Rants from the Crib

An Ob/Gyn gone mad

Archive for the month “January, 2014”

Take Your Vitamins

Most of you are familiar, I believe, with the concept of vitamins. They are compounds that are essential (or at least damn useful) to the physical well-being and development of the organism taking them. Many of us take vitamins. Some take them religiously. They have been seen as possible cure-alls for almost everything. My husband superstitiously takes magadoses of Vitamin C whenever he feels like he is getting sick, which I think is a crock, but it probably won’t hurt him. The problem is, when I feel like I might be getting sick, he tries to foist them upon me too, and he becomes indignant when I refuse to take them. My dad, in the past, has dabbled with mega-doses of various vitamins and minerals. Usually when you take hyperdoses of vitamins, your body takes out what it needs, and dumps the rest into the toilet, wasting your investment

I will stand on my Doctor Soapbox for a moment, and remind my gentle readers that it is actually dangerous to take excessive doses of the ADEK vitamins (a mnemnotic for vitamins A, D, E, and K), which are the fat soluble vitamins, and they can actually hurt you in excess. It has been discovered that Vitamin E, taken in dosages higher than recommended, can cause heart problems.

Among other things, excessive vitamin A can cause birth defects in a fetus who is conceived when Mom is on megadoses. The acne medicine Accutane is actually a form of extremely high-dose Vitamin A, and they medically recommend abortion if you become pregnant while taking it – it often results in babies born without brains, which, needless to say, is an extremely undesirable outcome. Physicians are required not to prescribe Accutane for a female of childbearing age unless it is verified that she is on a reliable form of birth control. Accutane has been linked to suicide in some users. I don’t like Accutane. It is nasty stuff.

Then there are “medical vitamins”. These are not actually vitamins, but are very useful medications. Anything we medical types jokingly call “Vitamin” is usually a drug that gives immediate results, typically for a patient who is anxious, in need of immediate intervention, or a pain in the ass.

Vitamin K is a good one. There is an anesthetic drug out there called ketamine. Some of you may know of it. It was initially used as a veterinary anesthetic, because when they tested it on humans, it caused pretty intense hallucinations. It is seeing more widespread use now in people. My specialty uses it frequently to boost pain control in an awake patient who is having some discomfort during her c-section with a poorly functioning epidural. This results in the patient saying some pretty darn amusing things. I was actually given it during my c-section, because I had a hot spot in my epidural and was in a lot of pain. I watched the anesthesiologist squeeze something into my IV really fast and then I was out. When I awoke a few minutes later, the pain was gone, but all I could see were blue brains. Fortunately, I am not easily rattled and pretty much realized they had just dosed me with ketamine. The blue brains turned into blue triangles, and then I realized it was just the blue surgical drape that was placed over me. I couldn’t remember what I was doing for a minute. “Oh,” I thought, “I’m having a baby. Is it a normal delivery? No. It’s a c-section. What’s a c-section?” We also use it to quickly sedate uncooperative patients who need to undergo anesthesia. We hit them with something called a ketamine dart, usually in a sneak attack on the shoulder. Most typically this is used for patients who are unable to understand or cooperate, or who may be outright combative. I have a fairly large group of patients in a state facility who need annual pelvic and breast exams, but they may be violent or scared and unable to be awake for them. They are brought in, given a ketamine dart, and then their IV is placed after they are asleep. In one particularly funny episode, we were sedating a large and dangerous mentally handicapped female patient who struck fear and respect into everyone she came into contact with. She is missing one eye, and legend has it that she is so mean, she removed it herself. At any rate, she bites, spits, and hits anyone who comes near her, and she packs a mean wallop. Our anesthesiologist danced around her like a prizefighter, trying to sneak up on the side of the missing eye to administer the ketamine dart. She caught sight of him anyway, and administered a massive blow before he could duck away. She was finally successfully sedated, but not without a lot of expletives from the nurses and the anesthesiologist. Ketamine is also a street drug, prized for both its general anesthetic and its hallucinatory properties. On the street it is known as Special K.

Vitamin A is Ativan, which is a drug in the same class as valium and it works great on addled little old ladies who are in the hospital and causing a fuss. Typically the anxious patients are placed on this medication, or others in its class, as outpatients, to calm nervousness and the bad habit of calling the office daily with imaginary problems.

Vitamin H is Haldol, which is less commonly used, but extremely useful in the case of a violent or psychotic patient as it is a rapid acting antipsychotic and has an almost immediate sedating effect. We will frequently call for “a butt full of Haldol” for an out-of-control patient, because they aren’t going to cooperate with any pills given them, and pills wouldn’t act fast enough anyway. The key is to, well, corral them enough to pin them down and administer the aforementioned Haldol Butt Shot.

Vitamin V, or Versed, is also an antianxiety drug that is extremely potent. It is used for situations where a patient needs to remain conscious but sedated for a procedure, and combined with a good pain med, it keeps them calm and comfortable. Vitamin V is used routinely in the OR holding area, where the patients waiting for their surgery are almost certainly anxious, whether they seem so or not. Versed also has a powerful amnestic effect – that is to say, once you are given it, you will almost certainly not remember what transpires in the next few hours. This is handy, because the patients will not remember the ride back to the cold OR, the positioning on the table or preliminary and potentially frightening discussions about instruments or other such. Best of all, should a patient have an extremely rare consciousness experience under general anesthetia, which I understand is terrifying, they will probably not remember it. Having been given Versed myself, I can testify that the stuff is AWESOME.

Watching a patient being given Versed is a wonderful thing to see. At the bedside, in preop holding, your patient is trying to hold it together but it is obvious that they are tense and aprehensive. After your preop chat, where you address any final questions or concerns, it is nice to be able to then say to the patient, “Anesthesia is going to be coming in a couple of minutes, and they will be giving you the equivalent of at least 3 margueritas in your IV. Once you get that stuff, you will be grinning and telling me that you’re so psyched, you’re having surgery!” They look at you skeptically, and you hang around because it is so merciful and fun to see that stuff kick in. When anesthesia arrives with the syringe of Versed, you tell the patient, “Here come your margueritas!” They will eye their arm apprehensively and watch as the needle pushes the medicine into the IV. Then, about 30 seconds later, you can see them visibly relax, and almost sink into the bed. A lot of times they will look at you out of stoned eyes and slur, “Thish shtuff is AWESOME! I’m having Shurgery! YAY!” Gives me a kick every time! And a lot of times, they will tell you some REALLY funny things. One patient, after her Vitamin V, became convinced that the handsome CRNA was a doctor whom she needed to seduce and make her sugar daddy immediately. She pinched his ass repeatedly, making him yelp and jump every time he tried to check her vital signs. She kept offering him fascinating sexual favors, some of which are only available online, and he was so embarassed that he turned bright red, which was hysterical because he is normally an obnoxious and non-embarassable person.

My husband has a very funny history with Versed. After we married, for the first several years, he seemed to need a surgery almost every year, usually in November. For his first ever surgery, I accompanied him to the holding area because I am a doctor and I can. I also had some concerns. My husband, in his right mind, is a blabbermouth who cannot keep a secret even if he really means to, and has very little internal filter regarding whether something might be inappropriate to say. He has mortified me on numerous occasions. Rarely, I have seen him drunk, and am surprised he has not been arrested (or at least had the shit beat out of him) for some of the things he says. He loves women and doesn’t have any problems with discrimination against women, near as I can tell, but what he thinks is subtle sexual innuendo, out of his mouth, can be freaking AWFUL. No filter. Then he brightly looks around and says, “Oopsie! Was that my out loud voice?” I maintain that it is his out loud OINK.

At any rate, I had concerns about his behavior under the influence of Versed. It was entirely possible that he would began to disseminate details of our intimate personal lives, or the last awesome video he saw on YouTube, all of which would render me humiliated and my colleagues confused as to what kind of person would marry someone this awful. So I was there to police him, at least until he was wheeled back to the OR. Well, Vitamin V knocked him on his ass. I somehow kept him on track until they wheeled him back, but I am still worried about what he may have said on arrival to the operating room. The problem is, it may have been embarassing enough that my colleagues would not report it to me. I will never know.

After the surgery, my husband waxed lyrical about the amazing stuff they gave him on the way back to the OR. “I never understood how anybody could crave or be addicted to drugs, but I could sure see wanting more of THAT stuff!” He did remark, however, that he found it extremely disarming that he could remember nothing after the injection was given. That could be disturbing for a bona fide control freak, which he most certainly is. At any rate, despite that, he found the stuff quite enjoyable.

A year later, we were back in the holding area, getting ready for another surgery. My husband had told me that he was psyched, because he was looking forward to the Vitamin V, but that this time, he was DETERMINED not to forget events that followed its administration. I told him that was probably not possible. He insisted that his superior intellect would absolutely make memory of the event possible. I found this immensely reassuring, because, distracted by the work of recalling all events with his “superior intellect”, he would be unlikely to say anything inappropriate, because he would be focused on remembering everything around him. I also found this extremely amusing, because a fiendish plot was forming in my mind.

Prior to the administration of the Versed in the holding area, I pulled the CRNA, who is a friend of mine, aside. I explained to him the whole dislike of forgetfulness and loss of control thing, and about my husband’s determination to use his “superior intellect” to beat the amnesia. My friend, who is my friend because he catches onto things very quickly, smiled a sneaky Grinch-like smile at me. “I’m doubling the dose.” he told me. This did not concern me as it would not harm him – he was about to be put all the way to sleep. It would, however, be wicked funny as hell.

Sure enough, my friend loaded up enough Versed to drop a rhino and pushed it through my husband’s IV. He was WHACKED. I watched him ride back to the OR, pointing at objects on the way back to the operating room and slurring, “I’ll remember you DOOR and I’ll remember you WINNOW and I’ll remember you LADY and I’ll remember you DESK…”. Awesomesauce. Never laughed so damn hard in my whole life.

After the surgery, I asked him how his memory was. He was indignant, because somehow, the drug had overcome his superior intellect. He couldn’t understand it. Of course, at that point, the final stop in my plot arrived – I told him I had arranged to have him DOSED and he couldn’t have remembered his name if someone had asked for it at that point. He was downright incensed. And then he laughed. And laughed. Because he loves a good joke, even if it is on him.

So as a medical person, I must say, it is essential to remember your vitamins! And not just the ones that come in expensive bottles at the GNC…

Weird Things I Hate

This may seem negative and self-centered but I’m going somewhere with this. First, I have tried to feature things that are particular to me, or at least my personality, so you won’t find “cancer” or “thieves” in here. Everyone hates those things.  Second, I would like participation from my loyal readers.  Do you totally agree with something, is there something you’d like to add to the list, or do you think that one of my items makes me an complete ignoramus?  Why?  Leave me a discussion!  Third, I’d like to use this list as a springboard for future blog posts, and I’d like to encourage you to do the same!  Expound on an item, argue for or against it.  I’ve thrown these out in no particular order of any kind.  Some are damn trivial.  Some could keep us talking for years.  If something on here inspires a post, it would be awesome if you put a link or a pingback to this blog.  I want to see!  Last, I intend to create a similar list of things I love, and I won’t include anything like “love”, or “world peace”, which would be obvious and not indicative of an individual.

1.  Things that can eat me.
2.  Monkeys.
3.  Cameo jewelry.
4.  Trucker hats on women.
5.  Any phrase beginning with Keep Calm And…
6. The word “colorway”.
7.  The use of the word “dashboard” to denote a control panel of any kind.
8.  Plastic jewelry.
9.  Brighton jewelry – higher than sterling prices for base metal crap
10. King Arthur Court pewter and the fact that they didn’t even bother to put the apostrophe in.
11. Referring to plus sizes as “Women”.  What the hell are the rest of us supposed to be?  Kids?  Robots?  Stepford Wives?
12. The name “Dress Barn”.
13. PC bullshit
14. Proselytizing.
15. Insect mandibles.
16. That sinking and panicky feeling you get when you realize you may have left something important somewhere.
17.  Bills for magazine renewals when they are nowhere near due to be renewed.
18. Brown recluse spiders
19. That moment when you’re typing along and feeling really excited about what you’re writing and you realize that you’ve just hit some random key that made the whole freaking paragraph disappear, and Ctrl-Z will not bring it back.
20. Windows 8
21. My kid’s homework
22. Paper cuts.  Under your fingernail.
23. Eggplant.
24. The smell of crickets
25. Wire coat hangers
26. Fax machines
27. Any TV show containing the word “reality”.
28. Super skinny jeans
29. Selling things.
30. Wrestle Mania
31. Motion activated sinks
32. Asymmetry.
33. The color yellow.
33. The Minneapolis-St Paul airport.
34. Carrying 12-pack can boxes.
35. Those hideous flat Ugg boots.
36. Tom’s shoes.
37.  Getting called in to deliver a baby at 6 AM when your call is over at 7.
38. My phone”s autocorrect.
39. Being really angry shaky hungry.
40. Filling out forms.
41. Being bothered in the middle of something.
42. Cheap stinky candles.
43. People who call you while you are in the middle of texting.
44. Small talk.
45. Bungee jumping
46. Marathoners
47. Ignorance, particularly willful.
48. Small mindedness.
49. People who say “I’m not creative.”  What in the hell is that supposed to mean?  Human beings are born creative.
50. Medical insurance companies.
51. Pear yogurt.
52. Self-help books.
53. Bigotry, hatred, intolerance, and any permutation therein.
54. Conceit.
55. Elitism.
56. Stepford wives
57. Nordic tracks
58. Maxi pads.
59. Cascade commercials.
60. Ads for weight loss products -they’re lying through their teeth and taking advantage of a group of people who are desperate enough to try anything.
61. Panty hose.
62. Ads for super-expensive, super-enriched pure beef and chicken and gluten-free pet food when people are starving to death all over this planet.
63. Sperry topsiders.
64. Virtually anyone with the last name Kardashian.
65. Plums.
66. Banana pudding.
67.  Figuring out the switches on ceiling fans.
68.  The reset button on hotel hair dryers.
69. Malingerers.
70. People who want to have something wrong with them when they are well.
71.  Picky eaters.
72. Crystal meth.
73. People with Borderline Personality Disorder who proudly proclaim that they have it.
74. Accutane.
75. Tornado sirens.
76. Chitlins.
77. Packing plant trucks full of chickens.
78. Daylight Savings Time.
79. Winter.
80. People who put apostrophes on plurals.
81. Bulkhead seats
82. The smell of the water in the vase when you leave the flowers in them a little too long.
83. Dog poop.
84. Trying on bathing suits.
85. Chain restaurants.
86. Airplane bathrooms.
87. People who pee all over the damn toilet seat.
88. Fake leather, or no tag on the item to describe whether it is leather or not..
89. Paying full price for anything.
90. Liquid paper.
91. Double butt underwear – those of you who were gifted with curvaceous bottoms know what I mean – the leg elastic cuts your butt cheeks in half and makes you look like you have 4 buttocks back there.
92. Being interrupted.
93. Fruit flies.
94. Kale.
95. People who put green shit in smoothies.
96. People who “forget to eat”.
97. Stupid or guilt-inducing Facebook memes.
98. Carbonated water.
99.  Pop-up ads.
100.Formulaic pointless movies for mass consumption

Things My Patients Say To Me

Since I recently prepared a list of things that my patients’ men say to me, I guess it’s only fair that I do one for the women too. Notice that I have taken particular care not to violate anyone’s privacy – their identity cannot be guessed by what I’ve written here. Therefore, here they are. The cringeworthy, the funny, the not-so funny, and the sad, all rolled into one big list.

1. This is gonna be about all the action I’m gonna get this Valentine’s Day.

2. So THAT’S where that went!

3. If you’re gonna do that, doc, you should at least buy me dinner and a movie first.

4. Why in the world would you choose to do this all day?

5. I gotta say, I’m disappointed, doc. You’ve really let yourself go.

6. I dunno. Everytime I see his truck in the driveway, I just get nauseated.

7. This is a great day for me to have my hysterectomy. It’s National Spay and Neuter Day!

8. We’re going to have a hysterectomy party. So don’t be surprised if you get in there and find balloons and confetti.

9. Just don’t tell my husband you found that. It’s not his wedding ring.

10. So sorry! I forgot to shave!

11. Yeah, I shouldn’t have gotten that tattoo.

12. I’m getting these breast implants out. I don’t wanna go to the old folks home and be the Boobs In Room 8.

13. I wish I had gotten this breast reduction years ago.

14. Can you give me a pill so I want to have sex with my husband?

15. When I get a hot flash I just go into the cooler where I work until it passes.

16. I quit smoking because my doctor gave me this mental image of a scrawny old lady pushing an oxygen cart.

17. Sorry I stink, doc. I couldn’t clean up after work.

18. When I’m 30 weeks pregnant, can I still drive the fork lift?

19. I need a note to get off work. They won’t let me sit down at the cash register.

20. Yep, I’m gettin’ my surgery! Doc here is gonna jack me up real good.

21. Isn’t there some other way we can smear my pap?

22. I can’t get an IUD. I can’t stand the idea of something stuck up in me.

23. I can’t take birth control pills. I got my last two babies that way.

24. I eat like a bird. I don’t know why I weigh over 300 pounds.

25. My husband said I had to come.

26. If I have my uterus out, where does the sperm go?

27. Do I really have to take my bottoms off?

28. Can your nurse come hold my hand?

29. Sell, dammit! Dump that stock right now!

30. I have fireballs in my eucharist.

31. My cat hoit.

32. I’ve got a rash on my monkey.

33. I broke out in whelps. (You had puppies pop out all over your skin? That MUST be painful)

34. I hate needles.

35. Can you give me some ‘Tabs for the weekend, doc? Just a few ‘Tabs?

36. My PMS is giving me road rage.

37. Do hysterectomies run in families?

38. Can you look at my foot? I think I have toenail fungus.

39. While I’m here with my daughter, can I just ask you a question about my hormones?

40. Every time I watch a McDonald’s commercial, I cry.

41. Hell no, I’m not depressed! I’m not crazy!

42. What do you mean, antidepressants treat menopause symptoms? I’m sweaty, not crazy!

43. If I find out he’s cheatin’, I’m gonna throw his dead body in a ditch with his arm stickin’ out of it.

44. He swears it’s ME that was cheating. He won’t go get tested.

45. How can I be pregnant? I only had sex once!

46. Of course we can’t give our baby to STRANGERS! She’s having an abortion!

47. My urine smells like old gym socks.

48. I believe this pregnancy occured after the aliens came got me and probed me.

49. Does having sex hurt the baby’s head?

50. I’m scared my water’s gonna break in front of my kindergarten class.

51. Why did they do my c-section? To have my baby!

52. They did a c-section because my baby’s feets was stressed. (Fetal distress, I believe)

53. Does a c-section count as surgery?

54. Can I have a water birth?

55. We didn’t bring a camera because my husband didn’t buy one. You cheap ass bastard!

56. You have to make the baby come now because my mom already bought plane tickets.

57. Please don’t let his mom in here.

58. Get this damn thing outta me!!

59. If you tie my tubes, can you set fire to them, drop them on the floor and stomp them?

60. To enhance the natural atmosphere of the birth, my husband and I will both be naked.

61. My GOD that jelly is cold!

62. We can’t have the baby born on Halloween. She’ll be a witch!

63. Can I have my nails done while I’m pregnant?

64. All I can eat is Spaghetti-O’s cold out of the can.

65. I’m throwing up my toenails.

66. Morning sickness, hell! It’s all day and all night sickness!

67. Do you have to cut through my tattoo?

68. If I breast feed, will my nipple rings leak milk? What if the baby swallows them?

69. Can I get a tattoo while I’m pregnant?

70. I don’t want that epidural thing. My friend said one move and you’re paralyzed for life.

71. We want an all natural birth. Don’t offer any pain medicine or an epidural. WHERE’S MY F*CKIN’ EPIDURAL???

72. (Said about an epidural) Oooooh, the man who invent that thing gonna be RICH!

73. Honey, you’re never touching me again. You can go find a prostitute.

74. He’s in jail; he couldn’t make it.

75. I missed my appointment because I was in jail. I didn’t do nothin’.

76. Shut up and quit talkin’. The doctor’s here.

77. Can I take the baby outside to go smoke?

78. The meth in my urine ain’t my fault. I was at my friend’s house and I found this cookie…

79. I dunno why I put that up there.

80. I slipped in my living room and fell and that’s how that squash got up in there.

81. I think my daughter’s a lesbernopian.

82. I have Barney Rubble feet.

83. My husband won’t let me have a vibrator. I think they make him insecure.

84. If I never had sex again I wouldn’t care.

85. Why does my twat smell like fish?

86. I noticed this smell and I realized I never took my last tampon out.

87. How did I catch this?

88. How can I have gonorrhea in my throat?

89. No, my daughter will NOT get the cervical cancer vaccine. She’ll think it means she can have sex.

90. My mom’s in the lobby. She doesn’t know I’m pregnant. Can you tell her?

91. Agggh, that burns! Blow on it! Blow on it!

92. Are you gonna stick that whole thing up in me?

93. I don’t wanna tell him I have herpes! He won’t like me anymore!

94. Sorry I peed on you.

95. Did I just poop?

96. I think my daughter stuck a golf ball up in there.

97. Does oral count as sex?

98. I’ve got clogs of blood, cher, clogs of blood.

99. Well, I’m never doing THAT again!

100.If men had babies, the human race would die out.

Medical Coding Made Easy

Many of you may wonder, how is medical billing done?  How are your unique ailments translated into standardized format, to be recognized as payable by the insurance company?  Or, more likely, NOT recognized as payable to the insurance company.

The first coding category is ICD-10 code.  Translated into English, this category encompasses Shit That Is Wrong With You.  For example, gonorrhea is 098.0, which encompasses the following conditions and more:  acute gonorrhea, gonorrhea of the vagina, gonorrhea penis, gonococcal urethritis and acute Bartholin’s gland gonorrhea.  However, something slightly different (and you may be provided hours of entertainment trying to visualize how this was transmitted), gonococcal infection of eye is 098.4.  There are codes for every possible disease, illness, deformity, even one for High Risk Sexual Behavior.  I have this one memorized.  The digits in front of the decimal point usually delineate the main category of the disease, whereas the 2 digits after the decimal point delineate more specific details.  That fifth digit (the second one after the decimal point) is added only where extreme differentiation is required, say as in 607.83 (edema of penis) and 607.84 (impotence of organic origin).  In my opinion, many codes for Shit That Is Wrong With You have been excluded.  It would be very useful, for example, to have an ICD-10 code for Skank Ass Ho.  This would immediately trigger payment by insurance for things such as testing for STDs, multiple pregnancies, and chain smoking.  You could add a fourth digit, after the decimal point for Skank Ass Ho Who Lives In A Trailer Park, and a fifth digit to delineate Skank Ass Ho Who Lived In A Trailer Park But Got Thrown Out On Her Ass For Screwing The Guy In The Trailer Next Door.  See how useful this would be?  Also there could be one for Neurotic Middle Aged Woman, which would cover any number of ills, which I will not go into here for fear of being lynched.  Another highly useful code would be for PITA (which physicians all know stands for Pain In The Ass).  That code should cover all sorts of tests that the patient demands for ailments that he doesn’t really have, and allow higher billing, because the visit will be interminable because of all the whining and complaining.  The ICD-10 codes are changed almost annually, to numbers that are frequently completely different, by the Powers That Be,which are most likely owned by Big Insurance Companies.  The changing of the codes occurs in hopes that some hapless doctor will accidentally use last year’s code, which is now obsolete, and then they can weasel out of paying. 

The second category is the E Codes, which in English mean Bad Shit That Can Happen To You, basically from an external force.  These are numerous and extremely specific, such as Slipped On Deck Of Yacht While Walking In Swim Fins.  I believe this one actually exists, although I seldom have cause to use it.  The ones I use are usually tragic, things like Spousal Abuse, or Rape, Alleged.  You gotta love it.  Even medicine is biased against the sexual assault of women.  There is no Rape.  There is only Rape, Alleged.  I am totally surprised that they don’t have an E Code for:  Rape, But The Bitch Totally Had It Coming.  They have numerals that differentiate between Jumped and Was Pushed.  I shit you not.  There are some E Codes that would be extremely useful but do NOT exist, such as Had His Ass Kicked In A Bar Parking Lot After Talking Smack To Some Gangsta Guy.  Now THAT would be useful.

Then there are CPT codes, which translated into English are Shit That The Doctor Does To You, which covers most surgeries, treatments, and other medical interventions, or a badly needed bitch slapping.  We use these to cover Normal Spontaneous Vaginal Delivery, Primary Cesarean Section, Total Abdominal Hysterectomy, and Oopherectomy (removal of the ovaries), just to name a VERY few.  The insurance companies like to “bundle” these codes, which is to ensure that we are paid as little as possible.  For example, you are paid so much for just a Total Abdominal Hysterectomy.  If you remove the ovaries at the same time, these two codes are bundled, because they are frequently done together.  If you had removed only the ovaries, you would have been paid for that, but for both together, you just get paid the one reimbursement, usually the lower of the two costs.  They bundle some rather unlikely things, to make sure that we don’t get too big for our britches and do “unrelated” stuff.  Also, let’s say you do two procedures, with two different surgeons.  The specialist OB/Gyn does a hysterectomy, and a sub-specialist Urogynecologist does a bladder lift procedure, during the same surgical episode.  Typically only the sub-specialist is reimbursed, for both procedures, because they are considered capable of doing both, and sub-specialist outranks specialist.  I consider this outrageous, because it deters physicians from seeking specialized care for their patients, because if we bring in a sub-specialist, we don’t get paid for anything.  Thus, patients may be subjected to two different procedures at two different times, so that reimbursement will be given to both parties.  Now tell me how that optimizes patient care?

There is another coding system, for psychiatrists, which I believe is now DSM-4.  They change that up a lot, just like the CPT codes.  New diseases are added and removed with each revision.  For example, Female Hysteria was finally fortunately removed .  See?  We are making progress.  Psychiatrists code things on Axes (plural for Axis), in which one axis might be physical (like psychosis induced by lack of sleep), or biochemically induced bipolar disorder.  Another axis might be external, such as psychosis triggered by drug ingestion.  My friend, with a PhD in psychiatry insists that they should add a whole other axis, “The Axis of Evil.”  She also states they should be better reimbursed if it is invoked.

So let’s see how all this works.  A patient presents to the ER, bashed up and ranting and raving.  ICD-10 codes might be Acute Alcohol Intoxication, Chronic Alcoholism, Oppositional Defiant Disorder, Nausea and Vomiting and Opioid Addiction, Other.  E-codes might be assigned for Had His Ass Kicked In The Parking Lot Of A Bar After Antagonizing Some Dude Named Vinnie and Blunt Force Trauma To The Head, .  CPT codes for Shit The Doctor Did might include codes for Gastroesophageal Lavage (stomach pumping), four-point leather restraints, skin suturing, CT scan of the Head, and Adminstration Of A Rapid Paralytic Agent To Settle The Guy Down And Shut Him The Hell Up.  See how neatly that works?

I hope that this quick guide has helped you to a deeper understanding of the inner workings of the world of medicine.  If it does, I’ll send you a bill.  ICD-10:  Eyestrain, and Complete Incomprehension of Medical Procedures, E-Code:  Spending Too Much Time Reading Blog Posts, and CPT code:  Administration of basic information needed to comprehend the complexities of the medical world.  That’ll be $1,349.53, of which your insurance will cover $135.  Any further questions will cost you extra.

French For Dummies

My mom was a French teacher, so guess what language I got to take in school?  Yep.  French.  I must say, no one even inquired whether I would like to take a different one, as was so often the case.  Mom used a lot of French and English words interchangeably, so a lot of our little family jokes are multilingual.  She minored in Spanish, but apparently this did not rate, except that we always referred to hands as “manos”.

I got pretty much immersed in French.  I knew a lot more words than I thought I did, even as a kid.  My folks referred to each other as “Homme” (Man), and “Femme” (Woman), except to be cute, they shortened their pet names to Um and Fum.  Since French for girl is “Fille”, I got called Fee, and was photographed in front of every US Fee area sign across the United States.  Ha ha.

Mom referred to most body parts by their French names, so when I was a kid, a “bouche” was of course a mouth, and “pieds” were of course feet.  Didn’t everybody know that?

Mom was a Helicopter Parent long before it was cool (was it ever?) and had me doing all sorts of fun projects, like doing French language tapes while washing the dishes, which annoyed the piss out of me.  I used to roll my eyes and rattle the dishes while chanting zombie-like enchanting phrases such as “Bonjour, Sylvie!  Ou est le bibliotheque?”  (Because a library is the first thing we look for when we arrive in France.)

By the time I got to high school, I had taken years of French.  Looking back on it, it was pretty amazing.  I remember in one French lit class, we read Camus and “Le Compte de Monte Cristo” in the original.  In my boarding school, we were given assignments to translate Edie Piaf songs into English for fun.  One day, it was pretty outside, so we had the classroom windows open.  Our teacher required us to speak only French in class.  A wasp flew in the window, landed on the soft part of my thumb, and stung the crap out of me.  I jumped out of my seat and yelled “SHIT!!”  Madame eyed me with irritation, sighed, and said, “Non.  MERDE.”  Je regrette, Madame, je regrette..

I admit, we did have fun.  Mom and I went to Europe together at least two or three times, once on an art museum tour, since we took an Art History class from the same teacher at Alabama, just about a decade apart.  (We were, of course, superlative students.)  We hit the Louvre, and Les Tuileries, and Monet’s home, with the real water lilies.  We used our French every chance we got.  Mom had lived in France for a time when she was in college, as part of an exchange program, so between the two of us, we could whip up a pretty good conversation.

I did discover that native French speakers are not necessarily ecstatic about dabblers in their language.  When trying to buy a t-shirt in Paris, the sales girl hautily informed me to “Speak English.  It will be easier.”  Bitch.

We derived great amusement from travel guide books.  You can learn some truly useful phrases in them!  One that can still make Mom and me howl after all these years:  “Il y’a des moustiques au plafond!  Veuillez les vaporiser.”, which translated literally into English means, “There are some mosquitoes on the ceiling.  Please come vaporize them.”  Awesome.

While I was in medical school, dating the Emotional Terrorist, his sweet sister lived in Montreal with her super jock boyfriend, who was an extreme skier who had grown up there, among other places.  We would go up to see them every winter, to ski Mont Tremblant.  Quebec, of course, has attempted to secede from Canada over the use of the French language, among other things.  The Quebecerais are pretty insistent about the correct use of French, especially outside the tourist area of Montreal.  The Emotional Terrorist, who had no language ability or knowledge (except for the ability to hurt my feelings, in which he was both fluent and multilinguall) wanted to insist on using “French” at all times, despite the fact that he didn’t know any.  (He tried to pull the same bullshit in Chile, with Spanish, years later when he was visiting me there, with equally unimpressive results.)  He crawled over the seat at the drive-through window at McDonalds and attempted to order his Egg McMuffin in French.  Our host clapped his hand over ET’s mouth and hissed, “Don’t DO that!  They will SPIT IN OUR FOOD.”

Years later, when I lived in New Orleans, I was friends with a “mixed” family – a French speaking Cajun woman had married a native Parisian, so their kids spoke fluent French, in two completely distinct dialects.  When the daughter, my “birthday twin”, got married, she married an Irish man, in full tartan and kilt, and his best man was a Scotsman. What an amazing, wildass party!  A bunch of drunk cajuns, Parisians, Scots and Irish?  In New Orleans?  And no, they don’t wear anything under those kilts!  I was lucky to speak French well enough to speak it at the wedding and for some peculiar reason, one of my Mom’s childhood gifts to me were an entire collection of French folk songs, which by happy coincidence turned out to be French drinking songs. Who knew?  Not my mom, that’s for sure.  Somehow I got us started and we all started slurring, “Sur Le Pont D.Avignon”and “J’En Bourrez, Oui Oui Oui, J’En Bourrez, Non Non Non, J’En Bourrez, Si Le Vin Est Bon….”

I used to love to torment my friend Fred with phone calls, after I had moved away from NOLA.  I was pretty good with accents, and I would ring him up and say, “Bonjour, Fre-e-e-d,” in this really sticky sweet accent, and I always had him convinced it was his ex-girlfriend, calling from Paris.  He’d start jabbering away, and I’d hold up the receiver and laugh and laugh, and he’d know I’d got him again.

The ridiculous irony was, of course, that I had always wanted to learn Spanish.  Beautiful as French is, in the US, it’s not all that useful. Some Cajuns (mostly the older ones) do still speak French, but the dialect is so extreme that it hardly sounds like French at all.  You can use it in Quebec, but at your own risk, since they may spit on your McMuffin.  Some regions of Africa are French-speaking, but if you’re stranded there, you may have worse problems than not speaking French.  You can use it on some Caribbean islands, but frankly, they pretty much speak anything involving money.  You can, of course, speak French in France, but again, native speakers of French are somewhat less welcoming of inexpert attempts than, say, their Spanish speaking counterparts.

Which leads us to Spanish.  Which is spoken here and in myriads of other places, all the time.  So when I started med school, and  noticed that a LOT of my patients spoke it, it was time to learn Spanish, which is a whole ‘nother blog, for another time.  But if I ever want to order “fries with that” in, say, a ski lodge on Mt Tremblant, I can at least be fairly confident that they won’t expectorate in my food.

Why Is It…

I have been accused by many of being a cynic.  I can’t imagine why this is.  My question for you is:  Is it cynicism if it’s true?  I have heard cynics described as “failed romantics”, and if that is the case, I guess I am a cynic.  I tried to deny it during a visit to my shrink, and he reminded me of a statement I made on one of my worst days.  When asked if the glass were half full or half empty, I replied that someone had stolen my damn glass.  Now that I would refer to as bitterness, but who am I to argue?

My cynicism, if it exists, began in junior high, but was firmly seeded when I started medical school.  The summer before I went to med school, several people told me that I needed to read Samuel Shem’s “The House of God”, which everyone agreed “told it like it is” and I would know what to expect when I started that July.  Let me say that it is an excellent book, but you should not read it prior to starting medical school.   It will set the stage for bitterness beyond repair, because all of the things in that book ARE true, and they are a horrible sad reality.  My husband has questioned the source of my somewhat bitter outlook, and among those sources are that book.  I have urged him to read it, so that he may better understand, but he has not read it yet.  He will probably not, unless I maybe read it to him.  He is very busy, and mostly reads technical journals.

I have made many observations, which I insist are realism and not cynicism.  Maybe you will agree with me, or maybe you won’t.  I suspect these random thoughts may ring some very familiar bells, which likely cannot be unrung.

Why is it that when you are terribly late, that you will hit every light on the way to your destination, but if you are early and hoping to delay your arrival, all your lights will be green and there is smooth sailing?  This also happens when you really need a stop light to quickly check a text, which may be crucial to your outings that day.  My husband would claim (I sometimes refer to him as Mr. Spock) that these occurrences are mere coincidence, and that our mind only registers the outcomes that we (bitterly) expect.  I don’t know.

Why is it that my husband always calls me when I am running between airplane terminals, on the toilet, sleeping, or otherwise engaged in an activity that makes it virtually impossible to answer the phone with any convenience at all? He indignantly denies this, and tells me if I don’t stop complaining, he won’t call me at all.  It would be churlish and counterproductive to suggest that this is a desirable suggestion.  It certainly would not make for good marriage relations.

This may not be a problem for most of you, but why is it that when you have been up all night delivering a baby, and desperately need to go home and shower and rest, that just as you walk triumphantly out of the delivery room, there is another woman sitting there in a wheelchair who has just come up in labor?  This seems unnaturally cruel.  It is a lot more unlikely to happen if you are well rested.  It is most likely to happen at 4 in the morning.  Studies actually bear this out.  Human cortisol cycles dictate that more deaths and births occur around 4 in the morning than at any other time.  The baby I delivered this morning came at 4:17 AM.  I rest my case.  When I got the delivery done, there was another woman being admitted in labor.  Really?  Uncool, universe, uncool.

Why is it that when you are in a rush to pick your daughter up from school, she will be covered in paint, in the middle of a project, and her backpack completely unpacked?  If you have plenty of time, she is packed, homework done, and ready to go home.

Why is it that the hotel WiFi always cuts out when I am actively doing something, like Skyping with my family?  It never does it while I am asleep.  Then I get accused of deliberately cutting off the connection.

Why is it that when I am finally getting some sleep, (and of course have not put up the Do Not Disturb sign at the hotel, because I think that there is no possible way that housekeeping will come around that early) that they come banging at my fricking door at 8:45 in the morning?  However, when I am at work at the hospital, and hoping that they will have come already, when I return at noon, they still haven’t come and start banging at my door wanting to know if I want service?  Why is it then, after they have already come and gone (and tried to weasel out of various services because I am sitting there, and they can ask me if I “really need my bed made”) that just after I have gotten rid of them and locked up the door, the head of housekeeping will show up, bang on the door yet again, just to ask if I have gotten my room cleaned.  Why is it that no matter how loud I yell, “COMING” in a tiny hotel room, that they NEVER hear me, even though I yell it twice, they still jam their keys in and pull at the door?  It’s one room.  I have a loud voice.  Have they all been deafened by their vacuum cleaners?

Why is it that there is always massive, dense frost that must be scraped if I am in a hurry or running late, but the windows are always pristine if I have plenty of time?

Why does the damn hospital always call when I am in the shower?

Why is it that they only show the episodes of Law and Order, NCIS and SVU that I have never seen RIGHT when my husband calls and wants to Skype.  Why does he blather on until the whole show is over?  Why can’t he ever call in the middle of the multitude of episodes that I could recite verbatim and am sick to death of?

Why is it that the patients that wake you up in the middle of the night are always the ones that you don’t know, that belong to another doctor or hospital, that have no prenatal care, and who are unbelievable pains in the butt? 

Why is it that after many days of clear skin, on the one day you will see someone whose opinion of your appearance matters to you, will you wake up with an enormous zit?  Why is it always the one that has roots in your damn tonsils, the kind that you can’t hide no matter what, and the kind that takes days (if not weeks) to clear up?

Why is it that if you are late for your plane, the parking lot will always be super full and you will have to park 8 miles away and run? Why, when you are early, will it be totally empty and you have your choice of spots?

Why is it that when you are about to miss your flight connection, your gate will be 6 concourses away, always in the Minneapolis-St. Paul airport, where you have to run most of the way and the tram will take you about 5 inches.  When you are early, your gate will be directly next to the one where you have disembarked.

Why is it that if you decide to go home because a patient’s labor may be awhile, that they will either develop conditions that necessitate multiple phone calls and the need to go back in to the hospital, or they will dump the baby out in the bed before you can get there, but if you decide to wait at the hospital, everything will go smoothly and will take forever, while you are trapped there with nothing to do?

Why is it that in winter, the beautiful sunny days are always horribly cold, and the ones at a temperature where you might actually want to venture out, are always gray, depressing, and raining.  Actually, there is a known reason for this, having to do with weather patterns.  I disapprove.

Why is it that when your call ends at 7 AM, you will get called in for an emergency delivery at 6 AM, which will necessitate you working over your call time, especially on the day that you have to be returning to the airport?  Why is your call replacement always late getting into town?

Why does Walmart never have enough fricking lines open, even during times that are known to be busy? 

Why is it that yogurt, toothpaste, coffee, and other staining items always splorp out on your work or travel clothes, but never on your t-shirt and yoga pants, even if you are being very careful?

Why, when you drop something small, expensive and important, will it always take a bounce that defies the laws of physics, and land in the one place that you believe it was physically impossible for it to go?  Why, if it is unimportant or messy, will it always land right in front of you, or splat on your clothes?

Why is it that the piece of luggage you drop always contains your computer?

Why, within months of the time that my GI doctor told me that I should not drink coffee, were not 1, not 2, but 3 Starbucks erected in my previously Starbucks-less town? 

Why do you always miss the flight when you are headed somewhere of tantamount importance or great desire, but never when you are going somewhere where you couldn’t give a shit if you get there?

Why are the totally cutest clothes and shoes marked down to a totally awesome price only available in someone else’s size?

Why is it that you always have some weird muscular spasm and ram your freshly manicured toenail smack into the underside of the drying table when you are getting up to leave from your pedicure?

Why does your car wait to go off waranty before it totally falls apart?  Why does this happen one day after it expires?

Why is it that the drier always beeps when you are in the middle of dinner, or a shower, and it is always the load that must be hung up immediately?  It is never towels.

Why is it only the glass ornaments that fall off the tree?

Why do you always have to poop right after your shower?

Why is it that you always get horribly sick on vacation, and not when you could totally use a break from work?  Why does your kid only get sick when you are about to leave on vacation?

Why is it that packages that must be signed for only come when you are not home?  Why does the mailman come at 2 PM when it doesn’t matter, and at 9:30 AM when you are struggling to get bills out on time?

Why does your phone lock up while you are trying to pull up your boarding pass to get on a plane?

Why is your plane seatmate always the last to board?

Why is it something different that sets off the TSA metal detector every time, when you always pack the exact same things in the exact same way?

Why is the person ahead of you in line at the grocery store always trying to pay in Euros, or trying to use their debit card to bring down the entire US banking system as we know it?  Why must their items always be price checked?  Why do they have 80 coupons?  Why is their credit card always denied?  Why is it that the line you pick is always the one that comes to a smack halt, when all the other ones are moving smoothly?

Why do travel opportunites, parties and visits with friends only come available when you have already made other, unbreakable commitments?

Why do your coat, backpack straps, purse straps and other items always get hung up on doors and handles so intensely that you must back up and untangle them?  Would this ever happen if you needed this to to save you from falling off a cliff?  Hell no.

How can an enormous ice scraper disappear out of a rental car that only you use, that you always keep locked, and that is so big that if it fell out, you would totally hear and feel it falling on the ground?  Why does this only happen on the day that the most ice forms all over your windows?

Why is it always someone else that wins the damn lottery?

Why is there always a crisis when you desperately need to be doing something else?

Why, if a cabinet door is opened for a minute, will you smash your head into the corner of it so hard that your ears ring and there is a bloody flap on your scalp?

Why does one earring always come out and get thrown away with the scrub cap?

Why, when you have to do a delivery so fast that you don’t have time to change out of your street clothes, or put on your tall hipwader boots, does the amniotic fluid explode all over you, the blood sprays all over and out of the cord, and the placenta flies out with a plop and a splat on to your feet, but when you have on your protective gear, the delivery is unbelievably tidy, and nothing gets on anything?

Why do you always get a paper cut right before you have to cover your hands with alcohol solution to do surgery?  Owwww.

I could go on.  Really.  Endlessly.  This is but a random smattering of my questions for the universe.  My husband would state that all of these occurences are random, and have nothing to do with the circumstances at hand, but I just don’t agree.  Somebody stole my damn glass.

 

 

 

 

 

Things That Men Say

Let me preface this for those who do not know my by saying that I am an OB/Gyn – a doctor that takes care of women, doing, you know, women stuff like baby birthing, hysterectomies, icky periods… yeah, that stuff. Because I care for women for a living, I get to spend a lot of time with their men, frequently under bizarre circumstances like childbirth, or a really icky pubic rash. Shhhh… I’ll tell you a secret. OB/Gyns have a saying: “All women are different, but all husbands look alike.” Their men are a constant source of amazement, embarassment, stereotypical behavior, sweetness, and hilarity, planned or not.

I made a previous post about things that patients say that amuse me. This one’s just for the guys! Here’s to you and thanks for all the laughs (and muffled sobs)!

1. When you do her hysterectomy, can you get the mean out of her too, doc?

2. Hey doc, while you’re sewin’ that up, can you throw in a couple extra stitches, just for me?

3. You mean that thing’s an extra nipple? Babe, you’re a FREAK!!!

4. Only YOU would ask the doctor for something like that, Princess.

5. I thought she’d go back to normal after the baby came out.

6. We both dug around and looked for it, doc. Just can’t figure out where the damn thing went!

7. Are you gonna stick that duck thing in ‘er?

8. I’m leavin’ the room. I don’t wanna see this.

9. Oh, my God, what’s THAT?

10. What’s that brown stripe in the middle of her belly for?

11. Hey, if you’re gonna do that to her, you oughta at least buy her dinner first!

12. I dunno, doc. She got off your scale and just started cryin’.

13. What do you mean, she got pregnant in April? I wasn’t here in April!

14. What’s THIS for?

15. Is it OK if we keep the litter box in the kitchen?

16. Don’t worry, doc. I ain’t gonna pass out. It’s just like guttin’ a deer, right?

17. If it’s a girl can you put it back?

18. If it’s a boy, you only got one dick you gotta worry about. If it’s a girl, you’ve gotta worry about ’em ALL!

19. She caught that somewhere else.

20. I AM payin’ attention, hon. You just keep pushin’!

21. I’m just gonna sit over here.

22. I feel a little…. THUNK!

23. There ain’t another un in there, is it?

24. You swear it ain’t twins?

25. Does that hurt, babe? That looks like it hurts! What do you mean, shut up??

26. OW! You’re gonna rip my fingers off!

27. What do you mean, this is all my fault? You was there too!

28. My wife is hurtin’! Fix that Goddamn epidural thing, NOW!

29. She done broke her water all over my truck upholstery!

30. What do I do? What do I do?

31. Damn, Babe! You’re big as a frickin’ HOUSE!

32. Is she gonna be OK?

33. I am NOT drunk!

34. Can’t you just grab its ears and pull?

35. Why’s his head all pointy? Is that gonna go away?

36. What do you mean, you don’t want my mom in here?

37. Some things a man just shouldn’t have to see.

38. What do you mean, she can’t just have it now?

39. Can you just spay her?

40. Damn, I can’t even look at her but she gets knocked up with another one!

41. What do you mean, we can’t have sex til the baby comes?

42. Seriously, what do you mean, we can’t have sex until the baby comes?

43. How long do we have to wait to have sex?

44. Tie her tubes? Cut ’em the hell out, set fire to ’em and STOMP ’em!

45. Semen analysis? Hell no, doc, I know it ain’t ME! Ain’t nothin’ wrong with ME!

46. How soon can you do a paternity test?

47. Where’d the red hair come from?

48. She said it was a alien probe! That’s funny Babe! Ain’t that funny?

49. I can’t wear one ‘a them things! Like taking a shower with a raincoat on!

50. It can’t just get lost up in there, can it?

51. Damn, looks like you’re stickin’ your whole HAND up in there!

52. Oh my God! I shouldn’t’a looked down there! Oh, CRAP!

53. What’s that stuff comin’ out of her now?

54. That is just so GROSS!

55. Gawd, doc! How’m I gonna compete with THAT thing?

56. She told me she couldn’t get pregnant.

57. Can you give her somethin’ to make her wanna, well, you know… ?

58. Why’s she squallin’ like that?

59. Damn, her boobs got BIG!

60. Her nipples look like dinner plates!

61. Her boobs are bigger than my kid’s HEAD!

62. That thing makes her look like she’s on a milkin’ machine! OW, Babe!

63. I can’t pick him up. I don’t know how to hold his head.

64. COOL! He blew poop out his diaper right up his back! THAT’S my boy!

65. What do you mean, I get to have the next one?

66. I swear I didn’t think that thing’d get stuck up there.

67. Oh my God! Why’s that woman next door SCREAMIN’?

68. Did you really have to go into labor right in the middle of the Iron Bowl?

69. Do some jumping jacks, Babe. We need to have that thing this year – we need the deduction.

70. Can’t tell if she’s walkin’ or rollin’.

71. Why does she still look pregnant?

72. She can’t have the baby Thursday. I can’t get off work then.

73. She cain’t have the baby on Halloween – he might be a WITCH!

74. What the hell’s a onesie?

75. If her mom don’t leave I’m gonna go nuts.

76. No, you can’t buy all new shoes if your feet spread.

77. How come you need your toenails painted? You can’t even SEE ’em!

78. Stirrups? You mean like on a horse?

79. Why’s she so grouchy when she’s on the rag?

80. Oh my God! That needle is huge!

81. Don’t worry. I’ll make her take her pills.

82. Damn, girl! Your Tweety Bird tattoo’s done turned into Big Bird!

83. Is she gonna have to take that piercing out?

84. Looks like he’s a little alien tryin’ to crawl out your belly.

85. What’s that cut for her c-section gonna look like?

86. She doesn’t want an epidural. You don’t want an epidural, hon. We want an all natural birth.

87. Just breathe, hon. You’re not breathing the way we practiced. What do you mean, shut the hell up?

88. What the hell do you want me to do??

89. Why are all the magazines in here for women?

90. She’s a MILF in training.

91. I forgot the camera.

92. This wasn’t in the birth plan.

93. You’re not the doctor we’ve been seeing.

94. How can you stand looking at this stuff all day? Why’d you decide to do this?

95. Don’t you feel weird looking at women’s crotches all day?

96. Will she still be a woman if she has a hysterectomy?

97. Will she still be mean when her periods go away?

98. You gotta do something, doc. She’s rippin’ the covers off and freezin’ my ass off every night.

99. I told her I was coming in with her to make sure she addresses this issue.

100.Thank God I’m a man. That’s all I’m gonna say.

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