Medical Humor Essay

I won a medical humor essay contest.  Check it out!!

http://doccartoon.blogspot.com/2014/10/medical-humor-writing-contest-winner.html?m=1

And now for something COMPLETELY different....

You've seen my nephews.

You've seen a day in my life.

And now you get to see inside the cogs that make my mind go around...

I've started a new blog with a new goal completely.  It's called The Surgeon Innovator.  It's dedicated to the idea that all surgeons are innovators and  our brilliant ideas should be shared and celebrated.  Think of it as the TED conference of surgical innovation, but without the fancy microphones, elegant speakers and heart-warming anecdotes.  Ok, maybe its not like TED. It's my thoughts that will hopefully stimulate your thoughts, and maybe, somehow, all those thoughts will smush up against in each and be awesome.

Check it out! You seem like someone with a lot of great ideas. We're going to be good friends.  I can tell.  Also, I'd LOVE LOVE LOVE any guest posts. Email me if you've got stuff to say.

Men In Surgery

As a woman in surgery, gender issues come up frequently.  It’s something that really weighs on my mind, and I want to take this opportunity to set the record straight.  Gender equality matters, and we all need to do our part to the even the playing field in surgical specialties.

The fields of sewing and knot tying have historically dominated by women.  For thousands of years, everything that was sewn by a human, was sewn by a women.  In the modern era,  woman  are taught from a very young age to handle needles and thread, and go through rigorous afternoon craft sessions where our work is critiqued and judged until it reaches a level of precision suitable for a surgeon, or at least enough to hold our handmade pillow case together.   When we wanted to cement our social standing with our best friend, we were forced to undertake a tedious and tiresome knot tying ritual known as “making friendship bracelets”.    The intricacy and precision of the bracelet was believed to be reflective of the commitment to the friendship, forcing BFF’s to engage in a never ending competition to out-tie and out-braid their brightly colored mess of threads into a work of art.  

Our hands would ache, our eyes would water, and all we could think was  “one more knot,  just one more knot….”  Looking back at my Girl Scout experience, it really could be renamed “Surgical Technique 101”.  Except there would be less cookies.

Despite our natural and obvious dominance of the skills required for surgery, women must actively work to welcome men into the field of surgery.    This revolutionary and controversial viewpoint is not embraced yet by the mainstream surgical audience, so allow me to make my case.  I truly believe that there is a role for Men in Surgery, and that, over time, we will come to find them a truly valuable part of the surgical community.

Despite their obvious deficit in sewing and knot tying based on childhood experiences, men can in fact develop these skills if given proper time and training.  A patient teacher and an abundance of motivation must be present in order for these men to make up on lost time, but it is possible.  There’s a growing body of evidence that video gaming at a young age improves laparoscopic skills.  So we should remind them that their wasted youth, devoid of knot-tying, may still have some usefulness.

Another obstacle that men must overcome is their natural urges and biologic shortcomings which often distract them from surgery.  Their frequent requests to time off to attend major sporting events, improve their golf game, or simply to fart and scratch their balls at home, must be met with tolerance and understanding.  The biologic differences between women and men cannot be changed, but we must work to adjust our expectations and work schedules to account for these inconvenient and unexpected interruptions to the work flow. 

The operating room can be a hostile place for men in surgery, and as women we must actively work to reform this.  Both circulating and scrub nurses are almost uniformly female, and careers in anesthesia (including CRNA’s) is rapidly trending toward a female predominance.  Many scholars have postulated that men are simply no longer a relevant part of the operating room culture.  The sisterhood that has developed often alienates men. They are kept out of the social circle by their lack of understanding of our reality TV show and Glee references.  Metaphors related to the contestants on the Bachelor often go over their head  and they  find themselves lacking a common language as their female peers.  As women in surgery, we must actively reach out to these men.  Take time away from the operating room to review common metaphors which they may overhear.  Answer their questions about Grey’s Anatomy in a honest and respectful way.  It’s not their fault that they cannot participate in the female-dominated operating room culture- they were simply raised differently.

Change must come from the leadership in our field.  There is no room for gender bias in the hiring process. Science has proven repeatedly that women tend to be more detail oriented, more patient, and better at resolving complex emotional and relationship issues- all of which are highly valued in chosing which surgeon to hire for an open position.  But I urge my colleagues to consider some of the lesser known traits of men which may in fact be just as valuable.  For example, I bet you didn’t know that men can lift very heavy things.  Additionally, men tend to have larger hands.  While this makes them struggle in many of the fine and delicate aspects of surgery, it could be seen as a positive when considering stool disimpaction.  Lastly, remember that men have feelings too.  They just might surprise you with their compassion and grace.  Oh yeah! And they are tall.  Think of all those dead light bulbs they could change.

Allowing men to become surgeons enhances the diversity of our work force, which I’ve been told is a good thing.  If we hope to remain a vital and relevant field amongst medical specialties, we must embrace all gender equally- even the ones with external genitaila. Gross.

The Little Monster Inside of Me

I'm working on my next book, which is a humor/memoir about medical school and residency.  Some of its funny, some of its sad, and some of its silly.  Here's a poem that I wrote for the book, enjoy!

The Little Monster Inside of Me

There’s a little monster inside of me

He lives a funny life

He’s been places you may never see

Unless you wield a surgeon’s knife.

He slips down my gallbladder like a waterslide

My stomach cushions his fall

He burrows in the pile of small bowel to hide

And bats at my appendix like a whiffle ball

He dances to my heartbeat

And my aorta launches him like a trampoline

He lands on my kidney with both his feet

And wiggles down next to my spleen

He’ll fight infections if he’s done playing for the day

With sword and shield he’ll charge

“You foolhardy intruders will have to pay,

No foreingers allowed, small or large!”

He’s my inner child

Injecting fun into my veins

His playground is strange and wild

Free from all of life’s little pains

He’s all of my vices

When I smoke or drink too long

He the one who pays the prices

While singing his shanty song

When a surgeons knife unroofs his house

He hides behind my bladder

He stays as quiet as a mouse

Til alone again, climbs my uterus like a ladder

It’s not my fault when things go wrong

The monster must be scheming

Distracting my hands with his song

Pulling my mind into his dreamings

Blame the monster inside me

If I quiver or quake

Blame the monster inside me

If my nervous hands shake.

Blame the monster inside me

When I falter or fail-

But you’ll never catch the monster

Even if you see the tip of his tail

He’s crafty and sly

He knows where to hide

I will never say goodbye

To my little monster inside

A Day in The Life

My sister did a cute blog post about "A Day In The Life", which mostly involves my adorable nephews, and I highly recommend reading it (LINK!)  I decided to do one of my own, so here goes: A Day in the Life of a Second Year General Surgery Resident.

This is what time my car says when I get up in the morning.  OK, I lied.  That's what time I left work. But 5am feels like 3:45am.

This is the parking garage at my work.  I would be lying if I didn't say that free parking in downtown Chicago is one of the reasons that I picked my program.  I would also be lying if I didn't say that I lose my car in this garage about once a week.  I've been told by multiple sources that we have the largest parking garage in all of Chicago.   But really?  O'Hare?  McCorkmick place?  I think it's a lie made up by people who lose their cars in here often and are trying to feel better about it.

This is part of the hospital complex.  The newest, shiniest part. Does it just make you want to cut someone open?  Mmm.  I love it.  Also, this is why your medical bills are so high.

This is the locker room where I change into scrubs.  You really weren't expecting this detailed of a look int my life, were you?    It's thrilling, right?

There is only one important thing about my locker: it's where I keep food.  Yum yum yum.  I guess the combination is also important, but not a important as the food.

This is pre-op, where we meet the patient before surgery.  I basically live where that other guy is standing.  Why do I love standing beside that window so much?  Well...

Skyline view!!! I'm obsessed with this view.  I take a picture of it at least once a week.

 Don't believe me how much I love this view?  Would you like to see it on a cloudy summer day?

Or a sunny summer day?

Or a kinda foggy morning? You name the condition, and I've got a picture of this skyline in it.  But moving on...

 So we wait in pre-op for everybody to be ready to start surgery.  Here's my attending waiting.  Don't be mistaken, this isn't a scene from the action-packed Gray's Anatomy, this actually happened in front of me.  THRILLING.

Finally we get to wheel the patient down the long hallway with the pretty view to the OR.  The patients are given drugs before we roll back, so they either sleep through the scenic view, or they think it is super awesome and trippy (depending which drug we give them)

Then anesthesia puts the patient to sleep in the operating room.  Two things I would like to point out about this picture.  (1) This was for a small breast biopsy that took about 30 minutes, and anesthesia has enough IV fluid hanging to do a freaking liver transplant.  Chill out anesthesia.  (2) Did you notice the artfully placed wires and lines that make it so you can't see the patient's face?  HIPPA compliant and artistically pleasing.

The OR's have an awesome BOSE sound system, that unfortunately only plays Apple products, not Droid.  So I had to find my old 80gb, 3 lbs iPod to bring to work to play music.  My old iPod is as big as my current laptop.  Or close.  And it has zero music from the past 5 years on it.  O well.

And then we do surgery. Love love love.

I made sure to include the instruments in this picture that look most like torture devices.  Mwahaha.

I always have the exact same snack after surgery- cranberry juice and graham crackers.  I steal it from the food cart meant for patients who have finished surgery.  The taste of cran-crackers (patent pending) is my favorite thing after finishing a long surgery.  It's probably disgusting, but it means I get to sit down after a long case, so I love it.

I also drink a lot of Diet Coke, which was the initial purpose of this picture.  I only noticed after I took it, that there is a jug behind it labeles "24 Urine Collection".  I hope that jug was empty.

I sleep at work every chance I get.  You can send my Doctor of the Year award via fax, email or snail mail.  If everything I have to do is done, I'm no stranger to a midday nap and I'm not a shamed of it.  There are a few keypoints I must teach you, though, if you hope to successfully take a nap at work.  Lines on your face or drool are for amateurs   To successfully sleep at work you have to look like you are doing something.  So I kick my feet up and put something that I could be reading on my nap.  Extra points if its something that I should be reading (aka a medical journal). You have to lean straight back, no resting your cheek to one side or the other, or you will wake up with lines.  And then...

.... you can just close your eyes and sleep.  If someone walks in, it's a simple as opening your eyes and you look like you are wide awake and busy studying.  Some newbies lay down on couches to sleep, but that is super awkward if your boss walks in.  You have to sit up fast, wipe away drool, and try not too look like a slacker.  But my way is magic.  Eyes close, night night.  Eyes open, study study.  I won't tell you my record for longest nap in this position, but I will tell you that its legendary.

So there you have it.  A day in my life.  I love it.

Burnt

I wrote a novel.  I love it.  It's emotional, it's vibrant, it's raw and it's real. It's all the stories that I wish I could put on my blog about my work in the burn unit, but I can't do that.  So I changed everyone's names, changed their stories a little, added a few dragons and now I get to call it fiction.  

It's the story of a Burn ICU.  A group of patients, all severely burned and all comatose, embarks on a grand adventure together in a fantasy world.  They fight for their lives.  They fall in love.  They learn the truth about who they are, and they must decide what it means to hope and to love.  

As an aside to anyone who read my first novel attempt- this is much better.  I took writing classes. I read books about how to write a good novel.  I had professional writers read it and give me feedback. I talked to people who know stuff about publishing. I spellchecked it.

So if you love good stories and compelling characters, then you should read this. And tell your friends.

-Buy it for you Kindle for $3.99
-Buy it for your hands for $9.99
-Get it for  free if you are an Amazon Prime Member 
        (I get paid whether you buy it or borrow it, so go crazy and borrow it for free and save your $3.99 for that latte you will sip while reading it)

My Patient, My Character

I'm writing another novel.  And it's good.  Like really good.  But enough about that.

One of my characters is based on a patient who I have kind of met.  Four months ago, when I was on SICU, I would cover the Burn ICU at night.  I spent many hours at her bedside, placing lines, adjust medications, drawing labs, changing dressings- but she was basically in a coma, so I met her but she never met me. Anyway, I've taken her and developed an entire imaginary life and personality and made her a character in my novel.

Now I am on Burn Surgery and she came to clinic today.  Let me tell you- it was AWKWARD.  I walked into the room and saw her name and immediately felt like I was meeting a celebrity or something.  She probably thinks I'm a total freak.  But I kind of wanted to get to know her and be her BFF, mostly because I'm curious if I got ANY of her life or personality right. 

The verdict?  She is much more stylish, funnier and nicer than my character.  I guess that's better than if she ended up being a jerk.  Anyway, now I feel like I need to make my character better, to live up to her.

Meeting one of my characters in clinic.... craziness.

Also- here are 2 AWESOME quote about writing I like:

"Although physicians are not deities, novelists are."

"The difference between fiction and reality is that fiction has to make sense."

Changing Names

 

Here's a funny thing that happens alot on trauma surgery at County-  I'll be seeing a patient named Michael Phelps for three or four days, and one day I will show up and suddenly he will be named Ryan Lotche.  Same guy, same room- new name.  The problem is that we get so many gang related gun shot wounds, that sometimes 2 guys from the same fight (but opposite sides) end up in the ICU together.  If they find out that one of their enemies is there too (by overhearing a nurse, seeing a list of patients, etc) , they try to get a fellow gang member to come and "finish him off".  No joke.  So we regularly have to change certain patient's names so that they won't be recongized.   Gabby Davis become Jordyn Wieber.  It is biazarreo.

 

PS- Obviously the names above hvae been changed to protect the innocent. Ironically.   

So Rich It Hurts

Check out this email I just got:


"As a member with direct deposit payment option set up with CreateSpace, we want you to have the most current information regarding royalty payment terms.   Your direct deposit minimum payment threshold amount is now $10/£10/ €10 (previously $20) and the new payment terms will be effective for payments made in June 2012, for any royalties earned through May. "


As some of you may remember, I wrote a little novel a while ago.  (LINK!)  Anyway, the website that I used to publish it (CreateSpace) previously had a $20 minimum for royalty check payment.  Meaning that even though the book was the best-selling title (of my apartment) and made the topped the Best Seller List (of my blog); I wouldn't get my royalty check until I had $20 worth of sales (I make about $2 per book sold, and yes, selling 10 books was a lofty goal.  Since I only have 2 parents).


BUT! now the minimum payout is $10!!!! 


That means I've got a check for $11.74 coming my way.  I need to find something AWESOME to do with it.  Here are my leading thoughts:


-Find a stock and invest.  That way, if my some crazy turn of events, I happen to pick a stock that ends up making millions from my $11.74; I can tell people that I made my first million from my novel.  And then drink tea with my pinkie up.
-Similar line of thought:  buy lottery tickets with the money.  Same general principle applies: Laura makes millions, Laura gets to act like the millions came from her proliferative and astounding career as a novelist.
-Give the money to a charity.  "Why yes, I did write a novel.   But I donated all my profits to a charity.  Because I'm not only creative but also generous..."
-Buy two Chipotle burritos and eat them with my boyfriend.
- Divide the money in 4 parts, and do a little of each.  "I took my proceeds and invested part, gambled a bit, made some charitable donation, and still had money left over for these 6 tortilla chips.  Now bring me my golden footrest!"

Stress

Last night my wallet was stolen at a bar.  Once we realized it, Dan asked me why I wasn't freaking out.   My honest answer was that this wasn't stressful at all- because there wasn't any way it could kill anybody.  Since becoming a surgery resident,  somehow that had become my new standard of stress.    An old lady getting post MI? Stressful.  All of my credit cards and ID's bring stolen? Not stressful.  See the second one is fixable with a few phone calls and one trip toothe DMV.  The first one may or may not be fixable, they may or may not be doomed, but I have to work my damnest to to try to fix the- and no matter what happens, I'll probably think I should have done better.

I guess i'm learning the difference between stress and annoyance.  Stress is when someone might die. Everything else is just an annoyance.

A Day To Remember

This is a day that I want to remember.  I sort of want to freeze it into a little snow globe so that I can put it on my bookshelf and take it down when I need a pick-me-up.

I presented at Morbidity and Mortality for the first time this morning.  It's the conference where we present cases that have gone wrong for one reason or another; and the attendings will ask us very challenging questions about why certain decisions were made.  It's a weekly ritual at every surgery residency around the country.  Patients are usually presented by a senior level resident or fellow.  There are has not been an intern to present this whole year.

A few weeks ago, while on thoracic surgery, I was involved in a case which developed a severs postoperative complication and needed to be presented at M&M.  My attending asked if I would present it since I was intimately involved.  Loving  a challenge, I said yes!  Only to be told be every resident that I mentioned it to that interns weren't allowed to present unless approved by the Big Boss.

Now Dr. Big Boss happens to be a tough man to work with, but I have gotten a special place in his heart somehow.  He was attending on my first rotation of intern year.  He usually calls every female resident "Girl" or "Her", and most men get a individualized nickname.  We bonded early over something silly that I can't even remember now, and he started calling me Red.  Word spread through the program pretty much instantly that he liked me enough to promote from from Girl to Red.  Unfortunately, he called me Red because my hair was dyed pretty red when I started intern year.  Confession: My hair is not really red.  Confession: I have consistently dyed it every month since I started because I can't give up a nickname from the Big Boss once I've earned it.  Confession: I will dye my hair for the next 5 years.

So I asked the Big Boss if I could present at M&M.  He looked at me, arms crossed and said (verbatim),  "Did you shit your pants out of fear during the case?".  "Umm no?"  "Good, then don't shit your pants when you present."   "Ok, thanks?"

So I presented this morning.  Word had spread through the residents pretty quick that an intern was going to be presenting; so when I stood up to go the the podium everyone was at the edge of their seat.  Sort of like watching the gazelle getting stalked by the lion; they were all waiting for something pretty gruesome.  I was pretty terrified too; I'd been walking around with a knot in my stomach all week.  One of my co-interns sat next to me and literally held my hand as I was waiting for my turn to present.

So I take the podium.  I look at the 100+ people I'm presenting to, including all of my bosses and colleagues. And I feel prepared.  I've run over my case and my research numerous times.  I've prepared for every question I can think of- not just with an answer, but I've read the research that backs it up.  And so I go.  I give my presentation exactly like I've practiced and it sounds awesome.  I open the floor for questions; and I get thrown about 5 softballs right away that I just pound out of the park.  It's a freaking homerun and I can tell it.  I'm grinning like a goofball as I walk back to my seat.

I take my cell phone out of my pocket a few minutes later to find the following text messages from my co-residents (verbatim) "You killed it! Congrats!"  "U did so awesome!"  "Stop making us all look bad! You rocked it". And from an attending who I know well, "Great job, Laura!"  And (perhaps my favorite) from an attending who I barely know but somehow had my email address "Beautifully presented m&m case, Laura. You are years ahead of your rank."    Another resident said that they had never seen Big Boss look so proud as he did when I was rocking at answering questions after the case.


Needless to say, I walked around all day floating about 6 inches off the ground.  And the icing on the cake, is that about 10 minutes ago, I received a page from an attending who I have never worked with before.  I called it back, and he went on for 5-10 minutes about how astounded he was when he found out after M&M from one of his colleagues that I was a first year resident.  He had assumed I was a new fellow who he hadn't met yet; and simply could not believe that I was an intern until he heard from me directly. 


Somedays I feel stupid, like there is so much to learn in medicine that I could work my whole like and never make a dent in it.   Somedays I feel clumsy, like my hands look like chunks of meat as opposed to the graceful instruments of my mentors.  Somedays I feel underappreciated for all the hours I put it and all extra miles that I go which no one every notices.  And then there are days like today, when I get to feel like the King of the World.  


This is a day that I want to remember.

Pictures

My dad really wants me to update my blog.  So here goes.

Watch "Sneaky Kitty" on YouTube

Watch "New Kittens" on YouTube

The Decisions You Didn't Know You Made

I'm good at multiple choice tests. 

What I've found is that if I can turn a patient into a multiple choice question, then I can generally come up with the right answer.  But my newest realization about patient care is that most of the time when the wrong decision has been made, it's a decision that you didn't know that you made.

When we have a choice, we choose right.   But when we have momentum in a direction and no one is asking any questions; then we charge ahead without recognizing the number of decision that are being made without deliberate consideration.  It's not until something goes wrong that can turn around and look back and saw, "Why didn't we do x, y or z? "

Maybe that's true in life too.   I think that's what mid life crises might be about- all of the sudden you realize that you've made a bunch of decision without realizing it and are somewhere different than you should be.  I'm going to start trying to recognize the impending "mid life crises" of patient care, and recognizing the slowly boiling pot of water that's about to cook the frog.