Cruel Resident Stories

Weekly Whine: Guys with long hair

Two hair-related whines in a month? Craziness.

I can't help it though. I hate it when men have long hair. Clearly there are other women who disagree... I've deduced this because there are a lot of guys out there with long hair and there probably wouldn't be if all women found it unattractive.

I'm not sure why I hate it so much. Maybe because it shows a degree of vanity that I don't find attractive in the opposite sex. Also, a man with long hair reminds me of a very hairy woman.

In college, I dated a guy with long hair. His hair went way down his back. And it was curly. It was pretty much everything hair on a guy shouldn't be.

I was hoping that in time, I'd grow to like the hair, but that didn't really happen. On one occasion, I got one of his hairs caught in my throat, and I wanted to vomit from disgust. I realized that I was going to have to dump this guy because of his hair.

Of course, I'm not that shallow and this guy had other redeeming non-physical qualities, so I decided instead to try to get him to cut his hair. I started out by casually asking him what he liked so much about having long hair. He figured out what I wanted pretty quickly, and to my amazement, he agreed to cut it. And that definitely helped, although he was still the kind of guy that had long hair.

And after we broke up, he immediately grew it out again.

Primal Pleasures

There are a lot of things in life that everyone enjoys. For instance, taking a nice vacation someplace warm. Having a delicious meal. A fun night out on the town.

But there are a few very simple pleasures, primal pleasures if you will, that we sometimes forget about. Fortunately, my medical training allowed me to be reminded of many of these simple pleasures. I have highlighted five of them below:

1. Water

When I was rotating through surgery as a third year medical student, I would intentionally deprive myself of all food and water prior to my first surgery at 7AM (I was in the hospital since 5AM), because I was absolutely terrified of having to pee during the surgery. The nurses and surgeons were more terrified of my having to faint, so they would always ask me if I ate something, and I'd always lie and say, "Of course!"

My clever trick worked in that I usually didn't have to pee too badly during the surgery, but I would get SO thirsty in the morning. If I was really desperate, I would take a mouthful of water and just let it sit in my mouth for a few seconds before spitting it out. Or maybe, if I was feeling really gluttonous, I'd just let a single drop of water go down my throat.

Then after that first surgery was over, I would go to the lounge and drink half a Styrofoam cup of water (not a whole cup, since I had another surgery coming up). Ah heaven.

2. Sitting down

An upperclassman once said to me at the beginning of third year of med school, "One of the hardest things about being a third year is learning to stand all the time." It totally is! I started my third year with the cushy psych rotation. Unfortunately, when you START with psych, it doesn't seem quite as cushy. 8AM is great if you just finished getting up at 4AM for surgery, but not as good when you're coming off a vacation.

Anyway, our psych rounds would last about three hours every morning and we would be standing the entire time. My feet and ankles would be on fire. But it was a big no-no to sit down during walking rounds, so I would try to "sneak in a sit". Like if there was a sink in a patient's room, I'd surreptitiously rest my butt on the edge to allow the pressure off my feet for just a few minutes. Ah heaven. And then when rounds ended and I could sit for real, it was like my feet were being licked by kittens (I'd imagine).

Of course, I didn't know what I was in for back in psych. Three hours rounds? Try seven hours holding a retractor and suctioning.

3. Post-call sleep

After 30+ hours awake, there is nothing more wonderful than turning your pager off (or flushing it down the toilet), pulling the shades, and snuggling into the blankets for a nice nap. Even though you know you're going to feel crappy and disoriented when you wake up.

4. Being able to scratch your face

There are a lot of things we take for granted when we're not sterile and one of those things is being able to touch/scratch your face (or body). Maybe real surgeons are so focused on the awesome task at hand that they aren't as bothered by random itches, but when you're holding a camera in one spot for hours, intermittently being yelled at by the surgeon who says you're going to make him vomit, things start to itch. Especially when you're wearing an uncomfortable mask and cap. The second those gloves came off, I really went to town--rubbing my nose, scratching my neck, etc. Ah heaven.

5. I+D

Maybe it's not a primal pleasure, but there are very few things as satisfying as sticking a scalpel blade into a huge abscess and watching the pus pour out. The patients usually like it too. Therefore, fluctuant is one of my favorite words. Fluctuant.

New Resident Skillz

Whenever we'd get a new resident come in mid-year in my program (happened a lot), everyone would want the low down. Usually we'd hear some gossip about the resident, but it was hard to know what to make of it sometimes:

Me: "So what's the new resident like?"

Co-resident: "He's supposed to be really good."

Me: "Good in what way?"

Co-resident: "I don't know. Just good."

Me: "Good at taking tests?"

Co-resident: "I don't know."

Me: "Good at shafting his work onto others? Good at leaving early?"

Co-resident: "I don't know. I just heard that he was good."

Me: "Good at picking up chicks??"

Co-resident: "Haha... maybe. I don't know."

Me: "Because we've already got like five residents who are really good at that and we don't need another."

Babies in class?

I posted about this on Facebook, but I figured I'd bring it here for wider discussion.

One of my favorite bloggers, The Skeptical OB, posted about a female professor who got in trouble because she breastfed her baby while giving the lecture.

Apparently, her baby was sick, so she couldn't bring her to class. She instead brought the baby to the lecture she was teaching. Instead of asking her teaching assistant to look after the baby, she instead let the baby roam around the lecture hall. At one point, she had to stop the lecture because the baby was eating a paper clip. Another time she had to stop because the baby was getting close to an electrical outlet. And then she decided to breastfeed while giving the lecture.

I agree with Skeptical OB that there's pretty much nothing appropriate about what she did. As a professor, I think you owe your students more respect than to simultaneously babysit while you're teaching a class.

And while I think breastfeeding is wonderful and would never want to discourage it, I think I'd be pretty distracted by a professor breastfeeding while trying to teach me.

Tales from Intern Year: Intermediary

On certain specialty services during intern year, we would have to answer pages from outpatients. In which case, we'd generally serve the role of a secretary, except even more useless:

Operator: "Doctor, I have a patient on hold to talk to you."

Me: "Okay, put them through."

Patient: "Doctor, I had chemotherapy a few days ago and ever since, I've been having hiccups. It's really bothering me."

[conversation follows about hiccups]

Me: "Okay, let me ask my attending about this."

I page my attending, Dr. Lazy, then wait for him to return the page

Dr. Lazy: "Well, if he's having hiccups, we can giving him some thorazine. Can you write outpatient prescriptions yet?"

Me: "No."

Dr. Lazy: "Then I'll call in the prescription. Call the patient and ask where they want the prescription sent to and then call me back."

Me: "Okay."

I call patient back.

Me: "We can give you some thorazine for the hiccups. Where do you want the prescription? A pharmacy or at the hospital?"

Patient: "I'll just pick it up at the hospital."

I page Dr. Lazy and wait for him to return the page.

Me: "The patient wants to pick up the script at the hospital."

Dr. Lazy: "Okay, I'll call it in."

So this was (count 'em) four phone calls dedicated to a patient with hiccups. What a freakin’ waste of time. But then again, it’s obviously more important to save five minutes of an attending’s time than to save an hour of an intern’s time.

Part 2: The Dreaded Reflex Hammer Returns

A physical exam yesterday:

Me: "OK, I'm going to check your reflexes."

[I take out reflex hammer]

Patient: "Oh my god, are you going to hit me with that?"

Me: "Um... yes?"

Patient: "No, please don't."

Me: "It's just a tap."

Patient: "I don't like having my reflexes checked. It's just... ugh!"

Me: "Well, I guess I can tap you with my fingers. Would that be OK?"

Patient: [grudgingly] "I guess so."

Seriously, what's up with this fear of reflex hammers? Are my patients talking to each other?

Beaten with a reflex hammer

When I was checking a patient's reflexes last week, I apparently gave her a little tap on the olecranon. I've never seen a person react that way to being tapped with a rubber hammer. I mean, occasionally people say "ow" or something. But this woman asked for an ICE PACK, which I gave her and she used for all of 30 seconds. She showed me her elbow and complained that it was all red (it wasn't).

Then at the end of the visit:

Patient: "Is my elbow still red?"

Me: "No." (it never was)

Patient: "Can I see that hammer you used?"

Me: "What?"

Patient: "I want to look at it. What is it made out of? Steel?"

Me: "No, rubber."

She wasn't satisfied until I took out my reflex hammer and showed it to her. I think that needing an ice pack after having your reflexes checked should count as a Waddell's sign.

Weekly Whine: Cards

It irritates me immensely that every single chain store you walk into expects you to have a card for that particular store. And makes you feel bad if you don't have one.

I signed up for a card for our closest grocery store. But I don't always shop there, sometimes I shop at other grocery stores. So how many of these freaking cards am I supposed to carry around?

I recently signed up for a Walmart card (even though Walmart is evil) because I was buying something big there and there was a large discount associated with the card. I wasn't even out of the store when Walmart freaking texted me. I immediately cancelled the card.

Moreover, I really hate when the person on line in front of me doesn't have a store card, and decides to take the cashier up on their offer to sign up for one. This happened to me recently when there was a HUGE line behind that customer. I mean, seriously. Not a great time to have someone filling out paperwork.

What inspired this post was an interaction I had yesterday at CVS when I attempted to buy a single toothbrush:

Cashier: "That'll be $3.15. Do you have a CVS card?"

Me: "No, I don't."

Cashier: "Would you like to donate $1 to Random Charity?"

Me: "No..." [feels guilty]

Cashier: "Would you like to buy a $10 book of coupons for CVS which has a $50 value?"

Me: "I really just want to pay for this three dollar toothbrush, please."

Nice vs. mean residents

When you're an intern, the difference between having a nice senior resident and a mean one is tremendous. Toward the end of the year, I had a really nice resident named Liz, as opposed to my first resident Jessica, who was evil incarnate.

1. When I'm post-call, Liz was constantly asking how I'm feeling.

When I was post-call with Jessica, she was constantly yelling at me.

2. When I wrote some discharge summaries for patients who might go tomorrow on my day off, Liz told me, "Stop! You don't have to do that! I can write them myself."

Jessica told me she expected me to have discharge summaries in the chart for every single patient on my service on my day off, just in case there was some remote chance they might go. And have skeletons of notes for all my patients printed up for her to fill out.

3. When I didn't have a piece of information on a patient when I was presenting late at night, Liz said not to worry about it and we'd look it up together.

When I didn't have a piece of info for Jessica, she would yell at me then throw me out of the room and say that I couldn't present to her until I was prepared.

There was one pre-call day when I had only one patient and Liz called me at home to tell me I could "go ahead and take the day off" and she'd cover my patient since she'd be there anyway. I seriously almost started bawling.

Crimes I might have committed

Usually when I see an article about someone being arrested for drug trafficking or grand theft larceny, I think to myself that is something that could never happen to me. But here are two crimes that I definitely could have easily committed (and still could):

This woman got a ticket because her two year old peed in the grass in public. How is that illegal? Especially awful because she tried to use a public bathroom and wasn't allowed in. I can totally imagine this happening to me.

Someone said this woman should have planned better. How exactly do you plan for a two year old urgently needing to pee?

This woman got in trouble because she forgot to pay for a couple of items that she had stored in her stroller while shopping. I used to shop with a stroller all the time, and this easily could have happened to me. I'm actually amazed it never did.

My mother showed me that article and said that it was clear the woman was guilty. When I said I could see exactly how that happened, she insisted that there's a video where it was clear the woman was being sneaky and trying not to pay for the items. I still doubt it.

Vasectomy

I know a lot of men are reluctant to undergo a vasectomy, but I always say that it's a much easier procedure than a woman having her tubes tied. This is how I explain that:

When I was a med student on my surgery rotation, there was one urologist in our department who had actually performed his own vasectomy.

He apparently used local anesthesia and did the procedure with a colleague present in the room "just in case." There were no complications.

I dare you to find a female ob/gyn who tied her own tubes.

Paternity Leave

I think it's a shame that more men don't take off time when their babies are born. For a first time mom, especially if you have a difficult baby or had a difficult labor, the extra help at home can be really valuable. And why shouldn't new dads have time to spend at home to bond with their babies?

But men almost never take more than a week or two off when their babies are born. So I tried to brainstorm why that is:

1) It's not "manly" to take off time for the birth of your child.

2) Since nobody else does it, bosses frown upon paternity leaves.

3) Loss of income since it's not supported by short-term disability.

4) If in training, that time will need to be made up.

5) Work is the only place for a new dad to escape his screaming newborn.

The main reason I think men should take paternity leave is because I think it might result in more understanding toward women taking maternity leave if both sexes are entitled to time off. Then we'll just all be hated by childless people.

Priapism

Me: "I'm going to start you on trazodone, but I want to make you aware of some of the side effects."

Patient: "Okay..."

Me: "It can cause your blood pressure to drop."

Patient: "Oh no."

Me: "So if you feel dizzy, stop taking it."

Patient: "Yikes. All right."

Me: "Also, in some patients... male patients.... it can rarely cause a... prolonged erection."

Patient: [smiling] "Oh?"

Me: "If it doesn't go away, you need to see a doctor."

Patient: [smiles wider] "Sure."

Me: "Immediately."

Patient: [grinning] "Heh."

Honesty: The best policy?

One thing I do a lot at work is pulling out feeding tubes. In my experience, this is a very painful procedure. It almost always really, really hurts. If it's a balloon tube, it won't hurt, but if it's not, I'm pretty sure it's really painful. Most patients look at me like they want to punch me in the face when it's over. One patient said to me, "I can't believe someone so small could cause me so much pain."

So I do now warn patients before I do it that it will hurt.

There was an NP who used to pull out all the tubes before I worked here (she left), and a therapist was telling me today while I was pulling one out, "She used to be really good. She didn't even tell them what she was doing then she'd just yank it out."

So I said, "Is it really better not to warn them?"

I mean, I don't want to freak a patient out and scare them, but I also don't want to lie and say that it won't hurt when I know it does. A few patients have told me it's one of the most painful things they'd ever experienced.

I don't know. Is it better to lie about it or to be honest and scare them?

E

A while back, I was doing all these short story challenges, which I found kind of fun. Stuff like, write a story with no prepositions. Or, write a story where no sentence has more than three words. This was one of the more challenging ones:

Write a very short story of one paragraph (50+ words) without using the letter E

Agonizingly difficult. Here's my attempt:

DOGHOOD

"Congratulations, happy birthday!" Mark said to his old dog Sparky, who was now 13. "Your manhood starts today."

Sparky's bar(k) mitzvah was that day and Mark said d'var Torah for Sparky. That night, Sparky drank his first alcoholic drink. Mark also bought him his first razor.

It was a good day.

Weekly Whine: Blondes

What's up with blond hair and men?

Men like blond hair. A lot. My mother once gave me the advice that if you are single and want to make it easier to meet men, dye your hair blond. I did once, and guess what? More guys hit on me.

I've known several women who got tons of male attention who are not pretty at all, but had very blond hair. They all would have failed the Rosanne Rosannadanna test. (i.e. if you put terrible hair on an attractive girl, would she still be pretty? They wouldn't have. They were actually downright unattractive.)

I remember when I was a med student, I was working with an intern who used to get constantly hit on by patients. I remember one old guy looking at her and saying, "Wow, you're beautiful." And the thing of it was, she wasn't pretty at all (I can be objective). But she had really yellow hair and they all loved it.

I guess instead of whining, I should feel comforted that men are so easy to attract. No need for plastic surgery, only a bottle of peroxide.

Coverage in pregnancy

On my post about how women are ruining medicine, one of the comments was the following:

"For me as a resident, when my female colleagues go out on maternity, we get pulled off our vacations, electives and otherwise down time to cover for them, and this infuriates me. Doesn't seem fair that I should have to suffer. Pregnancy is a choice, so just plan wisely and think about those your decisions might effect [sic]."

I was going to respond to this as a comment, but I realized I didn't have a post scheduled for today, so I figured I'd make it an entry so others could weigh in. Plus it turns out I had a lot to say on the matter!

First, I think this is a super common sentiment among male residents as well as among the female residents who don't get pregnant, even if they don't say it. I applaud the commenter for being honest. Let me respond:

A lot of people argue that covering for a pregnant woman is different from covering for other illnesses (which we all love doing, of course) because pregnancy is a choice.

Is it though?

I haven't seen any stats on this, but I have to wonder how many residency pregnancies are intentional? A resident friend of mine got pregnant while on birth control. Even sterilization isn't 100% and many methods have far less efficacy. And say a resident was just careless and missed their birth control for a night? Does that still make you angry about covering? As angry as it would make you to cover for a resident who chose to go skiing, then broke his leg? If not, why? Both constitute taking risks and having an unexpected outcome.

Isn't a lot of life based on choices? If you choose to live further away from the hospital and then get in a car accident, wasn't it due to your choice? If you stayed up too late and get a bad cold, maybe you shouldn't get coverage then.

But if you break a leg skiing, there's no way to unbreak your leg. Should a resident who gets pregnant by accident have an abortion to avoid inconveniencing others? Does anyone think that?

Of course, it's different with pregnancy because it's a happy event, as opposed to an illness. And it's true, there is certainly usually a happy element to a birth. But for most women, your body feels pretty much wrecked after a birth. After having a major surgery, most people have the luxury of lying in bed and taking care of themselves. After a C-section, you have to spend your recovery caring for a helpless newborn baby. I think what childless men don't realize exactly how women feel physically during that recovery period, no matter what the method of delivery.

I think that men may feel resentful, not because women make the choice to have a baby, but because it's a choice that they simply don't have. Keep in mind guys, that you also don't ever have to do nine months of residency with swollen legs, an aching back, and carrying 30 pounds of baby and fluid around with you everywhere you go... doesn't sound as bad now, does it?

Someone once suggested to me that men should get a 6 week vacation in lieu of a maternity leave. That suggestion is a bit of an insult to the amount of work that a woman must do during a maternity leave. But at the same time, I do think there should be a more lenient policy for taking time off. Most residents will work when they're sick, will work when close family members are ill, etc. Maybe if men felt that they could take time off when they needed it, they wouldn't feel as resentful?

The comment states that "we get pulled off our vacations, electives and otherwise" to cover for maternity leave. Considering you should have like seven months of advance notice, it doesn't seem like anyone should get pulled off anything, unlike when there's an unexpected emergency. Every resident is guaranteed a certain amount of vacation time, no matter what. If pregnant residents aren't letting their programs know early enough about their condition, maybe it's because they're so fearful of the attitudes expressed here.

Finally, the comment states that women should "plan wisely and think about those your decisions might effect [sic]". If that's the case, then when can a working female have a baby without it affecting anyone else they work with? Is it worse during residency, when coverage is spread out over 20+ residents? Or worse later in practice, when there may be only one or two other attendings available to cover? Should a female physician simply never have children out of fear of inconveniencing others?

Some would probably say the answer is yes.

Mixed alcoholic drinks for doctors

If I see one of these appear on a drinks menu, I will officially die of Awesome.

Are women ruining medicine?

This is the kind of post I'd usually make on Mothers in Medicine, but someone has already posted there today and I'm overeager, so it's going here instead! Plus it's probably been discussed there ad nauseum anyway.

A while ago, I was involved in a vicious forum discussion about how women are ruining medicine because "work 20% to 25% fewer hours than their male counterparts."

Women doctors in the U.S. work less—47 hours per week on average, versus 53 for men. They also see about 10% fewer patients and tend to take more time off early in their careers. "It's pretty much an even bet that within a year or two of entering practice they will go on maternity leave," says Phillip Miller, a vice-president of the medical recruiting firm Merritt, Hawkins & Associates. "Then they are going to want more flexible hours.

(Sorry, I'm too lazy to find the reference.)

Yes, I know women are lazy bums because we only work 47 hours per week. On the other hand, women are more likely to pick specialties men don't want, like primary care, pediatrics, or ob/gyn.

Anyway, without further discussion, here are a few choice comments from the discussion that still really grind my gears:

"If a woman wants to get pregnant, then she should have a job where she knows this is possible and convenient for the company. If someone wants a job with less hours, they should go find one, not try to get less hours in the job they're in."

"It's a matter of economics, not sexism. You wouldn't hire a heart surgeon to scrub the floors, because it's not a proper utilization of their skills - it would be a major waste of training and resources. You hire someone with a less developed skill set, and free up the surgeon to do what they, and only they, can do.

Likewise, it's a waste training and resources to have a heart surgeon raising babies, something that, to be honest, people with no formal education can and have been doing for millenia.

In the end, it has nothing to do with sex or gender. If the heart surgeon is a woman, and has an au pair or husband to raise the baby - bully for her. But if doesn't use her skills to do what only she can do, then she's wasting the time of the people who trained her and the money of the taxpayers who funded her training."

"This is not an issue because women take six months off for pregnancy and delivery. This is an issue because they take a decade off to raise children.

There are a fixed number of medical-school positions, and this number has changed very little over the past two decades while the population has increased by nearly 30%. Assuming that most doctors work 30 years or so (a little after age thirty to a little after age sixty), a woman who takes a decade off from work to raise children serves as a physician for only 2/3 of the time that a non-child rearing colleague would.

It may not be fair, but for some reason, most of the people who leave work to raise children are women.

Yes, it's hard to be a mother (I imagine, I don't and will never, know), but the reality is, there are a lot more women in the world who can raise children than can repair an obstructed bowel, and part of pursuing any advanced degree is a certain social obligation to actually use that investment for the betterment of humanity. If you've taken a medical school slot (and a federally funded residency) you should use it. If you're just going to squirt out kids you could have done that with a tenth grade education.

I'm an asshole, I know. But with a finite number of med schools, and a finite number of slots, accepting people who will practice only a fraction of the time of their colleagues is a net loss. This in one reason that it is so hard to get into medical school."

Typos

A typo from a sign-out that made me crack up:

"If patient is agitated, OK to give small dose of fativan."

9/11/01 and med school

My first exam of med school (biochemistry) was scheduled for 9/12/01. For obvious reasons, it got rescheduled. Sadly, this resulted in a major rift in my class that lasted for years.

The test was supposed to be rescheduled for the next week, but people in the class protested this. Because they were still sad. They wanted to wait two weeks, because apparently, it takes two whole weeks to get over a horrible tragedy. One week just isn't enough.

Let me just say that 9/11 affected me very personally. I'm from NYC and a friend of mine from high school died in the WTC. I can't think of that day without tearing up. So I entirely sympathize with feeling unable to take a test when this was going on. Yet...

It was ONE test. Out of dozens we'd be taking that year. I mean, so you can't concentrate that great. Is that really the end of the world? The doctors helping people injured in 9/11 were emotional and probably had a hard time concentrating, but they still did their jobs. I felt it was a little ridiculous to keep postponing this exam, especially since we had several other exams on the horizon.

I still remember we had this huge meeting with our entire class where we fought over when this exam would be. One guy was saying that he wanted to postpone the test till the week after Rosh Hashanah, because when he went to synagogue, he might hear about someone who died and not be able to concentrate. Again, this was ONE exam that wasn't even worth that much. There were four exams in biochem. I mean, who cares if you don't get the absolute best score you can? Just take the damn test.

Of course, maybe I'm not thinking like a future dermatologist.

I know it's cynical on my part, but I honestly believed that the requests to postpone the exam were just excuses to get more study time. And this cynical theory was completely supported a year later, when the EXACT same reaction occurred when a test was postponed due to a snowstorm.

Shame on you, Costco!

I was at Costco last weekend, and we made a stop at the food court after making our purchases.

Now the food court at Costco is horribly unhealthy already. A slice of pizza there is 700 calories. I'm not even kidding. So I thought that if I'm going to have a 700 calorie slice of pizza, I should at least have water to drink with it.

At Costco, you can pay for the food while buying your groceries, so that's what I did. My husband wanted a Diet Coke, so we got one medium drink, and I figured I'd just ask for a cup to get water from the fountain.

Unfortunately, when I went to get my food, all they were willing to give me was an insultingly tiny cup. It was smaller than the cups that you use to rinse your mouth at the dentist. Here it is next to our medium cup.

And when I asked if I could possibly have a slightly larger cup, just for water, they told me that I could wait on line again and purchase a drink, and that's the only way I was going to get a normal-sized cup.

I've complained before about how food courts are so resistant to giving you cups of plain water, but this one just really infuriated me, because the cups were so ridiculously small. Like, why have cups at all if you're going to do that?

Abstracts

When I was doing my fellowship, one of my attendings asked for my opinion on some abstracts that had been submitted for a conference. I gave him my thoughts on whether the abstracts he showed me should be accepted or rejected, but this was one where I really didn't know what to say:

It was a case of a patient who was having chemo with vincristine, which was mistakenly injected intrathecally (into the subarachnoid space) instead of intravenously on cycle #5. First, let's examine that sentence: Vincristine was mistakenly injected intrathecally instead of intravenously.

How is that POSSIBLE? If I went in for chemo and I was supposed to get a drug in my vein, and they accidentally injected it into my spinal fluid, I really think I'd notice. Especially if it was my fifth time. Is there something I'm missing?? There must be. Anyway, the patient got a spinal cord injury and ended up quadriplegic. Yikes.

The abstract wasn't reporting this interesting complication though, but rather, the challenges associated with rehab for a patient on chemo. However, instead of actually reporting anything specific to this patient, he just gave a little book report on general complications associated with chemo during rehab.

But my absolute favorite part is the random "results" section he threw in:

Results: Spinal cord injury after accidental administration of intrathecal vincristine with ongoing chemotherapy is very difficult to treat.

It sure is.

Weekly Whine: Why I Whine

The Weekly Whine is my favorite segment on my blog. I started it in response to someone complaining that I whined too much. I figured by starting this segment and being forthright about the fact that I was whining, nobody had the right to complain. After all, if you're reading an entry titled "weekly whine", you know what you're getting into. So if you don't like it, it's your own damn fault for reading in the first place.

The truth is, I don't think this blog is particularly whiny or negative about medicine. Mostly it's anecdotes, drawings, quizzes, etc. Yet sometimes people will start inexplicably yelling at me for being too negative, such as on this post (not even a particularly negative one). Or criticize me for complaining too much or something.

Yes, I do tend to keep from telling particularly positive stories or writing love letters to medicine. And here's why:

A couple of months ago, I completed a year of pumping for my baby. Even though I strongly believe women shouldn't place undo stress on themselves to pump, I was still proud of this achievement. It was a lot of work and it also took a lot out of me. So I made a post on Mothers in Medicine talking about my accomplishment.

For a while, nobody commented. Nobody cared, which is fine... it was a personal achievement. Then finally, I did get a comment. Was the comment saying, "Hey, good job working hard to provide nutritious breastmilk for the sake of your baby's health for a whole year!" No. The comment was to yell at me for saying that the stress of breastfeeding had caused me to have a BMI of 18 despite getting to eat anything I want. That I was glamorizing being dangerously underweight.

Just a little background on the BMI of 18:

I don't own a scale. Since I'm not trying to lose weight, I don't really see a need to own one. Why would I want to know what I weigh? What good does that do me? I had noticed that I had lost weight based on the fact that my clothes all fit me like a tent and my wedding band kept falling off. But it was during my yearly PCP visit that they told me my weight and calculated my BMI for me. I was very surprised, and for a week or two, I was talking about it a lot, not to brag, but the same way I told everyone when my hematocrit got really low when I was pregnant the first time. That got reflected in that particular post, I suppose.

The commentor also pointed out that I glamorized the fact that I didn't gain much weight in pregnancy. I did mention this fact once while talking about testing for gestational diabetes, where it was very relevant (I, in fact, didn't post at all about pregnancy while I was actually pregnant). It's true that I didn't gain much weight during pregnancy, but that's because I was violently ill for the first 20 weeks, and mildly nauseated for the second 20 weeks. If vomiting every day is glamorous, then I am the glam queen. Believe me, I got very jealous of pregnant people who said, "Oh, I have no symptoms at all."

Subsequently, a second post appeared on this blog (which I had written the same time as the other post, but had scheduled for weeks later) that mentioned my weight loss caused me to feel colder than usual. Someone then commented that talking about my weight made them absolutely furious (?) to the point where they couldn't read the rest of the post, that I was again glamorizing being underweight, and it was irresponsible for me to do so.

One thing this all demonstrated to me is this:

Nobody wants to hear you say anything about yourself that could be construed as positive. If your baby is sleeping through the night at one month old, nobody wants to hear about that. If your baby wakes up every hour, then that's an acceptable blog post. If you get a raise, nobody likes you. If you can barely afford food, that's an acceptable blog post. Whenever you tell positive stories about yourself, people think you're bragging and hate you.

Maybe that's a pessimistic view of the world, but it's just an observation I've made. And that's why I err on the side of whining. Because if I didn't, you'd probably hate me.

Ass injections

I don't do these anymore, but as a resident, I used to sometimes do coccyx injections under fluoroscopy for pain.

On one occasion, after finishing the injection, the attending wanted me to put a bandaid over the injection site. When I asked for one, he insisted he had already given me a bandaid. Except I didn't have it.

So the attending started searching for the bandaid in the patient's butt crack. Like he thought it got lost in there or something. Finally, he gave up and got a new bandaid.

We still don't know where the original bandaid ended up. We don't want to know.

Depression and Medical Training, Part 2

I've written before about how medical training does very little to help people in the midst of depression, despite how prevalent it is. This is a story about a personal experience during training, and how my attending basically got pissed off at me for showing signs of depression. I've changed several details, but the idea remains the same.

Right before the end of my PGY3 year, a close relative died and another one was diagnosed with cancer. On the tail end of these tragedies, maybe because I wasn't taking great care of myself, I injured my back pretty badly lifting my daughter. I'd hurt my back a few times before, but usually it resolved within a day. This time it wasn't getting better. I had daily, severe pain, and it was keeping me from being able to sleep or stand or do anything.

At that time, I was on an inpatient rehab rotation with an attending who I will call Dr. Comp (short for compassion). Dr. Comp was kind of used to PGY4s blowing off her rotation, so I can't blame her for thinking the worst of me. But I was very honest with her about what I was going through. I told her about my pain and I even cried in front of her once. I don't think I was behaving like a slacker resident.

Throughout this, I was managing my patients adequately. They were chronic patients who required a very low level of care... some had been on the unit for months, one for a year. I never felt like I dropped the ball and even remotely put anyone in danger. In fact, I had to put together my own signout sheet for my census, since the last resident had graduated and left me with no information on any of the patients. I spent hours digging through all notes to give myself a full picture of every patient.

Meanwhile, I was quite depressed. I was having pain with prolonged standing/sitting, lifting my baby, and difficulty sleeping. I did see a doctor, but Dr. Comp was a little passive aggressive about letting me go to appointments. Finally, she told me that she had "reported" me to the program director for my behavior.

The program director, at least, was very kind. He told me he knew I was a good resident and that I had been through a lot recently. He told me that if I needed to take a short leave, I could do that, but I said I wanted to try to get through it. He even did acupuncture on me, which didn't work. (Surprise, surprise.)

On one morning when Dr. Comp and I were alone together (about two weeks into the rotation), she asked me how I was doing and that's when I started to cry. She told me to get myself together and call the mental health services. I did. For the first and only time in my life, I tried going on an anti-depressant, and had a severe reaction to it that finally necessitated my having to take a few sick days from work.

When I got back to work, Dr. Comp told me that she wasn't going to allow me to take call anymore because she had to change the call schedule for my illness, and she didn't want to do it again (on this particular service, the attendings generally took call alone so putting me on the schedule just meant the attending would be a second back-up). I asked her how I could make it up and she said simply, "You can't." I felt really burned by this. On my last rotation, the attending had told me I was the best resident he'd ever had. It didn't seem fair that in two weeks, I could go from that to feeling completely untrustworthy.

I did eventually start to feel better and pulled myself together again maybe three weeks into the rotation (it was a two-month rotation). But the way Dr. Comp treated me always seemed to drag me down again. Every interaction I had with her brought me nearly to tears. I remember there was a patient on our unit who was going for a colonoscopy, and she had somehow expected me to know to start the patient on IV fluids the night before (still unsure why). When she saw I hadn't done this, she said to me, "It's clear that I can't trust you at all. You are completely scattered and have no idea what's going on."

Admittedly, Dr. Comp was not the queen of psychosocial skills. She would routinely fight with patients during rounds, sometimes loud screaming fights. She was also quite "scattered" herself and would often claim she told me things when I was fairly sure she didn't. But other residents in the past said she was nice enough.

The second month was better. I still had issues with pain, but I had gotten to the point where I could deal with it, and it didn't affect my work. When we sat down for my evaluation at the end, she said, "I got the impression in the beginning that didn't want to do any work, but then I realized that wasn't the case."

You know, I could see how a depressed, tearful resident might make you think they were incompetent or unstable. But I'm baffled that the impression she formed of me was that I was a slacker. Half the reason I was so depressed was because I couldn't do my job well.

Permanent Jewelry

When I'm trying to do an EMG on a patient, often I have to ask them to remove their watch and jewelry. The watch is usually not a big deal, but it seems like every other female patient has on a piece of jewelry that literally cannot be removed.

Personally, all my jewelry comes off. Of course, the only jewelry I ever wear is my wedding band, which I take off every day in the shower. I could almost see having one ring that doesn't come off. But there are a lot of people who have like six or seven rings that don't come off. Or large bracelets that don't come off. No wonder your nerves are compressed if you're wearing this tight bracelet all the time.

One of my patients last week had this incredibly ugly blue bracelet that she was unable to remove. I realized this means that she wears this awful bracelet every single day, all the time, even when she sleeps.

50 Ways to Leave Your Residency

Some of you who are longtime followers of my blog may know that I started out in an internal medicine residency and quit for PM&R. Switching residencies? Not recommended. But entirely doable.

I spent most of my first half of internship being really, really miserable. I remember sitting in the call room during my ICU month, talking to my mother about how badly I wanted to quit and what my options would be if I quit. Every time my resident would say, “This patient is really sick,” my stomach would churn. In the very beginning of the year, I’d only dread call on the morning of a call. Then I started to dread it the night before. Then I started to dread it like five minutes after the previous call ended.

Then I started to wish a car would hit me on the way to the hospital so that I wouldn’t have to go.

I may have been a little (or a lot) clinically depressed, but the truth was, I just really, really hated internship. At the time, I think I hated it more than most people, but in retrospect, I’m not entirely sure.

One night in December, I got very sick during a call. The whole thing made me realize that I couldn’t live like this anymore. I hated medical school and now I hated internship. I couldn’t go through one more year of hating my life, hoping things would get better. I mean, what if I died tomorrow?

Nobody believed me at first. I’m not the kind of person who makes crazy decisions. When I start something, I tend to stick with it. I’m incredibly responsible. So when I told my family I was quitting my residency, they all said, “You’ll never do it.”

But even though it was a “crazy” decision, I’d never been so sure of anything in my life. I wanted out. So without any kind of back-up plan, I met with my program director and told him that I was leaving at the end of the year.

My father told me I was an idiot for doing that. I should have first sniffed out my options, not told anyone what I was planning. But, you know, I was already a quitter. I didn’t want to be a liar on top of that.

I was given a month to think about my decision, but I really didn’t need it. I knew I was leaving. My two options were to spend a year doing urgent care moonlighting or to follow my “dream” and land a PM&R residency.

There happened to be a PM&R residency in the same hospital where I was doing my internship, and I had rotated there as a fourth year med student. I had clicked with the attendings and the residents, so I thought I might have a chance. I contacted the program coordinator and found out that a PGY2 spot was open for the next year.

I went to talk to one of the residents at the program to get his advice. He said to me, “There are a few other people trying to get that open spot. If you really want it, you have to go meet with our program director and really suck up to her. Because you can bet that’s what the other people are doing.”

And I said, “If I were the kind of person who would do that, I wouldn’t be going into PM&R.” And I sure as hell didn’t do it.

An attending I had worked with named Dr. Lane wrote me a strong letter, and I also got a letter from my program director. I was told during my interview that they appreciated how I had been honest with my current program about my intentions. That was a golden moment during an otherwise somewhat mortifying experience during which time I had to take a tour of the hospital where I’d been working for six months, wearing my little interview suit.

A couple of weeks after that, I received an offer from that program and I happily accepted.

Obviously, I got lucky. If there hadn’t been a spot available at that program, there were no other nearby programs and I would have been screwed. Before I even got the acceptance, I found out that my spot in the IM program had already been filled by a woman who wanted to move to be closer to her family.

Do I ever have regrets? Yes, sometimes. But retelling this story, I remember how miserable I was, and I know it wasn’t even a decision—it was something I had to do. And I feel good about the fact that I did it the “right” way. I was honest and I didn’t screw my program over by leaving at the last minute. (Another intern left in June and DID screw everyone over pretty badly.) Someone else got a spot that they really wanted thanks to my leaving. I don’t feel even a shred of guilt.

And you know what? I actually liked my residency. You can’t argue with that.

"Urine" tox

During my intern year, my co-intern Sam had a chest pain patient who was a young female. In the review of system, she admitted she was taking some weight loss pills she ordered online from Brazil. Obviously a really reputable source.

Sam suspected that the pills contained amphetamines, but he couldn't convince the toxicology lab to analyze pills. So he took one of the capsules, broke it open and dissolved it in water. He then handed the specimen to a nurse and said, "This is urine. I want a tox screen."

The lab analyzed it and it came back positive for methamphetamines.

Weekly Whine: Privileged

Every so often, I'll say something negative about medicine, and I get a comment along the lines of:

Remember that you're lucky to even have an education and be able to earn a good living. This is a privileged discussion.

These comments kind of remind me of when you're a kid and your mom plops down some disgusting food like brussel sprouts in front of you, and you don't want to eat it, and she's like, "Other kids don't have food! You're lucky to have food! Would you rather live in [insert name of third world country]?"

No, I wouldn't. But that doesn't change the fact that brussel sprouts taste like crap.

If you go to a restaurant and the food you ordered doesn't taste good, are you not allowed to complain because other people don't have money for food? If the heat goes out in your house in the dead of winter, are you not allowed to complain because at least you have a home?

Are there good things about being in medicine? Yeah, of course. Is it absolutely always wonderful? Of course not. Are there aggravations, as there are in any job? Uh, yeah. Am I allowed to talk about these aggravations online without putting in a disclaimer each time? Last time I checked, I am.

Besides, you'll notice that the vast majority of my weekly whines are not about medicine.

To tell or not to tell

When I was an intern rotating in the ICU, I happened to be in a room with a third year ICU resident named Jill and her attending. And they were having a conversation like I wasn't in the room.

Jill started complaining to the attending about her resident Max. Max was an intelligent guy, very nice and conscientious, and mature beyond his years. I'd worked with him several times and he was always someone I felt like I could rely on. But I gathered from this conversation that Jill and Max were not getting along.

Max was interested in doing critical care as a career and Jill was complaining about the number of mistakes Max had made that month. Jill was going on and on about how he didn't pay enough attention to details and that he didn't know the patient's meds (so I guess I wasn't the only one). And the attending was agreeing with her. Max apparently also did something bad in terms of having some important code discussion with the family without including the attending.

I felt really bothered by the conversation that Jill was having with this attending (especially the fact that it was right in front of me). I went home feeling conflicted, wondering if I should warn Max that Jill had been dissing him so that he could do damage control.

Ultimately, I ended up not saying anything. Max already knew Jill didn't like him, and I didn't want to be the bearer of bad news. But I always wondered if I did the right thing.