Ah, medical humor....

This guy cracks me up. Which I'm almost ashamed to admit, if you look at some of his other stuff....

Hysterical. No, wait, that would be gynecology...

I stumbled across this today. I heart it so.



Happy Friday!!!

Fun with pictures

Call it Wordless Tuesday. Except with words. Lots of 'em.

So Sparrow and I are on together tonight. Which, so very rocks.

(PS - did I mention that Sparrow had a birthday last week? I think I forgot. She had her first 29th birthday this past week. We went out for "Asian Fusion" - if several days later - and it was yummy. The company was impeccable, of course, as well...)

(Ruthie's birthday is today, also. I made an impromptu little banner on our door using Post-It notes.)

(But I digress.)

So Sparrow and I are here. And we had a lot of funny, funny stuff come across our paths last night. So we decided to take pictures (you'll notice that all the patient identifiers are conveniently missing...).

Shortly after I came on, a direct admission came from one of the community hospitals. I went down, signed her in, talked to her a bit, and then came back upstairs and looked through the thick envelope of material that the outside hospital sent with her.

I found about twenty pages of MARs (medication administration records), which was ridiculous because this woman is on exactly ONE medication. And of course, they sent a big stack of nursing notes.

Notably missing? A discharge summary. Or, say, a psych consult note. But in case you were worried, we got her post-endoscopy nursing notes, too.

Absolutely essential to good psychiatric care.

They also...seriously, I almost fell off my chair when I saw this. This is not a diagnosis.

The word is hypokalemia. I mean, really. They are just makin' shit up at this point.

You know you're in good hands when your doctors start making up diagnoses just for you. That's a sure sign that they really know what they're doing.

Also waiting for me when I came in was this hand-off note:

Oh, but, be sure to notice the patient's age.

It's the the Playskool Trenchcoat Mafia out there. They're just starting younger and younger these days. Sparrow tells me she got a report from a parent the other day that some three year old girl was "pole dancing". Really? A three year old taking off her clothes. Astonishing. That's highly unusual. Toddlers almost never like to run around naked.

And furthermore, pole dancing is not an innate talent, unless you're a surgeon (inside joke. Sorry...). So if you find your little one working the pole at Gymboree...you've got ask yourself where she could possibly have learned that behavior.

I'm just sayin'.

Acronym of the night

VORB.

Taken as a word by itself, kinda makes me giggle. This was all over the ER charts tonight, I'd never seen it before. Anybody care to venture a guess what it means?

(Yeah, I'm on call again. Why do you ask?)

Time for voice recognition software...

I...I hate people.

So I dictate my clinic notes, because it's marginally faster and is sort of the quickest way to get something into the patient's record. They get transcribed reasonably quickly, and then in theory we correct them and sign them, and all is well in the universe. Except...I'm not always the most conscientious about the correcting and signing step, because it often takes me almost as long to correct the damn dictation as it took me to dictate it.

The short version of this story is that I went into this weekend with sixty some dictations that needed attention, some from as far back as October. I've been neglecting them because, well, I have a crapton of other work to do, and it's in the medical record, so, is there really a time crunch on this? Apparently, there is, if we want to bill for it. So I've been getting all manner of nasty emails from my attendings that are like, sign your damn notes already, kid!

I'm down to 20. I've been doing them like five at a time because it takes so damn long and it pisses me off. Apparently we outsource our transcription to some little old ladies in India. Sometimes the syntax is off, in sort of the typical ways you'd expect from non-native speakers. That's fine. It amazes me, really, how many random typos are typically in these things - extra letters, too many spaces, line breaks where there shouldn't be, etc. But, fine. What actually gets to me is the crazy things that end up in the medical record that make no sense whatsoever, when, if whomever was transcribing took a minute to think about what they were typing, just a second, really, they'd figure out what they'd just said was ludicrous. I've been cutting and pasting some of the worst offenders...

"He is currently working on reading the Tail of Two Cities." (Hmm, I think I missed that one in high school...)

"He says he has been helping his dad with some construction projects, and supervising the construction of his grandmother's edition. " (Addition. Although...)

"He had begun calling her and taxing her incessantly." (Uh, that would be "texting". He is not a government official)

"The patient is handling this very well, and being very supportive of his friend, the deceased girlfriend." (That was supposed to be, "the deceased's girlfriend. It's different.)

"His family recently took a vacation to Cozumel, I believe, in the Caribbean." (They went to Cozumel, Belize, and the Caribbean. I know Cozumel is in Mexico, dammit!)

"He will go to the transplant percipient class, at which point he will go on the list for a kidney transplant." (From Merriam-Webster Online, the definition of "percipient" (n): a person on whose mind a telepathic impulse or message is held to fall. Um, please stop reinforcing my patient's psychotic delusions!!)

"She is concerned that this has gone largely and addressed." (Me, too)

"He presents today meeting a bridging prescription for his lithium." (Steve? Lithium. Lithium? Steve.)

"They have has no other complaints today." (That is was sure a good thing idea, there, hey.)

"She also has done two sits in rehab." (Hmm, maybe that's why it didn't work...)

"It was the first Thanksgiving without his grandmother, who recently passed out and that was a little difficult for the whole family." (Until grandma woke up, six feet underground because the rest of the family thought she'd passed ON.)

"He says that as long as he is alerting he is okay." (Well...then...carry on.)

"And that she particularly likes school because they are free, contained no clipart" (I have no idea what this means...)

"The idea of writing the letter but not sending it was discussed and she seemed to devaluate that." (Devaluate isn't even a word! It's like "ironical". And furthermore...I really just have no clue what the hell word I actually used there...)

"His property is routinely searched for code violaceous." (I hate it when that happens.)

"He is feeling like this man is 'how to get him'" (How is that, exactly?)

(In a continuing description of my patient's car accident, where he was driving on the straightaway with his dim headlights and missed the fact that the road was about to end, so he ended up in a ditch) "...and that it was very dark and his headlights particularly bright. He came to T in the road, coming on the strayed away, and crossed over the perpendicular road and went into a ditch. He severed only minor abrasions to his left hand."

"He also had surgery on his finger in 1992 after a crush." (Injury. Crush injury. That's an important distinction!)

"We will continue with Remeron 45 mg p.o. q.h.s. He is given a prescription for 50 mg tablets." (You've just got to shave 'em down a little, it's no big deal.)

"If her panic attach become more frequent, we will consider something like propranolol." (Or possibly a crowbar.)

"He says that he is not happy with his current physician, that he is a "kangaroo psychologist"." (Yep, that's exactly what he said. No, I still don't know what that's supposed to mean. But perhaps if he stopped going to veterinarians, he'd get better mental health care?)

"He states now that that was primarily over the mounting is fair." (I...um...huh?) (You know what I think that was, originally, actually? "Mounting despair". Yeah, different...)

"He notes that he is 'still measurable.'" (Well, thank God! No one likes an unmeasurable patient. Especially not one who's, say, MISERABLE!!! Really, people, this is not that hard!)

"There is heavy alcoholism on both sides, and his paternal uncle is a aeronautics." (Wow, he must be confused about why all those AA meetings are required for the space program.)


Idiots.

Um, but then there were the dumb things I actually did say...

"...and was initially initiated on amitriptyline..."

"The patient has a somewhat impulsive and minimally jerky kind of gait that his mother reports is at his baseline." (I...guess it gives you a picture of how this guy walks?)

"I will fax a copy of his lab report to Dr. X at [fax number], as well as the copy of his lab report." (Right before I fax him the lab report.)

"The patient denies any suicidal or homicidal ideation; however, she does note that she once considered throwing a plate of food at her father this week." (Hey, they say it, I just put it in the chart.)

"The patient was counseled that he should probably stop smoking marijuana." (Yeah, you know, sometime, when you get around to it...)

"She says that her symptoms have maintained at about the same level, although she does also state that her symptoms are significantly improved since starting the Celexa." (Honestly? I think she really did say both, but...)


And then...sometimes, maybe it's a little of both...

"The patient agrees that he probably needs to stop watching U-tube."


Oy. I still have 13 left, but, they're going to have to wait...

Urine Ecstasy

(I am?)

This was the title of a fax I got today about one of my patients. Which followed a call I got about the same patient, saying that she'd shown up in this outside ER all threatening to kill herself and oh by the way, her urine had popped for MDMA (commonly known as? You got it. Ecstasy). Which is really out of character for her. So I called their tox lab (after calling our tox lab, who said they couldn't tell me anything without knowing what assay the other lab used), and said, what cross-reacts with the MDMA reagent? Turns out, a whole lot.

It was a helpful giggle in what turned out to be a long, long day.

Man, I'll be glad when the holidays are over...

Weird things over email.

First of all, happy December. Or to those who survived NaBloPoMo, way to make it through the whole month!

I had a couple of bizarre things in my email today when I got home. And I feel crappy and am borderline grouchy and, well, I needed a post today without a lot of thinking involved (if you think I'm kidding, it took me four attempts to properly spell "involved" just now). I think I may have honked my brain right out my nose and it's now been replaced with mucous.

Anyhow.

Item one, from CNN Breaking News. Let me say that again - BREAKING News.

-- The U.S. entered a recession in December 2007, according to the National Bureau of Economic Research.

Um...yeah, thanks, I kinda noticed that already.

They get that it's December 2008, right? As in, almost 2009. As in, you're just getting around to deciding this NOW?

And further more...breaking news? Really?? Really. You're sure? They didn't send me an email about Mumbai, but, deciding we've been in a recession FOR A YEAR somehow qualifies as an emergency. Come on, folks. It's a developing story like the Grand Canyon was a riverbed.

Item two - today's Merriam-Webster's word of the day: alienist.

Who knows what it means? Want to venture a guess? And no, neither Scully nor Mulder was one.

It's a psychiatrist.

No, really! Or at least that's what they claim. Here's their explanation:

Did you know?

"Alienist" looks and sounds like it should mean "someone who studies aliens," and in fact "alienist" and "alien" are related — both are ultimately derived from the Latin word “alius,” meaning "other." In the case of "alienist," the etymological trail leads from Latin to French, where the adjective “aliéné” ("insane") gave rise to the noun “alieniste,” referring to a doctor who treats the insane. "Alienist" first appeared in print in English in 1864. It was preceded by the other “alius” descendants, "alien" (14th century) and "alienate" (used as a verb since the early 16th century). "Alienist" is much rarer than "psychiatrist" these days, but at one time it was the preferred term.

Makes me glad I didn't practice in the 1860s. As do many other things....

See? Don't you feel wiser now?

I'm perhaps more ill today than I have been. My working theory is that while I was down with the plague I caught a nice hefty rhinovirus, and the two progressed more or less seamlessly in a continuous blog of grossness. I miss breathing, I do... It could just be a continuation of the Pink Office Plague, though, because both Peng and Ruthie have remnants of their respective bouts some three or four weeks later. Apparently, also, down South this sort of thing is referred to as "the crud," or when particularly epidemic, "the creeping crud." So I'm attempting to fight the crud with its known natural enemy - soup in a bread bowl.

My dad is doing okay, and thanks everyone for their concern and good wishes. So far, there's nothing super informative to report. He's apparently in a room that makes the Hilton look dingy (internet! cable! fold-out couch!), and they haven't decided what, if anything, they're going to do yet. He's on the OR schedule for Wednesday morning, but, uh, no one's really certain what surgery - if any - he's going to have. Which is fair - they're waiting for the culture results to decide the next course of action, but, you've got to claim the room before another surgeon does, else you might not have it if you need it. So we're waiting. And he's well-vicodenized.

Maybe I should tell my mom to bring him some soup in a bread bowl...

A very embarrassing story...

One morning in high school (I think it was in the morning), we were running in gym class. Now, as I think I've mentioned before, I was in fat gym in high school. Which was actually way better than being in regular gym. We got to wear what we wanted, one day a week we had classes on stuff instead of dressing out and sweating, and not once did we have to spend weeks at a time playing Ultimate Frisbee. We did more actual working out than any regular gym class. And no one was the fat kid. In fact, not everyone was really fat. But, we won't single them out (even though some of them read this blog).

So anyway. We're running in gym class. I think this was my Junior year. I had on at least one sports bra (I eventually progressed to three before the jiggling was sufficiently contained). I'm running along, talking to whomever I was running with, and my friend says something behind me. And I made a very poorly timed look over my shoulder...

...and smacked myself in the face with my boobs.

Now, naturally, the four of us involved dissolved into giggles, and my gym teacher suggested moving up to two sports bras.

I'm a little afraid of a similar incident tonight, frankly.

I'm all vamped up and ready to go to Cleo and Tony's Halloween party. And I look like the prow of a ship.

A glittery, black-lipsticked, giant-hoop-earringed prow of a ship. Wearing jeans, because I never could find the skirt I wanted, and a name tag that says, "Hello, my name is Id. How can you serve me today?"

It's all very tawdry and...um...unconscious (that was a psychiatry joke, sorry. My anxiety's up a little, here).

::whimper::

The funniest thing, I think, is that this whole costume started with a ridiculous black and pink wig that Ruthie talked me into buying. Which annoyed me so much I'm not actually wearing it.

Okay. I'm going to stop babbling and go find my boxing gloves. Wish me luck, y'all.

"Where Id was, there shall Ego be."

Freud, of course.

So, I had today off. It was actually a really nice day. I ran some errands. I had some therapy. I had my second interview for the Psychoanalytic Institute - an old, semi-retired shrink who lives out in the country (there were cows! And cute little turtles at the pond sunning themselves) and who got way too intrusive (I was there to apply for an education in analysis, not to actually undergo analysis!). And then I came home and spent a few hours creating the finishing touches for our trio of Halloween costumes. Eva, Matt and I are going to be the Ego, the Id, and the Superego.

We had a hard time coming up with an Ego costume for Eva that actually meant anything. This is what we ended up with.


Not the strictest Freudian interpretation, but...

Matt's going with the Clark Kent Superego thing. Peng's loaning him a cape, Eva's lending him her riding crop, and I'm providing this:

My costume centers around this.

And, you know, my boobs. And that goofy black and pink wig Ruthie talked me into buying. And I'm thinking of wearing my boxing gloves. Id is all about libido and aggression and all of those primal things.

It should be a good party on Saturday. And good practice staying up, for me, because I'm on night float again next week.

Fun Stuff

So it's a bit past midnight, but hell, I have four days off. Four. Days. Off. Ahhhhh.....

Ruthie kidnapped me again (well, in that she asked me, "what are you doing tonight?") and took me for dinner (and a mani/pedi while we waited - yay! It WAS right across the way, and the wait for dinner WAS awfully long...) in honor of that day that's coming up on Monday. There will be more festivizing tomorrow, don't worry.

We also wandered around looking for Halloween costumes in preparation for the costume party that Cleo and her hubby are throwing in a couple of weeks. Ruthie got a silly nurse's outfit (as I explained to the purple-haired pincushion of a punk chick that checked us out, no, it's funny because we're doctors....) and I found a ridiculous black-and-pink wig. I'm going to be the Id.

And then we dognapped Little Maxine on the way home, because Sparrow's on call tonight. She was happy to help me show off my Affair in Red Square polish job (you gotta love those O.P.I. color names...):

Pretty, huh?

Also worth a gander - Li'l Kate sent me this:



It's worth it just for the music. And the mind boggles at the shear amount of pot that must've gone into that production. Because I have a degree in biochemistry, I get protein synthesis, and that...well, that was not helpful.

Here's what Little Maxine thinks of it....

Who doesn't?

I think of this scene every single time I try to fax something at work....

Things people say

Life is like algebra: it goes on whether you understand it or not.

A quote from Allison's blog. Which apparently comes from her mom. Who is a wise woman.

My own life philosophies I've developed over the years? Sometimes life gets in the way. Sometimes the only way out is through. People occasionally suck. Sometimes when you get to the end of your rope, you just have to let go and trust that what you fall into is going to be better. People will disappoint you when you need them most, and amaze you when you least expect it. Life is like a box of chocolates.

Oh, wait, no, that last one's not mine.

Apparently, I'm very fond of "sometimes".

And if you were wondering, the title is actually a reference to this song.

I've been thinking a lot about words today, for a variety of reasons, not the least of which is a conversation I had with a colleague today about a lot of psychiatry-related esoterica.

But, for instance, I woke up this morning with a verse from this song in my head, which has in it this line: It's hard to make conversation when he's taking my breath away.

I really like that.

Actually, the first thing that was in my head this morning was something closer to this: Why are the neighbor's dogs barking? Wait...why is it so bright in here? Crap, what time is it? Awww, does that say six fif-....ugh, shit.

Hmm. Not as articulate. But as it turns out, I had left my phone, which is, of course, also my alarm clock, in the car. Helpful.

Anyhow. I digress.

So we've all started dictating lately. Because apparently this is faster than direct entry (it might be, actually). Now, some members of our class have been doing this for a while. Mike, for example, is a master dictator. Me? Not so much. I spend a lot of time saying things like, "Um....ummm....the, ah....." But what's been particularly amusing is how this all gets translated into text.

Seriously. You know that thing about how, if you set an infinite number of monkeys at an infinite number of typewriters for an infinite length of time, they would eventually produce the collected works of Shakespeare? Yeah, I'm wondering if maybe we could hire those monkeys.

We're all wondering what the heck is going on down in Transcription. They make up words, they input stuff that makes no sense, they take liberties with what we say...and it's so inconsistent. Yesterday, I was reviewing my reports, and like, they somehow understood the words "cacophony" and "cultural moree", but in that same group of reports was this sentence:

"Patient states that since that time, things have been ruff."

Wait. My patient was a dog? I totally missed that!

The mammalian theme continued today when PenguinShrink apparently had a patient who was "white as a sheep." She also had a patient who went from having Lou Gehrig's Disease to having "an LS".

I had another note regarding a patient who had some very strong things to say, and, as we often do, I included several direct quotes from the patient (in quotes. It's okay to swear in a note if it's in quotes). When I got the transcript, all of the expletives mysteriously became (INAUDIBLE).

Honest. You're not going to burst into flames if you type the word bullshit. I solemnly swear it. See? I'm not on fire.

Other amusing quotes of late, yesterday, Sparrow tells me (and I think she's right) that we may well be on the verge of World War III. Apparently, Russia thinks that Georgia brought this all on themselves. Sparrow says, "In general, it's a bad idea to invade people."

The other quote of the week? Ruthie. So, to fully understand this one, you have to understand two things. The first is that we're all supposed to be learning something called CBT, or cognitive behavioral therapy, this year. None of us are super thrilled about this. Because, among other things, it's this very formulaic kind of therapy with homework and worksheets and all that sort of stuff, but you know, it's not like we're going to know anything about the real meat of this stuff until after we've already started doing it.

The second piece of this story is our office. So Ruthie, Peng, and I are crammed into a two-person office. It's cozy, but, it's ours. Peng and I managed to find a few things for it...a nice little fridge, I had a little desk lamp, Ruthie had bought a microwave...and then, like, three weeks ago, Peng and I are on call together and hanging out in our office, and Ruthie shows up all of a sudden with a dolly full of...well...stuff. She brought a coffee pot and a grinder, another desk lamp, a bunch of random little things, a weird little black desk (that we promptly set the med student to work assembling), and this...well...there's this hot pink, cushioned, suede folding butterfly chair, and then there's this five-headed pink medusa lamp. So, basically, we have a dorm room (no really. There's even a bed...well, a camping mat...under my desk). Other words that have been applied are "bordello" and "trippy." John pointed out that he was walking down the hall and just "drawn in by the pink glow emanating from the doorway." So earlier this week, Ruthie and I were rearranging the office (all of our stuff fit just fine until we had to put, you know, Ruthie in there), and we solicited a second opinion on the layout from Tyler, and Edwina, who's one of the social workers. Tyler suggested we needed a stripper pole. Edwina suggested that we could use that as a means of teaching our patients a marketable skill. Like vocational rehab, I suggested.

So Ruthie and I passed this idea on to Peng. Who pointed out that she didn't really know how to use a stripper pole.

"Oh, no problem," Ruthie says. "Stripping is like CBT. You'll just pick it up as you go along."

I laughed my ass off. But, yeah, that was probably only funny to us, wasn't it....?

Amusing videos

Because I'm tired and slept most of the day and yet...still tired. Call was vewy, vewy quiet until about 4pm. And then...eiy.

So, here, watch these. They're funny.

This has been circulating around the hospital. It cracks us all up, because we're a university hospital that deals with a lot of little community dumbass hospitals and it's just so true.



Don't believe me? Click here. It's one of the little local hospital chains. Eerie, huh?

These are funny too. This? Was totally me in medical school:



The whole series of these Real Med Students of Genius spoofs can be found here. They're very funny. My favorites are Mr. Floor Team Avoider Guy (SO TRUE - my med students that were on for the first half of Neurology were totally like this) and Mr. Really Bad With Children Guy.

How can you not love this?

Dude. It's a big, cuddly giant neuron.

Reminds me of the time my best friend gave me syphilis and the clap for Christmas.

That was a big year.

I'm very tired. Maybe I'll muster a meaningful post tomorrow.