ndab Ah Yes, Medical School: Scrotal Support: A True Journey In Existentialism

Tuesday, January 24, 2006

Scrotal Support: A True Journey In Existentialism

Sitting with my resident in the nurses station adjacent to my patient’s room yesterday, we made eye contact immediately after I hung up the phone.
“Looks like we can discharge him,” I exclaimed with a joy understandable only to those unfortunate few who had the pleasure of regularly smelling this patient over the last five days.
“Great, I’ll get started on the discharge summary and you finish up the paperwork!” My resident shared this enthusiasm, but did not have the same zeal for paperwork.
“OK, just one thing: the attending mentioned that we better get the patient some sort of harness, a truss? Some kind of support thing, you know, for the herniated bowel and bladder that’s in his scrotum before he has his surgery? Do you know where I can get one of those?”
“Just write an order for physical therapy to bring one up. That should be it.”
I jumped out of my chair and hunted down my patient’s chart, scribbling furiously in the orders section for physical therapy to come by and give the patient his scrotal support, the last vestige of responsibility I would have before I could get him and his massive scrotum out of here. I wrote the order, had my resident sign it, and proudly handed it to the clerk who enters in the orders.
“Umm…doctor?” Marveling at my newfound efficiency, I chose not to correct him. “You should ask the nurse about this. I don’t know if physical therapy can get what you want.”
I walked over to my patient’s nurse, a middle-aged heavy-set woman with an enthusiasm for her job rivaled by the most grisly of hazardous waste disposal guys, and asked.
“Honey, do I look like physical therapy to you?”
I walked back to the phone and called physical therapy. A man picked up the phone.
“Sure, we can get that, just have him come by our office with a referral.” I wrote up a referral, had my resident sign it, and put it in the chart. The clerk looked at it and said, “Umm…doctor? You should ask the nurse about this. I don’t know if that’s how it will get done.”
I walked over to my patient’s nurse and asked.
“Honey, do I look like the clerk to you?”
I walked back to the clerk and asked him what I should do to make sure a scrotal support sac was acquired.
“I don’t know, perhaps you should call up physical therapy.”
I walked back to the phone and called up physical therapy, hearing the familiar male voice once again.
“Just have nursing transport him down here. We’ll get him his truss and send him back up.”
I walked over to my patient’s nurse and asked how to transport the patient.
“Honey, do I look like the transport nurse to you?”
I walked over to the transport nurse and asked how to transport the patient.
“I guess so. But not now, I’m busy. I’ll take care of it later.”
I reminded her of my eagerness to get this patient discharged, and how this would be the final step in making everyone’s job easier.
“I’ll take care of it later.”

I returned to my patient’s ward an hour later and found my patient still in his bed, still smelly, and still sporting a massive scrotum.
“Did you go downstairs to get your special support underwear?”
“The what now?”
I walked back to the nurses station and found my patient’s nurse.
“Honey, do I have to remind you of who I am?”
I found the transport nurse.
“I said I’ll do it later.”

I returned two hours later and was approached by my nurse.
“Are you the doctor for patient [HIPAA says no!]?”
Marveling at my moderate efficiency, I chose not to correct her. “Yep.”
“They just called from physical therapy and are sending the patient back up.”
I left for a few and came back, finding my patient back in his bed.
“Did they give you the special support underwear?”
“The what now?”
I walked back to the nurses station and found the transport nurse.
“I brought that guy down there and they had no idea who he was, what he was there for, or anything.”
“Don’t make me repeat myself, son.”
I walked to the phone and called up physical therapy. A woman picked up this time. “Yes we remember that patient. You can’t just send a patient down here to get a truss.”
“I was told by someone a few hours ago that would be OK.”
“Who did you speak too? We don’t do that.”
“It was a man.”
“We don’t have any men here.”
“We took his measurements though.”
“Huh? Look, how do I get this for him? We can’t send him home without one and my attending said you guys would have it.”
“We can have him come back to clinic. We order these things from an outside place so it should be there by then.”

“Why is he still here?” Four hours after sending me on a quest for a scrotal sac, my resident was not pleased. I explained the situation. “When is clinic? He smells. He needs to go.”
I walked to the phone and called up physical therapy.
“I don’t know when the truss will come. Call me back later after I talk to my supervisor.”
I walked back to my nurse and asked if there might be anything in the supplies area.
“Honey, do I look like I’m the supplies manager?”
I asked another nurse.
“Here’s a key, just give it back.”
I went to the supply room, marveled at the endless supply of douche bags in the closet, found nothing of use, and walked out. I returned to the phone and called up physical therapy.
“We don’t know if we can get this for your patient.”
“Wait, the truss doesn’t exist?”
“Pretty much.”

A little while later, I found my resident once again.
“Wait, you mean after all this, your patient is still here?”
“Pretty much.”
“OK, well, you can make a temporary scrotal sac out of two Ace bandages.” She proceeded to explain this process and sent me on my way. I walked back to the nurses station and wrote an order for some Ace bandages.
Marveling at my excellence in futility, I corrected the clerk. “I’m just the medical student.”
“OK, well, I don’t know if we can get this for you. You should ask the nurse.”
I found my patient’s nurse and asked.
“Honey, do I look like I would know where to get some Ace bandages?”
I asked another nurse.
“I bet physical therapy would have it.”
I called up physical therapy, and now a man picked up the phone.
“Sure, I know what you’re talking about. Just send the patient down and we’ll set him up with the temporary scrotal sac.”

(If you would like to learn more about existentialism, here are a couple of links, one brief and the other extensive. For the three or four of you who do not already know this, I am a massive dork and actually read this sort of stuff from time to time.)


Blogger Sofi said...

Honey, does this Prozac prescription look attractive to you?

I'd post something more insightful, but I'm too busy mulling over the meaning of my existence with rebellious teen angst.

10:34 PM  
Blogger incidental findings said...

And this is why it's nice to have discharge planners and patient care coordinators around.

10:45 PM  
Blogger Rebecca said...

Sofi, I don't think you could get any more insightful. Prozac looks like a perfect fit to me.

10:48 PM  
Blogger Searcher said...

Thanks that was hilarious. Bet you didn't find it a bit funny at the time. The whole thing reminds me of those call centers to sort out billing problems.

11:24 PM  
Blogger Suchie said...

[HIPPA says no!] is going on my facebook profile under favorite quotes, even though it's really HIPAA. do you, fake doctor, have facebook, and if so, will you be my friend?

11:55 PM  
Blogger Kate Mc said...

Ever considered history (or any other branch of academia)? The only endless running around I've had to do lately was from office to office getting my Canadian tax forms signed by a UK finance officer at the university.

3:40 AM  
Blogger nurse pica said...

oh lord, i hate it when hospital officials send me bouncing around other peoples offices...i found the best way to get something done is to do it myself, even if my methods are unorthodox!

6:04 AM  
Blogger Kyla said...

It's never going to get any better, either. You're ALWAYS going to be sent from place to place, and the patient will stay due to conditions outside of your control, and you'll STILL be held accountable for it.
I say take Nurse Pica's advice, and take matters into your own hands. Of course, that will require some confidence... just refer back to your Bullshitting post.

6:28 AM  
Blogger MamaChristy said...

Can someone please slap the patient's nurse into the middle of next week? Please? I know there is a shortage of health-care workers, but my goodness, can we please have someone with compassion? If not for the patient at least for those who have to smell him?

8:04 AM  
Blogger GB, RN said...

Sheesh...I'm glad I don't work at your hospital. The nurses sound really, really dumb.

8:32 AM  
Anonymous Anonymous said...

someone once told me, great future doctor, that one can detach a scrotum with only a few pounds of pressure. is this true? i've been threatening my future husband with it from time to time, but would like to know if it works in case one day i really need to use it.

9:40 AM  
Blogger Unknown said...

Lordy, sounds like an awful lot of my clinical days. Except, at most hospitals, no one teaches us how to use the phones.

11:37 AM  
Blogger missbhavens said...

Surreal, ain't it?

(you should always just MacGuyver your way through that stuff. It's faster. I'm pretty sure I could do a vacuum delivery with an oxygen tank, a plunger and a hockey-ticket stub)

1:03 PM  
Blogger dr-exmedic said...

It actually sounds pretty easy to rip off a testicle:


1:25 PM  
Blogger Darwin said...

How do you manage to maintain your sense of cool and not lose your temper? How did you not respond "'Honey then what the hell DO you do around here??"

I suppose that's why I never considered medicine as a career. Too many people (idiots) to deal with!

2:05 PM  
Blogger Sarah said...

wow, definately would have started banging my head into a wall about midway through that whole ordeal...

4:48 PM  
Blogger Rachel said...

who's on first?

5:32 PM  
Blogger Watergirl said...

Quite sisyphean that ordeal of yours.

6:48 PM  
Blogger Daphnewood said...

now that post just frustrated the hell out of me.

HIPAA sucks. I had to take the compliance test not once, not twice but three times. It wasn't because I failed. It was because they kept spelling my name wrong and had 'no record' of me taking the dumb test.

8:01 PM  
Blogger Lauren said...

Truly, truly scary... I have to wonder some times how anyone actually SURVIVES a trip to the hospital. For instance, when my dad went in after going into cardiac arrest and FALLING INTO A PIECE OF EXERCISE EQUIPEMENT, the doctors were ASTOUNDED that he had internal bleeding -- which was discovered only after pumping him full of anti-coagulents and inserting three stents. He nearly bled to death... crashed four times... before they finally discovered that he had broken five ribs -- one of which had punctured a blood vessel and filled his chest with blood.

I hope I drop dead in my kitchen floor. I do NOT want to have to go to a hospital ever again!

8:28 PM  
Blogger woundnurse said...

that nurse needs to be bitchslapped. If the pt. was stinking, ya shoulda told that ass of a nurse to go clean him up! Thats just downright wrong to have someone lie in bed and smell his own rotten odor, besides having elephant balls to boot!

8:46 PM  
Blogger lee said...

how did you resist strangling the nurse with the frigging bandage,that's what i want to know!-and then why she's there on the ground gurgling and taking her dying breathes,reaching up, imploring you for help have the pleasure of saying: "honey,do i look like i know CPR to you?".A opportunity for a good time,and you blew it! ;).

3:36 AM  
Anonymous Anonymous said...

miss anonymous- u know hwat u need? Candy stripers! those eager hospital volunteers who make ppls days better (do they still exist?) if so, grab one of them and say u need their help to run these errands, they'll certainly make ur day better :) get them some chocolate afterwards :)

8:19 AM  
Blogger square peg said...

Oh I totally feel THAT PAIN. Let me guess -- internal medicine at the VA? VA is the paragon of efficiency and intelligence. Discharging patients took longer than the actual hospital stay, and usually the poor medical student has to act as social worker, PT, patient transport, and finally bouncer.

9:56 AM  
Blogger genderist said...

This is what I refer to as existential angst -- and sounds like you had one all day long.

Bless your little heart!

4:52 PM  
Blogger design42 said...

I can't believe I read your blog regularly and I still want to be a doctor. I even gave up business, and the nice mixers, to back to school for it. But you know... I want to make sure no man in need is without his scrotal sling...

8:43 PM  
Blogger An Enlightened Fellow said...

For Amanda Rials: One could detach almost anything with a few pounds of pressure from a running chainsaw.

9:12 PM  
Blogger confused arab chick said...

Aren't all nurses evil?

I don't think I've ever met a nice nurse.. ESPECIALLY in ER- they are almost always grumpy and bitchy!!

11:10 PM  
Anonymous Anonymous said...

This comment has been removed by a blog administrator.

11:03 AM  
Blogger "Jet" said...

I would have went insane!! You have more patience than I!

11:12 AM  
Anonymous Anonymous said...

I don't want to sound like I don't have a sense of humor, (and the nurse you described certainly sucked), but don't healthcare workers in general lack compassion and professionalism? I get screamed at or hit on by physicians everyday. I just feel like nurses take more flack than physicians, PT, RT, and the interdisciplinarian medical team in general takes combined. Can't we all just agree we're a group of flawed humans in need of more time, patience, knowledge and skills? You influence a lot of people--just as every healthcare worker does. What you write is interesting (and sadly true) but can you be more objective with the unflattering assessments?

7:30 PM  
Blogger UnsinkableMB said...

confused arab chick is definitely confused since she made a sweeping generalization like that.

anyway, that nurse sounds like she something stuck up her ass. if i were you i would give some feedback to nursing management. obviously, there is not much you can do about someone's personality; however, when a person affects your ability to do your job then that's an issue that warrants attention.

3:14 AM  
Blogger Emily said...

that sounds EXACTLY like what happened when I went to Temple. Every day.

7:18 AM  
Blogger wendela said...

You have a lot more patience than I do. I guess this prepares you for all the cr*p you've gotta deal with down the road, I dunno. As for Amanda's comment, yes, I think it wouldn't take much pressure to detach. I worked for a vet and that's how he neutered male cats (under anesthesia, thank goodness). I am hoping there is a better way, but he was just too cheap. Got outta that place fast. I enjoyed working in a human hospital far better than there.

12:52 PM  
Blogger Holy Mother Eph said...

I think existence is frequently more than just a philosophical problem.

9:21 AM  
Anonymous Anonymous said...

Hi Fake Doc,

Sorry this is slightly off topic, but someone has just pointed me at your excellent site and I have just been routing around.

I spend quite a lot of time advising and interviewing pre-med students in the UK. Competetion for med school is as strong as ever BUT it is now approaching 70/30 female entrants and between 10-20% of medical graduates are leaving medicine altogehter as soon as they graduate to go into business.

I see you carry a plug for business.

So what's happening overthere?


4:49 AM  
Blogger Margie the Pickle Princess said...

In my mind, that nurse looks JUST LIKE the large black nurse on Scrubs. I think her name is Laverne. But she's much funnier on Scrubs than she would be in real life. I think I would have had to kill someone in this situation. This is why I'm glad I work in a dental lab with just one other person. I don't get the run around, and I only want to kill him occasionally. :)

10:31 AM  
Blogger Esin said...

Perhaps the title of your blog should be, "Alas, Medical School." Hah. <3

3:47 PM  
Blogger The Red said...

You know, there are some times when violence really is the answer.

3:00 PM  
Anonymous Anonymous said...

amen, red!

4:50 PM  
Anonymous Anonymous said...

This is straight out of teatre de l'Absurd. I feel like I was reading a med student version of Waiting for Godot

9:06 PM  
Anonymous Anonymous said...

So are you going to share what you are looking for in this single cute Jewish female? Are you looking to marry a doctor?

9:32 PM  
Blogger commonlyusederrors said...

the whole incident kind of reminded me of ground hog day or some thing... i don't know, if becoming a medical doctor would mean i have to get through a whole lot of that, i'm having second thoughts....

2:50 AM  
Blogger AznMarkofDaFiji said...

hahaha, omgsh, I find it hard to believe you went through all that!

Sounds like something the main character goes through in a RPG, run around, talk to other people, and collect items from them and repeat.

4:09 AM  
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Blogger Leslie said...

Oh MY GOD!! I have spent 30 years in this scene, but I am a helpful beaver so the med student and the resident would have left and I would be doing this!!! I almost cannot take this pain. OOOWWWWWW!! My head, my soooulll.

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