Well, after all the talk of “professionalism”…

Mr. G was a 45 year old who presented last week to the ED. He’s a rather unpleasant guy with over 50 prior ED visits and multiple notes in his chart about being “uncooperative” and “noncompliant”. We were consulted because he complained of right arm tingling and weakness that was present when we examined him, but mysteriously disappeared when we left the room. His exam was nonfocal (neuro code for “nothing wrong”).

There was nothing else in the history that would have clued you in to any diagnosis, except his abuse of the emergency room. No trauma, no vascular disease, nothing. He’s a deadbeat dad who is currently remiss on his child support (recently documented on his chart). He hinted that he’s currently homeless. In the hospital he gets a warm bed and free meals.

This guy is faking it.

We still ordered an MRI of the head to rule out the slim possibility of stroke - only to find that he actually crawled out of the MRI machine, yelling at the tech that he was uncomfortable. We finally convinced him to get the MRI, and on a whim, got images all the way down his neck. Just in case.

- Radiology Report -
MRI Head : normal, no stroke seen.
MRI Neck : acutely herniated C5, C6 disks impinging on the right neural foramina. Correlates anatomically with pattern of right arm weakness and tingling.

Oops.

Well, this post goes out to all my new readers, visitors, site-linkers, email-subscribers, Google-searchers, etc. etc. etc. There sure are a lot of you! I truly appreciate all your comments and support. This blog is cathartic for me - it’s really nice to know that it’s a fun read for you.

On to the goods. Neurology has been a lot of fun. This became apparent when I had to pull myself away from work at 5:15 - my team was laughing so hard about our day, we had tears in our eyes. It wasn’t even all that funny. I’d tell you all about it, but it was full of stories that end in “…well, I guess you had to be there”.

Thinking back on it, pound for pound, my Surgery rotation was more interesting. I pulled a kid’s spleen out in my hands (seen the heart scene from Indy & the Temple Of Doom? It was like that). I sewed an arm back together that was severed in two. I saw a surgeon tell a patient he would “drag your ass behind my truck with a goddam tow-rope until you run long enough to lose that weight†”.

But honestly, they don’t have time to be fun. They can’t sit around and digest their experiences. Surgeons are go-go-go, and while that’s exhilarating for a 6 week rotation, I think it’d get old after a while. What’s the point of having an amazing job if you can’t ever think, talk, or blog about it?

Listen, not that I’m hating on surgery. I loved surgery. But in hindsight, I’m glad it’s over. I had fun today. I’ve still got stories and stories and stories (one dude got a little too friendly with his floor-mount dildo††) - but this time around I can really talk about them. And laugh harder than I have in months.

† Yeah, actually, that guy was just a total dick.
†† How does that relate to Neurology, you ask? Stay tuned, says I!

I’m on my neurology rotation (and what a difference from surgery it is! No need to scarf down food like a lion on the Serengeti! Residents that look happy! Attendings that leave the hospital at 2!)

Today in clinic we saw a very, very fat man. To my best estimate, he weighed upwards of 350 pounds. He had the distinct, unwashed smell of someone who weighs so much he can’t even bathe himself any more. He couldn’t say the word “no” without stopping to pause in the middle to catch his breath. He struggled to reach the joystick on his electric wheelchair.

This was one fat guy. It was like Fat Bastard from Austin Powers without the funny.

We were treating him for some arm pain that, for all intents and purposes, is untreatable. We couldn’t find a single medication that didn’t interact with the other 28 he was taking - or that hadn’t already failed to work. We finally prescribed an arm prosthesis for “nerve cushioning” that will probably cost the American Taxpayers thousands of dollars (he’s a vet). We know it probably won’t help.

I could barely stop myself from saying that losing 100 pounds might give him a shot at some semblance of a normal life. As it is, I give him a few years, tops. Right now he’s in constant pain and needs home health to help him shit - not because he’s 97 and dying a natural death, but because he’s 55 and so fat his body is shutting down.

What I’m wrestling with now is the realization that I was so thoroughly disgusted by him, I’m not even sure we did the right thing by “treating” him. I’m pretty good at keeping my professional game face on, but I wanted to pull him aside and tell him that frankly, I would write him off as a lost cause.

Edit: I’ve been thinking about the last sentence I wrote- it’s not exactly what I wanted to say last night, but at the time I couldn’t think of a better way to put it.

I think it might be more accurate to say that the way we’re currently treating him, I’ve written him off as a lost cause. But if he were my patient, and I his doctor, we would have had a very different office visit yesterday. As far as I’m concerned the only solution to his problems is weight loss.

I love checking my incoming links from google. I’ve been gradually getting more and more traffic, and it’s always fun to see what comes up. Lets be honest, folks… what people search for from the privacy of their own homes is pretty enlightening. Who needs a mailbag when you have Google? Jimmy, put another category on the board!

Can jogging make you burn 7,000 calories a day?

No. No. No. Not in your wildest dreams. Maybe Lance Armstrong, but not you.

A 150 pound person can expect to burn roughly 100 calories per mile jogging. It would take you 70 miles to reach your goal, and assuming that you’re running 10 minute miles, that means 700 minutes - or 11.5 hours - of “jogging”. So, no, unless you’re planning on running a marathon, every day, you can’t burn 7,000 calories a day.

Can You Eat Haggis During Pregnancy?

Look, I’ve said it once if I’ve said it a thousand times. Haggis is always a terrible call, pregnant or not. Your unborn fetus will thank you.

How To Catch Chlamydia

I’ve actually seen this question come up multiple times now, so it’s gotta be a popular one. Look, I can’t imagine why you’d want to, but as they say, different strokes for different folks. I’m sure a spot of unprotected sex with prostitutes would do the trick. Or better yet; your boyfriend already had it and he’s lying to you when he says “I have no idea where that rash came from”. Probably far more likely.

By the way: to the person who searched for “my boyfriend sleeps with prostitutes” and got to the post that read “…sleeps with prostitutes and probably has gonorrhea”… I’m sure it isn’t true. But, if you’ve got a frothy discharge, I suggest you go see a doctor, now.

Oh, and though it’s slightly apples to oranges, as this seminal paper demonstrated, you pretty much can’t catch Gonorrhea from a toilet seat, if that’s what you meant.

So I’ve spent 6 weeks on various surgical disciplines, and I’ve come to a few conclusions.

1) Your surgeon is human†. This means that despite the downright vicious hours, the 9+ years of medical training, the stress of taking someone’s life in your hands 5 or 6 times a day… they still sit around and talk about Barry Bonds’ steroid-riddled “record”. Except they do it while ripping out your colon.

2) Surgeons personify constantly. An artery spurting all over the place during routine surgery earns a “you little arterial bastard… I swear I’ll get you for that”. Then they take extreme vengeance by clipping the artery and severing it in half.

3) Surgery is fun as all hell. Ever popped a particularly heinous zit? Surgery’s kinda like that, except that the zit is the size of your fist, bears the moniker “perianal abscess”, and shoots pus 2 feet in the air.

4) You have no idea how expressive your face is behind a mask. Pre-op, one of my residents was cleaning a necrotic, smelly belly button. He paused, then looked up, one eyebrow cocked, without saying a word. That moment, in his eyes I saw “this is what I trained 6 damn years for”, and started laughing hysterically with everyone else in the room.

5) Doctors can “see you” without ever having actually interacted with you. It’s kind of like medical telepathy. If you’re in the hospital because you haven’t shit for 20 straight days… but coincidentally you’re an opiate addict and have been sneaking pillz in, chances are the Surgery Consult doesn’t need to check in with you every day. We’ll still write a note in your chart to say no surgical intervention is required.

6) Surgery is an art. I’ve seen the same procedure performed by 7 different people. It can be slow, boring, and dangerous, or it can be beautiful, efficient, and safe. I’m really happy I got to see an experienced surgeon at work before I left the rotation… it’s like watching Bob Ross paint a happy little mountain scene.

†Although Girlfriend has informed me that all surgeons have Narcissistic Personality Disorder††.
††You all should be informed that Girlfriend is on her Psychiatry††† rotation right now.
†††All Psychiatrists are working out their own issues.