NSAID seekers

In residency, I had a patient who only wanted Toradol. We gave him Vicodin, tons of morphine, but he was obsessed with getting his toradol shot. For those of you who don't know, toradol is like a stronger form of motrin. I would love to give him as much toradol as he wants, but you can't give it for more than five days because it can cause bleeding.

My attending: "I've never seen a patient who wanted an NSAID that badly."

Me: "Yeah, I think he must think toradol is like demerol or something."

Attending: "Well, we can give him an oral NSAID. Which one do you want to give him?"

Me: "I don't know. Which one sounds the most fancy?"

Attending: "There's motrin, naprosyn, voltaren..."

Me: "Voltaren! Yes, that sounds good."

Orthochick

Unfortunately, I have run out of Orthochick posts. You know she is very busy, being an orthopedic surgery resident and all, but I think if everybody lets her know how much you love her posts, she'll send me more.

Okay everyone, let's hear some Orthochick love!

Weekly Whine: Data

I don't know what's going on with my data usage on my iPhone. I have only 200 MB of cellular data each month and usually I use only about two thirds of it. However, occasionally I have a month where I come a little bit closer using it all up.

Last month I got a note saying that I had used 90% of my data with two days left to go on the plan. So I shut down everything except for my email thinking that I wouldn't use much more data.

Not so.

My phone continued to use data even when the cellular data was turned off. It even used 7 MB of data while I was sleeping in my apartment where we have Wi-Fi.

Wtf? How is that possible?

History of Present Illness

Dr. Orthochick: Old but not so good

Dr. Old: Granola***, I have something for you. I know you read a lot and I was looking through my ortho books and I found one that I thought you would like.
Me: Thanks!

He then gave me a copy of the 7th Edition of "Campbell's Operative Orthopaedics"

Don't get me wrong, "Campbell's Operative Orthopaedics" is a great book. It is such a great book that we are currently on the 12th edition, which I have online access to, and I have my own personal copy of the 11th edition.

The 7th edition was published in 1987. I was three years old, which means I was getting ready to start preschool when this book came out. You could make the argument that general orthopaedics hasn't changed much since 1987, except it totally has. In the past 25 years, there have been many, many, many medical discoveries. I'm pretty sure we didn't have arthroscopy back then. Joint replacements were in the early stages, bone substitutes hadn't been invented, neither had locking plates, and it was perfectly acceptable to leave people in traction for 6 weeks for a femur fracture. Even between the 11th and the 12th edition there have been some modifications. For example, the 12th edition has a chapter on ankle arthroplasty and the arthroscopy sections are more developed. I guess the anatomy sections of the 7th edition are the same, except that's about 50 pages in volume 1 and it's a 5 volume set (another change--we only have 4 volumes in the most recent editions)

So yeah...anyone need a paperweight? It also works as a great doorstop, not that I know this from personal experience or anything.

(I left it in the call room because I wasn't sure what to do with it. I didn't particularly want to take it home because then it's going to sit on the bookshelf until I move and throw it away, but it's not like I could tell Dr. Old that I didn't want his stupid crappy book from 25 years ago.)


***No idea why he's still calling me that, but I'm pretty sure he doesn't remember my real name by now so it works

Fun With Pharmacy

What did the pharmacy find fault with this order:

The old man and his bowels (a poem)

I said, "I'm worried
Your blood pressure continues to raise."
The old man said,
"I haven't pooped in three days!"
I said, "I'm worried about hardening
Of your arterial walls."
The old man said,
"My stool is hard little balls."
I said, "I've got a new medication for you
That will help your blood sugar to improve."
The old man said, "That's good.
Will it also help my bowels move?"
I said, "Do you have a question
On a topic we touched upon?"
The old man said, "Yes
Where is the john?"



(I know nobody liked my last poem, but I had one more left I'd written and what else am I supposed to do with it?

Dr. Orthochick: Follow up

So lately when you present a case in conference, there's been a push to get us to have at least 6 months of follow up on the patient. I understand the logic behind that, because you usually don't know if the surgery was a good idea or not until 6 months after the fact, but it's a pain to get 6 months of data because i usually don't see the patient back in clinic after the surgery. So I need to drive to one of the outpatient clinics and ask if I can look through their office notes. And since I didn't see the patient at the time, if someone asks me a question about what the patient looked like at the follow up, I can't answer it, so it's pretty useless. If the note just said "she is doing well," then I don't really know how that helps anyone do anything. Also, it means i can only present stuff I did 6 months ago, which seriously, I don't remember what i did yesterday. And then if someone asks me a question about something that happened intra-operatively 6 months ago, then no, I do not remember. (Also, if it was 6 months ago, there's a good chance I didn't know or wasn't paying attention in the first place.)

So I've been trying to find creative ways around this since i have to give a presentation every week and no way in hell am I spending my free time driving around town trying to find follow up notes.

Me: ...and here are the intraoperative xrays. They show--
Dr. Douche: Why do you only have the intraoperative xrays? We need at least 6 months of follow up! I urge you residents to have 6 months of follow up before giving a presentation. I think it is your responsibility as a surgeon to have adequate follow up on the cases you do.
Me: Uh, I'll explain it in a second, thanks.

My next slide said "Pt died the following day"

Me: So that's my 6 months of follow up
Dr. Sportsfem: How does that count as 6 months of follow up if she died the following day?
Me: Fine. Then as my dad would say, she's decaying quite nicely.

My department and welcome to it.

More fun with pharmacy

Why did the pharmacist say this order was unacceptable:

Weekly Whine: How long is too long?

Yesterday I walked into a patient's room and she was talking on her cell phone. I told her that I would come back later but she waved at me to indicate that she was almost done.

So I waited

and I waited

I don't want to tell you how long I waited but by the end when she finally got off the phone I was pretty pissed off.

So how long is a reasonable amount of time to wait for patient to get off their goddamn cell phone?

Confused (a poem)

"Doctor, I believe your patient going home today
Is a bit more confused."

"Nurse, tell me why you think so
Please don't think me rude"

"Well, I asked him where he was today
He said he was on a cruise
He didn't say what kind it was
But hinted there would be booze
I asked him the name of the President
And he said it was 'some black dude.'
Then his tray of lunch arrived
And he said he didn't want food.
Instead he threw the contents of his tray
On Mrs. Smith, who is being transfused.
Except for the peanut butter and jelly
Which he spread on his body nude.
And now he's up on top of the roof
Dancing to Huey Lewis and the News."

"Nurse, I appreciate your concern
But I don't share your views.
Yes, I think he'll still go home today
That diagnosis has not been proved."

"Send him home if you'd like, Doctor
It's you who will be sued."

Dr. Orthochick: Bone(r) Health

Dr. Sportsfem: Order a set of bone health labs on her. departs
Me: OK, so I know that's TSH, PTH, free T4, ionized calcium...is it 1,25-Dihydroxy Vitamin D or just 25-Dihydroxy Vitamin D?
Co-resident: I don't know. You're doing better than I am with these.
Me: No, you're probably better at this. Because every time I see or hear "bone health," my first thought is "boner health" and then I start giggling and I can't actually concentrate on learning about bone health.

For the rest of the morning, whenever my co-resident dictated "bone health,' I whispered "boner health." I'm sure he loves doing clinic with me.

Seriously though, does anyone see "bone health" and not immediately think "boner health?" I'm the same way with a "bone stimulator," my first thought is "boner stimulator." I would be more annoyed with myself for not knowing anything about bone health, but I am probably more interested in bones than the average person and I still think boner health sounds a lot more interesting and a lot more important in the grand scheme of things.

Fun with Pharmacy

Our pharmacy is completely crazy.

They call us constantly, sometimes about things that are legitimate and sometimes not so much. I think everyone I know has lost their temper at a pharmacist at least once.

Anyway, we play game where every time we get called by the pharmacist about an order to try to make other people guess what the problem with the order was. See how you fare at this game:

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Good guess

Patient: "I have that disease .. You know, the one that affects your knees and feet."

Amazingly I guessed it on my second try!

(You can have three guesses.)

Dr. Orthochick: Locked in

Me: hangs up phone

Dr. Dream: What the hell was that about?

Me: I put in an order for a patient to have a foley put in in the recovery room. but they just paged me and told me that they can't do it because her knees are, and I quote, "locked together." According to the nurse, the patient said that her knees are always locked together and she needs to sleep with a pillow between them. So then the nurse yelled at me for not putting a foley in when the patient was in the OR because apparently I should have known that her knees are locked together when she's awake. So I asked how the patient walked and then nurse was mad at me for being obnoxious. I thought it was a legit question. I know she walks, so how the hell does she do that if her knees are permanently locked together?

Dr. Dream: My first question wouldn't have been about how she walked

Me: Heh, yeah. Good point. Poor lady.

Dr. Dream: Poor husband.