Tuesday, August 30, 2005

No placenta is safe

Make sure you are sitting down, you are in the presence of something special. Uterine contractions quiver at the sound of my name. Heavily gravid women panting on the once-dry hospital sheets reach to touch the back of my coat for a chance to cease the abdominal gripping that occurs every two to three minutes. My mere presence sends fetuses scrambling back into the womb. I, DocAMAZING, am a human tocolytic. No babies breathe free air on MY watch.

At least, my tocolytic effects last just long enough for an intern to walk into Labor & Delivery, at which point babies launch from their respective uteruses into fumbling hands. I post about this special ability now because it took me nine days to even see a vaginal delivery.

At the beginning of my Sunday shift, two women were brought into L&D for induction. Paydirt! Two women, both at term, without complications, were coming to my floor to have their babies chemically encouraged to squeeze out into my gloved and gowned arms. It’s really as poetic as it sounds. To accentuate my dorky over-excitement at getting a chance to deliver, I donned a pair of paper boot covers that stayed on my feet for the rest of the afternoon. These paper boot covers are called “Personal Protective Gear” because they (A) protect your tennis shoe laces from bodily fluids and they (B) protect the soles of your shoes from dangerous “traction” with the floor. I've learned about both of these uses personally.

Unfortunately, medical students get demoted to the level of ‘dust ruffle’ the second a first-year resident enters the room. They have few responsibilities when they get to the residency program except for writing most of the patient histories, tying knots, and delivering babies. This makes them pretty unwieldy in a clinic or hospital setting, so when a chief resident finds one of these tasks for the intern she unloads it upon him in an attempt to keep him busy.

At this point the student’s job is to observe the first-year performing said tasks – a weighty task worthy of someone with six or more years of higher education. In this case, the intern arrived thirty minutes before both women delivered and I did my best 'keen observer' bit, natch.

So, like so many students who rotate with interns early in the educational year, I’ve learned that I’ve got to go where the interns are not.

But until then…

I am king of the placenta delivery. I OWN that placenta. After the baby is out, it is show time. Over the past six days I’ve learned to deftly massage the uterine fundus with my right hand while carefully maneuvering the umbilical cord with the left, all the while never ashing my cigarette. Once that fleshy bag ‘plop’s into the placenta bucket, I don’t even have to examine it to know that I didn’t leave a piece behind. (I NEVER leave a piece behind) In one swift move my gown is off and I strut out the door yelling, “THANK YOU FIVE-CENTRAL! I LOVE YOU! GOODNIGHT!” amidst thunderous applause.

Stay tuned as I aim for a fifth placenta!


Anonymous Diddy said...

And you, young padawan -- I'll be watching your career with great interest. Keep up with that placenta count. I check back hourly for updates.

10:29 PM, September 01, 2005


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Friday, August 26, 2005

Wow them with your next PowerPoint presentation! --PART 2--

So I lied. I said I’d have this out BEFORE Friday conference, but, as you can see, this is published decidedly AFTER Friday conference. I give half-hearted apologies to the residents who read Part 1 and had only backgrounds, animations and sounds for their slideshow today. The good news, though, is that I picked up a few more tips to add to my sixth element of MSPP. Rejoice!

4. Image THIS
Before ‘pixels hit the paper’, as they say, pick out which of MSPP’s limited clipart pictures you want to use. Then, later, add the clipart and conform the title to the picture.
Come up with your own bright ideas!
(These just come to me. A special gift, I know.)

Don’t forget that your audience is in the medical field and therefore must be constantly ‘softened up’ with smarmy images. Good image breaks include comic strips (preferably the Far Side or a Rube Goldberg contraption) or pictures of your children in adult clothing or covered in spaghettios.
Feel the magic

5. Content Schmontent
Text: the icing of the PowerPoint cake. This is where the proverbial men are separated from the proverbial boys, proverbially. The factor that separates the two is this: pure unaltered volume of text and information. A medical textbook is best likened to, and best read as, an epic novel with recurring themes of suffering, illness and dysdiadochokinesia. We, as medical practitioners, are not expected to slice into the text, tease out the pertinent items and dissect extraneous or harmful text. In fact, I cannot think of a single physician with any experience or qualifications in such practice.

Some hacks who present themselves as ‘professional speakers’ would mangle this following paragraph:
Traditionally, inflammation of the liver capsule has been attributed to direct bacterial infection. Organisms were thought to travel from the genital area via the fallopian tubes and the paracolic gutters to the liver capsule. Some evidence supports this: Holm-Nielsen et al1 demonstrated that peritoneal fluid is propelled from the pelvis to the diaphragm, where it is preferentially absorbed on the right side. The association between recent insertion of an IUD and Fitz-Hugh-Curtis syndrome also supports the hypothesis of intraperitoneal spread of organisms. While direct spread may occur in some cases, several factors suggest an alternate etiology. Bacteria have only rarely been isolated from the liver surface or surrounding ascites in patients with Fitz-Hugh-Curtis syndrome.

into this:
One hypothesis for FHC is direct spread from the pelvis

Do you feel as dissatisfied as I do? Where is the heart? The meat?! I’m starving for character arc and drama. That molestation of the text is like removing the scene where Juliet stabs Romeo from Shakespeare’s play - the name of which escapes me at the moment.

6. Present 'till it hurts. Bad.
Presentation time. You’ve been waiting for this all morning, since you probably finished around three or four in the AM. You’ve got your most comfortable shoes on for nervously shifting weight from foot to foot. You did your lat and triceps stretching preparing to clasp the remote with both hands in front of your stomach like a Dell-branded infrared emitting umbilical cord. All you need is a few last reminders to make your presentation top-notch.
  • Let the laser be your sheepdog – Without a laser point constantly moving under each word you read aloud who knows where your audience’s attention is!? Don’t trust in medical professionals’ ability to follow what you are reading by sheer linguistic acumen. Lead them through the information with the comforting guiding-hand of trillions of photons. Remember to circle madly each diagram you are referring to.

  • Dump the red laser– Through the miracle of applied physics and filling needs that never existed, manufacturing has made available a new brighter green laser for use with your presentations. These babies are a cheap $119 apiece since the US military stopped using them for guiding laser missiles for the reason: “too strong for military use”. Not only can these sweet pointers be seen from 1.2 miles, 80% of their luminosity is returned to the viewing audience off of the semi reflective projection screen. Your audience is certain to remember the points you made, as a mish-mash of purple trails will be left in their vision for thirty minutes afterward. Their retina’s inability to restore visual pigments to their receptive state after a photo optic assault is to your benefit.

  • Read directly from the slides – Since you have gone through the trouble of cutting and pasting large amounts of unformatted text haphazardly, do your audience the favor of reading directly from the slides. They didn’t come to hear summaries, opinions, or new corroborating information that is not on the slide – they got enough of that crap in college.

You now have the tools that will fill in the holes in your personal communication skills. Be assured that people will be talking about your presentation for days.


Anonymous Diddy said...

I, for one, have been waiting on pins and needles for your latest MSPP advice.

I can't wait to try out my new-found knowledge on my students.

Thank you for sharing your wisdom and mystical greatness.

4:48 PM, August 27, 2005

Anonymous Anonymous said...

informative and entertaining, i wish i could go back to residency and prepare a power-point presentation all over again.

2:11 AM, August 28, 2005


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Tuesday, August 23, 2005

PolitiPost: God bless The Onion!

You've already heard everybody's opinion on this topic, so I won't waste your time with mine.

Evangelical Scientists Refute Gravity With New 'Intelligent Falling' Theory

On allowing Kansas students to make an informed decision from all sides of the issue:

Dear Kansas School Board...

In response to Dr. Hovind's $250,000 evolution challenge...


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Sunday, August 21, 2005

Wow them with your next PowerPoint presentation! --PART 1--

Yesterday, I was schooled in that fine art of PowerPoint presentations. It is only fair that I share this information to give med school hopefuls and other PowerPoint neophytes a running start at the fun and furious world of audio-visual presentations. Jump on it!

So, you're about to do a medical presentation and have decided to enlist the aid of Microsoft PowerPoint. Let me be the first to welcome you to the exciting world of adding color and pictures to your presentation. PowerPoint (MSPP) can not only improve a mediocre or even gut-wrenchingly bad presentation, but it can do so moderately well! However, before you start copying large amounts of extraneous unformatted text onto your first slideshow there are a few tricks of the trade that will help you turn that snooze of a lecture into a visually engaging one.

1. Background check
The quickest way to lose an audience is with an unexciting background. Who wants to watch yet another presentation with a muted blue-black gradient that draws your attention only to the text? At least 60% of the screen space should be accentuated with background graphics. MSPP has a poor selection of quality backgrounds, consisting of the 'notebook' and 'fireworks', both of which only use about 40% of the screen (if formatted correctly). If you don't have time to find better, more ostentatious, background you can make up for the aesthetic weakness with tips 2, 3, and 4. If you do have time, here's two winners I know will fill the projection screen with character:
Got a recipe to share in your next presentation?

Even Frank Lloyd Wright knows a good background!

2. Animation Station
There are two types of animation to choose from for your MSPP presentation: tasteful, appropriate animations and AWESOME animations. There are three pillars of animation - no wait, make that three keystones of MSPP animation: slide transitions, text animation, and looping.
  • Slide Transitions: In a normal slideshow, slides are changed without any of the necessary transition. This rough transition is as abrupt as an eye blink and just as unnatural. You would much rather have the interim thought between two slides be "Hey, we're going to open the curtain onto the next slide" (blinds vertical transition) or "Newsflash! Let's go to a new slide" (newsflash transition), than "SMACK!" (no transition). The previous leads to contented grins and lowered blood pressure while the latter leads to weeping and rending of clothing. Also, keep it fresh and use a different transition for each slide.
  • Text Animation: Do you remember the last book you read? Of course you don’t! Words in books are what scientists call “static” or non-interesting. Their value lies completely in their meaning, but luckily your words do not have to – your words can spin and then change color. Don’t rely solely on fade in or left to right sweep like an amateur. If you have MSPP 2003 you can allow your text the same expansive freedom afforded only to Americans and feral cats by linking several text animations in a row. My personal favorite is floating the text in from the bottom, fading it out, fading it back in, expanding it 200%, spinning 720 degrees, then changing the color to bright red. I call this animation “The Widowmaker”.
  • Unleash the torrent of mouse clicks: It goes without saying that you do not want to let any of the animations start on their own. Once you let the slideshow take control you have already lost. Make sure that all animations start ‘on click’ so that each slide is slowly unveiled like the antagonist’s motives in a suspense novel. You may not be able to write a lyrically as Dan Brown, but at least you can tug on people’s waning attention like he does.
Behold The Widowmaker

3. Sounds and the Fury
Let’s take a moment to discuss the layout of a good movie. It starts with the Exposition, then the Building Action, which is followed by the Climax, and then wound up with the Denouement. Sounds are the artistic glue that holds all of these elements together.

  • Exposition: (1 minute) Self-introduction and reading all of the information off of the title slide. {sounds: your own quavering voice}
  • Building Action: (30 seconds) Pregnant silence as you fiddle with the mouse and try to figure out how to get rid of the pop-up right-click menu you just brought up. Add an additional 30 seconds if you advance two slides forward by accident and have to restart the whole show to get back to slide 2. {sounds: your own nervous laughter, scribbling on paper as people start writing notes to each other, your own voice saying “it’s never done this before”}
  • Climax: (45 minutes) Ah, the 45 minute climax. Slides #2 through the next to last slide. Here lies the majority of your MSPP sounds. {sounds: ‘drumroll’ at the beginning of slide #2, ‘whoosh’ anytime a word flies onto the screen, ‘laser’ for any and all bulleted text, ‘cash register’ whenever insurance or worker’s compensation is mentioned ,‘typewriter’ on the bibliography page, etc}
  • Denouement: (1 minute) The last slide, if not a picture of a Caribbean island beach, should say “Thank You” and have the applause sound. Failing to do this is like having a slide that says “I verily do NOT thank you” with the sound of a high-pitched baby scream. {sounds: ‘applause’, or ‘high-pitched baby scream’}

Once you get enough experience you can start adding your own sounds like ‘rusty can opener’ or ‘ovulation’… you’ll know when those sounds are appropriate.

Stay tuned for the exciting conclusion before your own Friday conference!


Blogger DocAMAZING said...

I'm curious as to how many Google hits I will get with the phrase "45 minute climax".

10:11 PM, August 21, 2005

Anonymous Diddy said...

After reading the "45 minute climax" paragraph, I had to go take a cold shower.

Thanks for the MSPP tips. I'll be sure to use them in class today. I can see, now, where I've been going wrong. My background graphics are way too boring for high school kids. Time to spice things up a bit so I can enhance learning and retention.

6:15 AM, August 22, 2005


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Saturday, August 20, 2005

Next week we will be presented with transcripts of books on tape...

I just had my first Friday grand rounds of my OBGyn rotation. If there is a god in heaven all of the conference rooms at the hospital will spontaneously fill with concrete and rebar next Thursday evening. It turns out that presentations by the residents are actually word-for-word transcripts of our textbooks in a timed audio visual format. That’s right: we read a book then get to have residents read the exact same paragraphs off of a projection screen. For four hours. I won’t even say they regurgitated information straight from the book because that would imply some amount of digestion took place.

In more positive news I got to see three cesarean sections this week. I have to say I’ve mastered the subtle art of holding retractors, snipping sutures, and suctioning smoke from the electrocautery gun. Keep your fingers crossed that I'll get to see at least one vaginal delivery in my last week in labor & delivery.


Anonymous Diddy said...

People deliver through vaginas?

10:11 PM, August 20, 2005


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Wednesday, August 17, 2005

Medicine: old school

All doctors that teach medical students, at some point or another, will squint their eyes and speak wistfully of the good ol’ days when medical students slept three times a week and got humiliated frequently in front of patients and staff. It truly is a sad testament to modern medical education that it is the doctor who gets in trouble when he open hand slaps a student for omitting vital signs in a progress note!

Today, was supposed to my day off after twenty-four hours at the hospital. But before I left I noticed there was a surgical procedure that I wanted to watch, so, figuring that I wouldn’t have many more chances to see it, I scrubbed in anyway. After four hours the surgery was over and I changed back into my clinical attire to go home. At which point Dr. Pettigrew asked, “You going to a conference?”

“No,” I replied handsomely, “I’m off today and am going home to catch up on studying and sleep.”


Dr. Pettigrew then turned to the resident and reminisced about when he was in medical school and didn’t have the option to go home after a night of call. He then looked at me and nodded expectantly. “I couldn’t agree more,” I said, “we’re all a buncha pussies.”

Actually, I know better than to make such a comment in front of an obstetrician unless I can back it up.

What I really did was give the furrowed-brow-head-bob, as if to say, “Your opinion is full of consequence to me.” Then I looked at my analogue watch suddenly as though it had suddenly started shrieking and told then that I’d see them tomorrow after an afternoon and nighttime full of sweet sweet slumber. I believe that is the correct etiquette for having been called inadequate.


Anonymous your biggest fan said...

Very funny! I have a feeling I am going to thoroughly enjoy reading your blogs. Your wife sounds really hot too! Is she smart? I mean you are going to be a doctor so she is probably just some ditz looking for money right? Although, fencing takes some brains so she can't be completely empty-headed. I bet she is great in bed though. Good luck with your rotation.

9:23 AM, August 18, 2005

Blogger J. Star said...

Hey--judging from this post, it looks like you've got some good blogger potential. :) I'd have voted for your unvoiced comment over your voiced one, but hey, that's just because it makes for interesting reading. :)

11:25 PM, August 19, 2005

Anonymous Anonymous said...

very fun post, keep it up, you've got style.

10:51 AM, August 20, 2005


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"Welcome to my blog! It is full of random thoughts! I hope you enjoy blah blah blah...."

I spent an hour today trying to figure out the “first post”, and figured the test post I published a week ago sums up everything well enough.


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Thursday, August 11, 2005




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