Sunday, September 20, 2009

Idiots in Public

Some people have a problem leaving their work in the workplace. For the first two years of medical school, I couldn't walk in public without thinking to myself, "Neurofibromatosis. Alcoholic. Morbid obesity. OOOohhh that guy's a 60 year smoker!" Even now that I have a handle on that, sometimes it just finds me in ways I can't ignore.

Last week at a grocery store around 4:00 this child in front of me asks for cigarettes. "If he's 18 I'm Rush Limbaugh" I thought to myself. The astute cashier asked for his ID. Twitching slightly, he handed it over. She entered his birth date and it of course set off the alarm. "This won't work" she said. "Why not?" "It says you're not 18" "What do you mean?" "What year were you born?" "1993". "So you're not 18. You can't buy cigarettes." "Oh, ok." And then he took his ID and left.

Did he not know you have to be 18 to buy tobacco? Did he think he was 18? Was he just hoping the cashier wouldn't ask a 16 year-old who obviously came to the grocery store right after school? What the hell is wrong with him, buying cigarettes in 2009?

I seriously considered smacking him upside the head for being a dumbass.

Wednesday was even funnier, in a pathetic kind of way. I was minding my own business, eating out with a girlfriend for lunch, when our waiter (affectionately known as "Creepy Johnny") came up to chat and take our drink orders. An old man with a beer belly in the cubbyhole next to us (it's a subway station themed restaraunt, though not actually Subway) interrupted our waiter midsentence--wow, really rude, even for the elderly--and asked for his Bud Light. "Sir, I was on my way to talk to you; we are out of Bud Light. We have several other domestic light beers." "Whaddy mean you're out? Harrumph Harrrumph harrumph blustery bluster I take Miller Light I guess. I just need it now. I'm diabetic you see, and my sugar is getting low."

Excuse me, I think I just had a seizure. Did you just demand your beer extra quick because of your diabetes? I'm so sorry Wilbur, either modern medicine or God has failed you miserably.

If only it were this easy.

So no reader of mine ever sounds this stupid in public, here's what's real: Alcohol is not a treatment for diabetes. Actually, alcohol impedes your liver from producing glucose at times when your blood sugar is Old Man Impatient stomping around until he got his Bud Light was actually being counterproductive. After discussing this with my girlfriend, who is a pharmacist, we also hypothesized that his choice of light beer, while possibly a help for his weight control, actually would have fewer carbs--which is what he was after if his sugar was really truly low. So bend over, Samhill, you've just screwed yourself twice.

Here's why I'm going to be a radiologist. A family doc would have probably rolled his eyes, sighed, thought a few bad things about this guy, but then would want to teach him about his disease very patiently. At least, a good one would. I, on the other hand, felt like ordering him a few more beers and REALLY treating that there diabeetles. Of course, this was before I actually ate. If he hadn't interuppted the process of me obtaining food I probably would have felt more charitable.

Friday, September 11, 2009

Stub or Nubbin'

One of the reasons I like radiology is that it seems like once a day you get something completely surprising.

I was looking at plain films with one of the residents two days ago when something nearly unrecognizable popped up on the screen. I thought the system had flipped out and scrambled an image, but no, it was a real x-ray.

"What is that?" I asked.
"It was supposed to be a foot," he said.
"Well why isn't it?" I replied.

This foot had no toes. And it didn't really have any meta tarsals (the bones in the middle) either. Or if it did, they were all smashed and grown together. It didn't look like an acute injury because the bones actually looked like they'd grown together. Have you ever seen a tree that's been cut and twisted (as if someone were half-heartedly trying to remove it because his wife told him to but he just kinda wrenched on it instead of actually pulling it out) and eventually grew together all gnarly and intertwined? No? Didn't you have a dad with a lawnmower?

Speaking of lawn-mowers, I think that's how this guy lost his toes. That could be totally wrong, the report just said "traumatic amputation in 1972" (this is where you wish those internal medicine guys were a little more forthcoming), but something in me says lawnmower. Must be the memory of that poor little oak tree.

Anyway, that brought up an interesting question: would I call this a Stub or a Nubbin'? After much thought and a few cups of coffee, I decided it was definitely a nubbin'. A stub clearly means the amputation was above the wrist or ankle line. A Nubbin'? Well, let me use it in a sentence to make my point. "If you try to touch my mashed potatoes you will pull back a nubbin'!" Ahh childhood.

My point is, a nubbin is a much smaller amputation than a stub.

Oh yeah, and guess what the patient was in for? Foot pain. No kidding.

Wednesday, September 9, 2009

So I got married

And then went on a honeymoon. And then applied to residencies. Life has been very busy lately.

but I will write more.