I finally got my wonderful guitar gift fixed up for the low low price of 10 dollars, so I can put this to music:
9 AM, the flames are lickin'
10 AM, the porch ain't there
At noon, I'm getting that call saying, girl you're gonna stay where?
And you got no way to get going now,
Naw, they burned up your ride too,
Now I'm sitting in the ruins singing the economy car blues, baby...
Can't get to work
Can't get to church
I'm in the lurch
Can't head to the Red Cross
Can't get to tell my boss
Can't get to the downtown, feeling lowdown blues...
No, I've got the economy car blues.
Where's your bed baby?
That futon? It's gone
Your tv and vodka bottles?
Just pieces on the lawn
But I'm sleeping out here barefoot; yeah they got my pretty shoes,
And now all I got are these economy car blues, yeah
Those subcompact blues,
Those window-crank blues.
When you're missing your stride, you got no ride
Want your stereo, want those sexy pleather seats back
A three quarter spare, smells like burning hair,
and the paint job's turned smoky black
That's just the economy car blues, yeah it is
That's just the economy car blues.
Can't get to work
Can't get to church
I'm in the lurch
Can't get to the mall, not the justice hall
Not the clinic, I can't win it blues
I got these economy car blues.
Yeah yeahhhhhhh CHA.
(guitar slide)
---
See, this is what happens when I don't get enough sleep and get called out in derm lecture.
Apr 23, 2012
Apr 17, 2012
Meanwhile, in hemelandia
I don't even watch Portlandia much, but I really like adding "ia" onto everything. And putting a bird on it (Okay, I watch Portlandia a little).
Anyhoo: Dear Clinicians, we do actually read your notes. And you are hilarious. "The patient is obese, and extra personnel will be needed in the OR to deal with the obesity of the patient, who I may have mentioned, is obese."
Also, all notes begin "The patient is a pleasant blah blah blah. And all the referrals begin with "Thank you Dr. ScaryName for referring your patient, who is a pleasant blah blah blah". Sometimes, they're "very pleasant". Which of course, is meaningless to us, and after reading thirty notes that begin that way, is either a complete lie, or we have the most pleasant group of in-pain people ever. "The patient, Ms. Jones, is a demanding chore of a woman who has threatened to sue me five times. By referring her to me, I can only guess I have grievously wronged you in some way, and for that, I do apologize."
I know as a medical student, I got some unpleasants. One wanted to be her doctor, which is a story for later and helped me run screaming into my field just in case she ever found me. "My patient, Ms. Really?, said she threatened to slap a nun. I feel no further history is needed."
That's not really heme though. That's everything, including autopsy, though in the latter they tend to add, "In this unfortunate case", which is weird because no death note is going to begin with "Well obviously..." The unfortunate part seems implied.
Heme. Things are difficult. Good difficult, but difficult. I'm starting to absorb the immunostains, which is extremely important in heme. CD20 and CD3 in particular are becoming my bestest friends.
My attending freaks me out a little bit, so I'm just as pleasant (see what I did there) as possible while remaining self deprecating enough to not be aggressively pimped. For instance...
Attending to other resident: Go slowly through this; Ishie won't mind. She's very patient.
Me: It's one of exceedingly few virtues, sir.
Fellow: (chokes)
An interesting thing... I'm either "The Quiet One" (go figure) or "The Extremely Inappropriate One". The former is usually to avoid the latter when I'm around people that I'm not sure will appreciate it, which to be fair, is most people. This occurred in my surgery rotation, which is the only way I made it through the rotation alive. This confused a friend of mine, because the secretary specifically referred to me as the Quiet One, which sparked "Wha??"
The fellow seems to be around me enough to know I'm secretly a horrible person. He hasn't told anyone at this point, so I think we're cool.
Other heme stuff... we work much closer with clinicians, which is cool in a sense, but sucks in a sense, because it means we have to talk directly with people who talk to our patients and they say stuff like "Awww, that's a shame. This kid's so sweet and is such a fighter", and that personal touch is honestly really deflating. Not in a "grave detriment to my work" way by any means, and I do like giving good news on any front, but surgical pathology is quite hands off when people aren't hounding you for frozen sections, and you can be like "Oooh, weird melanoma!", whereas when you see someone's repeat-after-chemo bone marrow packed with Unspeakable Evil and you have to immediately call the clinician, who at times comes down and looks through the scope with you, there's no real excitement to it. "These stain really weird!!!" just doesn't cut it. The heme/onc people are great though. I suppose you'd have to be.
In other news, my mom's coming down to visit for her birthday, so I get to show off Charleston in a hopefully non-murdery, good food sort of way, which contrasts sharply to her last visit which was to a Motel 6 in the hood where someone immediately got killed outside the freeway exit the night we'd gone to a Denny's for dinner. I seem to attract trouble.
Anyhoo: Dear Clinicians, we do actually read your notes. And you are hilarious. "The patient is obese, and extra personnel will be needed in the OR to deal with the obesity of the patient, who I may have mentioned, is obese."
Also, all notes begin "The patient is a pleasant blah blah blah. And all the referrals begin with "Thank you Dr. ScaryName for referring your patient, who is a pleasant blah blah blah". Sometimes, they're "very pleasant". Which of course, is meaningless to us, and after reading thirty notes that begin that way, is either a complete lie, or we have the most pleasant group of in-pain people ever. "The patient, Ms. Jones, is a demanding chore of a woman who has threatened to sue me five times. By referring her to me, I can only guess I have grievously wronged you in some way, and for that, I do apologize."
I know as a medical student, I got some unpleasants. One wanted to be her doctor, which is a story for later and helped me run screaming into my field just in case she ever found me. "My patient, Ms. Really?, said she threatened to slap a nun. I feel no further history is needed."
That's not really heme though. That's everything, including autopsy, though in the latter they tend to add, "In this unfortunate case", which is weird because no death note is going to begin with "Well obviously..." The unfortunate part seems implied.
Heme. Things are difficult. Good difficult, but difficult. I'm starting to absorb the immunostains, which is extremely important in heme. CD20 and CD3 in particular are becoming my bestest friends.
My attending freaks me out a little bit, so I'm just as pleasant (see what I did there) as possible while remaining self deprecating enough to not be aggressively pimped. For instance...
Attending to other resident: Go slowly through this; Ishie won't mind. She's very patient.
Me: It's one of exceedingly few virtues, sir.
Fellow: (chokes)
An interesting thing... I'm either "The Quiet One" (go figure) or "The Extremely Inappropriate One". The former is usually to avoid the latter when I'm around people that I'm not sure will appreciate it, which to be fair, is most people. This occurred in my surgery rotation, which is the only way I made it through the rotation alive. This confused a friend of mine, because the secretary specifically referred to me as the Quiet One, which sparked "Wha??"
The fellow seems to be around me enough to know I'm secretly a horrible person. He hasn't told anyone at this point, so I think we're cool.
Other heme stuff... we work much closer with clinicians, which is cool in a sense, but sucks in a sense, because it means we have to talk directly with people who talk to our patients and they say stuff like "Awww, that's a shame. This kid's so sweet and is such a fighter", and that personal touch is honestly really deflating. Not in a "grave detriment to my work" way by any means, and I do like giving good news on any front, but surgical pathology is quite hands off when people aren't hounding you for frozen sections, and you can be like "Oooh, weird melanoma!", whereas when you see someone's repeat-after-chemo bone marrow packed with Unspeakable Evil and you have to immediately call the clinician, who at times comes down and looks through the scope with you, there's no real excitement to it. "These stain really weird!!!" just doesn't cut it. The heme/onc people are great though. I suppose you'd have to be.
In other news, my mom's coming down to visit for her birthday, so I get to show off Charleston in a hopefully non-murdery, good food sort of way, which contrasts sharply to her last visit which was to a Motel 6 in the hood where someone immediately got killed outside the freeway exit the night we'd gone to a Denny's for dinner. I seem to attract trouble.
Apr 12, 2012
Attempting to be Southern...
Attending: I'm not going to tell you anything about this patient's history; I'm just going to show you the slide. Tell me what you're seeing.
Me: Sickle cell patient
Attending: What cells are you seeing?
Me: Uh... target cells, fragments, reticulocytes, lots of polychromatic forms, SICKLE CELLS
Attending: What cells are these? (points at sickled cells)
Me: Sickle cells
Colleague: Elliptocytes?
Attending: No, not quite elliptocytes. These are sickle cells.
Me: ...
Attending, to me: See right here, this group? (points with scope arrow), they don't look like typical sickle cells, but that's what they are.
Me, flatly: I know.
(pause)
Me: I mean, yes sir.
Surprisingly, the conversation went perfectly normally after that even as my brain was screaming "I SAID SICKLE CELL LIKE FOUR TIMESSSSS IT'S THE ONLY THING I KNOW ASIDE FROM PROSTATE. ACKNOWLEDGE MY GREATNESSSSSS AAAAHHHHH must have theee PREEECCCCIIIOOUUUSSS"
Yeah, I say sir and ma'am now. I pick up strange idiosyncrasies but without the accent or upbringing to back it up. One of my attendings may well be called "Dr. Bless his heart" because he's so damn nice to everyone all the time. "Bless his heart" is a phrase I *NEVER* used before I moved here, and certainly not said in its original intention, but today, while talking to my mom on the phone, I uttered "And Dr. C, bless his heart, actually ordered in bagels from New York for us."
I blame my former roommate for my calling people "doll", "dollface", "baby", and "babycakes" though. People may think I picked them up here, but they were instilled by an exuberant roommate and a lot of burlesque announcers in New York.
The sir thing is weird though. I've never been a sir person, but now it's just part of how I talk to my attendings. "No sir, I'm pulling the patient's history up right now, I apologize for that sir". Every time I do it, in my head, I sound like Bill from True Blood, which eventually means that by the end of my residency, I'm going to have the voice and accent down. Ishie! Did you check the trends on this guy's urine proteins? Sir, I must regret to inform you that those files remain untouched by my hands. Now, if you'll excuse me, sir, I will escort Miss Stackhouse out of the hospital before she surely incites trouble in these halls. Where is that girl... SOOKIE.
Me: Sickle cell patient
Attending: What cells are you seeing?
Me: Uh... target cells, fragments, reticulocytes, lots of polychromatic forms, SICKLE CELLS
Attending: What cells are these? (points at sickled cells)
Me: Sickle cells
Colleague: Elliptocytes?
Attending: No, not quite elliptocytes. These are sickle cells.
Me: ...
Attending, to me: See right here, this group? (points with scope arrow), they don't look like typical sickle cells, but that's what they are.
Me, flatly: I know.
(pause)
Me: I mean, yes sir.
Surprisingly, the conversation went perfectly normally after that even as my brain was screaming "I SAID SICKLE CELL LIKE FOUR TIMESSSSS IT'S THE ONLY THING I KNOW ASIDE FROM PROSTATE. ACKNOWLEDGE MY GREATNESSSSSS AAAAHHHHH must have theee PREEECCCCIIIOOUUUSSS"
Yeah, I say sir and ma'am now. I pick up strange idiosyncrasies but without the accent or upbringing to back it up. One of my attendings may well be called "Dr. Bless his heart" because he's so damn nice to everyone all the time. "Bless his heart" is a phrase I *NEVER* used before I moved here, and certainly not said in its original intention, but today, while talking to my mom on the phone, I uttered "And Dr. C, bless his heart, actually ordered in bagels from New York for us."
I blame my former roommate for my calling people "doll", "dollface", "baby", and "babycakes" though. People may think I picked them up here, but they were instilled by an exuberant roommate and a lot of burlesque announcers in New York.
The sir thing is weird though. I've never been a sir person, but now it's just part of how I talk to my attendings. "No sir, I'm pulling the patient's history up right now, I apologize for that sir". Every time I do it, in my head, I sound like Bill from True Blood, which eventually means that by the end of my residency, I'm going to have the voice and accent down. Ishie! Did you check the trends on this guy's urine proteins? Sir, I must regret to inform you that those files remain untouched by my hands. Now, if you'll excuse me, sir, I will escort Miss Stackhouse out of the hospital before she surely incites trouble in these halls. Where is that girl... SOOKIE.
Apr 8, 2012
Happy Easter!
Dinner will be courtesy of Trader Joe's. I actually googled to see whether there was a TJ's in Charleston when I was moving here, and was bummed that there wasn't, though there's a Whole Foods, and then a month or two after I moved here, they opened one, which makes me way happier than it should since I can't really afford to shop at Whole Foods until I'm an attending.
I'm not sure why I'm expounding on my favorite grocery store. Because I can, I suppose. Anyway, I had aspirations of baking my own ham (for two people) and all sorts of fanciness, then went to the store, saw they had some cheap awesome looking precooked and figured making potato salad and asparagus is enough cooking for a holiday I really only celebrate to score Cadbury eggs.
Speaking of cooking, I literally can't remember the last time I got take out or fast food. That doesn't mean I'm eating healthy or anything (since I learned how to make cupcakes out of alcohol), but it's a huge financial boon, so I took all that newly uneaten money to buy clothes-that-are-not-scrubs because new month new rotation. Since I don't have creepy crawlies, bowel contents, and blood (weirdly) to contend with, I no longer have an excuse to spend all day in my pajamas. Yes hemepath, a field oddly lacking in fresh blood.
See, I took it from grocery stores back to medicine. I'm a jedi. I'm in hematopathology now, which is a field that's in my "maybe I'll do that when I grow up" box without the financial apocalypse that is forensic pathology, which is also interesting, but does not promise to pay off my loans. Also, I hate courtrooms, and considering I just had to rush out to go shopping due to being in another flavor of path, I definitely don't want a closet full of jury fodder to worry about.
ANYway, I initially developed a crush on hemepath when I did pediatric hematology/oncology as my pediatric elective.
For the uninitiated, hematopathology deals with blood (duh) and has a pretty large focus on leukemias, lymphomas, and hemoglobinopathies (like sickle cell), though the former two much more than the latter. Hemepath is much more diagnostic contrasted to blood bank which deals more with obtaining and matching blood, though I actually like both.
Essentially, in hemepath, someone comes in with a blood problem, and we do science at it until we arrive at an answer. We also evaluate treatment, so if someone's been on chemo for a while and their bone marrow is still packed with evil, that's bad. Other stuff. We mostly look at peripheral blood, bone marrow aspirates, bone marrow biopsies, and lymph nodes if they are suspicious for lymphoma. If there are weird blood cells in other body fluids like cerebrospinal fluid or belly juice (usually cytology's turf), we look at that too.
Blood is tricky, because while it may be kind of obvious about being "BAD" or "probably not bad", the different categories of badness look very similar, and knowing whether you have promyelocytic leukemia versus lymphoblastic leukemia versus etc is extremely important for treatment, so we do all sorts of voodoo to these cells and get way more money allocated to play with them. This is in contrast to autopsy where you do not order special stains EVER. "What kind of cancer did they die of? Fatal cancer. Next case."
I'll take a minute to sideline on a couple perception pet peeves here. Cancer is a fantastically expensive set of diseases. It's not anyone's fault. I'd love to blame drug companies and corrupt doctors and government, but cancers are extremely specific self made little assholes, and it takes thousands of hours of manpower and chemical warfare to get into it. A whole spectrum of specialists needs to find out what it is, where it came from, what broke, and then either a magic bullet for it (there are a couple of cancer types that produce a specifically combined gene product that doesn't normally occur and we can target it and kill the cells that make it, but that's unfortunately not many of them) or the specific combination of horrible chemicals that will target the cancer first. A lot of promise in treatment is coming along the way of the understanding of the genome but things like targeted antibodies and the whole new wave thing is outrageously expensive.
I say this to make two points. One. No one can privately afford this. I'm glad that back in someone's grandpa's day, health care was simple and affordable, but if grandpa's sister got leukemia, she'd have died. Two, anyone that says "Sure, we can _____________, but we can't cure cancer!" needs to shut up. Seriously, anything they have to say after that is irrelevant. Most things that can be murdered with a single inexpensive drug (looking at you, syphilis) have been.
I'll also bring up another point, more as an education thing. Since cancer is *not* one disease, approach to treatment is extremely specialized, so anyone thinking "If I got diagnosed with cancer, I wouldn't go through ______", not a good way to look at it. There are pediatric leukemias that have an 80-90% ten year survival rate. The kids lose all their hair, turn white, look like death, get scary pneumonias where they're on a ventilator and you're absolutely certain they're done, and two years later, boom. Hair back, rallied, good grades in school, no cancer. Breast cancer? Runs everything from "not a big deal" to "death sentence". If you ever get cancer, talk extensively with your doctor, look up articles, etc. Also, don't wait because you don't want to deal with it or you don't have the money. Often the only difference between outpatient surgery and stage four metastatic disease is time. Keep in mind, I am *not* saying cling onto the promise of life by your fingernails in the face of everything or that I should manage your individual situation. Believe me, I have a list of cancers and progressive diseases that are in my "Give up and run up all my credit cards in Thailand" category, but I'll be damned if "breast lump" will be one of them.
And please listen to your doctors once you have a diagnosis. If you don't like yours, get a new one, but absolutely consult people with peer reviewed literature on their side *before* and possibly as an adjunct to the other stuff you try. As far as all natural goes, cancer is all natural, which is why you really have to go unnatural to kill it. Lest you think I'm MD patronizing all of you, my grandfather died because of prostate cancer that remained quite treatable until quite late, thus leaving me at 13 with *no* grandparents (last man standing) so it's a topic I care about.
But soapbox off. Where was I? Oh yes, the battery of heme tests. For the most part, heme feels approachable, memorizable. There are nuances to the cells I'm learning to appreciate on morphology, but a lot of it is memorizing which markers correspond to which cells and which markers are likely to go screwy first when the cells they're sitting on go bad.
Unfortunately, one test they run is flow cytometry. Part of tomorrow is going to be spent trying to make heads or tails of it. It's super duper important, and unfortunately, looks like this:
Yeah. When I encountered flow on my first day, a little avatar-Ishie from college calculus popped up, had a seizure, and dropped dead. Lest you think that little graph up there could be comprehended, most flows are about six-ten pages of that run against different parameters and cluster differentiations. So the heme path fellow is flipping through it realllly quickly considering it's full of math and says something to the effect of:
"Okay, it does look like we're dealing with an M4 type acute myelogenous leukemia."
Noooo... it doesn't look anything like acute myelogenous leukemia. AML looks like this:
Whereas that looks like this:
But I'm going to try to get it, so I can pwn hemepath and show it the love I think it deserves.
In the meantime, as your Easter/Game of Thrones Episode 2 present, here's Joffrey getting slapped.
I'm not sure why I'm expounding on my favorite grocery store. Because I can, I suppose. Anyway, I had aspirations of baking my own ham (for two people) and all sorts of fanciness, then went to the store, saw they had some cheap awesome looking precooked and figured making potato salad and asparagus is enough cooking for a holiday I really only celebrate to score Cadbury eggs.
Speaking of cooking, I literally can't remember the last time I got take out or fast food. That doesn't mean I'm eating healthy or anything (since I learned how to make cupcakes out of alcohol), but it's a huge financial boon, so I took all that newly uneaten money to buy clothes-that-are-not-scrubs because new month new rotation. Since I don't have creepy crawlies, bowel contents, and blood (weirdly) to contend with, I no longer have an excuse to spend all day in my pajamas. Yes hemepath, a field oddly lacking in fresh blood.
See, I took it from grocery stores back to medicine. I'm a jedi. I'm in hematopathology now, which is a field that's in my "maybe I'll do that when I grow up" box without the financial apocalypse that is forensic pathology, which is also interesting, but does not promise to pay off my loans. Also, I hate courtrooms, and considering I just had to rush out to go shopping due to being in another flavor of path, I definitely don't want a closet full of jury fodder to worry about.
ANYway, I initially developed a crush on hemepath when I did pediatric hematology/oncology as my pediatric elective.
For the uninitiated, hematopathology deals with blood (duh) and has a pretty large focus on leukemias, lymphomas, and hemoglobinopathies (like sickle cell), though the former two much more than the latter. Hemepath is much more diagnostic contrasted to blood bank which deals more with obtaining and matching blood, though I actually like both.
Essentially, in hemepath, someone comes in with a blood problem, and we do science at it until we arrive at an answer. We also evaluate treatment, so if someone's been on chemo for a while and their bone marrow is still packed with evil, that's bad. Other stuff. We mostly look at peripheral blood, bone marrow aspirates, bone marrow biopsies, and lymph nodes if they are suspicious for lymphoma. If there are weird blood cells in other body fluids like cerebrospinal fluid or belly juice (usually cytology's turf), we look at that too.
Blood is tricky, because while it may be kind of obvious about being "BAD" or "probably not bad", the different categories of badness look very similar, and knowing whether you have promyelocytic leukemia versus lymphoblastic leukemia versus etc is extremely important for treatment, so we do all sorts of voodoo to these cells and get way more money allocated to play with them. This is in contrast to autopsy where you do not order special stains EVER. "What kind of cancer did they die of? Fatal cancer. Next case."
I'll take a minute to sideline on a couple perception pet peeves here. Cancer is a fantastically expensive set of diseases. It's not anyone's fault. I'd love to blame drug companies and corrupt doctors and government, but cancers are extremely specific self made little assholes, and it takes thousands of hours of manpower and chemical warfare to get into it. A whole spectrum of specialists needs to find out what it is, where it came from, what broke, and then either a magic bullet for it (there are a couple of cancer types that produce a specifically combined gene product that doesn't normally occur and we can target it and kill the cells that make it, but that's unfortunately not many of them) or the specific combination of horrible chemicals that will target the cancer first. A lot of promise in treatment is coming along the way of the understanding of the genome but things like targeted antibodies and the whole new wave thing is outrageously expensive.
I say this to make two points. One. No one can privately afford this. I'm glad that back in someone's grandpa's day, health care was simple and affordable, but if grandpa's sister got leukemia, she'd have died. Two, anyone that says "Sure, we can _____________, but we can't cure cancer!" needs to shut up. Seriously, anything they have to say after that is irrelevant. Most things that can be murdered with a single inexpensive drug (looking at you, syphilis) have been.
I'll also bring up another point, more as an education thing. Since cancer is *not* one disease, approach to treatment is extremely specialized, so anyone thinking "If I got diagnosed with cancer, I wouldn't go through ______", not a good way to look at it. There are pediatric leukemias that have an 80-90% ten year survival rate. The kids lose all their hair, turn white, look like death, get scary pneumonias where they're on a ventilator and you're absolutely certain they're done, and two years later, boom. Hair back, rallied, good grades in school, no cancer. Breast cancer? Runs everything from "not a big deal" to "death sentence". If you ever get cancer, talk extensively with your doctor, look up articles, etc. Also, don't wait because you don't want to deal with it or you don't have the money. Often the only difference between outpatient surgery and stage four metastatic disease is time. Keep in mind, I am *not* saying cling onto the promise of life by your fingernails in the face of everything or that I should manage your individual situation. Believe me, I have a list of cancers and progressive diseases that are in my "Give up and run up all my credit cards in Thailand" category, but I'll be damned if "breast lump" will be one of them.
And please listen to your doctors once you have a diagnosis. If you don't like yours, get a new one, but absolutely consult people with peer reviewed literature on their side *before* and possibly as an adjunct to the other stuff you try. As far as all natural goes, cancer is all natural, which is why you really have to go unnatural to kill it. Lest you think I'm MD patronizing all of you, my grandfather died because of prostate cancer that remained quite treatable until quite late, thus leaving me at 13 with *no* grandparents (last man standing) so it's a topic I care about.
But soapbox off. Where was I? Oh yes, the battery of heme tests. For the most part, heme feels approachable, memorizable. There are nuances to the cells I'm learning to appreciate on morphology, but a lot of it is memorizing which markers correspond to which cells and which markers are likely to go screwy first when the cells they're sitting on go bad.
Unfortunately, one test they run is flow cytometry. Part of tomorrow is going to be spent trying to make heads or tails of it. It's super duper important, and unfortunately, looks like this:
Yeah. When I encountered flow on my first day, a little avatar-Ishie from college calculus popped up, had a seizure, and dropped dead. Lest you think that little graph up there could be comprehended, most flows are about six-ten pages of that run against different parameters and cluster differentiations. So the heme path fellow is flipping through it realllly quickly considering it's full of math and says something to the effect of:
"Okay, it does look like we're dealing with an M4 type acute myelogenous leukemia."
Noooo... it doesn't look anything like acute myelogenous leukemia. AML looks like this:
Whereas that looks like this:
But I'm going to try to get it, so I can pwn hemepath and show it the love I think it deserves.
In the meantime, as your Easter/Game of Thrones Episode 2 present, here's Joffrey getting slapped.
Apr 1, 2012
Wahoooooooooooooo
So what, I have a GME presentation and an abstract due because it's SUNDAY SUNDAY SUNDAY...
It's been what... nine months?? I'm all "Dun dun daddda dum, da dum dum daadda dum."
SO freaking excited. Particularly with True Blood and Dexter both being poor showings this last year, I've needed this.
I am being responsible by not going to see Hunger Games with some of the other first years though. Gotta get some work done.
Addendum: Since I haven't geeked out over this show enough, here's some amazing dude playing the opening against multiple copies of himself.
It's been what... nine months?? I'm all "Dun dun daddda dum, da dum dum daadda dum."
SO freaking excited. Particularly with True Blood and Dexter both being poor showings this last year, I've needed this.
I am being responsible by not going to see Hunger Games with some of the other first years though. Gotta get some work done.
Addendum: Since I haven't geeked out over this show enough, here's some amazing dude playing the opening against multiple copies of himself.
Mar 31, 2012
Surprised by progressive people...
I wear my scrubs home from work a lot because I'm lazy and never sterile anyway. I'm a short female frequently wearing a backpack, so General-Populationville usually thinks I'm a nursing student, which I've stopped really giving half a crap about since it's easier than explaining what I actually do.
The CSI watchers jump to autopsy (Yes, I carry a gun and chase criminals around crime scenes. In heels. I'm badass that way. I also used my kelp knife to fight great white sharks rather than using it to avoid being murdered by algae), and any further explanation of what pathologists do, ie, most of our job, is lost on people.
I would say that etiquette would dictate erring on the side of highest education/deepest loan burden, thus I insist all people noticing my scrubs address me as "You must be the program director of neurosurgery at Johns Hopkins!" else be branded as sexist pigs. On the other hand, I'd note that my hospital is one of the biggest employers in this city, as well as being a medical school, so seeing someone in scrubs should usually prompt people to not guess what you do, since they have as much chance of getting your profession correct as you do seeing someone in a suit.
Still, imagine my surprise:
Rite Aid cashier: "Oh, are you a doctor?"
Me (shocked stutter): "Yes!"
Rite Aid cashier: "Surgeon?"
Me (double shocked stutter for the double un-sexism): "No, uh.. pathologist."
Rite Aid cashier: "Ah! Heh. 'Are the margins clear?? Are the margins clear??' "
Me: "You appear to know more about pathology than most doctors."
It's true too. In med school, I had a frigging anesthesiologist hear my interest and go "Oh, but don't you mostly deal with dead people?" Dude, you're in the OR when they send specimens. You have to sit there and wait for the phone to ring so the operation can proceed. How do you not know what we do?
Then I remember I've been on autopsy for two months and feel like I'm fulfilling some sort of stereotype, like if I'd been caught painting my toenails and watching Fried Green Tomatoes while crying into a kitten's fur and asking a man what he's thinking.
The CSI watchers jump to autopsy (Yes, I carry a gun and chase criminals around crime scenes. In heels. I'm badass that way. I also used my kelp knife to fight great white sharks rather than using it to avoid being murdered by algae), and any further explanation of what pathologists do, ie, most of our job, is lost on people.
I would say that etiquette would dictate erring on the side of highest education/deepest loan burden, thus I insist all people noticing my scrubs address me as "You must be the program director of neurosurgery at Johns Hopkins!" else be branded as sexist pigs. On the other hand, I'd note that my hospital is one of the biggest employers in this city, as well as being a medical school, so seeing someone in scrubs should usually prompt people to not guess what you do, since they have as much chance of getting your profession correct as you do seeing someone in a suit.
Still, imagine my surprise:
Rite Aid cashier: "Oh, are you a doctor?"
Me (shocked stutter): "Yes!"
Rite Aid cashier: "Surgeon?"
Me (double shocked stutter for the double un-sexism): "No, uh.. pathologist."
Rite Aid cashier: "Ah! Heh. 'Are the margins clear?? Are the margins clear??' "
Me: "You appear to know more about pathology than most doctors."
It's true too. In med school, I had a frigging anesthesiologist hear my interest and go "Oh, but don't you mostly deal with dead people?" Dude, you're in the OR when they send specimens. You have to sit there and wait for the phone to ring so the operation can proceed. How do you not know what we do?
Then I remember I've been on autopsy for two months and feel like I'm fulfilling some sort of stereotype, like if I'd been caught painting my toenails and watching Fried Green Tomatoes while crying into a kitten's fur and asking a man what he's thinking.
Mar 29, 2012
And now for something completely different
I had a request for a new blog post today, and responded with something to the effect of "I'm in the middle of trying to get an abstract accepted and everything I'm doing at work right now is confidential", so I came across a colleague's link of facebook which led to a post that really moved me a lot, while also reminding me that I became a pathologist to help with situations like this while not having to directly deal with situations like this:
An Ode to a Patient
There's a bunch of fighting about health care currently, and if I were a truly good politically aware doc, I'd be paying more attention, but honestly, this whole health care legislation/insurance company screwage is so confusing that it's honestly not because we don't care. We don't get it either.
This doesn't really relate to the current bill either. It's just a general observation.
Common situation even as a medical student:
Patient: I have insurance. I have a complaint. Please address my complaint.
Doctor: I am a doctor, thus interested in your complaint. Let me examine you and run tests and get images.
Patient's insurance company: We're going to cover 60% of this and some of this, but this image you ordered we aren't going to cover because... blahblahblahfishcakes. So you're not going to really get paid much, but the patient's general expenses are going to still be life altering, and patient still isn't going to be able to afford the MRI, and if you want the MRI, you're going to have to cough the two grand out of your bank account, since while you can comp your services, you don't own an MRI or an MRI technician, or a radiologist. Addendum, we're adjusting our provider options, so the specialty treatment your patient requires is going to be at a hospital across town. Double addendum. Those lab tests got sent out to a lab that wasn't covered, so the patient's getting charged four hundred dollars she's going to blame you for. Meanwhile, people are just going to keep thinking you're a Mercedes driving golf club swinging douchebag while you drive your used jetta to work and pay off a quarter million in loans, cool?
Doctor: Super.
Patient: Why can't YOU treat me???
Doctor: I genuinely don't know.
An Ode to a Patient
There's a bunch of fighting about health care currently, and if I were a truly good politically aware doc, I'd be paying more attention, but honestly, this whole health care legislation/insurance company screwage is so confusing that it's honestly not because we don't care. We don't get it either.
This doesn't really relate to the current bill either. It's just a general observation.
Common situation even as a medical student:
Patient: I have insurance. I have a complaint. Please address my complaint.
Doctor: I am a doctor, thus interested in your complaint. Let me examine you and run tests and get images.
Patient's insurance company: We're going to cover 60% of this and some of this, but this image you ordered we aren't going to cover because... blahblahblahfishcakes. So you're not going to really get paid much, but the patient's general expenses are going to still be life altering, and patient still isn't going to be able to afford the MRI, and if you want the MRI, you're going to have to cough the two grand out of your bank account, since while you can comp your services, you don't own an MRI or an MRI technician, or a radiologist. Addendum, we're adjusting our provider options, so the specialty treatment your patient requires is going to be at a hospital across town. Double addendum. Those lab tests got sent out to a lab that wasn't covered, so the patient's getting charged four hundred dollars she's going to blame you for. Meanwhile, people are just going to keep thinking you're a Mercedes driving golf club swinging douchebag while you drive your used jetta to work and pay off a quarter million in loans, cool?
Doctor: Super.
Patient: Why can't YOU treat me???
Doctor: I genuinely don't know.
Mar 20, 2012
This is why the boys don't call me
Financial advisor: Is there a time you can talk tomorrow morning?
Me: Uhhh... I don't know yet.
Financial advisor: You don't know?
Me: Well... I'm on autopsy this month, so it kinda depends on.. ya know, who dies.
Financial advisor: "..."
Me: Uhhh... I don't know yet.
Financial advisor: You don't know?
Me: Well... I'm on autopsy this month, so it kinda depends on.. ya know, who dies.
Financial advisor: "..."
Mar 17, 2012
Happy St. Patrick's Day!!
I'm pilgrimming to Savannah tomorrow for what I'm told is an incredible celebration, and most importantly, I made these:
I got the recipe from here which is an adaptation off the Smitten Kitchen.
Pretty much it's an Irish car bomb shot that's been made into a cupcake. More significantly, *I* cooked. Which I can't generally, but I've been on phase 45 of trying to become a grown up at the tender age of 31 and eat something that hasn't come out of the hands of a delivery boy or out of a microwave or through my car's window.
And I get to see New York friends again! Which is super awesome.
Other news:
The fire: I replaced my fabulous alligator head purse which I loved so much and feel a little more complete.
I attended another hearing for the little shit that started all this and this time got to see him, look him in the eye, and tell him what he did. Heard his mother talk about his neighborhood and how he wasn't a bad child even though he's already committed a decent smattering of felonies and misdemeanors without being beaten to death. I love my mom, but somewhere between larceny and assault, I would have concerned myself with finding and recovering tooth fragments rather than progressing to arson. Not that she beat me, because I didn't give her a compelling enough reason to do so, because I knew better. Anyhoo, the next hearing was waved and next step is a trial, so I don't have to worry about it for a while and getting to say "This is what you did" in a court and have people listen to me for a change felt a lot like closure.
I feel comfortably settled into my new life. My roommate's dog is hating me me less. My car is awesome, shuttled me to and from Maryland last weekend without incident, and tempts me every time I shift into first gear to really rev the engines and let it run, but I'm trying to behave myself for the sake of my greatly inflated insurance rates.
Work: Pretty not bad. Autopsy is calming; I like the attendings, and I'm beginning to not feel like a complete idiot. The heart used to panic me since there's a whole process for it and it's usually what kills someone, and now I can teach it to med students so they can cut it shakingly while I watch. I can toss stuff off while I'm dissecting. Here's the conduction system; here's the substantia nigra; what's the significance of it? Why don't you see it in babies? This is a pulmonary embolism. This is a postmortem blood clot. This is how you can tell. Do you remember the liens of Zahn?
I still feel an odd sense of fascination about the snapshot of a person we get from their personal effects. Especially since the police usually take wallet and phone (and guns and such) so no picture, no identification, just.. cough drop wrappers. A crack pipe. A penny. A photo. Fifty dollars and a gap coupon. A handful of tree leaves and branches from where they died. When someone's tried to help, the sequella of events is extremely clear, the laryngeal edema from the endotracheal tube, bruises on the chest, the rib and sternal fractures, the punctures all over from rapid indelicate IV attempts. The battle scars of the good Samaritan.
A word of advice though, which I reserve for myself a lot. It's never as bad as you think it is. Tomorrow will always be better when you've had time to process it. The idea that you're going to "show someone" you're fighting with and teach them a lesson either leads to you hurting someone who cares about you or killing yourself over someone who doesn't. Just sleep on it. The bridge or the gun or the chainsaw or the pills will always be there tomorrow, so why be hasty about it? No one will ever find you? Of course they will. And it won't be as bones or a memory. It'll be bloated and stinking and that's the legacy you'll leave to a room full of people that refer to you by a number. So therapy and some perspective guys; just saying.
I got the recipe from here which is an adaptation off the Smitten Kitchen.
Pretty much it's an Irish car bomb shot that's been made into a cupcake. More significantly, *I* cooked. Which I can't generally, but I've been on phase 45 of trying to become a grown up at the tender age of 31 and eat something that hasn't come out of the hands of a delivery boy or out of a microwave or through my car's window.
And I get to see New York friends again! Which is super awesome.
Other news:
The fire: I replaced my fabulous alligator head purse which I loved so much and feel a little more complete.
I attended another hearing for the little shit that started all this and this time got to see him, look him in the eye, and tell him what he did. Heard his mother talk about his neighborhood and how he wasn't a bad child even though he's already committed a decent smattering of felonies and misdemeanors without being beaten to death. I love my mom, but somewhere between larceny and assault, I would have concerned myself with finding and recovering tooth fragments rather than progressing to arson. Not that she beat me, because I didn't give her a compelling enough reason to do so, because I knew better. Anyhoo, the next hearing was waved and next step is a trial, so I don't have to worry about it for a while and getting to say "This is what you did" in a court and have people listen to me for a change felt a lot like closure.
I feel comfortably settled into my new life. My roommate's dog is hating me me less. My car is awesome, shuttled me to and from Maryland last weekend without incident, and tempts me every time I shift into first gear to really rev the engines and let it run, but I'm trying to behave myself for the sake of my greatly inflated insurance rates.
Work: Pretty not bad. Autopsy is calming; I like the attendings, and I'm beginning to not feel like a complete idiot. The heart used to panic me since there's a whole process for it and it's usually what kills someone, and now I can teach it to med students so they can cut it shakingly while I watch. I can toss stuff off while I'm dissecting. Here's the conduction system; here's the substantia nigra; what's the significance of it? Why don't you see it in babies? This is a pulmonary embolism. This is a postmortem blood clot. This is how you can tell. Do you remember the liens of Zahn?
I still feel an odd sense of fascination about the snapshot of a person we get from their personal effects. Especially since the police usually take wallet and phone (and guns and such) so no picture, no identification, just.. cough drop wrappers. A crack pipe. A penny. A photo. Fifty dollars and a gap coupon. A handful of tree leaves and branches from where they died. When someone's tried to help, the sequella of events is extremely clear, the laryngeal edema from the endotracheal tube, bruises on the chest, the rib and sternal fractures, the punctures all over from rapid indelicate IV attempts. The battle scars of the good Samaritan.
A word of advice though, which I reserve for myself a lot. It's never as bad as you think it is. Tomorrow will always be better when you've had time to process it. The idea that you're going to "show someone" you're fighting with and teach them a lesson either leads to you hurting someone who cares about you or killing yourself over someone who doesn't. Just sleep on it. The bridge or the gun or the chainsaw or the pills will always be there tomorrow, so why be hasty about it? No one will ever find you? Of course they will. And it won't be as bones or a memory. It'll be bloated and stinking and that's the legacy you'll leave to a room full of people that refer to you by a number. So therapy and some perspective guys; just saying.
Mar 1, 2012
My handwriting...
Forensic fellow: "Oh! I've been looking for you. Did you add an addendum on to an older case but crossed out some stuff, because it's a different case number?"
Me: "Uhh... I have the attention span of a goldfish, thus no idea what you're talking about if it doesn't relate to a case I've been doing in the last day."
Forensic fellow: "It's a girl's handwriting."
Me: "Oh, then it's not mine."
Forensic fellow: "Oh, do you write like a boy?"
Me: "I write like someone in the middle of a seizure."
-----------
Follow up: Yeah, I did it. Apparently, my handwriting is 'curvy', thus I write like a girl. I defended myself by saying that I can't write like a girl because I don't dot my i's with little hearts. He wasn't buying it.
Me: "Uhh... I have the attention span of a goldfish, thus no idea what you're talking about if it doesn't relate to a case I've been doing in the last day."
Forensic fellow: "It's a girl's handwriting."
Me: "Oh, then it's not mine."
Forensic fellow: "Oh, do you write like a boy?"
Me: "I write like someone in the middle of a seizure."
-----------
Follow up: Yeah, I did it. Apparently, my handwriting is 'curvy', thus I write like a girl. I defended myself by saying that I can't write like a girl because I don't dot my i's with little hearts. He wasn't buying it.
Feb 18, 2012
More than you wanted to know about autopsies
Hola amigos. Autopsy's been pretty crazy this last week. There's an interesting split in pathology because there's more than one type of autopsy. There are baby autopsies, forensic autopsies, and medical autopsies. The babies tend to involve perinatal circumstances so more to find out why something went down either before birth but after 20 weeks gestation, or right after birth, and hopefully find something to give the parents some idea of how likely it is to happen again.
Forensic autopsies are what everyone things pathologists exclusively do, and also, people think they encompass way less than they do. Essentially, if you don't die in the hospital, you get a forensic autopsy. Homicides, the famous one, but suicides, car accidents, bike accidents, pedestrian accidents, old people found at home, boaters found in rivers, etc. Full spectrum. When you're not the lead on these cases, they're actually less of a pain in the butt then people would expect since mail off labs are the ones that have to do the extremely slow version of all that CSI stuff.
Medical autopsies are the ones that are most important to the residents, and constitute the most paperwork. They give you a benefit over forensic autopsies because you have all the hospital paperwork at your disposal. Unlike most forensic autopsies though, this complicates the course because people in hospitals don't tend to die of really straightforward things. So... what killed this person? Cardiac arrhythmias are a particular headache. If it's not caught on a monitor, we can't demonstrate it happened. An MI will leave evidence (sometimes) but the arrhythmia it triggers? Not so much. We were given a handout describing death not as a loss of structure, but of function, and since we get them after the cease of function, it can be something of a mystery.
An added aspect to medicals is unlike with forensics, unless the forensic has a really medical-ly component to it, is we have to explain it to their clinicians AND families in a write up. This is difficult. Laymen understand why getting crushed by a truck causes death. They do not generally know what an amniotic fluid embolism is, why their mortality rate is so high, why doctors couldn't really do anything about it, and what the mechanism of death is, all without using words like "disseminated intravascular coagulopathy", and I have to explain it without being callous. And cite references.
But it's all good, and ultimately, way less stressful than surgical pathology. My attendings are super cool, and one of them caused me to discover an autopsy scully doll that I didn't know existed, and sparked my long dormant desire (coupled with Slappy mailing me a Scully action figure to replace the one burned by a fire, and yes I am a complete dork) to collect X-Files things. I'm trying to temper it with a more normal grown up habit like buying nice shoes or purses, but damn that stuff is expensive. I feel like a yuppie tool every time I pay 80 bucks for running shoes (worth it) but I saw a pair of Gucci boots that I liked decently online and they were 1100 dollars. Noooooo.
What else... Oh! People have been sending me pictures! See???
My nudibranch from Monterey!
Grenada hash!
The Alps!!!
Soooo awesome. Great to have memories back.
Forensic autopsies are what everyone things pathologists exclusively do, and also, people think they encompass way less than they do. Essentially, if you don't die in the hospital, you get a forensic autopsy. Homicides, the famous one, but suicides, car accidents, bike accidents, pedestrian accidents, old people found at home, boaters found in rivers, etc. Full spectrum. When you're not the lead on these cases, they're actually less of a pain in the butt then people would expect since mail off labs are the ones that have to do the extremely slow version of all that CSI stuff.
Medical autopsies are the ones that are most important to the residents, and constitute the most paperwork. They give you a benefit over forensic autopsies because you have all the hospital paperwork at your disposal. Unlike most forensic autopsies though, this complicates the course because people in hospitals don't tend to die of really straightforward things. So... what killed this person? Cardiac arrhythmias are a particular headache. If it's not caught on a monitor, we can't demonstrate it happened. An MI will leave evidence (sometimes) but the arrhythmia it triggers? Not so much. We were given a handout describing death not as a loss of structure, but of function, and since we get them after the cease of function, it can be something of a mystery.
An added aspect to medicals is unlike with forensics, unless the forensic has a really medical-ly component to it, is we have to explain it to their clinicians AND families in a write up. This is difficult. Laymen understand why getting crushed by a truck causes death. They do not generally know what an amniotic fluid embolism is, why their mortality rate is so high, why doctors couldn't really do anything about it, and what the mechanism of death is, all without using words like "disseminated intravascular coagulopathy", and I have to explain it without being callous. And cite references.
But it's all good, and ultimately, way less stressful than surgical pathology. My attendings are super cool, and one of them caused me to discover an autopsy scully doll that I didn't know existed, and sparked my long dormant desire (coupled with Slappy mailing me a Scully action figure to replace the one burned by a fire, and yes I am a complete dork) to collect X-Files things. I'm trying to temper it with a more normal grown up habit like buying nice shoes or purses, but damn that stuff is expensive. I feel like a yuppie tool every time I pay 80 bucks for running shoes (worth it) but I saw a pair of Gucci boots that I liked decently online and they were 1100 dollars. Noooooo.
What else... Oh! People have been sending me pictures! See???
My nudibranch from Monterey!
Grenada hash!
The Alps!!!
Soooo awesome. Great to have memories back.
Feb 6, 2012
Values
I want to tell you all a story about a dead man and a penny.
We received a man in the autopsy suite. This is in no way uncommon. One of the things we do, part of our list of things to check off as certainly as the weight of the heart and lungs, is to inventory anything we receive. Clothes, money, drugs, all on a checklist.
As we carefully removed the man's pants, we heard a sound, a clank on the floor, and we observed a single penny, the culmination of everything he had, and something we had missed in our initial exam.
"Get it!" my attending said sternly, and I chased the penny around the floor until I had it, detailed its worth on the sheet, and placed it carefully in a bag of personal effects so that the penny could be returned to be distributed as the deceased had seen fit. That penny rightfully belongs to the next of kin. If this man has a will, he can be burned, buried, or shot into space with his penny, and no rational individual would contest it. No moral person would contemplate stealing the penny, nor denying the ownership of said penny.
And I didn't contemplate stealing the penny, nor throwing it away, nor anything else. Because the penny belonged to the dead man.
I'm telling you this story to tell you another story. I received a page from a transcriptionist that lives around the corner from where I used to live. She told me she'd seen bulldozers by my old place. I left work (on time) to try and get access to the building for what must have been the eleventh time, since no one had called me, despite assuring me they would, but when I got there, everything had been reduced to a pile of rubble. The house is functionally gone, and the contents inside are buried under tons of bricks, lumbar, and debris, and what is visible has been crushed into the ground by a large machine.
I stood there in front of this silent but for a few profanities and saw a purple piece of fabric, and pulled, from the side of the lumbar, an intact blouse that was mine that had been untouched by fire, and had not been ruined by the water. It had been on my floor near my bed (I'm messy). Pulling a few nail-ridden boards out of the way, I saw the cane I had when I tore my plantar fascia, broken in half (because a bulldozer drove over it), but with every bit of plastic design on it unburned. This cane (which I didn't use) is notable because it had been leaning against the case of my solid top Takamine guitar, giving me reason to believe that my guitar was fully intact before being crushed under a building. I looked a bit further in and saw the splayed torn remains of a step 2 book.
There were things in there that were mine. That were driven over recklessly with no opportunity for me to access them because of the inconvenience of being on a second floor. Most of those things can be replaced. Many, I'm sure, were fully destroyed by the fire, including my back up drive, which contained all my pictures, and I'd fully come to terms with that. Some things cannot be replaced. They are memories and creations with emotional value. Now that the building has been reduced, anything that belonged to us now freely belongs to whoever risks looting the wreckage, including the owners of the bulldozer that brought it down.
I'd come to terms with the loss. I expected a complete loss after the fire due to seeing the skeleton of the building. I kept asking fire, police, anyone, if I would be allowed to see if I could recover anything, and I was treated like it was a crazy request that inconvenienced everyone, and ultimately, a futile one. My landlord was threatened with fines or imprisonment by the city of Charleston if he did not remove his arson-destroyed building from an area poorly served by police, and the eyesore was removed without much care to the people that lived inside of it.
It is reprehensible to steal from the dead. It is crucial to retain their memories so that their family and friends have items to remember that individual, or if nothing else, so that the individual's wishes can be enacted. And I'm all for that. But the contrast struck me. Why are the memories of the living in turn so valueless?
I apologize for having another dark entry so close to the last, and I am well aware that this is hardly why anyone would read this blog. I'm not wallowing in despair, I'm feeling happy most of the time, I'm moving on with my life, and I enjoyed the hell out of the Giants winning the Superbowl. This has been due *entirely* to help from friends and family, and I can say with certainty, *no* help to anyone representing the city or its offices. Well, the Giants thing more due to the Patriots' inability to catch a pass, but still.
I'm also in autopsy now, which is about half the hours and half the stress of surgical pathology, but is going to cause entries to take a pretty significant turn for the dark, and unfortunately, the still ambiguous. HIPAA applies to dead people too. Autopsy is also, already, giving me a raging case of weird insecurities and half-phobias.
A not case-related example: Back when I was doing a path rotation at Coney Island, I was looking through topics to present and came across vehicle vs pedestrian deaths and being a grisly lass, thought "perfect". Until I came to the chapter about dead people being found by the side of a road or interstate with a cause of death by a single blow to the head and no other injuries. Hypotheses collided... An extremely specific and weird gang initiation in which people leaned out of cars with baseball bats? Coconuts being dropped out of planes?
Or... buses and trucks have large side mirrors so they can visualize their blind spot, and if a stranded motorist is walking a little too close to the road, BAM! And the truck driver or bus driver may never know he hit anything.
"Neat", I thought morbidly. Until the next time a city bus pulled up to the stop and I jumped back like it was made of cockroaches and canned tuna. EVIL DEATH MIRROR.
The brief rule of autopsy is that absolutely everything *can* kill you. Some things like killing you more than others, popularly bullets, rapid decelerations, other cars, and bacon in your coronary arteries, but these are things we should already know to be paranoid about. If someone pulls a gun on me, I'm like "Uh oh, death possible", but thanks to the wonderful world of autopsy, I will eventually feel the same way about bus mirrors, bees, carnival rides, and hammocks.
Oh, and crabs. F- crabs, dude. If PETA had any idea, they'd be like "Animals are our friends. Except crabs. Eat them, wear them, torture them, but seriously... crabs are not your friends. F- crabs. PS, don't wear fur. Here's a picture of Pamela Anderson naked. Love PETA."
We received a man in the autopsy suite. This is in no way uncommon. One of the things we do, part of our list of things to check off as certainly as the weight of the heart and lungs, is to inventory anything we receive. Clothes, money, drugs, all on a checklist.
As we carefully removed the man's pants, we heard a sound, a clank on the floor, and we observed a single penny, the culmination of everything he had, and something we had missed in our initial exam.
"Get it!" my attending said sternly, and I chased the penny around the floor until I had it, detailed its worth on the sheet, and placed it carefully in a bag of personal effects so that the penny could be returned to be distributed as the deceased had seen fit. That penny rightfully belongs to the next of kin. If this man has a will, he can be burned, buried, or shot into space with his penny, and no rational individual would contest it. No moral person would contemplate stealing the penny, nor denying the ownership of said penny.
And I didn't contemplate stealing the penny, nor throwing it away, nor anything else. Because the penny belonged to the dead man.
I'm telling you this story to tell you another story. I received a page from a transcriptionist that lives around the corner from where I used to live. She told me she'd seen bulldozers by my old place. I left work (on time) to try and get access to the building for what must have been the eleventh time, since no one had called me, despite assuring me they would, but when I got there, everything had been reduced to a pile of rubble. The house is functionally gone, and the contents inside are buried under tons of bricks, lumbar, and debris, and what is visible has been crushed into the ground by a large machine.
I stood there in front of this silent but for a few profanities and saw a purple piece of fabric, and pulled, from the side of the lumbar, an intact blouse that was mine that had been untouched by fire, and had not been ruined by the water. It had been on my floor near my bed (I'm messy). Pulling a few nail-ridden boards out of the way, I saw the cane I had when I tore my plantar fascia, broken in half (because a bulldozer drove over it), but with every bit of plastic design on it unburned. This cane (which I didn't use) is notable because it had been leaning against the case of my solid top Takamine guitar, giving me reason to believe that my guitar was fully intact before being crushed under a building. I looked a bit further in and saw the splayed torn remains of a step 2 book.
There were things in there that were mine. That were driven over recklessly with no opportunity for me to access them because of the inconvenience of being on a second floor. Most of those things can be replaced. Many, I'm sure, were fully destroyed by the fire, including my back up drive, which contained all my pictures, and I'd fully come to terms with that. Some things cannot be replaced. They are memories and creations with emotional value. Now that the building has been reduced, anything that belonged to us now freely belongs to whoever risks looting the wreckage, including the owners of the bulldozer that brought it down.
I'd come to terms with the loss. I expected a complete loss after the fire due to seeing the skeleton of the building. I kept asking fire, police, anyone, if I would be allowed to see if I could recover anything, and I was treated like it was a crazy request that inconvenienced everyone, and ultimately, a futile one. My landlord was threatened with fines or imprisonment by the city of Charleston if he did not remove his arson-destroyed building from an area poorly served by police, and the eyesore was removed without much care to the people that lived inside of it.
It is reprehensible to steal from the dead. It is crucial to retain their memories so that their family and friends have items to remember that individual, or if nothing else, so that the individual's wishes can be enacted. And I'm all for that. But the contrast struck me. Why are the memories of the living in turn so valueless?
I apologize for having another dark entry so close to the last, and I am well aware that this is hardly why anyone would read this blog. I'm not wallowing in despair, I'm feeling happy most of the time, I'm moving on with my life, and I enjoyed the hell out of the Giants winning the Superbowl. This has been due *entirely* to help from friends and family, and I can say with certainty, *no* help to anyone representing the city or its offices. Well, the Giants thing more due to the Patriots' inability to catch a pass, but still.
I'm also in autopsy now, which is about half the hours and half the stress of surgical pathology, but is going to cause entries to take a pretty significant turn for the dark, and unfortunately, the still ambiguous. HIPAA applies to dead people too. Autopsy is also, already, giving me a raging case of weird insecurities and half-phobias.
A not case-related example: Back when I was doing a path rotation at Coney Island, I was looking through topics to present and came across vehicle vs pedestrian deaths and being a grisly lass, thought "perfect". Until I came to the chapter about dead people being found by the side of a road or interstate with a cause of death by a single blow to the head and no other injuries. Hypotheses collided... An extremely specific and weird gang initiation in which people leaned out of cars with baseball bats? Coconuts being dropped out of planes?
Or... buses and trucks have large side mirrors so they can visualize their blind spot, and if a stranded motorist is walking a little too close to the road, BAM! And the truck driver or bus driver may never know he hit anything.
"Neat", I thought morbidly. Until the next time a city bus pulled up to the stop and I jumped back like it was made of cockroaches and canned tuna. EVIL DEATH MIRROR.
The brief rule of autopsy is that absolutely everything *can* kill you. Some things like killing you more than others, popularly bullets, rapid decelerations, other cars, and bacon in your coronary arteries, but these are things we should already know to be paranoid about. If someone pulls a gun on me, I'm like "Uh oh, death possible", but thanks to the wonderful world of autopsy, I will eventually feel the same way about bus mirrors, bees, carnival rides, and hammocks.
Oh, and crabs. F- crabs, dude. If PETA had any idea, they'd be like "Animals are our friends. Except crabs. Eat them, wear them, torture them, but seriously... crabs are not your friends. F- crabs. PS, don't wear fur. Here's a picture of Pamela Anderson naked. Love PETA."
Jan 28, 2012
Wow, that was dark
See title. Goodness.
So, sorry about that last one folks. I contemplated deleting it and as I said at the intro to that post, didn't even initially post it, but then left it for the sake of honesty and completeness I suppose?
I asked my mom for her opinion, and it was like, med school/residency is the ups and downs, which is a point for leaving it up. Then I'm like, this is a very specific situation for which it's hard to imagine anyone looking for advice. Grenada's rock fever with study darkness with fulminant breakdown? Sure. That's at least half the student body and everyone that has a medical school related meltdown feels like they're alone in it and everyone else is succeeding. Same with residency. Normal stuff. We laugh about it now at work because we were all in various stages of it without knowing the others were suffering it. Doctors seem to be bred with a specific blend of arrogance and self doubt that starts a spiral of "I'm smart and med school/residency shouldn't be hard. I am struggling. Therefore, I am stupid and everyone around me is smart and ohmigod."
This peculiar blend of impotent rage I feel intermittently in this really specific situation? Not so much relatable. At least I hope not.
But enough of that. Tonight was really really good. We had a mini spontaneous surgical pathology girls' night bitch-a-thon, and it was a bunch of fun with great people that did, I admit, involve some poking fun of surgeons. Lighthearted, I assure you. My mom sent me a hard drive that I got today that has all of my diving pictures and California pictures and the like salvaged so I did not lose those, and that was really incredible. The response of you guys, as I've mentioned, has been fabulous, and it helps me quite a bit. Surgical pathology ends in three working days (but who's counting) and I'm pretty excited about it. While being the bread and butter stuff, it's really work intensive, so it'll be great to have a break working more normal hours. I am getting a lot more of the diagnoses and have a general idea of logic and workflow, which I've mentioned before.
Good stuff. I'm planning a trend of increasingly positive blog posts to follow, but right now, I'm crazy tired. Night all.
So, sorry about that last one folks. I contemplated deleting it and as I said at the intro to that post, didn't even initially post it, but then left it for the sake of honesty and completeness I suppose?
I asked my mom for her opinion, and it was like, med school/residency is the ups and downs, which is a point for leaving it up. Then I'm like, this is a very specific situation for which it's hard to imagine anyone looking for advice. Grenada's rock fever with study darkness with fulminant breakdown? Sure. That's at least half the student body and everyone that has a medical school related meltdown feels like they're alone in it and everyone else is succeeding. Same with residency. Normal stuff. We laugh about it now at work because we were all in various stages of it without knowing the others were suffering it. Doctors seem to be bred with a specific blend of arrogance and self doubt that starts a spiral of "I'm smart and med school/residency shouldn't be hard. I am struggling. Therefore, I am stupid and everyone around me is smart and ohmigod."
This peculiar blend of impotent rage I feel intermittently in this really specific situation? Not so much relatable. At least I hope not.
But enough of that. Tonight was really really good. We had a mini spontaneous surgical pathology girls' night bitch-a-thon, and it was a bunch of fun with great people that did, I admit, involve some poking fun of surgeons. Lighthearted, I assure you. My mom sent me a hard drive that I got today that has all of my diving pictures and California pictures and the like salvaged so I did not lose those, and that was really incredible. The response of you guys, as I've mentioned, has been fabulous, and it helps me quite a bit. Surgical pathology ends in three working days (but who's counting) and I'm pretty excited about it. While being the bread and butter stuff, it's really work intensive, so it'll be great to have a break working more normal hours. I am getting a lot more of the diagnoses and have a general idea of logic and workflow, which I've mentioned before.
Good stuff. I'm planning a trend of increasingly positive blog posts to follow, but right now, I'm crazy tired. Night all.
Jan 27, 2012
Good few days, bad few days
Okay, I wrote this yesterday night when I was in a *really* dark place, so I almost didn't post it, but figured it's honest, so I'd go ahead. I'm feeling better now, I am. It's almost the weekend; people are being nice to me, I pulled doctor-card on a surgeon and John Legend got properly replaced by Nina Simone, but DAMN, was I feeling nasty yesterday, so:
So here's the reverse.
Call it PMS. Call it delayed anger. Call it whatever, I'm feeling it. Maybe I'm just feeling tired, and I'm at the culmination of two months of surgical pathology...
I've been getting really nasty sleep lately, hence the 1 AM post, worse than usual. The week after the fire, it was nightmares and anxiety dreams, and I could pinpoint and be like "Yes, that dream I had where the insurance company repossessed the rental car and yelled at me was likely stress related to this situation" but lately it's just like "Wake up for no reason at 5 AM sucka!"
So I try to wind down again, and I miss lecture AGAIN and I wonder how my eval is going to go with all that crap missing, and I struggle to make it from new home in new car on time to at least get my duties done.
This morning, I got my first speeding ticket since I left for Grenada. My fault, of course. I overslept (again) because I couldn't sleep (again) and was racing to work (again) so I could make sure I was there for frozen sections and I got busted.
The whole where are you going in such a hurry, and I don't even really make eye contact with people or emote anymore because I DON'T CARE, so the second I hit "I'm a doctor and..." I get the instant cop-black-out, the "rich doctor", the "I'm the problem with health care" and nothing else I have to say matters like "my pager is going off" and "I'm in scrubs" and "This car costs less than yours" and "The address on my license is no longer valid because that address burned down" (he asked if my license info was accurate, and when I said 'no, it was burned', he got busy writing down... my old address.
Fine, ticket, whatever. My insurance company needs more money anyway. They just took a 13 thousand dollar loss.
I was following a car most of the way to work (before the ticket) with a bumper sticker that said "God doesn't believe in atheists". I haven't put similarly anti stickers on my car because A... I haven't had a car that's lasted more than 3 months, and B... people who put stickers like that on their cars are assholes and I'm trying not to be an asshole.
Things God believes in in Charleston:
-Shooting a 5 year old in the face
-Burning down three houses and killing a cat
-Letting an arsonist go free for NINE YEARS with dozens of fires
-More unsolved homicides than Dexter has to clean up in Miami
Things God doesn't believe in in Charleston:
-Me
Cool, we've nailed God's priorities. God doesn't have to like me. Lots of people don't like me. God seems to like the Patriots. I'm thinking of putting *that* sticker on my car, but I'm guessing someone would then cause yet *another* insurance hit on it if I did.
This whole asshole thing has been eating at me. When I got my new car, I went asshole mode because I was honestly so livid about having to shop again that I didn't care who I offended, and in doing so, managed to circumvent the type of people that would try to eke an extra two grand out of an arson victim.
It's a weird title to wear. As I left the parking garage today, having had a last minute surgeon dumb of specimens that kept me three hours late, I decided that in lieu of jumping off said parking garage, which crossed my mind, I would put in one song on my iphone... put it on repeat, and BLAST it. just freaking BLAST it.
That song turned out to be Stereo by John Legend. Is it a good song? I don't know. Probably kind of. Do I like it? I don't know. Does it have a really loud obnoxious baseline that you can jar the city with for no other reason than you're an asshole? Yes it does.
So I did that. No "I hope I'm not bothering anyone" or that crap, just one song, on repeat, for 25 minutes. Loud enough to hurt. Loud enough for people at home to have a brief moment of irritation and rage and assume that I'm a 16 year old ethnic kid outside, and I can say "I'm causing that feeling in you because now I'm the one with power and you're not, and I'm tired of being nice".
Amazing, that is. There's a truly almost zen moment where you can look at everyone else and go "Hmmm... nope, don't care".
That seems to lead to enlightenment or flipping out. I'm not sure which path I'm on
Our landlord is being fined by the city to tear down his eyesore. No one has contacted us. No one seems the least bit curious as to why we'd want to see if we had anything left. I found out our landlord is trying to tear it down by hand because of our local yellow journal. People are in the comments section saying "Just bulldoze it!!!" That's OUR STUFF, motherfuckers, why don't you go bulldoze your pets? Why don't you go bulldoze your face. John Legend in your house, how's that? Like the bassline on that?
It's just stuff! It's OUR stuff. Clothes and pictures and memories and niceties and handiness and long nights talking and playing Mario Kart stuff! Just stuff. Not just their stuff.
Did you have renter's insurance? NO. I did not have renter's insurance, so fuck me. This is the first question, which they might as well rephrase into "Is this your fault?
Wow, that sucks, well your parents' homeowners...
WHAT DID I JUST SAY?
"Mmep. Oh"
People are being different levels of helpful. There's pure help: "Hi, here's a hug/check/gift card. I'm sorry this happened. See ya" There's the Monday morning quarterbackers.. Gods are there... why didn't you get insurance? Why didn't you put your external hard drive in a safety deposit box? Why did you live in the ghetto? Why were you speeding? Why didn't you set your alarm sooner??
That voice already lives in my head. It's called "Crippling self doubt" and it's an old war buddy of mine that likes to sleep on the fold out. Crippling self doubt doesn't need your help. We go WAY back. Crippling self doubt has been with me from the start, and you have no hopes of taking his place, so you might as well just put yourself on Team Supportive and stop giving me advice that isn't advice. "You should have" isn't advice. It's superiority seeking.
I'm half contemplating hulking out at my court date, since now the arsonist and I both get one, but I don't want to go to jail because my toilet wine always lacks complexity but there's a huge part of me that says "Everything in my life has turned to shit since I moved to your town. Transport me somewhere safer, like back to Brooklyn."
But that's that, I suppose.
So here's the reverse.
Call it PMS. Call it delayed anger. Call it whatever, I'm feeling it. Maybe I'm just feeling tired, and I'm at the culmination of two months of surgical pathology...
I've been getting really nasty sleep lately, hence the 1 AM post, worse than usual. The week after the fire, it was nightmares and anxiety dreams, and I could pinpoint and be like "Yes, that dream I had where the insurance company repossessed the rental car and yelled at me was likely stress related to this situation" but lately it's just like "Wake up for no reason at 5 AM sucka!"
So I try to wind down again, and I miss lecture AGAIN and I wonder how my eval is going to go with all that crap missing, and I struggle to make it from new home in new car on time to at least get my duties done.
This morning, I got my first speeding ticket since I left for Grenada. My fault, of course. I overslept (again) because I couldn't sleep (again) and was racing to work (again) so I could make sure I was there for frozen sections and I got busted.
The whole where are you going in such a hurry, and I don't even really make eye contact with people or emote anymore because I DON'T CARE, so the second I hit "I'm a doctor and..." I get the instant cop-black-out, the "rich doctor", the "I'm the problem with health care" and nothing else I have to say matters like "my pager is going off" and "I'm in scrubs" and "This car costs less than yours" and "The address on my license is no longer valid because that address burned down" (he asked if my license info was accurate, and when I said 'no, it was burned', he got busy writing down... my old address.
Fine, ticket, whatever. My insurance company needs more money anyway. They just took a 13 thousand dollar loss.
I was following a car most of the way to work (before the ticket) with a bumper sticker that said "God doesn't believe in atheists". I haven't put similarly anti stickers on my car because A... I haven't had a car that's lasted more than 3 months, and B... people who put stickers like that on their cars are assholes and I'm trying not to be an asshole.
Things God believes in in Charleston:
-Shooting a 5 year old in the face
-Burning down three houses and killing a cat
-Letting an arsonist go free for NINE YEARS with dozens of fires
-More unsolved homicides than Dexter has to clean up in Miami
Things God doesn't believe in in Charleston:
-Me
Cool, we've nailed God's priorities. God doesn't have to like me. Lots of people don't like me. God seems to like the Patriots. I'm thinking of putting *that* sticker on my car, but I'm guessing someone would then cause yet *another* insurance hit on it if I did.
This whole asshole thing has been eating at me. When I got my new car, I went asshole mode because I was honestly so livid about having to shop again that I didn't care who I offended, and in doing so, managed to circumvent the type of people that would try to eke an extra two grand out of an arson victim.
It's a weird title to wear. As I left the parking garage today, having had a last minute surgeon dumb of specimens that kept me three hours late, I decided that in lieu of jumping off said parking garage, which crossed my mind, I would put in one song on my iphone... put it on repeat, and BLAST it. just freaking BLAST it.
That song turned out to be Stereo by John Legend. Is it a good song? I don't know. Probably kind of. Do I like it? I don't know. Does it have a really loud obnoxious baseline that you can jar the city with for no other reason than you're an asshole? Yes it does.
So I did that. No "I hope I'm not bothering anyone" or that crap, just one song, on repeat, for 25 minutes. Loud enough to hurt. Loud enough for people at home to have a brief moment of irritation and rage and assume that I'm a 16 year old ethnic kid outside, and I can say "I'm causing that feeling in you because now I'm the one with power and you're not, and I'm tired of being nice".
Amazing, that is. There's a truly almost zen moment where you can look at everyone else and go "Hmmm... nope, don't care".
That seems to lead to enlightenment or flipping out. I'm not sure which path I'm on
Our landlord is being fined by the city to tear down his eyesore. No one has contacted us. No one seems the least bit curious as to why we'd want to see if we had anything left. I found out our landlord is trying to tear it down by hand because of our local yellow journal. People are in the comments section saying "Just bulldoze it!!!" That's OUR STUFF, motherfuckers, why don't you go bulldoze your pets? Why don't you go bulldoze your face. John Legend in your house, how's that? Like the bassline on that?
It's just stuff! It's OUR stuff. Clothes and pictures and memories and niceties and handiness and long nights talking and playing Mario Kart stuff! Just stuff. Not just their stuff.
Did you have renter's insurance? NO. I did not have renter's insurance, so fuck me. This is the first question, which they might as well rephrase into "Is this your fault?
Wow, that sucks, well your parents' homeowners...
WHAT DID I JUST SAY?
"Mmep. Oh"
People are being different levels of helpful. There's pure help: "Hi, here's a hug/check/gift card. I'm sorry this happened. See ya" There's the Monday morning quarterbackers.. Gods are there... why didn't you get insurance? Why didn't you put your external hard drive in a safety deposit box? Why did you live in the ghetto? Why were you speeding? Why didn't you set your alarm sooner??
That voice already lives in my head. It's called "Crippling self doubt" and it's an old war buddy of mine that likes to sleep on the fold out. Crippling self doubt doesn't need your help. We go WAY back. Crippling self doubt has been with me from the start, and you have no hopes of taking his place, so you might as well just put yourself on Team Supportive and stop giving me advice that isn't advice. "You should have" isn't advice. It's superiority seeking.
I'm half contemplating hulking out at my court date, since now the arsonist and I both get one, but I don't want to go to jail because my toilet wine always lacks complexity but there's a huge part of me that says "Everything in my life has turned to shit since I moved to your town. Transport me somewhere safer, like back to Brooklyn."
But that's that, I suppose.
Jan 17, 2012
A good few days
I'm kind of cautious about characterizing my days, because there are some spectacularly good ones to spectacularly bad ones and it's not always easy to tell which they are.
This weekend, new Roomie made chili qualified as "f'ing amazing". I got my Xbox, which was my "thank goodness this was belated" Christmas gift, so we set up with work friends and played Just Dance 3 for an embarrassingly long time. Which was awesome. Last night, Rock Star contacted me to see if I wanted one of his guitars since my beloved Takamine solid top got turned into firewood, so I met him downtown for tea and now I have a guitar so I can start work on the "Ratboy blew up my economy car" blues. It's gonna have four chords, all of which are 7s, and start with "I woke up this morning". Wait for it to show up on Pandora soon.
I've been putting off and rehashing an HLA presentation for about two months now. Pathology is difficult and studious and such. Blood bank is confusing, immediately consequential, and has a lot of letters and numbers. HLA beats up blood bank every day and hangs it on a locker by its underwear.
So I had a five minute presentation that was killing me. I did a first version of it about a month ago, which was extraordinarily bad, and I didn't know any of the case details. I got last minute belled out of doing it, and then was hacking some stuff together (which also sucked) which then got burned up by the fire. This last one I did on an extended weekend sleep deprivathon that was more my MO in college.
Unless my colleagues are being really forgiving, which is likely, it didn't suck. Despite my rambling it on 4 hours of sleep. So then I had sign out, but my attending got detained at the main hospital for over an hour and I didn't have many cases anyway...
So I propped up a chair to put my legs on in the sign out room and threw my sweater over my face. The accessioner pops her head in at some point where I'm halfway to Edward Norton's house, and I startle up a bit and act... I dunno, normal?
Her comment? "You know these lights have a dimmer switch?" and dims them.
Guys, that is as close to authorized naptime as you can get without having a yoga mat on the floor.
So nap at work. Frigging awesome. And almost no real work to do in the afternoon so I could get caught up on my other stuff. It's going to get me back tomorrow though. I'm getting all the breast cases in the land.
What else... music at work is interesting because a lot of us listen to music while we're grossing because we can. I'm included in that. It gets weird when we need an attending to come help orient a specimen, but we don't turn the music off because I am not laying a greasy Hep C liver covered finger on my precious iPhone.
Leading to this:
Attending: Okay... the stitch is here, so... this.. yes, this is anterior
Shirley Manson: I'm waiting... I'm waiting.... I'm waiting
Attending: So if we whip this around like this, I'm thinking this is the uncinate process
Shirley Manson: I'm waiiiiiiiting. I'm waiiiting.
Attending: And we can dissect the pancreatic duct from this axis.
Shirley Manson: I'm waiiiiiiiiiiiiiting
Attending: She's waiting.
Greasy finger exceptions are for F*** You, White America, and ANYTHING by Tenacious D. Jack Black is killing me. An hour of Pearl Jam goes by but the second I need an attending, I start to hear the beginning of "Ya don't always haveta f*** her hard..." and I'm going "Excuse me! Hold on... gloves off... fast forward!" "What was that?" "Nothing!"
I do really like my new car guys. It's all RRRRRRRRRrrrrrrrrRRREEEEEEEEE when I take off in traffic.
This weekend, new Roomie made chili qualified as "f'ing amazing". I got my Xbox, which was my "thank goodness this was belated" Christmas gift, so we set up with work friends and played Just Dance 3 for an embarrassingly long time. Which was awesome. Last night, Rock Star contacted me to see if I wanted one of his guitars since my beloved Takamine solid top got turned into firewood, so I met him downtown for tea and now I have a guitar so I can start work on the "Ratboy blew up my economy car" blues. It's gonna have four chords, all of which are 7s, and start with "I woke up this morning". Wait for it to show up on Pandora soon.
I've been putting off and rehashing an HLA presentation for about two months now. Pathology is difficult and studious and such. Blood bank is confusing, immediately consequential, and has a lot of letters and numbers. HLA beats up blood bank every day and hangs it on a locker by its underwear.
So I had a five minute presentation that was killing me. I did a first version of it about a month ago, which was extraordinarily bad, and I didn't know any of the case details. I got last minute belled out of doing it, and then was hacking some stuff together (which also sucked) which then got burned up by the fire. This last one I did on an extended weekend sleep deprivathon that was more my MO in college.
Unless my colleagues are being really forgiving, which is likely, it didn't suck. Despite my rambling it on 4 hours of sleep. So then I had sign out, but my attending got detained at the main hospital for over an hour and I didn't have many cases anyway...
So I propped up a chair to put my legs on in the sign out room and threw my sweater over my face. The accessioner pops her head in at some point where I'm halfway to Edward Norton's house, and I startle up a bit and act... I dunno, normal?
Her comment? "You know these lights have a dimmer switch?" and dims them.
Guys, that is as close to authorized naptime as you can get without having a yoga mat on the floor.
So nap at work. Frigging awesome. And almost no real work to do in the afternoon so I could get caught up on my other stuff. It's going to get me back tomorrow though. I'm getting all the breast cases in the land.
What else... music at work is interesting because a lot of us listen to music while we're grossing because we can. I'm included in that. It gets weird when we need an attending to come help orient a specimen, but we don't turn the music off because I am not laying a greasy Hep C liver covered finger on my precious iPhone.
Leading to this:
Attending: Okay... the stitch is here, so... this.. yes, this is anterior
Shirley Manson: I'm waiting... I'm waiting.... I'm waiting
Attending: So if we whip this around like this, I'm thinking this is the uncinate process
Shirley Manson: I'm waiiiiiiiting. I'm waiiiting.
Attending: And we can dissect the pancreatic duct from this axis.
Shirley Manson: I'm waiiiiiiiiiiiiiting
Attending: She's waiting.
Greasy finger exceptions are for F*** You, White America, and ANYTHING by Tenacious D. Jack Black is killing me. An hour of Pearl Jam goes by but the second I need an attending, I start to hear the beginning of "Ya don't always haveta f*** her hard..." and I'm going "Excuse me! Hold on... gloves off... fast forward!" "What was that?" "Nothing!"
I do really like my new car guys. It's all RRRRRRRRRrrrrrrrrRRREEEEEEEEE when I take off in traffic.
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