Weekly Whine: Vaccines the exception?

I know a lot of people have issues with the government passing laws for our own good, such as a law requiring parents to vaccinate their children. Except here's the thing. There are a lot of laws dictating what we can and cannot do with our children.

You can't feed them some crazy weird diet of like only wheatgrass juice that leaves them malnourished. Even if it's the diet you're eating and you think it is perfectly healthy, and that normal human foods are poison.

You must put a baby in a car seat, despite the fact that car seats are expensive and there are plenty of websites out there extolling the dangers of carseats. (One I found talked about some chemical used in making many brands of car seats.)

Your child must wear a helmet when riding a bicycle, even if plenty ofadults think helmets are stupid and useless hand refuse to wear them because it restricts their rights.

And the funny thing is, each of these laws just affect the individual child. It doesn't hurt your neighbor if your kid isn't eating properly or not strapped into a car seat.

However, vaccination is an issue that affects Public Safety as well as your own child (and unlike food, helmets, and car seats, vaccines can be obtained for free) yet there are no laws requiring parents to vaccinate their kids. What's up with that?

55

 I was looking up previous orders on Amazon and I realized that I have placed 55 orders in the last six months. I think putting Amazon as an app on my phone has definitely influenced my purchasing.  Since making this realization yesterday, I made two more purchases. I'm going for the world's record.

I may have a problem.

I'd like to argue that this is somehow okay though. When I looked through all my purchases, there are only two or three of them that I regretted. There were a handful that I returned as well, but most of them were things that I really needed.  For example:

-- diapers and wipes for six months, cheaper than I would've gotten them at the supermarket or Costco

-- each book of the diary of a wimpy kid series purchased used individually

-- scrubs (I inexplicably threw all my scrubs out a while ago during a bedbug infestation)

-- New crockpot

-- birthday presents for at least half a dozen birthday parties for little kids

-- supplies for my daughter's birthday party

-- thank you cards

-- some medical books that my work reimbursed me for

-- New bookcase

-- paperclips 

-- some pens I really like for work

So I don't think I've bought anything ridiculous. I mean, you've got to buy things, right? I'm stimulating the economy!

Marijuana

Apparently, Alaska has become the third state to legalize marijuana. Because I guess Alaska is the cool liberal state? Um, yeah.

Marijuana being illegal is one of those baffling things. It's much safer than alcohol or most illegal drugs. Nobody gets into a bar fight and kills somebody because they were high on pot. The worst they might do is break into a convenience store and steal some cheese doodles. No, you shouldn't drive while high, as you shouldn't drive drunk or on any number of mind altering legal substances. Alcohol is responsible for a huge amount of morbidity, and I've read that heavy drinking shortens your lifespan by an average of 30 years.

I think cigarettes are worse than marijuana too. Because people don't smoke two packs a day of joints for 30 years. The health implications of cigarettes and alcohol are considerable, but both of these substances are completely legal. Hell, you could argue that marijuana might be better for you then Coca-Cola. It's less addictive than caffeine.

I dated this guy in college who had a theory about why marijuana was illegal. It had to do with the paper industry and how hemp paper is cheaper than regular paper, so the paper moguls wanted to keep it from being produced. Sounds like a theory you'd come up with while high, right?

I've seen a lot of patients get considerable relief of pain and nausea from marijuana and it's pretty safe as a recreational drug. I think it's high time (no pun intended) that we legalize it everywhere.

Dr. Orthochick: Expectations

Dr. Germaphobe and I did a hip the other day, the patient got admitted, I rounded on postop day #1, everything was fine, then I went in to see her on postop day #2

Patient: Dr. Orthochick! Dr. Orthochick! You'll never guess who I saw yesterday!
Me: Who?
Patient: I'll give you a hint: he's a doctor and you work with him
Me: Ummm...an ortho doctor?
Patient: Yes
Me: Is it Dr. Germaphobe?
Patient: Yes! I was so excited to see him yesterday! He came in to visit me!

We are doing a really good job keeping our expectations low around here if patients are getting excited about seeing their surgeon the day after their surgery.

Self-publishing

I know several people who are attempting to contact agents and publishers to get their novels published. Obviously, I have chosen the self-publishing route for my books. Since I've been asked about it before, I thought I might talk about why I chose to “not get my book published for real", as my mother said.

I wrote my first novel over 10 years ago. By some stroke of luck, I did manage to land an agent for the book. Unfortunately, that’s where my luck ended. I didn't find a publisher, and after a year of looking, the agent dropped me and my book went unpublished. (Probably for the best, because it was sort of a dumb book.)

Several years later, I bypassed the agent route, and found a small publisher willing to handle a new book I had written, and then subsequently published a second one I wrote. While it was nice having my stuff in print, I wasn't really happy with the publisher. Sales for the first book were okay, nothing great, but sales for the second were abysmal. I felt that the reason for it was that the publisher didn't really do enough to advertise the book. In any case, we mutually parted ways.

I heard about publishing books on Amazon, so when I wrote The Devil Wears Scrubs, I decided to go that route. I paid to get the book professionally edited, and I made sure that it looked good. Long story short, I would never consider doing anything besides self-publishing again. Here's what I like about self-publishing:

-- You know exactly how many copies of the book you have sold in real time, which is definitely fun for an author

-- You have complete creative control over your cover, title, and work

-- You don't have to split the profits with your publisher

-- You can run promotions for the book on the Kindle, where you can literally sell 300-400 copies of your book in a single day

-- You can run free promotions on the Kindle, if you just want to find an audience, and have tens of thousands of people download your book

-- There's no point where the publisher "gives up" on your book and stops advertising it. You can continue to promote your own book as long as you want.

-- Chances are, you won't hit it big. But you might. 50 Shades of Gray was self published. And it's not like most traditionally published books sell huge numbers of copies.

There are so many resources out there to help self-published authors. These days, it almost seems stupid to go the traditional route. I have sold about 4000 copies of The Devil Wears Scrubs, and I’m continuing to run promotions on it. A friend of mine published in autobiographical novel the traditional way at the same time and it hasn't done nearly as well.

Bottom line is, I just think self-publishing is a lot more fun.

Weekly Whine: Lice

I hate lice.

I mean, I'm sure everyone hates lice, but as a woman who is the mother of two little girls, I really, really hate them. I would say that it is one of the worst things you can get after all the life-threatening stuff.

First of all, there's a huge social stigma attached to lice. If you have them, your kids can't be in school or daycare, you can't go on play dates, you can't tell anyone about it or talk about it (unless you have a big mouth like I do). If there weren't such a social stigma attached to it, I would've figured out my daughter had it much sooner, since her best friend's mom might've actually told me about it. (Or vice versa.)

And once you have it, it is impossible to get rid of if you have little girls who value not being bald. The shampoo? Useless. It basically says on the bottle that it's useless. It says that using the shampoo doesn't actually work, and in order to get rid of the lice, you must pluck them out one at a time from your daughters hair. You can imagine this is a really fun and easy task with a three-year-old.

When my girls had it, I cut their hair as short as I dared. My youngest definitely looked like a boy, and asked me tearfully, "will my hair grow back?" My older daughter cut her hair fairly short (it was buzzed in the back), but her hair is so thick that it was still really hard to comb it out. It was torture.

And I got it too. Yes, I admit it. I cuddle too much with my girls. And you can imagine that it was super fun trying to comb out my own thick, curly hair. I finally had to ask my husband to do it. Sexy.

I tried the following: the shampoo, olive oil, apple cider vinegar, hand lotion, a blow dryer. I lay overnight with a plastic bag on my head. (I heard about a little girl who suffocated during a lice treatment.) I came so close to getting out a razor and shaving all three of us bald.

Finally, after a month, at the point at which the girls would automatically burst into tears every time I got out the lice comb, I went to a service that combed out our hair for us for three hours and got rid of it. All for the low low price of $800.

And did the insurance cover it? Excuse me while I laugh.

Here's a thought: Lice is a health issue so why don't they actually make a treatment that works, or else make insurance cover some sort of professional treatment? I mean, I assume I wouldn't have to pay for my own scabies medication.

Funniest typo

In one of student written transcripts in medical school from biochemistry, I found what I thought was one of the funniest typos I've ever seen:

"The most advanced gene therapy is in pants."

It's funny because I assumed they meant plants, but you know, gene therapy, jean therapy, pants. Lol right?

Maybe you had to be there.

Anyway, over the years, I started to wonder if maybe this typo was made purposefully. It's almost too clever. Like the time when I creatively italicized certain letters in thrombocytopenias.

Dr. Orthochick: Pat your head and rub your stomach

Me: Hey, this is important. I was scrubbing with Dr. RBro and he said that Dr. Anal used to grab his junk every time he looked at an xray. Apparently in the days before xrays were online, he used to hold up the xray to the light with one hand and the other hand was on his crotch. So Dr. RBro asked me if he still did that and I legit don't remember because the last time I did hand was almost a year ago. Since you're on hand now, the next time you work with Dr. Anal, would you mind checking it out?

Hand Resident: I'm supposed to do clinic with him today so I'll look into it.

***12 Hours Later***

Hand Resident: The answer is, "yes." Dr. Anal now puts one hand on the mouse and the other hand is on his junk.
Me: Thanks for following up on that for me. I'll let Dr. RBro know.

We may not be curing cancer, but at least we're (occasionally) having fun.

(also, the word "crotch" will never not remind me of that time my high school boyfriend told me that his friend wanted to name his quizbowl team "Mike Rotch" and I asked--loudly--"who's Mike Rotch?"

Oh. Yeah.)

Informed

Patient's husband: "My wife hasn't had a bowel movement in a week!"

Confused Patient: "Yes, it's horrible!"

Me: "Actually, according to the nursing notes, you had a bowel movement yesterday."

Patient: "Oh. Well, next time they should tell me about it!"

Crockpot

After having the same crappy 2 quart crockpot for the last five years that I made stew in about once or twice a month, I finally decided to upgrade to a 3 quart crockpot that has (gasp) a piece that can be removed and washed in the dishwasher so I don't have to wash the entire thing in the sink.

 I'm very excited about this purchase and it's renewed my determination to make things in the crockpot again. When I first got my crockpot, I tried all sorts of recipes, and the only one that came out good was beef stew, so now that's all I do with it.  (And everyone loves the stew.… The whole family looks forward to stew night.) But everybody else raves about their crockpot, so I feel like maybe I'm missing something.

Does anybody have any good/amazing crockpot recipes that require five ingredients or less? That are kid friendly? And not a huge amount of preparation?  I found a website that has a few dozen easy crockpot recipes, but it's always good to hear some testimony.

Weekly Whine: No Show

I recently saw an article about a child who no showed to a birthday party and the parents sent the other child's parents an invoice for the amount they paid for his attendance.

Even though it seems ridiculous to send a bill for not showing up at a birthday party and unfair to drag the children into it, I actually have to sympathize with the parents who sent out the bill. It is so rude when people say they're going to show up for a party, you pay for them, and then they don't show. I probably spent an extra $500 at my wedding for people who didn't show up. And didn't even apologize for it.

For a birthday party, the amount of money is smaller, but really, it's the principle of the thing. You expect a certain number of people, you make an amount of food for that number of people, you pay the host, you make goodie bags. If you're not going to show up for the party, you better have a really damn good excuse. Not just "there was something else I felt like I'd rather do instead."

This is why, at an upcoming birthday party I'm planning, I am underestimating the amount of kids that will come. I'm sure they can make room for more kids at the last minute, but I'm not paying for the inevitable kids who don't show up.

More spiders, please!

For our coding, it's important to categorize certain comorbidities the patients have very specifically, because quite simply, it allows us to get paid more and for the patient to get more time in the hospital. For example, if a patient has congestive heart failure, we have to specify if it is systolic or diastolic.

One problem that many of our patients have is dysphagia. If I write down that a patient has dysphagia, I receive a letter asking me to categorize it, and gives me some options; for example, oral or pharyngeal.

When they showed us the form, one of the options for dysphagia was spideropenic. We were all looking at the form, trying to guess what this word meant. Our best guess was that the patient didn't have enough spiders in order to swallow properly.

Dr. Orthochick: Thanks!

Me: ...and I'm not sure if we need to do [options x, y, or z] because [long and complicated list of pros and cons]--
Dr. Dream: OK, I'll tell you what we're going to do. You ready?
Me: Shoot.
Dr. Dream: I am going to take charge of the decision making process. You are going to go home and relax and I will decide what to do about everything.

And if there is a better present you can give your post-call, pre-menstrual (actually, wait...menstrual) resident on a Sunday morning, well, I don't know what it is.

Physician parking

When I was a medical student doing my family medicine rotation, I worked in an outpatient clinic which was staffed by both doctors and nurse practitioners. As far as I could tell, the doctors and the nurse practitioners did pretty much the same job.

However, in the parking lot, which had ample parking, there were two physician parking spots right by the door. Not that there were any parking spots that were very far away, but these physicians spots were a little bit closer.

There was one doctor who worked at the clinic named Dr. Green, who went on at least two rants during my time working there about the fact that sometimes nurse practitioners would park in the physician spots. Dr. Green got really angry about it. He went so far as to make fun of the nurses who did it by calling them "doctor" facetiously.

My husband says that there is no need for physician spots and it's all just vanity, but there have been times in my career when I really needed a physician spot, such as when I had to race across a crowded parking lot to get to an emergency in the hospital. Or at two in the morning, when I had to treck 15 minutes in a dark desolate area to get to an emergency because there were no physician spots by the hospital. So it's not all about vanity. But I also feel like in an outpatient clinic, it sort of is about vanity.

Weekly Whine: Rocket Science

I hate it when people say "it's not rocket science" when they think something isn't that hard. As if rocket science is so hard.

What the hell is rocket science anyway? I'm sure the people who do the thing that we think rocket scientists do call themselves something else. The point is, who really knows how hard rocket science is? Someone told me once that quantum physics is much harder, so maybe people should say, "This isn't quantum physics" and they wouldn't sound as dumb then either.

One of the surgeons I worked with used to say to me, "This is just vascular surgery, it's not rocket science." Well, let me tell you, I don't think a "rocket scientist" could walk in and do an aortic aneurysm repair just like that.

Books I've been meaning to read

Since I got a Kindle and discovered that I could borrow books from the library for the Kindle, it's very hard to force myself to buy books. Or read anything that isn't available from the Kindle library. I mean, why should I pay for a book when there are just so many that are available for free? That said, there's a short list of books that I have been meaning to read for years, but I haven't gotten around to it because unlike most of what I read, they're not available for free.

1. This won't hurt a bit: this is the book by Michelle Au, of underwear drawer fame. She is hilariously funny, and I know the book is probably great. I just somehow can't make myself read one more medical autobiography.

2. My stroke of insight: this is a book by some sort of neuroscientist who suffers a stroke. It's been recommended to me by multiple people, but I just haven't gotten around to reading it.

3. Still Alice: I loved Lisa Genova's other book, and this one seems right up my alley, about a young woman who experiences early dementia.

4. The Room: this bestseller was one of the first books I recommended to my bookclub. Unfortunately, one of the members had already read it, so it was rejected, and I haven't gotten around to reading it on my own.

5. Gravity: this is a book by Tess Gerritsen, who is one of my favorite authors. I recently read all her books that are available in the library, and she has a few medical thrillers that are not available in the library, but I can get on the Kindle for only five dollars. It seems like it would be worth five dollars for a book that I really enjoy, but somehow there's always something that's free that I can read instead.

6. The perks of being a wallflower: this is a book that kept coming up when I was reading stuff for young adults. The first chapter wasn't compelling enough to get me to buy it, but I do think I would probably like it.

Dr. Orthochick: Overslept

I totally overslept yesterday morning and didn't actually make it down to work until 6:30. I think I hit "off" instead of "snooze," which happens to me every now and then. Fortunately I wasn't scheduled for any early cases and I only had three patients, so the situation was nowhere near as bad as it could have been.

Nurse: oh good, you're here. Your patient in room 355 really wants to see you.
Me: is everything ok with her?
Nurse: She keeps on saying that she wants to see you.
Me: OK, I'll go see her now.

***

Me: So what's up?
Patient: Oh, thank G-d. I was so worried about you. You always come in at a quarter to six and you didn't this morning. i was scared something happened to you. Is everything all right?
Me: Yup, just running a little late this morning.
Patient: I'm just glad you're OK. I was really scared when you didn't come in this morning. i thought you might have been on vacation today, but since you didn't mention that yesterday, I thought maybe you got into a car accident on the way over here. Or something happened to you last night.
Me: No, everything's fine. I just overslept a little.

That's actually kind of sweet. Admittedly a little strange, but definitely kind of sweet. Certainly a welcome change from my patients who yell at me for waking them up too early.

So young

I read somewhere that the number one thing you can do to make a woman feel good about herself is tell her that she looks young. So whenever I meet a new female patient who fits the bill, I make a point out of exclaiming how young she looks. I mean, I won't lie and tell somebody that she looks young if she doesn't, but I figure it doesn't hurt to compliment her, especially since people feel bad about themselves when they're in the hospital.

Most of the time, the women seem very happy with the compliment. Occasionally, it backfires.

Recently, I was seeing a new patient who was 75 years old. He looked pretty good for 75. When I asked him who he lived with for a dispo planning, a woman in the room raised her hand. I asked who she was, and she replied, "I'm his wife."

"Wow!" I commented. "You don't look anywhere near 75! You must be much younger than that."

"Yes," another woman in the room commented snippily, who we later found out was his daughter, "she's a lot younger than he is."

Oops.

I guess there was a reason she looked so young. She was the trophy wife.

I later tried to make up for it by exclaiming how young the patient looked, and then how everyone in the room looked young, and that the family had apparently discovered the fountain of youth. "What your secret?" I asked at one point. I'm not sure if that worked.

Suicide Med

I signed up for expanded distribution of my newest book Suicide Med, which I've been reluctant to do because it meant I would have to increase the paperback price, but I'm not selling that many paperback copies anyway (Focusing mainly on Kindle), so I figured it was worth it.  The price will probably come down again eventually as Amazon readjusts, but I don't know when that will happen. So if you've been postponing getting a paperback copy of the book, this is a good time to take a chance.

I haven't done as much to push this newest book, mainly because I haven't felt as confident about it. My first one was basically a fictionalized autobiography, sort of an extension of my blog, but Suicide Med is more difficult to characterize and involves a little bit more creativity.  So it's hard for me to go around telling people to read it when I don't feel confident about it.