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7 Types of Physician Handwriting

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Stages of studying

Holiday hiatus

I will be taking a break from posting for the holidays and therefore will be rerunning some of my very favorite cartoons in my absence. I will return as scheduled with new posts in 2015. 

Happy Holidays!

Dr. Orthochick: Friend me!

I got a friend request on facebook yesterday from someone I didn't recognize, I looked at the pictures and it turns out he was a guy I saw in foot&ankle clinic last week for his foot pain.

I politely declined that request.

Is it just me, or is that a little weird? I mean, I wasn't examining his bunions because I wanted to sleep with him. My sole interaction (no pun intended) with this guy was limited to talking about his foot problems. I'm not even sure how he remembered my name long enough to look me up on facebook.

This is probably a sign that I should either get off facebook or change my name on it, both of which would probably be fine since I rarely go on it to begin with. Because even though this is the first patient to try and friend me, I really don't want to be friends with patients at all. I don't really post anything on facebook and most of my friends don't tag me in posts, I don't have any incriminating photos, and there's actually not all that much personal information up there, but I still do not want my patients to see it. I don't want to blur the patient-doctor relationship here. And, truth be told, if they're not sitting in front of me, I don't really care what they're up to.

Put frankly, I do not want to be friends with my patients.

I don't know if I gave the guy the wrong idea or something, I thought I was pretty professional and it's not like I asked him to take off his shirt or something so as far as physical exam goes, foot&ankle is pretty low on the sexy totem pole, but maybe I said something wrong?

Me: Hey, you remember that younger guy we saw last week with the bunions? He sent me a friend request on facebook!
Dr. Critical: You're welcome. I guess that's an unintentional perk of the foot&ankle rotation--you get to hook up with the patients.

Evaluations

Actual line from an email I got during residency from my 67 year old department head to my entire residency program:

"Also worth spending a little time on milestone expectations so you know what you are being ejaculated on."

The number of texts and emails that followed that said some variation of 'my face' was starting to get a little extreme. Also, even though I felt like my program was constantly crapping on me, I never really felt like i was being ejaculated on.

I guess someone pointed it out to the boss because a few hours later he sent the following email:

"It has been pointed out that I used the incorrect use of Milestones in my last email to the group. We really use them to evaluate each resident."

(italics his, not mine)

I don't even understand how you could make that typo. "v" and "j" are not that close to each other on the keyboard. I guess we know what the boss does in his free time in his office.

He never managed to live that down and luckily retired shortly after.

Weekly Whine: Presents

I don't really believe in getting presents, mostly because I think that it's impossible to get somebody a present without making somebody else feel slighted.  Half the time, people don't even want what you got them.

Case in point, I was recently pressured to go in on a Christmas present for a coworker. Except if I get a present for this person, there are at least eight other people who would feel slighted if I didn't get them a present. So now I have to figure out what to do for eight other people. And there are probably a bunch of other people that I'm not even thinking of right now who will also be insulted.  This is really stressing me out, considering I usually just bring some treats for everyone to share.

Not to mention like 10 teachers and daycare workers that I have to get stuff for...

I think people should only give presents to children, and everything else should be communal baked goods.

Sexual abuse is OK?

I had a patient in residency who had a brain injury and we couldn't discharge him to his parents' house because he sexually abused his sister when she was nine (she's 14 now, and the patient had been living with his grandparents so he wasn't near her). I was mentioning this to the new attending and he was like, "So what? He sexually abused her a long time ago. He should still be able to live there."

Uh, okay... "I was told that if he goes back home, we have to report it to child protective services."

"That's not true," the attending insisted. "He hasn't expressed any intent to hurt her so we don't have to report it. The sexual abuse was a long time ago."

"Yeah, but he's already attacked two women here!"

"But his sister won't be involved in his care," the attending said. "They'll be living in the same house, but she can avoid him. And she can leave the house if she wants."

I didn't even know what to say to that. I mean, how would he like a serial killer living in his house, provided the murderer hasn't specifically stated he's going to kill him and he doesn't have to go near him? I was totally baffled by the fact that he thinks there's nothing wrong with making a 14 year old girl live in a house with a guy that abused her. And "she can leave the house if she wants"? WTF? She's FOURTEEN, not forty. Where was she supposed go?

Dr. Orthochick: Pinky

I got paged in around 23:00 the other night to reduce a kid's pinky finger. I would have been less annoyed, except it was the second time in a week that I've gotten paged in around 23:00 to reduce a kid's pinky finger. It's times like this I really wish the ER knew how to do stuff like reduce fingers. (they tried once earlier this year and then I got paged to redo it when they messed it up. So I guess they're scared of trying and honestly, redoing their crappy work was harder than if I had done it myself in the first place so I probably shouldn't complain, but seriously guys, it's a freaking pinky.)

Me: So when did this happen?
Mother: Around 19:00. So we went to (outside hospital) and they told us to come right here.
Me: Uhhh...
Mother: Well, first we went home and [patient] took a shower and then she had dinner and then we came over here.

One could make the argument that if you feel like showering and eating dinner, you probably don't have an emergency going on, you could also make the argument that doing a reduction sometimes requires sedation and if you've just eaten it makes it that much harder to do that. But I was telling this story to my sister and she brought up the time that she fell off her bike and needed stitches in her chin and mom convinced her to shower first under the pretense that she would feel better. She claimed that she did not, in fact, feel better, but this is the same sister who continued ice skating after she broke her elbow and continued skiing after she separated her shoulder. And the same mother who told me I was too old to have an earache (I was 13 or so), at which point my eardrums ruptured and leaked pus into my hair for the next week and I wound up on 2 courses of antibiotics.

Anyway, reducing kids' fingers is annoying. I'm a big fan of sedation for pediatric reductions. One of my coresidents never does it and things seem to go fine for him, but i'm of the opinion that you can only get away with that if you're convinced you can get it on the first try. And I'm not. So usually I sedate kids because it's a lot easier for me to do a reduction if they're relaxed, I can do it as many times as I need to to get it perfect, and I think the parents probably prefer not hearing screaming followed by the crack of a bone. (and sometimes it really does make a loud crack.) but if it's just a finger, it's kind of overkill to sedate the kid and the risks outweigh the benefits, so the ER won't do it for you. But you don't really have great options. I could do a hematoma block, but that involves sticking a needle in the sore area and injecting numbing medication, which burns. I could do a wrist block, but that's three needle sticks and burning. I could just do nothing, but then parents get mad. If it was my finger, I'd probably go for nothing since that numbing medication stuff seems to burn like hell and it's over quick anyway, (and I am sure my parents would be fine with that since over the course of my childhood I remember getting tylenol once and it was because I had a fever of 104 so really, mom and dad were not quick with the analgesics here) but not everyone's parents are so OK with hearing their kid yell.

So I gave the kid (and her mother) the option of hematoma block or nothing, they picked the hematoma block, and the kid screamed like hell while I did it and for a good few minutes after. This was after the 20 minutes of crying leading up to the hematoma block once i explained what it was. So once we did the stupid hematoma block we actually did the reduction (seriously, I pulled on the finger and got it straight. I would say this took under 10 seconds at a conservative estimate. We could have done this a couple hundred times in the time it took the kid to calm down from the stupid hematoma block)

::sigh::

At least the kid was super cute. She was actually the second super-cute girl under age 10 with a pinky fracture who I've seen in the past week, so either kids are getting cuter these days, pinky fractures only happen to cute kids, or I'm starting to get mushy in my old age.

Code Blue in the Rehab Unit

I still remember my first CODE BLUE IN THE REHAB UNIT.

My attending and I were seeing the patient in room 35, who was named Jim (not his real name). Jim was a little bit out of it and his rehab was actually stopped because he was making insufficient progress. But my attending liked him so we'd still come to his room every day (technically, only the resident had to see patients who are no longer being rehabbed).

We attempted to talk to him a little bit and made sure that his nurse call button was in easy reach of his one arm that moved. He gave us a big smile before we left the room. Little did we know...

About five minutes later, we were in the next room over, seeing our next patient. Suddenly, we heard the overhead alarm that still makes my skin crawl: "Code Blue in...."

We waited.

".... Code Blue in Two Rehab, Room 35."

Just hearing that it was on my floor was horrifying enough, but then it hit me that Room 35 was Jim's room. I was terrified for a good five seconds until I realized, "Hey wait, we were JUST in there and he was fine. How could he suddenly be coding?" That doesn't usually happen to healthy (but brain damaged) young men.

We ran back to his room and his bed was surrounded by several nurses. And he was still lying in bed, smiling.

"False alarm," one of the nurses said. "Somehow he managed to hit the Code Button."

So apparently, Jim called the code himself. I was very surprised to discover that there's a button right by the bed that's so easy to access that even a bed bound patient can hit it accidentally.

Weekly Whine: Checkout candy

I was recently shopping at a chain store with my kids. We had gathered a few purchases, which is no small feat when one of your children has the attention span of a cocker spaniel. We got on the rather long checkout line, and were immediately faced with about 20 feet of nonstop candy.

I get why stores do that. I'm sure they get a lot of people making purchases they otherwise wouldn't because they see an item while they're waiting to buy the items they already decided to purchase. I've done it myself.

But if you are a parent who does not want your child to get candy during every outing to a store, these checkout lines are torture. It is basically me saying over and over, "no, you can't have that candy either."

Reason number a million why I prefer to shop alone.

Gifts

We've had the same cleaning guy for the last three years. He's done a pretty good job with our apartment. He comes every other week and we pay him $80 per session.

I can't remember what I gave him for Christmas last year. I think I just added $20 to the check for that week. And I think he gave us a card.

Anyway, today we came home to find this array from him as a gift:



And now … I have no freaking idea what to get him. What do I do?

my time is important, damn it

When I was a resident, there was one night when I was on home call and hanging around the hospital, making sure there was nothing to do before I left. A resident on another service said that he had to leave to catch a plane at 4, so he asked if I could stick around till 5 so that if the med student needed any orders signed or whatever, I could cover for him. I said sure, because you can't really say no to a request like that.

Anyway, around 4:15, I came back to the floor and the resident was still there. I said, "Don't you have a plane to catch?"

He said, "Yeah! I'm going to have to run for it!"

"Do you need any help?" I asked him. "I don't want you to miss your plane."

"No, there's nothing I need, really," he said. "Why don't you ask the med student if she needs help? She's busier than I am."

For some reason, that got me really angry. I'm willing to sign orders or offer wisdom to his med student, but there was no way in hell I was doing her scut work so she could leave earlier. I was like wtf?! "I'll help YOU so you can make your plane," I said, "but if you don't need help, I'm going downstairs to do my own work."

And I stormed off (sort of).

Dr. Orthochick: Listen to your attending

Last day in clinic with Dr. Douche!

The nurses said if they had known, they would have brought in cake, which makes me feel good.

Anyway, Dr. Douche was in his usual mood, which means he does this thing where he seriously does not listen to anything. It's like once he decides what he's going to say, he sticks with it until I give up.

We had a lady come in with a chief complaint of knee and shoulder pain. If you have need a knee and hip replacement then you usually get the hip done first and then the knee because it's easier to rehab a knee after a hip, so I was wondering if there was an order for knee and shoulder.

Me: So, hypothetically, if this patient needs a knee and shoulder replacement, is there an order we do them in?
Dr. Douche: You haven't even seen the patient yet. You can't jump to that conclusion that she needs a joint replacement. First you need to ask about nonoperative management and what she's already tried.
Me: I know...OK, let's pretend you're not you, I'm not me, the patient's not the patient, and you and I are two other people talking about a third patient who does need a knee and shoulder replacement. Is there any special order they should be done in?
Dr. Douche: But we would never just jump to doing a replacement. We would start with physical therapy and long acting anti-inflammatories. We might then ask about injections--
Me: Ok...let's say I'm doing a practice question. The practice question tells me that a patient is having a knee and shoulder replacement. I cannot argue with this practice question so I am forced to do a knee and shoulder replacement on this patient in this practice question. So the question is asking me which procedure should be performed first?
Dr. Douche: You really need to see the patient first before you decide what procedures she's going to have done. We treat people, not xrays. Don't be so quick to jump to surgery, especially replacement surgery.

At that point I gave up and walked over to the next pod and asked Dr. Grandpa, who said it didn't really matter but to wait three months either way.

Sheesh.

Coke

I had to call a pulmonary consult once on a patient that I was covering just for the day and therefore barely knew. The consult was for possible obstructive sleep apnea... apparently, the guy drinks TWO CASES of Coca Cola every day to stay awake. Then he had a stroke.

So pulmonary came and evaluated him after an overnight pulse ox and an ABG. Since I was an intern at this hospital, I know all the residents on the consult services so I routinely get made fun of for calling consults. The pulmonary resident happened to be my resident from the ICU.

"So your patient does not have sleep apnea," she said. "Why did you call this consult anyway?"

"Well, it's not my patient, I'm just covering for the day," I quickly explained. "But I think they were concerned that he drinks two cases of Coke every day."

"Yeah, I asked him about that," she said. "He told me he just likes the taste of Coke."

Censorship

One thing that I have never done on this blog is censor comments.  For one thing, it's a pain in the booty (and mine is so painfully small to begin with). And for another thing, I think people all have the right to voice their opinion. The only comments I have deleted are the ones that are pure spam, and also ones by this one guy who kept posting really racist things.

As a result, I have several old posts, such as my one about dermatology, where the last 10 or 15 comments are all just people cursing me out. I actually have to approve all those old comments, which means I am actually saying "approve" to people telling me I'm a jerk.  It doesn't really bother me all that much though.  I think anybody who is getting so worked up and making a long reply to a post that is like three years old probably has some issues.

Anyway, my post yesterday did rile up a few feathers. In all honesty, when I do make a post that is controversial, I do it to spark interesting conversation. (I hope nobody thinks I am lying awake at night, upset about a booty song.) I've had some really interesting conversations on here… I doubt any opinions were changed, but I think both sides probably learned something, and at the very least, it was entertaining.  In any case, I don't make these posts to spark people calling me names or insulting me just because I disagree with them.  Yet unlike some smarter bloggers, like Dr. grumpy, I allow them to make insulting comments when I could just as easily delete them.  Eventually, the comments became more insulting and trolling than productive, especially from one anonymous commenter.

At some point yesterday, somebody made a very nice comment defending me. Subsequently, a second comment was made belittling that person. It was a mean and unproductive comment, and I hated the idea that somebody might feel hurt as a result of my blog, so I deleted the comment.

And then I wondered, why don't I pay myself the same courtesy?

Weekly Whine: Skinny Shaming

My husband will probably make fun of me when he reads this, but every time I hear the song "all about that base", I get a little bit teary-eyed. Because my older daughter, while not fat, is built like her dad and definitely not a "stick figure Barbie doll", and I like the idea of any song that potentially would make her feel good about herself. Not that she feels bad about herself or anything, but who knows, maybe in the future.

That said, I am skinny and I have always been skinny. But I am about as far away from being a Barbie doll as you could possibly imagine. I don't diet or do anything to watch my weight, but I am the sort of person who feels incredibly ill if I eat more than a small portion, and when I am stressed out, I end up not being able to eat it all. My father always told me that I have inherited the "McFizz stomach". I don't really feel lucky about that, but I guess it's good for my health to not be overweight, at least.

Occasionally, people make comments to me about how they think I am "lucky" to be skinny. But in general, people I know in real life don't comment much, either because they realize it's inappropriate, or because it's incredibly obvious that I am not at all obsessed with looks. If I were, I'd probably at least buy some make up and wear pants that weren't two sizes too big.

However, there was a period when I mentioned a few times on this blog that I am skinny, and there were a couple of very vocal people who got really really mad at me. I think there was one post where I said that my weight made me feel cold more easily, and somebody told me they were so angry at me for mentioning my weight that they were going to stop reading my blog. WTF?

Someone else, who claimed to be a physician, told me that just saying that I was skinny would give readers a negative body image. Because if I say I am skinny, then I am necessarily bragging about being skinny.

This completely shocked me. Even though I realize that women obsess about their weight, I was surprised that just mentioning it in an offhand way would make people so angry. In my opinion, weight is not what makes you attractive unless you are at an extreme. It's just a matter of preference. Frankly, I think I'd probably be more attractive if I gained 10 pounds. Or had silky blonde hair like Megan Traynor.

So while I like the message in Megan Traynors song, I also sort of take offense to the generalization. Just because you're skinny, that doesn't mean you are a silicon Barbie doll model bitch. You might just be a nice geeky girl with a weak stomach.

Name that injury

I know I haven't done many drawings lately, which may be why my artistic skills have been starting to deteriorate. Any guesses what this drawing I did for a patient yesterday is supposed to represent. Bonus points if you can guess the actual pathology:

Dr. Orthochick: Own it

Resident 1: Dude, you said "osteofart" instead of "osteophyte" in conference this morning.
Resident 2: Really? I get so nervous when I'm up there that I don't know what I'm saying.
Me: Oh come on, you gotta own it now. Like how I own "spontaneous vaginal deformity" and PD owns "interanal condyle" and Jared owns "depth of penetration"--
Resident 3: And I own "it eats out the PCL"
Resident 4: And i own "you whack off the condyle."

To quote Douglas Adams, "I may not have gone where I intended to go, but I think I ended up where I needed to be."

Micrographia

I saw this note in the chart recently and I swear to God, this is the smallest handwriting I have ever seen in my life:



It literally takes up 1/5 of the line!