Guest Cartoon: Profile of a Hospital Nurse

Note: Contributed by Eva Balajadia (aka evaganda), Creator of www.thenurseslockerroom.com

What will you do for me?

There was a resident in my program who I will call Bob. Whenever you asked Bob for a favor, his immediate response was, "And what will you do for me?"

Bob was a good resident, honestly. He was diligent and responsible. But I found this attitude really annoying.

For example, one day I got four admissions and Bob only got one. I was asked to follow up on a consult I'd seen a week earlier, and I asked Bob if he could cover that for me, since I was completely swamped. Immediately: "And what will you do for me?"

I feel like there ought to be a camaraderie in residency. If you do a favor for someone, eventually they will end up doing a favor for you. It shouldn't have to be a direct one to one trade-off.

One day some orthotists came to adjust Bob's patient's neck brace. They needed a doctor to hold the guy's head. Bob wasn't on the floor and I wasn't that busy, so I told them not to bother him and I'd do it. I didn't even tell Bob I was doing it. I had the time to do it, so I did it.

I feel like that's the way it ought to be in residency.

Relevant

Honestly, I understand why a physician might not want to seem nosy or asking inappropriate questions of a patient. But seriously:

Asking your patient why they don't have legs is a relevant part of the medical history.

I was supervising a resident doing an EMG the other day and I was shocked to enter the room and discover the patient was a bilateral above knee amputee. Granted, the patient came in for numbness in the hands, but I was still baffled when she didn't even ask the woman why she didn't have legs. I mean, at least mention it when you're presenting the patient so my jaw doesn't drop open when I see her.

Weekly Whine: Journals

I hate getting journals in the mail.

I guess in this day and age, it probably doesn't happen as much as it used to. But I still somehow have two journals coming at regular intervals to my house.

Do I read these journals? No, of course not.

I'm sure I should. I should at least read all the abstracts, so I can keep abreast of major developments in my field. But I don't even do that. I toss it, feeling simultaneously guilty about both the waste of knowledge and the waste of paper. But what am I supposed to do? Save them? Make some empty promise that someday I'd read them, maybe while I'm on the toilet or something?

I do get regular clinical updates online and I do my CMEs and I work in a somewhat academic environment, so I tell myself that's good enough. I don't have to feel obligated to read Archives of PM&R cover to cover.

Not a woman

Me: "Mr. Smith?"

Patient: "Yes..."

Me: "Hi, I'm Dr. McFizz."

Patient: "Oh no, are you the one who's going to be electrocuting me?"

Me: "Ummmmmmm.... I guess."

Patient: "But I specifically said I didn't want a woman to do it."

Me: "Are you serious?"

Patient: "Last time, a woman did it and she really hurt me. I don't want a woman."

Me: "Well, all the residents today are female, so it looks like you're out of luck."

Patient: "What about Dr. Attending? Can't he do it?"

Me: "Nope."

Patient: "Women always screw things up. They can never take my blood right. They're always hurting me."

Me: "I'll try not to hurt you, Mr. Smith." Even though I really really want to.

I have to admit, that was a first. Honestly, usually patients are happy to get a female doctor if they show a preference either way.

Triple negative

OK, this was in a dictation I read today:

"I do not feel it would not be contraindicated for the patient not to get coumadin."

Nice job with the triple negative. So, um, is it okay for the patient to get coumadin?

Radiation risks

This is a topic I discussed a while back on Mothers in Medicine, but it came up somehow in the comments on this blog, so I figured I'd turn it into its own entry. (i.e. it's my blog and I'll do what I want to)

It goes back to an experience I had during residency when I was about four months pregnant.

It was generally the resident's job to hold patients' heads during flexion-extension spine films, which would come up maybe every other week or once a month. Most of my attendings immediately insisted that I couldn't be in the way of X-ray beams and would generally do it themselves. So for the first couple of months, this was never an issue.

However, I had one attending (a mother herself) who seemed baffled by why I didn't want to do it. "But you'll be wearing lead," she pointed out.

In any case, she refused to do it for me and made me find another resident willing to do it. (And the first resident I asked was a total jerk about the whole thing, asking what I'd do for him in return even though I'd done tons of favors for him in the past without expecting immediate retribution.)

There are a lot of women out there in medicine who get exposed to radiation in pregnancy. It can be an occupational hazard. In my last month of residency, I was assigned to a rotation doing daily fluoroscopic injections (thanks, chiefs!), but I had absolutely no trouble finding another resident to switch with me since that was a coveted procedure.

People who work with radiation a lot will tell you that the risks are minimal. They wear radiation counters and will tell you that their exposure is practically negligible. And you know what? They're probably right.

But here's the thing:

1) The vast majority of attendings and residents I worked with never even remotely questioned my decision not to be exposed to radiation.

2) There's data but obviously no randomized controlled studies.

3) There's a box on X-ray forms for patients asking if the patient is pregnant. That's for ONE X-ray, not for repeated exposures.

4) When I received a serious injury during pregnancy and needed an X-ray of my ankle (not near my uterus), the doctor was really reluctant to order it due to my pregnancy.

5) I'd feel like a total slimebag if I asked my pregnant resident to do something like that.

6) On another occasion when I went to hold a patient's head and wasn't pregnant, the tech quizzed me on whether there was any chance at all I could be pregnant before he let me in.

7) There are fellows in cardiology programs who are not allowed in the cath lab. Presumably, this decision is made by educated professionals and not Scruffy, the bum who sits outside the hospital.

Clearly doctors are not comfortable saying that this exposure is safe in pregnancy, so I think it's wrong to call me "irrational" for wanting to avoid exposure. I think it's extremely rational and even normal to worry about being exposed to radiation in pregnancy and wanting to avoid it if possible.

However, it seems like women in medicine who have had exposures during pregnancy become absolutely furious when I mention this story. I have no idea why this is, but it's happened to me multiple times. Is it guilt? Is it that pervasive "I did it so you should too" attitude in medicine?

I don't think you're a terrible person if you went into the cath lab while pregnant. But I feel like it should be the pregnant woman's choice to do this. I maintain that I should not have been pressured to walk in front of X-ray beams while pregnant.

Sensory testing

Me: [lightly touching the inside of patient's knee, which is L3] "Does this feel normal?"

Patient: "Yes."

Me: "And equal on both sides?"

Patient: "Yes."

Me: "Okay."

Patient: "You can keep touching me there."

Me: [horrified]

The laws of driving

When I was taking my kids to daycare the other day, I was driving along a small two-way road. The speed limit was 30 MPH and I was going roughly 35 MPH.

Suddenly, the car behind me crossed the double yellow lines to my left so that they could try to overtake me. It was a little tempting to speed up at that point, but having my kids in the car and not being a freaking idiot, I just let them go ahead of me.

About a minute later, the road divided into two lanes and the other car arrived at the light at exactly the same time I did. So they broke two laws (crossing double yellow lines, speeding) in order to gain zero time.

I was a little irritated, but then I told myself: maybe this is an OB/GYN rushing to get to the hospital to do an emergency C-section! (Yeah, right.)

Of course, then I got to thinking about how doctors do sometimes get pulled over for speeding or breaking other traffic laws while rushing to an emergency. I even heard about an OB/GYN who got arrested after safely delivering a baby in distress because he had refused to wait around for the officer to give him a ticket.

Yes, there are emergencies in medicine and that can be an excuse for running a red light or speeding. But truthfully, no matter how important where you're rushing is, it's not more important than the lives of the other people on the road. I heard a story about a cardiologist rushing to get to an emergency at the hospital who ran a read light, and killed two children.

What do you think? Does a doctor who's speeding to get to an emergency still deserve a ticket? I say yes.

Cruel resident stories

As I mentioned earlier on this blog, I've been considering writing a fictionalized account of my intern year. Basically about how my senior resident was a total shit to me.

Since it's fictionalized, it doesn't have to be about my own experience. So I'm looking for inspiration. If you have a great story about how your senior resident or attending was super cruel to you in some horrible way, please email it to me at fizzziatrist@gmail.com (note the extra Z).

If I end up using your story, I'll thank you by name in the acknowledgements. (So tell me how you'd like me to mention you!)

The Giggles

People often tell me I have a good sense of humor, and it's not because I'm necessarily funny myself, but because I laugh at everything. When I was in grade school, people used to say that if Fizzy didn't laugh at something, then it definitely wasn't funny.

In that vein, it is really inconvenient when I get a case of the giggles in front of a patient.

When I was on my EM rotation as a med student, this six-year-old kid named Justin was brought in by his parents. Justin had a toy gun stuck in his hand. It had this little wire antenna sticking out of it and this was the part that had mysteriously gotten through his skin and wouldn't come out.

Apparently, Justin had been begging for this toy all summer. But the store wasn't stocking them yet. Finally, at the end of the summer, the store got a shipment and his mother bought it for him. The gun had a little antenna with a red ball at the end of it. Literally, within fifteen minutes of him opening the gun, the red ball fell off and the gun got stuck in his hand. Except nobody, including his mom, could figure out how he managed to do it.

I don't know what it was. Maybe it was the exasperated and baffled tone in which Justin's mother told the story. Maybe it was the fact that nobody could figure out how that little piece of the gun got stuck in his hand... even his mom kept asking, "Justin, how did you do that?" Or maybe it was the image of the little six-year-old calmly sitting there with his new toy stuck in his hand.

In any case, when they were cutting the toy out of his hand, and Justin's grandfather said to the mother, "Well, he's not going to play with it anymore... is he?" I don't know, I just lost it.

It was SO BAD. I mean, I held it in, for the most part, but I really just wanted to bust out laughing. And that's probably happened to me at least a dozen times in my career.

Not funny, Fizzy.

Weekly Whine: Crossovers

I remember when I first saw The Muppets Take Manhattan. They had the wedding at the end and some of the cast of Sesame Street was there, and I was like, "Oh my gosh, it's the cast of my favorite show in this movie! This is the best thing EVER!" I was mega impressed.

Of course, I was five years old.

I find it really hard to believe anyone much over the age of five could be that impressed by these crossovers. I actually find them very irritating. Like when I'd be watching Empty Nest and all of a sudden, one of the Golden Girls would pop in for no apparent reason (other than to get a ratings boost).

In my opinion, the ONLY show that ever did it well was The Simpsons. They were self-conscious enough about the crossovers that it was actually funny.

The reason I'm whining about it now is that I've been noticing it more and more in books I've been reading. Emily Giffin did it in her last two novels, and it's beginning to really piss me off.

If you are writing a sequel to a book you wrote, then fine, you can use the same characters. Otherwise, it's obnoxious.

For example, if Rose from In Her Shoes is walking her dog in the park, I don't want her to run into Cannie from Good in Bed and have a little conversation, just for fun. This has nothing to do with the plot. It's as tacked on as Jennifer Hudson in the Sex and the City movie.

I don't even know why authors do that. It can't help sales the way it helps TV ratings. Frankly, I think it's a form of masturbation.

Morning lectures

Most residency programs have some sort of lecture series built in to the program, in order the satisfy ACGME regulations. In my first year of residency, we had two hours of lecture weekly at 7AM.

For PM&R residents, especially at my program, 7AM was really early. I mean, it was prohibitively early. Nobody seemed able to make it to lecture that early and the residents whined constantly about it. The response of the program director was to threaten us. One of the first emails I ever got from the PD was saying that we’d be put on probation if we missed or were late for too many lectures (and welcome to residency!).

The next year, the lectures were moved to 7:30AM. This was still too early. Finally, in my last year, they were moved to 8AM. Still, this was kind of early, especially for the PGY4s.

These lectures somehow seemed to bring out the worst in everyone. The residents would whine about them being too early, not useful, and complain about the threats of extra call or probation for no shows or latecomers. Moreover, the residents would take their sweet time getting back to work after the lecture. Yes, we all worked at different locations, but none of them were more than 30 minutes away from each other, much less TWO HOURS.

At the same time, the attendings and administrators didn’t show their best side either. Instead of scaling back their clinics during those mornings, a lot of attendings canceled their clinics altogether. I mean, is an attending really incapable of seeing a few patients alone one morning per week? Really? And the inpatient wards were a mess. Some attendings had to be yelled at by the chairman because they would refuse to see any patients or do absolutely any work until their resident showed up for the day, leaving the resident to do a day’s worth of work in half a day.

And the threats were unpleasant as well. The most popular threat was that we’d get extra call if we were late. One particularly stringent chief resident informed us that there was absolutely no excuse for being late. He said if we were in a car accident that morning, we would still be marked down as being late or absent.

Me: “You’re joking, right? You’d penalize someone if they were late because of a car accident?”

Chief: “What’s the difference? It’s just one extra call.”

Of course, they were idle threats. I don’t think anyone ever got extra call over being late; otherwise, the senior residents would have done the majority of call during that year.

Residents are not slaves

Lately in some posts I wrote about my own residency, I got some negative comments about requests I'd made of my attendings. Apparently, some people feel that asking an attending to lift even a little finger is unacceptable. Like if you needed a piece of information, and the resident would have to run across town to get it versus the attending having to make one quick phone call, that resident better get on his running shoes.

And I quote:

"Interns do scut work. Attendings don't."

Here's a novel idea:

Residents are not slaves.

And on a similar note, attendings are not gods.

The purpose of residency is to learn, not to provide cheap labor. The job of residents is not to do scutwork. If they do scutwork, it's to free time up for the attending to teach. That is the exchange, or at least, it should be. The more scutwork you hand to residents, the more teaching you ought to provide. When I supervise residents, I always try to split the unpleasant work.

I've noticed an interesting pattern though: the more attendings seem to rely on residents for scutwork, the less interested they seem in teaching. Why is that?

Nostalgia

I was recently at my parents' house and looking over some old writing assignments I did as a kid. It was pretty awesome, to be honest. I wanted to share some gems.

This was a description I wrote of a character. The year was 1988:

Stephanie is cool. She has darkish golden blond shoulder length hair. Bangs too. It kind of curly, but not very curly. Her clothes are awesome! Today she was wearing a button-up shirt falling just above her knees, blue. Blue stretch pants. White high-tops. Push-down purple socks. It was cool.

Don't you love the totally horrible 80s outfit being described as cool?

A biography:

I’m Fizzy. I am 8 years old and my hair is dirty blond. My favorite sport is basket ball. I like to listen to the piano. My favorite food is a strawberrys. I like mystery stories and funny ones. I like lots of movies, especially funny ones. I don’t have any pets. I have a brother. My eyes are blue. My height is 4 feet and 6 inches. I like apples. I hate olives. My parents are both doctors. I like Spelling and math in school.

Also, for those of you who were wondering, I knew I wanted to be a doctor even when I was eight years old:

I want to be a doctor because I like when poeple are cured from a disease and if I become a doctor the population of sick people will go down a little bit more.

Aw. Hopefully, the population of sick people is going down a little bit more.

Also, I wrote a thriller:

I am a bus. I was made in 19--. I’m blue and silver. Sometimes people write on me. I can hold 50 passengers. I bus 203. I go up 3rd avenue and down 2nd. I have flashy lights, that are red. I have windows. I have doors. I have poles. I have wheels. I can make turns. I bump sometimes. My tires break sometimes, I have to get new ones. I have a driver. I ride up and down the streets. I enjoy being a bus. I enjoy the people who ride on me.

One day, my driver on vacation. My doors were open. Someone came in, he was dressed in black. He started driveing me. I went strate very fast, and then I made a turn, he fell out because the door was open. I was a hero.

I'm not totally sure, but I think that last paragraph referred to the bus getting highjacked. The comment from my teacher was "what a bus you are, and hero to boot!"

Also, a book report I wrote on a book called The Cay. The last paragraph had me laughing to the point of tears:

Write a short summary of the book.
Phillip was stranded on an island with an old black man called Timothy and Stew cat. The Phillip becomes blind. They have to servive the Cay all alone. Timothy is worried he will die. Then he does and Phillip is all alone. In the end they get rescued and Phillip can see again.

What would have been the hardest aspect of Phillip’s struggle for survival for you?
Trying to get used to being blind. If you could see all your life and then one day you became blind it would be scary.

Have you ever thought about being stranded on an island?
I once thought about being stranded on an island after I read this book, except I don’t remember it because it was a dream.

Why did Phillip and Timothy have some difficulty getting along at first?
Because Timothy was black and Phillip was white.

Think of another character that could fit into the story.
I wonder what would happen if they had a baby on board. They could make the baby in it’s terrible twos and wants to get into everything!

The comments from my teacher were "A+, Again, excellent report!"

Seriously, what do you have to do to get a 3rd grade teacher to tell you that you did a bad job? Do you need to crap on a piece of paper and hand in the excrement as your assignment? I honestly think that's what you would need to do.

Reading over my stories and papers, a few things occurred to me:

1) I wrote a LOT my whole life. Like an abnormal, crazy amount for a kid.

2) Around age 13, my writing suddenly improved dramatically. It suddenly went from stupid to halfway decent. Even my husband noticed from the things I gave him to read. He told me (of my 8th grade writing): "It was actually readable. I didn't want to keep reading it, but it wasn't hilariously bad anymore." Actually, there was one story I wrote that was a biography of my great-grandmother that totally blew me away.

3) I suddenly got sarcastic around age 13 too.

I could probably spend like a week going through all the stacks of crap in my old room, but I don't think it's worth my time even though I'd have tons of things to make fun of, such as the above.

Bus bum

A couple of years ago, I used to take the bus to work. I could go on and on about the aggravations of riding the bus, but it was also kind of interesting. There were quite colorful characters on the bus.

One day, I was staring at this guy for most of the bus ride. He was dressed like a total bum/hippie with frayed jeans, a T-shirt, sideburns, and some hippie drink. Then I noticed he was wearing an ID badge and it said MD after his name. I was like, "No way! How is this guy a doctor and going to work like this?!"

Then I noticed under his name, it said "Psychiatry." OK, that offered somewhat of an explanation, but seriously, I'm pretty sure even a psychiatrist can't come to work in dirty jeans and a T-shirt.

Supermarket

If you are ever in the supermarket and are not sure what line to pick, watch and see which one I pick. Then pick a different one. I always pick the wrong line.

Behaviors that people in front of me on line show with irritating frequency:

1) Paying with a check. Who writes a check every time they buy groceries?? All old people, that's who.

2) Dividing the groceries into two piles, each of which has to be paid for separately. Because if you're one person, it would just be impossible to pay for your groceries all together. No, that's crazy.

3) Using large amounts of coupons. Coupons should not exist. They store already forces you to get a store card that they use to creepily monitor your purchases, so why can't those coupons be programmed into the card? Why are people forced to take a scissors and cut out these stupid coupons, half of which are expired or didn't work they way they thought they did?

Yesterday I was at the supermarket with my baby, and I really just got on the absolute worst check-out line. Worse, I switched lines (always a mistake) and the person behind me and three people after that finished up before I got to the head of the line.

I'm trying to recite zen stuff in my head, and at least the baby was behaving, thank goodness. And then the cashier says to me, "Do you have a {Supermarket] card?"

"No, can you run the store card?"

The guy does, but then he stops running my groceries and launches into this pitch about why I should get the card, but there's a mile-long line behind us and I was so not interested. So I cut him off and said politely (I thought), "No thank you."

And then he got totally pissed off. He started mumbling under his breath, "Everyone's always in a hurry. You know, I can only go so fast. It's not my fault I can't go as fast as people like."

I was livid. Not only did I have to wait forever on line and be subjected to this salespitch ever time I come in, I have to be YELLED at for it???

Amazingly, I was the one who had to apologize and said I just wanted to finish before my baby started crying. And I stood there and let him do the pitch. And I nodded politely. And then he apologized for being rude.

I'm not sure if I'm going to go to that supermarket ever again. Seriously, I don't need to be treated that way while trying to buy groceries with my baby.

A bargain!

For some reason, A Cartoon Guide to Becoming a Doctor is on sale from Amazon for only $11.69! I don't know how long this deal will last, so buy it now!

In related news, I have been toying with the idea of writing a fictional book based on my intern year. If I were to do such and thing and sell it on the Kindle for like $2 or $3, would people actually buy it? Because I've been wanting to do this forever, but have had a lot of motivation due to the fact that I thought nobody would read it.

Hot patient

How do you react when a patient (of the opposite sex) is totally hot?

When I used to do Sports clinics, some of the patients would be total hotties. For example, I remember one guy who was about 25 and a firefighter. He was in excellent shape. He had shoulder pain and in order to properly evaluate shoulder pain, you must have the patient remove their shirt. It's part of the physical exam, I swear.

Anyway, he took off his shirt and it was sort of like that moment in the movies when the hot guy takes off his shirt and all the women in the audience gasp and they play that "oh yeah" music. I mean, wow, he was ripped. He was so ripped, it was actually getting me a little flustered.

Now I was a total professional, I promise. Honestly, muscles don't even usually impress me. I mean, maybe if instead of being a firefighter, he worked at Google or something, that would have been different. But even so, like I said, I was definitely slightly flustered. Maybe it was because he was shirtless and I was worried that he thought I might be admiring his huge muscles. Or maybe because a guy roughly my age was half-naked in front of me.

I mean, I'm only human, right?

Oh alone!

So a couple of months ago, I asked if anyone could help me identify a song from the radio. The only lyrics I could remember were "Oh! Alone!"

So the song came on again today. I managed to identify it this time. The song is called Alive by Krewalla.

I guess I can't be disappointed nobody got it, since I only could remember one word and it was the wrong word.

Weekly Whine: Mama's boys and Daddy's girls

I have two daughters, and it seems like a lot of people are compelled to point out to me that:

1) Boys are always closer to their mothers

2) Girls are always closer to their fathers

I guess they're trying to tell me I should have had sons? That I blew it?

Aside from the fact that it's obnoxious to say that to a woman who has two daughters, I think it's untrue. Correction: I know it's untrue.

I love my father and I consider myself close to him, but I'm far closer to my mother. When I was growing up, it was my mother who heard about every single one of my friends, all my crushes, my dates, etc. My father only knew who I was friends with or dating on a strictly need-to-know basis. In college, I talked to my dad once a week on Sundays, and my mother every single night. I can't even imagine talking to a man (even if that man is my father) about some of the personal things I talk to my mother about.

I do think girls tend to be closer to their parents in general. I always use the example of a pair of siblings I knew in college: a boy and a girl. The boy used to call his parents once a week, the girl every night. Same parents, same family.

Ultimately, I think it depends on the parents and the child what their relationship is going to be. Your relationship is what you make of it. I certainly don't think it's fair to say that just because my child is a girl, I'll never be as close to her as if she were a boy.

Pregnancy prevention

Quote of the day:

Patient: "I don't like taking medications. If I were a woman, I would have gotten pregnant at, like, 14."

Me: "Um..."

Patient: "Because I could never have taken the birth control pills every day, ya know?"

Yeah, it's a damn lucky thing all 14-year-old girls are on birth control pills, otherwise there'd be an epidemic of pregnancies. Clearly, there's no other way to prevent pregnancy. Like, for example, condoms. Or maybe even not having sex at age 14.

Profile: 4th Year Med Student

Politics in the family

As part of my mental status exam, I always ask patients if they know who the President is. At least 90% of the time, the patient feels compelled to make a comment about it. Like, "Unfortunately, Obama." A few of them hate him so much that they refuse to say his name.

I don't need to know your political affiliation, really. Just tell me the name of the President.

I interviewed a patient yesterday who launched into a segue about how she voted for Obama but her husband didn't. That he's a staunch Republican and she's a staunch Democrat.

I didn't ask her, but I couldn't help but wonder how that works. Can you really be married to a person whose political views are so diametrically opposite to your own?

More Cruel Resident Stories

For all of you who have been reading Cruel Resident Stories, you already know that my very first senior resident Jessica was, like, my archnemesis. I really, really hated that woman. And I hated her even more when she was assigned as my resident again during my first week of ICU. I was really being punished.

After spending a week of ICU hell with Jessica, I ran into one of my co-interns named Nancy on the wards. One thing I loved about Nancy was that she was very honest about herself and about others. I told her that I hated the ICU, but I didn't hate it as much now that Jessica wasn't my resident anymore. Nancy nodded knowingly.

I was encouraged by this, because I was beginning to think I was all alone in hating Jessica. Especially after the last ICU intern, Connie, had seemed to like her. I grilled Connie about her, and Connie had absolutely nothing bad to say.

Nancy told me that when she was doing cross-cover, there had been an incident and Jessica told Nancy flat out that she had "dropped the ball." Nancy, not being the sort of person who takes shit (unlike me), had shot back that she didn't drop the ball and that she had done everything right and the outcome couldn't have been avoided. Apparently, according to Nancy, Jessica apologized after that. Nancy also told me that she had heard Jessica mumbling about interns not dictating discharges when they knew they had a day off coming up.

“So how come Jessica was so nice to Connie?” I asked.

“Well, they’re both new moms,” Nancy said. “So they relate to each other. It’s a mother thing.”

I told Nancy that I used to go home crying after practically every call with Jessica, and Nancy said, "I'm sure she knew. And that's why she treated you the way she did."

Cruel Resident Story

This isn't a cartoon, but at least it's very cruel...

On call, during hour #26 of being awake:

I’m rushing to finish writing one of three transfer orders, two discharges, and six notes, all of which had to be done before hitting my thirty hour cap. While juggling two things at once, my attending (who was actually a very nice guy) asked a question about a patient that I didn't quite catch.

I guess nobody knew the answer to the attending's question and he had to go to the patient's med rand to find the answer himself (the med rand being about 10 feet away). While the attending was going to look up the info, my evil senior resident Jessica leaned toward me and said, "You should never let the attending stand up. When he wants information, you should get up and get it before he does."

First of all, Jessica, the attending hasn't been on his feet for 26 hours straight. And he doesn't have five billion things to do in the next four hours. And furthermore, it's not like she was doing anything so important that she couldn't go look up the information herself. Why don't I just carry the attending on my freaking shoulders during rounds, how about that?

After Jessica finished quietly scolding me, the attending returned with the information he had wanted and didn't seem at all upset that I hadn't dropped everything and raced across the room to retrieve it for him.

And as you can see, almost a decade later, I'm still pissed off about it.

(Not really. But sort of.)

Single parent

A long time ago, before my husband and I were married or even dating, I told him that if I wasn't married by the time I was 35, I was going to go ahead and have a baby on my own.

He felt this was a totally ridiculous concept and still mocks me for having said it. He doesn't necessarily think a single woman who gets knocked up should have an abortion, but he's horrified that someone might plan to be a single mother.

I still feel like I was justified in saying that. If a woman wants to be a mother and she hasn't found a partner yet by an age where her reproductive time is coming to an end, why shouldn't she go ahead and have a baby on her own? What is so wrong about that?

Weekly Whine: I have the flu

This isn't a whine about the flu, even though I certainly don't like the flu. This is about about being who go around saying they have the flu.

When I was in my first year of residency, I was about four months pregnant and doing a rotation with an attending, who came in one day wearing a mask and announcing she had the flu. I was pretty irritated for a number of reasons:

1) I didn't think she had the flu, for starters. It was early October, not really flu season yet. And she didn't seem that sick. I tried to point this out to her and she insisted it was the flu as she coughed all over me.

2) If you have the flu, don't come to work and tell everyone about it! For God's sake, stay home! Especially if it's so early in the season that nobody has been vaccinated yet.

3) I hadn't been vaccinated yet. And I was pregnant!

OK, I've written about how it's hard to take time off if you're a sick doctor. And I stand by that. But at the same time, if you're going to come to work sick, you're obligated to at least play down how sick you are, not play it up. Telling everyone you have the flu as you cough on them is not cool.

Annoying attending

During residency, I had a vacation day scheduled for a Monday. I told my attending Dr. Amnesia about it on Thursday, since I knew she was going to be off on Friday.

Well, when I came back on Tuesday, I found out from other residents that Dr. Amnesia somehow FORGOT that I was taking a vacation day, and was panicking and paging everyone when I didn't come in Monday.

Best of all, when I returned, I was hoping Dr. Amnesia could fill me in on any updates from the day before on the patients on our service (each service had one attending and one resident). She completely refused. She said, "Well, how do you think you would find out what happened with your patients? You could read the chart, couldn't you?"

Yeah. Or you could just take five minutes and TELL me.

Ethical dilemma for a PCP

This is a follow-up to my post yesterday about abortion.

I think almost everyone, no matter what their stance is on abortion, agrees that no physician should have to perform an abortion if they believe it's wrong. I certainly believe this.

However, consider this scenario:

There is a primary care physician named Dr. Green who believes abortion is wrong. Naturally, as a PCP, she does not ever have to perform this procedure.

However, Dr. Green has a patient named Mrs. Blue. Mrs. Blue has some serious medical issues, and recently became pregnant accidentally with her husband, despite believing she was sterile. She was told in the past that she would definitely not be able to carry a pregnancy to term; however, Mrs. Blue really wanted a child and initially was hopeful she could make it work. Unfortunately, about six weeks into the pregnancy, Mrs. Blue starts bleeding and feeling ill. She makes the difficult decision to terminate the pregnancy, as it is almost certain to miscarry or else result in significant morbidity to herself and/or the baby.

However, due to her significant medical issues, Mrs. Blue is told that she needs medical clearance prior to the abortion. She quickly makes an appointment with her PCP Dr. Green. Dr. Green knows Mrs. Blue's significant medical history, knows she is already bleeding, but at the appointment refuses to give her medical clearance because she feels abortion is wrong.

This appointment occurs on a Friday and now Mrs. Blue must wait through the entire weekend to see her specialist to get clearance. Unfortunately, she does not make it through the weekend, starts hemorrhaging on Sunday, and has to have a hysterectomy.

Should Dr. Green feel responsible for this turn of events? If there are complications involved, should Dr. Green be subject to lawsuit?

(Some variation on this happened to a woman I know.)

Hypocritical

Somebody made a comment on a recent post of mine where I mentioned abortion. I know this is a super controversial topic, but I've noticed that I can sometimes post about really controversial stuff and nobody seems to care, whereas I'll say something about rice and get 200 comments.

Anyway, my statement was mostly that I think the Republican party's platform that abortion should be illegal except in the case of rape and incest is total bullshit. Completely hypocritical.

If you think abortion should always be okay, fine.

If you think abortion should never be okay, fine.

If you think abortion should be okay after a certain number of weeks or that some procedure is inhumane (even if that procedure is actually the safest for the mom), well, okay.

But I just can't understand how anyone could say with a straight face that they think abortion illegal except in the case of rape and incest. If you think it's murder, then it's ALWAYS murder. Do you really think that fetuses conceived through rape or incest have less of a right to live than those conceived by two stupid teenagers who never heard of a condom?

Okay, maybe you could argue that a girl who was raped went through some horrible trauma and she shouldn't have to relive nine months of the results of that trauma. And you know what? I totally agree. But I also think that a teenage girl who has consensual sex with protection and that protection fails shouldn't have her entire life ripped apart. There are tons of women who make responsible choices and still get pregnant.

To me, the Republican platform is about punishing women for choosing to having sex. It's not about saving poor little babies from being killed. If you are the child of rape, I still think your life is as valid as mine, so I don't know why that shouldn't apply prenatally.

PM&R by any other name....

All the people in my field kind of mourn the fact that the name of our field is so terrible. Physical Medicine and Rehabilitation. It's too long and doesn't have the same ring as... otolaryngologist. But nobody can think of anything better.

Here are some failed names suggested:

Myoneurobiologist
Neuromuscular orthopedist
Regenerist
Orthomyologist
Strategic medicine specialist
Neurosynergist
Physiomed
Flexicologist
Biomedist
Externist

Actually, I think it would be a good idea to just scrap the term "PM&R" altogether. Since we're called physiatrists, why don't we just call the field physiatry??

April Fools

Reception: "Your first patient of the morning called to say he's running late. He's a worker's comp patient. He doesn't speak English. He's coming in for pain in his head, shoulders, arms, back, hips, and legs."

Me: "Is there any possible chance this is all an April Fools joke?"

Not that I don't love worker's comp patients who don't speak English and have pain in every part of their body.

Well, could have been worse. At least "groin" wasn't included in there.