Dr. February is . . . Charity Doc

Picture of "Serious" Charity Doc

PART ONE

Another one of my favorite ER docs. Charity Doc knows how to inform, educate and express his views in an entertaining way that even non-medical types like me can understand and enjoy. Who else would think of using a butt pus analogy when explaining how he would go about solving our health care crisis? [Note to self: consider adding "in ten words or less" to some of the calendar doc questions].

In Part Two, Charity answers some of my more juicier questions.

Here's Part One of my interview with Charity Doc:

Q.1 WTF? Where have you been? What are you doing? Are you coming back? Why did you leave us hanging like that? you get the idea...

A.1 I haven't left medicine at all, I'm still taking care of patients but in a much different capacity. I abandoned my old gig because had to practice medicine on my own terms. I desperately needed to eliminate all of the bullshit that had made me miserable as an ER doc. I had to do it without the fears of litigation. I had to do it without the guilt of streeting a patient because he/she does not have health insurance or cannot afford what needs to be done. I was sick and tired of arguing with consultants night in and night out about admitting a patient to the hospital only to have them refuse. Or after forcing them to admit, they then turn around to discharge the patient the very following morning. Here's one such scenario…There's this homeless lady who comes into to the ED all time with right upper quadrant abdominal pain. I performed a bedside ultrasound on her during one of the early visits and found her to have gallstones. I did the study informally (because we had an ultrasound machine in the ED) so that she wouldn't have to incur the charges of an ultrasound. She never paid any of her hospital bills anyway so that, too, is a pointless discussion. In all of her visits she would get lab'ed up every time and discharged home for outpatient follow up when her labs came back normal without elevated liver function tests or pancreatic enzymes or leukocytosis. Bottom line, this lady has chronic cholecystitis and needed to have her gallbladder resected, but no damn surgeon in town would do it for her for free. She shows up to the clinics for follow up but gets turned away at the front desk after a negative wallet biopsy each time. This is after me getting personal verbal reassurance numerous times from different surgeons over the phone that they will see her in clinic. Several times, I begged the hospitalists to admit her to the hospital and consult the surgeon on call, which they did as a favor to me. But then she got streeted the following day each time after getting "plugged in" with social services to procure fundings from local resources and agencies for her "elective" surgery. This funding never materialized so she's still out there, over a year now, suffering miserable pain and waiting for the day when she gets really sick with a fever and her labs coming back abnormal to show that she has gallstone pancreatitis, cholangitis, or a perforated gall bag. It's despicable!

I also despised the hospital administrators to no end. They have no clinical experience or background whatsoever (zero, zip, nil, nada!), yet they see it fit to dictate how I treat my patients by establishing all sorts of bullshit rules to impede what I do. One such glaring example was when they came down with this firm no diversion policy, yet won't allow me to use the hallways to put, see and treat patients in because "It's against JCAHO." So when the ED is filled to the gills with no empty beds, patients being boarded because there is no room upstairs, the waiting room/lobby is filled with triaged patients to be seen, ambulances keep calling in, surrounding Podunc hospitals on the phone requesting transfers, etc…what the hell is a frustrated ER doc to do? Pull a magic wand out of his ass? On top of that, hospital administrators have a very uncanny way of pissing off the nursing staff to make them quit. Every month, more and more experienced nurses leave to go elsewhere, and I'm left to deal with incompetent and inexperienced traveller nurses. Some of them are great, but the majority of them are horrible. Then there's the contentious issue of utilization reviews and patient satisfaction survey scores to piss me off even more. I've blogged about this ad nauseum already.

I had to get away. The ER had made me become an angry and suspicious doctor that I didn't like. I hated myself for seeing every patient as a potential lawsuit and hated myself even more for the cynicism and bitterness that now grappled me after over 20-something years of medicine. When you start referring to patients as trolls and squirrels, it's time to call it quits. I had to get away. I had to free my conscience and get back to the humanity of medicine. So, I opened my own free clinic using the available spaces provided by a local church. I see patients 3 days/wk. M, T, W 10a-1p, break for lunch, then 2p-5p. That's it. Very limitted funding from the local churches in the community. Quite busy though. The only folks helping are the local churches and a few local businesses, radio and TV stations. I couldn't get the local hospitals to donate anything. Nor could I get any local docs to volunteer their talents either. I did get a few nurses to volunteer, though. I suppose the hospitals see me as a competitor and business threat, which made little sense to me because while I was working in their ED's these patients weren't paying them a dime anyway. But, hey, I know the game, the county hospitals do get some fundings for providing indigent care. However, here's my point, there are plenty of poor and homeless folks out there to go around and if I can do my part to keep them from coming to the ED's for non-emergent problems, shouldn't that be the goal? This month, I'm running real low on disposable lac trays, 4x4's, iodoform packings, 1% Lidocaine, 11 blade scalpels, betadine, and sutures. Heck, I'm running low on everything and have already spent a hefty hunk of my own money to get this clinic up and running. I spend the majority of my clinic days I&D'ing CA-MRSA abscesses, suturing lacs, refilling meds (antihypertensive and oral hypoglycemics for the most part), and stomping out sorethroats, coughs, UTI's and STD's. Lord knows that homeless folks gets freaky, too! There are no diagnostic studies performed, I just treat them and street them. Thank Jesus for $4 meds at Walmart (matched by Target, CVS and the other local pharmacies). The drug reps help, too. I love it when they bring free lunch. I'm under no pressure to prescribe any of the meds that they peddled, of course, since my patients cannot afford them anyhow. As to the liability aspect of it all, I'm not sure and try to keep as detailed records of each encounter as I can. I'm just hoping that the Good Samaritan laws apply and have been wingin' it day by day. All patients must sign a liability waiver to be seen. I may have to cut down to 2 days a week because of lack of fundings. I moonlighted in a Podunc ER the other day after a friend begged me to help out. The stock market is tanking, I may have to go back working for real pay.


Q2. Tell us how you are going to spend Valentine's Day.

A.2 Having hot steamy sex with my wife, like always, of course.

Q.3 One of the presidential candidates has asked you for some advice on how to improve the nation's health care system. What do you tell them?

A.3 The health care crisis facing our country is akin to a festering butt pus in dire need of incision and drainage. Like butt pus, it's well covered up so no one else can see, but it sure hell is a huge pain in the ass! My long rant on the subject can be seen here.

To summarize, we have a real national crisis at hand and it seems that none of our politicians know how or even care to solve. When over 47 million Americans do not have health insurance, we have a big problem. When a person in America has to make a decision between food on the table or pills in a bottle to take for his/her medical problems, it is a national disgrace. When a man have to resort to committing a petty crime to land him in jail just so he can get the medical care that he couldn't otherwise afford, it is disturbing. When hospitals pass on the costs of healthcare to the public by marking everything up by 1000%, we all have to pay painfully. When doctors, who all took the Hippocratic Oath, are too fearful of litigation to take care of patients, order more unnecessary tests (shotgun CYA medicine), spread the liability by consulting other doctors and specialists to get everyone under the umbrella, or worse yet, abandon clinical privilege at a hospital so he wouldn't have to take care of unattached, nonpaying patients...the situation sucks all around. When hospital and HMO administrators without any clinical experience or medical background can dictate what tests and studies physicians can or cannot order, the ship is being run by idiots and is doom to sink. We're headed toward disaster, there's no doubt about it. This isn't all new. Everyone knows that this health care crisis exist but our nation choose to turn a blind eye. It is analogous to knowing that the levees in New Orleans cannot withold a hurricane for decades but we choose to ignore it all the same.

So how do we go about solving our health care crisis? Well, let's go back to the butt pus analogy. Taking care of butt pus ain't as easy as you think, but it ain't impossible. A clinician must first be able to see the bigger picture and look beyond the patient's ass. For instance, is this patient immunocompromised, is he a diabetic, etc…? Otherwise, just cuttin' and draining the abscess won't address the underlying disease. How did this butt pus come about? Is it an infected pilonidal cyst? MRSA? And before cutting on this butt pus, one must ask, is this a peri-anal or peri-rectal abscess? Is there a fistula? You get the point, there's more to butt pus than just the ass, or meets the eye. The problem with our politicians is that they cannot look beyond the ass and thus are oblivious to solving the problem.

From the patient's perspective, health care should be affordable, easily accessible, and without compromise to quality. From the provider's point of view, liability is the biggest issue, as well as autonomy, reimbursement and quality of family life. The buzzword that we often hear regarding health care reforms from our politicians lately is UNIVERSAL HEALTH CARE. Yes, indeed universal health care is a noble endeavor that we all should strive for in this country. But our politicians are approaching it all wrong, sliding into the direction of socializing health care. There is a HUGE difference between universal health care and socialized health care, but too many people mistake them for one and the same. They are not! It has been shown time and time again throughout history that whenever the government has absolute control, all things go to hell quickly in a handbasket. Our government cannot even keep its promise to provide health care to our veterans, what makes you think that Obama or Hillary can provide health care for every American in this country? With that said, however, we can have universal health care without socializing it. In fact, you might argue that we already have universal health care right now. The Federal EMTALA law (Emergency Medical Treatment and Active Labor Act) requires that every patient who shows up to a hospital ER must receive a medical screening and stabilization if that hospital participates in Medicare. Without Medicare funding, a hospital is certain to go belly up bankrupt and thus EMTALA is pretty much inclusive of all hospitals in the USA. Private clinics, however, are not bound by EMTALA to do the same. So in a way, we already have, sort of, universal health care here. The word is long out. If you have no health insurance and can't pay for health care, go to the nearest ER. You don't have to pay up front and we are too scare of law suits not to take care of you. You can make up phoney information about yourself, fake who you are, give 'em aliases, fake phone numbers and addresses, phoney social security numbers and you'll never have to see that hospital bill. Heck, all the homeless folks show up every night looking for a warm bed and free meal anyhow, in addition to free health care, of course. Two hots and a cot, as we call it. Now there's a novel idea! If you have a real medical problem that needs true emergent care, like an acute appendicitis or a hot gallbladder that needs to be operated on or something...pretend you're a homeless drunk, mess yourself up a little bit, wear dirty old clothes, not shave or shower, sprinkle a little beer on yourself for the smell...and if you want to really get into the role...piss in your pants for the stale urine effect...show up to the ER of a hospital they'll have to take care of you. You'll never see the hospital bill, guarantee it!!! The beauty is they will never come after you, not for collections, not even with a 20 ft pole, not ever! So there, you see, we already have universal health care in this country. Albeit twisted and somewhat sordid, but free/charity healthcare nonetheless. EMTALA is a well-intentioned law meant to prevent patient dumping and abandonment. Too many people, however, take advantage of it and abuse the system. In honesty though, we're not all heartless, money-grubbing bastards. We're here to help everyone who truly needs our expertise.

Oops, I got a little distracted. We can achieve universal health care coverage for everyone in this country without socializing it through government mandates. And we don't have to do it either by forcing everyone to buy health insurance policies that they can't afford. And we don't have to require all employers to provide health insurance coverage for their workers either, because small businesses would go belly up. How can we achieve such a gargantuan tasks? Too good to be true? Not really. Our health care crisis is multi-faceted and complex, and addressing only one aspect of it alone will not solve the problem. Putting a band-aid on a butt pus doesn't make it go away! Over the years, many have blamed the increasing costs of health care on the enormous jackpot awards of frivrolous lawsuits brought forth by greedy trial lawyers, like John Edwards. Many states have tried to solve that problem by capping non-punitive damages on malpractice suits, but guess what, the plaintiff attorneys just worked harder, bringing up more lawsuits in order to make up for loss revenues they once enjoyed. Did health care cost go down? Not really. Did it make health care more accessible? Nope. More Americans are uninsured than ever and ER census across the country continue to rise in reflection to those numbers. Are doctors still practicing defensive medicine and ordering unecessary tests? You betcha, even in Texas and Florida. So do groundless lawsuits drive up the cost of health care? It may have contributed some but isn't the only factor that has made things spiral out of control. Mitt Romney, to his credit, tried to solve the problem by a different approach while he was the governor of Massachusetts. His plan, mandating health insurance coverage across the board for every citizens, has proven to be too expensive, even for the rich state of Massachusetts to stomach. Government mandates have never worked, and never will. I can't imagine poor Mississippi or Louisiana being able to do the same when the wealthy folks of Massachusetts have failed so miserably. The benevolent aspirations of Mitt Romney were there, but the execution, was all wrong, and it wasn't just the mandates alone. Though the plan addressed the accessibility of health care, it failed to address the other problems. For true health care reform to work, every aspect of the problem needs to be addressed:

Patient's perspective:

Accessibility

Affordability

Preservation of quality

Provider's perspective:

Liability

Autonomy

Reimbursement

Let's break it all down.

A) Accesibility. Health care has to be easily accessible to all. For over 47 million Americans without insurance (and that number is projected to reach 50 million by the end of the decade), it ain't so accessible. In many cities, aside for the safety net of the ER, there is little to nowhere else for these folks to turn to. But it need not be that way. We already have the infrastructures at the local and state levels to increase health care access. I say expand our local Health Department system. Give the health departments a more clinical role rather than just being there to provide routine vaccinations and monitoring of infectious diseases. Doing so would, in essence, establish a national health care system to where people who cannot afford insurance or a private clinic can go to for routine primary care. This would serve the poorest and most impoverished segments of our society, in addition to providing care for those lazy asses who choose not to pay for themselves, the so called leeches. How do we fund this expansion? The states are already funded through medicaid. Right now, the states are allowed considerable flexibility on how to execute the program that costs over $300 Billions/yr. Anyone who has ever done a shift in the ER's knows full well how rampant Medicaid fraud and abuses are. Let's eliminate some of that flexibility and force the states to beef up their local health departments to a more clinical/primary care role. Give sovereign immunity to health care providers who are willing to take a pay cut to work in our health departments (more on liability issues later). You want free care? You can't eat your cake and have it too. Eliminate Medicaid and establish a national health care system through expansion of the health departments. Let the states run them, if they don't want to relinquish control. But Eliminate medicaid! The reimbursement for medicaid, as it exists, is paltry anyhow. Most private clinics refuse to accept medicaid anyway. They shun them like butt pus.

While we're at it, get rid of the federally funded State Children's Health Insurance Program (SCHIP), too. Here's the truth to the notion of providing umbrella health insurance coverage to every child in America, it's wasteful and fattens the wallets of the insurance carriers and HMO's more than it benefits us tax payers. While it's a noble endeavor, it's not cost effective. At first blush, it would seem to be a grandly benovelent idea to require health insurance across the board for all children. You can hear the outcries, can't ya? "But, but, but...it's for our babies! We are the wealthiest nation in the world...and we can't provide healthcare for our children?..." Problem is, SCHIP is a gargantuanly expensive endeavour that does not provide the biggest bang for the bucks and makes no economical sense. Fact is, the overwhelming majority of kids do not get severely sick and have no need for expansive health insurance coverage. Sure they'll get the routine common colds, snotty nose, cough, sore throat and the sniffles. But for the most part, the majority of kids are healthy and are not afflicted with serious illnesses. Therefore, mandating health insurance coverage across the board for every kid in America is wasteful and serves the health insurance industry more than it does the kids. As a physician, I would love nothing more than seeing a well insured kid for a routine viral snot nose and sniffle in my ER. Quick 5 minute exam...Easy Chaching! But as a responsible taxpayer I see it as nothing but wasteful drain on our collective wallets. Day after day on duty I see hoards of medicaid covered kids rushed to my ER, sometimes even by ambulance, for routine snot noses and sorethroats. Sadly less than 10% of all the kids I see in my ER have a true medical emergency. Medicaid abuse is sickeningly rampant. Fiscal discipline and responsibility is called for here and "it's for the kids" can no longer cut it as an excuse.

Instead, for kids and healthy young adults, a catastrophic insurance policy makes more sense and is more cost effective, because these policies are much cheaper and are applicable in instances of unexpected calamity such as injuries after a motor vehicle accident, sudden illnesses requiring extensive/prolonged healthcare (meninigitis, appendicitis, new onset diabetes, broken bones ect...).

Abolish Medicaid and SCHIP! Use that $300+ Billions to establish a national health care system through expansion of the existing health departments. To get the manpower for the national health care system, give student loans breaks to physicians, PA's, ARNP's, RN's, LPN's, etc…who are willing to work for the health departments. Recruit students through scholarship offers to work in the health departments once they're done. 4 yrs of med school for 4 yrs of indentured servitude in the national health care system is a very fair deal, much like the military's GI Bill.

B) Affordability. Unless your portfolio rivals that of Bill Gates, Warren Buffet and the likes, for most Americans, myself included, we are all just one medical disaster away from bankruptcy, insured or not. Imagine a serious car accident, or heaven forbids, a diagnosis of some malignant cancer. If you're uninsured and play by the rule, you're screwed. If you are insured and think that your HMO will be there for you, you're naïve. ~$5,000 per day in the ICU ain't no chump change! The spiraling costs of health care just boggles the mind. By 2012, health care expenditures are expected to be about 17-20% of the GDP. A routine visit for an ankle sprain with a simple ankle series xrays used to cost $40 bucks when I first started medical school, now it costs $240 bucks! That's just the charges for the xrays alone, not for the visit, splints, crutches, nor is radiologist's charges for reading the films included.

There is a 1000% mark up for every thing as soon as you step through the door of the hospital. That's right ONE THOUSAND PERCENT mark up, not including physician fees, just hospital charges alone. One could argue that the $6 Tylenol pill is also paying for the heating and air conditioning, lights, utilities, house keeping, grounds maintenance, etc… But c'mon 1000%? Ain't that a little too obscene?

We've already established that socializing health care through gov't mandates does not work. It never has, but creating a national health care system as discussed above is absolutely necessary and would certainly increase primary care access for the extremely impoverished segments of our society who could not otherwise afford it. And for children and young healthy adults, a catastrophic insurance plan makes more economical sense as such policies are much cheaper. But what about the rest of us who plays by the rules and see government handouts as un-American and an insult to the very foundation of our democracy, self-reliance and individualism? How can we make health insurance more affordable for people who wants to take care of themselves and not rely on the gub'mint?

One of the main problem of our health care system is that there is no true competition. By that, I mean that there is an absolute lack of capitalism in health care. The spirit of capitalism is what made this country great, yet it is completely absent and devoid in the health care industry. From DRG fixed pricing through ICD codings established by Medicare, to the limitting and confining of insurance purchases within certain regions and state lines, capitalism does not exist in health care at all! And as a direct result, prices soar out of control to no end. To fix this problem we need to inject capitalism into health care and let the basic principles of supply and demand in economics take care of itself. Laissez-faire and let the market forces work! Let all of the hospitals and clinics compete. Let them set their own prices to drive down market costs. If at hospital A, I can get a hip replacement cheaper than at hospital B, transfer me to hospital A…If at the neighborhood clinic a routine visit is cheaper than at uptown clinic….you get the point. In the same vein, let all of the insurance companies compete across state lines. Allow small business, citizens of cities, towns, municipalities, etc…to band together for purchasing power to leverage for a cheaper price with insurance companies, much like the deals that large corporations can cut with these insurance companies.

The answer to our health care crisis is not to socialize it but to inject capitalism into it. Free enterprise! Let the market work!

C) Preservation of Quality. It is without question that we have the most technologically advance health care system that is the envy of the word. As it should be, because Americans demand no less. Any discussion in the overhauling of health care must include the preservation of quality that we currently have. Our health care providers must pass stringent criterias including appropriate trainings and board certifications. That cannot change as public confidence, not to mention safety, in our profession is of utmost importance.

D) Liability, Autonomy, Reimbursements, and Quality of family life (The physician side of the story). I would like to lump all of this into one discussion from a physician perspective, as these issues are all dynamically related and intertwined. As a physician who has been frivolously sued numerous times, I can personally attest that each case was equally gut wrenching and ripped me to the core. It was one of the major factor that weighed heavily and contributed to my decision to leave Emergency Medicine. Yes, every single one of those cases were completely meritless but they still haunted my psyche all the same. I hated to practice defensive CYA medicine. I hated myself for seeing every patient encounter as a potential lawsuit. Do groundless junk lawsuits drive up the cost of health care? Not entirely as recent studies dispute such argument that frivolous claims are the largest contributor to our health care problem. But one thing is clear, these junk suits certainly do contribute to the pie of discontentment making all physicians miserable. On top of that liability insurance costs are insanely astronomical. In my group of physicians covering an ED of 78,000 patients/yr. census, it costs us $1.2Million/yr in liability coverage. And that's cheap compared to other groups of comparable census in other states. Patients and their family bring suit, for the most part, due to bad outcomes. However, recent studies have shown that nearly 80% of all claims did not involve errors and did not receive compensation. So why the hell are the rest of us paying so much for liability insurance to the point that it cripples our business?

Escalating matters in our current health care environment is that more and more Americans are uninsured and the numbers are expected to continue to rise. And where do they go for their health care? They show up to the ER's across the country, of course, bogging down the system causing a serious overcrowding. Why do they not show up to the local clinics for routine nonemergent stuff? Well, that's because the clinics will first do a wallet biopsy as soon as patients show up at their reception desks. Thus, uninsured patients show up in hoards to the ERs because we don't and cannot make them pay first to be seen. That's the problem, EMTALA IS AN UNFUNDED MANDATE! I talk about the ER mainly because it is my field of expertise. But more importantly, I bring up this issue because unattached ER coverage is the single greatest cause of malcontent among the hospital staff of all specialties and subspecialties. As the growing numbers of uninsured patients continue to rise, compounded by the flood of illegal aliens, the safety net of the ER is the only place that these patients can turn to. At the hospital where I had been, our census doubled over a short period of 3 years. However, our ER reimbursement rate dropped to 27%. That means only 3 out of every 10 bills we send out get paid. About 3 out of every 10 patients we see actually pay us! Can you imagine any other business being able to survive on such piss poor returns? Just how do we survive and maintain our practice? The hospital has to kick in a subsidy, of course. But it's no where near enough for us to hire adequate staffing to be able to efficiently handle the patient load. The hospital in turn gets funding from the federal and state and local levels. What's more, the current nation wide nursing shortage bottlenecks our situation to a grinding halt on many nights. Not only are there not enough ER nurses, there aren't enough floor and ICU nurses as well. The facility actually has plenty of beds, just not enough nurses upstairs to take care of patients so they get boarded in the ER until one becomes available. Meanwhile, patients keep on showing up with no rooms to put them into. We triage and care for the sickest ones first, of course, and do the best we can. An average of 4-5 hours waiting time for nonemergent cases such as sorethroats, runny noses, toothaches etc..is not uncommon at all....which all equate to crappy Press-Ganey patient satisfaction scores and lower incentive driven reimbursements and bonuses for grunts like me. Damn vicious cycle and ploy isn't it.

The problem with uninsured patients is just not the financial aspect alone. Uninsured patients usually do not have a primary care physician. Because of such, many of them have not had any routine maintenance or preventive health care and have neglected themselves for years. They tend to be noncompliant with medical management when they do show up. It's pretty hard to be compliant, though, when you can't afford things such as medicaltions. Thus, it is of no surprise that the uninsured patient will usually have more complex medical problems and more comorbidities. From the consultants' side of the story, the longstanding rule is that for a physician to have practicing privilege at a hospital, he/she must agree to take unattached inpatient and ER calls. Now if you are a specialist or surgeon, why would you want to take call at a busy county hospital that requires you to see more patients, who are sicker, who don't pay, have more medical problems that are more complex with higher comorbidity and thus, higher liability? Yes, these are precisely the patient demographics that sue most often. Taking call at a hospital means that you'll have to work longer hours, see your family less, take care of more patients, with higher acuity, more complex comorbidities, who are likely to sue you more...and finally the kicker...not get paid for it. Furthermore, having to care for these unattached, nonpaying patients disrupts the physicians' private practice and detracts time away from their own paying clinic patients. As a result of this, outpatient surgical centers are popping up everywhere across the country. These centers allows a surgeon/specialist to maintain his/her clinic and paying customer base while not having to take on unattached ER and hospital calls. Likewise for this reason, many internists, family practicioners, and pediatricians have given up their hospital privilege and just maintain a clinic. I can't say that I blame them. Many factors play into why physicians abandon hospital privileges, but bottom line, higher census, lower reimbursement, higher liability are all major factors. And quality of life kinda sucks when you're spending more time at the hospital than with your own family.

To answer for fewer doctors wanting to take unattached calls, many hospitals have started IMS (inpatient medicine service) programs and are paying physicians to work as Hospitalists. Once the hospitals started paying the internists to take unattached calls, they opened a can of worms, as all of the surgeons and all the subspecialists soon started demanding compensation for taking unattached calls as well. With low reimbursement, limitted fundings, and all the specialties wanting a piece of the small pie, hospital administrators are faced with tough decisions as they cannot afford to pay everyone.

Such are the realities of modern medicine. So how can we fix this mess? What incentives can we offer to health care providers, physicians, esp. the subspecialists, to retain them at the hospitals and take care of patients? It is my personal faith in the altruism of my colleagues that I say I doubt there are that many physicians so cold-hearted to the point of refusing emergent care of a patient based on inability to pay. I personally believe the ones who do are very few and far in between. Admittedly however, this broken health care system does grind us all down and has undeniably made cynics out of us all, unfortunately. But I refuse to believe that those of us in medicine, entrusted to care for our fellow man, someone's father, mother, brothers, sisters, sons & daughters… have abandoned humanity altogether. The root cause for such discontent in the medical community regarding unattached calls is the fact that EMTALA IS AN UNFUNDED MANDATE. But as I said earlier, I don't think that any physician would deny emergent care to a patient based on inability to pay. What's frustating about EMTALA, though, is that it's a one way street that does not provide the physician any liability protection after being forced by federal laws to care for a patient with whom he/she does not have any established relationship with. Not getting pay for it is just adding salt into the wound. And the final thrust of the knife is the disruption of the physician's office practice by taking away the time the physician could have spent with his/her paying private patients. It's a triple whammy that leaves no incentive for the doctor to take call at a hospital at all. There will always be indigent patients, that's a given. But let's level the playing field. If physicians are forced to emergently care for patients with whom they have no prior established relationship with, then let's make it a little fairer by allowing sovereign immunity for EMTALA care. Let the physician practice medicine the way that it ought to be without the fear of litigation. Let the physician use his/her clinical skills and intuition instead of ordering unecessary tests out of fear of a lawsuit. That certainly would help cut the costs health care. Or at least establish a medical court to where physicians will be judged by a jury of their true peers rather than by an easily persuaded sympathetic jury. Let's face it, expert witnesses are a dime a dozen and both sides can pay a so claimed "expert" to say whatever each wants. I'm too familiar with this game after being embroiled in numerous groundless, frivolous lawsuits. Sovereign immunity for EMTALA care would be ideal, but let's be truthful, there are plenty of incompetent quacks out there who should have never been given a license to practice in the first place. Let's restore justice and establish a medical court system. You have patent courts, why can't you have medical courts? Surely you cannot expect Joe/Jane Average to be a fully knowledgeable and informed peer of a physician who spent well over 12+ years of higher education and training to hone his/her craft? It's only fair that we establish a medical court wherein a physician may be judged by an impartial and qualified jury comprised of not only respected physicians in the specialty pertinent to the case but also patient advocates who actually have a clinical background. If you think that physicians would be reluctant to punish another physician then you haven't obviously been to any hospital Morbidity and Mortality Conferences, esp. the ones held by the Dept. of Surgery. Those folks are brutal to each other.

Lastly, the lack of reimbursement for EMTALA care must be offset for the time spent. As has been displayed by the State of Massachusetts, mandating health insurance coverage for every citizen is unfeasible as it is too costly. But for physicians willing to take on unattached calls, not getting paid for the work and on top of that, a double whammy to the books from time detracted away from paying clinic patients hurt. This is essentially charity work so for fairness sakes, allow physicians to deduct non-reimbursed EMTALA care from their taxes. If you donate money or items to charity, you can deduct it from your taxes. This is no different. If you want us to provide charity/free care to the public, at least allow us to deduct a percentage of it off our taxes so it wouldn't cripple the operation of our clinics because when we're spending time to take care of uninsured patients, it is time taken away from our paying patients.

There you have it, those are my suggestions for overhauling our health care system. Make it accessible, esp. to those who can't afford it, by eliminating the inefficient and wasteful Medicaid and SCHIP programs to establish a national health care system through the expansion of the existing health department system. Make it more affordable by injecting capitalism into health care to allow hospitals, clinics and insurance companies to compete among each other. Ensure quality and patient safety. And lastly for health care providers, establish a medical court and level the playing field for EMTALA care.

Thank you Charity Doc for being Dr. February.

Hint for Dr. February

He's got a lot of s'plaining to do.

Post No. 200

Blogger says this is my 200th post. Something tells me Blogger is including the 99 posts that I deleted before anyone could read them. Thanks for continuing to stop by.

Okay, I can't stop playing with it. Thank you for your comments. It's called Toondoo. Here's the link.

Running with the Big Dogs . . . Not

A couple of days ago, I began to notice that in addition to my usual 15 (loyal, faithful) readers, I was getting 2-3 visitors from the Healthcare100 site. That was unusual, so I went on over there to check things out. I thought maybe they had a Bottom Dweller of The Week spot, and it was ATM's week.

Well, it turns out that a mistake has been made somewhere, probably Technorati, and ATM is now ranked Number 47.

So, welcome Healthcare100 visitors, if you are looking for a real top 50 medblog, take a look at my blogroll.

(I apologize to the real Number 47; I'm sure that the error will be corrected soon and all with be right with the blogosphere again. And thank you Healthcare100 for the listing, top 50 or top 500.)

**Calendar Watchers -- my ass has been getting whipped at work and I haven't had time to even come up with some questions (yes, I spend more than 15 minutes on the questions, smartass. I told y'all it takes me longer to come up with the questions than it does for the doctor to come up with the witty and amusing answers.) But it's a very special Valentine's edition, so it is worth the wait.

Saturday Night

Your Lucky Underwear is Yellow

You're an extremely happy, laid back, fun soul. And your lucky yellow underwear can help you get even more out of life. In life, you rather play than work. You're apt to quit any task that doesn't nourish your creativity and inner child. Sometimes your drive for freedom hinders your quality of life. You find it impossible to do anything unpleasant. If you want to have responsibilities and still have fun, put on your yellow underpants. They'll help you make a party out of the most mundane tasks.

What Color Is Your Lucky Underwear?

Yep, these yellow underwear really make a difference. I can't think of any place I'd rather be, than sitting here at my computer on a Saturday night working on a brief.

And why do these quizzes always come up with this "happy person" crap for me. Just once I would like to take one where the results say "seductress".

Here's another quiz, in case you don't wear underwear:

Who is Your Ideal TV Boyfriend?

Created by BuddyTV

Dr. January Excuses

I’ve been working 14 hour days – great for my billable hours, but not so good for my blog.

I have already started stalking e-mailing Dr. February so, I promise, there will be a very special Valentine edition of the Calendar Docs.

Other blog business. Thank you Disappearing John for the lawyer joke AND for letting me know that my e-mail address had disappeared from my sidebar. Dr. Shroom, I don't think I will ever finish my guide to understanding the BritMeds. How about if YOU wrote a guide? Then we would actually know the information was right. Sisters=nurses? You start medical school when you're 12? And what the heck is a SHO?

Hmm, Dr. Schwab has posted three times (one about scrubs!) since I kicked his ass in my comment section. Coincidence? Of course. I doubt he even read the comment. But am I gonna take credit for his current torrent of posts? Of course!

photo credit: i don't know, but the wet t-shirt photo was photographed for Vman by Inez van Lamsweerde and Vinoodh Matadin

You Know You're A Medblog Addict

Well, this is embarrassing. All of these are true.

You know you must be a medblog addict when:

You are planning a romantic weekend getaway to another state and wonder “If we were in an accident and had to be taken to the ER, would I see MonkeyGirl, ER Nursey, DisappearingJohn . . .?”

You blush and inappropriately laugh out loud in Court because you are reading one of TrenchDoc’s posts while you wait for your case to be called.

You hear something on the news and think “I wonder if Scalpel is going to blog about that?

You are in the mood to cook, but instead of looking in a cookbook or searching for a recipe online, you click on The Blog That Ate Manhattan.

Your secret crush on an ER doc changes from Dr. Kovak to Dr. X.

You look at the scar on your belly and think “If Dr. Schwab had done my chole, that scar would be about two inches shorter.”

You walk around the office all day wearing Diet Coke on the front of your blouse because you made the mistake of drinking while reading MDOD.

It’s 10:00 p.m., you’re at work, and all of your friends are pissed because you had to work late AGAIN and are missing ANOTHER celebration. Needing a break, you click on Doc’s Girl’s blog because you want to read a friendly voice.

You read that Charity Doc was on one of those ER shows on the Discovery Channel and ever since then, you have been trying to figure out which doctor is Charity.

And finally,

You feel a little down because another one of your favorite bloggers is calling it quits. I will miss you Amy at Hallway Four.

I Didn't Know Doctors Really Used Placebos

I should have one of those counters on my blog that reflects how many days I have gone without reading more than 1-2 medblogs a day, except the ones on Bloglines, which aren't as fun because I can't read the comments. A side effect of not reading the medblogs is that I write more, which explains the sudden appearance of more posts on my blog.

One of my favorite Andy Griffith episodes is the one where the new pharmacist (Andy asks her if Ph.G means pharmacy gal) won’t give a little old lady her “medicine” without a prescription. The medicine costs a dime and the lady goes downhill quickly when she can’t get it. Of course, it turns out it was only a sugar pill, the little old lady gets her medicine and everyone lives happily ever after (except for the pharmacy gal, I think Andy must have eventually dumped her for Helen Crump).

I’m supposed to be working tonight, but I stumbled onto this little article by accident and now I can’t let it go. I’ve heard of the “placebo effect” and I know placebos are used in drug studies. I don't doubt the power of a placebo, I was just surprised to learn that, according to this article, doctors really used placebos in the treatment of their patients.

1: J Gen Intern Med. 2008 Jan;23(1):7-10. Epub 2007 Nov 10
Academic physicians use placebos in clinical practice and believe in the mind-body connection.
Sherman R, Hickner J.
University of Chicago Pritzker
School of Medicine, Chicago, IL, USA.

BACKGROUND: The placebo and the placebo effect are often investigated in the context of clinical trials. Little data exist on the use of placebos in the course of routine health care. OBJECTIVE: The aim of this study is to describe a group of academic physicians' use of placebos and their knowledge, attitudes, and beliefs about placebos and the placebo effect. DESIGN: A 16-question anonymous web-based survey of physicians from Internal Medicine departments of 3 Chicago-area medical schools was used. RESULTS: There were 231/466 (50%) physicians who responded; of these, 45% reported they had used a placebo in clinical practice. The most common reasons for placebo use were to calm the patient and as supplemental treatment. Physicians did not widely agree on the definition of a placebo and had a variety of explanations for its mechanism of action. Ninety-six percent of the respondents believed that placebos can have therapeutic effects, and up to 40% of the physicians reported that placebos could benefit patients physiologically for certain health problems. Only 12% of the respondents said that placebo use in routine medical care should be categorically prohibited. Regarding "placebo-like" treatment, 48% of respondents reported giving at least 1 type of treatment in a situation where there was no evidence of clinical efficacy. CONCLUSION: Nearly half of the respondents use placebos in clinical practice and most believe in the mind-body connection. The results of this study, based on retrospective self-reported behavior, are subject to recall bias and may not be representative of American physicians. PMID: 17994270 [PubMed - in process].

I don't know, though. I think I would be pissed if I found out a doctor gave me a placebo, especially if I had to pay more than a dime for it. [What? No one asked me why I would be pissed, since I was "cured"? and, if I were cured, why would cost matter?] So now, instead of researching “lien stripping”, I want to research placebos. If physicians use placebos in their medical practices, then that must mean there is a placebo industry. Do the pharmaceutical companies manufacture placebo pills or does the pharmacist just go to the backroom and break open a box of TicTacs? Is there an official name (or better yet, a secret code name) for placebos, or does the doctor write “sugar pill” in Latin? How much do the pills cost? Or do doctors just hand them out as "samples." Do doctors ever openly admit to prescribing placebos or is this one of those deep dark doctor secrets? What do the medical schools teach about placebos? Can they use Splenda instead of sugar? Liability issues?

Dress Code

Since I've been working so much, I haven't had time to do much perusing of the medblogs. I guess that's why I keep coming up with these work related posts.

I had to go to Court in another federal district this week, so I checked out the Court's website to see if the Judge had any special rules or preferences. I learned that this is always a good idea since I would be the "outsider". His dress code is as follows:

All attorneys shall dress in appropriate business attire preserving an atmosphere of dignity and respect to the Court.

While no formal dress code exists, all persons entering the courtroom are to dress in a manner respectful to the Court. Attorneys are responsible for conveying the proper attire to their clients and staff members.

While I was on the website, I thought I would check out the rules and procedures for the other judge. Her dress code is as follows:

All persons present in the courtroom must dress and conduct themselves in a manner demonstrating respect for the Court.

COURTROOM DECORUM

All persons entering the Courtroom shall refrain from chewing gum, drinking, eating, smoking, wearing hats, or reading newspapers, books, etc. in the courtroom. Counsel shall turn off his/her cell phone and instruct all parties and witnesses to do the same. All counsel and parties are expected to stand at the lectern when addressing the court or examining a witness.

COURTROOM ATTIRE

Attorneys and their staff are required to wear standard business attire. Parties, witnesses and spectators shall dress appropriately and respectfully for the courtroom. No shorts, tank tops, midriff-baring or other revealing low-cut clothing, extremely short skirts, sunglasses, flip-flops, or hats shall be permitted in the courtroom. Counsel are responsible for ensuring compliance with these rules by their clients, party representatives, and witnesses. Counsel should contact the Court in advance if special accommodation is desired for a client, party representative, or witness. (emphasis added)

First, I thought it was interesting that she was so specific in her rules. Second, I thought that last sentence was funny, i.e, counsel should contact the court in advance to make special accommodations for a client that wants to wear a low cut tank top, extremely short skirt, and flip flops to Court.

I'm surprised she didn't mention perfume. I was in Court one time when the courtroom deputy stood up and announced (right after a woman left his desk) that the Judge doesn't allow any fragrances to be worn in her Courtroom. It doesn't really matter to me because I rarely wear perfume when I am working.

Wanted: Ethics

I am trying to complete my continuing legal education (CLE) requirements for 2007. I am doing it online. I actually registered to attend a "live" out-of-town seminar, but for the second straight year, something came up and it was decided that I shouldn't go. Yep, I am so important that I can't leave the freakin' premises for two days to attend a seminar. It's true, no one else around here can sit on their ass for hours on end researching crap like I can. And who else would they call on to attend a hearing at the last minute just because they "don't feel like going." But it's mighty nice of them to pay for the seminars anyway, even if I can't go.

We are required to rack up a certain number of CLE "ethics" hours. I had a hard time trying to find ethics hours in my area of practice, so I decided to be adventerous and look in the medical/health law sections. I saw some familiar names--HIPAA, EMTALA. Only one problem . . . none of the medical/health law seminars included ethics hours, so I had to settle for a nice seminar about legal malpractice. Only 3 more hours to go. This means I'm going to go home and listen to some old fart trial attorney talk about jury selection**. And then after he goes to bed, I'm going to find an online seminar so I can meet my CLE requirements.

[**For the record, I really do enjoy listening to him talk about his work.]

You See Possum; I See Cat

I swear it looked okay on my monitor. The fireworks were to the left of the post.

Look, y’all know I have no technical knowledge or skill when it comes to my blog, so I have a favor to ask. The next time I have some kind of weird ass layout with pictures covering the text of my posts, please leave a "WTF" in my comment section.

I realize that after my Christmas layout, when it looked like an elf exploded on my blog, it might be hard to tell the difference between intentional and mistake. I promise I won’t be offended if you leave a comment telling me I screwed up. I may write crap, but I would never intentionally cover it up.

Thank you and Happy New Year (without the fireworks).

Lawyer Joke Resolution

I've been told twice this year that "you must have gotten up on the wrong side of 2008." I don't even know what the hell that means, but I'm guessing these people think I've been a bitch for the last three days.

In an effort to improve my disposition, and avoid writing more posts wherein I call other bloggers "little shits," I have decided to start updating Lawyer Joke of the Day on a daily basis again (or whenever someone sends me a new joke).

credit: Charles Fincher

New Year, Same Me

I am going through another one of those identity crisis blogging phases. Don't know what to write or why anyone visits. blah blah blah. I did something different this time. I told that little voice inside me to shut the fuck up (as long as I'm just talking back to one of the voices, it's okay, right?) and I went back to read over some of my older posts. That led me to remember something I stumbled across when I needed to translate my questions to Russian for Dr.X on the MDOD calendar post. I'll bet you thought those weren't real Russian words.

Yeah, even I know you can translate anything to another language on the internet. But I learned you can also "convert English text to any of several comic dialects," including redneck, pig latin, moron, Elmer Fudd, etc.

I converted my blog description to Redneck (The Dialectizer):
It is as though someone has drilled peep holes into th' walls of emerjuncy rooms, operatin' rooms an' docko's' offices. ah cain't look away.

Ok, I'll admit it. It doesn't sound much different from the way I say it.

Here's part of Dr. Schwab's latest post Sampler in Redneck:

ah present a samplin' of whut this hyar blog has been about. Occashunal rant aside, it's been mah goal t'let varmints into th' operatin' room, an' into th' life an' thunks of a surgeon; t'share mah take on some surgical corndishuns, an' sometimes jest t'git a laugh.

Memo'able Patients: I've told sto'ies about varmints who made a trimenjus impresshun

har, (the dawgoned-est stool I've evah see in a belly)
har, (when mah partner got sick)
har, (she killed her caregivah, an' almost killed herse'f)
har, (thirteen years old, an' ah c'dn't save her)
har, (until th' end, she kepp brin'in' me grub)
har, (kidney kincer in his pancreas, an' he kepp on truckin')
har, (bleedin' so fast, ah c'd hear it)
har, (no stomach, kepp eatin' steak)
har, (breast-heart cornneckshun?)
an' hyar. (a screw-up in a great guy)

Here's part of Dr. Dino's The Wiseass on the Elevator via Smurf the Web:

Our local mall has two levels. Darling Spouse and I headed over there this afternoon to get a few gifts and enjoy some smurfy people-watching. Smurfilicious! At one point, we were on the bottom level and needed to go to the upper one; the most direct route was smurfily the elevator.

(well, just be thankful there was no mention of Itchy Smurf)

One more, in Pirate talk (The Voices of Many) from MDOD's The Naked, the Fat and the Dead:

Here’s some free advice: Don’t get so fuckin' fat that when ye die, yer family has t' deal with yer ginorm'us whale-carcass.

One o' me local pathology colleagues had a gastric bypass patient die today – he be 45 years old an' 780 pounds. I think his BMI be, like, a trillion! Avast!!

Listen, I be havin' nothin' against fat people. First o' all, fat chicks love t' be havin' sex, an' be good at it, because they be so grateful fer the attention! Avast!! Second, fat people get sick an' die m're often, which be great fer business. Third, an' most important, fat people be great t' make fun o'.

(I make it a policy not to criticize other people's posts on my blog, but Eto-whatever's post kinda pissed me off when I read it (and, no, you little E-shit, I'm not fat). However, I just finished off a pound of fudge in four days and now I plan on reading E's post every day until I lose the holiday weight. Although I did like that part about being good at sex...)

If you have some time to kill and want to play with your own blogs:

Smurf the Web
The Voices of Many
The Dialectizer

Dr. December is . . . GruntDoc

I saved GruntDoc for December because he reminds me of Santa Claus. It’s my blog, I don’t have to tell you why. This wasn’t the picture I originally chose for GruntDoc, but 10/10 called him Grandpa GruntDoc in Twas the Blog Before Christmas, so I needed something to get that image out of my head. Just because GruntDoc is the patriarch of medblogs, doesn't mean he can't be hot.

GruntDoc is one of the good guys and he is one of my favorites. His blog is full of interesting medical stories and posts about his family and his work. Plus, I love how he dresses up the title to his blog during the holidays. I only wish he’d write more essay-type posts, like his poignant “My Grandfathers’ Guns." (please)

Here’s my interview with GruntDoc:

Q.1 On one post, you wrote that according to LongtoLive, “I should die on Tuesday November 26, 2052 at 1:36:21 AM.”

What are you going to be doing on Monday, November 25, 2052, at 1:36:21 a.m.?

A: Changing my answers. [that’s no fair~MA]

Q.2 What was the last movie that you saw?

A: Cars. I really liked it. (Last night I watched Monty Python and the Holy Grail on DVD, which was terrific. BTW, it seems nearly 98% of ER docs can quote lines for the Grail, way more than other specialties. Seems to be another self-selection thing).

Q.3 MSN says one of the ten questions you are supposed to ask your doctor is “will you remove that wedding ring?” (Honest. Would I make this stuff up?) I’d like to use that line question sometime. If a patient asked you to remove your wedding ring because he/she was afraid it had germs, would you do it?

A: NO. I’ll glove up, but I’m not removing my ring. I do make quite a show of waling into the patient’s room applying my skin-disinfectant, which I think is plenty.

Q.4 Charity Doc left the ER and is setting up a free medical clinic. 911DOC is looking for a new job. Scalpel needed a change from his “vampire” schedule. You have a stressful job with crazy hours. How do you avoid the burnout factor?

A: Who says I've avoided it? Maybe I'm just a glutton for punishment, and the job is stressful, but I'll do it for a long time. I will say that how much stress you're willing to put up with has to do with your options; when I get closer to a retirement income I'll probably be less inclined to put up with some of the stresses.

Q.5 How did you and Mrs. GruntDoc meet?

A: She was the Assistant Lab Director where I got my BS and MS. We were engaged the summer before I started med school, with a plan to get married after I graduated. After the first 7 weeks, it was get married after the first two years. We got married New Years' Eve of my first year. Planning has always been one of my strong suits.

Q.6 When you posted the request for Match Day stories, you said “My Match Day story is a super-denouement, and is 14 years old, so I’ll not be adding it. For now.” After I looked up “denouement” in the dictionary, I thought that might make a good story. Can you tell us about it here or are you saving it for a post?

A: Eh. As Uncle paid for my med school, I was required to apply for a Navy Internship, which I got, and knew about well before all my colleagues matched. I was happy for them, and acutely aware our immediate futures would be different. Not bad, just different.

Q.7 What was the first job you ever had? Do you remember how you spent your first paycheck?

A: I was a dishwasher at Swenson's Ice Cream, for $3.10/hr (minimum wage). I have no recollection what I spent it on, but remember that I wasn't a very good employee.

Q.8 Do you have any pets?

A: One mutt cat. I've never had a dog, and a goldfish was the only other pet type I've had.

Q.9 I saw this question in a comment section and decided to steal it:

“How many true emergencies do you have on every shift of every day of every week? I think a lot of you would be out of work if you only had REAL emergencies come to the ER for treatment.”

A: The second part it true, but we'd be pretty darn happy with our jobs: it's the non-sick who can suck the joy out of the job.

Q.10 Three most favorite television shows of all time?

A: Star Trek reruns (Kirk and Spock), That 70's Show, and Scrubs.

Q.11 As part of my research (yes, research) on ER docs, I did a search on YouTube for “ER Docs” and found that quite a few people videotape their visits to the ER.

Has anyone ever asked you if they could videotape their experience with you?

A: I've had a lot of cellphone pics during suturing, nobody thought to ask if either I or the patient minded so far (it's always been friends of the patient doing it). I wouldn't like someone videotaping me on the job.

Q.12 How’s that “no coffee at work” thing going?

A: Better than I would have predicted. I can now focus better, my hand doesn't shake, and my BP is down. I smell coffee in the department, and curiously don't miss it much. I do have one cup in the morning, but that's it.

Q.13 When you shed your scrubs, what do you like to do for fun?

A: I read a lot of blogs, I spend time with my family, and I like to shoot at the range. It's my kind of personal entertainment: I have to focus, pay attention, and see how I'm doing immediately. I intend to get back on the bicycle when it warms up.

Q.14 Favorite cookie?

A: Peanut butter, with the fork crosshatches on the top.

Q.15 And what everyone wants to know, do you have any tattoos or piercings?

A: As I'm not a Pirate, I have no need for an earring. No tats, no piercings, just all me.

Q.16 I’m not going to ask you the usual scrub question. This time I want more information. Do you pay for your own scrubs? Do you have to wear a certain color? Do you always wear scrubs when you work? Do the bottoms always have to match the tops?

A: Scrubs are supplied, free, by the hospital, a reasonable light-blue color. We're not required to wear any particular color, but most of us just wear the ones supplied and washed by the hospital. I always wear scrubs, and a lab coat. As for wearing different color tops and bottoms, I'm not stylish enough to pull that off.

Thank you, GruntDoc, for being my Dr. December.

Hint for Dr. December

I once commented (on my own blog, of course, since I'm a lurker) that this doctor's readers never let him have any fun. He wrote a post about how a female patient winked at him, made him feel good, then he found out she was a drug rep. I thought it was a funny post, but all of the comments were so serious, talking about how dangerous it is when patients seem overly friendly. Hopefully, I will "expose" the fun side of Dr. December...but first I have to get him off that couch so he can finish answering his questions.

If you want to see the "rejected" Dr. December pics, head over to ATM-Two.

For some reason, I thought about Scalpel when I saw this picture:

Porn is Part of Medical School Curriculum?

I just found this ER doctor's site, where I read:

"At Wayne State University's School of Medicine, we were shown dozens of pornographic (OK, highly pornographic) films as part of the curriculum. The rationale for such an unusual academic inclusion, we were told, was so that we would not react in disgust or surprise if a patient revealed sexual proclivities that were, well, strange. By exposing us to every imaginable sexual practice, they hoped to desensitize us so that we could just deal with the medical issues, leaving judgment about such practices to God, or perhaps to Jerry Springer and his audience."

Is this a part of every medical school curriculum?

I still don't know what to think about Dr. Pezzi's site, other than it's "interesting". I wish I had more time to spend on it. Here are a few things to check out on Dr. Pezzi's site if you are in the mood for something different:

http://www.erbook.net/
All about emergency rooms and ER as a career (he pretty much says it sucks).

http://www.er-doctor.com/
Information for people contemplating a career in emergency medicine and other medical specialties (he pretty much says don't do it, it sucks)

You can read about love and lust in the ER here.

This is the best part. Dr. Pezzi provides a way for people to show their appreciation to ER docs:

>

Christmas Overboard

I know, it's starting to look like an elf threw up on my blog. I can't help it, I have Christmas fever.

I haven't seen the Holiday meme around yet, so I'm gonna post last year's list. (Okay, I haven't really had a chance to visit a lot of medblogs lately, so the Holiday meme might be out there, this is just one more opportunity for me to post Christmas stuff.)

Dr. Rob
IslandMedStudent
Dr. Couz
Shadowfax
Dr. Dino
AmbivalentMSILF
Kim at Emergiblog
GruntDoc
Scalpel
Dr.A
Shinga
ThatMedSchoolGuy
Small Town Nurse
Dr. Wes
Stethoscopes and Diapers
Dr. Gwenn
Shrink Rap

Hey! There is a new Christmas meme out there. Well, new to me since I haven't been out in the medblog world lately.

WhiteCoatRants

MonkeyGirl

Seaspray







ONE LAST CHRISTMAS THING -- THE BACHELOR -- SANTA EDITION

Crackmuffin.com
Funny Video From CrackMuffin.com

So Much Cooler Online

I don’t know if y’all know this, but in my mind, y’all are all good-looking. Men, women, young, old, whatever. Why would I picture someone ugly in my head when I’m reading your medblogs, when it’s just as easy to picture someone hot? And male. It's not just me, though. I know there are a few others out there who are always crushing on one or more of the medblog docs. (I was going to link y'all, but damn, you ER nurses are intimidating.)

Every time I hear this Brad Paisley song, I think of my blog. Yes, I like country music and I'm not apologizing. For you bloggers that can't stomach country, you still might find this video kinda funny. Jason Alexander is in it, and William Shatner, and Marcia Brady, and George's mom from Seinfeld.



Okay, this is my last post with a video, quiz, etc. I am actually going to try to write something this week.

And yes, I know this video has been out for months; I am just now getting around to writing about it.

Another Quiz

61%How Addicted to Blogging Are You?

I'm fairly confident that 99% of y'all have already played around with this quiz, but I like it.

The house is decorated, inside and out, so now it is time to decorate the blog. I plan on getting technical and messing around with the "code", so if you don't see my blog again, it was nice knowing y'all.

Don't Hurt Me, I Don't Do MedMal

I've been reading more lawyer bashing**. This time they were joking about lawyers who make sure their doctors know they don't do med mal. I have to admit, I do it, and not just with doctors and med mal.

When I was in law school, I was pulled over for speeding (ok, it was really kinda, halfway, sorta like, racing) on the freeway. It was late at night and the officer kept shining his flashlight in my face the whole time he was asking me questions (like did I know I was engaging in a dangerous activity). After a few minutes, I realized he was distracting me while his partner was peering into the windows on the passenger side of my car. He came around the car and asked me if I was in law school (no shit Sherlock; my passenger and back seats were covered with my textbooks). I was scared, and I saw the looks they gave each other, so I blurted out, “Yes, but I’m going to be a good lawyer, I hate criminals.” Fortunately, they laughed and just let me go with a stern warning.

I feel the need to defend my chosen profession, so I am going to post this item from the state medical board’s website about the disciplinary action taken against a doctor, just as a reminder that there are some interesting apples in every profession:

On April 13, 2007, the Board and Dr. ________ entered into an Agreed Order requiring that he complete additional continuing medical education in the area of ethics over two years, and assessing an administrative penalty of $1,000. The action was based on allegations that Dr. ________, because of a hole in his pants and because he routinely does not wear underwear, unintentionally exposed his genitals to a patient and her daughter while examining the patient.

I normally don't frequent the state medical board’s website, I was just doing a little research for a series of posts I have planned. But I have to say, it makes for some interesting reading.

12-1-07; 12:20

**Ok, ok. I exaggerated. It was good-natured joking in GruntDoc's comment section. But I needed something to justify including the underwearless doctor story in my post. And I think I more than made up for it by telling y’all about the stupid thing I said to the officers~MA

Dr. November -- Not

No excuses. I screwed up. Dr. November 2007 will not appear until sometime next year. But he will appear.

And yes, JMB, there is a Santa Doc.

Video Tuesday -- Spiders On Drugs

I really am planning on writing something soon, this is just to stall for time. Plus, I think it's kinda medical. Be sure to watch the whole video.

Nosy Thanksgiving Questions

Thanksgiving is my favorite “eating” holiday. And I’m nosy. I want to know what y’all are eating for Thanksgiving. Favorite dish? Your specialty dish?

I will go first. My favorite dish is dressing…cornbread, of course. My cooking skills aren’t exactly what you’d call consistent, so when I’m asked to bring something, I always opt for the relish plate and crudités. Now just wait before you start writing that comment about me taking the easy job. I personally wash and cut up each vegetable, create the presentation on the platter, and make the dips. More importantly, I make vegetable animals. My radish mice are famous. When I was looking for a picture to post, I came across these instructions. I make the squash duck too, but the mice always get the most attention. The mice in this picture are cute, but mine are cuter, plus mine have eyes (at least until someone removes the eyes from three of the mice and starts singing).

I Forgot

Rats! I forgot to post something yesterday. I will probably get a citation from the NaBloPoMo police. I will post twice today to make up for it. Or I guess I could just go under "Post Options" and change the post date and time to reflect I posted this yesterday. Yeah, that would work.

The Blog Readability Test

What Level of Education is Required to Understand Your Blog?

I got no problem with that.

Well, now that I think about it, maybe I'm speaking too soon. The last time I took one of these tests, I became obsessed with increasing my blog rating. At first I wasn't bothered by my PG rating, but then it started eating away at me. I played it over and over in my head...you're only rated PG...you're only rated PG. So I tried to spice things up and boost my rating. My second try was only worth a PG-13 rating. I wanted to quit, but I was urged on by my blogging pals to try again. I added another paragraph, upping the sex and violence, and I finally scored an "R" rating. What a sense of accomplishment.

So I have a choice: Do I want to write a bunch of intellectual crap and try to boost my readability score? Or do I want to go watch a South Park rerun? Hmmm...



***BTW, when I said "Do I want to write a bunch of intellectual crap", I really meant, do I want to try to think of a subject I could Google that would lead to sites containing a shitload of big words, then cut and paste that content onto my blog.

Hang Up the Damn Phone and Flush!

Sorry for today’s subject matter, but this just pisses me off. Our firm shares a floor with another law firm and there is a common “Ladies Room” used by both firms. About three weeks ago, I and the other girls in our firm noticed that every time we went into the Ladies Room, there was an unflushed toilet. That’s just gross and we were wondering what kind of person would do something like that. We knew it had to be someone from the Other firm.

So today I was in the Ladies Room and heard someone come in. She was talking on her cell phone and she continued her conversation during the entire time she was doing her business. I was at the sink washing my hands when I saw her walk out of the stall WITHOUT flushing. The bitch didn’t want to interrupt her phone call by flushing the commode. She started walking toward the exit door because, of course, she couldn’t put the phone down long enough to wash her hands. All I had to do was turn around and give her a look and she immediately told the party on the phone “Bye” and returned to the stall and flushed. She had actually looked embarrassed and didn’t come out of the stall, so I think she was waiting for me to leave.

We’re hoping this will be the end of the “flushing” situation in the Ladies Room. Maybe I’m just overreacting, but that has to be one of the most inconsiderate things a person can do at the place where she works. Well, maybe her sticking that unwashed paw into the community candy bowl is a close second.

A Post A Day

Since I haven’t been able to read the medblogs in a while, I didn’t realize that November was designated NaBloPoMo (National Blog Posting Month). The rules seem simple enough:

“Post every day for the month of November. That's all you have to do.”

I’ve decided that even though I’m already twelve days behind, I am going to do it. A post a day for the rest of November.

I know, I know. How can I write a post a day when I can’t even update “Lawyer Joke of the Day” on a regular basis? I like a challenge. Plus, no one said it had to be a good post, it just has to be a post. And it’s not like the blogging police will throw my ass in jail if I miss a day. At least I don’t think they will. I didn’t actually read all of the NaBloPoMo instructions. I’ll explain why in tomorrow’s post.

Rudy Guiliani's Push To Save America

This is about as political as I will ever get on this blog.


Sorry, I can't give credit for the photo. I received it in an e-mail.

Another Timekiller

I can't stop playing with this.








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Dr. October is . . . MDOD Part Two

911DOC

Q.1 Do I really have to call it the ED? I don’t like the negative connotations ED raises.

A.1 bad habit of which you have just disabused me. i had an attending physician in residency who would nearly pop a blood vessel in his brain if someone called it the "emergency room". his point being that we are really a department and not a 'room'. whatever. most of us who work in the ER suffer from ED. [What a way to kill a fantasy~MA]


Q.2: If MDOD were a boy band, who would be the bad boy? the heartthrob? the gay one? the shy one? the one who can't dance?

A.2 i think ETOTHEIPI, 'cat, and I could compete for the bad boy and heartthrob moniker especially looking at our picture, we are dead sexy no? since erdoc85 is new to the 'band' i will have to reserve judgement. (DRX refused to be in the photo). Oldfart is not so much shy as just grumpy. he's more like eeyore. DRX definitely cannot dance (nor can most of us) and he might come across as shy but that's just his barely concealed anti-social psychosis. none of us can sing or we would have a band and suffer only from hangovers and the clap.

Q.3 We read all the time on the medblogs about what sucks about practicing emergency medicine, tell us what is rewarding about being an emergency medicine physician.

A.3 there is a lot that is rewarding. i do try to write about this stuff when it happens but i guess i have fallen into the trap that traditional newspapers do which is that the good stuff does make me reflect and does give me warm fuzzies but somehow does not spark the writing impulse. the things they tell you in med school that ARE actually good about emergency medicine are the obvious: no beeper, no call, no clinic, and mobility. ironically, many of those things cut both ways. after years doing this the big saves matter a lot, making a difference in an instant IS gratifying, but the thanks from a worried mom or the "hey doc, you don't remember me but you took care of me three months ago..." meeting in the supermarket are just as good.

Shrodinger’s Cat

Q.1 Sorry, but I have to ask. Is the cat dead OR alive or dead AND alive before we open the box to check?

A.1 The CAT, which is me, was and is obviously alive, however it will not be the vial of poison that will kill me; I die slowly inside with every 3:00 am toothache. This is not a paradox, but a sad reality. I will soon be starting a SAVE THE CAT fund, to which all can contribute. All contributions will be matched and multiplied by the Hamiltonian operator.

Q.2 Tell us an embarrassing story about your residency.

A.2 As for me, I visited a friend in another state and after imbibing many screwdrivers, decided it would be a good idea to shave my head. Returning to the ED that next Monday brought many stares and snickers, and the attendings thought I had lost my mind. As for patients, two come to mind. Undressing a 55 year old "normal" appearing gentleman after an MVA only to find a silk victoria's secret thong left a lasting impression. Also, interviewing a crazy lady while she left a steaming pile of shit in the middle of the floor was another time I won't forget, but I wasn't embarrassed. The CAT remained calm and collected throughout residency.

Q.3 Favorite:

Swear word- bullshit or mother-scratcher
Ice cream- chocolate
Vice president-George Clinton because he was a P-funk all star and is no relation to Bill
Love song- Endless Love
State- tie -Arkansas and Utah

Etotheipi

Q.1 OMG –you not only see dead people, you touch dead people, then you cut them up into little pieces. Maybe I'm thinking about something else. What exactly do you do? Describe your typical workday.

A.1 I look through a microscope for about 6 hours a day. This allows me to:
1. avoid human contact; 2. not talk to patients; 3. shun interpersonal interaction.

Basically, I make all the tissue, blood, fluid etc. diagnoses in the hospital, write them down, then go home and turn off my pager. Sometimes I cut up dead people. I love my job.

Q.2: What's your guilty pleasure?

A.2 Masturbating with a Kermit the Frog puppet.

Dr.X

[These are the only questions I know how to ask in Russian--MA]

Q.1 âû õîòèòå êóïèòü ìåí& ïèòüåì? (Do you want to buy me a drink?)

A.1 What is the cost?

Q.2: âû õîòèòå come up ê ìîåé êîìíàòå? (Do you want to come up to my room?)

A.2 Are there any hidden listening devices or cameras there?

Q.3 âîë&, êîòîð âû íîñèòå ýòè scrubs? (Will you wear these scrubs?)

A.3 Da, I mean 'yes', after my food-taster/bodyguard has had a chance to inspect and clean them.

Q.4 òî áûëà ïîòåõà. ìîæåì ìû äåëàåì åãî ñíîâà? (That was fun. Can we do it again?)

A.4 I cannot commit to such a proposal but there is a strong likelihood that we can, at a time and place of my choosing.

Old Fart

Q.1 Old farts usually like to give advice. What is the best piece of advice you can give a young doctor?

A.1 stop now! find a new job...

Q.2 I find it interesting that you love to hunt and that you really wish you were a veterinarian. If you were a vet, after you shot the creature, wouldn’t your first instinct be to run over and see if you could save it?

A.2 I don't generally shoot dogs, horses, etc...

Q.3 Tell us about the good old days. Best changes? Worst changes?

A.3 a) CT Scanners; b) government

erdoc85

Q.1 So, what's the 85 stand for? Wouldn't erdoc69 be more fun?

A.1 '85 is the year I graduated from college. It's also the year I got married, but mostly I celebrate the former. erdoc69 WOULD definitely be more fun, but wouldn't get much done. Besides, when the doc leans close to listen to your heart, wouldn't you rather smell coffee breath than fish-face?

Q.2 Tell us your funniest "foreign object" story.

A.2 Hands down, this was the 82 year old with an antique porcelain door knob up her vagina. She "slipped on some newspapers". She waited 3 months to come and be seen (I'm safe in assuming no one else was paying a visit to "the creepy old dry cave"). I have photos and xrays to illustrate this one (patient name redacted). After I removed the object...she wanted to tell me this object's history! Like I said, it was an antique. >[10/27/07 -- I apologize to the visitor who arrived here by searching for "antique porcelain door knob cleaner". I don't think this is what they had in mind. Well, it is the Internet, so maybe it was. MA]

Q.3 We don't know that much about you. What kind of car do you drive? What color is your hair? Are you a glass half full or half empty kind of guy? How much money is in your wallet right now? Lefty or righty? Favorite fast food? Do you own a hat?

A.3 In order...Chevy Tahoe, brown hair, ONLY half-full (cautious optimist), $150, righty, Whataburger (they are the only 24 hour restaurant on my drive home), lots of hats--all baseball caps though I seldom wear any of them.

Thank you MDOD docs!

Dr. October is ...MDOD

When I started the Calendar Doc series, I knew the MDOD docs were going to be Drs. October-Halloween Edition. I’ve always thought the MDOD site was SPOOKY. The dark background, the dark stories, the dark humor. Before they hit the big time, it was like visiting a deserted ghost blog. I never saw comments from the MDOD docs on other blogs, and there were never comments from outsiders on MDOD. When I wanted to link the Throckmorton post, I asked for 911DOC’s permission because I was afraid to send my 15 readers over there unannounced.

The MDOD doctors are "different." They post interesting stories about their work and, in their comment section, make frequent references to masturbation, exhibit homoerotic tendencies toward one another, and call each other lewd and lascivious names, which makes MDOD one of my favorite medblogs. I have to admit, though, more than once when I was reading their responses to my questions, I would think “that boy just ain’t right.”

Here is Part One of the interview:

Q.1 I think at least one of y'all is a girl. Am I right?

911DOC: no, we are all genetically XY though given the recent coming to prominence of the transgender movement one of our number may not exactly identify himself as 'male'. i'm not saying who it is but if you ever played 'one of these things is not like the others' on sesame street you can figure it out pretty quickly.

Etotheipi: Don't be stupid. Girls are too yucky to write such brilliant socio-politico-medical commentary. Boys rule! [censored-sorry, but I don’t want no trouble from the authorities (or hits from those kinds of perverts). I haven’t had my law license very long, I don’t want to lose it over your penchant for ***** **** MA]

Oldfart: Doubt it

Q.2 How much money have y'all made off those Google ads on your blog?

911DOC: right now the counters are ticking so fast that i should have my kid's college education paid for before Al Gore's apocalypse.

Etotheipi: Ask 911… and then tell him to give me some of it.

Oldfart: I ain't seen no $$!

Q.3 Any tattoos? Piercings?

911DOC: not yet. considering either a puking skull on my left arm or a still-life of flowers or something.

Shrodinger’s Cat: 1 tattoo [he didn’t say where or what, and there's no way I'm gonna ask, so just assume the worst-MA]

Etotheipi: If I did, they would all be on my genitals.

Oldfart: Nope x 2

Q.4 Write a dirty haiku for me.

911DOC:
men can not find it
is it fact or friction-y
the graffenberg spot

Shrodinger’s Cat:
Looking in your eye
Dingleberries everywhere
Your stinking brown eye

Etotheipi:
I've been a bad boy.
My sister's still a virgin
But not anally.

Oldfart: what the fuck is a "haiku"?!

Q.5 Do one of y'all work with a monkey?

911DOC: see

10/18 post. DRX and erdoc85 have some experience in that department. schrodinger's cat had an organ grinder act many years ago but lost the monkey on a bet so had to become a doctor.

Shrodinger’s Cat: no monkeys

Etotheipi: This better not be some racist question because I'm 1/32nd Kickasquaw.

Oldfart: No, but I trained a few!! Damn fine doctors they are..

Q.6 Why do doctors look hot in scrubs but dentists don't?

911DOC: good question. i have a suspicion that it has to do with the fact that you know they are dentists and that if you had a heart attack in their chair that they would call the ambulance to come and get you. perhaps it's the same kind of thing as wearing a band uniform or a USMC uniform? all that being said, i would be much happier as a dentist.

Shrodinger’s Cat: I look great in my scrubs because I work out, eat right, and wear no underwear.

Etotheipi: Because of our oversize genitals (especially the large vaginaed women).

Oldfart: Cause we are

Q.7 And of course, what color scrubs do you wear?

911DOC: black usually though a reddish top i used to have has now faded to pink. i love it.

Shrodinger’s Cat: Maroon scrubs

Etotheipi: Heliotrope and puce.

Oldfart: Blue

In Part Two, the MDOD doctors will answer more questions. I just have to do a little more legal research on some of their answers. That boy just ain't right.


Picture: MDOD doctors less Dr. X and erdoc85. Don't worry, doctors that don't cooperate get "special" candid pics posted, so look for pictures of Dr. X and erdoc85 pictures in Part Two.

PART TWO is here.

Request for Match Day Stories

Ms. Jones asked me if I would post her request for Match Day stories. Of course I told her yes. But I also suggested that if she wanted to reach more than 15 people, she needed to contact someone like GruntDoc or KevinMD. It sounds great. I would love reading stories about Match Day.

Proto magazine is looking for short, exciting Match Day stories from doctors who participated last year or just remember like it was yesterday. How were you affected by the tension of the moment? Did you faint with relief (or disappointment) upon opening your envelope? Did another student’s reaction catch your eye and make you think?

If you didn’t match, were you lost in “the scramble?”

Please send your stories to Carrie Jones at carrie_jones @ timeinc.com and include your full name and contact information with your submission. If we like your story, we may need to contact you for a brief follow-up. If you’d rather remain anonymous, we can withhold your name for publication.

Thanks!

Calendar Doc Tomorrow! Let's just say it's going to be a "different" kind of interview.

Memeing My Own Business

It's late, I'm tired, that's the best title I can come up with. I was tagged by 911DOC on that 8 random things meme. I've already done it twice, but I think I read somewhere that if the tagged people didn't participate, 911DOC would have 7 years of bad luck and/or his dick would fall off. I don't want either one of those things hanging over my head, so I'm going to play. Listing 8 more personal things about myself would require me to open up the "crazy" files, and I don't want to do that, so I am doing an 8 random things about the Calendar Doc series. What a coincidence, since I just e-mailed the questions over to Drs. October and I can use this post to give y'all a hint.

First, my blogging pal Amanda can't think of anything to write about so she has requested that she be meme'd. I still have a few memes left over from when she insulted me by questioning my womanhood, so I am happy to oblige. Since it's more than a few questions, I am going to send you over to Addicted to Medblogs Two for the memes. Be sure and let me know if you participate, so I can link it here. I know my 15 readers would like to see your answers.

Eight Random Things About the Calendar Docs

1. It takes me longer to write the questions than it takes the doctors to answer the questions.

2. The doctors don't get to see their picture before I post the interview. Except for Drs. October, who submitted their own picture. (Something about not trusting me with a camera after talking to Scalpel.)

3. I joke about being afraid to e-mail the docs, but its true that I am shy and the first e-mail is always the hardest to send.

4. When I started the series, I knew immediately who the first 6 doctors would be. I also knew exactly who I wanted for Dr. June, Drs. October and Dr. December. I already have Dr. December's picture. hehehe

5. My original idea was to make up both the questions and the answers, using information from the doc's blog. I couldn't do that with Trenchdoc because he no longer had a blog, so I asked him if he would mind answering some questions. It worked out so well that I decided to scrap my original idea and make it a real interview.

6. Hint for Drs. October.

7. Come on, do you really need a hint?

8. I hope that this counts as 8 random things, otherwise, 911DOC is going to have a problem.

I Like Free Stuff (Or, I'm Playing With My New Printer Again)

I love shopping at the mall, but I don't go very often because it usually means trouble. I lose all track of time and get way behind schedule. I've had to wrap gifts in the car on the way to parties more than once, which for some reason really annoys the hell out of BF. Yes, I know stores will wrap gifts, but I am semi-famous among my family and friends for my unique and festive gift wrapping abilities, so I like to do it myself, even if I have to do it cramped in the car.

The mall is also a good place to get free stuff. There's nothing I like more than getting free stuff. I've been known to buy stuff I don't need or want, just to get the free stuff (usually more stuff I don't need or want--but it's free). My strategy is simple, I just act interested, and I may get a few free samples of cosmetics, perfume, etc. You know, fun stuff.

So I was at the mall, heading for Sephora, because I wanted to see if they had the lip plumper that I saw on an infomercial. Hey, don't laugh, it has the Good Housekeeping Seal of Approval, so it must work. Anyway, on my way there, I saw the L'Occitane store and decided to go in there and see what rich people smell like.

Sales Guy saw me walk in and immediately asked me if I wanted to put all my smaller bags in two larger bags. Well, sure I do. I love those free shopping bags. I'm in a closet and drawer cleaning frenzy right now and those bags come in handy for carting stuff to the Women's Center. But I don't think he was necessarily trying to be helpful, he just recognized I was an accident waiting to happen and he didn't want to be cleaning up stuff I knocked over with my bags. (BTW, I also walked through two department stores where I know they will ask if they can put your stuff in their bags when they see you carrying a competitor's shopping bag. I walked out of the mall with 8 large bags and 6 smaller bags. Free stuff that I can actually use.)

Sales Guy was very nice, and after I told him I wasn't going to buy anything, I just came in to smell, he took me on a tour of the place.

As I was leaving, Sales Guy asked me if I wanted some free samples. For some reason, I told him no thanks, and I turned to leave. He refused to let me leave without free samples and filled a small shopping bag with all of these goodies:

So now, I'm thinking my new strategy will be to refuse samples, and maybe I will get even more free stuff.

Okay, I realize this isn't a particularly interesting post, but it did serve a purpose. It gave me a chance to see what other tricks my new printer can perform. I learned that I can pile a bunch of crap on top of my printer, press a button, and Voila! I have a picture for my blog. I know, I know, any fifth grader already knows this. The only complaint I have is, the picture isn't big enough to illustrate how many goodies I actually walked away with.

The July Syndrome

This is a page from my SiteMeter stats. Note the Visitor's Time and the Search Words.

I had always heard that you shouldn't go to the hospital in July because that is when the new doctors start. Being a non-medical type, my warped medblog addicted mind immediately figured this must be a new intern. It was his first day, he was asked to do something, and the patient wouldn't cooperate and refused to pull his pants down. Now, the new intern probably didn't want to be forever known as the doctor who couldn't get a patient to drop his pants, so he snuck off and Googled it.

I know, this would have been funnier and more appropriate if I had posted it on July 2nd. That's been the theme of my life lately--a day late and a dollar short. I could tell y'all that I was busy working, but the truth is, I couldn't figure out how the hell to get the SiteMeter page onto my blog. I am technically challenged.

But now I have a fancy new printer. I probably made it infinitely more complex than it should have been, but I managed to not only get the page to show up on my computer, I have added red circles!

So what if it is two months late? BFD. It's still funny.

Well, kinda funny.

Ok, so it's not funny anymore, but who cares? I put red circles on it and posted it on my damn blog.

No telling what y'all are gonna see on my blog in the future.

Just in case another intern has this same problem next year, is there anything you can do when the patient won't pull his pants down?

A Kernel of Corn ~ The End

I wish I could say that things ended well. The treatments were tough on Nicole. She joked that she thought Elizabeth was going to grow up thinking all mommies came home and took their hair off. Nicole fought a good fight but eventually decided it was time to stop fighting. I was surprised at how many people would criticize that decision. Really, I guess I was surprised that anyone would think they had the right to question her decision.

I said goodbye to Nicole in June. She assured me that she wasn't in pain and she wasn't scared.

I cried silent tears the entire trip home. I know everyone who saw me that day at the airport and on the plane thought I was crazy.

As soon as I got home, I started writing a letter to Elizabeth, telling her everything I could remember about her mother during those college years. I told her every single thing we did, no matter how irrelevant or inconsequential it was. At first, I thought that I would give the letter to Elizabeth when she went away to college, but now I'm not so sure. Maybe it's something she will want to read when she is thirteen or fourteen. I guess it doesn't matter right now, I still have a few years to decide.

The call came in September. Nicole had died at home, in her own bed, with Mark by her side. Just like she wanted.

I will be carrying a locket with pictures of Nicole and Elizabeth when I am running in the Susan G. Komen Race for the Cure this month. And Nicole will be looking down laughing at me because she knows how much I hate to run, especially in the morning.

A Kernel of Corn ~ The Middle

This is harder than I thought it was going to be. Long story short, Nicole’s life went on according to her master schedule. She met the man of her dreams during the summer between our junior and senior years. Mark was six years older than Nicole, tall, blond, and handsome. He gave her an engagement ring for Christmas, and Nic and I spent the last semester of our senior year planning and preparing for her wedding.

After the wedding, I went back to my hometown and Nicole and I kept in touch. She must have been made for marriage because she said the hardest part about it was trying to come up with ideas for dinner every night. Nicole decided to accelerate her master life plan and, about a year after she married Mark, Nicole gave birth to the beautiful Elizabeth. I went to visit Nicole when Elizabeth was three months old. I was afraid to hold her, but Nic sat me on the couch and put Elizabeth in my arms. Once Elizabeth realized I wasn’t a source for dinner, she put her head down and fell asleep. I can still remember everything about that night, the feel of Elizabeth’s weight on my chest, her soft breathing, and that baby smell. I was afraid to move because I didn’t want Elizabeth to wake up and be taken away from me.

A few months after my visit, Nicole called and told me she had found a lump in her breast while feeding Elizabeth. She made an appointment to see her doctor, but she wasn’t really worried because everyone said she was way too young to have cancer. I asked Nicole how big the lump was, and she said "the size of a kernel of corn."

A Kernel of Corn ~ The Beginning

This is one of those times when I wish I were a writer. I've been sitting here for hours trying to write about my best friend/college roommate but I'm frustrated because I just can't seem to put the right words together to express how much I admire her, or to illustrate her beauty, courage and spirit. Nevertheless, over the next few days, I am going to write about my friend Nicole.

We were nineteen when we met, the first day of our sophomore year in college. Nicole and I had a lot in common and we became fast friends. We shared a townhouse during our junior and senior years. Those three college years with Nic were full of Lucy and Ethel adventures and misadventures and I loved every fun, crazy minute.

Nicole was tall and beautiful and would turn heads when she entered a room. She was also one of the nicest people I have ever met. In the entire time I knew her, I never once heard her say anything nasty about anyone. But she wasn’t nice in that overly sweet, annoying way. She was just confident and easygoing. Nicole was religious, but not judgmental. She lived her life the way she needed to but accepted people as they were. Nicole would get up every Sunday morning and go to church, no matter how late we had stayed out the night before. I always thought it was funny because Nicole went to church on her own volition. I slept in every Sunday because my parents weren’t around to make me get up and go to church.

Nic wasn’t perfect. We had the largest collection of stolen bar glasses in town. I can’t remember ever leaving an establishment without hearing the sound of clinking glasses in Nicole’s purse. She (with three unnamed accomplices) once left a banquet with two complete place settings stashed away. It was a dinner for the football team; very festive and pretty. And yes, everything was lifted before dinner; Nic wasn’t about to ruin a good purse. Plus, our boyfriends at the time drew the line at sneaking out dirty dishes for us.

Nic had a stalker during our senior year. He eventually stole a load of MY clothes out of the dryer and nailed a pair of MY panties to our door with an obscene note to Nicole. It didn’t take long to figure out it was the weird neighbor who came over to introduce himself wearing nothing but his Speedo's in 30 degree weather. We heard his parents spent all night packing his stuff up so he could be gone by the next morning. I teased Nic for years about how she owed me new towels and underwear because of her bad choice in stalkers.

Being best friends, Nicole and I talked about everything. While we were alike in a lot of ways, we didn’t share the same hopes and dreams. I wanted a career with no concrete plans, no boundaries, no fences. Marriage before age thirty wasn’t an option for me. Nicole, on the other hand, had her life mapped out. According to her master plan, she would graduate, get married, work for a year, have her first child, then spend the next twenty years being a wife and mother. There was never any doubt in her mind that this would happen, in that order, and according to her schedule.

Law School Musical

Not a day goes by that I don't get a few hits from people searching for information on the LSAT or law school. I hate for people to walk away disappointed, so this is for all of you wannabe lawyers (or for you people who just want to confirm you made the right decision by not going to law school).