Unusual Conditions

High School Stereotypes

Guarantees for Intern Year

Reasons to call in sick

Personality Disorders in Med Students

The 32 Types of Med Students

First Week of Med School

Ways Med School is like Kindergarten

What's on your tie?

Holiday Hiatus

I will be going away for the holidays and therefore will be rerunning some of my very favorite cartoons in my absence. I will return as scheduled with new posts on January 2.

Happy Holidays!

Weekly Whine: Christmas music

For the love of god, enough with the Christmas music!

One of my favorite radio stations turns into an all Christmas music station in late November. Late November! That's an entire month of nonstop Christmas songs!

I mean, there are a couple of Christmas songs I like, but I can't imagine most adults want to listen to a month of nonstop Christmas music.

Life Insurance

I used to have life insurance at my old job, but my new job doesn't provide it. (We do get some token amount, not really much.) Anyway, somehow I dropped the ball and forgot to get life insurance, so at the moment, my life is totally uninsured. My husband does have life insurance, at least more than me, but not as much as he probably ought to have.

I started to panic a little bit about this recently, and I found a broker that was highly recommended to me by someone I trust. The broker gave us some paperwork to fill out, which I have done, but my husband is very reluctant to do this. He feels that we don't need life insurance since one of us dying is very unlikely, and furthermore, he is worried that the broker will share all our personal information.

He quoted:

"One data broker is selling lists of addresses and names of consumers suffering from conditions including cancer, diabetes, and depression, and the medications used for those conditions; another is offering lists naming consumers, their credit scores, and specific health conditions."

So he doesn't want to get life insurance. But I'm extremely nervous having two small kids and no life insurance. He should probably be even more nervous than me, considering I earn the majority of our income, and the disparity may be even greater in the future since he may switch to an academia career.

What do you think? Can you convince my husband to get life insurance ASAP? Or do you agree with him?

WORLD backwards

Worst Rehab Call

This is the story of my worst call as a rehab resident. If you only enjoy happy stories with no complaining, then you should probably stop reading now. (Actually, if that's the case, why are you reading this blog in the first place?)

I hadn't been dreading it that much. I was on home call Friday night, Saturday, and Saturday night, which is better than Saturday and Sunday at least. I was stuck with the slowest attending, Dr. Blabber. Most of the time, Saturday rounds are maybe from 8 to noon (or at worst 2 or 3), but I had a bad feeling it might be longer. I was also about six months pregnant at the time.

I got called at around 2:30AM Saturday night about a patient who had just been transferred over from medicine that day. He was one of those awesome patients who had just had bypass surgery and was horribly unstable, now sitting in a rehab bed. His name was Mr. Nguyen (not his real name) and he spoke no English. And he was having chest pain. I called a mini-Code.

Off to the hospital I went. I called medicine to come help me and fortunately got the resident who had transferred the patient to rehab. We did the whole EKG, enzymes thing and everything was normal.

At that point, I had given up on getting a good night's sleep at home, so I decided to stay at the hospital. I went up to the call rooms, except rehab had no dedicated call room and most of the rooms had threatening notes on them saying that they would cut anyone who they found sleeping in their call room. So I picked the med student call room, thinking that this was the one population in the hospital who had less power than me.

Sleeping was not an easy task. At six months gestation, I had two positions I could sleep in: my right side and my left side. Except on Friday, I got a flu shot in my left arm and that was hurting a lot, so it was hard to sleep on my left side. So I had exactly one comfortable sleeping position. But as you may know, if you're a human being, it's hard to stay in one position all night. And in the miracle that I was actually able to drift off for a minute, my pager would wake me up.

I had asked Dr. Blabber when she wanted to meet on Saturday morning. She told me 7AM. She said she knew this was earlier than normal, but she thought that getting an early start would help us get out of the hospital earlier, which I totally agreed with. So I showed up to the trauma center at 7AM and got a bunch of crackers for breakfast (yum). By 7:10AM, Dr. Blabber hadn't arrived yet, so I told the nurse to start giving me report.

At 7:30AM, Dr. Blabber still hadn't arrived. I finally paged her. She said that she was listening to signouts on her answering machine and then she wanted to get breakfast. So what the fuck was all that about an early start???

I finished getting signout and went to the cafeteria to meet Dr. Blabber. Unfortunately, she seemed to have no interest in having a quick breakfast and getting to work. She wanted to bullshit with me, mostly about how cruel internal medicine is to residents (as the day went on, this became increasingly ironic). And on an unrelated note, this woman spread PEANUT BUTTER on her pancakes and then covered them with syrup. What sort of psychopath eats pancakes like that???

Around 9AM, we made our way down to the trauma center. I was bitter that I could have slept an extra two hours, but I tried not to think about it. I figured that at least since I had gotten signout, things would move faster. But no. Dr. Blabber basically rewrote every single one of my notes verbatim, which took another half hour.

At 9:30AM or so, we FINALLY started seeing patients in the trauma center. I figured since there were only six patients and none of them were sick, it should go fairly quickly. I don't know why I kept being so naive. The thing is, Dr. Blabber LOVES to talk to the patients for as long as possible. Our first patient:

Dr. Blabber: "How are you feeling today?"
Patient: "I'm fine."
Dr. B: "There's nothing that's bothering you that I could help you with?"
Patient: "No."
Dr. B: "Nothing at all?"
Patient: "Not really. Well, I am still having some nausea."
[Twenty minute discussion ensues involving remedies for nausea, including sea bands and ginger ale]

Dr. B: "Also, what color are your eyes?"
Patient: "What?"
Dr. B: "What color are your eyes?"
Patient: "Uh... blue."
Dr. B: "Well, you know what? Your eyes are going to turn brown soon."
Patient: "What?"
Dr. B: "Your eyes are going to turn brown."
Patient: "What?"
[Twenty minute discussion ensues about how it's been two days since patient took a crap]

By 10:30AM, we had managed to see two patients. We saw two patients in an hour. That's fine, except we still had the rest of the hospital to round on with about SIXTY patients. At that rate, we were set to finish rounding about..... 4PM the next day.

We also had an admission. OMG, acute REHAB admission on a Saturday!! This patient needs physical therapy STAT. Give me 20 cc of ankle foot orthoses!! Actually, the admission turned out to be a blessing, because I left to do the admission and was freed from the agony of Dr. Blabber telling every patient how their eyes were turning brown. Also, since the new patient was aphasic (can't talk), I figured even Dr. Blabber couldn't spend more than 10-15 minutes talking to her later.

I took my time with the admission, thinking I'd let Dr. Blabber finish seeing some patients on her own. I had honestly expected her to move on to a different floor at least during the hour and a half it took me to finish the admission, but she only managed to finish seeing the patients in the trauma center. Three hours for six patients. 56 patients left to go.

At noon, she came over to see my patient. She made me present to her in like two seconds, like she didn't have time to hear the whole story. Then she barely even saw the new admission, even though she spent FOREVER seeing the patients who had been there for months. I couldn't criticize though, because I thought she was finally going to get serious about rounding and maybe we'd finish at a reasonable time. She also told me to get lower extremities ultrasounds on the patient, which I wasn't going to do since she had been on prophylactic heparin (more on that later).

We started rounding on the next floor of patients (there are three floors total). Unfortunately, I had been totally wrong about picking up speed. We were going just as slow as ever. And every patient's eyes were turning brown.

By 1:15PM, we had only seen a handful more patients. I finally said to Dr. Blabber: "If I don't get lunch in the next few minutes, I'm going to faint."

I was really hoping she might continue rounding while I went to get lunch, but she wanted to come with me and sit with me. I was so angry at her though, I didn't say a word through the whole meal. I got meatloaf, which I thought was covered in onions but it was actually covered in BACON. Ew. I just don't believe in meat being covered by other meat. I ate a few bites and was promptly completely grossed out.

When I finished, I said to her, "Okay, are you ready to go back?"

"Not really," she said with a long, drawn out sigh. Like she was so tired. Uh, between the two of us, which one of us had been in the hospital since 2AM?? Which one of us was growing another person inside them??

And which one of us was taking freaking forever to talk to every single patient? You want to move faster? Then MOVE FASTER! It's not like I had any control of the situation.

We went back to that same floor. It was almost 2. I felt like we were never going to finish. And I was getting calls from the next floor... they were confused because they didn't know why we hadn't come down there yet to round. As I said, most attendings were done by no later than 2. I had to break from rounds for a good half hour to deal with a guy on another floor whose suprapubic catheter was leaking and when I came back, Dr. Blabber was still with the same patient as when I had left. And not only that, the patient was a medicine patient who we weren't even supposed to see!!

At about 3:45PM, we were halfway down the final hallway. One of the orderlies came up to Dr. Blabber and put his arm around her, "What do you look so sad about? You're almost done."

"We still have another floor to go to," Dr. Blabber said.

"Really??" the orderly looked astonished.

"Stop talking about it or else I'm going to start crying," I said. I wasn't kidding.

I was beginning to feel like I couldn't take another second of this endless rounding. It was horrible. Plus my feet were killing me from standing so long and my legs were swelling up. Finally, I said to Dr. Blabber: "I feel like my heart is pounding in my chest."

"You do?"

I held out my wrist and she took my pulse. "It's 126," she said. "Go get some water and sit down."

I really felt pretty crappy. I hadn't slept last night, I was six months pregnant, and I had been standing nonstop almost all day.

Dr. Blabber finished up on that floor, miracle above miracles, at around 4. She told me she was going downstairs to the final floor and I said I'd go with her.

We got to the first patient, who was possibly the sickest one on the floor. We all surrounded his bed and started asking him about his leaking catheter, although I tried to stay in the periphery.

"Wow, you look tired," the patient said, looking at me.

"Hmm?" Dr. Blabber said.

"She looks really tired," the patient said.

"Who do you mean?" the nurse asked him.

"He means me," I said.

Around that time, I got a call that my new admission had a HUGE deep vein thrombosis in her leg. I was actually not that upset, because it gave me an excuse to call radiology to put in an IVC filter. I thought I'd get to escape from rounds for a little while, but I hadn't counted on Dr. Blabber sitting down next to me and staring at me as I made all the calls. Um, I think I can handle asking IR to put in a filter. I don't need to be supervised, thank you very much.

I tubed upstairs the orders for the filter to be placed. Unfortunately, I forgot to write the phone number for the patient's husband (who had to give consent) on the form... and even though I had told radiology that phone number, I thought it would be best to have it on the form.

I called the second floor: "Hi, did you get the form I just sent upstairs?"
Charge nurse: "Yes, we did."
Me: "Can you write a phone number on the form for me?"
Charge nurse: "I can get the patient's nurse if you want to give a verbal order."
Me: "No no no, I just want you to write a phone number on the form. Not a verbal order."
Charge nurse: "Huh?"
Me: "On the form, just write the phone number--"
Charge nurse: "Hold on, I'm going to get the patient's nurse so you can give a verbal order."
[I wait for several minutes]
Nurse: "Hello?"
Me: "Hi, are you the nurse for Mrs. G?"
Nurse: "I don't know. Let me check."
[I wait several more minutes]
Nurse: "No, I'm not. Do you want me to find out who it is?"
Me: "Forget it, I'll come upstairs."

So much for saving time by tubing something. I was actually glad to escape from rounds for even longer though. I was unfortunately unable to locate the patient's nurse, but they told me that since it was 5:30PM, the patient hadn't eaten yet, so I made her NPO for the procedure. I then had to contact the husband to get consent, which wasn't easy (even though he had told me that he'd wait by the phone in case we needed to do this procedure). He also told me that he was a MALPRACTICE ATTORNEY, which made me feel so much better about all of this.

Long story short, I got the consent, rewrote all the patient's orders (for some odd reason, this needs to be done if a patient goes for a procedure), and made sure she was all set to go for the IVC filter.

I got back to the first floor at around 6. I had hoped Dr. Blabber was almost finished and by golly, she was (almost finished). She had one patient left. The nurse gave me a list of all the orders that Dr. Blabber had failed to write while rounding and I wrote them all, plus some stuff that had been in our signout that she had never done. How is it possible to be so slow, yet miss so much?

I came in with her to see the final patient. It was a spinal cord injury patient and her husband. The husband was sitting right by the patient's bedside.

Dr. Blabber: "Hi, I'm Dr. Blabber. I'm covering for the weekend. How are you doing today?"
Patient: "I'm okay."
Dr. B: "Any problems?"
Patient: "No."
Dr. B: "Are you sure?"
Patient: "Yes."
Dr. B: "I got the results of your spine X-ray and it showed..." [ten minute discussion of the results of the X-ray]
Patient: "Okay."
Dr. B: "Do you have any questions?"
Patient: "No."

At that point, I was psyched that we were going to leave. But then Dr. Blabber turned to the husband, who as I said, was sitting right next to the patient.

Dr. Blabber: "Hi, I'm Dr. Blabber. I'm covering for the weekend. How are you doing today?"
Patient's husband: "I'm okay."
Dr. B: "Any problems with your wife?"
Husband: "No."
Dr. B: "Are you sure?"
Husband: "Yes."
Dr. B: "I got the results of your wife's spine X-ray and it showed..." [ten minute discussion of the results of the X-ray]
Husband: "Okay."
Dr. B: "Do you have any questions?"
Husband: "No."

I was like, Am I on crazy pills here??? Why did she have to have an identical discussion with two people who were sitting right next to each other????????

But at that point, I was beyond caring. It was 6:30PM, I had been in the hospital for about 16 hours and I was very ready to go home.

Practically the second I got home, I got a page: "Doctor, I'm worried about Mrs. G getting the IVC filter placed because she ate dinner."

"But I made her NPO!!!!!!!!! There was a sign on her door!!!!"

At that point, I started crying. Literally. I was practically hysterical. I cried and cried. I used to cry after almost every medicine call, but I really thought I was past that. But somehow, they broke me. I kept crying that I didn't want to be a doctor and that I wanted to throw my pager out the window.

While I was crying, I got another page. I calmed myself down and called back: "Mr. Nguyen had a large bloody bowel movement."

"Okay..."

"It's frank blood."

His vitals were totally stable so I had them place a second large bore IV with a fluid bolus, got a stat CBC, type and cross. I called Dr. Blabber and she didn't have anything else to add.

I was debating if I should go back to the hospital again. I really didn't want to. Then I got another call: "Doctor, Mr. Nguyen just became unresponsive and coded. He's responsive now."

I got to the hospital just in time to wave to Mr. Nguyen before they whisked him away to the ICU.

Dr. Orthochick: Scrub Nurses

Top Tricks Used By Scrub Nurses to Make You Look Bad

1. They say they have your gloves but then when you walk in after getting scrubbed they say "why didn't you get your gloves for me?"

2. Overuse of the phrase "you almost touched something sterile!" Even when you are sterile

3. Ignoring you when you ask for scissors so you look unprepared when your attending finishes tying a knot

4. Telling you you desterilized yourself when you very clearly didn't

5. Asking you if you know how to scrub in

Kindle Matchbook

I have just enrolled The Devil Wears Scrubs in the Kindle Matchbook program. What does this mean?

If you buy a new print edition of this book (or purchased one in the past), you can buy the Kindle edition for only 99 cents.

So if, for example, you buy the print book for a friend, you can also get yourself a Kindle version for under a dollar. I'm not sure if this will encourage sales at all, but it can't hurt.

Characteristics

At the end of my first year of med school, I was having dinner with some other students. Someone mentioned a student in our class named Jean, and my friend Alice asked, "Who's Jean?"

It was pretty weird Alice didn't know who Jean was, considering we only had like a hundred people in our class and we spent pretty much every minute together. But it wasn't entirely out of character for Alice.

"She's the one who always finishes exams early," one person volunteered.

Alice still didn't know who she was.

"Her hair has red streaks in it," someone else said.

Alice still didn't know who she was.

We all looked at each other, knowing the hair wasn't going to clue her in to Jean's identity. Finally, a girl named Maria stood up, walked over to Alice, and whispered something in her ear.

Alice said quietly, "Oh!"

When Maria sat down again, we all looked at each other awkwardly. "It's funny," she murmured, "everyone knows what I just said."

Weekly Whine: Little Pocket

What's the deal with little pockets on clothing?



Obviously, they're not functional. Do they look good? I don't think so. I think they're a little ridiculous.

It's good to be grown up

One thing I really hated about med school and residency was when you were stuck in a patient's room while the attending decided to get all chatty with them about things unrelated to medicine. For example, I got stuck standing there for a twenty minute conversation between an attending and a patient about Valentine's Day presents their husbands gave them. And you're just trapped.

When I was an intern, I was rounding on a Sunday one day and I got trapped in a really irritating situation. The attending started talking to an elderly patient's family. This led into a big nostalgia fest. I swear to God, I heard every story about this woman. I now know her favorite music, her favorite TV shows, her favorite color. And we'd had a meeting with the family practically every day and her elderly sister loved telling these stories. I'm a somewhat patient person, but for Christ's sake it was Sunday and the room was 2,000 frickin degrees and I just wanted to finish up my work and go home. I still had a lot to do.

The worst part was the attending was eating it up! He was chatting with them and not making any move to leave during breaks in the conversation. If the family ran out of things to say, the attending would be like, "So who was her favorite movie star?" I was like, "You've got to be kidding me, let me out of here!!!"

As I stood there, I prayed to god that my pager would go off, because I knew that would be my only means of escape. I kept looking at it, wondering if I could do something to it to even make it SOUND like it had gone off. Finally, I fiddled with it, it beeped softly, and I exclaimed, "Oops, I gotta go!" And I ran out.

I got some of my work done outside, wrote orders, finished notes, and signed out to cross cover. Then I came back to the room and the attending was STILL talking to the family. I quickly slipped away.

I paged the attending when I was ready to leave. I said, "I'm sorry I left but it was really hot in that room and I had work to do."

He said, "It's okay. They just seemed like they wanted someone to talk to."

And then I felt like a huge jerk. But then again, I still don't think my standing in that room made much of a difference.

Reasons not to have kids

One day in residency, I was having lunch with three people who did not have children, two of whom were female attendings who were in their 50s (so it's safe to say the childbearing years are over). The third was a male resident who had definitively decided not to have kids (although later actually did).

The conversation was basically about how horrible having children is and how it ruins your life and wrecks your marriage. I was NOT participating in this end of the conversation because I didn't agree.

One of the attendings involved in this conversation was Dr. Blabber, the most notoriously horrible attending that our hospital has every had, so nicknamed for the painfully long and irrelevant conversations she had with every patient, especially on weekend rounds. She was universally thought of as incompetent, slow, and dumb by other attendings, therapists, and nursing staff. She was so awful that even though she was a terrible teacher, the powers that be were afraid to take her resident away because they thought she would kill someone if she were all alone.

So this is what she said:

"I made the decision not to have kids because I didn't think I would be able to have children and also be able to do my job really well."

I thought that was absolutely hilarious. This was what she called doing her job "really well"??? She should have just had the kids.

The best moment was when the resident asked me how having a baby affected my marriage. I was about to answer something along the lines of, in some ways we're closer, but some things are more difficult because we don't get to spend as much time with just the two of us.

But before I could say this, Dr. Blabber broke in, "There IS no marriage. It's just about the baby."

Thanks for your input on my life, Dr. B.

Actually, she's someone who really seemed like she should have had kids. She's got kind of matronly quality, and she loves telling people what to do in a very patronizing tone.

Dr. Orthochick's Guide to Proper OR Etiquette

1. Never finish scrubbing in before your attending

2. When the entirety of the room yells at you for breaking sterility, apologize profusely and go back out and scrub. If someone else breaks sterility, keep your mouth shut

3. If someone elbows you in the face, you are at fault

4. The first rule of draping the patient is to not contaminate yourself. The second rule is to actually section off a sterile field.

5. Preface all requests with 'I'm sorry to bother you but would you mind passing me the ____'

6. When adjusting the lights for your attending move them away from the field first so that when you bring them back, everything looks brighter

7. Actually being able to see what's going on is overrated

Who are you?

As a med student, you meet a lot of new people.

For every rotation, you are obliged to meet at least a hundred new people. There's the attendings, the fellows, the residents, the interns, and the patients. I always found it disconcerting, because it meant I kept running into people who looked very familiar and saying hi, but in actuality having no idea where I knew them from.

For example, on my way to the library one day, I ran into this guy who I was certain I knew, especially after he gave me a big hi. I was searching my brain... he definitely wasn't an intern or a resident... was he some kind of PT? A nurse? Then it hit me: he was the renal fellow, Joe. I felt relieved for remembering.

Then again, as I was leaving, I saw this girl who I was certain I knew. She didn't say hi to me, but she looked so familiar, I was certain she was someone I had met. What's more, I got this distinct feeling that I hadn't liked her when I knew her.

Then it hit me: she was my roommate from one year previously. Damn, what a thing to forgot.

And it was true, I didn't like her.

Weekly Whine: C8

Why is there a C8 nerve?



In the cervical spine, the nerves exiting the spinal cord are named for the inferior vertebrae. For example, C3 exits between C2 and C3.

Then between C7 and T1, there is a C8 nerve.

And subsequently, nerves are named for the superior vertebrae. For example, T2 exits between T2 and T3.

I haven't heard a reasonable explanation for why this is done, besides to confuse medical students.

Sleep Medicine

The most bullshit rotation I ever did in med school was Sleep Medicine. A true budding physiatrist, I selected most of my fourth year electives based on which ones had zero call and the shortest hours.

Maybe other Sleep Medicine rotations are really hardcore, but this one wasn’t. Every new patient evaluation went something like this:

Patient: “I’m having trouble with my sleep…” [describes sleep problems]

Sleep fellow: “OK, let’s schedule you for a sleep study.”

Needless to say, it didn’t take long for me to get the hang of it.

Anyway, I had been on the rotation a couple of weeks, and was seeing a new patient and was about to present the patient to one of the attendings, Dr. Roberts, after having already presented the patient to the Sleep Fellow, Scott. When Scott told Dr. Roberts I would be presenting, she seemed surprised.

“You saw the patient yourself?” she asked.

“Yes,” I said.

She gave me a disapproving look. "Don't you think Scott maybe knows a little more than you and maybe you could learn something from watching him ask questions?"

Because I am a huge wuss, I said, "Yeah, maybe."

But what I was really thinking was that this was the dumbest thing I've ever heard in my entire life. For starters, I think active learning is the best kind of learning. Any med student will tell you that watching interview after interview is boring as hell. This way I got to ask my own questions and Scott could point out to me the things I should have asked. If Dr. Roberts were right, then why do they ever assign patients to med students? Why don’t they just have med students observe for two years straight, then go release them into practice, without having actually done anything themselves? The reason is because you learn best by doing.

This reminds me, of course, of another great quote from an attending I had during residency, who was very overprotective of his patients and often made us just stand in the corner and watch procedures. He once said to me, “I don’t like residents learning on my patients.” That’s great… so what are you doing as an attending in a teaching program?

Vicious cycle

Doctor gives patient prophylactic dose of SQ heparin

--> Patient has serious GI bleed

--> Doctor gets sued

--> Doctor is scared and doesn't give any patients SQ heparin anymore

--> Patient gets pulmonary embolism

--> Doctor gets sued

--> You can't win

(No, this hasn't happened to me. Yes, I've seen it happen to multiple doctors.)

Dr. Orthochick: Condescending

We got a massive polytrauma yesterday (we actually got a couple of massive polytraumas yesterday, it's good to be back) so the trauma surgeon (Dr. Traumafem) paged me down to check out a dude with some skeletal injuries. I walked into Trauma Room C and they were going to move the dude off the backboard so I grabbed his legs since he had some lower extremity injuries.

ER Intern: OK, sweetie. I have a very important job for you! You can hold the legs. But be careful because he might have a broken ankle.

Me: Did you see his xrays? He has an isolated tibiotalar dislocation on the right and a posterior wall--posterior column acetabulum fracture on the left with posterolateral dislocation.

ER Intern: Oh my G-d. I'm so sorry. I didn't realize you were a resident!

Me: Honestly, I don't think you should be so patronizing to anyone.

We had to take a break for a minute so Dr. Traumafem could stop laughing. The ER intern left the room shortly thereafter.

Seriously though, if you wouldn't speak that way to another resident, you probably shouldn't speak that way to another person. Geez. Me being a resident doesn't mean I'm entitled to any more respect (hell, I'm probably entitled to less) and don't call a girl "sweetie" unless you're over the age of 80.

Rectal exams

I always feel really bad when I have to tell a patient they have to have a rectal exam. Especially if they’ve never had one before. I always try to be nice about it, but sometimes the response I get is kind of weird. For example, I got this response from a rectal bleeding guy in the ER:

"I'm sorry," he said when I broke the news.

"No, I'm sorry," I said. "Have you ever had one before?"

"No..."

"Well, I'll try to tell you everything I'm going to do before I do it so you feel more comfortable," I said. "Lucky for you, I have very small fingers."

He replied, "Well, either way, it's better than a fist."

Guh?

Black Friday Deal

The Devil Wears Scrubs in paperback is on sale for only $8.99 (discounted from $10.95). Buy it as a gift for yourself or a friend!

Hamstring

The other day one of my colleagues told me he had a patient who had a really impressive hamstring reflex that helped diagnose a L5 radiculopathy. It was so impressive that he apparently filmed it.

I said that he should write a case study of the first time a hamstring reflex has ever been useful ever.

Thanksgiving poo

This frosting is probably supposed to look like a turkey, but to me it looks more like, well...

Book recs

In lieu of a real post, I'm doing my yearly "give me book recommendations" post. We just did The Silent Wife for my book club, and I was not a huge fan.

If you want to know my taste, this is my reading list.

Dr. Orthochick: Worst morning...

Patient: I love your hair this morning. You're wearing the same earrings as yesterday, aren't you? They're very pretty.

Me: Thank you. I'm going to check your incision now-- [leans over]

Patient: Oh honey! Are you pregnant? [puts hand on my stomach]

Me: Uh, no. I guess I'm just fat.

The annoying thing is, I can't play this off as her being grossly demented if she remembered my earrings. I guess I'm just getting fat, although if we're getting technical about the whole thing, I lost around 10 lbs from this time last year so I guess I must have really been a whale then.

Well, that ruined my morning.

Lobotomy

In residency, we had a patient who has a frontal lobe injury (among other things) and the woman was frequently crying and screaming. She was somewhat controlled on Depakote, but we had to stop it for various reasons. We did a lot of fiddling with her medications with no improvement.

Anyway, my attending had me consult psych to find out what they might suggest for a medication for when she got really agitated.

The psych attending wrote a note on the patient. This was the gist of it: "May want to consider doing a frontal lobotomy. Consult neurosurgery to put her on the schedule."

At first, I thought it was a joke or I read it wrong. I showed it to our psychologist and she couldn't stop laughing. We were giggling about what the response of one of our all-important neurosurgeons would be if we actually consulted them for a frontal lobotomy.

So the next morning, my attending asked me if psych had any suggestions about the patient.

"Oh yes," I said. "They wrote a really helpful note. You should take a look at it."

I found the chart for him and waited for him to read the note. His jaw fell open, "I can't believe he wrote this." He shook his head. "He really ought to talk to neurosurgery before he writes a note like this." He looked at me, "Did you ask him about Geodon as a medication for agitation?"

"No," I said, "but I didn't ask him about frontal lobotomy either."

Weekly Whine: Jars

Why are jars so freaking hard to open? It seems like with the technology we have, this shouldn't still be such a problem.

Last summer, I was trying to open a jar of pickles. I couldn't. I brought it to the local pool and asked the lifeguard to open it. He couldn't. We were passing the jar around to everyone at the pool, and I think we finally got it open.

It's ridiculous. I mean, what do old, weak people do?

Expanded distribution

The Devil Wears Scrubs is now available EVERYWHERE. Including:

Through Barnes and Noble

And in Canada!

Buy a copy today!

Most Useless

Question of the day:

What was the most useless thing you learned in med school?

(Or if you haven't been to med school, just school in general)

My answer:

Kreb's Cycle. What a waste of brain cells.

In general:

All the capitals of Africa.

Dictation errors

Seen in dictated note:

"Bladder ultrasound was done after void in Texas Capital."

Say what?????

Dr. Orthochick: Overreaction

Me: I presented our case of the lady who had the distal femur fracture that we treated with a retrograde nail.

Dr. James: What did everyone say?

Me: There was some debate as to whether we should have ordered a CT of the knee.

Dr. James: What? That’s the dumbest thing I’ve ever heard in my life! Of course we didn’t! Why would we? Who would say such a thing? I’ll tell you what, anyone who would say that, well, that’s a cry for help. It’s someone who shouldn’t be an orthopedic surgeon. I hope you told them that.

Me: Not quite…

Dr. James: Well, you should have. Because that’s f***ing idiotic. That’s the absolute dumbest thing I’ve ever heard in my life.

It must be fun to be married to that guy.

Sleep and residency

I'm currently reading a book called State of Wonder by Ann Patchett and this is a quote from the book:

"She knew how to close her eyes for two minutes. It was a magic trick she had picked up in residency, falling asleep in the corner of the elevator then waking up on the right floor."

Interestingly, I've read this type of things before in books... someone saying as a resident, they trained themself to fall asleep instantly.

Patchett isn't actually a doctor, and I'm going to go out on a limb to say she's got it wrong. Residency has trained me to be a much lighter, worse sleeper. I can't imagine any other outcome to having a pager by your head at night.

Weekly Whine: Show up early

Why do doctors' offices tell you to show up 30 minutes early to fill out paperwork, then the paperwork takes 1 minute and you're sitting there for 29 minutes, getting more and more pissed off? And you have nothing to do but text your husband:

Septic

My husband wants to know what is the difference between a patient being septic and a septic tank. (i.e. why they use the same word) Sadly, I don’t know the answer.

Six Pack

President

Me: "Who is the President of this country?"

Patient: "Osama?"

Me: "Uh, not quite."

Patient: "Bin Laden, right?"

For the hundredth time, our President is not a dead terrorist. Geez.


P.S. If you missed out on buying The Devil Wears Scrubs for 99 cents, it's still discounted now to $1.99 until midnight tonight. It's this weird Kindle Countdown Deal thing.

Dr. Orthochick: Pre-op

Patient A.G. is involved in a motor vehicle accident on December 27, 2011. She requires emergency neurosurgery and is admitted to the hospital. On December 28th, 2011, A.G. begins experiencing knee and ankle pain and orthopedic surgery is subsequently consulted for further evaluation. Dr. Orthochick diagnoses the patient with a left tibial plateau fracture and pilon fracture, both of which will require surgery.

Orthochick asks the trauma attending, Dr. Sicu, when the patient will be cleared for surgery. Dr. Sicu says to wait until the weekend. Orthochick tells her attending, Dr. Germaphobe the news. Dr. Germaphobe says he is going away over the weekend and to call his partner, Dr. Innocuous to do the surgery. Orthochick calls Dr. Innocuous to see if he's available, he's not. Orthochick reports back to Dr. Germaphobe, who says he will do the surgery the following Thursday. Orthochick tells Dr. Sicu.

Dr. Sicu discharges the patient to the rehab part of the hospital.

2 days before the surgery, Orthochick goes over to the rehab part to start getting things in order. The nurse tells her that A.G. has been having more headaches and that the rehab attending, Dr. Physiatry doesn't want her to have surgery. Orthochick speaks to Dr. Physiatry, who says that it's fine with him if it's fine with neurosurgery. Orthochick calls Dr. Brain of neurosurgery, who says it's fine but to not put A.G. on any anticoagulation afterwards. Orthochick realizes that this means that A.G. is at a high risk of developing a blood clot because she won't be able to walk for 6 weeks after the surgery and subsequently consults Dr. Filter of interventional radiology for placement of an IVC filter. While documenting this in the patient's chart, Orthochick sees a note from Dr. Monday of plastic surgery, who was consulted for A.G.'s facial fractures. Orthochick thinks it would be a good idea for A.G. to have both procedures done at the same time and calls Dr. Monday to see when he's available on Thursday. He says he's available after 15:30. Orthochick then calls Dr. Germaphobe's office to see what he has doing on Thursday. She discovers he has Thursday free after 13:00 and schedules A.G.'s surgery for Thursday starting at 13:00 with Dr. Germaphobe and Dr. Monday will scrub in after he's done, which will be around 15:30.

Dr. Physiatry calls Orthochick to let her know that A.G. won't be able to come back to the rehab facility until she's off IV pain meds. Orthochick figures this will be a 2-day stay and gives Discharge Planning a heads-up.

Orthochick explains all this to the patient, who is in agreement.

On Thursday, the day of surgery, Dr. Physiatry discharges A.G. from rehab, and she goes over to the main hospital. She is met by Dr. Filter, who puts an IVC filter in her. She then goes to the pre-op area. She's brought to the OR at 13:00. Dr. Germaphobe finishes around 16:00, Dr. Monday finishes around 17:30. A.G. is brought to her room around 19:00, in stable condition. Orthochick has been in scoliosis clinic all afternoon as scheduled, so Dr. Engineer is the resident in the surgery. Dr. Engineer then goes on vacation, leaving Orthochick to round on his patients, including A.G. A.G. is sent back to rehab on postoperative day 4.

I swear, sometimes it's the surgery that's the easy part.


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2 (Parody of Taylor Swift's 22)

It feels like a perfect night to dress up in mom's clothing
And spill juice on it, uh uh, uh uh.
It feels like a perfect night for breakfast at 5AM
Wake up and make me Cheerios!, uh uh, uh uh.

Yeah,
We're happy, crying, confused, and noisy at the same time
It's exhausting and magical.
Oh, yeah
Tonight's the night we clog the toilet with baby wipes
It's time

Uh oh!
I don't know about you
But I'm feeling 2
Everything will be alright
If you catch me and wipe my poo
You've barely slept all year
But I'll bet you want to
Everything will be alright
If we just keep coloring on the wall like we're
2 ooh-ooh
2 ooh-ooh

It seems like one of those nights,
I want my socks off,
Now I want them on again uh uh uh uh
(Now I want them off again)
It seems like one of those nights,
We ditch the bottle and end up screaming
Instead of sleeping.

Yeah,
We're happy, stinky, hyper, and sleepy in the best way
I'm going to rip my hair out.
Oh, yeah
Tonight's the night when we climb into your bed and kick you in the head all night
It's time

Uh oh! (hey!)
I don't know about you
But I'm feeling 2
Everything will be alright
If you find my little pink shoe
(Where is it???)
You don't know about me
But I'm the one who spilled that glue
Everything will be alright (alright)
If we just keep bouncing on the bed like we're
2 ooh-ooh (oh, oh, oh)
2 ooh-ooh

It feels like one of those nights,
We run around the house naked
It feels like one of those nights,
Then pee on the carpet
It feels like one of those nights,
You look like scissors
I gotta have you,
I gotta use you.

Ooh-ooh
Ooh-ooh, ye-e-e-e-eah, hey
I don't know about you (I don't know about you)
But I'm feeling 2
Everything will be alright
If you bring me back that toy I threw
(again)
I haven't napped all day (haven't napped all day)
But I'll bet you want me to
Everything will be alright
If we just keep watching Elmo like we're
2, ooh-ooh
2, ooh-ooh
2, ooh-ooh, yeah, yeah
2, ooh-ooh, no, no, no, NO!


(I know it's a little cheesy, but my six-year-old daughter couldn't stop laughing at this)

Weekly Whine: Old Comments

Sometimes people find (likely via Google) an old post I made and start yelling at me in the comments. They write some long-winded reply, even though nobody is reading the post or the commments anymore.

If you do that, it's fine, but recognize that it's all masturbation. I'm probably just going to skim the comment if that, but I definitely won't reply. I'll probably publish it, but if the post is two years old, nobody else is going to read it.

Some people have too much time on their hands.

Post-call checklist

For my own amusement, I once saved a list of everything I had to do post-call prior to going home as an intern in the ICU with my census of 7 patients. And here it is:

-Check labs on all 7 patients
-Write morning labs for tomorrow on all 7 patients
-Call case manager about punting patient to a nursing home
-Recalculate pt's insulin regimen
-For a discharge on Monday: call cardiology about follow up, call rheum about follow up, call renal about follow up, call neuro about follow up
-Write discharge note, plus the four consult notes
-Fill out forms for "home health care"
-Beg chief residents to transfer a pt to the wards
-Long list of medications that needed to be ordered or changed, including antibiotics, which require a separate form
-Long list of tests that needed to be ordered
-Consult ENT about getting pt a trach
-F/U several tests on patients, including LE dopplers, echos, CXRs, cultures, more labs
-Call oncology about starting pt on chemo
-Call chemo pharmacy about ordering chemo meds
-Try to find a "chemo nurse" to administer the meds
-Call IR about meta-port clotting off
-Consult GI about anemic pt
-F/U GI recs
-Call hematology about hem pt being discharged
-Renew orders for restraints and antibiotics
-Write pt's discharge
-Write notes on all 7 patients
-Write off-service note on patient being transferred to wards

Pants

This morning, my phone woke me up. The number was my dad's, so I answered it. But there was only shuffling and distant voices. I hung up and called him back. He seemed surprised to hear from me.

"Did your pants call me again?" I asked him.

"Oh yeah. Sorry."

Every once in a while, my dad's pants call me. He hasn't figured out how to lock his phone, so his pants just call people indiscriminately. Sometimes I'll be with my dad, and we'll hear this faint little "hello? hello?" coming from his pants.

Sometimes his pants leave a ten minute message on my voicemail.

Flu vaccine

Have you gotten your flu vaccine yet?

It always astounds me that people can believe there are so many good reasons not to get a flu shot.

(The myths debunked)

Dr. Orthochick: Oxygen

I got paged in the afternoon for a patient who was scheduled to be discharged.

Nurse: We just need a prescription for oxygen for her. Social work said they could get it filled.

Me: Wait, does she normally use oxygen? Who usually prescribes it for her?

Nurse: No she doesn't use home oxygen, but she's been on oxygen ever since she got here. The husband is really anxious to take her home, so do you mind coming in to write for it?

Me: So she's never been on oxygen before and all of a sudden she can't get off it?

Nurse: We tried taking her off and her oxygen saturation dropped into the 70s.

Me: Ummm...I'm not comfortable discharging her like that. If she's never had this problem and all of a sudden ,since surgery, she has this problem, I don't think I can discharge her in good conscience. I mean, that needs to be worked up because it's not normal.

Nurse: Well the husband is yelling at me--

Me: I'll be there in 15 minutes and I'll talk to him.

The husband was a jerk, but I explained that I really didn't want the patient to leave with an oxygen tank since I had no way of regulating that. I mean, then I wouldn't know how much she was using or how often, those things are flammable as hell, and really, I think it's a bad idea to not work that up completely. They both yelled at me, but I said that I was going to ask internal med to look at her and determine why she needed oxygen. If they said everything was great but she needed some oxygen, then fine, I'd gladly write them a script. but if they said something was wrong, we'd have to try and fix it. The husband yelled at me again, but they were both OK with it in the end after I explained that I really didn't want her to go home, have some sort of fall or stroke or something terrible, and have to come back.

About 2 hours later the nurse paged me that the patient was being moved to the ICU because she had suddenly developed chest pain, increased shortness of breath, and crazy high cardiac enzymes.

I seriously started shaking and it took me a little while to calm down. I'm really glad I didn't send her home.

Consults are fun

Chief resident: "Hey, can you see a consult for me?"

Me: "I've got EMGs all day today."

Chief: "I thought you didn't have EMGs on Monday mornings?"

Me: "That's true."

Chief: "So why do you have EMGs this morning?"

Me: "Today is actually Tuesday."

Chief: "Oh, yeah. It is."

Me: "Fine, I think I can do it."

Later:

I finally sat down for lunch and I got a page from the chief: "Hey, you know that consult I gave you this morning? You don't have to see him."

Me: "You mean the consult that I already SAW and already STAFFED??"

Weekly Whine: Hyperlink

This is both a whine and a plea:

If you ask to repost my cartoon and I give you permission with the caveat that you provide a link back to my website, please for the love of god, make it a hyperlink.

If you say the cartoon comes from doccartoon.blogspot.com, that does absolutely nothing to help my traffic. Nobody is going to cut and paste that. I wouldn't do it to you, please don't do it to me.

I'm going on a book tour!

Next week, I'm going on a book tour, courtesy of Juniper Grove.

Luckily, I don't have to actually go anywhere. Good thing, because I'm still exhausted from trick or treating. Seriously, how do people have small children in their forties?

A long month

Found in a chart:



I can see thinking September has 31 days, but I'm really glad someone realized it doesn't have 32 days...

Dr. Orthochick: Bad med student

We had a medical student last month, Brad. He was rotating with us from a nearby DO program, which seems kind of weird because we don't accept DOs into my residency program so I'm not sure what the benefit to rotating at a program you know won't take you is, but I'm also not sure when to recommend a growing rod implant, so there's a lot out there I don't know.

Anyway, Brad was a third year and normally they don't rotate through ortho, so he got special permission from his school to rotate with us so I'm guessing it was because he really wanted to be a pod. Although I don't know if he didn't actually want to be a pod, he decided midway through that he didn't want to be a pod, or if he just knew that he wasn't getting in to our program and therefore didn't want to be a pod here, but he really didn't make much of an effort to be nice. If we were all at OrthoBreakfast, he would sit two seats over and not talk to anyone. I tried starting a conversation with him once walking from Point A to Point B, and he walked ahead of me after a while so that was the end of that.

I didn't really have much contact with Brad because I've been hanging out in Hand Land, but this other resident Paul hated Brad. His big argument was that Brad sucked in the OR and he was lazy in general. The OR thing I'm pretty understanding of, although I think after your first surgery week, you could figure out that if someone's tying knots, you should cut them. Hell, if your scrub nurse is nice, he'll hand you the stupid scissors when it looks like someone's about to start suturing, so this really isn't rocket science. But I'm pretty sympathetic to this sort of thing because I know what it's like to stand around and feel useless.

As for the laziness though, the rule is, if you operate on a patient, you round on him/her. Brad did not get this rule. I personally do not think it's all that hard to figure out, but Brad never did it. Paul told him at least six times that he had to round on his patients, but he never actually did it. And that's actually kind of obnoxious because it shows that you're paying attention and you care enough about your patients to see how they do afterwards. And if you want to do ortho, then you have to know how to manage postop ortho patients. You have to look out for the POD#2 hemoglobin drop in total joint patients, you have to make sure everyone's weightbearing status is being observed, and you have to make sure your incisions look good. This really isn't rocket science, but it takes a while to get used to how things are going to be after surgery and what to look out for. You want to know how much swelling is normal and how much erythema you can have before we worry about infection. And really, if a resident asks you to do something, you freaking do it.

My experience with Brad was limited to Friday night, when I walked into the OR and Brad was walking out.

Me: We're going to be doing a hemi in here, if you want to stick around.

Brad: I'm on vacation now.

Me: Oh. That's nice.

Brad: Yeah, two weeks off.

Me: Enjoy.

He left, the scrub nurse asked me if Brad was going to be back for the next case, I said no, and the circulating nurse said "Thank G-d!"

Like I said, Brad was not known for his operating prowess.

Anyway, as a final act of laziness, Brad never told anyone besides me that it was his last day on the rotation. So for Monday, the chief left Brad's assignment on the bone phone.

Me: You don't have to schedule something for Brad anymore. Friday was his last day.

Chief: Well, it was nice of him to tell me.

Resident: He was one of the worst med students we've ever had. We need to give him a bad evaluation. Something really terrible, but not so bad that he needs to rotate with us again.

Chief: I'll do that.

I guess on the plus side, since we don't take DOs at my program, Brad really didn't blow his chances here in that regard. I hope he decided to do something else though, because if not, this eval is going to look really bad on his application.

Guest Cartoon: Studying definition

Contributed by The Health Scout

The Devil Wears Scrubs: Addressing Comments

I'm overwhelmed by the number of nice comments I've gotten on The Devil Wears Scrubs. But there have been a few persistent negative comments I've gotten on Amazon that I wish to address here:

1) It's too short

That's legitimate. If I had it to do over again, I would have definitely written an epilogue.

2) Alyssa, the evil resident, is too much of a stereotype

Yes, except nearly everything she did was actually done to me by a particular resident. Maybe there's a reason things are stereotypes, because they're real.

3) We never find out why Alyssa doesn't like Jane

Hmm. How many times in your life has someone been a jerk to you, and you found out it was because, like, you reminded them of their great-aunt, who never believed in them. Most of the time when someone doesn't like you, there's no real good reason and you never ever find out why it is. I refuse to come up with some contrived reason that didn't feel real to me.

Weekly Whine: Commenting

Recently, I was trying to comment on a wordpress blog entry and I nearly lost it.

I have a google account, a yahoo account, and a facebook account, but the blog was complaining if I tried to use any of them to comment. And of course, it wouldn't allow me to comment anonymously. I had something to say, but eventually it just wasn't worth the effort.

And don't get me started on "disqus" commenting. I went through signing up for an entire account and it *still* wouldn't let me comment.

I'm done with commenting on blogs. I have nothing important enough to say to make me sign up for an entire account just to say it.

Pretty sure...

"Doc, I keep having this pain here on my left side. Do you think it's my liver?"

"Your liver's on the right."

"Really? I always thought it was on the left."

"No, your liver's on the right."

"Are you sure?"

"Yes."

I love it when patients try to argue with you about stuff like that.

Penny

I was just at Culvers and something super-annoying happened.

The food cost $13.11 and we had a $20 bill, so I tried to dig up some change so as not to get back 89 cents. But sadly, I only had ten cents. We gave the cashier $20.10, asking if she could possibly spot me the penny. They always spot you the penny.

But this cashier instead gave back 99 cents, saying that otherwise the register wouldn't balance. WTF???? What is this world coming to where someone won't spot you a penny?

Transcription error

What was said:

"We then performed renoscopy again."

What was written:

"We then performed with David Bowie again."

Clearly transcription thinks being a doctor is much more glamorous than it really is.

Dr. Orthochick: Knee Pain

We had a consult at 3AM from the ER for a patient who had gotten run over by a car and was now having knee pain. They had done an x-ray at some outside hospital that showed a possible avulsion fracture, but they had repeated the x-ray here and it didn't show said possible avulsion fracture. Oh, and the patient was demented and only spoke Spanish. The worst thing I can think of happening with a possible avulsion fracture is some sort of ligament tear and half the time we don't do anything for that even if it exists so we're really not going to do anything for it after 1AM.

I got down there and the guy was looking pretty good for a 90 year old who got run over by a car, so I'm not sure about the mechanism of injury here. They already had an interpreter and there were a whole pile of family members, so at least I had that going for me.

Me: Where does it hurt?
Interpreter: He says in his knees
Me: Where in the knees?
Interpreter: He says in his knees
Me: In the front? The sides? The back?
Interpreter He says in his knees
Me: Is it a sharp pain? dull? shooting pain?
Interpreter He says the pain is in his knees.

I attempted to do a physical exam, except since half of a knee exam involves doing something and asking if it hurts, it's a little hard to do. That being said, I'm a pretty firm believer that if the patient has to tell you it hurts, it means it doesn't hurt enough to consider it a positive test (it's not too hard to figure out when you're really hurting someone. If you don't believe me, do Yergasson's test on my dad.) so that one at least crosses the language barrier. On physical exam, the only thing I could get was medial pain with valgus stress testing on the right knee, so I decided he probably had a partial MCL tear. I couldn't actually confirm it with an MRI since the guy had a pacemaker in, but I figured we were going to treat it the same way regardless of whether or not it existed, so I told the ER doc to stick the guy in a knee immobilizer until he felt better and just let him weightbear as tolerated.

Me: There's nothing broken in your knees and we don't need to do surgery.
Interpreter: He says his knees are broken
Me: They're not. There's a tear in the ligament. That's what holds the bones together.
Interpreter: He says his knees are broken
Me: I'm sure they're hurting, but the bones are OK
Interpreter: He says his knees are broken
Me: The thing that holds the knee bones together is torn
Interpreter: He says his knees are broken.

Gunner stories

I've been kinda sorta working on a new book about med school. And no book about med school is complete without some awesome gunner stories.

So please comment or email me (fizzziatrist(at)gmail.com) with your awesome gunner stories. As a few people can attest, if I use your story, I'll mention you in the acknowledgements!

Weekly Whine: Inappropriate childcare

About a year ago, I met this woman in my building named Diane who had a daughter Mel's age and another daughter a little younger than my toddler. I'd been itching to be friends with her for this reason, but she hadn't been great about replying to my emails. I emailed her about a playdate one day, and.... no reply. Until three weeks later. I am copying and pasting what she wrote below:

Fizzy, a play date on Saturday would be best, I know my husband will be home watching the Superbowl on Sunday afternoon, so just let me know what a good time for you is and we'll work it out. So I wanted to run something else by you, let me know what you think.

I've decided that I want to stay home with my children and care for 1 or 2 other children in my home. Just yesterday I posted on several websites to offer my services for childcare. I am just letting you know that I am available if it would be something that you and your husband would consider for your 2 girls. I understand that your girls have probably been going to [Trusted Daycare] for some time now, and they are probably comfortable there, however, if it is something that you would consider I would love to care for your kids at my home full time.

I don't know if you remember but I do have my Master degree in Early Childhood Education and I have been a kindergarten teacher for 5 years. I have all of my teaching materials and I would teach my daughter and Mel during the day, as well as put them on the bus to go to afternoon kindergarten. That way she will be able to get familiar with the school and kids that she will be attending school with in the future. My specialty is teaching reading and I can absolutely raise Mel's reading level greatly, no matter what level she is currently reading. I will also teach the girls math, science, and social studies and we can do some great experiments and activities involving the younger ones as well. Because I will be able to easily manage and keep the older girls busy, I could do many educational activities with your baby also. I could help with potty training and anything else that you would need for her.

I have hundreds of books and a ton of educational materials. I think the girls would all be easy and we would have a lot of fun learning. Your kids would get more one-on-one attention, and more individualized attention, with a highly qualified teacher. The best part would be that you could stay in the same building to drop off and pick your children.

Let me know what you think. I just wanted to run it by you first before I take on another child.

I was pretty freaking mad. Here I am wanting to be friends and she is essentially trying to sell me something. I would never ever consider doing this for so many reasons:

1) Why would I take Mel away from all her friends 2/3 of the way through the year and plop her in a class of kids who know each other and don't know her?

2) If she thinks she can teach two kids how to read while simultaneously caring for two infants, that is very unrealistic.

3) When you have a job where you MUST be there every day, relying on a single individual who can get sick, wants to take vacations, etc, is far less than ideal.

4) If you even want me to consider you to watch my kids, you should at the very least be willing to reply to emails.

And here's the best part:

About two months after she sent me this, she moved away forever.

Famous Kidneys in History

Dr. Orthochick: Thorough exam

Me: Dr. Trauma wrote 'pubes OK' on a pt's physical exam. Awesome.

Resident: Really? That's hilarious... did he mean pulses?

Me: I don't know but seeing that was almost worth the crap consult.

Worst surgery story

This is probably the worst story I've ever heard about a medical student on a surgery clerkship:

Many years ago, a female colleague of mine was doing her surgery rotation. She was retracting for a male surgeon, and a few strands of her hair escaped from her cap.

So the surgeon reached out with his surgical scissors and cut off her hair!

I'd like to think that wouldn't happen anymore.

What is your worst surgery clerkship story?

Weekly Whine: Michelle Au

For the record, I have nothing against Michelle Au. I think she's awesome. I love her blog. (Although I don't read it since it's become a Mommy Blog, albeit a really really funny Mommy Blog.)

But I have heard dozens of times in the lifetime of this blog:

"Your cartoons are a rip-off of Michelle Au's, except not as good."

And you know what?

They're right. At least about the last part.

Michelle is a better artist than I am. She puts more effort into her cartoons. She's funnier. She's got more kids. She's probably a better doctor too.

But that doesn't mean I can't be entertaining also.

Admittedly, there is a similar flavor to Michelle's and my cartoons, which stems from the fact that it's clear that we're both big Matt Groening fans. The "12 Types of Whatever" is very Life in Hell and we both make lots of Simpsons references. But I swear, I've been drawing these long before I knew Michelle existed.

That test... you know....

What do you call the lab test that includes Na, K, Cl, CO2, BUN, Cr, and Glu (+/- Calcium)?

I've been noticing that what you call that test seems to vary between a lot of different names based on hospital and part of the country. Sort of like soda vs. pop vs. coke.

I made a mistake

Sales of The Devil Wears Scrubs have dropped since I increased the price. Since my goal has been to sell enough copies that my husband has to read it, clearly I made a mistake that I've now rectified.

Buy it now for only $2.99!

Dr. Orthochick: Code M, Part 2

Me: Do you work right now?
Patient: I like to masturbate.

Seriously, what is it with guys and playing with themselves?

The guy was in his thirties and drunk as a skunk. He also had just gotten sliced across the arm with a steak knife, c/o some unknown assailant who accosted him while he was innocently sitting at home. So that wound up having to go to the OR since his tendons were flapping around. I'm not sure my consent was actually legal since his blood alcohol level was approximately 25 times the legal limit, but hey, he was talking to me and he voiced understanding of the procedure, as we say in the biz. Dr. Ortho called me to tell me we were next in line for the OR, I got everything set up downstairs, which involved suturing up the guy's other hand and listening to him complain about his roommate and his ex-wife.

Me:
12:25AM, text message
Not sure if they told you, [other] case is over. Your case will prob start around 1. Our guy informed me he likes to masturbate. Just fyi

Dr. Ortho:
12:49AM, text message
Hope he's ambidextrous...

Dr. Ortho did compliment my very thorough history when he saw me in preop.

Get a free Kindle copy of The Devil Wears Scrubs

If you have a popular blog, Facebook site, or Twitter account (or something like that), I can gift you a free Kindle copy of The Devil Wears Scrubs in exchange for a positive mention/review on your site.

I understand not everyone has time to read and write a review, so even a mention with a link to the Amazon site would be great!

If you're interested, please send me at email.

(And remember, if you have Amazon Prime, you can still borrow it for free.)

Apple recipes

I have a lot of apples now. This is my most amazing apple pie recipe, the best apple pie I ever tasted:

* 1 recipe pastry for a 9 inch double crust pie
* 1/2 cup unsalted butter
* 3 tablespoons all-purpose flour
* 1/4 cup water
* 1/2 cup white sugar
* 1/2 cup packed brown sugar
* 8 Granny Smith apples - peeled, cored and sliced

Directions

1. Preheat oven to 425 degrees F (220 degrees C). Melt the butter in a saucepan. Stir in flour to form a paste. Add water, white sugar and brown sugar, and bring to a boil. Reduce temperature and let simmer.
2. Place the bottom crust in your pan. Fill with apples, mounded slightly. Cover with a lattice work of crust. Gently pour the sugar and butter liquid over the crust. Pour slowly so that it does not run off.
3. Bake 15 minutes in the preheated oven. Reduce the temperature to 350 degrees F (175 degrees C). Continue baking for 35 to 45 minutes, until apples are soft.


Any delicious and easy recipes involving apples?

Confused?

Me: "Who is the President of the country?"

Patient: "Obamacare."

Weekly Whine: Bitch

I find it really shocking and upsetting that the word "bitch" does not get censored on general TV.

My daughter really enjoys cooking shows. She's really into cooking and making taste tests and we're totally watching Masterchef Junior this year. But I'm always on the edge of my seat because people on Masterchef or other adult cooking shows will come out using the word bitch, which is a word she otherwise would never hear in our house. (We never ever swear.)

I mean, I just want to watch a COOKING COMPETITION. It's not like it's freaking, I don't know, South Park.

Working with residents

I have to be honest, as an attending, I don't love working with residents. I'm certain that it's a failing on my part, but I feel like a large percentage of the residents I've worked with have been kind of.... well, maybe not lazy exactly. But definitely a little reluctant to do work.

Me: "I need you to help me present this trauma patient during the team conference this week on Friday. Your consult note on the patient didn't have that much information, so it would really help if you were there."

Resident: "Well, nobody gave me any instructions at all when I started this rotation!" (it was actually the third time she'd done the rotation and she was a senior resident)

Me: "Um, well, my fault then. Still, I need your help."

Resident: "I won't be here Friday. It's my bridal shower."

Me: "Oh, how nice. Um, well, how about Tuesday we can call a short meeting to discuss the patient?"

Resident: "That's our lecture day."

Me: "But your lectures are only in the morning, right?"

Resident: "Well, until 2."

Me: "And what do you have after that?"

Resident: "Nothing."

Me: "So how about we discuss the patient after your lectures are over?"

Resident: [stares at me in horror]

Obamacare: Love it or hate it?

In the last several years, a lot of people have huffily told me that they were never going to read my blog again. I guess they meant it as a diss, but frankly, I see it as a blessing. Honestly, I think the people who read this blog are a great group of people. Most of the comments I get are intelligent, thoughtful, respectful, and/or humorous. So I thank you readers for being awesome.

In light of the recent disastrous government shutdown, I'm dying to ask my readers:

What do you think of Obamacare? Love it or hate it?

I presume that you will give me intelligent answers and not just say you're afraid of being raped by a scary puppet.

Personally, I am in favor of it. I believe people using the ER for their medical needs is costing the taxpayers a bundle... unless we are heartless people who will turn away uninsured patients whose lives are in danger, it doesn't make sense to allow people to be uninsured. And there are other countries and even states within this country (e.g. Romneycare) who use a similar system and have good healthcare. Definitely no puppet rape.

Now your turn.

Be nice.

Dr. Orthochick: Dilemma

Dr. Hospitalist admits a patient to the hospital with left hip pain. She consults Dr. Dream of orthopedic surgery and Dr. Dream's resident, Dr. Orthochick, diagnoses the patient with a left hip infection. Dr. Dream and Dr. PD operate on the patient the following day. They discover a large amount of pus in the hip and Dr. Antimicrobial of Infectious Diseases is consulted. Dr. Antimicrobial recommends doing a repeat irrigation & debridement of the patient's hip. She wants more cultures to be taken at that time, so she writes orders for the cultures she wants and includes it in her note. She asks the floor nurse to make sure this is done.

The floor nurse calls the ortho resident on call, Dr. Orthochick, to tell her this. Dr. Orthochick says she will tell Dr. Dream and the resident in the case.

Dr. Orthochick tells Dr. PD because he's the one following the patient. Dr. PD writes this in his note as well but he does not tell Dr. Dream.

Dr. Orthochick tells Dr. Schnoz, the resident assigned to the case. She figures that since Dr. Schnoz knows, she doesn't need to tell Dr. Dream.

Dr. Schnoz is late to the case and, as a result, he forgets to tell Dr. Dream.

Dr. Dream did not read the last note written in the chart and, as a result, he does not think he needs cultures.

The circulating nurse in the case did not notice the orders and, as a result, she does not realize that several cultures have been ordered.

Cultures are not obtained during the surgery.

So...who should Dr. Antimicrobial be the most mad at?
A. Dr. Orthochick for not telling the attending
B. PD for not telling the attending
C. Dr. Schnoz for forgetting
D. Dr. Dream for not reading the note
E. The circulating nurse for not reading the orders
F. Herself for not contacting the attending directly and for actually trusting all of us losers
G. The long-suffering ortho resident on call who gets stuck trying to explain all this, who is overworked, underpaid, and already feels kind of bad about the whole thing and really doesn't need a lecture because she is well aware that she messed this one up
H. A and G, who may or may not be the same person.

Guest Cartoon: Premed vs. Med School

Contributed by The Health Scout

Weekly Whine: Thank you cards

Being the social butterfly that I am, I go to a lot of parties. Most of which involve buying a present for a small child.

And after, I can always guarantee that I'll get a thank you card, written by "the child" which says:

"Thank you so much for [insert toy name]! I really like playing with it."

It's a nice thought, but I think we can skip the cards. It's a waste of paper and energy. I mean, do I really care if I get a stupid form-letter thank you card? And the whole thing means that I have to keep stacks of blank thank you cards in my bookcase, for fear of offending someone.

And don't get me started on those fancy bags every present has to come with these days.


P.S. Don't forget that if you have an Amazon Prime account, you can borrow The Devil Wears Scrubs free on the Kindle! Not sure how long this promotion will last though.

Guest Cartoon: The truth about doctors

Submitted by Caz

What I won't wear

I was just shopping at a department store and I'm beginning to think my taste veers significantly from the average female. Here's a list of things I will NOT wear:

--Sequins

--Anything that sparkles

--Any colors that do not appear in nature

--Ruffles

--Anything with faux-diamonds or gems glued on

--Floral patterns

But according to what was being sold in that store, this is apparently ALL other women wear.

Dr. Orthochick: Screw

The other day when I was scheduled to take a screw out of a guy I went in to see him before the surgery to make sure the paperwork was filled out and everything.

Patient: Can I have the screw after you take it out?

Me: Uh, sure

Patient: So I can keep it? And take it home?

Me: Yeah, OK...what are you going to do with it?

Patient's wife: We're going to put it on the mantel next to Pa!

I'm guessing they mean Pa's ashes are on the mantel and not Pa himself sitting on the mantel, but I feel like if my soul was hanging out in someone's living room for all eternity, I wouldn't be all that comforted by a syndesmotic screw next to me.

Things I loved as a kid that no longer exist

1. Jello pudding pops

2. Dark meat Chicken McNuggets

3. Pop rocks

4. Twinkies (not really)

Compliments

My latest thing is paying people lots of compliments. To colleagues and to patients.

I think it feels nice to get a compliment, so I'm been making an effort to pay it forward, so to speak. And for the most part, they are genuine compliments. Like if I like someone's shirt, I say, "Hey, I really like your shirt."

On the other hand, if someone gets a haircut, I almost always say, "I love your hair." Whether or not I actually love it. Is that wrong?


Speaking of being nice and paying compliments, today seems like a good day to review The Devil Wears Scrubs...

Weekly Whine: Literally

I was having a conversation with someone at work yesterday and they were literally using the word "literally" in every sentence. I feel like "literally" is a word that is really, really overused.

They were using it properly. They weren't saying things like, "I was literally going out of my mind." But it was still too much.

I mean, you don't need to say, "It literally took me five tries to get the line going." You could just say it took you five tries. Everyone is going to assume that you mean it literally.

Guest Cartoon: Profile of a phlebotomist

Contributed by www.thenurseslockerroom.com

The worst way to dictate

I recently saw a resident named Jimmy dictate in the worst possible way I've ever seen anyone dictate in my whole life.

Before dictating his note, Jimmy types up the HPI so that he can read it for his dictation. So for every single patient, he types the history, then dictates the entire note. Have you ever heard of something like that? You should have seen my face when he told me.

Me: "No way. You don't really do that."

Jimmy: "Yeah, I do."

Me: "No way."

Jimmy: "It's just easier for me."

Me: "Oh my god."

Jimmy: "Yeah."

Me: "You have to stop doing that!"

Tattletale

The first time I ever saw a renal biopsy, I nearly fainted.

I was sort of squeamish when I started med school and this was my very first rotation. What can I say? It was a really big needle.

I really tried to be strong. The first time I started to feel that queasiness, I ran from the room, collected myself, then came back. Then it happened again. And I left and came back. And one more time after that.

Not my finest moment.

Anyway, a few weeks later, I was talking to a fellow med student who had watched a renal biopsy that day. The renal fellow apparently said to her, "Well, you did better than Fizzy."

The bastard TOLD her about me and my embarrassing near-fainting!

I thought that was really wrong. But maybe I'm just oversensitive.

Dr. Orthochick: Ankle Injury

Me: So how did you hurt your ankle?
Patient: I was making sweet love to my woman.
Me: ...
Patient: If I had known it was going to hurt so much, I wouldn't have had all that sex. I like pain, but this was just a little too much.

If you can think of something to say in response to that, you're doing better than me. I just sort of nodded and wondered how a 40 year old guy could say that with his mother right there in the room. And his woman, whoever she was. She didn't appear embarrassed, although she did show me her new tattoo and the patient said I could get a discount on tattoos at his friend's place if I mentioned his name.

Me: He said I could get a tattoo for $70.
Dr. Innocuous: Is that a good price?
Me: I have no idea
Dr. Innocuous: I think it might actually be pretty cheap.

I seriously have no clue how much a tattoo would cost. And I didn't bother to write down the name of the store so now I missed my opportunity to get a cheap one.

The 11 Types of Physicians

Dedicated to Dr. Grumpy. Thinking of you.

Review my book day!

If you bought a copy of The Devil Wears Scrubs and have read and enjoyed it, please take a minute to review it today on Amazon!

Weekly Whine: Lazy Liars

Scenario:

I suggested a playdate next Wednesday morning with a mom from my mom's group and she emailed me a couple of days ago to tell me she's busy that day.

Then about 24 hours later, someone in the mom's group suggested a playdate at a farm on Wednesday morning and she immediately emailed "Count me in!"

Fine, she lied to me. She doesn't want to have a playdate. But couldn't she at least have sent a private reply to spare my feelings?

Also, I recently asked an online acquaintance for advice on a topic. She said she had no advice. Five minutes of browsing later, I discovered she'd written a "book" on the topic on Amazon.

So the question is, was she lying to me or to all the people who purchase the book?

Guest Cartoon: Before and after

Contributed by The Health Scout

Dang college

After ignoring the whole "how are we going to pay for college" problem for years, we recently started ufund accounts for our kids.

It's safe to say we have no idea what we're doing. We're trying to add $10K each per year, which is an amount I totally just made up. And probably won't be enough, since I expect college will cost one million dollars per year by the time they're ready to attend.

How are you saving for college?

When did you decide to apply to med school?

I know for a lot of people, this decision is a process that occurs over years. For me, I guess it was.

But probably the real moment it crystallized was when I took the MCATs and got a decent score and realized at that moment there was nothing else I really wanted to do. I applied to med school because I could and no other exciting options presented itself.

I hope somebody has a better story than that...

Dr. Orthochick: Code M

I admitted a guy the other day with a hip fracture who had a really serious traumatic brain injury. He could talk, but we weren't really talking to each other and I don't think he really understood much of what I was asking him.

Anyway, the following morning I went in to see him before surgery and he was lying in bed masturbating. He had a Foley in but somehow he still managed to have an erection and was really going at it. He didn't even stop when I walked in, although he did glance at me.

Me: [turns red] Uh, I can come back
Patient: Hi!
Me: How's your, uh, hip?
Patient: It hurts
Me: Uh, that's why we're going to fix it.

I scurried out of the room like a dung beetle. I mean, I get that it's not the guy's fault that he didn't realize that it's a little inappropriate to lie in your hospital bed masturbating in front of the resident, but that didn't mean it didn't make me a tad uncomfortable. Also, if you masturbate with a Foley in, where does the semen go to, exactly? I mean, the tube's in the bladder, not the seminal vesicles, so I can't imagine sperm are going to start swimming out the Foley and into the leg bag, but do they get clogged? Do I have to worry that he has that thing that guys with vasectomies get where they have a clot of semen that hardens and then you form an inflammatory response to it? (pretty sure I read about that somewhere, presumably in the anti-vasectomy literature) I don't want to start having to fish crap out of his urethra here.

Also, you'd think whacking off with a tube coming out of your schlong would be really uncomfortable. Maybe it's just because I've never had to have anything snaked up myself, but I can think of few things in life that are less sexy. I'm not usually feeling it with the airplane bathroom since there's not enough room for one person and you're constantly at risk of getting sucked into the toilet, but given the choice, I'd go for airplane bathroom over Foley catheter. Hell, I think I'd go for port-a-potty nookie over Foley nookie.

Help/Opportunity

Thank you to everyone who has bought a copy of The Devil Wears Scrubs! Have I mentioned how much you guys rock?

If you enjoyed the book, please consider leaving a review on Amazon and/or let people know via Facebook/Twitter. If you didn't enjoy it, you can just keep that to yourself....

Also, I want to present an opportunity:

I am trying to get more reviews of the book out there. For those of you with a blog or site that you are looking to promote, if you will put up an honest** review of my book with a link to buy it, I will give you a mention at the end of one of my posts or on my Facebook page (your choice). I think this is a really good opportunity for anyone looking for free promotion.

In other words:

Please review my book!

---

Also, I want to mention that the book was proofed by my good friend Jenica. If you write your own book, you really must have someone look it over, and Jenica was both professional and fast. I highly recommend her services.


**I don't want you to lie and say you loved the book if you hated it. Be honest. That said, if you say on your website that it sucks ass, I reserve the right not to link to you.

Things I hated as a kid and still hate

1. Learning history

2. Seaweed (to eat)

3. Raw tomato

4. Running

5. Cole slaw

Weekly Whine: Middle Finger

There are certain people who always gesture at things with their middle finger.

I know there was a whole Seinfeld about that, but I genuinely don't think it's purposeful. I've seen people who will be having a formal meeting and point at a document with their middle finger. And it makes me uncomfortable, to be honest.

What's up with that?

Organs I wouldn't mind losing

In discussion of the Whipple procedure, my husband and I got to talking about organs you wouldn't mind losing. This is the order in which I wouldn't mind losing the following internal organs, where #1 is the organ I'd most like to keep (fairly obvious from the list).

16. tonsils
15. appendix
14. gallbladder
13. spleen
12. one kidney
11. large bowel
10. small bowel
9. bladder
8. one lung
7. pancreas
6. both kidneys
5. stomach
4. liver
3. both lungs
2. heart
1. brain

Yes, I'm aware I can't live without some of the higher ranking organs. That's why I ranked them so high... duh.

The Devil Wears Scrubs

I did it! I wrote that book about my intern year!

It's fiction. But it kind of isn't. You know? In any case, if you enjoy reading this blog, I feel certain you'll really enjoy reading it. Here's the blurb:

Newly minted doctor Jane McGill is in hell.

Not literally, of course. But between her drug addict patients, sleepless nights on call, and battling wits with the sadistic yet charming Sexy Surgeon, Jane can’t imagine an afterlife much worse than her first month of medical internship at County Hospital.

And then there’s the devil herself: Jane’s senior resident Dr. Alyssa Morgan. When Alyssa becomes absolutely hell-bent on making her new interns pay tenfold for the deadly sin of incompetence, Jane starts to worry that she may not make it through the year with her soul or her sanity still intact.

Please buy it!

It's available for the Kindle. For now, I've kept it at the low, low price of only $2.99, although that is subject to increase in the future.

Also, you can get it in paperback!

It's short, it's fun, it's deliciously evil, and if you buy it, you'll make me really happy. What other incentive do you need?? :P

If you're not sure, you can read an excerpt.

Dr. Orthochick: Back to normal

Seen in a clinic dictation:

The patient is doing very well. In fact, his mother reports he kicked the dog very hard yesterday without injuring himself.

No word on whether the dog is doing OK.

Unisex

A friend of mine wants to name her unborn son Madison. She insists this is a unisex name and she likes it for a boy. I think naming a boy a name that is unisex but more common in women (Dana, Leslie, etc.) is just asking to be teased constantly during childhood. I know dozens of Madisons and they are all little girls.

What do you think?

Forgetful

Last night, I needed olive oil to cook dinner and I was exhausted, so my husband volunteered to go to the supermarket and get it. While he was there, he figured we should get a few other things too, like bread and cereal. I'm usually a little hesitant to send him to do our shopping because I’m a little anal about my shopping, but I was really really tired and I needed olive oil.

He came back half an hour later with two bags of groceries. The first thing I said was, "OK, where's the olive oil?"

He pulled out this minuscule little container of oil that contained maybe five drops of oil.

"Why didn't you get more?" I asked him.

"Because I got a different brand than usual and I wasn't sure if you'd like it," he explained.

"Well, why didn't you get my usual brand?"

"Because...." He hesitated. "I actually forgot to get the olive oil at the grocery store.... so I had to stop at a drug store on the way back to get it."

"But the only reason you went to the grocery store was to get the olive oil!"

"I know, it's ironic." He hung his head. "You were right, you never should have trusted me to get groceries."

But it's all okay, because I didn't need that much olive oil and I need to go to the grocery store to get meat soon anyway.

Weekly Whine: Updates

Why is everything on my computer and phone constantly needing to update?

Every time I open practically any application, it harasses me to install updates (I'm looking at you, iTunes). You know what I want to do when I open an application? I want to USE it. I don't want to wait five minutes to install updates.

The worst is when I'm at work and I try to open, say, epocrates to look up a drug, and it won't let me use it till I install the updates. So I have to sit there, waiting for the updates to install on the slow as ass connection, before I can figure out the correct dose for freaking Detrol.