Unusual Conditions

High School Stereotypes

Guarantees for Intern Year

Reasons to call in sick

Personality Disorders in Med Students

The 32 Types of Med Students

First Week of Med School

Ways Med School is like Kindergarten

What's on your tie?

Holiday Hiatus

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

Happy Holidays!

Weekly Whine: Christmas music

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

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

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

Life Insurance

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

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

He quoted:

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

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

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

WORLD backwards

Worst Rehab Call

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Really??" the orderly looked astonished.

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

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

"You do?"

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

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

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

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

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

"Hmm?" Dr. Blabber said.

"She looks really tired," the patient said.

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

"He means me," I said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Okay..."

"It's frank blood."

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

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

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

Dr. Orthochick: Scrub Nurses

Top Tricks Used By Scrub Nurses to Make You Look Bad

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

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

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

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

5. Asking you if you know how to scrub in

Kindle Matchbook

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

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

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

Characteristics

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

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

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

Alice still didn't know who she was.

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

Alice still didn't know who she was.

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

Alice said quietly, "Oh!"

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

Weekly Whine: Little Pocket

What's the deal with little pockets on clothing?



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

It's good to be grown up

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

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

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

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

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

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

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

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

Reasons not to have kids

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

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

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

So this is what she said:

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

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

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

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

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

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

Dr. Orthochick's Guide to Proper OR Etiquette

1. Never finish scrubbing in before your attending

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

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

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

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

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

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

Who are you?

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

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

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

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

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

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

Weekly Whine: C8

Why is there a C8 nerve?



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

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

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

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

Sleep Medicine

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

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

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

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

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

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

“You saw the patient yourself?” she asked.

“Yes,” I said.

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

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

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

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

Vicious cycle

Doctor gives patient prophylactic dose of SQ heparin

--> Patient has serious GI bleed

--> Doctor gets sued

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

--> Patient gets pulmonary embolism

--> Doctor gets sued

--> You can't win

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

Dr. Orthochick: Condescending

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

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

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

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

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

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

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

Rectal exams

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

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

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

"No..."

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

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

Guh?