Tuesday, July 31, 2012

Why I (Almost) Didn't Do PM&R

I've been doing this series for a while and somebody requested I do one for PM&R. Considering I did PM&R, it's hard to write a post about why I didn't do it. But then again, I matched in another field initially, so I could explain my original thinking process.

I did a rotation in PM&R during October of my fourth year, which was just a little too late. I liked it a lot. I liked the pace, I liked the types of patients, I liked the procedures, and I thought all the attendings were really nice and laid back. I noticed the residents got to go home when they were on call and worked very reasonable hours.

Again, it was mostly about location for me. There was only ONE PM&R program in the area where I wanted to live to be near my husband, so that limited my choices significantly. And even if I matched at that program, I was worried about finding a prelim spot in that region. But here are a few other reasons why I initially decided against PM&R. I am basing this on an actual pro/con list that I made during my fourth year:

1) Can be kind of boring, at least on the inpatient side. On inpatient rehab, things move slowly and there's a lot of documentation involved. There's no adrenaline rush, even compared with internal medicine.

2) Fewer opportunities for specialization. I wrote this, but it actually isn't true. Physiatrists can specialize in brain injury, spinal cord injury, stroke, pain medicine, pediatrics, electrophysiology, sports medicine.

3) Longer residency than internal medicine. Apparently, I didn't want to be in residency one extra second.

4) Jobs limited to urban areas. I'm not sure if this is exactly true, but I'd definitely say the job options for PM&R are limited compared with internal medicine.

5) No minions. When you're a medicine resident, you get interns to help you. When you're a PM&R resident, you don't. I liked the idea of having minions. Then again, when I was a PM&R resident, there was actually a really good support staff that made the need for minions less. Like instead of making my intern figure out how to get the patient off our service, we'd have a case manager who would do it.

6) Not as respected. Within the medical profession, it's definitely true that a lot of people don't respect physiatrists. And outside the medical profession, a lot of people don't know what we do. And vice versa.

Ultimately, looking through my list, a lot of the reasons I didn't want to do PM&R weren't really all that accurate. Mostly, it was about location and the fact that I did my rotation much too late.

Monday, July 30, 2012

It's easier to bother you

On a weekend call I did during residency, I was in the hospital till 6PM on a Saturday. I was exhausted and relieved as I was driving home, but naturally, about 10 minutes after I left, I got a page.

I had to pull over to answer it, because I didn't have my hands-free device and I lived in a state where driving while talking on a cell phone is illegal.

Nurse: "Did you write that restraint order I told you about?"

Me: [gritting my teeth] "Yes, I did."

I was pretty pissed off. Instead of picking up the chart right next to her to see the order was there, the nurse decided to page me while I was driving home. Kind of shows a lack of respect for me, I think.

Sunday, July 29, 2012

Dr. Joint

One of the rough things about leaving my first residency was that I felt that I was letting people down. Namely, I was letting down the attendings who had written me letters and supported me to get into that program.

There was one attending named Dr. Joint who was a rheumatologist that I had rotated with during medical school. After a month working together, I told him that I was really interested in doing my medicine residency there and I begged him to write me a letter.

Dr. Joint didn't love me, but he appeared to like me well enough. He gave me honors in the rotation and wrote some nice stuff about me. He also probably wrote me a letter to help me get into the medicine residency.

I felt like when I decided to leave, I was really letting Dr. Joint down. I felt awful about it. I saw him around the hospital a few times and I basically ran and hid so I didn't have to face him.

Then one day I ran into him while I was walking to the hospital and I couldn't avoid him. He started walking next to me and asked me how I was doing.

"I'm okay..." I said.

"How is intern year?" he asked. "It's almost over, right?"

"It was... pretty busy," I replied.

"Worse than you expected?"

"No, not really."

He laughed. "So are you here for the whole three years?"

I was shocked. After all my obsessing about how I let him down, he didn't even know whether or not I was a medicine resident. It just goes to show that nobody cares about what you're doing as much as you think they do.

Anyway, I told Dr. Joint I was only there for the year and he asked me if I had switched over. (So maybe he did know?) I told him that I was doing rehab the next year and his response was: "I know, medicine's pretty intense, isn't it? I don't like it either, that's why I did rheumatology. Rehab is nice and laid back."

Then he started talking about how much rehab relates to rheumatology, etc. I think of everyone in the entire hospital that I told about my decision, he was the most positive about it. I guess as a rheumatologist, he was used to being given crap about his specialty being too boring and too easy.

Saturday, July 28, 2012

Weekly Whine: Be more responsible!

No, this doesn't refer to my work or home life. I am incredibly responsible in both. This refers to blogging.

Sometimes I get a comment on a post that says:

You should really be more responsible with your content.

Basically, the person disagrees with something I wrote and feels that it sends the wrong message, and I should be "more responsible" in what I post.

The thing is, this is my personal blog. What I write on it is my personal opinion. Nobody hired me to write this. I'm not getting a salary. I'm not any kind of respected authority figure. And there are only a few thousand readers, which is absolutely tiny in the scheme of the internet.

So really, I think I have the right to say whatever I want on here (short of urging violence) without having to worry about being "responsible."

Not to mention the fact that when someone says that, the post in question is usually something completely benign.

Friday, July 27, 2012

Tales from Residency: Senegal

When I was doing primary care clinic as an intern, I once had a patient who was a recent immigrant from Senegal and only spoke Senagalese.

As the nurse handed me the chart, I looked at the name and saw that the first name was different from the name on my patient list. I asked the nurse about this and she said, "Oh no, I gave you the wrong patient!"


It turned out there were two sisters from Senegal and both needed physicals. One patient was for me and one was for Virginia, another intern.

The patient didn't speak even a word of English. I called up the translator services and actually managed to get a Senegal translator. Yay. I started asking the usual routine history and physical questions and found out that this woman had been told by "some doctor somewhere" that she had "anemia and a fast heart beat."

"Do you have any documentation of this?" I asked.

She told me that she did have papers from the doctor, but her sister had the papers. Her sister was in the next room with Virginia, but they hadn't reached a translator yet, so I couldn't ask for the papers myself. So I brought my patient to the next room and she asked her sister for the papers herself. After they talked for a minute, no papers had been produced. So I brought my patient back to the examining room to figure out what happened through the translator.

Apparently, the BROTHER had the papers and he was out in the waiting room. OK, so now we had to go out to the waiting room and locate her brother. A man stepped forward who seemed to know my patient and they talked for a minute. The man didn't speak any English either. No papers were produced.

A nurse passed by and said to me, "If you're looking for her brother, Sam is examining him right now." (Sam was one of the residents)

I was completely confused now.

I brought my patient back to my examining room and knocked on Sam's room. When I opened the door, I saw Sam talking to a patient through the translator phone who looked a lot like my patient. I told Sam I needed his sister's papers.

Sam to the translator phone: "Can you ask him if he has any of his sister's papers? This other doctor needs them."

Translator: "What?"

Sam: "He has some of his sister's papers."

Translator: "What? You're breaking up!"

Finally, I brought my patient into the room so that she could ask her brother for the papers. But when my patient saw Sam's patient, it turned out they didn't know each other. "I'm from Sudan," Sam's patient said.

"Great," Sam said, "now we seem really racist."

I gave up on finding these mysterious papers. I attempted to get more of a history from the translator phone, but it wasn't easy. She told me that she thought maybe she had hepatitis, but then the translator said: "No, not hepatitis. Jaundice. Are those different?"

And she was taking some medication for the anemia. Maybe iron. She wasn't sure and she didn't have the medication with her. Where was it? Her brother had it (of course).

Thursday, July 26, 2012


I must still be pretty immature because seeing this at the grocery store today totally made me laugh:

Calm Down

I think a very important quality in a young physician is the ability to remain calm and not lose your temper. As a trainee, you are dealing with angry attendings, angry patients... basically, everyone is yelling at you. If you start losing your temper when it happens, you're finished.

I remember during my intern year, I was talking on the phone to the son of a patient. He was angry about something that had nothing to do with me, but he wanted to yell, so he spent about 20 minutes yelling at me. I continued writing my notes, checking labs, etc, while intermittently saying something like, "I'm so sorry." When he finally finished yelling, I talked to him calmly for another minute, then we hung up.

Unfortunately, I do think part of being a physician is being able to take a moderate amount of abuse while still remaining calm yourself.

I'd like to think I have a good ability to keep my temper in check during my other personal interactions as well. It can be hard when someone lets loose on you for no reason, but I feel like you can't go wrong from remaining calm and polite at all times.

Keeping my temper on the internet is slightly more of a challenge. In general, the things people say on the internet make me sad for society. Is this really what people are like inside? When someone comments on a blog post I wrote calling me an idiot or something along those lines, it's hard to reply calmly. I can't say I've always done that. In the past, I've definitely allowed myself to be provoked.

Recently I've been attempting to change that. I've been at least trying to respond to all comments respectfully and calmly. Sometimes achieving this involves writing a very nasty response, deleting it, then starting over. I feel like as I get older, I have more responsibility to act like an adult. Or at least, act the way I believe an adult should act.

So if you ever notice me acting really bitchy to someone in the comments, you can totally call me on it. You can link to this entry and say, "Hey, Fizzy, you said you weren't going to do that!"

Tuesday, July 24, 2012


Patient: "I really don't like this cervical collar."

Me: "I know, but it's really important that you wear it."

Patient: "But it's not doing anything!"

Me: "Well, it is, actually. It's helping the bones in your neck to heal."

Patient: "Can't we just use duct tape for that?"

Seriously, what is it with guys and duct tape?

Monday, July 23, 2012

What's that, sonny?

While sticking some electrodes on an 85 year old patient's foot, I was trying to explain to him what I was doing....

Me: "So now I'm going to look at some of the nerves in your foot."

Patient: "My crotch?"

Me: "No, your foot."

Patient: "My butt?"

Me: "No, your foot." [taps his foot, now covered in sticky electrodes] "This thing."

Patient: "Oh. I don't hear very well."

Sunday, July 22, 2012

Weekly Whine: Family Decals

Have you seen these things?

Someone pointed them out to me, and since then, I noticed they're on every car. Notably SUVs. It's out of control.

I don't know why they irritate me so much. I guess I just feel like there's something obnoxious about putting icons of all your family members on the window of your giant SUV. You've got a lot of kids. We get it.

Saturday, July 21, 2012


When I was a resident, our Pain clinic shared an office with GI Clinic (for some reason).

When patients came in, the nurses would put their charts out for us to see. The GI patients' charts were green and the Pain patients' charts were yellow.

So one day they ran out of yellow charts, I guess. So instead, they started putting out charts for the Spine patients that were orange-yellow. I came out from having seen a patient and I noticed that the other resident was just sitting there and had let like three charts stack up without seeing any of the patients. I pointed this out to him.

Resident: "Oh my god! Those were our patients?? But the charts aren't yellow!!"

Seriously, it wasn't that big a jump to figure out that the orange-yellow charts were ours. I mean, they clearly weren't green. They were basically just a shade darker. I figured it out somehow. I think some people are intentionally colorblind.

Anyway, a few days later, they ran out of the orange-yellow charts I guess, because they were putting out blue charts for us. I made a point out of telling the other resident that the blue charts were our patients, figuring that if a slightly darker shade of yellow threw him for a loop, he'd never be able to deduce that the blue charts were ours. (Despite the fact that we were the only people in clinic that morning.)

Friday, July 20, 2012

Top 10 Favorite Movies

I love making top 10 lists, so maybe this will be a new thing.

I love movies. I'm always the person who does really well at movie trivia games. But there are a few movies that I really love more than all the others, that I could just watch over and over and still think they're brilliant. It's hard to pare that list down to just 10, but I did it and here they are in alphabetical order:

1. Annie Hall

2. Austin Powers

3. Back to the Future

4. The Cable Guy

5. Clerks

6. Ghostbusters

7. Jurassic Park

8. Little Shop of Horrors

9. The Matrix

10. Pulp Fiction

There are some runners-up, which were on the list before I pared it down. Numbers 4 and 7 were particularly difficult to cut from my top 10, and even now I kind of still want them in there....

1. Fargo

2. Ferris Bueller's Day Off

3. Happy Gilmore

4. Office Space

5. The Great Muppet Caper

6. Who Framed Roger Rabbit?

7. Spaceballs

Thursday, July 19, 2012

Holiday Feast

This is a reboot of a cartoon I posted a long time ago that I always really liked:


Have you ever heard of grapenuts cereal? There are no grapes in it, there are no nuts in it, so why is it called grapenuts? *buh dum ching* (But seriously, why is it called grapenuts?)

The commercial advertises it as a cereal that maintains its crunch in milk. The actor in the commercial is baffled at how crunchy it still is after sitting in milk for five seconds (which I suppose is a commentary on the sogginess of most cereals). And then they put a single grapenut in their mouth and marvel at how loud the crunching noise is. "You mean that noise is coming from only ONE grapenut?!! Why, that's preposterous!" I guess high sound volume is a desirable quality in cereal.

I've learned, however, that there's such a thing as TOO crunchy. My husband bought a box of grapenuts the other day and when I took a bite of it, I was overwhelmed by crunchiness. I felt like I had a mouthful of glass shards. I had to chew really careful, for fear my mouth was being cut to shreds by grapenuts.

So that's my new idea for an advertising slogan for grapenuts: "Grapenuts cereal: it's so crunchy, you'll swear you're eating broken glass!"

I know, I missed my calling in advertising.

Wednesday, July 18, 2012

Why I Didn't Do Family Medicine

As people suggested in my Primary Care post, Family Medicine might have been a better choice for me. I liked outpatient medicine much better than inpatient medicine. I like procedures, even pap smears. The hours are generally regular. Several people suggested family medicine as a good choice for me. Here's why I decided against it:

1) Family medicine is very regional. In some parts of the country, many of the docs are family practitioners. In other parts of the country, there are few and they are not well respected. I trained in an area of the country where family medicine was not as common. Our family med sub-I was a disorganized joke. Almost all the people in my med school class who were interested in primary care did internal medicine or primary care residencies. Only a couple of people matched in Family Medicine.

2) I never wanted to deliver another baby for the rest of my life.

3) If I was overwhelmed by the idea of having to "know it all" in primary care, it's even worse in family medicine, where you're taking care of an even larger spectrum of patients. (Yes, you could restrict your practice, but you don't always have that option.)

4) I worried that family med residency would be like a repeat of third year of med school, where you're always in unfamiliar territory, always fumbling, and always the one who knows the least.

5) Much like primary care, the compensation is not great.

6) Much like primary care, there's pressure to see a large number of patiens in a short number of time, and elderly patients are getting sicker and more complicated.

7) Less chance for subspecialization compared with internal medicine.

Writing this post, I feel slightly regretful that I didn't train in a place where I got more exposure to family med. I liked my family med rotation, and it actually might have been a good fit for me. I might have liked doing women's medicine, as long as I didn't have to deliver any babies.

Monday, July 16, 2012


One issue that comes up a lot during residency is payback. If you get sick or take a leave for some other reason, should you offer to pay back the people who covered you (by covering something for them)?

In theory, I believe the answer is no.

I feel like it always evens out in the end. I didn't "pay back" any of the residents who covered me during maternity leave because that would have been pretty much impossible. But later in my residency, I did tons of coverage for others: people on vacation, doing interviews, and for other people on family leave. At some point in residency, most people do need coverage, and at some point, most people receive coverage. It's the Circle of Coverage.

In practice, things are a little different. I'm going to tell two stories about interns who are not me, but that I worked with closely. There are no secrets in internship. I've changed details to protect their privacy.

The first story is about a categorical medicine intern named Jane. Jane's father was diagnosed with cancer and since she was very close with her dad, she became very emotional and started having trouble focusing. She made some mistakes with patients and broke down crying during a call, and when confronted about it by her program director, she admitted what was going on. Her program director made the decision to give her a week's vacation, starting immediately. Jane was on a wards rotation and had one call left, which was on Thanksgiving. She begged the program director to let her do the call, but he decided she was not safe to work and made her take the vacation to regroup and be with her dad.

When she returned to work, she heard that people were mad at her for not covering her call. She was open about her experience and why she had left, but she still heard that people were angry. When her father was doing better, she asked the chief for the name of the person who had covered her call. It was a transitional intern named Don.

Jane approached Don. She told him she had a month of elective coming up in May, and she wanted to repay the call he had done for her on any weekend he wanted. Don angrily told her that he would be on a surgery month, so she would not be able to cover any calls for him. He made it very clear that he did not appreciate having to cover for her.

Jane later found out that Don had actually been pulled second to cover her call. He had covered for another intern named Mike, who had plans for Thanksgiving. Mike had already paid Don back by doing a call for him. Jane then offered to do a call for Mike, who thanked her and said not to worry about it.

Story #2:

After the death of several of her patients in the ICU, Mary became very disillusioned with medicine and told her program director that she was thinking about quitting. They talked it over and she was given a month of leave to think over her decision. Coverage was difficult with an intern unexpectedly gone, but everyone worked together and they got through it.

Mary ultimately made the decision to stay in her residency program, and she resumed her internship. Later in the year, an intern named Sue had to go to a wedding, and she asked Mary (who was on an elective) if she could cover a call for her.

Mary already had plans for that weekend. She felt wracked with guilt. She finally said to Sue that she couldn't do it.

"You know," Sue said. "We all worked really hard covering for you when you were gone."

Mary held her ground, although the fact that she was gone for a month did make her feel obligated to automatically give in to anyone's requests for coverage.

Sunday, July 15, 2012

Facebook Update

Recently I started a Facebook page for this blog. Mostly I did it because I was giving in to peer pressure, but I've actually found a use for it: posting links and stuff that I don't want to waste a whole blog post on.

In any case, if you follow my Facebook page, it's mostly going to be stuff from the web that I find interesting, not just a repeat of the content that's on here.

I'm not joining Twitter though. No no no. Never happen.

Compliment or not?

Overheard at hospital:

Consulting Attending: "Wow, this is a fantastic H&P in the chart. This is really thorough. Did you write this?"

Resident: "Yep."

Consulting Attending: "Are you a medical student?"

Saturday, July 14, 2012

Weekly Whine: Why aren't you 10,000 pounds?

With alarming frequency, people say to me, "You're always eating, but you're so skinny. How come you're not 10,000 pounds?"

First, I don't think it's possible to weigh 10,000 pounds.

Second, let's examine the statement "you're always eating."

My husband says that I eat less than anyone he knows. Which is interesting, considering everyone else seems to think I eat like a pig. My aunt actually made the above statement less than 48 hours after I gave birth while she was visiting me in the hospital and I finished the rather large meal they brought me (having just expended massive quantities of energy pushing out a freaking baby).

I could go through my caloric intake for them. I could mention the fact that I drink nothing but water. That I bring a healthy lunch rather than eating the fried cafeteria food. That when I go out to dinner, I usually put aside half the food for a later meal. That I snack a lot, because I usually become physically ill after eating a large meal.

But really, I just don't understand why everyone is watching what I eat so carefully or cares enough to make a rude comment.

Friday, July 13, 2012

The Nicest Attending

There was an attending I worked with in residency who I will call Dr. Lane. He was my absolute favorite attending. He's the reason I ended up in PM&R in the first place, partially because I ran into him during a very low moment in my internship, and partially because he wrote me a letter of recommendation (and one for fellowship later on).

I loved that Dr. Lane always told corny jokes. I loved that he offered me Vitamin C tablets when I was sick because he said he felt like he had to look out for me since my parents were far away. I loved that at the end of every rotation, he treated his residents to lunch at his favorite falafel place.

And he actually did something for me once on call that was unbelievably nice:

We took call from home. One evening at about 7PM, I got a call that a patient's halo brace had fallen off. A halo brace is what is used to stabilize the neck after a cervical fraction, so when it falls off, that's really bad. It's an emergency.

I called Dr. Lane, who was the attending on call that night. He told me he was still in the hospital (for some reason). I told him I'd meet him there, and he insisted that I stay home. I tried to insist on coming in, but he said, "It's not a big deal. I'm already here. And you're pregnant." (I was six months pregnant at the time.)

And he did take care of it himself. It probably took him hours. I will never, ever forget that.

Thursday, July 12, 2012

How to answer a nurse's question

My last reboot. New material promised for next week.

Foods I Hate the Most

These are the foods that I will literally spit out of my mouth if necessary:

raw tomato
gefilte fish
pasta salad
diet coke

I used to have "olives" on this list, but my daughter decided she likes olives, and I tried them again, and now I don't think they're so bad.

Wednesday, July 11, 2012

Should you ask a question in lecture?

Have a nice trip!

A few years ago, I was walking through the hospital parking lot, and I tripped over one of the parking dividers and fell hard.

While I was lying on the cement, there were hospital workers walking past me and NOT ONE OF THEM stopped to ask me if I was all right. After several minutes of nursing a badly scraped knee on the ground, some construction worker came over to ask me if I was okay.

I always feel baffled by that situation. I was in a hospital parking lot, for god's sake. These were medical professions walking past me. Why didn't they help me?

Tuesday, July 10, 2012

iPhone apps

Today at work, I was attempting to look up which medications cause elevated ammonia. I couldn't get a decent internet connection, so I attempted to use my Medscape app. Unfortunately, it decided it needed to download 29 updates before I could look anything up.

Does anyone know any decent medical apps for the iPhone? Something like the old 5 minute clinical consult.

Should you go to med school?

Another reboot:


I have to tell you, if your doctor sees your breasts and your nipples are unusual in some way, this will almost definitely become a source of conversation later. Even if your complaint has nothing to do with the nipples.

For example, I remember during a surgery when I was a med student, the patient had really inverted nipples. The surgeon made us all look at her nipples and try to figure out why they were like that, and if it might be pathological. I think she was having, like, brain surgery or something.

When I worked in urgent care, I saw a patient with breast pain, who had the most unusual nipples I have ever seen. When I first saw her breast, I thought, "Oh my god, she has a huge tumor coming out of her nipple!" Then I looked at her other breast and it looked identical. Her nipples were like... pedunculated. They looked like huge polyps coming out her areolas. They were so long that the nipples themselves were actually sagging enough to have folded in half. And it was even more significant because her breasts were really small.

When I presented her to the attending, I told her, "She has really strange nipples."

"Are they inverted?" she asked.

"No, it's even weirder than that. You'll see."

The attending was also pretty impressed with the woman's nipples and said she had "never seen anything like that." We had a whole discussion about how on earth the woman managed to breast feed... I would have thought an infant would choke on a nipple like that.

But at least that time we were supposed to be looking at her nipples. And no, we never figured out why she had breast pain.

Monday, July 9, 2012

Medical Specialties Algorithm: Reboot

How to pick a medical specialty:

Home call and ACGME

As everyone in medicine knows, there are rules in place to keep tired residents from harming patients. When I was training (and perhaps still), you were not allowed to work for more than 30 hours in a row. Only 30 hours in a row. Because when you've been awake 29 straight hours, you're feeling fab and totally capable of caring for patients.

Home call is an exception to the rule. If you're taking call from home, you are not post-call the next day. Even if you had a really rough call and got zero sleep, you still have to put in a full day of work the next day. And if you're doing home call for a whole weekend, you could potentially get zero sleep the entire weekend and yet still be caring for patients (with very little back-up).

I was told by an administrator that there are some protections in place. If you're on home call, but you manage to spend 30 straight hours in the hospital, you must leave. But here's the catch:

If you leave the hospital during that time for any reason, the 30 hours restarts.

So say you run to the food cart outside to grab a sandwich, the 30 hours restarts. Say you step outside to vomit from exhaustion, the 30 hours restarts. The person literally said that to me.

Of course, this makes absolutely no sense.... the reason for the 30 hour rule is to protect residents (and thereby patients) against fatigue, so you're not less fatigued if you leave the building for five minutes. You've still been awake 30 hours. It's not like they're protecting us against some toxic chemical that's in the hospital that will kill us if we're exposed for 30 hours in a row, but if we get some fresh air we'll be okay.

For those of you residents who do home call, what happens when you've had a really rough call with no sleep?

Sunday, July 8, 2012

Weekly Whine: Birthdays

I hate birthdays.

I hate birthdays because my birthday usually sucks. It's hard to remember any really great birthdays. My husband jokes that it's a good birthday for me if I don't end up crying. It does seem like I've been sad enough to cry on a lot of my birthdays.

During my first year of college, I made a big fuss out of everyone's birthdays. I planned elaborate surprise parties at most, nice dinners at least for everyone in our group of friends. Then my birthday was during the summer, and nobody even bothered to wish me happy birthday. After that, I decided I was never going to plan anything for anyone's birthday EVER AGAIN.

The thing is, I'd like to be considerate to people. I'd like to bring in a cake every time someone at work has a birthday, but first of all, that would likely result in nonstop cakes, and I think it would also result in me feeling even more hurt than usual when my birthday goes unnoticed.

There's a lot of pressure on birthdays. You have to do something special and if the day is just GOOD, then it's a disappointment. Also, it would be cool to have been surprised at least once with something awesome.

Saturday, July 7, 2012

Mystery patients

I used to get excited with mystery patients.

Like a patient would come in with a super low hematocrit and we had no idea why, and I'd actually be curious to figure it all out. Unravel the mystery, so to speak.

Now I'm jaded. I've realized we often never find a good answer to those mysteries. Like at the beginning of my intern year, I had a young healthy patient who spontaneously went into heart failure and nobody ever figured out why, despite the fact that I sent a huge viral panel.

It's sort of like when I used to watch X-Files, back in the day... there would be some really interesting build-up and I'd be really excited to find out the answer to the mystery, but it would always end up being pretty unsatisfying with a lot of loose ends. Ditto with Donnie Darko.

Friday, July 6, 2012


There are two kinds of people out there that I really admire: surgeons and marathon runners.

I admire surgeons, even though I sometimes hate them, because they do something amazing that I could never do. They are ordinary people, yet they gown and glove in the OR, cut people open with a scalpel, and fix their insides. To me, that's amazing, even superhuman. It almost makes me wish I were a surgeon, except not really.

I admire marathon runners for some of the same reasons. Here they are, these ordinary-looking people who run these incredible, superhuman distances. 26 miles? I can run, like, a mile. Not even. Maybe two blocks.

I had a patient a little bit ago, let's call him Clark, who was a very nice, benign-looking 35 year old man, who was also a marathon runner. A few years earlier, Clark had a femoral stress fracture, which basically means you've been running so much, your hip's about to crack in two. =That fracture healed up with rest, but now his other hip had started to hurt in exactly the same way.

Me: "When did your hip start to hurt?"

Clark: "About a month ago."

Me: "Are you still running?"

Clark: "Well, I cut back my mileage."

Me: "By how much?"

Clark: "I was running 80 miles a week and now I'm only running 30 miles a week."

Your hip is broken so now you're ONLY running 30 miles a week? Awesome. You're practically a couch potato.

I think if you totaled the distance I've run over my entire life, it probably wouldn't add up to 30 miles. That's why I admire the hell out of these guys. I don't know how they do it.

Wednesday, July 4, 2012

Tales from Residency: Like, forever

A conversation I had with a resident in my class who I spent my first 6 months of residency working with side by side:

Me: "I really want to buy my daughter a doctor's kit, but she's too young for that."

Resident: "How old is she now? Three? Four?"

Me: "Three or four??? When we met, I was barely pregnant and we've only been in this residency for a year and a half!"

Resident: "Oh yeah, I guess we have only been in residency a year and a half.... It seems like a lot longer."

Me: "I guess it does..."

Tuesday, July 3, 2012

Why I Didn't Do Pathology

In a lot of ways, I would have been a good match for pathology. I'm a huge nerd, for starters. I'm lazy, so I'm sure I would have enjoyed sitting in one place, looking at slides. Plus you don't have to do an intern year. You don't have to do an intern year! I mean, why isn't everyone a pathologist?

Here's why I didn't do pathology:

1) I am very prone to eyestrain and looking in a microscope was possibly the best way for me to do it. If I were a pathologist, I'd be walking around with a headache 100% of the time.

2) I didn't enjoy my histology OR my general pathology courses. So... yeah. Pathology was taught badly, but histology was just hella boring.

3) I think it would freak me out having to be so detail-oriented. You miss one cell and that could mean your whole career.

4) It seems like pathologists are people who need to know everything about everything, which is a lot of pressure.

Although this wasn't the reason I didn't do pathology, but I've heard the job market in path is dire right now. But the biggest reason is that if I had done path, I'd probably have gone blind from looking at all those slides.

P.S. Still hoping y'all will like me on Facebook...

Monday, July 2, 2012


So all the kids have been talking about this new-fangled thing on the internets called Yearbook that they say everyone is using now. No wait, not Yearbook, Facebook. Anyway, it's supposed to be kind of popular so I decided to put up a page for this blog. Also, to invest my life's savings in its stock.

A Cartoon Guide's Facebook page

Anyway, please like me or tweet me or whatever the hell you're supposed to do on that thing.


An oddly realistic dream:

I was in a Pain clinic, seeing the usual mix of back and neck pain. Super exciting.

I went to get the next patient and saw that there were three charts for patients waiting to be seen, meaning I was really behind. I took the next chart in line and went to the room listed on the front of the chart:

"Hi, I'm Dr. McFizz," I said. "Are you Mrs. Hong?"

"No," the patient in the room said. "Although maybe I should pretend I am so that we can get seen."

"I'm really sorry," I said. "We're running behind."

I decided that the number of the room on the chart must be wrong, so I started checking every room for the patient. Finally, I found my patient. It was a blonde woman in her 60s who was there with her husband and two grown kids.

"Hi, I'm Dr. McFizz," I said. "What is bothering you today?"

"Actually, we BOTH have pain that you need to see us for," the blonde Mrs. Hong said. (Her husband was a blond guy too.)

Husband: "She has back and neck pain and I have back pain."

I felt a sinking feeling in the pit of my stomach. "Listen," I said, "I can only see ONE of you today. We can only see one patient at a time or else it's not fair to the other patients waiting. So which one of you is having worse pain?"

The husband and wife conferred and couldn't decide who wanted to be seen.

I had a bright idea: "Why don't you each write down your pain scale from 1 to 10 and whoever has a higher pain scale will be seen."

I gave the husband a piece of paper to secretly write down his pain scale. He wrote down 5. I wasn't too happy about this because it sounded like the women was having more complicated pain.

I went over to the woman, who was calculating her pain score on a styrofoam cup since I didn't have anything else to write on. For some reason, her calculation involved two-digit numbers.

"My pain score is 55," Mrs. Hong announced.

"You know it's from 1 to 10, right?" I said.

"Oh, I thought it was a 100 point scale," she said.

So it was sort of a tie. Mr. Hong had a score of 5 and Mrs. Hong had a score of 5.5. I was leaning toward Mrs. Hong since her pain was 0.5 worse and women are easier to examine than men, but then baby crying woke me up before I had to decide.

Sunday, July 1, 2012

Healthy recipes

Due to a recent illness, my husband has gone on a mission to lose weight and just eat healthier in general. As a good wife, I totally support him on this mission.

So far, he's cut back on soft drinks, which is really good. He has another plan which involved buying a combination toaster/egg poacher to make himself an egg muffin. I don't quite understand this plan, but it has to do with eating more protein and also his LDL is 20 for some reason. It has a cute little tiny egg frying pan.

In any case, I am trying to find easy recipes to make for him that are also healthy. Two constraints:

1) The recipes must be really easy, since I'll be watching two children as I'm cooking.

2) No seafood

Any good healthy easy recipes you'd like to share would be greatly appreciated.

My favorite gunner

When I was a third year med student, I worked in the ICU with Jake, one of our class's favorite gunners

Although it was early in the year, Jake already had quite a reputation for stealing procedures and just generally being a huge suck up. He also treated other students like they were beneath him and actually scutted them out. He arranged to have a specific attending on medicine that he knew really liked him, and then he'd position his lips right by the attending's ass at all times.

On one occasion, Jake had the nerve to yell at me because I didn't come get him to tell him that we were going to the radiology room for rounds. In fact, I did come get him and tell him that the attending had arrived. I only didn't come get him a second time to say that rounds were officially starting (like five minutes later). I wasn't his goddamn secretary.

A week into the rotation, we got a new attending, Dr. Barb. Dr. Barb did not like Jake. She vehemently did not like Jake. She yelled at him for getting an ABG when she specifically told him not to ("weren't you standing right there when I said that?") and became furious when he neglected to report a drop in his patient's O2 sats.

Jake's excuse (to me, not to her) was that he was at some pulmonary conference all afternoon, discussing that very same patient.

Me: "Hey, wouldn't it have been ironic if your patient died while you were discussing him at that conference?"

Jake: "Yes. It would have been ironic."

At the end of the rotation, Jake cornered me and said that he thought we should conspire not to give Dr. Barb our evaluation forms. He said if I gave in my eval, he had to give in his. This sounded like a really dumb idea to me.

But Jake was really persistent. He said, "Right now I have like high, high honors and her evaluation would knock me down to... I don't know what." He went as far as to say that if he had to hand in his eval, he "would be pissed." I finally said that I would think about it, just to get away from him.

We ended up handing in our evals. I later heard that because of Jake, Dr. Barb banned med students from presenting patients. I also heard that Jake passed by her while she was conducting rounds and she visibly shuddered and said, "I hate that kid."