Are you a gunner or a nerd?

The word “gunner” gets thrown around a lot, sometimes unfairly. Just because you study a lot and get good grades, that doesn’t necessarily mean you are a gunner. You may just be a huge nerd… after all, you went to med school, which is a pretty nerdy thing to do.

How do you tell the difference between a gunner and a nerd? Until now, there was absolutely no way to tell. But now there’s a quiz!

OMG, take the quiz!!!

Weekly Whine: Middlesex

(May contain mild spoilers, but not really.)

Has everyone read this book? I think they have. Apparently, it won a Pulitzer Prize. Sounds impressive.

I recently finished reading Middlesex because I heard such good things about it. To put it mildly, I didn't like it.

The book actually made me angry because the subject matter had so much potential to be awesome. I mean, it's a book about a hermaphrodite. It's about a person who is born a girl then turns into a boy. I find that fascinating.

Except for 300 pages, the book just talked about how the hermaphrodite's grandparents immigrated to this country from Turkey. And then about Detroit in the first half of the twentieth century. And all the while, I'm screaming, "GET TO THE HERMAPHRODITE!"

And then as soon as the book actually gets interesting and the protagonist is dealing with becoming a man, the book ends!

I guess the family stuff is supposed to fit in because her grandparents were siblings, so that was what caused her to have the 5 alpha reductase deficiency. Except, of course, it didn't. Your grandparents being related wouldn't give you two recessive genes. It was because her parents were second cousins.

Also, the language was so dense and overly descriptive. For example, take the following sentence:

"Sing how the unsightly black fuzz, like the Persian legions of Darius, sweeps over the Achaean mainland of girls barely into their teens!"

I mean, why can't he just write: "Fuck, I'm getting hair on my upper lip."

I guess you don't win the Pulitzer prize by writing that though.

The great thing about being an attending

When I started my first attending job, a senior physiatrist was explaining to me this very specific way he liked to do his dictations, which wasn't really the way I was taught to do them (or the way most people do them).

After a few minutes of this, something amazing occurred to me:

While this guy was an attending, he had no authority over me whatsoever, and I could do my own dictations however the hell I wanted! It was really liberating.

Legal advice

Many years ago, I was having some issues getting out of an apartment lease. I decided to contact a lawyer in the area for advice on the matter. I picked a random lawyer out of the phone book and called him.

Me: "Hi, I was wondering if I could consult with Mr. Lawyer about an issue that may require hiring a lawyer."

Secretary: "Sure, what's your name?"

Me: "Fizzy McFizz."

Secretary: "Just hold on a minute."

A minute later, I was put through to Mr. Lawyer:

Mr. Lawyer: "Hey there. How are you?"

Me: "Fine, thank you. I just needed some legal advice on my lease. I was wondering if--"

Mr. Lawyer: "Wait, this is Fizzy McFizz?"

Me: "Um, yeah."

Mr. Lawyer: "I went out on a date with a Fizzy McFizz last weekend. That's you, right?"

Me: "Um, no..."

Mr. Lawyer: "Are you messing with me?"

Me: "No, I'm really not."

Mr. Lawyer: "Oh."

Me: "So I was just wondering, if I break my lease--"

Mr. Lawyer: "Are you sure you're not the Fizzy McFizz I went out with?"

Me: "I'm definitely not. But I just wanted to know if--"

Mr. Lawyer: "Listen, I don't give legal advice over the phone. The only reason I agreed to talk to you was because I thought you were this girl I went out with last weekend."

Me: "Oh."

Mr. Lawyer: "Sorry."

Me: "That's okay."

Of course, after I hung up, I was remorseful that I didn't tell the guy I was his date to get my free legal advice.

The patient was shoeless... I repeat, shoeless

One day while doing EMGs, the tech came into the room with a perplexed look on his face. "Okay," he said. "The last patient is standing in the middle of the exam room wearing one shoe. He says he can't find his other shoe."

Attending: "Well, it couldn't have gone far, could it?"

So we went on a hunt for the patient's missing shoe. We went into the room and next to the one-shoed patient was a lone shoe lying on the floor. "There's your shoe," the attending said, happy to have solved the mystery so easily.

"No, that's not my shoe," the patient insisted.

Except on further inspection we determined that it was, in fact, the patient's other shoe. No, it didn't match the shoe he was currently wearing, although both me and the med student noticed earlier that he had been wearing non-matching shoes. More perplexing was that both shoes were for the left foot.

I'm not sure how the patient made it all the way here from home without realizing he was wearing two left shoes. But I'd say that's a pretty good positive test for a sensory peripheral neuropathy, maybe even better than the EMG.

Patient: "I've got a pair just like 'em at home."

Tales from Residency: Logic puzzles

Resident: "When I was doing the mental status exam, I asked the patient what the saying 'People in glass houses shouldn't throw stones' means and he didn't know. Then when I was trying to explain it to him, I realized that I actually don't know what it means. I mean, I sort of do, but..."

Me: "I think it means something like, don't be a hypocrite."

Resident: "Yeah, that's what I said, I think."

Me: "I always give the patient a logic puzzle."

Resident: "What puzzle?"

Me: "So there's an old man who says that he's not in as good shape he used to be, because he used to be able to walk all the way around the park, but now he can only walk halfway around the park, then he has to turn back."

Resident: "Huh?"

Me: "He says he used to be in better shape because he could walk all the way around the park, but now he can only walk halfway around the park, then he has to turn back. So was he in better shape before?"

Resident: "Yeah, he was in better shape then because he could walk all the way around the park."

Me: "..."

Resident: "Oh! Right, okay."

Joints

Neurologist: "Okay, so you're a physiatrist, right?"

Me: "Yup." (whatever that is)

Neurology: "So which way is internal rotation of the hip? Is it like this?" [internally rotates her hip]

Me: "Yeah...." (is this a trick question?)

Neurologist: "Because I heard when you internally rotate the hip, you are actually externally rotating it in its socket."

Me: "Um...."

Neurologist: "Maybe I'm thinking of another joint? Where when you internally rotate it, you are actually externally rotating it? What joint is that?"

Me: "Not one that I've ever heard of."

I asked another physiatrist about this, who does a lot of musculoskeletal medicine. His response was: "I think the kind of joint she is talking about is only legal for medicinal purposes."

Do you know what she was talking about?

Most Coats Award

Sometimes a patient does something so crazy that I kind of want to give them a little award for being crazy in such a unique way.

Most Coats Award in my residency went to an elderly non-English speaking patient, who did put on the gown... but was fully clothed under the gown. She was also wearing her winter coat over the gown, completely buttoned up. And if that wasn't enough, she had THREE sweaters on top of her lap, covering her legs. And she was still wearing her shoes and socks, of course.

As soon as I finished examining her, she immediately put all her coats and sweaters back on, and put on her shoes. I was frustrated that she had to go through taking them all off again for my attending, but I was glad he got to witness the crazy firsthand.

Tales from Residency: New Fellow

Man in scrubs: "Hi, I'm the pain fellow. My name's Josh."

Me: "Oh hi, I'm Fizzy, nice to meet you."

Man in scrubs: "I'm going to be helping out in clinic today."

Me: "Oh great!"


Two minutes later:

Me: "Guess what? One of the pain fellows is going to be helping out in clinic today."

Attending: "Oh, great! Which one?"

Me: "Oh. It was.... uh... hmm."

Attending: "Was it Steve?"

Me: "No, I don't think it was Steve...."

Attending: "Was it Jamie?"

Me: "Maybe...."

Attending: "Was it a black guy?"

Me: "Uh..."

Attending: "Was it a white guy?"

Me: "Uh... I don't remember."

Attending: "!!"

Me: "This is embarrassing. Please don't tell him I forgot his name."

[Pain fellow (who it turns out is Indian) walks into the room]

Attending: "Oh, hi Josh. We were trying to figure out who you were. Fizzy forgot your name."

Isn't it wonderful that I'm so "colorblind" that I couldn't even remember the race of a person I had just met two minutes ago? That or dangerously overtired. (Probably the latter.)

Weekly Whine: Test Fees

So far, I have paid (approximately):

Step 1: $500

Step 2 CK: $500

Step 2 CS: $1000 + transportation and hotel

Step 3: $600

Part 1 PM&R boards: $1300

Part 2 PM&R boards: $1700 + transportation and hotel

Might I suggest that these fees are entirely ridiculous? I'm especially irritated about Step 2 CS, considering I was the very first class who had to take it, and it was just not a pleasant way to spend $1000+ when I was already broke.

I read somewhere that approximately 20,000 people go to medical school every year. So if they are charging $500 for Step 1 (I think it's actually more now), that is $10 million. Where the hell does that money go?? Why does it cost 10 million dollars for a bunch of students to sit in front of a computer and all take the same test? Who is profiting from this?

For that amount of money, we could, like, make a really cool movie about pirates going into outer space.

Alternate uses for scrubs

Why I didn't do Pediatrics

I love kids.

In college, my advisor was a pediatrician, because I thought that's what I wanted to be. When I was in medical school, I was the co-President of the pediatric club. During third year, I scheduled pediatrics to be my third rotation because that's the order in which you're supposed to do the field that you're interested in. (You don't want to do it too early because then you'll look like an idiot, but not too late in case you hate it and change your mind.)

I'm not a pediatrician. So what happened?

Here's why I decided against pediatrics:

1) I spent my whole damn rotation sick with URIs and GI bugs.

2) Really sick kids make me desperately sad, to the point where even doing a practice question about a child with cancer ruined my whole day.

3) I am really, really bad at looking in screaming baby ears. And that's like half of what pediatricians do.

4) I found medicine involving non-sick kids to be really boring. Strep throat? Boring. Rashes? Boring. Otitis media? Boring.

5) Parents = mega aggravating. (Of course, now I deal with adult children, which are also mega aggravating.)

6) When I saw a cute baby, I mostly just wanted to play with the baby, kiss him all over his cute little pudgy face, and then go home and make lots of babies. And when I couldn't do those things, I got frustrated.

7) Whenever we'd have guests at peds club, they always complained about their salary. (I saved the most shallow reason for last.)

It was telling that my lowest shelf exam score the whole year was in pediatrics. Somehow it just didn't mesh for me. Although there are certainly times when I wish I was hanging out with cute little kids all day.

How to contact a surgery resident

Me: "Excuse me, I'd like to speak to the surgery resident taking care of this patient?"

Nurse: "He's in surgery, so you can't contact him."

Me: "Yeah, but I need to tell him something important about his patient."

Nurse: "Well, you have to wait till the surgery is finished."

Me: "But it's almost 5. Do you know when he'll be done?"

Nurse: "No."

Me: "Is there any way I can leave a message for him?"

Nurse: "No. You have to wait until the surgery is finished."

Me: "But isn't there someone answering his pager?"

Nurse: "Yes, but if you call, they'll just tell you that he's in surgery."

Me: "So what if something happens with one of his patients? Like what if the guy starts having chest pain? Doesn't someone still have responsibility for his patients?"

Nurse: "You can try paging him after the surgery."

Drug Companies

During my intern year, the primary care intern group (of which I used to be a part) received a lecture on how drug companies suck for spending more on advertising than they do on research. I volunteered as a guinea pig and the lecturer emptied my white coat pockets of all drug company related materials.

I'll be honest: there was a LOT. Between at least half a dozen pens, my ID badge holder, my pharmacopoeia, and some various other stuff, I was loaded. Even the lecturer was surprised. "I didn't think you'd have this much stuff," he said, shaking his head in utter disappointment.

I used to go after those drug company pens like they were... drugs. I spent a day in a urologist's office and I was so excited that I got a pen for Viagra, Levitra, AND Cialis. Every time I saw a drug company representative, I'd go after them to get that pen and whatever else they had to give me.

Why did I do this? One, when you're a med student, DRUG COMPANY PENS ARE COOL. The fact that the drug reps are willing to court you makes you feel all special. Plus, I love clicky pens and the drug pens are all clicky pens. Because you can't, like, BUY clicky pens or anything.

Over the course of residency, I'm proud to say that I purged my white coat of all drug company products. I went to Costco one day and they had this huge package of clicky pens (exactly the kind I like) and purchased enough to last me the rest of my career. I still kept wearing the elastic ID holder from a drug company, but the drug name had completely rubbed off.

The way I look at it is this: If a drug company paid you 10 cents to wear an ad for their company for months, would you do it? No, of course not. But that's what you're doing when you use drug company pens.

However, there was a drug company that sponsored all our grand rounds in residency. And our grand rounds were MANDATORY. So I was forced to go to these drug company sponsored dinners. And it honestly wasn't that huge a hardship, because we'd always get to go to a nice restaurant and have a delicious meal that I couldn't afford on my own. IS THAT SO AWFUL?

I know the arguments against drug company advertising, but I just can't get passionate about it either way. I like getting a free meal. And when they tell me their spiel, I mostly just nod and say, "Uh huh, uh huh." It takes more that a cute drug rep to penetrate my sleep deprived brain.

Denial

This is an actual conversation I had with a patient during my primary care clinic as an intern:

Me: "So do you have any medical problems?"

Patient: "No, nothing."

Me: "Nothing at all?"

Patient: "No."

Me: (flipping through the chart) "Wait, do you have AIDS??"

Patient: "Oh. Yes."

That was sort of a weird situation.... I have never seen a chart of a HIV+ patient that was so completely stripped of any information on her disease. It's almost as if her denial transmitted itself to her chart.

Weekly Whine: Wellness Group

During my first year of residency, they started up something called a Wellness Group. It was led by an attending psychiatrist who worked at our hospital who I'll call Dr. Freudella (because she was a woman). Basically, we all sat in a conference room for an hour with Dr. Freudella and discussed things that were bothering us. And got a good lunch.

Sounds great, right?

Except I hated Dr. Freudella. It started out with her yelling at me when I was an intern. And she didn't yell at me exactly. She yelled at me like a psychiatrist. It's hard to explain.

So we had our first wellness group and we each went around the room and talked about ourselves for a little bit. Most people said a sentence or two. Dr. Freudella basically told us her whole life story, and by the time she was done with that, the group was over.

We had one more meeting and that was it for wellness group for the year.

The next year, the wellness group started up again. Dr. Freudella showed up 30 minutes late to the meeting. Then we started discussing how best to hold the meeting in the future, and how to get the attendings to allow us to be available for the meeting and even hold our pagers.

At some point during the meeting, I started sighing. Loudly.

Dr. Freudella: "Fizzy, is there something wrong?"

Me: "No, I just think it's pointless to discuss this."

The reason I'm telling this story now is that yesterday, my five year old daughter told me she got in trouble in class for sighing loudly when someone else was talking. It made me realize how immature I was at that meeting. I mean, a five year old was supposed to know better than to act like that. I was a pretty immature 28 year old, I guess.

But I still maintain that Dr. Freudella was really annoying and the group was pointless. (And sure enough, there was never a meeting again.)

An interview gone wrong

Me: "I think my residency prepared me well for this kind of job."

Interviewer: "So you did your residency in Maryland, right?"

Me: "Um, no."

Interviewer: "Wait, where did you go to med school?"

Me: "I went to the University of--"

Interviewer: "Maryland?"

Me: "I've never actually gone to any school in Maryland."

Interviewer: [disappointed] "Oh. So I guess I can't talk to you about crabcakes."

Groceries

I go to the grocery store about once a week. I remember a time when I'd spend $70 on groceries and think it was a lot. Now, ever since the baby started eating mashed food, I'm spending $120 per week.

Is it just me or is that a LOT of money for groceries?

Medicine is depressing

I was talking to my father yesterday about all the young stroke patients on my service. He was like, "That's so depressing! I don't know how you could work in a depressing field like rehab!"

"I think your field is WAY more depressing than rehab," I said. (He's a psychiatrist.) "I remember I cried on the first day of my psych rotation because I felt so sorry for my patients. At least on rehab, I mostly get patients who are on the road to recovery. A lot of them do really well and it's very uplifting to see that."

Dad: "I guess that's true..."

Me: "I mean, isn't EVERY field in medicine inherently kind of depressing sometimes?"

Then we brainstormed to think of a field of medicine that was never depressing and we couldn't.

Why I didn't do Emergency Medicine

When you get to your fourth year of medicine, there are a lot of different paths you can take and each one probably would change your life entirely. This entry is about why I didn't do EM. If people like this entry, I can talk about other fields I was considering as well.

EM has a lot of awesome things about it, and in many ways would have been a perfect field for me. I really love procedures. I work quickly. The hours are very reasonable. The pay is great.

Here's why I didn't do EM:

1) For some reason, I really hate shift work. I like having a specific amount of work to do and know that I can leave when I finish it. Looking at a clock makes me physically ill.

2) I can't sleep when the sun's out. I'm like a reverse vampire. Or a human being. Anyway, those night shifts aren't going to work for me.

3) I actually like continuity of care a lot. I even like the annoying patients when I get to see them continuously and build a relationship.

4) If there's some new horrible killer virus out there, who's going to get exposed first? Certainly not the physiatrist.

5) Although I like the idea of knowing everything about everything, I realize that it's actually impossible. And that would eventually make me second guess myself to death and all the consultants would hate me.

6) Let's face it, too competitive. If you want to live where you want, you have to lower your expectations.

Also, what do you call an ER physician? An emergentologist? Emergentician? There's no well known name for it. Unlike physiatrist. Everyone knows what this is.

I guess that's all I could come up with. I guess it all came down to the fact that when I was on my ED shifts, I wanted to shoot myself in the head. That's how you know.

Anatomical Cartoon Characters

Legendary

Where I went to high school, we were all a bunch of left-wing liberals. We all shared the same blue state beliefs, which would have made social studies class discussions very uninteresting except that there was always ONE PERSON, one future young Republican, who disagreed with all of us.

In my junior year, that person was a guy named John. John didn't believe in services like welfare, medicaid, or any of that. "If you don't have money, get a job." Wow, when you put it that way, it's so simple.

Anyway, at the end of a semester of everyone arguing with John and getting more and more riled up, there was a formal debate on the death penalty. John was arguing in favor of the death penalty and someone less interesting, let's call him Ted, was arguing against it.

Early in the debate, Ted put forth the argument: "The death penalty is applied more frequently to black criminals than to white criminals."

And John replied, "Well, that's just because more crimes are committed by blacks."

Now unfortunately for John, our class had a visitor that day. And more unfortunately for John, that visitor was an African American female who was a highly placed member of the NAACP.

To say that she ripped him a new one would be an understatement. She basically angrily lectured to him for the entire rest of the period, and John just sat there in humiliated silence.

Best social studies class EVER.

Most potentially embarrassing moment of residency

When I was a PGY2 resident, I was starting a new rotation on a brain injury. At the end of my second week, I was rounding on my brain injury patients, and there was one patient admitted the day before that I couldn’t find. I looked all over the ward for him and he was nowhere.

Sometimes patients went outside to this gated garden that attached to the unit, so I checked out there for my patient. Sure enough, I saw him sitting on a bench in the middle of the garden.

I went outside and sat down next to him. “Hi,” I said.

“Hi, Dr. Fizzy,” he said pleasantly.

“Um,” I said, “how are you doing?”

“Okay,” he said. “How are you?”

“Okay,” I said. I was beginning to find this interaction a little weird somehow. “Are you sure everything’s okay?”

Now the patient was giving me a really odd look. “Yes…”

At this point, I was going to get out my stethoscope and listen to his chest, but something was telling me I shouldn’t. So instead, I got up and went back inside.

About half an hour later, my patient knocked on the door to the resident office. I went out to see him and it was at that point, I noticed his ID badge. He wasn’t my patient at all. He was actually one of the case managers on the unit. In my defense, I didn’t know him very well, he was dressed casually, and he really sort of looked like my patient.

He asked me what was up with that interaction we had, and I made something up that was probably not believable, but way less mortifying than the truth.

All I can say is thank god I didn’t try to listen to his chest with my stethoscope.

Dating doctors

Conversation I had will a fellow physician, who I will call John:

Me: "Hey, do you know any single guys who might want to get set up? I know this really cute and awesome girl. She's an engineer. Do you know fo any guys who might be interested?"

John: "I would. Except I'm spoken for."

Me: "Really?"

John: "Sure. I love smart girls and I love careers that show they're smart, like engineer, teacher, etc. As long as they're not doctors or lawyers."

Me: "What??"

John: "There are all these power issues involved in dating female doctors or lawyers. It's not worth it."

Me: "I'm so insulted!"

John: "I dated one female doctor and it was awful. Of course, she was also blonde."

Me: "I hate male doctors too. So there."

John: "What about your husband?"

Me: "My husband isn't a doctor!"

John: "Anyway, I'm not alone. I read that there's a much greater chance of a female doctor marrying a male doctor than vice versa."

Me: "That statistic makes no sense."

John: "Yeah, I was thinking the same thing."

Weekly Whine: Dates

Every attending is anal about something, right? No matter how normal and easygoing you are, there will be some specific way you want your resident or students to do things and it will drive you a little nuts if they don't do things your way.

I feel like my "thing" is wanting to have dates on everything. And honestly, I think that's very legitimate. It drives me NUTS when someone writes an H&P or discharge summary that doesn't have the dates of certain important events. When did the patient have that stroke? When were they admitted to the hospital? When was the ORIF on their radius fracture performed? And no, Hospital Day #6 is not acceptable.

There's one hospital we admit a lot of patients from that never, ever puts dates on anything. It drives me CRAZY. I have to flip through half the discharge paperwork to find out when the patient was admitted with their subarachnoid hemorrhage. Isn't that kind of IMPORTANT?

And I guess there's one other thing I'm a little anal about: I like things numbered. It drives me totally insane when someone's plan is just one huge dense paragraph of rambling thoughts.

Dedication

One thing that was a little humbling:

I spoke to a doctor once who was really dedicated and clearly cared very deeply about his patients. The doctor was an outpatient physician of a patient of mine who has glioblastoma (glioblastoma = generally horrible prognosis). This doctor had been spending his own time calling everyone in our hospital to try to get the patient chemo or radiation. He told me today: "Don't send the patient to hospice without calling me first! Don't!"

Personally, I don't think hospice is such a horrible thing and it's something that's very underutilized in this country. But that's besides the point. The point was that I was impressed by how much that physician clearly cared about his patients. I wish I could be as dedicated as that doctor.

How to be a Fast Resident

When I was a resident, I prided myself on being super fast. On the busiest rotations, I always managed to leave at a reasonable time. These are some of the tips I have for those of you who want to be as speedy as me:

1. Never do something twice. If you have something that needs to be written, only write it once. That refers to writing orders, or if you're doing an H&P, take notes from the patient on the actual H&P form. If you can help it, never use a scrap paper as an intermediary.

2. Multitask: If you're making a phone call, you should also be writing a note and eating lunch at the same time. If you're only doing one thing, you're being too slow.

3. Don't get too caught up on details. If you leave something minor out, the patient won't die. But you might be at work till midnight every day if you obsess over leaving something out. Remember that there's an attending, a pharmacy, and a nursing staff to catch mistakes.

4. Checkboxes: Is there anything checkboxes can't do? If you make checkboxes for everything you need to do on Mr. Smith, you won't be searching for his chart 30 minutes later when you realize you forgot to order his AM labs.

5. Interrupt patients. If you don't know how to redirect a patient properly, you will never leave work ever again.

6. Talk fast. Nobody's listening anyway, so you may as well say what you need to say as fast as possible.

7. Show up late to conferences. If you show up on time, you'll be staring at the wall for a guaranteed wasted 15 minutes and also look like a total loser.

8. Never show up early. To anything. Especially to work. I've noticed that when I come in earlier, I end up just doing everything more slowly and finish at the same time.

Most important though is to learn when you need to not go too fast, even when things are crazy busy. Like when an opportunity came up for education, either being on the giving or the receiving end, I'd always make time.

Tales from Residency: Skydiving

Attending: "You need to seriously consider hip replacement at this point."

75 year old patient: "But what precautions will I have to take if I have a hip replacement?"

Attending: "Well, you can't flex your hip more than 90 degrees or internally rotate it too much."

75 year old patient: "What if I want to go skydiving? Would I be able do that?"

Me: [choking back laughter]

Attending: [with straight face] "You probably wouldn't be able to skydive because the landing would be too rough on the hip joint."

75 year old patient: "Oh." [very disappointed] "You mean I'd never be able to skydive?"

Attending: "Probably not."

Me: "Maybe you could go bungee jumping instead."

Erroneous

Nurse: "So the patient's hematocrit has always been high thirties, but yesterday it was 26. Now it's back up to 35."

Me: "I guess that value from yesterday was erogenous."

Nurse: "..."

Me: "That was the wrong word, wasn't it?"

Tales from Residency: April Fools

Me: "Hey, it's April Fools!"

My co-resident: "Yeah, that's right."

Me: "We should totally play a prank on Dr. Levin!"

Resident: "Yeah, totally! But nothing too mean."

Me: "We need to brainstorm this."

We tried to come up with a good April fools prank, but then the other resident got busy on the phone, so I was left to brainstorm by myself. The schedule for the day was posted on the board behind us, so I decided to write in two add-on patients for 4PM:

Johnson, David: NEW PATIENT, chronic lower back pain

Lopez, Manuel: NEW PATIENT, possible complex regional pain syndrome

I figured two new patients with those diagnoses at 4PM was about the most horrible thing I could think of. The next time Dr. Levin came into the room, I said casually, "Yeah, I think they added a couple of new patients to the schedule for today."

Dr. Levin looked at the schedule and he groaned loudly. "Great..."

Then I got to say, "April Fools!"

My co-resident missed the whole thing because she was on the phone, but when she got off the phone, we all admired how awesome a prank it was and how the second patient REALLY sounded like someone we would get in clinic, from his name to his diagnosis.