Ugh...kvetching...

Emotionally I'm not in a good place. I'm beyond tired of waiting on things to happen. I'm tired of everything being dependent on somebody else's time schedule. I'm not sure what to do about somebody that's been a very close and serious part of my life for almost a year now. It's become obvious to me that the situation is static and is not working for me. But how do I change that without being a complete jerk? You want me as a friend...but you want to keep me on line romantically because you've admitted you have feelings for me. That's just not cool. You don't want to rock your own boat because it's "safe." That's a copout. Nothing worth having is "safe" or easy. You want to talk about living with me...thankfully I don't take you seriously...but later tell me that you just wanted to say it because you wanted to see what it would feel like to hear yourself say it...excuse me??? Perhaps it would've been a good idea to say that to somebody else...

In local news it's New Year's Eve. Not one of my favorite nights. I had originally planned to do something, but last night I went to sleep feeling like a bug under a brick, and I woke up not feeling emotionally or physically much better. Last year I went to Athens with Redd and Amigo...but Redd and I felt like grandparents at a preschool, so we gracefully bowed out not long after the countdown. In general I never have a great view on New Year's Eve because there are just so many people...most of them pretending to have the time of their lives. Ugh. There's just very little pleasurable about standing shoulder to shoulder with 400 of your drunk friends trying to do the Macarena, during which elbows and armpits continually find your face. No creo asi. On top of that I'm incredibly wary of having more than one drink because the police are justifiably everywhere. The problem is I need more than one drink to ignore the 400 drunk somebodies.

I'm just ugh...so I'm gonna sit here at home probably, have a glass of wine...and watch All About Eve. Go me?

Baby on Board

These signs need to go away in 2012. Through extensive therapy I have overcome the almost unyielding urge to barrel full steam ahead into the back of a car. This urge could ONLY be overcome with the knowledge that you had a baby on board...Fool. As if the giant car seat doesn't give it away.

Too Funny

Sad News

I found out today that an online pen pal died early on Saturday after a three year battle with stomach cancer. I'm not sure how to feel because I had never met him. We had talked about hanging out, but one of us was always off somewhere, so it never worked out. But we talked a lot. He was always positive and had a good sense of humor. He had a particular knack for rewriting the lyrics to some of my favorite Stevie Nicks songs. His new lyrics were somewhat, er, colorful, but I always had a laugh. I'll miss talking to you my friend. Rest in peace. It's just so sad. It's such a waste. Twenty-four years old. In what is perhaps going to become an all-too-common occurrence, it is bizarre looking at the Facebook pictures of someone who just died, and have them be your age.

Today's humor

Lifted from here:
Edited because swear words make me blush...but otherwise I find it hysterical, and entirely true.
Note: The grammatical errors ain't mine.

OK, I am not going to lecture you about the dangers of narcotic pain medicines. We both know how addictive they are: you because you know how it feels when you don't have your vicodin, me because I've seen many many many people just like you. However, there are a few things I can tell you that would make us both much happier. By following a few simple rules our little clinical transaction can go more smoothly and we'll both be happier because you get out of the ER quicker.

The first rule is be nice to the nurses. They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think. When you are tempted to treat them like [horsesqueeze] because they are not the ones who write the rx, remember: I might write for you to get a shot of 2mg of dilaudid, but your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot.

The second rule is pick a simple, non-dangerous, (non-verifiable) painful condition which doesn't require me to do a four thousand dollar work-up in order to get you out of the ER. If you tell me that you headache started suddenly and is the 'worst headache of your life' you will either end up with a spinal tap or signing out against medical advice without an rx for pain medicine. The parts of the story that you think make you sound pitiful and worthy of extra narcotics make me worry that you have a bleeding aneurysm. And while I am 99% sure its not, I'm not willing to lay my license and my families future on the line for your [bum]. I also don't want to miss the poor bastard who really has a bleed, so everyone with that history gets a needle in the back. Just stick to a history of your 'typical pain that is totally the same as I usually get' and we will both be much happier.

The third rule (related to #2) is never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine. I've seen people in a 10/10 pain and you sitting there playing tetris on your cell phone are not in 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm. Even when I passed a kidney stone, the worst pain I had was probably a 7. And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8. That means to me you are hurting by you might not be lying. (See below.)

The fourth rule is never ever ever lie to me about who you are or your history. If you come to the ER and give us a fake name so we can't get your old records I will assume you are a worse douchetard than you really are. More importantly though it will really really piss me the [bleep] off. Pissing off the guy who writes the rx you want does not work to your advantage.

The fifth rule is don't assume I am an idiot. I went to medical school. That is certainly no guarantee that I am a rocket scientist I know (hell, I went to school with a few people who were a couple of french fries short of a happy meal.) However, I also got an ER residency spot which means I was in the top quarter or so of my class. This means it is a fair guess I am a reasonably smart guy. So if I read your triage note and 1) you list allergies to every non-narcotic pain medicine ever made, 2) you have a history of migraines, fibromyalgia, and lumbar disk disease, and 3) your doctor is on vacation, only has clinic on alternate Tuesdays, or is dead, I am smart enough to read that as: you are scamming for some vicodin. That in and of itself won't necessarily mean you don't get any pain medicine. Hell, the [nimcompoops] who list and allergy to tylenol but who can take vicodin (which contains tylenol) are at least good for a few laughs at the nurses station. However, if you give that history everyone in the ER from me to the guy who mops the floor will know you are a lying douchetard who is scamming for vicodin. (See rule # 4 about lying.)

The sixth and final rule is wait your [bloody] turn. If the nurse triages you to the waiting room but brings patients who arrived after you back to be treated first, that is because this is an EMERGENCY room and they are sicker than you are. You getting a fix of vicodin is not more important than the 6 year old with a severe asthma attack. Telling the nurse at triage that now your migraine is giving you chest pain since you have been sitting a half hour in the waiting area to try to force her into taking you back sooner is a recipe for making all of us hate you. Even if you end up coming back immediately, I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances. And I firmly believe that if you manipulate your way to the back and make a 19 year old young woman with an ectopic pregnancy that might kill her in a few hours wait even a moment longer to be seen, I should be able to piss in a glass and make you drink it before you leave the ER.

So if you keep these few simple rules in mind, our interaction will go much more smoothly. I don't really give a [flip] if I give 20 vicodins to a drug-seeker. Before I was burnt out in the ER I was a hippy and I would honestly rather give that to ten of you guys than make one person in real pain (unrelated to withdrawal) suffer. However, if you insist on waving a flourescent orange flag that says 'I am a drug seeker' and pissing me and the nurses off with your behavior, I am less likely to give you that rx. You don't want that. I don't want that. So lets keep this simple, easy, and we'll all be much happier.

Sincerely,
Your friendly neighborhood ER doctor 

Just can't help but laugh...

I was sitting in the doctor's office today with my grandmama. The guy sitting relatively near us had his cellphone, but obviously forgot to silence it. While the room was dead silent, it goes off and I hear this: "You have another f*cking email." He heard it start to talk and out of the corner of my eye I saw him frantically try to silence it, to no avail. I just could not help but laugh. Grandmama asked me what I was laughing about (because of course she didn't hear it...) and I'm not sure I could have used the F-bomb in my Grandmama's presence...so I just said I read a funny joke on the internet. That satisfied her.

Movie Time

I saw "My Week with Marilyn" last night with Redd. Because none of the theaters near us were playing it (why?!?!) we had to haul tuchus across town. While searching for the theater, because a) the name had changed despite Fandango's insistence and b) Fandango's geographic awareness remains wonting, we stumbled across a Tapas bar that looked much more promising than the standard fare Chili's and Taco Bell-esque restaurants surrounding it. We were not disappointed. It was so good!

Then...for the movie. I thought it was really good. The performance of Marilyn was what I would call "delicate" or "fragile."  It wasn't over the top, it wasn't wishy washy, it wasn't "girly." I enjoyed the movie.

So so tired. I just want to do nothing, and I feel like doing nothing. Why does it take days to decompress?

Done...for now at least

All right. So I'm done, I guess for now. And I have no clue how things went with the USMLE Step 1. It was a just a really long Multiple Choice Question Blur. I don't even remember that many questions. One or two that I had a question about I've looked up, and I was right about the answer I chose. Perhaps that's a good sign. Having not slept much the night before, and having woken up at 4:15 the day of the test...I slept like a baby last night. The only problem was I woke up, with nothing to do. It's an odd feeling, and I'm afraid I'm going to get sucked into riveting tasks such as vacuuming, or ummm...doing anything but reading the stack of happy nonsense books I've neglected since the start of the decade.

At the moment I'm content to watch Will & Grace. Why? No clue. That pile of goo on the floor? Yeah that's my brain. It oozed out of my ear.

QOTD

A: Miriam Makeba, who's that??

B: You know, that black lady on the Cosby Show...

C: Oh yeah...her...

Dumb question of the day:

If laboratory tests determine that the patient has a general medical condition that underlies the symptoms, which of the following is most likely?

A: Addison's Disease
B: Cancer of the Pancreas
C: Hyperparathyroidism
D: Hyperthyroidism
E: Hypothyroidism

...Could I get some symptoms please....(Insert biggest eye roll ever). Finally I get to use those mind-reading and X-ray vision skills!!!

Taken from Lange Q&A: USMLE Step 1.

Um, duh?

This is an excerpt from an article I was reading. I'm so glad it took research to figure out what anybody with an ear and a brain connected to each other could deduce. Insert eye roll.

"The researchers at the University at Albany in New York found that R&B contained the most references to sex per song (an average of 16 sex-related phrases per song). The top three sexual themes in R&B songs were the singer's sex appeal, the singer's wealth as it relates to finding a partner, and descriptions of sex acts. A total of 19 song themes were examined."

And could this article be ANY longer???

29 November 2011

While studying I’ve learned that propofol is high in TGs, and potentially damaging to the pancreas. I wonder what Michael Jackson’s pancreas looked like when they did an autopsy…

Kvetching...

Beyond tired of over zealous Psychofacebookmoms, and my friend list has over two dozen new or young moms. Your child was cute until picture number 6,734—and that’s just this month’s crop. Also, I really do not care what cutesy thing your child had to say. I hope I remember this when and if I have children, but listen up; your children are only interesting to you. Sadly, because I know of the parent-child relationship in many of these cases, I look at the postings by the overzealous Psychofacebookmoms and I see a spoiled brat in the works. Remember, brats are the product of lousy parenting. After that thought runs through my brain for the millionth time, another occurs to me—this child’s sure-to-be-histrionic teenage years will be penance enough for subjecting hundreds of innocent Facebookers to never ending pictures, anecdotes, and not-so-cutesy quotes. Your child is a child, and needs to be appreciated as such. They did not hang the moon. Since I’ve noticed the vast majority of psychofacebookmoms only have one child, the recommended treatment should be the crank out another kid—STAT. Note: I have PLENTY of friends with children who aren't guilty of being a Psychofacebookmom.

28 November 2011

Due to inclement weather (I’d heard there’s a chance of snow) I went out into the deluge to get firewood. I wanted the wood inside so it would be completely dry in the event that we experienced a power outage. Like a schmuck I went without shoes. So naturally in the process of removing a piece from the wood pile, another piece decided it didn’t want to be left out, and landed squarely on my (bare) foot. Ouch. Not ten minutes later it is already hurting, and I have the hematoma from hell. It is sore but not broken, because I can stand solely on the ball of my left foot.