Saturday, August 30, 2014

Weekly Whine: Neighbors

I completely hate our upstairs neighbors, which is a couple and their teenage children. This is my list of grievances:

--they have screaming cursing arguments and the police have been here twice

--They gave us bed bugs

--they have a gigantic dog that barks at us when we come home

--they smoke on the porch and throw cigarette butts onto our porch and lighters onto the common lawn

--They are really loud, even late at night

--On several occasions, they have parked in front of our garage, blocking us in

The problem is, even though it's annoying that they smoke and curse on the porch right above us, it's not illegal. Enough people have complained about them that the management claims their lease hasn't been renewed, but they are apparently living there month-to-month. Or else the management is full of shit and their lease has been renewed.

The only good thing is that I was able to use their presence as a reason for a rent increase reduction.

Thursday, August 28, 2014

On a serious note…

I feel like I have to comment on here in light of the recent two suicides by medical interns in New York.

I feel like a medical intern committing suicide is one of those things that is shockingly sad. These are people who are so young, who worked so hard to be where they are, yet are so miserable that they are willing to end their life rather than face another day. As an attending who has a family and a good lifestyle, it's hard not to think, "How could they possibly do this?"

But at the same time, my intern year is not so long ago that I don't remember.

I was someone who was particularly miserable. I had worked really hard to be where I was, I did have a support system in that I was married, but I was still desperately depressed. I genuinely wished that a car would hit me on the way to work so that I wouldn't have to face another day of my internship. I don't think I ever had a call where I didn't feel like crying at least a few times. In fact, during at least 50% of my calls, I would go home and immediately burst into tears.

Why was I so depressed?

For starters, I worked with a couple of residents who were particularly nasty to me. But even when I had a really nice resident and coworkers, I was still unhappy. I didn't want to be at work in the middle of the night. I wanted to be home with my family. And treating sick patients, some of whom were dying, made it all that much harder and made me wish to be with my family even more.

On top of that, nothing I was doing felt incredibly important. It felt like everything I did involved following some sort of formula and not really thinking at all. If a patient had a symptom, you do the appropriate test, and treated the way the textbook told you to. It felt like a machine could do it just as well. It felt pointless. And the patients didn't seem at all grateful to us. (This probably wasn't made better by the fact that I was at a county hospital where a large percentage of the patients didn't speak English, were homeless, or drug addicts.)

But the crazy thing is, nobody knew.

Aside from my family, nobody at work had any inkling how miserable I was. I know this, because when I made the decision to leave my program (my alternative to suicide), my program director told me he had checked with my previous residents and attendings and asked them about me, and they all thought I seemed completely fine. So either I was really great at hiding my emotions, or every single intern was completely miserable, so we all basically seemed about the same.

So what can be done to keep tragedies like these suicides from happening again?

Well, I don't really know. But whatever they're doing now completely stinks. Despite the fact that all of us interns were under so much stress and pressure, nobody bothered to check in on our mental health at any time. During residency we had some sort of discussion group with a psychiatrist that we all went to, but that was useless and got canceled half the time anyway.

Maybe every program should be required to hire a good therapist to check in with all residents a few times a month and make sure they are doing all right. Maybe there should be worse consequences (or just consequences at all) for residents and attendings who are cruel to underlings. Maybe there should be more interns in every program, so if you gets sick and need a day off, you don't feel like everyone in the program hates you. (I will never forgive my co-intern who sent me a nasty email while I was having a threatened miscarriage for missing a few hours of a call.)

Even if most interns don't end up pulling the trigger, we don't want a bunch of suicidal interns responsible for patients' lives. I really think this is an issue that needs to be addressed seriously, but in the end, I sort of doubt anything will change.

Wednesday, August 27, 2014

Writing Contest

Announcing the First Annual Medical Humor Writing Contest!

Here are the qualifications:

1) Must be at least 1000 words. There is no upper limit on word length.

2) Must relate to medicine in some way. I can be extremely flexible on this. It can be your experience as a premed, medical student, physician, nurse, physician assistant, or even patient. I would accept anything ranging from how you worked as a nurse treating ebola in Africa (or Colorado) to a medical school interview gone wrong.

3) Must have some element of humor. It does not have to be laugh out loud funny, but at least make me crack a tiny smile.

4) Deadline is October 15, 2014

5) Multiple submissions are permitted. There is no entry fee.

6) Must be HIPAA compliant (no patient identifiers)

What do you win?

First prize will be a $25 gift certificate on Amazon.

In order to have completely objective judging, Dr. Grumpy has agreed to help me by selecting among my favorite choices to anonymously pick the winner.

All submissions of reasonable quality will be collected and published in a book of medical stories that will be available on Amazon. By submitting, you are giving your approval to be included in this book. All profits from the book will be donated to Red Cross.

Email all submissions to fizzziatrist@gmail.com with the subject Writing Contest Entry. Make sure you include a title and byline.

Questions? Comments? Let's hear it!

Tuesday, August 26, 2014

Dr. Orthochick: Pampered

I did a bedside I&D of a patient's hand in the ER the other night. It really wasn't a big deal, I made an incision and rinsed everything out, then stuck a dressing on it. The whole thing took less than ten minutes but holy hell, the patient screamed. She started screaming before i touched her so I really wasn't in a huge hurry to continue with that, but she said she just wanted to get it over with so I did. She thrashed around like a jellyfish having a seizure. And that was just when I numbed her up.

Her: I can feel you slicing into me!
Me: I'm not touching you right now.

I finally got it done and the patient was either having an orgasm or Kussmaul respirations, either way, she as putting on quite the show. So the doting boyfriend asked if he could talk to me in private for a second, I figured he was going to ask about pain meds but I stepped outside the room with him.

Him: So now that this has happened to [patient], do you think I should pamper her a little?
Me: Sure, that's never a bad idea.
Him: Should I treat her really nice?
Me: I guess it wouldn't hurt.

He then walked into the room and yelled "HONEY! GUESS WHAT? WE'RE HAVING TV DINNERS TONIGHT!"

The two of them then started making out and I tactfully slipped out of the room.

Monday, August 25, 2014

99 cents

Don't forget to pick yourself up a copy of Suicide Med for only $.99 while the deal lasts!

PhD

Patient: "I see that your badge says MD. Do you have a PhD as well?"

Me: "No, I don't. Just the MD."

Patient: "Oh. You think you'll go for your PhD?"

Me: "No, I don't think I will."

Patient: "I guess an MD is good enough."

Me: ".... you know, MD stands for medical doctor."

He then proceeded to call me by my first name for the rest of the visit.

Sunday, August 24, 2014

Suicide Med -- 99 cent promotion tomorrow!

Suicide Med is having a promotion tomorrow! It will be on sale on the Kindle for only $.99 for a very limited time.

Please buy a copy! And if you're willing to promote the book on your Facebook, twitter account, or blog, let me know and I can gift you a free copy. The reviews have been very good so far, so you should check it out! Most people say they read it in only a day.

Saturday, August 23, 2014

Weekly Whine: Phonics

Even though we used pay like $700 per week for both kids to go to daycare ($40K/year), there were are all these extras that we always feel guilted into paying for. Like we signed Mel up for a phonics class that was an extra $125 per month. They also had a cooking class, soccer, math class, etc. We even signed her up for something called Splish Splash, which as far as I could tell, involved spraying the kids with a big hose for $40 per month.

They even had an extra class for Arts and Crafts! This seemed a little fishy to me because Mel was only four years old, so if they weren't already doing arts and crafts with her, what exactly were they doing with her all day? Trigonometry? (No, because that would be extra.)

Seriously, what were they going to start charging for next? Nap time? Outside time?

At first I was always looking for sheets in her mailbox about what she had learned in phonics that day, but eventually I sort of lost track of the class because I had a new baby and all. One day, I asked Mel how the class was going and she informed me that she hadn't had any lessons in a month.

Being a small child, she wasn't exactly reliable. So I finally went to the day care director and asked about it.

It turns out she was right. Due to a shortage in staffing, they had stopped having the phonics class. But they were still charging me for it and obviously didn't tell me that this was happening.

What really bugs me, is that if Mel were just a little bit younger, she might not have even been able to tell me that this was going on. And they would've just gotten away with it.

Thursday, August 21, 2014

Tuition

From what I've read, tuition of private medical schools is now upwards of $50,000 a year. I think that is insane.

When I started medical school at a state school, my tuition was about $10,000 a year. Very reasonable. I was almost able to pay it myself.

While I was in school, they decided they needed to raise tuition for state schools. Actually, to double it. They felt we weren't paying nearly enough. It had to do with earning revenue, although they probably would've earned more money from a $100 a year raise for college students than they did for doubling the tuition of a couple hundred medical students. Whatever money they made was peanuts compared to the enormous burden that it placed on individual students.

They didn't raise tuition for college students though. They didn't raise it for law students or graduate students. Only medical students.

There was some talk of raising it even further after I left, to maybe $30K. The exceptions would be:

--You get a (slightly) lower tuition if you stay in state

--You get a (slightly) lower tuition if you choose a primary care field

I'm not sure if this is fair. I guess that it's important to encourage people to go into primary care, but I also don't think it's fair to force medical students and residents to live in poverty. Many of us could have easily gone into investment banking or some other field where we could've gotten rich right off the bat. Why drain us dry preferentially over all other students?

Tuesday, August 19, 2014

Dr. Orthochick: Football

Dr. Sportsfem: So you're going to need to go to physical therapy for a month for your knee pain.

13 year old boy's mother: Will he be able to play football?

Dr. Sportsfem: Not until his knee stops hurting

13 year old boy: OK, I just won't play football this year

Dr. Sportsfem: Well you can still play, you just can't play for a month or so.

13 year old boy: No, it's OK. I understand. I just won't play.

Dr. Sportsfem: Your knee will probably be ok by the time school starts

13 year old boy: Yeah, but there's summer practice so I'm going to have to miss that. And I know myself, if I go back too early, I'll play too hard and then I'll just hurt my knee again. So I just won't play this year.

After we left the room, I turned to Dr. Sportsfem and said "I don't think he likes playing football too much." She said "I was thinking the same thing." I realize I am not an expert on 13 year old boys (and trust me, I am OK with that) but I've never seen a kid give in that easily to not doing a sport.

Monday, August 18, 2014

The Simpson Personality Quiz

Back before I had kids, and I had oodles of free time, I made a Simpsons personality quiz with my husband. We were both huge Simpsons fan, at least of the first nine seasons.

It was actually very elaborate and there were like 20 characters that you could be. Unfortunately, I posted the quiz on GeoCities, so now it's gone. But I saved it, and now I'm posting it here. Because I can. Those of you who loved the show (at least the first nine seasons) will appreciate it.

Obviously you can't really take the quiz anymore, but trust me, the answers were hilarious. I just don't have the time or energy to set this up like a real quiz again.


The Simpsons Personality Quiz









1. Your body habitus could be described as:

Morbidly obese

Obese

Buff

Shapely

Stickly

2. What is your career of choice?

Lawyer

Doctor

Homemaker

Systems Analyst

Bartender

Stripper/Chief Justice of the Supreme Court

Illiterate clown

Teacher

3. Have you ever attempted murder?

Yes

No

4. What is your school of choice?

Yale

Caltech

Hollywood Upstairs Medical College

Harvard

Brown

Vassar

Bovine University

Clown College (i.e. Princeton)

5. What is your religion?

Christian

Jewish

Buddhist

Hindu

Snake Handler

the one with all the well-meaning rules that don't work out in real life

Misc.

6. What are you sick of?

hoagies

the coroner

Razor Fight II: The Slashening

these constant bear attacks

Ray Jay Johnson

yo-yos

7. Which medical conditions do you have?

Lyme Disease

Acute hypochondria

Homer Simpson Syndrome

Kidney failure

Amoria phlebitis

Falling on a bullet that got wedged into your chest

Skin failure

Hysterical pregnancy

8. Do you think Ziggy has gotten too preachy lately?

Yes

No

9. Which of the following aliases do you sometimes go by?

Chesty LaRue

Nguyen Van Phuoc

McBain

Armand Tanzarian

Brian McGee

Rory B. Bellows

Santos L. Halper

Mohammad Jafar

Joey Joe Joe Jr Shabadoo

10. What is your favorite meal of the day?

Kippers for breakfast (on St. Swithin's Day)

Brunch

the meal between breakfast and brunch

Lunch

Dinner

Dessert

the feast of Maximum Occupancy

11. How would you describe yourself?

Brainy

this century's Dennis the Menace

lazy, clumsy, dim-witted, and monstrously ugly

the richest guy you know

a mafia hitman

the school bully

proactive and totally in your face

12. What are you most afraid of?

flying

sock puppets

blood

cupcakes

the king of England pushing you around

13. Do you think eggs have gotten a bad rap lately?

Yes

No

14. When it comes to relationships, you are:

Eternally faithful

Sometimes tempted

Have strayed

Comfortable with your womanizing

A homewrecker

Gay

15. What is your favorite catch phrase?

D'oh

Ay carumba

You're off your case, chief

Worst episode ever

Excellent

Thank you, come again

I'm a bad wittle boy

Ay chihuahua

Radical!

If anyone wants me, I'll be in my room

16. How many children do you have?

none

1

2

3

8

greater than 20

17. Who have you had a crush on?

an older woman

the oldest woman

the school bully

a Beatle

MacGyver

Lisa

a billionaire

your sister

18. What are you doing this weekend?

Something gay, no doubt

Bringing a microscope to the beach

Sex cauldron

Sharpening pencils

Going to the dog races

Touring the bridges of Madison County

19. What would be an appropriate nickname for you?

Springfield Fats

Spanky

Bleeding Gums

Kid Presentable

Diamond Joe

Grifty McGrift

20. What sort of vehicle do you drive?

Light pink VW

Canyonero

Hum V

Limo

Bike

School bus

You prefer to be carried

21. Have you ever seen a man say goodbye to his shoes before?

Once

No

22. What languages do you speak?

Klingon

Hindi

French

Spanish

American

23. What is your level of intelligence?

Genius

Smart

Average

A little slow

Smrt

"Extended warranty? How can I lose?"

24. What kind of surgeries have you had?

Triple bypass

kidney transplant

lung and kidney removed

boob job

a real boy operation

twisted stomach repair

appendix taken out

25. What is your secret shame?

Picking your nose

Wetting your bed

Eating flowers

Gambling

Fabrege eggs

Murder

26. What is your favorite animal?

Fish

Pony

Elephant

Lawyer-bird

Fox

Pocket fox

Rockin' Dog

Smell-hound

Octopussy

27. Of what weren't you informed?

The grammar rodeo

The optics fair

Chili Cook-off

A counterfeit jeans operation running out of your car hole

That teachers can go through red lights

28. Who is your hero?

A washed out clown

A jazz musician

Mr. T

Ringo

John Travolta

Stan Lee

Matlock

29. What is your favorite kind of music?

Christian

Jazz

"It's Raining Men"

Disco

Rock and/or roll

MacArthur Park on the tablah

Cyanide, a loving tribute to Poison

30. Do you ever get tired of being wrong?

No

Sometimes

31. What do you collect?

Sugar

Malibu Stacy dolls

Stamps

Women

Silhouettes

MacGyver's hair

32. When you stick your hand into the pile of goo that's your best friend's face, will you know what to do?

Yes

Forget it, Marge, it's Chinatown

33. True or false: You can get mono from riding the monorail.

False

No wait, maybe it's true








Saturday, August 16, 2014

Sitcom recs?

My husband and I watch three TV shows together: The Mindy Project, parks and rec, and the daily show. But since parks and rec is apparently soon coming to an end, we'd really like to start watching some other 30 minute sitcom to fill in the gap. We want something that's funny and that is no longer than 30 minutes.

Any recommendations?

Here are some examples of sitcoms that we have both liked:
Seinfeld
The Simpsons
King of the hill
The office
Friends
30 rock

Bonus points if the series is available on Netflix streaming or Hulu. Don't bother recommending the Big Bang theory, how I Met your mother, or modern family. Those are all shows that I like that my husband won't watch.

Weekly Whine: Book fairs

I hate book fairs at daycare/school.

It seems terrible to complain about books, because obviously you want your kids to read. But I just hate the way these things are set up. It's always in a really obvious place, where they are completely unavoidable in case you don't want to buy your kid a book. Then your kid cries and screams every day because you don't want to overpay for some book that they could get the library.

Book orders are new to me and I find them equally annoying. Every month, my daughter comes home with the book order and begs me to get her books. Some of the books are actually really great deals and I would be happy to get her those. But those aren't the one she wants. She wants the stuff on the book order that are practically toys, like the sticker books or the fancy diary. And if I don't buy those things for her, she feels left out when the books arrive.

Thursday, August 14, 2014

Prohibited abbreviations

Prohibited abbreviation:



Reason:

Commonly mistaken for boobies



Prohibited abbreviation:



Reason:

Commonly mistaken for God
Violates separation of church and state

Prohibited abbreviation:



Reason:

Gives residents painful flashbacks to college chemistry courses

Tuesday, August 12, 2014

Dr. Orthochick: Polytrauma

My co-resident Don picked up the worst polytrauma patient anyone in this town has ever seen yesterday. He broke at least 3 bones in all 4 extremities and Don picked a cigarette butt out of his knee. He also had 3 dislocated joints. He ruptured his spleen and bowel, broke all his ribs, and had pulmonary and cardiac contusions. We were supposed to do some light surgery on him yesterday but he was too unstable so it was rescheduled for today.

Don: I don't think you're going to operate on this guy today

Me: Why not?

Don: According to [the computer system], his most recent pulse is 0, respiratory rate is 0, and blood pressure is 0/0.

Me: Yeah, I'm not sure putting a rod in his tibia is going to help that much.

(yes, he died. And I realize no one should die without metal in their body, but we decided no surgery was indicated acutely, although I feel like we could have all had a field day fixing this one. Requiescat in pace.)

Monday, August 11, 2014

Summer fun

My younger daughter's camp gave us a form to fill out about the summer. I gave it to my husband to fill out because I was busy that day. See if you can spot the trick he used to fill in the answers, and tell me if I was wrong to be too embarrassed to give the form back:

Saturday, August 9, 2014

Weekly Whine: Note

After my daughter's birthday party, I was trying to follow the tradition of handing thank you cards to the kids who came and gave her presents. Unfortunately, I discovered the school policy is that this is not allowed. (Actually, it's not so much the school as apparently the district. I got an administrator to readily admit that it was silly.) Anyway, the first time I sent my daughter to school with the cards, I received this note back from her teacher:



I debated if I should post this, because I really did like her teacher. But the use of "thier" just killed me. She used the wrong version of the homonym and then she spelled it wrong on top of that. This is a woman who is teaching my child to read and spell. Actually, I think that this was one of their spelling words.

If she had typed it, I wouldn't have made a big deal because anyone can make a typo. Or if she just used the wrong version of their, I could have lived with that because anyone can make that mistake if they are busy. But the misspelling on top of it was what put it over the edge.

Thursday, August 7, 2014

Ode to Kindle

I used to be one of those people who said that she would never ever buy a Kindle. I loved paper books. I liked the feel of them and I liked the fact that you could drop them in the bath and they would still be okay. I felt like the kindle was such a waste. And buying books on it was needlessly expensive when there was a perfectly good library.

Now, about two years later, if somebody tries to give me a paperback to read, I tell them that I only read things on my Kindle.

Why I love my Kindle:

1) I love gadgets

2) there are constantly book deals on the Kindle. I haven't paid full price for Kindle book more than one or two times ever. Plenty of books are free and there are many that are only a dollar, or at the most three dollars. If you buy a used paperback on Amazon, the minimum you pay is four dollars.

3) I can actually borrow books from the local library on my Kindle, which not only suggests things for me to read, but allows me to borrow books without having to worry about rushing back to the library to return it on time.

4) works in any room brightness setting.

5) you can change font size. this is actually a big deal for me, because very small print books give me a headache.

6) my bookcase is no longer collapsing from the weight of my many paperbacks.

7) makes me feel really green.

8) I can use the Kindle to read other things, like word documents people send me.

9) You can read books with embarrassing titles.

The biggest downside of the Kindle is the fact that I have to charge it. But not very often. Also, there's the fact that I have to be careful about losing it, whereas books felt pretty dispensable. Except for library books, of course, which I guarded with my life.

Yeah, so if you love to read, buy a Kindle.

This message is not paid for by the Kindle. I have no affiliation to the Kindle or anything related. I just really like it a lot.

Dedicated to Gizabeth, who needs to get a Kindle, like, yesterday.

Tuesday, August 5, 2014

Dr. Orthochick: Hit and run

My co-resident was on call last night and around 2AM he picked up a patient who had attempted to run her husband over in her car. She hit him but didn't kill him and he got up out of the middle of the road and ran away. Once she saw he was still alive, she became so angry that she decided to kill herself to spite him. She drove into a tree, which didn't kill her but she did wind up breaking her femur.

See, this is why 18 year olds shouldn't get married.

Monday, August 4, 2014

Dysphagia

The word dysphagia means difficulty swallowing, which is something I deal with a lot in my work. One problem I've had lately how to pronounce it.

Until I started working at my current job, I always pronounced the first "a" as a long vowel sound. Dysphay-gia. But for some reason, everyone here pronounces it as an "ah" sound. Dysphah-gia.

After looking it up, I felt that I was correct and everybody else was wrong. So I persisted in pronouncing it the same way. But strangely enough, nobody knew what I was talking about. Even the dictation system was interpreting the word as "dysphasia." When I was having a conversation with a neurologist, a very brilliant person, he actually didn't know what I was talking about when I used my usual pronunciation. He looked at me, baffled, and said, "Do you mean dysphah-gia?"

I'm still convinced that I'm right. But I've given up, and started pronouncing it the wrong way.

Sunday, August 3, 2014

Suicide Med Revisited

Last month, I released my latest book Suicide Med. I put up a teaser and have billed it as a thriller. However, I'd like to give you guys, my loyal readers, a better idea what it's about and if it's something you'd be interested in reading:

Anatomy is possibly the best class that I've taken in my entire life. It was incredible experience for me, and I wanted to capture that in a novel.

This book is about five anatomy lab partners, two male, three female. It is told from alternating points of view and is about each of their very different experiences making it through the term. One is a borderline admission, who is desperately trying not to fail, while another is a staunch feminist, and a the third is a hardcore gunner, who is dead set on landing a plastic surgery residency at any cost.

I called it a thriller, for lack of a better term, but it's a lot more quirky and your ordinary thriller. I tried to make it funny and the characters true to life, even if their experiences are unusual.

So please, pick up a copy today. Or if you bought a copy just to be nice, please read it!

Saturday, August 2, 2014

Weekly Whine: Daycare, Part 4

So a couple years ago, one of Mel's teachers at the daycare, Becky, offered to give me a few of her 4 year old daughter's old shoes for Babygirl. I thought, "Wow, that is so nice!" Becky was a float teacher, so she watched both Mel and Babygirl from time to time, and she always has really positive things to say, especially about Mel. She told me that Mel is always really nice to her daughter and always makes an effort to be kind to the younger kids. I thought that maybe Becky was doing this because she really liked Mel.

Anyway, she gave me the shoes and they were all way too big, which she realized, but I figured Babygirl could grow into them and it was still nice of her.

Then I mentioned the shoe thing to my husband, and he was like, "It's probably because Babygirl's shoes are filthy and she thinks you're a charity case."

And that kind of made sense. And I wasn't so pleased anymore.

I got Babygirl's shoes at a consignment sale. They were light pink and made from fabric, so they showed dirt really, really easily. About a week after she started wearing them, they looked filthy. But you guys, she was ONE YEAR OLD. Who cares what her shoes looked like? They fit her well, she liked them, and they were not actually dirtier than anyone else's shoes. It's just that they were freaking light pink.

We actually did have another pair of shoes that were dark brown and a half-size bigger. I'd been saving them until the light pink ones fell apart or got outgrown, because it's nice to have back-up shoes. But now I felt like the stupid daycare was judging me so I had to switch.

I was surprised that of all people, Becky would be judgmental of Babygirl. First of all, she was super nice and always saying what an amazing wardrobe Mel has and how she's such a fashionista. Also, she was a single white lesbian with a black adopted daughter. You'd think she of all people would recognize that appearances don't matter. But maybe she felt sorry for me because the other teachers were talking smack about Babygirl's shoes behind her back and she wanted to help me. That's what I choose to believe.

Sure enough, when I brought Babygirl to school on Monday with new shoes, everyone made a big deal about it.

Yes, I could afford brand-new expensive shoes for my daughter. I could also afford to take a $100 bill and burn it. I just don't see the point.


P.S. I promise this is my last weekly whine about day care. Unless you guys are loving this.

Friday, August 1, 2014

Like a room without a roof

When I was in medical school, one of my classmates made a list of things that you need to be happy. He actually put a lot of thought into it and made it into a very comprehensive list.

I don't remember much of it, but it contained the usual suspects. You need a significant other, a career that you enjoy, and the ability to be able to enjoy good food.

But number one on the list was:

Being able to pee.

Because he figured that if you couldn't pee, then you couldn't enjoy any of those other things.

(What specialty do you think this guy went into?)