Tuesday, January 31, 2012

Whole lotta lovin'...

This is brought to you by the letters V-O-M-I and T.

Nurse:  "Ok, sorry about the noise, but the construction workers are fixing the tile out here for a bit."

500-lb patient:  "Ooh, construction workers.  Ask any of them out there if they like big, nasty girls.  I needs me a man."

#bringyourforklift

Submitted by Kelli.

Monday, January 30, 2012

Promises, promises...

I typically like sewing up lacerations; it's a mindless job unless it's very severe, then it's off to the surgeon if that's the case.  One afternoon, I was working in an urgent care clinic shortly after getting out of residency when a woman came in saying that she had a laceration on her wrist.  I told her I'd take a look at it to see if I could fix it.   When I removed the bandage from her wrist, the arterial spray covered a wall five feet away, over my right shoulder. The patient looked at my reaction, then looked at her blood-soaked wrist again.

Patient *hushed tones*:  "Can't you just sew it up?  I hate the ER.  I promise I won't sue."

#yeahright

Sunday, January 29, 2012

One of these Sundays...


I want this played at my funeral...

Welcome to Sunday...

Saturday, January 28, 2012

I'd like to buy the world a....

This one is from yesterday and I'm poking fun mainly at my colleague, who was thoroughly embarrassed by the slip of the pen(is).

Seen in chart:  "Patient really wants some cock."

I'm not sure how they spell it in Nepal, but here the correct spelling is "Coke."

#haveacockandasmile

Friday, January 27, 2012

Willy Wonka presents....

Chief complaint:  Back Pain.

Height:  4'10"

Weight:  352 lbs.

Patient (wearing a blueberry-colored shirt):  "Do you think that epidural from eight years ago caused my back pain now?"

Me:  "Something tells me no."

#violetbeauregard

Thursday, January 26, 2012

Read the directions...

Patient:  "That Flonase spray you prescribed me tastes terrible."

Me:  "That's because it's a nasal spray."

Patient:  "But it says right here, 'One spray each tonsil'."

Me:  "That word is 'nostril'."

#youshouldtrytheKentuckyjelly

Wednesday, January 25, 2012

How-to Guide...

Seen in dictated History and Physical:  "Chief Complaint:  Patient found unconscious at computer with empty bottle of Ativan and a webpage pulled up entitled 'How to commit suicide with Ativan'."

#subtle

Tuesday, January 24, 2012

Text me....

This post goes with yesterday's...

Me:  "We'll be getting some blood work today to check out your cholesterol and your liver enzymes.  They should only take a few minutes to get back."

Patient:  "I don't have time to wait, I'll need you to text me the results."

Me:  "Sir, we don't have the capability to text you the results."

Patient:  "Well, use your phone, type them in and text them to me."

Me:  "No, sir. I am not going to text you the results. You can either call back and get them or wait for us to send them to you by mail."

Patient:  "I can't believe you won't text them to me.  You have a phone, just type them in and send them to me."

Me:  "I am not sending you a text from my phone."

Patient:  "You think I'm going to call you or something?"

#yesexactly

Monday, January 23, 2012

The subscriber you are trying to reach....

There is a reason doctors don't give out their personal phone numbers and they don't friend patients on Facebook.  Even with the best of intentions, inevitably the patient will make a decision to turn that act of goodwill into an opportunity for free medical care.  Happens all the time.  If you accede to it just once, it will become a free-for-all event later down the line.

In residency, we had to return phone calls for people who would call the clinic in the middle of the night.  Just once, I was so half-asleep that I ended up calling one of my patients back from my own cell phone.  For the next three years, I received phone calls, often past midnight, from this patient and friends they had given the number to.  Yelling at the patient did no good, they would insist there was an emergency and that I was obligated to help them.  It did not matter if I was on-call, on-vacation, or even no longer working at the residency.  The calls continued until I moved out of the state and changed my number.  I can only imagine what the poor soul who got that number is going through now.

Guy with my old phone number:  "I'm telling you, for the fifteenth time, I am not a doctor. Also, it's 3 a.m."

Patient:  "Haha, very funny, Dr. Say.  So anyway, the kid has this rash on his junk and a bit of a fever at 98.7 degrees...."

#nolongerinservice

Sunday, January 22, 2012

Saturday, January 21, 2012

Spanola Saturday...

Very little sleep last night on call, so will post this short movie written and starred in by a friend of mine.  Enjoy.

Friday, January 20, 2012

Aryan pharmaceuticals...

Often, if a patient takes a drug that is very expensive or hard to get we will allow them to take their home supply rather than take several days to get it from the specialty pharmacy.  However...

Last night, 10 p.m....

Nurse:  "The patient wants to know if he can take his home medicines."

Me:  "Which ones?"

Nurse:  "All of them."

Me:  "Read them to me."

Nurse reads them off.

Me:  "There's nothing on that list that's hard to get, why does the patient wants to take his own?"

Nurse:  "He says our medicines here aren't 'pure' enough."

Me:  "Are you kidding?"

Nurse:  "No, that's what he said."

Me:  "And what is he in for again?"

Nurse:  "Stroke."

Me:  "Uh-huh...tell him that his 'pure' medicines did not keep him from having a stroke and he's just going to have to trust us to take care of him while he's here."

#theniacinbrotherhood

Thursday, January 19, 2012

Lost his leaves...

Seen in chart:  "Patient has a deciduous ulcer on his right buttock, present on admission."

#myulcersareallevergreen

Wednesday, January 18, 2012

Free-basing Bartles' and James'

Me:  "Do you smoke?"

Patient:  "No."

Me:  "Drink?"

Patient:  "No."

Me:  "Any bad drugs?"

Patient:  *pauses a sec*  "Well, I want to be honest with you.  About every two years, I go buy either a four or eight-pack of wine coolers and I usually drink them in one sitting."

#winecoolersthedeadliestdrugofthemall

Tuesday, January 17, 2012

Hope he's left-handed...

Seen in chart:  "Previous surgeries:  Appendectomy, Cholecystectomy, Left Frontal Lobotomy."

#I'dratherhaveabottleinfrontofme

Monday, January 16, 2012

Reverse Jesse Jackson phenomenon...

I have often heard tongue-in-cheek stories about ignorant white people asking black acquaintances what major black figures in our culture are thinking, the implication being that, by virtue of skin color, they gain some sort of insight into their mindset.  I like to call this the Jesse Jackson Phenomenon.  I do believe I am the first to use the term "Jesse Jackson Phenomenon" and certainly the first to imply a "Reverse Jesse Jackson" when I'm not talking about some sort of sick, invented sexual term, so I claim dibs on it.

Elderly Black Woman:  "Well, I went downstairs to get the mail and I ran into my friend, Ella.  You're white, I'm sure you know Ella.  She's white, too."

#naturally

Edit:  As an ignorant white man, it did not even occur to me that I posted this on Martin Luther King, Jr. Day. This was pure coincidence, as unlikely as that may seem.

Sunday, January 15, 2012

Saturday, January 14, 2012

Open wide...

A few months back I had a patient who came in who was all but wearing a shirt that stated "I'm a lesbian, if you hadn't noticed."  That's fine, she was obviously very proud of who she was and I can respect that.  When it came time to examine her, I asked her to open her mouth.  She initially began to, then began giggling.

Me:  "Something funny?"

Patient:  "No.  Well, it's just the first time a man has asked me to do that in a long time."

#mentalimageembedded

Friday, January 13, 2012

Death Wish...

There is a reason that hospitalists are given extended periods off.  A lot of us work one week on, one week off.  From the outside, this looks like a great deal, but the time off does little to make up for the time we work.  For the last several weeks, we've had to work extra shifts at my job to make up for our shortage of two physicians who moved to another hospital.  Last week, I was on my 17th or 18th day in a row, getting up at 6 a.m. and working 12-14 hours a day. That morning, I woke up instantly, five minutes before my alarm sounded, wide awake.  I never do that.  I am not a morning person by any stretch of the imagination.  When I awoke, the house was eerily silent, I was completely comfortable.  No pain, lying next to my dog and my wife.  I couldn't even hear the sound of my own breathing.  For a brief moment, I thought I had died.  My first thought was not of panic, nor fear, nor anxiety.  What I first thought was, "Oh, thank God. I don't have to go into work!" 

Then my back started hurting and the dream crashed around me.  I went back to sleep for another thirty minutes.

#sigh

Thursday, January 12, 2012

How cute...

A nurse at the local children's hospital was in charge of triage one night in the ER when a mother brought her child in to be seen. Young children often make a game out of their clothing, pulling their arms inside their shirt. When the time came for the nurse to do vitals, she told the child, "Ok, pull your arms out of your shirt so I can take your blood pressure." There was a brief pause and a moment of silence before the mother quietly whispered, "Um, she doesn't have any arms." The shocked nurse stood there a moment before replying, "Ohh...how....cute."

#diggingdeeper

Wednesday, January 11, 2012

Terrible doctor...

The way I was taught in medical school and residency was that, if you were going to order a test, you needed a few criteria. 

1.  The test will tell you something you do not already know from history and physical.
2.  The test will change your treatment of whatever disease you are treating or confirm your suspected diagnosis.

If the test doesn't do these two things, it's probably not cost-effective to order it.

Patient's Mother:  "Aren't you going to swab him for strep?"

Me:  "No, there's no need.  I can tell from physical exam that he has strep and I'm going to give you an antibiotic to treat it."

Patient's Mother:  *mumbled, as I'm walking out*  "I'll take you to a good doctor next time."

#DoctorWho?

Tuesday, January 10, 2012

Clinic time...

As I have mentioned before, I often moonlight at clinics during my time off from the hospital.  A few weeks ago, I was seeing a fairly attractive 21 year-old, accompanied by her grandmother.  Her case was relatively simple, a sinus infection and I told her I needed to step outside to write her prescriptions and such.  Her grandmother had talked loudly the entire time I had examined the patient, since she was hard of hearing.  As I stepped out and closed the door I heard her say (more than a little audibly) to her granddaughter, "Show a little more skin.  This one's cute."

#grandmaisalwaysright

Monday, January 9, 2012

Hunter S. Thompson visits the hospital...

Most people don't remember the hallucinations they had when they were delirious.  This is a good thing.  I have had a few recall some of the more vivid ones, but usually delirious people's real personalities and memories are locked away inside, separately.

Me:  "How are you feeling today?  You were pretty sick for awhile."

Patient:  "I'll be fine as long as you don't grow another lizard head."

#RaoulDukelives

Sunday, January 8, 2012

Sunday Random Pictures...

My work wife calls me her evil twin, we often conspire and have extended bitch sessions with each other to pass the time.  Here is how she labeled my patient list this morning:



The second picture is from one of our GI guys.  I have tentatively entitled it "Lions and Tigers and Ulcers..."


Oh, and Welcome to Sunday...


Saturday, January 7, 2012

Is Alice there?

Nurse:  "This guy is a known drug-seeker, he's in rehab.  If he asks you for narcotics, do not give them to him."

Me:  "OK."

Nurse:  "He also doesn't need to see Alice."

Me:  "Who's Alice?"

Nurse:  "What?"

Me:  "You said he doesn't need to see Alice.  Who is Alice?"

Nurse:  "I said he doesn't need any Cialis."

#hardtoheardowntherabbithole

Friday, January 6, 2012

Back dat up....

Frontal lobe dementias often make some of our most memorable patients.  The reason is that your frontal lobe is your social filter, if you will.  Some of you will remember Phineas Gage's story from over 100 years ago.  If not, look it up.  Imagine for a moment if you just spouted out all the thoughts that come into your head every day, out loud, the moment you had them.  Now imagine if you didn't have the filter that comes before those thoughts arise.  You know, the filters that say "Hey, that's racist/sexist.  You shouldn't think like that."  (My filter screams "Get out of my head!" at random intervals).  Minus those filters, imagine the conversation stoppers you could drop with almost every line that came out of your mouth.

Patient:  "I need to ask you something."

Nurse:  "What's that?"

Patient (sticking out tongue):  "If I stick my tongue out like this, do you think you could back that ass up on it?"

#gurlyoulookgood

Thursday, January 5, 2012

Quitting makes it all better...

Mr. COPD:  "I just don't get why I'm not breathing better."

Me:  "Yes sir, but you smoked for 50 years."

Mr. COPD:  "Yeah, but I quit last week!  I thought that was supposed to make me better!"

#Igotnothin'

Wednesday, January 4, 2012

Voices in my head...

There is a cubbyhole on the fourth floor of our hospital for doctors to sit in and dictate or check stuff on the computer.  The acoustics in said cubbyhole defy any explanation.  Sounds will come from anywhere on the floor and possibly in the building.  One afternoon, I was writing in a chart in this cubbyhole with my back to the wall and the opening to the area in front of me.  I was considering altering treatment on the patient when, all of the sudden, there was a voice which whispered directly in my ear, "I'm here to kill you!"  I jumped up and turned toward the wall where, of course, nothing was there.  I sat back down, fairly freaked out.  A few minutes later, the same voice said "Now, I die an honorable death."  Much less specific and more puzzling as I knew there had never been any seppuku or glorious battles on the grounds, at least not in the official records.  We finally managed to track down the source to a dubbed samurai film playing about eight rooms down the hall.  It was not audible from the nurses desk, but somehow had bounced off about ten walls before speaking directly in my ear. 

#weird

Tuesday, January 3, 2012

Registered Nuts

Quick note today, my friend Molly has a blog that I think you should check out.  She's fairly intelligent (FOR A GURL!!), witty, and downright hilarious.  Give today's post a glance, if you get a moment. 

http://registerednuts.blogspot.com/

Plenty for all...

Me:  "So, I'm going to put you on an antibiotic for the urinary tract infection and your pneumonia."

Patient: "Just one?"

Me:  "Yes, just one."

Patient:  "Don't I need two antibiotics, one for each?"

Me:  "No, one will cover both infections."

Patient:  "Are you sure there will be enough to go around?"

#withsometospare

Monday, January 2, 2012

Blunt force honesty...

I am honest at work, brutally so, to the point of being blunt.  Do not think that means I do not empathize with patients with a terminal diagnosis, I most certainly do, but it's not my job to provide false hope to people.  To do so is a breach of their trust, in my opinion.  If you think this makes patients hate me or think I'm calloused, then you haven't seen the Press-Gainey scores I turn in monthly. 

Medicine is one of a few fields in which you can be proud of both saving lives and, in essence, causing them (or allowing them to happen).  I know this is an odd statement to make, so I will explain.  The saving lives thing is easy to explain: save a life, be proud of it.  The "causing" death one is best summed up with a story, I think.

I had a patient once who had stage 4 cancer of an incurable type, found by me when he came in for a pneumonia.  He asked my opinion on the matter, which I freely gave.

Patient:  "So, if I don't do anything about the cancer?"

Me:  "You'll die."

Patient: "And if I take chemo and radiation?"

Me:  "You'll die bald and probably anorexic."

The patient laughed for a full minute.

At the end of the conversation, he thanked me for my honesty.  I found out later he decided to go home on hospice rather than undergo treatments.  I received a card a few months later thanking me for my care of him.  He died at home, surrounded by friends and family, free from pain and anxiety, to my knowledge.

I can be proud of that.

#Godspeed

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