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Holiday reruns

I got the idea from Dr. Grumpy that it's okay to post reruns of older (better) material during the holidays so that I don't have to actually think.  So I'm going to spend the holidays posting some old cartoons, from back in the days when the name of this blog actually meant something...

Holiday shopping

I was recently shopping at Target on a weekday morning, not so much for the holidays but because my underwear and socks are hanging together by threads and I happened to have the day off.

Anyway, a friend of mine called me just as I got to the megastore within the mall, and I put on my handsfree device so we could chat while I shopped.  We were talking while I was comparing two socks I was thinking about buying, when this woman suddenly yelled at me:

"You're being really obnoxious!"

I looked up in total shock.  This middle aged woman was standing in front of me, glaring at me angrily.

"What?" I said.

"You're just being really obnoxious," she said.  "I'm trying to focus on shopping and I can't concentrate because you're talking on the phone.  It's really obnoxious."

I think there was a time when I would have mumbled an apology, but maybe it's just that I'm older or maybe it was my friend on the phone saying, "What the hell?"  Or maybe it was another shopper who was looking at that woman and shaking her head like she couldn't believe it.  But I wasn't going to be yelled at for OMG talking on the phone at a department store.

"So you're saying I'm not allowed to talk at Target?" I shot back.  "So if I had a friend standing next to me, we wouldn't be allowed to speak?"

"That's different," she said. "What you're doing is obnoxious."

"How is it different?" I said.  "Are we all just supposed to shop in absolute silence so that you can concentrate?  Nobody is allowed to talk in this whole store?"

"Look, I'm sorry I said anything," the woman finally said.

"Yeah, happy holidays," I said.

I mean, WTF?  I get that there are times when being on your phone would be obnoxious.  Like, if I were on a train, where we were all trapped there, I wouldn't talk on my phone.  But I was at a huge store that was noisy as hell already, and in all likelihood, if she hadn't said something, I would have moved on in about two minutes anyway.  I mean, how long can you spend looking at socks?

I would never consider going up to a complete stranger and criticizing their behavior.  Speaking of obnoxious.

Legos

For Christmas, my mother bought my younger daughter a kit of Legos to put together.

Older daughter: "When I get back from basketball, I'll help you put the kit together."

Me: "I can help her do it now."

Older daughter: "It's pretty complicated, Mom.  I doubt you'll be able to do it."

Me: "I think I can put together a Lego kit. I'm a doctor."

It's this the stage where my kid starts thinking I'm a totally incompetent idiot?

Bullying

I was just catching up on a tv show I watch, Hell's Kitchen.  It's a cooking competition where there's a male and a female team, and they compete against each other until there's one winning chef.

In a previous episode, all the men ganged up against a female contestant, telling her that nobody liked her, and it got her so upset that she got eliminated almost right away, in spite of probably being a decent cook.

On the episode I was just watching, the male contestants were trying to decide "who to bully next." They picked a woman and all decided to target her. One of the guys bragged "this is what I do," and that he couldn't wait to make this woman cry.  The brilliant insults they came up with to target the woman included telling her she had a rat face and calling her Splinter.  (I'm not sure why Splinter was so bad... isn't he like some wise master of ninja?)

The whole thing made me so furious, I could hardly concentrate on the rest of the episode.  I felt so awful that they were targeting this woman to bully, and even though it was within the confines of a stupid competition, that sort of thing does happen all the time in real life.  And of course, then I started getting pissed off about the fact that a man can be a horrible misogynist and bully and still get elected President with lots of women on his side.

There were certainly kids who were mean to me when I was growing up, probably to the point of bullying.  And I never knew how to deal with it... fortunately, it was always self-limited.  But I realized that even as an adult, I don't entirely know how to deal with it.  If someone tried to start bullying me, I think I'd be in trouble.

When my daughter was facing mild bullying at one point in school, we counseled her that they only keep doing it if it bothers you. So the right response is just to say, "Whatever!"  And ignore them. We even practiced saying "whatever."  But easier said than done.

Anyway, in watching Hell's Kitchen, I was really proud of the woman they were attempting to bully.  When they called her "rat face," she actually just laughed and said, "I have a rat face?  Whatever."  (She actually had quite a pretty face.)  And while she did get slightly worked up (it is reality TV), she basically called them on what they were trying to do and walked away with the more intelligent last word.

Oranges

I was in a meeting last week and I suddenly noticed that I smelled oranges.

Sometimes people snack in our meetings, but I looked around and couldn't see anyone eating oranges or anything that might smell like oranges.

So I started freaking out.  Why was I suddenly smelling oranges?  Was this some sort of weird type of seizure?  Was this the aura for an impending migraine?  Was this the first sign of a brain tumor?  Was it a tumor?

Finally, during a break in the conversation, I nervously commented, "Does anyone else smell oranges?"

"Oh yeah," one woman said.  "I was eating an orange just before I came in."

Apparently, the smell of oranges really clings to you.  Orange smell--worse than glitter?

The packages

When I got home from work the other day at around 6:30PM with the kids in the car, there were two giant rectangular boxes taller than I am blocking my garage.

I got out of the car and saw a note from my neighbor (who I've never met).  It said that the boxes were delivered and left in front of our garage by accident and could I please put them in her garage because she's pregnant and can't move them.

First of all, I was not thrilled that I had to get out of my car in the dark and the cold with two cranky kids in the car at the end of a long workday because my garage was blocked by her package. Also, these boxes each easily weighed more than I do.  And I have musculoskeletal issues.  So there was no way in hell I could move these boxes and put them in her garage.  All I could do was knock them over (not gently), and shove them over and out of  the way of my own garage, which was in my case, a feat of superhuman effort.

I was so pissed off. I taped the following note to the package:

"Dear Neighbor,

I don’t know exactly what you wanted me to do with these boxes but they were completely blocking my garage with both my kids cranky in the car, and all I could do was push them aside to get into the garage.  I could not even close to physically lift them (they probably weigh twice as much as I do) and I have back problems, so I am sorry I could not do anything with them. I know this wasn’t your fault, but please have your husband move them when he gets home.

Thank you very much."

I thought it was a very polite note, considering how angry I was.

Yeah, maybe it wasn't her fault that the boxes were delivered to the wrong place.  But leaving two 100+ pound boxes blocking your neighbor-who-you've-never-met's garage and hoping that they'll just move them for you seems a little rude.  For all she knows, I could be ninety years old.  Was there no other person who she could have called to move them?  Maintenance, perhaps?  A young strapping male passer by?  That's what I would have done. I once got a lifeguard to open a jar of pickles for me. Just leaving them blocking my garage and expecting me to move them seems like not such a neighborly move.  Which wasn't even physically possible for me.

At the very least, she could have left a note saying that she had tried to take care of the situation and that her husband would be home soon to move them.

When my husband finally got home an hour later, the woman's husband was moving the boxes.  I told my husband what happened and he went out to help.  Then my husband informed me that the packages weren't that heavy (I swear, they were) and I overreacted.

Me: "I couldn't move them at all aside from tipping them over."

Mr. McFizz: "I don't know what you want me to say."

Obviously, I want you to say I'm right!  Sheesh, is a little blind support too much to hope for?  Do all men do that?

Transcription errors

Every time I think I've seen the funniest transcription error ever, I see something like this:

Patient had watery stools coming out of his eyes.

Suicide Med on sale!

I haven't put Suicide Med on sale in a while because I've been sort of ignoring my earlier books, but I decided to do a little sale this week.  It will probably be the last one ever, so....

Get Suicide Med for less than a dollar!

Mini-blurb:

Southside Medical School is nicknamed “Suicide Med” because for each of the last six years, one student has taken his own life. Is it the heavy workload?  Is the school simply cursed?  Either way, the same question echoes through the minds of every student at Suicide Med: 

Who will be next to die?

Shooter drills

Everywhere I go, there are shooter drills.

We've had one at our hospital.  My kids have had them at school.

I'd like to say that this is a ridiculous overreaction to something that's really rare, but I can't entirely say that. Yes, it's really rare. There have been over 50 school shootings this year, which isn't very much compared with the number of schools in the country, but it's not winning the lottery rare.  It's probably more common than being involved in an airplane crash.

I just find it really depressing that the country has gotten to the point where we have to do this.  When I was a kid, we weren't having shooter drills.  There's obviously a problem, yet we've elected a President who is potentially going to loosen the gun restrictions that most people in this country want.  That's what bugs me--that the vast, vast majority of people in this country are more worried about mass shootings than they are about their second amendment rights being taken away.

I don't understand how the solution to increasing mass shootings is to teach people what to do when it happens and just accept that there's nothing we can do to stop them.

Thank you for your donation

In September of last year, I put out a collection of short stories called 11 out of 10.  I solicited contributions from readers online, and I've been selling the book for $2.99 on Amazon (of which Amazon takes a cut).  I've been donating all profits (and change) to Deworm the World Initiative, a charity that treats parasitic infections in developing countries.

So far, I have sold over 3,000 copies.  I've donated about $6,000 to this charity.

The book has been out a little over a year, and I had figured that after the first year, I'd drop the price to a dollar and just give like a thousand bucks to the charity to cover any income it might make in the future.  But considering I've still been able to donate $200/month from the book, it seems like it'd be better to just keep going!

Anyway, I want to say thank you to everyone who bought a copy or contributed.  It's pretty cool how much money the book managed to raise.

The Fire

Yesterday, I was doing laundry when I heard my older daughter screaming.  Apparently, she put something metal in the microwave and it was spinning around on the tray, shooting up orange flames.

Now I feel she's old enough to use the microwave, but at some point, everyone accidentally puts something metal in the microwave (this was a piece of shiny wrapping that food was wrapped in).  But she wasn't old enough, apparently, to know what to do when it caught on fire.

I've set small fires to the microwave before, but this was quite a dramatic fire.  And I realized that my two kids were in the house and I was the only adult.  So it was up to me to either extinguish this fire or figure out the next step.

Fortunately, the second I turned the microwave off, the fire went out.  Good thing, because I really didn't know what the next step would be for a microwave fire.  Would water make it worse, like for grease fires?  Would a towel have been better?  Clearly there was no time to google it.

Sometimes it's scary being the adult.

Any other questions

When I ask a patient, "Any other questions?", usually I mean about the stuff we've just been discussing.  But not infrequently, this is taken as an opening to ask me personal questions.  Such as:

"Where did you go to medical school?"

"Where do you live?"

"Is your hair naturally curly?"

And from yesterday:

"What is your favorite jazz song?"

That was one I literally could not answer.

Two

These were the two saddest comments I heard from my family members about the election:

From my daughter: "Well, at least Clinton won the election we had in our school."

From my mother: "I'm so excited... now we get to see what Melania Trump is wearing for the next four years!" (Not said sarcastically)

Current events

Me: "Who is the President?"

Patient: "Oh!  I know one... oh my gosh, I can just picture him..."

Me: "What does he look like?"

Patient: "Well, he has this strawberry blond hair and it puffs up over his head.  I don't know how it does that!  I think his name is... Target?"

Me: "Um, who is the current President?"

Patient: "Oh!  Yes, well, that's... hmm..."

Me: "It starts with an O."

Patient: "Oprah?"

Actually, I remember at the start of the election, people were saying that Oprah should run for President.  I was discussing this with my husband and telling him how much respect I had for Oprah, because I saw her go on some show where she was like, "What is wrong with people saying I should run for President!  I have no experience with government!  I'm totally unqualified!"

And she has great insight.

Although actually, if she were running for President against either candidate, she'd probably win in a landslide. She's really likable.  Hell, I'd happily vote for her against Trump.  She seems like a smart lady (based on not wanting to run) and she's certainly a feminist.  She seems very even-tempered and compassionate. And unlike Trump, she built her enormous empire from scratch. Actually, I'm liking this idea more and more.

My patient was right!  Oprah for President!

A Halloween Conversation

Patient: "I'm just feeling incredibly depressed about my whole situation."

Me: [thinking] "I really wish I weren't wearing fox ears right now."

A lot of staff members dressed up for Halloween this year and there was a whole theme going.  I don't usually dress up and I didn't this year either, but because everyone else was doing it, I found a really discrete pair of fox ears in my kid's room and I wore them about half the day.  Most patients either didn't notice or they seemed to appreciate my Halloween spirit. I only wore them for follow-ups, not to see new patients.

But there were one or two times when I desperately wished I didn't have them on.  And I was like, do I take them off?  Because that would call more attention to them, right?

What do you think?  Is it inappropriate for a non-pediatric physician to dress up for Halloween?

Email scandal

I was recently talking to my mother, who is at least fairly well informed about politics, and I was really surprised to learn that she didn't understand that there was a difference between Clinton's being investigated for the private server and the hacking of the DNC emails.  She thought it was all the same thing.

Husband: "At least she knows what email IS."

On discussing this more with my husband, I discovered that even I don't understand the email scandal with the private server, despite the fact that I read the news all the time.  My husband, who has worked with classified government information, asked if I could explain it and I explained it incorrectly.  

Can you explain what Clinton did wrong with her email server, if anything?

The Cleaning Guy, continued...

Remember when I wrote about wanting to fire my cleaning guy? Well, a few days ago he quit.

He blamed it on my cat. He said his cat allergies were really bad and he was getting constant infections thanks to my cat. Thanks to the one and a half hours a day he spent cleaning my apartment every other week.  I guess it could be true, despite the fact that he never ever mentioned anything about this to me until I got to the point where it was so bad that he apparently had to quit.

In his usual style, he didn't tell me he was quitting and that he wouldn't be showing up until it was an hour before he was supposed to come. There was apparently no possible time he could've told me about this until right before.  

I don't get it. He was so good when he started out. Then he gradually morphed into being completely unreliable. I still don't understand how he forgot to take the check I left for him on multiple occasions.  I gave him several opportunities to quit if he wanted, and he never took it.  You know you don't trust somebody when they tell you they couldn't show it because they were in a car accident, and you think they were lying.

Also, weirdly, he left his vacuum cleaner in our garage. Like, forever.

My husband and I disagreed over whether to change our locks.  The cleaning guy didn't offer to return our key, even though I didn't ask.  I just wanted to have the locks changed, either way. My husband said that he was the one who quit, and if we were trusting him with our key before, why wouldn't we trust him to have it now? I still wanted to change the locks.

Current events

Me: "Who is the President?"

Adorable 93-year-old patient: "Obama.  But a better question is, who is going to be the next President?"

Me: "Trump."

Adorable 93-year-old patient: "I hope you're joking."

Me: "I'm joking."

Adorable 93-year-old patient: "Good.  Because if you weren't I'd have to ask you to leave."

Call me maybe

At a recent meeting, it was suggested that all physicians at our hospital give out our personal cell phone numbers when patients are being discharged, and tell them to call us with any issues.  This would supposedly improve patient satisfaction.  The medical director said he'd been doing this for years and had only gotten "like two calls ever."

The response was overwhelmingly, "Hell no."

I know of several physicians who have given out their cell to a patient and been harassed for years.  But apparently, doctors giving out their cell numbers is a thing now.

What do you think?

Genuine

My older daughter's latest thing is accusing me of not being genuine.  Like, she got angry at me because she showed me her drawing and she felt that my "oooh" sounded phony.  Well, it was kind of phony.  But what the hell was I supposed to do?  It was a drawing of a cat.

Mel: "You know what? My teacher was telling us about how if the whole class does really well on the spelling test, we're going to get to have a party next week."

Me: "Great."

Mel: "You weren't listening to me!"

Me: "Yes, I was!"

Mel: "Then what did I say?"

Me: "You said your teacher was telling you about how if the whole class does well on the spelling test, you're going to get to have a party next week."

Mel: "NO."

Me: "Uh, yes."

Mel: "I said if we do really well on the spelling test."

Me: "Ugh!  I was obviously listening."

Mel: "No, you weren't.  You were just repeating back what I said."

Aaaaaand that was the end of that argument.

The Bug

A few weeks ago, I was working at a computer when I heard a strange buzzing in my ear.  At first, I thought it was a fly, but then I turned my head and saw a GINORMOUS insect buzzing around right next to my head.

Obviously, I screamed.

The insect landed right on the computer monitor.  So obviously, I couldn't use the computer anymore.  Not until somebody (else) killed the flying terror for me.

A female physical therapist came over to me and asked if I was okay.  I explained about the giant bug on my computer and that I was basically paralyzed with fear.  The therapist then reached over and smooshed the giant bug with her hand.

If I were a man, I would have been totally emasculated.  As it was, I was a little emasculated.

This has happened before.  I think there was a jar I couldn't get open or something along those lines.  I certainly don't mind getting help with something that either frightens me or involves physical strength that I don't have, but it does make me feel slightly like a wimp when a woman helps me.

Affiliation by Specialty

I was recently reading a NYT article about political affiliation by specialty.  It broke things down as below:



I think it's interesting that the ROAD specialties as well as Surgery are more red, whereas medical specialties are more blue.  I suppose it correlates very well with income.  It also seems to correlate well with more female-oriented specialties.

Some things don't entirely make sense to me though.  Why are ID docs so liberal?  And why are Family Med docs more red than blue?

Locker room talk

I try not to get TOO political on this blog, but what the hell, it's my blog and I can write about what I want...

When I first heard Trump's comments with Billy Bush, I was more amused than anything.  I mean, we ALL knew this was what Trump was like... this was just verification.  And it was also amusing that of all the Bushes, it ended up being Billy Bush who brought Trump down.

But the more I hear people talk about this, the more angry I get.  It's a well known statistic that 25% of women are sexually assaulted by age 18.  I'm a woman and I have two daughters.  It's horrifying that it's not only acceptable to "joke" (let's assume it was a joke, although i have my doubts) about sexually assaulting a woman.  If that's "locker room talk," then locker room talk is unacceptable.  If that's a joke that it's okay to make even in private, then there's something really wrong with our society.

Whatever his other politics are, I think it's horrifying to put a man who thinks that way and talks that way up as a role model for our entire country.  What message are we sending to women?  To young people?

People keep pointing out that Bill Clinton did it.  JFK did it.  Other politicians did it.  Well, George Washington owned slaves, so does that make it okay? What Bill Clinton did wasn't okay and what Trump said (and likely did) isn't okay either.  We need to move away from that, not repeat the same mistakes.

A lot of people in this country don't respect women.  This is part of why we get paid less for doing the same job.  And why so many women get sexually harassed and assaulted, and a lot of the time don't/can't even say anything about it.  Because it's so acceptable.

Sexually assaulting a woman should be something that a man should be deeply ashamed to joke about, even in a "locker room" situation (whatever that means).  The fact that Trump is clearly not ashamed, in spite of his bogus apology, is deeply troubling, as is the fact that so many people don't think he should be ashamed and simply accept that this is the way men are allowed to talk.

I get it, Hillary

The more I watch Hillary speak and debate, the more I feel kind of sympathetic towards her.  Whatever else you can say about her, Hillary is a smart woman.  But she's not a great speaker or particularly charismatic, like her husband or Obama (or HIS wife). She's not the kind of person you just automatically like. I think that if a more charismatic person were running with her same exact background, they would be killing Trump.

I get it, Hillary. I'm not charismatic either.  And while I'm not running for public office, being a doctor (at least in some fields) does require some amount of charisma.  It's hard to know that no matter how hard I try, I just can't obtain the same level of likability that some of my colleagues get to without even trying.

So I paste that same smile on my face that Hillary has through the debates and try to provide good care, and hope that it's enough to get patients to like me.

Too many errors?

I was recently reading a discharge summary on a patient, trying to figure out what the imaging showed, and this is what it read:

"The right hip showed unspecified mild assist in nephritis and mild effusion. There was mention of lumbar spondylosis.  Imaging otherwise of the lumbar of the lumbar spine otherwise appears rather underwhelming for parasite."

What???

I know nobody corrects their errors on these notes, but I genuinely think there is some level of mistakes that is truly detrimental to patient care.

Carseats

Now that both my kids are in elementary school, I had really been looking forward to being car seat free. Unfortunately, I discovered at my last pediatrician appointment that my youngest (who is average weight) is still 10 pounds shy of the cutoff.

Gah!  This is getting ridiculous. Soon they're going to say that I have to sit in a car seat.

Recently, I had a conversation with a friend on Facebook that baffles me:

Her: "I am so excited about my son turning one!  He finally doesn't have to be rear facing anymore!"

Me: "i'm sorry to break it to you, but the recommendation is actually two years old for rear facing now."

Her: "oh, I know. He just doesn't like being rear facing."

Great. So if you're just going to do it based on what your kid likes, why are you waiting until one year? It's sort of arbitrary at that point. Just turn the damn car seat around already.

Sale!

For a short time, Brain Damage will be discounted to 99 cents!  Get it now!

Family History

I find the family history to be the most useless part of my history.

For some doctors, I'm sure it's really useful. If you are evaluating a patient with chest pain, it's useful to know that their father had a heart attack at age 42. But considering every patient I've seen has already had a diagnosis, it ends up being completely useless to me.

Unfortunately, I don't get to decide what is useful or not. If I write a 30-page history and physical, I can only bill at the very lowest level unless I include a family history.  So you can bet I'm asking about it.

The Closet Situation

Our closet is one large source of marital discord in our household.  

We have a walk-in closet in our bedroom. However, the only way to get inside is through the bathroom. So if one of us is in the bathroom, and the other one wants to get dressed, they have to knock and make a big thing of it. I certainly don't mind if my husband comes inside the bathroom if I am showering or brushing my teeth, but I don't really want him coming in while I am on the toilet. Fortunately, I'm not one of those people who spends more than a minute or two on the toilet, so it's not a big deal.

Unfortunately, my husband is more like Al Bundy, in that he goes into that bathroom for the long-haul. It can be an hour easily. And he doesn't want anyone coming into the bathroom while he is on the toilet, which I suppose is understandable.  (We do have a second bathroom.)

However, sometimes I need something from the closet. Like the other day, my kids wanted to go outside and he was on the toilet, so I had to come in to get my sweater and some socks.  He was not pleased. I told him that if he let me know when he was going in, I could get out what I needed, but he says he shouldn't have to and that I should already have out everything I need before he goes in. But I don't think that every time I leave the closet, I should have to grab everything that I could possibly need from it?

The laundry also causes problems, because sometimes I'm in the middle of doing it and he goes into the toilet. There was one occasion when I was in the middle of putting away clothes. I went to the closet, put away some shirts and pants, then went back to the dryer to get the second armful of clothing. And in that 30 second window, he had run into the bathroom and was in there for the duration. It was so frustrating!  He tells me to just dump the clothing on the bed and put it away later, but when I'm doing laundry, I want to put everything away when I'm doing it. I don't want to have to come back later and start putting away clothing again.

I know this sounds like a really stupid problem, but sometimes really stupid problems can get you really aggravated. Any suggestions? And most importantly, who is right??

Buy the book

During residency, one of my junior residents, let’s call him Jimmy, asked me for book recommendations.  I told him some good books, and mentioned one book that was absolutely essential for our residency.  Our main Sports attending was in love with it and would nag you on that rotation unless you had it.  And it was actually a really good book.

Jimmy didn’t buy the book.  He took it out from the library and agreed it was a good book, but he didn’t want to buy it.  He told me he’d just take it out from the library during rotations where he needed it.  He said he didn’t want to actually buy any books during residency when he could get them for free from the library.

OK, yes, residents are not exactly rolling in dough.  But Jimmy was married to a hospitalist, who was probably pulling in about $200,000 per year.  He had no kids and wasn’t planning on having any for at least a few years.  I don’t know his debt situation, but I’m fairly sure he was doing better financially than me and my student husband and baby requiring a nanny.  So I was seriously kind of irritated by his refusal to spend $40 on a good book.  

What was up with that?

("Wouldn't it be easier to buy your own copy of the Bible?" "Sure, maybe on a librarian's salary.")

 

Book recommendation

If you want to read a short, interesting medical thriller, I recommend Side Effects.  Just finished it and really enjoyed it! (And it's only a dollar.)

Help me fire my cleaning guy

I really want to get rid of my cleaning guy.

When we first got him, he was amazing.  The apartment was spotless when he got done with it, and he even gave us a toy box at one point.

However, he used to have this female assistant who would help him. Now he doesn't have her, and he seems to get done with the cleaning very quickly, and things just don't seem that clean after.  Once I specifically asked him to clean the microwave, and it was still covered in grime after.

Also, there are some days he just doesn't show up.  Not often, but enough.

Strangely, on multiple occasions, he's forgotten to take the check I left for him.  That just seems beyond weird.  Not bad for us, but weird.

Our babysitter would like the job of cleaning for us.  She's amazing at cleaning.  I want her!

I think he's checked out.  He told me he was thinking about moving south in the near future, and I've kind of been hoping he'll just do it.  Because I don't know how to fire someone who has the keys to my home.

Clarinet dilemma

My daughter is in a grade where the children are allowed to join a band and start playing an instrument. Our town schools have a "rent to own" program where you can rent an instrument until you have paid enough to own it.

My daughter decided on the clarinet, so we rented a clarinet.  It seems like every other kid was there renting instruments too. So I was sort of shocked when I saw that the amount I would have to pay to own the clarinet was $720!  (Even the flute was $700.)

I have no doubt that a really nice clarinet could probably cost more than $720. But I can't fathom paying that much for an instrument for a child to learn on. There are decent clarinets available on Amazon for $100, which is what we will have paid after only four months.

Is there something I'm missing? Is there a reason to keep renting this instrument when I can buy one much cheaper?

Women and ladders

I deal with a lot of multi-trauma patients and the other day, I had two patients who were injured falling from ladders. And that's when I realized that in all my years of practice, I have had a lot of patients were injured falling from ladders, and not even one of them has been a woman.

I have never had a female patient who is injured falling off a ladder.

I have never had a female patient who fell off a roof.

I have never had a female patient who was in a motorcycle or ATV accident.

Is it that females never do these things or just that they are more careful?

On the other hand, I did have a female patient who injured herself trying to carry her 12-year-old son up a flight of stairs.

License plate

I saw a car yesterday with the Vanity license plate:

IBS

I'm sure anyone in medicine thinks of the same thing I do when I see that acronym: irritable bowel syndrome.

I'm assuming whoever bought that license plate has those initials? I wonder if anyone has clued them in.  Or maybe they really do have irritable bowel syndrome and are proud.

Dogs, Part 2

I'm convinced that I will die trying to get in my 10,000 steps per day.

So I'm walking through a residential neighborhood and I see two dogs on a lawn across the street.  They're large dogs--pitbull mixes, I think.  Anyway, at first I'm not that worried because they're across the street, but then, to my horror, they cross the street and start walking in my direction.

I totally freak out.  I turn around and start walking away, but the dogs are following me.  Briskly.  My heart is pounding and all I can think about is that these dogs could easily kill me, and there are NO human beings around to help me.  

I thought about running, but I remember the last time I posted about dogs here, someone commented that a dog could easily outrun me, so I decided to just play it cool.  Eventually, I got to the end of the block, and the dogs stopped following me.

At that point, I called the police.

I later found out from our Facebook community that the dogs belonged to a family that lived quite a few blocks away.  That they "sometimes get out" but are really, really friendly.  Fine, maybe they wanted to play with me and not maul me.  But still... I didn't know that!  And they crossed several major streets, putting their own lives in danger, as well as a car that might swerve to avoid them.

Not sure what to do at this point....

Typos revisited

When I made a recent post about how confused I was that people keep commenting on how many typos there are in my book Baby City, a lot of people took that to mean that I can't take criticism. But that wasn't it at all. I just am truly baffled as to how a book that was combed for typos by three different people including myself could still have so many typos that somebody would say they want to take a red sharpie to it.

So I don't know if anybody would be willing to help me out with this. I'm thinking that a "distracting" number of typos for a book would be more than one per 10,000 words. The book is 80,000 words.

For those of you who like a challenge, if you read Baby City and can point out 8 or more typos, I will gift you five dollars on Amazon. If you find more than 15, I'll give you $10.

And by that, I mean genuine typos. Things that are clearly errors, like "he were thirty years old." 

Offer only applies to the first five people. Not that I think more than five people will possibly do this.

EDITED TO ADD: Never mind, I'm rescinding this offer before anyone else does it.  I apparently was entirely wrong and I'll admit it. Thank you for pointing out my errors, Liana.  

Teen idol

Recently I had this song in my head that I liked, and when I looked it up, I realized that it was by 17-year-old blossoming teen idol Shawn Mendes.  I was a little disturbed because:

--I can't believe I like a song by a teen idol

--I can't believe I find him hot

I mentioned this to my husband, who thought it was slightly amusing.

Me: "He's so young I'd go to jail if I had sex with him."

Him: "True.  But so what?"

Me: "Our daughter should be the one who thinks he's hot.  She's closer in age to him than I am."

Him: "A fetus is closer in age to him than you are."

Me: "Oh God.  You're right.  But when I actually was a teenager, there weren't any teen idols. Like, in the 90s."

Him: "Yes, there were.  There was NKOTB."

Me: "No, that was really early 90s.  And anyway, can you even name a NKOTB?"

Him: "No, but I'm not a girl.  What about Justin Timberlake?"

Me: "No, that was very late 90s.  I'm talking mid-90s.  Who was the Justin Bieber of the mid-90s?"

Him: "I don't know.  I'm not a girl."

Me: "I'm trying to think of who the teen idol singer was in the mid-90s and I can't think of anyone.  I really can't."

Him: "And I don't care."

Seriously, who was the Justin Bieber of the 90s?  Also, why did girls like Justin Bieber?  He isn't even hot.  Shawn Mendes is much hotter.  Damn!

C9 fracture

When I was in residency, a co-resident came up to me one day and said, "Hey, I saw your patient with the C9 fracture.  I guess he was a giraffe."

"Huh?" I said.  (The human cervical vertebrae only go up to C7.)

He filled me in that in a consult note I'd dictated on an inpatient several months earlier, a C9 fracture had been noted among the patient's many injuries.  I did a little research and realize I had said "sphenoid fracture."

Except the funny part (or not so funny part) is for the next several weeks of the patient's hospitalization, multiple physicians noted that the patient had a C9 fracture.  Some were clearly copied and pasted from my note, but others actually broke down the injuries one by one, still noting the C9 fracture.

The moral is either that people in medicine sometimes don't think, or else maybe it's that I should check my damn dictations better.

Transcription error

This one made me laugh for like five minutes:

"Ice cream was applied to dry feet."

Worthless

Most useless family history I have ever seen in a chart:

Wife had gestational diabetes.

69

Me: "I have to give my dad a call. It's his birthday today. He's 69."

Husband: "69, huh? I guess we know what he's going to be doing with your mom tonight. Heh."

Me: "..."

Buh bye

I really have trouble ending phone messages to patients and their family members.

Usually I say something like: "this is Dr. fizzy calling from session such and such. I'd like to speak to you about such and such."

And then what do I say? Goodbye just seem so abrupt.

"Hope to hear from you soon!"

"Byie!"

"Laterz!"

No matter what I say, it always so awkward in my ears.

Typos

Here's something I don't get:

My third book, Baby City, was professionally edited for typos and grammar issues. However, more than any other book, I have gotten nonstop comments about how many typos there are in this book.

One reader commented that he lowered his rating of the book from 5 to 4 because of how many typos there where. He was kind enough to send me those typos. There were five. Out of 80,000 words.

So I fixed all of those typos, yet I still get complaints. See this review I recently received:

"just could not get past the lack of editing. If I could print this out, I would take a red Sharpie to it."

I don't get it. Even the person who read the book for audiobook said she didn't see many typos. Where are these typos that are upsetting people so much????  I'm sure there are a couple that got missed, but no more than in my other books, which nobody has complained about.

Furthermore, I have seen other books that were littered with typos. There were literally typos on every single page. Yet they had dozens of reviews without one mention of the copious typos. I really just don't get it.

Tax Guy

Right now, we do our taxes with TurboTax. My husband actually does it. It doesn't seem that hard or that big a deal. He claims not to mind doing it.

However, we've had some tax issues recently due to my extracurricular activities. That is, I moonlight at a place that doesn't remove taxes when they pay me. And also, last year I earned close to $20,000 from book sales from Amazon. So between those two extra incomes, we ended up owing a lot of money and I think even had to pay a penalty. We donated quite a bit to charity, but it didn't really balance things out.

A friend of mine was telling me that having a tax guy would help us find more deductions, and ultimately, we would end up saving money. My husband says that's bullshit. That all they really do is plug the data into TurboTax.

What do you think? Should we pay for a tax guy?

I don't get it

So I don't write a whole lot about politics on here. But I have to say one thing:

I don't get how anyone is voting for Donald Trump.

Putting aside the fact that he's been a joke in this country for my whole life. Putting aside the fact that this guy has beaten and probably raped at least one of his wives. Putting aside the fact that he knows nothing about foreign policy and seems to have no interest in learning. Putting aside the fact that he's encouraging white supremacists. Even putting aside the fact that his economic plans would probably result in economic disaster...

I'm terrified of Trump being President.

The guy has expressed extreme willingness and even eagerness to resort to use of nuclear weapons against ISIS, and even apparently in Europe, if need be. He does not want to work with NATO and will scrap all the diplomacy that we've built over the last century. He wants to tell our allies to go fuck themselves. He'll stand by and watch while our former enemies invade our allied countries. That's why Putin has endorsed him.

It doesn't matter if you're Republican or Democrat, because even his own party is turning against him. How can you not be terrified of this man having our nuclear codes???

From a note

The funnies way I've ever heard anyone state code status:

"Patient states if she is found already expired in her bed, she wants to be left there."

I hate paperwork

One of my responsibilities as a physician is to sometimes fill out paperwork for disability or medical leave. I know, very glamorous.

Recently, I was filling out a form for the husband of a woman who had a significant stroke to take a family leave. I started filling it out, but I got really frustrated midway through the questions like these:



How the hell do you fill this out in any sort of accurate way? What sort of medical condition would result in a flare is that I could remotely estimate in an hourly way and describe exactly what care is needed during those flareups? And the page before it asked me in three different ways what sort of care exactly would be needed. The guy's wife had a freaking stroke. He wants to take an unpaid leave from work to take care of her. That should be all I have to say! Why is so much stupid paperwork required?

Who wrote this form? Certainly not a person with any medical knowledge or experience.

Career

Preparing for career day at school:

Me: "what do you want to be when you grow up?"

My daughter: "maybe an author. But definitely not a doctor. Definitely not. Anything other than that."

Um. Okay....

Like 2,000 spoons...

Recently, I was staying at a relative's house, and when I was having a bowl of cereal in the morning, I literally could not find one normal spoon. When I opened the silverware drawer, this was the array of spoons that I found:



Tell me, who buys 20 little tiny baby spoons, but does not have one normal spoon?

When Dogs Attack

In my attempt to get to 10,000 steps per day, I've been trying to take more walks around the neighborhood. I don't live in a big city or anything, and walking paths are hard to come by. So I can either walk around the center of town, where I'm likely to get hit by a car, or go to a more residential area.

The problem with the residential areas is that there are dogs. Not that I have anything against dogs, but it sort of disturbs my peaceful walk when I can't walk by any houses without a dog barking its head off at me.

The other day, I was walking through a residential area, on the sidewalk in front of a house, when a dog started racing down the lawn towards me, barking like crazy. At that point, I realized that this dog was not on a leash. I backed up a few steps, off the sidewalk, in what would probably have been a pretty meager attempt to not get mauled by this dog, if its owner hadn't come out and yelled at it.

Unfortunately, as I stumbled into the street, a car had to swerve and just barely avoided hitting me.

I was really freaked out by the whole thing. Seriously, if that car had hit me, Who would have been at fault? The car? The owner of the dog that didn't have a leash? Or me, for being stupid enough to dare to walk in front of a house that had a dog in it?

I swear to God, these 10,000 steps a day are going to kill me.

Book recommendation

For those of you who are looking for a medical thriller to read this summer, an indie writer I like recently came out with a new book called Dead Still. Be sure to pick it up today!

300!

Who wants to write the 300th review of The Devil Wears Scrubs? Which is inexplicably outranking House of God on Amazon.

Also, I'm proud to report we have raised nearly $5,000 from sales of 11 out of 10 for Deworm the World. That's a lot of parasites we've killed. Strong work!

Surgeons who shouldn't be surgeon

I was having a conversation with some colleagues recently about surgeons who really shouldn't be surgeons.

For example, they were talking about surgeons who just had clumsy hands or were bad at suturing. One person told me about a CT surgery fellow who had a HORRIBLE essential tremor.

The problem is that generally people are accepted to surgery residencies based on grades and research. And maybe even interpersonal skills. But how can you even tell if a med student is clumsy with his hands? Aren't they all?

I guess I feel sort of bad for a surgery resident who discovers that they really kind of suck at surgery. But what can they do at that point?

(Also, I feel sorry for their patients.)

Damn you, Dory

Recently, we took my younger daughter to see Finding Dory. She'd seen Finding Nemo many times, and it was one of her favorites.

As per normal for Pixar movies, I shed plenty of tears during the movie. But my daughter was totally stoic, as per normal for her.

Then as soon as we got out of the movie, she burst into tears. And didn't stop crying for two hours. Then that night, she said she couldn't sleep because she kept thinking about the movie and how sad it was. And intermittently, she's had trouble sleeping since then.

I've never had to deal with this before! I don't know what to do. She's intermittently terrified of being lost and sad for Dory.

Damn you, Pixar. Why do you have to pull heartstrings so effectively?

$60???

I think I've mentioned here that I've been trying to look a little nicer at work recently now that I'm getting freaking old. So for that reason, my parents treated me to a shopping spree at some nice stores for my birthday. Instead of my usual Old Navy and Target, I was told to go to nicer places like Ann Taylor and J. Jill. And for the first time since I was a child, I didn't even look at the price tags. I just got what I liked because my parents can afford it.

Until I got home.

I really couldn't help but gasp a little when I was cutting the tag off what appeared to be a plain white shirt and saw that it cost $60. Seriously, WTF? That shirt should cost, like, $7.

Who buys a plain white shirt for $60???? I never would have bought that with my own money! And I'm supposedly one of the wealthier people in this country. Who supports these stores? How are there enough people who want $60 white shirts when 2/3 of American don't have enough money to cover a $500 emergency?

Are there people out there spending more than 10% of their savings on a single shirt? I just don't get it.

Allergies

Recently, my daughter has become allergic to water.

No, not really.

But she started breaking out in hives whenever she went in our community pool last summer. It doesn't happen in the pool where she has swim lessons, so I figured it was too much chloride. But then she started summer camp a couple of weeks ago, and she breaks out in hives at the beach and even during a trip to a water park.

I called her pediatrician and they recommended Zyrtec. Which helps only slightly. So then they suggested allergy testing to figure out what's wrong and how to treat it.

We got a referral to their allergy clinic. I explained the situation.

Receptionist: "We can't test her if she's been on any antihistamines in the last week."

Me: "Oh man. We just gave her one on Thursday."

Receptionist: "Oh. So it's going to be a whole week until we can do it. And you can't give her any more."

Me: "Fine. We can wait."

Receptionist: "Okay, so, our first appointment is.... September 1."

Me: ".... But the whole summer will be over by then."

Receptionist: "Well, it will be useful information for next summer."

First of all, why did they ask me if she'd had any antihistamines this week if they were booking two months ahead??? Just to torture me? Second, I feel like all specialists have zero appointments within a two-month window. So if you have any urgent need for a specialist, then... I guess you're just shit out of luck.

It sucks that my daughter has like three water-related trips per week at camp and every single one of them makes her break out in itchy hives, and she can't be seen by an allergist until the summer is over. I'd probably be even more pissed off if I actually thought the allergist would be able to do anything to help her.

A Case of Left neglect

You can't pick your parents and you can't pick the side of your brain that you damage.

I always thought that injuries to the left side of the brain would be the worst, because that's where the language centers generally are. And talking is basically all I do. But after seeing uncountable numbers of strokes and brain injuries, I've changed my mind. Right brain injuries are worse.

The right side of the brain controls attention, memory, reasoning, and problem solving. Very often, people who have an injury to the right side of their brain have very bad insight into their deficits (anosognosia). Let me tell you, it's really hard to recover from brain damage if you don't even recognize that you have a problem. Also, many people with right brain injuries become absolutely obsessed with their bowels. Even more so than my elderly parents.

But one of the most striking deficits that you can see with a right brain injury is left hemineglect. That happens when you basically stop paying attention to the left side of your world... like it doesn't even exist! (It can happen on the right, but it's less common and less marked due to redundant processing of the right side.)

A while ago, I had a rehabilitation patient named Lucy with horrible left neglect. When I first met her, she was lying in bed, her head cocked over to stare to the right. When I stood on her left side to talk to her, she wouldn't turn her head no matter what. I finally gave up and stood on her right side.

"Lucy," I said to her. "Can you lift your left arm for me?"

Lucy glanced down at her arm. "Oh, that's not my arm."

"It's not?"

She shook her head. "No, that's the arm of the patient in the bed next to mine."

Granted, our hospital can be crowded, but we generally do try to keep two patients out of the same bed.

We worked with Lucy to improve her left neglect. She improved, but it was still pretty bad. Lucy would walk into walls on the left and only eat the right half of her lunch tray. But the most intense moment in Lucy's recovery came a few weeks into her rehab stay. A physical therapist named Jim went into her room to treat her, and she started screaming her head off. We'd never heard her shriek like that, and several people came running.

"What's wrong, Lucy?" a nurse asked her.

Lucy pointed to Jim. "That man is a rapist!"

Now even though Lucy had a brain injury, that is a very serious accusation that we had to take seriously. After all, people with impairments are often a target of abuse. We got Lucy calmed down, and we asked her what Jim had done to make her think he was going to rape her.

"It says right on his badge that he's a rapist!" she cried.

Jim's badge said "PHYSICAL THERAPIST." Because Lucy had a left neglect, she didn't read the left side of that phrase. So all she could see on his badge was "RAPIST."

Jim was acquitted of all charges.

(If you enjoyed this story, you should check out my book Brain Damage.)

The Demented Attending

There was this attending I worked with in residency who we were all certain was getting demented. He was about eighty years old and he always talked in a voice twice as loud as anyone else. Plus I would have interactions with him like this:

Dr. Old: "Fizzy, there's an article I really want to show you about neurogenic bladder. It's excellent. I'm going to bring it in for you."

Me: "Okay."

Next day:

Me: "Did you bring me that article on neurogenic bladder?"

Dr. Old: "No, I forgot. I'll bring it tomorrow. I promise."

Next day:

Me: "Did you bring me that article on neurogenic bladder?"

Dr. Old: "I forgot again. I'll definitely bring it tomorrow."

Next day:

Me: "Did you bring me that article on neurogenic bladder?"

Dr. Old: "What article?"

Generic

I'm a big believer in buying generic brands of products. I don't understand why the generic isn't as good as the brand name. But sometimes... the brand names really are just better.

Like recently I bought some generic brand butter. And the butter was... weird. I couldn't detach it from the wax paper wrapping it. It was just an odd texture.

And I'm currently getting burned by some generic paper towels I bought. I'm beginning to realize that toilet paper and paper towels are two things that you CANNOT cheap out on. The generic paper towels were two-ply and I thought they'd be okay. Like the Sparkle commercial says, "Do you really need a paper towel that can hold a bowling ball?" No, but you need something that can clean up a tiny spill without using like ten paper towels. (Sparkle brand sucks too.)

While it isn't generic, I feel like Scott paper towels should be called out for the awfulness of their toilet paper. I didn't realize how bad toilet paper could be till I used Scott.

Descriptions

I recently went to a restaurant to meet a friend, who I knew had already arrived. I approached the hostess:

Me: "Hi, I'm meeting a friend here who came a few minutes ago. I think she's seated already."

Hostess: "Oh! Yes, I think I know who she is.... Um, she has dark hair and she's about this tall...."

Me: "She's Asian."

Hostess: "Yes! Okay, I'll take you to her."

I mean, sheesh. It's not like "Asian" is a bad word that you're not allowed to use to describe another person.

The shoes make the outfit?

I've recently been trying to upgrade my look at work a little bit. I feel like when I was younger, it was okay to be a little sloppy because I was young and poor, but not so much now.

So I bought a bunch of new clothing, but a friend of mine was arguing that, really, all anyone looks at is a woman's hair and shoes.

She might be right about the hair, but I don't know about the shoes. If that's true, I've got a problem. I was never the queen of great shoes, but recently I burst a blood vessel in my foot and I've had to really prioritize comfort. So this is what I've been walking around in:



I don't think they're horrible or anything. I was looking around at my physician coworkers' shoes, and it ranged from bad to worse. One doctor was wearing sneakers. But the thing is, I never noticed! I never notice shoes.

What do you think? Are the shoes the most important part of the outfit?

Gross

So I pay a cleaning guy $80 every other week to clean our apartment. Lately, I feel like he's been doing not as good a job as he used to do. He probably spends less than two hours total cleaning our three-bedroom apartment. But this is one thing that kind of bothers me:

Every week, he does a load of towels in our washing machine. Not the laundry, mind you, just towels. So today I was putting clothes in the wash and I noticed the machine looked like this:



Obviously, he must have noticed that it looks so cruddy and chose not to clean it. Is this something I need to specifically ask him to do? Like, do I need to tell him each individual thing in my home that I want cleaned?

Muffins

About a year ago, I had an elderly patient who I will call Sally for HIPAA purposes. Sally suffered a pretty severe stroke and was very impaired. That’s not the funny part, obviously. Anyway, her husband Harry was a really sweet guy. Despite the fact that he was in his eighties and looked it, he visited her in rehab every single day. We all agreed he was one of the nicest family members we’d ever met.

In case you didn’t know this, if you want to suck up to the hospital staff, the best way to do it is to bring them free food. Either someone told Harry this tip, or maybe he was just raised right, because every single time he came in, he brought us food.

The first day he came in, he brought us three boxes of muffins from Dunkin Donuts. We were all elated. Muffins! In three different flavors! We were fighting over those muffins, diplomatically dividing them into quarters so everyone would get some muffin.

The second day he came in, he brought us… three boxes of muffins from Dunkin Donuts. We were still excited. Muffins. But they were somehow a little easier to distribute that day.

The third day he came in, he brought us… three boxes of muffins from Dunkin Donuts. Ugh, muffins. Suffice to say, we were all a little sick of giant muffins by then. I took a single muffin and brought it with me for my kids to snack on during the car ride home.

The fourth day he came in, he brought us… well, you get the idea.

Sally was a patient at our hospital for well over a month. Every day, Harry came in and brought us three boxes of muffins from Dunkin Donuts. By the end of the first week, we couldn’t even look at those muffins anymore. My kids begged me never to bring them muffins ever again as a snack. We felt bad throwing them away, so we just let the boxes and boxes of muffins accumulate in our back room. The room was being overtaken by these stupid muffins.

“We have to tell him,” a nurse said. “He can bring us anything but muffins. Bagels, donuts… whatever. Anything but muffins.”

We discussed the morality of the muffin situation. I mean, Harry was being nice by bringing us anything. How could we say to him, “Hey, your muffins suck. Bring us something better.” But at the same time, we felt bad he was spending time and money every day bringing us a present that we were basically just throwing away.

Eventually, Harry made the difficult decision to transfer Sally to a nursing home, because he couldn’t care for her on his own. Even though we were sad to see them go, we were a little relieved that there would be no more muffins. (Except for the chief attending, who inexplicably never got sick of the muffins, and was totally bummed that his supply would be coming to an end.)

Several months later, Harry dropped by our unit to say hello. A lot of times, former patients will come by just to say hello. But on this visit, Harry had some sad news to share with us: Sally had passed on.

He cried a few tears and we took turns hugging him and telling him how sorry we were. Then he flashed us a brave little smile, and showed us a large paper bag he had been holding. “I brought you all a little something,” he said.

It was four boxes of muffins.

But something amazing had happened. In the few months since Sally’s discharge, we had miraculously stopped being sick of muffins. So we were able to bring the boxes of muffins to the back room and enjoy eating them. Still teary-eyed over Sally’s death, we laughed about muffins one last time.

Help with cover?

I've never loved the cover of my book Baby City. It looks cool as a paperback, but I never liked it as an ebook cover. So for that and other reasons, I decided to redesign the cover.

But we're having some issues. Kelley, my coauthor, and I can't seem to agree on what we like. So I recruited some other opinions, and there's a lot of disagreement there too. So I want to get a larger sample size. Please tell me which cover you like best... or suggest an alternative:

NUMBER ONE:



NUMBER TWO:



NUMBER THREE:



NUMBER FOUR:



I am horrible at making decisions, so please help me. I'll refrain from telling you my favorites. Note that I will actually buy the high resolution version of which image I choose.

To Yoga or Not to Yoga

I've been doing yoga classes for the last year or so, and I've been contemplating quitting.

I'm taking an hour and fifteen minute "relaxation yoga" class where we spend most of the class on the floor, doing vaguely sexual poses. I started taking it because I wanted to improve my flexibility and decrease my musculoskeletal pain. I'm not entirely sure if it's done those things. Maybe a little?

The thing is, I hate the class. I dread it every week. I don't enjoy it when I'm doing it. I occasionally injure myself in the class. During the meditation at the end, I am completely unable to turn my brain off. But at the same time, I feel like.... I don't know, maybe it's good for me. Maybe I should try harder. Sometimes I feel really good after the class.

I also do yoga during the week. I have the Yoga Studio app on my phone that one of you recommended. Maybe that's enough.

Please review

If you haven't already, please please PLEASE put up an Amazon review of my latest book, Brain Damage!!!!

Review it here!

The End of Your Life

I've mentioned before on here how frustrated I am that health insurance is willing to pay for things to prolong a person's life, but nothing that will improve their quality of life. This is an example I recently saw that made me really angry:

I was consulted on a woman in her eighties who had metastatic cancer. She had decided against further treatment, which the insurance would have covered. Unfortunately, her husband was nearly 90 and could not care for her at home, considering she couldn't do any of her ADLs without a lot of help.

However, even though the insurance would have paid for cancer treatment, they would not pay for her to go to a nursing home. They would not pay for the home care that she needed. Hospice services could not provide the care she needed. So the only option was for her elderly husband to deplete their life's savings to pay for her care, and have nothing for himself after she died.

I feel like there's something wrong with a system where this could happen.

My doctor, the waitress

Me: "Is there anything else I can do for you?"

Patient: "Yes. Can you get me a ginger ale?"

Me: "Um. Okay."

Patient: "With ice."

Me: "Okay."

Patient: "But not TOO much ice."

I do spend a lot of time fetching drinks for patients. They ask for drinks and what am I supposed to say? No? Am I supposed to track down the nurse who is impossible to find and, in all honestly, busier than I am? It's easier to just fetch them their drink. I'm not some sort of diva who is above helping out with some menial tasks. It's just one of many jobs I do for patients that really don't require a medical degree or even a high school diploma.

To be honest, I sometimes feel guilty that I don't do more of the menial tasks. Sometimes I feel like we should all pitch in, and who am I to say I'm above it all?

Becca

Patient: "What did you say your name was?"

Me: "Dr. McFizz."

Patient: "Becca?"

Me: "No, Dr. McFizz."

Patient: "Becca."

Me: "No. It's Dr. McFizz. M-C-F-I-Z-Z."

Patient: "..."

Me: "Anyway, what did you want to ask me?"

Patient: "Well, Becca..."

Even though my last name isn't actually McFizz, I swear it doesn't sound anything like "Becca."

May I please...

Recently, I made a post in Mothers in Medicine about Why I Fired My OB/GYN.

The reasons ran the gamut from a rude doctor to painful blood draws to ridiculously long waiting times for visits. But the straw that broke the camel's back happened about a year after I delivered. I was having my annual exam done by a male OB/GYN that I’d seen a few times before and liked well enough. After he finished the speculum exam and the bimanual exam, he said to me, “Now I’m going to do a rectovaginal exam.” And then two seconds later, he just DID it.

I’m sure somebody could present me with a body of literature on the importance of the rectovaginal exam. But I don’t care. He didn’t give me fair warning. He didn’t ask if it was okay. And it was certainly not something I ever expected, considering in my 15-odd years of annual exams, not one doctor ever deemed it necessary to perform. Plus he was a man.

I’m not saying I’m traumatized or anything. I’m not having recurrent nightmares over it. I wouldn’t report him. I mean, let’s be real here--rectal exams happen. But I didn’t like the way it happened, and I would never go see that doctor again. And since I hated the practice so much, it gave me the impetus to finally leave.

When I posted this to MiM, there were variable responses, but one in particular struck me from a recently retired physician:

The rectal examination is not ridiculous. It is not done just to detect rectal cancer but as a part of the overall evaluation of the pelvis. It allows a better feel of the uterus and ovaries and can detect conditions such as endometriosis in the septum between the vagina and rectum. In women who have had children, it allows an assessment of the muscular support of the pelvis, identifying defects in the muscles of the posterior pelvis.

I have found significant pelvic pathology, ranging from a pelvic kidney to ovarian tumors, during "routine pelvic exams" for women with no symptoms at all. Women with fibroids commonly have no symptoms. Serial exams can monitor for growth and direct the need for imaging.

Pap guidelines take into consideration many factors for an individual patient which result in a considerable fraction of the population who will not be well served by a five year screening interval.

In my practice, a patient coming in for her *annual* examination completely undressed, had her vital signs taken, thyroid, heart, lungs, breasts, and abdomen examined, and the pelvic exam, including the rectovaginal exam. I even did fundoscopic exams, finding some conditions justifying referral to an ophthalmologist.

The writer of this article was obviously already unhappy with her care. Her physician obviously had no idea she would object to the rectovaginal exam. Personally, I would have *expected* it to be done.

For goodness sake folks, if you do not understand a medical procedure of any kind, just ask. The gynecologist would have been happy to explain why he did the exam.

Fizzy, your "privates" were not "violated". Sheesh.

I think this is a perfect example of the difference between the way old school medicine was practiced versus now. For starters, saying "sheesh" and mocking me for having an exam performed that I did not consent for is not what I'd expect from a physician. You don't do whatever you want as a physician and say the patient can ask about it later. Hell, I ask permission before I even listen to heart and lungs!

I also maintain that the rectovaginal exam was NOT something I should have necessarily expected. But either way, I believe he should have asked.

Anatomy of a Brownie

Recently, I baked a tray of brownies. I put some on a plate for work, then left a few on a smaller plate to leave at home. My husband wandered into the kitchen while I was doing this.

Husband: "The ones you put on the plate for us to keep are all edge pieces!"

Me: "Right. Is that a problem?"

Husband: "The edge pieces aren't as good. They're not as chewy."

Me: "What are talking about??? The edge pieces are the best pieces!"

Husband: "I don't think you understand chocolate."

Me: "I don't think you understand chocolate."

I know I'm not alone on preferring the edge pieces. But I also once met a woman who told me that for years, when she made brownies, she actually threw away the edge pieces because she thought they were garbage. What a terrible, terrible waste!

I don't know

When I was in residency, an attending I wasn't even working with overheard me talking to a patient, and when the patient asked me a question that I didn't know the answer to, and I replied, "I'm sorry, but I don't know."

Afterward, the doctor took me aside and said, "you should never say you don't know."

"But I didn't know!" I protested.

"But you shouldn't say that."

I guess as doctors we are supposed to give the impression of knowing everything. All the time.

I object to this though.  I would rather be honest with a patient when I don't know something, rather than make something up or say some sort of mumbo-jumbo to avoid admitting that I don't know everything.

Let's get loud

A recent interaction I had with a patient:

Me: "Hello, Mrs. Patient! I'm Dr. McFizz! It's nice to meet you!"

Patient: "Oh my God, why are you screaming at me?"

I admit, I might have been talking a little bit loudly. What was worse, two other times when I was talking to the same patient, she had to ask me to stop yelling. I'm actually a fairly soft-spoken person, so I don't know how my default voice for patients has become yelling. It seems like I can't even control it anymore. I think it's probably because I work with an elderly population, and several times a day, I have this interaction:

Me: "Hello, Mrs. Patient! I'm Dr. McFizz! It's nice to meet you!"

Patient: "What did you say?"

Me: "I'M DR. MCFIZZ! IT'S NICE--"

Patient: "I can't hear a word you're saying."

Me: "I'M DR. MCFIZZ!!!!!!!!!!!!!!!! IT'S NICE TO MEET YOU!!!!!!!!!!!!!!!!!"

Patient: "Can you help me find my hearing aid?"

And then we spend the next ten minutes searching for the hearing aid. Which never, ever works.

My mother vs the fire alarm

About a month ago, my mother apparently put some food in the stove and decided to take a nap. My stepfather, who was going out, suggested she not go to sleep while cooking, but my mother said, "Oh, I never actually fall asleep."

But she did fall asleep. My stepfather couldn't reach her and ended up having to call the doorman to enter the apartment to wake her up so the apartment didn't burn down.

When she was telling me about this, I said, "Why didn't the fire alarm go off?"

She said, "I don't have a fire alarm."

Yeah, why have a fire alarm?

My mother is very sensitive to noise, and apparently, the alarm was going off all the time, so she dismantled it. Now she refuses to get a new one, because she claims the noise will give her a heart attack before she burns down. It's driving me crazy that she won't get a fire alarm! And moreover, when I try to convince her, she acts like I'm being cruel.

She's not afraid of death. She's only afraid of noise. What can I do?

Opioids

I know there's an opioid epidemic that is apparently a leading cause of accidental death, so I wasn't entirely surprised when I got a call from Walgreens about a script I wrote for one week of narcotic for a patient to go home with.

I was like, fine, if Walgreens wants to call every single doctor to ask him about every single opioid prescription, let them do it. Maybe it's a good idea.

But then Walgreens started asking me questions about the patient. Like their diagnosis. And I felt a little uncomfortable giving that information out, so I didn't. Isn't it a violation of HIPAA for Walgreens to be asking me patient information? I don't know if I would want Walgreens to know all my medical information.

Review

If you read and enjoyed Brain Damage, please please please PLEASE with sugar on top consider leaving a positive review on Amazon.

Would be super grateful!

Fresh apple pie

Because it's nurses week, I bought a beautiful apple pie at the supermarket.

I happened to notice that although it's packed professionally, it comes in a pie tin that I would use to make a homemade pie. After I noticed that, the temptation to remove all the outer packaging, mess up the crust a little, cover it with tin foil and pass it off as homemade has become overwhelming.

I shouldn't do that.

Or maybe I should....

--

On an unrelated note, Brain Damage is now available in paperback. For those of you who love the feel and smell of paper, for some reason.

Also, if you read and enjoyed the book, please consider leaving a review!

Richard Gere and the hamster

Recently, my 65-year-old mother called me up and said: "Guess what! I discovered the most amazing actor ever!"

Me: "Who?"

Mom: "His name is Richard Gare."

Me: "Richard Gere?"

Mom: "Yes!"

Me: "How is it possible that you're just discovering him now? He's been famous since, like, the 80s."

Mom: "Well, I knew who he was. But I didn't know how wonderful he was!"

Apparently, she watched some movie called Primal Fear and now she's in love with Richard Gere (who she keeps calling Richard Gare). Anyway, I told this story to my husband.

Me: "How could she not know who Richard Gere is! He's so famous."

Husband: "He was the one in Pretty Woman, right?"

Me: "Yes, and he was married to Cindy Crawford."

Husband: "He was?"

Me: "Yes! How do you not know that?"

Husband: "The only thing I know about Richard Gere is about how he put that hamster up his butt."

Me: "What??"

Husband: "You haven't heard that story?"

Me: "No..."

Husband: "It's pretty well known. That's probably what most people think of when they think of Richard Gere."

Me: "I really don't think so."

Husband: "Yes. If you asked a group of guys, I bet that would be the first thing that most of them would say about Richard Gere."

Me: "That's definitely not true."

But apparently, it is true. Thanks for proving me wrong.

So now settle another argument:

Is the term "amazeballs" more likely to be said by a man or a woman?

Richard Gere

Help me settle an argument with my husband.

If you had to name only ONE FACT that is most well-known about Richard Gere, what would it be? Also, state your gender in your answer.

New Book!!!!!!!!!!!!!!!!!!!!!!

I'm proud and excited to announce the release of my newest (and possibly final) book, Brain Damage.

Buy it now on Amazon!

From the back cover:

After years of hard work, Dr. Charly McKenna finally has it all. Prosperous career as a dermatologist? Check. Spacious apartment overlooking Central Park? Check. Handsome lawyer husband? Double check.

Then one night, a bullet rips through the right side of her skull and she loses everything.

As Charly struggles to recover from her brain injury, she begins to realize that the events of that fateful night are trapped in the damaged right side of her brain. Now she must put the jigsaw pieces together to discover the identity of the man who tried to kill her... before he finishes the job he started.


If you want to read an excerpt, go here.

Or just buy it now! It's only $2.99! What have you got to lose? (Aside from $2.99.)

Reunion

I've got a college reunion coming up. I'm not going to say which one it is, but it's one where people are starting to all have kids and be balding and wrinkled and pregnant and all that.

I had wanted to go to the last one, where everyone was still fairly young, but my husband got appendicitis like three days before. This time, I had decided not to go pretty definitively. But now I'm feeling conflicted. Is this something I'll regret if I don't go?

Then again, I can't think of even one person I'd be super excited to see. I feel like seeing all these people, many of whom I haven't seen since we were 22, looking all grown up will be.... really disturbing. Because I find Facebook disturbing. So it stands to reason.

I don't know.... can't someone get appendicitis again so the decision will be made for me?

The Garbage

When I was in residency, I probably sacrificed a tree or two photocopying patient documents. But sometimes it was easier to do that than to go find the chart every time I wanted to look at a patient's discharge summary from another hospital. When I was done with the document, I'd throw it in the shredder bin: these bins we had with a small hole to insert papers that had private patient information to be shredded.

At some point during my residency, we noticed that an important piece of a patient's paperwork had gone missing from the chart. I remembered that I had photocopied that document, so I knew there was an extra copy floating around. Unfortunately, I dropped the paper in the shredder bin the day before. I explained this to the attending and showed him what bin it was in.

"That sucks," he said. "We don't have a key to this bin."

He then flipped the bin upside-down, stuck his hand into the tiny hole, and started pulling the papers out one by one.

I had no idea you could do that! Doesn't seem very secure. Anyway, even though I had thrown my paper in the day before, it seemed like the papers he was pulling out were much older than that. I had a growing sick feeling in my stomach as I wondered if I was making my attending stick his hand into what was essentially a garbage and the paper wasn't even in there. That seemed like an offense worthy of disciplinary action, or at least major embarrassment.

Thank God, we found the paper.

Nickelback!

Years ago, I was sort of into the band Nickelback. I downloaded two of their albums. My husband used to make fun of me, because he especially hated Nickelback for unclear reasons. "they just seem especially douchy."

Now it's over 10 years later, and I'm not entirely clear how Nickelback evolved into this personification of terrible music.

For example, I was recently watching an episode of modern family, and there was a random joke making fun of Nickelback. And then I saw an attack ad yesterday on Ted Cruz, citing his love of Nickelback.

Seriously, is Nickelback that bad?  I can see not thinking they were the greatest band ever, but how did they become this joke about bad music?  Surely there's worse music out there...

A stranger is just a friend you haven't met

A short time ago, I met Dr. Orthochick for the first time.

I've known her online for a really long time. I can't remember exactly how we found each other, but I was definitely still in residency at the time. Anyway, we've had a lot of contact with each other over the years, and Orthochick always said to me that she thought we'd get along really well if we ever met in real life.

I agreed, but with reservations. I have no doubt in my mind that Orthochick is really cool, based on everything she had told me. However, I know for a fact that I am not really cool. When you talk to people online, it's easy to portray only the good aspects of your personality. Of course, I guess the opposite is also true. I've confessed things online that I would never tell real life friends.

This was not my first time meeting an online friend. The first time was about seven years ago. A blogger I knew really well was coming out to my neck of the woods with her husband and child, and we all went out to lunch. I was sort of terrified about meeting her, although she seemed more excited than terrified. But in reality, I really enjoyed meeting her. Having known her so well online, it didn't even feel like I was meeting a new person. It seemed like getting together with an old friend.

More recently, I met Gizabeth from Mothers in Medicine. She and I had talked a lot privately over the years, so we finally got together. Again, I really enjoyed meeting her and her children.

Weirdly, I didn't tell anyone that I was meaning Orthochick until right before. I finally told my husband the day before, when I felt obligated to say that I was going out and would be leaving the kids with him.

Me: "I’m meeting a friend."

Husband: "who?"

Me: "you'll never guess."

Husband: "yeah, I'm not going to play this game."

Me: "fine, I guess you'll never know…"

Husband: "gah!" (Proceeds to guess every single one of my real life friends)

Me: "no."

Husband: "is it someone you know online?"

Me: "yes."

Husband: "is it a doctor?"

Me: "yes."

Husband: "Oh, I know. It's that one who's the doctor who specializes in… you know, things."

Me: "huh?"

Husband: "You know what I mean! Things! Like, ortho things."

Me: "ok, you're right."

Husband: "Well, when will you be back?"

Me: "I don't know. If we're just sitting there in awkward silence, it could be pretty quick."

Anyway, I refused to make a big deal out of the whole thing. I was working that day, and I even kept on the same comfy shirt and fleece that I wore to the hospital, although I did change into jeans from my scrub pants.

When I met Orthochick for the first time, she gave me the absolute best hug that anyone I've ever met for the first time has ever given me. She raced across the train platform and threw herself at me and I almost fell over backwards. It was the kind of hug that makes you like a person instantly, as long as you survive the hug.

Anyway, we definitely did not sit there in awkward silence. I should have recognized that the two of us are both...well, let's just say, loquacious. We both had so much to say, we were practically interrupting each other the whole time. She's really funny and interesting and it was even fun to talk shop with her. And I don't think I've exchanged that many Simpsons quotes in quite a long time. I also learned that apparently, if I have to work with a big group of guys, my best bet is to become well-versed in South Park, and short of that, say "that's what she said" as much as I possibly can.

Also, I was pleased and/or disturbed that even though I was gone for close to three hours, I did not receive one hysterical text asking where I was, despite having gone out with random internet possible murderer.

So in summary, I'm happy to report that Orthochick is absolutely as awesome as I always imagined she would be. It was bittersweet though, because she lives far away for me now and the chance of us ever being real life friends is basically zero. But we'll always have oreo ice cream cake.

Dumb button

I was recently staying with some relatives, and I woke up early in the morning with my daughter. She wanted to watch them TV, but we literally could not figure out how to turn the TV on.

When did this become a thing? I remember back when I was a child, turning on the TV with easy. It was literally one button on the television to turn it on. Now they're like 10 million buttons and devices. I know I successfully turned on the cable box, but somehow turning the actual TV on was an impossible task. I even pressed the on button on the actual television to no avail.

There needs to be a "dumb" button on the tv so that people who don't live in that household can turn it on without needing to wake up the host.

In other news, about six months ago, a fan of Baby City contacted me about wanting to turn a book into an audiobook. She's a nurse, and she worked hard to do an amazing job turning Baby City into an audiobook.  It is finally available: 

http://www.amazon.com/Baby-City-Inside-Labor-Delivery/dp/B01DWVG2GO/