Today's Menu's Friends

And after all
I'm back in the jerz and mim and harold and i are all going out for lunch with Unc once he gets here. Mom left us an email to tell us this, which makes my family sound significantly more dysfunctional than we actually are.

Anyway, I got back to Ohio on Saturday night, except technically it was Sunday morning, my flight didn't get in until a little after 1AM so I didn't get back to my apartment until around 3AM-ish because it was snowy and I had to drive slower. On the flight I had the window seat and the guy with the aisle seat wouldn't shut up. First he told us all about how someone had stolen his cell phone. Then he told us all about his ex-fiancee. Then he talked about how he used to be in construction. I got lucky though--the guy in the middle seat did me a huge favor and started talking to AisleGuy so that little miss window seat could take a nap. When I was getting off the plane at the end MiddleSeatGuy said to me "happy holidays" and I said "thanks, you too" and he said "and I hope I was able to keep you from having some conversations that you didn't want to have" and I thanked him for that as well, so I guess I wasn't all that subtle about the fact that I didn't care. I don't care about too much after midnight. I'm gonna be an awesome doctorb.

Then my brother came up and we drove from T-do to the jerz yesterday, I'm pleased to report that we're still friends. We made really good time because the turnpike was all cleared off so we didn't have to worry about that, plus my baby brother drives like a maniac. I'm pretty sure he didn't go below 85 the whole way there. I think the speed limit was 65 most of the time. We also didn't stop for anything but gas although at one point we bought pretzels at a gas station. So we got on the road around 10 and made it to jersey around 6, which is pretty phenomenal if you think about it. And we didn't kill each other. That's a good thing too.

So...I guess that's about all the news from over here, I'm probably going to slow down on the posting for a little while since I don't predict anything will really be doing, unless you want me to write about running in the snow and watching Law&Order. I have a while off, BTW. I have 2 weeks of vacation now and then I'm taking 4 weeks of "flex time," which means i don't have to do anything. I'm supposed to be using it for interviews although all my interviews are Fridays and Saturdays so really, I probably could have snuck another rotation in but I have 8 weeks of flex time and I can't think of any other time that I'm going to really want to use them so I'm taking off the month of January and the month of May. Should be OK.

That's it from over here.

Current Mood: apathetic

JaxJess
Mmmm...I"m currently in the Jacksonville Airport and they've decided to give everyone free wireless this month, which is more than I can say for the hotel I was in last night. Anyway, it's also around 70 degrees here, which is pretty freaking awesome. Granted, it was rainy this morning, but it was 70 freaking degrees!

Yesterday though was really great--I got to go for a run outside, in shorts and a tee-shirt, and I even put on sunblock! (Partly because melanoma is the leading killer of women aged 26--34 and partly because I didn't want to have to do an interview with a peeling pink nose) And really, that was all I wanted--a nice run in the warm sun. My derm partner told me that I was going to finish running and it would be around 1PM and I would wonder about what they were doing in derm clinic. I can honestly say, that did not happen. The only skin I cared about at 1PM was my own. (seriously, I'm a little scared of melanoma these days. I've seen patients younger than me who had it and whereas everyone I saw was lucky and managed to get it excised before it metastasized, Dr. Dermafem had a lot of patients who were my age and dying of metastatic melanoma. She didn't let me in those rooms with her. I was OK with that.)

Anyway, I felt so much better after getting a little bit of sun. Maybe this is something I should do more often--disappear in the middle of the winter and go someplace warm for 36 hours and be someplace where you can stand outside for longer than 5 minutes. Granted, it's kind of an expensive way to get your kicks, but hot damn, I was feeling better 2 hours after landing. I was supposed to go to Arizona in March for my lifepartner's wedding, but then she decided to move her wedding back to October, so that's out. Maybe it'll be warm when I hit up Augusta, Georgia in early January. But yeah, it's weird to open a door and have it be warm outside. We always say that you can tell who the Ohioans are because it'll be the middle of summer and we still brace ourselves before we open a door leading outdoors because we're so used to it being cold all the time.

I totally can't wait to be a snowbird :-)

Current Mood: content

time on my hands
I had a patient today in clinic who was a really heavy smoker. i mean, really. He admitted to smoking 3--4 packs a day. His fingers were all yellow and so were his teeth and even his hair was stained kinda yellowish. Plus he totally stank. I walked into the small, unventilated room and my eyes watered a little bit. Then after a while I had to excuse myself so I could leave the room and start coughing. It was seriously that bad.

Anyway, in addition to a little problem with nicotine dependence, he also had hepatitis B and C, as well as psoriasis and chronic pain from psoriatic arthritis in his feet. I asked what meds he was on and he said that he took 2 Vicodin every 4 hours. I asked him where he got those from (that's a crazy high dose) and he said that he was only supposed to have one every 6 hours but he was able to borrow some from friends so he could take more.

Here's where things start getting sticky: the only thing that worked for his psoriasis and his psoriatic arthritis was Enbrel. But Enbrel is the kind of drug that tones down your immune system a tad so you can't take it if you have hepatitis because then your immune system will stop fighting the hepatitis virus and you get crazy liver failure (and trust me, fulminant hepatic necrosis is not pretty. I've seen it. It's actually pretty horrible.) So we couldn't give him the Enbrel because of the hepatitis. But by not giving him the Enbrel, it meant he was stuck stealing Vicodin to deal with his psoriatic pain. But we couldn't really give him a different psoriasis medication either because pretty much all of them either knock down your immune system or get metabolized by the liver, and you can't use the latter kind in hepatitis patients either because you don't want to stress their livers too much.

Some days I really hate my "job." Today was one of those days. I had to go back into his room and tell him that we couldn't give him Enbrel because of the liver problems.
Him: Let me guess, they sent you back in here to tell me the bad news.
Me:P Yeah, pretty much. I'm sorry. We're not going to be able to give you the Enbrel. We want you to get a liver biopsy and then, depending on what the results show, maybe we can find a different drug that'll work for your psoriasis.
Him: It doesn't matter. When my psoriasis gets really bad, I just want to kill myself.
So that got my attention because really, I'm not good at dealing with those situations. That's a little more psychosocial than I like to get into in my every day wheelings and dealings. Plus I never know how to respond to that. I mean, what the hell am I supposed to do, sympathize and say "yeah, life is hard and I understand that sometimes it doesn't seem worth the effort?" That doesn't sound like a great sound byte, in my humble opinion. But you can't just blow that stuff off. I remembered from my psych rotation that you can't actually hospitalize everyone who's ever made a suicidal statement because then we'd all be in the hospital at some point in time or other. You're supposed to find out if the person has a plan. So I asked him, "are you planning on hurting yourself?" and he said "no" so that was kind of a relief because if he had said yes, i wasn't totally sure what the next step was.

So he left clinic, I started coughing, and that was pretty much the end of that. Although now I have to wonder--was I supposed to report any part of that? The guy admitted to taking much more vicodin than he was prescribed and stealing it to get more. And he admitted to suicidal thoughts. Should I have done more to follow up on those two thoughts than just mention them in the "assesment" section of my note? I was in sports clinic once and a patient made a statement about how he was in so much pain that sometimes he just wanted to kill himself and the attending called the patient's psychiatrist to tell him. Was I supposed to do something like that or is that an invasion of privacy? And was I supposed to call the PCP and let her know that the patient is abusing Vicodin? But if I do that and he can't get any, then the pain might cause him to do something drastic. So maybe it's best that I didn't do anything?

Did I mention that there are some days when I really hate my "job"? Because I really hate not knowing what the right thing to do in these situations is, almost as much as I hate not being able to help patients who are in pain. I sat through over 2 years of ethics class in med school and I still don't know what to do, ever.

Current Mood: gloomy

she's going to testify against him
Patient: I'm pretty sure I have psoriasis because i'm having an allergic reaction to my knee replacement.
Nurse Practitioner: Oh, jess just did a presentation on that! Jess, why don't you do your presentation for Mr. Smith?

Clearly it was a memorable presentation.

The only fly in the ointment is, the presentation had absolutely NOTHING to do with titanium allergies OR psoriasis. It was about how to choose a prophylactic antibiotic to protect your knee joint from skin bacteria. And even if my presentation was relevent (which it wasn't), I'm pretty sure the patient did not want to hear it. Even Dr. Dermafem didn't want to hear it yesterday when I did it and it's her job to sit there and listen to stuff about skin. And now I'm inclined to believe that the NP wasn't paying attention at all because really, there's no way to confuse the topic of my talk that badly.

So instead of redoing it, I just told the patient that it was impossible that the psoriasis on his shins was caused by the titanium in his knee. (trust me, it is impossible. it's possible that the stress of the surgery caused him to develop psoriasis, but even that's pushing it) He didn't like that answer and tried to tell me that parts of the artificial knee had migrated down to his shin and causes psoriasis to start growing over it. I gave up fighting pretty quickly.

Current Mood: blah

and you learn to accept it
While I'm complaining about stuff, can I just say that it really annoys me when a patient tells me something and says "shouldn't you be writing this down?" I'm not totally sure why this bugs me so much but it's one of my pet peeves. I think part of me is just insulted that the patient doesn't trust me enough to remember stuff long enough to tell it to Dr. Dermafem.

Me: Have you had any unexplained changes in weight recently?
Patient: How recently?
Me; in the past year
Patient: No, I guess not
Me: OK, so--
Patient: Well, the reason I asked how recently was because about 5 years ago I was diagnosed with diabetes. So after that my wife and I went to a dietician and he put us on a special diet. So I managed to lose 20 pounds on this diet and I was around 260. I stayed around 260 for a while but then I gained all but 5 pounds of it back. So that's why I asked you how recently but since you said a year, that doesn't really count.
Me: OK, so--
Patient: Shouldn't you be writing this down?

I'm not saying there aren't times when I forget to write something down and then I don't know the answer later on. It happens a lot. Particularly when I get really tired. But I don't need to sit there taking notes on every little thing the patient says. Especially the stuff that the patient himself acknowledges doesn't answer the question posed (for 2 reasons!) And I only get 4 lines to write a history of present illness on these derm forms. So if I start writing everything down on the form that the patient tells me, I'm going to run out of room at some point when they're talking about the grandchildren and before I get to the part about the crushing chest pain that radiates down the left arm. Plus I have a decent memory most of the time and I can remember stuff and write it down later. I guess patients are worried that their story is going to get twisted or forgotten in the retelling, which is a pretty valid fear. But I kinda wish they'd put a little more faith in me. And if they think I got something wrong, they can always tell it to Dr. Dermafem or the nurse practitioner when they come in the room with me. (i do tell all my patients that either dr. dermafem or the NP will be coming back with me after i'm done in there)

Man, I'm really whiny tonight. I should probably go to bed instead of complaining.

Current Mood: whiny

intergalactic
I was running the other day and I was trying to think of what this year's resolution should be. 2 years ago was to quit cursing (I'm doing a lot better with that) and last year was to quit hitting snooze so much, which didn't go too well. So I was thinking maybe I could resolve to stop interrupting people so much because I feel bad that I don't let people finish their sentences a lot of times and it's pretty rude.

The problem with this is, sometimes you really have to interrupt patients. I know they teach you that everything patients say is important, but a lot of times it isn't and you have a finite amount of time to get to the important stuff. And what patients think is important is not always what's actually important. I was talking to a guy today who's going into radiology and he said one of the perks is that all the important information is already there for you and you just have to interpret it, you don't have to be the one to dig it out. So if I just let my patients talk forever, I wouldn't get too much more useful information than I would if I interrupted and redirected. And a lot of times you kinda have to redirect patients after they get on a tangent and that can involve interrupting because if you wait for them to finish, you'll be there forever. Generally if they start talking about how smart their grandchildren are, I interrupt and attempt to steer them back to the problem at hand because really, I'm a busy woman.

The only time I won't interrupt a patient is when he/she is talking about someone else's death. I feel like it's really rude to interrupt someone when he/she is talking about something that personal, so even though it generally has nothing to do with their chief complaint, I let them go on a little bit longer.

So I'm not sure how I can turn this into a new years resolution--what am I supposed to do, not count patients as people? Or should I actually stop interrupting my patients so much? The latter is probably the preferred option because I'm sure I interrupt people too much and miss important stuff that way but at the same time, when you have less than 10 minutes to do a history of present illness and a physical exam, you can't mess around too much. Maybe I should just resolve to have better bedside manner. I was talking to my baby brother today and he said that he thought my bedside manner was terrible and I was mean to my patients, but I really don't think that's true. I know I complain about them all the time, but I really do try to be polite when i'm with patients and I try not to show it when I'm losing my mind. I'm pretty sure I've never rolled my eyes in front of a patient before, although i promise the temptation is there on a daily basis. But I really do try to have good bedside manner and i'm sorry it doesn't shine through in my blog.

Current Mood: blank

keep it copacetic
Dr. Dermafem: You realize that if you match here, it's only because Dr. Orthohead enjoys staring at your boobs and wants to have sex with you eventually.

It is really hard for me to articulate how much that pissed me off. Because I really don't think that's a fair statement at all and I don't think I deserve that. I tried laughing it off and saying "I'm more than just a great rack," but she said "i'm sure you are, but all he cares about is your boobs."

Screw you, bitch.

It's probably a good thing tomorrow's my last day on this rotation because I'm not sure how much longer I can go before I snap at Dr. Dermafem and say something I really regret.

Current Mood: pissed off

again and i can't turn away
I started getting really excited that toilet bowl cleaner was on sale for $0.99 so I decided to mourn my youth and buy some animal crackers.

Anyway, I was sitting at home, eating my animal crackers like a normal human being, when all of a sudden I noticed that some of the crackers were in the shape of a HOUSE! Seriously! Which means that I was eating crackers that weren't animal crackers! The package clearly said "animal crackers." They did not warn me that they were going to sneak in non-animals and hope that I didn't notice. So I was stuck with all these stupid houses that didn't taste as good as the giraffe and horse and cow and pig. I mean, there was no way these things were anything other than houses, so I can't even try and convince myself that they're some sort of animal. And even if the cracker people decided to toss in some houses so that the animals had a place to live, then they should have warned me so that I knew what was coming before I munched through a bunch of them. Plus they put in way too many houses. There was at least a 1:1 ratio of houses:animals. I mean, was I supposed to give each animal its own house? Because that's stupid, they'd get lonely. The only animals I can think of that didn't live together were the three little pigs and we all saw how well that worked out--they all wound up in the brick piggie's place in the end. So I'm not about to try and separate out all these animals.

What is this world coming to if you can't even trust your animal crackers not to betray you?

Current Mood: enraged

Pour some Ancef on me...
I pulled together a powerpoint on "Protecting Hardware from Skin Flora: Prophylactic Antibiotic Choices in Total Hip and Total Knee Arthroplasties" in 20 minutes today so go me. I have to give a presentation tomorrow in derm and I was supposed to pick a topic that had something to do with ortho and something to do with derm so this was the best I could think of off the top of my head. And the only reason I came up with it was because JBJS had a really awesome review article on the subject in October. I'm hoping no one notices that I only mention skin flora on two slides. The rest of it is more ortho-related. Whatever, I don't really care, if they want to give me a "pass" instead of an "honors" for this rotation then they are more than welcome to.

Today we were with the nurse practitioner all day. I think I've mentioned before that I don't like the NP. Today further cemented that. Holy crap, she really really really really annoys me. I don't think she's a bad person and I'm sure she means well, but she spends most of the day talking to hear herself talk. So I just want to tell her "shut up already! the patient left 20 minutes ago! You don't need to keep on talking about his unusual shaped mole!" Also, she spends forever with each patient. But not in the Dr. Selleck tell-me-your-life-story way. More in the way where she talks to the patient while flipping through his/her chart, which means she doesn't pay attention to either of the two. So then she needs to ask the questions again. Then she needs to flip through the chart again. Also, for whatever reason, she'll never put the chart down on the desk. She hands it to me. Then when she needs it again, she'll stick out her hand and I'm expected to put the chart in her hand so she can flip through it before handing it back to me. I don't get it but I'm not about to fight it.

And the NP told me today that I should go to the antique mall because I would love it. When I was working in rehab that summer, for whatever reason, physical therapy decided to take a bunch of stroke patients to the antique mall for a field trip. I'm not sure why they thought taking a pile of middle-aged men to go antiquing was a great idea but hey, their prerogative. Anyway, there was one patient who couldn't speak at all who wound up going. When he got back I saw him and I asked him how the antique mall was. I figured he was going to roll his eyes at me because that was generally how he communicated, but I guess he must have been really moved by the antique mall because he screamed at me "BORING!" I guess it was so boring, that the damaged part of his brain was inspired to work again so he could communicate just how boring it really was. I'm pretty sure they never took the stroke patients back there although there was that fiasco later on where they tried to get the spinal cord injury patients to play volleyball. It went about as well as you'd think it would go. Generally people who can't move their arms aren't good at volleyball. Anyway, I have about as much interest in the antique mall as the stroke patients. Possibly less. As anyone who knows me will attest to.

But...I only have 2 days left of this rotation (I'm taking off Thursday and Friday to go down to Florida for my interview) so that's pretty nice because it's been a crappy 4 weeks. I don't find the subject material interesting at all and the attending is a piece of work, which is not a great combination. I was hoping to come out of this with a great female role model and an appreciation of the differences between a papule and a macule. I figured out the latter but I'm still sorely lacking in the former so it's back to the drawing board.

Current Mood: quixotic

middle
The hotel I was in last night had a remote-controlled mattress(!!!!!) I figured out after a while (OK, technically someone told me) that if you pressed the "up" button, it made it firmer and if you pressed the "down" button, it made it softer. So that kept me occupied for a while. As in, I spent the better part of Law and Order playing with the bed.

Then they had french toast sticks at the breakfast buffet. Since the program was nice enough to give me a $10.99 breakfast buffet for free, I had to eat at least $10.99 in french toast sticks. Man, those things are awesome. i truly believe that french toast tastes better when it's in stick form.

Plus the program gave me a coffee mug and specialty popcorn in addition to the hotel room and the breakfast. That was good too :-)

Current Mood: content

Happy Hanukkah!

ܗܚܠܛܬܝ ܫܐܢܝ ܠܐ ܡܚܒܒ ܟܬܒ ܪܗܘܛ ܥܒܪܝ, ܗܝܘܬ ܫܩܝܝܡܗ ܟܒܪ ܟܬܒ ܝܕ ܩܫܘܪ ܠܟܬܒ ܗܥܒܪܝ: ܗܟܬܒ ܗܣܘܪܝ. ܠܟܢ, ܗܚܠܛܬܝ ܠܢܣܘܬ ܠܠܡܘܕ ܠܟܬܘܒ ܒܟܬܒ ܗܣܘܪܝ.

(Translation: I've decided that I don't like Hebrew cursive, seeing as there already existed a script related to the Hebrew alphabet: the Syriac script. Therefore, I've decided to try to learn to write in the Syriac script.)

In other news, my sister says that my journal is hilarious, but only once you realize that it's hilarious? I'm not completely sure what to make of that statement. I mean, I've been told that my sense of humor is "subtle", and I've been told that it's "dry" — both of which surprised me, because I usually think of myself as very straightforward — but this is the first time I've been told that it's actually invisible until you know it's there. *shrug* So anyway, if any of you is looking for some hilarity in your life, um, just "know" that my journal provides it, and suddently it will. How's that for a parlor trick?

I was planning on writing about some other things, but I haven't really eaten or drunk yet today, and I gave blood (I've now given three gallons in Ohio! — but man, am I starting to hate the Red Cross), so I should really take some steps towards making my stomach not collapse in on itself.

Eau de Rotting Feet
I tend to be a tad scent-sitive, in that I buy lotions without fragrances, I never wear perfume, and being around people who wear too much perfume makes me cough and my eyes get itchy. There's a woman who used to work out at the same time as me and after she was done, in the locker room, she would spray perfume all over herself and I would start coughing from across the locker room because she put on so. damn. much. I'm not allergic to fragrance or anything, but i prefer to smell like soap. Unflavored soap. And a little bit of deoderant.

Anyway, today in clinic I had a patient with the absolute most smelliest lesions on her feet. I walked into the room and the smell hit me and oh G-d, I couldn't breathe. For those of you who have never smelled rotting flesh that's just been released from a sweaty ace bandage, trust me, you're lucky. She was missing a lot of skin on her feet. She was missing so much skin on the top of her right foot that you could see her tendons, those thick white cords across the top of the feet. Except on her, they weren't white. They were covered in thick yellow grease. She was also missing skin on the backs of her heels and you could see straight to the bone in one part. The surrounding skin was bleeding and oozing pus, so it was a thick liquid that was red blobs swimming in yellow-tinged mucus puddles. The remaining skin on her feet was discolored a violaceous hue and covered in scales. When I went to touch her feet (wearing gloves!) chunks of skin started flaking off. I couldn't figure out whether it was best to breathe through my nose and get the full effect of the smell, or breathe through my mouth and risk inhaling a skin flake. In the end, I decided to go with the smell, even though it was horrible. Seriously, I can't even think of anything to compare it to, it was so bad. I would rather hang out with my cadaver from anatomy lab then her feet. I'm pretty sure I would rather kiss my anatomy lab cadaver (RIP Bernie) than smell this patient's feet.

Then I had to go get Dr. Dermafem and she came in the room with me so I had to smell them again. Then we left the room but i had to get a consent for medical records form signed so I had to go in there again. Then I had to bring her a prescription so I had to go in there again. Which meant that by the time I was done with all that, I was starting to get the feeling that I smelled like her feet. I mean, enough of those smelly particles could have landed on me and covered me with their foul stench in that amount of time. At the very least, I'm pretty sure I got smell-particles caught in my nose-hairs because I kept on smelling that horrible rotting smell.

I think I'll wash my white coat when I get back to my apartment. And I'll say a prayer that I never ever ever ever ever get Bullous Pemphigoid.

Current Mood: nauseated

when the wheels touch ground
Dr. Dermafem and I had some girly-bonding-time today after my partner and the resident left. (I was finishing up a note) After she made the requisite comment about my boobs (she informed me that women with big boobs, like me and her, couldn't play golf because "the girls get smooshed." Good to know) she mentioned something about doing kids' melanoma screens.

Dr. Dermafem: They're at the age where they find penises funny
Me: Well...penises are kinda funny, I guess.
(it should be noted, I meant the word "penis")
Dr. Dermafem: You're right, they are. Did you know, the best kiss of my life was with a woman?

And really, what the hell was I supposed to say in response to that? The conversation died soon after although Dr. Dermafem did wish me luck on my interview tomorrow. And I did giggle a little when I saw her husband after I left clinic and was walking up to the gym.

That being said, Dr. Dermafem is not the only attending to tell me about her private life. One of my attendings once told me all about his vasectomy. First he told me about how his wife told him to get one, then I heard about the procedure, then I heard about his recovery from the surgery. Seriously, I don't need to start imagining my attending's penis, which is what I'm going to do if he starts telling me about his vasectomy. I had a different attending who told me about his colonoscopy, which meant I had to picture him lying on a table with a camera up his butt. Wow, thanks for that image. Then one of my attendings really crossed the line and told me about how often he and his wife had sex. I suppose it could be worse, one of my friends was with him and he showed her a naked photo of his wife, but still, hearing about them doing it was pretty icky. Plus he told me that if his wife died, he would be devastated, but if the kids died, he would be OK with it. I really didn't have a response to that one.

So sometimes I wonder, do people realize that they're leaking personal details? Or is it just that you get so used to being around someone (I worked one-on-one with a whole pile of attendings for 4--6 weeks) that they forget to turn on the filter? Which leads me to wonder how much personal information I've divulged to my attendings. My OB-GYN attending asked me about my menarche and I told him, but I feel like once I realized that he didn't actually have the right to ask me that, I became more guarded about the information I volunteered. I didn't want him to say that he assumed I was comfortable talking about sexarche/thelarche/masturbation with him because I had already told him personal details about myself without being prompted. But I'm sure I let my guard down at some point in time. Not that I really have all that much info to divulge, but there's stuff that my attendings don't need to know about me. Like whether or not the best kiss of my life was with a woman.

Current Mood: calm

and i must be what i must be and face tomorrow
Me: OK, something really funny happened the other day in clinic. I was walking into my patient's room and I was holding my can of liquid nitrogen so I could freeze off his actinic keratosis and--
Mim: Yeah, that happens to me all the time.

I suppose a lot of my experiences are really not stuff that non-medical types can relate to. Unfortunately, medicine has pretty much taken over (and destroyed) my life so there's not too much else I can write about these days. I should really get a hobby. They teach painting to adults at the Y and I really want to take a class but it's at 10AM on Wednesdays or something so that's out. (seriously, who the hell are they trying to attract to this class? retired people?) I already know how to weave baskets so I don't need to learn how to do that so that's out as a hobby. Maybe it's time to get into knitting although honestly, I don't see that being too exciting.

Current Mood: tired

Atarax
Todey it was cold to the point where my soggy bathing suit freeze-dried in my car and I had to dip it in warm water to get it to relax because I figured the one thing worse than putting on a wet bathing suit was putting one on that had icicles on the crotch. So yeah, it was pretty darn cold. According to theweatherchannel.com, it was -7 with the windchill. So I decided to work out inside today instead of running outside.

I finished up my workout and was leaving the gym when some guy caught up to me.
Him: I've never seen you here before. Are you a student?
Me: Yup, I'm a med student here.
Him: I'm a masters student in accounting. Do you come here a lot?
Me: Usually I run outside but it's too cold today
Him: Oh...are you going to be here tomorrow?
Me; Probably
Him: What time?
Me; I don't know.
Him: How do you not know? When are you going to be back here?
Me: When I'm done for the day.
Him: Do you have class? When is it over? Will you be back here after that?
Me: I have clinic.
Him: When does it end?
Me: After the last patient leaves
Him: Oh...well...are you going to be here on Saturday?
Me: No, I have an interview in Kalamazoo
Him: When are you getting back from there?
Me: Depends on the weather
Him: I can drive you if you're scared to drive in the snow
Me: Uh, thanks but I need my car
Him: I can drive your car for you
Me: No thanks.
Him: So will you be here on Sunday?
Me: Maybe. Um...I'm running late for a meeting so could you excuse me?
Him: OK, I'll see you on Sunday!

Either i'm paranoid or the encounter was a little creepy. Regardless, I predict a lot more outdoor runs in my future. Because I'm a little edgy around the gym now.

Current Mood: weird

and i wish i was a better one
We wound up having a drug company lunch today in derm. I'm not sure how they managed to pull that off because drug reps were banned from our campus during my first year of med school, but we always get reps in dermatology. They drop off samples a lot. Truth be told, I'm a fan since then we give the samples to patients and they don't have to go out and buy the stuff. This way you can use something and if it doesn't work, you're not out any money. Or for the old patients who are in wheelchairs and can't drive, it means they don't have to find some way of getting to a pharmacy. I really feel like having free samples to give out benefits patients far more than it hurts them. One of my residents once did a survey (the abstract is on pubmed) of 10,000 or so people in some county in Michigan and discovered that most of them were against physicians getting free stuff from drug companies such as pens and golf outings. However, the same group of people was almost unanimously united in their support of physicians getting free drug samples to give out. Just saying.

Anyway, my partner left by the time the food got there but I was stuck in a room with the nurse practitioner who had decided to explain the mechanism of action of TNF-alpha blockers to a non-medical woman. (it was painful) So I came out of the room around the same time the food was delivered and started writing up my note. After i finished, Dr. Dermafem asked me if I wanted to stay for lunch and I said I actually brought food with me. i also threw in something about how it wouldn't be fair to my partner if I got free lunch and he didn't but I was joking about that one.

I didn't actually have food with me but really, I wasn't willing to sit through yet another awkward lunch, even if it meant I got free Mediterranean food. Seriously, I'm tired of it by this point. I used to kind of like them when I was in Bryan because it meant someone spoke to me and I could avoid my attending and I didn't have to watch everyone read the golf page of the paper but by now I've figured out that "drug company lunch" really means "sit around and discuss your kids while jess sits there awkwardly because she doesn't have kids." Except in derm it's even worse--Dr. Dermafem and the NP have dogs, not kids, so it becomes "sit around and discuss your dogs while jess sits there awkwardly because she doesn't have dogs." So I'm tired of having to pretend to be interested while everyone shares humorous anecdotes about their dogs. I don't care. And I can't contribute anything to the conversation. And the drug rep keeps everyone talking because then they build better rapport with all the physicians, so the conversation never changes. I really hate these things. Even that time we got lunch from the Cheesecake Factory when I was in neuro. That one was especially bad because Dr. Neurofem's daughter and husband came too so not only did we have to hear stories about the daughter and the drug rep's kid, but the daughter was there so anytime she did or said anything, we all had to find it adorable and smile and comment on how cute she was. By the time the meal was over, even oreo cheesecake couldn't put me in a good mood. In family med my attending's wife and daughter used to come every day for drug company lunch and it was the same thing--talk about the kids and give running commentary on how adorable they were. I guess on the plus side, I don't have to worry about Dr. Dermafem bringing her dogs into clinic, but I'm sorry, I just can't get excited about listening to dog stories. Although I guess most of hte time I find them no less interesting than kid stories. But really, I couldn't make myself sit through this today. So I grabbed a can of slim-fast from my car and joined my partner in the cafeteria for an hour before afternoon clinic.

I wonder, does this mean I'm growing up if I'm no longer willing to do anything for free food?

Current Mood: cold

electrocautery hemostasis
Speaking of names, today in clinic I had a 92 year old woman with itchiness (or as we medical types call it, pruritis) Anyway, she didn't remember what meds she was taking but she said her son, who was out in the waiting room, would know. Which gave me the fun task of attempting to find the son.

I walked out to the waiting room and asked one of the women at the front desk if she knew whether the son was there or not. She said she had no idea. I asked if there was any way to find out, short of walking around the waiting room yelling. She said there was not. I asked if it was a HIPAA violation to start screaming a patient's name in the waiting room. She said it was not. I asked if she was sure. She said she was.

So I walked around the waiting room yelling "IS THE SON OF JANE SMITH HERE?"

He was not there. I did, however, get a bunch of weird looks while I was out there. After I had done 3 laps around the place I decided to cut my losses and give her refills on the last stuff she had used and hope it worked out OK. Because I wasn't sure how else to get ahold of the son. I mean, I already embarrassed myself enough for one patient.

I realize I am not exactly the model of professionalism 99% of the time, but 5% of that 99% is not completely my fault.

Current Mood: sleepy

lapping it up
I had a kid today in clinic who had a first name that was totally a girl's name. I have only heard of girls having this name. I can't actually write the name, but rest assured, it was a total girl's name. I mean, I've heard of guys named "Tracy," "Kim," and "Hilary," so I guess you have to check the gender with those names (there are a few more but that's all I can think of off the top of my head) but this name was unequivocally a female name.

As you can probably guess, I entered the room and instead of a 13 year old girl, there was a 13 year old boy sitting there. My first thought was that I had walked into the wrong room (hey, it's happened) but since his last name was a guy's name, I assumed the chart was wrong and he was actually Lastname Firstname so I said "Hi, Lastname" and he said "it's Firstname." I really hope I managed to conceal my shock a little bit.

After I finished up in there I went back to the office to write up my note and Dr. Dermafem looked over at my chart and said "how's she doing?" So I told her he was actually a he and she said "poor kid. You just know he's getting picked on all the time." I'm pretty sure the only reason Dr. Dermafem decided to put him on Accutane for his acne was so that it would clear up quickly and the kids at school would have one less thing to pick on him for. Because he didn't actually look that bad. He wasn't great, but I've seen a lot of kids worse.

Since he was going on Accutane, I had to bring him in the paperwork for him and his father to sign and initial. (you need to fill out all this stuff saying you're aware of the side effects, you won't share your meds, you won't give blood or have unprotected sex, etc.) It was then that I learned that the father had the same name. So I guess it's a possibility that the father wasn't picked on as a kid if he decided to pass the name on. Of course, it's also a possibility that the father was vindictive and decided that if he was miserable with this name, someone else should be too.

Dr. Dermafem: You can't have unprotected sex while on this medication.
Father: Well, once he comes off it, how soon can he have unprotected sex? Will he be able to do it right away? Or will he have to wait until he's 18 or so?
Dr. Dermafem: You can have unprotected sex a month after you stop Accutane. But we recommend you wait until you're in a loving relationship and you have a stable source of income.

Anyway, I hope the kid is good at sports. Because then at least he can join the NFL or something and become a household name and everyone will know his gender. Plus no one will pick on him if he's a badass linebacker. But otherwise, I predict a long life of confusion and frustration for the kid every time he has to do something involving his name. Although according to Dr. Dermafem, his life got better today when he got to look at my boobs. She claimed he was eyeing them the whole time she was talking to him.

Current Mood: cold

hand-foot-mouth disease
So around Thanksgiving I got bilateral foot infections after running in crappy shoes. (I got major blisters in my instep, they popped and got infected. This happens to me roughly once a month. Bacitracin and I are buddies.) They finally cleared up, but I'm still missing some chunks of skin on the bottoms of my feet. Then over the weekend I went rock climbing and the combination of that and wearing uncomfortable shoes to my interview really destroyed my feet and I wound up with deep fissures in the parts that were missing skin.

I try not to be a wimp about this sort of thing, but holy crap, it hurt so much it woke me up at 3AM when I tried to move my foot. I guess I must have either flexed or extended my toes in my sleep, but it did something to the fissures and I wound up waking up with sharp shooting pains in my left foot. I would have gotten up to do something about it, but I didn't want to put any weight on my left foot so I lay in bed until it subsided. I managed to fall back asleep but I woke up another 3 or 4 times in between 3AM and 6:45AM (when I normally get up) because every time I moved my foot or the sheet brushed against my foot, it started stinging and I woke up again. It was a great night, as you can probably guess. And now my feet are taped up again for the trillionth time but at least by this point I'm good at taping and wrapping feet, which is more to do with the fact that I'm always getting blisters and infections than any significant time spent in foot&ankle clinic.

Anyway, I'm generally not a particularly sympathetic person, as most of you will attest to. But today in clinic I had a woman who had psoriasis plaques on her feet. So she had these raised, rough, red areas with silver scales and cracks running along the soles of her feet. For obvious reasons, she was having a lot of trouble walking and she said she was in constant pain and her psoriasis meds (Humira) weren't working.

Can I just say, I was so incredibly, ridiculously sympathetic in clinic today. I'm pretty sure it's the most sympathy I've ever had for a patient. I was practically about to hold her while she cried. Because if I can't handle having a few cracks in my feet, I can't even imagine how horrible it must be to have psoriasis lesions on your soles. And I even managed to convince the NP that we should switch the Humira to Stalerno. The NP thought we should just increase the dose of Humira and wait 6 months but I said she had already been on it for 6 months and she was still having horrible foot lesions so it was time to switch to something else. Hopefully this new stuff will work for her because that looked really awful.

I've had a lot of friends and physicians say that having experiences with medicine and healthcare in general make you a better doctor. And I've always felt bad that i really haven't had any experiences with medicine so I worry that it makes me a worse little MS4. If the only thing I can relate to is foot pain, then how am I going to relate to patients with joint replacements? I was talking to a (male) friend once and he said he didn't want to go into OB-GYN because he would never be able to understand what the women were going through. I said that if we could only do stuff we had personally experienced, i'd go into preventative medicine (ugh).

Current Mood: tired

cold front
I had a 25 year old female patient today in clinic who was really beautiful. I mean, really. She was so beautiful that I had to comment on it once and Dr. Dermafem mentioned it at least 3 times. I can't really think of any celebrities she reminded me of so I can't compare her to anyone, but she had a gorgeous face, nice hair, and a really good figure.

Thing was, though, she was there for her "acne." And I put that in quotes because she didn't actually have any acne. Maybe it's because she was wearing some makeup, but really, her skin was almost completely flawless. I have significantly worse acne than she did. She had maybe a slight bump in the skin on her chin but that might have just been the angle I was holding my penlight on her. But she was convinced it was terrible and requested Accutane. For those of you not doing a dermatology rotation at present, Accutane is the big guns. You generally go on it for 5 or 6 months and it works so well that it totally shuts down your acne-producing glands and you never need to go on it again. The downside is, you have to go to your doctor monthly to get bloodwork done and to get checked out. Also, it has practically a 100% chance of causing birth defects so if you're a woman of child-bearing age, you have to use 2 forms of birth control. (the big one is it causes deformities of the head) So going on it is a big production and it's not something to be taken lightly. It's also not used unless your acne is really bad and immune to anything else. It's kind of a last-ditch effort because it's so annoying for patients to get the bloodwork and everything every month.

So she totally didn't need Accutane. She didn't need anything. I tried convincing her of that but it wasn't working too well so then Dr. Dermafem tried. I think the only way Dr. Dermafem managed to convince her that Accutane was a bad idea was by telling her that she wouldn't be able to get pregnant while she was on it (she and the husband were trying to get pregnant) So then she asked if she could get botox while pregnant. Or Juvederm. Dr. Dermafem told her that any doctor who performed either of those procedures on her could be sued for malpractice.

It was kind of sad. She was totally beautiful and she was still trying to go to all these extremes (botox at 25???) to cover up defects that didn't even exist. I'm not sure if this was a cultural thing (according to Dr. Dermafem, she sees a lot of Middle Eastern women who want to have invasive procedures for imaginary defects) or if she was just self-conscious but really, she was so beautiful that she didn't need to worry about anything. And she was married so it's not like she even had to worry about that. (her husband's a fellow at my school and alls i can say to him is, good job! He's almost bald and is totally not hot at all.) Plus it made me a little self-conscious about my appearance. I think Dr. Dermafem felt the same way.

Also, she requested a female med student instead of a male and Dr. Dermafem said "jess, you and your boobs get in there." I asked if I should also bring my vagina and Dr. Dermafem said that was a good idea.

Current Mood: confused

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