Top 10 songs of 2015

Uptown Funk

Cheerleader

Drag me down 

Stitches 

Here

Ex's and Oh's

Same Old Love

Stressed Out 

Elastic Heart 

Uma Thurman

Least favorite songs:

Fight Song

Love me like you do

Shut up and Dance 

Top 10 books of 2015

I read about 50 books this year. Go me! These were my favorite, in no particular order:

Stolen by Daniel Palmer

Dirty Little Secrets by CJ Omololu

Say What You Will by Cammie McGovern

Pear-shaped by Stella Newman

Pines series by Blake Crouse

Die Again by Tess Gerritsen

Out of my Mind by Sharon Draper

Maude by Donna Mabry

Big Little Lies by Liane Moriarty

Still Alice by Lisa Genova

Cryin' shame

I was just thinking about one morning during my intern year. One of our patients had died the night before, and my resident Annie had given consent to have the body transported to the morgue. I don't remember the exact details of what happened, but apparently she didn't have proper consent, which she hadn't realized, and she got bawled out by the coroner. I think the words "you're going to be in big trouble" were thrown around.

Annie and I were alone in the resident room. And as soon as she got off the phone with the coroner, Annie started crying hysterically. She was actually sort of a tough cookie, but I guess it was all too much for her: having her patient die, being awake for 30 straight hours, and now being told she was in big trouble over some confusing issue. I made an awkward attempt to comfort her, mostly just saying I didn't think she'd really be in big trouble, but I was pretty tired and depressed too.

Annie managed to pull herself back together before anyone else came into the room. So nobody but me knew that she had been crying. But even if they had, I'm pretty sure nobody would've done anything about it. We all would've just looked at her awkwardly, and tried to pretend like it wasn't happening.

That's how residency is a lot of the time. You hate your life, you cry, and nobody really seems to care.**

What baffles me is that this is OK somehow. That we were all so miserable, we did nothing to help each other, and everyone basically pretended like it wasn't happening. Despite the fact that the responsibilities heaped upon us were enormous enough that we really should have had our mental health monitored better.

Granted, it's been a long time since the morning that Annie cried in front of me. But I'm pretty sure that things haven't changed much.

**Except in PM&R presidency. There you go to work for a few hours, then head to the beach, and nobody really seems to care. (Just kidding.)

The Neurosurgeon

Recently we had a patient who had part of his skull removed following an accident. In the aftermath of this, we called up the neurosurgeon who had performed the operation to make a follow-up appointment. The response of the receptionist at his office:

"Does he really need a follow up?"

"Um, you removed his skull, so yes, I would think so."

We basically had to beg and plead in order to get the neurosurgeon to see this guy. Finally, after a month, he got in for an appointment. We had been eagerly waiting to see what the neurosurgeon thought, because the patient had not been doing that well. Unfortunately, we couldn't find any notes returned to us from his visit. Finally, we found the following scribbled on the back of one of our many notes that we provided him:



First, what the hell does that say? Second, was it really that difficult to use a separate piece of paper? We even provided one that was supposed to be for his recommendations, but instead he chose to scribble it in a completely random place.

Admittedly, I've lost a lot of respect for neurosurgeons thanks to a certain presidential candidate, but I really feel like I would want to have more follow up with a patient if I took off part of his skull. It just seems like the basic minimum of reasonable patient care, right? You see a patient for a major surgery, so you schedule at least one follow-up visit. I mean, it's not brain surgery.

Cat update

In case anyone was curious, we ended up adopting a cat from an animal shelter. My husband didn't feel allergic at all while he was in the shelter, so we figured it would be OK. 

We got a black, five-year-old female cat.  Her back story is that three months ago, she approached a person in their driveway for help, and the person took her to a shelter. Apparently, she had been living with a family a year ago, and either they abandoned her or she ran away. In any case, they located the family through her microchip and they said they didn't have money to feed her.  

The shelter was a little bit ridiculous about letting us adopt her. We had to fill out pages of paperwork, and even though we gave them a reference, they actually called me at home, asking for a SECOND reference. They even called my work to verify my employment. I mean, I'm glad they make sure that the cats have a good home, but this is a cat that was eating out of garbage cans three months ago. I'm sure it was pretty obvious we could do better than that.

Anyway, the cat is currently in our bathroom, and seems to be very happy. She purrs a lot, and we were all relieved that she used the litter box.  Nobody seems to be allergic either, so that's a plus.

Good deed?

It seems like I have a particular skill for choosing the exact wrong line in the supermarket.

A few days ago, I was in the supermarket with my preschooler. We were in a bit of a rush, and the supermarket was surprisingly crowded for the middle of the morning on a weekday. But since we had only eight items, I was able to go to the 10 items or less line, where there was only one woman in front of me, and she was currently paying.

Unfortunately, we only discovered after my daughter had painstakingly loaded all our items onto the conveyor belt that there was an issue with the woman's payment. The woman kept running her debit card and typing in the pin number, and it kept giving her an "insufficient funds" message. I think she actually even called the number on the back of the card while in line. The manager came over, but there wasn't really much that they could do for her. She was buying a pack of cigarettes, which cost $11, and she did have eight dollars in cash, but that left her three dollars short.

It was getting a little bit ridiculous. The woman obviously didn't have the money to pay for her item, but she was basically not willing to move off the line. And to add to the pathetic factor, she was in one of those motorized shopping cart, so obviously she had some medical issues. Considering she was only three dollars short, I really wanted to just offer to pay it for her. If she had been buying a loaf of bread or something like that, I would've happily paid it immediately, regardless of the cost, and counted that as my good deed for the day. But she was buying cigarettes. The most evil product you can buy in a supermarket. I felt like I couldn't in good conscience give money to the tobacco companies, and buy this woman a product that was contributing to her premature death.

However, several minutes later, with this issue still not resolved and my daughter getting antsy, I decided that just this once, I would give three dollars to the evil tobacco companies.

I didn't feel good about the situation. But what could I do? I didn't want to be the jerk yelling at the poor woman to get off the goddamn line if she couldn't pay.

Cat advice

My husband has wanted a cat for literally the entire time we've been together. I'm sure we would have a whole clowder of them (I bet you didn't know that was the name for a group of cats) except that my husband has pretty bad pet allergies.  He gets itchy and breaks out in a rash around any pet that sheds hair.  I don't have bad allergies, although I definitely have gotten stuffed up when I visited an animal shelter before.

But recently, we decided that we wanted to get a cat.  Actually, my husband asked me if we could get a cat, and promised that he would feed it every day and change its litter box.  

Anyway, because of his allergies, I thought maybe we should spring for one of those hypoallergenic cats.  My husband doesn't want to do that though, partially because of the cost, partially because he would rather rescue an animal, and partially because he'd rather have an adult cat than a kitten.  (I agree about the kitten part. The last thing I want is a needy kitten. I've already got at least two needy children.) Also, the closest cat breeder to us won't have kittens until the spring.

However, I'm worried that we're going to get a cat from the shelter and my husband will be so uncomfortable that we'll have no choice but to return it. Which will be really heartbreaking.

I don't know if there's some other option that we are missing. For a person with cat allergies, is the only choice to buy a snooty hypoallergenic cat?

Why I don't have a resident

Currently, I don't work with a resident. I know a lot of attendings love working with residents and I do believe in teaching and how important it is. But I just don't want a resident. I've made the decision to work alone for several reasons:

1) I care too damn much

Don't laugh, but it's true. It's so important to me that the resident I work with has a great experience, that I end up spending massive amounts of time teaching them, which is time that I don't really have to spend. And I feel guilty giving them any scutwork. So having a resident always resulted in my being way behind.

2) I like to know my patients

Whenever I have a resident, they end up knowing their patients better than I know them. And that makes me uncomfortable.

3) I don't trust them

This may be something specific to PM&R, but I seriously don't trust the residents. Sometimes I would get a good one that I could trust, but I can't tell you how many times I have asked them to do something and they never did it. Something important.

4) I need my space

If I am feeling stressed out or sick, I can't deal with having a little shadow. I want to murder the little shadow.

Spam filter

I really have to question google blogger's spam filters if they did not flag the following comment as spam:

Was I wrong?

A few years ago, I used to supervise residents during an interdisciplinary clinic. The resident would work with me four days of the week. On Thursday morning, the residents would have lecture. Since there was no clinic in the afternoon on Thursdays, they basically had the afternoon off.

On one occasion, the interdisciplinary team was meeting to discuss one of the patients. Usually we had these meetings on Friday, but for whatever reason, we had to have the meeting on Thursday afternoon. This was an important meeting, which was supposed to last about an hour.

As I said, the resident generally had Thursday afternoon off because there was no clinic. But because there was this meeting, and the resident knew this patient very well, I asked her if she would come.

Basically, she looked at me like I was crazy and told me that she had Thursday afternoon off. And acted like I was being unreasonable for even having asked.

We had the meeting without her and life went on. But I was also always kind of peeved that she didn't show up. I'm sure if she was on an inpatient rotation, she wouldn't of got to have Thursday afternoon off. It wasn't like Thursday afternoon was protected time. She just expected the afternoon off.

There was a similar situation that happened while I was a resident. Another resident had a clinic that was ending at 2 PM, and an attending asked if he would stay an extra hour or two to help at an adjacent clinic that was overbooked. The resident refused, saying he had to look at cars or something, and the attending was so angry that he blocked that resident from becoming chief the next year.

Donation

I just wanted to let everybody know that based on the revenue for the month of October for 11 out of 10, I was able to donate $1200 to Deworm the World initiative!  Thanks to everyone who bought a copy. I think this is the most money that I ever "raised" for charity.

Typos

In the Amazon reviews of Baby City, multiple people complained about the number of typos. Early on, two people complained in their reviews, one even saying they lowered their review because of it. One of those people was nice enough to tell me that they had kept track of all the many typos they found in case I wanted to fix them. Of course, I said absolutely yes and they forwarded me the typos. I expected at least several dozen.

There were five.

Five typos in over 400 pages. Roughly one typo per 100 pages was terrible enough that multiple people complained and one person lowered their review.

So I fixed the typos, and yet I still get complaints. There can't possibly be more than one or two left. Yet I recently got a review from somebody saying they had never seen so many typos in a novel.

I feel like I'm going crazy. How is it that so many people are complaining about typos in this book? The weird thing is that my other books have typos too, which I've noticed when looking at them later, yet not even one person has complained.

The fact of the matter is that I don't have the resources of a major publishing company to have multiple people going combing through a book. As good as my editor is, she is one person. In light of that, I think my book is very cleanly edited and free from mistakes that I find in a lot of other self published books, like characters' names randomly changing.

So what is the deal with all the complaints about typos? And seriously, would 5 typos in 400 pages really be something you would feel affects the quality of the book and disrupts your "reading pleasure"?

Relate

The other day, I saw a patient who used to be a teacher, and I mentioned that my daughter was in the same grade she used to teach. We got to talking about it, and she asked me a bunch of questions about my daughter, who I of course always love to talk about.

Years ago, I remember reading an article about how doctors shouldn't discuss non-medical things with patient. It cited as an example a doctor and patient who got so caught up discussing the doctors recent trip to Europe that they forgot to discuss one of the patient's medical issues. I obviously really took that article to heart, and I try not to discuss my personal life with patients.

But patients seem to want to discuss me, for some reason. At the end of a visit, when I ask the patient if they have questions, about a third of the time, it's a personal question about me. (Often it's asking me if my hair is naturally curly.)

Is it wrong to discuss your personal life with a patient?

The Necklace of Yasagriell

Years ago, when Lord of the Rings was popular, my husband and I wrote a story together that was supposed to be a spoof of the trilogy. I recently ran across it and thought it was pretty funny:



Prosolo gasped as she clawed at the peak of the Halobarad Mountain, her paws slipping on the slick rocks.

"The necklace of Yasagriell," Prosolo breathed, as she gazed upon the shimmering circle of light that was illuminated by a ray of sun.

For thousands of years, the necklace of Yasagriell had been protected by a worthy member of the tribe of Beaudeindalf. The Beaudeindalves were winged creatures that sacrificed one castrated male each year to defend the necklace of Yasagriell. This had been the purpose of the Beaudeindalves in Middle Earth since the beginning of time.

But in the last century, all of the Beaudeindalves had been slain by a gypsy tribe of Tirithiomirs. Tirithiomirs were a particularly fierce breed of elves that Prosolo had come across only once in her life, when she was only a child wandering through a forest, and it had made a tingle go through her thick fur. Prosolo was later told by her grandmother Legoladaine that the Tirithiomirs had led a secret attack on the Beaudeindalves in the Valley of Malahthiel, killing all but Ondodo, Grandolier, Nobb, and Vanaroond, their eldest members, who were later sacrificed to Andumeeh, the elfin god of the Tirithiomirs.

It was uncertain if the Tirithiomirs had slain the Beaudeindalves with the intention of swiping the necklace of Yasagriell. But if this was the case, Prosolo could not let this happen. She had to protect the necklace of Yasagriell herself at any cost.

As Prosolo edged toward the necklace, she was suddenly blinded by a creature that leaped in her way. She fell back upon her hind legs, and watched the blue animal with thick fur snatch up the necklace with his paw. The creature held up the necklace of Yasagriell in the air triumphantly.

Prosolo felt her stomach sink. "Who... who are you?" she stammered. He didn't appear to be a Tirithiomir. "What do you want this necklace for?"

"I need this necklace to get to the next level," the creature explained. "My name is Sonic."

Current events

Every time I see a patient with cognitive deficits, I ask the same questions:

"Who is the President?"

And

"Who do you think is going to be the next President?"

It's my own little unofficial poll.  I'm not really getting any reasonable answers yet though. Most people just look at me, shake their head, and say, "I have no idea."  Which is probably a reasonable answer right now.  Most people who hazard a guess usually say Trump.

In terms of assessing current events knowledge, it would be just as easy to ask them to name a few candidates. But that's not as fun.  

Although I do worry that at some point somebody will complain that I'm trying to talk politics with them.  Which is why I'm careful not to give any sort of opinion of my own. I just listen.

The Psyching

In honor of Halloween, for a short time, my short story The Psyching (included at the end of "11 out of 10") will be available for free in the Kindle store!



Download a copy now!

Here is the blurb. Obviously, any similarity to The Shining is completely and utterly not not coincidental.

Jack Lawson's job as the psychiatric resident at the Overlook Hospital is perfect for him. As the overnight resident on call at the psychiatric ward, he'll have plenty of time to spend teaching his medical students, Danni and Wendy, and working on his writing. And most importantly, sleeping.

But as the evening wears on, the idyllic psych ward feels ever more boring… and also more sinister. And the only one to notice the strange and terrible forces gathering around the Overlook Hospital is Danni Gerard, a uniquely gifted 24-year-old medical student.

Write a sentence

The Mini Mental State Exam (MMSE) is a test given to elderly patients as an assessment of their memory and cognition. One of the questions on the test asks the patient to write down a sentence of their choosing. I recently performed this test on a patient who is 90 years old, and I think they wrote my absolute favorite sentence in all my years of performing this test:

Photo day

Photo day at school has definitely taken on a new meaning in modern times.

When I was a kid, my parents agonized over how many copies of which picture to get. Or I'm sure they would have, if they were interested in pictures. Anyway, what I'm saying is I'm sure it was important in those days.

Now all I want is one copy so I can make my own damn prints. I'm paying for somebody to take a nice picture of my kid, that's it.

Somehow the packages don't reflect that:



I don't know why anyone would pay so much money for a bunch of prints that they can order on their own for 1/10 of the price. I feel like these companies should just recognize that and basically just email us the one print at whatever cost is reasonable.

Useful measurements

Can anybody tell me why this is a statistic included in the discharge summary for adult patients:



(And more disturbingly, why is it 0%?)

On blogging

I have been blogging for a long time, in one form or another. Since college, actually. There were times in my life when I used to write posts two or three times a day every day. In this blog, I had  2 pages worth of posts scheduled at any given time. There were times when it was almost like an addiction… I tried to quit or at least cut back, but I couldn't.

I don't have that problem anymore.

I recently went to Michelle Au's blog, and realized that it had been dormant for almost 2 years.  It comforted me to recognize that it is a normal and natural thing, after having multiple children, to lose motivation to keep blogging.  Healthy, even.

The problem with this blog is twofold. First, blogging is dying. Most of the blogs I used to follow years ago are gone. Truthfully, I don't really have any desire to read blogs anymore. Second, because this blog is public, I can't write about anything from my personal life or job. So if I can't write about that, the topics I can write about are limited.  And less compelling.

I've lost a lot of readers in the last couple of years.  Also, I try not to respond to subversive comments, because I just don't care enough to have an argument anymore. And partially for that reason, there are less subversive comments. I think it's obvious when a blogger has lost their enthusiasm.  

I want to stick around. There are times when I want to write about something and I'm grateful this blog exists. But I refuse to look at this as an obligation. So I apologize if my posts become more infrequent.

Donations

I just wanted to let everybody know that thanks to your purchases of 11 out of 10, I was able to donate $300 for the month of September to deworm the world initiative!

And I am also donating a portion of the profits from Baby City to the fistula foundation. I was able to give them $750!

Appropriate

Physician colleague: "did a urologist call looking for me?"

Me: "I don't think so. What's the urologist's name?"

Physician: "Dr. Wang."

Me: (bursts out laughing)

Physician: "you're really immature."

ICD 10 WTF?

This is just an example of how ridiculous ICD 10. These are the codes I came up with when I tried to type in pedestrian hit by a car, which is a common occurrence that should be easy to look up:



So it's easier to code for somebody injured on a kayak than being hit by a car?

WTF abbreviations?

I have to say, after number of years of being a doctor, I am familiar with most abbreviations the people use. But I have to say, this exam was completely unintelligible to me:

ICD 10

This week, I have been in ICD 10 hell.

I understand needing a new coding system to address new diseases or whatever. (Actually, I don't entirely understand.)  But so far, it's been a big pain in the butt.

One problem that I see right off is that it seems to expect us to have much greater knowledge than we actually have. If a person had a stroke, you have to know the exact reason why they had the stroke. Ditto with any other medical condition. Because medical knowledge is apparently perfect.  

Also, the diagnoses are ridiculously long.  Take E08.329, which is:

"Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema"

It took reading that three times just to absorb what it actually meant, much less figure out if it applies to my patient. It seems like the goal of this coding system is to make our heads hurt.  If that's the case, it has succeeded big-time.

Useful vaccines

Woman: "my granddaughter is getting vaccinated, but I'm not sure if she should get all the vaccines available."

Me: "She should if the pediatrician recommends it. Which one are you concerned about?"

Woman: "the vaccine for HIV."

Me: "Wow. She should definitely get that one."

Weekly Whine: Lost

I was complaining to my mother the other day that I found it hard to get to an ATM, and I never ended up having enough cash on me.  She said to me, "I'll give you some cash next time I see you. Just don't lose it."

I found that remark completely baffling. She says that to me all the time, whenever she gets me something, that I shouldn't lose it.

The confusing thing is that there is absolutely nothing I have ever done to make her think that I would lose money that she gave me. Even as a kid, I never lost things. And as an adult, I definitely don't lose things.  

Is there a point when your parents stop thinking of you as a three-year-old?

2 Driving Stories

This is a story about something that happened to a friend of mine:

A while back, he was parked in a lot during his kids ball game. Somebody was pulling out of another space and smashed into the back of his car. Then they drove away without stopping or leaving a note.

However, as it turned out, my friend was actually in the car. He got bored during the ball game and was sitting in his car, playing with his phone. He got out of the car after the impact, but the woman who hit him apparently didn't notice in her eagerness to speed away.

But he did see her license plate and wrote it down. They managed to find her and she had to pay for the damage to his car and there were some charges for having driven away.

Moral: if you smash into somebody's car, leave a note.



This is a second driving story that I also found kind of satisfying. It also happened to a friend of mine.

She was pulling alongside another car, and her rearview mirror scraped against the other car's mirror. She was at fault, and she pulled over to exchange information.

Unfortunately, the old guy that she hit was a huge jerk. He started blaming her for all sorts of other damage to his car and yelling at her for having a car that was "too big." (She had several children so she had an SUV, but it wasn't that big.)

Anyway, a week later, she was shopping at a department store, when she ran into none other than the old man who gave her a hard time after the accident. Bizarrely, the man was actually shoplifting. She saw him stuffing products from the store into his pockets surreptitiously. Nothing huge... she said that he took a coffee filter or something like that.

In any case, she alerted the store management on the way out.

New release!

"What is your pain level on a scale of 1 to 10, where zero would be no pain, and 10 would be if you had an attack of kidney stones while in active labor, and while all that was going on, you were set on fire. Starting with your genitals. And then you were disemboweled, and the bowels that were removed were then also set on fire. And then while you were running around in active labor, passing a kidney stone, on fire with your bowels also on fire, you accidentally stepped on a Lego with your bare foot. And that Lego was also on fire."

"It's an 11."

At long last, I have assembled the book of humorous medical short stories that I've been talking about for freaking ever:



We've got 36 stories for you: true, fiction, and in-between. Admittedly, about 25% of them are stories you may have read on this blog or another, but at least 75% is entirely new material. I worked really hard to put together an enjoyable experience for you.

Please check it out!

After much thought and discussion, I've decided that all profits will be going to Deworm the World Initiative. It's incredibly sad that there are children out there who are riddled with parasitic infections that they could be rid of for a medicine that costs only pennies. Even if you don't want to buy the book, consider donating individually to this worthy charity.

Hand sanitizer challenge

I contend that there is far too much hand sanitizer in the dispensers at hospitals.

This is the amount of foamed hand sanitizer that was dispensed into my hand:



This is the amount that is still left after 15 seconds of scrubbing:



After 30 seconds, it was mostly gone, although my hands were still somewhat damp.

Honestly, I think it's way too much.

Typos

I am almost done working on the stories anthology, but I'm still paranoid about typos. Would anybody like to volunteer to read through the anthology just to look for typos? Not grammar errors, not anything else, just blatant typos like missing words or whatever.

If you can do it within the next day or two, please send me an email! It would be much appreciated.

Weekly Whine: Women are slow

Seriously, why do women take so long to use the bathroom?

Being a woman myself, I really don't understand it. I feel like when I am waiting for a woman to get out of the bathroom, I am just waiting forever. Whereas two or three men will come out in that period of time. What takes so long???

You'd think since they take so long, they would at least be able to clean up the urine splashes I find on the seat like 1/3 of the time.

I think I must take less time to use the bathroom than any other woman. I'm the only woman who gets out before my husband. I wash my hands, I swear.

DNR

I recently had a patient who we had The Code Discussion with, a guy in his early 80s who had a hip replacement, and he emphatically said that he wanted to be DNR/DNI. We recorded his wishes in the chart. End of story, right?

Except the next day, the patient's wife called us into the room. She said she wanted to change her husband's status to full code. He wasn't particularly happy about it, but was agreeable. She said to him, "I'm not ready to lose you yet."

That story, to me, demonstrates two important facts about code status:

1) When elderly patients are made full code, it's often family members pushing for this status, rather than the patient himself.

2) People not in the medical field really just have no concept of what survival rates are when somebody goes through cardiopulmonary resuscitation.

For a patient over 70 years old, the chance of ever leaving the hospital after being resuscitated is only about 18%. But it gets better. If you do leave the hospital, you have a 60% chance of going to a nursing home, a 50% chance of having moderate to severe neurologic deficits, and a 50% chance of dying in the next year.

So basically, if you have CPR and are over 70 years old, your chances of returning home and not having severe disability are well under 10%. And the worst of it is that the person often pushing for the full code status isn't the patient who actually has to live through it.

I believe that patients over the age of 70 should not be given the option to be full code. That removes the stress and anxiety of having to make a decision, especially when the decision is not based on facts. Yes, maybe that 5% of people who would've lived happily for several more years might be sacrificed. But we will save 95% of people from weeks or months or even years of suffering, save probably millions on medical costs that could be better utilized, and also remove the guilt from family members.

But that's just my opinion. I could be wrong.

Electronics Day

My daughter informed me today that she's very excited about her new teacher because he has something every year called "electronics day." Apparently, all the kids are invited to bring in one electronic device, such as an iPhone or an iPad for the day.

Then I made my daughter cry because I told her there was no way she was bringing a $300 piece of electronics to school with her.

I mean, the kid can't even manage to bring her water bottle home. And even if she were entirely responsible, she goes to an afterschool program where her backpack is out in the hallway, unguarded.  Someone could easily just steal an iPad.

I don't know what they were thinking asking a bunch of eight-year-olds to be responsible for expensive electronics. seems like a recipe for trouble. Plus if anyone doesn't have those devices, they feel really left out.

I'm not sure what to do now. I don't want her to be only kid who doesn't have something with her. But I'm not letting her bring a $300 items to school with her. She'd be more upset than anyone if the iPad disappeared.

Math

From a note I read:

The patient is on a dose of Neurontin 100 mg tid, which is much too high and is causing her to be confused. Therefore, I have decreased the dose to 200 mg bid.


(Note: TID = 3x/day, BID = 2x/day)

Stethoscope

I recently got the following letter in the mail from my former medical school:



This request irritated me on so many levels. Let me present the following exchange:

Friend: "Hey, I really need $160. Could you help me out?"

Me: "I can't, but..." (reaches into pocket) "...here's 15 cents! That should help ease your burden."

Friend: (throws 15 cents in my face)

Basically, getting a letter from the school complaining about how much they themselves are charging the poor medical students and can't we help them out with some token amount of money is not going to get a donation from me.

I have no idea how the tuition at a state medical school got so high. It was only $11,000 a year when I started, and I only graduated about 10 years ago. The out-of-state tuition they quoted seems impossibly high. I think $80,000 a year might be a bit pricey for medical school.

But still, my sympathy is a little bit limited. When I donate money, I'd rather give it to somebody who really needs it, rather than some medical student I've never met who will probably be making more money than me in 10 years.

Lottery

Yesterday at work, we were having a discussion about the big lottery jackpot. I don't play the lottery, because there's a much worse chance of winning than there is a being struck by lightning, but I get it that some people enjoy playing.

Anyway, we were all discussing what we would do if we won the lottery. Everybody had these grand plans. I was the only one who couldn't come up with anything I would do with the money.

It's not like I have the greatest life and I have everything I want, and I can't say I don't worry about money, but I really can't think of too many things in my life that would be fixed with just money. I feel like I have all the money that I need right now.

Would more money keep my kids from fighting? Probably not. It would just spoil them. Would it cure any of the medical issues I've had? Doubt it.

Hands free

Yesterday a lot of people seemed in favor of big phones with hands-free devices. My hands-free device is a piece of crap. Any recommendations for something decent that won't break the bank?

Weekly Whine: Big Phones

I currently have an iPhone 5s. I really love it. The size is perfect in terms of being small enough to fit in my hand and big enough for me to comfortably see the screen.

My husband has a iPhone 6. He likes it, but he says it's difficult to hold because of its size. And his hand is a lot bigger than mine.

I feel frustrated because if I want to upgrade my phone, I can't, because I don't want to have a giant phone. I just want something small that I can hold in my hand. Is the future of phones really having something so gigantic that you can't even hold it to make a phone call?

My husband claims that nobody wants small phones anymore. But then he admits that he wants a smaller phone. And I want a smaller phone. I can't believe that we are the only two people in the universe who don't want a gigantic phone.

Good news/bad news

Urologist: "I have some good news and some bad news for you, sir."

Patient: "what's the bad news?"

Urologist: "you are retaining urine and we have to put a catheter back in your bladder."

Patient: "And what's the good news?"

Urologist: "Obama is only going to be president for another 14 months."

Extra credit

I was recently reading this story about an extra credit question on a final exam posed to a class of students:



My instant response was that I would pick two points. 10% is not very much, so that seems like the safest answer to get any points at all. But apparently, only one class in the entire time the professor has been asking the question has gotten the extra credit points.

How many points would you pick and why?

Weekly Whine: Advertising

It really bothers me when something that I am already paying for is coated with advertisement. I don't mind commercials on TV, because I know that pays for the shows, but it bothers me when I've already paid a lot.

Movies are a good example of this. If I pay $60 to take my family to the movies, I feel like I shouldn't have to watch advertisement for 20 minutes.

The thing that really baffles me is websites that sell products having advertisements. Like on fandango, I get so inundated with their movie trailers, I can't even use this site to buy tickets sometimes. When your advertisements make it hard for me to buy your product, that's a problem.

Misogynist

I like Donald Trump. I truly do. Because the guy is just the biggest asshole ever and has no chance of winning the election, which I'm sure he realizes, so I can only assume that he is running for our personal amusement. So I really appreciate that he's spending so much money just to make this election fun for us.

That said, if we were to take his candidacy seriously for a minute, I can't fathom how any female in her right mind would ever vote for him. Is there something I'm missing?

1) The guy sponsors the Miss America pageant, which obviously completely objectifies women.

2) He has publicly referred to women (Rosie O'Donnell for starters) as "ugly"

3) He may have raped his wife. And when his wife accused him of this, his lawyer stated that you can't rape your wife, so he's obviously innocent.

4) He called a female lawyer "disgusting" for wanting a break from a trial to pump milk for her 3-month-old baby.

5) When a woman does something to piss him off, his first response is to suggest she's on her period. I hate Megyn Kelly, but that was still really obnoxious.

6) He seems to believe vaccines cause autism. Well, maybe Jenny McCarthy would vote for him. So that's one woman.

I know he has 18% of the Republican vote right now, but I really find it very hard to believe that any of those 18% are women.

Dr. Orthochick: Simple joys

Simple Joy of Surgical Residency #37:

I finally took off the underpants I was wearing for 41 straight hours in 85 degree heat.

(and if you would excuse me, I'm off to really experience sensory overload by taking a shower. And maybe, you know, sleeping. Because it's been 41 hours.)

Code Hair

When I was growing up, I thought I was the hairiest girl in the world. My two best friends were Chinese and Vietnamese, and were virtually hairless. Compared to them, I felt like an ape.

Then when I was in medical school, my best friend was Indian, and after talking with her, I decided that maybe I was just the hairiest white girl in the world.

Lately though, I've been talking to more and more women and realizing that not only am I not the hairiest white girl in the world, I'm probably about average. I really had no idea how much hair removal women go through.

Many times, we will have a woman admitted to the hospital who had some sort of significant traumatic brain injury or stroke, and because she can no longer take care of it, her facial hair gets a little bit out of control. It's not at all uncommon if the woman is elderly, but I feel much worse if the woman is in her 30s or 40s. I'm pretty sure that she wouldn't want her family and friends seeing her with a mustache and beard.

Obviously, these women have much worse problems, but at the same time, I still feel like we should do something about it. We should let these women have their dignity.

But what can we do? It's not like we're some sort of experts in hair removal. And it seems like a weird thing to even broach the topic with the patient or family. "Hey, would you like us to wax your wife's mustache?"

So generally, we just let them be hairy.

Dr. Orthochick: Confession

I would like to take this opportunity to make a confession:

After my third year med school general surgery rotation we had to take a skills test that involved doing a horizontal mattress suture, a vertical mattress suture, and a couple of hand-tied knots....

Not only could I not do any of that, but I started crying while attempting to tie a knot and the woman in the room who was precepting told me to stop, hugged me, and then told me to try again, sweetie.

I really feel like that should have prevented me from becoming a surgeon, not because I couldn't do it, but because i started crying and quit.

(If I pulled that now, I think I'd get kicked out of residency and they'd be right to do so.)

Donation

Way back when I released Baby City, I mentioned that a portion of the profits would be donated to the fistula foundation, a charity that helps women with childbirth injuries in developing countries. I just wanted anyone interested to know that I have donated $250 to the fistula foundation based on profits from May and June.

Thank you to everyone who bought the book!

Weekly Whine: Road Rage

I think that the Internet has taught us that when people feel anonymous, they will act like jerks. But I think road rage is worse than Internet rage, just because it can potentially be dangerous. When I'm driving, the only thing that matters to me is getting from point A to point B safely. If I'm a few minutes late to wherever I'm going, the world will not come to an end. I can't think of any place that I need to be exactly on time that is worth risking my life over.

Other people apparently feel differently.

There's this really difficult left turn I have to make when I leave work. The visibility isn't great, and of course everybody is speeding in both directions, which makes it harder. But on multiple occasions, I have made the turn with plenty of room, yet somebody has honked at me (and I mean really leaned on that horn) just because maybe they had to lift their foot off the accelerator for half a second. I'm not making a left turn as a personal insult to you, I swear. Honestly, when I see people trying to make what look like difficult left turns, I usually slow down to let them go.

I don't think people should be allowed to honk their horn out of anger. Horns should be used in order to prevent an accident, or possibly as an alert. That's it.

A friend of mine was recently telling me a story about how she was at a light and her car just died. She immediately turned on the blinkers, and most people recognized that she couldn't move the car and went around her. But there were one or two cars that just didn't get it, and kept honking and honking angrily. She said that one guy finally went around her, and gave her the finger and yelled curses at her.

I can't imagine what would make a person behave that way. Oddly, she told me she got out of the car after that, and subsequently multiple people stopped to ask her if they could help. Maybe after she was out of the car, she was less anonymous, so people felt more compelled to be nice?

Go to the doctor!

My father-in-law Joe doesn't have a primary care doctor. Or if he does, he hasn't been to see that doctor in years. It drives my husband and my brother-in-law crazy that Joe is in his early 70s and never goes to the doctor.

Actually, it's not true that he never goes to the doctor. I remember he had some issue with his ears a year or two ago and got treated in the emergency room. So he does go to doctors if he has a problem. But definitely doesn't engage in any primary care.

As the doctor in the family, I'm supposed to be the one to convince Joe to see a doctor. But actually, I'm sort of on Joe's side with this one.

As I said, Joe is in his early 70s and appears to be in good health. He doesn't smoke or drink. He has had his blood pressure checked, and it's normal. He eats well and is skinny as a rod. He probably walks about 5 or 6 miles every day, maybe more. He seems to have lots of energy.

Even if his cholesterol is a little high, would it really help him all that much to go on a statin that might have unpleasant side effects? If he has borderline diabetes, is that really such a big deal at his age when the negative effects take years to accumulate? I suppose he could get cancer screening, but he's probably at an age where it's not worth it to do that either. Prostate cancer is generally slow growing, and testing isn't recommended for men over 75. I guess he could have a colonoscopy, but again, he's getting to the age where anything they could do that would prevent cancer probably isn't worth it. And if he has colon cancer, he's probably screwed either way.

He feels good, lives a healthy lifestyle, and I figure if he prefers not to take any medications or find out about any terrible diagnoses he might have, I don't see anything wrong with that. I suspect healthcare is over utilized in the elderly anyway, so I actually really respect his decision not to go to a doctor.

What do you think? Should Joe go to his primary care doctor or should his sons leave him alone?

Dr. Orthochick: Achievements

TV in Patient's room

"... A 9-year-old boy who successfully climbed the highest peak this side of the globe, Argentina's 22,837-foot-tall Mount Aconcagua..."

Me: You know, I could have done that, but my parents wouldn't let me.

Patient: Really?

Me: No. I was chubby, unathletic, and always picked last in gym class.

(I actually have no idea what my parents would have done if I had broached them with that idea. They probably would have pointed out that there were no mountains nearby and I should focus on doing math flashcards. But I always wonder about the kid's parents in these cases. I mean, was it their idea or are they just really really really supportive of their kid?)

Anyway, congrats to him.

Weekly Whine: One piece

It baffles me how many one-piece outfits there are out there for female adults and children. Whenever somebody buys my daughters clothing, it seems like about half the time it's some one-piece outfit (Shorts attached to a shirt).

I can only assume that the people who designed these outfits are some super humans who don't have to use the toilet. In any case, I just cut the shorts bottom off to make them into a dress.

The worst is one piece bathing suits. Because I'm sure everybody loves having to take every stitch of your child's clothing off so that they can pee. Which, if there anything like my daughter, they have to do on an hourly basis.

Another benefit to being a female....

Amazon review

I've written in the past about having had issues with belts I've purchased falling apart. Someone commented hear that I'd be better off buying men's belts, so at the end of May, I bought two nice men's belts.

However, when I got home, I realized the belts were a bit too big. So I got the brilliant idea to purchase a leather hole punch from Amazon.

I bought the number one rated leather hole punch, which didn't ship through Amazon but they have free shipping from a third-party seller. After I bought it, I realized the delivery date was June 24 through July 13. But this has happened to me before, and the item usually arrived much sooner than that.  

Anyway, fast forward to July 13, and the hole punch still hadn't arrived. I was kind of annoyed, because I really wanted to use my belts.  My pants are falling down! I contacted Amazon, and the third-party seller assured me that my item was in the country (!) and would arrive in the next week.

Yesterday, July 23, two months after I ordered the item, it still hadn't arrived. I contacted the seller and asked for a refund. I had every intention of going on Amazon and giving the product a scathing review.  But then I got this email from them:

"Ok, we have make a refund for you, we have send you the item and we have make a refund for you, we lost my product and my money, if you don't mind, could you please don't leave us any bad feedback, bad feebdack fatal to me, hope you can understand, thanks."

And now I feel like I would be a bitch to give the scathing one star review.  But at the same time, I feel like people need to know that this could happen. What should I do?

Religion

In my class in medical school, there was this religious Jewish guy named David who always wore a yarmulke (skullcap). During the first two years of medical school, I never saw him without it.

Then sometime in the middle of third year, I ran into David and I noticed he wasn't wearing it. Someone later told me that he stopped wearing it during the clinical rotations.

It always sort of bothered me that David stopped wearing his yarmulke. I don't know if he felt like people were treating him differently because of it or he was being discriminated against. I know that David was going for a very competitive specialty, so his evaluations were really important to him.

On the other hand, there was a Muslim girl in my class who wore a scarf around her head and she kept right on wearing that during her clinical rotations.

Party dilemma

A friend of mine was telling me that she wanted to have her daughter's sixth birthday party at an outdoor play area. It's this arcade that's outdoors, and they host birthday parties. It's a really fun place to have a birthday party, and her only reservation is that she doesn't feel comfortable watching 20+ kids in a place where they can easily escape.

I was just completely baffled by this. I asked her why it was her responsibility to watch all the children at the party, when she was hosting it at a third-party location, and presumably those children also have parents. She told me that it's her experience that the parents will just leave the children there, and then it is her job to keep track of them. If one of them got lost, she would be responsible.

Again, I was baffled. If a parent goes to a party and leaves their five-year-old child there without asking if it's OK, and the kid gets lost, how is that in any way the fault of the person holding the party? Does "party" somehow equate to "licensed childcare center"? There's nothing in the party invitation that says your child will be watched. I personally would assume that a person hosting a children's party would be far too busy to take care of 20 children, so as painful as it is, I usually stick around at these parties.

I pointed all that out, but my friend was insistent that multiple parents had left their kids at her parties in the past, and she felt responsible for all the children. She said if something happened to one of them, even at a third-party location, she would almost certainly be legally blamed for it.

What do you think?

Dr. Orthochick: Curing cancer (not)

Mom: What's on your agenda for the week?
Me: Curing cancer.

Hey, it's not a total lie.

We did a big sarcoma case today, which I was looking forward to because I've never seen one. Soft tissue sarcomas are pretty rare, which is a good thing because they're aggressive as hell. It's deceptive, you figure if you have a tumor on your arm you can cut it out and you'll be fine, but they tend to invade your nerves and blood vessels, which means if you cut it out, you probably also have to cut off your arm since it won't be viable anymore. Also, they metastasize to the lungs. So they have a pretty crappy 5-year survival rate, and since they're so rare, not much research goes into these things so we don't have great ways of treating them. Usually you hit them with radiation, which in and of itself carries a risk of causing sarcoma.

So like I said, the surgery involves totally gutting the extremity. If you're lucky, you wind up with a functional extremity. If not, you get an amputation. This guy had a giant soft tissue tumor sitting right in his arm. It was about the size of a grapefruit and had been steadily growing for the past few months, but since he didn't have insurance and it didn't hurt, he didn't do anything about it. So by the time he was able to get an MRI of it, it had invaded his radial artery and a couple of nerves. It was also sitting right in the muscle that helps you extend your wrist. It hadn't spread to his lungs, which is good, but it also hadn't shrunk much with the 30 doses of radiation it had been attacked with, which is bad.

We made a long incision over the mass and the radial artery was pulsating through it. Which meant the radial artery had to go. Most people are actually ulnar artery-dominant (even though the radial pulse is the one you feel) so you can still have a functional arm without a radial artery, but it's not a great sign if that's the first thing you see in a surgery. So we tied off the artery, which is probably one of three times in ortho that I hand-tie my surgical knots. (I'm not including arthroscopic knots in this. The other two times that I can think of off the top of my head are when you use pop-off sutures at the end of a spine surgery and when you're with Dr. Smile and he makes you sew wound towels into your sterile field) The only reason I mention this is because this was stressed as very important on my general surgery rotation and my OB-GYN rotation and seriously, it's instrument tie or bust over here. I mean, I know how to hand tie, but I promise, you can be a surgeon without really being good at it.

The rest of the surgery was pretty much more of the same. Since he had received radiation preoperatively, his tissues were really friable, so they bled any time you touched them. Which meant the surgical field was a big bloody mess. Also, we had to sacrifice most of his wrist extensors since they had tumor strewn throughout them. We lost a couple of nerves to the tumor. After about three hours of this, we closed him up and called it a day. Except the thing is, we hadn't removed the whole tumor. It was so extensive that there wasn't going to be a way to get the whole thing out and still give him a viable arm. The tumor had crawled over almost the entire forearm and slimed down to the bones. So normally you resect the whole tumor and 5cm margins in all directions, but in this case we didn't bother since it wouldn't be possible to get margins without an amputation.

Dr. Tumor: We are so intralesional, it's not even funny.

So yeah, surgery was a big bloody mess and the dude is still going to need an amputation. I guess we're not really curing cancer over here.

2 degrees

In the back office where I do my charting, we had an air-conditioner installed for the summer. I'm one of those people who is basically always cold, and it takes 90° weather to make me even take my sweater off.

So basically, I am constantly changing the thermostat on the air conditioner. I raise the number, then someone else lowers it.

But the crazy thing is that we are fighting over 2°. I raise the temperature to 73° and somebody else lowers it to 71°. I have no idea why those 2° makes such a difference.

It's sort of makes me feel bad for mocking that car commercial where you could have one half of the car at a slightly different temperature than the other half of the car.

Trivia

Patient: "Now that you've asked me your questions, I've got one for you."

Me: "go for it."

Patient: "there were five presidents who were Generals in The Civil War. Can you name them?"

Me: "Grant…"

Patient: "right..."

Me: "that the only one I can think of."

Patient: "I'll give you a hint. Two of their names start with H, two start with G, and one starts with A."

Me: "Garfield..."

Patient: "right."

Me: "Arthur."

Patient: "right."

Me: "Harrison."

Patient: "right."

Me: "um... Hoover?"

Patient: "oh my God, that's completely the wrong war."

Me: "I give up."

Patient: "it's Harrelson."

Me: "I'm pretty sure there isn't a President named Harrelson."

Patient: "look it up."

I don't need to look it up to know that there isn't a president named Woody Harrelson.

Dr. Orthochick: Haircut fail

My last haircut was back in July, I had just finished up Saturday call so I figured Sunday morning would be a good time to go because most people get stuff done on Sunday afternoon. As far as I can tell, the best part about weekend call is when it's over it's usually still early in the morning so you can be the first person at the wal-mart auto department and you don't have to wait in line for an oil change. So all unpleasant tasks get relegated to postcall weekend mornings for me.

Anyway, I was getting my hair brushed out when my pager went off. So I answered it because I feel like it's sort of a dick move to not answer your pager if it's physically on your person and you're getting paged about a patient you saw less than an hour ago. You could also make the argument that it's a dick move to ask the person cutting your hair to stop for a minute, but I feel like the potential for death in that situation is lower.

The pager was quiet until about halfway through the haircut, at which point it went off 4 times and I told the hairdresser it was OK for her to help someone else. Also at that time, Dr. Alcoholic called me about a patient. During the course of the conversation, his computer stopped working and I tried to walk him through how to restart it in safe mode to reboot to etc etc etc.

Dr. Alcoholic: Can you just come back and help me?

So I did. I paid for the haircut (the whole thing, I guess), left a nice tip, and told the woman I would be back later.

Hairdresser: I was jealous of you for being a doctor, but now I'm not.

I was too embarrassed to go back so I finished it up myself at home and I've been wearing it skewered back ever since. According to my hairdresser today, the layers were uneven, the front was choppy, and the right side was longer than the left.

So yeah. I figured I should probably get that remedied before I go for interviews, even though mom told me to wear my hair back to look more professional. I'm not sure how to take that since mom told me to wear my hair down on my first day of internship to look older.

Baby City

Baby City is on sale today for only a dollar!  Buy it now!

Weekly Whine: Teen Suicide

As a person who will be the mother of teenage girls in the not so far off future, the idea of teen suicide scares me. A lot. I think that books about teen suicide may serve a purpose in educating potential bullies, the bullied, and adults about what makes a teenager take their own life.

That's why it makes me so angry that so many of those books are so bad.

One book I read recently was called 13 Reasons Why. It's about a girl who makes a tape blaming 13 people who she felt contributed to her recent suicide. Except none of the people she were blaming actually did anything that bad. One was a girl who was her friend at the beginning of the year, then *gasp* stopped being her friend. Another with a guy who got grabby on a first date, then called her a tease and stormed off when she pushed him away. I kept waiting for one of those people to be the uncle that molested her or something, but no... there was only a guy who voted her Best Ass in the grade. Oh my God, I have a great ass, I'm going to kill myself. The book got really good reviews, although there were a few reviewers who said that they actually work with teenagers who are suicidal, and the book in no way represented them.

More recently, I read a book called Tease. This was an interesting book from the point of view of the bully. Except once again, the suicide didn't make sense. The girl who killed herself basically stole the boyfriend of another girl at her own party right in front of her, then they got revenge by making a nasty Facebook page. Then after the suicide, they got in trouble for being bullies, but really, what did the girl expect after she stole the other girl's boyfriend? I mean, we are talking about 16-year-olds. It's not like she was minding her business and everyone just targeted her.

And these books all feature the most useless guidance counselors ever. In at least two books to read, the girl outright says she's thinking about suicide, and the guidance counselor just says, "you probably shouldn't do that," then takes no further action. I hope that doesn't really happen.

It would just be nice for these books to get into the real reasons that teenagers commit suicide. Because I feel like these books are just an insult.

Human body

This is a drawing my daughter did of the human body from memory:



I challenge you to find three things wrong with it.

Red Cross

In the upcoming anthology I am publishing, I had pledged to donate all the profits to Red Cross. However, since then, a few people have made me aware of a scandal involving Red Cross.

I'm not sure how much of this all is legitimate. I always thought of Red Cross as being really a good charity. But I don't want to donate money to them if it's not going to go to the right place. I feel like donating to Third World countries is the best use of donations.

Another alternative is Doctors Without Borders, which we already donate to. But I liked the idea of Red Cross better, because it seem to encompass all medical specialties more generally.

Thoughts?

Dr. Orthochick: Got the giggles

Text message received today from my co-resident:

We consulted urology on a patient and they recommended a jockstrap

Dr. Orthochick: Misspeak

I was giving a presentation today and I accidentally said "patient was born full term via spontaneous vaginal deformity." (instead of delivery)

If nothing else, it killed some time while everyone tried to collect themselves. I think I got a bigger laugh than my co-resident did that time he wrote "interanal condyle" instead of "internal condyle" in his slide. Or that time another resident presented an article that not only contained the phrase "depth of penetration," but also discussed factors that influence the depth of penetration, such as reaming harder, faster, deeper thrusts...

Won't we all...

Conversation with patient being fitted for an artificial leg:

Me: "how are you doing?"

Patient: "I'll be feeling a lot better once I get my prostitute."

Weekly Whine: Happy Birthday, buy a car

I'm finding it more and more irritating to get birthday messages from my dentist, eye doctor, car mechanic, etc.

It's not that I don't appreciate that they have an automatic system that's considerate enough to remember my birthday. But it just makes me feel kind of like a loser when I get more birthday wishes from people who want to sell me stuff than I do from people who actually are my friends.

Comorbid

Me: "do you have any medical problems?"

Patient: "no."

Me: "do you have diabetes?"

Patient: "yes, but it's controlled."

Me: "with diet?"

Patient: "no, with two medications."

Me: "And do you have high blood pressure?"

Patient: "yes, but it's controlled."

Gah!

Dr. Orthochick: High school sports clinic

As luck would have it, since I'm this month's sports chick, I got roped into helping with high school student sports physicals on Saturday. Technically I didn't have to, but the way it was worded meant I sort of had to if I wanted to pass this rotation. Also, Dr. Douche kept on talking about how this would not only benefit my education now, it would also benefit me in the future so I could have a job doing sports physicals. I guess he doesn't think I'm going to be a very good surgeon if my best option is to do sports physicals for the rest of my life.

Back in the olden days, when I was doing high school sports, you brought the form to your pediatrician, he signed it, and you were good to do sports for the year. That does not fly anymore. Now you need a comprehensive examination by a medical doctor, a musculoskeletal specialist, and a cardiologist before you get cleared to play sports. And if anyone in your family has heart disease, you need a transthoracic echocardiogram for clearance. So our Ortho group organizes it so that you can get all of this done on one day for free, which is a pretty sweet service because otherwise it would take a lot of time and money. (and my parents were into us doing sports, but if mom had to drag us to a cardiologist every year, I think she would have told us to get fat and make daisy chains in the backyard for exercise)

Physical-a-palooza started at 8AM, I got there around 8:30 because I had to change a wound vac before leaving the hospital and it took a little while, and there was a line of high school students and parents that curled around and outside the parking lot.

I started out in the musculoskeletal section, which consisted of doing a scoliosis check, anterior drawer tests of the knees, moving the hips, and checking neck and shoulder range of motion. On anyone who had a specific complaint I did a focused physical, but for the most part that was alls I did. I did it at least 25 times before I got switched to the medical stuff because they had enough musculoskeletal specialists but you need to be a doctor to do medical exams. (MSK can be done by a physical therapist or PA) I guess "ortho resident" falls under the realm of "doctor," but I feel like if we're going to all the trouble of cardiac screenings, we might want to have someone who uses a stethoscope on a regular basis do these medical exams. Not that it's hard and G-d knows I did a trillion heart-lung-abdomen exams in medical school, but by this point I don't remember which murmurs radiate to the carotids and which ones increase with valsalva etc etc etc. Good thing no one had a murmur. I did at least 50 medical exams, except I made it very clear that I was only going to do medical exams on girls. For boys you have to do a hernia check and yes, I do know how to do that, but I don't want to be in a room with a teenage boy who's naked from the waist down without a chaperon. I feel like that's putting me in a potentially litigious situation and whereas I'd like to think no one would accuse me of anything, honestly, I don't want to put myself in that position. Plus I feel like most teenage boys would probably prefer a male doctor doing that. So I did the girl stuff which involved asking a lot of questions about menses (r/o Female Athlete Triad) but didn't require anyone to disrobe.

Dr. Douche must have been bored because he kept on wandering over to my examining room to talk. He asked me repeatedly if i was learning about the importance of the physical exam and OK, it is important, but checking neck range of motion on 25 asymptomatic high school students is not going to convince me of that. Also, I'm not sure what he thinks I do all day if asking about menses is going to prepare me for the future.

So yeah, not sure I really got out of that what i was supposed to get out of that but I guess it's good to know that if this surgery thing doesn't work out in the future then yes, I feel very comfortable doing high school student sports physicals and I can make my living doing that.

Last chance to contribute!

A long time ago, I posted about putting together an anthology of humorous medical stories, and donating the proceeds to Red Cross. Well, as I mentioned in a prior post, I have collected enough stories to start putting together the anthology:



It is nowhere near complete, but I have enough stories that I can definitely make the book. However, the more the better, so...

If you would like to contribute a humorous medical story to this anthology, send it along to me at fizzziatrist@gmail.com. This is a great opportunity to have your work published in a book, and also to make a contribution to what I consider a really worthy charity! This is the last time I'm going to solicit stories.

Specs: It must be at least a little bit humorous and also at least 1000 words. Other than that, go crazy. Deadline: July 31!

Weekly Whine: Birthday rules

A few simple rules for people who get invited to a child's birthday party, especially if it is at a paid location rather than at somebody's house:

1) RSVP prior to the RSVP date. Not the day after the date, not the day before the party. Just let the parents know if you're coming or not with enough time to plan!

2) If your child is invited to the party and you want to bring your other children along, ask if it's okay. Don't just assume you can bring your other three kids and nobody will care. Many locations have an upper limit on the number of children that can come to a party.

3) If you RSVP that you are going to the party, go. If you RSVP that you're not going (or not at all), don't go.

4) Don't say something like "we might be able to stop by." Are you aware that these places charge $20 per kid sometimes and need to know in advance?

5) Just bring one present. Who started this precedent of every family bringing like three presents? My kid has enough toys already.

6) Do not leave your kid at the party unless you are explicitly told it is okay. If your kid is under five years old, it is probably not okay. The last thing I need to deal with when running a party is your kid sobbing because he can't find you.

I hope kids appreciate how stressful these parties are for the parents…

Was I wrong?

One day when I was in the middle of a vacation, it was the last day at work for a friend of mine and they were having a special potluck breakfast for her at the nurse's station. So I decided to come by for an hour in the morning with cinnamon buns and my toddler to bid my friend goodbye.

I was glad I came to see her, and also my daughter had a great time, plus I got to show her off. But when I was there about half an hour, a nurse came up to me holding some pills and said, "Can I ask you a question?"

I said, "No, I'm on vacation. I'm not really here."

The nurse said, "It's just a quick question about a patient."

Then about three other people said, "No! She's not here! She's on vacation!"

The nurse gave me an exasperated look and said, "You're really not even going to answer a question?"

Then someone told her to go page the attending on the floor.

I mean, was I wrong? I was sitting there with my two year old child, chatting with friends, on my freaking vacation. Why should I have to answer non-urgent medical questions about patients I hadn't even seen in several days? But she seemed so irritated I wouldn't do it. It made me wonder if I should have just been nice and helped her.

(For the record, two of the people chatting with me were practitioners AND were working, and somehow she only asked me.)

Dr. Orthochick: Whoops!

I scrubbed in for bilateral knee multiligamentous reconstructions with Dr. New the other day. I figured he would appreciate having a more senior resident help him since his options were me or an intern and I'm better at holding the arthroscopy camera, I like to think.

In the first 5 minutes of the surgery, one of us broke both the patient's tibias and one of us broke sterility.

Alls I can say is, glad those two weren't reversed. Because whereas it was an accident, it would have been less of an accident had I been the one who broke the tibias.

I scrubbed in again. We then spent the next two hours putting plates on the proximal tibias.

Circulating nurse: Should I call the family [in the waiting room] and tell them what you're doing?
Dr. New: No...I don't think they'd understand.
Me: I bet they'd get it if we said "hey, sorry, we broke both your daughter's legs and now we need to fix them."
Dr. New: You should let me be the one to talk to the family when we're done.

So yeah. It added about 2 hours to the surgery, but I was so busy being relieved that I hadn't done it that I didn't really mind too much.

Squeaky Wheel

Recently I was wondering if more difficult patients get better care.

We recently had a difficult patient. Every day, a doctor would have to spend over an hour talking to the patient about her many concerns. There were meetings about how everything needed to be carefully documented for this patient so that she would not throw a fit. Considering how much time we spent on this patient, it seems like she was getting better care than any other patient.

But is that really true?

I'd like to think that every patient we treat receives good care. Just because that care was being meticulously documented to avoid a lawsuit doesn't mean that the care was better. Just because the doctor spent time arguing and discussing the same issues with the patient over and over doesn't mean the care was better.

But I did notice that nurses and staff would avoid going into the patient's room if remotely possible, unless they absolutely had to. Nobody wanted to see that patient because they didn't want to get yelled at.

What do you think? Does the squeaky wheel gets the most grease or the least?

Weekly Whine: Pool etiquette

It was so hot yesterday that I took the kids to the pool, which I never do because our community pool is so freaking cold. The water in the pool is so cold, it makes my feet go numb. But because it was so hot, the water temperature was almost tolerable. Almost.

So while I was at the pool, there was this man throwing the ball around the pool with his son. He was standing at one end of the steps into the water, and his son was at the other end, and they were whipping the tennis ball back-and-forth. At one point, the ball hit the table where his wife was sitting, and she yelled at him, "What's wrong with you?? Stop throwing the ball around!"

I expected lifeguard to say something to him, but she was apparently on another planet. It was really upsetting me that they were throwing this ball back-and-forth pretty hard. I don't think it would've seriously injured anyone, but it would've definitely caused a bruise. I was afraid to even go near the pool because I didn't want to get hit.

Finally, I said to the guy, "Would you mind not throwing the ball around the pool? I'm afraid somebody's going to get hit by it."

The guy seemed upset. "It's just a soft tennis ball."

Tennis balls are not that soft if you're throwing them really hard, which it looked like they were. I thought the whole thing was ridiculous. Isn't it obnoxious to be throwing a ball around in an area where people are swimming?

Anyway, his wife yelled at him again to stop, so he stopped. I don't think I overreacted...

Stages of getting older

Dr. Orthochick: Help

I had a really bad call the other week of the variety where I couldn't do anything right. And it was busy so I kept on having to double back because I was redoing a lot of stuff. Around 1 in the AM I got consulted for a guy with a finger infection, he had been bit by another person and some genius in the ER had sewed it up so that the infection brewed deep to the sutures and ravaged his pinky. I looked at it and he seemed to have infection diffusely--the whole finger was swollen and he couldn't move it and he had erythema and lymph nodes tracking past his elbow. So I didn't really feel like I could handle the situation on my own in the ER, and I say this as the chick who once washed out a septic wrist in the ER. (Disclaimer: Even at the time I knew that was a bad idea)

The problem was, the hand surgeon on call that night was Dr. Ortho. I don't like Dr. Ortho, he doesn't like me, I spend a decent amount of time and effort trying to stay out of his way. So I really didn't want to call him to tell him I needed help, but since the alternative was make a mess out of everything, I gritted my teeth and told myself it was in the patient's best interest.

What I wanted to say was, the reason why I was scared to do this was because i had a similar patient with Dr. Pregnant at the beginning of the year and I tried washing him out on my own in the ER. I made a small incision in the base of the finger the way you're supposed to and tried flushing out the sheath, but the infection seemed a little too diffuse for that so I wound up flaying open his finger. I made zigzagging cuts across the palm of the index finger and created flaps. At some point in all that, I must have hit one of the digital artery and nerve bundles (you have 2, one on each side of your finger) and knocked them out. I remember a lot of bleeding and trying to get it under control. Anyway, because he had reduced blood supply to his finger, the antibiotics couldn't get to his finger and the tip died off from lack of blood and infection. The flaps I had created on his palm turned black and fell off because they didn't have enough blood. We took him back to the operating room to try and save something, but we saw pus dripping off his other digital nerve and artery. We couldn't clean them off because we wanted to save at least one in the hopes that his finger wouldn't die, which meant that we left pus to rot in his finger. He lost his index finger. He was 35 and a laborer.

So I wanted to tell Dr. Ortho that story, but I didn't want to admit that it was my fault that a healthy young guy lost a finger and even though I have a better idea of what to do now, I was scared. So he came in to do it with me, after berating me over the phone for a good 10 minutes for not knowing how to do a flexor tenosynovitis/septic arthritis washout by this point in my education. He came in to the ER at 2AM, washed out the guy's finger without talking to me, turned to me at the end of the hour and said "write admission orders and dictate this procedure," and then walked out without looking back.

I know I should know how to do this by now, and it's not that I don't per se, but I really don't think it's the worst thing in the world to ask for help.

White coat burnout

After diligently shrugging on my white coat for pretty much every single day throughout my entire residency, I abandoned my coat the minute I graduated. I haven't worn one at all since I've been an attending. Here's why:

1) No other physicians I work with wear a white coat, except for the weird ones

2) They get dirty so easily. And of course, they show every speck of dirt because obviously they are white. Duh. My white coat from residency retired with a layer of indelible grime on the sleeves and hemline. I have to believe white coats are incredibly unsanitary.

3) If you are a female, you cannot pee while wearing a white coat. If you keep it on, you risk dipping it in the toilet. That is a fact. If you take it off, where are you supposed to put it? On the nonexistent hook on the stall door? On the floor??

4) While it was nice having the pocket space, I think the sheer number of things I always kept in the pockets was contributing to neck pain.

5) The white coat does absolutely nothing to decrease the number of patients who call me "nurse"

I do keep my white coat around, mostly in case the air-conditioner goes crazy and I need an extra layer of clothing. But I can't really see going back to wearing it regularly.

What do you think? Should doctors wear their white coats?

Weekly Whine: Profanity

One thing that irritates me both as a writer and reader is that Amazon does not have a good way to denote how much profanity there is in a book. There ought to be a clear rating for every book saying how much profanity or sex there is.

Personally, the profanity does not bother me. But I have had many people give my books a bad rating with no other explanation other than "there was cursing." Obviously, it doesn't take much profanity to upset people. If you read my books, you'd recognize that I hardly swear like a sailor. Any profanity is few and far between.

And as a reader, I've noticed that there are certain books that may have lower ratings and I have to read through all the readings to realize that the books just got dinged for having profanity. I don't get it. Do people just go around giving bad reviews to books that have any profanity in them? This upsets me both as a reader and a writer. I use the ratings on Amazon to decide whether to buy a book, so a bad review that has nothing to do with the quality of the book misleads other people.

And I guess it sucks for the people who hate profanity too. If they are still bothered by a few curse words and have no way to tell if a book is going to offend them until they are immersed in it.

Transcription errors

Take a guess what this transcription error was supposed to be:

"DVT prophylaxis is to be done with Betadine."

By the way, we don't use any sort of automated transcription program. The transcriptions are done by human beings. Who apparently have very little medical knowledge.

Dr. Orthochick: Eval

Dr. Jameson: Mid-cycle evals are tonight and I can't go. I also couldn't figure out how to fill out the form online. So how about I just tell you what i would have written on your evaluation.

Me: OK...

Dr. Jameson: You're doing fine.

As far as my evaluations go, that's probably going to wind up being one of the better ones.

What does this mean?

I spent like ten minutes puzzling over what this order meant, and had to ask someone before I figured it out:

Reviews

If you read and enjoyed my newest book Baby City, please please please consider giving a positive review on Amazon!

If you didn't enjoy it, please please please just keep that information to yourself.

Weekly Whine: Hairy

I went out to dinner to a nice restaurant with a friend of mine the other night, and while she was eating, she suddenly exclaimed, "Oh my God, there's a hair in my food!"

She called over the waitress and told her about the hair. It was really disappointing because we had been to this restaurant many times and we really liked it. The waitress apologized and asked her if she wanted something else. My friend said she lost her appetite, and she just wanted a cup of tea.

We didn't expect to get a free meal or anything, and she didn't get charged for the food with hair in it, but my friend was pretty upset that they charged her for the tea. The tea was only $2.50, but it was the principle of the thing. Her whole meal had been ruined. She was entitled to a free cup of tea.

My friend is a lawyer, so she wasn't about to let this go. She called over the waitress to complain.

The waitress could've been a little nicer about the whole thing. When addressing the matter of there being hair in the food, she said, "well, that can sometimes happen." Like you have to expect about 25% of all meals to have a little hair in them.

The waitress finally said she'd talk to the manager, and when she returned with our check, she just tossed it on the table without saying anything to us. Obviously she was pissed off or something.

I get that waitresses have crappy jobs, so I can't blame her for not being nicer, in a way. But considering I spend half my day apologizing to patients for things that have absolutely nothing to do with me, I thought she could've been nicer. I certainly would've tipped her a lot more if she had been nice about the whole thing. If there's a problem with the food and the check gets adjusted, I always try to tip based on what the bill would've been. I mean, it wasn't her fault there was a hair there.

(Unless it was her hair.)

Alphabet soup

This was the cut and pasted medical history of a patient I saw:

HTN, PAF, CHF, GERD, OSA, CAD, DVT, PE, PMR, COPD, HLD, PAD, DJD, CVA

I thought it was quite an impressive list of acronyms.

Where?

Me: "do you know where you are?"

Patient: "yes."

Me: "where are you?"

Patient: "I'm here."

Me: "and where is here?"

Patient: "in a chair."

Me: "but where?"

Patient: "in a room."

Me: "but what kind of a place is this?"

Patient: "a nice place."

Me: "okay then."

Dr. Orthochick: Zinger

Patient: What should i do about this rash on my back?

Dr. Douche: I recommend you start showering.

Zing!

Weekly Whine: Annoying pregnant women

I'm not saying that all pregnant women are annoying. It's just that I've noticed women who are already annoying tend to become orders of magnitude worse when they become pregnant.

For example, someone I know was saying that she invited a pregnant friend of hers to a party, and the friend wrote back, "is the fetus in my belly also invited?" (The appropriate response would be, "No, you must get an abortion if you would like to come to my party.")

I don't know what it is about pregnancy that brings out the annoyingness in certain women. It's like having an extra person inside them makes them feel entitled to be completely obnoxious without any boundaries.

And don't get me started on television pregnancies. I recently finished watching the last season of the Mindy Project (which will be the last season, because apparently, I'm not the only one who grew to hate it with a passion). In this season, Mindy (who is already annoying, but it's okay because her life is so imperfect), becomes pregnant and then suddenly becomes unacceptably annoying. Anytime anyone asks her a question, the answer always somehow involves her being pregnant. She has weird food cravings, bemoans her weight gain, all the stereotypical pregnancy stuff. And she's got a boyfriend who is always saying stupid sentimental stuff about the baby and putting his hand protectively on her belly. *Vomit* At some point, a sassy black woman comes in to make her feel more confident about herself. Just... enough already. Please.

If you are pregnant, you are only allowed to talk about it if somebody specifically asks about it. Or I guess it's okay to mention it if your water broke and you have to leave.

Dollar

My husband was recently trying to use a dollar on a vending machine, and it refused to take his money. When he looked at the dollar bill, it looked like this:



I'm actually surprised that was enough for the machine to reject the dollar.

Husband: "I can't believe I never thought of doing that before."

Typos

In looking through the reviews on Amazon for my newest book, Baby City, two of the reviewers pointed out that there were a few typos, and one said that they gave it a lower rating because of that.

I'd just like to say that one of the readers was kind enough to email me the typos (there were 5 of them in 400 pages) and they have all been corrected.

I apologize if anyone was annoyed by typos. I did pay an editor, but I think it would be difficult for any human being to not miss a few typos out of almost 90,000 words. I'm sure the publishing companies have multiple editors go through books and I still frequently find typos in books published by large publishing houses. I also frequently find formatting errors in the Kindle conversion, especially for older books. I actually found a ridiculous number of errors in the Hunger Games sequels, to the point where I wrote Amazon to complain.

In any case, the typos are all fixed, so if you feel that those five small errors will disrupt your enjoyment the book, please feel free to download a new copy (you can do this for free).

Dr. Orthochick: Hip dislocation

I was supposed to have a "research day" yesterday, which would have been really nice since Dr. Jewish emailed me to inform me that my whole "summary" section for my paper sucked and i had to redo it since it did not "emphasize the points of this paper or convince the orthopaedic surgeon that this paper is in any way useful or relevent." He also asked me if I wanted to help him with a project, which means I have 3 projects going and potentially 2 more starting soon. So yeah, a research day would have been nice and I would have actually used it to get research done, thankyouverymuch.

As luck would have it, I had to cover a Dr. Grandpa case. It looked like a cool case, it was a hip replacement but the lady had a really deformed hip socket so it was going to be done a special way. The advantage to this is that it's a cool case, the disadvantage is that I don't get to do much. but i like hip replacements so OK, I'm cool with the whole thing. The surgery went fine and I ordered a postoperative xray to be done in the recovery room because that's Dr. Grandpa's MO. By that point it was around 10:30AM so I figured I could stick around and wait for the xray results and the results of the patient's hemoglobin and then head out to get some research work done.

I got paged by the xray tech who said "I'm not sure, but the hip looks dislocated."

If you think a hip looks dislocated, it probably is. It's one of those radiographic findings that's pretty hard to screw up. I'm pretty sure if you showed the xray to a bunch of laymen standing in Times Square, they could probably identify a hip dislocation. So I pulled up the xray and not only was the hip dislocated, but the whole hip socket had been ripped away from the rest of the pelvis.

If your hip dislocates, you can just do a closed reduction. If your hip socket gets pulled out of your pelvis, that's a bigger issue. So I frantically called Dr. Grandpa to tell him, left him a voicemail saying to call me back ASAP, sent him a text to call me back ASAP, tried calling him again, and finally established connection 20 minutes later. I also sent him a picture of the xray, he said he was driving back to the hospital now and to please tell the patient.

Great.

The patient was surprisingly nice about it, I told her what happened, she said "shit," and I said "yeah, that's pretty much what I said." Her daughter and husband were not quite as understanding, so I figured the learning experience in all this was to only deliver bad news when people are waking up from general anesthesia. I showed them the xray, they demanded to know how this happened. Um, good question. They also demanded to know what we would do if the revision didn't work. Um, equally good question. I would say try Plan C, but they would probably ask me what that was and I didn't really have a great answer. I could probably make up something and use enough scientific terminology that they wouldn't question it, but that seemed a tad unethical.

Dr. Grandpa showed up an hour later and we took the patient back to the OR to start the surgery.

The problem was, when we got in there and discovered there was a huge chunk missing from the hip socket, Dr. Grandpa decided to use trabecular augment. Which is not the wrong thing to do in that situation, except we don't keep trabecular augment at this hospital. We don't even keep it in this city. So the patient got an extra hour of general anesthesia and Dr. Grandpa and i played 6 games of tic-tac-toe with the sterile pen. (all ties) Then the scrub tech and i played hangman with the sterile pen until the sterile pen ran out of ink and we thumb wrestled in sterile gloves. Then Dr. Grandpa told us to knock it off so we stood there and stared at each other until someone put the radio on.

So yeah, the whole day went a lot longer than expected. but at least the patient had her surgery and she seemed to be doing OK this morning. So fingers crossed this works, because if not, well, I guess we have to come up with a plan C.