Sunday, April 29, 2012

Things I Hate About New Jersey: part 485

Why is it that grocery stores and Walmarts in this state can't seem to hire people to bring in the shopping carts, yet every gas station has an attendant or two to pump your gas for you?

For that matter, why are there crossing guards at every freaking stoplight that do nothing but stand on the sidewalk and stare at their phones? I'm pretty sure it's Communism.

Why has this state never heard of on-ramps to highways? You have to sit at a stop sign and wait for an opening in the traffic. News flash, NJ, there is never a break in the traffic. Especially when every person in this state drives like the Devil is chasing them.

Oh baby

The hospital is a really bizarre place. Really, really bizarre. I've never experienced such unapologetic interest in the state of my reproductive system as I have in the hospital. There really should be more boundaries. The problem with being in medicine is that it's so all consuming that we forget that it's just not normal to talk about your health status with people who are basically strangers.

For instance: This one has nothing to do with my ovaries.

I was on anesthesia last month in an OR where I'm pretty sure 50% of the surgeries are AV Fistula placements (for you non-medical people, I'm not even going to attempt to explain because it would just cause mass narcolepsy). This type of surgery is always done with the assistance of a C-arm, which is a portable x-ray machine in the shape of a C (clever, huh?). Because radiation is generally considered a bad thing, we all have to wear these attractive lead vests that weigh a million pounds and don't help my already kyphotic posture. Now these lead vests only come up to the collarbone, leaving your neck exposed. Here's your medical lesson for the day: what really important endocrine organ that is sensitive to radiation exposure sits in your neck? Answer: your thyroid.
Stupid hospital lesson for the day: Guess who's hospital is too cheap to buy enough thyroid protectors for the whole OR? Answer: Mine.
I'll be damned if this place gives me thyroid cancer in 20 years, so I have to spend the whole surgery holding my lead vest up around my ears. But then I have to do something that involves my hands and they always choose that moment to shoot the x-ray. Good thing thyroid cancer has one of the highest cure rates.

For instance 2: Back to the ovaries.

I'm in an exploratory laparotomy for a guy that has a ruptured colon. The end of the case comes around and the surgeon calls for the x-ray tech to take a quick picture to make sure they didn't leave anything inside of the patient (which unfortunately happens more than you'd think). I don't have a vest on so I go to leave the room, but somebody's blocking the door. One of the PAs, Raj, this 5 foot tall Indian guy old enough to be my grandpa starts waving frantically for me to get out of the room. He keeps saying "We need to protect your ovaries. I want to be able to play with your kids some day. Protect the ovaries!"

For instance 3: My uterus.

I'm in a surgery and my anesthesia attending is talking about the different volatile anesthetics (the gasses) we use to put people to sleep. He tells me that studies have shown that exposure to nitrous increases the incidence of miscarriage in women. And what's more, if a man is the one exposed, his female partner also has a higher chance of miscarrying.

Thankfully, the gasses that we administer, when they are exhaled by the patient are delivered back into the machine and then vented out into air outside the hospital, where they will not be harmful (unless, I guess, you are standing right next to the vent doing your daily breathing exercises or something).

While he's telling me this, the resident is puttering around and ostensibly listening to our conversation. Not two minutes later the resident is dismantling the breathing circuit (which is where all the nitrous and sevoflurane and CO2 the patient has been breathing off is now sitting).

He looks over at me and says "You're not pregnant, are you?" (Which, by the way, I was asked on a daily basis during my radiology rotation).

I say, no, I'm not.

He says, "Oh, good," and pops the bag off the circuit and vents all the gas directly into my face!

Really? REALLY? Did you not just hear what your attending said or do you want me to have a spontaneous abortion?! I just felt one of my eggs disintegrate right then and there! I may not be capable of taking care of myself (evidenced by the fact that there hasn't been food in my fridge for almost two weeks) right now let alone a child, but someday I might want an embryo to actually stay in my uterus long enough to metamorphose into a baby. At the very least so Raj has somebody to play with one day.

Saturday, March 10, 2012

Scenes from Internal Medicine: or When are they letting me out of here?

From a guy admitted for chest pain to rule out a heart attack:

Doc, sometimes I get these electric shocks in my hands. I thought you might want to know about those too.

You mean like numbness or tingling?


Do these shocks shoot down your arms?


Happen at the same time as your chest pain?


Ok. What are you doing when they happen?

Usually I'm walking across my living room. And then I touch something metal and I get shocked. What's that called, Doc?

Static electricity.


You got a foot doctor in this hospital?

Yep, we have podiatrists here.

Good, get me one of those. I want to ask him about my foot.

Me (thinking): Shit, there's something wrong with his feet. Now I have to take off this old guy's sock and there's gong to be a huge diabetic ulcer and I'm going to smell like gangrene for the rest of the day.

I pull off his sock...and there's nothing visibly wrong with his foot.

So what's wrong with your foot.

Well, sometimes the muscles under there move around. What's up with that?

I'm pretty sure that's what muscles are supposed to do.

Huh, didn't know that. Okay, well, you can go now. And I'll be right here for the rest of the night thinking up all the other things that are "wrong" with me. I'll tell you about them in the morning.

Can't wait.


Sir, your hemoglobin dropped a little overnight. We're worried that you might be bleeding from someplace that we can't see. We need to do a rectal exam to check your stool for blood.

What's that.

A rectal exam? It's kind of like a prostate exam except we check for stool.

Oh, I see. Well, I guess you can do that. As long as it don't hurt or nothing.

It won't hurt but you might feel a little discomfort.

Hmm. Nevermind then. I think my head hurts too much for you to do that right now.

Maybe later then.

Sorry, Doc. Don't mean to ruin your day. I know how much you want to do this rectal exam on me.

Words cannot describe how much I'd like to stick my finger up your butt to check for blood.

Thursday, December 8, 2011


Another post that I wrote and never published. Either I thought I had more to say, or I'm really bad at the follow through.

What is with people who think that refusing treatment for their medical problems somehow makes them healthier? It doesn't make you healthy, it only makes you sick and stupid. Happy thoughts about puppies and rainbows won't cure the raging skin infection you have on your foot. And neither will ocean water, btw.  I had a patient today decline to take a short course of oral antibiotics to treat the not insignificant cellulitis on his foot because, and I quote, "my yoga teacher said that those antibiotics will cause bone thinning." Yes, because taking two weeks worth of Duricef is going to give you the age of 24. It's not that I'm opposed to not taking medications, because I would gladly never pop another pill for the rest of my life. But if there's something seriously wrong with me, then sign me up. Bring on the drugs!
Maybe it's because I have a better knowledge base about medicine and health to know what is serious and what isn't, but it boggles my mind when patients play the either-or game with their health. Why is the anecdotal threat of "bone thinning" worse than your skin infection that could progress to septic arthritis, which according to all my vast medical knowledge is dangerous, hard to treat, and hurts like a bitch? Why is the ability to proclaim that your family is proudly crunchy and anti-Western medicine and just generally more awesome than everyone else more important than giving your kid an asthma inhaler so he can properly oxygenate his body?

It's patients like these that make me want to go into forensic pathology. Their patients don't say stupid things...or say anything at all.

Wednesday, December 7, 2011

Here's What I Learned In Pediatrics:

aka: A post that I wrote and never published, probably because I wasn't done learning! Or because I have a short attention span and forgot it existed. So here you go.

1. It is surprisingly difficult to make a kid open their mouth when they don't want to. They have little piranha jaws and I don't want my fingers to be their next meal.

2. There is just a never-ending supply of screams.

3. If I ever want to have kids, then I needed to get married yesterday. Old mothers=Down's syndrome. Old fathers=Autism. There is no winning either way. I love Autistic kids, but what I love more is sending them home with their parents. From the way they scream, you'd think my stethoscope had been dipped in molten lava or something. It sounds callous, but I'm being completely serious. The possibility of having a kid with Autism is so scary that it makes me just want to skip the whole genetic lottery of having children altogether because its heartbreaking to watch those families in the office and know that they never get a break from it.

4. Hyperbaric oxygen therapy can cure any ailment if you have enough money. Diabetic ulcers? Definitely. Cerebral Palsy? Yep. Autism? There's no proven evidence, you say. Oh well, why not? Arthritis? Who knows, but we're not going to say no if you want to fork over $100 every day for two weeks to lay in a glass coffin while the magic oxygen rushes around you.

5. Fanny packs are making a comeback, heaven help us.

6. All doctors are assholes. This is what my attending told me at least once a day. I didn't quite have the guts to ask her what that makes her then.

Tuesday, December 6, 2011

And All God's People Said AMEN!

In the psych ward, every morning we have group. We go around, one by one, and share our name and our goal for the day. Group is its own special brand of torture that involves giving actively psychotic people a platform in which to espouse their crazy theories and delusions in lieu of just stating their damn name and goal.

My goals, by the way, are always something lame like getting my oil changed or actually studying instead of spending four hours playing spider solitaire or working out. The nursing students that show up always try to outdo each other with increasingly stupid existentialist goals like accepting myself and others, finding my inner peace, making a new friend. Kill me.

My absolute favorite goal ever came today. This patient I like to refer to as Santa shared his name and his goal. Now, everyone's goal is to get out the hospital and go home, but that's not really in their control so they have to come up with another goal. So he said his goal was to relax today. The staff member leading the group asked what he was going to do to relax. His answer: have sex. The staff member, after he stopped laughing, politely informed Santa that this goal was for today, not just in general, and there will be no sex in the mental hospital thankyouverymuch. Santa just nodded and said, "Huh, I thought that was allowed under certain conditions."

Hmm. I don't even want to imagine what those conditions might be.

Today's group was more akin to a church service than a group meeting. In the psych ward, religion spreads like mass hysteria did in Salem, Massachusetts. Last week, only one guy had a Bible, from which he would quote long (made up) passages intermingled with very inventive strings of curse words. Then a couple more people took up Christianity. But that must have gotten old fast because today everyone was Muslim. Half the group said "Allah Akbar" before they introduced themselves.

Then the church service began. Some lady shared with us a five minute ramble on what God wanted her to do with her life. An old demented lady started singing hymns and praising Jesus like they do on those televised services on TV and everybody joined in. And, lo, there was dancing and shouting to the heavens. And all we were missing was someone speaking in tongues and a giant snake.


Last night I had a nightmare that I was involuntarily committed to the psych ward. And then I missed the morning shower time, and they wouldn't let me shower in the psych ward. I had to be dirty the rest of the day. In the psych ward. Did I mention that I was stuck in the psych ward?

I'm still recovering.