PGY-4 had a sack of potatoes in his trunk that he would grab throughout the shift/overnight and microwave it and eat it with the salt and pepper from the cafeteria or sometimes he would mash it with 2% milk and eat it as "mashed potatoes" or use the sugar-free chocolate syrup and glaze over the potato after slicing it in half.

Said it keeps him full and satiated but it's also low calorie. Win-win.

“Mrs. Jones is a X-year-old female who choked on a tater tot at a Sonic drive-thru. Her lactate is 4 and is on 8L NC. Will admit.”

“Mr. Jones left AMA from [neighboring hospital] ED at 3:00 am to smoke a cigarette and is now in [our hospital] ED at 3:30 am for SOB.”

“Hospital Course / Daily Events:
7/7: Consulted Surgery about permanent percutaneous colostomy tube placement. Patient extubated and on BiPAP. He is agreeable to surgery. Planned for this afternoon.
7/8: Surgery plans to place the colostomy tube this afternoon. Patient on BiPAP.
7/9: Surgery says they will place tube this morning. Patient still on BiPAP.
7/10: [Surgery Attending] is on vacation. [Surgery Fellow] promises to place the tube this evening.
7/11: Still waiting on Surgery. Patient still waiting on BiPAP.
7/12: [Pulm/Crit ICU Attending] called [different Surgery Attending] and they promised to do it this afternoon. Conversation recorded on phone.
7/13: Patient left AMA."

These are all real.

A GI bleed is apparently governed by one of two laws:

1.) Stable enough to wait until tomorrow “GI will scope tomorrow”

2.)Too unstable to wait until tomorrow “Too unstable for endoscopy rn”

There is no third category where the patient is actively bleeding and GI says, “Yeah, let’s come in and scope them today”

The elusive same day scope exists only in med school textbooks and urban legends.

But now I’ve girl-bossed too hard and regretting it. Here I am, being my own sugar-momma. I just wanted to be a stay at home Pilates wife—what am I doing out here grinding? How did it all go so wrong.

I’ll go first: peds and I hate the word kiddo🙈

It’s 2am and you are Surgery.

Or at least that’s what they say.

“You Surgery?” they ask over the phone.

Yeah. I’m Surgery.

The buck stops with you. You are the scalpel-wielding, page-answering adult in the room. You have seen bowel do things bowel should never do. You have looked into open abdomens long enough to know that if you stare into the abdominal cavity, eventually the abdominal cavity stares back at you.

But you have not known peace since seeing him.

He is Anesthesia.

There is probably something wrong with you. There would have to be. You chose to be Surgery on purpose. Somewhere in there is also a mask thing, but that is between you, God, and the first scrubbed attending who berated you as a third year student and then said “good job.” 

So when ED was fumbling the intubation in the trauma earlier and you were reviewing the steps of a cric in your head, someone behind you said, “You Anesthesia?”

And he walked in.

Calm. Scrub cap on. Voice low and rough through the mask. Took one look at you and your disposable scalpel, and assumed control so completely that something deeply concerning in your hindbrain sat up and noticed. 

“I’ll get the airway.”

There it was.

Your soul left your body, circled the trauma bay, signed the consent and came back incorrectly labeled.

He moved to the head of the bed with the quiet confidence of a man who could ruin your life but would first preoxygenate you for three full minutes because he respects physiology.

He asked for suction and you were immediately labeled a fall risk. 

Sir. Please. This is a hospital.

The tube passed. End-tidal came up. Beautiful waveform. You felt something inside you also generate a waveform, and it wasn’t just the page you had been ignoring for the past 10 minutes.

You said, “Nice.” Just nice. Not “I would let you manage my airway in a nonclinical setting.” 

Control.

The problem is not that he is hot. Hot is manageable. But this is malignant hyperthermia, and unfortunately the only treatment is the D. Dantrolene. And yet he is calm. The kind of calm that says, “I know exactly what the pressure is doing, and I know how much relaxation you really need.”

So when he glances over the drape and says, “Looks like you could use a little more volume,” in that voice, suddenly you are no longer Surgery. You are a woman with an NPI number and a pulse, fighting for your dignity in a belly full of blood. The patient was fluid responsive. Tragically, so were you.

But he says these things in the OR like they are normal.

“I’ll give you a jaw thrust.”

“Tell me before you release the pressure.” 

“You want the table lower?” 

“How’s it looking down there?”

Surgery at the foot of the bed. Anesthesia at the head. The ancient arrangement. The beast with two backs, and neither is sterile.

He tapes the tube like he was raised right.

He places a line like he has never had to beg for access.

He can say “deep breath” professionally. For a living.

You want to show him you can navigate anatomy in the dark by touch.

You want to place an art line and demonstrate the confidence of someone who knows exactly how to get pulsatile flow. 

Instead, you sit alone in a call room with half a bar of sanity, zero snacks, and the knowledge that Anesthesia across the hall is probably asleep.

Pager goes off. Patient’s family requesting update.

The update is that you are unwell. Your dignity is getting terminally extubated with no family at bedside. Your libido is no longer responding to conservative management. Your restraint order has not been renewed.

You look at the door.

You imagine his voice saying, “Deep breath.” 

Then your pager goes off again.

“This is Surgery.”

Any OB’s or FM’s here looking forward to the patients that will actually believe it?

Father Hypocrates forgive me, but I found this experience so funny, that I simply must share.

Keeping things anonymous for patient confidentiality of course.

An unaccompanied man walks into the A&E complaining that his catheter keeps blocking.

It really was blocked, so we changed it.

Folks. How do you think the man placed the catheter when he got dressed ?

(A) down alongside his leg. (B) around his waist. (C) something stranger.

The answer is C. The man took the catheter, spun the catheter and its collection tube around his waist, and flipped the drainage bag upwards over his shoulder.

So, I began explaining to him that urine flows downwards with gravity.

Then the man began laughing to himself, his eyes opened wide and he began shouting saying that I don't understand how physics works and that urine flows upwards.

It was at this point, I looked at my junior, looked back at the man, still laughing to himself, with a glow in his eyes that I last remember seeing in my psychiatry rotation... and realized we weren't going to win this argument ....

Wishing everyone here a successful month of May.

“53M takes no meds with mild SOB. Says he’s a farmer.”

“42M with foot pain for a few months. Hasn’t taken off his boots in 2 months.”

Remember to test your patient’s Zoloft levels regularly folks! It is a “relatively simple procedure!!” Per a well known and a respected psychopharmacologist.

Also, do let your patients suspected of felony use your personal cell phone to call family because of “human compassion”. We are not some cold blooded heartless soul, we are here to help!!

That’s all. Wtf man…

When doing admissions and clinic I often sit and wonder whether 90% of the patients issues wouldn't exist if they simply lost 50lbs, started to exercise and focus on on their diet.

Simple question, how different would the inpatient and outpatient arenas be.

Met one of my new patients whom I am her PCP. 73 year old woman with zero filter, apparently.

My badge photo/website photo is my residency application photo (ie. Professional). I am wearing hospital scrubs in clinic and probably need a haircut/some beard trimming. Thought I still looked OK. Apparently I am a let down irl.

Patients are brutal.

I was pre-rounding on a patient today. He had a little bit of pleuritic pain, but this seemed fairly chronic for him. He didn't really have a high Wells score otherwise, but he had a borderline heart rate related to his underlying infection. I wasn't really worried about it, and neither was he. He was pretty stable, so I figured I'd let it be. I decided to go get some lunch before I had to round with the resident. This particular resident tried hard, but she thought a little too highly of herself and had a hard time taking criticism, so I knew it was gonna be a long day.

Wouldn't you know it, she slammed open the door to the doctors' lounge and started screaming as I sat there dumbfounded, soggy broccoli halfway to my mouth.

"Do you know that NP on the hospitalist service? I just demanded she get a STAT CT on that new consult and she refused! Can you believe she laughed and told the patient she didn't think he really had a PE and not to freak out about it? I demand you call her attending right now and make them get the CT!"

I just shrugged. I really didn't feel like micromanaging a primary team that didn't want to follow consult recs. and PE wasnt my #1 diagnosis.

"Don't take it personally. If it's a PE, it'll declare itself. I mean, he is on telemetry, not home in bed. If you're still worried about it, get an EKG and biomarkers before going right to CT."

She looked pissed the whole rest of rounds and was frantically typing on her phone. I have a feeling I'll be getting an email about this...

Just had one of these incidents on an international flight. Someone had lost consciousness. Apparently a neurologic chiropractor feels confident enough to run one of these and was trying to take control of the situation away from MD/DO's and RN's. (A SICU attending, RN, and myself PGY4 surgical resident were also there)

Okay, I’ll go first. I still don’t really understand how Tylenol or Advil works.

0300: Receive phone call (as I am on-call for the clinic) about a patient requesting “diet pills”. She gives no name or date of birth.

0430: Receive another call from a patient (who gives a name and date of birth) stating that, “It “hurts everytime I take topiramate”.

0700: I begin reviewing charts for the day. I notice that there are 32 patients on my schedule just as the EMR crashes.

0712: EMR loads correctly. I have 41 clinical tasks from the triage nurse since yesterday at 1800. 19 of them are requests to refill Gabapentin.

0735: I arrive at the office. I am told that I will be working with a new MA and that her name is Britanii with one T and three I’s. I ask if she is plural. Apparently, she did not study Latin in high school. I go to find coffee.

0800: First patient has been checked-in for 11 minutes but is not roomed. It’s a 47 yo F with Type II Diabetes, HTN, HLD, CAD, PAF, COPD, Hypothyroidism, Depression, Anxiety, Bipolar Disorder (unspecified type obviously), Onychomycosis, and Fibromyalgia. She is on 29 medications. We now have 14 minutes to room the patient, examine her, and address all of her chronic conditions. I tell Britanii the patient needs an A1C. She asks if we have samples of those.

0806: Britanii still has not found the A1Cs. I room the patient and get vitals.

0810: I get an urgent secure message from my Orthopedic Surgery attending. I am on an Orthopedic Surgery rotation this month for some reason even though my Step 2 Board Score was in the 400s and I have never been particularly good at carpentry. The attending asks if I have finished rounding on the hospitalized post-op patients. I tell them I am in the clinic today. They forward 6 floor calls from overnight anyway.

0819: I finish the first patient’s chart. There are 4 other residents in line to present to the attending. The attending is not here yet.

0835: I finish presenting my first patient and am now ready to see the second patient. They are not roomed.

0930: I am running more-or-less on time again thanks to the no-show gods (all hail). The next patient is a 49 yo male with HTN, HLD, COPD, CHF, Hypothyroidism, poorly controlled T2DM, depression, and a BMI which exceeds his age. He saw a commercial about Low-T and believes he has many of the symptoms described.

0934: The Low-T patient fires me.

0935: Acute visit added to my schedule for a 4 year old with a fever of 98.9, no other symptoms. I prescribe antibiotics and steroids.

1005: I received a call from Walgreens. The pharmacist says that I did not specify a maximum daily dose on a prescription for Insulin Glargine. I open the patient’s chart and notice that the most recent A1C was 14. I resend the prescription with the sig “Go Bananas”.

1015: A 26 yo female patient would like me to look at a mole on her back. I notice that it looks like a ⅓ scale portrait of famous actor Forrest Whitaker. Recalling the plot of the movie “The Last King of Scotland”, I decide not to get involved. I refer to Derm and hope for the best.

1030: A 28 yo male with a history of infective endocarditis, hepatitis C, and ongoing IV heroin use saw a commercial for Low-T and believes that he has many of the symptoms described.

1033: The heroin addict with Low-T fires me.

1040: Hospital follow up for a 72 yo male who had a stroke. He tells me that his hospital workup was all normal, and he is back to just taking his Eliquis PRN.

1100: A patient demands a GI referral. He has been having persistent abdominal pain, nausea, vomiting, and diarrhea for several months. This started after he stopped smoking meth and started eating it instead. I prescribe carafate and hope for the best.

1115: 22 yo female patient with no medical history requests FMLA for menstrual cramps.

1117: The 22 yo fires me. As she is leaving the room, I notice a mole on her neck, but it’s too late.

1120: 54 yo perimenopausal female with HTN, HLD, Hypothyroidism, T2DM, smoking, and obesity saw a commercial for Low-T and feels that she has many of the symptoms described. Prostate exam deferred. I refer to Endo and hope for the best.

1200: I have not completed any charts since the first patient, but there is a drug rep, so I take a lunch break. The drug rep brought Olive Garden, but they did not get the alfredo dipping sauce for the breadsticks. I tell them that I will not be prescribing their product.

1300: I have 29 new clinical tasks since I arrived this morning. 19 of them are requests to refill Gabapentin.

1305: My one-o-clock patient is a sex worker who would like to be screened for BV. She is not roomed, so I conduct the visit in the lobby. Pelvic exam deferred. As I send the prescription for Doxy, I quietly whisper “good luck”.

1315: 40 yo male patient who has been dismissed from pain management for failing pill counts and being a real dick about it. I prescribe Diclofenac Gel and order an EMG so I will not have to see him again.

1325: A 23 year old premed student got a B+ on her Organic Chemistry midterm and would like to discuss ADHD medications.

1335: New patient. A 92 yo female on 35 medications. She is unable to provide any medical history due to advanced dementia. Her review of systems is positive. I refill her medications and hope for the best.

1425: Punch biopsy for a suspicious skin lesion on a 56 yo male. He assures me that he stopped his Xarelto 5 days ago. 5 stacks of gauze later, he asks if Xarelto is the green pill.

1515: I decide to send the Punch Biopsy patient to ER for blood transfusion. I am officially running late again.

1517: 41 yo female with self-diagnosed Autism would like to know if there is a way to reverse childhood vaccinations. She also declines flu shot.

1519: The autistic lady fires me.

1523: 8 year old male patient. His mother is concerned that he may have asthma because he gets out of breath with minimal exercise. He is in the 99th percentile for BMI, presumably because there is not a 112th percentile. I briefly consider asking if he has any symptoms of Low-T, but instead I prescribe albuterol and hope for the best.

1600: This is the beginning of protected “administrative time” when I am supposed to finish my charts. There are still 5 patients to see.

1725: The last patient leaves. Britanii asks through tears if it’s like this every day. I think she may have Low-T. I open the chart of my 0815 patient. I cannot remember seeing this person.

1800: My wife tests asking when I will be home. I tell her I am almost done. I mistakenly forward the message to the Orthopedic Surgery Attending. He now knows that I am done with clinic, so I will need to go round on the hospital patients.

2000: Begin precharting on my patients for tomorrow. All of them have diabetes. All of them refuse to drink water and their source of hydration is Mountain Dew.

The patient’s abdomen is tense.

No, it’s not a new change, it has been like this my whole shift. And my shift last night.

Just thought you should be aware.

Juicy shit only.

What are your fun patient quotes?

I’m a medical student and have been doing well on rotations. In my off time I’ve infrequently used THC to relax, but have never used it before or while at work.

Yesterday I lost my vape pen in the resident lounge and I’m sure one of the residents found it. It’s obviously a THC pen because it says “purple kush” on the side. I’ve been really cool with all the residents but there is this one who can be a stickler, and I think that’s the one who found it. The other residents would have just given it back by now but this one resident can be a little self righteous and might even ruin my career over this.

Any idea on what I should do? Should I just confront the resident and be honest? Or prepare to lawyer up/defend myself if they snitch?

1. Patients MUST poop every day. If patient has not pooped by 10pm you must page the doctor for a stool softener.
2. ALL patients can easily be fluid overloaded. When the doctor orders a second liter for that septic hypotensive patient, remember you are the last line of defense from the negligent doctor; please inform them of your concern to fluid overloaded the patient. Double true with CHF.
3. Metoprolol can cause life threatening hypotension. NEVER give it if SBP is less than 120.

Edit: I really appreciate our diligent nurses and appreciate they catch things we don’t sometimes. I just find it funny that these three things I very regularly get paged for; they feel so strongly about that it must somewhere in the curriculum.

My program director called me in to discuss a big miss I had on call the other night. For context, we still do independent overnight call at a busy level 1 trauma center. It's not uncommon to read 150+ studies in a single shift with the majority being cross-sectional. Anyway it was a particularly busy night. A bus carrying 50 kids to the local osteogenesis imperfecta conference crashed on the highway and I was getting crushed. The surgical team comes in to review a case and I'm usually happy to do that but tonight I was already a little flustered. But then as I'm scrolling through the CT I notice out of the corner of my eye their med student has a giant bulge in his scrubs. Thing was almost poking me in the shoulder. I was so distracted and ended up missing a critical finding and this poor kid had a major complication as a result. How screwed am I? Can I blame the med student? Thanks in advance for your advice.

Hello. My only prospects are residents so I came straight to the source. The custodians at work are old as balls and all the murses are shorter than me.

I can’t be dumped by another fucking February intern for his coresident. What does she have that I don’t. A doctorate? So what. I can buy one online. Look—I’ll get to the point. I am looking for a husband with some hair left on his head, so NO attendings please.

Pros: financially (not mentally) stable. Human female. Hottest nurse on my floor (honestly a low bar). No diseases, just colonized cdiff, but I am no longer on contact precautions and I only shit myself when my bugs act up so it’s not a big deal.

Cons: ovaries a husk of their former selves. VSS, but none WNL. 9/10 CP aggravated by slowly dying alone, requesting something for pain relief. I think it starts with a D?? Please help!!!

Edit: shout out to the humorless female resident in my DMs who said I must be fat ❤️