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Thursday, January 31, 2013
Wednesday, January 30, 2013
Tuesday, January 29, 2013
Passive-aggressive
I've noticed that sometimes in the comments on this blog, people have called me "passive-aggressive" a few times. It's not that I'm never passive-aggressive, because sometimes I am, but I can't say that one time I've been called that, it's been appropriate. So maybe people don't know what it means?
According to Wikipedia, "passive-aggressive behavior is a category of interpersonal interactions characterised by an obstructionist or hostile manner that indicates aggression, or, in more general terms, expressing aggression in non-assertive, subtle (that is, passive or indirect) ways." Say wha? That definition is a little confusing, but it's a term my father used to use a lot (correctly), so I know it when I see it.
For example, say 13 year old Fizzy was told to take out the trash by her dad. 13 year old Fizzy doesn't like taking out the trash. So she puts it off as long as she possibly can, has to be told three times, each time replying, "All right! I'll do it!" Then when she finally does it, she allows some excess garbage to spill on the floor of the kitchen. And then when she's dramatically dragging the garbage out to the bin, her father says, "Fizzy, quit being so passive-aggressive."
Other examples include conveniently "forgetting" things I didn't want to do, sulking excessively, and making excuses for things I didn't want to do.
Things that are not passive-aggressive:
My post about "DO discrimination." I was trying to explain about why people discriminate against DO's and I was accused of being passive-aggressive. Because....? I'm not a DO, I like DO's, I was just trying to make an informative post. How in any way, shape or form was that passive-aggressive?
In a recent post about internship, I talked about how I didn't like when I was asked to come in on my day off for orientation, and I was accused of being passive-aggressive. So any time you are upset about something, you are passive-aggressive? In order to be passive-aggressive, I'd have to come in and do my job shittily and act like a bitch to everyone there.
I think people need to learn what that term means, seriously. Because I'm getting sick of explaining it.
According to Wikipedia, "passive-aggressive behavior is a category of interpersonal interactions characterised by an obstructionist or hostile manner that indicates aggression, or, in more general terms, expressing aggression in non-assertive, subtle (that is, passive or indirect) ways." Say wha? That definition is a little confusing, but it's a term my father used to use a lot (correctly), so I know it when I see it.
For example, say 13 year old Fizzy was told to take out the trash by her dad. 13 year old Fizzy doesn't like taking out the trash. So she puts it off as long as she possibly can, has to be told three times, each time replying, "All right! I'll do it!" Then when she finally does it, she allows some excess garbage to spill on the floor of the kitchen. And then when she's dramatically dragging the garbage out to the bin, her father says, "Fizzy, quit being so passive-aggressive."
Other examples include conveniently "forgetting" things I didn't want to do, sulking excessively, and making excuses for things I didn't want to do.
Things that are not passive-aggressive:
My post about "DO discrimination." I was trying to explain about why people discriminate against DO's and I was accused of being passive-aggressive. Because....? I'm not a DO, I like DO's, I was just trying to make an informative post. How in any way, shape or form was that passive-aggressive?
In a recent post about internship, I talked about how I didn't like when I was asked to come in on my day off for orientation, and I was accused of being passive-aggressive. So any time you are upset about something, you are passive-aggressive? In order to be passive-aggressive, I'd have to come in and do my job shittily and act like a bitch to everyone there.
I think people need to learn what that term means, seriously. Because I'm getting sick of explaining it.
Monday, January 28, 2013
Sunday, January 27, 2013
PRN
As I mentioned in a recent post, during my residency, we took call from home. That meant that nurses could call us with issues about cross cover patients all night long, and we still had to work all day the next day.
Early in the year, several of us residents noticed that practically every night around 11 or 12, we were getting called about several of an attending named Dr. Brown's patients. It was always the same thing: "Can we give Mrs. Smith something for sleep?" And we'd give a verbal order for Ambien then go back to sleep ourselves.
(The ultimate insult is getting woken up from sleep to be told that a patient can't sleep. And then you can't get back to sleep. And you can't take anything because you're on freaking call.)
Since all the admission orders had a check-box to give Ambien for sleep, we finally cornered Dr. Brown's resident and asked him why he wasn't checking off that box. He said that Dr. Brown wouldn't let him, because she wanted to know if the patient had trouble sleeping and asked for a sleep medication.
Because there's absolutely no way to tell if a patient got a PRN order overnight unless you make the person on call give a verbal order for it.
Eventually, we bullied the resident into telling Dr. Brown that he was going to be checking off that box from now on.
Early in the year, several of us residents noticed that practically every night around 11 or 12, we were getting called about several of an attending named Dr. Brown's patients. It was always the same thing: "Can we give Mrs. Smith something for sleep?" And we'd give a verbal order for Ambien then go back to sleep ourselves.
(The ultimate insult is getting woken up from sleep to be told that a patient can't sleep. And then you can't get back to sleep. And you can't take anything because you're on freaking call.)
Since all the admission orders had a check-box to give Ambien for sleep, we finally cornered Dr. Brown's resident and asked him why he wasn't checking off that box. He said that Dr. Brown wouldn't let him, because she wanted to know if the patient had trouble sleeping and asked for a sleep medication.
Because there's absolutely no way to tell if a patient got a PRN order overnight unless you make the person on call give a verbal order for it.
Eventually, we bullied the resident into telling Dr. Brown that he was going to be checking off that box from now on.
Saturday, January 26, 2013
Weekly Whine: Flirt
My husband probably won't appreciate this whine, but maybe you can help me settle this once and for all.
He used to have this single female friend from college named Patty who was a few years younger than him. A few years ago, we moved to an area where Patty lived, and he suggested that we all get together.
In the past, he'd suggested that I was jealous when he IMed with Patty. I guess I was a little jealous, but not really. We were mostly just joking around about it. I was entirely on board with having lunch with Patty and getting to know her.
So we arranged for Patty to come over for lunch. She brought a nice present for our daughter, which was nice of her. But the niceness of this gesture was diminished by the fact that when she walked into the living room, she said, "Wow, this place is really messy."
I think I had cleaned the night before, but as we all know, a two year old can create a huge mess in a matter of minutes. So I was caught at a bad moment. In retrospect, in the five minutes before she arrived, I should have quickly swept everything away. But I didn't, mostly because we were going straight out to eat, so I didn't think it mattered.
And she actually managed to comment on it a second time. She said, "It's just really messy. I didn't expect it to be so messy."
Fine though. She was right, to some extent. Although this was the very first time a non family member had criticized my apartment for being messy. Either I managed to clean better in the past, or else the others had a modicum of manners.
Anyway, we went out to lunch. It was going all right, I guess.
Then about midway through the meal, my husband said something to Patty that was somewhat teasing. She giggled, smacked him in the arm, and said, "He's so bad!"
I felt really awkward and definitely pissed off. This was pretty blatant flirting, done right in front of his wife, who she just met. I had been totally open to liking Patty, but I felt like her behavior made me really uncomfortable and I didn't want to see her again.
When I brought it up to my husband later, he admitted he thought it was a little weird, but she's like that with everyone so there's nothing he could do.
What do you think? Was I right to not want to see her again?
He used to have this single female friend from college named Patty who was a few years younger than him. A few years ago, we moved to an area where Patty lived, and he suggested that we all get together.
In the past, he'd suggested that I was jealous when he IMed with Patty. I guess I was a little jealous, but not really. We were mostly just joking around about it. I was entirely on board with having lunch with Patty and getting to know her.
So we arranged for Patty to come over for lunch. She brought a nice present for our daughter, which was nice of her. But the niceness of this gesture was diminished by the fact that when she walked into the living room, she said, "Wow, this place is really messy."
I think I had cleaned the night before, but as we all know, a two year old can create a huge mess in a matter of minutes. So I was caught at a bad moment. In retrospect, in the five minutes before she arrived, I should have quickly swept everything away. But I didn't, mostly because we were going straight out to eat, so I didn't think it mattered.
And she actually managed to comment on it a second time. She said, "It's just really messy. I didn't expect it to be so messy."
Fine though. She was right, to some extent. Although this was the very first time a non family member had criticized my apartment for being messy. Either I managed to clean better in the past, or else the others had a modicum of manners.
Anyway, we went out to lunch. It was going all right, I guess.
Then about midway through the meal, my husband said something to Patty that was somewhat teasing. She giggled, smacked him in the arm, and said, "He's so bad!"
I felt really awkward and definitely pissed off. This was pretty blatant flirting, done right in front of his wife, who she just met. I had been totally open to liking Patty, but I felt like her behavior made me really uncomfortable and I didn't want to see her again.
When I brought it up to my husband later, he admitted he thought it was a little weird, but she's like that with everyone so there's nothing he could do.
What do you think? Was I right to not want to see her again?
Friday, January 25, 2013
Cell phones
I can't complain enough about people answering their phones during clinic visits. I swear to god, the next patient whose cell phone rings while I'm talking to them, I'm going to take it and throw it out the window. (If the exam rooms had windows, which they don't. Maybe I'll just run water over it in the sink.)
It’s kind of out of control. During any given clinic, about 75% of the time, the patient's cell phone starts ringing while I'm talking to them. At least a third of the time, it starts ringing more than once.
First, who the hell is calling these people at 10:30 in the morning? Second, if your doctor is talking to you, do you think you could stand to not answer your phone and just call the person back later? Believe it or not, people can turn off their cell phones for brief periods and be *gasp* unreachable for a short time, like back in the olden days before cell phones (back when lions had riches). I mean, you turn your cell phone off in the movie theater or at least put it on vibrate, right? Is it too much to ask to give your doctor as much courtesy as you would "Scary Movie 8"?
Last week I was interviewing a patient and his phone started ringing. He looked at me and said, "Should I not get that?"
I said, "I'd appreciate it if you didn't." Did he think I was just going to sit there while he chatted with his friend? I was so angry. I had two other patients waiting and I was tempted to just leave him in the room for another forty minutes with his cell phone while I saw them both first.
It’s kind of out of control. During any given clinic, about 75% of the time, the patient's cell phone starts ringing while I'm talking to them. At least a third of the time, it starts ringing more than once.
First, who the hell is calling these people at 10:30 in the morning? Second, if your doctor is talking to you, do you think you could stand to not answer your phone and just call the person back later? Believe it or not, people can turn off their cell phones for brief periods and be *gasp* unreachable for a short time, like back in the olden days before cell phones (back when lions had riches). I mean, you turn your cell phone off in the movie theater or at least put it on vibrate, right? Is it too much to ask to give your doctor as much courtesy as you would "Scary Movie 8"?
Last week I was interviewing a patient and his phone started ringing. He looked at me and said, "Should I not get that?"
I said, "I'd appreciate it if you didn't." Did he think I was just going to sit there while he chatted with his friend? I was so angry. I had two other patients waiting and I was tempted to just leave him in the room for another forty minutes with his cell phone while I saw them both first.
Thursday, January 24, 2013
Snarky
As an intern, I was supposed to start my emergency medicine rotation on a Sunday. The schedule listed me as starting at 1PM, so I thought it would okay to make plans for the night before. Specifically, I bought tickets to a Green Day concert for Saturday night.
So you can imagine I wasn't thrilled when I got an email from the rotation director, saying that we were having an orientation Sunday morning at 7:30AM.
That totally sucked for me. But it sucks even worse for the two people who had Sunday as one of their days off. In fact, only one person was actually supposed to be working on Sunday morning, even though we all had to show up at 7:30AM. On a freaking Sunday.
I emailed the director and asked him how long the orientation was going to last because I made plans (to sleep). He replied:
My plan is to done by 900-930h, but we can do the computer training (without many questions) first which takes under an hour, tour the ED, and then do the practice on the computers part last. My experience in the past is that the people who are not beginning an AM shift spend a lot of time practicing on the computers rather than starting their shifts, and those with the day off leave quickly (strange how that works!)
My first thought was, "FUCK YOU!" He's making people come in on their day off and he has the nerve to make a sarcastic quip about how those people want to leave early? Days off are very rare in intern year. I assume this guy did a residency and went through the same shit we have to, but maybe he'd just forgotten. Or maybe he was just insensitive.
Anyway, it turned out that having me come in at 7:30AM then start my shift that afternoon and work all night violated some sort of ACGME rule, so he ended up switching me to the day shift on Sunday. I spent a very long time practicing on the computers.
So you can imagine I wasn't thrilled when I got an email from the rotation director, saying that we were having an orientation Sunday morning at 7:30AM.
That totally sucked for me. But it sucks even worse for the two people who had Sunday as one of their days off. In fact, only one person was actually supposed to be working on Sunday morning, even though we all had to show up at 7:30AM. On a freaking Sunday.
I emailed the director and asked him how long the orientation was going to last because I made plans (to sleep). He replied:
My plan is to done by 900-930h, but we can do the computer training (without many questions) first which takes under an hour, tour the ED, and then do the practice on the computers part last. My experience in the past is that the people who are not beginning an AM shift spend a lot of time practicing on the computers rather than starting their shifts, and those with the day off leave quickly (strange how that works!)
My first thought was, "FUCK YOU!" He's making people come in on their day off and he has the nerve to make a sarcastic quip about how those people want to leave early? Days off are very rare in intern year. I assume this guy did a residency and went through the same shit we have to, but maybe he'd just forgotten. Or maybe he was just insensitive.
Anyway, it turned out that having me come in at 7:30AM then start my shift that afternoon and work all night violated some sort of ACGME rule, so he ended up switching me to the day shift on Sunday. I spent a very long time practicing on the computers.
Wednesday, January 23, 2013
Type A vs. Type B
A lot of doctors call themselves Type A personalities. We're high achievers, hard workers, competitive--basically, the definition of Type A.
I totally seemed like a Type A growing up. I always had to get the highest mark on exams even in stupid classes like history, I was a valedictorian, I finished projects like a week in advance and always went above and beyond what I was supposed to do.
Then, I don't know how, something changed when I went to college. I stopped caring so much about grades. I still did well, but trying to get the highest score wasn't even on my radar anymore.
In med school, people thought I was really laid back. I did okay grades-wise, but I wasn't stepping on toes or even pulling all-nighters to get the best possible grades. I wasn't AOA. When I told people I was thinking about PM&R, they said, "Oh, that's perfect for you because you're so laid back."
I can't figure out which is the lie. Am I a Type A competitive gunner? Or was that just inflicted on me by my parents and I'm really just a totally laid back Type B?
I was looking online and I found a few questions to help me differentiate:
Are you pressed for time at and after work?
I am writing this at work, so... no.
Do you always take work home with you?
Ew. No way.
Do you eat rapidly?
No. Unless it's McDonald's!
Do you have a strong need to excel?
Yes, I love the function where you type SUM() and it adds the numbers in the column for you!
Do you have trouble finding time to get your hair cut/styled?
No. Salon d'Fizzy's Bathroom is always open.
Do you feel or act impatient when you have to wait in line?
Does anyone like waiting on lines?? Plus I always choose the wrong line, where someone decides to pay with a check. Why would you buy groceries with a check?? What is wrong with people???
Do you get irritated easily?
Only if someone is buying groceries with a check. Or if I'm on my period or something.
Are you bossy and domineering?
Only if you're my husband. (Sorry, hon!)
When you were younger was your temper fiery and difficult to control?
I never actually get mad. The closest I come to getting mad is me saying in a calm voice, "I'm really mad."
So maybe I really am Type B. Or Type A. Or maybe you can't divide everyone in the world into two personality types.
I totally seemed like a Type A growing up. I always had to get the highest mark on exams even in stupid classes like history, I was a valedictorian, I finished projects like a week in advance and always went above and beyond what I was supposed to do.
Then, I don't know how, something changed when I went to college. I stopped caring so much about grades. I still did well, but trying to get the highest score wasn't even on my radar anymore.
In med school, people thought I was really laid back. I did okay grades-wise, but I wasn't stepping on toes or even pulling all-nighters to get the best possible grades. I wasn't AOA. When I told people I was thinking about PM&R, they said, "Oh, that's perfect for you because you're so laid back."
I can't figure out which is the lie. Am I a Type A competitive gunner? Or was that just inflicted on me by my parents and I'm really just a totally laid back Type B?
I was looking online and I found a few questions to help me differentiate:
Are you pressed for time at and after work?
I am writing this at work, so... no.
Do you always take work home with you?
Ew. No way.
Do you eat rapidly?
No. Unless it's McDonald's!
Do you have a strong need to excel?
Yes, I love the function where you type SUM() and it adds the numbers in the column for you!
Do you have trouble finding time to get your hair cut/styled?
No. Salon d'Fizzy's Bathroom is always open.
Do you feel or act impatient when you have to wait in line?
Does anyone like waiting on lines?? Plus I always choose the wrong line, where someone decides to pay with a check. Why would you buy groceries with a check?? What is wrong with people???
Do you get irritated easily?
Only if someone is buying groceries with a check. Or if I'm on my period or something.
Are you bossy and domineering?
Only if you're my husband. (Sorry, hon!)
When you were younger was your temper fiery and difficult to control?
I never actually get mad. The closest I come to getting mad is me saying in a calm voice, "I'm really mad."
So maybe I really am Type B. Or Type A. Or maybe you can't divide everyone in the world into two personality types.
Tuesday, January 22, 2013
What's in a name?
The name of this blog is A Cartoon Guide to Becoming a Doctor. Back when I first started this blog about three years ago, my idea was to post cartoons I drew about medicine. I thought it would be a really fun blog. And for a while, I only posted cartoons.
Then I started running out of ideas for cartoons. So I started posting my stories about residency and sometimes my opinions. And those posts often got more comments and hits than the cartoons, and sometimes sparked interesting discussions.
Subsequently, I had another baby, and I just didn't have the time to draw lots of cartoons anymore. And I was sort of running out of fresh ideas.
These days, I try to post at least two cartoons every month, just to stay true to the name of the blog. But I still get complaints along the lines of:
"Hey, where are the cartoons?"
"The name of your blog is a lie."
"You should change the name of your blog."
"Yo, where's the cartoons?"
Yes, I get it. It's called A Cartoon Guide to Becoming a Doctor, and there aren't that many cartoons anymore. It's not like this was some kind of well thought out plan.
I don't want to change the name of my blog. I think there are enough cartoons in the archive that it's still a fair name. The only thing I'd consider changing it to would be The Blog Formerly Known as a Cartoon Guide to Becoming a Doctor. (And then it would eventually just become known as The Blog.)
Then I started running out of ideas for cartoons. So I started posting my stories about residency and sometimes my opinions. And those posts often got more comments and hits than the cartoons, and sometimes sparked interesting discussions.
Subsequently, I had another baby, and I just didn't have the time to draw lots of cartoons anymore. And I was sort of running out of fresh ideas.
These days, I try to post at least two cartoons every month, just to stay true to the name of the blog. But I still get complaints along the lines of:
"Hey, where are the cartoons?"
"The name of your blog is a lie."
"You should change the name of your blog."
"Yo, where's the cartoons?"
Yes, I get it. It's called A Cartoon Guide to Becoming a Doctor, and there aren't that many cartoons anymore. It's not like this was some kind of well thought out plan.
I don't want to change the name of my blog. I think there are enough cartoons in the archive that it's still a fair name. The only thing I'd consider changing it to would be The Blog Formerly Known as a Cartoon Guide to Becoming a Doctor. (And then it would eventually just become known as The Blog.)
Monday, January 21, 2013
Fee for advice
This is a topic I wrote about several years ago on Mothers in Medicine, but I've decided to revisit it here. (Because it's my blog and I'll do what I want to!)
When my older daughter was two, she woke up one Sunday morning and one of her eyes was really swollen. This had never happened to her before and I was concerned, so I called our pediatrician's office (it was a large, university-affiliated practice). I was met with the following message:
Due to the high cost of after hours phone calls, all calls to the advice nurse after regular business hours will be charged a $20 fee.
At the time, I was a resident and my husband was a student. I thought about the $20 and decided her eye didn't look that bad and decided not to pay the $20.
In retrospect, I'm still pissed off. I think this is a terrible practice. I can understand charging parents who call excessively a copay, but I don't feel like it's fair to put a parent in the position of deciding if their kid's swollen eye is worth the $20. And what if my kid had a health problem that required more monitoring? Would I just be screwed and have to keep paying $20 every time my kid got sick and I wasn't sure whether to go to the ER? What if it's the middle of the night and I need to give my kid some Tylenol??
I've used two different pediatrics practices since then and neither charged a fee for after-hours advice. (My current practice actually has an amazing email line that I use frequently for rashes and appointment scheduling.)
When I initially posted this, several people vehemently disagreed with me and said I was wrong. And this bothered me because I'm never wrong. (Just kidding! (Or am I? (Yes, I am.)))
The biggest argument against me was that other people aren't expected to give advice for free, so why should doctors? Also, that if there's no $20 charge for calls, that cost will be otherwise worked into your bill anyway. Also, I was told I just "didn't get it" because I never ran a private practice.
I'd say that, yes, I'd rather the charge for all services go up than have to make a decision about whether my child's health problem is bad enough to call the pediatrician. And I say this as a doctor, who is probably better at making these decisions than the average person. If I were a pediatrician, I'd be a little frightened about discouraging parents from calling when there might be something serious going on. On my Tylenol post, a resident commented she didn't even trust parents to correctly give their kids Tylenol!
And there are tons of professionals who will talk to you on the phone or on off-hours for free. If I have a problem with my cable and call the company at 9PM, they don't tell me that I'm going to have to pay $20 to talk to someone about it. When I have an after-hours plumbing emergency, I don't have to pay $20 to talk to the super. Part of what is generally expected is for people to be able to call their medical practice if they need advice.
Do people abuse it? Yes, of course. But I'd say to deal with the abusers individually rather than punish everyone.
When my older daughter was two, she woke up one Sunday morning and one of her eyes was really swollen. This had never happened to her before and I was concerned, so I called our pediatrician's office (it was a large, university-affiliated practice). I was met with the following message:
Due to the high cost of after hours phone calls, all calls to the advice nurse after regular business hours will be charged a $20 fee.
At the time, I was a resident and my husband was a student. I thought about the $20 and decided her eye didn't look that bad and decided not to pay the $20.
In retrospect, I'm still pissed off. I think this is a terrible practice. I can understand charging parents who call excessively a copay, but I don't feel like it's fair to put a parent in the position of deciding if their kid's swollen eye is worth the $20. And what if my kid had a health problem that required more monitoring? Would I just be screwed and have to keep paying $20 every time my kid got sick and I wasn't sure whether to go to the ER? What if it's the middle of the night and I need to give my kid some Tylenol??
I've used two different pediatrics practices since then and neither charged a fee for after-hours advice. (My current practice actually has an amazing email line that I use frequently for rashes and appointment scheduling.)
When I initially posted this, several people vehemently disagreed with me and said I was wrong. And this bothered me because I'm never wrong. (Just kidding! (Or am I? (Yes, I am.)))
The biggest argument against me was that other people aren't expected to give advice for free, so why should doctors? Also, that if there's no $20 charge for calls, that cost will be otherwise worked into your bill anyway. Also, I was told I just "didn't get it" because I never ran a private practice.
I'd say that, yes, I'd rather the charge for all services go up than have to make a decision about whether my child's health problem is bad enough to call the pediatrician. And I say this as a doctor, who is probably better at making these decisions than the average person. If I were a pediatrician, I'd be a little frightened about discouraging parents from calling when there might be something serious going on. On my Tylenol post, a resident commented she didn't even trust parents to correctly give their kids Tylenol!
And there are tons of professionals who will talk to you on the phone or on off-hours for free. If I have a problem with my cable and call the company at 9PM, they don't tell me that I'm going to have to pay $20 to talk to someone about it. When I have an after-hours plumbing emergency, I don't have to pay $20 to talk to the super. Part of what is generally expected is for people to be able to call their medical practice if they need advice.
Do people abuse it? Yes, of course. But I'd say to deal with the abusers individually rather than punish everyone.
Sunday, January 20, 2013
Saturday, January 19, 2013
Weekly Whine: Having kids is a choice
I hate it when people say "having kids is a choice" as an excuse for denying parents things like maternity leave, etc. For several reasons:
1) Having kids is not always a choice. Many people use birth control properly and still get pregnant. People get raped.
2) If you expect someone else to abort a fetus so you don't have to work a little harder, then you are a bad person. I don't care where you lie on the abortion debate, that definitely makes you a bad person.
3) We don't refuse to provide food to destitute children just because their parents made a choice by having them. Forcing a parent to do something that is detrimental to the child just because a choice was made to have them is not ethical.
4) Having kids is as much of a choice as eating. You don't have to eat. You could stop entirely if you wanted. Of course, you'd eventually die. But that's what would happen to the human race if everyone made the "choice" to stop having kids. Anything that is almost solely responsible for preserving the species is not a choice. Some people feel that compulsion more than others, but it's quite powerful, especially in many (not all) women.
There are few things more natural than having sex and procreating. Every species, every race has done it since the beginning of time (unless you're an amoeba). It's an essential component to most romantic relationships. And if you try to use the "sex is a choice" argument, all I think is that you're not getting any at home, sorry.
I should also mention my husband's argument, which is that doctors who say that are a bunch of snobs who think that what we're doing is so important that we're on some higher level of humanity that ought to be exempt from basic human functions like procreation.
1) Having kids is not always a choice. Many people use birth control properly and still get pregnant. People get raped.
2) If you expect someone else to abort a fetus so you don't have to work a little harder, then you are a bad person. I don't care where you lie on the abortion debate, that definitely makes you a bad person.
3) We don't refuse to provide food to destitute children just because their parents made a choice by having them. Forcing a parent to do something that is detrimental to the child just because a choice was made to have them is not ethical.
4) Having kids is as much of a choice as eating. You don't have to eat. You could stop entirely if you wanted. Of course, you'd eventually die. But that's what would happen to the human race if everyone made the "choice" to stop having kids. Anything that is almost solely responsible for preserving the species is not a choice. Some people feel that compulsion more than others, but it's quite powerful, especially in many (not all) women.
There are few things more natural than having sex and procreating. Every species, every race has done it since the beginning of time (unless you're an amoeba). It's an essential component to most romantic relationships. And if you try to use the "sex is a choice" argument, all I think is that you're not getting any at home, sorry.
I should also mention my husband's argument, which is that doctors who say that are a bunch of snobs who think that what we're doing is so important that we're on some higher level of humanity that ought to be exempt from basic human functions like procreation.
Friday, January 18, 2013
Nice lady
This is a conversation I had with a patient who was in really bad medical condition, but it didn't keep her from brightening my day a little.
Patient: "What's your first name?"
Me: "Fizzy."
Patient: "Fizzy, I just want to tell you that I love your hair. It's so pretty."
Me: "Oh, thank you."
And after I was done with her exam, I asked if she had any questions:
Patient: "Are you married?"
Me: "Yes."
Patient: "Do you have children?"
Me: "Yes, I have a daughter."
Patient: "I can't believe it! You look like you're eighteen!"
Me: "Oh, thank you. (I think.)"
Patient: "When you get home, I want you to tell your husband...." [takes breath from ventilator]
Me: "Yes?"
Patient: "That he is the luckiest man in the world to be married to you."
Me: "Okay, will do."
I could probably say the same for her husband.
Patient: "What's your first name?"
Me: "Fizzy."
Patient: "Fizzy, I just want to tell you that I love your hair. It's so pretty."
Me: "Oh, thank you."
And after I was done with her exam, I asked if she had any questions:
Patient: "Are you married?"
Me: "Yes."
Patient: "Do you have children?"
Me: "Yes, I have a daughter."
Patient: "I can't believe it! You look like you're eighteen!"
Me: "Oh, thank you. (I think.)"
Patient: "When you get home, I want you to tell your husband...." [takes breath from ventilator]
Me: "Yes?"
Patient: "That he is the luckiest man in the world to be married to you."
Me: "Okay, will do."
I could probably say the same for her husband.
Thursday, January 17, 2013
Cry It Out
I'm a strong believer in letting babies cry it out (CIO) and learn to self-soothe.
I feel like parents who don't believe in CIO couldn't possibly have ever tried it in earnest. Here's how it works, in my experience:
--On the first night, the baby throws a shitfit, screaming and getting really upset while you huddle in a corner, feeling like a horrible parent. It lasts, like, 45 minutes.
--On the second night, the baby cries for about 15 minutes.
--On all subsequent nights, when you put the baby down to sleep (drowsy but awake), she goes to sleep immediately.
--If the baby wakes up in the middle of the night, she will generally go right back to sleep without requiring extra comfort.
I suppose one could argue that this is a horrible thing, that I've raised a baby who is so apathetic that when she wakes up during the night, she knows nobody will come for her, and just gives up and goes back to sleep. But she cries for me in the morning when she's ready to get up for the day. And she cries for me all the time during the day. But when she's tired and in her crib, she's learned to settle down without me.
Prior to doing CIO, when I put her down in her crib not sound asleep (which is hard to manage sometimes), she'd pop up immediately, panicked and upset that I was leaving. It was awful. I felt so freaking guilty.
I knew this woman who strongly believed that it was very unhealthy to let your kid cry. Period. She said it could result in permanent hoarseness. And actually, I read an article on attachment parenting that said infant crying results in "increased heart rate and blood pressure, reduced oxygen level, elevated cerebral blood pressure, depleted energy reserves and oxygen, interrupted mother-infant interaction, brain injury, and cardiac dysfunction." Well, that's perfect, actually. Because my sleep-trained baby cries way less than one who is waking up screaming during the night multiple times.
In any case, that particular woman had a four year old daughter who cried her head off every day when she got dropped off at daycare. And at four years old, she was still waking up multiple times during the night.
I feel like parents who don't believe in CIO couldn't possibly have ever tried it in earnest. Here's how it works, in my experience:
--On the first night, the baby throws a shitfit, screaming and getting really upset while you huddle in a corner, feeling like a horrible parent. It lasts, like, 45 minutes.
--On the second night, the baby cries for about 15 minutes.
--On all subsequent nights, when you put the baby down to sleep (drowsy but awake), she goes to sleep immediately.
--If the baby wakes up in the middle of the night, she will generally go right back to sleep without requiring extra comfort.
I suppose one could argue that this is a horrible thing, that I've raised a baby who is so apathetic that when she wakes up during the night, she knows nobody will come for her, and just gives up and goes back to sleep. But she cries for me in the morning when she's ready to get up for the day. And she cries for me all the time during the day. But when she's tired and in her crib, she's learned to settle down without me.
Prior to doing CIO, when I put her down in her crib not sound asleep (which is hard to manage sometimes), she'd pop up immediately, panicked and upset that I was leaving. It was awful. I felt so freaking guilty.
I knew this woman who strongly believed that it was very unhealthy to let your kid cry. Period. She said it could result in permanent hoarseness. And actually, I read an article on attachment parenting that said infant crying results in "increased heart rate and blood pressure, reduced oxygen level, elevated cerebral blood pressure, depleted energy reserves and oxygen, interrupted mother-infant interaction, brain injury, and cardiac dysfunction." Well, that's perfect, actually. Because my sleep-trained baby cries way less than one who is waking up screaming during the night multiple times.
In any case, that particular woman had a four year old daughter who cried her head off every day when she got dropped off at daycare. And at four years old, she was still waking up multiple times during the night.
Wednesday, January 16, 2013
Kindle
Accomplishment: according to my reading list, I read 33 books in 2012!
After I badmouthed it in an early blog, I've now been thinking more about getting a Kindle. I used to get most of my books at the library, but it started to get inconvenient to go there, and they only gave you two weeks to read the books, which I didn't like. Then I started buying all my books used from Amazon. Now my baby rips books out of my hands, so I started reading them all on the laptop, which she amazingly does not touch.
The benefits of reading Kindle books on the computer are thusly:
1) No books accumulating in my bookcase
2) Can read books with embarrassing titles
3) I started getting books online from library, which not only saves money but gives me guidance over what I should read (i.e. I based it on what comes available)
4) Many books available from Amazon on the Kindle for very cheap or free
But I'd like to switch to an actual Kindle to get more portability, plus I could borrow books from Amazon prime. Also, I hate the fact that when I'm reading, everyone thinks I'm just surfing the web. I think there's value in your kids seeing you reading a book, especially if they can't tell it's a junk book because it's on the Kindle.
Then again, by the time my baby is old enough that I feel like I can safely have a Kindle, the Kindle probably won't even exist. There'll probably be some new invention I have to buy. Like a K-Pad. Or an iNdle.
After I badmouthed it in an early blog, I've now been thinking more about getting a Kindle. I used to get most of my books at the library, but it started to get inconvenient to go there, and they only gave you two weeks to read the books, which I didn't like. Then I started buying all my books used from Amazon. Now my baby rips books out of my hands, so I started reading them all on the laptop, which she amazingly does not touch.
The benefits of reading Kindle books on the computer are thusly:
1) No books accumulating in my bookcase
2) Can read books with embarrassing titles
3) I started getting books online from library, which not only saves money but gives me guidance over what I should read (i.e. I based it on what comes available)
4) Many books available from Amazon on the Kindle for very cheap or free
But I'd like to switch to an actual Kindle to get more portability, plus I could borrow books from Amazon prime. Also, I hate the fact that when I'm reading, everyone thinks I'm just surfing the web. I think there's value in your kids seeing you reading a book, especially if they can't tell it's a junk book because it's on the Kindle.
Then again, by the time my baby is old enough that I feel like I can safely have a Kindle, the Kindle probably won't even exist. There'll probably be some new invention I have to buy. Like a K-Pad. Or an iNdle.
Informed consent FAIL
Another thing I hate about consent forms:
Back in residency, I was scheduled to do a biceps tendon injection on an elderly female patient and naturally, the first thing she said when I walked into the room was, "I've been waiting an hour."
"I'm sorry," I said. What could I say to that? Patients get so angry that they're waiting, but it's not like the resident has any control over it. Did she think I wanted to double book patients? Note to patients: we're not sitting around sipping tea while you're waiting. (And then those same patients are probably the ones who call the clinic and BEG us to overbook them for an earlier appointment.)
Anyway, I set her up for an injection and handed her the consent to sign. For every outpatient procedure in the entire hospital, we used the same standard consent form and I just wrote the procedure on one line at the top. As the patient was carefully looking over the consent prior to signing it, I let her know, "That's just the standard consent that's used for everything in the hospital."
She signed the consent and I got the supplies ready and came back to the room.
"By the way," she said to me, "I don't mean to be rude, but just so you know, you should never EVER say to a patient that it's a standard consent form."
"What?" I said, baffled.
"You should let the patient read the consent," she said, "and if they ask, then you can tell them it's the standard consent. But never tell them that." She said all this to me with this huge shit-eating grin on her face, which made the bitchiness of what she was saying very unsettling.
"Um, I let you read the consent," I said.
"I'm just telling you this so that you can learn something," she said.
What I replied was: "Okay."
What I really wanted to say was: "I have a tip for you too. It's not such a good idea to be a patronizing bitch to the doctor right before they stick a bigass needle in your arm."
God forbid she should feel that I'm rushing her at all after she already astutely noted that we were running an hour behind schedule.
Back in residency, I was scheduled to do a biceps tendon injection on an elderly female patient and naturally, the first thing she said when I walked into the room was, "I've been waiting an hour."
"I'm sorry," I said. What could I say to that? Patients get so angry that they're waiting, but it's not like the resident has any control over it. Did she think I wanted to double book patients? Note to patients: we're not sitting around sipping tea while you're waiting. (And then those same patients are probably the ones who call the clinic and BEG us to overbook them for an earlier appointment.)
Anyway, I set her up for an injection and handed her the consent to sign. For every outpatient procedure in the entire hospital, we used the same standard consent form and I just wrote the procedure on one line at the top. As the patient was carefully looking over the consent prior to signing it, I let her know, "That's just the standard consent that's used for everything in the hospital."
She signed the consent and I got the supplies ready and came back to the room.
"By the way," she said to me, "I don't mean to be rude, but just so you know, you should never EVER say to a patient that it's a standard consent form."
"What?" I said, baffled.
"You should let the patient read the consent," she said, "and if they ask, then you can tell them it's the standard consent. But never tell them that." She said all this to me with this huge shit-eating grin on her face, which made the bitchiness of what she was saying very unsettling.
"Um, I let you read the consent," I said.
"I'm just telling you this so that you can learn something," she said.
What I replied was: "Okay."
What I really wanted to say was: "I have a tip for you too. It's not such a good idea to be a patronizing bitch to the doctor right before they stick a bigass needle in your arm."
God forbid she should feel that I'm rushing her at all after she already astutely noted that we were running an hour behind schedule.
Tuesday, January 15, 2013
Informed consent
I do a fair amount of procedures (mostly injections), and one thing I must do prior to every injection is obtain informed consent.
Getting informed consent often takes longer than the procedure, in all honesty. (I mean, how long does it take to stick a needle in a shoulder?) First, you have to tell the patient about the procedure, including the risks and benefits (I always accidentally write "injection" as a risk, meaning "infection"), then you show them the consent form. And they have to sign it, which in the case of my patients, can actually be a bit of a process. And then I have to track down someone to witness the consent.
And THEN there are about five or six other places I have to sign and date the form, like to say that I verified I have the right patient, that I'm injecting the correct side, etc.
Recently, I was near a colleague of mine who was finishing filling out the consent form and he started grumbling, "This form is ridiculous. You have to sign it like ten times."
He was right. But here's the thing: for every place you have to "sign and verify", it's because somebody else did something stupid. We have to sign that we checked that we're injecting the correct side, because obviously a bunch of people injected the wrong side.*
So in that sense, I do think it's important.
But in another sense, if you're signing and dating the form five minutes after the procedure, I'm not sure how much it's going to help those errors. And I bet that's what 90% of doctors do.
*A favorite quote of mine:
"If you have the fever, there's only one cure; take two tickets and see the game Sunday morning. Warning: tickets should not be taken internally."
"See? Because of me, now they have a warning."
Getting informed consent often takes longer than the procedure, in all honesty. (I mean, how long does it take to stick a needle in a shoulder?) First, you have to tell the patient about the procedure, including the risks and benefits (I always accidentally write "injection" as a risk, meaning "infection"), then you show them the consent form. And they have to sign it, which in the case of my patients, can actually be a bit of a process. And then I have to track down someone to witness the consent.
And THEN there are about five or six other places I have to sign and date the form, like to say that I verified I have the right patient, that I'm injecting the correct side, etc.
Recently, I was near a colleague of mine who was finishing filling out the consent form and he started grumbling, "This form is ridiculous. You have to sign it like ten times."
He was right. But here's the thing: for every place you have to "sign and verify", it's because somebody else did something stupid. We have to sign that we checked that we're injecting the correct side, because obviously a bunch of people injected the wrong side.*
So in that sense, I do think it's important.
But in another sense, if you're signing and dating the form five minutes after the procedure, I'm not sure how much it's going to help those errors. And I bet that's what 90% of doctors do.
*A favorite quote of mine:
"If you have the fever, there's only one cure; take two tickets and see the game Sunday morning. Warning: tickets should not be taken internally."
"See? Because of me, now they have a warning."
Monday, January 14, 2013
Why I didn't do research
You may or may not be aware from reading my prior writings that for a time, I was considering a career in research. I worked in labs during every summer through college, and even though I didn’t do any research during med school and not a whole lot during residency, I actually ended up doing a research fellowship.
Also, I have research in my blood. My father is a physician who gets a chunk of his salary from research grants. My mother didn’t go quite so far as that, but did publish around a hundred peer-reviewed articles during her career. My father especially encouraged me to incorporate research into my career, saying that it was interesting and also provided extra career flexibility.
So anyway, I did this fellowship. And it sucked.
I mean, it was pretty much The Fellowship Where Everything Went Wrong. I know what you’re thinking, that it’s not possible for a research fellowship to go that badly. Well, what if your research mentor is arrested and goes to jail midway through the year?
I’m not saying that happened. But I’m not saying that didn’t happen either.
Bad fellowship aside, I did get a taste of what it was like to do research. There were some parts of it I liked very much. For example, I really liked when the article I wrote came out, and I got to gaze at it lovingly. All the other parts weren’t quite as good. But I like to write, I like statistics, etc., so it wasn’t all bad.
Soon after my mentor was arrested, I learned about a career development award that seemed like an obvious one for me to apply to. I had been working on putting together a project, but things weren’t going so great (what with the arrest and all), so I knew I was going to have to do some fast work to put it all together.
My idea involved using Zoloft for hair loss in men (not really, but let’s say it did). I figured I could give guys a pill, either Zoloft or a placebo, and then have them return at regular intervals to measure their hair growth. It seemed simple enough, but there were SO many barriers to making it happen. First, we had to figure out a way to pay for all those Zoloft tablets. Second, I had to assure a bunch of other people doing various other studies that I wasn’t going to steal and taint their research subjects. Then, I had to write a 200 page IRB application, describing every tiny detail of my study and how I wasn’t going to kill my subjects or even harm one precious hair on their heads (and most likely, not make the hairs grow either).
But you know what? I was kind of excited about it. It was a fun little project. And this way, I’d have the next two years of my life guaranteed. I remember discussing it with my new mentor (who was still a free man):
Mentor: "And after this grant ends, you could apply for the NEXT level career development award! And you could just live in a little research cave."
Me: "I always wanted to live in a cave."
Mentor: "You'd be like Batman! Except you'd be a scientist."
Me: "Actually, Batman was a scientist."
Mentor: "So you'd be exactly like Batman!"
Unfortunately, my Batman aspirations were never realized. My application for the career development award was rejected without them even asking to see my proposal.
It was a blow. It made me feel like shit, to be completely honest. At the same time, another friend of mine applying for a different research grant also got rejected. He showed me the rejection comments and they were actually really, really mean. And suddenly, I felt like research was all about rejection. My skin wasn’t thick enough for this. And I couldn’t imagine having to depend on these grants in order to make a living. I couldn’t live that way.
And the next day, I started applying for real jobs.
Also, I have research in my blood. My father is a physician who gets a chunk of his salary from research grants. My mother didn’t go quite so far as that, but did publish around a hundred peer-reviewed articles during her career. My father especially encouraged me to incorporate research into my career, saying that it was interesting and also provided extra career flexibility.
So anyway, I did this fellowship. And it sucked.
I mean, it was pretty much The Fellowship Where Everything Went Wrong. I know what you’re thinking, that it’s not possible for a research fellowship to go that badly. Well, what if your research mentor is arrested and goes to jail midway through the year?
I’m not saying that happened. But I’m not saying that didn’t happen either.
Bad fellowship aside, I did get a taste of what it was like to do research. There were some parts of it I liked very much. For example, I really liked when the article I wrote came out, and I got to gaze at it lovingly. All the other parts weren’t quite as good. But I like to write, I like statistics, etc., so it wasn’t all bad.
Soon after my mentor was arrested, I learned about a career development award that seemed like an obvious one for me to apply to. I had been working on putting together a project, but things weren’t going so great (what with the arrest and all), so I knew I was going to have to do some fast work to put it all together.
My idea involved using Zoloft for hair loss in men (not really, but let’s say it did). I figured I could give guys a pill, either Zoloft or a placebo, and then have them return at regular intervals to measure their hair growth. It seemed simple enough, but there were SO many barriers to making it happen. First, we had to figure out a way to pay for all those Zoloft tablets. Second, I had to assure a bunch of other people doing various other studies that I wasn’t going to steal and taint their research subjects. Then, I had to write a 200 page IRB application, describing every tiny detail of my study and how I wasn’t going to kill my subjects or even harm one precious hair on their heads (and most likely, not make the hairs grow either).
But you know what? I was kind of excited about it. It was a fun little project. And this way, I’d have the next two years of my life guaranteed. I remember discussing it with my new mentor (who was still a free man):
Mentor: "And after this grant ends, you could apply for the NEXT level career development award! And you could just live in a little research cave."
Me: "I always wanted to live in a cave."
Mentor: "You'd be like Batman! Except you'd be a scientist."
Me: "Actually, Batman was a scientist."
Mentor: "So you'd be exactly like Batman!"
Unfortunately, my Batman aspirations were never realized. My application for the career development award was rejected without them even asking to see my proposal.
It was a blow. It made me feel like shit, to be completely honest. At the same time, another friend of mine applying for a different research grant also got rejected. He showed me the rejection comments and they were actually really, really mean. And suddenly, I felt like research was all about rejection. My skin wasn’t thick enough for this. And I couldn’t imagine having to depend on these grants in order to make a living. I couldn’t live that way.
And the next day, I started applying for real jobs.
Sunday, January 13, 2013
Archie and Me
When I was a kid, I was totally obsessed with Archie comics.
There was this comic book store on my way home from school and I'd always try to convince my mother to buy me the new comics. I still remember the excitement I felt when I had a brand new comic to read. Especially the double digest.
When I was about eight years old, I learned how to draw from Archie comics. I'd draw Veronica and Betty over and over. Essentially, they are the same, except if you're drawing Betty, you make her hair in a ponytail and you don't color it in. And Veronica usually looks a little angry.
(Drawn without peeking!)
Aside from the usual Archie comics, there were offshoots. Like, for example, there would be a Jughead comic, which would be the same basic comics, but all sort of revolving around Jughead. I remember there was also an Archie 3000 comic, which was supposed to take place in the year 3000. (Interestingly, Archie comic's idea of the year 3000 wasn't terribly different from Back to the Future's idea of the year 2015. One word: Hovercars.)
Even though my parents bought me the comics, they'd also kind of belittle me for reading them. I mean, couldn't I read more, I don't know, Baby-sitters Club and less comic books? It got to the point where I started to feel bad about reading them, so when I turned eleven, I gave them up cold turkey. No more Archie comics. The only residual was that I kind of liked redheaded guys for a while (till I dated one who really sucked).
Years later, when I was in medical school, I was at a friend's house and she had an Archie comic lying on her coffee table. I'd imagine this was how a former crack addict must feel if they gave up crack at age eleven, then walked into a friend's house and saw some crack lying on the coffee table. Anyway, my friend offered me the crack... er, Archie comic, and I read it, and just like that, I was hooked again.
It was even worse to be hooked on Archie comics at age 24 than it was at age 10. At 24, you can see how silly and repetitive all the storylines are, yet I still felt compelled to keep reading. And my boyfriend totally encouraged it by buying them for me.
Let me tell you, if it's embarrassing to be buying an Archie comic at age 10, it's mortifying at age 24. I had to pretend I was getting it for some imaginary child.
I was hooked for another year, then I finally quit again. I think I've finally got Archie out of my system, at least until he chooses between Betty and Veronica, because I've got to know how that ends up.
There was this comic book store on my way home from school and I'd always try to convince my mother to buy me the new comics. I still remember the excitement I felt when I had a brand new comic to read. Especially the double digest.
When I was about eight years old, I learned how to draw from Archie comics. I'd draw Veronica and Betty over and over. Essentially, they are the same, except if you're drawing Betty, you make her hair in a ponytail and you don't color it in. And Veronica usually looks a little angry.
(Drawn without peeking!)
Aside from the usual Archie comics, there were offshoots. Like, for example, there would be a Jughead comic, which would be the same basic comics, but all sort of revolving around Jughead. I remember there was also an Archie 3000 comic, which was supposed to take place in the year 3000. (Interestingly, Archie comic's idea of the year 3000 wasn't terribly different from Back to the Future's idea of the year 2015. One word: Hovercars.)
Even though my parents bought me the comics, they'd also kind of belittle me for reading them. I mean, couldn't I read more, I don't know, Baby-sitters Club and less comic books? It got to the point where I started to feel bad about reading them, so when I turned eleven, I gave them up cold turkey. No more Archie comics. The only residual was that I kind of liked redheaded guys for a while (till I dated one who really sucked).
Years later, when I was in medical school, I was at a friend's house and she had an Archie comic lying on her coffee table. I'd imagine this was how a former crack addict must feel if they gave up crack at age eleven, then walked into a friend's house and saw some crack lying on the coffee table. Anyway, my friend offered me the crack... er, Archie comic, and I read it, and just like that, I was hooked again.
It was even worse to be hooked on Archie comics at age 24 than it was at age 10. At 24, you can see how silly and repetitive all the storylines are, yet I still felt compelled to keep reading. And my boyfriend totally encouraged it by buying them for me.
Let me tell you, if it's embarrassing to be buying an Archie comic at age 10, it's mortifying at age 24. I had to pretend I was getting it for some imaginary child.
I was hooked for another year, then I finally quit again. I think I've finally got Archie out of my system, at least until he chooses between Betty and Veronica, because I've got to know how that ends up.
Saturday, January 12, 2013
Weekly Whine: Tylenol
Have you noticed that they don't put the dose anymore on the bottle of Tylenol for babies? If you have a child under 2, you're supposed to "ask your doctor".
So if my 18 month old has some pain from teething at midnight, I'm supposed to call the freaking doctor and ask them how much Tylenol to give???
Of course I'm not going to do that. I'm going to look up on the internet how much to give. Of course, there are different kinds of Tylenol, like concentrated or non-concentrated, so I have to stress over whether I got the right one.
Congratulations, Tylenol. You're really saving lives by not printing the freaking dose on the container.
So if my 18 month old has some pain from teething at midnight, I'm supposed to call the freaking doctor and ask them how much Tylenol to give???
Of course I'm not going to do that. I'm going to look up on the internet how much to give. Of course, there are different kinds of Tylenol, like concentrated or non-concentrated, so I have to stress over whether I got the right one.
Congratulations, Tylenol. You're really saving lives by not printing the freaking dose on the container.
Friday, January 11, 2013
Alexander Hamilton
In paying for food with a ten dollar bill, I wondered aloud who was on the ten dollar bill. It's sad that I don't know. It turns out it's Alexander Hamilton.
Me: "Why is Alexander Hamilton on the ten dollar bill?"
Husband: "I don't know... wasn't he the President?"
Me: "No."
Husband: "Are you sure? I thought that Benjamin Franklin was the only non-President who's on money."
Me: "I'm pretty sure Alexander Hamilton was never President."
Husband: "Well, he did something. Maybe signed the Declaration of Independence."
Me: "All I know is that he was shot by Aaron Burr in that duel. And I only know that because of that commercial."
Pretty sad that the knowledge two adults have of American history comes almost exclusively from a milk commercial.
Tangentially related funny story:
Back in high school, my brother wrote a paper on Alexander Hamilton, which I happened to notice on the computer a few days after he handed it in. I'm not sure what compelled me to read this paper, but it was pretty unintentionally funny. The most hilarious thing I remember about the paper was that halfway through, he suddenly started calling him "Mark Hamilton" for no apparent reason. I guess he got him confused with Mark Hammil or something?
Me: "Why is Alexander Hamilton on the ten dollar bill?"
Husband: "I don't know... wasn't he the President?"
Me: "No."
Husband: "Are you sure? I thought that Benjamin Franklin was the only non-President who's on money."
Me: "I'm pretty sure Alexander Hamilton was never President."
Husband: "Well, he did something. Maybe signed the Declaration of Independence."
Me: "All I know is that he was shot by Aaron Burr in that duel. And I only know that because of that commercial."
Pretty sad that the knowledge two adults have of American history comes almost exclusively from a milk commercial.
Tangentially related funny story:
Back in high school, my brother wrote a paper on Alexander Hamilton, which I happened to notice on the computer a few days after he handed it in. I'm not sure what compelled me to read this paper, but it was pretty unintentionally funny. The most hilarious thing I remember about the paper was that halfway through, he suddenly started calling him "Mark Hamilton" for no apparent reason. I guess he got him confused with Mark Hammil or something?
Thursday, January 10, 2013
Wednesday, January 9, 2013
Disoriented
Me: "What year is it?"
Patient: "2012."
Me: "Right."
Nurse: "..."
Me: "Oh. I mean, WRONG."
It takes a while.
Patient: "2012."
Me: "Right."
Nurse: "..."
Me: "Oh. I mean, WRONG."
It takes a while.
Tuesday, January 8, 2013
Shameful, Part 2
We had some good stories yesterday, but most of them were more "oh shit" stories. Like you were doing your job and then realized that "oh shit" you made some horrible mistake.
I don't think that's shameful though. I mean, to err is human, right?
I'm not sure whether this is a particularly saintly group or people are just scared, even though this is entirely anonymous. But I used to see on a regular basis residents doing things that I thought were pretty shameful.
One thing that I saw residents do a lot in residency was handle things on homecall from home that should have been handled by coming in to evaluate the patient. And I worked with several residents who used to lie about having seen a patient if they were short for time. I worked with a med student who was told to go out and rescrub, and he was so pissed off that he rescrubbed with the sponge he'd thrown in the garbage, then went back in.
That's the kind of shameful stuff I'm talking about. But nobody here would do anything like that, huh?
I don't think that's shameful though. I mean, to err is human, right?
I'm not sure whether this is a particularly saintly group or people are just scared, even though this is entirely anonymous. But I used to see on a regular basis residents doing things that I thought were pretty shameful.
One thing that I saw residents do a lot in residency was handle things on homecall from home that should have been handled by coming in to evaluate the patient. And I worked with several residents who used to lie about having seen a patient if they were short for time. I worked with a med student who was told to go out and rescrub, and he was so pissed off that he rescrubbed with the sponge he'd thrown in the garbage, then went back in.
That's the kind of shameful stuff I'm talking about. But nobody here would do anything like that, huh?
Verbal orders
For those of you in medicine, you surely know that verbal orders can be a lifesaver. If I had to go to a unit every time I wanted a patient to get Tylenol, that would be a massive waste of my time. Instead you can just tell the nurse over the phone to give the Tylenol, then sign the order when you're on that unit.
An attending I talked to recently told me that when he was a resident, the hospital where he trained didn't allow verbal orders. But at the same time, the residents took call from home.
So say a patient had a mild headache and wanted Tylenol. Instead of telling the nurse to give it, you had to drive all the way to the hospital (he lived thirty minutes away) and write the order, then drive home.
He said that it resulted in crazy amounts of PRN orders. He said that the residents would sit there, brainstorming every medication a patient might possibly need during the night, and writing a PRN order for it.
An attending I talked to recently told me that when he was a resident, the hospital where he trained didn't allow verbal orders. But at the same time, the residents took call from home.
So say a patient had a mild headache and wanted Tylenol. Instead of telling the nurse to give it, you had to drive all the way to the hospital (he lived thirty minutes away) and write the order, then drive home.
He said that it resulted in crazy amounts of PRN orders. He said that the residents would sit there, brainstorming every medication a patient might possibly need during the night, and writing a PRN order for it.
Monday, January 7, 2013
Shameful
There are times in many physicians' careers when they do something that they are not proud of, whether because they are overworked, overtired, or just plain burned out.
I have done a few things I am not proud of during my residency, especially during internship. There are days I allow myself to think back on it and I wince and hate myself. Thank God, nobody was ever harmed as a result. But I still hate myself, which is part of why I made sure to find a job that wouldn't put me under so much stress that I would do something stupid ever again.
I am certain I'm not the only one, so I'd like to give you a rare opportunity. If you have done something that you are not proud of during your medical training, please share it ANONYMOUSLY in the comments. Please don't reveal who you are--I don't want to know. And we get enough, like more than 20, I may share one of my own anonymously.
I think it will feel good to get it off your chest and see that we all occasionally do things we're not proud of.
I have done a few things I am not proud of during my residency, especially during internship. There are days I allow myself to think back on it and I wince and hate myself. Thank God, nobody was ever harmed as a result. But I still hate myself, which is part of why I made sure to find a job that wouldn't put me under so much stress that I would do something stupid ever again.
I am certain I'm not the only one, so I'd like to give you a rare opportunity. If you have done something that you are not proud of during your medical training, please share it ANONYMOUSLY in the comments. Please don't reveal who you are--I don't want to know. And we get enough, like more than 20, I may share one of my own anonymously.
I think it will feel good to get it off your chest and see that we all occasionally do things we're not proud of.
Sunday, January 6, 2013
Should flu vaccines be mandatory?
In an Indiana hospital, eight employees were fired for refusing the flu vaccine. This begs the question: should employees in a hospital who have direct patient contact be forced to get a flu vaccine?
I say yes. For sure, yes.
Tens of thousands of people in the United States die each year from the flu. Here's a shot that can greatly reduce your risk of being one of those people. Why wouldn't you take it?
But fine, I'm not going to say everybody in the country should be forced to get a flu shot. Most people who get the flu probably aren't going to die from it, after all. But if you're going to be around a vulnerable population of sick patients in a hospital or nursing facility who can't fight the bug as well as you might be able to, you have a moral obligation to get a flu shot.
And I don't see any reason why a hospital can't require all employees to get flu vaccines. It doesn't seem all that extreme. I am required to have a PPD placed in order to stay at my job. That ain't saline they're injecting into my forearm.
I once had an argument with a nurse about flu vaccines. She (much like the nurse in the story) was saying that she never gets the vaccine because a long time ago, she got the vaccine and subsequently got the flu from it. I said, "How would you feel if you got the flu and then several patients caught it from you and died as a result?"
Her: "How would you feel if you got the flu from a vaccine and several patients caught it from you and died?"
Me: "I wouldn't feel bad at all because you can't get the flu from a killed vaccine."
Honestly, I am always really surprised to hear a nurse say something like that. I have a lot of respect for nurses, and I would think they would be smarter than that about a medical issue.
I say yes. For sure, yes.
Tens of thousands of people in the United States die each year from the flu. Here's a shot that can greatly reduce your risk of being one of those people. Why wouldn't you take it?
But fine, I'm not going to say everybody in the country should be forced to get a flu shot. Most people who get the flu probably aren't going to die from it, after all. But if you're going to be around a vulnerable population of sick patients in a hospital or nursing facility who can't fight the bug as well as you might be able to, you have a moral obligation to get a flu shot.
And I don't see any reason why a hospital can't require all employees to get flu vaccines. It doesn't seem all that extreme. I am required to have a PPD placed in order to stay at my job. That ain't saline they're injecting into my forearm.
I once had an argument with a nurse about flu vaccines. She (much like the nurse in the story) was saying that she never gets the vaccine because a long time ago, she got the vaccine and subsequently got the flu from it. I said, "How would you feel if you got the flu and then several patients caught it from you and died as a result?"
Her: "How would you feel if you got the flu from a vaccine and several patients caught it from you and died?"
Me: "I wouldn't feel bad at all because you can't get the flu from a killed vaccine."
Honestly, I am always really surprised to hear a nurse say something like that. I have a lot of respect for nurses, and I would think they would be smarter than that about a medical issue.
Saturday, January 5, 2013
Weekly Whine: Flowers
I'm sorry, but I just don't "get" flowers.
They look nice, I guess. But plenty of things look nice and don't require as much maintenance as flowers. When someone gives me flowers, I just feel like I don't know what to do with them. I don't want a gift that all I do is look at. I'd prefer a gift that I can do something with, like eat it.
Plus they die, especially in my hands. If you give me flowers, you are basically giving me something that will almost definitely rot and die within days.
But I do feel like I'm a little bit odd in my dislike of flowers, so I'll generally at least pretend to like them in social situations.
I was at a park with a good friend of mine over the summer, and there were all these flowers blooming everywhere. She was getting really poetic about it.
Her: "Oh my gosh, look at those beautiful purple azaleas!"
Me: "Oh wow!"
Her: "And look at those [insert adjective + name of other kind of flower]!"
Me: "Wow, so beautiful!"
Her: "Oh wait. I forgot--you said you don't have any interest in flowers. You don't care about any of this."
Me: "Yeah, you're right. None of these flowers interest me at all."
At least I was willing to fake it though.
They look nice, I guess. But plenty of things look nice and don't require as much maintenance as flowers. When someone gives me flowers, I just feel like I don't know what to do with them. I don't want a gift that all I do is look at. I'd prefer a gift that I can do something with, like eat it.
Plus they die, especially in my hands. If you give me flowers, you are basically giving me something that will almost definitely rot and die within days.
But I do feel like I'm a little bit odd in my dislike of flowers, so I'll generally at least pretend to like them in social situations.
I was at a park with a good friend of mine over the summer, and there were all these flowers blooming everywhere. She was getting really poetic about it.
Her: "Oh my gosh, look at those beautiful purple azaleas!"
Me: "Oh wow!"
Her: "And look at those [insert adjective + name of other kind of flower]!"
Me: "Wow, so beautiful!"
Her: "Oh wait. I forgot--you said you don't have any interest in flowers. You don't care about any of this."
Me: "Yeah, you're right. None of these flowers interest me at all."
At least I was willing to fake it though.
Friday, January 4, 2013
Losing my mind
How I know I'm losing my mind:
I always knock on the door before I go in to see a patient (then I come in without waiting for an answer). The way I know I'm losing my mind is that I accidentally knocked on the door to the stairwell last week.
I have also recently got out my keys to open the door the stairwell. (They don't require keys.)
I always knock on the door before I go in to see a patient (then I come in without waiting for an answer). The way I know I'm losing my mind is that I accidentally knocked on the door to the stairwell last week.
I have also recently got out my keys to open the door the stairwell. (They don't require keys.)
Thursday, January 3, 2013
I like the date
Coworker: "Hey, it's 12-12-12 today! Isn't that cool?"
Coworker #2: "Yeah, that IS cool! It's sort of fun to write it."
Me: "Yeah, I'm going to really enjoy writing that today."
And I wasn't being sarcastic. Which says something about my life not exactly being filled with excitement.
Today is 1/3/13, another date that's "fun" to write. I don't know if there will be any more of those this year, so I'm going to have to really enjoy it and make it last. (OK, now being a little sarcastic.)
One of my coworkers told me a story about how at a nursing home several years ago, she had a patient who was this really demented little old lady. She was completely and utterly confused, but she remembered one thing about herself: she was born on 11/11/1911. She was like 98 years old and she knew that she was going to turn 100 years old on 11/11/2011. It was the only thing she could keep in her head.
She died at age 99, without making it to 11/11/2011. My coworker told me they had a moment of silence for her on that date.
Coworker #2: "Yeah, that IS cool! It's sort of fun to write it."
Me: "Yeah, I'm going to really enjoy writing that today."
And I wasn't being sarcastic. Which says something about my life not exactly being filled with excitement.
Today is 1/3/13, another date that's "fun" to write. I don't know if there will be any more of those this year, so I'm going to have to really enjoy it and make it last. (OK, now being a little sarcastic.)
One of my coworkers told me a story about how at a nursing home several years ago, she had a patient who was this really demented little old lady. She was completely and utterly confused, but she remembered one thing about herself: she was born on 11/11/1911. She was like 98 years old and she knew that she was going to turn 100 years old on 11/11/2011. It was the only thing she could keep in her head.
She died at age 99, without making it to 11/11/2011. My coworker told me they had a moment of silence for her on that date.
Wednesday, January 2, 2013
Home call pages
When I was a resident, we took call from home. Considering we had to work the entire next day after being on call, the attendings would tell the nursing staff that they shouldn't page us in the middle of the night about unimportant things that could wait till morning. But they still did, because that's life.
A few of us were complaining about it during lunch one day, and an attending sitting near us in the cafeteria overheard. She came over to us and said, "The nurses shouldn't be paging you about unimportant things like that."
Yep.
"I'd like you to write down every single page you get every time you're on call," she told us. "And then hand it in to me.
"You mean just the inappropriate pages?" I asked.
"No, all of the pages," she said.
"When it's 2 in the morning, you want us to find a piece of paper and write down what the page we just got was for??" a flabbergasted resident asked.
I get that she was trying to help and meant well, but creating extra work for residents in the middle of the night was not helpful. We might have been more on board if we thought there was absolutely any chance that this measure would result in any changes. The nurses didn't respect this attending any more than we did.
Needless to say, none of us started writing down every single page we got.
A few of us were complaining about it during lunch one day, and an attending sitting near us in the cafeteria overheard. She came over to us and said, "The nurses shouldn't be paging you about unimportant things like that."
Yep.
"I'd like you to write down every single page you get every time you're on call," she told us. "And then hand it in to me.
"You mean just the inappropriate pages?" I asked.
"No, all of the pages," she said.
"When it's 2 in the morning, you want us to find a piece of paper and write down what the page we just got was for??" a flabbergasted resident asked.
I get that she was trying to help and meant well, but creating extra work for residents in the middle of the night was not helpful. We might have been more on board if we thought there was absolutely any chance that this measure would result in any changes. The nurses didn't respect this attending any more than we did.
Needless to say, none of us started writing down every single page we got.
Tuesday, January 1, 2013
Diapers are not expensive
This is sort of like an anti-whine.
When I was pregnant with my older daughter, everyone told me how expensive diapers are. From now on, diapers were going to be making up a huge chunk of our budget. I should consider cloth diapering just so we didn't descend into poverty due to the huge cost of diapers. I was going to have make a hard decision between paying for diapers or sending my kids to college. In order to pay for diapers, I was probably going to have to, like, sell my body or something. And so forth.
And then I had the baby, and you know what? Diapers are not expensive.
No, they're not free. But for a middle class family, they're not really a significant expense. We get our diapers now on Amazon through subscribe and save, and they cost 17 cents each. So that's about a dollar a day for diapers. If spending an extra dollar a day is enough to break me, I probably have worse concerns than diapers.
When I was pregnant with my older daughter, everyone told me how expensive diapers are. From now on, diapers were going to be making up a huge chunk of our budget. I should consider cloth diapering just so we didn't descend into poverty due to the huge cost of diapers. I was going to have make a hard decision between paying for diapers or sending my kids to college. In order to pay for diapers, I was probably going to have to, like, sell my body or something. And so forth.
And then I had the baby, and you know what? Diapers are not expensive.
No, they're not free. But for a middle class family, they're not really a significant expense. We get our diapers now on Amazon through subscribe and save, and they cost 17 cents each. So that's about a dollar a day for diapers. If spending an extra dollar a day is enough to break me, I probably have worse concerns than diapers.
Stages of a 30 hour call
Happy 2013! This will be my last cartoon repeat. Back to regularly scheduled blogging manana.
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