Friday, November 29, 2013

Black Friday Deal

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


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

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

Thursday, November 28, 2013

Thanksgiving poo

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

Wednesday, November 27, 2013

Book recs

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

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

Tuesday, November 26, 2013

Dr. Orthochick: Worst morning...

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

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

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

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

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

Well, that ruined my morning.

Monday, November 25, 2013


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

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

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

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

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

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

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

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

Saturday, November 23, 2013

Weekly Whine: Jars

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

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

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

Friday, November 22, 2013

Expanded distribution

The Devil Wears Scrubs is now available EVERYWHERE. Including:

Through Barnes and Noble

And in Canada!

Buy a copy today!

Thursday, November 21, 2013

Most Useless

Question of the day:

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

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

My answer:

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

In general:

All the capitals of Africa.

Wednesday, November 20, 2013

Dictation errors

Seen in dictated note:

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

Say what?????

Tuesday, November 19, 2013

Dr. Orthochick: Overreaction

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

Dr. James: What did everyone say?

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

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

Me: Not quite…

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

It must be fun to be married to that guy.

Sunday, November 17, 2013

Sleep and residency

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

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

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

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

Saturday, November 16, 2013

Weekly Whine: Show up early

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

Friday, November 15, 2013


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

Wednesday, November 13, 2013


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

Patient: "Osama?"

Me: "Uh, not quite."

Patient: "Bin Laden, right?"

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

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

Tuesday, November 12, 2013

Dr. Orthochick: Pre-op

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

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

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

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

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

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

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

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

P.S. Only a few hours left to get The Devil Wears Scrubs for only 99 cents! It's Dr. Orthochick-approved!

Monday, November 11, 2013


For TODAY ONLY (and for 24 hours), The Devil Wears Scrubs will be on sale on the Kindle for only 99 cents. This is a special KDP promotion that will not be repeated!

The promotion starts today, Nov 11, at 8AM PST!

Buy it now!

Saturday, November 9, 2013

2 (Parody of Taylor Swift's 22)

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

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

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

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

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

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

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

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

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

Weekly Whine: Old Comments

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

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

Some people have too much time on their hands.

Friday, November 8, 2013

Post-call checklist

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

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

Thursday, November 7, 2013


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

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

"Oh yeah. Sorry."

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

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

Wednesday, November 6, 2013

Flu vaccine

Have you gotten your flu vaccine yet?

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

(The myths debunked)

Tuesday, November 5, 2013

Dr. Orthochick: Oxygen

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

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

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

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

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

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

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

Nurse: Well the husband is yelling at me--

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

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

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

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

Monday, November 4, 2013

Consults are fun

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

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

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

Me: "That's true."

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

Me: "Today is actually Tuesday."

Chief: "Oh, yeah. It is."

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


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

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

Saturday, November 2, 2013

Weekly Whine: Hyperlink

This is both a whine and a plea:

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

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

Friday, November 1, 2013

I'm going on a book tour!

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

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