Wednesday, November 30, 2011

Tales from Residency: No hablo ingles

When I was a resident, I had one attending who was fluent in Mandarin. We got Mandarin-speaking patients from time to time, so when we did, they were all assigned to that attending. Made good sense.

But I have to say, it wasn’t incredibly fun to round on those patients. It’s often a little dull to sit there and listen to an attending converse with a patient, but believe me, it’s way less fun when the conversation is in a language I can’t even begin to understand. (I speak passable Spanish.) And this particular attending liked me to act as her shadow, so there was no chance of leaving, even when the conversation turned away from medicine and was about, like, Mandarin TV shows.

But okay, rounds are rounds. The more annoying thing was when it would be the middle of the afternoon and the attending would suddenly realize "we" forgot to ask a Mandarin-speaking patient if his arm pain was any better. So she would come up to me and say, "Let's go ask him about his arm pain."

I would always be in the middle of doing like a million things and it was like, "You want me to drop everything and come with you to this guy's room to watch you ask him in Mandarin if he has arm pain? Do you REALLY need me for that??"

Tuesday, November 29, 2011

How to be a good med student

As a resident, I worked with med students a fair amount. Some of them I really liked. There was one med student I worked with who I liked so much that I wrote a very effusive letter to our program director in her favor because she expressed concern that her grades weren't good enough.

I didn't have any lofty expectations of med students. These are a few qualities I looked for in a med student:

1) If teaching is offered to you, you accept teaching happily. Groaning because you were hoping to leave early or sit on ass is not an acceptable response when a resident offers to teach you something.

2) When you say you will be somewhere at a certain time, you show up on time. If you can't show up, you give an excuse in advance.

3) You talk to patients but don't interrupt the resident. Especially if you're interrupting to ask the patient about the slogan on their T-shirt.

4) You're nice, get along with everyone, and smile sometimes. Being funny is not required, but helps.

5) When you notice the resident needs something, you volunteer to get it before they have to ask, so they don't have to feel like a jerk ordering you around.

6) You're enthusiastic, even if fake.

7) Doing after-hours activities are a major bonus. The med student I really liked worked a Saturday race, which impressed me a lot.

8) When you're leaving for the day, you let the resident know by saying, "Is there anything else I can do?" That's optimal, but at the very least, say, "I'm outta here, seeya." It looks really bad when you leave without telling anyone and we're all looking around, saying, "Where'd the med student go?"

I can imagine all sorts of angry responses to this list from med students:

So if a med student's car breaks down and they're late, they have to let you know in advance?? I'm so sorry we can't be psychic and predict every emergency that could come up!

Obviously, that's not what I mean. I've been in many, many situations where a med student had some planned meeting or appointment, and instead of letting me know they'd be late, they decided to just not show up. Or if you're sick and can't come in, don't tell me the next day.

So the med student has to know what you're thinking at all times and predict what you want them to get before you ask for it?? I'm so sorry we can't be psychic and know what you want at all times!

Again, not looking for psychic abilities. But say I need to know a med the patient is on, and the patient says, "My wife, who's in the waiting room, has my list of medications." A good med student might volunteer to quickly retrieve the list.

Truthfully, #4 is the most important thing to me though. Oh, and that you're not annoying.

Monday, November 28, 2011

Cruel Resident Stories: Discharge Summary

*I actually thought I was 100% in the wrong for this one until I had this same exact situation come up with another senior resident, and she just laughed at me when I apologized for not having done the discharge summary and said, "I think I can write a discharge summary myself."

Sunday, November 27, 2011

Weekly Whine: Burger King

Are you a Burger King person or a McDonald's person? Because you can only be one or the other.

I'm a McDonald's person. I could eat it every day for every meal (for a month and then get addicted, vomit, and go into liver failure). I love salty food and that's McDonald's. Love those fries. I used to love their chicken nuggets, but then they RUINED them by making them real chicken. (If you know about dark meat chicken nuggets then we are soulmates.) Now I love their Southern Style Chicken Sandwich. It's just like chick fil-a except not evil.

However, on my drive home, there is a Burger King and not a McDonald's. So I'm forced to get BK if I want takeout that doesn't involve me getting out of the car (practically impossible with two kids in tow). Their burgers are OK, so I suck it up.

However, the drive-thru BK on my way home ALWAYS gets my freaking order wrong. ALWAYS, for about a year. And it was always this one same guy at the drive-thru.

At first, they just would forget the fries or one of the burgers. This was annoying because I'd have to drive back to get it after arriving home. Then I learned my lesson and started checking before driving away. (I also once had to demand change of my twenty. "You gave me a twenty??")

However, they managed to thwart me by putting the right NUMBER of items in the bag, but just the wrong items. So I got home one day and found that our two burgers were actually two chicken sandwiches. So I started checking the wrappers to make sure all the sandwiches are the right ones before driving away.

Then I discovered that this is not good enough because they labeled a wrapper as California whopper and instead gave me a regular whopper. So it got to the point where I had to open every single sandwich to make sure it was correct before driving away.

One day, I got my order, checked the sandwiches were right, and started driving away. Then I noticed that they had forgotten my daughter's chocolate milk.

I was so angry, there was steam coming out of my ears. The drive-thru already had two cars waiting, so I parked and got out of my car with my two children. I stormed into the Burger King, asked for the manager, and basically started screaming. I relayed all my pent-up anger at BK, about how they ALWAYS got my order wrong. I kept yelling, "I'm so angry!" The manager kept nodding and at one point, I think he looked at the drive-thru guy and said, "See?"

I vowed not to go back there again, but a few weeks later, it was late and didn't feel like making dinner, so I decided to try it again.

When I pulled up to the drive-thru, I saw the usual drive-thru kid was gone. And since then, he never came back.

I wonder if he got fired or if my rampage contributed to his being fired. Or maybe they just reassigned him to the back. Anyway, they haven't gotten my order wrong since then.

Saturday, November 26, 2011

The late intern

One of my most hated rotations in internship was my ER rotation. I dreaded each shift with every fiber of my being. I'm not sure why I hated it so much. I think I'm not a fan of shift work. I also hated the fact that every patient was new to me.... I like developing a relationship with my patients and the longer I know them, the better.

I started out the rotation doing night shift, which wasn't so bad because there were a lot of lacerations to suture, which I enjoyed. However, on day shift all the lacs went to urgent care.

To add insult to injury, interns had longer shifts than anyone. Attendings and med students had eight hour shifts. Residents had nine hour shifts. But for some reason, interns had eleven hour shifts. It was horrible.

On one of my last shifts, I was so depressed about the whole thing that I intentionally overslept, then arrived at my shift a whole hour late. I didn't even rush. I figured nobody would notice because the attendings didn't really know when our shifts began and ended and I honestly didn't care that much if they did.

Except just my luck, guess who the attending was? The rotation director. I couldn't believe it. When I saw him, I ran away to a corner and hid, trying to think of an excuse aside from, "I hate this rotation so much that I couldn't bring myself to come to work this morning."

Finally, I got up the courage to approach him. He just said hi and acted like I wasn't an hour late. I said, "I'm so sorry, I'm kind of late! I forgot I had a shift today!" (my chosen lie)

He shrugged and laughed, "I guess I have no choice but to throw you out of the residency then, huh?"

(He didn’t throw me out of residency. Unfortunately.)

Friday, November 25, 2011


2 successive subjects of unrelated messages in my inbox:

"FDA warns of Botox side effects, death"


"Please order Botox for Tuesday"

Thursday, November 24, 2011

Tales from Residency: Sharps

OH MY GOD Moments:

Me: "Where's the needle I used to inject the Botox? Did you put it in the sharps container?"

Attending: "Oh, I dropped it on the floor."

Me: "Uh... so where is it??"

Attending: "Still on the floor somewhere."

Me: "Where??"

A ten minute search of the floor of the patient's room ensues, turning up nothing.

Me: "This is not good."

Attending: [totally unconcerned] "I guess it'll turn up eventually."

A minute later, I was clearing some syringe wrappers and I saw the needle lying on the keyboard of the EMG machine. I felt like we were starring in some med school video about Careless Doctors.

Wednesday, November 23, 2011

25% off!

Fizzy: "Why haven't you bought the book version of A Cartoon Guide to Becoming a Doctor yet?"

Reader: "It's a little bit expensive for me. If you had some sort of 25% off coupon, maybe I'd buy it then."

Fizzy: "Oh wow, you're in luck! If you type in BUYMYBOOK305 at checkout, you get 25% off your order!"

Reader: "Oh. Great."

Fizzy: "So you're going to buy it now, right?"

Reader: "Um...... I'm not....

Fizzy: "..."

Reader: "Um, probably... not....."

Fizzy: "Well. This is awkward."

Tales From Residency: Shut-up, Medicine!

I think evidence-based medicine is important. But there are also times when I just want the medicine consult and I don't want to hear the 30 years of research behind the consultant's recommendation. You know a lot, I get it. Just tell me what to do.

During residency, Medicine was consulting on a patient of mine who required an angiogram. I called them while I was on call on a Saturday and they returned the call while I was eating lunch:

Me: "So how much Mucomyst should we give to protect the patient's kidneys?"

Medicine consult: "Well, historically, we've given 600mg in four doses, but...."

Me: "Uh huh...."

Medicine consult: "...there was a randomized controlled study done in 2006 which showed that a dose of 1200mg compared to 600mg is more effective in cases where..."

Me: (thinking) "Oh my god, just tell me how much Mucomyst to give so that I can eat my Philly cheesesteak!"

Tuesday, November 22, 2011

Drawing a Skeleton

When I was in fifth grade, I was the second best artist in the class. I'm not sure exactly how this was determined, except I remember everyone thought I could draw well but there was this one guy named Kevin who was better than me.

One day, we had a challenge in our class: to draw a skeleton from memory. There was a judge who was going to walk around and decide which skeleton drawing was the best, and it was going to be posted on, like, some bulletin board somewhere.

I had a lot of doctors in my family, and I thought this was a challenge where I had a chance to beat Kevin. So I drew my skeleton, although I honestly didn't really know what I was doing.

The judge kept going back and forth between my drawing and Kevin's drawing. It was agonizing. But finally, they picked.... Kevin's. Of course.

Anyway, I was just thinking about that day and wondering how good a drawing of the human skeleton I could do from memory now, since I've actually taken anatomy and all that. So here's my present attempt, totally from memory, no cheating:

How do you think I did? And let me point out that completely perfect ankle mortise on the left.

Monday, November 21, 2011

Tales from Med School: Preparing for OB/GYN

When I was in my third year of med school, I ran into a fellow med student named Greg soon after finishing my OB/GYN rotation and thought he was going to ask me about the best way to study for the rotation:

Greg: "Hey, Fizzy, you just finished OB/GYN, right? Can I get your advice on something?"

Me: "Yeah, sure."

Greg: "Do you think I should start working out?"

Me: "... What?"

Greg: "Well, all the residents on OB/GYN are women, right?"

Me: "Um, yeah..."

Greg: "So they'd probably appreciate it if I were more in shape, huh?"

Me: "..."

Greg: "What do you think I should do?"

Me: "Um, OB/GYN Blueprints is good."

Sunday, November 20, 2011

A Physician's Guide to PENS

Everyone knows that doctors and med students are huge pen nerds. I have probably spent more this year on pens than I have on heat and water. Therefore, I present...

For the record, I prefer the Pilot G-2 Bold.

Saturday, November 19, 2011

Weekly Whine: Fashion, Part 2

You know what I hate? Fitted jeans.

As far as I can tell, these look good on nobody. Even in the above photo, the model's butt looks big. The other day, I ran across a gaggle of attractive college girls, all wearing these fitted jeans, and none of them looked good in it. Now imagine a non-college girl trying to wear these jeans, one who has curves and perhaps has had a couple of children.

I assume the women who wear these jeans think they look good and are not just wearing them to be ironic or something. Do they actually look good and I'm just a fashion idiot? Or is this like the eighties, when a whole generation was pretty much fashion-deluded?

I don't know what's wrong with boot cut jeans. I think those look good on everyone. Especially me.

Friday, November 18, 2011


At the hospital where I did my internship, we used to get a lot of patients from prison. The main thing about prisoners is that you can never, ever ask them why they're in jail. You can't know and you probably don't want to know. Also, it's probably drugs.

When I was working in the ED, I saw a male patient with what looked like an abscess on his leg. One common cause of abscesses at the hospital where I worked was "skin popping." This means injecting drugs like meth under the skin instead of in the vein. We used to see this, like, a couple of times a week.

So of course, I quickly jumped to the conclusion that this jailbird patient had been skin popping at some point and now had an abscess from it.

Me: "Do you use drugs?"

Patient: "No."

Me: "So you've never injected any drugs under your skin?"

Patient: "No, I don't do drugs."

Me: [very skeptical]

Police officer: "It's true. His problem is credit cards."

Thursday, November 17, 2011


The oddest thing happened while I was at the doc's office yesterday. The nurse was taking my past medical history and in the middle of a sentence, I thought she cursed at me! I was fairly sure she said, "Pussy!"

I thought to myself, why would she do that? Did I do something to offend her? I became slightly agitated.

Then she said it again, much clearer this time, "Pussy!"

That's when I realized it: This woman had Tourette's Syndrome.

I am fairly sure that's what it was, or else she just randomly said "pussy" about 10 times for no reason. She just seemed fairly twitchy in general and she said a few other things that were less remarkable. I've never experienced active Tourette's before, so I was surprised how easily I recognized it from the caricatures in movies like Deuce Bigalow. I knew someone in college who had it, but he was controlled with meds and didn't seem to have any symptoms.

It didn't bother me that much once I realized it, but I find it interesting that a woman who randomly says dirty words would have a job taking histories in a gynecologist's office. I'm sorry if this sounds discriminatory, but it definitely kept me from wanting to talk to her more.

Wednesday, November 16, 2011

Free shipping! Yay!

For those of you who have not yet purchased A Cartoon Guide: The Book, there's another deal on Lulu to get free shipping with the code RUSH.

Hiccups Cure!

There are very few things in medicine that can be "cured" and now the hiccups is one of them.

When I was a kid, one of my friends told me she had a surefire hiccups cure, although it only worked once. She said you ask the hiccup-stricken person what they were doing yesterday at 3PM. When they are working this out, their hiccups disappear. This cure absolutely does not work, as far as I know.

However, later I read a study that showed that another particular hiccups cure was effective in 100% of subjects. It's simple and works quickly. And for only $19.99, this cure can be yours!

Just kidding, here it is:

While you are hiccupping, take a deep breath like you usually would to try to get rid of your hiccups. After you take that deep breath though, now take another deep breath on top of that one, to suck in as much air as you can hold. Hold those two breaths worth of air for as long as is comfortable (15 seconds?) then release.

Your hiccups should be gone.

Try it! It works for me 100% of the time.

Tuesday, November 15, 2011

Best memory ever?

A lot of this blog is about reminiscing about my training. I've decided that my job is too important to me to write anything specific about my coworkers or the patients I see, for fear any stories will come off the wrong way. I don't even want there to be a remote chance that a patient I saw in the last few years will recognize himself, so I only write about patients that I saw at least 2-3 years ago. As I've said before, if there's an entry that would get me in trouble if my boss saw it, then I don't write it.

So you might be wondering how I remember all these stories from med school and residency... do I have the best memory ever?

When I was in training, I kept a journal that was not public. I wrote pretty much every day, as a way to vent and just because I like to write. It was cheap therapy for me. Just to show how much I wrote, I recently turned all the entries into books via Lulu and this is how it looks:

I didn't make the entries public for the same reason I don't write about my current job: I didn't want my co-students to hate me.

But now I could give two shits if that gunner on my psych rotation knows that I thought he was a little kissass. So I go through the old journal entries and publish the ones I think are interesting, no holds barred. What you're seeing is the "best of" from my eight years of training. When I have some free time, I'll copy and paste like 10 of my previous blog entries and then schedule them for future posts.

And you're lucky, because the vast majority of what I originally wrote was stressing, obsessing, and rambling. As opposed to what's on this blog, which is of course all pure gold.

Monday, November 14, 2011

Medical Jeopardy

Let me just state right now: I hate playing jeopardy. I have been playing jeopardy in classes in one form or another since I was in grade school and I am so sick of it. Winning a piece of chocolate just isn't worth the chance of looking like a complete idiot in front of your peers by missing a very basic question. (It happens to the best of us...)

I still remember during senior year of high school, my AP American history teacher used to have us play jeopardy before each exam for extra points. I guess only advanced placement classes get to simulate TV game shows. I remember that if we didn't answer in the form of a question, she'd make us rephrase our answer. Even if she had asked in the form of a question:

Teacher: "In what year did they sign the Declaration of Independence?"

Student: "1776."

Teacher: "No, I'll need that in the form of a question."

Student: "Uh... what is 1776?"

See how she totally missed the point of the jeopardy answer/question format? And it's super important to maintain that format in order to preserve the integrity of the game.

Anyway, during my MS3 year, we were playing a game of medical jeopardy with the MS3s and interns against the MS4s and the PGY2s. The intern on my team had just about had it with this ridiculous gunner we had been working with for the last two weeks, and I still remember how amused I was by the following exchange:

For the record, the interns and MS3s won. Maybe medicine residency makes you dumber or perhaps medical jeopardy doesn't actually test knowledge that well. I still remember the answer to the final jeopardy question (or question to the final jeopardy answer): silicosis. That is, What is silicosis?

Is there some point in your life when they stop making you play jeopardy? When I'm 60 years old and an attending, will I still be deciding how much to risk for double jeopardy? God help me if I am.

Sunday, November 13, 2011

Reading list

Because nobody seems to be making commentary on my "currently reading" sidebar, I went ahead and made a whole big booklist:

I guess I've been reading a lot lately. People always say they have no time to read when they have a baby, but I find the opposite is true. Usually when I'm holding the baby, I've got a book in my other hand, because really, how many hours in a row can you gaze lovingly at that cute little sleeping face?

The MCATs and me

I took the MCATs a long, long time ago. Back in those days, we had to hike five miles in the snow to get to the testing site and then churned our own butter. (Butter churning used to be one of the domains tested on the MCATs.) Back in those days, the test was on paper and we bubbled in our answers on something called a "scantron". Ask your parents about it.

Since the test was such a big, exciting event, it only took place twice a year: in August and April. I didn't want to take it during the school year and I thought the August before my senior year was too late, so I took it during the August between my sophomore and junior year of college. I had taken all my prereqs at that point aside from Term 2 of Biology, so I figured I was set.

I decided I didn't see a point to them fancy prep classes, so I spent the summer doing studying on my own. I already knew my strengths and my weaknesses. English, biology, and orgo were my weaker areas. Chemistry and physics were my stronger areas. I figured if I could at least get a solid 10-ish score in everything else, I'd balance it out by getting 14 or 15 in chem/physics. I never got below a 13 on that section in the practice tests, so I figured I was golden. (For those of you not in the know, scores were out of 15 points.)

The format that the test used to have (and perhaps still does) is that there would be a reading passage followed by questions. I recently explained this to my husband and he was utterly perplexed.

Husband: "You mean, there would be a reading passage for the English sections only."

Me: "No, the science sections would have a passage too."

Husband: "Even, like, physics?"

Me: "Yes."

Husband: "Like what?"

Me: "I don't know... there would be a little story about physics and then you'd have to answer questions about it."

Husband: [baffled] "A story... about physics??"

I don't know why it was done this way, but it was. I'm a fast reader, so it wasn't necessarily a bad thing for me. The bad part is if you run into one hard passage or something that isn't your strength, you're screwed on like 6-7 questions instead of just one. And in my case, I ran into TWO really hard passages on the chem/physics section.

I swear, it was unfairly hard, you guys. I can't remember anymore what the passages were, but I remember telling a physics major friend about the hard physics passage, and he said, "Whoa, that's pretty hard." And then a second hard one too... it really hurt me. I walked out of that test not feeling good about it.

Ultimately, I swung a disappointing but sufficient 10 on the chem/physics section. Fortunately for me, I did much better than expected on the other two sections, so overall I got around the score I had hoped for and decided I had a good enough total score to avoid retaking it, especially since I didn't want to go to a fancy schmancy school.

Oh, and the writing section? Abysmal. One interviewer made fun of me and asked if I was literate. (I did get into that school, so that goes to show how little that section mattered. Although an attending once told me the writing section correlates best with med school performance.)

Saturday, November 12, 2011

Weekly Whine: Fashion

One of my mother's great joys in life is buying clothing for her only daughter (i.e. me). The two of us have very different taste in clothing, which is kind of a problem. The other problem is that she thinks I'm a size Large and I think I'm a size Small. (Or maybe she doesn't think I'm a size Large so much as she thinks I'm still going to grow a few inches this year so I need to buy things big and grow into them.)

Last year, my mother bought me a bunch of shirts and they are all what I call "comment-provoking" shirts. What that means is that when I wear any of these shirts, someone at work (usually someone much older than me) will undoubtedly make a comment along the lines of, "I like your shirt."

I do not like this.

First, I don't like being complimented on a shirt that I know looks ridiculous. I wore one of these shirts on Halloween and someone thought it was my costume, so I know it didn't look good. I only wore it because I was sick of my usual clothing rotation and it pains me to see a shirt in my closet with the tag still on it.

Second, I generally dislike compliments about my clothes from people I see every day. Because if they have complimented me, that means they noticed my clothing. And that means that I can't wear that outfit again too soon because as a woman, I have to maintain the illusion of never ever wearing the same outfit twice, despite the fact that I basically rotate between 6-7 different shirts and pants.

Damn, it's hard to be a woman.

Friday, November 11, 2011

Insane Attending Stories: Breast Exposure

(Of course, this happened before I had a nursing child myself. That kind of eliminates your modesty. Eventually you think nothing of peeing with the bathroom door open.)

Thursday, November 10, 2011

Rejection template

For some of you applying to med school with multiple acceptances, you may be wondering how to break the news to those unlucky schools you won't be attending. This is a template I used:

Dear __________ School of Medicine,

I am writing to share what I believe will be disappointing news. Fizzy has considered with care your school for admission. Unfortunately she is unable to attend your school.

Fizzy very much appreciates the time and effort you have spent crafting and compiling your brochure, and the interest you have shown in Fizzy. The fact that Fizzy is only one person dictates that she must limit her enrollment to a frustratingly small proportion of those seeking her enrollment. Fizzy can assure you that your school was considered with thoroughness and care despite this disappointing outcome.

Fizzy does hope that you will find the students you seek for your class of 2015 and beyond, and she appreciates the chance she has had to learn something about your school.

Yours sincerely,
Fizzy McFizz

Hope you found that helpful!

Wednesday, November 9, 2011

Rave Reviews!

So to my surprise, a few major papers agreed to write reviews of my book. The reviews were really outstanding. Here are a few excerpts:

“Often called the greatest novel ever written, A Cartoon Guide is at once an epic of the Napoleonic Wars, a philosophical study, and a celebration of the Russian spirit!” –The New York Times

“A monumental artifact of contemporary American literature, almost assured of longevity as the statues of Easter Island... A Cartoon Guide is a novel that reminds us once again of all that we have taken for granted in our world and should not, the madness we try not to bother to notice, the deceptions and falsehoods we lack the will to try to distinguish from the truth.” –The Boston Globe

“The author's radiant wit sparkles as her characters dance a delicate quadrille of flirtation and intrigue, making this book the most superb comedy of manners of Regency England.”
–Chicago Tribune

“In A Cartoon Guide the author taps all her mesmerizing talent and scientific brilliance to create her most electrifying technothriller.” –Scientific American

“A Cartoon Guide is fascinating and absorbing--perfect for history buffs, conspiracy nuts, puzzle lovers, or anyone who appreciates a great riveting story.” –New England Review of Books

“A Cartoon Guide is a splendid book, deeply interesting and extraordinarily moving, remarkable for its sympathetic insights into both genius and schizophrenia.” –Roger Ebert

“A brooding Yorkshire tale of a love that is stronger than death. It is also a fierce vision of metaphysical passion, in which heaven and hell, nature and society, and dynamic and passive forces are powerfully juxtaposed.” –some British guy

“The classic tale of fantasy, this delightful masterpiece depicts all sorts of characters: greedy, selfish, obnoxious, compassionate, loveable, and generous. Throw in the amazing factory tour, and the hardworking singing Ooompa-Loompas, and you have a compact and entertaining story, which should be required reading for all ages.” –Billy Mumphrey, age 6

OK, I'm joking.

Now you can challenge yourself to guess which book was actually being reviewed in each of these. Fun fun! Or you can buy the book now and get 20% off with the coupon code VETERANS305.

Fizzy's Choice

Submitting a 300 words or less abstract for a conference:

Me: "It will be easy to write this abstract, but getting it down to 300 words will be rough. I'm going to have to make some hard decisions."

Jamie (a psychologist): "It's going to be like Fizzy's Choice."

Me: [laughs] "Totally."

Mike (foreign research fellow): [stares blankly]

Jamie: "There was this movie, which I never saw, but it's about this woman who.... well, she..."

Me: "Actually, this is kind of a downer."

Jamie: "...she has to choose which one of her two children lives."

Me: "During the Holocaust."

Mike: [soberly] "Oh."


Jamie: "That was definitely a downer."

Me: "Nothing kills a conversation faster than the Holocaust."

Speaking of the Holocaust, I recently finished reading Sarah's Key for my book club. I read it quickly, but I felt it was a bit needlessly horrible. I feel like when a book makes you cry, it should be necessary and earned.

Tuesday, November 8, 2011

Physics and Medicine

This was a conversation that occurred during rounds on my GYN-onc rotation:

Attending: "If you have a tumor in the colon, what destroys those tumor cells to keep it from growing?"

Intern: "Uh...."

Attending: "I'm a logical person. I like to think in logical steps. So let's go through this logically."

Intern: "Okay..."

Attending: "What's the strongest force in the world?"

Me: (thinking) "Love?"

Intern: "I was going to say electromagnetism..."

Chief Resident: "Is it gravity?"

Attending: "No..."

Senior Resident: "Is it gas?"

Attending: "No. Look at it this way, if someone dropped a nuclear bomb on Mt. Everest, how much of it would be destroyed?"

Chief: "Maybe half."

Attending: "Yeah, if that much. But if you dropped rain on that mountain continuously for eighty years, would that destroy the mountain?"

Intern: "Yes."

Attending: "Water is a huge destructive force. It might be slower, but it does a lot of damage. And it's the water in the colon that destroys those tumor cells."

Except isn't force a function of time? What's that whole meters per second per second business? Moving something 10 km (the height of Everest) in 80 years isn't that great a force. I think dropping nuclear bombs on Mt. Everest is going to destroy it a hell of a lot faster than some heavy rain.

I hate it when people pontificate on stuff they know nothing about and make me lose all respect for them.

Monday, November 7, 2011

My First Med School Interview

My very first medical school interview was at Albany Medical School. The interview date was at a horrible time. It conflicted with a lecture in my Social Psychology class where we were supposed to anonymously write down our intimate fantasies and the professor Dr. Rogers was going to read a selection out loud to the entire lecture hall. I’m not even kidding. (I heard it was awesome, even though like 50% of them were, “I want to make passionate love to Dr. Rogers.”)

Anyway, I made it out to Albany, which was not a short trip. (Question: Is anything close to Albany? Answer: No.) My boyfriend at the time was very into long road trips and not so much into going to class, so he agreed to drive me. But then when we got there, I sort of wanted him to disappear. I mean, how uncool is it to bring your boyfriend to an interview? It’s like a step above bringing your mom to an interview. Or going to prom with your cousin.

During this first interview, I started what became a tradition for me of befriending all the other interviewees. I don’t know why I did this. I felt like I had to. It’s like, if you were all stuck on a crazy bus that had to stay above a certain speed or else it would explode for some reason, you’d befriend the other people on the bus, right? It’s sort of like that.

The interview day started out with a tour of the school, given by this guy named John who was the dumbest kid in the class. I’m not saying that to be mean, but it was basically the only conclusion I could draw after he regaled us with the story of how he took the MCATs ten separate times, and then he proceeded to fail every single class in med school. By the end of the tour, I was sort of thinking I was too good for Albany.

Finally, we got to the interview part. My first interviewer was Dr. Watson and I didn’t like him. I don’t know why I didn’t like him, but it was just one of those bad vibes I got and couldn’t turn off. I did not like this man. He was also responsible for one of the most embarrassing exchanges I ever had during an interview:

Dr. Watson: “If you could have dinner with any person living or dead, who would it be?”

Me: [inner monologue] “I can’t believe this jackass is asking me such a stupid clich├ęd question, and now I have to try to come up with an answer that would impress him.”

Me: [inner monologue] “I’d really just want to have dinner with some friends from school, not a dead person. Guess I can’t say that though.”

Me: [inner monologue] “A better question would be, ‘Who would I like to fight, living or dead?’ Shit, I’ve been watching Fight Club too many times.”

Me: [inner monologue] “Maybe I should say Elizabeth Blackwell, the first female doctor. But that’s so lame. I’m going to sound like such a kiss up tool if I say Elizabeth Blackwell.”

Me: “Elizabeth Blackwell, the first female doctor.”

Oh well.

He asked me another trick question that I think I fielded very well: “If you go through your first two years and you don’t like medical school, what then?”

Clever me, I figured out that the answer he was looking for was not: “Quit.” I said something about the clinical years being the most important, too soon to decide, yadda yadda yadda.

After the interview, I compared notes with my fellow interviewees, i.e. my new best friends. My interview didn’t sound quite as bad as the one where the 70 year old male attending pretended to be a pregnant 12 year old and made the interviewee counsel him.

My second interview was with an elderly attending named Dr. Flynn. I meshed much better with Dr. Flynn. We seemed to like each other immediately and he told me that with my stats, I would 100% get into Albany. It was a no-brainer, he said. After a pleasant discussion with him, he asked, “Do you have any questions for me?”

Me: “No.”

Dr. Flynn: [gapes at me in astonishment]

See, here’s the problem: I genuinely didn’t have any questions. I spent the whole day learning everything I needed to know about the school, I read the brochure, and I already had one interview. How was I supposed to know that you’re supposed to make up a question even if you don’t have one just so you appear interested? It was my first goddamn interview.

After that I devised a bunch of questions to ask, even though I didn’t care about the answers:

--Do you have a systems-based curriculum?
--What are research opportunities like?
--Does the curriculum have more large lectures or small groups?
--How much early clinical experience do students get?

You get the idea. It didn’t matter that these questions were generally answered like five times before I got to the interview. I asked ‘em again. Also, FYI, asking where the bathroom is doesn’t count as a legitimate question.

Anyway, my boyfriend drove me home after the interview and we got in a HUGE fight over the artistic integrity of Kevin Smith. Basically, I thought Kevin Smith was a hack for making Dogma and he thought that nothing Kevin Smith did could qualify as hacky. Too bad we broke up before Jay and Silent Bob Strike Back came out, and I could say, “I told you so.”

Oh, and in case, you’re wondering, I got waitlisted at Albany. Waitlisted! Not that I wanted to go to that stupid school in stupid freezing upstate New York anyway. Pssh.

Sunday, November 6, 2011

Weekly Whine: Snarky cats

Recently I was having some argument in an online community and one person's reply to me included a picture of a snarky cat. I won't show the actual cat used, but it was along these lines:

I was a little shocked. Maybe I don't spend enough time arguing online, but this was the first time someone replied to me with a snarky cat photo. I mean, I've seen them before in other contexts and always thought they were a little lame, but this was the first time someone used one on me.

What do you say to a snarky cat photo? I felt like I was communicating with a grade schooler.

I wasn't sure what to make of it. But I'm pretty sure when the argument has degenerated to the point of namecalling via cat photos, it's time to back out gracefully.

Or...... fight with MORE CAT PHOTOS!!!

(Seriously, there's a whole website of these things!)

Saturday, November 5, 2011

Guess where I'm from....

During a conference yesterday, someone brought it a breakfast of bagels. The big bag of bagels was labeled "New York Style Bagels". Actually, it was labeled "Safeway's New York Style Bagels", which is just as ridiculous as Domino's Brooklyn Pizza.

I was really hungry, so I grabbed a plain, plump looking bagel. I spread cream cheese over it and hungrily took a bite. And was shocked. "This bagel is spicy!" I exclaimed.

Everyone looked at me like I had lost my mind. I was baffled. How the hell could a bagel be spicy?? Even I thought that I must have been imagining it.

I took another bite and it was still really spicy. "It's spicy! I swear!" I said.

Finally, I forced someone to try it. He took a bite and agreed that yes, the bagel was in fact, spicy. We surmised that even though the bagel looked totally normal, it was in fact a jalepeno bagel. Now how was I supposed to know that??

There was no way I was eating a jalepeno bagel and since I clearly couldn't distinguish those from the normal plain bagels, I decided to go for a cinnamon raisin bagel. Once again, I spread cream cheese over the bagel and took a big bite.

"Oh my god, what is this?!" I cried. It definitely wasn't cinnamon raisin, that was for sure.

"You know, that's a chocolate bagel," one of the residents informed me.

Apparently, what I thought were raisins were actually chunks of solid chocolate in the bagel. I don't even like solid chocolate, so this was again unacceptable to me.

I was so frustrated. All I wanted was a normal bagel! Finally, I saw a bagel that had already been broken in half and it looked relatively normal inside. I broke off a tiny piece and nibbled it cautiously. It was a plain bagel.

So on my third try, I did finally get to have a normal bagel for breakfast. Stupid Safeway freak bagels. Believe me, this would NEVER happen in New York.

Friday, November 4, 2011

Evaluating Spinal Cord Injury

This is part of a series of entries I should probably entitle something along the lines of "WTF does a PM&R doctor do?" If people like this entry, I could do more. I guess.

One of the main ways to evaluate a spinal cord injured patient is something called an ASIA exam. Contrary to popular misconception, this test was NOT developed in Asia. ASIA stands for American Spinal Injury Association. Why isn’t it called American Spinal Cord Injury Association? Because then it would be ASCIA. And that’s just ridiculous.

We do this exam on every spinal cord injured patient both on admission and on discharge and then a few times in between. I hate this exam with passion. When you’re first starting out, it seems kind of interesting, but eventually every resident grows to hate it. First, because it takes for freaking ever to do. Second, because it ends with a rectal exam. Nothing good ends with a rectal exam.

The point of the exam is to determine the patient’s level of injury. This has implications both for function and prognosis. We assign the patients a spinal cord level (C2 through S2) above which “everything works” and call them either complete (A) or incomplete (B through E). Complete means nothing works below the level of the injury and incomplete means some things work below the level of the injury. So if a patient is C6 ASIA A, it means everything works at and above the C6-innervated myotome, meaning they have full biceps strength, wrist extension at least against gravity, and no triceps, finger movement, or leg movement. The fact that it’s a complete injury (A) basically means no rectal voluntary tone or sensation.

The strength exam involves testing "key muscle groups" in the arms and legs. You want to find out the patient has full strength (5), less than full strength (4), strength against gravity only (3), strength with gravity eliminated (2), or just a muscle twitch (1).

The sensation exam is the most agonizing part. We have to go through every dermatome from C2 through S5 and test it both with a cue tip and a safety pin. This is why every PM&R resident has safety pins hanging off their ID badge, not because they are cloth-diapering babies between patients. If the patient has a complete injury where their spinal cord is just totally severed, there’s usually a line above which they feel everything and below which they feel nothing, so it’s pretty easy. However, if sensation is partially preserved, you may have to test the dermatome several times before the patient can give you an answer of whether sensation is normal (2), partial (1), or absent (0). For pinprick, it is truly agonizing, because they have to distinguish between sharp and dull 8 out of 10 times. If they can’t feel it at all, it’s easy. But for an incomplete injury, this can really take forever. Especially if the patient is intubated, which they often are.

Then comes the rectal exam. You’re checking if there’s any sensation in the rectal area or if they can voluntarily contract. I love this part (not really). But it’s probably the most important part for prognosis, because if they have any sensation or contraction, there’s a good chance for improvement of function. If the patient has no sensation or contraction whatsoever, there’s only like a 10% chance of improvement.

There's also a really complicated-looking form:

(Don't you love the picture of the guy bending over with his butt pointing at you?)

OK, example: if a patient is T4 ASIA B, that means that they have completely intact movement in their arms and completely intact sensation above the nipples. Since their score is B, that means they have some sensation in the rectal area and possibly other places. OK, I’ve said “rectal” way too many times.

This system is nice because when you hear a patient’s score, you should have a good idea of what their function is and what their spinal cord injury-related medical issues should be. Like can they use a manual wheelchair or a powerchair, can they live independently, can they breathe on their own, are they continent, etc. In a way, there’s something very analytical about it.

All right, I think I'm done boring you all to tears. Fin.

Thursday, November 3, 2011

Tales From Residency: Phone Messages

In residency, one of our jobs on the Pain rotation was to return messages from patients. It was one of those really, horrible jobs that everyone hated. Every phone message I returned went exactly the same:

Message: Patient would like to speak with you, they have question.

Me: "Hello, is this John Smith?"

Patient: "Yes."

Me: "Hi, this is Dr. Fizzy. I'm calling from the Pain Clinic."

Patient: "Oh."

[long pause]

Me: I'm returning your call."

Patient: "Okay."

[long pause]

Me: "Do you have a question for us??"

Seriously, throw me a bone here people....

And then when they'd finally come up with a question, it was always either wanting narcotics or asking, "Why am I scheduled to see you?"

Then another gem: a woman who asked us to call back with her lab results.

Me: "This is Dr. Fizzy from the Pain Clinic. You called us about your blood test results."

Patient: "I'm busy now. Can you call me back in an hour?"

Me: "No."

Maybe I'm biased but if I had some blood test results pending and the doctor was nice enough to honor my request to call me back the same day, I wouldn't tell them to call back in an hour no matter how "busy" I was. That was incredibly rude, I thought. (All the results were normal.)

Tuesday, November 1, 2011

A promise

A promise from me to you: This blog will not make you cry.

People in medicine can always make you cry. We've got enough stories about death and dying that it's likely one of them is enough to make you pretty sad. I've got such stories. During my ICU rotation, I cried after every call, and only about half those times were because I felt sorry for myself. And don't even get me started on pediatric rehab.

So it would be pretty easy for me to tell those tearjerkers. But I won't. Not even one.


Because life is already too damn sad. Why should you be slapped in the face with it on the internet too?