Thursday, May 31, 2012

First year of med school: The Quiz

For those of you who have earned your MD or are close, do you ever wonder how much you remember from your first year of med school?

For those of you who are pre-med, do you wonder how you'll fare during your first year?

Everyone else: Do you ever get the feeling that what med students learn that first year is total bullshit and you probably know it all without even studying?

Well, now there's a quiz!

Tuesday, May 29, 2012

Why I Didn't Do Primary Care

My first residency was actually in a primary care program so this was obviously a field I was very interested in. But I aborted it. Why?

1) Partially it was a problem with my residency and probably a lot of residencies. Most internists who do primary care spend much of their residencies doing inpatient medicine, out of necessity. My "primary care residency" only different from general IM in that we got one month of primary care per year, which was a mix of clinic and urgent care. Enough to feel comfortable being a PCP? I felt it wasn't.

2) I didn't like the idea of having to know everything about everything, especially in a field where things are constantly changing and patients were getting more and more complicated. I felt like I'd have to be reading constantly just to stay current.

3) People would keep coming up with random complaints that I had no idea how to address, like, "My belly button feels cold."

4) It felt like there was a push to see patients as quickly as possible, yet many of the patients were incredibly complicated. When an elderly patient hands you a bag of 30 bottles of medications and four of them are half-filled bottles of atenolol, just sorting through that alone takes like twenty minutes. I felt like I was being pushed to short-change my patients.

5) The reimbursement is not great and just getting worse. Which means being pushed to see more patients in the same period of time.

6) I didn't want to take hospital call, but I felt like in the areas where I wanted to live, the hospitalist system wasn't established enough to avoid that.

7) I worked with a PCP during my third year of med school. I will never forget this experience with her: She had an upcoming vacation and the whole two weeks I spent with her, she was arranging coverage and sorting things out for this big vacation. How long was the vacation? Four days. Including a weekend.

8) I kept hearing about high rates of primary care burnout and it scared me.

Ultimately, the "hating my residency" thing may have played the biggest part of all. I didn't think I could make myself be miserable for another two years for a field that might also make me miserable. I'm pretty sure I made the right decision by switching.

Monday, May 28, 2012

Science Museum

We took the family to a science museum yesterday where there was an exhibit on the human body. One part of the exhibit was a hologram of a human body showing nerves, blood vessels, etc, depending on where you were standing.

While we were looking at the hologram, these two obnoxious middle aged ladies told us to move because they couldn’t see. Then they told us we were looking at it wrong and that we’d see it better from farther away, as well as spouting some other nonsense. We kind of just looked at them and left the exhibit. As we were leaving, we heard one of them comment: "Oh, they're not interested in learning."

Clearly, these two women were great experts on the human body.

Later, I observed them looking at an exhibit of the male urinary tract, which included the bladder leading to a urethra that went through the penis. As one of the women contemplated this model, she queried: "So how does the baby get out?"

Sunday, May 27, 2012

Weekly Whine: The Library

In theory, the library is a great place (although possibly on its way to becoming obsolete). It encourages reading in that you get books for free. Totally free, no strings attached!

But if you think about it, who do we want to encourage to read most of all? Kids, right? Except libraries, in my opinion, are incredibly kid-unfriendly.

There was a time when I used to bring my preschooler to the library to read to her and spark a love of books. But I eventually stopped because I intensely disliked being shushed and yelled at the entire time I was there.

Did we deserve to be shushed? Yes, probably. I'm sorry, sir, that my child was a little loud while we were waiting on line to use the restroom. I was already telling her to quiet down though, so I'm not sure what you hoped to accomplish with your angry shush.

The moment that made me angriest was when I dared to take my child with me to pick out my own book. Now it is difficult for a small child to sit quietly while her mother is spending five minutes looking for a book, so I was relieved when she found quiet enjoyment by pushing the books into the rack. (You know how all the books are protruding out a bit? I used to like pushing them in too when I was a kid.)

Anyway, a woman who didn't even work at the library snapped at me for letting her do this. She said, "Now someone has to pull them all out again!" I was upset because:

1) Why was this any of her business?

2) If I had just looked at a couple of books in each of those rows, I would have done an equal amount of "damage."

3) Someone gets paid to fix this. We're stimulating the economy!

4) My kid was being quiet and had no idea she was doing anything wrong.

5) Why was this any of her business?

In summary, I really don't feel the libraries nurture children's love of books.

Saturday, May 26, 2012

Tales from Residency:Tigan

My attending offered my patient with nausea a medication called Tigan, which I've never used before. I didn't know why he chose it, except to make my life harder.

Friday morning: Patient says she wants Tigan, but she'd prefer a suppository because she doesn't like to swallow pills. I write the order for Tigan 300mg PR. (PR = per rectum)

Saturday morning: Patient says she's now reconsidered and doesn't want pills pushed up her ass. She says she wants the Tigan orally. I discontinue my old order and write for Tigan 300mg PO. (PO = oral)

Saturday afternoon: I get paged and told that Tigan only comes as 200mg pills and I have to rewrite it.

Sunday morning: I get paged and told that the patient now wants the Tigan as a suppository. So I give a verbal order to give the 200mg of Tigan either PO or PR.

Later that morning: I get paged and told that the Tigan suppositories only come as 300mg tablets, so I give another verbal order.

When I finally arrived on the patient's floor on Sunday, I was approached by like three nurses who said that I need to clarify the Tigan order. I flipped to the orders in the chart and see like three pages of orders for Tigan. I said, "This is ridiculous! I've written for this like six times!"

Sometimes I feel like there must be a better way.

Friday, May 25, 2012

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Doctor-Patient Disconnect

I've noticed that there are times when, despite best intentions, a patient and a doctor just don't connect.

Like the doctor thinks the patient is completely on board with what they're saying, yet they're about the opposite of being on board and are actually really upset.

An example of this occurred during my intern year, when I was on the medicine consult service:

We were consulting on this 40 year old guy on the ortho service with end stage liver disease and a recent above knee amputation following a trauma. His creatinine bumped a little (meaning his renal function got worse) and he's got major ascites from his cirrhosis, so they called us to figure out what to do with his fluids.

The patient needed a liver transplant, but couldn't get one due to his amputation. My attending Dr. Smith and I decided to calculate his MELD score, which is a score that determines the 3-month mortality of a patient with end-stage liver disease. His score gave him a mortality rate of 50-75% over the next three months. So basically, he had at least a 50% chance of dying in the next three months.

I knew that the patient wasn't even remotely aware of this. The amputation was due to a trauma, not diabetes or something like that. He had told me that his doc had been trying to get on a transplant list, but his liver disease "wasn't bad enough". He believed he was in the earliest stages of liver disease.

Dr. Smith said that we needed to give the patient a "prognosis report", meaning we should be honest with him that he has a good chance of dying soon and encourage him to go on hospice.

"I don't know about this," I told her. "I think he's going to be really shocked."

"You think the other doctors haven't been telling him this all along?" Dr. Smith challenged me.

"I mean, I saw him trying to do work on his computer this morning," I said. "I think he believes he's going to recover from this."

"I doubt he really believes that."

I said that he's a young guy with small children and he's not going to easily accept going on hospice. I know hospice is an underutilized service and I wasn't saying this guy shouldn't on it... I just felt like it was going to be a big surprise to him to hear all this.

"Are you saying he doesn't deserve to hear all this?" she asked me.

"No," I said. "I'm just saying he's going to be surprised."

We went to see the patient and Dr. Smith told him everything. She was completely blunt with him. She even talked to him about end of life issues like would he want to be on a vent, etc. The guy looked completely SHOCKED. He was just staring at the wall the whole time she was talking. I felt awful for the guy.

When we got out of the room, Dr. Smith said to me, "See? He didn't seem surprised, did he?"


"He's heard all this stuff before," she said. "He's just in denial."

Dr. Smith had done this hundreds of times (I assume), so part of me wanted to defer to her experience. But then the next day, the social worker came up to me and said, "You know that patient you talked to yesterday? He's completely shocked about what you told him and he's freaking out. He's really depressed. You need to come talk to him again."

I was like, "Goddamn it, I KNEW it!"

It was clear when I went back to the patient that he hadn't heard any of this before and he wasn't in denial at all. He was crying and asking me very legitimate questions.

I don't know how this disconnect happens, but I suspect it happens to all doctors. You think the patient is thinking one thing and they're actually thinking something completely different. And you only find out a few days later, when you've been reported to a patient advocate.

Thursday, May 24, 2012

Post call = slightly drunk

A shining post-call moment:

I was trying to call the chemistry lab to cancel a lab I had inadvertently ordered on a patient.

First I called and wasn't paying enough attention to the phone menu, so I pressed the wrong number.

I called back, but this time I dialed the wrong phone number altogether.

I called back again and listened to the message, but accidentally pressed the wrong menu number again anyway.

I called back again and this time didn't listen to the message, but accidentally pressed the wrong menu number once again.

Finally, on the fifth try, I managed to get through to the lab.

Time to go home, eh?

Wednesday, May 23, 2012

IQ and Stereotypes

Husband: "If you really want to make people angry, you should post this article."

The article is about how people who stereotype are more likely to have low IQ. The article then makes the jump that these people are more likely to gravitate toward socially conservative ideologies. A while back, I was arguing with someone on here, who repeatedly argued that "liberals are emoters and conservatives are thinkers," but this study would imply that the opposite is true!

For the record, I don't think "conservatives are thinkers" and I don't think conservatives have low IQs. I think everyone has prejudices and stereotypes, and some people are just more proud of them than others. It's dumb to say "all conservatives are like this" or "all liberals are like that" when both are such incredibly diverse groups.

Tales from Med School

I've been wanting to post more about medical school on here, for a few reasons:

1) I'm trying to distance myself as much as possible from writing about anything that's actually happening to me now.

2) You can only truly be honest about events long after they've happened, especially when you no longer care about the people involved in those events.

(Admittedly, I am the tiniest bit afraid of someone in my medical school class finding this blog, although this would have no real consequences considering I hardly have any contact with any of them anymore. If someone from my med school class did find the blog, they'd very likely know it was mine, so the fact that none of them have emailed me about it is a testament to how large the internet is.)

On that note, I'll leave you with one of my favorite quotes from med school, which took place at a drunken party the night of our anatomy final:

Anatomy T.A.: "So what did you think of the anatomy practical?"

Female Student #1: "I don't know... some of those pins were really hard."

Female Student #2: "Girlfriend, you just haven't been meeting the right men!"

Tuesday, May 22, 2012

Apartment Hunting

We’ve done our fair share of apartment hunting in the last several years, thanks to multiple different jobs and moves. This is the story of the worst apartment showing we ever had, several years ago:

We arrived at the apartment building at the scheduled time of 2PM, but the manager was nowhere to be found. I called him and nobody picked up. And this was after he went on and on when I talked to him on the phone earlier about how people didn't show up to see the apartment and never called to say they weren’t coming.

So we drove around and looked at some other random places in the area. We saw one place that seemed pretty nice and had a 2 bedroom available, but only one bathroom. And it was the same price at the first place we looked at that had 2 bathrooms. Plus it was practically ON the train tracks. A second place we found looked like some kind of slum with the gate duct-taped together.

I tried calling the place we were scheduled to see and to my surprise, the manager picked up this time. Apparently, his cell phone had run out of batteries, which is why he didn't answer my calls, although it didn’t explain why he didn’t show up at the door. He apologized profusely and said he'd be happy to show us the place now.

So we drove back to that apartment complex again. The manager was in the basement, fixing some sort of "really bad plumbing problem," which he didn't elaborate on at the time. He was this kind of doofus guy who looked like a heavier version of Trey Parker. The apartment was pretty small for a two bedroom two bathroom, but what really struck me was that it was completely uncleaned. The carpet was dirty and the kitchen was really filthy. I don't have high standards about cleanliness, believe me, but you'd think they'd try to clean a place that they were trying to lease out.

Then the manager showed us our "porch." I use quotation marks because the porch was just the outdoors. There was this little square right outside the apartment, not separated from anything by any physical boundaries, that he was calling our "porch.” It was kind of ridiculous. He actually said, "This is your little square. You can put things here."

When we were out on the "porch," another tenant was coming out of his apartment. "Hey, is it really bad in your apartment?" the manager asked the tenant.

"Well, the carpet is still pretty wet," the tenant said.

I don't know why the manager chose to advertise this in front of us, but he then explained that the plumbing in the building is really old and when the building filled up with tenants in the last year or two, there was a huge "backlog of crap" (the manager's words) and two apartments got completely drenched, but all the apartments were affected by the flood of shit. At that point, I cast a horrified glance in my husband’s direction.

Yeah, so I was not moving into an apartment that was literally a shithole.

To add icing to the cake, we asked about parking and found out that we only got one parking spot, even though it was a two bedroom apartment and you couldn’t really go anywhere without a car. We asked if it was easy to park on the street and he was like, "Well, theoretically you could. But I wouldn't want to do it." (We had guessed that anyway, since we didn't find parking that easily and had to *gasp* parallel park.)

We also asked about the fact that the apartment was close to the railroad. I'd lived close to a railroad before and I knew there could be varying degrees of loudness. "It's really not that bad here," he said. "You can barely hear the trains at all. Well, except for this one really big, loud train that comes by every night at one in the morning." (You really can't make this stuff up...)

We told the manager we'd think about it and he gave us some forms to fill out if we came back. Mostly he was very interested in getting us to sign this form saying he had shown us the place. In any case, the second we walked out the door, we quickly called back the apartment we had seen the day before, which suddenly seemed like a palace.

Monday, May 21, 2012

Tales from Med School: Failing Anatomy

I first became friends with Lily when I found out she was failing anatomy during my first semester of med school. It was a doomed friendship.

I was pretty lonely back then, so I certainly wouldn’t have turned away any friends at that time. Lily had a lot of important qualities I look for in a friend: she was nice, she was talkative, and most importantly, she wanted to be my friend too.

Lily had a great sob story. Her roommates, who were also her lab partners, were really mean to her. She ate some of their cereal and they screamed at her. I could relate to that.

Except there were always these signs that her stories weren’t exactly true. Like maybe she wasn’t as much of a victim as she made herself out to be. Namely, I knew one of her roommates pretty well and that girl was awesome. The roommate told me some stories about Lily that made my toes curl, but I told myself that it was probably just misunderstandings.

I tried to help Lily as much as I could. The thing is, it actually wasn’t that easy to fail anatomy where I went to school. The professor provided us with old exam questions that repeated each year, so all you had to do was go through the last few years of old exams. You might not honor, but you’d pass. Unless, of course, your knowledge of anatomy was so poor that you had zero chance of passing the practical or answering any questions that weren’t direct repeats.

Unfortunately, Lily was in that position. When we went over basic anatomy, she knew nothing. I genuinely tried to help her, but I could tell there was no way she was going to pass the final. And I was right.

Also, she failed all her other classes that semester.

Even though she didn’t tell me this, I heard from a reputable source that Lily had officially flunked out. I wasn’t sure what to believe though, because Lily kept going to classes like nothing had happened. In fact, when we were reforming lab groups for the second semester, she asked us if we could kick out a member of our group so that she could be part of the group instead.

Moreover, she continued to expect me to help her study. She wanted me to put aside my own work to help her. If she wasn’t even in our class anymore, it seemed a bit selfish for her to ask that of me. It got to the point where I felt like she was pestering me all the time. I would have just walked into the histology lab and immediately Lily would find me and say, “Hey, Fizzy, how have you been studying for the histology exam?”

Me: “I’m not sure. I just started studying like two minutes ago.”

Lily: “Yes, but what have you done so far?”

Me: “I told you, nothing. I just started two minutes ago. Literally.”

Lily: “Oh, okay.”

Then she would leave and come back in five minutes:

Lily: “So what have you been studying?”

And she started pestering me during class too. We had histology lectures where we would watch a large TV with slides on it while the lecturer talked about them (don’t you wish you were in med school?). And Lily would constantly ask me questions during these lectures:

Lily: “What did he say that was?”

Me: “Bone.”

Lily: “What about bone?”

Me: “I don’t know! It’s just bone!”

What I really wanted to say was, “Maybe I’d know more about the slide if you’d shut up for a minute.”

Anyway, it eventually got back to me that Lily thought I didn’t like her anymore.

It made me feel bad to hear that. I think we’ve all been in situations where we’ve been friends with someone and all of a sudden, they didn’t seem to like us anymore. And you wrack your brain, thinking, “What did I do wrong? What’s wrong with me?” I didn’t want to do that to someone. I’m nice. And I generally have a high limit of tolerance for annoying behavior. But Lily had managed to exceed that limit.

After about a month, Lily stopped going to class and she did end up repeating that year. We never became BFFs, but we were friendly. I wish I could say this story had a happy ending for Lily, but it doesn’t. At the very least, it got worse before it got better.

Saturday, May 19, 2012

Weekly Whine: Laundry

One of my most hated chores is doing the laundry. Up until college, my mother did my laundry, so I never realized how much it sucked. I remember when I was in college, I made a blog entry along the lines of, "I will probably have to do my own laundry for the rest of my life dammit." But now I have my own washer and dryer, so it isn't quite as bad. I don't like doing it, but it isn't quite as horrible.

However, before getting my own W/D, I had years of horrible communal laundry experiences. I used to whine incessantly about "laundry assholes." A laundry asshole is defined as anyone who does their laundry in a communal laundry room and is not me.

I used to get SO ANGRY when I'd get down to the laundry room and someone had taken my clothes out of the washer or dryer for me. Inevitably, they had put the clothes somewhere unacceptable, because there were never any clean surfaces in the laundry room.

There was one occasion in my adult life when I came down to transfer my clothes from the washer to the dryer. I noticed that there were still two minutes left on the washer, so instead of standing there staring at the washer, I went to this adjoining room and sat down on a couch. I was literally three feet away from the washer.

I was in there maybe two minutes and thirty seconds, then I came back to transfer my clothes. And to my shock, there was already a woman there who was pulling them out of the washer. She must have seen the washer stop running and instantly started pulling my clothes out. And even when I announced to her that they were my clothes, she continued pulling them out. It was like, "I'm RIGHT HERE. Can you STOP TOUCHING MY UNDERWEAR PLEASE?"

Jeez, can't a person have sixty seconds to get her clothes out?

And on the other side of things, when I was in med school, I would constantly get frustrated because people would leave their clothes in the washer or dryer for indefinite periods of time. The machines were always full but not running.

One day, thwarted by four full (but not running) washers, I removed the clothes from just one washer (even though I really had enough clothes for two). I squeezed all my clothes into that one washer, and as I was turning it on, this guy came in and gave me this astonished look and said, “You took my clothes out?” He acted like I had just murdered his family or something. He claimed the rule was that I had to wait for ten minutes before taking someone’s clothes out.

Excuse me? Am I just supposed to stand there for ten minutes and wait around like an idiot? I have to assume when I got down there that the washers that are stopped have not stopped at the instant I got down there. So presumably the person has already had a grace period of ten minutes or so.

Anyway, I graciously apologized to the guy. Then after he put his clothes in the dryer and left, I took some trash from the trash can and threw it in with his clothes.

Who's the laundry asshole now, huh?

Friday, May 18, 2012

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Tales from Med School: Happiness

Splitting up the surgeries in OB/GYN:

Jon: "OK, how are we gonna divide up the cases?"

Amy: "I'll take the first case."

Jon: "I've already seen another cone biopsy, so I don't need to do that."

Me: "Okay, then I could take the cone biopsy."

Jon: "Then I'll take the hernia."

Amy: "So... everyone is happy then?"

Me: "Yeah. Wait, I mean, no. But I would say that the schedule for surgery has no impact on my happiness."

Thursday, May 17, 2012

My friend Doug

This is a story about a friend of mine from college named "Doug." The story has no moral, but I've always found it kind of interesting and somehow it seems relevant right now. (Some of the details have been changed.)

At one point, I considered Doug one of my very good friends. He was a really cool, fun, funny guy. He always made me laugh. One night when he was drunk, he peed in the sink of our dorm common room on a dare (or maybe there wasn't a dare and he just had to pee). We weren't the kind of friends who used to have deep discussions about our feelings, mostly just bitching about classes or talking about our crushes, plus we hung out in the same Circle of Nerds.

During our sophomore year, one of our beloved professors died. He was fairly young and it was sudden and tragic. Doug sent out the following email to all our friends:

I know it's tragic that Dr. Goldberg died, but what's even more tragic is that because he's Jewish, he'll be going to hell.

This was not a joke. He really meant it. This was pretty much the opposite of what a bunch of grieving students wanted to hear. We were pretty pissed off, but eventually, it was forgotten.

A year later, Doug abruptly decided he didn't want to be part of our circle of friends anymore due to our excessive partying. (We did party, but not that hard. Believe me. I mean, we were a bunch of geeks.) He joined a Christian group at our school. He called me one day and said he wanted to get together and I agreed:

Doug: "Fizzy, I'm worried about you. It seems like you drink a lot of alcohol, go to a lot of parties, and hook up with a lot of guys."

Me: "Yeah, I wish."

Doug: "I'm serious. You need to change your life and stop partying so much."

Ah college, how I miss you.

In any case, I didn't really have much contact with Doug after that, for obvious reasons.

I heard these crazy rumors about Doug after college. Like that someone ran into him and his hair was dyed pink. But I never actually talked to him directly.

A few years ago, Doug friended me on Facebook. At first, I thought it was a joke profile someone had made to mock him, because it said he was in a committed relationship with another man. But it turned out to be him. And his profile picture is now a photo of him posing with Barack Obama.


The other day when I was leaving the hospital, this guy sitting on a bench with a laptop stopped me, "Hey, can you tell me how to spell 'resuscitate'?"

I guess a doctor's as good a person to ask as any. Maybe not me though. (For the record, I did spell it right for him.)

Wednesday, May 16, 2012

Job offer

I get a lot of job offers from recruiters, none of which I'd be interested in even if I were looking for a job. But this one was more interesting than most:

I believe I have an opportunity that may interest you and would be interested in discussing it further. Please reply back to me as soon as possible. I look forward to hearing from you.

My Client is currently seeking several PM&R's to work at a US owned Hospital System in Kuwait City.

Kuwait City! That's totally my dream city to work in! Sign me up!

They are specifically looking for Physicians that have experience in a JCAHO accredited Facility. This Is a 3-5 year contract.

Oh good, I get to stay there a long time.

Relocation Paid, You are able to take your Family with you.

You mean I don't have to sign a contract to go to Kuwait for 5 years all alone without my family?

Qualifications: 7 years working in/for teaching hospitals post BC; trained in the US, American BC, and licensed in the US.

Why would anyone with those qualifications take this job? I don't even have those qualifications.

Tuesday, May 15, 2012

Tales from Residency: Sliding scale

During my residency, we took call from home, which meant that we weren't post-call the next day. Which meant that getting paged a lot during the night was a guarantee you were going to feel like shit and do your job crappily all day the next day.

Anyway, on one such homecall, I got a page at 2AM to let me know that a patient's blood sugar was....

wait for it...


I was so furious. "But doctor, there's no sliding scale!" First of all, if there was never a sliding scale, maybe you could have let me know about this during the DAYLIGHT HOURS. Second, probably half the overweight people in the country over age 50 have a glucose of 190 right now. At 2AM, I expect to be paged about heart attacks.

The best part is that after I told him to cover it with a mild sliding scale and spent like an hour trying to get back to sleep after the anger-induced adrenaline rush, he paged me AGAIN at 6AM. "Doctor, the patient's blood sugar is now 230."

"I told you to cover his sugars with a mild sliding scale!"

"What's a mild sliding scale?"

Our hospital had a two-page sheet that was to be used with all diabetic patients where you could circle the amount of insulin coverage you wanted (mild, moderate, severe). I explained this to the nurse and he claimed no such form existed.

Now I had worked at that hospital for three years and this was not a new form. And I'm pretty sure it's something that exists in most hospitals. So I knew the form existed. And even if it didn't, why didn't he let me know about this on the FIRST phone call when I ordered the mild sliding scale? What had he done about the sugar of 190?

I started yelling, which is something I never do. I was like, "You've been waking me up about this minor issue all night and I have to work all day today and tomorrow. This is really unbelievable."

When I finally got to the hospital, I reached into the drawer of forms, got out the insulin sliding scale form (which took me about five seconds to find), and SLAMMED it down in front of the nurse. Not my finest moment, but I feel I was provoked.

Monday, May 14, 2012

Why I Didn't Do Neurology

Neurology was my last rotation of my third year of med school, and you guys, I Loved It. I found it so fascinating that for the first time ever, I didn't mind staying long hours at the hospital. When I did the consult service, it was like solving little puzzles all day. And the residents and attendings were my favorites... I fit so well with them (being Nerdy McNerderson and all).

So why didn't I do neurology?

I could list reasons, but there was one big reason that pretty much explained everything:

In the area of the country where I wanted to live to be near my husband, there were a total of eight neurology spots. Four of them were at a highly malignant program. And I felt that I wasn't competitive enough to win one of four spots in a very desirable region of the country where I had zero connections. So I didn't bother to try.

That said, here are the reasons I'm glad I didn't do neurology:

1) The job market is tight right now in neurology.

2) Not much in the way of procedures if you don't do a fellowship.

3) I think neurologists are much better at diagnosing than treating, especially in the area of stroke. I'm not impressed with the medications prescribed by neurologists. A neurologist friend of mine is convinced that neurontin is actually just a sugar pill.

4) A lot of neurologists are geeks, which is great. But a lot of them are also arrogant hyper-intellectual geeks, which is not so great.

I guess I can't come up with too many reasons. For me, it was all about location, location, location.

Sunday, May 13, 2012

Guest Cartoon: Abbreviations Kill

Originally posted at Poor MD

The Purpose of Residency

A conversation during residency:

Patient: "How long do you have left?"

Me: "About a year and a half."

Patient: "Well, that's good. You can see a lot of different things... and it'll give you time to find a husband."

(I was already married.)

Saturday, May 12, 2012

Rudest patient ever

This was one of the rudest patients I ever had. I saw her at clinic few years ago:

I was in the room for about five minutes, maybe less, when the patient's cell phone rang. Have I mentioned that I HATE it when a patient's cell phone rings? OK, I guess I don't expect them to turn it off while in the office (I don't), but it's really amazing how many people get called multiple times at like 10:30 in the morning. And then I really get angry if they answer it.

This lady answered her phone. And not only that, she started having a conversation with the person on the other line! Right with me sitting there! She didn't even tell the person that she couldn't talk long because she was with a doctor.

She seemed to be giving the other person instructions on how to take care of another person. I could hear the person on the other line and every time I thought the call was almost over, the other person would say, "Oh, and one more thing..."

Finally, I had enough. I said, "I'll be back." Then I pretty much stormed out of the room and slammed the door behind me (not totally intentionally... it just closed faster than I intended, but I was definitely pissed).

I was tempted to simply go see the next patient and really make that woman wait after how disrespectful she was of my time, but I decided to just do a quick dictation and go back into the room.

Except when I went back to the room... the patient was gone.

I thought at first that she went to the bathroom, but she didn't. We had the nurses look for her and nobody could find her.

I have no idea what happened. Maybe she realized I was pissed and realized that there was nothing we could do to help her chronic lower back pain anyway, so she decided to leave. Although it seems like a lot of trouble to drive all the way over to the doctor just to leave before they can even talk to you. Or maybe there was an emergency at home. It followed her pattern of rudeness that she didn't even let anyone even know she was leaving.

Friday, May 11, 2012

Weekly Whine: BBQ Sauce

It really pisses me off that McDonald's has recently become so stingy about their sauce.

I remember learning in my high school economics class that if the price of butter goes up, the price of lobster still won't be affected because the price of butter is so small compared with lobster. Now I'm not comparing McDonald's to lobster, but I really have to ask if it's worth it to isolate millions of customers over those little packs of BBQ sauce. Was this honestly such a loss for them?

For instance, if you get a six piece chicken nuggets, you get one pack of sauce. That's it. If you want to try a different flavor of sauce, that's extra. If I want some sauce for my chicken sandwich, that's extra.

And if you get the giant 20 piece chicken nuggets, they'll grace you with three sauces. Except at my local McD's, they sometimes will just give you one packet unless you specifically ask for all three.

Really, McDonald's? Is it really worth it?

Wednesday, May 9, 2012

Better than a colostomy

Since every patient I've ever since in my entire career is constipated (except of course, for the ones with diarrhea), I have made good friends with Milk of Magnesia (MOM). A while ago, I wrote the following order on a patient:

"Please give MOM every 6 hrs until patient has a bowel movement."

Then I remembered that the patient had a G-tube and thus should receive the MOM through the G-tube. So as not to create any confusion, I decided to add this to my order. Unfortunately, in my haste, the order came out:

"Please give MOM every 6 hrs until patient has a bowel movement through his G-tube."

I didn't even notice what I had written until I got paged by like five nurses, giggling about a patient pooping through his G-tube. "Look what you wrote, Doctor! Hee hee!"

Tuesday, May 8, 2012

A completely random question

Help me settle an argument.

In a fiction book, when someone says "oh my god" or "for god's sake," do you capitalize the word "god"?

So would it be:

"Oh my God, this blog is just so awesome, I can't even believe it."

or would it be:

"Oh my god, I just wasted an hour reading this blog, and for god's sake, where are all the cartoons?"


When I was in my third year of rehab residency, I ran into a friend of mine named Steve at the hospital where I was rotating. I knew Steve from med school and I hadn't seen him in about two years. We had about five minutes to catch up before we had to go our separate ways. I still remember the conversation:

Steve: "So how's PM&R residency?"

Me: "We see some pretty crazy things. Are you still riding that motorcycle?"

Steve: "Yeah... sometimes..."

Me: "I've just seen some horrible motorcycle accidents. I mean, people get really badly hurt in those accidents. I think about half our patients right now were injured on motorcycles."

Steve: "Oh, yeah?"

Me: "You really have to be out of your mind to ride a motorcycle. We have one guy who is paralyzed from the neck down, and then another lady who--"

Steve: "Actually, I have to go now."

Later I was looking back on that conversation and I couldn't believe I spent my entire time with a friend I hadn't seen in years warning him about how likely he was to get badly hurt on his motorcycle. But I feel that passionately about it.

Think about your car. Say you have a new car with all the safety features. You've got a seatbelt. You've got airbags everywhere. You've got a shell of metal protecting you. And some new cars have head injury protection. And even with all that, people still get badly injured or killed in car accidents.

So what have you got on a motorcycle? A helmet? (If you're lucky.)

I think the statistic is that you're more than thirty times more likely to be badly injured in a motorcycle crash than a car crash. Maybe this is my problem for being scared of taking risks. I'd never jump out of a plane, but this is something that people do. It's not a matter of debate that jumping out of a plane is much riskier than what I do, which is not jump out of a plane.

I have just seen a LOT of really horrible motorcycle accidents. Bad head injuries, bad spinal cord injuries, amputations. Yes, I've seen more people badly injured from car accidents, but it's not like you can avoid driving in this day and age. You can, however, avoid weaving in and out of highway traffic on a bike going 80 miles per hour.

Also, do you know why motorcyclists wear leather jackets and leather pants? Not to be badass. It's because if you fall off the bike, it helps keep your skin from being shredded.

So that's why I think people who ride motorcyles are out of their minds.

(And dirtbikes too.)

Monday, May 7, 2012

Typed medical history

Don't get me wrong, it's not necessarily a bad thing when a patient types out their medical history. Sometimes it can be incredibly helpful and saves me a lot of time and effort.

But at the same time, you just get a sinking feeling when a patient hands you a detailed five-page long medical history typed in 8-point font and the first line says:

April 20, 1936: Agnes Smith was born.

Sunday, May 6, 2012

How (NOT) to be Intern of the Year

I was reading a blog post from attending who had been Intern of the Year at his program in residency. He gave a list of instructions on how to follow in his footsteps and be Intern of the Year. I'm not going to link to it here, because then you'll all read that post instead, but basically he said some things that were good ideas and other things that were borderline insane.

The thing is, many of us have no desire to be Intern of the Year. Especially those of us who are going into cushy sub-specialties. All we want is to go through the year without losing our mind or killing anyone. Therefore, I present:

How to NOT be Intern of the Year (yet not kill anyone)

1) When your work for the day is done, LEAVE. Don't wander around the hospital, looking for people who might be coding. Go home. Sleep. Smell flowers.

2) When there's a code on a patient, don't run to the code. Walk. Possibly in the opposite direction. No person's life was ever saved by an intern. Your presence in the back of the room, squished up against the wall, isn't helping anyone.

3) If a clinic patient turns out to need a procedure like an injection or a pap smear, schedule it for the next visit. Preferably after you've graduated.

4) Patients' families are like the plague. Avoid them or at least sequester them in a plastic bubble.

5) Whatever your patient wants, give it to them. Arguing with a patient who wants pain medication takes a lot longer than just giving them pain medication.

6) When it's lunchtime, eat lunch. When it's dinnertime, eat dinner.

7) Don't work-up chronic conditions on inpatients, no matter how "interesting" they are.

8) When starting a new rotation, do absolutely nothing to prepare for it. You'll figure it out eventually.

9) By the time rounds are over, you've seen your patient twice. Do not see your patient again for the rest of the day unless forced. And even then, try to get out of it.

10) Block consults with every fiber of your being.

Saturday, May 5, 2012

Weekly Whine: Teleholic

There have been several times in my life when I've been accused of watching too much TV. I grew up with very little TV, mostly only being allowed to watch Sesame Street as a kid. I remember in college, I had a boyfriend who claimed all I wanted to do was watch TV and the only thing he knew about me was that I liked The Drew Carey Show. (In my defense, I didn't own a TV and he did, and I really didn't like Drew Carey all that much. I kept a blog then that I wrote in daily, which he read, and never once wrote about TV.)

Then in my fourth year of medical school, for a couple of months I subletted a room in some friends' house who had a giant TV. It was fourth year and I was bored, so I watched a fair amount and I somehow got a reputation as somehow who watched a lot of TV. Like, they would make jokes about it.

And now, my husband alternates between asking me if we can watch a show tonight and complaining we watch too much TV.

All these experiences with being nagged and teased about watching TV have led me to worry: do I have a secret television addiction? I really don't think I do, but am I simply in denial?

So as an experiment, I've decided to apply the CAGE questions for alcoholism to my TV watchage:

C: Have you ever felt you should cut down on your TV watching?

Not really. I never felt like my watching of TV ever got in the way of anything else.

A: Have people annoyed you by criticising your TV watching?

Yes. But in my defense, people can be very annoying.

G: Have you ever felt bad or guilty about your TV watching?

Hell no. TV is awesome.

E: Have you ever watched TV first thing in the morning to steady your nerves or as an eye-opener?

No, I usually just drink vodka.

My score of 0-1 indicates no apparent problem, so I think we've proven I likely don't have a problem with television. I just use it recreationally.

It does really irritate me though when people try to tell me I have a problem. I mean, from age 18 to 25, I didn't even own a TV and didn't miss it at all. I only bought a tiny one during my third year of medical school because my mother insisted it would make me feel less lonely. In 2011, I read over 40 books in my free time... it's not like all I do is sit there staring at the TV. Sheesh.

Friday, May 4, 2012

Things you need to live

I lift up the patient's shirt to examine his abdomen and it is covered with long scars.

Me: "How did you get these scars?"

Patient: "Oh yeah, I had, like, my liver removed."

Me: "!"

Patient: "But they put it back."

Me: "Well, that's good."

Thursday, May 3, 2012

Why I Didn't Do Psychiatry

In some ways, psychiatry is sort of similar to PM&R. For one thing, psychiatry and physiatry sound really similar. They are both pretty laid back, have good hours, not too competitive, great pay. When my psychiatry rotation started and the hours were 8 to 5 with weekends off, I thought, "Hey, I could get used to this."

I thought most of the psychiatrists I worked with were really cool. And there was an abundance of great stories. I was never bored on my psych rotation. And I actually had a knack for it, I think.

So what went wrong?

1) I like procedures and psychiatry is one field where you really don't get to do any procedures.

2) My father is a psychiatrist and told me repeatedly, "Don't become a psychiatrist."

3) I don't know if I believe in a lot of the medical interventions psychiatrists do. Unlike physiatric interventions like TENS units, which are, of course, rigorously supported by randomized controlled trials.

4) Maybe it's because it was my first rotation, but I just found psychiatry really sad. I remember calling my mother crying one night because I felt sorry for my patients. I suspect I would have gotten over this though.

5) When I was on my psychiatry rotation, I spent much of the rotation scared that I was going crazy.

Actually, #5 was probably my most important reason for not doing psychiatry. After talking to a string of schizophrenics, I literally started to worry that I was going crazy, and wondering what set me apart from my patients. I was about the right age for a schizophrenic break. I was so relieved when the rotation ended and I got to do inpatient renal, because I was pretty sure I didn't have kidney failure.

Wednesday, May 2, 2012

Cross cover psychic

When I did cross cover as an intern, there were some exciting things that happened from time to time. But usually it was pretty repetitive. That or I started to develop psychic powers:

Nurse: "Doctor, I have this patient from..."

Me: "Copper Medicine."

Nurse: "Yes, that's right. This patient is diabetic and she's been NPO till now, but now she's eating--"

Me: "And you want to change her fingersticks from q6hours to qAC and switch her back to a moderate sliding scale."

Nurse: "Yes, that's right..."

Me: "Okay, that's fine."

(Also, you are going to find true love on flag day.)

Tuesday, May 1, 2012

Who has two thumbs and hates back pain?

I once had a pain patient who kept referring to his pain as "this guy". As in:

Me: "What is hurting you the most today?"

Patients: [rubs lower back] "Well, this guy hurts me a lot when I'm sleeping..." [rubs thigh] "but this guy hurts me when I'm walking..." [rubs hip] "and this guy hurts me when I first stand up."