GomerBlog is introducing a new section titled, “Ask a Doctor Anything.” This is where to find all the great advice you’ve been looking for, but been afraid to ask. Thank you all for your questions and we know you’ll love the answers. We will start by asking a surgical intern. Let’s begin!
Dear Surgical Intern,
I’m kind of embarrassed about this, but I’ve been having this tugging sensation down in my groin. It started after I was lifting something heavy, and I kind of heard a pop. Do you think I have a hernia?
– Bulging in Buffalo
Dear Bulging,
Listen, Bulging, I have to speak with my 3rd year medical students for a second. Guys, look. I know you’re 3rd year students and all, but there are like 2 things for you to do. One, don’t kill anyone. Two, update the list. There’s no diagnosis on half these people. You’ve got this patient listed as in room 7402. There is no unit 7400. Brad, I swear if you put ‘hypocreatinemia – replace creatinine’ under the assessment and plan again I’m going to slap you. Kevin, parathyroid hormone doesn’t come from the posterior hypothalamus. It comes from the parathyroid. Jen, abdomens are not ‘clear to auscultation bilaterally.’ When you present it like that to an attending, after I TOLD you not to, you kill me. On the inside.
Dear Surgical Intern,
I have this stomach pain that kind of comes and goes. It like starts on my right side, but then it moved to the left. And I got all hot the other day, could that mean something? It’s weird, like, when I stand on the left foot, it makes the pain worse. Do I need an MRI?
– Concerned in Kansas
Dear Concerned,
Yeah, this is acute care surgery, I was paged? Thanks. Consult? Okay, name? Medical record number? Okay. Yeah. Okay. How long? What’s the CT show? What’d the labs show? You’re joking me right now, right? You’re getting a surgery consult, because you pressed on his belly, and he was in pain? You have no CT, no labs, no NOTHING, and you’re getting a surgery consult because his belly hurt and you want to rule out acute abdomen that’s been going on for 3 months? Do you at least have the results from a KUB? No? Of course not. Hold on, let me pull up the CT and look at it. This isn’t really showing anythin….wait, did you order a non-contrast CT? You ordered a NON-CONTRAST CT on a patient with NORMAL CREATININE?! What you’re saying sounds like you’re joking, but your tone says you’re serious. Maybe we should do a non-CT contrast study for further evaluation. Please don’t order that, I can’t tell if you’re going to. Fine, yeah, I’ll come see him. I hate you.
Dear Surgical Intern,
I’ve had this bump on the outside of my arm that keeps getting a little bigger in size. I was reading online that it could be a lipoma? Can you guys take it out?
– Lumpy in LA
Dear Lumpy,
Hey, Humpty Lumpty. Oh one second. Is this 7200? Yeah, nurse for room 3, please. Yeah, hi, it’s Mark with general surgery. Yes, I’m aware she says she’s in horrible pain. What’s she doing? Eating pudding and watching tv, huh? Is that her laughing at the TV in the background? Nice. Yes, I’m aware she says that Dilaudid is the only thing that takes her pain away. She’s on a PCA already. No, I’m not going to give more. Because. Sure, whatever, Robaxin 750 milligrams q8. No, I don’t need to come evaluate her because she has pain all over.
No.
No.
No.
No. Ahhhhhhhhhhhhhhhh. Fine. I’ll come see her.
Be sure to send in more of your sensitive medical questions and surgical interns will take care of you!
Need some more advice?
– Ask a 4th-Year Med Student (Who’s Checked out for the Year)
– Ask a Hospitalist
– Ask a July 1st Medicine Intern
– Ask a Surgical Intern, Part 2
Please send it to us via email or the ‘contact us’ form http://gomerblog.com/contact-us-2/
May I send you a digital copy of my novel, Reluctant Intern, to read and possibly
review on your blog?
Description:
Addison Wolfe never wanted to be a
physician. He wants to be an astronaut. NASA turned down his application,
forcing him to seek employment as a doctor. The problem with obtaining a
physician’s license is the need to complete an internship to acquire one. Wolfe
finds himself in an undesirable rotating internship in a very busy public
hospital. Inexplicably, the Director of Medical Education seems to have developed
an instantaneous dislike of him and the remainder of the internship class. Another
mystery is why an attractive female physician expresses a romantic interest in
him on the first day of internship.
“The absolute worst time to go to a
teaching hospital as a patient is the month of July. Recent medical school
graduates, known as doctors, start their real training on July first. They
don’t know anything. They don’t get any sleep. They are underpaid and
overworked. Their stress is at catastrophic levels. Is it any wonder they make
mistakes?”
– Anonymous
“In local news today,” the reporter
said, “state and federal authorities are in the process of taking into custody
the entire intern class at University
Hospital in Jacksonville.
Officials cited the number of deaths attributed to this class as the reason. It
seems that wrong doses of medications, inappropriate surgeries, failure to
diagnose lethal conditions, and other mistakes have led to hundreds of
deaths….”
“The overdose?” Wolfe asked.
“Yes,” Dr. Rubel replied, “that
will be her legal cause of death, of course. The real cause of death was the
autopsy. Barbiturate overdose, followed by refrigeration outside and then here
in pathology, slowed her metabolism down. She was actually alive when they
started the autopsy. The flexing of her limbs when the saw touched her brain
happened because of nerve conduction, brain to extremities. But it was too
late; we cannot put her back together. A hard lesson for those poor boys to
learn. You, too, gentlemen. It is also true for those who are clinically dead
from exposure or drowning. Remember this: a patient is never dead until he is
warm and dead. Don’t forget that!”
The senior resident started his
description, “EMS
responded to a report of a cardiac arrest at 1:07
a.m. in Junior’s Topless Bar, on East Bay
Street….”
Figueroa again jumped to his feet.
“What is this, a bad joke?” he asked. “Two EMTs walk into a bar…. Let’s be
reasonable, guys. The most likely reason for needing a paramedic in a bar at 1 a.m. is a knifing or a gun shot wound, not a
heart attack.”
The autopsy and x-rays were
condemning. The thirty-nine year old, black male had no history of heart
disease. No medical history of any kind. He did have a bullet entrance wound to
the back of his head with no exit, bullet still in his brain.
The patient was a massively obese
woman who complained of a headache. The intern knew only that she was
complaining of a headache and had requested aspirin. Extremely busy, and
assuming the nurse would let him know if it were not a good idea to give the
patient aspirin, he quickly flipped to the order page and signed the order that
had been written by the nurse. Figueroa asked the intern if he had talked with
the patient. No. Had he examined the patient? No. Had he even skimmed the
chart? He had not. He asked if he knew what allergies the patient had. The
intern did not know. At the time he approved the order for aspirin, did he
realize the patient was on warfarin, another clotting inhibitor? No. Did he
know that aspirin also inhibited platelets and clot formation? Yes. Did he know
the patient had a history of blood clots? No. Did he suppose that a blood clot
in someone’s brain, or a ruptured berry aneurysm in the same area might cause
headaches? Yes, he knew that. The autopsy pictures revealed stenosed carotid
arteries, two small clots in the patient’s brain, and massive bleeding from a
ruptured berry aneurysm.
Haha consult medicine for the H&P!
Sounds like a great segway into “Ask a Medical Intern”
Maybe the dude who prematurely ordered the surgery consult was wanting to pay back the surgeons who like to order medical consults without even looking at the patient’s chart. Lol.
This is far too accurate…
Love it!
Love it
Lol! Is it weird that I actually miss working with surgery interns? Bless their little hearts…