Medical terminology

Since I did a rerun entry earlier, here's a real one:

Honestly, I find it slightly amazing how terminology that is second nature to doctors and nurses is completely foreign to others, even some people in medical careers.

For example, I recently had a patient whose medical history said she was "Gravida 2 Para 2" without further explanation.

Psychologist: "Gravida 2 Para 2?? What on earth does that mean?"

Me: "Oh, that means she was pregnant twice and had two babies."

Later:

Therapist: "Dr. Fizzy, can I ask you something? What does gravida 2 para 2 mean?"

Me: "Oh, it means she was pregnant twice and had two babies."

Therapist: "I have never ever heard that terminology before."

Later:

Me: "When I was at work today, nobody knew what a female patient being gravida 2 para 2 meant. I was surprised. Do you know what it means?"

Non-medical husband: "Does it mean she's a paraplegic?"

Me: "No."

Husband: "Does it mean she's really serious? Like gravitas?"

So apparently this is really obscure terminology!

Halloween repeats

OK, I didn't draw a cartoon for Halloween. My bad. But here's one from 2 years ago that surely no one remembers:

How to take a family history

Weekly Whine: Expensive garage sales

I hit up a couple of garage sales last weekend and I'm kind of shocked by how much people seem to expect you to pay for their crap.

For example, I saw this table for sale that was $200. Really? I wouldn't even buy a new table for $200!

But the most shocking thing I encountered was this:

I was at one garage sale where there were a bunch of baby clothes. I figured, Score! I'll spend like $10 and get a whole winter wardrobe.

So as I was flipping through the hangers of tiny onesies and baby dresses, I happened to notice a price tag on one of the outfits: $14

$14 for a baby dress at a garage sale?????????

My mind was boggled. I went up to the woman selling the clothes and was like, "WTF?" She apparently was a children's clothing wholesaler and these were clothing samples she was selling, so the clothes were new. But still! I wouldn't pay that much for brand new baby clothes, much less something I found on the street.

I guarantee nobody bought those clothes.

Seriously, what are people thinking?

Tales from Med School: Mr. T

You all remember Mr. T, don't you?

I pity the fool, etc etc.

When I was in med school, we had a transcription service where all the students in my class took turns transcribing lectures. If you didn't want to transcribe your lecture, you could pay another student to do it. There were 4-5 students in the class who regularly got paid to do transcriptions. Most of them were very good at it. And then there was Tim. Tim liked Mr. T.

Tim put multiple photos of Mr. T in every transcript, some of them quite large. You know there's a problem when your transcript on the brachial plexus has six photos of Mr. T and none of the brachial plexus. We would have to manually remove all the images from Tim's lectures (signed as Mr. T) before printing them out. It was out of control. These were transcripts he was getting paid $50+ a pop to write.

Finally, enough people complained and he was forced to cut back on the Mr. T photos. From 6-7 per transcript to like 2-3. Because you can't possible have no Mr. T in your transcript. That's ridiculous.

Why haven't you bought the book yet?

Now a lot of you have bought copies of A Cartoon Guide for yourself. But did you know you can also buy a copy for other people?? It's true! Here are some people you might want to buy the book for:

--friends

--enemies

--lovers

--your favorite doctor

--your least favorite doctor

--that bastard kiss up gunner student on your team

--your senior resident who doesn’t seem to like you no matter how much you kiss up

--your lazy ass son, who needs to quit that damn band and do something productive with his life, maybe medical school

--your dad, in lieu of tie

--your girlfriend, in lieu of engagement ring

--your boyfriend, in lieu of BJ

--homeless guy in front of your building who is building fort out of books

--your future self, for when deforestation causes trees to become extinct and you need toilet paper

When you think about it this way, there are so many people in need of a copy of A Cartoon Guide! How could you NOT buy a copy?

Tomorrow is the last day to get 20% off your order! Buy it now!

Huge Nerd

This is possibly the nerdiest thing I did in residency:

So I had been outlining our orthopedic physical exam textbook in order to not appear like a complete idiot in sports med clinic (which, sadly, was unavoidable). After finishing the book, I decided to turn all my notes into a little guide that I could use in clinic.

So I reduced the font size to 9 point, bolded key points, turned it into columns, and printed the whole thing out. Then I cut all 18 pages of it into quarters and stapled together little guides for each different system:



The whole thing took me about an hour. I was so proud of myself as I nerdily splayed out my little books and photographed them. My husband offered to help, but I didn't want him to be a part of my little nerd sweatshop, because then every time I looked at the guides, I'd feel guilty.

I could have been worse. I could have used a ruler to make sure that the pages were totally aligned and cut perfectly. (Notice that the heading on the page sticking out due to being misaligned is actually "Alignment"... how ironic.)

I haven't done anything this nerdy in a long time, but I've definitely been guilty of such offenses in the past:

--Remember the problems in the back of the chapters of math/science textbooks? Before my math/science exams, I used to do every single problem in the back of those chapters twice. Even if it was a really easy topic and I knew the answers cold. Because 98 wasn't good enough... I had to get that 100.

--In history class, I read and made a detailed outline of every single page of our huge textbooks.

--I've done this since high school and as recently as med school: I used to outline the textbook, then make a briefer outline of that outline, then make an even briefer outline of that, which would act as my final "cheat sheet".

OK, your turn: What's the nerdiest thing you've ever done?

Brain teaser

This is a brain teaser someone sent me years ago. I saved it because I thought it was cool. See how many you can guess. (Clearly you can look these up on the internet, but that's cheating.)

Example: 52= W in a Y --> 52= Weeks in a Year

1. 26= L of the A
2. 7= D of the W
3. 1001= A N
4. 12= S of the Z
5. 54= C in a D (with J)
6. 9= P in the S S
7. 88= P K
8. 13= S on the A F
9. 32= D F at which W F
10. 18= H on a G C
11. 90= D in a R A
12. 200= D for P G in M
13. 8= S on a S S
14. 3= B M (S H T R)
15. 4= Q in a G
16. 24= H in a D
17. 1= W in a U
18. 5= D in a Z C
19. 57= H V
20. 11= P on a F T
21. 1000= W that a P is W
22. 29= D in F in a L Y
23. 64= S on a C B
24. 40= D and N of the G F
25. 76= T in the B P
26. 50= W to L Y L
27. 99= B of B on the W
28. 60= S in a M
29. 1= H on a U
30. 9= J on the S C
31. 7= B for S B
32. 21= D on a D
33. 7= W of the A W
34. 15= M on a D M C

Guest Cartoon: Dora-rrhea

As the mom of a preschooler, I can definitely appreciate this one:

Contributed by James at www.poormd.com

Another book discount

Again, Lulu is offering 20% off all orders with discount code BURIED.

You know you want it...

And if you want to buy 31 copies so you can have a book for every flavor of Baskin Robbins ice cream (which you obviously do), you get 25% off your order with discount code MUMMIFIED. Slow down, don't all order at once please.

Just kidding!

I like to joke around (obviously) and as such, sometimes I end up joking around with patients, sort of as a way to try to bond with them. Sometimes I get worried though that I went too far....

When I was rotating in the ER as an intern, a patient came in with a really bad headache. It sounded like a migraine, but my attending was rightfully worried about a subarachnoid bleed. We did the CT and it was negative. But his clinical suspicion was high enough that he wanted to do a lumbar puncture.

For those of you who haven't experienced this firsthand, during an LP you basically stick a HUGE needle into the back until you hit the spinal fluid. The attending let me run the needle, but even though I was sticking it exactly where he told me at the exact angle he said, I kept hitting bone. It was really frustrating, but more than that, the patient was in excruciating pain. Every time I pushed the needle deeper, he would SCREAM. I felt terrible.

Finally after like 30 minutes and trying a different needle, we got it. The one good thing was that the pain in his back took his mind off the pain in his head. He was pretty nice about it. He said to me, "Now do I get to do one on you?"

About half an hour later, the results of the tap came back: normal.

I went into the patient's room and for some reason, I decided to say: "Well, it turns out we have to do it again."

Of course, I followed that immediately by: "Just kidding! It was normal!"

He laughed but I remember I was a little sorry I joked around like that afterwards. It seems like the sort of thing you could get sued for if you do it with the wrong person. I only did it because I had been treating this guy for hours and I felt like we had a "relationship." In fact, when we discharged him, he said to me, "Thank you. God bless you."

So I don't think I did a bad thing. I mean it's not like I said, "You have a huge brain tumor. Kidding!" But I still felt uneasy about it.

"I'm afraid that arm's going to have to come off. Did I say arm? I meant wet bathing suit."

Attendings with a temper

Anyone who's worked with doctors, especially surgeons, know that some of them have a bad temper. I have no idea if more doctors have a bad temper than in the general population. I have no idea if they started out with the rotten temper or if it developed from being giddy with "attending power." I have no idea if the bad tempered doctors are bad tempered outside of the hospital as well. All I know is that I've gotten yelled at a lot for no good reason (and sometimes for kind of a good reason).

For example, during my sub-I, there was one day when our attending Dr. Brown decided to systematically rip apart the whole time. (At the end of his rampage, the senior resident actually said, "Stop it, Dr. Brown, you're ripping apart my team!")

I still remember why he started screaming at me. It was because one of my patients was supposed to be discharged that day, but he needed PT to walk him around first. I had put in the order and even called PT, but they failed to show. Was this my fault? No. But Dr. Brown said what I did wrong was that when PT didn't show up, I should have walked the patient around myself. Of course, my patient was an elderly obese man who weighed twice what I did and was attached to an IV pole. Absolutely nothing could go wrong with that.

Another time, during residency, I got yelled at by an attending named Dr. Green in front of several other residents for something I did wrong on home call. I still honestly am not sure what I did wrong, other than being unable to instantaneously transport myself from home to the hospital after getting paged. In any case, after it was over, the other residents comforted me and said that everyone knew I didn't do anything wrong, and that Dr. Green just had a bad temper.

A couple of months later, Dr. Green was telling us about how he'd been walking through a parking lot with his daughter in her stroller, and a car had driven dangerously close to them. His response was to yell and kick the car hard enough that he said he dented it pretty badly (scaring the female driver into quickly driving away). Although I was silently cheering for him because I'd been in that same situation and not had the nerve to do anything, I also recognized that this was not normal behavior. It was pretty obvious Dr. Green had anger issues and we were all just at his mercy.

Weekly Whine: I hate landladies

It seems like we've had more than our fair share of horrible landladies. To the point where my husband and I have agreed that we will only lease from large faceless corporations who only base decisions on money.

A couple of years ago, we leased a condo that I initially loved. It was in a great neighborhood, was large, and even had free heat (a nice perk in the windy city). The landlady was a woman we never met who owned 3 condos in the building. I loved the apartment for about five months, until the lock on our front door broke. I don't know what happened to it, but one morning when I was trying to leave to go to work, I kept turning the lock and it wouldn't open. I had to call the super to rescue me from my apartment.

I am not a complainer (at least as a tenant) and this was the first repair I had requested. I emailed my landlady (she'd only communicate with me via email) and told her about the lock. I have copied and pasted her reply:

"The lock has been operational when you move in and it functions now as well."

So apparently, if something worked when I moved in, it cannot stop working. This ended up being a huge fight. She was in Europe at the time the lock broke, but somehow managed to come to our apartment to inspect the lock. I don't know what it would have cost to fix that lock, but I think it must have been less than a trans-Atlantic flight. Anyway, she never fixed it. The super just put some oil in it and it usually worked after that.

Then next month, on the third of the month, she emailed me to tell me that she didn't want me to mail her the check for that month because she would be traveling for a while. Except I had already mailed it days ago, which I told her. What she wanted was for me to go to the bank and directly deposit the rent. I told her I didn't want to wait on line at the bank every month. She replied, "I travel a lot and this is difficult. The bank is right at the corner for you." (I ended up mailing her checks to the bank and they deposited them for me.)

Finally, about six months before our lease was up, she emailed me to ask if we wanted to renew our lease. I asked her what the rent would be. She was increasing it by $100/month.

Now I don't have to tell you that we're in the middle of a recession. Apparently, the landlady had bought the condo during the housing bubble and was now losing a lot of money on it. But that didn't mean we were willing to pay the highest rent in the whole neighborhood. I tried to point this out to her, but she said something about condo fees and that brokers had told her she could rent out the apartment for much higher.

I'm not sure why she was so confident about being able to rent out the apartment, considering the apartment had been sitting empty for months when we rented it. Even if the apartment was empty for a week or two, between that and the broker's fee, it was obvious that she would come out ahead if we stayed in the apartment.

I told her we'd pay a $50/month increase. She refused to budge. So I gave her permission to show the apartment.

That's when the hell really started.

First the landlady came by to test if her keys work. I gave her permission to test her keys, but apparently, she decided to take a look at the apartment too, because I received the following email:

"I would greatly appreciate it if you could please put a little time into tidying the apartment. There was food on the floor and dirty pots in the kitchen and things on the floor in all the other rooms."

Now we had guests that weekend, so the apartment was actually quite clean. I had done all the dishes the night before so I can say for a fact that there were no dirty pots in the kitchen (and I had vacuumed that morning, so there was no food on the floor, unless my daughter had dropped a cheerio or something). But even if there were dirty pots int he kitchen, so fucking what??? It was OUR apartment. And we had zero interest in helping her rent it out.

And then another follow-up email, when I told her she was rude:

"As I said, the apartment was delivered to you spotless, newly painted, new kitchen. As it is now it is in non showable condition."

Event though the apartment was in non-showable condition, we proceeded to get inundated with calls from brokers over the next several months. We had people looking at our apartment 2-3 times per week. A couple of times, I even had a broker demand that I come home from a lunch out so that I could let him inside. I really started to despise all brokers.

When there was only a couple of months left on the lease, the landlady started to realize that it wasn't going to be so easy to rent it out. She started pleading with me to stay. But at the same time, she wouldn't lower the rent increase.

Finally, we moved out and it was such a relief to be free of those horrible brokers. I was so happy when one called to demand that I let him in and I told him that I was no longer living there and didn't have the key.

Just out of spite, I checked craigslist to see if the apartment got rented. I saw the apartment listed on craigslist for close to two months after we moved out, and the rent had been lowered to what we were paying when we moved in. All told, she would have lost less money if she had lowered our rent by $500/month.

Useless pages

When you're first starting out an intern, you literally get called on every page you write. Mostly cuz you forget obvious things, like writing that the order was PO. But when you start working in a new hospital, especially one where orders are not electronic, sometimes that constant paging on every order starts again:

Pharmacy: "Hi, Dr. Fizzy, I'm calling about an order your wrote on Mr. Smith for natural tears."

Me: "Oh...."

Pharmacy: "You wrote for Natural Tears 2-3 drops per eye nightly. But we don't do ranges. So you have to rewrite the order as either 2 drops or 3 drops per eye."

Me: "You're kidding me."

There was an episode of Scrubs where JD asks Dr. Cox about the dose of Tylenol, and he replies angrily, "It's regular strength Tylenol. You just throw it at the patient's mouth and whatever stays in, that's the dose." That line always bothered me, because of course, you can easily overdose on Tylenol and get very sick. But you can't overdose on Natural Tears! You just squeeze the bottle and whatever goes in is the dose!

The best part was how I didn't rewrite the order immediately, and they paged me about it AGAIN. Because clearly this was really urgent.

Last chance for free shipping!

Today is the last chance to get free shipping on the book version of A Cartoon Guide with code OCTGROUND305!

Which is worse?

Which of the following would you be least excited to see on your patient roster:

a) Patient over age 80

b) MMP = multiple medical problems

c) Six or more medications, one of which is Vicodin

d) History of substance abuse

e) Nursing home patient

f) Non-English speaking

g) Chief complaint contains words “chronic” and “pain” in it, and possibly “back”

h) Chart is Volume 15 of 15

Radiology and me

One thing you don't learn very much about in medical school is radiology. If you want to learn radiology, you basically have to do radiology residency. During anatomy class, there was a radiologist who used to lecture to us sometimes, but by the time I figured out what a "sontimeter" was, the class was almost over.

During my ICU rotation, we would have X-ray rounds. For me, this was basically, Look at This Abstract Art Exhibit rounds.

Finally, in my fourth year, I took a radiology elective because I heard it was EASY. Unfortunately, I took the elective at a semi prestigious med school, just because it was in the city where my boyfriend lived. I don't think I had ever truly felt like an idiot before I took that class. I consider myself to be a fairly intelligent person, but when it came to radiology, I just didn't get it.

Of course, it didn't help that the class was made up of future radiologists. I remember on the first day of the class, the clerkship director went around and asked us what field we were going into:

Clerkship Director: "So what are each of you going into?"

Girl #1: "Radiology."

Girl #2: "Radiology."

Guy #1: "Radiology."

Guy #2: "Radiology."

Me: "Endocrinology."

[everyone gasps/giggles]

Clerkship director: "God, why?"

Like I said, I just didn't get it. I would look at the images and not understand how other people in the class could tell what was wrong with the patient and I couldn't. It was humbling.

During my intern year, I decided I wasn't going to be a radiology idiot anymore. If I was going to do a residency in internal medicine, that meant I needed to learn how to read chest and abdominal films. And I tried... I really did. When I was rotating in the ER and there was some downtime, I'd bring up random chest films on the computer and try to read them.

And you know, it's not that easy. I still remember on an ICU call, we got a chest X-ray on a sick patient, and my senior resident read it. The patient died that night, and the next morning, the attending pointed out a small pneumothorax that she missed. It almost definitely wasn't the cause of the patient's death, but the resident burst into tears.

In any case, by the end of that year, I was okay at reading chest x-rays and sort of okay at abdominal films. Then I switched the PM&R residency and that was the end of that.

Actually, that's not entirely true. I can still read KUBs since we order them all the time to look for retained stool.

Homunculus of a med student

Required reading

One great thing about being in a book club is that it forces me to read great books I wouldn't read otherwise. Sort of like school.

This gets me thinking about all the books I was forced to read for school that turned out to be actually REALLY good. Here's a list of my favorite...

Books I Was Forced to Read But Actually Really Liked

1. A Tree Grows in Brooklyn
2. Jane Eyre
3. To Kill a Mockingbird
4. Brave New World
5. Lord of the Flies
6. Lolita
7. The Chosen
8. Of Mice and Men


Books I Was Forced to Read For School But HATED

1. Frankenstein
2. Tom Sawyer (first scene great, everything else boring)
3. Zen and the Art of Motorcycle Maintenance
4. The Scarlet Letter
5. Siddhartha

I guess there were a bunch of other books I feel pretty neutral about. Although amazingly, I wasn't forced to read that many books in school. Maybe I should have been. I might have discovered some good stuff.

How about you? What was the best book you were ever forced to read?

Weekly Whine: Selling Shit

I hate, hate, hate selling shit.

I've moved a lot of times in the last 10 years and many of those moves were large enough that I had to get rid of a lot (or all) of my furniture and belongings. In the past, I've sold them, which has always resulted in way more aggravation than it was worth.

For example, when I moved out of my dorm after my third year of med school (I was essentially a nomad during fourth year, in which most of my belongings were in my car), I needed to get rid of all my furniture by the end of the month. I sent out an email to the rest of the med school and these were some of the replies I got:

"I would like to have the bookcase and the boom box if they aren't already taken. Can we work something out for $30 for both, that is all the money I have in my wallet and for the rest of the summer."

If I had only $30 for the entire summer, I might save a little bit for food...

"if the bookcase less than 2 ft wide, i'll totally take it. how about $13? the only reason im asking is b/c ive been looking online for the bookshelves, and they're basically around $10-$15 for that size."

I love when people try to bargain me down a dollar or two. I accepted the discounted offer and actually sort of wished I had charged her less because she paid for the damn thing in quarters.

This was my favorite of all of them:

"how tall is the bookcase? and if i'm not there over the summer would you have any way to keep it for me?"

This after I just sent out an email saying I was selling all my stuff because I was moving. Doesn't storing a fucking bookcase for you all summer sort of defeat the purpose of this? What an idiot.

And finally:

"Fizzy-- I would NEVER buy your stuff."

(My friends decided to take that opportunity to tease me with a bunch of fake emails.)

I did end up selling most of my stuff, but it was totally not worth the aggravation. But I didn't learn my lesson and when I had to relocate far away again at the end of residency, I decided to try to sell my furniture on craigslist.

Selling furniture on craigslist was one of the most stressful things ever. People would demand to know absolutely everything about an item down to the last detail, they often wouldn't show up when they said they would, and many of them didn't have a way to get the furniture out of the apartment. Overall, for everything we owned, I made about $800, which was entirely not worth it. Putting that in perspective, I spend that much on about a week of daycare.

Recently I was moving again and had a bunch of stuff I wanted to get rid of. I cleared a bunch of toys out of my daughter's room and we had a mini garage sale at the playground. After three hours, we made a grand total of...... $6! And I got to spend an hour having some little boy pick up every toy in the box and explain to me what it did.

After that lovely experience, I decided to offer our other unwanted items for free and donated the rest. Maybe I could have made $50 or so, but that amount of money just so isn't worth it to me.

Tales From Residency: Wishful thinking

Resident: [looking at prior note on computer screen] "Wow."

Attending: "What?"

Resident: "This history and physical describes our next patient as an 'attractive female'. Isn't that kind of inappropriate?"

Attending: "It says 'attractive female'?"

Resident: "Yeah, it says she's a 24 year old, attractive female."

Attending: [looks at note on computer] "It says she's a 24 year old, active female."

Resident: [disappointed] "....Oh."

Free shipping

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Sense of humor

During one of my residency interviews, the program director was flipping through my resume and saw that I had been on the staff of our med school humor magazine. (A few of the cartoons I've posted her are actually reproductions of ones I did for that magazine.) He looked me over and said, "Wow, that's hard to believe."

WTF? I had just met the guy ten minutes earlier and I was on an interview. Did he expect me to have launched into a stand-up comedy bit by now? "If the little black box is so safe, why don't they make the whole plane out of the black box?" Should I have dressed up in a red rubber nose and floppy shoes? Seriously, I think you can really only be so funny during an interview.

So then, as he's flipping through my letters of recommendation, he noted that one of the doctors said I had a "good sense of humor." So I guess he decided I wasn’t lying about the humor magazine. Of course, I’m pretty sure the only reason that attending said I had a good sense of humor was because I laughed at all his jokes.

Protect life

I don't usually write about political stuff, but the Protect Life Act going through the House this week allows hospitals to not only refuse abortions to women in life-threatening situations, but allows them to refuse transfer of these patients to a facility that will treat them. So basically, a hospital has the right to just allow a woman (and her baby) to die right in front of them and do nothing. How does this protect life?

I think if there's one time it's worth contacting your Congressman, it's over this bill.

Foods I regret

The two foods I often crave then often regret are:

1) KFC

2) Giordano's pizza

KFC always seems so appealing to me in theory and it tastes good when I'm eating it, but afterward, I feel so ill that I can go without it for months.

Giordano's stuffed pizza is one of my husband's favorites and I admit it tastes really good, but I just can't consume a pizza stuffed with cheese without wanting to throw up.

How to find out you're pregnant

I'm going to go out on a limb and say that nobody ever gets pregnant during their intern year on purpose. So when interns find out they're pregnant, it's usually an accident and they sometimes find out in interesting ways.

For example, one intern in my class was feeling really fatigued. She went to her doctor because she believed she had lymphoma. It wasn't lymphoma.

A second intern had been having pelvic pain and it was thought that she had ovarian cysts. She went to have an ultrasound to assess the cysts and they found a heartbeat.

The Colors of Medicine

If you're interested...

If you have any desire to buy a hard copy of my cartoons, you can type in "FALLBOOKS" right before submitting the order and get 20% off. Thanks for the tip, Jacob!

A Cartoon Guide: The Book!

So one of my summer projects was to get all the cartoons I'd drawn into one place so I could print them out and keep them 4ever 'n ever. Fortunately, Lulu is awesome and I recently formatted the document and printed them out in one 145 page book:

It just came this weekend and I love it! It looks exactly how I wanted it to look. You guys, I would have taken it to bed if it would have been socially appropriate.

And you can buy it too right here on Lulu!

I could care less about making money off the book. But I have this fantasy about someday walking into a fellow doctor's house and they have the book on their coffee table. Don't be coldhearted.... help me realize my fantasy.

Of course, all the cartoons are still available on this blog. So why would you buy the book if you can read the content for free? I'm glad you asked.

Six reasons why you should buy my book when you can already read the cartoons online for free:

1) Great present for your nephew who just graduated from med school, and he already has a stethoscope, so you can’t buy him that.

2) Can be placed strategically on coffee table prior to hot date with cute doctor who lives next door.

3) You bought Jorge Cham’s PhD book and all his comics are online. Plus you bought that book with all the funny cake mistakes.

4) Much easier to bring to toilet.

5) Book comes highly recommended by:
--Fizzy’s husband
--Fizzy’s mom
--Actually, Fizzy’s entire extended family

6) Will make Fizzy smile. And you want to make Fizzy happy, don’t you? In spite of her annoying tendency to refer to herself in the third person?

Buy book here!

(It will be available on Amazon in 1-2 months, but it's cheaper from Lulu.)

Photographic Evidence: Unorthodox bracing

We had a resident-led lecture on lateral epicondylitis (tennis elbow) and this handout was given to us:



If pain continues after 3 weeks, consider vulvar wrist splint to decrease active wrist extension.

The best part was that the resident actually read the sentence out loud and it took him several seconds of us snickering before he realized his mistake. He then turned pink and said, "Oh shit." And we all laughed hysterically for several minutes.

(What he meant was volar wrist splint, volar referring to the palm of the hand.)

My husband is funny

Me: "My med student wanted a patient, so I gave her this young guy with a pineal gland tumor."

Husband: "A what?"

Me: "A pineal gland tumor."

Husband: "That sounds like a painful place to have a tumor."

Me: "Uh..."

Husband: "I wouldn't want a tumor on my pineal gland."

Me: "Probably not."

Husband: "Can women have a pineal gland tumor?"

Me: "..."

Husband: "Is there a such thing as a clitoral gland tumor?"

Me: "The pineal gland in the brain, you know."

Husband: "It doesn't sound like it's in the brain."

Me: "Well, it is."

Husband: "What does it do?"

Me: "Well, it....... hmmm..... it does something."

Tales from Residency: Notes

During our morning lectures in residency, most people didn't take notes. But our chief resident always did. Except one morning, I guess he forgot to bring paper, because he started taking notes on a cup.

So yeah, as I watched, the chief actually started copying slide points onto his styrofoam coffee cup. Then when he ran out of room on the cup, he started taking notes on his hand. I don't know what would have happened if he ran out of room on his hand. I don't want to know.

Weekly Whine: Not really trolls

Last week, I wrote about trolls in my weekly whine. But the thing is, there are a lot of people who yell at you online, not because they're trolls, but because either they have a chip on their shoulder or because their opinions vary vastly from yours.

For example, when this cartoon appeared on KevinMD, some woman actually started yelling at me that the cartoon was "offensive" to stay at home moms. At first I started arguing with her, but it quickly became obvious that the woman had a huge chip on her shoulder. I know a lot of SAHMs who love being SAHMs and none of them found the cartoon remotely offense. It's pointless arguing with someone who is so sensitive about her career choice that she sees any joke in any way involving SAHMs as a personal offense.

I also made a couple of posts on here where I said that certain med students were "annoying," which caused some med student readers to fly off the handle. That seemed a little bit of an extreme reaction. Now I'm not saying the med students who were offended are themselves annoying, but... well, they probably are. Anyway, they annoyed me.

Finally, there are people online whose fundamental opinions differ from mine so drastically that it's hard to believe we even live on the same planet. I've gotten in some brutal arguments in the past about homebirth or vaccinations (guess which side I'm on) that started out as a discussion but quickly degenerated into mudslinging. When someone's viewpoint is so different from yours on an issue that's so emotionally charged, that's pretty much inevitable.

I think these people are even harder to ignore than trolls, mostly because you feel like you might actually have a chance of bringing them around to your own point of view. And of course, sometimes they're challenging a point of view that means a lot to you. How can you back down in that situation?? It would be like admitting that they're right. It takes a lot of willpower to ignore them. Plus it's sort of fun to argue until things get really nasty, which of course, they usually do.

Natural progression

Tales from Intern Year: Plates

On an intern year call, my very awesome attending bought us dinner from a nice restaurant. I was concerned that the dinner might not come with plates and utensils, so I decided to go over to the cafeteria to grab a few at around 5PM. I took five Styrofoam plates and a handful of forks and knives. As I was walking out of the cafeteria, the cashier (who I hate) said to me, "Oh, are you buying some plates?"

I think I laughed because I thought she was joking. I started to walk out and she said to me, "You have to pay for those."

"Seriously?" I said.

"Yes, they're five cents each."

I was totally fucking shocked. Not that I cared about the money, because I had a card that gives me unlimited free food (also, it was all of 25 cents), but it was irritating that I had to stop at the cashier and have her ring me up for these five stupid plates during my call.

Because I had to pay anyway, I decided to grab a bag of gummy bears. When the cashier saw the gummy bears, she said, "Oh, since you're making a purchase, I can give you three of the plates for free. But I still have to charge you for two of them. That's ten cents."

"Fine, whatever," I said.

Photographic evidence (guest post)

Contributed by Dr. H, pediatric gastrointerology fellow

Tales from Residency: Adam Sandler

Consult Resident: "This stroke patient has really impaired short term memory. It's like... have you ever seen that movie, 50 First Dates? With Drew Barrymore?"

Me: "Yeah...."

CR: "It's like that. Every five minutes he'd forget what we had just been talking about."

Me: "So it's actually more like Memento."

CR: "Oh yeah. I guess so."


Ten minutes later, while presenting to the attending...

CR: "...and every five minutes he'd forget what we had just been saying..."

Attending: "Oh, like that movie, 50 First Dates, right?"

It's sad when our knowledge of memory disorders comes from an Adam Sandler movie.

The difference between men and women

It's never so obvious to me that there's a big essential difference between men and women as when we take a family trip to Target.

First, when you're holding a small baby or even an older baby or even a preschooler, you get a lot of attention. People love to look at small babies. And by "people," I mean "women" only. When I walk around with the baby, women are constantly coming up to me to gaze upon her. On at least three separate occasions, old ladies have stopped me and said, "Can I please look at your baby?" And then I held the baby out so they could marvel over her little face for several minutes.

Has a man of any age ever expressed any desire to look at the baby? No, never.

It's not that men don't like babies, I guess, but there's something innate to men that keeps them from gushing about little babies in the aisles at Target. Something beyond just not wanting to look like a pervert.

And then there's the other difference:

When we go through the clothing department, I must look at the clothing. Even if I came to the store for something entirely different, even if I don't need clothes or even really want clothes, I have to look at the clothing. I'm not even really into clothes, but I still feel this compulsion.

And if I see something I like, I have to touch it and maybe check to see if it's in my size. Sometimes I even have to try it on. And it takes huge amounts of willpower for me to drag myself away from an item of clothing that I really like.

I know it's not like that for my husband. If he needs shirts, for example, because every shirt he owns is falling apart at the seams, he goes to the store and buys shirts. If he doesn't need shirts, he doesn't have any interest in looking at shirts. It's like they don't exist. When he sees me eying the women's clothing department, he always laughs and says, "What's wrong with you?"

I was recently reading a post by the very articulate Dr. Whoo about the difference between male and female patients. She says that female patients are more complicated (in a good way), whereas with male patients there is "little extraneous conversation, merely exam, diagnosis, suggestion for treatment." With all due respect to Dr. Whoo, I 100% disagree with this analysis of the male patient. I put in oodles of time at the VA, and I've had men that I could not shut up for anything, who pick apart everything I say, or who are very anxious or batshit insane. I can't honestly say that male patients are in any way simpler than female patients, and I certainly can't say they're less talkative.

However, her post got me wondering if there are specific differences between male and female patients (beyond the obvious anatomical differences). Because we are definitely different, as evidenced by my trip to Target. But I'm really having trouble thinking of any consistent differences I've noticed...

Weekly Whine: Trolls

I really admire Dr. Grumpy because (among other reasons) I've noticed when people make inflammatory comments on his blog, he just ignores them. It's really hard to ignore trolls. They take something you said, often something totally benign, and twist it as an attempt to get you really upset. Often the attacks try to get personal, although how personal can someone who's never met you get?

It always kind of baffles me. I mean, what kind of person is so pathetic that they need to spend their time trying to upset random strangers on the internet. Get a girlfriend or something.

Now that this blog has gotten more readers, I've gotten a handful of trolls. Less than I thought I'd get, to be honest. (Should I be insulted?) It is SO tempting to take the bait and reply to their inflammatory comments, but then I remember that that's just want they want.

So my new mantra is that when a troll comments or emails me, I just laugh at the fact that this person wasted their time doing this, and ignore it. Thanks, Grumpy, for showing me the way! (And for having the funniest blog on the internet.)