What with Halloween mere days away, I thought it would be fun to dig up a little more horror history in the medical world. If you recall, In medical ghosties and ghoulies, I talked about the medical basis of the vampire and werewolf myths.

But it's not always the fictional monsters that can be the scariest. Before 1832 there were not enough cadavers legitimately available for the study and teaching of anatomy in medical schools. The university of Edinburgh in scotland was renowned for sciences, as a result of the fact that they had access to the only legal supply of cadavers at the time, which came from executed criminals.

Of course, with law reform being what it was in the early 19th century, the number of executable offenses had begun to drop, thus lessening the supply of cadavers to only about 2 or 3 corpses per year for the entire university. As a means of comparison, my medical school offered up roughly 1 cadaver for every 6 people, all of which graciously donated their bodies to science.

This sudden demand (WONT SOMEBODY THINK OF THE MED STUDENTS!) attracted criminal elements who were willing to obtain "specimens" by any means. They came to be called resurrectionests, or body snatchers

Two of the more famous were burke and hare, low class gentleman who happened to bring a deceased tenant from their lodging house to a local surgeon for cash instead of burying him. This proved so profitable that burke and hare proceeded to kill off several other tenants, inventing or at least popularizing their method so much it later led to the rise of the word "burking" meaning to purposefully smother and compress the chest of a victim

This carried on for 17 more deaths until the two were finally found out when Knox, the surgeon buying the bodies and his students recognized one of the victims. It can be summed up in this jaunty little song
The ultimate result was the passage of the anatomy act of 1832, which expanded the venues from which med schools could obtain cadavers to unclaimed bodies, or allowed donation by the next of kin if in exchange for a decent burial

So the moral of the story is, too many murders for medicine in the past is the reason people are allowed to donate their body to science today!

Happy Halloween!

-on a side note, please check out my new food related blog, Chef M.D., located at http://chef-md.blogspot.com/

While on my way to noon conference today one of the med students stopped me and asked me how I liked the program. I told him truthfully, I was very happy with it. Then he asked if there was anything I didnt like about my residency program.

And I had to stop and think about it. I remember not so long ago when I was in the exact same position on the interview trail, questioning every resident I could find about hidden flaws, what the program directors werent telling you. It was almost cute to be so interrogated.

So I wanted to give him an honest answer. I thought long and hard, and at the end of it, I honestly couldnt come up with anything. There are certainly things I dont think are perfect, but they are the same things I would be complaining about in any program. As things go I have it pretty good. No overnight call, a q6-7 call schedule on wards, great coworkers, attendings who are enthusiastic about teaching, a prompt and efficient ancillary staff, the list goes on. Nothing overtly bad or unpleasant really came to mind.

I told him so, and then I smiled to myself. It was nice to rrealize that I picked the right program for me.

After all, the man who is truly happy is the one who smiles when there is no one else around to see

Sometimes I ask myself, "is there anything, that someone, somewhere WONT put into their ass"

And thankfully for comedians everywhere, the answer is always a firm resounding NO.

marriedtothesea.com

What all my patients are really thinking...

Residency is hard work. There's a lot to keep track of, whether it is patient care issues, studying for licensing exams, or just wondering about my overall performance and what the other residents/interns think of me. Am I the intern that has the horrible notes? or the one who everyone is glad to have on their team? I know the medication i need to prescribe, but what is the proper dosage and why does everyone but me know it? WHY DOES THE PAGER KEEP GOING OFF?

So with the minute little stresses throughout the day, it's important to find ways to keep myself grounded in reality. Or at least my reality. So what helps me get through those stressful days?

--Taking the stairs from the 6th to 7th floor and pausing to look at the hollywood sign through the glass wall

--shouting "wheee" and throwing my hands up as i enter the steep highway ramp on my way home from work

--wandering the halls of the hospital humming whitesnake when nobody's looking (and journey when they are)

--checking off boxes on my to do list for patients

what helps keep YOU sane?

I have been neglecting those of you who still come here, I know. I also know that this meta-regretting is a typical way for me to start posts lately. So by way of brief apology, let me just say I do miss those of you who i have virtual conversations with, and I will make more of an effort to at least comment, if not post more on my own.

That said, I finally began service on the wards today! Yes, my 2 months of night float are over, and now I am back to a more classical residency block...admitting patients, rounding on them, and treating them until they get better, get transferred, or get dead. Ideally less of the latter.

Now I am a fairly proactive person, so when the resident was handing out patient assignments I volunteered for the liver patient. Liver patients tend to be complicated, as since the liver metabolizes most drugs and produced the majority of clotting factors and proteins, pts with defunct livers have a ridiculous amount of things they cannot be prescribed or have to be monitored closely to prevent multitudinous complications.

One of these complications is known as Ascites. It is basically a fluid buildup in the abdomen due to loss of proteins by the liver. But while i could get technical all day, lets consult Dr Google for a picture, shall we?

The main way to treat an ascites that has gotten this bad is to drain it. That's right, just stick a needle in and deflate the belly by draining all the liquid into vacumn sealed liter bottles. Did I mention the yellowish ascitic fluid can occasionally be reminiscent of beer

That's right, my first day on wards and i was setting up my own microbrewery!

So cheers to my first completed procedure of the year! Anyone want a stella?

An orca fat patient (BMI 40) came in for diabetes and sleep apnea. As part of the social history, she mentioned she loves disney, especially the little mermaid. During which the following song would not leave my head (to the tune of part of your world)

Look at my fat
Isn't it neat?
Wouldn't you think my belly's complete?
And wouldn't you think I'm the blob, the blob who ate...
Everything?

Look at my rolls, how many's untold?
How much jelly can one belly hold?
Lookin' around here you'd think
Sure
She's eaten, everything

*(yes, inner me is horribly insensitive. often outer me too in non professional settings: deal with it)
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Then 18 year old male patient who could, perhaps, be a bit more worldly
Dr J: Have you had any unusual discharge from the penis, or any burning when you urinate?
Pt: "I have a white discharge, but only when I'm excited."

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and from one of my nursing friends...

Gentleman comes into ER with 3y/o child w/ c/o fever. i go into the room to do a rectal temp. father pulls down the pull-up and i go to it. the child screams "no, not in the butt!!" the father replies " yeah, you and your mother both" ...