1/4 Sale

Lulu is having a special sale for today only that they say comes only once every four years. Is today some sort of special occasion that comes only once every four years?

Anyway, if you buy A Cartoon Guide from Lulu TODAY ONLY, it will cost only $9.22 with the code LEAPYEAR305. You'll spend more than that eating dinner at McDonald's and this won't bring on those chest pains that radiate into your left arm.

Specialized Schools

I grew up in Manhattan and attended public schools my entire childhood. I'd say I got an okay education. I mean, I'm a doctor now, so you can't exactly hold me up as a failure of the public school system.

I guess most big cities have magnet schools or specialized schools or whatever you call them. As far as I know, for the grade school years, Manhattan only had Hunter Elementary School. No wait, it was actually called Hunter College Elementary School. You know you're sending your kid to a good elementary school when it has the word "college" in its name.

According to their website, Hunter is a "publicly funded school for gifted and talented students pre-primary to grade 6." So basically you get this great education for free and all you have to do is prove that you're gifted.

The admissions process at Hunter is two rounds. "In the first round, the parent takes the child to an approved psychologist, who is trained to give an assessment of intellectual reasoning, a modified Stanford-Binet exam. Children who score at or above an eligibility score are invited to Round 2. At Round 2, children meet in groups of nine where trained consultants observe the child’s behaviors in individual and group tasks, as well as their interaction with peers and a teacher."

So basically, they watch you eat paste and see if your paste-eating skills are intellectually superior to that of your colleagues.

Can you see where this is going? That I didn't get in? As a three year old, my paste-eating skills just weren't on par with other kids.

I could make some comments about how skeezy it is to put preschool kids through a testing process like that and then tell them that they weren't good enough. I could also suggest that perhaps the whole idea of singling out "gifted" children at such a young age is a little ridiculous and that probably the majority of kids would do well if placed in a rich learning environment. But that would all sound like sour grapes.

Anyway, if you fail to measure up as a preschooler, you get a second chance to get in for 7th grade, now to Hunter College High School. Again, note the word college.

Again, there were two rounds. First, they looked at your standardized test scores and selected the kids they deemed worthy to take their exam. Then you took a test that involved a math, verbal, and essay section.

I was one of the kids in my class selected to take the exam, because of course, I was hella smart (i.e. I was a huge nerd). I didn't have any tutoring specifically for it, but my mother kind of prepped me and she certainly put a lot of pressure on me. Anyway, long story short, I failed the exam. Actually, my score on the math and language part of the exam was passing, but there was an essay portion that I bombed. Two kids in my class got in and it killed me that my score on the math/language portion was much, much higher than either of them. Same thing happened to me on the MCATs. Seems like these standardized essays are my Achilles heel. Maybe I shouldn't have written an essay about a boy in my class I was crushing on.

Anyway, it didn't end up mattering a whole lot, because I got into a specialized public high school for 9th grade, and I'm just sayin', we regularly kicked Hunter's ass in pretty much all academic competitions. Except for paste-eating, they were way better on that.

So many journals...

Seriously, why are there so many medical journals?

Whenever I have to do any research, I access the ejournals at our local university medical library, and I'm always shocked at how many journals there are.

Like just starting with the letter J, there are almost 1500 journals.

Not 1500 pages, not 1500 articles, 1500 journals. Many of which have been around for decades, publishing volumes either quarterly, monthly, or even weekly.

Who's writing all these articles??

Having attempted to do research in the past, I know firsthand how difficult it is, how many steps and barriers there are. So it amazes me that there are enough research studies going on to fill 1500 journals. And that's just the ones starting the J! (Granted, J is a popular letter for a Journal.)

Parameters

Most awesome page ever, which woke me at home at 5:30AM:

Nurse: "The patient's blood pressure medication order says to hold it if the systolic pressure is under 100. His pressure is 107/69 and his pulse is 79."

Me: "So?"

Nurse: "Should we hold it?"

Me: [very sleepy but still able to do simple math in head that 107 > 100] "No, give the medication."

Nurse: "Give it anyway?"

Me: "Yes!"

Maybe I'm wrong, but I thought the reason we constantly get harassed and reminded about hold parameters is so that the nurse doesn't have to call us at 5AM to ask these questions.

Guest Cartoon: History of Medicine

Cartoon originally posted at Poor MD.

Weekly Whine: Polite

I've written on here before about the fact that I'm very polite, sometimes to a fault. But sometimes even people like me slip up.

Recently I was struggling in the freezing cold with both kids. One was slipping out of my arms and the other was whining that I was hurting her hand by holding it. I was also carrying a huge bag. As I reached a door, there was a guy holding it and as I shepharded the kids through the door, I guess I failed to say thank you.

So the guy said, "YOU'RE WELCOME!"

And of course, I was really embarrassed and I mumbled thank you, but felt kind of annoyed by the interaction the whole day. I mean, do we only do good deeds in order to be verbally thanked? Is it not enough to just feel good that you helped someone without being an asshole who demands to be acknowledged for it?

(Remember that Seinfeld where he lets someone ahead of him in traffic and they don't give him a wave? "It would have been nice to get a wave." That's why I always give a wave.)

I had an experience in college that still resonates with me. I was at a bank and I failed to hold the door for a woman with a cane. I'm not sure why I didn't hold the door aside from the fact that I was 18 and my mind was on another planet. In any case, the woman started YELLING at me for not holding the door for her, telling me how rude I was.

And all I could think was, "Wow, I am so glad I slammed the door in your face, you bitch."

Guest Cartoon: The Cost-Benefit Paradox of Education

See more cartoons by this author at Paradoxical Syncope

(Submitted by Hali Vanderburg)

Tales from Residency

One morning when I came onto the ward during residency, I overheard that the on-call third year resident yelled at a nurse early that morning because she called him at 7AM for a systolic BP of 182.

"I can't believe you woke me up for a blood pressure of 182!" the resident allegedly ranted. "You know, I had a blood pressure of 160 over 90 this week!"

I thought the resident was wrong to yell. I mean, that's a significant blood pressure and the nurse needs to inform the doctor. OK, she could have waited an hour till I got there. But who the hell is still sleeping at 7AM anyway?? That's a nice life he's got.

"Dr. David has a blood pressure of 160 over 90?" another nurse said. "He's probably going to have a stroke."

I felt pretty sure that Dr. David was totally going to get away with this minor transgression. He's of the young, good looking male doctor variety, so I figured he could get away with yelling for basically no reason. But no (sort of). The nurse told on him to our attending. Who laughed.

Kinda sorta history

If you ever wondered why the doctor presses you to give more specific information, it's because we don't want our dictations to sound like this:

Mr. Smith is an old man with pain everywhere for an amount of time he won't tell me. He rates his pain as "okay" out of 10, can't describe it, and says it is associated with a funny feeling in his legs. He takes a medication for the pain that starts with the letter R. He is not sure of the dose. He went to an emergency room somewhere for the pain a while ago and they took X-rays and gave him a shot of some kind, which didn't help. He had an MRI ordered by some doctor. He doesn't have the MRI or report, but he thinks it showed a disc.

Are you smarter than a chemistry teacher?

During my senior year of high school, I took AP chemistry. (I know, you're very impressed.)

I had possibly the worst teacher in the history of the world, Dr. Alkaline. Her idea of teaching involved copying our textbook onto the blackboard verbatim, without any sort of explanation or demonstration. It was painful.

One day, Dr. Alkaline had to do some calculation that involved conversion of units and she incorrectly converted cubic centimeters to cubic meters. It wasn't a careless error, but rather an intrinsic misunderstanding of basic unit conversion.

I was a math team dork, so I pointed it out to her. Dr. Alkaline told me I was wrong. The guy sitting next to me, a fellow math team dork, chimed in that I was correct and she'd done the calculation incorrectly. She continued to insist she was right.

Until the next day, when Dr. Alkaline admitted in class that we had been right. At least she owned up to it.

And most baffling of all, Dr. Alkaline had a PhD. We had to call her Doctor. Is that mind-blowing or what? We wondered what the PhD could possibly be in. Definitely not chemistry. Do they award PhDs in stupidity?

Moral: If you're going to teach AP Chemistry in a magnet high school, try to know basic math. Otherwise your snotty students are going to talk about how dumb you are for the next 15 years.

Bonus question: How many cubic centimeters are in a cubic meter?

Insane Attending Stories: The Plane Flight

Music of the future

I'm kind of digging the new single by Red Hot Chili Peppers.

Husband: "If someone asked you fifteen years ago who would have been more famous in fifteen years, Red Hot Chili Peppers or Green Day, what would you have said?"

Me: "Fifteen years ago? Probably the Chili Peppers, cuz they were already pretty famous. Green Day didn't seem like it was going very far back then... since, you know, they only had three chords."

Husband: "Really?"

Me: "What's your point? They're both still really famous."

Husband: "I don't know. I just wouldn't have said that a bunch of guys singing in their underwear would have had potential for long term fame."

Me: "So would you have picked Green Day?"

Husband: "I think I would have said neither."

Weekly Whine: Writers Workshop

When I was in college, I took a few writer's workshop classes, because I like to write. The beginners workshop class was pretty fun, but then I made the mistake of taking an advanced writers workshop. It was a nightmare.

The students in the class were all these pseudo-bohemian English major types who thought they were all going to write the great American novel. They looked like they thought they should be smoking cigarettes at a café in Amsterdam (or something equally pretentious).

One thing they did that annoyed me to no end was they couldn’t write normal dialogue. Maybe I’m old fashioned, but to me, dialogue is supposed to open with a quotation mark and close with a quotation mark. I mean, am I on crazy pills here? Nobody managed to stick to this. We got people who would just put a little dash before the dialogue:

-Hi, what's going on?
-Not much. How are you?

Or maybe italicize it:

Today I am bored, I am filled with boredom, he said.

Or my personal favorite, not denote that it was dialogue at all:

It's rather hard to tell that I'm speaking, he said.
Oh, I agree, she said.

You arrogant pricks, just put in a freaking quotation mark, will you?!

One guy wrote this story that everyone was slobbering all over themselves for. It was about this woman who took a bus trip. I think the woman was also world-weary. I really don’t think anything else happened except that this woman took this bus trip for like ten pages. At some point, she got off the bus.

I remember someone in the workshop commented in amazement, “She got off the bus at the exact time I wanted her to get off the bus!” I wanted her to get off the bus too, mostly because I wanted something to happen in the story. Anything. I think this story won some contest later on. I showed it to one of my (math major) friends who didn’t get it either.

Maybe my problem was that I just couldn’t appreciate all kinds of writing. A writer once said to me that she had to teach herself to recognize what was good and bad in different styles of writing, even if it wasn’t the style she preferred. I can’t do that. I only know what I like and don’t like.

And in case you were curious, none of them wrote the great American novel. (Thanks, Google.)

Doctor picture

After so much drawing, I needed a break. So I asked my daughter to draw a picture of a doctor and this is what she came up with:

Daughter: "I drew her with blond hair because most doctors have blond hair."

Me: "I don't have blond hair."

Daughter: "Yeah, but most doctors do."

Me: "Like who?"

Daughter: "They just do."

Also, halfway through, she said she was going to draw a nurse instead, and I had to persuade her to make it a doctor. Then as I was scanning it in, she told me to make it pink.

(Cross posted to Mothers in Medicine)

Life insurance

A quote I heard from an attending:

"Every so often, I cut someone off in traffic. I figure that will ensure I don't get cancer or ALS."

(Actually, I don't think this guy had anything to worry about...)

Is there any truth to that statement? Is being nice a poor prognostic factor?

Answer

In my last post, I asked what was the one lab ordered on a patient with third degree burns. The answer?

Hemoglobin A1c

Congrats to Agnes, for knowing how important it is to find out how well your patient with new severe burns had been controlling their blood sugar for the past several months.

Burn victim

When I was an intern on the medicine consult service, we got consulted about a patient on the plastic surgery service with a history of hypertension and diabetes who had suffered third degree burns on his buttocks.

When I was checking his labs, I was shocked to see that in the week he had been in the hospital, only ONE lab test had ever been ordered.

Pop quiz: What lab test was it?

Spreading Santorum

By putting up a link to this site, I am doing my part to ensure that the name of an anti-women, anti-gay bigot gets the meaning it deserves.

(The more people who link to it, the higher it stays in the google queue.)

Happy V-day!

I still remember that soon after I got married, my father said the following to me:

"I was reading yesterday that people in their late thirties are actually less depressed if they've been married and divorced than if they'd just stayed single. So I guess it's okay that you got married."

It's really nice when your parents approve of your choice to get married.

Tales from Med School: Drool

When I was doing my anesthesia rotation, I remember one of the nurses complained that the unconscious patient drooled all over her.

Another nurse said something like, "So? It's only baby spit."

Actually, even though patient was about 8 or 9, she had a good point: patients slobber on you a lot, and it's much less unpleasant to be slobbered on by a kid. The younger the better. (Well, maybe not BETTER, but less unpleasant.)

After that comment, I started to wonder who is the least or most unpleasant person that can drool on you. Obviously, a loved one's drool is not that bad. Baby drool is definitely on the low end as well, barely even icky at all if it's your own baby. I have been covered in baby drool and barely cared. My daughter, who is no longer a baby, sometimes licks me for some reason... and that's not so bad either. I guess as a person gets older, their drool becomes more and more disgusting, especially after that big jump during adolescence. I think in general, 20 year old drool is a lot better than 89 year old drool. I also think that senile people with candida have worse drool.

And of course, there is the question of male vs. female. I think female drool is probably better than male, if only because women have smaller mouths so I'd guess there's less of it. But the age thing still applies... 20 year old male drool is better than 89 year old female drool.

Wow, what a disgusting entry. I'm so sorry.

Rice

I do all the cooking in our house. And I use the word "cooking" very loosely. If something needs to even be microwaved, it falls to me.

A while ago, my husband wanted some rice and he asked if I could make it for him. I was busy and it was Uncle Ben's instant rice. It was the kind that's in a package and all you have to do is put the package in the microwave for 90 seconds. You don't even have to take it out of the package. I told him that I thought he could handle that on his own.

So I went into the kitchen and I see the rice is in the microwave. It's lying on its side instead of upright, but I figured that shouldn't matter. All of a sudden, I hear a really loud BANG. I looked over at the microwave:

Me: "Oh my god, the bag of rice exploded open!!"

Husband: "What? How did that happen?"

Me: "I can't even trust you to microwave a bag of rice...."

Husband: [hangs head] "But... I followed the instructions carefully..."

Me: "Did you put it in for only 90 seconds?"

Husband: "Yes!"

Me: "Well, maybe it's because you didn't put the rice upright?"

Husband: "But it wouldn't stay up!"

I pulled the bag of rice out of the microwave and examined it. "Hey, you didn't open the tab to vent the rice!"

Husband: [confused] "But I thought you're supposed to vent the rice AFTER cooking it."

Me: [reading package of rice] "Step 1, shake package. Step 2, open the tab to vent the rice. Step 3, microwave for 90 seconds. Step 4, eat the rice."

Husband: "Oh."

Me: [shakes head]

Weekly Whine: Milk for Babies

Are you never satisfied, Breast Nazis?

With my first child, I supplemented with formula. I make no secret of that, and honestly, I don't see wrong anything with it. (It saved me from needing the vitamin supplement drops that I spilled on our sheets and could not be washed out after three runs in the washing machine. WTF?) But certain women called me out and said it was horrible, HORRIBLE to give my baby formula.

My idea of "horrible" is the three month old baby I saw in the ED with multiple fractures from abuse. But whatever. I was HORRIBLE for giving formula.

With my second child, I was totally on the ball. I started pumping during my maternity leave and had a huge stash of breastmilk when I went back that was the envy of all the villagers. The only problem is that I have to actually use that milk before it expires, so I store my freshly pumped milk and use the frozen milk that is close to expiration.

Except now I'm HORRIBLE for using icky frozen breastmilk over the freshly pumped milk. I mean, what the hell is the point of building a stash if I'm just going to let it expire and throw it away? And then what will I do when I ramp down the pumping and now my whole stash is expired?

Of course, it doesn't matter because I'm horrible for using a bottle at all. I should be nursing directly all day. And all night too, since it's HORRIBLE to try to train your baby to sleep through the night.

Tales from Med School: The Cracker Incident

How I decided geriatric psychiatry wasn't for me:

During my psychiatry clerkship, I noticed that most of the patient population was pretty young. But there were a few older patients as well.

I don't remember what Mr. Smith's diagnosis was, but he was one of our few geriatric patients and he managed to annoy me beyond belief, despite not even being my patient. I guess he didn't mean to, but he spoke so slowly and always had so many complaints, I felt like I want to shoot myself while we were rounding on him.

One day, we came to his room and he held up a brown paper bag filled with crackers (where this came from, I have no idea) and complained that he "can't eat crackers because I'm a diabetic." I have no idea why he felt that as a diabetic he couldn't eat crackers, but the attending promised he'd look into a special diet for Mr. Smith (who seemed very agitated about these crackers).

We continued rounds and a minute later, Mr. Smith opened the door to his room and asked me if he could speak to the doctor. I said, "Just a minute, we're doing rounds."

He nodded like he understood, but then he held out the bag of crackers to me and said, "Take these crackers."

I said to him, "Just leave your crackers in your room. We'll come get them later."

That wasn't a satisfactory answer. Mr. Smith insisted again that I take the crackers with me, but I told him again to just leave them in the room. I tried to close the door, but as I was closing it, Mr. Smith slipped the crackers through the door just before it closed in an Indiana Jones-esque move.

So I was stuck with those goddamn crackers. I mean, he wasn't even my patient.

Top 8 Books I Used in Med School

This is a list of the best 8 books I purchased during med school. Why 8? Because I started making a list and when I finished, there were 8 books on it.

1. Surgical Recall

For most rotations, students would argue which book was best. Was it Blueprints, First Aid, etc? But for surgery, the choice was obvious. This little book had everything and fit conveniently in my white coat pocket, causing my shoulders to sag down only 1.5 inches.

2. Clinical Microbiology Made Ridiculously Simple

I think I still have a good understanding of micro due to this book. The only problem is that I still remember some of the mnemonics better than what the mnemonics actually mean. For example:

Be serious, Dr. Goofball!

I know this has something to do with B cereus, but what? Also, whenever I prescribe Amantadine, I think of "a man to dine" but also can't remember what it means.

3. BRS Physiology

This book allowed me to do well in physio without attending one lecture. Which is great, because the lectures were hella boring.

4. Dubin's Rapid Interpretation of EKG

I was an idiot about practically everything when I started internship, but thanks to this book, I knew my EKGs.

Cons: Dubin is a child pornographer.

5. Pharm cards

I realize these aren't a book exactly (or at all). I think they're based on Lippincott's Pharm book. But these cards helped me so much, they deserve a shout out.

6. Felson's Principles of Chest Roentgenology

There's no better book to help you learn how to read a chest X-ray. And maybe by the end, you'll know what the hell "roentgenology" is.

7. First Aid for Step 1

If you're a med student, you must buy this book. End of story.

8. Step 2 Secrets

This book basically summed up all of third year in 350 pages.

I went to med school a long time ago. I mean, I think dinosaurs were still roaming the earth back then, so you know that if I remember a book as being great, it must have made quite an impression on me. And I guess there were others that you sort of had to buy, like Netters, but I just didn't have the same kind of love for Netters. Sorry, Netters fans.

I could make a similar list of books that were useless, that I regret buying, but it would probably just say ROBBINS in big red letters.

Something in the water

During my last rotation of intern year, I discovered I was pregnant. I worked with a senior resident named Angela and my attending was a woman in her thirties named Dr. White.

In January of the next year:

I gave birth to a daughter.

Angela gave birth to a baby boy.

Dr. White gave birth to twins.

All within a couple of weeks of each other.

Coincidence?

Conditions you don't learn to treat in med school

Thanks to Alex G for the inspiration!

The President

Usually as part of a mental status exam, I ask patients who the President of the country is. If they don't know that, it's pretty bad. It's kind of annoying when a patient refuses to answer on account of not liking the President.

This was my favorite response to that question:

"An asshole."
--Said in 2005. I'll let you figure out who was President at that time.

My second favorite response:

"I'm from Canada."

A guy I worked with said that his two favorite answers were Ringo Starr and Bob Newhart. Not simultaneously, of course.

Happy Superbowl!

For those of you who still haven't purchased A Cartoon Guide: The Book, Lulu is having a sale for 20% off today with the code MORESHADOW, so you can pick up the book very cheap.

Good luck to both Giants and Patriots fans. And for those of you just watching for the commercials, I hate to disappoint you, but I don't think there will be any commercials featuring Betty White this year.

Weekly Whine: Anonymous

You know what really grinds my gears? When people make "Anonymous" comments on a blog.

I don't dislike it because I find it offensive or anything (although it's true people are more likely to be jerks when they're anonymous, which does not make a good statement about humanity). The reason it annoys me is that it is completely inhibitive to discussion, which is even more annoying when the Anonymous is asking a question. Or more likely, when there are multiple Anonymouses posting.

My replies always have to sound something like this:

Well, I agree with Anon@12:45, but I think Anon@3:45 makes a good point too. Of course, Anon@6:32 is being a complete jerk.

Annoying, right?

So if you comment on a blog, at least make up a name for yourself. Call yourself Joan of Arc for all I care, just please don't leave yourself as Anonymous.

Tales from Residency: Stupidest consult

As a resident, you're sometimes forced to call consults that you don't think are necessary. I mean, your attending is sort of your boss, so if they tell you to call a stat GI consult on a patient who obviously has hemorrhoids, what can you do?

This is the most embarrassing consult I was ever forced to call:

I had a patient during residency who was wearing a condom catheter for incontinence. He had a rash on his penis that I thought was very obviously a contact dermatitis from wearing basically a condom all day. However, my attending looked at the rash and thought it was kind of flaky. So he forced me to call dermatology and ask if the patient might have psoriasis (localized to his penis).

I was pretty embarrassed having to call derm and ask if this penis rash was psoriasis. I wanted to ask them, "Is this the stupidest consult you've ever received?"

Words of Wisdom

These are some random words of wisdom that I heard as a medical student from my residents. I committed these statements to memory and repeated them as much as possible. I want to reproduce these words of wisdom so as to preserve them for all eternity.

"When I was an intern I never knew what I was doing and I was always all over the place."

"Go home and study. Otherwise you'll end up matching in medicine like me."

"I miss being an intern because nobody expects you to know anything. You can make all the dumb mistakes you want and then just be like, 'What do I know? I'm just an intern.'"

"What does CHF stand for again? Is that like.... congenital heart failure?" (this is sort of like the opposite of wisdom)

"What sucks is when you go through all the work of medical school and then you can't even do the field that you want to do."

"Now that I've done three years of ob/gyn, I could become a malpractice lawyer and I'd clean up. I could look at the fetal heart tracing and tell you the exact second that baby should have been delivered. Of course, in real life, it doesn't work that way."

"What's the most common cause of right heart failure? Left heart failure. Whenever I ask a question, I always tell you the answer immediately so it's not pimping." (The wisdom is in the last sentence, since the first sentence is common knowledge. Except for that resident who didn't know what CHF was.)

The punishment fits the crime

Patient: "The nurses.. they woke me up..."

Me: "When?"

Patient: "During the night. They keep... waking me up. They should..."

Me: "They should what?"

Patient: "They should be sent to jail."

Me: "Oh. Well, I'm sorry they're waking you up all night and I'll try to get them to stop doing that."

Patient: "They should be sent to jail."

Me: "I really think jail seems a little harsh."

Guest Cartoon: Disruptions

See other cartoons like this at Paradoxical Syncope.

Guest Cartoon: Wernicke vs. Broca

See other cartoons like this at Paradoxical Syncope.