ndab Ah Yes, Medical School: January 2006

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.”
“OK.”
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.”
“Great!”
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.”
“What?”
“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.”
“Huh?”
“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.
“Umm…doctor?”
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.)

Wednesday, January 18, 2006

Use Your Illusion

(Please note: while the pictures in this post are all medical in origin and detail the effects of an important medical and surgical condition, they are undoubtedly going to offend some people. So by putting this warning up here, I'm shifting any blame for your discomfort squarely on your shoulders. Nice job.)


Yesterday was long call day, which means our internal medicine team was admitting every dreadful walk of life that wandered into the ER and needed a hospital stay. After being given a notice by my resident to check out a new admit in the ER for renal failure, I was not particularly excited. Perhaps it was the fatigue, perhaps the knowledge of the work that lay ahead, or perhaps it was simply my utter distaste for smelling all those awful smells in the ER, but I was very hesitant. However, sacking up like the manly man that I am, I reattached my testicles to myself and marched on forward to the ER.

That's when I saw them...

They were the most magnificent things I had ever seen. Big, bountiful, yearning to be freed from the tight cloth that so cruelly repressed these enormous jugs, these fantastic melons, these glorious mounds of delight from exploding in a fit of pornographic ecstasy. Stunning. Awe-inspiring. Some would even call them beautiful. I found that, throughout the workup of this patient, I couldn't help but stare at those miraculous works of art, distracted by the sheer glory of their creation. How could I have been so fortunate as to receive an admission like this?

Of course, it came as some surprise to that these were, in fact, fake. Crafted not by the hand of God but instead by a more malicious force.

Yes, these supple jugs were in fact the unfortunate side effect of one man's longterm bladder and fluid herniation through his inguinal canal, which ultimately led to his kidney failure.








Wait, you know I'm talking about my patient's massively swollen scrotum, right?


If you would like to read more about acute renal failure, click here.
If you would like to read more about scrotal swelling, click here.
If you feel at all cheated by this post, then try a little harder when you're searching for porn on the internet next time. I'm trying to educate people about medical school, here. Jeez.
And if you're wondering what prompted this juvenile post in the first place (my sporadic fits of immaturity notwithstanding), I'll just say that sometimes, with today being a prime example, you witness things so emphatically and definitively depressing that you have to find some way of coping, and my way is manifested here.

Thursday, January 12, 2006

Seeing Is Believing

One great thing about being a third year medical student (stop laughing) is that everything you see, hear, smell, etc. on the wards is so new to you that you really have no idea if what you are observing is important, relevant, or even present in the patients you are studying. This is another way of saying that you have absolutely no responsibility for being right about anything, as long as you have a pulse, show up on time, and can at least pretend like you are paying attention (for personal lessons on my patented "I look like I'm paying attention but I'm actually daydreaming about Natalie Portman" face, the same squint-eyed, furrow-browed face that has fooled everyone from high school teachers to attending physicians into thinking I was furiously focused on the stream of poo emanating from their mouths, inquire below). The downside of all this is that at some point, like say when you're the chief resident in your field six or more years later, you're going to have to actually know something. And if you don't, you not only make yourself look bad, you make the specialty you are representing look even worse.

I bring this up because I observed a rather interesting event on my second day of inpatient internal medicine this afternoon, one that really makes me wonder whether I've actually been right all along in my as-yet-incomplete and poorly thought out theory that...well...medicine is bullshit, and succeeding in a medical field is all about who can bullshit the best and convince everyone else that their bullshit is cleaner than yours. Don't get me wrong, medicine (and I'm speaking broadly here, so not just internal medicine) has obviously done billions of wonders for prolonging people's lives blah blah blah, but while I can't really describe what I mean in words just yet (as this is something still formulating in my mind), I know what I mean. I hope that is vague enough for you.

Anyways, our chief resident gathered me and the other four medical students rotating through internal medicine at a specific hospital and conducted the first of our physical diagnosis rounds, where we are introduced to patients with interesting physical findings on exam and then have to figure out what's going on, with chief resident guidance and teaching along the way. In other words, this is the part where we ignore that whole "a patient is a human being to be respected with privacy" crap and instead adopt the "a patient is part of a circus freakshow and must be displayed, poked, and prodded by as many people as possible in as open of an arena as can be found" philosophy of patient care, where not even my dreamy blue eyes and soothingly sexual voice can put a patient at ease. I actually enjoy these rounds, because sometimes I...brace yourselves...learn something. Really, I swear.

After seeing a few patients, she asked any of us if we had patients with interesting findings that the group could check out, and one of my colleagues (who I must admit is one of the rare medical students I genuinely respect, mainly because he's almost as big a jackass as I am) recommended one of his patients, ultimately proving that if one learns nothing else in medical school (and believe me, most don't), it's that one should never, ever volunteer for anything. Ever. He described a malar rash we were supposed to see, and we went in to see the patient. The chief did an exam and started pointing out a rash she was outlining with her finger on this lady's face. Now, I didn't see a damn thing other than a big bandage over her right eye that was placed there after her eye surgery that morning, but if you refer to the first sentence of this post, you'll find that this sort of thing happens to me all the time and I just did what I normally do and kept my mouth shut. Also, being at the absolute bottom of the totem pole means you speak your mind when it does not come at the cost of embarrassing your superiors, so I've gotten pretty used to this scenario. We talked some more about the rash, look at it for a little while longer, and then walked out.

It's at that point that my friend (obviously feeling as stupid as I felt at not seeing what should have been a textbook rash) looked at his notes, smiled like the jackass that he is, and said, "Oh, umm, so ya the patient we were supposed to see was actually in the other bed." Which means we saw the wrong patient. Which means the patient we saw did not have the disease we thought she had. Which means there was no rash. Which means the chief, drawing on four years of clinical experience, essentially willed into an existence shared only by her imagination a rash that was in fact not there, never was there, and likely would never be there. Which means the chief tried to teach us and show us a rash that never existed, and we (sort of) believed it and were ready to learn from it.

In other words, medicine is bullshit.

Now, it's obviously ridiculous to draw that conclusion based solely on one example, but I just thought I'd describe this scenario because a) it actually happened, b) it probably happens all the time, and c) I really think I might be on to something here, as I'm wondering how much of medicine is really just a product of one's imagination versus how much is rooted in actual science, fact, and reason. In other words, how much of medicine is geared towards the patient, and how much is really only for our own peace of mind? After all, if someone can will a figment of one's imagination to appear on the face of another person, how much more can one imagine? A diagnosis that is wrong? A cure when there is in actuality no hope? I'm clearly not even sure where I am going with this, but hopefully you get a sense of what I mean, and if not, I'll try better next time.

Oh, I should also add d) it reminded me, yet again, to never volunteer for anything.

(And in case you are counting, I made five direct references to excrement in this post. Hi Mom!)

Saturday, January 07, 2006

100,000

Marking perhaps the greatest understatement in internet publishing since the immortal "Hey, I think if we put porn on the internet a few people might buy it" thought posited by some wise pre-pubescent boy many years ago, I seriously cannot believe that I am approaching my 100,000th hit on this blog. Granted, much (OK, all) of the credit goes to the glorious folks at Blogger.com for making me a Blog of Note a while back and propelling my previously dreadful life as a medical student into a popular but still dreadful life as a medical student. Either way, I just wanted to thank you all for making it possible, for inspiring me to place myself in increasingly awkward situations, for forcing me to place my hands where they were never meant to go, for allowing me to shamelessly whore myself on the internet for all the ladies out there time and time again. I would also like to thank the good folks at SiteMeter, for without this handy tool I would not be able to find out how many hits I get, and, more importantly, I would not be able to figure out how so many of you find my site in the first place. Yes, I mean those of you who, after typing into Google search terms such as "turned on by gyno exam", "rectal fetish", and the always classic "anal porn doctor pics" (no joke on any of them...and yes, you can figure this out with the SiteMeter thing), were magically directed to my blog and stayed for approximately 0 seconds before turning your attention elsewhere...thank you for driving up my hit count.

As I embark on yet another rotation this Monday (Internal Medicine...that sound you hear is me crying), I hope that the coming six months will provide me with some enlightenment regarding a specialty, some clarity regarding my future, and, naturally, some hot Jewish girls (remember that part about me being shameless?). But, most importantly, I hope that during the next six months I am afforded the privilege to...umm...continue dissuading the impressionable young minds of the world from going into medicine. Seriously, I put a link to business school here for a reason, people.

Amen.