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?
 
Hmm.
 
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.
 
#7) Walk around with a strange man you only met a few hours ago. Ok, fine, he’s hot, but really, what do you know about him? Nada. Except that he’s hot. So there’s that. At least have your pepper spray ready. Oh wait, you did have your pepper spray ready? Ok.
 
#6) Jump off of tall buildings, like you don’t care. Sorry, what? You really don’t care if you live or die because you hate your existence? Oh, well. Hmm.
 
#5) Have unprotected sex. Yes, that’s the biggie. The only time I would ever give a pass on using the big johnson wrapper is in paranormal, because you can suspend disbelief and push reality a smidge. So we’re going to say if you’re 400 years old and quick-healing, then it’s unlikely that you can A) get someone pregnant (but you never know…) or B) have STD’s. Those are the rules of the world I created. Now, in my contemporary suspenses? Condoms all day long.
 
#4) Crawl into dark places like caves and tunnels without a helmet. How many times do you people have to get hit on the head to figure this one out?
 
#3) Not dress properly for inclement weather. Like snow, frigid temperatures, molten lava. When will they learn?
 
#2) For my female characters, stroll around the really bad parts of town. Ok, I get that you’re a badass nearly-immortal, but why take such chances? Oh, you don’t care if you live or die because you hate your existence? Ok, then. Got it.
 
#1) Blindly sign bogus contracts with creepy, really old dudes. At least read the fine print, people. That’s what got you into this mess in the first place!

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.)

#7) "Just give me the fat pill. But make sure it won't cost me anything."

(This is going to be a big disappointment. Exercise is free. Reducing calories is free. Popping Contrave, Qsymia, or Belviq will cost you anywhere from $50-300/month. About as much as your cigarettes + daily Mtn. Dew habit costs.)

#6) "Can your staff just watch my baby while I run to the grocery store?"

(I cannot make up this s%@t.)

#5) Friday. 3pm. I've been in the office the prior 4 days. Appointment slots have been available. Phone note:  "Please have Dr. Jill admit Granny to the nursing home. We have to go to a niece's wedding tomorrow."

(I haven't done the required face-to-face visit, I don't know if Granny actually qualifies for nursing home care, and I'm up to my eyeballs in actual honest-to-Pete emergencies on this lovely Friday afternoon. Failure to plan on your part....Results in a low satisfaction rating on my part...)

#4) Phone note. "Patient 7 months pregnant, contracting and water leaking FOR 5 DAYS. Wonders what to do."

(5 days? Now you're calling???)

#3) "While I'm here today, could you just "take a quick look" at my 4 children who have runny noses. Also, could you fill out this packet so I can get my Zippy wheelchair?"

(Nothing is quick about working in 4 ill children. But what really makes you mad is the fact that you'll have to wait a bit until I can get the kids squeezed into the schedule, but by God, I'll try and help. Then I have to generate an actual patient note including vital signs, exam findings and treatment. For this, your insurance will be charged and you might have a copay. And that pisses you off even more. As for the Zippy paperwork, insurance mandates this be done as a separate visit. I agree, that's a stupid policy. But if you want it paid for, you must make another appointment.)

#2) I'm 34 weeks along. Why can't I be induced? My mom/friend/cousin/facebook pal's doctor did it for them. The baby came at 34 weeks and it did fine.

(sigh)

#1) The only thing I can take for my fibromyalgia pain is Percocet. 6 times daily. I'm allergic to tylenol.

(You realize Percocet contains TYLENOL, right?)

I can't take it any more.
Logic? Nope.
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.

#4) Clear liquids, part 3. GOD HELP ME. Ok, seriously? No, Taco Bell does not count as a clear liquid, either. Please quit arguing with me. I can see what was in your chalupa as it oozilates down the pike. It's not appetizing and it's a waste of everyone's time.

#5) Nothing by mouth (NPO), part 1. "But why?" Because if you drink that triple milk-sugar frappuccino with extra cream, your sky-high triglycerides (which I will be able to see with the NAKED EYE floating like little globs of noncompliance in the blood tube) will make you appear to be diabetic. Pills and insulin will follow. Is that what you want?

#6) NPO, part 2. If you have a 7:30am c-section, please believe me when I say that your 6am sausage and egg McMuffin will NOT be digested in time for the procedure. In fact, it will likely feature heavily in a repeat performance of aforementioned breakfast when you yuke all over the anesthesiologist. Do you even understand how much anesthesia folks HATE patients who vomit? Almost as much as they hate patients who are awake, which c-section patients are. Anesthesia folks don't make good small talk. Trust me, I've heard them try. They're even less chatty when covered in partially-masticated McMuffin.

#7) NPO, part 3. Same goes for scopes. Let's say I'm doing an EGD (upper endoscopy). Let's just say. And let's say you simply could not go from midnight until 8am without eating a hamburger. Let's just say. Would you like to venture a guess as to what I can see in your stomach? That's right: hamburger. Not ulcers, not esophagitis, not gastritis, not celiac disease. Hamburger. And care to tell me what happens to hamburger in the stomach after I pump aforementioned gastric organ full of air? Please refer to above McMuffin discussion.

#8) Botox. I have told you personally and then given you a paper that says not to lift, bend, strain, massage, rub or otherwise do anything that moves the botulinum toxin I've strategically placed in a few key areas. Why in the name of all that holy, would you immediately leave the office and go get a facial? After I SAID NOT TO?? And now you're complaining that your eyelid droops? Crazy folks like you make my eyelids twitch, thanks.

#9) Juvederm. Same deal. You and I have agreed that you WANT it where I put it and you LIKE it where I put it. So why, after paying over a thousand dollars, would you do anything to screw with something that affects your appearance? You can hold off on a facial for 48 hours, I promise your pores will be okay.

#10) Skin lesion removal instructions. Help me out here. When I said keep it dry for 24 hours, how did that translate to "soak neck-deep in a hot tub"? How? Is it somehow a DRY, bubbling, steamy hot tub? I am not familiar with a dry hot tub. I am, however, familiar with WOUND DEHISCENCE which is where the artfully sutured skin freakin' FALLS APART because you are a numbnut. And again, why are you somehow mad at me? I gave you these instructions both verbally and on paper. Might should have texted it, since that's the only thing you're paying attention to...

#11) INSANE BONUS. You know how, when you take antibiotics, a great way to prevent vaginal yeast infections is to consume a cup of yogurt daily? Yogurt totally works. But NOT if you place the yogurt (Yoplait. Blueberry. Yeah.) INTO your vagina. Then it totally doesn't help prevent jack. And after the first 30 minutes of "yippee, blueberry scented no-no area" then it just all starts smelling funky. Let me reassure you that I have not consumed blueberry yogurt in 8 years (either by mouth or vaginally) after a patient told me how they utilized Yoplait. ("Yoplait: It is SO good." No. Just, please. No.)

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. 

#6) "Pop drop"  Don't ever do this. It's truly evil. Here's how it goes: 
     When family members become inconvenienced by granny's mild dementia/incontinence and caring for her is cramping their need to get drunk/high, go hunting/shopping, attend a New Year's Eve party, etc., they drop her off at the ER with a slew of nebulous symptoms like "weak in the eyes" or "poor appetite". Unfortunately, malpractice and family demands being what they are, ER docs must perform a full workup to make sure granny is truly ok. It's during this time of extensive testing that family members will DISAPPEAR, and amazingly the phones in which their noses were stuck no longer work until the weekend or holiday is over. So granny sits in the ER, kind of sad and hopeful, eating hospital sandwiches, cups of juice and graham crackers for Saturday night or Christmas Eve. If you ever do this to an old person, I will find you and do mean things. I'm a part-time endoscopist. Do not screw with me.

#7) "Two big dudes" = The exact number of attackers described by any male trauma victim. Amazingly, every single time there is a guy who gets beat up, it's always because of "two big dudes". I'm guessing it's too embarrassing to admit to "my girlfriend whooped my ass". Often "two big dudes" description is prefaced by the phrase "I was just minding my own business." Interestingly, in trauma centers and ER's, "minding my own business" is the #1 cause of injury.

#8) "You can't kill dirt" = The meanest, nastiest, most horrible excuses for human beings who have a plethora of impossible-to-treat conditions….somehow always survive and live to torment us another day.

#9) "LLMNLD" = Looks Like Mom, Not Like Dad.

#10) "WADAO" = Weak And Dizzy All Over. Not to be confused with "weak in the eyes" which, in Appalachia, is something very different, distinct, and requires "another medical test" that we haven't done yet (despite the fact that the first 50 tests were perfectly fine).

#11) Bonus: "WFD" = Waiting For Disability. I had a patient list that as her "occupation" on the patient intake form. Yup. I pay taxes for that. (By the way, this person was a little overweight, had nice gel nails, a new cell phone with fancy cover, pack of cigs in the pocket, and drove a nice SUV. Saw me for "tired all the time". Staff later reported that patient was seen twerking for hours at the bar the following Friday night. This is why it's good to practice in small towns. That's some good info right there.)

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.

#3) "GOMER" = Get out of my ER. (Also known as "treat and street".) The most annoying/dramatic human being/family member in the universe or the most sick-as-s$#t patient you've ever seen. Either way, and for totally different reasons, you really don't want them in your ER. Folks who work in Level I trauma centers are screwed here. All the bad stuff from our critical access hospitals (GOMERs) go to the Level I's. (All doo-doo rolls downhill.)

#4) "AODHOB" = Angel of Death, Head of Bed. Don't judge. It's a quick way for the ER doc to describe the state of the patient who might not survive the trip down the hall to the ICU.

#5) "CTD" = Circling the Drain. See above.

#6) "FLK,NLM" = Funny Looking Kid, Normal Looking Mom. (Can be NLK,FLM or can be FLK,FLM.) Most often used in the nursery when the kid comes out and the squishy, weird facial features from passage through the birth canal don't improve at 24 hours. Then you look a little more closely at the parents and make a comparison.

#7) "PPPPP" = "Piss Poor Protoplasm, Poorly Perfused" Really, do you need me to explain this one?

#8) "All foam, no beer" = Not necessarily specific to medicine, but it works just fine.

#9) "The Q sign" = Ok folks, let's visualize this one. Picture a patient who is obtunded from, say, alcohol intoxication and is passed out in the semi-recumbant position on the hospital bed. His head is tilted to the side, mouth is open, and tongue is hanging out of the dependent corner of his mouth, thus making the tail of the Q.

#10) "Squirrel" = Often accompanied by the tch tch tch squirrel sound and a nose scrunch/wiggle. When someone can't keep their story straight about why their drug screen is positive for meth when they've never smoked it "ever" or how they managed to get a broom handle lodged in their rectum. "One in a million shot, doc." (thank you Frank Costanza)