Posts Tagged humor

Linguaphiles welcome

Every year, linguaphiles salivate over the release of the release of the latest edition of Webster’s Dictionary and the new words that made the cut.  I proffer these new phrases for  your consideration:

History alternans– the change in a patient’s history between triage and the time the attending sees the patient.  A common variant is found at academic centers where a team consisting of medical students and residents are interpolated between triage and attending, called history alternans mulitforme.

Narcotics inflation– the escalating narcotics requirements for common pain complaints.  Where once hydromorphone was reserved for terminal cancer patients, it is desperately needed for ankle sprains and nausea.

Dead celebrity effect- the surge in patient volume when a celebrity suffers from some severe or deadly process.  A related process is the Hystericus reportercillium in which whatever illness is in the news is immediately contracted by one third of your patient population (e.g., Swine Flu), even those without any symptoms.

Tooth to tattoo ratio– the ratio of teeth to tattoos, which has an inverse correlation to the risk for trauma.  If tattoos=0, then the ratio is undefined and may not be used to estimate trauma risk.

Politicus apoplexy– the overwhelming frustration that overcomes both participants when discussing health care policy with someone who holds the contrary position.  Because they are clearly wrong.  Whatever their positions.

Pucker effect- an involuntary visceral twisting sensation you get upon arrival at work and your collegue says, “Hey, do you remember that patient you had last night?”

Five-second pain delay- five seconds after you leave a patient’s room, the nurse approaches you for pain medicine for the patient who just assured you that he was feeling much better and ready to go home.


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Disaster is in the Details

On my way to work this morning I listened to the re-run of President Obama’s interview with Fox News, which had been vilified by him and his staff at every turn and now apparently rates his attention when he feels the need to  plead for support from those who don’t understand the new math.  I, too, was unclear on the details of the massive program that is not being voted on this week.  He clearly stated that the details of the health care plan, which he doesn’t know, will be posted many days before the actual vote which is funny because Nancy Pelosi said last week that if you want to know what is in the health care bill they will have to pass it first.  Huh? 

I also missed the math class in school that allowed you to save money and still spend it- I’d like to be able to do that in my own expenses.  

This whole Health Care Debacle  Debate- feels kind of like a marathon in which everyone disagrees on the route and the goal, and we aren’t making good time.  And the people who are in charge of it are fish.  I don’t mean that Congress People are slimy sea creatures, though I’m not ruling this out, I just mean that fish don’t ambulate, so have a difficult time telling bipeds how to provide health care.  

Are we really talking about adding a trillion dollars to the deficit that we can’t pay now?  Doesn’t the word “deficit” mean that we can’t pay it now?  That’s what it means in my house.  It is like the thought that we can’t be out of money because we still have checks left.  We just came through a financial crisis that was partially caused by thinking like that.

I’m confused and want to know- is tort reform in or out?  Is the public option in or out?  Is the opening of health insurance sales across state lines in or out?  Are we still voting on the bill?  Because it doesn’t sound like congress is even going to vote on the bill, but on the second derivative of the bill, and this violates the principles of SchoolHouse Rock in which the rules were clearly laid out by Jack Sheldon (www.schoolhouserock.tv/Bill.html).  So you can understand my confusion.

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ED Portmanteau

Inspired by this NY Times On Language article, I present some medical portmanteau:

  • Labnormalities: Dear lord, LFTs are all messed up; this guy’s got a lot of labnormalities, but it looks like it’s all from his chronic alcoholism.
  • High-NR: I have no idea who thought it’d be a good idea to put this alcholic GI bleeder on coumadin, but judging by all that melena, he’s definitely going to have a High-NR.
  • Awheezile: Yeah, she was both inspiratory and expiratory when she came in, but after nebs and steroids she’s totally awheezile and asking to leave.
  • Pelvicize: The ultrasound’s normal, but I guess I should still pelvicize her to make sure her os is closed.
  • Milk of Amnesia: Let’s secure the tube and start the milk of amnesia drip, please.
  • Sprintubate: We’d better sprintubate: that neck hematoma’s not getting any smaller. (Okay, fine, I’ve never used this one.)

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A Means To An End

… was my initial, no-pun-intended explanation about why I needed to disimpact my patient; luckily his sense of humor (and the 10 of valium I gave him) helped. After the fact (and washing my hands), also inappropriate would have been:

  • It stinks that you’re constipated.
  • Can I log this procedure?
  • It’s hard to get it all.
  • What a crappy job.
  • So this is Brownian motion.

See also: Whit Fisher’s Rectal Regrets Procedurette on how to gown up appropriately.

(Side note: An attending once told me the most awkward thing he’d heard during a disimpaction was his patient, saying, “What, you aren’t going to take me out to dinner and a movie first?”)

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Ban That Ringtone!

Like many Emergency Departments, we have a batphone. New York City EMS will (usually!) give us a ringdown when there’s a critically ill or trauma patient en route, with a few mixed in “Ooops, wrong number” calls. Ever since I started residency my ears quickly perked up at the sound of the tone, even before the overhead page “GREEN TEAM TO THE TRAUMA ROOM ETA TWO MINUTES” screams through the department. I know pretty immediately that I need to wrap up whatever I’m doing, if possible. I’m Mr. Airway.

And that, my friends, is why this evil, evil ringtone needs to go:
[wpaudio url=”http://thecentralline.org/wp-content/uploads/2010/01/oldphone.mp3″]

Yes, mostly iPhone users are to blame (even some of my beloved attendings use it as their ringtone), but really, it’s got to stop. A female friend once said that “All men are dogs;” I think if she was referring to the Pavlovian type, she’s probably right. Stimulus, response.

RINGRINGRINGRINGRIIIING! In a coffee shop: Ohmygodwhere’sthe–oh, wait, nevermind.
RINGRINGRINGRINGRIIIING! In an airport terminal with an old style phone: Calm, calm, you’re not at the hospital.

So please, PLEASE, people who are in an Emergency Department (who okay, probably, technically, shouldn’t even be using their cellphones to begin with): get a new ringtone. My peptic ulcer will thank you.

(One of my favorite sites, audiko.net, has a ton of song ringtones for free download, or you can even create your own by uploading your favorite song!)

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Well Hung

Hangman-5 According to one of my attendings, the phrase comes from the priapism a spinal cord injury causes, indicating a successful hanging. Of course, due to a Hangman’s fracture.

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Telephone Line

DictaphoneI have a friend who works as a transcriptionist.  She blogs and occasionally talks about her work.  However, she talks about the business side of her work:  how much she makes per line, how she can’t understand what the doctor is saying, how she has to undergo QI, etc.  One thing she’s never mentioned is if she ever takes the time to think about what she’s transcribing.

I’m currently on rotation with a group that dictates their H&P’s along with their assessments and plans.  After a day or two of dictation (which by the way I hate to do because I can’t stand the sound of my own voice) I started to wonder if transcriptionists laugh at some of the content in dictations or if they’re like mailmen who deliver postcards without reading the back.  I know I sometimes chuckle when I get the transcribed note back to sign for the chart… especially when I read things like:

“Patient states they have been constipated for a whole month.”

“87 year old patient states she fell off a chair while painting her ceiling.  She states her bridge club was coming over and didn’t want them to see a brown water spot that was on it.”

“Patient states that she has vomited several times.  The last emesis looked like blood, or it could have been the cranberry juice she had been drinking just prior.”

“Patient denies any alcohol, tobacco or drug use, except for the occasional marijuana use whenever her son is in town.”

“Patient states he thought his abscess was due to an ingrown hair, so he shaved off his all the hair in his axilla thinking it would go away.”

“Patient presents asking for Tamiflu because “there’s a lot of sick people hanging around the grocery store.””

Did I really dictate that…?  Yep, patients say the funniest things…

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Crazy Trippy Post-Nights Dreams

Sorry for the dearth of posting lately. Been in web design mode, updating the mdcalc.com with a few extra neat-o features, as well working on a top secret, really cool, hopefully really-helpful new website for therapies in the ED. More on that later, trrrust me.

So I had a big long slew of nights-and-days-and-nights-and-days last week, and wanted to see if my freaky dream phenomenon persists amongst my five readers. My current strategy for resetting my clock goes something like this:

  1. Finish final overnight. Go home, get to bed around 8am.
  2. Fall asleep. Force myself to wakeup and stop sleeping around 1pm.
  3. Do something — anything — to stay awake and out of my bed.
  4. Try to time it so that I hit the “bedtime sweet spot” where your body is tired enough it’ll sleep through the night, but also not too early in the evening so it doesn’t just think you’re taking a nap.
  5. If you time it just right, you wake up ready for work the next day, refreshed and feeling great.
  6. If, however, this did not go as planned, you wake up at 2am, completely, totally wide awake after a deep, deep sleep. With really freaky-deaky, very vivid dreams. Usually about work. Most recently was that I was putting a line in a French teenager, got bloods, took the tourniquet off only to realize his hand had gone completely gangrenous and necrotic from the tourniquet, only having a bony distal radius and ulna left.

Uhm, yeah. And that happens whenever I’m finishing night shifts. Is this a common phenomenon that everyone has, but just has the common decency not to discuss it? Or is it just me? (I have, on occasion, been accused of lacking common decency, for what it’s worth.)

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Non-Clinical Clinical Prognostic Indicators

Good Prognosis:

  • Your doctor hasn’t seen you yet, and you’ve been waiting for (insert average wait time) hours.
  • You’re in a bed in the hallway.
  • Your complaint consists of “months” or “years” of pain/nausea/headache/X Y Z.
  • You’ve come to the emergency department for a second opinion, despite multiple subspecialist evaluations.
  • You answer yes to every symptom the doctor asks you about.
  • You get a blood draw, but no IV.
  • The only medication you’re given is tylenol.
  • Your doctor says the words “probably” and “virus” in the same sentence.
  • You are talking on your cellphone, playing a game, or chit-chatting.
  • You are talking on your cellphone, playing a game, or chit-chatting and the doctor has to ask you to stop.
  • You “just wanted to get it checked out.”
  • Your primary care doctor sighs on the phone when the emergency physician calls him or her.

Bad Prognosis:

  • You get not one, but two IVs.
  • You remark, as my GI bleeder did last night, “Boy, I’ve never been to a hospital so attentive and efficient!”
  • You get your own personal doctor to take you to the CT scanner.
  • Multiple doctors, nurses, and staff greet you in your room.
  • The triage nurse walks you to your room and points at you while speaking to the doctor.
  • You get a room all to yourself.
  • You get a monitor.
  • Your monitor keeps beeping, even though you’re not doing anything.
  • Your doctor keeps checking on you.
  • Your doctor sticks a finger in your bottom.
  • You don’t argue with the doctor about getting this treatment or that one.
  • You are kind, good-natured, and have been a good person in this life.

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Dirty Talk

courtesy wikimedia commons

courtesy wikimedia commons

Upon reflection, and despite being a polyglot and the easy access to translator phones, I often find myself needing to say or understand the word for “poop” in other languages. I’ll either have just hung up the translator phone, or someone is trying in broken English to explain something to me involving their stools (often either a parent of an infant, or an elderly person). My nominations, in order of “getting the point across” (or at least thinking it got across) include, in order of frequency:

  1. Caca
  2. Poo poo
  3. Ca-kie
  4. Poop
  5. {Me squatting and motioning inappropriately}

I’m also guilty of the “louder will somehow translate the word into native tongue” business, especially when it’s an elderly person. You know, as in, maybe they’re just not hearing me. Put the two together, and apparently you quickly become quite the comedic entity for the nearby doctors when yelling “POOP! POOOO! CACA! POO POO! WHEN DID YOU LAST POOOOOOOOOOP? YOU KNOW, CACA? WHEN?”

And that is all.

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