Inmate: “Who is that girl over there?” (motions toward me)
Nurse: “She's a medical student. She's with Dr. Smith today.”
Inmate: “She scares me. (pause) Is she an albino or something?”
Nurse: “No, I think she just has blond hair.
(pause) She doesn't have to come in if you don't
want her to.”
Inmate: (Shakes head vigorously)
Needless to say, I didn't get to examine that patient. However, if I ever meet him in a dark alley, I guess we know which one of us will start running first.
ANOMALY
It was the end of my sixth month of medical school and it was getting old already. The same routine of going to classes, lab sessions, or working with the microscope was monotonous. I wanted to be a real doctor and not a professional student. Each night was spent studying for three to five hours. Each morning the same faces were sitting in the same seats in the same lecture hall. Some were ass kissers. Some were bullshitters. The only reprieve, I thought, was the anatomy lab.
At first, the anatomy class was exciting. A group of four would receive their “body” at the start of the year and dissect it over the next six months. Ours had tattoos on his forearm so he was affectionately named Popeye. By the end we were down to bare bones and tendons. Initially, the class gave us a chance to joke around. It sounds worse than it was, but it was a way for medical students to blow off steam. Sure it was gallows humor but it was fun. We did respect the dead but we also joked around. That was in the beginning. After a few months, however, we just wanted to be done with it. The tests were hands-on practicals as well as the basic memorization written tests. We prepared for this, not only by the normal dissection practices, but also by going to small lectures. These were held in tucked-away classrooms containing around thirty first-year medical students. Twice a week we had to present our findings in the lab to the rest of the class. An anatomist professor would preside over it but the student would do most of the work presenting.
These side sessions soon became extremely tedious as well. Although they were needed and classroom attendance was mandatory, they soon became draining as well. I remember, like it was yesterday, the time I was to present on the renal system. The kidney was my topic and I had to stand up and draw pictures and discuss all the functions of this most mundane system. The problem on this day, however, was that I was too mentally exhausted to prepare. An hour before the side session I was eating a salad in lunch when it hit me. My classmates were in a solemn mood as we talked about life, medicine, and school in general. I knew that after this break we all would walk to the classroom to watch me do my show. I, however, had no show to give … until I looked in my salad dish. There lay a perfect kidney bean with a remnant of its skin hanging down.
Hell, it looked a miniature kidney (with a ureter attached)!
After sneaking it into a napkin, I stuck it into my pocket and walked with the rest of my classmates. No one saw what I did. After we arrived, the teacher gave his introduction to the subject and called me up to present. I began stating that instead of doing the usual routine, I was going to spend my time discussing an amazing discovery. I brought the napkin and raised the small kidney bean.
“You have before you an anomaly. Our cadaver seemed to have an abnormal kidney One side was normal and the other had shrunk due to either disease, non-use, or a congenital problem. I know it is wrong to take the organ out of the lab, but you all need to see the miniature kidney and its very small ureter.”
For the first time in a while, the students seemed awake after their luncheon slumber. Their eyes were like saucers as I walked around and showed each and every one of them the pale and decayed organ (or salad condiment). No one caught on, not even the teacher.
I walked up to the head of the classroom again and made up some more crap about why it could be so small. Then, after a few seconds’ delay and an uncomfortable silence, I tossed the kidney bean up in the air around four feet and caught it in my mouth and ate it. “Oh my God!” one student said. No one else said a word as the uncomfortable silence continued. The teacher didn't even say anything but instead maintained a very strained and constipated look on his face. At that point I said “thank you” and walked back to my seat.
The grumblings began to start as I hit my chair and the teacher got up to walk toward me. It was only then that my classmates, who had been sitting next to me at lunch, realized what the truth was and started laughing their asses off. Knowing that I was soon to get into major trouble, I confessed my sins to everyone. The teacher was not pleased and many of the other students were also pissed off. I was not suspended, but for the rest of the semester I was treated with a little disdain and a lot of disgust by many of my peers. I now had a reputation. An anomaly is a rare abnormality out of the norm. I, like my miniature kidney, was now the anomaly of medical school.
We called him the Cone, or Cal Conehead because it was the early eighties and he related to the house staff like an extraterrestrial. He was the chief of the Department of Medicine at a large midwestern academic hospital and he occasionally would come down from his ivory tower to enlighten our early morning intake rounds on the wards. His wisdom was worthless to us, and after decades without any patient contact, he could no longer connect with our lives. But he was a likeable fellow, and so we referred to him not derogatorily but in a cynically affectionate way as “The Cone.” I was a fourth-year medical student like eight or ten others. We were assembled in a circle outside a patient's room with our medical resident and two medical interns one predawn morning late in the academic year when The Cone arrived unexpectedly. It had been a brutal night on-call for many of us who were still clad in wrinkled scrubs and in need of a shower and a shave (even the women), not to mention rest. To make matters worse, we had recently learned where we had matched to do our internships the upcoming July, and we all had fulminant cases of FUBIGMI (F%ck You, Buddy. I Got My Internship).
This made it safe to behave a little less submissively than usual.
The Cone began lecturing profusely and irrelevantly about the difference between “people doctors” and “thing doctors.” Being Chief of Medicine, The Cone had a prejudice against surgical types who he called “thing doctors,” a derogatory term for a physician who viewed his patients as a bag of removable things (organs). Internists, by contrast, we were told, were “people doctors” because of their more integrated and holistic view of the patient as an entity comprised of interrelated physical and mental systems.
We were each forced to answer in turn if we were on our way to becoming “people doctors” or “thing doctors,” an exercise in humiliation for the surgeons-to-be amongst us. Begrudgingly, we answered in turn, forced to call ourselves “thing doctors” or “people doctors.” The best answer came from the fourth-year medical student on his way to becoming a neurosurgeon with the worst case of FUBIGMI ever witnessed at our institution. When his turn came, he proudly announced, “Dr. Cone, I'm not gonna be a people doctor or a thing doctor. I'm gonna be a doctor who turns people into things!” We laughed so hard, one guy wet himself and another dropped his clipboard. The Cone reportedly stopped rounding with post-match students thereafter.
EDITOR’S NOTE: Let's hope this neurosurgeon doesn't get patients that PITH him off or they will be wearing drool buckets.
MAKE YOUR QUESTIONS CLEAR
As a fourth-year medical student on my gynecological rotation I was faced with a twenty-ish patient whose chief complaint was, “My funk do smell.” Examination of the patient and her vaginal discharge made it obvious that I was dealing with a sexually transmitted disease.
I asked, “Are you sexually active?” to which she replied, rather indignantly, “NO!!”
I repeated my question, feeling perhaps that she had misunderstood, yet the answer was still, “NO!!”
Confused, I then gently asked, “When was the last time that you had sex?”
Her answer then was straightforwardly delivered as, �
�Last Friday.”
“I thought you just told me that you are not sexually active?” I exclaimed, to which she answered, “I'm not, I just lay there.”
EDITOR’S NOTE: I had always thought this was a joke or an urban legend. Our reader signed off that this was “absolutely true” and happened to him.
Escapee
I was a wet-behind-the-ears third-year medical student on my trauma surgery rotation. One afternoon, I was relishing the opportunity to put in a central line on a comatose ICU patient. When I had finished, it was close to our usual check-out time, so I looked around expecting to see the other trauma team members. Not only were they all missing, but so were several ICU nurses. I could not imagine what sort of emergency would require the attention of the entire trauma team and nurses without setting off my pager as well.
As it turns out, one of our patients had gone AWOL.
The patient was a young man who had walked into the ED last night after being shot in the head. I repeat: he WALKED into the ED on his own, after being SHOT IN THE HEAD. He also had fractures of two cervical vertebrae. The young man had been in the ICU, with a neck brace on, when several police officers and FBI agents came looking for him. When he heard that they were there, he got out of bed, removed his neck brace and IVs, and ran, stark naked, out of the hospital. They finally caught him in the hospital parking lot, trying i to find an unlocked car in which to make his getaway. Needless to say, he had a police guard posted on him continuously until he was discharged.
EVERYONE NEEDS A NICKNAME
I was a third-year medical student on my OB rotation. The usual crowd was assembled in the delivery room as my buddy Marc, a fellow MS3, was preparing to inject local anesthesia into the perineum of an immediately pre-delivery mother-to-be who was about to receive her episiotomy. Also present in the room were two more students, an intern, a resident, the chief resident, the expectant father, and three nurses.
With Mom in the lithotomy position, legs spread wide, Marc approached her with the syringe filled with lidocaine. [i He was visibly nervous, having never done this before, and being where he was between this woman's gaping legs and in the presence of so many people only added to his burden.
His tension was infectious, and the room I was completely quiet for a moment as Marc brought the needle closer to its intended target.
The mood changed immediately when Marc perfunctorily announced to the patient and everyone else present that she was about to feel,
“a little prick.
Everyone, even the mother, was laughing at Marc, who had that day inadvertently coined his own new nickname.
Going NUTS in Anatomy Lab
Our days as medical students in the anatomy lab had become terribly monotonous. Certain days were exciting … slicing through layers of fascia, digging around in the abdomen, and sawing through the skull. But most days were the same old thing … following an artery or nerve through its twists and turns or delicately scraping fat from thin muscle fibers. As the days went by, my good friend and I felt the need to spice things up. We found a metal nut that had become unscrewed from the metal cadaver tank and thought we'd do a little experiment. Medicine is supposed to be evidence-based, right?
We hadn't yet dissected the uterus, so using the handle of a scalpel, we carefully pushed the nut up into the uterus of our dear Rosemary. A few more boring weeks passed until we began studying the reproductive system. Finally, the day came when we were told to dissect the uterus. My friend and I watched in anticipation over the body as a classmate sawed down Rosemary's midline into the uterus. As the uterus split in half, we could see the student's jaw drop. Sitting smack dab in the middle of the posterior wall of the uterus was a nice shiny nut.
Our classmate screamed, “I found a nut; I found a nut!” Classmates began gathering around the dissection table to witness the “discovery.” Within seconds, the entire class was gathered around. Of course, everyone initially thought Rosemary had a testicle, which would have been a pretty cool finding, but when they realized it was a metal “nut,” the excitement in the room grew out of control. We had seen prosthetic knees, pacemakers, and even an “old-school” penis pump, but nothing compared to this discovery!
Before long, the sea of medical students parted as the teaching assistant approached the body. His face lit up; you could see the “I'm gonna get published with this discovery” sparkle in his eyes. With amazement he proclaimed, “I've never seen anything like this. Don't touch it. Leave it in its natural state.”
As he ran out of the room, my friend and I began to worry. We knew where he was going; this whole adventure was beginning to get carried away. Lab work seemed boring, but flipping burgers at McDonald's after getting expelled from med school would be even worse. Suddenly the lab door flew open and the crowd was silenced. The God of Anatomy had just entered. The professor was in the lead with the teaching assistant kissing his rear end. As the professor approached the body, my friend and I were shaking in fear. It was too late to say anything now! We just held our ‘ breath in hopes that the whole ordeal ‘ would end quickly. Our future in medicine was quickly fading while the scent of McDonald's fries filled our minds. The professor examined the nut, scratched his chin, and stated, “I have read several publications on this matter. This is definitely not the first finding of this sort. Whether it be a sexual fetish or a migration from another part of the body there are scientific explanations for such a finding.”
Once the professor was gone, we let out a sigh of relief and explained to our classmates the true origin of “the nut.” For some reason, the days following the “discovery” weren't so boring anymore! We were just thankful to be handling fatty human muscles rather than fatty hamburger patties!
Cracking (Up) the Code
I am a fourth-year medical student currently (and mercifully) finishing up my last few rotations at a Big Academic Center Hospital in Boston. My colleagues and I were interrupted in the middle of SICU (Surgical Intensive Care Unit) rounds last week by one of the nurses, who wanted to tell us about the new code protocol.
She explained to us that next time one of us (obviously not me) responded to a code, we would be asked as we arrived whether or not we would be leading the code. If the answer was yes, we would be immediately be handed a ring-bound collection of laminated green cards upon which were printed the ACLS (Advanced Cardiac Life Support) algorithms. These cards, she explained as we passed them around, would serve two purposes: to identify the code leader, and to help him or her with the algorithms (not that any of our residents would EVER forget such a thing).
As soon as she left, we started thinking about what other means might be used to identify the code leader in the event that the green cards were misplaced. Here are some of the alternatives we envisioned:
A beanie cap with a propeller on top. Clearly the silliest of the options, this would also be the most unmistakable, visible even from the medical student's vantage point (which tends to be somewhere out in the hall).
A large red clown nose. This would not only identify the code leader, but also, if it squeaked loudly enough, aid him or her in attracting the attention of other code responders at critical points in the resuscitation (such as when the defibrillator is about to discharge).
A “Miss America”–style satin sash emblazoned with “Code Leader” in cursive lettering. Though it might be cumbersome to drape properly during the middle of a code, this is definitely the most photogenic of the options.
A crown and scepter. These would undoubtedly help instill the code leader with the confidence and authority necessary to perform his duties. In a pinch, the scepter could also be used to deliver precordial thumps.
A coach's whistle. Visually subtle, this little tool would be indispensable in calling attention to “code fouls,” such as catheterizing the carotid artery, intubating the esophagus, or successfully resuscitating a patient who was DNR (oops).
Our university hospital treated the prisoners from the State Pen. We had a prison
unit complete with guards and sliding barred doors that we had to pass through in order to make rounds.
The prisoners really liked the unit; it had private rooms, three square meals a day, color TV, etc. They figured out a clever way to get admitted: they would place a piece of masking tape over the edge of a single-edge razor blade and then swallow the razor blade. Then they informed the guards, who brought them to the ER.
Sure enough, when we shot a KUB (abdominal X-ray) there was a razor blade in the stomach. We would then admit them for observation until they passed the razor blade. We eventually caught on.
One night I was in the ER, as a third-year student, and one of these guys came in. We had just figured out what the prisoners were doing, but they didn't know yet. The new protocol was to drop an NG (naso-gastric) tube, and if there was no blood, send them back to the jailhouse.
Well, I dutifully snaked the tube down, and there was no blood that couldn't be accounted for by my root-hogging this tube through his nose. I told the guy he was being sent back to the big house.
Thank God for the prison guards, because this guy went totally ballistic. He lunged at me, but the guards caught him by the arms. Then he tried to reach out with his foot and kick me, but I managed to dance away. Unfortunately, I was not out of projectile range and he hit my tie with a nice, juicy loogie.
The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge Page 5