The Legally Mad Uterus and the New year

The Mad-Uterus continues to grow and this year is bound to bring to us a magic we have never known. A new Future Intern that is going to lay some new rules. She’s confident that with a little voice training she will be able to take control of this house immediately. Speed of light quick.

Right at this moment I am in an alcoholic daze on new year's eve and we’re negotiating a truce. I‘ve threatened not to let her out. Maybe I’ll get one of my surgery friends to come over and stitch up the wife’s cervix. “No way out Intern, not until you give up, I own this place”.

She agreed, but I know she lies. She lies, already. Maybe she has future as a lawyer, follow in her mother’s footsteps. She’d be a great lawyer that future Lying Intern. Hmmm, maybe a writer of fiction even.

To my future Intern:

“This is 2005, it’s MY year, you’re just part of it. Get it? You’re just gonna come in here, you’re gonna keep quiet, you’re gonna let your daddy sleep, otherwise, you know...”
“Sure daddy, whatever you want”
“You bet whatever I want” (as I smash a beer can on my forehead)

And as the alcohol wears off I come to my senses. I turn to this womb, this placenta that feeds this future great liar of mine, put my mouth up to the belly button and scream:

“You Liar”

And I could swear that as I listened intently, using a stethoscope, I could swear I heard a faint but recognizable voice from within the depths of this womb of flesh. It was a high pitched voice and it scared the stool (medical terminology) out of me. I quote:

“Tell your readers to have a wonderful new year and a happy and prosperous one to boot. Oh…and get some sleep daddy...You’ll need it”

Parody of Blog (Episode 3)- Resident Olympics

This week’s Parody includes Aint Chicken and Morning Retort, both excellent blogs that can be found in the consult section.

Tonight would be the night that Surgery will learn their lesson. Their outburst at the annual Christmas party must be addressed, we decided, even if they were pissed drunk . Medicine doesn’t like to be slapped in the face no matter how much jargon is used, no matter how funny it was. We certainly took it personally. Tonight, the first annual resident Olympics were going to be held and 3 South converted into our own Roman Coliseum. Surgery versus Medicine, they must learn that we are not to be messed with and they will learn this magnificently .

As three AM approached we changed from our white coat and into something much more deadly. We stole the wheelchairs from the rehab floor and lined them on opposite ends of this barely lit third level. A long corridor of pain and suffering was going to be transformed into a hallway of high speed colliding residents and chairs in the first ever game of wheelchair chicken. The Resident Olympics were born.

In our hearts we knew Surgery didn’t have it in them. As MorningRetort, the Surgery resident, lined up on the opposing sideline we saw how his glee had turned to fear. Even a slight glint of frustration was obvious in his worrisom face. The chairs of steel were loaded with their respective drivers and as the overhead system glared, paging resident after resident, we began pushin the first of these metal train wrecks down the corridor on a collision course with an unlucky surgery resident. A train wreck of disproportionate importance. A battle for the house.

AintChicken volunteered to be the pilot for our deadly wreck of metal. Her name made and reputation as a downright jedi of transformation made her the obvious choice. And as we pushed this cocoon to momentum previously unknown we knew that there was no turning back. We pondered all the things we never said and we knew that soon there would be relief; soon we would feel MIATA.

To be continued next week…

To have your blog featured on next week's Parody read here

This is why I NEVER CALL CONSULTS

Seems I upset a few people. hmmmm...

However, the resulting debate is heated and, may I add, quite interesting.

Some highlights:
1. It begins with an "anonymous" reader expressing how disappointed he/she is that I own an MD (I will say no more, you know what they say "If you live in a glass house...").
2. My name shortens to MHMM, soon I will be quoted everywhere as MHMM and everyone will know who it is, like "madonna", "sting".
3. And, according to Rebeldoctor, I need therapy.

but it gets very interesting after that (and long..) and you should enjoy it. Check out the consult section of previous post or go here.

Then you'll understand why I never call consults. You pick your specialist you pick your disease.

Grand Rounds 14

Grand Rounds (Fourteenth addition) is happening over at Codeblog, head on over and see the best medically related posts of the week.

Don't forget the Parody of Blog this thursday right here at the Mad House.

You Suck!

When physicians get sued after all they’ve sacrificed it’s just a horrible slap in the face. It degrades us, makes us feel worthless and makes everything we’ve worked to achieve seem unappreciated. If you could do a better job, you should do it yourself! People die, sometimes early, sometimes, no matter what we do. Accept it.

But here is something I recently discovered after speaking to my patients this month. Patients believe this shit. They really believe it. The lawyers have won and you know who’s to blame, we are.

Us “doctors” who have been so nice as to not speak up, instead, we’ve had our heads in our asses, quite frankly. My father puts it best “they were spitting in your face and you denied and said it was raining”.

It began with HMO’s screwing us because they want to get their bottom line up and our payments down. Now we can’t see a patient for longer than 10 minutes and we get paid less than we ever did. Furthermore, we’re the ones they sue when something goes wrong not the insurance companies. We were nice and felt bad for the patients, who really are just stuck in the middle of all this. Yep, “nice”. Were the lawyers nice? Were the insurance companies?

Now, we’re getting sued because lawyers need to make a living. We again stood by as they did a fantastic job of selling this to the general public. Believe me, it’s sold! Are you going into medicine? Expect to get sued. Lawyers win.

Personally, I’ve had enough. You patients suck. I know you believe this shit and, unfortunately, I don’t think you’re worth it any longer. From here on in my primary goal is to protect myself. Even, if it’s at a cost to your health, time and energy.

Deal with it.

23,000 Dead. Please Help

Send online donations to the International Committee of the Red Cross here, and donate to Care International here.

Update: Some more choices for giving. The American Red Cross has an International Response Fund, which includes aid for tsunami victims:

"You can help those affected by the recent tsunamis in South Asia, the humanitarian crisis in Sudan and Chad, and countless other crises around the world each year by making a financial gift to the American Red Cross." Donate here. (Select International Response Fund from the menu.)

Also, the Canadian Red Cross has sent out an urgent appeal for cash donations for victims of flooding in Asia. Donate here (Select "South East Asia Tidal wave and Earthquake" from the menu).

Another update! Hugh Hewitt has recommended World Vision for excellent disaster relief for tsunami victims. I make no claims about any of these organizations, but I'd just like to do something...

Hat tip to Shrinkette for the post

Death Defeated

“She was ninety four but she was in perfect health, the doctor at the hospital gave her the wrong medication”
“missed the diagnosis”
“forgot to order this test”
“didn’t know what he was doing”
“gave too much morphine”.


News Flash: You heard it here first.

DEATH HAS BEEN DEFEATED. THE MAD HOUSE MAD MAN KILLS DEATH, NO ONE WILL EVER DIE AGAIN.

Have you heard the latest news? Through the almost instantaneous nature of Blogs I get to beat out the New England journal and be the first to report this. Get ready. People will no longer die, death has been Defeated.

With the tremendous media coverage of the Vioxx and Celebrex scandals I am astounded that no one has reported the scoop. I am proud to be the first to bring you this discovery. In fact, if anyone you know ever dies again I can with 100% certainty say that someone screwed up. It was probably the doctor. Maybe it was the nurse. Possibly even a number of screw ups. Because no one is expected to die any longer, especially not anyone you know.

Regardless of the disease, sorry, that’s not what did it. You see that poor guy with the white coat over there. Yeah that one who’s been here all night, slaved over books his whole life, hasn’t seen his family in a few days all to help your sorry ass. Well, you better watch out for him because he has it out for you.

Yep, it’s his fault!

Mad House Santa

I confess my complete lack of knowledge about this most overwhelming of holidays. Unfortunate, but once circumcised my ultimate role on Christmas was decided and will likely forever be “coverage”. Thus today I was called to cover the CCU, AGAIN.

I was proud of myself, though, for taking the time to self educate and relieve some of my ignorance. Here is what I found out about Santa. Thought I’d share:

In Greek, St. Nicholas is known as Hagios Nikolaos, Bishop of Myra (in the present day Turkey),
St Nicholas reportedly died about 350 AD.
Today, this mythical character is still alive and well and is known all over the world as: Nicholas of Myra, Santa Claus or "Santa" in America.

His fame spread rapidly during the Middle Ages and thousands of churches are dedicated to him.

He has been the patron saint of Russia, Moscow, Greece, children, sailors, prisoners, bakers, pawnbrokers, shopkeepers and wolves.

His gift-giving role in Christmas rites probably follows from his fame as the friend of children. The story also tells that he used to give anonymous donations of gold coins to persons in need.

His cult spread in Europe and Christmas presents were distributed on December 6th when the celebration of St. Nicholas took place.

In many countries this day is still the day of Christmas gift-giving, although there is a mounting pressure everywhere to conform to the custom of 24th/25th December.

The relics of St.Nicholas are in the basilica of St. Nicola, in Bari, Italy (they were stolen from Myra in 1087 AD). For this reason he is sometimes known as St.Nicholas of Bari.

In the United States and Canada, his name is Santa Claus.

In China, he is called Shengdan Laoren.

In England, his name is Father Christmas , where he has a longer coat and a longer beard.

In France, he's known as Pere Noel.

In Germany, children get presents from Christindl, the Christ Child.

Customs of the Christmas Season in Spanish speaking countries have many similarities, and many variations. All of Latin America and Spain are predominantly Catholic. For many of these countries Baby Jesus, el Niño Jesus, brings gifts for children.

In Costa Rica, Colombia, and parts of Mexico, the gift bearer is el Niño Jesus, "the infant Jesus."

In Brazil and Peru, he's called Papa Noel.

I even managed to memorize some of that wonderful poem that made old St. Nick the man we know and love today.

Please spend this time with the ones you truly love.

Merry Christmas,
Sincerely,
Mad House Madman.

Parody of Blog (Episode 2)

(The two web sites featured this week are Ad Nauseum and the Anonymous Clerk. Both can be found in the consult section of this blog)

A healthy young woman found comatose on a main avenue sidewalk. Onlookers pass by as if this specimen is not of their race, not to their liking. AdNauseum was raised off the cold pavement by a caring Emergency Technician who was called to perform this duty but carried it out whole-heartedly as he knew this soul was in need of help. The stench that emanated from the overused clothing was both worrisome and nauseating and as she entered this mad place disapproval was present.

I know these patients need my help, but more often than not, they refuse it. Being on the receiving end of medicine is often not as thrilling as we’d like to pretend. No matter how nicely we dress it up .

When we arrived at the ER we found her in the company of a student. This lone Anonymous Clerk (*Student) is often the only aids eager to help. More often than not, they are also the only ones who know what is going on .

This young man, a single medical student fending for himself in this Mad House stood before us. He was instructed to find the urethra and insert a foley. Usually, this should be done by nurses but due to the nature of this pungent specimen they sent the poor med student. Sometimes the staff can be such asses .

It is only after being in the house for a long time and seeing these cases repeatedly that one realizes how unfortunate the whole thing is. How unfortunate for them for going through this, how unfortunate for us for witnessing. How unfortunate for everyone locked in their role, attending this house, this shift. Everyone trapped in their own Homonculus .

To submit your blog for participation in future Parodies, read here

This “May” Be Consistent With My Therapy

A sad memory. He dies.

As I write this I cry. Honestly.

It has been a very rough week. First day on service and on call at the same time, had 2 patients on the floor crashing while trying to admit eight more, figure out the patients I am suddenly managing and teaching two relatively new interns how to do anything. Left very late at night and presented my patients to the Chief of Medicine in the morning. Who made me look like shit in front of everyone. The week went downhill from there. After this afternoon, I am broken.

On my first night I admitted a poor (very poor) fifty something y/o man. He had no medical history, because he never goes to doctors, because he can’t afford it and has no insurance. He had some "smudge" on his x-ray way up on the top left side of his lungs. To quote the radiology resident’s preliminary report this smudge “may be consistent with cancer”. “May be consistent with cancer” as a Ferrari “may be consistent with an expensive car”.

It was cancer, it was horrible cancer, it was inoperable horrible cancer, and it’s the angel of death on an x-ray.

In today’s medical world radiologists, and just about everyone else, covers their butt by using words like “may be consistent with” or “cannot exclude”. This x-ray should have been dictated the way it was dictated back in the 50’s: “C.A.N.C.E.R.!!!!CANCERCANCERCANCERCANCER!!!!!”

I think in a way that it would be more humane and honest!

Before I left I had to tell his wife that we need a biopsy to check if this could be cancer. I was lying because I know it is. We have to confirm it anyway. She cried. She has no one else in this world. She has no money, they don’t have a real place to live, she barely gets by with him and now she will have to get by without him. I nearly broke down in tears right in front of her and had to leave the room as fast as possible. I locked myself in the on call room and cried. I’m still crying.

My message to the tobacco industry and the great CEO’s of the past (and present) who found ways to play with people’s brains and make them believe they were somehow better for smoking: Thank you very much for your wonderful gift. So many people dead, dying. So many residents crying, so many wives watching their world crash around them. Thank you so very much. I hope one day you’ll have something that would be “consistent with a conscience”. Maybe we should tattoo it on your forehead, but only the way they used to do it:

“KILLERMURDERERKILLERMURDERER”

License to Pry

(Rated R)




“So how come you came to the clinic today Mr. Johnson” I said in my innocent, non-judgmental tone of voice, as this young man settled into the seat.

“No real reason, just for a regular checkup and..stuff”.

His eyes fixed on a corner of the room where he wished he could roll up like a ball and hide from my gaze. “And stuff”, I’ve come to realize, is the male codeword for sexual “stuff”. I continued.

“Is there anything that concerns you?”

“No. not REALLY”. He attempted to deliver the cryptic message he so wanted to tell.

“Well, is there anything you want to discuss? Is everything all right in your life? At home? At work? Or...In the bedroom?” I attempted to coax my patient into telling me the secret I already knew.

“Well, now that you mention it doc, I’ve been having trouble in the bedroom”. Aha.

Occasionally my license to pry gets me in trouble. This was one of those “occasions”.

“You see when I see my girlfriend and I Wanna rip her clothes off and FUCK the CRAP out of her but then we GET-IT-ON and WE FUCKIN and then I finish too quick..you know”.

“You mean that when you have INTERCOURSE you think that you reach ORGASM too fast?” I was Attempting to both set the tone and um, vocabulary, for the remainder of this interview.

The two hardest things to handle in life are failure and success, this was the former. He continued.

“You know once we get goin, and uh”, gyrating his pelvis in a manner reminiscent of bad 80’s porn (not that I would know), “we goin and goin, and she like tell me like, hold it, and I’m like, I can’t baby”.

Watching him, I was reminded of a time when life still seemed so simple, and his attempts at non-verbal communication had brought back memories of why I still pay for a broadband connection month after month. He was, after all, attempting to bond with me in that macho male sort of way. I felt for him.

He continued his pelvic dance as I reached for my prescription pad in panic to find the latest SSRI we have on formulary. I felt this interview needed to come to its unfortunate and quick demise. After finding this medication I needed to explain the effects he should expect.

I found that our difference in terminology was interfering with his complete appreciation of this magical remedy. He was after all a young man in whom I recognized the special features of another’s, more personal, adolescence. I felt sad that I would have to watch him leave unsure of his own virility.

Suddenly, the boy who was raised in Brooklyn, and still resides somewhere within me, took it upon himself to make a cameo appearance in order to bring clarity to his confusion.

“What I’s sayin is that you gonna be able to fuck her for longer, you get it?”

Yo!

Grand Rounds

This week Code Blue blog has the honors of hosting the weekly Grand Rounds, a round up of the best medical related posts of the week.

Deception

“Well, what do you think is wrong with you?”

“I don’t know doc”

“Well, you say that you get upset because you drink too much. That your marriage is in ruins because of it and that you can’t function every day, right?”

“Well, yes”

“So what’s your impression of what’s happening?”

“Maybe, I drink too much”

“Why do you drink?”

“Well…When I drink there’s this feeling that comes over me, this release. I’m not the same person; I’m happier, more easygoing and more fun. I really love that person, that me who drinks.”

“Sounds like fun. Why in the world would you want to stop?”

“I’m not sure that I do”, “Do you think that my problems with my family and my job come from my drinking?”

“Sounds like it does”

“But I love drinking”

“Then you should keep doing it”

“But it’s destroying my life”

“That’s also true. There are consequences to everything. Are you ready to stop drinking?”

Long pause.

“No”

The easiest person to deceive is one’s own self
Edward Bulwer-Lytton, writer

My Future Intern (Part 1)

My Future Intern knows heart sounds. I taught her overnight as we both lay there, two insomniacs, in a state of pure, brilliant ecstasy. We converse now through an outwardly protruding umbilicus. She tells me of all the wonderful things she learned and I advise her on their meaning. Her thirst for medical knowledge astounds me. If only she had room to read her own books, once again, I’m reminded of her limited real estate. She informs me of things she has planed and I laugh. How she will have to catch up on her own blog, because internet access in not currently available in her area. But there will be time for that and she will have her chance to outdo her father.

Thus far, we’ve covered heart sounds, lung sounds and even body parts. Soon, we’ll get to the really difficult topics like how to give bad news and all the other stuff they never teach you.

Every so often when I can’t fall asleep I will touch this growing mass of life and wonder whom leys within. Our future is in that tummy. It will be our responsibility that this Intern should know how to tap veins, place IV’s and do all the procedures a good intern should know.

In my imagination this future Intern is practicing breast exams, reading Harrison’s and learning Anatomy. She is taking the opportunity to experience life from within, life via placenta, a special opportunity that only special Future Interns like her will remember. This experience may bias her towards a future in gynecology and obstetrics and I will have to caution her against this. She will have to listen and she will have to learn just like a good student does. She will be my Intern and I can be her Resident.

In her seventh month of training now and she is steadily improving. She can do physicals, take histories, do neurological exams and form her own second opinion. In her womb she is Attending, better yet, she is the Chief of Medicine. My future Intern is training there, in her womb, and her papa is training in this crazy world she will soon call home.

Parody of Blog- (Where Blogs come to Life) Episode 1

“There are lies, Damn Lies and Statistics” I said, smiling at the attractive pharmaceutical agent, Alexa, as she made her best attempt to persuade us that we should prescribe more Vioxx. Blogborygmy, our *Sub-I, asked if they were thinking about taking the drug off the market. He overheard DB and the *COMMISH speaking about the latest research that the drug increases cardiac complications. “Cardiac complications? No waaayyyyl, look at these charts” she said as she bent forward, revealing a small morsel of her delicious bottom. Our morning began well and the team was in good spirits.

My entourage grows daily now. Our two students, RealSpace and Cerebral do a very good job. Although Cerebral is always in the bathroom on account of that constipation, he still somehow manages to get all the blood draws done. The Sub-I keeps us updated about who’s doing this week’s Grand Rounds and stuff. We never get to go because our Attending Charles continues to chat away about some transsexual from the office and wastes our precious hours rounding. Whatever man, I got rectals to do! This morning are especially brutal as he started going on and on about some med student he’s teaching in clinic. It’s a med-student man, get over it.

Our daily war with the Surgeons and the nurses continues. When CutToCure caught a glimpse of us during rounds he began running in the other direction. Probably didn’t want our consults. We heard last night he was up pretty late with some nincompoop who he operated on last year. Oh well, compassion only goes so far in the Mad House and we scurried down the hallway hot on his trail. He ran to the basement towards the linen closet. On our way there we stopped in to see what the FUG girls were trying to promote as “the new white coat”. Actually, it was a rainbow colored design by some guy named Louie Vuitton. Seems the French are sticking their noses in our hospital fashion now. We found CutToCure and punished him by asking him about some basic cardiac murmurs. He said “I’m a surgeon man, all I need to know is that the heart is still beating”. Blasphemy!

The nurses give everyone a hard time, especially that HeadNurse. The other day she nearly cursed out RebelDoctor and called him a “Shrink, voodoo maker, nutso bag James Dean…What’s with all that Grease on your hair doc”. Her voice was loud and intimidating (That sleep apnea is really taking its toll on her and she is much more agitated during the day). We had to restrain her with some Haldol and called the Copper for Security, because you know these nurses are nuts. On second thought, a Doctor walking around with leather coat looking like James Dean? Someone should definitely remind the good doctor that this is a hospital.

To top things off, Observer, our favorite patient codes early in the morning. In the rage of machinery and flying syringes that follows we pound his chest with fury and stick lines in every orifice we find. All the alarms, blood, flesh and tears really got my blood flowing and as he came back to life, and immediately demanded breakfast, I headed upstairs, back to the conference room, to find Alexa. I hope there’s a free call room somewhere.

And all before 9 AM.

Welcome to the Mad House.

(To Participate in future Parodies read here)

Grand Rounds

A whole bunch of links coming your way today.

This week's Grand Round are hosted by Dr. Emer, a physician based in the Phillipines, on his site Parallel Universes.

Tomorrow, check out the Carnival of the Vanities at The Pryhills.

Thursday, tune in here for the first ever Parody of Blogs. As blogs come to life in the Medical Mad House.

Congratulations to CodeblueBlog on his award as the best blog in his category. He certainly deserves it.

Shameless Self Promotion

(Express your fury in the consults section. Or your agreement, although, I highly doubt it)

After four years of college, one year of a masters, four years of medical school and two years of residency, I am tired.

This year, I competed for a gastroenterology (GI) fellowship. After many hours of work on applications, personal statements and waiting, I have gotten absolutely no invitations for interviews. The time has come to accept the inevitable; GI is not in my future.
Now, the more difficult question, what do I want to do with the rest of my life?

I never really expected that it would come to this. Throughout medical school I assisted in a lot of research and worked in many different GI clinics. The thought of trying something else never really occurred to me. For a while I had an affair with Cardiology but that affair has fizzled and I am left widowed, without a future and without motivation.

General Practice is the next obvious choice. I enjoy people and also enjoy weekends off. Obviously, I’ll have to learn how to inject steroids into joints and maybe even some Pediatrics. But I will survive. I will thrive.

In a year or so I will change the name of this blog to “Chronicles of a Corrupt Medical Madman”. A meeting will be arranged with all my future consulting physicians and I will hold an auction to see who can give back the largest “kick-backs”. Beautiful young female pharmaceutical agents will enter every other day, each with their daily offering of pens, lunches and vacations. I will enjoy them all, I will prescribe them all and I will take whatever this system has to offer.

After twelve years of work and one large disappointment, am I not entitled?

Bobby McFerrin

As I write this, the song “Don’t Worry, Be Happy” by Bobby McFerrin plays in my head. I’ll start you off “Here’s a little song I wrote, you might want to sing it note for note…” (include the whisteling parts)

Today I had to take a day off my busy clinic schedule to cross cover the CCU for a friend who was too busy to cross cover his own coverage. A 67 y/o man (Mr. Shock) was brought into the CCU, awake, alert, on a gurney and in stable ventricular tachycardia. Usually, this arrhythmia can be managed with medication if the patient is stable. However, if the patient becomes unstable then we must defibrillate (ie: shock him). At that time the patient can either revert to normal sinus rhythm or die.

Fortunately, he was stable for a while. Then, slowly his BP began to drop 120/…110/…100/…90..80. So we had to defibrillate.

Me: Listen Mr. Shock you’re blood pressure is slowly beginning to drop, we have to shock you. We’re just going to give you this medication to make you a little drowsy first, ok?

Mr. Shock: Sure Doctor, do you think it’ll be ok?

(Nurse beside me beginning to panic and realizes we may soon have a code on our hands)

Me: Well, most probably it’ll be ok. (Sympathetic tone of voice) You know we have to do this now.

That’s when the defibrillator entered the room. The nurse yelled outside the door to another nurse to bring the crash cart…the “CRASH” cart.

Mr. Shock (tears forming in eyes): Doc, are you sure things will be ok?

Respiratory therapist entered the room as she informed me, quite loudly, that she “IS READY TO I.N.T.U.B.A.T.E. IF NEEDED”, Did you hear that Mr. Shock. Oh no?…let me repeat.

Me: I hope so.

The sound of latex gloves slapping flesh could be heard throughout. As everyone around begins to suit up…for a code.

The song continues..“Your landlord says you rent is late, he may have to litigate, so don’t worry…”

Parody of Blog-“Where Blogs come to Life”

The Parody of Blog is a short story meant to showcase interesting blogs. The blog may take on a certain character in the story itself or links will be included that are relevant to the short story. All writers are encouraged to submit their blogs and I will do my best to include what I believe reflects your best writing. The rules are simple:

1. If you would like to be included please email me at Madhousemadman *at* gmail *dot* com.
2. All of your posts are up for consideration and I may include only those I wish to include.

The Parody of Blog will appear here intermittently on Thursdays.

p.s. Non-medicine blogs are encouraged to participate

Reader Response 1

(Below is an email sent to me by a thoughtful reader in response to a previous post)

"Sometimes it happens that you fuck up.

Sometimes it happens that they die, either because of or in spite of you.

Sometimes it happens that you can't save every one, or fix everything, or even make a single person feel much better.

Sometimes it happens that you have to give 'em bad news.

All you can do in those cases is remember that your white coat isn't a cage. It's not armor, either. It's a symbol of the fact that you're a human being who just happens to know more about some specific group of things than other human beings, and that you're muddling through doing the best you can with that knowledge.

So you have to take your own pulse first during a code. Big deal. You still know more about codes, presumably, than the person who's coding. Your simply being there helps. Muddle through if you have to, but remember that bit, okay?

Be easy on yourself, doc."

Sleep well. Jo

Thanks Jo, very well written.

Grand Rounds 11- Psychiatric Delirium

(Fiction- Part 3)- Here for part 1 and 2.

We were unable to find Codeblue. That guy is never where he should be. We think he has a drinking problem but nobody wants to tell him. At least his Rosacea makes us suspicious. Regardless, it looks like we were on our own with this mystery. Psychiatry was our only lead.

If we’d be able to somehow persuade the shrinks to spill the beans all this would be over. What happened in that room? What happened in Risk Management? The cloud of mystery had to be lifted so that life in the Mad House could return to normal. During another meeting we engineered a plan.

The plan was simple, yet powerfully persuasive. Every resident in the house was told what to do. The instructions were crystal clear and even simple enough so that the Surgery residents couldn’t screw it up. For good measure, we questioned them thoroughly to make sure they had it straight. Things got ugly when the Surgeons accused the Medicine residents of being lazy and we had to whip out an EKG and watch them run for cover.

I headed back to the clinic to work on the fine details. On my way there I ran across DB who requested that I review some of my observations. DB is one of the Attendings I normally trust, however, he was recently indicted by the DEA for some “missing” pain medication and since then he’s never been the same. After he was seen at the Emergency Department last month with questionable painful “muscle spasms” I began to have my reservations about how much he could be trusted. The plan occupied my mind and so I cut our meeting short.

Here was our plan: All Residents would call a consult for a “change of mental status” in patients clearly suffering from delirium (change in mental status due to organic cause). The consult was ridiculous and we knew it. It was wasted paper and wasted hours of writing. But if Psych was to learn their lesson it had to be done. They would soon learn that everyone, even Psych Attendings, are at the mercy of the House Staff.

One by one all our old ladies with UTI’s were evaluated for their “change”. Shrinkette must have seen twenty consults that day only to consistently write “Rule out delirium”.
We would refuse to rule out delirium (since we knew it was) and we would call the same consult the following day. Once again, we refused to rule out delirium!

It was only a matter of time until Psychiatry would break.

Our luck struck on the fifty second hour. Intueri, the other psych consult, was the first to break. On day three, after seeing her 14th “Rule out delirium” of the day, and her 67th in the last three, she collapsed on the floor. All that could be heard from the wreckage was the whisper: “January 11th, January 11th, January 11th”.

It makes sense now. 1.1.1. is a date (January 11th). Well at least we only have to figure out what does “Big Circle” mean?


In the meantime, check out this week’s Grand Rounds at The Exam Room of Dr. Charles. Charles does everything well, I doubt this will be an exception.

P.S. Dear Readers, I apoliogize for these horrific fictional posts. OK, here's where I throw in the towel. I was trying to promote the upcoming grand rounds coming to the Mad House on January 11th..get it "Big Circle". Oh well, upon further consideration and much ?????? from fellow visitors who crought me back to my senses. I will cease now. no more fictional posts. Who likes fiction anyways

So Am I

How did this happen? Were people always this depressed? Was I just too ignorant to notice? Is it just that it’s more acceptable to be depressed now? Why is everyone divorcing? Is it television? Is it expectations? Who gave you these expectations? Who lied to you?

Why does everyone expect so much from life? Every commercial says you “deserve” this and that, who says so? Why are you doing this to me? What, I’m just a sponge for your marketing? Is that all my life is worth whatever is in my pocket? What has become of my life, trapped in this call room? What have you done to my patients?

I don’t care what J-Lo’s house looks like or how much Puff Daddy parties? How does he have so much money? Where is this money coming from? How come he has that house and I’m stuck in this stinking call room trying to pay back student loans? Is this a sad joke? Have we gone mad? What the hell is going on here? Shut off this stupid television box that poisons my mind.

My patients came here with a promise of great fortune and then got depressed when they find they can’t make ends meat?

YOU WILL NOT MAKE MILLIONS HERE, IT'S A LIE, A MYTH. DON”T COME HERE, STAY HOME. YOU WILL BE HAPPIER!!!

I Promise.

Everyone HERE is depressed. Rightfully.

So Am I

Carpal Tunnel

It is true that personal experience is the weakest form of evidence. However, after a few days of clinic work let me fill you in on some of my observations:

About Others:

Everyone is on Disability. Furthermore, usually for diseases which don’t preclude a person from continuing to work. This requires that physicians sign their SSI forms.

Apparently, there are physicians who will sign these even though they know the individual can continue working.

Everyone is depressed. “Unhappy” is no longer used. “Depressed” is the new IN term. (Readers will recognize this as a topic of this essay, previously posted here)

Everybody believes that they have a certain condition because someone (most likely a physician) gave them the wrong medication once and they were never the same again.

Apparently taking three pills every day to keep yourself alive for an extra ten years is not convenient. Some would like to go back to the days when we used to do a lobotomy to treat hypertension.

About Myself:

I have a certain amount of Attention Deficit. Not enough to qualify for a disorder but attention deficit nonetheless.

I am happy with a certain degree of attention deficit. It keeps me from becoming depressed, stopping work and collecting disability.

If a patient complains of something that I am unfamiliar with I am likely to think they are lying. I have no idea why and what that says about me, yet.

Lobotomies were ineffective for hypertension but very effective for creating stupid people who believed the craniotomies were effective.

After five hours of clinic I no longer care- unfortunately.

I must force myself to take a break after five hours of clinic.

As much as I believe I’d like to work in academic medicine for the rest of my life I am only fooling myself. I like the clinic so much more.

After Residency I am collecting disability. I just have to find a physician who will sign this form, any volunteers?

The Promised Land

(am·bu·la·to·ry, Pronunciation: 'am-by&-l&-"tOr-E, a : able to walk about and not bedridden b : performed on or involving an ambulatory patient or an outpatient)

The morning has come and the sun has risen. Free at last. The shackles of my CCU are only a distant memory from my ambulatory block exam room, shall we call it “The Exam Room of the Madman, M.D.” (What do you think Charles?).

Nothing brings more joy to my life than the beginning of a good ambulatory block month (unclear as to what that says about me). This means, that instead of pacing the halls of the Mad House whiffing the wonderful aroma of feces in diapers (a.k.a. “Odeur de résidence”) I get to talk to wonderful little old ladies and treat their perfectly harmless urge incontinence and gossip about life.

Gossip, oh how I love thee.

If you could see me now. My smile is a canyon and my dimples are beginning to show, I am soooo cute when I smile (did I ever tell you that). Tonight, I will be home at a normal time. We’ll enjoy a normal dinner. Maybe even a good movie. Although, last time I checked, they weren’t making any of those any more.

(p.s. The sunrise pictured above is the sunrise over my most favorite city. does anyone recognize it?)

Carnival of the Vanities

Check out this week's Carnival of the Vanities. It's full of interesting posts, most even non-medical. I didn't know those existed ;-}