Don't Google this

Patient: What's the name of what I have?
Me: It's a Bartholin's gland cyst
Patient: what?
Me: I wrote it down here on your discharge worksheet. Important to know if you see another doctor for similar complaints, but I'm going to have to recommend you don't google image that.
Patient: Really?
Me: Trust me on this one. 

Kids say the darndest things

3 year old patient as I leave the room: I like her shoes, Mommy!

It's the little things that keep you going when you spent an hour of your morning with a 12 year old who has a history of crack cocaine use, suicide attempts, homicidal ideation, getting caught having sex in the school bathroom and who's mother died of a drug overdose, father is in jail, the great aunt who used to take care of him died recently, cousin's husband raped him when he moved in with them, and is now living in foster care. But don't worry, the state hasn't deemed it a priority to get him some psychiatric help.

Also, this conversation:

Me: How many girls have you had sex with?
Him: Just the one! It's true love!

[15 minutes later, at the end of the visit]
Him: So....am I allowed to have...you know....
Me: ......
Him: s......e......
Me: Sex?
Him: yeah.
Me: That's not for me to say. That's a personal decision. You need to understand the risks though. You could get an infection, like syphilis, chlamydia, or even an incurable infection like herpes or HIV. You absolutely have to use protection. You also have to be ready to become a father, because you could get a girl pregnant. You also can't have sex in school; I'm pretty sure that's a rule.
Him: So you're saying if I use protection and am ready to be a baby daddy, I can have sex?
Me: If that's the right decision for you and the person you're having sex with is okay with it, then yes. But you can't force anyone to have sex with you.
Him: I know. Can you tell my social worker to drive me to my girl's house then?
Me: ......no.
Me: What makes you think you're ready to be a father anyways?
Him: I am ready!
Me: you think you can take care of a baby? Another person? You just don't me you can't even take care of yourself.
Him: I can do it -- I've been waiting for a baby forever!
Me. How would you buy your child food and clothes?
Him: I'd get a job.
Me: You're 12.
Him: I'd lie about my age.
Me: Pretty sure they're going to require some documentation.
Him: I'd sweep up hair at a barber shop for like...$13 an hour
Me: Pretty sure it doesn't pay that much.
Him: Well, also. I get an allowance. Duh.

What's that?

**Warning: graphic content. not approved for all viewers**

"What?" my 16 year old patient in the emergency department asked.

"Huh? I asked if you were having vaginal, oral or anal sex...." I repeated, a little confused. She'd already revealed she was sexually active.

"Yeah. What's that....vaginal sex?" she said quietly.

"As opposed to oral or anal sex....?" I started.

Blank stare. Guess that approach wasn't going to work.

"It's when a penis goes into a vagina" I said, not breaking a sweat.

"Ew." she groaned. "you didn't have to say it like that."

Yeah, I think it's pretty clear I did.

And if you don't know what it's called, maybe you shouldn't be doing it, girl. Also, use protection, you're in the syphilis capital of the country, for goodness sake.

Just another afternoon in the wide-reaching and sometimes surprising world that is pediatrics. 

Rule number three

Baltimore, charming as it may be, can be a lot like a war zone. They (where they = M*A*S*H) say there are two rules of war. Rule number 1: young men die. Rule number two is that doctors can't change rule number one.

And I think rule number three is don't look back......


"This is not the right fucking suture" the trauma surgeon muttered as he threw it back on the tray. "How can we not have the right sutures in the fucking trauma bay" he said, impressively calmly, and to no one in particular.

The patient, a delta trauma, had come into the emergency department with his t-shirt soaked in blood, his face already pretty lifeless. Multiple gun shot wounds to the chest.

I ran to the next trauma bay and returned with every suture I could find, handing them to the nurse closest to the surgeon as he called out for them.

"So did this guy have vital signs in the field or not? Does anyone know?"

Silence. The question was a critical one. A gunshot wound to the chest, or any other penetrating wound, can sever a major blood vessel or the heart itself. If the victim is gotten to early enough, if he hasn't lost too much blood, an ED thoracotomy -- cutting into his chest wall in the emergency department -- might save his life if the surgeon can find the injury and sew it up. If a patient comes in with blunt trauma to the chest, or never had vital signs in the field (a sign he'd been down for a while), the process is invariably futile.

No one responds.

"Hold compressions," the surgeon says calmly and the tech performing chest compressions stops.

Before I can fully register what is happening, the patient's left chest has been flailed open. We just opened a man's chest in the emergency department trauma bay. Some injuries are found and stitched close. Vital signs do not return.

"Sharon, get in here," the surgeon says, gesturing with his head. "See what I'm doing? Do that."

What he was doing is internal cardiac massage.....CPR inside the chest. Rather than compressing someone's chest wall from the outside in an effort to pump blood from their heart, you simply squeeze the heart itself.

Let me repeat. I stuck my hands through an incision on a man's chest and squeezed his heart with my bare gloved hands to circulate his blood through his body.

Then the patient was declared dead.

The room cleared out.

I removed my hands from his chest and looked down at my blood soaked gloves and gown. My visor had flecks of blood on it and I'm sure the pattern extended to my mask as well. I'd just held a man's heart in my hands. His blood was covering me, almost from head to toe. And now he was laying in front of me, dead. Everyone else had left and the nurses and techs were already starting to clean up.

I tore my gown, gloves and mask off in one swift motion, threw them near the trash bin, and walked out of the trauma bay.

I didn't look back. 

Looking good

"So...Sharon....did you say yet what the anatomical segments of the right upper lobe are?"

Ugh. I was hoping he'd forgotten he'd asked me. I'd gotten how many segments there were correct (three), but I'd be damned if I remembered the names (remembered? shoot, I'd be damned if I ever knew to begin with). I stood next to the attending, my cheeks burning with embarrassment, though thankfully covered by a surgical mask and goggles. It had been a few minutes since the question was first put to me, as there was the entire matter of the patient on the operating table in front of us who needed her right upper lobe removed. I wished I was the one under anesthesia. The intern across from me locked eyes with me and I could tell she was trying to send me the answer. Telepathically.

"I just said one of them," the attending continued. "were you not listening?"

"Posterior" I said, way less than confidently. I hadn't been listening. 6 hours of standing here doing basically nothing will drive you to weird mind games to keep yourself awake. And it rarely includes being fully tuned in to what is happening.

"And then....?"

He really wasn't letting this go. I shifted my feet uncomfortably and tried to look competent with the suction.

"Anterior" I blurted out, more guessing than anything.

"Yes. And the last one...?"

I had no idea. Time to say words I did know..... "Superior?"

"Now you're just guessing. You've been on this service how long? You've been on this service a week and you don't know the anatomy of the lung? Really? A week? Really?"

Well that just seemed unnecessary. I could tell the intern was incredibly uncomfortable. The fellow didn't even look at me. Anesthesia was poking his head over the drapes at this point, staring at me, probably remembering why he didn't go into surgery. The scrub nurse fiddled with her instruments. "Yeah," I thought, "looks like I don't know."

"Interesting," the attending mumbled to himself and he continued the procedure, "don't even know your lung anatomy."

He turned to the intern -- "well?"

"Apical," she said. More than a little bit apologetically.

Surgery 1, Sharon 0

How many roads must a man walk down

The next time you hear on the news that a 19-year-old man got shot multiple times in the chest and abdomen, let me assure you -- he's not a man. He's a  kid. He looks like he's about 12 years old. He probably can't even really grow facial hair. He might be close to six feet tall, but he weighs about 140 lbs dripping wet. He hates it when his mom asks medical students questions. He gets cold in his hospital bed and wants more blankets. He's scared of how much pulling his chest tube out might hurt. He cries in anticipation and pleads for you to put him asleep for it. He holds his momma's hand as the tube comes out and squeezes hot tears out of his eyes. So the next time you hear about a 19 year old getting shot or stabbed, despite whatever preconceived notions you might have, let me assure you, he looks much more like Doogie Howser circa 1990 than LeBron James circa 2004. Definitely not a man. 

So You're Saying I Don't Have Syphilis?

I spent a month on the trauma surgery service. There is clinic every Friday, in which we see patients who have been discharged from the trauma surgery service to remove sutures/staples, ensure their pain is properly managed, and make sure they don't have any signs of post-operative complications (infections, etc). On my first day, I went in by myself to see a patient. He was a middle-aged guy who had gotten beaten up by "a gang of dudes" one night while "minding his own business." (NB: every trauma victim is minding their own business when tragedy befalls them. I have made it a personal goal to never be minding my own business. It seems quite dangerous in this city). His incisions were well healed and he only needed staples and sutures removed from several sites on his back. After checking in with my attending, I set about removing them, cleaned the sites, and told him he was free to go, but to be sure to call us if he had any problems.

"Doc, what about my blood tests I got when I was here?" Despite my normal announcement that I'm a medical student working with the team upon entering the room, many patients still refer to me as their doctor. It's uncomfortable (because it's inaccurate, because it sets an expectation I'm not ready for, and because people -- attendings, residents, other students -- would make fun of me if they ever found out). Not sure to what he was referring, I pulled up his record on the computer and realized that, while in the emergency room, he'd gotten some routine blood tests that basically said...nothing. I explained what the tests were and that they indicated normal blood counts and electrolyte levels in his blood at the time he was seen in the ER.

"So you're saying I don't have syphilis?"

.....what?

"I just got out of lock-up and the state keeps calling me and telling me I have syphilis."

.......ummmmmmmmmmmm

"Well we didn't test for syphilis, so I really can't say one way or another. If they tested you for syphilis in prison and the results came back positive, I think you should follow up with them and get treatment. It's a very simple antibiotic that you would have to take."

"So you're saying I don't have syphilis?"

"No, that's not what I'm saying. I'm saying I don't know based on what we did here. We did not test for syphilis."

"But you said my blood tests are normal."

"Yes, the blood tests we ran are normal. But there is a special test for syphilis that a doctor can run. It also uses your blood, but it is a completely different test from the one we ran. We did not test for syphilis."

"Well I don't think I have it. I had a test with my doctor once and she said I didn't have it."

"That's definitely possible. If it's a recent test, I think it is probably correct. However, if this was in the past and you've have any additional sexual partners since your negative test, you could have gotten syphilis between the test and now. Perhaps that is why your test from prison is positive."

"Doc, I'm a one woman man!"

"I don't doubt it. But syphilis can be a very serious disease if left untreated, even if you currently feel well now. I really think it's very important for you to follow-up with these tests. If you have a recent negative test from your primary care doctor, I'm sure she'd be happy, with your permission, to send it to the state so that they stop calling you. But I really do think you should follow up with here. It's important for your health and that of your sexual partner."

"So you're saying I don't have syphilis?"

This conversation probably went on for about 20 minutes. I finally got to a point where I thought I had somewhat conveyed the pertinent information and stood up to leave.

"Doc, what about these staples in my head? You gonna take them out?"

The previous note from the ED hadn't said anything about scalp lacerations or the placement of staples in this man's head. Nor had he said anything when I asked if the locations on the back were the only ones. But sure enough, beneath his tangled head of hair, he had two well healed lacerations on his scalp with lines of 20-30 staples in each. Since he had delayed his follow-up much past the recommended two weeks, his hair had grown in and around the staples, intermixed with scabs, and made a hot hot mess.

Having never taken staples out of the scalp before (and the scalp can bleed...A LOT), I went out to the physician work room to see if there was anything special I needed to do. Also to make sure someone else was there in case I ran into trouble with unexpected bleeding. No one. Everyone was gone. Clinic ended at noon and my patient's 20 minute confusion about syphilis had pushed the appointment way past clinic quitting time.

"Guess I'm winging this one alone," I thought to myself. And proceeded to remove 40 staples from the head of a recently released prisoner with questionable syphilis status.