The Uterus

My doc told me today that the uterus is like a fancy sportscar. Women love to have it but can't stand how often it causes problems and it's constant maintenance. They are relieved when it is gone. This was right after we left a room where a patient actually did a little dance saying "no more periods!" after discussing her surgical history. Thank god for the unassuming prostate.

Here's to you, Drug Rep!

Let's hear it for the hard working men and women of the drug companies. While most people entering a doctor's clinic sit quietly in the waiting room, you walk in uninvited through the side door with your pull cart full of pens and drug branded picture frames ready to engage each staff member avoiding eye contact with droll conversation. Certainly, none of your visits are complete without a "isn't that how it always is", "don't work too hard", or a peal of canned laughter.

When drug companies try to market an old antihistamine with new packaging and a new indication for something silly like "night allergies" or "insomnia complicated by hives", you step up to the plate and swing like mad. Sure, some would say it is just as effective high-dose Benadryl, but Benadryl doesn't have an FDA approved study stating it has no negative effects on prostate health. Take THAT nay-sayers!

Even though most doctors would just prefer a package of drug samples being dropped off at the front desk monthly, you continue to bring five or six samples to the office every week to add that personal touch. But just when they are about to tell you that they are too busy to talk "for the very last time" you bring a box of sugar cookies from the supermarket bakery as if to say "I know your price."

When the big drug companies made the Pharma agreement that prevented you from taking doctors and their spouses out to dinner you shrugged and said "sorry doc, but the cost of wining and dining doctors is making it tough to keep costs down for elderly people who need their blood pressure meds." You keep the doctors from thinking about how the Pharma agreement came about around the time drug companies were launching multi-million dollar ad campaigns for their wares. But you don't worry about that, because if doctors could think independently your job would be completely obsolete.

So kick back and enjoy the limelight drug rep! Each of you are an indespensible part of the medical team: the laundering tag on the quilt of America's health care system. Even while the ranks of reps swell with more hot women and ugly guys who know about golf, rest easy knowing as long as you have free stuff to give away our clinic doors will be open.

Rice Water Logorrhea

"So tell me why you think this guy is a good candidate for Lipitor."

"Well, HMG CoA reductase inhibitors have a good lipid profile of lowering LDL cholesterol and raising HDL. While some may choose niacin for it's HDL improving properties, it needs to be increased slowly over weeks to prevent overwhelming niacin flush, and this patient does not have very good compliance. However, in the future, two-drug therapy of a statin and niacin may be needed to blah blah blah..."

I've come to cherish nights like this. I'm enjoying the sweet, sweet sound of boy-band pop wafting up from our downstairs neighbor on the shoulders of a carton-worth of Lucky Strike smoke. It's all so very American. Unfortunately I haven't had the chance to introduce myself to them as they spend so much of their time procuring the 'sweet leaf' and running out to their respective Audis in the morning. I once dropped a bag of groceries outside their door, and while picking them up the neighbor I lovingly refer to as "YellowGrin" rushed out the front door grimacing with a pen in her teeth. It was as though she was in an old western, about to get an arrowhead removed from her shoulder after a raid on the moonshine silo. That is the most I've seen of her.

"Okay, so what do we do about..."

"... not that it is that common any more, but one must really be aware of niacin deficiency. Pellagra. That's what it is called. The classic triad is dermatitis, diarrhea, and dementia. Some would include 'death' as the fourth 'd', but it is in poor taste as no respectable triads have four items. It would be a quad... no, make that a tetrad. Plus death is not really a blah blah blah... "

Anyway, I've just finished a night of loading up on raw information for my Family Practice rotation. I spent the first night of the rotation learning everything about cholesterol, diabetes, high blood pressure, and asthma. I've never cared for expanding my mind or helping patients, but now, after my first day of FP, I've cornered myself into a endless spiral of helping and learning.

"Yes, but what about his..."

"... spent days observing patients with significant neural damage and defects and would occasionally stroke their feet with his reflex hammer. Those with upper motor damage would extend and fan their toes in response to this stimulation. The medical community named this reflex after this physician. This man: Joseph Jules François Félix Babinski. Now you know.. the rest of the story..."

But most importantly, FP covers more than just diabetes, hypertension, hypercholesterolemia, and asthma... no really, it does. It covers 75% of every other specialty as well. This has forced the usually unflappable and well versed DocAmazing to confront his tremendous ignorance in the management of just about everything. I can only be described in this context as unwell versed and flapped.

"...while the onion simmers in the bacon fat. You may be tempted to stir the onions, but the light browning is best achieved by leaving them alone. Start the milk simmering on low to medium heat and add the cubed blah blah blah..."

So now I've resorted to unleashing volumes of information each time diabetes, hypertension, hypercholesterolemia, or asthma comes up - frequently referring to any trivia slightly related to those four diseases. My doctor is currently afraid to even make eye contact with me for fear that I may spout off the diagnostic criteria for moderate persistent asthma. But, even I know this can not last.

"...it wasn't long after that I realized that that was neither the time or the place to make thrusting motions at the rabbi. However, the rest of the bris went along with out a hitch, and several phone calls later I blah blah blah..."

I'm hoping this will hold him at bay until I discover different ways to treat infections rather than following the DocAmazing law of: If the head and lungs be illin', give Amoxicillin, and everything else is done in by a dose of ciprofloxacin.

My ward has 3 Jesuses and an FBI secret agent

I WANT TO BELIEVE
I like psych. This bothers me because I've got too many preconceived notions about psychiatry and psychiatrists to unlearn. But as time goes on I'm finding that the docs actually know stuff about internal medicine and are pretty thoughtful, and that many of these patients would be pretty destructive to themselves and others without treatment. Furthermore, many treatments, including electro-convulsive therapy, actually seem to work without dulling the patients' personality.

DAMMIT!

Much of psychiatric treatment is more palliative than curative, and many 'successful' patients must be on medications for the rest of their lives. I don't know how I'd feel about getting into a profession where most people are never 'healed'. But regardless, against all of my previous rants, psychiatry is on my list of possible professions.

My feelings could also just be delerium from having to commute 3 hours a day. I will definitely enjoy my next rotation, where the clinic is just ten minutes from my house. Maybe then I'll actually get back to meaningful weekly posting.

Mia Listo Sekreto

Of all of the thousands of little 'insignificant' syndromes, tests, and signs we are taught in the first two years of medical school, there are a multitude of syndromes you don't plan on seeing. I plan on not seeing (or diagnosing) sarcoma botryoides, frotteurism, or scientology. They are all too uncommon to be seen by me, especially if I'm looking to go into pain management. There are several more on the list, but they are a secret. (secret=forgotten)

One of those things I thought I'd never see is Broca's aphasia. It's a syndrome where there is damage to the "outgoing communication" center of the brain, usually from a stroke, which leaves the patient unable to form words. They can still understand what is being said to them, unlike the very tragic Wernicke's aphasia. Well, one of our patients came in for treatment of shoulder pain and had symptoms of a somewhat resolved Broca's aphasia from a previous stroke. WHOA! Broca's! Here! As soon as that synapse connected in my brain the rest of my brain was engaged in inhibiting my excitement from causing me to blurt out "BROCA" several times in a Tourette's type manner.

Twenty painfully long minutes later the patient left the room and I struck an aloof pose on the side of the doorway, looked at my cuticles, and breezily told the doctor, "that was a pretty textbook case of Broca's if I've ever seen one." I'm not sure whether the phrase "if I've ever seen one" is a valid one if you've only seen one and there was no "if" about it, but I tossed it in to accentuate how aloof I was in the face of such a brilliant discovery. The discovery was, of course, that medicine includes things other than hypertension, high cholesterol, allergies, and low back pain - it includes those things we missed test questions about.
The doctor looked at me as though I'd just spoken in Esperonto.

"Broca's aphasia", I clarified.

His head tilted slightly to the side.

"From the stroke, affecting her speech", I stammered.

I wasn't sure whether he didn't understand or if Broca was a stupor inducing trigger like in Manchurian Candidate. Before drool started to gather at the corner of his mouth I went ahead and explained the condition. Deflated, I continued the rest of the day, deftly caring for hypertension, high cholesterol, allergies, and low back pain.

I apparently discovered something that was on his secret list.

Idealism returns like the herp

Manipulative medicine is taking more out of DocAMAZING than first expected. My clinic’s operating hours are 9 to 5, give or take the sum of those two numbers. So, except for one odd day out, I’ve been in clinic until 6 o’clock or, like today, 7:20. Tack on an hour’s drive home, forty minute workout, dinner #2, meaningful chatter with the missus, checking the latest dirt on my favorite BDSM anime forums, and bedtime snack and there’s not much time for working on the paper that is due at the end of the rotation. Yes, a paper is due at the end of the rotation. It feels very high school-like, such as when a teacher realizes that watching Tombstone for three class periods was not entirely justifiable and bookends the last day with a paper due comparing Doc Holliday’s motives with those of The Outsiders protagonist Pony Boy.

This rotation has been piquing my idealism in medicine again, though. It may be the actual patient contact that’s doing it. I actually switched with another person for this doctor because of his gentle, more focused, osteopathic manipulative technique. My first doc was known for what he called the “good ol’ fashioned osteopathy” of whipping joints at high velocity counter to other joints in positions that can only be likened to techniques seen in the “good ol’ fashioned Spanish Inquisition”. I feel that the ‘joint cracking’ that I thought was so cool the first year may sound and look effective, but they do little to reduce the ‘gamma gain’ that caused the lesion in the first place. In other words, I think it doesn’t really help the problem. It’s kinda like that three-pack of azithromycin you got last winter for the sniffles.

--------

On a side note, I've got good news for smokers that comes directly from one of my lunchtime study sessions: It turns out that smoking is protective against ulcerative colitis. Smokers are only a third as likely to get the dysentery and ulcerous rectum of UC than the rest of us non-smoking suckers. However, smokers are twice more likely to get the intestinal blockage and gastrointestinal fistulas of Crohn’s disease than us non-smoking smarties. But if you work it out mathematically I think smokers are still ahead of us in avoiding debilitating GI tract disorders by sixty-six something-or-others. Euros, I think. So smokers everywhere can hack a large wad of relief as their intestines remain the envy of us, the ignorant white-toothed masses, while their lungs turn the texture of Bea Arthur’s elbow skin. (covered in tar, natch)

The internet is TEEMING with people!

It's a momentous time in this blog's history. Now that it gets about 52 hits per week, other DocAmazings are coming out of the woodwork. I just recently received a 'cease and desist' post from another DocAmazing, asking me not to 'flood the market'. I assume this was meant to either close the blog or change the name (probably the latter). This is one of the problems with the 'internet'. The internet is full of people. Chock full. There are people pouring out of the seams. At least a million of them.

In this melange of people there is bound to be some name overlap. Go to any forum and there is a NiteShadow, but I doubt these are all the same NiteShadow. One could be a 13 year old boy posting about how cool Insane Clown Posse is, and another could be a 14 year old boy posting about how "teh r0xorZ!!11!" Insane Clown Posse is. You could get dizzy trying to work out the implications of such a split personality until you realize that the internet is just damned full of people. You can't miss em'. At least a hundred thousand of them.

However, in respect for the name DocAmazing, I will include a little disclaimer that this Doc is not the craigslist or the netherotarecords Doc. My internet sphere is much smaller and, frankly, better decorated. I think I'll stay here.

----------------
For an update on NiteShadow:
NiteShadow races Honda hatchbacks
NiteShadow has animated girls melting in his hands
NiteShadow is Death
NiteShadow hasn't sat on any good Goethe books lately
NiteShadow feels Mexican spices are below him
NiteShadow writes Melissa Joan-Hart for spiritual guidance

My white coat is one blueberry pie stain away from starring in a detergent ad

Yeah, it is time for my biannual white coat wash. Featured stains include: grease from the inside of my car door, a coffee slosh up the right arm, pen marks around the left pocket, something dark brown near said pen marks, ring around the collar, AND a brown ‘ring’ stain where the stethoscope diaphragm rests.

Well, OBGyn ended with a fizzle. The last two weeks were in the clinic where, due to the director’s decision, medical students never see a patient alone. You just follow a resident into the room, stand between the sink and the biohazard trash and nod appropriately when she makes comments about weight loss, smoking cessation, or the importance of Pap smears. The best residents don’t even introduce you to the patient so you might not even get eye contact during the entire process of patient care. It’s very good training for pathologists – bad training for DocAMAZING.

I did learn about the importance of the Spanish language, or, for my Spanish-speaking readers, la lingua de Dios. There were four Spanish speaking residents in the program, and getting linked with them led to a day of (A) being a wallflower per usual, and (B) being a wallflower that had no effing clue what was being said. I had minimal on the job training in Spanish, and all of it was in labor and delivery. So unless I needed to start yelling, “Puje, senora! Puje puje puje puje puje pujepujepujepujepujepuje, PUJE MAS MAS MAS MAS MAS MAS MASMASMASMASMASMASMAAAAASSSSSS… BUENO”, then I was more worthless than the otoscopes on the wall. Really. OBGyns are baffled by otoscopes.

So, I had three days at home without any responsibilities, except for making up for twenty-six months without my wife. Needless to say I was fulfilling my husbandly duties! *wink* You know what I mean? Yeah?! Well, if you don’t, it means opening relish jars and walking down the stairwell first to collect spider web strands before my arachnophobic wife descends. Arachnophobia is the fear of spiders, but the relative eased state of mind when a loved one is flailing in the midst of the remnants of last night’s spider silk cotillion.

I’m getting prepped for Monday, the start of my manipulative medicine rotation. I hear the there is a lot of student interaction on this rotation, so maybe my blog will shrivel up and die from lack of cynical content. If so, dear reader, I’ll make sure to continue with the ever so popular copied-lyric-blog, or the Blogspot favorite: list-blogs.

Ten little sins I don’t tell anybody about this week

1. I put peanut butter on BOTH sides of my PBJ!
2. I left my shopping cart right NEXT to the cart corral, not IN!
3. I threw a bottle at a homeless man!
4. …

I better stop now before I ruin my next post…

Wasn't placenta #6 delivered? Of course not!

That's right. Count 'em. Six. They're clearly labeled to the right.

I've been straining to find anything to write about this week, but there is nothing to write about except the nothing that is occuring here... er, or the nothing that is NOT occuring here. Wait. Nothing isn't occuring here never. "Nothing" is the occurance. Goddammit.

My wife says I have a deficiency in the area of double negtives. It pains someone like me to hear this as it is like having someone say, "you are clearly not able to stop breathing when submerged under water." The mechanism for double negatives seem simple enough: when a sentence has two negatives, ignore them. When the sentence has three negatives, take a deep breath, squint, then repeat the question back to the asker, hoping for a clarification using less cirmlocution or a complete topic change. The latter is used most often by my wife in between wiping the drool off my chin.

This is difficult enough for a person who has never memorized his multiplication tables nor his own age. Each time I'm confronted with either of these situations the Etch-A-Sketch of my weak cognition is shaken and the monkeys get to work tossing numbers at the wall until something sticks like white on rice (luckily, my mastery of metaphor amalgamation is not hindered by this).

"What's my age? Uhm..." I was born in 1980. It is currently 2005. 2005-1980=25, but my birthday has not occured yet this year, therefore 25-1=24. I am 24. "I am 24, Your Honor." *Self-satisfied swagger*

But then my wife tosses the wrench in the bathwater. She will ask me a question with one or more negatives, but then switch the rules of multiples of negatives! The gall! God has allowed one man to rewrite the rules of grammar and pronunciation like this and I'll be damned if we make a mockery of his office. Here's an example:

"Don't you think this new top is cute?"

At this point marriage has injured my thinking enough to translate 'hot' to 'cute' (two terms which used to be miles separate in my mind), and thinking that the top IS cute I answer truthfully: "No". Do I NOT think the top is cute? Of course I don't think it is not cute!

I quickly learn that Wife does not share my understanding of The Rules. Hours later, when my vision returns, I fail to convince her about the proper usage of "not". And I refuse to play the "ignore the not" game. Now I'm relegated to answering questions with recitation:

"Don't you think this new top is cute?"
"The top is cute."

"Didn't you like the salad?"
"I like salad. Specifically this salad."

"Wouldn't you rather watch Shakespeare in Love before Elizabeth?"
"I would prefer to not see Gweneth Paltrow at all, whatever the circumstance."

Ah, sweet middle ground.

Placenta #5!

I'm a mad placenta-delivering machine, sent back through time to change the future for a handful of lucky uteruses.

Today I was on call with a cool resident and a cool attending, both of whom made it a point for me to deliver a baby. However, I was confounded on both deliveries.

Lady #1 decided to all but launch the baby before we entered the room. We were at the L&D nurses' desk when we heard her scream, and when we entered the baby's head was already out. By the time I got my gloves on the thing was 4/5 the way out. I could have told the attending, "I'll take it from here", and extract the feet, but that would be tantamount to 'taking over' cleaning the kitchen for my wife right before she pushes the start button on the dishwasher.

Lady #2 was at only 5cm cervical dilation (full dilation is 10cm). I went to go sonogram another lady for 10 minutes, and when I returned the woman had delivered. God himself rewrote the laws of biology and tissue expandability solely for this woman. Maybe he did it because of my using his name in vain last weekend when this exact situation first happened. Or maybe it was for picking my nose in church. I perpetrated both offenses several times.


I also have a beef to pick with all women who choose to not get an epidural:YOU ALL MAKE ME SICKIt's true. ALL OF YOU. I can't stand being in the same room with you. I get PHYSICALLY SICK!

You must understand: I am a card-carrying candy-ass. Each time one of you starts moaning, crying, and writhing with contractions you transmit that pain through thin air into my own abdomen. I get a mixture of that feeling you get when the airplane drops altitude too fast and that feeling you get when you are being attacked with a claw hammer. I usually have to sit down when I leave the room to get my abdomen to release the evil pain mojo. I'm getting that feeling again even as I type about it! I wish there was some way for you all to understand the pain it makes me feel. Sigh. I guess that is just a wish I'll never see realized.