Minor details

Last month a local ER went to a Dragon-based dictation system that enters stuff in the chart as you type/talk, and you CANNOT undo anything. You can only dictate an addendum.

So I'm reading a note yesterday on a nice little old lady:

"When I went back into the room the patient was clearly intoxicated and verbally abusive. Her husband took off his belt and tried to hit me with it. Security was called and the husband was physically restrained, though he bit a guard in the process. The patient was put in 4-point leathers and given Haldol when she attempted to punch a nurse. Sorry, please ignore that, it's the wrong chart. Please rewrite it as: her head CT was normal, and I think she has benign positional vertigo. She and her husband were satisfied with this, and I gave her a prescription for Antivert. She'll follow-up with Dr. Grumpy next week in his office."

Attention patients:

Calling Mary "asshole bitch" for asking for your co-pay (or pretty much any reason) will not get you anything but the door.

Also, telling me "if you don't waive my co-pay I'll fire you", is not going to be taken as a threat.

Annie's desk, July 13, 2011

Annie: "Dr. Grumpy's office, this is Annie."

Ms. Whiney: "Yeah, I'm trying to get a lift chair, and the notes Dr. Grumpy furnished aren't getting it covered."

Annie: "Let me look at your chart... I don't see you having a neurological reason to have a lift chair."

Ms. Whiney: "I don't care. I want one. What's this line on the form that says 'neuromuscular disease'? Do I have one of those? Or can he at least check it off?"

Annie: "No."

Ms. Whiney: "I have migraines. Does that count as a neuromuscular disease?"

Annie: "No."

Ms. Whiney: "How about my bunions?"

Annie: "Goodbye."

Ways you don't want your body found

No matter what you did in life, it will always be overshadowed if they find you like this.

Thank you, M!

Let's hope she was adopted

Dr. Grumpy: "Have you had any surgeries?"

Mrs. Olde: "I had a hysterectomy, but I don't remember when. Susan, do you remember?"

Mrs. Olde's daughter: "I'm not sure, Mom. Was it before or after I was born?"

July 13

His name was Girard. He had back pain. That's all I remember about him.

On July 13, many years ago, he was the very first patient I ever saw on my own.

Working without a net for the first time is terrifying. I'd survived 4 years of medical school, 4 years of residency, and 1 year of fellowship to get there. This is the goal I wanted. And when it finally came it scared the crap out of me.

There was fear in medical school, starting classes and later starting clinicals, and even more in residency. But in both those cases there was always a back-up system- more senior people who actually knew what they were doing. There was also a herd-based support system: You were with plenty of other people, all sharing the same challenges.

But here, after 9 years of training, it was just me and Girard. Even though his case was simple, it's pretty damn scary to realize that YOU are the attending, and if you screw up there's no one else to blame.

I remember another patient that day started the visit by saying "I came to Humungous Neurology because I heard you guys are the most experienced." My inner voice said "you probably don't want to know this is my first day."

Throughout medical school you saw the attending physicians as omniscient giants. Suddenly you're one of them, and realize that they don't know everything. And you aren't a giant.

Like everything else, after a while it becomes routine. But trying to remember that first day still helps to keep you on your toes.

I don't remember how many patients I saw that first day. A handful compared to what I see now. One of them is still with me. I think I told her a few years later she was on my first day. I even got a hospital consult, a lady who'd obviously had a stroke. I got lost in the hospital trying to find her room, then sat in the MRI control room to see images, terrified at the thought that if they were normal I'd have no idea what was going on.

I've now spent an estimated 4,420 days of seeing patients in one place or another, with a lot more to go. But the first one was the scariest. And hopefully always will be.

To all who are starting this July, good luck.

I'd like to thank ER's Mom, who's recent post got me thinking about this.

Public Service Announcement

Attention kids: It is NOT safe to pet an alligator.

Especially if it is a stranger telling you to do so.

You're not supposed to talk to them, so WHY THE HELL would you listen when one tells you to play with a gator?

Thank you, Lee!

Lost in translation

While doing an online research survey this morning, I encountered this question, which bizarrely switches between Portuguese and English in the same sentence:

(click to enlarge)

Huh?

Dr. Grumpy: "Any major illnesses in your family?"

Mr. Mendel: "My first cousin was adopted, so I have no idea what my aunt had."

Rhyme and verse

Some days I think the staff at Local Hospital tries to invent new ways to torment me. This message was left on my voice mail last night:

"Dr. Grumpy, this is Local Hospital.

We have a consult for you
In room 722
Call me at extension 16742

First name Mel, last name Bell
He fell, and doesn't feel well
Requesting physician is Dr. Patel
When you call back, his nurse is Nell."


For doing this to me, you people can go to hell.

Dude, am I driving?

Another fine moment in alcohol use.

Memories...

In medical school I (briefly) joined a local singles group.

The only event I remember going to was a dinner party at someone's apartment.

Me and another guy (even more geeky than me, and he was quite drunk, which didn't help) were both interested in the same girl (I think she was the only pretty one there. Possibly the only female there at all).

Anyway, I won, and she ended up leaving with me to go get a drink afterwards.

A week later I discovered the geeky guy was an Internal Medicine attending. At my medical school.

And I was assigned to him for a week.

He, fortunately, either didn't remember me (he'd been pretty drunk) or was pretending not to remember me (didn't want to admit losing the girl to a med student).

Things that go BOOM!

Instead of a regular post...

With this year's July 4th fireworks behind us, here are some of the odder explosive-related news stories I've been sent.

1. A guy who tried modifying them in his kitchen.

2. A school with an explosive way of starting classes.

3. A gentlemen who, in lieu of regular fireworks, lit a military-grade explosive (not for the squeamish).

Pick-up lines from a pizza

I'd like to thank Webhill for sending in this picture from a pizza place.

(click to enlarge)