dictation error (I hope)

From a dictation:

"The patient fell and hit the back of his head. I then went to his son's wedding."

Beyond the call of duty I think...

I've got a job for you right here

Me: "Where do you insert the needle to sample the adductor longus muscle?"

Dr. Inappropriate: "Right here." [points to area one centimeter below his crotch] "So you feel for the pubic bone and--"

Me: "Um, maybe you could show me on the patient?"

Dr. Orthochick: On Peeing

One of the things i was worried about when I started med school rotations was the possibility of having to pee during surgery. (At the time i didn't realize that having to pee during surgery is about as inconvenient as having to pee during rounds or having to pee when you're following your attending around clinic. As far as I can tell, there are no rotations you do as a med student where you can just go to the bathroom if you have to go to the bathroom) So I didn't drink much water during my surgery rotations and everything worked out fine.

Since then, I've rarely had to pee during surgery. I think most of this is that orthopaedic surgeries aren't all that long. Usually they're around 3 hours or so, if I do a 5 hour one then I count that as a long surgery. I've done 8 hour surgeries (Although I seem to only do those during nights and weekends. Thanks, world.) and i figure when I start my spine rotation they'll get longer since it takes an hour to position the patient and get everything set up, but for right now it's not usually a problem and I can drink coffee in the morning and be OK.

The exception to this is if you have 2 rooms going. This happens a lot over here because ortho is such a big money maker for the hospital. So while you're finishing up in one room, they bring the patient back to the next room and you can just walk over when you're done, instead of waiting for the room to get cleaned and anesthesia to bring the patient back. Seeing as how it usually takes in between 15 and 30 minutes to get the room set up for the next case, this really saves a ton of time. But it means that I'm rushed like hell because the attending leaves the room while I'm closing up and then I have to finish closing, move the patient, do the orders, and meet the attending in the next room in the time it takes anesthesia to put the patient to sleep and for the patient to be positioned, prepped, and draped. Those are the days where you pray someone's got a difficult airway and they need a laryngoscope or something. So I don't get any time in between surgeries. It means on those days I'm hungry and i need to pee like hell.

I was closing up the other day and i seriously had to pee. Like, it was fast moving from "urgency" to "emergency." But I didn't have time to take a bathroom break in the middle of the cases since i had to rush over to the next room. In these types of situations, you're forced to make a choice: either wet your pants, or announce to the room that you need to pee. I've tried asking to be excused, but then people think you're just trying to get out of helping.

Me: I REALLY need to pee. Is it OK if once i finish closing I go pee instead of helping move the patient? Will you be OK without me?
CRNA: Do you also have to take a shit?
Me: No, I just have to pee
Scrub Nurse: elbows me in the bladder How badly do you have to pee?
Circulating Nurse: hey stop that, Orthochick has to pee really badly!

They did let me leave and I bolted for the bathroom and did my thing. (and for the record, really, I just had to freaking pee) I then walked over to the next room to start the next surgery.

CRNA2: Did you get a chance to pee?
Scrub Nurse2: Did everything come out OK?
Circulating Nurse2: Are you feeling better?

Seeing as how these three people were completely different from the three people in the previous OR, word spread that I had to pee in the time it took me to actually pee.

You seriously cannot go to the bathroom in peace in this place. Either your pager goes off mid-stream, someone knocks on the door when you've just pulled your pants down, or you get made fun of for needing to take care of a biologic function.

Also, seriously, how desperate are we for conversation if me having to pee becomes a hot topic for discussion in the entire operating area?

Hate it

When I was an intern, there was a third year resident in my program named Anna. I never liked her that much in the past because she always seemed really tired and irritable. She had a reputation for being a super ICU blocker. This means that when she was the resident in the ICU, she'd block patients that she knew were ICU level and make the residents on the wards manage them so she didn't have to deal with them. (Even though she knew they'd just come to the ICU the next day, after she was done admitting.) Conversely, when she was on the wards, she'd call the ICU and tell them she "doesn't feel comfortable" managing a sick patient on the ward and insist they go to the ICU. It's the sort of behavior that doesn't get other residents to love you.

But one month I started talking to her a little bit, and even though she was sort of tired and irritable, I kind of liked her style.

I collapsed into a chair in the admitting unit around 9PM and said, "This is the first second I've had to sit down all night." (And that included my "dinner", where I got paged no less than ten times and had a nurse demanding that I talk to a family NOW.)

Anna: "Yeah, night float is an awful rotation. It's really miserable."

Me: "It really is."

Anna: "But it's still better than wards."

Me: "....Yeah.... you're right, it is."

My revelation: Oh my god, you hate it here as much as I do!

Weekly Whine: Healthy Foods

For my daughter's class, she has a challenge where she has to bring in healthy snacks every day with the following constraints:

Less than 5g fat
Less than 5g sugar
Less than 200mg sodium

After a trip to the supermarket, I've decided my daughter will be eating water and air.

Seriously even unsweetened apple sauce had 6g of sugar! Is food really that unhealthy or are those constraints crazy?

What medication are you on?

Dr. Orthochick: Social Work

Medical Social Worker: You patient is allergic to (very cheap) Drug A but she doesn't have insurance. What are you going to send her home on?

Me: Well, we could put her on Drug B, which is cheap, but then she'll need to stay in the hospital an extra 2 days to make sure it's working, plus she's going to need weekly lab draws. Drug C is going to be approximately $140 a month and she'll have to learn how to inject herself. Occasionally you can get assistance with that, but it takes at least 24 hours for the paperwork to go through, so we're not going to get that until tomorrow so she's going to have to pay for another night here. Drug D is going to cost $280 a month but at least it's a pill that you take once a day. We're not going to be able to get assistance with coverage because she had an elective surgery. The only other alternative is Drug E, which we can take advantage of a loophole and get it covered for $15 a month if I call the company before 16:00, but it's not technically approved for (this issue) so she has a higher risk of (complication). So I'll go in and talk to her and see which option she wants and then I'll make the necessary phone calls.

MSW: Do you need anything?

Me: Nah, I have the numbers for [Drug Company D and Drug Company E] in my phone and the forms are saved on my usb drive.

MSW: You've done this before, haven't you?

Me: Once or twice.

See, this is why attendings choose to work with residents. Because otherwise they have to do all this crap themselves.

Penny

So a week ago, the monitor on my computer at work stopped functioning. I called IT, and they said they'd probably have to replace the monitor.

The next day, I came to work and the monitor was functioning again. Except there was a penny taped to it:

I can't figure out why the penny is there. But I'm afraid to remove it because it may be the only reason the monitor is working.

Weekly Whine: Life Insurance

Since I left my job that provided life insurance, the process of getting my own has been ridiculous.

My husband wasn't too keen on the idea because he thinks we're immortal, so he left it to me. And I am horrible with anything financial. But I figured I could find an agent to take care of it for us.

First I got a recommendation from my boss of a really good agent. But this agent seemed reluctant to work with us after my husband wanted a guarantee he wasn't going to sell our medical info.

Then I got a second recommendation of an agent. Who has done nothing but lie to us. I knew insurance agents were pushy but I never thought they could be so sleazy. This guy (unbeknownst to me when I hired him) is a contractor for an insurance company that sells mostly whole life insurance, not term. So he offered us horrible deals on term insurance ($5,000 a year for my husband, who is mid-thirties and relatively healthy). And he has been really reluctant to get us quotes from other companies.

We've been working on this for about five months and now are contemplating a third agent. We've already filled out tons of paperwork and had physicals and I just want to cry at the thought of doing it all over again.

Why is it so goddamn hard to just buy some simple life insurance.

My First Residency Interview

My first residency interview was at 7:45AM. This seemed horribly, prohibitively early to me. It was fourth year, after all. It may as well have been at 3AM. Actually, 3AM would have been better because I would have still been awake at that time. In any case, I was not exactly bright eyed and bushy tailed when I went out the door in the morning. And I couldn’t sleep on the train to the interview site because I was afraid of missing my stop.

Most interview days for internal medicine programs started out with forcing you to attend morning report. I guess they figured this would ensure there would be a few people who were awake during morning report. They had free breakfast at the morning report, and some overpowering force made me select a box of Frosted Flakes. I instantly regretted this choice, because eating frosted cereal made me feel about five years old.

Right before morning report started, the assistant in charge of interviews approached me and for a second, I was sure she was going to tell me that my cereal was too loud and I should stop eating. But instead, she had come to warn me about my interviewer. He was a bit of a character, apparently. That made me feel great.

The actual interview wasn’t terrible. During IM interviews, if you’re a US grad and unless you’re interviewing at Snooty Ivy University Hospital, they’re mostly trying to impress you so you’ll come to they’re program. But since this was my first interview, I didn’t know that yet. So I said something incredibly dumb. I said, “Can you please tell me about some of your interesting cases?”

In other words, I held up a giant sign saying, “Please pimp me.”

The interviewer started in about a case of a patient with low potassium, high aldo, low renin. He looked at me and I guessed, “Conn’s Syndrome?” Score! It was a possible pheo, apparently. Then he started in on another case and I must have look horrified or something.

Interviewer: “Am I boring you?”

Me: “Um. No! Of course not. No, I was just wondering if you would give that last patient an alpha-blocker as a precautionary measure?”

Nice save, right?

At the end of the interviews, we all regrouped for a delicious meal of sandwiches in plastic wrap. The chief resident asked us if we wanted to go take a tour of the new wing of the hospital, which would mean staying later. I thought for half a second, then I made a disappointed face, "Sorry, I have to go back to work after this."

Oh my god, what a lie.

I sort of wanted to get into this program, so I don't know what possessed me to do it. I just didn't feel like staying. I was tired, I worked till 5 every other day, and I just wanted to go home.

Anyway, I connived my way into a ride to the train station with a guy named Richard who was also interviewing. He was also giving a ride to another interviewee named Christina. Through the whole ride, I totally got the vibe that Richard was macking on Christina. I felt very third wheely.

Christina was talking about her ethnic background and how she's got dark hair and eyes, but her young cousins are blonde, so she thinks when she's with them, everyone thinks she's their nanny. Richard said to her, "You? No way. You don't look like a nanny. You look...."

I expected him to say that she couldn't be a nanny because she was too hot, but instead he said, "I would say you're like... thirteen." And I was like, WTF was that? Is that supposed to be a compliment? No wonder you’re single, Richard.

Finally, we arrived at the place where we were dropping Christina off. She said, "Hey, let me get your email address in case I wind up getting a residency out here." Richard wrote down his email address and I didn't even offer her mine. I assumed she wasn't talking to me, although I had already said I was probably going to be in the area. Slightly awkward. But I was happy for Richard that he got some e-digits during an interview.

Dr. Orthochick: Court

Me seeing a new patient in clinic today. Middle aged guy with knee pain.

Me: So what's been going on?
Patient: Well, I'm an Officer of the Court. So I need to be very active and I'm always walking or running when I'm in court. And lately my knee has gotten so bad that I can hardly do my job.
Me: OK, so--
Patient: I don't know if you've ever been to court in session, but it's busy. I need to be on my feet. So when my knee gets bad, I have trouble walking from one side of the court to the other.
Me: So are you a judge or a bailiff or something?
Patient: No, I'm a basketball referee.

That is really not my first thought when I hear Officer of the Court.

Also, he kept on referring to it as "officiating in court," which I guess is not technically incorrect, but is really freaking confusing.

Bactrim

"This is inpatient pharmacy. You wrote for the wrong dose of bactrim."

"I didn't write for it. I'm cross cover."

"Why are you giving this patient bactrim?"

"Uh........" (checks sign-out) "PCP prophylaxis?"

"Then the dose is too high for that."

(checks sign out again) "Oh wait, maybe they're treating PCP."

"Then the dose is too low."

"Shit."

Beta

I've a favor to ask of you:

I wrote another novel, this one about medical school and gunners. I guess I'd describe it as a thriller. It's also about twice as long as The Devil Wears Scrubs, which everyone complained was too short.

I've had a few people read it, but I'd really like to get a couple more opinions and general critiques. If you'd like to be a beta reader, please send me an email. Here's what I'm looking for:

1) You have to have read and enjoyed my other book, since my writing style is what it is

2) You have to have time to do this... please don't tell me you'll get to it after your exams are over in June. I'm looking for it to be finished by the end of the month or at least mid-April. If you can't commit, please don't offer.

3) Preferably you're someone who's emailed me and who I've communicated with before, so I feel comfortable with you

4) Preferably this is something you're excited about doing, and not just a grudging favor to me

Send me an email if you're interested and I'll send you more information! Thank you!

EDIT: I got tons of replies already so no more needed! Thanks!

Weekly Whine: No show

On my last post about people RSVPing late to a child's birthday party, someone commented:

"I agree that not RSVPing until after the date is a bit rude, but I have a feeling that even if the people did RSVP and didn't show up [Fizzy would] still find fault."

Well.... yeah! I pay by the kid, so if someone doesn't show up, I'm paying extra for them for nothing! I paid an extra several hundred dollars for my wedding reception due to people saying they'd show but didn't for no apparent reason. And I had negative income at the time. Anyone who's ever planned an event should realize this is rude.

I mean, how hard is it to tell someone you're going to be somewhere in a timely fashion and then actually show up? Doesn't anyone have a sense of responsibility anymore?

That same lovely commenter also wrote:

"I'm sorry, but the weekly whines seem really trivial and nit picky lately."

Ha. Okay, I'll try to cover more important topics like I used to, like car decals, how nobody reads the books in my book club, or my very first whine, about how the cleaning woman won't take out the garbage.

Look alike

Lately, I've been getting a lot of good feedback from patients, which makes it hard to get as pissed at them as I'd like to be. I had a non-English speaking patient today with her son translating, which is always a hard situation, but especially hard when the patient has multiple complaints, most of which are random aches and pains, for which there is likely no answer except that she is old. Her neck hurts, her knee hurts, her hand hurts, her bunion hurts... what the hell am I supposed to do for you, lady?

I was trying to keep from becoming visibly annoyed from this long list of complaints when her son told me, "She says she's really happy to see you."

"She is?"

"Yes," he said. "She says you look like her daughter, who she hasn't seen in a long time."

Aw. How can I get annoyed with a patient who says something like that? Here, have some more vicodin.

Dr. Orthochick: Rapid Response

I was on call the other day and i got paged by the Rapid Response Team around 11 at night, which really freaked me out. Normally if the RRT calls you, it's because something's wrong with your patient. And whereas 75% of the time it's not a big deal, I still don't want any of my patients to get in trouble with anything on the off chance the RRT is actually doing something important.

RRT: Hi, this is Linda with the Rapid Response Team
Me: Hi, it's Orthochick from ortho returning a page?
RRT: Yes, we have a patient, Ethel Roberts
Me: I'm sorry, I don't know her. What procedure did she have done?
RRT: No, she was admitted a few days ago for pneumonia and we just got called because she has altered mental status and she's hypoxic. But they did an xray of her knee two days ago and it looks like she has a distal femur fracture so we were wondering if you would mind checking it out?

Just another reason to hate the Rapid Response Team.

Anyway, since i was awake I went to check out the situation. The patient was hypoxic and either altered or demented, I have no idea since I had never seen her before. She couldn't answer questions, I couldn't do much of a physical exam, and truth be told, I don't know why an xray was ordered of her knee in the first place. Fortunately, it was and it showed a horrible fracture. It was around a total knee prosthesis and the whole knee had broken off and there were bone chips everywhere and the titanium part of the knee replacement was floating around. That's a big problem because it means you probably have to do a distal femoral replacement, which is a huge messy surgery with a lot of blood loss, recovery time is forever, and if you're old it's not going to end well. But the problem is, if you don't fix the fracture, the patient is going to have horrible pain and it's never going to heal. So really, it's not an easy decision to make in an older person with lots of medical problems.

Since I had no information from the patient, I started picking through the chart to find something about when she had the knee replaced etc etc etc and I stumbled across this gem in the physical therapy notes:

Pt is not eligible for PT because, according to MD, she has less than 5 days left to live

So just to recap: At 11 o'clock at night I get consulted for a broken bone in a woman who has not only been in the hospital for several days, but who has had a known fracture for two days. And the perfect time to do this is when she has less than a week to live?

I honestly do not know what they were expecting me to do about this patient, but on the plus side, I really have no qualms about proceeding with nonoperative management

Empty Theater Joke

Whenever I go to the movies with my father and there are like three people sitting in a huge theater, he always complains, "All the good seats are taken!"

He has been telling this joke for at least thirty years to basically the same five people and I can't even remember anyone ever laughing at it. Yet for some reason, he still persists in saying it.

This is my Empty Theater Joke:

There are a few services in the hospital that notoriously don't answer pages. It varies from hospital to hospital, but I'll go out on a limb and say that surgery never answers their pagers. It's not their fault though, I guess. I mean, they're in surgery.

Anyway, whenever someone suggests that I page surgery or another equally unreachable service, I say, "I may as well just write my callback number on a piece of paper, stick it in a bottle, and throw it in the ocean, right?"

I think this joke is incredibly witty, yet I can probably count the number of laughs I've gotten on one hand. Like maybe a chuckle or two. And maybe one, "Yeah, they suck!" More often the person just shrugs and says, "Page them anyway."

Yet I still persist in saying it. Because I know in my heart that it's a great joke and that someday, somewhere, I will meet that one person who really gets it and we'll have a good laugh together and it will all be worth it.

Weekly Whine: RSVP

For my daughter's birthday party, I sent out 15 invitations three weeks before the party with an RSVP date one week before. I was hoping to get ten guests since we get charged extra for anything more than that.

A week and a half before the party, I really started to panic. We had one yes.


I started sending out a couple more invitations. I finally collected seven guests and felt satisfied with that.

Then ON the RSVP date, I got two more yeses from the invites I'd given out two weeks earlier.

Several days later, I got THREE more yeses from invites now given out nearly three weeks ago.

Seriously, RUDE. I ordered party favors online and now I have the wrong number of everything. Plus more kids than I wanted. Why does it take three weeks to RSVP??????