Sunday, April 24, 2011

NaK Attack.

I have a thing of Trader Joe's delicious Tomato Bisque soup that was accidentally purchased as the low sodium version.  More or less, they try to replace sodium with potassium.  Now I don't know much about gustation (the sense of taste), but I do know that if my body were easily confused about the difference between sodium and potassium, I would be fucking dead.

Everything, from the function of my nerves, to my cells, to my freaking heart are completely dependent on my body's exquisite ability to tell the difference between those two ions.  It is the crux of all of life.  This isn't shitty sorbitol, Soup, this is ionic gradients, the foundation of cellular survival.

There is even a sodium/potassium pump in every single biologic cell.  This thing takes sodium, and pumps it out of the cell, and at the same time, brings in potassium.  It knows the difference so well, that it can let 2 of one in, while pushing 3 of the other out.  It's the racist bouncer of the body.  And to say you might slip one K+ by, disguised as a Na+, would be like saying, oh yeah, Oxygen and Carbon Monoxide are pretty similar, my body won't know the difference.
And yet this low sodium variant is so bold as to think that it can trick my tongue, and a few billion years of evolution, into believing I'm having awesome soup and not mediocre soup.

But I trust you Trader Joe's, so let's do this.

Saturday, April 23, 2011

Phoenix University, ur dewng it rong.

I had a girl come in recently to get her her meningococcal vaccine because she was starting college.

"Oh great, no problem.  What school are you going to?"
"Phoenix, it's an online school"

I'm not sure you need this.  Maybe try McAfee or Norton. And if you find that one day your laptop can't touch its screen to its keyboard, take it in immediately.  Macingitis is nothing to joke about.

Tuesday, April 19, 2011

In my cult, we drink the milk

If I offered you a snack with the following nutritional information:
110 calories
1g of fat
135mg of sodium
25g of carbs with 3g of fiber and 12g of sugar
10-25% of your daily value of all vitamins

Would you say that was a healthy snack?  Would you consider that pretty good stats for a meal addition?  I mean, it has infinity the fiber of juice, 12g of sugar is less than would be found in 110 calories worth of carrots, and it has more iron than lean beef (and apparently "Pilchards" according to this website  So is that a decent choice as part of a meal? Yeah?

Great, now lay off my fucking Froot Loops.

Yes, that's the only thing I would do with a time machine.

If I had a time machine I'd go to DC comics and be like, listen, Batman is going to be huge. Are you sure you want to call him fucking "Robin"?

Tuesday, April 12, 2011

SOAP notables

This is a new segment I'm starting called The POETRY of SOAP notes*.  Like all of my new segments, this will be the first and likely the last of its kind.

There was an old woman who lived in a shoe. She had so many children, she didn't know what to do. Old woman doing well, going home. 
Signed: Ob/Gyn

Roses are red, violets are blue, but up to 20% can appear inhomogeneously blue-black.  Cannot exclude mets.
Signed: Radiology

There once was a man from Nantucket, which is a major breeding ground for the Ixodes tick species that carries Lyme disease.  Consider starting Doxycycline after ID approval. Consider running serology for Nantucket Nectar intoxication after ID approval.  Consider starting ID approval after ID approval.
Signed:  ID

Humpty Dumpty 36, male, s/p great fall.  Assessment and Plan: External fixation. Going to OR now. Get platelets high before OR.
Signed: Orthoepoediaec surgery

Ring around the rosie, pocket full of posey, ashes, ashes, then see how they all fall down?  That's pathognomonic for cancer. It's the pseudo-rosette, signet ring, atypia sign.  As you can see, this is a perfect case of cancer.  We recommend starting a drug that treats cancer.  Also, from a humanistic perspective, we recommend informing the patient it has the cancer.
Signed: Pathology

I know an old woman who swallowed a fly, why oh why did she swallow a fly?
Assessment:  Hypothyroidism vs. Hyperthyroidism.
Problem list: 1) Discharge: patient ready for discharge.  Social work consulted.
2) Patient swallowed fly: Follow up on TSH.  GI consulted. Psych consulted.  Social work consulted.
3) Discharge: Nursing facility placement pending.  Patient ready to leave when social work issue resolved.
4) Hypotension: Fly anaphylaxis vs. sepsis.  Pressors started.  Patient intubated. Anesthesia consulted.  Social work consulted.
5) Discharge:  Patient refusing to leave or follow commands.  Social work consulted.  ER blamed.
Signed: Internal medicine

*Note: These are very esoteric and I apologize.  I hate both making esoteric medicine references and making fun of specialties.  This is both together.  Let's just bury this one and pretend I didn't do it.  SOAP notes are what every specialty in the hospital writes so that other doctors can see how shitty their notes are.  Mets are metastatic cancer (i.e. traveling, bad cancer) , they can never be excluded.  S/p means "status post", which is a fancy, confusing way of saying "here after". Pathognomonic means "synonymous".  Psuedo-rosettes, signet rings, and atypia are things that are specific to certain types of cancer in the same way that shirts are specific to certain types of people.  A TSH is a thyroid test and can be blamed for just about anything.  So it is.  Hypotension, pressors, and intubation are bad; very busy scene with dramatic music on Grey's Anatomy kind of bad.

Wednesday, April 6, 2011

Don't worry, I'm not looking...or listening...or smelling.

Let me tell you, there are some uncomfortable situations that they put you in during medical school.  Some real awkward turtles.  Having to do your first pelvic exam, being sent back in to ask a 70 year old their sexual history, putting your hand wrist deep inside of someone, you know, awkward shit.  But nothing so far has beaten having to stand there in the room and make small talk with a girl about your age while she is bent over the exam table with her butt cheeks taped open while the attending goes to find a nurse to do a proctoscopic exam.  

"So... I guess while the doctor is going to find something to shove inside of your butt, I thought we could take this time to talk about coronary artery disease.  You see your vessels are like pipes..."