Me: Do we have consent for [patient]'s surgery?
Nurse: No, the family wanted to talk to Dr. Ortho. They had a lot of questions and they wanted to talk to a doctor.
Me: Well, maybe i can answer them so we can get consent tonight and we don't have to worry about it tomorrow.
***
Me: Hi, I'm Dr. Orthochick from orthopedic surgery, I'm one of the residents working with Dr. 0rtho. I heard you had some questions about the surgery?
Patient: Yes, what time is it going to be at?
Me: Tomorrow afternoon. Anything else?
Patient: No, that's it.
Me: OK, can I get your signature on a consent form for the surgery?
Patient That's fine.
4 years of undergrad, 4 years of med school, a year and a half of residency, and I'm qualified to tell people when their surgery is going to be. I really question the value of this degree on a regular basis.
Also, I always like to get consent myself so I can answer patients' questions, although I've noticed they only ask two questions:
1. What time will the surgery be at?
2. How long is it going to take?
And those are the two things i can't answer. What time it'll go at depends on when the surgeon is free and how many other things are going on in the OR at that time, as well as how many other traumas we have to do and who's the most injured. Plus, to quote Dr. Monday, "a chance to go early is a chance to go on time." Surgeons are not known for being punctual. Especially if your surgery is scheduled for after the surgeon finishes at clinic. Then you're really screwed. As for how long it takes, I don't like to tell people that because if I say it takes an hour and it takes longer, people really start to flip out. So I just say we won't know until we get in there and see. Which people seem to accept, even though if you think about it, it doesn't make that much sense. There's really not all that much we can get from looking at the bone vs. looking at an x-ray. So yes, I'm anal about getting consent myself, but in the grand scheme of things, I don't think it really helps the patient, since I can't answer the only two things they ever want to know.
Tuesday, September 30, 2014
Monday, September 29, 2014
Teacup pain syndrome
Patient: "Doctor, I've got pain in my left hip."
Me: "When does it hurt? When you're walking?"
P: "No, not really."
Me: "Does it hurt when you're exercising?"
P: "No..."
Me: "Does it hurt right now, while you're sitting here?"
P: "No, not right now."
Me: "Okay, so when does it hurt?"
P: "Doctor, it hurts when I do this." [Patient stands up, spreads his legs apart and lifts his left hip while simultaneous fully externally rotating it. Sort of a "I'm a little teacup" pose.]
Me: [barely concealing laughter] "Well, how often do you have to do that?"
P: "I guess not too often."
Me: "Okay, just try not to do that anymore."
Me: "When does it hurt? When you're walking?"
P: "No, not really."
Me: "Does it hurt when you're exercising?"
P: "No..."
Me: "Does it hurt right now, while you're sitting here?"
P: "No, not right now."
Me: "Okay, so when does it hurt?"
P: "Doctor, it hurts when I do this." [Patient stands up, spreads his legs apart and lifts his left hip while simultaneous fully externally rotating it. Sort of a "I'm a little teacup" pose.]
Me: [barely concealing laughter] "Well, how often do you have to do that?"
P: "I guess not too often."
Me: "Okay, just try not to do that anymore."
Saturday, September 27, 2014
Weekly Whine: Westinghouse
When I was in high school, there was a contest called the Westinghouse science contest. It's one of the biggest science contests in the country and it's since been renamed the Intel science talent search.
Becoming a semi finalist in this contest was a pretty big deal, and becoming a finalist was an even bigger deal, and of course, winning with the hugest deal of all. I entered the contest, but didn't win and did not even make semifinalist.
I know this is going to seem like sour grapes, considering everything, but now that I know a lot about the contest, I think it is all sort of bullshit. I worked in the lab with three other students, and we were each basically randomly assigned projects. Before we started the project or even wrote one word, I could've told you which of the four of us was going to be the semi finalist, based on how interesting the projects sounded.
Don't get me wrong, there were people who came up with math projects that were entirely their own invention, and they were geniuses and definitely deserved to win. But I would say the majority of people who did well just lucked into a really good lab and got assigned an interesting project. For example, I am sure that anyone whose project involved PCR was just following what their mentor told them to do. I know from my own lab, the guy who was a semi finalist didn't do any more work than the rest of us, and basically had no creative say in the project. We all just followed what our mentors told us to do.
I guess this is the fatal flaw in having high school students do fancy science projects.
Becoming a semi finalist in this contest was a pretty big deal, and becoming a finalist was an even bigger deal, and of course, winning with the hugest deal of all. I entered the contest, but didn't win and did not even make semifinalist.
I know this is going to seem like sour grapes, considering everything, but now that I know a lot about the contest, I think it is all sort of bullshit. I worked in the lab with three other students, and we were each basically randomly assigned projects. Before we started the project or even wrote one word, I could've told you which of the four of us was going to be the semi finalist, based on how interesting the projects sounded.
Don't get me wrong, there were people who came up with math projects that were entirely their own invention, and they were geniuses and definitely deserved to win. But I would say the majority of people who did well just lucked into a really good lab and got assigned an interesting project. For example, I am sure that anyone whose project involved PCR was just following what their mentor told them to do. I know from my own lab, the guy who was a semi finalist didn't do any more work than the rest of us, and basically had no creative say in the project. We all just followed what our mentors told us to do.
I guess this is the fatal flaw in having high school students do fancy science projects.
Thursday, September 25, 2014
Tuesday, September 23, 2014
Dr. Orthochick: Amputation
During my first month of internship (that would be Vascular Surgery), we had a patient come in with gas gangrene. She was totally septic and actively dying, so about the only thing we could do was amputate her leg in a guillotine amputation. We cut it off a little below the knee and didn't even bother to cover the stump because we knew we'd have to go back to revise it. You could see the ends of the bones and the muscles like some sort of weird cross sectional drawing. Anyway, we then went back and revised her to an above knee amputation. By that point she was doing a little better, but she was still in florid renal failure and I don't even remember what else. So she started getting better and one day I was rounding on her while she was in the dialysis center, she was a little more with it, and then I went to write my note.
I have no idea what happened, but she started crying and the nurse ran over there and the patient said "I want to know what happened."
The only person in the room who knew exactly what happened was yours truly, I was writing a note, I was running low on time, and really, I didn't know how to explain to a woman that we just cut off her knee. (This was long before I had to tell people they were going to die/their spouse was going to die/their spouse already died/they were never going to walk again/they had metastatic unresectable pancreatic cancer...) So the nurse asked me to talk to the patient despite the fact that I was practically hiding under the computer in an effort to be innocuous, and I went over there to see her.
Her: What happened?
Me: Well...you got really sick, you know? And the only way to get you better was to, uh, cut off your leg.
She was crying and said, "I don't want to hear this anymore."
Me: No, I want to talk about this with you. We cut off your knee. You don't have any leg past your knee. But your infection is mostly gone. You're getting a lot better. I've been talking to your husband and he's been here every day to see you and he's excited to see you get better--he told me your anniversary is next week. So you don't have a knee. But it was the only way we could get you better.
I remember I had her reach down and feel her stump and that really made her cry. Truth be told, I don't think I did a great job breaking the news, but looking back I'm not sure how I would have done it all that differently. I guess i could have eased into it a little more, although it's pretty hard to soften up "we cut off your leg."
***
Flash forward a year and a half and I still really hate having to tell people we amputated their bodyparts. I've had to do it 2 or 3 times since July of 2010 and really, it's up there with the "you will never walk again" speech for me. Anyway, yesterday I had a guy come into the ER with a huge open hand laceration. I took about three looks at it and called Dr. Pregnant.
Me: This is going to have to go to the OR
Her: What is it?
Me: An emergency. I'll call the OR and get everything started.
He had gotten his hand stuck in a woodchopper and there was a huge gash going across the palm. Through the gash, you could see the tendons were cut, as were the bones. Bone fragments were stuck in the severed tendon ends, and the whole thing was bleeding profusely. I touched the index finger and it flopped backwards. The joints of the middle finger were dislocated, so it was bent the wrong way in the middle. There was still wood in the whole thing.
We got that case booked pretty quickly, Dr. Pregnant came in from home, and we started working on him, at which point we realized all the tendons, nerves, blood vessels, and bones to the index finger were cut, which meant the finger was totally dead. This also explained why it was so cold and it didn't bleed when we cut it. So we had to amputate it, because you can't keep dead fingers on your hands due to the high risk of infection. (and really, would you want a finger that was only attached to the rest of your hand by skin?) We then did some exploration and discovered that a lot of his blood vessels were ripped in half. We repaired the tendons, fixed most of the bones, and sewed him up, with the plan being to watch him for the next 24--48 hours and see if his fingers survived. If they did, we would go back and fix the nerves, if not, choppy-choppy.
That ended kind of late at night so I wrote my orders and figured I would tell the patient the details in the morning. So I was doing my morning rounds and the nurse came up to me and said "[the patient] is really worried that his index finger is numb." I said "that's because we cut it off." She said "I didn't know that," I said "neither does he. I was about to tell him."
Me: Can I talk to you for a little bit?
Patient: OK. Why is my hand numb?
Me: That's what I wanted to talk to you about. See, when I saw you in the ER, I told you it was a really bad injury.
Him: Yeah, it was bad.
Me: Well, it was so bad, that we had to cut off your index finger because it died because it was so badly injured.
Him: Oh my G-d.
Me: So now you only have 4 fingers. But we're really worried about your middle finger and your ring finger. Because when we saw it in the operating room, a lot of blood vessels were cut. If you don't have blood vessels, the finger is going to die. So we're going to watch you closely for the next 2 days to see what happens.
Him: I could lose my hand?
Me: No, you're not going to lose your hand, but I will tell you now, I think there's a greater than 50% chance you could lose your middle and ring finger. Your pinky is fine and your thumb is fine, but those two fingers didn't look good in the operating room.
He cried. As I would too if you told me you were going to start cutting off my fingers.
I wonder if this is the sort of thing you get used to doing. The other day I was talking to an attending and he said he called his dad to talk after he had to amputate an arm and it made me feel really good to know that other people also feel weird and guilty about cutting off bodyparts. As much as I appreciate a good amputation, it just feels so unnatural. Especially when you do it and they don't even know. I mean, how do you explain 'while you were sleeping, we cut off part of your body?'
I have no idea what happened, but she started crying and the nurse ran over there and the patient said "I want to know what happened."
The only person in the room who knew exactly what happened was yours truly, I was writing a note, I was running low on time, and really, I didn't know how to explain to a woman that we just cut off her knee. (This was long before I had to tell people they were going to die/their spouse was going to die/their spouse already died/they were never going to walk again/they had metastatic unresectable pancreatic cancer...) So the nurse asked me to talk to the patient despite the fact that I was practically hiding under the computer in an effort to be innocuous, and I went over there to see her.
Her: What happened?
Me: Well...you got really sick, you know? And the only way to get you better was to, uh, cut off your leg.
She was crying and said, "I don't want to hear this anymore."
Me: No, I want to talk about this with you. We cut off your knee. You don't have any leg past your knee. But your infection is mostly gone. You're getting a lot better. I've been talking to your husband and he's been here every day to see you and he's excited to see you get better--he told me your anniversary is next week. So you don't have a knee. But it was the only way we could get you better.
I remember I had her reach down and feel her stump and that really made her cry. Truth be told, I don't think I did a great job breaking the news, but looking back I'm not sure how I would have done it all that differently. I guess i could have eased into it a little more, although it's pretty hard to soften up "we cut off your leg."
***
Flash forward a year and a half and I still really hate having to tell people we amputated their bodyparts. I've had to do it 2 or 3 times since July of 2010 and really, it's up there with the "you will never walk again" speech for me. Anyway, yesterday I had a guy come into the ER with a huge open hand laceration. I took about three looks at it and called Dr. Pregnant.
Me: This is going to have to go to the OR
Her: What is it?
Me: An emergency. I'll call the OR and get everything started.
He had gotten his hand stuck in a woodchopper and there was a huge gash going across the palm. Through the gash, you could see the tendons were cut, as were the bones. Bone fragments were stuck in the severed tendon ends, and the whole thing was bleeding profusely. I touched the index finger and it flopped backwards. The joints of the middle finger were dislocated, so it was bent the wrong way in the middle. There was still wood in the whole thing.
We got that case booked pretty quickly, Dr. Pregnant came in from home, and we started working on him, at which point we realized all the tendons, nerves, blood vessels, and bones to the index finger were cut, which meant the finger was totally dead. This also explained why it was so cold and it didn't bleed when we cut it. So we had to amputate it, because you can't keep dead fingers on your hands due to the high risk of infection. (and really, would you want a finger that was only attached to the rest of your hand by skin?) We then did some exploration and discovered that a lot of his blood vessels were ripped in half. We repaired the tendons, fixed most of the bones, and sewed him up, with the plan being to watch him for the next 24--48 hours and see if his fingers survived. If they did, we would go back and fix the nerves, if not, choppy-choppy.
That ended kind of late at night so I wrote my orders and figured I would tell the patient the details in the morning. So I was doing my morning rounds and the nurse came up to me and said "[the patient] is really worried that his index finger is numb." I said "that's because we cut it off." She said "I didn't know that," I said "neither does he. I was about to tell him."
Me: Can I talk to you for a little bit?
Patient: OK. Why is my hand numb?
Me: That's what I wanted to talk to you about. See, when I saw you in the ER, I told you it was a really bad injury.
Him: Yeah, it was bad.
Me: Well, it was so bad, that we had to cut off your index finger because it died because it was so badly injured.
Him: Oh my G-d.
Me: So now you only have 4 fingers. But we're really worried about your middle finger and your ring finger. Because when we saw it in the operating room, a lot of blood vessels were cut. If you don't have blood vessels, the finger is going to die. So we're going to watch you closely for the next 2 days to see what happens.
Him: I could lose my hand?
Me: No, you're not going to lose your hand, but I will tell you now, I think there's a greater than 50% chance you could lose your middle and ring finger. Your pinky is fine and your thumb is fine, but those two fingers didn't look good in the operating room.
He cried. As I would too if you told me you were going to start cutting off my fingers.
I wonder if this is the sort of thing you get used to doing. The other day I was talking to an attending and he said he called his dad to talk after he had to amputate an arm and it made me feel really good to know that other people also feel weird and guilty about cutting off bodyparts. As much as I appreciate a good amputation, it just feels so unnatural. Especially when you do it and they don't even know. I mean, how do you explain 'while you were sleeping, we cut off part of your body?'
Monday, September 22, 2014
Foreign accent syndrome
Recently I made a post about things that you see in movies involving brain injury that don't really happen in real life. But I don't want to spoil all the fun, so I thought I would make a post about something cool that actually can happen in a brain injury that you wouldn't think was real, but it is. And that's foreign accent syndrome.
I recently saw a case of this, and I talked to a neurologist who told me she's actually seen many cases in her career, Although most of these involved stroke. Some cases she told me about:
1) an Italian American man who had started speaking with a Haitian lilt
2) A native Californian who started speaking with a British accent
And all of these cases, the patient had never even been to the country whose accent they had adopted. Apparently the etiology involves damage resulting in altered pitch or mispronounced syllables, causing speech patterns to be distorted in a non-specific manner. So it's just a coincidence that your speech sounds like it comes from a specific place.
As far as I'm concerned, it's a good thing that can come out of a stroke or brain injury if you are an American. As Jason Lee said, Americans totally got screwed on accents.
I recently saw a case of this, and I talked to a neurologist who told me she's actually seen many cases in her career, Although most of these involved stroke. Some cases she told me about:
1) an Italian American man who had started speaking with a Haitian lilt
2) A native Californian who started speaking with a British accent
And all of these cases, the patient had never even been to the country whose accent they had adopted. Apparently the etiology involves damage resulting in altered pitch or mispronounced syllables, causing speech patterns to be distorted in a non-specific manner. So it's just a coincidence that your speech sounds like it comes from a specific place.
As far as I'm concerned, it's a good thing that can come out of a stroke or brain injury if you are an American. As Jason Lee said, Americans totally got screwed on accents.
Saturday, September 20, 2014
Weekly Whine: Life Insurance
Recently, my husband and I purchased life insurance. It was one of the hardest things we've had to purchase, which seems sort of ridiculous. Isn't life insurance supposed to be really easy to buy? Like, aren't you supposed be fending off life-insurance agents who want nothing more than to sell you a policy?
The first person we approached to help us buy insurance was somebody recommended by my boss. He said the guy was very reliable and fair. Unfortunately, it didn't work out, for reasons that somewhat confused me. My husband was concerned about our health information being sold to a third party, so he asked the guy for some sort of written guarantee that this wouldn't be done. The guy became offended and said he didn't want to work with us anymore.
The second agent was a recommendation from a friend of mine. She got her life insurance through him, but he also handled her investments. That was sort of a red flag, but I didn't realize it at the time. The other red flag is that he worked with an insurance company named Guardian. So obviously, despite his assurances, it was less about getting us a good deal and more about getting us to buy insurance through his own company. And also to make investments with him.
Initially, I was taken in by the fact that he was charismatic and said all the right things. I don't pretend to be incredibly savvy as a consumer, and I think I was taken in by every sales trick in the book. We went through our physical exams and we were offered policies that sounded fairly high. Mine was kind of high, but my husbands policy was really high. Now, he is a man and he does have some minor medical conditions, like sleep apnea, but this was out-of-control high. People at work that I told about it said that somebody 20 years older would probably pay less than that.
I told the agent that I wanted him to look into some other companies and he sounded shocked. He said that the policies we got were pretty standard. But if I insisted, he would look at some other companies. Basically, his suggestion was that my husband should buy whole life insurance instead of term life insurance due to the fact that he has so many medical problems (he doesn't actually).
We gave the guy a grace period to look into other companyies, but it was beginning to feel like he was just putting us off. And it also felt like he was lying to us and I really didn't want to buy anything from him anymore. At the point when he explained not having called us due to a family member's death and I actually believed he had made the whole thing up, I realized I probably shouldn't be buying anything from this guy. So I went and found another agent.
We had to go through the physical exams all over again, which sucked. But not long after, the third agent came through with a policy for me, which cost about half of what the last agent had offered me.
Unfortunately, my husband wasn't getting any offers. The reason for this was that the company hadn't received one piece of his medical records. I ended up having to make about a dozen phone calls to try to track down his medical records. Obviously, it would be too easy if the medical office actually had those records. I had to go through a third-party, who kept telling me to go back and call the medical office. The whole thing ended up taking months to straighten out.
Finally, my husband was offered a policy. It cost about 1/5 of what the offer had been through Guardian.
At least now we can die in peace.
The first person we approached to help us buy insurance was somebody recommended by my boss. He said the guy was very reliable and fair. Unfortunately, it didn't work out, for reasons that somewhat confused me. My husband was concerned about our health information being sold to a third party, so he asked the guy for some sort of written guarantee that this wouldn't be done. The guy became offended and said he didn't want to work with us anymore.
The second agent was a recommendation from a friend of mine. She got her life insurance through him, but he also handled her investments. That was sort of a red flag, but I didn't realize it at the time. The other red flag is that he worked with an insurance company named Guardian. So obviously, despite his assurances, it was less about getting us a good deal and more about getting us to buy insurance through his own company. And also to make investments with him.
Initially, I was taken in by the fact that he was charismatic and said all the right things. I don't pretend to be incredibly savvy as a consumer, and I think I was taken in by every sales trick in the book. We went through our physical exams and we were offered policies that sounded fairly high. Mine was kind of high, but my husbands policy was really high. Now, he is a man and he does have some minor medical conditions, like sleep apnea, but this was out-of-control high. People at work that I told about it said that somebody 20 years older would probably pay less than that.
I told the agent that I wanted him to look into some other companies and he sounded shocked. He said that the policies we got were pretty standard. But if I insisted, he would look at some other companies. Basically, his suggestion was that my husband should buy whole life insurance instead of term life insurance due to the fact that he has so many medical problems (he doesn't actually).
We gave the guy a grace period to look into other companyies, but it was beginning to feel like he was just putting us off. And it also felt like he was lying to us and I really didn't want to buy anything from him anymore. At the point when he explained not having called us due to a family member's death and I actually believed he had made the whole thing up, I realized I probably shouldn't be buying anything from this guy. So I went and found another agent.
We had to go through the physical exams all over again, which sucked. But not long after, the third agent came through with a policy for me, which cost about half of what the last agent had offered me.
Unfortunately, my husband wasn't getting any offers. The reason for this was that the company hadn't received one piece of his medical records. I ended up having to make about a dozen phone calls to try to track down his medical records. Obviously, it would be too easy if the medical office actually had those records. I had to go through a third-party, who kept telling me to go back and call the medical office. The whole thing ended up taking months to straighten out.
Finally, my husband was offered a policy. It cost about 1/5 of what the offer had been through Guardian.
At least now we can die in peace.
Thursday, September 18, 2014
Why a doctor?
When I ask a patient if they have any questions, sometimes they take this as a license to ask me whatever personal questions they'd like to know about me. The two favorites are how old am I and where am I from.
Yesterday, a patient came up with a new one: "What made you become a doctor?"
I haven't been asked that question in a long time. I quickly stammered my medical school interview answer. "There are so few fields where you can really help somebody…"
The patient seemed pleased with that answer. And even though I felt silly saying it, there is a grain of truth in that. I do like helping people.
But what's the other real reason?
1) my father, who is a doctor, pushed me into it
2) I wanted a career where there would be a stable, good, steady income
3) there was no other career path that I was particularly drawn to
How about you? Why did you decide to go into medicine?
Yesterday, a patient came up with a new one: "What made you become a doctor?"
I haven't been asked that question in a long time. I quickly stammered my medical school interview answer. "There are so few fields where you can really help somebody…"
The patient seemed pleased with that answer. And even though I felt silly saying it, there is a grain of truth in that. I do like helping people.
But what's the other real reason?
1) my father, who is a doctor, pushed me into it
2) I wanted a career where there would be a stable, good, steady income
3) there was no other career path that I was particularly drawn to
How about you? Why did you decide to go into medicine?
Wednesday, September 17, 2014
Tuesday, September 16, 2014
Dr. Orthochick: Off topic
So before you do an outpatient surgery, you have to make sure the H&P (history&physical) has been done within the past 30 days. If it hasn't, you have to write one out. It's this little form and you pretty much just have to write out a sentence for the 'history of present illness,' so it's not a big deal and it takes less than 5 minutes to write. It is far and away not my least favorite job. Although I feel dumb asking patients what happened because I feel like I should know a little bit more about them 5 minutes before I take them down to the OR to start cutting. My solution to this is, I kind of pretend I already know what's going on. So I always say, "I know this is a pain for you because I'm sure you've gone over this a million times already, but I just need to ask you one last time to tell me what happened." Most people laugh and tell me, in two sentences or less, when they fell and broke their distal radius.
Me: OK, so I know this is a pain for you because I'm sure you've gone over this a million times already and everyone's asked you, but--
Yesterday's patient: How many times do I need to tell you people? I'm gay!
It was really hard to segue from that into "so when did your trigger thumb start bothering you?"
Me: OK, so I know this is a pain for you because I'm sure you've gone over this a million times already and everyone's asked you, but--
Yesterday's patient: How many times do I need to tell you people? I'm gay!
It was really hard to segue from that into "so when did your trigger thumb start bothering you?"
Monday, September 15, 2014
Recruiting
I got an email just now with the subject "California Corrections." I got really scared. I thought maybe they caught up with me on that hit and run. (Just kidding, but I really did get a little scared.)
Anyway, this was the email:
I hope that you do not mind me emailing you this afternoon. I am quickly sending this email to you in case you are looking for a new opportunity or perhaps a higher paying job. The California Detentions Centers (CDC) have contact us to assist them in providing Family Practice coverage. The compensation is in the range of $130.00 an hour to $160.00 an hour. Credentialing and getting processed through the CDC system is a lengthy process. It can take about 3 to 4 months.
It's nice that although I told this recruiting agency to leave me alone, they are still sending me jobs nowhere near where I live, as well as in the wrong field. Good work, Staff Care. I also find it kind of funny that they're looking for family practice doctors for detention centers. I just picture a whole family in jail and being seen by the doctor.
Anyway, this was the email:
I hope that you do not mind me emailing you this afternoon. I am quickly sending this email to you in case you are looking for a new opportunity or perhaps a higher paying job. The California Detentions Centers (CDC) have contact us to assist them in providing Family Practice coverage. The compensation is in the range of $130.00 an hour to $160.00 an hour. Credentialing and getting processed through the CDC system is a lengthy process. It can take about 3 to 4 months.
It's nice that although I told this recruiting agency to leave me alone, they are still sending me jobs nowhere near where I live, as well as in the wrong field. Good work, Staff Care. I also find it kind of funny that they're looking for family practice doctors for detention centers. I just picture a whole family in jail and being seen by the doctor.
Saturday, September 13, 2014
Weekly Whine: Insurance
Recently my husband and I bought life insurance. It was a huge saga, which I may post about in the future if I am motivated.
One thing that struck me about the whole process of applying for insurance is how it punishes both honesty and self-improvement.
For example, my husband has sleep apnea. Obviously, this is not something that would be picked up by a clinician during a routine exam like high blood pressure or high cholesterol. However, in order to improve his health, he opted to get diagnosed and treated. And he has faithfully used a CPAP machine every night for the last six years.
Unfortunately, a person who never bothered to get treated for severe sleep apnea and presumably has higher health risks would probably have a much lower insurance rate than my husband. Ditto for people who seek treatment for mental health issues like depression or anxiety, which probably wouldn't be caught during a routine exam.
I understand that insurance companies need to use some sort of model to assess risk. But I do feel like that model shouldn't punish people who try to help themselves.
One thing that struck me about the whole process of applying for insurance is how it punishes both honesty and self-improvement.
For example, my husband has sleep apnea. Obviously, this is not something that would be picked up by a clinician during a routine exam like high blood pressure or high cholesterol. However, in order to improve his health, he opted to get diagnosed and treated. And he has faithfully used a CPAP machine every night for the last six years.
Unfortunately, a person who never bothered to get treated for severe sleep apnea and presumably has higher health risks would probably have a much lower insurance rate than my husband. Ditto for people who seek treatment for mental health issues like depression or anxiety, which probably wouldn't be caught during a routine exam.
I understand that insurance companies need to use some sort of model to assess risk. But I do feel like that model shouldn't punish people who try to help themselves.
Friday, September 12, 2014
Thursday, September 11, 2014
Suicide Med
If you read and enjoyed Suicide Med, please consider going to Amazon and leaving a review. I would really appreciate it!
Either way, if you read it, I would love to hear from you and get any sort of feedback, so send me an email.
Either way, if you read it, I would love to hear from you and get any sort of feedback, so send me an email.
Tuesday, September 9, 2014
Dr. Orthochick: TOXIC SHOCK SYNDROME
If your first thought upon reading the subject was "tampons," then congrats, you're normal. (If you don't know what that is, then that's normal too.) If your first thought was something other than tampons or nothing, then you're a freak of nature. (sorry. I hate to be mean, but really...what else is there besides "tampons"? Freak.)
We learned about it at some point second year of med school and they didn't teach us anything you can't find on the side of a tampon box. It's not particularly common, even among dedicated tampon wearers, but it does happen, in which case the treatment is removal of the tampon. Once you get that thing out, TSS usually clears up pretty quickly. Allegedly there are other ways of catching it, but as far as me and the rest of the world can tell, that's the only important way. Also, I remember Dr. McYummy telling me that I didn't need to know anything about it since I would never see anyone with it, now that the particular brand of tampon that was responsible for causing the outbreak was recalled.
Anyway, the other night when I was on call we got consulted in the ER for a 15 year old boy who had had metal pins stuck in his arm for a humerus fracture and was now presenting with an infection. The pin sites looked fine but the kid looked pretty sick. I asked the ER attending if we could consult pediatrics to admit the kid, he agreed, the kid got admitted that night. It wound up being the right decision because something happened that night and the kid crashed. Between when I saw him on Friday evening and 6AM Sunday, the kid wound up intubated, ventilated, sedated, and with a blood pressure so low they had to start him on multiple pressors.
He was diagnosed with toxic shock syndrome, source of infection unknown.
Dr. Sweaty: They now think he has toxic shock syndrome
Me: Has he been using tampons?
***
Me: They now think [your pediatric patient with the pins] has toxic shock syndrome
Dr. Orthoking Jr.: Where is he hiding a tampon? It comes from tampons, right? I think that's what we learned in med school.
Me: I think that's the only thing we learned about it in med school.
Dr. Orthoking Jr.: It's nice to know that med school hasn't changed.
***
Dr. Orthoking Jr.: That patient who we put the pins in now has toxic shock syndrome.
Scrub Nurse: Why is he using tampons?
***
Me: Hey mom, what's the first thing you think of when you hear "toxic shock syndrome"?
Mom: TAMPONS
We took out the pins, but they looked fine and they have yet to grow anything in the microbio lab. Anyway, I'm no doctor or anything, but I'm starting to wonder if it's not completely impossible that the kid actually does have a tampon inside himself. Assuming that Chuck Palahniuk short story did not lie to me, 15 year old boys like to do...uh...disgusting things to...uh...self stimulate. So I don't think it's completely inconceivable that he could have, well, I'm not going to spell it out here. But 15 year old boys are disgusting human beings and I don't think it's out of the realm of the possible that he does, in fact, have a tampon lodged inside him and it's causing all these problems.
I really think someone should give the kid a good rectal exam, but I'm not sure how to suggest it. And i'm not exactly about to sneak into his room and do it myself. Also, I didn't really want to dwell on what the kid did or didn't have lodged in his anus. (hey, there's a reason I'm in ortho and part of it involves staying the hell away from that thing) And it's possible that the kid has some foreign body that's not disgusting that's causing this problem, but we already removed the pins. What else is there?
I guess I'll never find out.
We learned about it at some point second year of med school and they didn't teach us anything you can't find on the side of a tampon box. It's not particularly common, even among dedicated tampon wearers, but it does happen, in which case the treatment is removal of the tampon. Once you get that thing out, TSS usually clears up pretty quickly. Allegedly there are other ways of catching it, but as far as me and the rest of the world can tell, that's the only important way. Also, I remember Dr. McYummy telling me that I didn't need to know anything about it since I would never see anyone with it, now that the particular brand of tampon that was responsible for causing the outbreak was recalled.
Anyway, the other night when I was on call we got consulted in the ER for a 15 year old boy who had had metal pins stuck in his arm for a humerus fracture and was now presenting with an infection. The pin sites looked fine but the kid looked pretty sick. I asked the ER attending if we could consult pediatrics to admit the kid, he agreed, the kid got admitted that night. It wound up being the right decision because something happened that night and the kid crashed. Between when I saw him on Friday evening and 6AM Sunday, the kid wound up intubated, ventilated, sedated, and with a blood pressure so low they had to start him on multiple pressors.
He was diagnosed with toxic shock syndrome, source of infection unknown.
Dr. Sweaty: They now think he has toxic shock syndrome
Me: Has he been using tampons?
***
Me: They now think [your pediatric patient with the pins] has toxic shock syndrome
Dr. Orthoking Jr.: Where is he hiding a tampon? It comes from tampons, right? I think that's what we learned in med school.
Me: I think that's the only thing we learned about it in med school.
Dr. Orthoking Jr.: It's nice to know that med school hasn't changed.
***
Dr. Orthoking Jr.: That patient who we put the pins in now has toxic shock syndrome.
Scrub Nurse: Why is he using tampons?
***
Me: Hey mom, what's the first thing you think of when you hear "toxic shock syndrome"?
Mom: TAMPONS
We took out the pins, but they looked fine and they have yet to grow anything in the microbio lab. Anyway, I'm no doctor or anything, but I'm starting to wonder if it's not completely impossible that the kid actually does have a tampon inside himself. Assuming that Chuck Palahniuk short story did not lie to me, 15 year old boys like to do...uh...disgusting things to...uh...self stimulate. So I don't think it's completely inconceivable that he could have, well, I'm not going to spell it out here. But 15 year old boys are disgusting human beings and I don't think it's out of the realm of the possible that he does, in fact, have a tampon lodged inside him and it's causing all these problems.
I really think someone should give the kid a good rectal exam, but I'm not sure how to suggest it. And i'm not exactly about to sneak into his room and do it myself. Also, I didn't really want to dwell on what the kid did or didn't have lodged in his anus. (hey, there's a reason I'm in ortho and part of it involves staying the hell away from that thing) And it's possible that the kid has some foreign body that's not disgusting that's causing this problem, but we already removed the pins. What else is there?
I guess I'll never find out.
Monday, September 8, 2014
Lesson in Honesty
A few days ago, I was at Kmart and I was taught a valuable lesson about honesty.
My daughter found a really cool pair of sunglasses in a three dollar bin. She loved them so much, she wore them all around the store. We bought about $50 worth of stuff, and when we were paying for it, she was still wearing them, so we accidentally forgot to pay for them.
When we got to the car, I noticed she was wearing the sunglasses and I asked if we had paid for them. She said that we hadn't. Obviously, at that point, we had gotten away with it, but I wanted to teach my daughter that it's not okay to steal, even accidentally. I wanted to teach her to be honest. So we went back to the store to pay for the sunglasses.
The lines were long, but we got back in line, so we could pay for the sunglasses. Unfortunately, it turned out the sunglasses didn't have a tag on them. The cashier asked for a price check, and let somebody else go in front of us while we were waiting, because obviously getting a price check is such a long ordeal that we couldn't possibly allow the line not to move. She was right. The person didn't know what the price was and we had to locate another pair of sunglasses in the bin, but those weren't labeled either.
We had to call another person to find out what to do about the situation. This person suggested getting another pair of sunglasses from another place, and then marking those down to three dollars. At this point, we had been dealing with this for at least 10 minutes.
We followed the cashier and she got us another pair of sunglasses and then we had to get in the customer service line, because obviously the cashier couldn't do it herself. That line was very long too. I said to the cashier that I would just hand her three dollars and then asked if we could leave. She said it didn't work like that.
After several minutes of waiting in line, I started to get pretty pissed off because it didn't look like the line was moving at all. I asked to speak to the manager. The manager came over and I told them all we had been through in attempting to pay for the sunglasses, and they said since they were only three dollars and we just spent $50 at their store, I thought he should let us just have them and let us leave.
He said he couldn't do that and then I started fighting with him. I said that this was ridiculous, that it was their fault that they didn't label the item had such terrible customer service that they had no way of dealing with us without it taking practically 30 minutes of my time. I was SO ANGRY. Finally, he agreed to give me the sunglasses for 50% off. I said fine and that I was never going to shop there again.
Maybe it's impossible to get an item for free just because the store sucks, but considering it was only three dollars, I don't think it was worth anyone's time. For me it was just about principle at that point. What sucks the most is that my daughter was so miserable through the whole process and I was just trying to teach her to be honest. I don't think that lesson succeeded.
My daughter found a really cool pair of sunglasses in a three dollar bin. She loved them so much, she wore them all around the store. We bought about $50 worth of stuff, and when we were paying for it, she was still wearing them, so we accidentally forgot to pay for them.
When we got to the car, I noticed she was wearing the sunglasses and I asked if we had paid for them. She said that we hadn't. Obviously, at that point, we had gotten away with it, but I wanted to teach my daughter that it's not okay to steal, even accidentally. I wanted to teach her to be honest. So we went back to the store to pay for the sunglasses.
The lines were long, but we got back in line, so we could pay for the sunglasses. Unfortunately, it turned out the sunglasses didn't have a tag on them. The cashier asked for a price check, and let somebody else go in front of us while we were waiting, because obviously getting a price check is such a long ordeal that we couldn't possibly allow the line not to move. She was right. The person didn't know what the price was and we had to locate another pair of sunglasses in the bin, but those weren't labeled either.
We had to call another person to find out what to do about the situation. This person suggested getting another pair of sunglasses from another place, and then marking those down to three dollars. At this point, we had been dealing with this for at least 10 minutes.
We followed the cashier and she got us another pair of sunglasses and then we had to get in the customer service line, because obviously the cashier couldn't do it herself. That line was very long too. I said to the cashier that I would just hand her three dollars and then asked if we could leave. She said it didn't work like that.
After several minutes of waiting in line, I started to get pretty pissed off because it didn't look like the line was moving at all. I asked to speak to the manager. The manager came over and I told them all we had been through in attempting to pay for the sunglasses, and they said since they were only three dollars and we just spent $50 at their store, I thought he should let us just have them and let us leave.
He said he couldn't do that and then I started fighting with him. I said that this was ridiculous, that it was their fault that they didn't label the item had such terrible customer service that they had no way of dealing with us without it taking practically 30 minutes of my time. I was SO ANGRY. Finally, he agreed to give me the sunglasses for 50% off. I said fine and that I was never going to shop there again.
Maybe it's impossible to get an item for free just because the store sucks, but considering it was only three dollars, I don't think it was worth anyone's time. For me it was just about principle at that point. What sucks the most is that my daughter was so miserable through the whole process and I was just trying to teach her to be honest. I don't think that lesson succeeded.
Saturday, September 6, 2014
Weekly Whine: Health insurance is expensive yo
Recently, I had a really bad sore throat. Instead of abusing one of my colleagues, I decided to take a trip to urgent care to rule out strep.
Obviously, I have health insurance. However:
It cost $20 co-pay for the visit.
It cost $30 for the Z pack they prescribed.
It cost $30 for the throat culture.
So with my health insurance, it was $80 to treat my sore throat, which turned out to just be viral after all. Good thing I make a doctor salary.
Obviously, I have health insurance. However:
It cost $20 co-pay for the visit.
It cost $30 for the Z pack they prescribed.
It cost $30 for the throat culture.
So with my health insurance, it was $80 to treat my sore throat, which turned out to just be viral after all. Good thing I make a doctor salary.
Thursday, September 4, 2014
Stick Figure Death
Circa 1998, there was a little fad on the internet called STICK FIGURE DEATH THEATERS....
The basic idea is that you animate little scenarios of stickmen dying in creative ways. Always one to get sucked into internet fads (in college), I immediately downloaded some animation software and made my own stick death site.
I made about a dozen or so animations. I showed them to everyone. I was very ghetto and low tech about my animations, but I got a lot of hits initially because I came into the game early. I was on the top 20 site for a while and I was an early member of the stick death ring. The animations on other sites quickly became pretty elaborate and my site got pushed out of the mainstream, but I will always carry a piece of that site with me (on my harddrive).
Here's a sample:
For the next month I'm going to keep posting these intermittently. Because it's my damn blog and I want to.
The basic idea is that you animate little scenarios of stickmen dying in creative ways. Always one to get sucked into internet fads (in college), I immediately downloaded some animation software and made my own stick death site.
I made about a dozen or so animations. I showed them to everyone. I was very ghetto and low tech about my animations, but I got a lot of hits initially because I came into the game early. I was on the top 20 site for a while and I was an early member of the stick death ring. The animations on other sites quickly became pretty elaborate and my site got pushed out of the mainstream, but I will always carry a piece of that site with me (on my harddrive).
Here's a sample:
For the next month I'm going to keep posting these intermittently. Because it's my damn blog and I want to.
Wednesday, September 3, 2014
Three common myths about brain injury
As somebody who frequently sees patient who have real head injuries, it bugs me how many misconceptions are inflicted upon the public. So I want to share with you three common myths about brain injury that I frequently see in movies and TV shows.
Three common myths about brain injury
1) A second head bonk is not curative
You know what I'm talking about. Somebody gets hit in the head, gets amnesia, and this lasts until something hits them in the head again. And presto, they're cured! Recently I saw this depicted on The Muppets Take Manhattan, which my kids were watching. (Muppets frenzy and all.)
Actually, there is a phenomenon called Second Impact Syndrome, involving getting hit in the head again shortly after a first impact. Unfortunately, this second head bunk does not cure you but rather kills you.
2) You don't wake up from a coma one day and are just totally fine
The length of time you are in a coma is extremely predictive of outcome. If it lasts longer than three months, even if you "wake up", you will almost certainly have severe cognitive deficits. At that point, it is essentially impossible to wake up and be completely normal.
And you definitely won't have a psychic powers. I'm looking at you, Dead Zone.
3) You can't really function in normal society with severe short-term memory loss from a head injury
It wouldn't be possible to have a head injury with severe memory loss, but still be able to drive a car, have normal conversations, normal relationships, or solve mysteries about who killed your wife. You might not even be able to figure out how to bathe or dress yourself.
But you probably could go on 50 first dates with Adam Sandler, because I'm pretty sure that having impaired cognition would be a plus in that situation.
Three common myths about brain injury
1) A second head bonk is not curative
You know what I'm talking about. Somebody gets hit in the head, gets amnesia, and this lasts until something hits them in the head again. And presto, they're cured! Recently I saw this depicted on The Muppets Take Manhattan, which my kids were watching. (Muppets frenzy and all.)
Actually, there is a phenomenon called Second Impact Syndrome, involving getting hit in the head again shortly after a first impact. Unfortunately, this second head bunk does not cure you but rather kills you.
2) You don't wake up from a coma one day and are just totally fine
The length of time you are in a coma is extremely predictive of outcome. If it lasts longer than three months, even if you "wake up", you will almost certainly have severe cognitive deficits. At that point, it is essentially impossible to wake up and be completely normal.
And you definitely won't have a psychic powers. I'm looking at you, Dead Zone.
3) You can't really function in normal society with severe short-term memory loss from a head injury
It wouldn't be possible to have a head injury with severe memory loss, but still be able to drive a car, have normal conversations, normal relationships, or solve mysteries about who killed your wife. You might not even be able to figure out how to bathe or dress yourself.
But you probably could go on 50 first dates with Adam Sandler, because I'm pretty sure that having impaired cognition would be a plus in that situation.
Tuesday, September 2, 2014
Dr. Orthochick: Nails in feet
I had a guy the other day who shot himself in the foot with a nail gun. Fortunately, he wasn't an idiot so he was wearing steel-toed shoes, unfortunately that meant the nail went through the top of his shoe before coming out the other side. So it was straight through his shoe and foot.
Once i finally got his shoe off, removing the nail took 30 seconds. Until that point, however, it was me, a scalpel, a pair of scissors, some four-letter words, a cast saw, and my fingers. Seriously, this took forever. And since it was the middle of the day, apparently no one else had anything interesting going on so half of the ER was clustered outside the room watching me attempt to get this guy's shoe off. Since it was a heavy-duty construction shoe it was built to last, and i really think we should send a letter to the company congratulating them on making such an indestructible shoe. Because I was hacking away at it with a scalpel for a while. Technically I had to change scalpels every 45 seconds or so because they kept on getting dull, but that probably helped me out when I stuck the stupid thing into my own hand. (so there was a 30-second pause in the action when I got a bandaid) Even using a cast saw I couldn't get the stupid thing off. I appreciate light carpentry as much as the next orthopod, but this was getting a little ridiculous.
I know it seems counter-intuitive to take the shoe off when I could have just pulled the nail out through the top, and that was my first idea, but according to the patient (a construction worker), his father (a construction worker), and his brother (a construction worker) this type of nail had to be removed from the bottom. You had to cut the head off and then pull it out the bottom of the foot. Something about the way the threads were going. I don't know but I decided since it was their occupation, they probably knew what they were talking about.
Patient: Whenever you shoot yourself, you have to pull off the head and pull it out the bottom.
Brother: Yeah, normally we can just do it ourselves but since the shoe was in the way, we came here
Father: When it's in your hand, you can just pull it out.
Me: Wait, so have all of you shot yourselves?
Patient: Oh yeah, we do it all the time.
I was tempted to dictate in my H&P "family history is positive for multiple family members with nail gun injuries."
It took the better part of an hour, but I finally managed to dig the shoe off so I could get to the head of the nail to cut it off. (the nail was really embedded in there. Those nail guns have force, yo) I don't know why we keep pliers in the ER, but they came in handy there. Then I just grabbed the bottom of the nail, pulled and twisted it a little, and, thank G-d, that thing came out. I asked the patient if he wanted it, but he said to just hold on to it as a souvenir. I tossed it in the sharps container.
What's the difference between a carpenter and an orthopedic surgeon?
A carpenter can name at least 2 antibiotics
Once i finally got his shoe off, removing the nail took 30 seconds. Until that point, however, it was me, a scalpel, a pair of scissors, some four-letter words, a cast saw, and my fingers. Seriously, this took forever. And since it was the middle of the day, apparently no one else had anything interesting going on so half of the ER was clustered outside the room watching me attempt to get this guy's shoe off. Since it was a heavy-duty construction shoe it was built to last, and i really think we should send a letter to the company congratulating them on making such an indestructible shoe. Because I was hacking away at it with a scalpel for a while. Technically I had to change scalpels every 45 seconds or so because they kept on getting dull, but that probably helped me out when I stuck the stupid thing into my own hand. (so there was a 30-second pause in the action when I got a bandaid) Even using a cast saw I couldn't get the stupid thing off. I appreciate light carpentry as much as the next orthopod, but this was getting a little ridiculous.
I know it seems counter-intuitive to take the shoe off when I could have just pulled the nail out through the top, and that was my first idea, but according to the patient (a construction worker), his father (a construction worker), and his brother (a construction worker) this type of nail had to be removed from the bottom. You had to cut the head off and then pull it out the bottom of the foot. Something about the way the threads were going. I don't know but I decided since it was their occupation, they probably knew what they were talking about.
Patient: Whenever you shoot yourself, you have to pull off the head and pull it out the bottom.
Brother: Yeah, normally we can just do it ourselves but since the shoe was in the way, we came here
Father: When it's in your hand, you can just pull it out.
Me: Wait, so have all of you shot yourselves?
Patient: Oh yeah, we do it all the time.
I was tempted to dictate in my H&P "family history is positive for multiple family members with nail gun injuries."
It took the better part of an hour, but I finally managed to dig the shoe off so I could get to the head of the nail to cut it off. (the nail was really embedded in there. Those nail guns have force, yo) I don't know why we keep pliers in the ER, but they came in handy there. Then I just grabbed the bottom of the nail, pulled and twisted it a little, and, thank G-d, that thing came out. I asked the patient if he wanted it, but he said to just hold on to it as a souvenir. I tossed it in the sharps container.
What's the difference between a carpenter and an orthopedic surgeon?
A carpenter can name at least 2 antibiotics
Monday, September 1, 2014
Young Adult
Lately, I have been reading a lot of young adult books. They are sort of addictive in that it's hard to go back to normal books after reading a few of them.
What I like about young adult books:
--The language is simple and easy to read.
For example, these are the first two sentences of a regular adult book I recently tried to read: "An icy rush of air, a freezing slipstream on the newly exposed skin. She is, with no warning, outside the inside and the familiar wet, tropical world has suddenly evaporated."
Huh? I had to read that like three times in order to absorb it. I am way too tired for a book written like that.
--They are never boring. Yes, sometimes silly or annoying, but not boring. Because kids don't have the attention span for boring.
For example, I recently read an adult book that was spending about 10 pages going nowhere about this random drunk guy in a bar. If this were a young adult book, that scene would've ended nine pages earlier. Or left it out entirely.
--The ones that adults manage to remember from their childhood are usually pretty amazing. I mean, if something sticks with you for 20 years, it's got to be pretty good.
So does anyone have any recommendations for a really amazing young adult books? If you want to see what I have already read and enjoyed, you can look at my reading list.
Hurry, before I have to read something meant for people my own age!
What I like about young adult books:
--The language is simple and easy to read.
For example, these are the first two sentences of a regular adult book I recently tried to read: "An icy rush of air, a freezing slipstream on the newly exposed skin. She is, with no warning, outside the inside and the familiar wet, tropical world has suddenly evaporated."
Huh? I had to read that like three times in order to absorb it. I am way too tired for a book written like that.
--They are never boring. Yes, sometimes silly or annoying, but not boring. Because kids don't have the attention span for boring.
For example, I recently read an adult book that was spending about 10 pages going nowhere about this random drunk guy in a bar. If this were a young adult book, that scene would've ended nine pages earlier. Or left it out entirely.
--The ones that adults manage to remember from their childhood are usually pretty amazing. I mean, if something sticks with you for 20 years, it's got to be pretty good.
So does anyone have any recommendations for a really amazing young adult books? If you want to see what I have already read and enjoyed, you can look at my reading list.
Hurry, before I have to read something meant for people my own age!
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