Wednesday, October 30, 2013

A long month

Found in a chart:

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

Tuesday, October 29, 2013

Dr. Orthochick: Bad med student

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

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

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

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

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

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

Brad: I'm on vacation now.

Me: Oh. That's nice.

Brad: Yeah, two weeks off.

Me: Enjoy.

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

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

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

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

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

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

Chief: I'll do that.

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

Sunday, October 27, 2013

The Devil Wears Scrubs: Addressing Comments

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

1) It's too short

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

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

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

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

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

Saturday, October 26, 2013

Weekly Whine: Commenting

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

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

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

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

Friday, October 25, 2013

Pretty sure...

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

"Your liver's on the right."

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

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

"Are you sure?"


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

Thursday, October 24, 2013


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

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

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

Wednesday, October 23, 2013

Transcription error

What was said:

"We then performed renoscopy again."

What was written:

"We then performed with David Bowie again."

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

Tuesday, October 22, 2013

Dr. Orthochick: Knee Pain

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

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

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

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

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

Monday, October 21, 2013

Gunner stories

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

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

Saturday, October 19, 2013

Weekly Whine: Inappropriate childcare

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

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

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

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

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

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

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

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

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

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

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

And here's the best part:

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

Tuesday, October 15, 2013

Dr. Orthochick: Thorough exam

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

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

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

Monday, October 14, 2013

Worst surgery story

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

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

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

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

What is your worst surgery clerkship story?

Saturday, October 12, 2013

Weekly Whine: Michelle Au

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

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

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

And you know what?

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

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

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

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

Thursday, October 10, 2013

That test... you know....

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

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

Wednesday, October 9, 2013

I made a mistake

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

Buy it now for only $2.99!

Tuesday, October 8, 2013

Dr. Orthochick: Code M, Part 2

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

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

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

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

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

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

Monday, October 7, 2013

Get a free Kindle copy of The Devil Wears Scrubs

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

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

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

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

Apple recipes

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

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


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

Any delicious and easy recipes involving apples?

Sunday, October 6, 2013


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

Patient: "Obamacare."

Saturday, October 5, 2013

Weekly Whine: Bitch

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

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

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

Thursday, October 3, 2013

Working with residents

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

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

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

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

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

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

Resident: "That's our lecture day."

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

Resident: "Well, until 2."

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

Resident: "Nothing."

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

Resident: [stares at me in horror]

Tuesday, October 1, 2013

Obamacare: Love it or hate it?

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

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

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

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

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

Now your turn.

Be nice.

Dr. Orthochick: Dilemma

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

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

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

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

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

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

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

Cultures are not obtained during the surgery.

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