I wish textbooks were as interesting as pleasure reading books. Like I wish Orwell wrote my anatomy text. It would be like, "the sun poured in through the window and landed gently on her scapula, which is attached to the Manubrium at the sternoclavicular joint, the subtlest of joints."
Showing posts with label Thoughts from the bottom of On Call. Show all posts
Showing posts with label Thoughts from the bottom of On Call. Show all posts
Wednesday, January 11, 2012
Monday, October 10, 2011
5 years. Is anyone still reading this?
Holy shit, I've been doing this for 5 years. Look at my first post, that was over 5 years ago and before I was even in med school. I was applying to med school; a doe-eyed premed, full of hopes and dreams, and fresh out of college. And look at me now, applying to residency, a weary-eyed soon-to-be doctor, filled with realities and not enough sleep for dreams, or fully coherent thoughts, still fresh out of college (right? right?!?! I can still party right? I'm cool, right? Say it! Say it!!). So let's highlight the differences between me now and me 5 years ago.
1) Let's start with the most pressing for any hopeful premeds. Primary care blows. I sort of figured I wanted to have a long-term relationship with my patients, doing primary care in an underserved area, stomping out diseases with a tongue depressor and deep thought. I'm going to listen to my patient. Fucking listen to her. That's what I'm going to do, fuck yeah!
Primary care sucks. I don't mean people who do primary care sucks, I mean the way primary care physicians are treated sucks. Every specialty has it's own brand of suck, but something about primary care, particularly outpatient, feels like you are standing there in your white coat, trying to listen to your patient, acting dignified and thoughtful, like a good doctor should, while monkeys surround you and fling poop at your face and laugh at you. Fifteen minute visits, gatekeeper status, hyper-specialized docs keeping you out of the loop are the poop on your face. The insurance companies are doing the flinging.
All of the underserved, long-term relationship, sword of justice stuff is superfluous to my new found love of hyperspecialization. Everyone with a brain tumor is under-served. I still like all that stuff, it is just mostly irrelevant in my world, and takes a back seat until I can breathe on the other end of residency.
2) I have confidence. As you can tell by my first post and the subsequent ones about interviews that I wasn't really sure how this whole thing would go. Med school has a 58% rejection rate the last time I checked. Residency is virtually guaranteed. I didn't know how I would do in med school, on my board exams, with extra-curriculars, etc. I now trust in the system. They let me in because they thought that I would be fine, and I was. "Med school is the narrowest hoop, and once through that, you will do just fine and get a residency" that's the basic idea and it is pretty much true.
3) I have chest hair.
4) I am jaded. Not jaded, that's not quite right, hardened, calloused. I try very hard not to be jaded, but hardened for sure. I've watched people die, I've pumped on their chest while they die, I've had my patients die. That's never great, but the weird thing is just how used to it you get. Not to mention all of the gross shit I've done or seen or been asked to do and just been like, "yeah ok whatever". As in "Stick my finger in that guy's butt? Yeah ok whatever."
Ways I am the same:
1) I still want to be a doctor. I want to be a totally different kind of doctor, but I love this profession so much. We love to bitch about it and prove how much more hardcore we are than all the other professionals, but truthfully, we get paid a more than decent salary to go around thinking about how the body goes wrong and fixing people. We can get jaded and bitch about the paperwork and the insurance companies (for good reason), but there are so many opportunities to more or less switch careers to teaching, or admin, or writing or even a different kind of doctor if it gets bad. Worst comes to worst, it becomes like every other job, we do it for pay and can't wait to get home to our real passion. Boo hoo for us.
2) I want a cat. I wanted a cat then, I want a cat now, I still don't have a cat and probably will never get one. Seems like a lot of work. A tattoo is in the same boat. The same boat as the cat. Which makes it some sort of strange boat with a cat and a tattoo and wanted by me, but only, like, sorta.
1) Let's start with the most pressing for any hopeful premeds. Primary care blows. I sort of figured I wanted to have a long-term relationship with my patients, doing primary care in an underserved area, stomping out diseases with a tongue depressor and deep thought. I'm going to listen to my patient. Fucking listen to her. That's what I'm going to do, fuck yeah!
Primary care sucks. I don't mean people who do primary care sucks, I mean the way primary care physicians are treated sucks. Every specialty has it's own brand of suck, but something about primary care, particularly outpatient, feels like you are standing there in your white coat, trying to listen to your patient, acting dignified and thoughtful, like a good doctor should, while monkeys surround you and fling poop at your face and laugh at you. Fifteen minute visits, gatekeeper status, hyper-specialized docs keeping you out of the loop are the poop on your face. The insurance companies are doing the flinging.
All of the underserved, long-term relationship, sword of justice stuff is superfluous to my new found love of hyperspecialization. Everyone with a brain tumor is under-served. I still like all that stuff, it is just mostly irrelevant in my world, and takes a back seat until I can breathe on the other end of residency.
2) I have confidence. As you can tell by my first post and the subsequent ones about interviews that I wasn't really sure how this whole thing would go. Med school has a 58% rejection rate the last time I checked. Residency is virtually guaranteed. I didn't know how I would do in med school, on my board exams, with extra-curriculars, etc. I now trust in the system. They let me in because they thought that I would be fine, and I was. "Med school is the narrowest hoop, and once through that, you will do just fine and get a residency" that's the basic idea and it is pretty much true.
3) I have chest hair.
4) I am jaded. Not jaded, that's not quite right, hardened, calloused. I try very hard not to be jaded, but hardened for sure. I've watched people die, I've pumped on their chest while they die, I've had my patients die. That's never great, but the weird thing is just how used to it you get. Not to mention all of the gross shit I've done or seen or been asked to do and just been like, "yeah ok whatever". As in "Stick my finger in that guy's butt? Yeah ok whatever."
Ways I am the same:
1) I still want to be a doctor. I want to be a totally different kind of doctor, but I love this profession so much. We love to bitch about it and prove how much more hardcore we are than all the other professionals, but truthfully, we get paid a more than decent salary to go around thinking about how the body goes wrong and fixing people. We can get jaded and bitch about the paperwork and the insurance companies (for good reason), but there are so many opportunities to more or less switch careers to teaching, or admin, or writing or even a different kind of doctor if it gets bad. Worst comes to worst, it becomes like every other job, we do it for pay and can't wait to get home to our real passion. Boo hoo for us.
2) I want a cat. I wanted a cat then, I want a cat now, I still don't have a cat and probably will never get one. Seems like a lot of work. A tattoo is in the same boat. The same boat as the cat. Which makes it some sort of strange boat with a cat and a tattoo and wanted by me, but only, like, sorta.
Tuesday, October 4, 2011
I am NSFW
A bunch of my classmates were asked to write blogs about their experience at my med school. I have no idea why I was not asked to do such a thing. I mean, I already have a blog; I feel like I'm an obvious choice. What could possibly make them not want me to do it? Pricks.
I was once asked to start a twitter account for the school where they would live feed my tweets to the admissions page. They pulled me down in a month. Apparently, the word "fuck" is not exactly the message they wanted to send. But that's a totally normal, med school reaction to finding out you have another write-up to do. "You have an incomplete write-up" "fuuuuuccckkk". See? Natural. "You are not allowed to write an official blog" "fuuuuuucccckkkk you". Just trying to express thoughts in real time.
I was once asked to start a twitter account for the school where they would live feed my tweets to the admissions page. They pulled me down in a month. Apparently, the word "fuck" is not exactly the message they wanted to send. But that's a totally normal, med school reaction to finding out you have another write-up to do. "You have an incomplete write-up" "fuuuuuccckkk". See? Natural. "You are not allowed to write an official blog" "fuuuuuucccckkkk you". Just trying to express thoughts in real time.
Tuesday, August 16, 2011
Downer alert. My B.
People dying is sad. That prolific statement is brought to you by my current rotation, Neurosurgery: "Where people die a lot." Not the slogan of the national society, but certainly a reasonable runner-up option.
What I've discovered during my recent acclamation with death is that I find certain deaths more emotional and tragic than others. This is another obvious statement, but instead of listing some criteria like "people with families" or "contributing members of society", I am basing this off of my emotional experience. I just sometimes walk away from a patient who died or is about to die, and find myself more moved than with a different patient.
The only variable I can seem to cite with some consistency is age. Social status, family status, mechanism of injury, events leading up to death; all seem to not make a difference, but age fucks me up. In particular, it's the 18-35 crowd that jerks my soul around. There is something about seeing someone with the prime of their life torn from them that really gets me.
I realize this is very egocentric, I myself being in this age range, but I think there is more to it than that. Older individuals have gotten to live an impressive amount of life. From your 85 year old former paper editor, to your 55 year old father of 3, their death is sad without a doubt, but their life is established and in status quo. A great place to be, but a plateaued place, at least from a year-to-year view. But 18-35, that's when you are really setting up the rest of your life. You are making the moves to get to that plateau. You are starting college as a theater major; getting promoted to manager; knocking up that waitress; heroine binging your way onto a reality show. You are a real fucking winner, and no one can tell you different.
Kids are obviously sad; there is so much life lost. But when I was a kid, I wanted to grow up to be a fire-truck (Ding-ding!), now I want to grow up to be a doctor and I'm like 90% there. If you robbed me of life when I was 8, then we can just build a new fire-engine. If you rob me of my life when I'm 28, then we have just lost my realistic future as a physician (and my loans, see you in hell Sallie-Mae).
People are in the active process of realizing their future. It's not a pipe-dream anymore. It might not be glamerous, it might be laying actual pipe, but it's an active, conscious persuit. It can be painful, and full of introspective self-doubt, but at least it's not boring status quo, like 20 years from now, and it's not dinasaur catchering and wand-makering like 20 years ago. It's like running a marathon and getting pulled at mile 16. You'll never know if you could have made it. And you won't care, you're dead. But I will. I care if you could have made it. I wanted to see how you finished college. Or even my Caesar salad. I hear they were going to promote you to manager...
Anyway, back to work.
What I've discovered during my recent acclamation with death is that I find certain deaths more emotional and tragic than others. This is another obvious statement, but instead of listing some criteria like "people with families" or "contributing members of society", I am basing this off of my emotional experience. I just sometimes walk away from a patient who died or is about to die, and find myself more moved than with a different patient.
The only variable I can seem to cite with some consistency is age. Social status, family status, mechanism of injury, events leading up to death; all seem to not make a difference, but age fucks me up. In particular, it's the 18-35 crowd that jerks my soul around. There is something about seeing someone with the prime of their life torn from them that really gets me.
I realize this is very egocentric, I myself being in this age range, but I think there is more to it than that. Older individuals have gotten to live an impressive amount of life. From your 85 year old former paper editor, to your 55 year old father of 3, their death is sad without a doubt, but their life is established and in status quo. A great place to be, but a plateaued place, at least from a year-to-year view. But 18-35, that's when you are really setting up the rest of your life. You are making the moves to get to that plateau. You are starting college as a theater major; getting promoted to manager; knocking up that waitress; heroine binging your way onto a reality show. You are a real fucking winner, and no one can tell you different.
Kids are obviously sad; there is so much life lost. But when I was a kid, I wanted to grow up to be a fire-truck (Ding-ding!), now I want to grow up to be a doctor and I'm like 90% there. If you robbed me of life when I was 8, then we can just build a new fire-engine. If you rob me of my life when I'm 28, then we have just lost my realistic future as a physician (and my loans, see you in hell Sallie-Mae).
People are in the active process of realizing their future. It's not a pipe-dream anymore. It might not be glamerous, it might be laying actual pipe, but it's an active, conscious persuit. It can be painful, and full of introspective self-doubt, but at least it's not boring status quo, like 20 years from now, and it's not dinasaur catchering and wand-makering like 20 years ago. It's like running a marathon and getting pulled at mile 16. You'll never know if you could have made it. And you won't care, you're dead. But I will. I care if you could have made it. I wanted to see how you finished college. Or even my Caesar salad. I hear they were going to promote you to manager...
Anyway, back to work.
Monday, August 8, 2011
Please don't take all of my hatred the wrong way
I realize that my post about my sub I makes me sound very bitter and begs the question, "why are you doing this?" And also, "please don't go anywhere near me if I'm in the hospital." Those are legit concerns. But let me reassure you, that was me bitching about the amount of work I'm doing and the basic quality, not me bitching about my future work. Let me shed a different light on it.
I fucking love the OR. I really do. I once heard this melodramatic, masturbatory statement, "If you can think of yourself doing anything besides surgery, surgery isn't for you". The same thing is told to ninjas before they start their training, imagines brain surgeon. Get over yourself.
But, it is a really brutal life during residency and if you don't love the OR, it's just not worth the pain. I don't get to do much in the OR. I regularly stare down a tiny hole, in which at best, I can see some fat for 5 hours, just so at the end of the case I can tie a few knots. Most of which will be cut out because they aren't tight enough and that layer of fat needs to be tightly tied to that other layer of fat. But two things. One, it is worth it. I love tying those knots and suctioning that blood and irrigating that wound enough that I'm willing to wait until I climb the ladder. And two, the shit I'm watching, if I can see, is awesome. Being a surgeon and being a med student interested in surgery are two totally different things.
No one likes watching someone else do something, particularly not the A-type* personalities that go into the surgical specialties. You have to imagine yourself on the other side of the body, the dude with his hands inside the human. The lady under the microscope. Those are the people you have to want to be. If you want that, and can deal with mostly watching for a few years, surgery is for you.
And it is for me. I love it and it's worth all of the pain.
People often comment that I'm a masochist for doing what I'm doing. No, I just find the pain to be less painful than others, so the pain to pleasure ratio is in my favor (I guess the same can be said for masochists, but let's not get into a philosophical argument about the true nature of pain and pleasure). I'm allowed to bitch about paying 70 grand a year to work over 100 hours doing virtually nothing. I earned that right, and in turn, earn that right to be the one elbow deep in a person**. Plus, I dropped out of ninja school and don't know what else to do.
*note: The A stands for asshole. ADHD. Arrogant. Get me a thesaurus and look up Douche-bag.
**note: I'm going into neurosurgery, if I'm elbow deep inside someone, something has gone terribly wrong.
I fucking love the OR. I really do. I once heard this melodramatic, masturbatory statement, "If you can think of yourself doing anything besides surgery, surgery isn't for you". The same thing is told to ninjas before they start their training, imagines brain surgeon. Get over yourself.
But, it is a really brutal life during residency and if you don't love the OR, it's just not worth the pain. I don't get to do much in the OR. I regularly stare down a tiny hole, in which at best, I can see some fat for 5 hours, just so at the end of the case I can tie a few knots. Most of which will be cut out because they aren't tight enough and that layer of fat needs to be tightly tied to that other layer of fat. But two things. One, it is worth it. I love tying those knots and suctioning that blood and irrigating that wound enough that I'm willing to wait until I climb the ladder. And two, the shit I'm watching, if I can see, is awesome. Being a surgeon and being a med student interested in surgery are two totally different things.
No one likes watching someone else do something, particularly not the A-type* personalities that go into the surgical specialties. You have to imagine yourself on the other side of the body, the dude with his hands inside the human. The lady under the microscope. Those are the people you have to want to be. If you want that, and can deal with mostly watching for a few years, surgery is for you.
And it is for me. I love it and it's worth all of the pain.
People often comment that I'm a masochist for doing what I'm doing. No, I just find the pain to be less painful than others, so the pain to pleasure ratio is in my favor (I guess the same can be said for masochists, but let's not get into a philosophical argument about the true nature of pain and pleasure). I'm allowed to bitch about paying 70 grand a year to work over 100 hours doing virtually nothing. I earned that right, and in turn, earn that right to be the one elbow deep in a person**. Plus, I dropped out of ninja school and don't know what else to do.
*note: The A stands for asshole. ADHD. Arrogant. Get me a thesaurus and look up Douche-bag.
**note: I'm going into neurosurgery, if I'm elbow deep inside someone, something has gone terribly wrong.
Saturday, August 6, 2011
Sorry mom, you may have to find a new blog to click 1000's of times
I haven't posted anything in almost a month. This does not bode well for my future in residency when I will similarly have no time. See right now I'm doing a "Sub I" in my chosen specialty, which happens to be a pretty intense one. Like the most intense one (arguably). And they are taking no shortcuts on mercilessly beating the living shit out of me at every turn.
See I'm on call literally every other day. That means every day of my life, I'm either on call (staying over night with a pager and a sticker on my forehead that says, "your bitch") or post-call (the day after call, when you haven't slept). That is brutal. Literally more brutal than anything else possible. You can't be on call more than that. And it's much worse than that. Instead of going home post-call at 11 or 12, like a resident on call, I'm going to the OR and staying until at least 530. Calculating it out, that's 36+ hours of straight work*. I've worked 41 hours in 2 days. That's overtime in 2 days.
Generally, this is because I'm there to love surgery, and since I don't have real clinical responsibility, they send me to the OR, so I can love more surgery. In the OR my duties range from suctioning blood to standing in a corner trying to peer over someone's shoulder. Well appearing to try to peer over someone's shoulder
When I get out of the OR, I do scut work. A term that means, scientifically, "shit work". Taking off bandages, drawing blood, telling residents how pretty they look, stuff like that. I do get to see patients that need a consult from my service, which can range from fun to extremely painful (turns out there are a lot of odd ducks in the world), but is generally the highlight of my non-OR time. We do this all through the night, then back to the OR, then home to sleep for 4 hours and back again the next day at 5am. So sorry about not posting a lot, mom.
*note: "Work" is a loose term. Generally work implies receiving monetary compensation for effort and results. Instead, I pay to do this.
When I get out of the OR, I do scut work. A term that means, scientifically, "shit work". Taking off bandages, drawing blood, telling residents how pretty they look, stuff like that. I do get to see patients that need a consult from my service, which can range from fun to extremely painful (turns out there are a lot of odd ducks in the world), but is generally the highlight of my non-OR time. We do this all through the night, then back to the OR, then home to sleep for 4 hours and back again the next day at 5am. So sorry about not posting a lot, mom.
*note: "Work" is a loose term. Generally work implies receiving monetary compensation for effort and results. Instead, I pay to do this.
Thursday, June 16, 2011
I guess the word HIPAA is kind of funny
I hate when a patient has a hilarious name. I want to tell the world about Ying Ding Woody Wang (dangerously close to a real patient's name), but that would be a violation of HIPAA, a government agency that makes sure health care providers don't share hilarious names.
How to get out post call; or How to be professionally unprofessional
I haven't posted anything in almost a month. See right now I'm doing a "Sub I" in my chosen specialty and they are taking no shortcuts on mercilessly beating the shit out of me.
See I'm on call literally every other day. That means every day of my life, I'm either on call (staying over night with a pager and a sticker on my forehead that says, "your bitch") or post-call (the day after call, when you haven't slept). This means that I've taken more call than any other human on earth in a 2 month period. Like seriously.
So with that experience, I'm going to take on one of the top 5 med student challenges. How to get out post-call.
Often, post-call, residents and attendings don't actually realize you are post-call (or there). Since you aren't calling the attendings and chiefs relentlessly all night, they don't know you are on hour 30; and the girl who took call with you is a real resident and has work hour restrictions, so she went home hours ago and can't get your back. This leaves you in the awkward position of trying to get people to notice you are post-call without mentioning that you want to go home. If you mention it, they may think you are uninterested and give you a bad grade for not working hard for 30+ straight hours like some sort of mortal. You need a strategy:
1. Pick one case from overnight and talk about it relentlessly. It will seem like you are super interested and also super there. Try to use it in every conversation. "Yeah, let's get lunch. You know who else had lunch? That guy who came in at 2am when I was here. I know so, because I took such a good history that I found out he ate Thai food, which isn't usual for him. Might have caused his stroke. Who knows."
2. Never shower. This is tempting. You feel disgusting and want to shower. Also, you are disgusting. But resist the urge. Instead, put on a nice potent deoderant or axe body spray or serious perfume. The mix of 30 hour musk and Red Zone makes someone think twice when you walk past. They will say, "Is that kid homeless? Wait, maybe he was on call." Goes without saying, do not brush your hair. Just look like you tried to brush your hair, but gave up when you fell asleep in the bathroom. Which I recommend.
3. Pick a post call look and stick to it. I only wear glasses post call. I never shave post call. I chew gum aggressively post call. If I could walk around without pants post call, I would. Motherfucker, these glasses mean I haven't slept; stop asking me to fill out discharge documents.
4. Save one task for the morning. That way, when a resident says, "hey are you doing anything? It's kind of scut work, but I have something for you." You can respond, "Yeah definitely! Let me just finish this post-op check from last night, then I'll be happy to do your paper work for you, you prick". Leave that last part out, but the first part is gold.
5. Run.
6. Ask if the coolest resident needs anything. There is one resident who all his friends from home always say, "how the hell is he a doctor?"; that's your guy. That guy channels his desire to go home into getting you home. Find him (he has long hair and Nike kicks) and see if he needs anything. His first thought when he sees you will be, "are you post call?" and then he will cover your ass while you sneak out before noon conference.
That's it for now. Since I'm post call writing this, I think it's only appropriate to post this in its raw form, unedited. Also, I really need to post something.
1. Pick one case from overnight and talk about it relentlessly. It will seem like you are super interested and also super there. Try to use it in every conversation. "Yeah, let's get lunch. You know who else had lunch? That guy who came in at 2am when I was here. I know so, because I took such a good history that I found out he ate Thai food, which isn't usual for him. Might have caused his stroke. Who knows."
2. Never shower. This is tempting. You feel disgusting and want to shower. Also, you are disgusting. But resist the urge. Instead, put on a nice potent deoderant or axe body spray or serious perfume. The mix of 30 hour musk and Red Zone makes someone think twice when you walk past. They will say, "Is that kid homeless? Wait, maybe he was on call." Goes without saying, do not brush your hair. Just look like you tried to brush your hair, but gave up when you fell asleep in the bathroom. Which I recommend.
3. Pick a post call look and stick to it. I only wear glasses post call. I never shave post call. I chew gum aggressively post call. If I could walk around without pants post call, I would. Motherfucker, these glasses mean I haven't slept; stop asking me to fill out discharge documents.
4. Save one task for the morning. That way, when a resident says, "hey are you doing anything? It's kind of scut work, but I have something for you." You can respond, "Yeah definitely! Let me just finish this post-op check from last night, then I'll be happy to do your paper work for you, you prick". Leave that last part out, but the first part is gold.
5. Run.
6. Ask if the coolest resident needs anything. There is one resident who all his friends from home always say, "how the hell is he a doctor?"; that's your guy. That guy channels his desire to go home into getting you home. Find him (he has long hair and Nike kicks) and see if he needs anything. His first thought when he sees you will be, "are you post call?" and then he will cover your ass while you sneak out before noon conference.
That's it for now. Since I'm post call writing this, I think it's only appropriate to post this in its raw form, unedited. Also, I really need to post something.
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.
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..."
"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..."
Thursday, June 17, 2010
Thursday, May 13, 2010
Notable quotables.
You and your friend's conversations are boring, stereotypical for your group dynamic, and annoying to the people around you in comparison to the conversations me and my friends have, which are notable for being awesome.
Thursday, February 18, 2010
Blowing off some steam-building exercises
Work provides a really unique opportunity. See you choose your friends, so you can't bitch about them too much. Your family isn't a choice, but you kind of love them no matter what. Now strangers can fuck with you and piss you off, but they are transient and not worth much energy. But co-workers? That's where you can really stretch your legs and do some serious, grade-A shit talking.
Thursday, February 11, 2010
Genie in a Speculum
I see so much vagina on OB/GYN. It's one of those be careful what you wish for things. "Oh you really want to see vagina? All the time? Here. Here's a vagina, she's 52 and is having atrophic vaginitis. And another one, this one's a 32 year old, 39 week pregnant woman who just broke her water. Have them. All the vagina you can ask for. All you have to do is shove this terribly painful metal object inside them and they are yours to view. They are in pain so you can visualize their parts. Visualize them and evaluate them for disease. Is that what you wanted 13 year old Meat? Is that what you wished for after you found your first Playboy? MWAAHAHAHAHAHAHAHAHA" (Meat writhes in the corner of the exam room while the camera slowly zooms out and ominous music plays.)
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