Holiday repeats

Another old favorite of mine:

Quote of the Day

"This will make you very popular."

--said to me by a nurse, while handing me a bottle of guaiac developer fluid
(guaiac card = card that you smear with poop to see if there's blood)

Makeshift

I remember back in residency, I once had a patient with a bad headache (her usual headache), which she was practically in tears over. Unfortunately, I checked her allergies and they included: morphine, vicodin, percocet, codeine, and motrin. She apparently gets a rash from these medications. So I said to her, "I'll give you some Tylenol."

"No, doctor, that doesn't help...."

OK, so what does that leave me? "How about some aspirin then?" (I knew she wasn't allergic cuz she was already on daily aspirin.)

"No, doctor, that doesn't help either..."

"Well, what do you usually take?"

"Excedrin helps me."

I didn't think we had Excedrin on formulary so I checked the PDR to see what was in Excedrin. It's Tylenol, aspirin, and caffeine. So I just ordered her some Tylenol and aspirin, despite what she told me.

Naturally, the nurse pages me and says exactly what the patient just told me. Tylenol and aspirin aren't going to fix her headache. I said, "But she's allergic to everything! What am I supposed to do?"

"She says Excedrin helps her... but we don't have it."

"But that's just aspirin and tylenol... and caffeine." I thought for a minute, "OK, tell you what. Give her the aspirin and tylenol... and a Coke."

The next time I came into the room, she was sleeping. I guess it worked.

Flattered, but....

I just looked on Amazon and apparently there is a used copy of my book selling for $999.99. I'm flattered, really, but I have to be honest... if you pay anything more than $900 for that book, I think you're getting ripped off.

I hate the airport

This might have made a good weekly whine, but I usually do that on weekends and I hate the airport NOW.

We've been traveling home for the holidays and I just got a reminder of how much I hate, hate, hate our home airport.

First, it is the busiest airport I've ever been to. I don't know why it's so damn busy, maybe all the connecting flights or something.

Second, the airport is gigantic and the terminals are like 500 miles away from each other. This is especially annoying when you have kids who do not like to walk 500 miles (to fall down at your door).

Third, there are always ongoing renovations. And because it's the holidays, nobody is actually working on them. Everything is just half-done, under construction.

Fourth, I've never been at a airport where there are so many delays. I think I read somewhere that nearly half our flights get delayed. Also not fun when you have kids.

Also, why does eating at Macaroni Grill always make me want to throw up?

Special sale

Today and tomorrow only, there's a special sale on Lulu and A Cartoon Guide will be available for only $8.50! Just go to Lulu and enter the code BLIZZARDS at checkout.

Insane Attending Stories: Porphyria

Tales from Med School: Anatomy Wanderer

When I was taking anatomy, there was this weird old gray-haired guy who used to wander around the lab every day. He wasn’t a professor or any sort of teaching fellow. He never spoke to us or anyone, but sometimes watched us as we were dissecting. We hypothesized that maybe he was a homeless man who wandered into the building at some point and then decided it would be cool to learn some anatomy and maybe sleep in the locker room.

One day, none of my three lab partners showed up to lab. Feeling quite abandoned, I tried to go about the lab alone, which was tricky since I never read the lab manual in advance. To my surprise, the weird old guy came over and started helping me!

I got to talking to him, and it turned out he was a retired chiropractor. He said that he always wanted to learn anatomy, so he got permission to observe our labs. He ended up being a really nice guy who helped us a lot over the course of the semester.

I guess the moral of this story is: If there’s a random guy wandering around your anatomy lab, don’t judge him too quickly. Unless he starts getting violent, then you should probably call the police.

Christmas repeat

I'm not going to bother with a new post today, so I'll entertain you with an old favorite, inspired by Jess (my favorite orthopod):

The answer

In this post, I asked you what I did that so horribly offended Mr. Hippie. This is what offended him:

Me: "Oh wait." [laughs] "You forgot all his paperwork." [hands Attending a stack of papers that Mr. Hippie had filled out]

Apparently, when I laughed, he felt I was belittling his pain.

Take note: Doctors are not allowed to laugh or show human emotions.

Weekly Whine: Netflix Killed the Video Store

In high school and college, my dates often consisted of the following:

1) Go out to dinner

2) Browse video store for like 30 minutes, trying to decide on a movie to see

3) Watch movie at whoever's house contained no parents

I have fond memories of browsing the video store. Going through each wall of videos, hoping something would spark our mutual interest. Making fun of that Britney Spears movie where she's inexplicably valedictorian of her high school. Then finally, selecting a movie and rushing home eagerly to watch it.

Netflix killed that experience. Now you have to decide on a movie days in advance. That instant gratification is lost, especially since their instant movie selection pretty much sucks.

I don't know what kids do on dates these days. Don't tell me. They probably don't have dates anymore. They probably just farm together on Facebook.

Last chance!

This is you last chance to buy A Cartoon Guide for a friend or loved one in time for Christmas!

If you don't buy it now, I'll have to think of some other excuse for you to buy it. Ummm.... Martin Luther King Day! Or, um... the... Feast of Maximum Occupancy... that's coming up soon, no?

What did I do wrong??

One thing that really bothered me during residency was when I did something that a patient didn't like, and then the patient told on me to the attending when I was out of the room. I can think of two occasions when this has happened and it pissed me off bigtime.

I remember there was one interaction I had with a patient where I actually thought I was completely hitting it off with him, then he complained to the attending about one specific thing I did. That especially bothered me because I felt like I had completely misread a situation. Sort of like in school when you think someone likes you and they totally don't.

The patient was a young guy with long hair who kind of had a bit of a hippie look to him. He seemed like a very nice, laid back guy. Let me reproduce part of our interaction and tell me what you think I did that upset him so badly.

Mr. Hippie: "I have pain in my mid-back, right below that bump."

Me: "You mean your scapula?"

Mr. Hippie: "I don't know what it's called."

Me: "It's called your scapula." [types this into note]

Mr. Hippie: "Okay."

Me: "So is there anything you take for the pain?"

Mr. Hippie: "I smoke marijuana."

Me: [continues typing into note] "Does that help?"

Mr. Hippie: "Sometimes."

Me: "How often do you smoke marijuana."

Mr. Hippie: "Maybe two or three times a week."

There is a knock on the door. It is the attending.

Me: "Excuse me for a moment."

I go outside and tell the attending about the patient. Since there's another patient waiting and we're getting really backed up, he agrees to further evaluate Mr. Hippie's back pain while I see the next patient. We both go back into the room together.

Attending: "Hi, I'm Dr. Attending. I'm going to take you into a different room to examine your back further."

Mr. Hippie: "Oh. Okay."

Me: "Oh wait." [laughs] "You forgot all his paperwork." [hands Attending a stack of papers that Mr. Hippie had filled out]

Attending: "Oh great, thank you very much."

Me: "Bye, Mr. Hippie. It was very nice meeting you."

So can you figure out what horrible thing I did/said that so greatly offended Mr. Hippie?

Hanitizer

At most hospitals these days, they seem to have an alcohol hand sanitizer (or as my daughter calls it, Hanitizer) dispensor outside the rooms. When you enter or leave the room, you're expect to give your hands a squirt of sanitizer.

Obviously, I want my hands to be sanitized, both before and after seeing the patient. But at the same time, why do these dispensors dispense so much alcohol?

I guess I have small hands, which means that the dispensor fills my entire palm with liquid that I then have to spend the next several minutes rubbing into my hands to dry off. Usually at the point someone in the room wants to shake hands with me, I have to apologize for my hands being wet (and cold, usually).

Lately, I've taken to just putting my hand under the dispensor and yanking it out before I can get the entire dose of alcohol. It's still a huge amount.

Nice

You know your expectations are low when this is your definition of "nice":

During one busy rotation, I had about five minutes between morning and afternoon clinics. I was halfway through my lunch sandwich when the first afternoon patient showed up. The nurse brought the patient into the room and my attending said to me, "It's okay, you can finish your sandwich."

And I thought to myself, "Wow, that's so nice of him!" (And I wasn't thinking it sarcastically.)

Best food in town

Resident: "I went to this new restaurant in New York that belongs to that famous chef... what's his name?"

Me: "??"

Resident: "He's got a lot of red hair..."

Me: "??"

Resident: "He's tall..."

Me: "??"

Resident: "Seems very jovial..."

Me: "Ronald McDonald?"

Resident: [stares at me]

Me: "What?"

(It was Mario Batali. But I think Ronald McDonald was a great guess based on the above information.)

Little help?

If you like Fizzy and her blog, for the holidays this year, you can give her a really special gift:

You can put up the Amazon link to her book on Facebook or Twitter.

This would make Fizzy* really happy. See, A Cartoon Guide is an indy book (kind of like Clerks, also in black and white) that is outside the realm of anything general advertising would touch. But if people in medicine mention the book on social networking sites that their buddies in medicine also read, well... it could be an underground success.

Fizzy loves the idea of people in medicine reading and enjoying her book. She priced it so low that she only earns two shiny quarters for the purchase of each book from Amazon, but luckily, Fizzy likes shiny things. A nice review on Amazon would be a good thing for her too.

Please, if you can, spare her a link. You're already on Facebook putting your cat photos up anyway, right?


*Note: Fizzy hates promoting herself and therefore must talk in the third person while doing so.

Tales from Residency: Irrelevant

In residency, we had a weekly lecture series. Sometimes the lectures were great and very useful for a future physiatrist. Other times they were totally irrelevant and a waste of our time. For example, one week where I was particularly annoyed by this was when we had a lecture on alcoholism and AA.

Not that alcoholism and substance abuse is totally irrelevant. I mean, it's something you need to know about in every field, right? But... by that logic, they could give us a lecture on any topic, like CHF, COPD, smoking, etc, and claim it's relevant because we could have a patient with that condition. Let's focus a little bit, shall we? Board exam in PM&R coming up, yes?

I fell asleep for about 15 minutes in the middle of the lecture, which was actually quite refreshing. I was struggling to stay awake and then the lecturer made a comment about how everyone was dozing off, so I figured one more wouldn't hurt.

When I woke up, the lecturer was talking about meditating on a raisin. Somehow I actually already had a lecture on how to meditate on a raisin. It involves holding the raisin in your mouth for a ridiculously long amount of time and thinking about the raisin a lot. I understand that meditating on a raisin is super-important, but I'm not sure how many times I needed to learn about it over the course of my medical training. Once more, maybe?

Question of the day, from the lecturer: What's the most difficult patient to have?

Holiday suck-up

Here's a cautionary tale with the holidays approaching:

During one December in my residency, I was doing a clinic with a resident that I didn't get along with super well named Jimmy.

When he arrived at clinic one morning in late December (1/2 hour late as usual), he announced that he had Christmas presents for everybody. He had an individually wrapped present for each of the three nurses we work with and for our attending.

Honestly, when I'm pissed off, I usually keep my mouth shut. But this got me beyond pissed off.

"So," I said, "you got a present for everyone in clinic, huh? You didn't get anything for me, did you? If you're going to make me look bad, you could have at least gotten me a present."

Jimmy: "But... I just wanted to get everyone a thank you present..."

Me: "Blah blah blah."

I absolutely did not want a present from Jimmy, but honestly, how shitty does it make me look if he buys a present for everyone in the clinic and I have nothing? He could have given me a heads up that he was going to do that or offered to go in on something with me if he felt so desperately compelled to give gifts. Plus, he gave a present to the attending which is just... well, you know. I've given a few boxes of chocolates to attendings but only to thank them for something very specific. (Like when one attending gave me a TON of used baby clothes and toys or one wrote me a letter of recommendation.)

I didn't bring it up again, but I was honestly so angry at him, I wanted to cry for a little while. I thought everyone was going to hate me now because I was the resident who didn't give everyone presents. I tried to redeem myself by seeing three patients out of turn while Jimmy was still struggling to get through his one new patient. (The attending said I didn't have to, but I figured I should in lieu of a present.)

Anyway, at lunch, all the residents were chatting and a few of the girls brought up the fact that for the second year in a row, our junior chief resident had bought presents for every single attending in the department, even the ones he never worked with. (This was also the second year in a row that he was the resident who got Christmas week off. Not sure how he maneuvered that.)

"What a kiss ass piece of shit," she said. Everyone else agreed. Jimmy was silent.

After the girls left, Jimmy said, "Gee, I didn't think about it that way. I guess I shouldn't have gotten those presents, huh?"

Damn straight. He was probably just grateful I didn't mention what he did to the other residents.

Weekly Whine: Consolation Prize

Last week, I went to a little indoor winter carnival with my daughter. In addition to food and decorations, there were a couple of little kiddie games that she could play.

One of those games was a ring toss that was $1 for 5 throws. A bunch of glass bottles were set up and if you were able to throw a ring over a green bottle (about 25% of the bottles were green), you won a crappy snake prize. There was also a white bottle and if you threw a ring over the white bottle, you won this gigantic monkey that was definitely worse than no prize at all.

Now let me say: this game was HARD. While we were standing in line, of the five kids in front of us, none of them won a prize. Finally a grown man tried to win one for his kid, and got it on the last of five throws. As a result, with less than an hour left of the carnival and most of the kids gone, there were like a hundred stuffed snakes still lying on the table.

Finally, it was my daughter's turn. She of course has no ability to aim, so she missed. (She missed the table entirely most of the time.) After she threw her last ring and it missed, the woman running the game said, "Okay, next." And my daughter just looked shocked. Where was her prize? Every other game she'd ever played in her whole life had provided a consolation prize.

Because her little face was crumpling, I paid another dollar and tried to win one for her. I hit a bottle, but it wasn't green, so still no prize. My daughter was devastated.

Perhaps you could say that this was a lesson in learning that you don't always get a prize, but honestly, I think it's unfair to do that to a small child who came to the carnival to have a good time. She would have been happy with anything, even a crappy plastic ring. And it's especially unfair since the game was so damn hard that all the prizes were still left over at the end of the night.

So my point is:

1) If you make a game for preschoolers, there needs to be a consolation prize.

2) What the hell were they going to do with 100+ stuffed snakes at the end of the night?

Tales from Residency: The Rotation of Far Far Away

When I was a resident, my program was contemplating adding a rotation that was about a two hour drive away from the main campus, where most of us lived. It was supposedly a “really good rotation,” which was meant to justify forcing residents to drive four hours round trip every day. I think that's incredibly far, don't you?

My program director was an incredibly nice, reasonable person, and I finally approached him about it during a clinic we had together:

Me: "Isn't that new rotation a really long drive away from here?"

PD: "Well, yes. About an hour and a half. Two hours at most."

Me: "You know, that’s going to be pretty rough for the residents who have kids.”

PD: "Well, nobody likes driving two hours each way."

Me: "Yeah, plus the gas prices are ridiculous."

PD: "True.

Me: "So why are you working so hard to add a required rotation that everyone will hate?"

PD: "Well, it will be a really good rotation."

Me: "Are you even allowed to add a mandatory rotation that's nearly two hours away from the main campus?"

PD: "Well, I'm not sure. We're looking into it..."

Me: "When I was in med school, they had a resident rotation that was an hour away from the main campus and they were required to provide housing for residents. I mean, some people just can't make that kind of drive every day."

PD: "Well.... maybe you won't be required to do the rotation."

I don't think you should have to be a squeaky wheel in order to be able to get the oil.

Top baby names

By the way, I'm a little obsessed with baby names, even before I was contemplating having a baby.

With 2011 coming to a close, MSN posted a list of the top baby names of the year:

Girls: Sophia, Emma, Isabella, Olivia, Ava, Lily, Chloe, and Madison

Boys: Aiden, Jackson, Mason, Liam, Jacob, Jayden, Ethan, Noah

I think these are really especially trendy names, especially the boys names. In 80 years, the stroke unit in hospitals is going to be filled up with Madisons, Jaydens, and Masons.

Stat rehab consult!

As I'm sure many of you know, often deconditioned patients require a PT/OT eval prior to being discharged home. In one hospital where I rotated during residency, only PM&R could order PT/OT consults. Basically, we acted as a buffer to make sure nobody had inappropriate consults ordered on them. That's how much our time was worth.

The result of this was that we'd frequently get frantic pages from medicine residents who wanted to discharge their patients but couldn't until they got PT/OT consults. Some of them got a little mean when I explained that I couldn't just abandon my clinic to go to the hospital to see their patient STAT.

Anyway, this was an actual urgent consult I got during residency:

DIAGNOSIS: Morbid Obesity s/p gastric bypass. Now 415# down from 690 pre-op.

TYPE OF REHAB NEEDED: Patient requesting "dressing stick"

WEIGHT BEARING STATUS: Remarkably mobile given morbid obesity.

PRIORITY: Today

Morbidly obese guy needs a dressing stick?? Well, this is a TOP PRIORITY. And it was odd that nobody seemed to understand what weightbearing status even meant. An appropriate WB status is not "I can't believe he can walk!"

Things I Learned in Residency

The Singing Attending

When I was in medical school, I had a middle aged attending who used to sing during rounds.

No, really.

OK, she didn't belt out "I Will Survive" at the top of her lungs, but during our sit down rounds, she would frequently start (loudly) singing a little tune as she wrote her orders or flipped through the chart. Something along the lines of, "La la la!"

What I found interesting about this is that there's NO WAY she was singing all through med school and residency. If a med student started singing like that during rounds.... well, I don't know what would happen, because nothing even close to that ever happened.

So I couldn't help but wonder: at what point in her career did she decide it was OK to start singing in front of her team? Did she do it as soon as she became an attending, since the music inside her was crying to break free? Or was it a more gradual evolution of humming giving way into actual loud singing?

Now on Amazon!!!!

I know a large number of you have signed up for Lulu accounts in order to purchase a copy of my book. And let me say, you guys are awesome. I'm touched, I honestly am.

But now you don't have to, because the book version of A Cartoon Guide to Becoming a Doctor is available from Amazon!

Buy it from Amazon now!!

I'm so excited, you guys!

Weekly Whine: Bones

As an anniversary gift soon after my older daughter was born, my husband paid for a personal chef to cook us some meals. It cost about $300 for 16 portions, which ended up being close to $20 each. Kind of a lot of money for food you're eating out of a box from your freezer. But admittedly, the food was really, really good, and it was a rare treat. (The baffling thing was that after the chef delivered the food, she asked, "What would you like me to make for you next week?" Did she honestly have a clientele that was paying her $300 per week for food for one person?)

Anyway, a year later, we decided to hire her again. This time one of the dishes we asked her to make was salmon.

Overall, I thought the quality of the dishes she made was not quite as good as a year earlier. But one thing that really surprised me was that I found bones in the salmon. Now it's not like I'm some kind of salmon connoisseur, but I like salmon a lot, and I eat it a good amount, and this was possibly the first time I'd ever found bones in a professionally cooked salmon. I mean, I get salmon at freaking Chili's and it doesn't have bones in it.

So obviously, I was sort of pissed off. I emailed her about it and this was her response:

I tried to get all the bones out of the salmon but some of them you just can't feel. Sorry about that.


Basically, she acted like it was unavoidable that there would be bones in the salmon. I say this is bullshit. If I'm paying $20 per portion, I want salmon that doesn't have bones that are going to stab the back of my throat.

Finally, she refunded us half the money for the salmon dish. (I actually tossed it after finding the bones because I was so disgusted.) Obviously we never hired her again. And I checked just now and her website is gone.

Guest Cartoon: How to Tackle Mindless Residents

Cartoon contributed by Scalpel Sculptor

My favorite author

One of my absolute favorite books as a kid was Summer Camp Creeps by Tim Schoch. I loved this book so much. It was a whodunnit mystery and it was really, really funny. I read it about a hundred times as well as everything else by that author.

It said on the back of the book that the author wrote books for adults too. I was 10 years old and I did read books for adults too at that point, so I tried to find Tim Schoch's adult fiction. I couldn't. I even enlisted the help of a guy at Barnes and Noble, who patronizingly told me that he was "a children's author." I gave up.

Fast forward 5 years later:

The internet grows in popularity.

Fast forward 15 years later:

I'm reminiscining about children's authors I used to love and I remember Summer Camp Creeps. I decide that I should use the internet to find those adult books that Tim Schoch authored. And I will love them.

I discovered thanks to Wikipedia that the adult books were authored under the pen name T.A. Schock. And it turned out that those adult books were....

No, not erotica. That's what you were thinking, wasn't it?

They were mysteries. No longer in print, but I found them used on Amazon. I was so excited, you guys. I mean, usually when you love something as a kid then experience it as an adult, it's nowhere near as good (except for The Great Muppet Caper, which got MORE awesome over the years), but I figured that experiencing this on an adult level would be fantastic. It would be a great mystery and would laugh and laugh. I ordered one of his books. (It cost like a penny.)

And....

I didn't like it. Honestly, I couldn't get through more than 50 pages.

WTF? How could the author of one of my favorite kids books write such a dry and unfun book? I'm filled with disappointment.

A well-rested student on surgery

During my surgery clerkship during my third year of med school, I woke up every day at 4AM. Yet I was rarely sleep deprived. Why?

Because almost every single day, I took a nap.

In retrospect, I'm not entirely sure how I managed this. But somehow I was doing a lot of ambulatory surgeries, and there was always a gap in-between surgeries, or at least a surgery I could skip out on. I never felt like I was doing anything wrong. I was just taking advantage of some downtime.

In retrospect though, it seems like I must have been doing something wrong, doesn't it?

I slept in the resident call room, which was always empty in the morning. I was on surgery in the middle of winter, but the call room was always nice and warm, like a womb. There were also no windows in the room, so it was pitch black with the lights out. I would put my head down on the pillow and be asleep in thirty seconds. Sometimes when I'm trying to fall asleep in my bed at home, I fantasize about that call room.

Even though I wasn't particularly secretive about it, I don't think anyone knew about my daily naps. Overall, I got good comments on that rotation and nobody wrote, "Student sneaks off every day to take nap."

Tales from Med School: The exam pusher

During my first year of med school, there was a guy in my class named Michael who was one of those former finance guys. Michael’s “thing” was trying to get every exam pushed back so we could have extra time to study. Whether we wanted it or not.

One notable example was a biochemistry exam that was supposed to be on the Tuesday before Thanksgiving. However, we had an anatomy exam the Friday before and Michael felt that four days wasn’t enough time to study for the biochem exam. Because, of course, it would be impossible to actually study for two exams at once.

After much arguing and the support of a small faction of the class that really, really wanted to honor biochem, the exam got pushed to Wednesday. This effectively thwarted my plans to try to get home for Thanksgiving a day early and not get killed by holiday travelers. It was total bullshit if you ask me.

On another occasion, we got an email the night before an exam that it would be canceled due to a blizzard. The blizzard wasn’t that bad and we received an email later on the snow day that the exam would be rescheduled for the next day, a Wednesday. Michael and a few other students flipped out. They said that they hadn’t been studying on the blizzard day because they didn’t realize the exam would be the very next day. They now wanted the exam scheduled for the weekend. The freaking weekend!!! There was a reason our class got labeled “the gunner class.”

After much arguing, we were finally given the option of either taking the exam on Wednesday or taking it on Saturday. I took it Wednesday.

Then later in the year, we had a neuroanatomy midterm that was taking place the day after the Superbowl. Once again, Michael tried to get this exam pushed back. This was possibly the least obnoxious reason he’d tried to get an exam moved, but I just was fed up with him by this point. I wrote a long email to the professor, saying why I thought the exam shouldn’t be moved. I don’t know if my email made a difference, but in any case, the exam didn’t get moved.

Of course, the karma was that I got the flu right during the midterm and ended up doing terribly on it.

Anyway, so that’s the story of Michael. The real question, of course, is do you think Michael ended up AOA? Junior AOA? What specialty?

Boring patients

One morning when I was a medical student on inpatient pediatrics, there were two admissions from the night before and I was told to pick up one of them.

One of the patients was a little girl who had some "interesting" disease, something rare that I might never see again.

One of the patients was a ten year old boy with periorbital cellulitis.

I wanted to take the boy with periorbital cellulitis, since the girl seemed more complicated and I wasn't interested in pediatrics. But the chief said to me, "Why don't you take the girl. She's very interesting."

"I'd rather take the boy," I said. "Isn't that something I'm more likely to see again in the future, so it's more relevant?"

"Fine," she huffed. "You take the boring periorbital cellulitis and I'll give the interesting patient to someone else."

Of course, it later turned out the boy had a brain abscess and became a much more "interesting" patient, unfortunately.

Regardless, I don't agree with the practice of finding "interesting" patients for medical students. I feel like interesting patients are great for attendings who see tons of patients and experienced residents, but for med students and new residents, even the bread and butter stuff is interesting because they've seen so little. Plus it's important for them to learn to treat bread and butter stuff, not rare diseases that they'll likely never see again.

For example: Say you have a med student on the renal service. Is it more important that they learn to manage a "boring" patient with diabetic nephropathy, a common disease that will be relevant in the future in almost any specialty, or an "interesting" patient with diabetes insipidus, a disease most doctors never or rarely see.

I mean, is the purpose of medical school to train students or to entertain them?

(Answer: Neither. It's to learn to pick up residents' drycleaning.)

You be the detective (answer)

1. Our junior chief resident took about five patient files out of the clinic in order to dictate the patient visits at a later time. One hour later, he reported those files missing.

Question: Where were those files later found?

Answer: The files were discovered an hour later in the public bathroom at the hospital. Why does everything lost always turn up in a bathroom?

2. I saw a patient in clinic today who was recently admitted to the hospital with severe leg pain. I looked at the discharge summary in the computer and saw the following identifying information:

30 year old male with chondrosarcoma [type of bone cancer] status post hemicolectomy [part of bowel removed] one month previously.

Question: Why did this patient with bone cancer need to have part of his bowel removed?

Answer: Although the entire dictation repeatedly referred to the patient's recent hemicolectomy, his surgery was actually a hemiPELVECTOMY (removal of part of pelvic bone). This is what happens when the medicine team takes an ortho patient.

Christmas presents for the spoiled relative who has it all

An all-too-common situation:

Your cousin Jack has it all. After getting a nearly perfect score on the MCATs, he floated into the ivy league med school of his choice. His parents are paying his way, as well as for that huge townhouse he's renting with his best buddy. They've even bought him a stethoscope, and all the other supplies he needs, even though you had to pay for that stuff out of loan money that you're still paying back 10 years later. That's right, you still haven't paid off your medical equipment that's practically cracking from overuse, while that asshole Jack could probably get his parents to buy him seven stethoscopes, one for each day of the week and still get that spring break in Bermuda while you haven't even left the state in.....

Wait, where was I?

Oh yeah, as I was saying, for that cousin or relative or spoiled jackass in medicine that has it all, for Christmas this year you can get them a copy of A Cartoon Guide to Becoming a Doctor. Great idea, right? Totally.

Free ground shipping (that's extra fast shipping) till tomorrow with code SLEIGHRIDES.

Tales From Residency: You be the detective

Two mysteries from my residency:

1. Our junior chief resident took about five patient files out of the clinic in order to dictate the patient visits at a later time. One hour later, he reported those files missing.

Question: Where were those files later found?



2. I saw a patient in clinic who was recently admitted to the hospital with severe leg pain. I looked at the discharge summary in the computer and saw the following identifying information:

30 year old male with chondrosarcoma [type of bone cancer] status post hemicolectomy [part of bowel removed] one month previously.

Question: Why did this patient with bone cancer need to have part of his bowel removed?


(Answers tomorrow)

Tabby cat

A friend of mine named Jane works as an attending supervising residents in a clinic. After the residents see the patients with Jane (or whatever attending is supervising), Jane signs off on the resident note and returns the chart to them.

One resident apparently thought that the attendings were not reading their notes. So he devised a note about a patient named Tabby. Tabby was a cat whose chief complaint was a hairball.

One day in clinic, this resident handed his note about Tabby the Cat to Jane, who signed the note. The resident then circulated the fake note to all his resident buddies as proof that he was right.

Of course, the note got back to Jane's supervisor and she got a note in her file.

Honestly, I'm sympathetic to Jane. Sure, she didn't read the resident's note. But who suspects that after the resident presents the patient to you that they're going to write something so entirely different? How many attendings truly read resident notes that carefully?

Weekly Whine: Coupons

I was at the grocery store yesterday and I got stuck behind a woman with COUPONS. I hate coupons.

Now I'm sympathetic to the fact that everyone isn't a rich doctor like me (yeah right), but regardless, I hate coupons at supermarkets. And this comes from someone who, when I get a "free card" coupon from Shutterfly, I immediately go to Shutterfly, make a card and send it out. (Total saved: $2.67) So I appreciate that two cans of catfood for the price of one is a deal that cannot be passed up.

What I don't appreciate is the way coupons slow everything down. I feel that there MUST be a better way. I already have a Safeway card... you bastards have my address and phone number and jeans size, why do you expect me to also pour over the newspapers in search of 33 cents off a quart of milk?

Incentives are great. Maybe when I've spent $1000 with the shopping card, I can have $10 off my purchase. Instead of having to cut a coupon out with a scissors and have it inevitably refuse to scan in.

You know what I'm talking about with the scanners. Have you ever been behind someone in line who had coupons and every single one of them scanned in without a problem? I haven't. Yesterday, one of the woman's coupons didn't work, and of course, they had to call the manager over. The problem? The coupon expired that day, so... yeah, I don't understand either.

That's another thing, people with coupons don't read the fine print or they don't sort their coupons prior to the grocery trip, so there's always one or two coupons that's expired or doesn't work for their purchase, and this requires several minutes of squinting at the coupon and explanation to the customer.

I just feel like in this day and age, with our iPhones and our iPads and our rock and roll music, there's got to be a better way to give discounts than forcing people to collect little scraps of paper.

And don't get me started on people who bring checkbooks into the supermarket.

Medical terms that scare me

(Yes, another Mr. T reference...)

My worst med student

Earlier in the week, I wrote about good qualities I look for in a med student. This, on the other hand, is the story of the worst med student I had during residency.

Generally, the med students we got were doing the rotation as an elective and therefore were interested in PM&R as a career... and many of them were specifically interested in our program. Occasionally, we got med students who were just there to have an easy rotation (although less often than you'd think).

This particular med student, Angie, seemed like she was going out of her way to try to appear uninterested in the rotation. I was generally pretty nice to the med students, but she brought out the bitch in me. For example, the following is a conversation we had after she showed up at 9:40AM for our 8AM clinic. She'd already been late every day that week.

Me: "Just FYI, if you're on a rotation that you're interested in, you should try to show up on time."

Angie: "But I thought I was doing the Sports clinic this morning."

Me: "I told you yesterday that there was no Sports clinic this morning. And even if there were Sports clinic, that starts at 9, so you're still late."

Angie: "I got lost on the way here."

Me: "Look, you don't have to make excuses. I don't care. I'm just saying that it looks bad when you're late every day. It's not something you want to do if you're interested in going to a program."

Angie: "Well, I'm not really interested in this program, I've decided."

Me: "Fine, then show up whenever you want."

I really can't imagine showing up over an hour late every day, even on a rotation I wasn't interested in. In addition, I don't think she went to even one lecture.

Angie also did this other thing that drove me crazy. Sometimes at some point during clinic, the attending would say to her, "Why don't you look up Topic X?"

So instead of looking up the topic that night at home like any half decent med student would, Angie promptly stopped seeing the patients and monopolized one of our only two computers looking up the topic for the entire rest of the day.

I had never seen anything like it. We had many other med students and not one of them thought that being told to look up a topic meant they were done with clinic for the day.

I was still not that mean to her. I think me being a bitch is probably still nicer than a lot of other residents. Even though I was still working, I asked Angie if she had her lunch at 12:30; when she said she didn't, I told her to go get something for herself.