardiothoracic surgeon."
Bone doctor starts laughing: "You're kidding me."

Embarrassing Teenage Story

My weekly whine this week was about fashion, so I thought I'd share a humiliating fashion story that happened to me when I was about 14.

My grandmother loved to buy me cheap bargain store clothing, and one birthday, she bought me a red checkered sweatshirt with gray sleeves and a gray hood. It wasn't the most gorgeous sweatshirt I had ever seen, but it was okay looking and it was new and I wasn't exactly a fashion queen, so I wore it one day.

I got to my chemistry class that day, and to my HORROR, the boy sitting right next to me was wearing the exact same shirt. Neither of us commented on this fact but I was absolutely mortified, especially since that same guy was in several of my other classes. In retrospect, it was probably more embarrassing for him because it's more acceptable for a girl to be wearing guy clothes than vice versa.

Anyway, I never wore that shirt again. The guy, on the other hand, wore it many many more times over the course of the year. Probably once a week, at least.

A couple of years later, I actually dated that guy and the topic of that sweatshirt came up between the two of us. He admitted that he noticed we were both wearing the same shirt and that it WAS embarrassing. But he just didn't have that many shirts.

Nicknames

Tales from Residency: Brain Injury

I didn't do a lot of pediatrics during residency (and none now), but during my short stints dealing with pediatric rehab patients, I noticed an important thing: normal pediatric patients are very difficult to distinguish from brain injury patients. You could probably create a scale that corresponds severity of a brain injury with the age of a kid that the patient acts like.

For example, this was my experience examining an 11 year old boy who we thought might have a traumatic brain injury:

When we were testing his proprioception (which basically means can he tell where parts of his body are in space), we placed a barrier in front of his foot and lifted his toe up or down and having him tell us which way it was pointed. Or as my attending said, "Is your toe pointing towards you or towards the wall?"

The kid was absolutely unable to give a straight answer to this question. Each time (and we did this ad nauseum), he told us everything he could think of that his toe was pointing towards.

Attending: "Is your toe pointing towards you or towards the wall?" (Answer: the wall)

Kid: "Well, it's pointing towards my dad, the wall, that sign, the bathroom, the edge of the bed, and... the door."

Attending: "Is your toe pointing towards you or towards the wall?" (Answer: toward him)

Kid: "Well, that's a trick question because it's really more pointing towards the window, the light, the dresser, my games, and a little towards me."

If an adult answered 10 straight questions in a row like that, I would think that they definitely had a traumatic brain injury. But for an 11 year old kid, we decided it was normal. Annoying, but normal.

And then at some point, the kid took out a robot toy from home that fired little pellets at the wall. I was so relieved when he ran out of pellets, but then he reloaded it. All I could think was, thank god I have a girl.

Lies I was told as a med student

I drew this cartoon for our humor mag in med school, and in analysis of the cartoon, I have a couple of thoughts:

1) Apparently, Frasier was still airing back then. It's funny because this is like the second Frasier joke I've had on this blog and I've only seen like a dozen episodes total.

2) Have you noticed that some of my drawings look a lot like Archie comics? This one especially is very Archie-riffic. That's because I learned to draw from Archie. I used to look at the comics and draw Betty and Veronica over and over again. And now, 20-something years later, I can't stand when my drawings look like Betty and Veronica.

Weekly Whine: Expensive clothes

Just out of curiosity, I was looking at some clothes online from some popular Manhattan shops, and I was just blown away by some of the prices. I mean, it seems reasonable that there are some people out there who should be able to afford these clothes. But how could there be enough that there's a whole STORE full of these clothes? During a recession, no less. It's mind boggling.

I've highlighted this shirt as particularly baffling, because not only is it $750, it's UGLY. If I wore this shirt, I would look like a pregnant Amish person.

Oh, and this bag costs $21,500. How is that possible? It's a handbag. My bag cost $10 at Target and I was looking for one that was a little cheaper. What is the obsession with nice handbags? (I know way too much about handbags now due to Lauren Weisberger and Sophie Kinsella.)

No matter how much money I make, I will never be able to justify spending that kind of money on clothes and purses.

Tales from Residency: Walkers a deux

Some people who do musculoskeletal medicine deal with young, fit athletes. But at the VA during my residency, most of the patients we saw in musculoskeletal clinic were elderly people. With back pain.

I remember I had a patient once who was kind of typical: an elderly man who was hard of hearing who came in with a walker. Except he also came with his wife, who ALSO had a walker. I brought the two of them to the examining room, which took about 20 minutes because they were both SO slow with those walkers.

Finally, finally, the man got to the examining room, but his wife seemed to be lagging behind. I checked the hallway and saw that the holdup was that she was weighing herself on one of the scales we have out there. No hurry, just take your time.

It was a follow-up visit, but the man had no idea why he was there. As usual. It took me asking the question about three times for him to even understand what I was saying. Then he thought about it and said, "All my joints hurt."

Then the wife, who wasn't the patient, said, "All my joints hurt too."

I tried to have a bit of a sense of humor about it. When I told my attending about them, I said, "It was awful. The two of them both came with walkers. I had to put them in the big room."

"They both came with walkers?" my attending asked in surprise. "That's unusual. Most of the time they both come with scooters."

Evolution of my handwriting

Now I have made fun of doctor handwriting on several occasions such as in this post many moons ago. However, now I will turn the spotlight squarely on myself and make fun of my own handwriting.

I don't think I ever had awful penmanship, but I do recall thinking when I was around 8 or 9 that my handwriting was too babyish and I had to step it up a bit to be cool. Because, as we all know, the key to being cool is having cool handwriting. Anyway, the way I remedied this was to give certain letters a little curl at the end. For example:



Cool, right? You'd totally want to come to my sleepover, right?

I later made further modifications to increase the coolness of my handwriting, such as changing my y's, g's, etc., from the very lame:



To the much more fashionable:



Then a year later, I decided all these flourishes were lame and had to train myself to stop doing them.

When I was in middle school, I started writing in script all the time, mostly because one of my teachers required it. God knows why a teacher would bring something like that upon himself. There are all these sayings about how you finally are an adult when you go to college, have your first kiss, get your first period, etc. But I think you are an adult when you stop writing script r's like this:



And start writing them like this:



I have to say, I do sometimes meet adults who write their r's in the former fashion, and I always secretly wonder if they have their pubes.

I kept on using script pretty much all through college, then in med school I switched back to print. Mostly because the only way I could stand to take infinite notes was to attempt to make them look pretty. (I also used a multi-color pen. Yes, this was a low point in my life.)

Eventually, after printing enough, my print evolved into that mixture of print and script that I like to call "scrint."

I actually think I have pretty readable handwriting. I've never gotten called by a nurse or pharmacy who couldn't make out an order I wrote. But I remember in residency, I handed out this handwritten cheat sheet to the junior residents and one of them complained about my handwriting. (Actually, what he said was, "Dr. Smith says she can't read my handwriting, but look how bad this is!")

Fortunately, I have saved a copy of that cheat sheet and I can provide a sample for your perusal:



(Bonus points if you can figure out what the cheat sheet was for. Dr. Grumpy is excluded.)

Anyway, I think I have totally readable handwriting and that junior resident was full of shit.