Lunch + Dinner = Dunch?

I got off my EM shift yesterday at 3.  Left the department at around 3:30, then stopped by Subway to Eat Fresh and to possibly fulfill both lunch and dinner.  Got myself a nice sub.  Foot long Honey Oat, Spicy Italian, Mozarella Cheese, toasted, lettuce, tomatoes, cucumber, onion, pickles, and olives.  Light Mayo to top it off.  This submarine was about to get torpedoed by my mouth as soon as I got out to one of the outdoor tables behind the School of Medicine.  So I get there, and there's a homeless woman.  She has a bunch of stuff with her.  She gets up and asks me to watch her plastic bag for her while she goes somewhere.  I say sure.  She comes back in about 5 minutes.  I'm about 3/4 done with the first half of the foot-long.  She sits down back at her table, looks at my sub, makes the motion of breaking bread.  I give her the other half of the foot-long.  I'm thinking, "This is a good deed. I will be fuller by having done a good deed rather than eating the whole thing myself."  And maybe I tricked my mind to feel that way initially...but my stomach wasn't fooled at all.  I hungered not more than 2 hours post-1/2-sub-feast.  So I had Thai food.  And that, kids, is the story of how my Tuesday Dunch failed and got really really fat.

Headline:

"Native Americans KILLED AND ATE DUMBO, say archaeologists"

White people came and KILLED THE NATIVE AMERICANS AND WASTED ALL OF THEM BY NOT EATING A SINGLE ONE, says Alex Lee

Extra Hot is not Extra good

I ate Thai food for lunch today.  As an open-minded consumer, I ordered the potato curry with chicken in extra hot.  Mistake number one.  I brought it home, and started eating it.  It was fine, except that it was extra hot with scathing pain on my tongue with every bite.  But because I bought it, I had to eat it all.  Mistake number two.  Now I have never experienced a stomach ulcer before, but if I were to have one, I imagine this is probably what it feels like to have one.  And my GI system must have panicked with the package it received today, because I feel a bowel movement coming on pretty soon.  And from past experiences, I know that things that burn going in, usually burn on its way out.

Pre-Step 2 Clinical Skills

I am dreaming about weird things.  For example, I dreamed about hidradenitis suppurativa yesterday.  A woman presented into some situation in my dream (neither clinical nor sexual) with several yellow purulent lesions between and under her breasts.  Maybe my dream is telling me to go derm.  Lol...nice try dream...the lesions are more classically just under the breasts, not in between them. #noderm

Selfish medical student = Alex bruising

I was hanging around the emergency room the other day just to get some face-time in with one of the staff that works there. By a stroke of luck, I ended up getting a bit of facetime with the residency program director as well.  Anyway, there were some M1s who were hanging around as well for their externship and they were just sitting around, so I decided to do some charity work and teach them how to put in IV's.  It was a female and a male student and the female student adamantly stated, "NO ONE IS STICKING ME!"  I replied that she didn't have to get poked, that I would volunteer.  So I let the guy go first and guided him on how to put in an IV into my right arm.

I remember when I put in my first IV.  I got that effer on my first try.

This guy, on the other hand, did not get me on the first try.  In fact, he would do things that I told him not to do, e.g. putting the needle in, and redirecting the needle while it's already kind of deep.  I have bruises here and there on my right arm to prove that this happened.  Alright, I'll face that fact that not everyone does perfectly on their first try.  But still, I think he poked me a total of 5 times before getting the IV.

In any case, the girl was able to do it to the male student on her first try, although she did withdraw the needle before advancing the plastic catheter part of the IV and did ultimately not get it in all the way.  The moral of the story is this: Don't let first year medical students try to put an IV in you.  Make sure they do it to each other - no matter how ardent they are about not wanting to be poked.  If you want to poke, you have to be willing to poke.

Now that I think about it, I think that's a good way to look at medicine overall.  We as caregivers probably shouldn't administer therapies that we ourselves wouldn't take.

I've learned too much...

I just arrived back in my apartment in Detroit after a weekend at my parent's home.  One of the first things I had to do after my drive back was use the toilet.  And I noticed that the water level on my toilet had significantly decreased...then I got to thinking...

...the humidity in my apartment must be low, meaning that the partial pressure of water is not being met for the temperature in my apartment, and so any available water is being vaporized into the apartment atmosphere, which includes my toilet water...and my roommate's toilet water...which means that I'm breathing in toilet water...lots and lots of toilet water...because we don't have any other sources of water sitting out anywhere else...

And that is when I realized that I've learned too much...

M3 OSCE (objective structured clinical exam)

(Patient with chief complaint of bruise over eye and wrist pain with associated bruise, very clear history of domestic violence)

Me: I just need to take some of your social history.  Who do you live with?

Fake Patient: My boyfraand

REALLY REALLY wanted to ask, 'Is your boyfriend Chris Brown?'

But I didn't

And I'll have to live with this fact forever.

Hard to believe

Patient: Last time I came here, there were 3 girls.  And no offense, but they were a lot more attractive than you guys
Bro Intern: Sir, if you were at the hospital you say you were at, I find that extremely hard to believe...

Real doctor

I love it when the patients say "When is the doctor going to see me?"
I always want to reply, "When you're done answering my questions."
But unfortunately, what I really say is, "Soon Sir/Ma'am. The doctor is slightly preoccupied at the moment and I'll be taking some of the preliminary information from you to expedite your visit.  I apologize about the wait."

My soul dies a little bit every time this happens.  Approximately 54 weeks from now, I'll have the MD behind my name and I'll be able to forever evade these questions, and even champion the med students who get this treatment.

FOBT

Me: Do you know what FOBT stands for?  It's actually Fist Occult Blood Test
Dude resident: Yeah, it was recently changed
Me: You have to use your fist, your whole fist, and nothing but your fist
Dude resident: So help you God
Female resident: Ugh

Diabetes pimping

Attending: How do you store insulin?
Other student: In the refrigerator
Me: Uh...in the pancreas...

Back at starbucks

I find myself at Starbucks today, sipping on coffee while eavesdropping on undergrads complaining about how their meager 20 year old lives are ruined because there is actually nice weather outside right now and they're at a Starbucks sipping on coffee while not eavesdropping but rather studying for peasant undergrad things.

I also started thinking about how the fahrenheit system and british imperial units should be phased out and the few countries left in the world still holding on to the idiotic method of measurements should change their ways.  I concluded that the easiest way to do this in the least bloody and geopolitically headache-free way is to build a time machine, go back in time, kill Daniel Gabriel Fahrenheit as well as the entire country of England circa whenever.  Sorry England...you came up with a bad system of measurement (so bad that the denizens of the countries that use the british imperial system don't even quite understand how it works...so bad that you are single-handedly responsible for the explosion of a space rocket)

Screening test

So during my general medicine months (Family medicine, Pediatrics, Internal Medicine), every attending I've worked with has not failed yet to ask/pimp about what makes a good screening test.  For those of you who don't know, it's

• Cheap test
• Enough of the population is affected by the problem you're screening for
• Good at ruling in disease (high sensitivity)
• There has to be fix to the problem you're screening for, and it must be available
• Some other stuff that I don't remember/care about but probably should

ANYWAY, I've decided yet again, with a stroke of my genius mind, to apply the principles of medicine (aka magic) to real life...

Screening test questions for a solid future mate

• Do you like me?
• Do you think you'll continue to like me for a while?
• Will you be immunizing your children?
• Do you like animals?

And that's it.  The only thing that makes my screening test a bad one is that the people are really difficult to change (can't fix the problem...easily anyway).  In any case, my future wife must answer yes to all of the above in order for me to propose to her.  No exceptions.  NONE.

(What brought this idea on?  During my week on neonatology, my attending told me a story of how his wife is an OBGYN and she was on call one night at the hospital and he was sleeping at home.  His wife called and woke him up at 4am and out of the blue to tell him, "David, I don't think I want to vaccinate our children," to which my attending replied "What?!"  to which he got the reply "Okay, now that you're really up and awake, I'm just kidding.  Have a good rest of the night not being on call.")

Clinic day

I had pediatric GI clinic in the AM, then adult internal medicine clinic in the PM today.  Usually, clinic is pretty uninteresting, but today...

Me: (seeing a failure-to-thrive patient) how many times do you feed the patient?
Pt's mom: Well...you see...I used to feed him every 3 hours, but people were telling me that's not good.
Me: Okay, so how often do you feed him?
Pt's mom: So now I feed him every other 3 hours
Me: So...like every 6 hours?
Pt's mom: No...like every other 3 hours
Me: Okay, so what times did you feed him today?
Pt's mom: 5, 8, and I'm going to feed him again at 11
Me: That's every 3 hours
Pt's mom: No, that's every other 3 hours

Later on in the day...

Me: So does anyone else in your family have the type of cough that you have?
Pt: Yeah, my nephew does
Me: Oh, okay
Pt: He's my son's son
Me: Excuse me? Your nephew is your son's son?
Pt: Yes
Me: ..................Okay (writes CONSANGUINOUS FAMILY in all caps on note)

The divide

The poor die from sicknesses that they shouldn't be dealing with because they're treatable but not affordable to them, or because of the community they live in make them susceptible to illnesses that the fat rich rarely deal with.

The rich die from stuffing their faces with $5/300 kcalorie starbucks and diabetes gets the better of them.  But of course not until they've spent all of their money paying for all of their anti-diabetics, anti-hypertensives, and unused monthly gym dues.

The poor need help period.  The rich just need to help themselves.

#thoughtswhiledrinking$5/300caloriestarbucksfromsuburbia

FAS

I turned the corner of a street while walking somewhere today and saw a young girl.  And my first thought 0.5 seconds after seeing her face was "Fetal Alcohol Syndrome"...

I knew I had gone too far...in my studies for my pediatrics exam

"Life is like a box of chocolates, you never know what you're gonna get"

Actually, mothertrucker, if you get a box of chocolates and you bought it from a reputable source, there's 100% chance that you're going to get chocolate of some variety.  I understand white chocolate might be in the box and technically that isn't real chocolate, but we'll let technicalities go.  In real life, just expect to be shit (chocolate?) on 100% of the time and you will never be disappointed, and you will be correct in about 80% of situations.

The Alex Lee RSV laws of Pediatrics

All patients admitted into inpatient pediatrics will have RSV (Respiratory syncytial virus)

1. If the patient is admitted with RSV, they will obviously have RSV
2. If the patient is admitted without RSV, they will get RSV during their stay because...
1. You (or any human) will pick up RSV from one of the patients from 1. and give it to the RSV(-) patient

roommate

Roommate: Yo, I saw you Tokyo drift out of that parking garage.  You couldn't have beat me home otherwise
Me: I was never in the parking garage.  I parked on the street
Roommate: Back to the place you were raised, eh?
Me: By your logic, you were raised in a parking garage
Roommate: No
Me: Your logic blows, just admit it.

Back pain

Attending: You can either deal with your back pain with medication or you can deal with it with surgery and medication.  Data suggests no difference in how your pain feels before or after surgery.
Patient: Really? Alright, just the medication then.
Attending: Ibuprofen is probably your best bet.  I want to stay away from opioids like Vicodin or Norco.
Patient: But I don't get addicted to stuff
Attending: Great. You won't get addicted to ibuprofen then!

Weight loss

Patient: I want to work on losing weight.
Me: Awesome! Do you have plans of how to do it?
Patient: Yeah, I was actually hoping you could tell me a bit about a medication called Adipex
Me: Oh, where did you hear about that?
Patient: Someone I know got it from their doc and lost a couple of pounds
Me: Well, to be honest with you, diet and exercise is a better approach to weight loss
Patient: I've tried that, and it doesn't work for me
Me: How much do you exercise a day?
Patient: Well, I work all day, and I walk around quite a bit at work so I don't really need to exercise
Me: Okay. How about diet?  How many fruits and vegetables are you eating each day?
Patient: I don't really like fruits and vegetables, but I eat a lot of chicken, rice, and pasta and stuff like that.  I try to stay away from fast food.
Me: That's a good start, but you'll need to balance your diet out a little more with greens and fruits
Patient: Okay
Me: How about water?  Are you drinking enough water each day?
Patient: How much is enough?
Me: You should ideally be drinking about 2 liters, which is about 4 of those regular Ice Mountain bottles
Patient: Wow, no, I don't drink that much water.
Me: Do you think we could get you there?
Patient: I'll try
Me: Great, so let's set those as our goals for the next visit: At least 2 fruits, 2 veggies, 2 liters of water.  And why don't you add a bit of walking after work each day?  You don't have to go far, just a mile or two each day.  That's like 15-30 minutes.
Patient: Alright.  So do you think I'll be able to use the Adipex?

Whenever...

...someone says "She's all I wanted in a woman and more"...I start wondering if "she" has a penis.

No, I'll take the bus

EMS line rings.  Surprise...it's EMS.  They responded to a call about a man who got hit by a truck had his legs run over.  Emergency resident picked up...

Resident: How soon will you be here?

EMS: We haven't left the site yet

Resident: What? Why?

EMS: The patient doesn't want to go to the hospital

Resident: What? Why?

EMS: He just wants to take the bus home

Resident: Is the patient awake? Put him on

EMS: You're on speaker phone now

Resident: Sir, you were run over by a truck.  If you don't come to the hospital, YOU WILL DIE

Victim: Man...I just want to take the bus home.  Leave me alone

(Attending takes over)

Attending: Is the patient intoxicated?

EMS: Negative

Attending: Do you think the patient is going to decompensate within the next 10 minutes?

EMS: Negative

Attending: Seriously?

EMS: Patient's BP is 210/110

Attending: Ugh

EMS: Patient wants to get on the bus.  I really feel like this patient should come in.  I'm afraid I'll lose my medical license if this goes wrong

Attending: Okay...well do your best to bring the patient in.  We want to see him.

Patient never came in.

"dream come true"

Someone I know recently posted on their twitter "Tailgaiting with such and such, this is such a dream come true!".  If your dreams (goals) are to get drunk with strangers, your dreams are kind of shit.