All Greek to me

Attention, class. Let's get started. Today will be a lesson in residency vocabulary.

OTD: Out the door. Discharged and (presumably) leaving the premises.

A la casa: Similar to OTD but employed mostly south of the Red River (ie, in Texas)

NMP: Not my problem. Someone else's problem.

HMP: Originally pediatrics, high maintenance parents. Adapted to adult medicine, high maintenance patient.

pimp: to ask series of questions to be answered verbally on the spot, especially on rounds, to those below you on the totem pole with the intent of either education and/or public humiliation.

GORK: God only really knows. As in, none of us have a clue what's going on. Often used in past participle form. Eg "He's totally gorked."

zonked: state of sedation or altered mental status, either due to medication administration or disease process Eg, "I tried to get more history, but she's totally zonked after that Phenergan."

rose: patient who is doing well, can refer to original state upon admission or progress made during hospital course. Eg "She looks like a rose. I don't know why she even got admitted." OR "She was crumping on me last night, but she looks like a rose this morning."

peach: difficult or challenging patient, usually referring to psychosocial needs rather than physical maladies. Eg, "Did you see Mrs. X is back on my service? Yeah, she's a real peach. I was up all night trying to find her a strawberry Ensure because she doesn't like the chocolate ones."

white cloud: State of good fortune, usually referring to low census (how many people are on your service) or quiet pace of call nights. Can also refer to the person who has this state of good fortune. Eg "I love being on service with Susan. She has a such a white cloud." OR "Don't worry, call will be fine. I'm a white cloud."

black cloud: State of unfortunate fortune (aka plain ol' bad luck). The opposite of a white cloud. (Incidentally, I don't believe in clouds. You make your own white cloud. But if you really pressured me, I'd say my cloud is white all the way.)

And PS, these are all in fun. Residency is tough, and we've gotta laugh so we don't cry. That doesn't mean we won't still take very good care of you, even if you are an HMP.

The silent treatment

Today was a long one. Eventful and long. Oh, if only I could tell you everything! Tales involving patients, attendings, and other residents involved in comical mishaps and heart-wrenching tragedy. OK, so that may be exaggerating a bit, but honestly, I've been on the verge of tears (both angry and sad) at least three times today.
But most unfortunately, in the interest of my long-term career viability, I dare not repeat that which I have seen, heard, and spoken. I know, what a let-down. The motto of the day is "polite but firm." I will go so far as to allude to the fact that I can't fix crazy, also known as "there is no reasoning with the unreasonable." If I tell you demonstrable, objective, reproducible medical facts, and you call me a liar, I just don't what there is left to do. I really don't. Especially if you cross your arms, roll your eyes, and refuse to talk to me when you are 38 YEARS OLD! I guess we're done here then. The best I can offer is to repeat myself over and over again (firmly and politely every time) until I'm blue in the face or one of us gives in. And I'll warn you now, I don't give in.
OK boys and girls, it's almost my bedtime. Gotta get my beauty rest so I can get up and do it all over again tomorrow. Good night and good luck.

No turning back now

I had two very exciting rashes last week. Well, not me personally, but my patients. I sat in the medicine resident work area, showing off pictures of some really wicked mouth ulcers, and thought out loud.
Me: Maybe I should have been a dermatologist. I love rashes.
Other resident: Yeah, maybe.
Me: And sleep. And money.
Other resident: Well, those are the three pillars of dermatology. Rashes, sleep, and money.
Me: Yuh-huh. Lots of money.
Maybe in my next life.

Insane in the membrane

I have a confession to make. If I were totally honest,the kind of honest you can only be when you're sleep-deprived punch-drunk and not looking anyone in the eye, I'd confess that I like Morgan (the general medicine service). People whine and complain about the work and how it's a dumping ground for the hospital's refuse, but I just can't help myself. I like general internal medicine. Did you hear that, world?
I LIKE GENERAL INTERNAL MEDICINE! I like finding heart murmurs. And googling "MAGIC syndrome"** in the middle of the night. And ordering pizza with my intern. And teaching my medical students to tie sutures.
That being said, I sure am tired today after call last night. Those two (count 'em, two!) admissions at 3am sure were brutal. Rheumatology still sounds like a mighty fine plan to me. I just needed to get this off my chest... I may be crazy, and you can judge me if you want; but, there are actually days when I like my job. And today is one of them.

**mucosal and genital ulcerations with inflamed cartilage - No, he didn't have it after all.

If I'm lyin', I'm dyin'

You can't make this stuff up.
I admitted a gentleman with a rectally-oriented problem. He believed the problem had resolved overnight, which he indicated via gesturing to his rectum on rounds. And by gesturing I mean touching.
Then I fell prey to one of the classic blunders, the most famous of which is, "Never get involved in a land war in Asia." Only slightly less well-known is this... When a man who has just touched his poopy-hole area offers you a handshake, never, ever accept. But I was living-dead tired and just straight up forgot until my hand was half-way to his. Then it was too late; I was committed. Shudder. My attending closed the conversation, and I bolted from the room with my arm extended high in the air.
"I'm contaminated!"
This drew the attention of several ER nurses and residents.
"He just touched his poopy-hole and then shook my hand."
A collective "Oooooohhh."
I found a sink and decontaminated myself. And life goes on.

Wake up call

I was supposed to be at work by 7:30am today. The alarm rang at 5:45am. I snoozed. I caught it at 5:49am and reset it for 6:00am but decided to get out of bed at 5:52am. Shower, breakfast, make-up, hair. I put on a dress and my jewelry. Then I vacillated, wondering if a different shirt would better complement my new Cole Haans. But I decided to just leave and arrive early. I pulled out at 6:43am.
Leaving my neighborhood, I saw a van on the side of the road with smoke rising from the hood that was wrapped around a tree. A young man was in the driver seat, trying to speak to 911 on his cell phone, clearly very disoriented. I approached, offering help, and stretched to reach inside for his phone. I spoke to the 911 operator, giving various details... street name, no I didn't witness it, just one victim. I couldn't examine his injuries since trees pinned the driver's door closed, but he did give me some pertinent medical information. He lost consciousness moments before the ambulance pulled up. After briefing the EMT on the brief history and survey I'd accomplished, I handed his cell phone to the cop and drove shakily into work.
Vandy is the only trauma center in the city, so I scanned the ER roster after rounds and found the trauma bay attending who'd seen him. Turns out he has a bit of internal bleeding and non-operative fractures but nothing too serious. He's gonna be fine. Whew. I even got to introduce myself to his very grateful parents.
Timing is everything, huh? If I'd changed my outfit, I might have arrived after he'd passed out. If I'd not hit snooze, I might have passed the scene before he wrecked. Moral of the story: God is in the details every second of the day.

Miscellaneous, etc, and so forth

I really should know better by now than to blog post-call. But I think the sleep deprivation disinhibits my creativity, and the words just flow more better. So please pardon the poor grammar. And typos. And the rambling. Especially the rambling.

Call last night was icky. First a geography lesson. Round Wing:Vanderbilt Hospital :: Puerto Rico:USA. If you chose b) far, far away but still technically all in the family, you are correct! I spent all night running back and forth to and from the Round Wing babysitting a sick, sick dude who just kept getting sicker no matter what I did. I made a valiant effort for 17 hours, but I finally had to cave and send him to the MICU after post-call rounds. Bleh. The good news is that no one else I talked to had any idea what was going on with him either, which is also the bad news. Guess we'll see how things shake out (or shook out? see, I really need to get more sleep) tomorrow morning.

Speaking of nothing in particular, I have the world's tallest intern. No, for real. At 6'9", Will most literally towers over me. Last year, I thought my first ever intern Joe (6'1") was really tall. Then Scott the intern was taller. Then Eric the intern was taller than that. Then Brad the intern was taller still. But I can't imagine anyone beating Will. If I find such an intern, I'm submitting him to Ripley's Believe it or Not.

Moving on. After my bleh night, I wanted to bake something. I've been jonesing for cupcakes lately. Not to be confused with Jonesy, see exhibit A:

So anyway, I made super tasty apple almond streusel cupcakes for my first day with the new team last week. And I decided to give white mountain cupcakes a whirl today. Bet you can't guess the etiology (there I go using medical words in normal conversation - why don't I just go to sleep?!) of the name. See exhibit B:

The 7-minute merengue-ish frosting is a nice contrast to the chocolate. And Nick approves, too. I've decided I'm going to bake my way through Elinor Klivans Cupcakes! cookbook. A la Julie and Julia, minus the snooty French words. Sticky fig cupcakes may be next. Yum, huh?

Speaking of yum, Nick tried his hand at hickory-smoked spare ribs today. Ohhhh myyyyy gooooodnessss. Sooooo goooood!!! Wish we had smell-o-vision because it was mouth-watering.

OK. I admit defeat. Must sleep. Buenas noches, mis amigos.