Rants from the Crib

An Ob/Gyn gone mad

Archive for the tag “Ob/Gyn”

The Truth About The Myths Of Pregnancy

There is so much that your doctors don’t tell you about being pregnant, because they consider the information trivial and they just don’t have time in a busy clinic to go over little, normal stuff with you.

There are many things that your friends, family, and complete strangers WILL tell you.  A great deal of it is wrong.

The national hobby is scaring pregnant women.  As soon as someone finds out you are pregnant, they will immediately start telling you their worst horror stories, most of which are greatly exaggerated.  I find this strange, because if they found out you had, say, diabetes, they wouldn’t tell you horrible stories about having toes cut off, heart attacks, blindness, and arterial bypass grafts.  So why is it OK to say these things to pregnant women?  Actually it’s NOT.  But everyone will do it anyway.

People, usually other women, will tell you the stupidest, most ridiculous folktales about pregnancy.  You may, say, be reaching up to pull a book off a higher shelf, and a random person may walk up to you and say, “If you reach above your head, your baby will strangle.”  WTF?  That makes no sense at all.  And yet, I have gotten calls (usually at 3 AM) from sobbing mothers who have been convinced that getting soup out of the pantry has killed their baby.

If it sounds ridiculous, or impossible, it probably is.  Check with your doc if you’re concerned.  Just not at 3 AM, please.

They will also tell you that if you get in a swimming pool, the baby will drown.  Really?  Because that kid’s floating in a bag full of fluid right now.

They will tell you that if you eat pears, the baby will be affected somehow.

They will tell you if you have heartburn, the baby will have lots of hair.  How the hell can those be related?  Hint: they aren’t.

They will tell you that the heart rate can tell you the sex of the baby.  Bullshit.  The heart rate changes throughout the pregnancy.  Does that mean the sex of the baby keeps changing?  Uh, no.

They will tell you that whether you are “carrying the baby high or low ” determines the sex of the baby.  Not.

They will tell you about their horrible 72 hour labors.  They will tell you about how they felt everything in their C-section.  They will tell you about how they had surprise twins at the last minute.  They will tell you about a “dry birth”, whatever the hell that is.  Ignore these people.  They are not helping.  They are just trying to show off and make themselves look more important and special, that they survived these “horrific “situations.

Strangers will touch your belly.  Strangers will tell you they know the sex of the baby.  Strangers will tell you that you don’t look pregnant enough, that there is something wrong with the baby.  They will tell you that you look too big, and that you will have the baby early, or that there are secret twins in there.

News flash.  These people did not go to medical school.  They did not do a 4 year specialized residency.  They mostly just go to Walmart.  Apparently they bought their medical license there.

Do yourself a favor.  Do me a favor.  Ignore this crap.  Tell them to leave you alone.  They are NOT trying to help.  They are trying to scare you.  And it’s working.  Stop the madness.  Tell the back seat drivers to go bother someone else.  Or better yet, bother no one at all.

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Sex Stuff Teens Should Know

I realized that my OB/Gyn self should make a post for the teens, since you are new at this stuff.

1. Yes, oral sex counts as sex.

2.  By law, your doctor can’t give any information about you to your parents, or anyone else, unless you sign a form saying it’s OK.

3. No, I will not be the one who tells your mom you’re pregnant.  You gotta tell her.  I don’t want to be around any flying bullets.

4.  Yes, you can get pregnant the first time.  And the second, and the third…

5. You can catch diseases having sex that can kill you.

6. There are some sexually transmitted diseases that can keep you from ever becoming a mom if they don’t get treated.

7. There is a safe vaccine that prevents cervical cancer and genital warts.  It’s almost 100% effective.  You can get it between ages 9-26.  Ask for it.  Ignore people who try to talk you out of it.

8. There is nothing shameful about giving up your baby for adoption.  If you are strong and smart enough to do it, you’re a hero.

9. Some states still require that we notify your parents if you are seeking an abortion.  Google your state laws. 

10. I don’t do abortions, but I won’t hate you, judge you, or stop seeing you if you have one.

11. Ask questions when you are talking to us.  We won’t think you’re silly, or slutty, or dumb.  We don’t judge and we will tell you the truth.

12.  If your friend told you something about sex that sounds crazy, it’s probably crazy.  Ask one of us.

13. Guys are dogs.  Especially guys your age.  They will screw anything that holds still long enough.  They will say anything to get laid.  Just sayin’.

14. If you are under 18, and the guy is over 18, they can be arrested for rape.  Even if you are OK with this, if your parents find out and call the cops, your guy will be arrested and will be a registered sex offender for life.  That is a life wrecker.

15. Do not lie about your age.

16. If you are in high school, any college-aged guy who wants to sleep with you is immature and shallow and will screw you over and dump you.  And if the guy is over thirty and he tries it, he is a FREAK.  And a pedophile.  He is not in love with you.  He might want to kill you and bury you in his basement.

17. I am totally not kidding about #16.

18. If it sounds like a bad idea, it probably is.

19. Parents are a pain in the butt sometimes, but they actually know about more than you think.  If they warn you about something, they are not trying to ruin your fun, they are trying to save your ass from horrible shit.  Same from us doctors.

20. 1 in 3 women will be sexually assaulted in their lifetime.  That’s a LOT.  Be smart.  Don’t be one of them.  Watch your drug and alcohol intake around guys, especially ones you don’t know.

21. Never accept a drink from someone you don’t know, and never walk away from a drink without one of your friends watching it.  Date rape drugs are out there.  A lot.

22. Travel in packs.  Predators are more likely to go after you if you are alone.

23. IF YOU ARE RAPED, go to the hospital ER immediately.  Do not shower, bathe, wash your hands, clean your nails, douche, or change your clothes.  There is evidence against your attacker in all of those.

24. You can be raped by an acquaintance, a date, a friend, a boyfriend, or even a husband.  If you said no, and they made you, it’s rape.  The law supports you 100% on that.

25. Use condoms.  Carry them with you.  I know, blah blah blah, they’re no fun, guys don’t like them, whatever.  USE THEM.  They will protect you from getting pregnant, and from some really nasty diseases, some of which we can’t treat. 

26. A guy who brings his own condoms is a SMART, COOL, and CONFIDENT guy.

27. If we tell you not to have sex while we’re treating you, don’t.  You’ll catch whatever it is back again.  Make sure the guy got treated for the infection too.  Don’t have sex with him if he didn’t.

28. If you feel like you don’t trust the guy, you probably shouldn’t.

29. Don’t jump into having sex.  Once you start, it is very hard to stop.  Make sure your partner is someone you care for and trust if you’ve gotta do it.  If you start out having sex with someone you don’t care about, it will mess up your love life forever. 

30. Anyone who threatens to dump you if you won’t have sex sucks.  Dump them.

31. Sexting will screw up your life.  Once you send a naked picture out, it belongs to the whole world.  EVERYONE can find it and see it.  Like your parents.  Your minister.  Every guy in your school.  Once you put that pic out there, you can NEVER get it back.

32. I am totally also serious about #31.

33. Never EVER tell a stranger online your real life name or address, and no pictures.  His avatar may look like a hot high school guy, but if you don’t know him, he really might be some forty year-old guy with yellow teeth, or a baby raper who wants to tie you up in some building.

34. Never use sex to pay for drugs.  If you start that, you will totally be screwed, in more ways than one.  When you were a kid, did you really wanna grow up to be a crack ho?

35. Ask your doc about what to expect if this is your first visit.  Ask to see things and find out what we will do and why.

36. Using birth control does NOT mean you are a slut.  It means you’re smart as hell.

37. There are a million ways to get birth control that are free or very cheap.  Ask your doc; we really don’t want you to be pregnant at a young age and we will do ANYTHING to make sure you can afford and get birth control.

38. If you have unprotected sex and are worried about getting pregnant, call us within 72 hours of having sex and we can get you a pill to help keep you from getting pregnant.  And no, the medicine does NOT cause abortions.

39. Don’t be scared of your OB/Gyn.  We can help you with LOTS of stuff.  We’re not looking to bust you.  Believe it or not, we’re mostly pretty cool people.   You can tell because it doesn’t freak us out to talk about random sex stuff. We get paid to talk about it.

40. Telling ANYONE anything about you in our office is against the law unless you sign a form giving us permission.  They can fine us up to 10,000 dollars if we do tell anyone.  We really don’t want to throw away that kind of money.

41. Some sexually transmitted diseases must be reported to the health department, so they can find and treat your partners.  They do NOT call your parents.

42. Having sex with lots of people is a terrible idea.  Your chances of catching diseases, getting pregnant, and other bad things go way up.  You are considered high risk if you do.

43. If you are wondering if you might be gay, or you feel confused about that, we are happy to answer ANY questions you  have.  3% of the population is gay.  We take care of GLBT people all the time.  We don’t judge.  And we won’t try to “talk you out of it.”. If one of us does try to, find a new doctor.

44. If anyone, even a doctor or a coach or a teacher or someone you babysit for, says things about sex that make you nervous, or asks questions about your sex life that are creepy and none of their business, stay away from them.  If they continue, tell a parent or some other adult you trust.

45. If someone in your life is hurting you, abusing you, or having sex with you against your will, your OB/Gyn office has phone numbers on little pieces of paper that you can hide in your clothes.  Call the number, and someone will come pick you up right away, no questions asked, and put you in a secret safe place.

46. If you are pregnant and hiding it from everyone, DON’T.  If you have the baby in secret, DO NOT EVEN THINK ABOUT KILLING OR HIDING THE BABY.  Almost every state has a law that you can drop a baby off at a hospital without being arrested.  Don’t be a baby killer.  They’ll catch you, arrest you, put your picture in the paper, and put you in jail.

47. If you are pregnant, the earlier you find out and make plans, the better.  Don’t wait until it’s too late to make any decisions.

48.  If you plan to stay pregnant, find an OB doctor right away.  Most pregnant teens can get health care.  We will make sure you and the baby are growing safely.  You or the baby are more likely to die or get sick if you aren’t seeing a doctor.

49. Be honest with your doctor about drugs you are taking, even if they are illegal.  We are not your parents.  We are not the cops.  We’re not going to bust you.  We just want to help you get off the drugs if you need help.  If you are pregnant, there are special things to do for you and the baby that will help keep you from dying because of the drugs.

50. We are here for you to use, for information, help, birth control, advice, and laws dealing with the things you are dealing with.  Use us!  We are like Google for female stuff. 

51. Ask your friends about an OB/Gyn that they like.  Your mom should almost certainly be seeing one of us.  Chances are, she would rather take you than let something bad happen to you.

How To Survive A Trip To Your Gyn

This post may seem somewhat redundant, and rather lengthy.  I am putting this out there because every day a search term such as “do you need to shave your legs to go to your gynecologist?” is the predominant search that brings people to my blog.  Obviously people are desperate for information.
And you men.  I see you about to click out of here.  Not so fast!  A truly wise man will absorb the wisdom here so he can a) sympathize with a woman when she is about go through this frightful experience and b) look like a totally cool guy who pays attention to women’s issues, which may get you laid.
So.  How to survive a visit to your Gyn in a few easy steps:
1)  Decide to make an appointment.  This may seem obvious, because we women can come up with two hundred thousand excuses not to go.  You need to go.  Go.  We may catch something early that will save your life!
2)  Make an appointment.  Do not overlook this important step, friends.  Making an appointment is NOT “just popping by because you were getting groceries up the street.”. Dropping in will make your Gyn grumpy.  And you don’t want a grumpy pants poking a speculum at you!
3)  Show UP for the appointment.  Otherwise you totally wasted steps 1 and 2, and you will be put in the Gynie Book of Shame.  (Just kidding.  We don’t have that book.  But if we did, you would TOTALLY be in it.)
4)  Don’t sweat the small stuff.  Literally.  We don’t care if you shave your legs.  We won’t even NOTICE that you didn’t shave your legs.  Unless you apologize for not shaving, in which case we will feel obligated to look.  It’s not your legs we’re looking at, ladies.  Also, don’t fret that it’s been a long day and “you’re not that fresh down there.”. This is a concept invented by the feminine hygiene products corporations.  And they sold you on it, didn’t they??  Unless you smell like a Tibetan Yak after a goat milk bath, which would be exceedingly rare, we don’t notice that either.  Last, don’t attempt to scrub away any “odor” with toilet paper.  It rolls up into little balls that get all tangled up in your pubic hair, and we have to figure how to work around them without embarrassing you by telling you they are there.
5)  We don’t care what you’re wearing.  With ONE exception.  If you are wearing leather shoes or boots without socks, your feet STINK.  Trust me.  And that smell can render an exam room unusable for a few hours.  PLEASE wear socks (plus, you can wear them for your exam so your feet don’t get cold – we’re not looking at your feet either) with any footwear, and try to avoid that pair of stinky Sperry’s you’ve been wearing all last year.
6)  We want you to tell us anything that might affect your female health.  If you’re a lesbian, speak up.  There are some health issues and screenings that are different, believe it or not.  You being gay is just a piece of information we need.  We are discreet.  We are NOT going to out you.  We will not put up a billboard.  I PROMISE.
7)  Please feel free to tell us about any of your sexual practices and habits that you think might be “unusual”.  Trust me.  They’re not unusual.  Unless you’re having sex with llamas, in which case, we need to talk.  We need to know because there is knowledge that you need regarding certain things that we do.  We aren’t fishing for information so we can tell funny stories.  Again, I promise.
8)  When it’s time to get undressed, the nurse will tell you exactly what you need to do.  If you’re confused, please ask.  Many doctors will leave your clothes on until we chat, because we know it’s a little disarming to meet someone when you’re stark naked.  We may have you immediately undress when you arrive if we know you, because it saves time.  But if you prefer to leave your clothes on until the actual exam, then ask the nurse.
9)  You are totally not expected to dress up for us.  After all, it’s not your clothes we’re looking at.  We don’t care if you’re wearing your best underwear.  We aren’t even going to see it.  Clothes that have at least been washed in the past week would be nice though.
10) We can’t do a very good breast exam if you leave your bra on.
11) Equipment:  if you’re just having your yearly, and not having specific problems, we don’t need much.  The main object of terror is the speculum.  Your friends may describe it as “the duck” or “the clamp.”. It is not a duck.  It kinda looks like a duck’s beak, I guess.  But there will be no quacking of any kind.  Now, about the clamp thing.  It is NOT a clamp.  It is the opposite of a clamp.  We just use it to hold your vagina open enough so we can see your cervix up there.  If you are clamped by a speculum, we are doing something wrong.
12) Other equipment:  if we are doing a pap, all we should need is a tiny brush and a jar to swirl the brush in.  On occasion, a q-tip may be used.  None of these are scary.  There is no cutting or pinching or whatever Gothic fear you may have about what we are doing up there.  We just sweep (in a circular motion) with the little brush.
13) Special equipment.  If you are having a particular problem, we may need some different equipment.  A lot of the time, the nurse will have these terrifying-looking implements laid out on a tray.  Do not look at them and panic.  Most of the time, we aren’t going to use all of them.  They are just there in case.  If you want to know what one is for, ask.  Some patients prefer to know NOTHING about what is going to be done.  If so, just say so.  I will stop the discussion about the Kevorkian biopsy forceps immediately, and I will distract you by talking to you about your cat, or your kid getting expelled from school, or any other topic you care to introduce.  If you are too terrified to talk, I will talk.  I will talk your ear off.  Many times my patients say, ” aren’t you going to use that q-tip?”, to which I will reply, “I already did.  While we were talking.” Gynies learn to be very good talkers, because a distracted patient is a more relaxed patient.  On occasion, I have a patient laughing so hard that I tease them that they are about to cause my speculum to fly out in my lap.  Which has actually happened on a couple of occasions.  Which was very funny.
14) You can bring someone in with you if they help you to relax.  Just be warned, I am going to assume that if you don’t mind being naked in front of them, you don’t mind me discussing things in front of them.  If that is not true, please let me know when I walk into the room.
15) I love to teach people about their bodies.  Unless you’ve been to medical school, there are TONS of things I can tell you about which will be really cool to know.  I’ll start with one now: the female parts on the OUTSIDE of you, the parts anyone could see if they just looked down there are called the vulva.  Not the vagina.  The vagina is the part on the inside.  That’s the part that we have to put something in there to see.  That’s where the tampons go.  Vulva = outside.  If it itches, or has bumps on it, it’s probably your vulva.  Because you can see and feel that part.  Vagina = inside.  You’d have to stick something up in there to feel it.  Now you will look really really smart when you next talk to your Gynie, and she will be very impressed.
16) Your Gynie should notify you of your test results somehow, by mail, or a lot of offices are going to email or web sites.  The old “no news is good news” system does not let you know if your test might have been overlooked or lost.
17) Some of the rules of testing have been changed.  You may be told that you don’t need a pap every year.  Don’t worry.  Be happy.  Same deal with mammograms.
18) More bleeding is usually more worrisome than less bleeding.  At worst, less bleeding might mean pregnancy or menopause.  Increased bleeding can be any number of things, some of them not benign.
19) We like to quiz you on which you hate worse, your gynecologist or your dentist.  People seem to be divided on this.
20) Please pay us.  I know people think we are rich, but we are paying the nurses, the receptionist, the coders, the billers, the phone people, the transcriptionist, the schedulers, the ultrasonographers…  You get it.  And we’re paying their health insurance, their 401k, our staggeringly horrifying malpractice, and on, and on…
21) Don’t panic!  We want to make this easy for you.  Also, if the receptionist was mean to you, or you had to wait 5 hours, please tell us (nicely) – we need to know.
22) Please no drama.  No fights in the lobby about whether the guy with you is the father of your baby, or yelling on the phone to your old man because he’s in jail, fistfights – we’ve seen it all.  And calling security is such a bummer.
23) We keep your information secret.  Not just because it’s the right thing to do, it’s the law.  We get fined around $10,000 if we give out any information.  A corollary to this:  we give you a form when you come in where you list the people we can give your results to.  If the person is not on the list, whether they be your husband, your sister, your teenaged kid (we are only allowed to give out a minimum amount of information, even though they are minors.  Otherwise kids would be too scared to ask for birth control, or tests for diseases, or pregnancy tests), we can’t tell you anything.  Not even that the person is a patient here.  We’re not being jerks.  If they sign that Mom can get all results, then we’ll tell you.
24) You’ll feel so much better when you’re on your way out the door!  Granted, you will have the icky gel stuff leaking out of you for the rest of the day, but your health is totally worth it.  I trust we’ll see you soon!

Birth A La Mode; No Cherry On Top

I miss the good old days. I admit, it’s hard to miss something you never actually witnessed, although that’s how things were when I was an infant.

No one who had a baby in the early sixties remembers giving birth. When women arrived in labor, their husbands were promptly dispatched to the waiting room, and the mothers were taken to a labor room.

They would not have signed a consent to give birth. The lawyers had not yet mucked up the entire medical system. What a laughable thing, signing a consent to give birth. What the hell happens if you refuse to sign the consent? That thing is coming out anyway; I can assure you of that.

On admission, they were administered a cocktail of at least two medicines: Demerol, a powerful painkiller, in doses calculated to make one gutter drunk, and scopolamine, also called the zombie drug, because if you give enough of it to someone, they are in a trance-like state and will almost certainly be suggestible and compliant with any orders. Scopolamine also has a powerful amnestic effect: given in sufficient doses, the recipient will remember virtually nothing from the time the drug was given.

Doctors back in the day tell me that those women were still awake; they still felt pain and yelled, but they did as they were told and didn’t remember a BIT of it. My mother remembers nothing about giving birth to me. And she doesn’t seem to regret that one bit. She told me, “Well, I had some contractions, so I did the laundry and vacuumed the house, and went in to the hospital. When I woke up 2 days later, I had a baby.”

That would be AWESOME. And I say this not because I am a narrow-minded misogynistic control freak, but because the pendulum has swung WAY too far in the other direction. The change began in the late 1960’s when the hippies decided that childbirth was a beautiful and natural experience and they wanted to live every bit of it. Grudgingly, the physicians agreed to allow the husbands to be present at the delivery. That meant no more doping the patient, so now they were dealing with a wide-awake very scared little person in massive pain, because they didn’t really do epidurals back then. And then they had to deal with the baby’s FATHER (I don’t say husband, because that was around the time of free love and marriage while procreating was optional at best).

I can just imagine the ambiance. The physicians at that time would still be all male, serious as all get out, and doing things the way they were done in the 1950’s: clinical and sterile and blue gowns and drapes and sterile instruments and obedient nurses all doing things very, very seriously.

And in the middle of all this would be the father of the baby (which we heretofore will refer to as the FOB, which is what we call the biological paternal unit, even on the chart, because it gets rid of all need to establish whether or not the patient is married, or if the guy in the room is indeed even the one who donated the DNA, or just some new guy). The FOB would be intoning things like, “Just stay groovy, baby. We want the little dude to have a peaced out aura. Like, so, you probably shouldn’t be screaming and stuff.” At which point, the woman in labor would probably do what all women in labor do at this point, and scream, “Shut the hell up, and get this damn thing out of me!” Hispanic women in labor scream this in Spanish. It is universal.

And then IT happened. After the major adjustment made by the obstetrical community, and the drastic move of allowing fathers in the birthing room, the slippery slope began. The logic being, well, if my FOB can’t be here, can my mom be in here? Which then extended to, well, if my husband or my mom can be in here, can they BOTH be in here?

And that is when stuff just fell all apart. It became anarchy. Allow me to describe a common scene when I enter a labor room: the patient is in the bed, hanging out comfortably with her epidural. Her boyfriend is in the bed with her. The mom and the mother-in-law are both there, because if HER mom can be there, then why can’t mine? Grandma is there too, over in the corner, reeking of gin. There is some young girl with low rise jeans and her thong hanging out sprawled in the recliner meant for the FOB, and her boyfriend is sitting on the armrest. We are not sure who she is but we think she might be the patient’s half-sister. It is explained with some giggling that the boyfriend in the bed is, well, not the FOB, because the FOB is in jail right now, but he didn’t do anything. There is someone’s toddler on the floor. No one is watching him; his diaper is dirty, and he is fondling the patient’s foley catheter bag.

When I enter the room, there are cries of, “Who’s that?” from the imbeciles who arrived late, and from those in the know, cries of “Hey doc, has she done dilated yet? Can we have this baby now? We done waited a long time!” I announce that I am going to examine the patient. Nobody moves. I pointedly say to the patient, “I am going to uncover you and check your cervix. Would you like anyone to step out?” The patient shakes her head. Over from the corner, where it emerges that the patient’s own father is lying on a sleeping bag on the floor, the father yells, “Naw, I done seen it before! Done changed her diapers all these years!” Again, no one steps out. There is a mass craning of necks (from the ones NOT passed out) and they all wait eagerly for the verdict. This is better than reality TV for them. We get more visitors yet on days when there is nothing good on cable, and they’ve already seen that episode of Duck Dynasty.

Now you may ask, why do you put up with this? The answers are multiple. First, this is now part of the birth culture. These people have already attended multiple other labors and would not understand why they were not allowed to hang out for this one too. Second, most of the time, they aren’t really hurting anything; they are just being picturesque and inappropriate. If they are really in the way. I will boot them out. If they are upsetting the patient in any way, we will boot them out, with the help of Security (or the police, if need be), and yes, I cannot begin to enumerate the number of times cops have been called to drag out feuding potential FOBs or belligerent family members.

The other reason for the tolerance is this. All these clowns seem to reduce the anxiety level of the patient and FOB by distracting them, and they are not staring at the baby monitors and pushing the nurse call button multiple times and yelling down the hall, “Hey, the baby’s heart beat done went down!”

Also, we are not nearly as tolerant at the births. After all, birth requires focus. And there can be complications of a birth, certainly, and you don’t want a room full of panicky bystanders with camcorders getting down every second of it. Most hospitals allow two guests at pushing time, usually the FOB and one of the moms. If the patient and family are well behaved, I may allow one more, so we have, say, the FOB, his mom, and the patient’s mom. I reserve the right, at any time to boot everyone out.

Everyone who has been shooed out into the hall for the pushing phase now gathers in the hall. Despite multiple warnings from the nurses, they ooze back out of the waiting room and materialize right outside the door. From out in the hall, we hear audible speculation on what is happening with each scream that is heard. Usually, there is a pool for the weight of the baby or the time of birth. Wagers are cast. I have literally exited the labor room to get something during the pushing process and had people who were pressed up against the door actually fall halfway into the room.

The plague of locusts is rousted one more time, hopefully timed so that the poor girl gets some privacy during the birth and her creative swearing and screaming may not be heard. I hand over the baby, give my congratulations, and head out to the desk to do the paperwork.

After the paperwork is done, I usually swing by the room to make sure everything is stable and mother and baby are well. At this point, all the starlings have come back to roost and are perched on every available semi-horizontal surface and playing Pass the Baby. The TV is blaring. Multiple cell phones are in use. Pictures of the baby and the bleary-eyed mother are being uploaded to every single social media site known to man. I can barely see or speak with my patient because the room is so full of family, friends, and random acquaintances who may have just wandered in.

So this is where we are. It is a far cry from the calm, controlled circumstances in the 1960’s, and all dignity pretty much seems gone from the process of birth. So, I feel I can hardly blamed for being nostalgic for the good old days, where the dads were out pacing the waiting room with cigars, and the moms were pliant and drugged to the gills. There is a happy medium somewhere between where we are now and where we were then. But since when does mob mentality settle for happy medium? We’re just another reality show.

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.

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.

 

 

 

 

 

Orientation Fun

 

Rapid City Regional Hospital Credit: Flickr Creative Commons – Emilio

 

I started a new locums travel doc adventure in Rapid City, South Dakota yesterday.  I was to report to the hospital for my “orientation”, a word to those in the know as “soul shattering meaningless tedium”.  My schedule was as follows:

0645 – 0701:  Lean up against the wall opposite the Medical Staff Office where I was supposed to report at 0700.  Watched 3 (count them, 3) employees come up, unlock the office and ignore me totally, despite the fact that I was obviously the new doctor who was getting processed (much like the beaks and assholes that go into luncheon meat) and that I was holding up a wall in the hall out of sheer sleepiness and boredom.  I did manage to get a picture of Traveling Guck sitting under the Med Staff Office sign, post it on Facebook, and email it to my daughter.

0701:  They actually stick their heads out and open the door for me.  Apparently they take the 0700 start time very seriously.

0701 – 0707:  Introduction to the 3 dickheads who left me standing in the hall.

0707 – 0720:  Taken to get a photo badge processed.  When I asked them if they needed ID verifying my identity, they said no.  Apparently they don’t mind issuing medical staff badges to random strangers.  I was of course lined up against a blue wall without opportunity to inspect my hair, and allowed one deer-in-the-headlights shot with no Mulligan.  I was told to go do something else; the badge was processing.

0720 – 0735:  Taken to IT to get computer passwords and immediately change them.  Since they wouldn’t tell me the criteria for the passwords (I swear, they didn’t know whether I needed capitals, lower case, special characters or numbers), I had several do-overs until I found a password that the freaking computer would accept.

0735 – 0740:  Back to pick up ugly badge. Future spoiler:  they set it up wrong and it didn’t open any of the doors that I needed it to.

0740 – 0815:  The ultimate in mind boggling tedium.  This is the same standardized spiel you are given at every single hospital that you work in:  it is dictated by OSHA and JCAHO and a few other acronyms.  Therefore I have heard this 3 times in the past 3 months.  It involves:  Hospital Mission – a retch-inducing phrase or two about Service, Teaching, Health Promotion and Other Grandiose Bullshit, Fire Procedures – seriously, who doesn’t know about RACE and PASS?, Infection Control – a list of all the nasty bugs floating around in the hospital and the special antibiotics used to treat them, if you are lucky and they can be treated at all  (Flesh-eating bacteria included), HIPAA – letters stand for “you’d better not give anyone any information about any of your patients and it we find out you did, we will fine you, fire you and set fire to you”, Code of Conduct – they now must produce a written list about how not to be an asshole (official name:  disruptive physician) because people apparently don’t have the sense not to be assholes and must be given a specific list of asshole things not to do,  Peer Review – we will be watching you, new doctor, and auditing your charts because you are probably incompetent, and Software Use and Access – the passwords never work.

0815 – 0830:  Ridiculously long-winded talk from the head pharmacist, who has a way overdeveloped sense of importance, and who gave me 8 (yes, 8) business cards of pharmacists who I would probably not encounter were I to work at the hospital for 10 years.

0830 – 0930:  Computer training.  This seems to follow a basic pattern – taken to a dark room where a pasty antisocial individual is hunkered down,  sat in front of a computer and given a mouse to click on various things without explanation.  This is all punctuated by, “oh, I don’t know why that’s not working – it usually works”, from the IT person who seems to have no idea about real-life applications of the material they are teaching.  An hour of, “Oh, let’s back up, oh, no, no, no, we didn’t want to go there, OK, try clicking on that” where really, I would have done just as well playing with the damn program myself.

0930 – 1000:  “Do we have anything else for her to do?  I’m not sure, do we?  Did she see the pharmacist?  Oh, I guess we should try to show you the hospital.”  Remember that I must see Medical Records for instructions for record dictation.  Meet with sourpuss from Medical Records.  Receive incomprehensible instructions and dictation cards.

1000:  Phone call from the doctor who is already turning call over to you, explaining that you already have a labor patient to take care of, despite the fact that you haven’t even seen Labor and Delivery yet.

1000 – 1020:  Taken at a gallop past the OR, doctor’s lounge, ER, radiology, and finally, Labor and Delivery where you are kindly intercepted by the chief MD of the Ob/Gyn department, who gives you an actually civivlized and useful tour of the area.  You are introduced to at least 25 people, none of whose names you will remember.

1020 – 1030:  Shown where the locker rooms, scrubs and break rooms are.  Both the MD call rooms are occupied, so no place to sit there.  Insructed to throw backpack on the floor in the nurse’s lounge.

1030 – 1040:  Locate and change your scrubs to their scrubs, because the ones you have on (although perfectly functional) do not belong to this hospital and are thus assumed to harbor awful bacteria.

1040 – 1500:  Sit around on Labor and Delivery because the patient in labor is having her third baby and it should come fast.  It does not come fast.  Chat with nurses (who are too busy to chat) and a Family Practice resident who is waiting to do a delivery and who is hoping you will let him do yours.  You don’t want to let him do your delivery, because you don’t like how anyone does deliveries except for the way you do them, but you have to be a good sport, because that was how you learned back in the day, and people have to learn, don’t they?

1500 – 1530;  Actual delivery of the baby.  You let the resident do it.  He does OK except for the suturing part, which is so slow and fumbling and incompetent that you want to kill yourself.  You would have finished 20 minutes ago.  The nurse is uncertain whether the stitching job is adequate.  It is adequate and you politely tell her to bugger off.

1530 – 1600:  Attempt to take care of strange paperwork and computer work, none of which functions the way you were shown by the creepy IT person in the basement.  Swear under breath.  Repeat.

1600 – 1615:  Use Google Maps (which totally rocks, by the way, and it’s free) to find your way out to Bumfuck where the Ob/Gyn clinic is located.

1615 – 1700:  Meet the doc you are working for and her office manager husband, who regale you with how awful and unfair the politics at the hospital are, and how they hope they will not make you suffer too much.  Yippee.

1700-1715:  Find way back from Bumfuck to the hotel using Google Maps, which by now has used up the battery on your phone.  Pray that you get to the hotel before the phone dies and you are stranded forever.

1715:  Collapse on the bed with the stuffed duck and eat an Atkins bar.  Plan TV watching.  Sulk because tomorrow the patient that delivered wants her tubes tied, a procedure you hate doing and you will have to get up early to do it.

Standardized, Bastardized, Smothered, Covered And Chunked

I spent all day filling out a standardized application online for a state medical licensure.  All day.  It went something like this:

1.  Name:

1a.  Ha!  Not that name, you sucker!  Now list all the other names you use:  the one you robbed that bank with a couple years ago, your ex-husband’s last name that you didn’t take…  By the way, why DIDN’T you take his name, you deviant?  Attach extra paper to explain here.

2  Address:

2a.  Is that really your address?  Why do you live in such a shithole?  Attach extra paper to explain here.

3.  Where did you go to medical school?

3a. Because we know you don’t remember,, we want the actual day of the week you started there, the street address, since you haven’t been there in over 20 years and haven’t the foggiest, and oh, we want their fax number too.  Even though faxes weren’t even invented when you went there.

4.  Where did you do your internship?  Your residency?  Never mind that they are usually both done at the same institution; we want you to fill out all the same information twice.

4a. What years did you go there?  If you were ever absent for more than three days during your entire residency, attach extra sheet to explain why you are so self centered that you thought you deserved a 2 week trip to Vail.  Because seriously, you should have been working.  Explain yourself.

5.  List everywhere you’ve worked since medical school.  We want exact dates, addresses, contact names (even though they bulldozed one of the hospitals you worked at – we want to be able to contact them at the Home Depot they built over it), email addresses, and, oh, if there is more than a month gap between any work engagement, attach extra sheet to explain here.  Vacation is not a real reason.  What were you really up to, what sinister antisocial behaviors were you engaged in that kept you from work?

5a.  Seriously, why weren’t you working that September in 1990?  You know we don’t believe you.  Enter your lame excuse and have it notarized.  In triplicate.  Send one copy to our office, one copy to your recruiter’s office, and one to the local paper so we can all laugh at you.  Send it Fedex Overnight.  On your bill.

6.  Enter all licensing exams you’ve ever taken, the exact dates, the exact scores, and whether or not you cried when you left the testing room.  If you ever failed anything, explain yourself.  Attach extra sheets if necessary, but don’t make the ink all runny with your sniveling.  Entries with sniveling runny ink will be returned, and you will have no opportunity to redeem yourself.

7.  Have you ever:  Pooped twice in one day?  Been laughed at for being too fat?  Been late paying a phone bill?  Forgotten to brush your teeth?  Made an illegal u-turn?  Withdrawn your hospital priveleges (even though it was just because you moved and there wasn’t a damn thing sinister about it)?  Been sued by some asshole?  Hung up on a telemarketer?  Missed church?  If any yes answers, tough noogies, attach extra sheet for each question and waste the rest of your day explaining yourself.  And don’t think we won’t check up on you.

8.  List all states in which you have ever had a medical license.  If you forget any, you are screwed, discredited, and we will hound you until you die.  Now what were those exact dates again?  Better not be a day off, or we will know you are lying.

9.  Attach triplicate copies of:  your state medical license, your DEA number, your residency certificate, your board certification and your med school diploma.  Never mind that they are indelibly framed and sitting in your garage and you are somewhere in North Dakota.  There’s no excuse for not having them copied.

10. Attach notarized originals of your birth certificate and your passport.  We need them for our files.  We will not return them.  What?  That’s your problem.  Go out to the hospital you were born at 45 years ago and get them to give you a new copy.  We’re keeping these.

11. Have you ever been diagnosed with sadness?  Feelings of hopelessness?  Inadequacy?  Stress?  Depressionbipolardisordermentalillnessobsessivecompulsivedisorderdissociativeidentitydisordermaniaanxiety?  If so, attach notarized letter from your doctor and explain yourself, you piece of shit.  Why would we let you work for us if you’re damaged?  And don’t lie.  We have friends at your insurance office.

12.  Have you ever commited a felony?  No?  Feeling smug?  What about a misdemeanor then?  Parking tickets?  Jaywalking?  ATTACH EXTRA SHEETS AND EXPLAIN WHY YOU DESERVE TO LIVE.

13. What is your address in the state you’re applying for?  We know you don’t live there yet.  We don’t care.  Fill in the address, or the app will be stuck on this page for the rest of the day.  And you’d better not be making stuff up.  We know where you don’t live.

14. OH, SORRY.  YOU LET THE APP TIME OUT WHILE GROVELING ON THE FLOOR FOR YOUR MISSING BIRTH CERTIFICATE.  Go back to Go.  Do not collect $200.  In fact, you owe us $200, one for each copy of the application.  And you must fill everything out again, because our IT people suck so bad at building cheap websites, they don’t let you save as you go.

15.  Welcome back.  What was your name again?  I’m sorry.  That password is incorrect.  You should have changed it the last time you logged in.

16.  I’m sorry.  The number you’ve reached has been disconnected.  Actually, it was never connected.  Sucker.

 

 

Thirty Types Of Baby Daddies

1.  The Fifteen Year Old:  No, really, he’s fifteen.  Has cap on backward.  Laughs uproariously at everything that is said, whether it is funny or not.  It usually isn’t.  Has his mom with him, because neither “parent” is old enough to drive yet.

2.  The Redneck:  Has on fishing hat with giant fishhook clipped onto it.  John Deere t-shirt.  Camo pants.  Dip can outline in his back pocket.  Talks much more than he should.  Asks really stupid questions.  Calls his girlfriend/wife “darlin'”.  Calls the doctor “darlin'”.

3.  The Metalhead:  Long unruly hair.  Black everything.  Is usually standing just outside the exam room door on his cell phone setting up drug deals.  Reeks of pot.  And what is that chain that hangs out of his pocket and hooks on to his beltloop?  Has not realized that Hair Bands were out after the eighties.

4.  The Tattoo Man:  Seriously.  Has full sleeves tatted on both sides.  Has tattoos on every visible part.  Has teardrop tattooed on his cheek.  Isn’t that supposed to mean he’s killed someone?  Or is that just urban myth?  Girlfriend covered in tats too.  Usually a pretty quiet, decent fellow.  Unless he’s actually killed somebody.

5.  The Head Shop Manager:  Marked similarities to #3 and #4.  But everything is also pierced.  Makes jokes about Prince Alberts.  Nods head and taps feet to imaginary music.  Reeks of patchouli.  Wears extremely hip and ironic t-shirt from the shop.

6.  The Dirty Ignoramous:  Wears the same thing everytime he comes in.  Fat, unshaven and slovenly  Everything is gray with dirt.  Stinks of body odor.  Tries to look wise by asking questions that actually make no sense.  Asks A LOT of questions, all of which make no sense.  Like, is it better to keep the cat box in the kitchen, or the bedroom?

7.  The Troubled Youth:  Slouches in chair with hoodie over face.  Refuses to look anyone in the face.  Refuses to answer questions, or speak when addressed.  Pants are falling off.

8.  The Uniformed Butthole:  Upright self-important martinet who wears whatever uniform he has to every appointment.  Police uniform (has to speak into walkie talkie at some point), military uniform, mall cop uniform, firefighter, whatever.  Distinguished from the general working population in that he wears a uniform every single time they come in, not just when he happens to be working.  He wears the uniform in the delivery room too.  Obviously has something to prove.  Very authoritative.  Wants to make sure everyone knows he’s boss.  Asks lots of dominant questions.  Demands certainties in circumstances where nothing is certain.  Wife not allowed to speak.

9.  The Concerned Yuppie:  Dressed in button-downs and khakis all the time.  Occasional blue blazer.  Very serious expression at all times, very earnest.  Lots and lots of questions.  Seems to feel deep down that if he doesn’t ask all these questions, that nothing will be done right.  That he alone must save his wife from our obvious incompetence.  Has done just enough reading to be dangerous.  Control freak.

10. The Asshole CEO:  Very similar to #9, but is extremely aggressive and accusatory in his communications.  May possibly be beating his wife.

11. The Tofu Crunchy Granola Dude:  Also very earnest.  Has also read enough to be dangerous.  Wants to know about tub births, birthing balls, candles and ambient music during labor, and doulas.  Feels that modern medicine is the enemy of natural childbirth.  Feels we will foist our uptight medical beliefs on his wife, and ruin her organic birth experience.  Rants about C-Sections.  Wants to refuse IV access and has to be talked down.

12. The Jokester:  Alway wisecracking, everything is funny, nothing is serious.  Passes out when his wife’s epidural gets put in.  Wife is exasperated with him.

13. The Leech:  Clings to his wife at all times.  Gives her deep soulful kisses while we are trying to find the baby’s heartbeat.  Holds her hand and strokes her hair while the big mean Ob/Gyn does her 15 second cervical exam.  Urges her to breathe deeply so she can survive it.

14. The Frequent Flyer:  Has actually impregnated two or more of our patients during the same time period.  Looks nervously over his shoulder a lot.  Yes, we know who you are.

15. The Gross And Annoying Kid:  Pops his pimples in the exam room mirror, without shame.  Rifles through our drawers and pulls out q-tips to clean his ears.  Holds up various medical equipment and says, “Whuts thi-yus?”  Breaks stuff.  Steals other stuff.

16. The Military:  Poor guy barely makes it to one appointment before he is redeployed to Afghanistan.  Is grateful just to be there and hear the baby’s heartbeat.  Sometimes is not allowed to come home for the delivery.  We literally Skype these births sometimes.

17. The Jailbird:  Usually only present on the other end of the mom’s cell phone.  She is screaming obscenities about child support.

18. The Jerry Springer:  Gets into arguments and fistfights in the waiting room, sometimes with his “fiancee” and sometimes with some stalker guy who thinks he may be the dad.

19. The Restraining Order:  This one is very serious, and dangerous.  He has actively harmed his girlfriend/wife in the past.  He is not allowed any information about the woman or her pregnancy.  Sometimes appears menacingly in the waiting room demanding to know where his “woman” is.  Scares the office girls to death that he will whip out an assault rifle and waste everyone.  Usually means a call to Security.  OK.  ALWAYS means a call to security.

20. The Addict:  Comes to appointments so wasted that he slumps out of his chair onto the floor.  The girlfriend explains:  “The demerol he got in the ER ain’t mixin’ good with his methadone.”  Babbles incoherently.  Slurs.  Stumbles around.  Too f’d up to be dangerous.

21. The Creepy Older Guy:  17 year old girl is accompanied by her 30-something husband.  Sometimes parental consent is the only thing between him and statutory.  Looks ridiculously pleased with himself all the time.

22. The Homewrecker:  The patient is married.  Just not to him.  Sometimes the husband shows up for the delivery.  AWK-ward.

23. The Great Guy:  Comes only to the appointments that his wife asks him to attend.  Obviously thrilled to be a daddy.  Pleasant and generally likeable.  Appropriately concerned.  Very rare.

24. The Extended Family:  One concerned citizen just isn’t enough.  The daddy brings his mom and sundry other family members.  They make sure  to ask questions too in case he forgot any.  They sit on every available surface in the exam room, and carry on loud conversations while the doctor is trying to talk to the patient.

25. The Absentee:  Never comes to a single visit.  Doesn’t come to the delivery.  Sometimes doesn’t even know he is a dad.  The girl is attended at the delivery by her mom and her two sisters.

26. The Mail-Order Husband:  Chubby, short, bearded dork accompanied by astonishingly beautiful Asian, Filippina or Eastern Bloc hottie.  The patient doesn’t speak a word of English.  The mail-order dad doesn’t speak a word of her language either, which he tries to overcome by shouting at her really loud because then she will surely understand him.  She just smiles inscrutably.

27. The Medical Dad:  Doctor, nurse, or EMT.  Either way, he knows WAY too much and yet not nearly enough.  Convinced of his absolute knowledge and our absolute incompetence.  Asks lot of technical questions meant to prove his medical prowess, which actually reveal exactly how little he actually knows.  Mentally exhausting.  Tries to control medical treatment at all times.  Makes helpful suggestions during times of crisis.

28. The Shrinking Violet:  The subject of anything medical or anything related to bodily functions makes him nauseous.  He blanches at discussions of labor, babies, vaccines, needles, IVs, blood or C-Sections.  Wife threatens him with bodily harm if he balks at attending the delivery.

29. The Family Guy:  They’re on their fifth baby, and he believes the first four should attend every visit with them.  Is frequently found crawling across the floor towards a toddler while another kid dangles from the exam room curtains.

30. The Documentation Guy:  Wants to get a recording of the heartbeat, stills and videos of every visit, plus video and stills of the gory details of the delivery.  Wants to photograph the afterbirth.  We never know if he is just overenthusiastic, or trying to sue us.

 

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