Wednesday, April 29, 2009

MMmm...Foot sure is tasty!

There are several reasons why I am going into radiology. One of them is my spectacular knack for putting my foot in my mouth. Luckily, it's usually in a ridiculous way and not an awkward one.

Yesterday I was in OB clinic interviewing a patient. She had life pretty rough, this was her tenth pregnancy (8 living children), and she had no money, no help, no good teeth to be honest. She mentioned that instead of working her husband liked to go drink in a local park. I will write more about our conversation that day in another post.

When I went back to tell my attending and resident about our conversation, I relayed that information. Now, I don't know how to make this politically correct, but in our city some parks are basically segregated. So, for someone to go to this park, they are probably a certain race.

My attending made the observation that he drove by the park and realized if he stopped he'd be the only white guy there. I was still trying to figure out the lady's family situation (and whether or not someone's presence in the park really guaranteed his race), and so, directly from my train of thought to my mouth came the comment, "Yeah, that park is not really a place for white trash."

There was a pause as I went on with my thoughts. Then the resident goes, "Wait a minute..."

Then it was all over. The resident and attending howled while my face turned the shade of a uterus. "You do know I evaluate you, right?" the attending said. "Ohmygodohmygoodgod" I thought. The rest of the day neither of them could look at me without laughing. I didn't give him an evaluation card...I think I'll do that on another day.

Tuesday, April 21, 2009

Hassled into blogging

My buddy pointed out that it had been DAYS since my last post, so here's what has been on my mind lately.

We pulled a monster out of a woman's pelvis the other day. She came in because she noticed something lumpy in her pelvis. Boy howdy did she ever. On regular physical exam, even I could feel a solid ball in her pelvis, presumably attached to her uterus.

Here is what a normal uterus plus all the trimmings (tubes, ovaries) looks like:

I actually got to scrub in on the case, so I was there for the birth of the beast. At first the resident pulled what I thought was the whole uterus out. Then the attending got his hands in there and wrenched and twisted and pulled and came out with this:

Ok, maybe not really. It was purple-ish, and had several lumps. No beard though. Here's a link to an illustration.

The resident thought it prudent to shell out a few of the lumps (fibroids technically), in order to debulk the uterus and be able to see down the pelvis to get the rest of the it out. He took a scalpel, cut through the muscle, and then basically popped out 3 baseball-sized tumors like popping peanuts out of a shell. I held one in my hand, it was white, shiny, lumpy, and solid. There were SEVERAL other fibroids, to many to count, making the whole thing look big and distended and bulge-y. And heavy. "I bet this takes a minute off her mile time", another resident observed.

I asked the usually stoic chief resident if pulling them out was as oddly satisfying as it looked. He turned to me with a gleam in his eyes like I'd never seen and said, "This is the coolest thing I ever do in surgery."

I can totally understand why.

Monday, April 13, 2009

The Tax-Man Cometh

It's almost tax day friends.

Luckily, I made a whopping $90.21 of income this year. Nope, the decimal point is in the right place.

How did I manage to make even that? You ask? It had to be something legal, because I got a W-2 for it. To make a long story short, I tutored athletes while I still had a little free time. Looks like I didn't tutor them nearly as much as I thought, considering I make over $10/hour when I tutor. Oh well, it was always about the football tickets anyway.

I've been getting mixed opinions on whether or not I should file. One friend, another student, said of course I shouldn't. She hasn't filed for two years! My fiance said the IRS was going to come after me (and him is what I think he worried about) once I actually made money. An uncle said it would just look suspicious.

I finally called my friends at the AARP tax help site. I started going there when I was a poor liberal bleeding heart volunteering in Montana. Taxes when you live in two states are complicated and they have a low-income loophole to help out the poor and tax-ignorant (me). I got my AARP card in the mail that summer (someone in Member Registration has cataracts!), and never looked at H&R Block again. I think I should apply for their insurance plan.

Anyway, the kind older man I talked to laughed out loud when I mentioned my apparently irrational fear of getting audited. He asked, "So, where does your living income come from?" he asked. "The kindness of strangers," I replied. Ok, so it's really student loans. "And you haven't paid any interest on those this year I imagine?" "Well, since I would have had to pay it with more student loan money, I didn't think that prudent."

"True true" he said. "Well, I can think of one reason for you to file. There's something called the Earned Income Credit (EIC). With your income, you might be able to get $5.

$5!! Then, I'm not sure why but I think it might have been out of the sheer hilarious desperation of the situation, he said, "Actually, I can look it up to make sure how much it would give you. Would that be ok? I'll call you right back." And he did. He proudly announced I could get six dollars in EIC. "I think you should file and frame the check. That way you can look back on it when you actually have a salary," he suggested. Then it was my turn to laugh.

You know though, $6 could buy several kiddie-cups at Sparky's Ice Cream Parlor. Hmmm....

Saturday, April 4, 2009

You Aren't Going to Cut My Kitty Are You?

This story is borrowed from one of the surgery fellows.

His fellowship is in general surgery, hernia repairs especially. One day he's getting ready to operate and goes to the preop area to say hello to the patient. The surgeons also have to sign the patient's body part on which they intend to operate. You know, so you don't wake up missing the wrong limb. I suppose it can't hurt, though when you're working on the abdomen, it seems kind of impossible to operate on the wrong one.

Anyway, this fellow asked the 72-year old lady if she had any more questions. "Are you going to cut my pussycat?" She asked.

My fellow is bald with pale skin, and he got red just telling this story. I can't imagine the tomato shade he turned when she actually asked him that.

"Um, no, ma'am, well, what do you mean?" he said, hoping she'd explain herself so he didn't have to take that leap. "Don't cut my pussy!" she replied.

"Well, we don't get that low in the abdomen during a hernia repair" he stammered, "We stay up above the vagina".

Then he went to sign her abdomen and noticed the kitty cat tattoo on her left lower quadrant.

He said at that point he turned even redder and she started howling with laughter. Did you get the part where this woman is over seventy? I hope I'm that feisty when I'm 72. After that he made her pull the same trick on the attending, who happens to be a ginger also prone to blushing. I got to see the lady in clinic for follow-up. It was really an honor.

#$%* in a Box!

Yesterday afternoon we had a marathon of lectures. Why the department thinks Friday afternoon is the perfect time for 5 (FIVE!) lectures is beyond me (mind you, I had every other afternoon off this week. It rained). Maybe they are so far removed from weekends that they can't remember what it's like to be stuck in lectures when it's a sunny 60 degree perfect Friday outside. Well it blows.

One of the bright spots was the "Pelvic Exam" Lecture. Not so much the lecture, actually, but the props. Before the lecturer got there her demonstrative equipment had been delivered to the room. Curious, one of the guys opened it up. Inside was a blue plastic box. On one end a hole was cut in the box, and where blue plastic should have been, there was a gaping vagina.

It was a #$@! in a box.

The Ladies Edition.

The crowd went wild. For those of you who haven't seen the SNL skit (like one of my hopelessly innocent girlfriends, who went, "why is that so funny?"), it has been hilarious for at least two years. I just watched it again when I made that link and laughed so hard I peed a little. (Another lecture topic: Stress Incontinence in Women). A couple of us hurriedly took pictures on our cellphones before the lecturer came back.
I couldn't find a picture of the exact thing on the internet (you wouldn't believe what I did find though), and my cell phone has been dropped too many times to take a good picture. So imagine the business end of this model peeping out at you unexpectedly from the end of an innocuous-looking blue box.

Sometimes I love medical school.

Thursday, April 2, 2009

YOU'RE a natural orifice.

Yesterday I found myself back in the general surgery OR. I shuddered a little bit as I entered.

The reason I had to go back is because our university is experimenting, I mean doing research on (sounds better) something called "Natural Orifice Minimally Invasive Surgery".

Which means instead of cutting a teensy hole in your abdomen and getting right to what they want, they go in through your hoo-hah. Or your pie-hole. Or your, ahem, back door. So now, instead of pulling the gallbladder or appendix out through the abdomen, they pull it out of somewhere else.

I'm pretty sure men came up with the idea to use the vagina as an porthole. Last time I checked, it was a vagina, not a top hat. There is no need to start pulling things out of it, even if you get a few quarters or a rabbit. Leave it alone for God's sake. Interestingly enough, there is no penile surgical equivalent. Hmph.

Given my history of fainting around things I empathize with, I stayed back. It wasn't very hard, since this is research we had three attendings, a fellow, and three residents all crowding around playing with each others toys. Double entendre intended.

What I can't understand is that they still had to put a port in through the abdomen. I would be fine with another little scar rather than a hole in my va-jay-jay.

The worse part, the part where I started to bob and weave until I pulled myself together, was that because it was an exploratory lap, meaning we were looking around for trouble in her abdomen and pelvis, the surgeons had to go down a list of anatomy to visualize and inspect. Any time they had to see behind her uterus, some guy would do a bimanual (two fingers) through her lady bits and go to town moving around all her innards. Um, hello? A little gentleness please. Just because she's out cold now doesn't mean it's prom night for the surgeons. She'll probably feel that later.

Which she did. When she woke up she was in pain, however one of the surgeons, standing all the way across the OR, said, "See? She feels no pain! She is not in pain!" I was like, "You are a lunatic," but of course only said it to another student. I'm getting plenty of sleep these days, and it's a little easier to keep my thoughts to myself.