Guest Post: Vaginal redistribution

My partner and I were gossiping about lab stuff the other day when another came in.

Dr. Woods: "Did you see who got their license revoked?"

He had brought in a copy of the State Medical Board newsletter. This was a guy we all new and liked. We hemmed and hawed and mourned and knew of his troubles but wondered about the straw that broke the camel's back. As I was looking at all the names on the list I noticed one that I had read about in the news last week. He had an Emergency Order of Suspension.

Me: "Hey, did you hear about this one?"

They hadn't.

Me: "A patient heard a click while he was examining her (an OB) and worried he had taken a picture of her vagina. She went to local officials with her concerns. They investigated. Turns out he had a ton of vagina pics on his phone."

They were shocked. Dr. Woods wondered: "Um, maybe boobs? Or a whole naked woman reclining? But just an iphone pic of that one part? Really?"

We all wondered aloud whose boat that might float. Maybe he did it for the thrill, and the pic was a treasure of his stealth.

Me: "Especially after kids. Vaginal delivery redistributes anatomy. Not necessarily in an aesthetically pleasing way. Well, everyone has individual taste. But it's not like it used to be, that's for sure."

Contributed by Gizabeth of Methodical Madness

Weekly Whine: How I Met Your Mother

note: this post contains spoilers for the above show.



I recently watched the series finale of How I Met Your Mother. I've been a huge fan of the show, although unfortunately, it's one of this few shows that my husband and I don't both like (or dislike). So I've been watching it on my own all this time.

I didn't get a chance to watch the last few episodes for a while after they aired, but apparently this series finale was a big deal and my husband heard what happened on the internet. Apparently, people were really mad about the ending and he said he heard it was a horrible ending. He said it was so comically bad, he wanted to watch it with me to see my horrified expression.

Well, I watched the end of the series. And I have to say, the ending was really beautiful. I hate to use that word referring to a TV show, but it was just so perfect. I didn't mind that the mother died, mostly because I kind of hated her throughout the last season. (I found her annoyingly adorable and sagely.) But the fact that she was dead through this entire story made me like her more. It just made sense, considering how the entire series was about Robin and Ted's relationship, and that it's really a story about how he wants to be with her. And the end, when his kids give him permission to ask her out and he shows up at her apartment building with the trumpet, is perfect.

I cry every time I think about it.

So obviously I loved the finale. So what is my whine, you ask? Well, my husband hates the show and nobody I know likes it, so I had nobody to gush to about how great it was! Lame.

Best Laxative

In my line of work, we use a lot of laxatives. Some of our favorites are colace, senna, dulcolax, miralax, mg citrate, MOM. But I recently discovered a laxative that works better than any of the above with relatively few side effects. The name of that laxative is...

Me.

I've come to that conclusion after every single time I enter a room to see a patient, they immediately comment that they have to use the bathroom. Without fail.

In fact, my laxative effects are so powerful that frequently when I am scheduled to see a patient, I come into the room and they're already on the toilet. With no end in sight.

I come in tablet, powder, and suppository forms.

--

P.S. Don't forget to buy a copy of The Devil Wears Scrubs while it's on sale for only a buck!

Dr. Orthochick: Mmm, sounds good

Me: after removing dressing over pt's incision It looks good!
Patient: Oh. Good?
Me: Really good.
Patient: Just really good?
Me: Really, really, really, really, really good.
Patient: Well, that sounds good.

See, this is what happens when I leave my thesaurus at home.

Help me!

I need your help.

When I first wrote my book, The Devil Wears Scrubs, my husband was not excited about reading it. So we made an agreement that if I sold 3,000 copies, he would read it. At the time, I think he felt that it was such a high number that he would be safe.

Well, I am getting close to 3,000 copies. I've sold about 2,350 copies.

I am putting the book on sale starting tomorrow. If you can try to encourage people to buy it, and I get to 3,000 copies, my husband will have to read the book! Please help me! It's only a dollar!

At the end of every day, I will post the number of sales. Please help me get to 3000 sales so my husband has to read the book!!!!

I'd consider it my birthday present.

Weekly Whine: You'd like this book

I do like to read a lot, and I admit I am usually on the lookout for new books. I've been into mystery and thriller books and I recently read everything the library had to offer by Tess Gerritsen.

So yes, I am looking for new books to read. But it baffles me the kind of recommendations that people who know me quite well seem to make to me.

For example, somebody who knows me very well and everything I like was recommending an Indian writer to me who writes about her early life in India. I don't know, maybe it's great, but it does not on any level seem like the kind of book I would read. My father-in-law is always recommending these weird guy books that I would never read ever. Like by authors that if I have read a book by them, I hated it. (Philip Roth, Don DeLillo)

If you know me and you actually have a decent book to recommend to me, fine. But don't play up something you read that you like that is obviously something that wouldn't interest me.

Guest Comic: Doctor Patient

Contributed by Diagnosis: Medical Student

Holy Pollen, Batman!

Either my neighbors are growing cotton or this explains my eye itchiness:

Dr. Orthochick: EMR

Why Every Hospital Needs an EMR (Electronic Medical Record) Part II:

Dr. Critical: Dr. Chatterbox told me that he had to round on my patient [in the other part of the hospital across the street] over the weekend and he didn't have a resident

Me: No, I saw the patient on Monday and wrote a note. My note was written 2 minutes after his, according to the timestamps.

Dr. Critical: Dr. Chatterbox was very upset that he had to write his own note and couldn't cosign a resident's note

Me: Are you sure he's not upset because he just noticed he wrote the patient was postop day 10 from a debridement of the "tibula and fibula"?

That was the end of that discussion.

(Probably shouldn't have said that, but seriously, I saw the patient before 7:15 when I had 14 other patients to round on and a surgery to do starting at 7:30, I wrote my note, and my note did not contain the word "tibula." That being said, Dr. Chatterbox just copied the previous resident's note, which has been copied from day to day because all you have to do is copy-paste in the electronic medical record, which means the previous 9 days postop also said "tibula." Seriously people, we're orthopaedic surgeons. Read your damn notes.)

Cold hands, warm heart

I touch patient's swollen knee.

Patient: "Your hands are so cold. That actually feels really good."

Me: "Uh, okay good."

Patient: "Now could you put your hands on my face?"

Weekly Whine: Facebook again

I definitely am not a fan of Facebook. But it especially sucks when people use Facebook as a communication source.

I can't tell you how many people I have inadvertently insulted when I missed their messages or parties I've missed because it was advertised on Facebook.

If you want to invite me somewhere, just send me an email! What's so hard about that? It's not like you have to actually talk to me, god forbid.

Veep

One question I ask cognitively impaired patients to test their knowledge of current events is who the vice president is. You'd be surprised how infrequently people know the answer.

Me: "Who is the vice president?"

Patient: "Nobody knows that!"

Very possibly true. I decided to do a test and see if my older daughter knew the answer to that question.

Me: "Who is the vice president?"

Her: "I don't know."

Me: "His first name is Joe."

Her: "What letter does his last name start with?"

Me: "B."

Her: "Bob?"

No, our vice president's name is not Joe Bob.

Dr. Orthochick: Personal?

I tried taking a nap today, but, as usual, my attempts were thwarted. My pager went off telling me a patient couldn't afford his meds, so I had to call back to see if we could get a different med covered, then I finally fell asleep after that one and my next door neighbor started banging on the door.

This old couple lives in the apartment next to me. They're both retired and around 75. They're really nice but they try and talk to me any time I go in or out of my apartment, which drives me crazy. Then I think the man is suffering from some sort of early dementia because every time he talks to me, he puts his hand on my stomach. I don't know if he's trying to feel the baby kick or something, in which case he's going to have to hold his hand there for a few years, but it's a little weird. He also has not yet figured out that if I'm home during the day, it's because i'm sleeping. So pretty much any time I'm postcall and trying to nap, he'll bang on the door. In the beginning I opened it because I thought he was going to tell me that the old lady broke a hip or something, but the last time I did he started telling me about how he broke his shoulder 2 years ago and he didn't have surgery, but now he wants to know if he should have etc etc etc. I know they're lonely old people and I should be nice, but I really do not want to be their default medical source and i wish they didn't try and come over every time I was at home.

Anyway, the old man started banging on my door today. He has not yet figured out that if he bangs 10 times and I don't answer, he should just give up, so he kept. on. banging. (they know which car is mine in the parking lot so he knew I was home) So I dragged myself out of bed, opened the door, and he thrust a letter at me and said "I got a letter from my doctor but I can't understand it so I need your help."

Me: Uh, are you sure you want me to read this?
Old Man: Yes, I need you to tell me what it's about!
Me: This is about your penis rash.

It was a letter from his urologist detailing their visit over his penis rash. As far as I could tell, the urologist wasn't sure what was causing the penis rash and wanted to order some labs to look for inflammatory conditions.

Me: It says here they did a biopsy of your penis.
Old Man: What's that?
Me: They take a small piece of skin off and send it to the lab to look at it under a microscope
Old Man: I don't remember. They did that?

I really feel like a penis biopsy is the sort of thing you would remember, but I'm also of the camp that you shouldn't ask your next door neighbor to interpret your penis rash paperwork for you, so maybe I'm just weird in that regard. And, quite frankly, I guess I got off easy that he didn't try to show me his penis rash.

The Italian Patient

Me: "Can you touch your nose and then touch my finger?"

Patient: "Of course I can! I'm Italian."

Is there something about Italians that I don't know?

Weekly Whine: Glee

I've been watching Glee since it first started. I have to say, it's an incredibly stupid show. I would never watch it in a million years except that I really like the musical numbers.

However, I recently watched the finale, and I feel it's reached new levels of stupidity. I sort of want to throw something at the TV and yell, "Stop being such a dumb show!" And I guess the public agrees because it's apparently not getting good ratings anymore.

I don't understand. You have a hit show that earns millions of dollars… why wouldn't you invest in somebody who can actually write a good script?

Hygiene

What is your hygiene routine like when you get home from work?

Usually the second I walk in the door, I wash my hands, even though I wash them right before I leave the hospital too. And I take my shoes off. But that's pretty much it. I always thought it was enough.

But recently, a coworker was telling me that the second she comes home, she strips down all her clothes that she was wearing that day and changes into something different. She's afraid of spreading MRSA to her household.

Is she overly paranoid? Or am I turning myself into a human petri dish?

Pretty please?

I was in the grocery store the other day and I had the following interaction:

The cashier was doing some paperwork when I walked over, so I said to her, "Are you open?"

Cashier: "Yes, of course!"

I only had two items, milk and bread, so she asked me, "Do you want the milk and bread in a separate bag?"

Me: "No, you can just put them in the same bag."

Cashier: "Please."

Me: "What?"

Cashier: "Put them in the same bag please."

I was stunned. She asked me a question and I was just answering it. I didn't know I had to punctuate every sentence with the word please. I always say thank you when they finish bagging. Do I now have to say please when they start bagging too? Is this some rule of etiquette that I'm not aware of?

I think a general rule is that you don't say something patronizing like that to another adult unless they are being outright rude.

Dr. Orthochick: Healthcare costs

Social Worker: It takes a strong woman to do that.

Me: To do what?

Social Worker: To admit the patient the way you did it. No consults, no head CT...

Me: Uh, what would most people do in this situation?

Social Worker: Most people would have had him admitted to internal med, then they would have called a neuro consult, ordered a head CT, and ordered an EEG. Probably a prolactin level as well.

Me: He is a 20 year old guy with a history of seizures who had a seizure after being up all night playing computer games. Had I been able to reduce his shoulder down here [in the ER] then I would have sent him home from the ER. The only reason I'm admitting him at all is because we need to go to the OR to do a reduction of his shoulder.

Social Worker: Most people would have done more of a workup for his seizures.

Me: Why does he need a workup? He has a history of seizures. He had a seizure. The last time he had a seizure it was because he was up all night. He sees his neurologist regularly. What is there to work up?

We reduced his shoulder dislocation and I sent him home from the recovery room. Go go modern medicine.

Guest Cartoon: MD vs. PhD vs. MD/PhD

Submitted by Keyun Wang