My ER is worse than yours

No matter where you go in the US, at every hospital in this country, you will find an internist bitching about the emergency department. And I think that my previous posts on dealing with the emergency department are proof enough of that.

Lately, I've been hearing the moaning and bitching of surgeons and gyn, complaining about the ER. Although I can sympathize, I can't really muster much pity, and the reason is that when they refuse an admission, then the ER calls medicine next. And I've heard it a million times before: "Surgery didn't want to admit, so..." "Gyn evaluated and thought the pt should be admitted to medicine..." "Neuro doesn't think this is a stroke and want you to admit..."

I am somewhat sympathetic to the plight of ER physicians. They are presented with a lot of difficult situations. However, some docs rise to the challenge and others fold under the pressure.

When you want to hear horrible stories about admissions from the ER, surgery and gyn and neuro and all those other services can talk a good game, but last I checked, I was the one admitting the 27 year old with chest pain, or the 30 year old with diarrhea, or the 60 year old with a sinus infection. Whatever you got, I can one up.

And how are you, doctor?

I was sitting at the nurses station, minding my own business, and Blondie nurse was walking by. Blondie nurse is probably the hottest nurse in the hospital, and she routinely has physicians wrapped around her finger. I've always been polite to Blondie nurse, but never much more.

She stopped, and we chatted for a few minutes about my life, and then I was paged away. She wanted to know all about my career plans, and was sad to find out that my rotation ends soon. The strange thing was that she was very flirty.

I am entirely unsure of what prompted this. Although I am nice to the nurses, it's not like I do anything novel or exceptional. In fact, some nurses have a pretty dim opinion of my medical abilities. So, it's hard for me to decide whether events like this happen because nurses think I'm approachable, or if it is because they are interested.

Now, I'm not complaining that the sexiest nurse in the hospital is talking to me, but I really wonder. Because I'm not that handsome or dashing. I'm not charming or romantic. I'm not flirtatious. So I have a hard time seeing why any woman would be interested in me.

Some of my friends find this self-assessment infuriating. But I just don't see it. I don't. When I look in the mirror, I see plain, boring, chubby, nerdy. It just doesn't make sense to me why women would be interested.

Chocolate Thunder, he tells me that I lowball myself. I'm a good person, a doctor, dedicated to my work. In a few short months, I will be making six figure salary. On paper, I'm great. But I can't help but see the same self-conscious, scared kid when I see myself. And maybe I'm still mired in the college age mindset, trying to impress these impossible to please 20 year old girls.

Someone told me something very profound: "You're such a funny guy. You're really nice and friendly, hard working, dedicated, and really compassionate, and you don't see any of that. You're always so down on yourself! You need to realize that you're a fantastic guy, and if some girl can't see that, then she doesn't deserve you."

I'm preventing prostate cancer

Sometimes in medicine, a paper comes out that invites so much humor that it seems a shame to forget it. I was reminded of one such article while reading Vitum's last post.

JAMA in 2004 ran an article about the effect of ejaculation frequency on the risk of prostate cancer. They found that those who reported higher frequency of ejaculation per month were less likely to have prostate cancer. This was a prospective analysis using questionnaires, and had a number of significant questions regarding validity. However, it reinforced a study done by the British Journal of Urology International, where 5 or more ejaculations weekly had a negative association with risk of developing prostate cancer.

My friends and I couldn't get enough of this medical breakthrough. Whenever we wanted to make a masturbation joke, it was couched in terms of prostate cancer risk. "I'm going to decrease my risk for prostate cancer." "I have 3 more to go this week, if I want to keep my cancer risk low." "What have you done to prevent prostate cancer today?"

However, one of my friends made a great comment when he read the article: "Five times a week: prevents prostate cancer. Six times? DEATH!"

Giles GG et al. Sexual factors and prostate cancer. BJU Int. 2003; 92(3): 211-6
Leitzmann MF et al. Ejaculation frequency and subsequent risk of prostate cancer. JAMA. 2004; 291(13): 1578-86.

Another Valentine's Day that SUCKS

How did I spend my Valentine's Day? Lost on TV. Dinner from KFC. 3 beers. Half a pack of cigarettes. But I've certainly had worse. So I'll take this one.

Church Barbie

Every week, my church has a lot of different mass times, but I go to the same mass every week because of one girl. She is a girl I casually refer to as church Barbie. I call her this because she is very blond, very pretty, very curvy, and very much an object in my eyes rather than a person.

After all, I don't know her. I have never had a conversation with her. I have in fact heard her say a total of 6 words, none of which were her name. She is just a pretty girl sitting in the next pew. For all I know, she is rude or mean or *shudder* a typical girl in her early 20's. I don't know.

I like to tell myself that she must be one of these shallow girls whom I've met so many times. Nothing is less attractive than the sense of entitlement that comes with being beautiful. I think back to high school sometimes to one girl in my class. She was gorgeous. I mean, wow, absolutely beautiful, but she was the worst person I had ever met. She was bitter and shallow and hollow. Interacting with her was sheer torture. It's like eating a chocolate truffle only to discover that it was full of vinegar and mustard.

So, I like to enjoy her from afar. That sounds far creepier than I mean it. What I mean to say is that I like to enjoy the beauty in the world, and I try not to question it. I try not to find the flaws and blemishes and cracks.

I used to go birding (aka bird watching) a lot when I was younger, and stargazing. I still go stargazing every now and then. I love to go to museums and wander through room after room of beautiful things that I cannot touch. I have sat for an hour in front of a painting of El Greco, soaking in the beauty of it. I walk through the woods and photograph things, trying to capture of beauty of it. I enjoy seeing beauty in the world.

Still, I know that there is another whole plane (as in plane of existence, not 747 plane) upon which beauty exists. I am just seeing the shadows on the walls of the cave, and am somehow content with that [blatant Plato's Republic reference]. "A bird in the hand is worth two in the bush" is often credited as an aphorism but it simply isn't true. A bird in hand is worth far more than two in the bush, or ten, or two hundred, or even a million.

Because a bird through the binoculars is beautiful and wonderful, but it is not mine. I can only enjoy it from afar, like the Mona Lisa behind bulletproof glass. And that is the relationship I have with church Barbie.

Voting made easy

John Edwards is making my election choices so much easier by guaranteeing that I would never vote for him. I mean, bad enough that he made a personal fortune as a malpractice attorney, but now he's standing by the hire of two (one just one, you have to get them in pairs, I guess) anti-Catholic bloggers.

Now, people make the argument that the criticism comes from the mouth of Bill Donohue, who is probably just behind Jerry Falwell in his rightward leaning. But the interesting thing about truth is that it can still be spoken by the people we despise. Truth is beautiful that way.

People are all up in arms about this, but I treat things like this like a 'tell' in poker or a pitcher tipping his pitches. It's much better information than anything he may actually say. And his message is actually quite clear: he cares more about appeasing the 'Blogosphere' community than he does about Catholic voters.

So thanks Mr Edwards. I can now cross another Democratic hopeful off my list.

I love surgeons

Surgeons are great folks. I was talking to some of the surgeons today about a patient, and they didn't know the patient's name. It was such a classic surgeon moment.

The thing I love about surgeons is that they are so very different from me. However you want to cut it up, my ability to do my job is entirely dependent on my ability to get reliable information from the patient. I need to establish rapport. I need to ask the right questions. I need to review systems. I need to advocate. I know my patients quite well.

Surgeons however, some of them at least, go out of their way not to know their patients. Of course they know the medical issues. They know the past history and the physical findings and the lab results. Sure. But I'm the one wasting my time talking to Mr H about his service in WW2.

I think that the reason for this is that it takes a certain level of detachment to be able to cut someone open and play with their innards. Surgeons have to distance themselves quite far from the people they cut on. It would be too much to see Mrs M, mother of 3, grandmother to 10, baker of the best pies of all the ladies in the local Legion auxiliary, as a scared and fragile human being. It is much more sane to view her as 20cm of necrotic colon.

I remember one of the surgery residents I worked with as a medical student. We took out half of this lady's colon because of obstructing mass. When we opened her up, we found diffuse metastasis all over the abdomen. We did a colostomy and that was that. I asked him several days later if she had a shot at survival. "I'm sure she'll do fine. We did our part."

Despite what you may think about surgeons, it seems to me to be quite an optimistic specialty. While I talk about CHF and renal failure and lethal arrhythmias, they cut to cure. And although I may disagree a lot of times, it's nice to have someone who thinks he can actually do something to make a difference.

The awkward turtle

I am officially old. I saw some college kids sitting around and one of them was doing this weird hand gesture. I was completely lost. I didn't think much of it until I found out about the awkward turtle.

For those of you who are also old, the awkward turtle is a hand gesture designed for the purposes of expressing the awkwardness of a situation. Example: your college professor is hitting on your friend. Awkward. And so you may display the awkwardness of the situation through the awkward turtle. It should be done inconspicuously, so that the instigator of awkwardness is not made aware. Were those college kids making the awkward turtle because I was staring at them? Doh.

The reason why I say that this means that I am old is that I distinctly remember being of the age when things like this abounded. It was stuff like "All your base are belong to us," dressing in flannel and torn jeans, and knowing that our parents had completely lost the ability to understand us. We communicated in some bizarre language that made no sense to the grown up world.

And it's entirely because of insomnia that I knew about Aqua Teen Hunger Force. Who knows what else I'm missing? I mean, I made a MySpace page just to say that I have a MySpace page, only to find out that MySpace is so last year, and that Facebook is the new MySpace. Wasn't MySpace the new Friendster? And wasn't Friendser the new


So, I keep hearing from various sources that a small amount of daily alcohol (whatever the source may be) is actually good for cardiovascular health. Although we don't recommend people drink, if you're going to drink, one or two a day may help. The problem is that one or two turns into eight.

In any case, I'm drinking one or two a day now, and rediscovering my love of beer. And wine. And scotch. And gin. And cognac. And martinis. And... hmm... I'm thinking that maybe I'm in trouble.

AHA Nutrition Committee et al. Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement from the American Heart Association Nutrition Committee. Circulation. 2006; 114(1):82-96.


I was sitting at a nurses' station working on my progress notes, and the nurses were all complaining that the printer wasn't working. I ignored them for as long as I could, but after they started ripping some sheets out (a big no no if you don't know what you're doing), I pushed to the front, cleared the jam, reset the printer, and got it running smoothly.

"How did you do that?" one of the cuter nurses asked. I have had such a stupid crush on her, because she is very hot, and very friendly. And very married, sadly.

"Oh, I used to build computers. This stuff is nothing." Play it cool. Nonchalant. Switching into 'Dr. ifinding knows everything' mode.

"Ohmigod! you're a nerd! Ha ha!"

If you ever want to have your self-confidence utterly destroyed, find the prettiest girl you know and have her ridicule you in public. That will pretty much do the trick every time. I felt like I was back in 7th grade. If I remember correctly, I went straight home and hid in my room with a six pack, reminding myself that I am a physician, one of the most prestigious and honorable professions, and how awesome I am in general.

But I guess there's no escaping it. I am a nerd. But maybe being a nerd isn't so bad anymore. After all, it got me this far.

It's official. The terrorists have won.

So, in a bout of insomnia, I was watching Cartoon Network, getting my fix of Futurama, and I see this odd bump (you know what I'm talking about if you've ever watched [adult swim]). It's apologizing for something in Boston? So, time for a websearch!

Turns out that all I needed to do was change the channel to Fox News to find out that apparently, these guys putting up Lite Brites around Boston are master criminals and jeopardizing national security. Let me repeat myself. According to the media, LITE BRITES ARE JEOPARDIZING NATIONAL SECURITY. I cannot believe that the city of Boston was paralyzed by LED's of Ignignokt, whom if you asked any random teenager on the street, would probably be able to identify. It would be like shutting down the subway system because of Towelie dolls found on the trains.

Everything we have done in this country for the past few years has been motivated by this ridiculous fear, paralyzing fear, that someone is out to get us. And we are so afraid that we fail to use things like common sense. We do things like piss off every single country in the world, and somehow remain convinced that we are right.

I have made fun of the phrase "...then the terrorists have already won" and how people used it all the time, and so ludicrously. But it's hard not to feel like we're a little less innocent today. Because this wasn't a subway plot. This wasn't canisters of anthrax. This wasn't a cache of guns and C4 found in the local dam. This was Lite Brites of a cartoon character flipping the bird.

An interesting note though, ten cities had these LED signs, and only Boston went into a hissy fit about them. So maybe it's just Boston that's gone to hell.