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.

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??"

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.

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."

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.

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.)

Botox

2 successive subjects of unrelated messages in my inbox:

"FDA warns of Botox side effects, death"

and

"Please order Botox for Tuesday"

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.

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!"

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.

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."

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.

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.

Jailbirds

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."

Tourette's

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.

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.

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.

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.

Reading list

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

http://doccartoon.blogspot.com/p/reading-list.html

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.)

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.

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.)

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!

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."

Silence.

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.

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.

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 clichéd 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.

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!)

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.

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.

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.)

How your specialist sees you

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.

Why?

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

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?