signout | June 27, 2007"How many times you poke me?" she asked. Then, in her heavily accented English, "Dr. Better never took this long for LP. Five minutes, always."
I made empathetic noises, apologized a few times, and tried to focus on the needle I was moving in and out of her back. I'd done four lumbar punctures before, and felt I was good at them. Wasn't I in the exact space where I needed to be? I stopped and felt again for her spine.
On my first day on the adult hematology-oncology service, she'd been described to me as an anxious, passive-aggressive woman who hated our hospital. She created traps for us,…
signout | June 22, 2007Signout has a new banner today. You might not have noticed--all that's missing is a couple of words, after all. I nevertheless ask you to regard their absence with some intention, as the missing words are, "first-year." That's right, children. Signout is a senior resident.
I'm not one of those people who normally gets a deep emotional rush at my own graduation ceremonies; I guess I'm usually just over it by the time they're playing the music and lining us up. But this morning, as I wrote "R1" next to my name on my last progress note for the last time, I could swear I heard a cheer swell…
signout | June 19, 2007Huzzah! The winner of SEED Magazine's Threadless t-shirt contest has been announced. Finally.
You wear, you like!
signout | June 18, 2007The other night, we had three trauma cases come into the pediatric emergency department, almost at the same time. The first to arrive was a boy who'd collapsed and stopped breathing after being hit in the head with a ball during his prep school's baseball practice. Then, in quick succession, came two 14-year old boys who had been shot while visiting a great-aunt. One had been hit in the arm, and one in the neck.
I was in charge of the airway of the kid who'd been shot in the arm. Trembling in his neck collar, blood oozing slowly out of the bullet wound, he eyed the IV catheter a nurse was…
signout | June 15, 2007Today, I want to tell you about puppies. And chocolate cake. And violets! All things we can agree we love, and discussion of which never generates a hostile environment.
The thing I like best about puppies is how kickable they are. Just kidding! Oh my God, you people are so sensitive.
I've been away for a while, due to a schedule apparently created by a sadistic baby, or a drunk monkey, or maybe a drunk baby monkey. Either way, the other day, I went to a concert given by a really famous musician, and about 15 minutes into this person doing his thing, I fell asleep. And he was really famous.…
signout | June 6, 2007The chief complaint listed next to her name was, "wants to know if she is pregnant." At first, it didn't seem like she wanted to know that badly--she barely looked up from her cell phone when I walked into the room for the first time. She answered questions the way fifteen-year-olds often do--briefly--and held out one skinny hand for the urine sample cup without turning her eyes away from the keypad of her phone.
I imagined the exchange:
"@ drs ofc 2 chk f nokd up"
"wnt 2 mt l8r @ mall 2 mk sum bad choicz?"
"abt fashn or sex?"
"both!!!!!"
"OK, f my boyfrnd cn come"
She looked up the second…
signout | May 28, 2007The other day, while I was carefully loosening a perfect oyster from its bearings, a good friend said to me, "Signout, your blog rocks my world. However, what is up with--if you'll excuse the expression--all the mental masturbation?" (Quite the wordsmith, this friend.) "You should use your blog to offer more than just discussion of interesting problems: you should offer concrete solutions."
I said, "Solve this," and pointed him toward the following post. Then, with great regret, I schlepped my bags to the airport and headed home…
signout | May 24, 2007While I was knee-deep in frozen river water the other day, someone said to me, "Your blog is great, but you hate men too much."
Bollocks! I love men! It's the patriarchy I hate. Please regard this entry, one of my personal favorites. Does it not demonstrate my sensitivity to the position of the much-put-upon man?
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Today has been an unbelievably frustrating day in the hospital, but I don't want to bring anyone down. In an effort to promote peace, harmony, and blogular happiness, I'm going to instead write about something everyone can…
signout | May 21, 2007Someone told me at a wine-tasting the other night that this blog is "good, but really depressing."
Depressing, my eye! This blog is all sweetness and light. Just behold this entry from my first month of residency; the last thing it makes me want to do is jump off a bridge.
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I got a spot of blood on my dress today. It happened as I was on my way out of the hospital and heard the code bells ring. I ran, cursing, past two women clutching each other in a hallway, into a room where a man was lying unconscious in a chair,…
signout | May 18, 2007In my second month of internship, when I was a brand new intern on the medicine floors, I took care of a very sick man with a complicated family dynamic. I knew at the time that this made it unpleasant and difficult to take care of him--so much so that I wrote about it here. I remember thinking, "This is one of many complicated family dynamics with which I will deal. It's good that I'm getting some practice."
Several days ago, there was a conference at my hospital to talk about the case, and I attended. I settled into my chair in the auditorium and regarded the panel at the front of the room…
signout | May 10, 2007I was recently asked by Blog, MD to weigh in on how I'd spend the $456 billion that has so far been spent on the U.S. military effort in Iraq if, by some terrible error, I were made Queen of the World. This is a difficult question for me because the only items of whose cost I am sure these days are grocery store sushi and sturdy shoes. And while it would be kind of awesome to buy enough spicy tuna rolls to last me until I'm too old to chew anything but the wasabi, that wouldn't exactly benefit humanity.
So.
If it were up to me, I'd spend this wad of cash entirely on education. I'm no expert…
signout | May 2, 2007It seems that my clinical activities this month have been assigned a theme: "cognitively disabled people who reproduce." Themes like this do not exactly renew one's faith in freedom of choice; after providing care to three developmentally delayed mother-child pairs over the last month, I feel that there are some people who maybe shouldn't have complete control over their uteruses. Uteri. Whatever--no more babies for these people.
On Friday, I did a newborn exam on a baby born to a 28-year old woman who's been pregnant nine times. This was the fourth child she's given birth to, and the fourth…
signout | April 26, 2007Lately, I seem to be having a bit of the writer's block. Yes, I'm still working, and yes, crazy things continue to happen on the job. It just feels as though it's been a while since I had a meaningful reaction to a patient or colleague interaction. I'm a little tired of feeling other people's pain.
As I often do when I'm not sure whether my findings are within the expected range, I did a literature search. It turns out my impending nervous breakdown is going to happen right on schedule--maybe even a little late. This study published in 2002 found that sixty-one otherwise well-adjusted…
signout | April 16, 2007It was a pretty simple story: their 3-year old had had fever and lethargy for three days. She was fussier than usual, but consolable. On the second day of the fever, her cautious doctor had done some blood tests and an x-ray, and although neither confirmed a bacterial infection, he'd started antibiotics. The medicine hadn't helped her much, and now they were in the emergency room on Easter Sunday, both furrowing their brows as I looked in her eyes, her mouth, her ears.
They were worried, but not worry-crazed, and they seemed cool--like the kind of people I'd sit down with for a beer. We…
signout | April 9, 2007A couple of weeks ago, a study appeared in the New England Journal of Medicine showing that patients admitted to hospitals with heart attacks on weekends had higher mortality than similar patients admitted on weekdays. The investigators' analysis demonstrated that the main reason for this was a decreased rate of invasive intervention--namely, cardiac catheterization and angioplasty--on weekend admissions compared to weekday admissions.
This is perhaps not the surprise of the century: interventional cardiologists like their weekends off, just like normal people do. And although any hospital…
signout | April 8, 2007Blog-a-rama:
Today's Pediatric Grand Rounds is up at the blog of the ever-inspiring and insightful Dr. Flea.
Additionally, Change of Shift is up at the marvelous Emergiblog.
signout | April 8, 2007It was street, y'all.
Team Phylogenetics came out busting chops, with a
and a
"Your mom," said HIV:
"She's so fat,"
Team Phylo sputtered.
"I thought we were brothers, man:"
"Oh yeah?"
"Booyah, biatch."
And as quickly as it had started, the game was over.
HIV moves on to the next round.
signout | April 6, 2007I'd ask Atul Gawande why he blogs.
However, 1) he doesn't blog, and 2) he's already answered, sort of. (Scroll down to the bottom of the second page, unless you want to read the boring details of a parathyroidectomy, or something.)
signout | April 5, 2007My fellow Scibling (cute, huh?) Bora is an incredibly friendly, warm, and funny blogger. He's also incredibly proficient: in addition to blogging at A Blog around the Clock, he's put together an anthology of science blogging, and a freaking conference of science bloggers. The man has the energy of a toddler on crank.
Bora just tagged me with the "Why Do I Blog?" meme, wherein I am meant to tell my volumes of readers why I blog.
That's easy:
1) I love to write.
2) I love to be read.
As far back as I can remember, I wanted to be a writer. I never pursued writing seriously because my folks…
signout | April 2, 2007Not half an hour ago, post-call after an exhausting night in our cardiac care unit, I stopped in at the residency program office to pick up my mail. At the top of the stack was an envelope with a familiar name in the return address--the name of a man I had taken care of while on a general medicine rotation a few weeks ago. Inside was my first thank-you note from a patient, written in a tender, newsy tone by an old man whose diagnosis I can't for the life of me remember.
It comes at a strange time. After my short time on the cardiac care service, I have become more dubious than ever before…