In a sleep-deprived state (thank you, little 3am vampire baby delivery), it occurred to me that the advice I give for medical care is pretty good. (The fact that only about 1.3% of patients listen to it is another thing entirely.) But then I got to thinking: what health behaviors do my characters portray? Am I sending the wrong message?
I give you: Things my characters do that I would never recommend.
#10) Drive really fast. Ok, maybe if there’s a reason, fine, just be aware of surroundings and careful of other vehicles/pedestrians.
#9) Drink far too much coffee. Which is funny, because I don’t like coffee. But my characters do. Don’t the women know that lots of coffee will increase fibrocystic breast changes? Don’t the guys know that it just makes them annoying as hell when they’re that peppy and talkative in the mornings?
#8) Leave the Emergency Department AMA (Against Medical Advice) while not yet recovered from life-threatening injuries. Don’t give me this BS about how you're almost immortal. You need neuro checks and vitals q hour for overnight observation.
No preamble. Here goes.
#10) "Doc, I've had a 99 temp since this morning and have a runny nose. I need antibiotics so I can go shopping/water skiing/off-roading this weekend."
(These are the same folks that check the "not satisfied" box on the patient survey when I recommend NO antibiotics based on radical concepts like "medical evidence" and "exam findings".)
#9) "Why can't Dr. Jill see me? I'm only an hour late. She knows I can't wake up before 10am."
(Look, when you made this appointment 1 month ago, there were numerous options for appointment times, including late afternoon. My apologies for not hanging out at the front desk and intervening on behalf of your delicate biorhythms, but administration wants me to actually SEE PATIENTS during business hours.)
#8) "Diet and exercise doesn't work for me. I have a glandular problem. Even though my thyroid levels are 100% normal, I still must have thyroid medication to make me lose weight."
(The reason your weight doesn't go down has to do with the 1 liter Mtn. Dew you're sipping and with the fact you consider daily exercise to be walking from your car to the office. A thyroid pill will give you an arrhythmia and osteoporosis. "Not satisfied" box checked yet again. I will be fired by next week.)
I can't take it any more.
Common sense? Nope.
Smart folks and simple folks alike have caused me to really beef up my standard instructions for procedures and medical tests. Here's a snapshot of why sometimes I'd like to pull my hair out.
#1) Preterm labor. I have told you very clearly, "Please do not have sex. Please do not put anything in your vagina." My simple instructions could only be clearer if I added in a diagram and an interpretive dance. Why, then, do I see you in the Ob department at 3am, contracting wildly at 26 weeks into your pregnancy as you are post-orgasmic from hours of wild nookie? And now you're somehow mad at ME? Talk to sperm boy over there. Cuddles, not thrusting. Come on, now. Don't make me do the "no-sex interpretive dance". (Actually, anytime I dance, it's pretty much assured no sex will occur within a 10 mile radius. I'm not lithe or seductive. Anyway.)
#2) Clear liquids, part 1. Colonoscopies. Yeah, I get that you don't want a scope, but everyone in your family has colon cancer, so you need the test. You'll thank me after I snip out 10 pre-cancers and save you from having a colostomy and chemotherapy. But until then, please understand me when I tell you that clear liquids do NOT include STEAK, no matter HOW THIN YOU CUT IT. My roto-rooter does not work in solid dooky.
#3) Clear liquids, part 2. Colonoscopies. Yes, I asked you specifically about your alcohol consumption and prayed you told me the truth. Let me now be perfectly obvious: GIN DOES NOT COUNT AS A CLEAR LIQUID. Ok, I get that it is technically CLEAR and you can see through it, and I can see how confusing that must be to you. But for the sake of me giving you IV anesthetic, let me repeat myself. I will NOT give you IV sedation if you smell like booze. If you cannot abstain from alcoholic beverages for 12 hours prior to your procedure, then a colonoscopy will not fix the majority of your health issues and your life will not be foreshortened by a colon problem -- it will be shortened by cirrhosis.
I couldn't stop with the first list. I kept thinking of more...
#1) "Double header" = I use this term when doing both an upper GI endoscopy along with a colonoscopy. (Don't worry, we use different scopes!) The scopes are often referred to as "roto-rooters". (In some places, the GI docs are called "roto-rooters" -- it's probably a regional vernacular difference.)
#2) "Donorcycle" = Trauma patients who were riding a motorcycle when they had the accident. Sometimes these patients are described as "ART", assuming room temperature….
#3) "BOHICA" = Also not necessarily medical, but Bend Over Here It Comes Again describes many ER shifts. Many cluster-f$%#s in the office, on an Ob call shift. Anything.
#4) "Vaginal bypass" = C-section
#5) "CNS-QNS" = Central Nervous System - Quantity Not Sufficient. I use this term to describe bone-headed 21 year old males who rode on Donorcycles.
Ok, I'm about to spill secrets. Keys to the kingdom. Pull the curtain aside to reveal the wizard.
May I humbly present: abbreviations/slang terms I have used in training/practice for the past 15 years. Otherwise known as reason #2461 why I am going to hell.
Disclaimer full of way too much honesty: I enjoy taking care of (nearly all of) my patients. The work is (exhausting) rewarding. But sometimes docs have to insulate themselves from the boatloads of >crazy< and frustration and quite frankly, keep from going down the black hole of sadness that sometimes comes with the territory. And no, I'm not depressed, not in the least. But this warped sense of humor is what keeps me from reaching for zoloft….
#1) "Calorie overdose" = Mentioned in an irreverent dictation by a colleague who was up to his eyeballs in obese patients. I think my buddy finally cracked. He also got a reprimand for writing that phrase. Come on, everyone knows you never EVER put this stuff on paper.
#2) "Facultative anaerobe" = Patients who survive in a low-oxygen environment. Often seen in little old 3 pack/day smokers who believe that their end-stage COPD requiring 4 liters of O2 has "absolutely nothing" to do with their tobacco use. Often as O2 levels drop, confusion increases, as does levels of denial and general blame of the doctor not being able to fix the breathing problem.
The practice of medicine has been part of my life for 15+ years now. The lessons keep coming. Just when I think I've got a great handle on things, new information comes out or I see something I've never seen before.
Here's what I've learned so far in medicine.
1) The learning doesn't stop at med school, residency or fellowship. That just scratches the surface. God, I was such a little punk then. Clueless.
2) Most of what is learned doesn't come from a book. It comes from experience, or it comes from instinct (a fancy word for experience + gut feeling). And it comes from trial and error.
3) Dr. House is right. Patients lie. All the time. Unless you can get them to trust you and tell you the whole ugly truth. Sometimes this will happen. But usually not when it involves controlled substance prescriptions.
4) There is humor in anything, even the process of dying. Sounds sick, right? Many patients have told me that they appreciate feeling "human" when I can still make (appropriate of course) jokes with them, even as they enter hospice. Everyone deserves to be treated like a human, not a collection or organs.
5) Emotional separation is necessary and possibly career-preserving for the physician. It's possible to care but not absorb all of the pain and suffering. Not having this ability to separate from the situation leads to depression and burnout. (been there)
Oh my, doesn't that title sound all romance-y and idealistic? Does it conjure up images of a perfectly groomed office and a woman in a fur-lined robe, madly typing away all day long, no cares in the world, eating boxes of perfectly packaged gourmet bon-bons whilst classical music wafts in an inspirational manner in the background?
So, here's the real day in the life of a procrastinating wannabe romance novelist.
Woke up to a cat grooming my head. Do you know what that weird kitty tongue does to hair? It pulls each individual strand, one at a time. Dammit, it's Saturday and I'm up before 7.
Kitty leads me to the fresh puke on the floor. Stares at me with a glint in her eye and then returns to bed where she promptly falls asleep. I am, unfortunately, wide awake. Snores from hubby emanate from the bedroom. Fabulous. Time for breakfast.
Yippee, Saturday. Sure, I'm on call, but there'll be plenty of time to get lots of writing done, right?
2 hours of my life, gone. Apparently the internet has taken me from Twitter to cute puppies to ASPCA videos to pitiful animals to news articles about animal cruelty. I'm mad about the pitiful animals, but haven't accomplished much more than wanting to get another pound kitty.
All right, after I check the Twitter feed, I'll be ready to write.
Public service announcement : I am alarmed by the amount of disease symptoms found in the typical text of romance novels. For the health and safety of the hero/heroines, I feel it my duty to alert my author colleagues of potentially life-threatening character conditions and suggest care and management options that all authors can employ.
So without benefit of typing symptoms into WebMD, here goes.
#1) "Her flashing eyes" -- Could be conjunctivitis, bilateral cataracts, or retinoblastoma (RB). Forget that RB is typically fatal by age 5 if untreated and your character is 25. We're not dealing in 100% reality with this romance novel thing anyway, are we?
#2) "His heart beat a tattoo against his chest" -- Clearly this description represents atrial fibrillation with rapid ventricular response. Give IV cardizem and if that fails, push amiodarone. FYI, expect to personally drop a load when you give amidarone. This med causes a prolonged pause in the heart where the person looks, well, dead, as they can be pulseless for several seconds until the heart rhythm resets and "jump-starts." (hopefully restarts)
Every year, I'm either on call for Christmas or Thanksgiving. This year, it's Christmas. My colleagues have bailed out of town, and I don't blame them. But for a sold 11 days, yours truly is it if you're sick or pregnant or have an impacted piece of steak in your esophagus. And here's what happens….
On the twelfth day of Christmas my call group gave to me….
12) Twelve refill requests (at 3pm on Christmas Eve, appreciate y'all planning ahead, there, folks)
11) Eleven blue haired ladies (but they're super cute and smell like White Shoulders and like to give hugs)
10) Ten lice-a-leaping
9) Nine (million) sperm-a-swimming (hey, bro, congrats!)
8) Eight teens-a-smoking
7) Seven social nightmares (nursing home placement on Christmas Eve or a Pop Drop, anyone?)*
6) Six Percocet honeys**
5) Five requests for the "fat pill" (ba DUM dum dum) ***
4) Four spewing kids
3) Three STD's
2) Two "emergency" scopes****
1) And a drug seeker in a nut tree….
Every single item contains true material, I am sad to say.
Let's be clear here: I'm not the poster child for skinny. However, I at least walk the walk. If I tell my patients to do something, you can bet I'm trying my darndest to do the same thing. For example, it's not BS when I tell my patients to get an hour of exercise 5 days/week. It hurts, but by golly I'm on the treadmill after office hours walking my miles to the tune of "Bad Things" (the opening song to True Blood). To be brutally honest, I walk faster when Joe Manganiello's chest is on the screen. Carrot. Stick. I'm about as willful as Pavlov's dog.
1) (patient) I don't have time.
2) (me) I walk even if I have an 80 hour week. There's always time. Exercising cuts down on louging-in-jammies time, but there's always time.
3) (patient who is morbidly obese sipping on a mocha-choco-latte) I eat like a bird yet I gain weight.
4) (me) If by bird you mean pterodactyl, then ok. By the way, you're mainlining cream and sugar.
5) (patient) Just give me "the fat pill." If I had that pill, I'd lose weight.
6) (me) Folks can out-eat any pill I give them. Last week, I had a fellow explain to me that the cholesterol medicine I gave him "made it ok" to eat at McDonalds. (doctor explanation fail, logic fail, patient reality check fail)
7) (patient) It's my metabolism that's the problem.
8) (me) If you do no exercise and eat no fruits and veggies, you're correct. The journey of a thousand miles begins with a single step.
9) (patient) What about the new supplement/magic beans/super omega something that Dr. Oz is hocking this week?
10) (me) Sure those work great, if that's the only thing you eat all day. And congratulations. By purchasing the snake oil of the month, you've also paid for his kids and grandkids to go to college. That's money that could go to your Rec Center membership.
Author, daydreamer, and practitioner of trying very hard to duct tape folks together and help when I can.
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