A Budding Emergencist
Monday, October 23, 2006
  Secret Lives of Doctors
This post's rating: HCPO-health care providers only.

WARNING: Insensitive, cynical, insulting, derogatory humor follows.

I'm just beginning my 2 month (mandatory) surgery rotation. THe Surgical service and residency program is known to be quite malignant. Not too long ago, all the surgeons and ancillary staff were forced by risk management to take anger management seminars after several battles betwen surgeons and nurses in the OR, throwing surical implements at each other.

I'm a rotating intern, which means I'm: a) completely unfamiliar with the idiosyncracies of Getting Things Done, b) agonizingly slow, c) a juicy scapegoat for any frustrations of my superiors, d) overwhelmed by my patient responsibilities, e) pimped and mocked twice daily on rounds, f) seen as a simpleton, charity case, or dismal failure by senior residents, nurses, and medical students, respectively and e) thankfully exempt from departmental politics (ass-kissing, back-stabbing, all other social climbing activities). Crumbs of thanks and praise I hoard and cherish like a refugee come from grateful patients and families. I reveal these to no one, they are mine. Black medical humor has been a delicious coping mechanism, to wit:

TOBASH: Take out back and shoot in head

AMF, YOYO: Adios, motherf*****, you're on your own!
Total Body Dolor: syn: Acute Puerto Rican Syndrome, FABIANS, FHHS, FINE, Goldbricker, Status Hispanicus, etc, etc. Unfortunately, inevitably, and astonishinly completely unrecognized symptom of nonexistent Doctor-Patient relationship, see "AMF, YOYO".

FHHS - (US) Female Hispanic Hysterical Syndrome (screaming and wailing)

FINE - F*cked up , insecure, neurotic & emotional. I'm not talking about the patients. :-/

FABIANS - Felt Awful But I'm Allright Now Syndrome

Assmosis: promotion by kissing ass.

BOHICA: Bend Over, Here it Comes Again.

PLGFD: Patient Looks Good from Door. Typical surgical progress note.

Chocolate Hostage: Constipated.

Snowed: Sedating an agitated patient with Vitamins A(tivan), H(aldol), or M(orphine) in order to shut them up.

COPD - Chronic Old Persons Disease (unwell, no specific cause).

CYA - My Prime Directive, the true indication for most medical tests, and the raison d'etre of bureaucrats.

Paper Pusher - AKA "Voldmort," "Darth Vader," "Ghengis Khan," "Pol Pot," etc. Nameless, faceless, unaccountable, creeping carcinogen. Power over others from an impenetrable fortress of regulations, the paper pusher is entropy personified.

DFO - Done Fell Out--either syncope (ER) or Ortho Consult if inpatient.

FCBP - Fellow of the College of Bystander Physicians i.e. doctor having a look-see
*Special Comment - Private (non-surgeons) IM Docs frequently round on our patients (unconsulted) and order limitless tests and procedures that not unfrequently delay discharge or directly conflict with our management, behind my back, i.e. repeated reordering of bicarb drips for non-acidemic pts, messing with vent settings, ordering tests irrelevant to the surgical problem but convenient for them, all under the surgical service. They shout "Ollie Ollie Ox-and-Free!" because it then becomes our problem, i.e. pos D-dimers on a pt about to be discharged, ordered at midnight the night before, without telling any surgeon. My secret weapon--order MORE tests and declare VICTORY by transferring the patient to their service. Ha! What's that you say? Pt care suffers? Sorry, I don't have the spare brain cycles. Call for help from a senior resident? Whatever, dude. Blood from a stone.

HAIRY PSALMS - Haven't Any Idea Regarding Your Patient, Send A Lot More Serum. The rule rather than the exception.

Intubate Mr. Johnson: What floor nurses do during a code, e.g. "Jesus is coming, look busy". /me ducks.

LMC--Low Marble Count (i.e. low IQ).

LOL in NAD - Little Old Lady In No Acute Distress.

WNL - We Never Look.

NAD - Not Actually Done.

GOMER - Get Out Of My Emergency Room; A demented and abusive patient.

TTFO - "Told To Fuck Off," or, when being deposed, "Told to Take Fluids Only".

PPP - Piss Poor Protoplasm, i.e. coagulopathic.

OB/GYN- "Oh Boy! Got You Naked!" Yuk yuk.

PHD = Pakistani Healing Dance (a useless procedure performed for benefit of patient and family).

PID - Pus In 'Dere (PID actually means Pelvic Inflammatory Disease).

Slow Code - A full code run half-assed because of medical futility-see CTD.

CTD - Circling The Drain, Fixin' to Die, Trying to Die - moribund patient, especially poignant and pathetic when the family wants everything done, see Denial.

Denial - Not just a river in Egypt.

Crimea River... - Where all young health care providers' idealism curdles. Don't forget the chorus: ...build me a bridge, and get over it.

SOCMOB - Context of all traumas. The most dangerous activity known to man...Standing On Corner, Minding Own Business. Best place to meet "Two dudes".

Two Dudes: Bin Laden is a choir boy compared to these criminal masterminds.

Throckmorton’s Sign - in the unconscious male, the penis points to the side of the injury.

UNIVAC - Unusually Nasty Infection, Vultures are Circling.

Double-Oh Doctor - "Licensed to Kill" - A dangerously incompetent physician. Patients inexplicably, paradoxically swear by these Drs. See syn "Hand-Patter".

Hand-Patter: A physician whose primary treatment modality is reassurance, often ignoring dangerous warning signs, and/or mismanaging simple medical problems, creating complications that are ignored until the patient guppies, then consulting every service in the hospital at once. Infuriatingly, their patients love them and revere them as medical gods. Alternatively, a doctor who admits patients with exceedingly minor, self-limited medical complaints, using homeopathic (vanishingly small) doses of medications until the patient gets bored, or the family comes back from Barbados. See "Pillow Fluffer". An endangered species; see "Sodomites".

Sodomites - Medical malpractice lawyers, aka Ambulance Chasers. See "BOHICA".

Carpenter - Orthopedic Surgeon.

Plumber - Urologist.

Guppy - a patient with agonal breathing. Looks like a dying fish.

Pillow Fluffer - The Nurse counterpart of the Hand-Patter, Pillow Fluffers do anything the patient wants, ignoring unpleasant physician orders and neglecting actual competent nursing care. An endangered species, Pillow Fluffers are retiring violets who can not tolerate the fast-paced, dehumanizing, and brutal world of modern medical care.

Urban Outdoorsman - Homeless person.

Vampires - those who take blood samples, e.g. lab techs or medical students.

Scut work - busywork unrelated/incidental to patient care; usually the majority of an intern's (AKA "Scut-monkey") responsibility.

VOMIT - Victim Of Modern Imaging Technology (i.e. try treating the patient, not the report from radiology; particularly referring to invasive procedures for false positives.)

Wallet Biopsy - (US) free medical test performed by hospital insurance department before patient is treated.

Zebra Hunt - for fever of unknown origin (FUO), or a (service) patient managed by a medical student. The student is indulged his improbable workup until the DRG money runs out, the patient is Turfed to Street, and the MS is told, "When you hear hoofbeats--think horses, not zebras." Also see HAIRY PSALMS.

A disclaimer - take this in the spirit in which it was intended--a coping mechanism to deal with the constant barrage of death and suffering. An ancient samurai saying, "Treat every light matter seriously, and every serious matter lightly," Another one, "The situation is hopeless, but not serious." Amazingly helpful to lighten the mood and let everyone "reboot" and get back to our calling; the alleviation of suffering, the prevention of death and disability. Greet every insult with a grin, keep 'em guessing. Join us as we liberal hearts and artists bang our head against some mad bugger's wall.
Saturday, October 21, 2006
  Money Shots from ER blogs
Asking for evaluations is a way to dilute responsibilty. Bureaucrats hate making decisions, especially decisions for which they will be held accountable. Evaluations and other forms of "decision support" are tools to deflect criticism if something goes wrong. Consensus is a totally gutless form of management employed by the spineless.
-Panda Bear

Sunday night. "CODE BLUE, RM._____, CODE BLUE, RM.____," came the blaring hospital intercom system. Damn, it's 3 AM and I'm the only doc in the hospital. The ICU nurses and I are the only ones who answer these Code Blue activations in the middle of the night anyway. Why can't they just call our departments directly by phone instead of blaring it over the loud speakers and waking up all the sick patients in the entire hospital???
-Charity Doc

"Today, people think of us as drug-dispensing walking lawsuits who are in fact less informed than their Internet phones".

Do women dress differently when they ovulate? ...Dr. Kavokin presents a very exhaustive examination/explanation of the causes of Yellow Poo...You will know you are “in” with the nurses when they let you have the last piece of pizza...

"I heard about you used to do spinal taps with your eyes closed," chimes in another[resident at Scalpel's residency alma mater]. "They said you preferred to do it by Zen."

New treatment for DVT--This blows me away. A deep venous thrombosis is crossed with a wire via a percutaneous approach, balloons are inflated on either side of the clot, a thrombolytic is administered through ports between the balloons (remaining in the target area), a spinning twisted wire acts like a blender which chops up the clot, and then everything is sucked back up into the catheter. Instant cure.
-Scalpel or Sword?

And other assorted excellence from my esteemed EN colleagues--see the links on my sidebar!-->
Emergency medicine, from the beginning of a new doctor's career.

Location: Big City, Metropolis, United States

Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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