Posts Tagged humor

Supinators of Steel

ring-cutter If you’re looking to get those supinators and pronator quadratuses in shape, might I suggest using a dull-bladed manual ring cutter versus 19th century Ukranian gold? You’ll be mildly sore afterward, you might recruit an intern to help out, but wow, 2-3 days later you’ll notice amazing results: difficulty washing your hands, turning doorknobs, opening the fridge, doing the Single Ladies dance.

Luckily, typing and using a mouse do not appear to be affected.

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Psychosomatic Scabies

courtesy wikimedia commons

courtesy wikimedia commons

… is that syndrome where, after unglovedly touching a patient, he/she/the nurse/the nursing home paperwork/the family member/the prior ED visit summary mentions scabies and you magically begin itching immediately. This also applies to words like “lice,” “ringworm,” “fungal infection,” “elimite cream,” “permethrin,” “that skin medicine you have to leave on all day” or even just “I have this rash and it really itches,” depending on the patient.

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True True Blood

TrueBloodSeason2b I’ll admit it. I love True Blood.

Part vampire flick, part fantasy series, part alternate-universe America, part Louisiana Bayou, and no-parts okay for children, it’s another in a long line of high quality, well-written HBO series.

And while I have no trouble suspending disbelief that vampires and mind-readers and beautiful men and women inhabit a tiny Southern rural town, can we please, True Blood producers, get the anatomy right?

IJ As you can see above, our vampires seem to prefer the internal jugular vein for their feeding access, but they’re just off by several centimeters. (No way is that an EJ. You’re just not gonna get enough flow.) Not that vampires need ultrasound guidance or anything, but come on, guys. You’re trying to go right through sternocleidomastoid, and that’s gotta hurt. A few centimeters lower and you’ll get the IJ every time. Just watch out for Big Red. (I’m also assuming that said vampires have some crazy powerful anticoagulant/procoagulant, since they can apparently decide whether they want their victims to bleed out or not, depending on if the bite is for business or pleasure.)

Okay, so let’s take this post to an even more ridiculous level.

If there really were vampires out there (porphyrians, you don’t Count), scientists would be all over them for their anticoagulating abilities and their blood’s ability to heal the wounded. You’d think the vampires would make a killing (ha!) just selling their undead enzymes to Big Pharma.

Lacrimal Gland, from Gray's Anatomy

Lacrimal Gland, from Gray's Anatomy

Okay and for my final anatomical rant, if vampires are going to cry blood, can we streak the tears from the actual lacrimal gland? I know, I know, everyone thinks tears come from the medial canthus, since that’s where they fall from, but no no, they come from the lateral eye, sweep across, and then fall.

I’d show you examples of all this stuff, except a) it’s probably a bit on the gory side and b) I’d probably get sued for copyright violation. So you’re just going to have to trust me or start watching.

Stick in the mud, enough-bad-puns-for-the-night Dr. Walker signing off. (And accepting offers to be the official medical consultant for the show.)

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Monday, Monday. Can’t Trust That Day.

What is it about Mondays in the E.D.?  I’ve talked to several colleagues of mine, and we all agree:  Mondays bite.  It’s the one day of the week when you can count on the mad rush of humanity coming in through your open doors.  Our residency program does sign out at 0700.  There’s usually  a few EtOH metabolizers or waiting for social work placement patients taking up a few beds.  The dental and STD patients started to arrive about 0630, so they’re good and ready to be seen by the fresh crew.   By 0800, ambulances start making their geriatric runs dropping off the weaknesses, AMS, choking episodes and difficulty ambulatings.  Around 0900 the next wave of gurneys arrive with the abdominal pains and short of breaths.

By 1000, the walking wounded begin to arrive:  back pain, leg pain, headache, and chest pains.  This is also the time when the “expect calls” start.   “Hi, I’m sending in this Marfan’s patient who’s had their aortic valve replaced, multiple abdominal surgeries, who by the way also has diabetes, HTN, and a liver transplant who came to the office this morning complaining of a strange pressure in their mid-abdomen, maybe in their chest. Would you please check them out?  It’s a half day in the office for me today, but I am sure the hospitalist service will be happy to admit them.”

1100 is when the real fun starts, the early HD patients start coming in with bleeding from their AV fistula sites, syncopal or hypotensive episodes that did not allow them to complete HD.  Oh yeah, they still have a potassium of 7.  Or, they missed their morning HD session and now need urgent dialysis because they visited their girlfriend who lives out of town and didn’t think to take any of  their medication with them.  This is also about the time that that coronary who thought they’d just had bad sushi for lunch realizes they’re having an MI and walks in the door.

Are your beds full yet?  It’s 1400 and you’re finally getting the last of your LOLs in NAD dispo’d.  You haven’t eaten.  You’re grumpy, and, all the patients who are supposed to be NPO for thier 10/10-I-need-that-Dil-ah-something abdominal pains have been complaining about not being able to eat or drink anything despite the fact they just swallowed down about a liter in contrast and told you earlier they haven’t been able to eat in three days.  Around this time, PMD’s offices begin closing or referring their patients to you.  You start getting the “I called my PMD about my nausea and vomiting for the last 3 weeks and he told me to come to the E.D.” patients.

At 1700, you’re swimming against the tide.  Fast Track is closed.  All the leftover lacs, ankle sprains, med refills and wound checks start filling up the waiting room.  The hospital housekeepers drop from 3 on the inpatient floors to about 1 on the floor, so your admits are sitting waiting for a clean bed.  Your dispo’s are all pending return calls from the PMD’s or consultants who are driving home and caught in traffic and unavailable to answer thier pages.  Ambulance gurneys are lining the hallways waiting to unload their shortness of breaths and abdominal pains that waited all day to call their PMD’s and then called late in the afternoon only to find the office was closed. This same group will stop deep breathing into their NRBMs and moaning and start yelling and raising a fuss when the gurney with the non-compliant, diaphoretic, hypertensive CHF exacerbation comes tearing into the ED and bypasses everyone to go straight into the Code Room.

That last hour you’re just watching the clock.  Should I see that GIB or leave it?  The lac can wait.  Maybe I better page the MICU again.  Can I get that 84 year old with no family admitted since I saw them at 1755 and Patient Placement leaves at 1800?  Where is my pen?

Sign out is at 1900.  “Sorry the board is such a mess.  But, you know how bad Mondays can be.”

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Hey, Remember That Patient You Saw…

… are the least favorite words you can hear as an Emergency Physician. Using the latest in Neuronal Pathway Imaging Technology, we here at The Central Line have actually been able to map what happens when you hear these words from a colleague:

Remember-That-Patient

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Hypochondriacal Bibles

d7ac53a09da089e284d66110.L Ran across a few funny-to-me, don’t-let-my-patients-see-these books last week, and they’re pretty hilarious. You take your symptom, “runny nose,” and see that it’s not actually a cold, but a CSF leak, or a nasal polyp or lymphoma or tuberculosis. Would also be useful for zebra differentials for the gunnering medical student.

51PHD46VSBL._BO2,204,203,200_PIsitb-sticker-arrow-click,TopRight,35,-76_AA240_SH20_OU01_ But please, if you’re giving this to a friend, please make sure they either a) can take a joke or b) don’t live anywhere near my ED catchment area. Thanks.

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The Goldilocks Syndrome

“Why did you wait so long before coming in?”

“1 hour of sore throat? Really?

Most patients can’t catch a break with us. We’re never happy when they come in: it’s either waaay too soon, or waaay too late. Never just right. (But I suspect that’s because we, just like all other human beings, are averse to work and like to complain.)

This applies, of course, only to the well patients, of whom we would probably complain whenever they come in. The sick ones are either sick immediately and come in, or get sick later and make their way to us. Perhaps: The Goldilocks/Well Patient Syndrome?

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Standardizing Answering Services Haiku

Can we standardize
A doctor’s call services?
I am losing it.

Sometimes, I hit STAR
Other times, it is SEVEN
One office is EIGHT.

Hold music is nice
Soothing while I am waiting
But please, hurry up!

Let’s just use ZERO!
Quit wasting my time, puh-lease
For courtesy calls.

Slow enough as is
Dialed three numbers already
Awaiting call back.

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Guess The Question

And now, in quasi-Jeopardy style, the answers to my most frequently-asked questions outside the hospital, in quasi-conversation style. (God I hate small talk):

  1. I’m an Emergency Medicine resident.
  2. No, I’m 28.
  3. I’m from Kansas.
  4. St. Luke’s-Roosevelt Hospital, two hospitals on the west side. One near Columbus Circle, the other in Harlem, across from Columbia University.
  5. For a few brief minutes, it’s like ER, yeah. But with a lot more runny noses, rashes, and drunk people either passed out or yelling at you. I think Scrubs is more accurate.
  6. Yeah, we see some crazy stuff. Brings out the best and worst in people.
  7. Hmm. Weirdest? I guess recently, I think a co-worker pulled a showerhead out of a butt.
  8. Lady that was hit by a subway car. Really sad.
  9. Doesn’t really feel that admirable. Feels like a job with training. I love it, but I wouldn’t be doing it just because “I get to help people.” Just like you wouldn’t be an X just because you like to Y.
  10. I have no idea why you’re breaking out on the right side of your face recently.
  11. Yeah, doesn’t look too bad. Regular borders, not discolored, small, not growing. But you should see your regular doctor, I’m not a dermatologist.
  12. Uhm, I guess I wish more patients showed more appreciation. And had better manners.

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