Monday, October 31, 2011

Halloween...

In short, it's Halloween, I gots stuff to do...

Sunday, October 30, 2011

Friday, October 28, 2011

Birther...

Me:  "Which family member do you want me to talk to about your condition?"

Patient:  "I have two sons, one is adopted, one is from my birth canal.  Talk to the birth canal one."

#I'lllethimshowerfirst

Thursday, October 27, 2011

Quick fix...

Mr. Non-Compliant:  "I need you to fill out my OSHA forms so I can drive a truck for my company."

Me:  "Sir, your average blood sugar has been over 300 for the past six months.  Your hemoglobin A1C is 18%."

Mr. Non-Compliant:  "So, I'll start taking my meds again and I'll come back next week to have you sign it then."

Me:  "Your OSHA form requires your A1C to be 7% or less, that will take roughly three years to accomplish safely."

Mr. Non-Compliant:  "Three years!  But I'm supposed to start next week!"

#lackofplanningonyourpart...

Wednesday, October 26, 2011

After lunch...

Me:  "Ok, everything looks good so I'm going to go out and write your discharge orders so we can get you out of here today."

Patient:  "Not until after lunch!"

Me:  "Umm, ok...I'll let you finish your lunch but the discharge paperwork will take awhile anyway, so you have time to finish your tray." *points to half-eaten tray in front of her*

Patient:  "Oh, I've been done with that for thirty minutes, you can take it."

Me:  "..."

#youhaveasecondlunchcoming?

Tuesday, October 25, 2011

I know, I know...

No one wants to be thought stupid or ignorant, doctors get that.  However, when a non-medical person is asking questions of us, we often leave things intentionally vague because you'd need years of training to even understand our answer (I'm not joking).  Another of my pet peeves is when you get the person who wants answers, but already seems to know everything.

Family:  "So how will you be certain that the pneumonia is gone?"

Me:  "Well, the pneumonia is not gone, but I am sending him home with enough antibiotics to finish out his course of treatment."

Family:  "I know that, but how will you be sure it's gone?"

Me:  "We'll have him follow up with his primary care physician next week for a re-check."

Family:  "I know that, but will you come out the house and re-check him?"

Me:  "Uhh...no, I will not be coming out to your house to check up on him."

Family:  "I know that, but who will be coming out to check on him."

Me:  "No one will be coming out to your house."

Family:  "I know that, but..."

Me (interrupting):  "Please stop saying that."

Family:  "I know that, but..."

#thiswentonfortenminutes

Monday, October 24, 2011

Free MRIs!

Patient:  "I want another MRI of my back."

Me:  "Sir, you just had an MRI last week and it was negative.  I can't order you a $5000 test every time you want one."

Patient:  "But I woke up with the left side hurting today and the right side was the one hurting before.  Besides, it should be free.  I have insurance."

Me:  *sigh*

#threatentosuemenext,thatwilltopthisoffnicely

Sunday, October 23, 2011

Saturday, October 22, 2011

Inconceivable...

Headed to the pumpkin patch and cycling today so quick post.

102 year-old patient:  "I just don't have any energy anymore.  I can't figure out why that is."

#I'llcheckyourbatteries

Friday, October 21, 2011

Moonlighting blues...

I moonlight in clinics on my off weeks to help pay down debt. The doctors I fill in for are often way too coddling of their patients for my tastes. A few of them will give into any demand. In my opinion this transforms you from a physician to a prescription-writing automaton. You aren't there to be their friend, you are there to do the right thing for them, despite their objections. You can be nice about it, but stand by your training and your knowledge. That's your job. Also, it's not a fever unless it's 100.5 or greater. I don't care if you "run low," that's the cutoff.

Patient: "I've been running a low-grade fever."

Me: "What was your temperature?"

Patient: "98.8."

Me (later in same conversation): "Ok, well this seems viral to me. I think with a few days of Tylenol and rest it will pass."

Patient: "You aren't going to give me an antibiotic?"

Me: "No, it's a viral illness and you have only had symptoms for two hours."

Patient: "Well, I will just wait until my regular doctor comes back and have her give me one. I can't believe they can't find a good doctor to fill in for her."

#Ican'teither

Thursday, October 20, 2011

Write it out...

One of the time-consuming tasks we were saddled with as interns was the discharge paperwork from the hospital.  Our usual routine was to see whose turn it was, go talk to the patient to see what prescriptions they needed refills on and write them all out.  To save time, I would write two or three different prescriptions on a single script and give it to the patient.  One afternoon, I was talking to an elderly woman with an enormous amount of medical problems.  As per routine, I asked her which meds she was out of at home, to which she replied, "All of them."  I groaned as I looked down and saw a grand total of 45 meds on her home medicine form.  I grudgingly stepped out to write the scripts and came back some time later with the scripts in hand, somewhere around 15 in total.  As I handed them to her, she stopped me and said, "Young man, these won't work.  The pharmacy won't take them without them being separated out."  I assured her that was not the case, but she wouldn't listen and I was forced to write them out individually.  Another 45 minutes to an hour later, I returned, scripts in hand.  The woman smiled as she took them and said, "Thank you, that looks much better."  I smiled at her as she took them and turned to leave.  As I reached the door she called out, "Now, if you could just call these into Walgreens, that would be great."

#causeofdeath:strangulation

Wednesday, October 19, 2011

Juan...

This is going to be a serious post, so turn away now if you want.

For the vast majority of my life I considered myself fairly lazy, as I'm sure most Americans would if they took a truly honest look at themselves.  It wasn't that I wasn't taught the values of hard work growing up, my own arrogance just naturally assumed that it didn't apply to me and I was able to get around most work simply because I was smarter than most (see above for "arrogance").  One would think that I would have taken med school seriously, though because...after all, I'm dealing with people's lives here.  One would be wrong, however. For me, med school was something to do while I continued what I considered my life:  chasing women and going out with friends, things all twenty year-olds who didn't jump straight into marriage could relate to.  I studied minimally and passed tests, oddly retaining info with a few readings that others only managed to get by studying it for weeks.  I did not ace tests, I performed well enough to continue and that was enough for me at the time.  I still learned medicine, for the most part.  I continued this pattern into residency, partying with my fellow residents, getting a few hours of sleep, heading to work.  This continued until I was almost done with my third year, when suddenly everything changed.

Juan Camero (yes, it's his real name.  I do not think he will mind.) was a year below me in residency.  He was medically brilliant, socially luminous, and fluent in several languages.  He was also one of my favorite people in the world.  He brought a light to any gathering that cannot be described.

This is the last picture ever taken of Juan:


This occurred on March 10, three months before I was set to graduate from residency.  I was crushed, as were most of my fellow residents.  This is the point, in my mind, at which I became a real doctor.  Something snapped when he died.  I became horribly critical of myself and my own behavior.  To me, it was unfair that someone this gifted, this brilliant, someone who loved life as much as he did to be taken away and be robbed of the chance to be the amazing physician that he would have been.  That he was taken and I was still here was cruel.  It was the second time in my life I have offered God to take me instead of someone.  If he was listening, he ignored my request or maybe he just doesn't work that way.  It was at that point that I changed how I approached medicine.  I volunteered to take Juan's preceptor positions in the coming months and began studying all the things I had neglected over the past seven years and made myself into a better, if not an ideal physician.  

The problem with death is not that it occurs, it's that it leaves unanswered questions.  Conversations you should have had go unspoken.  The biggest question of all is not "Why?" but something a girl he was dating at the time said to me as she exited my car after the funeral.  As she shut the door, she leaned back into the car and said to me, "You know, he was very jealous of you."  For the life of me, I cannot think of why.  If I somehow see him again, that will be the first question I ask him.

Would he have been a better doctor than me?  I don't know.  My wish for Christmas this year was the Rosetta Stone Spanish tapes.  It's a start to becoming the doctor he should have been.

There is an alternate possibility to the offer I made earlier.  Perhaps God makes the offer to return in exchange for someone to those who have died...and perhaps they say "No."

#R.I.P. Oldfriend.

Tuesday, October 18, 2011

Monday, 10 a.m...

Patient: "I'd like an appointment with Dr. On-Vacation, please."

Receptionist: "He won't be back in until Wednesday, but we have another visiting doctor who can see you."

Patient: "Wednesday! I can't wait that long for him to get back. I'll just go see my other doctor on Thursday."

#impeccablelogic

Monday, October 17, 2011

Coming off night call...

Forgot to post before leaving the house, quick post today.

Non-compliant patient: "Where's my regular doctor?"

Me: "He's on vacation this week."

Non-compliant patient: "I don't think doctors should be allowed to take vacation?"

Me: "Why does it matter who you see when you don't do what they tell you to anyway?"

#Ihadbeenworkingnightsandwascrabby

Sunday, October 16, 2011

Wicked Sunday...

I've developed a theory about music that simply goes like this...If you have to repeat your own name in your songs multiple times, there is no chance that you will ever produce anything musically memorable.  For examples of this, please listen to Jason Derulo or Nicki Minaj.  I have a feeling that, in ten years, most of us won't be able to hum a line from any of their songs.  It's tripe.  Stop listening to it.

On the other hand, I heard this song on the radio yesterday and knew it was a song I'd know and love for the rest of my life.  It's also one of the sexiest music videos of all time.

Saturday, October 15, 2011

Afford this!

Patient:  "I haven't been taking that medication my regular doctor prescribed; it's too expensive."

Me:  "Okay, well I'm sure we can find some...."

*Jay-Z ringtone blares from purse*

Patient:  "One sec, let me get that.  It's probably my husband."

*pulls iPhone from purse*

Patient:  "Hey, let me call you back in a minute, I'm at the doctor. Oh, okay...well don't forget the lottery tickets."

Me:  *sigh*

#thelotteryisavoluntarytaxonstupidpeople

Friday, October 14, 2011

Full house...

House Supervisor:  "We need you guys to get as many discharges as you can out today, we have five waiting in the emergency room for beds."

Me:  "You always say we need to get people out.  Have you ever considering refusing to allow them in?"

House Super:  "What would you suggest?"

Me:  "Lock the ER doors, sweep the bodies out from in front of it the next morning."

House Super:  *laughs* "You're so funny..."

Me:  "Why does everyone think I'm kidding?"

#Iseewhypostalworkersgocrazynow

Thursday, October 13, 2011

Excuses, excuses...

Me:  "Why is your blood pressure so high?"

Patient:  "Well, I've been out of my medications for awhile."

Me:  "How long is 'awhile'?"

Patient:  "Well, I couldn't get them refilled after Katrina, so..."

Me:  "Wait.  Are you telling me you're using a hurricane from six years ago as the reason why you don't have your meds?"

Patient:  "I just never got around to it, is all."

#naturalselectiondoesn'tworkfastenough

Wednesday, October 12, 2011

Good girl...

A standard portion of the history and physical revolves around asking people about their habits (smoking, drinking, etc...)  The following is a conversation I had with a woman in her mid-80's along these lines:

Me:  "Do you smoke?"

Patient:  "No."

Me:  "Did you use to?"

Patient:  "No."

Me:  "Were you ever a drinker?"

Patient:  "No, never."

Me:  "So what you're telling me is that you were a good girl?"  *smile*

Patient:  "Oh no,  I had lots of boyfriends.  *pause*  "Lots of boyfriends."

#thankyoumaewest

Tuesday, October 11, 2011

Signs of the Apocalypse....

Psychiatrist:  "What seems to be the problem today, sir?"

Manic patient:  "The apocalypse is coming.  There will be war, famine, death.  I have seen......FOX NEWS!  I am Jesus Christ!"

#thatmakesMeganKellytheanti-Christ

Monday, October 10, 2011

I smite thee...

Confused patients are some of the best source material for this blog.  Patients that come off the ventilator are often confused for awhile after, usually due to the medicines we give them to keep them sedated so they don't hurt themselves.  The upside is that you get priceless conversations like the one I had a few days ago with a woman we'd recently extubated...

Patient:  "Are you here to kill me?"

Me:  "No, Ma'am, I'm the doctor."

Patient:  "Damn.  I've been asking Jesus to kill me all day but I think he's busy."

#hedoeshissmitingafterlunch

Sunday, October 9, 2011

Step one of the conversion....complete.

Ok, so the new URL should be visible above.  I have confirmed blogger auto-updates your URL in the feed when you follow it on there, so no worries there.  I seemingly kept the Google connect followers.  Going to be working with my web designer friend this week to put in custom contacts for submissions, etc...

Attention Followers!

For those of you who follow me, I will be changing the URL slightly, taking out the blogspot to make the address simply http://thethingspatientssay.com.  This was always my intention, I just figure now is a good time to do it before the site gets too big.  For those of you using Google connect, I do not think this will affect you.  Those of you following me on Blogger may need to update your dashboard with the blogs you're following, I'm not entirely sure.  The site will still be hosted on Blogger, just with my custom domain name rather than the blogspot address.  With the change I will be adding features like an area for submissions, admin mail, that sort of thing.  Just keep an eye out over the next few days to see when the change occurs.  If you are still just typing in the address physically, you should be automatically forwarded to the new address.  Thx for reading!

Saturday, October 8, 2011

Perspective...

Going on dialysis is a hard decision to make for an elderly person.  Knowing you'll spend 3-4 hours three times a week hooked up to a machine doesn't make it an attractive prospect.  I recently had a woman who made the decision not to go on dialysis, much to the dismay of her daughters, who were griping at her for choosing to die.  I watched a tirade from one of them about how she was being selfish.  In the middle of it, the woman smiled and pulled me close before whispering in my ear, "I hope the kidney failure kills me before they nag me to death."

#metoo...wait...that didn'tcomeoutright

Friday, October 7, 2011

Sex Ed, 101...

Me:  "Are you having sex?"

Fifteen year-old patient:  "Yes."

Me:  "Are you trying to get pregnant?"

Fifteen year-old patient:  "No."

Me:  "Are you on birth control?"

Fifteen year-old patient:  "No."

Me:  "Does your boyfriend use a condom?"

Fifteen year-old patient:  "No."

Me:  "So you are trying to get pregnant."

Fifteen year-old patient:  "No."

Me:  *sigh*

#wheresyourmother?

Thursday, October 6, 2011

Transcription errors...

Read in one of my partner's dictations:  "Watch patient closely for signs of respiratory demise."

Second one:  "Patient does not drink alcohol, to her knowledge."

#Idonotsmokecrack,tomyknowledge

Wednesday, October 5, 2011

Smooth criminal...

I recently had an elderly woman who became very sullen after the nurses asked her what her pain level was, using the number scale we have developed for the hospital.  I later asked her why her attitude had changed, to which she replied, "It's criminal to ask people how they feel by numbers."

#lockmeup

Tuesday, October 4, 2011

Hipster Granny...

I recently had a patient in her mid-60's who I was discussing her care with when I noticed she had a tongue ring. I make it a point to mention these when I see them because I have one myself.  It turned out we had both gotten ours about 15 years ago (BEFORE it was cool).  We talked for a few minutes more, then I excused myself from the room.  As I left the room, I heard her turn to her husband and say, "I wonder if I should have shown him my nipple rings."

#hadthosetoo

Monday, October 3, 2011

Consult This, part 2.

Ward Clerk:  "We have a consult you for pre-op clearance on a patient."

Me:  "Ok, where's the patient at?"

Ward Clerk:  "They're bringing her up from surgery now."

Me:  "Wait, what?"

Ward Clerk:  "They're bringing her up..."

Me: "I heard that.  They want me to do a pre-op consult on someone coming back from surgery?"

Ward Clerk:  "That is a bit silly isn't it?"

Me:  "Fire up the time machine and I'll see the patient yesterday."

#docbrown

Saturday, October 1, 2011

Split personalities...

I don't think of myself as a doctor.  The "real" me is the guy who likes cycling, anime, my pet chihuahuas, and coffee.  The "real" me is the guy who sings Pat Benetar a little too loudly inside his car when it comes on the 80's station; the guy who loves cooking for other people, but hates doing it for himself.

That being said, my next statement might confuse you a little:

The "Doctor" part of me scares the bejeezus out of me.

Here's why, in scenario form...

Specialist:  "Dude, how did you ever think to look for Dengue fever in that patient?"

Me (confused look):  "Umm, I'm not smart enough to make a diagnosis like that."

Specialist (now with an even more confused look):  Oh ok...well, good call on that."

Me:  "Thanks?"

Now, with my curiosity piqued I walk up to the floor and look at the patient's chart.  There, in my hand-writing, is the order:  "Draw tropical viral panel, rule out Dengue fever" with my signature right below it.  I have little to no recollection of ever writing this order.

This occurs roughly twice a month.

Looking back on this scenario, I understand that this is how I go through almost every day at work.  The "Doctor" part takes the lead and does all the work while the "real" me is in the back of my head playing with legos and drooling uncontrollably.  I've heard serial killers describe a similar sensation when describing murders:  someone else takes over, they are merely bystanders.

Now you see why I'm scared.

As of yet no unexplained animal mutilations in the neighborhood, but there is a dead yellowjacket in the windowsill.  I'll keep you posted.

#Sybil

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