Shutting down... for a while...

Merry Christmas and a Happy New Year to ALL!

We're going on holiday... back in Jan!

Two vaginas?

And THIS?!


Click the image to see it full size...

Yowsers. Will have to wait for SA Doc's comment on this. She's still at work.

I think this is two vagina lady's blog: I have two vaginas!

A quote from the article, if you will...

When I was dating, I'd just say, "So I have a little something to tell you." I never got any other reaction except, "Oh, my God, that's so cool," because they'd want to have sex in both sides and see what it felt like. Apparently, the right side is, well, more normal. The left side is a lot smaller. But they're both tight. That's a plus. I've got two G-spots, too, so I've always appreciated men who were extra dexterous with their fingers. I get to have two orgasms at the same time.

So, who calls bullshit?

Best Of All Scrubbed Up (Part 1)

Not enough bloggers take the time to go back in the archives and rehash some of their best material... Egotistically speaking of course.

But we're different.

So, in case you didn't catch it the first time round - here's a quick series of posts with the REALLY funny stuff, the most viewed, the most commented, the dugg, the undugg...

Welcome to Best of All Scrubbed Up!

- - - - -
Talkin' about foreskin

More than a year ago, we started this blog with but two simple goals. Have some fun and make some statements about the South African (and international medical fraternity). What better way to start than an expose on what really matters to guys.

Their... well, thingies and the end of their thingy.

FORESKIN EXPOSE PART 1 - To chop or not to chop

FORESKIN EXPOSE PART 2 - Revenge of the Sif.

- - - - -
TV Doctor Showdown...

Doctors are all over the tube. They're in our face and up our proverbial skirts. And mostly... (well according to SA Doc at least)... they're a bunch of bollocks. So how would they fair when placed in a real-world tough-gun situation. Say... ummm... a night in Baragwanath in the TRAUMA ward (AFTER a Chiefs vs Pirates soccer game).

Find out here :)

TV Doctor Showdown - Meredith Grey
TV Doctor Showdown - Perry Cox
TV Doctor Showdown - Gregory House

- - - - -
And there ends the lesson. What do you think of the BEST OF selection? Let us know in the comments...

Medical Adwords

Google Adwords is context sensitive. Meaning it scans your blog posts and displays relevant advertising for your content / supposed audience. This has resulted in billions of dollars. And usually works FOR you.


Sometimes it doesn't.

GUEST POST: Superhero Surgeons - It ain't all Sex, Drugs & Rock 'n Roll (by Bongi)

Welcome to the third, in an initial series of 3 guest posts by our Mpumalanga HeavyWeight... Bongi. He's witty, he's irreverant - he's a little whack.

But it's all in the name of demystifying the doctor. Or not.

Enjoy SUPERHERO SURGEONS - It ain't all Sex, Drugs & Rock 'n Roll!

If you like Bongi's work - visit him here! Wear a glove. Spread the love.

- - - - -

yes i have an alter ego. yes, i dress in funny clothes with a cap covering my head and a mask covering my face. and yes, dressed as such i try to fight the powers of evil (mainly sepsis and bleeding and cancer and the like). i am ... a superhero.


but there is often little understanding for what goes on under the paper thin masks and baggy gowns we wear. certain …um…occurrences, well, occur with us just as much as with other people.

a common cold behind a theatre mask is no small thing. remember you can’t blow your nose. sniffing loudly only works for a while and attracts all sorts of strange stares. just leaving it is really the only option. the positive side of this is you suffer less from the mild dehydration that accompanies massive loss of …mucus. there is, after all, fluid replacement (it is a very short trip from your nostrils to your mouth over your upper lip). ‘nuf sed. somehow this never appealed to me though. so, for all you budding surgeons out there, when you have a cold, plug your nostrils with tissue before scrubbing up. once you’re scrubbed, it is too late. The side effects are only a slight change in voice which is a small price to pay to avoid the constant lip licking and salty taste throughout the operation.

then there is a running stomach. this may be one reason to excuse yourself, handle the situation and rescrub. however, there is the real problem of dehydration, confounded by long hours of standing and concentration. here may i suggest a drip. the gas monkey (anaesthetist) can quite easily give a quick bolus or change the vaculiter when needed. (quick note, i’m not pulling this out of my thumb. i have actually seen this). stay at home, i hear you say? somehow that just doesn’t work with us doctors. i’m not sure why, but it is very rare that a doctor will stay at home merely because he is sick. what sort of a superhero would that be.

the last problem that can be encountered is best explained by thinking back to my registrarship. i was assisting the prof with some or other laparotomy. my stomach had been giving me trouble for some time. up until just before scrubbing up with the prof i had found it necessary to quietly leave polite conversation to allow the release of colonic gas quite a number of times. but once scrubbed up, this avenue was no longer open to me. what could i do? i simply puckered up and held it all in. this worked well, but became progressively difficult. we were approaching the end of the operation, but i could pucker no more. finally i reached a point where i had no choice. i needed release. i decided to quietly let one slip as to not attract too much attention with loud noises. so, as the professor started to close the sheath, i did just that. i was just inwardly congratulating myself for the stealth with which the…um…operation had been executed when the professor stopped closing and dived back into the abdomen. in a dry voice he quietly says, “someone cut the colon.” as he started carefully moving bowel out of the way to better examine the colon. now imagine my embarrassment when i was forced to say’...

“colon? yes. cut? no”

Designer Surgical Masks

What will they come up with next? I must say, I fear any surgeon more interested in the effect of his headgear than my gaping wound.

Headgear #1



Headgear #2

The World Famous All Scrubbed Up: "What is THAT?" Competition #3 Part 2 - The Answer!

Congratulations EmergencyEmm!

Human Papilloma Virus is not rare. This guy had an immune deficiency which allowed a fairly common infection (warts) to get out of hand.


An extract from the original article:

After testing samples of the lesions and Dede's blood, Dr Anthony Gaspari of the University of Maryland concluded that his affliction is caused by the Human Papilloma Virus (HPV), a fairly common infection that usually causes small warts to develop on sufferers.

Dede's problem is that he has a rare genetic fault that impedes his immune system, meaning his body is unable to contain the warts.

The virus was therefore able to "hijack the cellular machinery of his skin cells", ordering them to produce massive amounts of the substance that caused the tree-like growths known as "cutaneous horns" on his hands and feet.

Dede's counts of a key type of white blood cell are so low that Dr Gaspari initially suspected he may have the Aids virus.

But tests showed he did not, and it became clear that Dede's immune condition was something far rarer and more mysterious.

HPV is very common. It’s the virus that causes the warts on your fingers and knees as a kid – and yes, it’s the virus that causes genital warts (yech!). All doctors love those.

As long as you all have good healthy immune systems, your wart virus will never get like this.

Without getting overly medical - here's our favourite source - WikiDoc!

Some HPV types may cause warts while others may cause a subclinical infection resulting in precancerous lesions. All HPVs are transmitted by skin-to-skin contact.

A group of about 30-40 HPVs is typically transmitted through sexual contact and infect the anogenital region. Some sexually transmitted HPVs -- types 6, 11, may cause genital warts. However, other HPV types which may infect the genitals do not to cause any noticeable signs of infection.

Persistent infection with a subset of about 13 so-called "high-risk" sexually transmitted HPVs, including types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 — different from the ones that cause warts — may lead to the development of cervical intraepithelial neoplasia (CIN), vulvar intraepithelial neoplasia (VIN), penile intraepithelial neoplasia (PIN), and/or anal intraepithelial neoplasia (AIN). These are precancerous lesions and can progress to invasive cancer. HPV infection is a necessary factor in the development of nearly all cases of cervical cancer.^[1]

Another pic:


So - 1 x guest post on offer to EmergencyEmm if he/she wants it!

The World Famous All Scrubbed Up: "What is THAT?" Competition #3 Part 1

This one really got to me. I don't know what it is about us mere non-doctor mortals. SA Doc giggled and said "fascinating". I almost threw up.

Anyhoo.

Welcome to the WHAT IS THAT COMPETITION PART #3! Guess the medical thingy in the picture and you could win an AMAZING guest post on All Scrubbed Up valued at millions of emotional dollars!

So... Here we go. What is THAT?!


HINT:

"I've never seen anything like this in my entire career."

- Dr. Gaspari

GUEST POST: Tough Surgeon (by Bongi)

Second post (in an initial public offering - har har - of 3) by our man with the plan - BONGI!

Enjoy... I didn't. This one was particularly gross for us "mere mortals". Read more of Bongi's stuff here.

- - - - -

A story that i thought quite funny at the time, illustrating us macho surgeons...

sigmoid volvulus. a wonderful condition which is very common in africa. not the type the textbooks talk about found in institutionalised old folk, but the type found in young black adult males. prevalence highest in uganda, decreasing as one moves south, but still pretty common in south africa. so in my registrarship, i became quite good at detorting the volvulus which is the emergency treatment in casualties. if this doesn't work or on sigmoidoscopy (siggy as we called it) if you see any questionable bowel, immediate laparotomy is performed.

anyway the patient came in and had a clear sigmoid volvulus on examination and x-rays. i got the siggy ready to detort and place a flatus tube. now, for the lay person, in this area of blocked colon, the feces has been rotting. yes rotten feces, the only thing to top regular or garden variety feces. the feces is also under extreme pressure, so as you insert the siggy, it deflates with vigor (explosively). many of my friends got showered with this rotten projectile fecal matter and often in their face when they detorted sigmoid volvulus on more than one occasion. i had evolved a way of doing it that decreased my chances of being the proverbial fan that was just about to get hit. yes, i think i was pretty good at it. in fact the picture above is me with my trusty siggy ready to detort a volvulus.

so, getting back to the story; i called the students to see the procedure, because this could be their only chance to see it. i set everything up and started the siggy, with an enterage of students, a house doctor and a rotating medical officer standing to observe. i got to the twist, observed to make sure there was no necrosis and started gently inserting the flatus tube. it slipped easily in. and as usual there was a sudden and massive release through the tube of rotten feces and particularly rancid flatus. i stood there trying to control my gag reflex. it would be considered an acute loss of cool if the tough surgeon was seen to be gaging at anything by his awe struck juniors (tongue in cheek for those who wonder). i just couldn't. i gagged over and over again. now i was struggeling to prevent myself from vomiting. despite this, my prominent thought was that the students would think i was a wimp.

then i looked up. every last one of them had bolted. not one had mannaged to overcome the stench to stay and watch. i laughed. all my ego driven worries about what they would think of me were in vain. obviously if a surgeon nearly gagged then mere mortals (tongue in cheek, flamers) like medical students and doctors would obviously not be able to be in the near vicinity of such a thing.

the patient did well, got his elective colectomy the next week and went on his merry way.

GUEST POST: Fashion Statements (by Bongi)

Ladies and Germs ... Please give a hearty, clinically clean, surgically scrubbed welcome to our first guest poster - Bongi from Other Things Amanzi! Welcome my man...

This is part of a drive to get more contributions to All Scrubbed Up. We're about a year old now and readership is growing rapidly. More content for you, our medically minded audience.

This is part 1 of a 3 post series. If you like Bongi's work - TELL US! It's a fascinating insight into Mpumalanga medicine (and this time, what they wear!)

- - - - -

Fashion Statements

sometimes we as surgeons are restricted by the most mundane of things. back in my kalafong days, more often than my first world visitors could imagine, entire theater lists would get canceled because of lack of theater attire (scrubs). this gave rise to a funny story and, indirectly to a more recent and somewhat more serious story.

story one.

i arrived in theater one morning in kalafong, ready and eager to operate. there were no theater pants, only tops. i quickly found out there were none available and the matron was on the verge of canceling my list. i checked my gas monkey (anaesthetist). he got one of the last pairs and was dressed for action. the sister was also appropriately attired. it was just me that couldn't enter the theater complex.

not to be blocked by such a minor thing, which was anyway an administrative error and therefore, i reasoned, should not disrupt theater lists, i made a plan. i took a sterile drape and wrapped it around my waist like a sarong and strutted out into theater.

my fashion statement it would seem was too much for the matron, because before i had made even 5 meters, she came rushing up to me with a clean pair of theater pants (she had apparently just created them from subatomic particles using a process of fusion) and insisted i go back to the change room to make myself decent. no fashion sense it seems.

the second story was more recently.

i was called to the theater at the local provincial hospital in the early hours of the morning. it seems they started a laparotomy for a gunshot abdomen and were now in deep water. i dived into my car (i reasoned i would soon be diving into their deep water with them and i wanted to get my eye in) and raced to the hospital, trying to fully wake myself up as i went. i parked and charged to theater.

there i encountered obstacle number one. the change room door was locked. no problem, i would just go in through the main door.

obstacle number two was the main theater doors had been locked using a piece of wood wedged through the door handles. i shouted into theater, but there was no reply. i reflected that, although they had called me in at some ungodly (but not unsurgical) hour, they had not allowed easy access. the telephone call had lead me to believe that the situation was critical. i could not let a mere locked door get in my way. i broke it down. inside i found one of the sisters sound asleep. my supplications to open the door as well as my violent attack on said door had, luckily, not disturbed her no doubt well deserved rest.

obstacle number three awaited me in the change room. there were no shirts. at this stage i was feeling slightly less than my usual cheery self. i was in no mood to waist more time. i dressed in theater pants and entered theater with a naked torso.

there was stunned silence. the medical officer was speechless. he started explaining his operative dilemma, but as he looked up and saw me he went quiet. if i wasn't in such a bad mood i'm sure i would have laughed. i started scrubbing. (i suppose i should say something like my godlike torso faintly illuminated by the one light in the scrub room, but that is implied, of course).


soon i was donned with the operating gown and got to work. no longer blinded with jealousy, no doubt, the medical officer found his voice again and could explain to me the situation. my mood also improved and soon the normal intraoperative banter was being exchanged as if it wasn't 3o'clock in the morning and as if the consultant hadn't just turned up half naked after breaking down the theater door and of course as if there wasn't someone whose life hung in the balance.

The World Famous All Scrubbed Up: "What is THAT?" Competition #2 Part 2 - The Answer!

SA DOC:

Easy one? Last time I saw one of these I was a student... They're nice and rare... but GREAT to look at!

(Yech! - Andy)

It's a teratoma!

Great definition from Wikipedia..

A teratoma is a type of neoplasm (specifically, a tumor). The word teratoma comes from Greek and means roughly "monstrous tumor". Definitive diagnosis of a teratoma is based on its histology: a teratoma is a tumor with tissue or organ components resembling normal derivatives of all three germ layers. Rarely, not all three germ layers are identifiable. The tissues of a teratoma, although normal in themselves, may be quite different from surrounding tissues, and may be highly inappropriate, even grotesque (hence the monstrous): teratomas have been reported to contain hair, teeth, bone and very rarely more complex organs such as eyeball, torso, and hand. Usually, however, a teratoma will contain no organs but rather one or more tissues normally found in organs such as the brain, thyroid, liver, and lung.

Next time you feel a lump in your groin (and it's helluva painful) - it's more likely to be a ovarian torsion or appendicitis than a teratoma. Don't fret! Teeth and hair are probably NOT growing inside your groin (for men - the pain would occur in your testes - and then NO, it's not appendicitis).

- - - - -
CONGRATULAIONS to EVERYONE. You're all bloody funny!

THe World Famous All Scrubbed Up: "What is THAT?" Competition #2 Part 1

Right. Next one!

THE CASE: 24 year old female presents with a lump in her right groin. Pain.

HINT: This "thing" can also occur in males.


Pretty, ain't it?

He drank so much - his liver split in half!

Spotted on Digg recently...

A young father who drank up to 15 bottles of wine a day died of cirrhosis so bad his liver had split in half, his family revealed yesterday.

Steven Massey, described as a 'Jack the lad', would drink his favourite Cassini sparkling perry 'just like he was drinking pop'.

The 21-year-old's death has devastated his parents and four older siblings, who hope his story will send out a shocking message about the perils of boozing.

I CANNOT believe that a 21-year-old could drink themselves to death!? Where the hell were the parents? Don't you think it's disgusting that you get first world countries where people are dying from social diseases.

Then I read a little further on, and this kiddie, Steven Massey, already has THREE CHILDREN! I ask again, where were the parents with the sex education (or at least a fuckin condom!). Bloody hell.

Split in half is fairly melo-dramatic. I guess it was so fragile, it just kinda fell apart. Lovely.

SA DOC's THOUGHT OF THE DAY: Social disorders are the hardest thing to deal with in society. You can't stop people drinking, having sex or taking drugs by reprimanding them. It takes a mindset shift. It takes a social change. And I hope to God first world countries out there (especially the ones who have a superiority complex over us third worlders) are doing something to fix this shit. Ahem. England.

Sorry about the anger, but I thought we only joked about towns where there was nothing to do except drink and have sex?

THe World Famous All Scrubbed Up: "What is THAT?" Competition #1 Part 2 - The Answer!

Ladies and Germs. I'm proud to announce the winner of the first World Famous "What is THAT?" Competition - ... BONGI! Nice one gal!

SA DOC says:

It's a multifibroid uterus. And yip, the story is true (some details have been changed to protect the patient). I'm not so sure why SA Surgeon (his alias) was so keen to take it out - usually gynae territory apparently.

Next competition coming soon!

(PS. Bongi - if you want your picture on the blog - drop your email in the a comment. AND... as a BONUS PRIZE - you get to write a guest post on SA's biggest medical blog. Keen? Drop us a line!)

The World Famous All Scrubbed Up: "What is THAT?" Competition #1 Part 1

So here's an idea for the medics and non-medics amoung you. Welcome to the first installation of the All Scrubbed Up "What is THAT" Competition. From time to time, we'll post something up that I've either removed during a surgery - or that we've happened on across the medical web. Your job? Tell us what it is!

WARNING: The following images may not be suitable for children under the age of 16 - and squirmish males.

CLUE: 42 year old woman presents with growing mass in her abdomen for three years.


What is THAT? (Please post your answers as comments - winner gets... uh... their picture on the blog!)

Update: ANSWER HERE!

Giant Microbes! As a soft toy?

Hell's teeth. And this!?


This website, Giant Microbes . COM, is selling soft toy Microbes. Presumably either to scare the living daylights out of kids - or act as a nouveau Med Student bedroom decoration device.

Freaky. But cool.

Managed Health Care... Here I come!

Some news! I've packed in the stethoscope & otoscope. Handed the snotty noses over to someone else. And have moved into managed healthcare. Hot damn! What a rush!

It's sad to be leaving some of the patients - who I really liked. I realised the other day how much of an influence I had (all Doctors have) in some people's lives. I'll miss hearing about the progress. And when I say progress, I don't mean medical. Who got their drivers license, picked a school for their kids or got the job they'd been hunting for size months. You get close.

But we must move on. Doing:

A) What makes us happy

B) What challenges us

C) Something which allows us to make the most impact.

Sometimes I felt like I was wheelspinning in General Practice. Now, I have a chance to affect the bigger picture. And that thrills me.

More on the job later... Give me a while to settle in, and I'll have some controversial views as usual. I must say... It's interesting to be "on the other side". I've been screamed at by no less than 10 doctors in the first week. I'm usually the one doing the screaming.

We're back...

Salaam and good evenin'. We're back. All honeymooned. Fat. Tanned. Ain't it cool. Thailand was incredible... So rural - yet so connected. 20c per minute internet certainly beats a lot of SA joints. Anyway, it was great to get away and forget about high pressured Joburg life for a while. We see Manto's been busy getting editors arrested since we left? :)

We're back. Post away.



"Viewpoint" on Phi Phi Island...



Divin'

MORE Scrubs Bloopers! Yes!

Just. Can't. Get. Enough.



PS Oh! Hello! We're back!

Gone marryin'

Hello lads and lasses! I'll be a little dormant for the next 3 weeks. SA DOC (aka Pharmy) and I are finally gettin' hitched. Holy Moly. I should be nervous right now eh? (T minus 6 hours).

Anyhoo - off to Thailand for the honeymoon - and going to try and not concern myself with posting. Keep your subscriptions up - call it a wedding present!

Later!

(PREDICTION: SA to WIN WORLD CUP)
(PROBLEM: How the HELL to watch it in Thailand!)

Cardiomyopathy patient wants to run a half marathon!

Here's a great story - a friend of ours is a cardiomyopathy patient. This is basically a illness of the muscular walls of the heart - you can't overstress yourself at all or your heart can give out!

This chap, bless his brave soul, wants to run a half marathon in a years time or so. Some people would say WOMBAT. Others... brave lad.

Some advice from SA Doc...

1. Take it easy. Small steps, slow training and build up over months, not weeks.

2. Frequent checks with your cardiologist to make sure your medication is optimal and the heart muscle training is coming along well. Your Echo needs to be "A" OK!

3. Don't run with scissors.

Please go visit his site and drop the guy a comment or two as motivation. It's a great mission to have - and if patients from around the world can stumble upon this kind of positivity? Well, it just can't hurt.

Visit Mark's site here...

Health Minister Manto - the jokes fly...

Sigh. What can you do but gigggle like a girl and book yourself into private. With leadership like this...

Manto vs Jack

Yes!

All about House #3: Season 3 Bloopers...

And to top it off... some bloopers from Season #3. Everyone loves it. And no. I'm not just posting for the search engine traffic. Ok. Well. Maybe.

All about House #2: CNN Says House MD is REAL...

Ok. Headline is a tad sensationalist. But it's an interesting CNN news clip on just how real the medical mysteries of House MD are.



My favourite bit... Chances are Gregory House wouldn't be employed for long. Damn straight. But I wouldn't mind dipping into his Vicodin bin from time to time :)

All about House #1: Hugh Laurie audition...

House Season 3 is in full swing in South Africa - and we're hooked. Cynical bastard. Loving it.

Found his audition on YouTube. Enjoy!

Manto vs. Joburg Gen

It has just been announced that the name of the Johannesburg General Hospital will be changed. From 1 September 2007 it will officially be known as the Manto Tshabalala-Msimang Pub & Grill.

Male Pregnancy: True or Hoax?

Now I'm confused. Anonymous (WHY always anonymous!?) posted a link to an urban myth page - with this exact story on it.

Extract from that site here:

Claim: A man who has had an embryo implanted in his abdomen is engaged in the world's first human male pregnancy.

Status: False.

Origins: The possibility of a man's becoming pregnant has been the subject of more than a few works of speculative fiction and comedy, and the topic was given some sober consideration in the media after the British weekly New Society ran an article discussing specifics of the procedure in 1986. It could be done, New Society reasoned, if an egg were fertilized in vitro and implanted in a man's abdominal cavity. The embryo would have to attach itself to a major organ, the man would have to undergo hormone injections, and the child would have to be delivered by caesarian section, but it was possible, they speculated. (The child would have to be male, though, or else the necessary hormone injections would effectively castrate the male host.)

The dangers of such a course of action are far too high for the idea to be taken as anything more than a bit of scientific "what if" entertainment, however. Although some women have successfully given birth to children conceived outside the womb, ectopic pregnancies are quite dangerous, and nearly all ectopic embryos are removed soon after diagnosis. For a man to attempt to carry a child to term in such a manner would be an unacceptably high risk (especially since the placenta would have to be left to decay inside the man's body after he gave "birth," as its removal would result in major haemorrhaging).

Now, fourteen years later, people have begun to wonder about the web site at http://malepregnancy.com, which purports to chronicle the efforts of one Lee Mingwei to carry off the "first human male pregnancy." The site hosts video clips of "Mr. Lee," an ultrasound video of his "baby," an "interview" in which he explains why he's doing this, a discussion of how male pregnancy is scientifically possible, and a chat room where visitors can discuss the "social implications" of male pregnancies.

Is this for real? No. It is, like its sister site at http://www.genochoice.com (where you can "Create your own genetically healthy child online!"), an exercise in speculative fantasy. Follow the links from the "Credits" section, and eventually you'll find a disclaimer which reads:

This site ("Site") was created to be an exploration of a very likely scenario that may one day result from new advances in biotechnology and infertility treatments. The Site itself does not provide actual commercial services, and the information contained on the Site is not represented as being factually accurate. This is a fictitious web site created by a single artist.

(You can also read profiles of Lee Mingwei and his collaborator, Virgil Wong, on the web.)

Perhaps some day these concepts might indeed become reality, but for now they exist only within the realm of fiction.

Odd. I searched around on their site for a while, even looking at their disclaimer which only reads:

The information on RYT Hospital-Dwayne Medical Center's web site is provided as a general reference; it is not to be used or relied upon for any medical decisions, diagnostic purposes, or medical treatments. This information is not intended to be patient education, and it does not create any patient-physician relationship. This site should not be used as a substitute for diagnosis and treatment by a medical professional.

Please consult your physician before making any healthcare decisions or for guidance about a specific medical condition. RYT Hospital-Dwayne Medical Center expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. RYT Hospital-Dwayne Medical Center does not endorse specifically any test, treatment, or procedure mentioned on this site.

By visiting this site you agree to the foregoing terms and conditions, which may from time to time be changed by RYT Hospital-Dwayne Medical Center. If you do not agree to the foregoing terms and conditions, please leave this site immediately.

Now what?

Male Pregnancy: The YouTube Interview

There have been a couple of comments over the last week on our male pregnancy post. Nooo. Can't be. Impossible. You're yanking our chain. La la la.

Chaps. It's true.

Check out the interview...

Antimicrobials...

I didn't get it. But the Doc did...

Male Pregnancy?

OK. So this isn't new news... But I'm willing to bet there are a BUNCH of people out there who don't read Time Magazine. So here it is. And it's FASCINATING! This is why I became a doctor (for weird shit, of course!).

My last post introduced the concept of extra-uterine pregnancy. So, is male pregnancy possible? Time magazine seems to think so...

Now, my position on this first of all (scroll down if you really must see the picture). As a women's rights activist (mostly), I DON'T think that men should throw down the corporate life and take up the child bearing role. Firstly, as a Doctor, I believe that it is extemely dangerous and you risk the life of not only the fetus, but also of the father.

Implantation has to be in a good place (where the HELL might that be in a man?! - Andy) giving a good supply of blood to the fetus... and at the same time not harming the father. Believe it or not, the liver is NOT a good place (when the placenta detaches, the liver could bleed out... it gets messy!).

There are a LOT of variables that Doctors have to get extremely right to make this safe.

Secondly, I don't know whether I believe that men should have to go through the extremely artificial physiological process required to have a baby. Any man wishing this on himself would have to be pumped with the right hormones to keep the fetus alive. What long lasting effects will this have on his body? How is this going to affect his emotions? God. Can you imagine a man PMS'ing? They can barely handle flu as it is.

Which brings me to my final (emotional - because I can) point. Do men have the nuturing emotional capability to go through pregnancy? I know a lot of girls wouldn't appear to have the traits. Then they get pregnant - and everything changes. I dont' know why, I can't explain it - but I think at least a good portion of it is encoded into our DNA as genetically historic child-bearers!
Can open. Worms everywhere.



Check it out... The world's first male pregnancy from RYT Hospital. Good luck Mr Lee Mingwei!

Pregnancy without a Uterus?

When I was still in medical school we had a very unusual case come to Groote Schuur Hospital. A woman had an ectopic preganancy in her liver. Tasty.

Now for those of you who don't know... or for some sicko Intern-like reason, are interested... An ectopic pregnancy simply means a pregnancy that occurs outside the uterus. Almost 100% of these will never survive as most ectopics implant into the tiny fallopian tube. At 8 weeks, the fallopian tube bursts as it cannot contain the growing fetus. Then, it's surgery and the usual save-her-life type stuff. Remove the tube, decrease fertility - but keep the patient. A delicate balancing act, no?

But, there is an exception every rule - sometimes - very rarely, the egg retrogradely moves out the fallopian tube into the abdomen and implants itself onto the bowel or peritoneal lining or, in this case, the liver...

This woman, with the help of some amazing Obstetricians and surgeons (to save her life and stuff) delivered a healthy baby girl.

And the point of the tale...

It just proves that you don't need to have a uterus to have a pregnancy... You know it's coming! Next post...

Is Depression on the rise?

GP's tend to deal with a lot of depression and anxiety (and I'm not talking about our own... who tends to us? Another question. Another post).

Is there more depression and anxiety in the 21st century or are we just getting better at recognising it?

The middle of the 20th century saw the rise in early recognition and treatment of psychiatric illnesses. In fact, most of the stigmas surrounding psychiatry, psychologists and psychological drugs were put to bed in the late 70's and early 80's. The rise of Freud and Mommy-consoling. They were heady days.

Back to the present – something is definitely up. It feels like at least 1 out of every 3 patients I see is on some type of an antidepressant or mood stabiliser. I used to have a professor who joked that lithium should be put into the water. Quick, painless alleviation of most of our problems. Imagine a world where the traffic driver is too stoned to cut you off. Wait. They are stoned. And still cut us off? Well, I did say “most” of our problems.

I see at least 3 people per week who arrive complaining of stress, an inability to cope – and of the opinion that medication (not psychological treatment) will help.

Has life really become more stressful in the 21st century? Dual incomes? Pressure for women to succeed and men to become more nuturing? Or have our parents not prepared us properly for the big bad world. Are we, as modern human beings, getting less and less capable of dealing with situations and just getting in with life?

Why do more and more people feel that they have to take medication (and/or drugs) to deal with the everyday stuff? Maybe it has something to do with the fact that everytime you pick up a YOU magazine, you're confronted with pretty looking people advising you seek out your doctor for the latest in smiley medication.

A lot of questions – and not too many answers I'm afraid.

Perhaps we should spend more time teaching stress management in schools? Or organisational skills... teach our children to be more efficient, manage money better, be more emotionally available?

Then maybe our next generation won't have to be permanently medicated to be happy and functional...

Pictures of the PTC (Patient Transport Compartment)...

Here are some pics from the journey...


All the equipment is attached to the back wall above the patient - very nice and compact.



A tiny drawer stocked with more drugs than I've seen in a while!



All the equipment fits into drawers the size of a food trolley!



And everything packed into a small compartment, snug between all the passengers.

The PTC (Patient Transport Compartment)...

On very short notice, I was asked to transport a quadraplegic patient to Miami for medical treatment. This might seem like a small task, but you've got to remember that a quadraplegic patient cannot sit in a normal chair unassisted - plus they have a higher rate of complication (basically anything going wrong). Hence the need for dedicated medical staff. And a some pretty funky medical technology...

Introducing the Lufthansa PTC (Patient Transport Compartment).

This is an amazing self-contained unit that fits into the middle of the plane to transport all ICU and critically ill patients. The patient is placed on the bed in the unit and the Lufthansa nurses and a doctor (me, in this case) stay with them in the unit.

What made this PTC so amazing was how well equipped it was. There were ventilators, all kinds of monitors, IV injection pumps and the largest stock of ICU / anaesthetic meds and equipment that I've ever seen. It was definitely better than the ICU I worked in at Helen Joseph.

The nurses were well trained, friendly and professional and the whole experience - phenomenal.

Yes, I was tired... It was like doing an intern shift (36 hours awake), on an airplane, in a 6 square metre space - that's one helluva intern shift. But, at the end of the day, the patient got the best possible care - and that's what counts.

Thanks - and congrats to a wonderful team of nurses. Katherine and Elke - it was a pleasure!

I'll post some pics soon...

Some articles:
*AeroCare Repatriates a Patient From Chicago to Singapore
*CEGA Group

Misconceptions about Health...

We'd just like to say... if you're getting this kind of advice from your health professional?! CHANGE!

Har. Har. Anyway... Round is a shape. Pah.


Q: I've heard that cardiovascular exercise can prolong life; is this true?

A: Your heart is only good for so many beats, and that's it... don't waste them on exercise. Everything wears out eventually. Speeding up your heart will not make you live longer; that's like saying you can extend the life of your car by driving it faster. Want to live longer? Take a nap.


Q: Should I cut down on meat and eat more fruits and vegetables?

A: You must grasp logistical efficiencies. What does a Goat eat? Hay and corn. And what are these? Vegetables. So a steak is nothing more than an efficient mechanism of delivering vegetables to your system. Need grain? Eat chicken. Mutton is also a food source of field grass (green leafy vegetable). And a pork chop can give you 100% of your recommended daily allowance of vegetable products.


Q: Should I reduce my alcohol intake?

A: No, not at all. Wine is made from fruit. Brandy is distilled wine, that means they take the water out of the fruity bit so you get even more of the goodness that way . Beer is also made out of grain. Bottoms up!


Q: How can I calculate my body/fat ratio?

A: Well, if you have a body and you have fat, your ratio is one to one. If you have two bodies, your ratio is two to one, etc.


Q: What are some of the advantages of participating in a regular exercise program?

A: Can't think of a single one, sorry. My philosophy is: No Pain...Good !


Q: Aren't fried foods bad for you?

A: YOU'RE NOT LISTENING!!! ... Foods are fried these days in vegetable oil. In fact, they're permeated in it. How could getting more vegetables be bad for you?


Q: Will sit-ups help prevent me from getting a little soft around the middle?

A : Definitely not! When you exercise a muscle, it gets bigger. You should only be doing sit-ups if you want a bigger stomach.


Q: Is chocolate bad for me?

A: Are you crazy? HELLO . Cocoa beans! Another vegetable!!! It's the best feel-good food around!


Q: Is swimming good for your figure?

A: If swimming is good for your figure, explain whales to me.


Q: Is getting in-shape important for my lifestyle?

A: Hey! 'Round' is a shape!

The price of life…

I’m back! Article about flying patients around soon. With photographic evidence… But first.

Helping with the Whipples the other day got me thinking.

The patient in question has a really bad Pancreatic Carcinoma and has quite severe abdominal pain. The prognosis is poor. Probably 3 months. By doing this palliative whipples (you can do the op for other reasons) - she will first need to recover, but then should have less pain.

The catch is - she is still going to die. We have not solved her cancer problem. We have probably extended her life by 9 months.

Here’s the second catch. She has no medical aid. All the theatre costs, ICU, ward stay, doctor and anaethetist will be paid out of her pocket! It could come to a quiet R100k.

Now is that worth it? Many would say yes. You can’t put a price on life can you? But I’m skeptical.

If I had pancreatic cancer, and I had 3 months to live, I wouldn’t want to spend my money having a huge operation, whiling away the time, drugged up in hospital – just for a few months. Remember, you don’t just skip out happy the next day – it takes TIME to recover from hefty procedures.

I’d rather take my wealth and spend it lavishly to live my remaining days on a deserted island somewhere.

So I told the surgeon…”If you ever open me up, and see the pancreatic tumour, please close me back up and send me packing to the Bahamas!”.

I don’t know if I’m right. But it sure got me thinking.

SA Doc flies patient to Miami...

I am left utterly uninspired and will wait to see what Lufthansa's onboard medical was like...

The taste of medicine…

Medicines have always inherited the somewhat unfair rep of being so vile tasting, that not even hungry dogs would go close. Why? Safety? Maybe

I am a doctor that likes to taste things before I prescribe them to kids (need to know if there’s a chance they’lll take it - or I’ve lost the battle before it has even begun – and Mom has gotta force feed).

I’m here to reassure you. They’re not all that bad.

Kerry, a previous commentor on the nose suction wonderment is right is right though, pharmaceutical companies really need to think about the taste of syrups before they make them for kids. If it’s going to taste KAK - make them in suppositories! And deal with the consequences.

But since we won’t be getting a horde of bum tablets from the pharmaceutical companies any time soon, here are examples of winners and losers in the taste category:

Winners:
Stopyne (berry flavour, yummy!)
Erythromycin (always my favourite)
Original Augmentin (bubblegum flavoured)
Prozef (strawberry flavoured – a clear winner from the kids)
Orelox (banana flavoured)
Lotem (better banana flavour)
Calpol (strawberry – the kids love this one, I personally hate the after taste!)

Losers:
Buscopan (the most vile tasting concoction! Why did they even bother to make it! I just tell mom’s to crush the tablet into their food.)
Prelone (yuk!)
Viral guard (what were they thinking?)

SA Doc stuck in a WHIPPLE...

Hehe. Just phoned SA Doc, only to have a scrub sister (I think they're called that) answer the phone. SA Doc, apparently, has her hands so deep inside someone the phone would surely get lost. It's a whipple... that's been going on for 8 hours.

I don't even know what a whipple is! Sounds dangerous.

When in doubt, Google it. As long as its not a symptom, remember...

The Whipple operation was first described in the 1930’s by Allan Whipple. In the 1960’s and 1970’s the mortality rate for the Whipple operation was very high. Up to 25% of patients died from the surgery. This experience of the 1970’s is still remembered by some physicians who are reluctant to recommend the Whipple operation.

Today the Whipple operation has become an extremely safe operation in the USA. At tertiary care centers where a large numbers of these procedures are performed by a selected few surgeons, the mortality rate from the operation is less than 4%. Studies have shown that for good outcomes from the Whipple surgery, the experience of the center and the surgeon is important. At USC, Dilip Parekh M.D. has performed more than 100 consecutive Whipple type of procedures over the past 9 years with good outcomes.

What is a Whipple operation?

In the Whipple operation the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum is removed. Occasionally a portion of the stomach may also be removed. After removal of these structures the remaining pancreas, bile duct and the intestine is sutured back into the intestine to direct the gastrointestinal secretions back into the gut.

Shudder. I hope the poor guys duodenum isn't useful! More info here.

PS. Took a flyer on the picture. SA Doc can confirm the gory truth tomorrow.

Scrubs & the Floating Head Doctor.

Floating head doctor at Baragwanath has a slightly different meaning. Rolling head doctor. Nah, I'm joking. That's just the political side of it.

Enjoy some Scrubs - and the Floating Head Doctor scenes...

Monty Python Hospital Sketch.

They just look so... professional.



Har. Har.

A nose aspirator?!

Again, I am obviously going through an ignorant phase. I saw this pop up on one of the comments and immediately ran off to the resident doc, citing possible child abuse, sex toy alert or crazy kid shoving tube up nose.

Once again, I was met with staid response: "Uh, Andy, that's a pretty common medical tool". Ja. Like Freddy Kruger's playkit.

So, for the people out there like me - presenting the nose aspirator.

Nosefrida is a doctor recommended nasal aspirator that removes mucous from your child’s nose. It was invented in Sweden by Ear, Nose and Throat Specialists, and has been used by Swedish Moms and Dads for years.

When your child has a cold with a runny stuffed nose, it can be frustrating when they can not blow their own nose. Congestion interferes with sleep, feeding and makes for an overall cranky child, and parent too.

Nosefrida is a plastic tube with a filter that the parent uses with their own mouths to get the mucous out of their children’s noses. WITH THE FILTER IN PLACE, THE PARENT DOES NOT COME IN CONTACT WITH THE MUCOUS FROM THE CHILD. There is no risk of bacterial contamination, in other words, you will not get the cold your child has.

Compared to the bulb aspirators on the market, Nosefrida is better and safer, since you never put anything inside the nose, and you control the amount of suction you apply. It does not irritate the sensitive lining of the nose.

Your child’s nose will be clear and she or he will be able to breathe, sleep and eat better.

Apparently, young children are obligatory nose breathers (THAT I didn't know). ie If you block their nose, they can't breathe. Useful tool in those cases.

Pretty hectic that they have an entire site dedicated to this wonderment! Get one here!

Med student dissecting kit. Buy now!

I'll never understand these bloody med students. They're quite serious about selling you the following piece of hardware. And I say hardware because, well, you kind of expect this to come out in a movie like SAW.

Feast your eyes on the cold steel available for just under $30!



AMA-approved anatomy dissection kit for first year medical students!

The American Medical Association (AMA), America�s most prestigious medical organization, worked in conjunction with DR Instruments, professors, and medical students to design this kit for first year medical students. The 10GSM kit contains the most widely used dissection tools for first year anatomy classes.

DR Instruments offers over 125 dissection tools including a wide range of dissection kits for medical school anatomy classes.

To purchase additional or replacement tools, please click on the part number for more information and to place your order!!

10GSM kit contains following tools:

- Teasing needle bent with metal chuck | Part # 38|
- Teasing needle straight with metal chuck | Part # 37 |
- Iris scissors fine point 4.5" | Part # 9 |
- Surgical scissors 5.5", one point sharp and one point blunt | Part # 5SB |
- Cartilage knife | Part # 26 |
- 1 x 2 Teeth tissue forceps 4.5" | Part # 13-T |
- Scalpel handle # 3 | Part # 27 |
- Scalpel blade # 10, pack of 10 blades | Blades for handle # 3 |
- Mall probe chrome plated | Part # 36 |
- Hemostatic forceps 5", Curved | Part # 45CD |
- Ruler 6" plastic ( Part # 30)

Buy it here, if you dare.

Where every treatment has a happy ending!

Isn't it good to know that in a country ravaged by HIV - the spread of other nasties hasn't abated. What the hell kind of advertising is this (on William Nichol nogal)!?

"Finally a place where gentlemen can relax, knowing that every treatment has a happy ending."

What makes it even funnier for any local followers of billboards - is that this one is a direct adaption of the "Little Holland Escort Club". Same pic. Same sultry white panties.

Tut tut.

Gravity... what happens when you hit rock bottom?

Hey Doc.



Har Har.

Major drug companies turn a blind eye to fake malaria medication!

Now here's a scary story...

The world's major drug companies have been accused of turning a blind eye to the multibillion-dollar trade in fake medicine that has resulted in an explosion of child malaria deaths in developing countries.

According to the British Independent newspaper, the problem has been particularly acute in Africa, with anti-malarial drugs faked on an industrial scale. One of the world's leading experts on malaria, Prof Nick White of Oxford University, estimates that malaria causes more than one million deaths each year of which 90% are children.

He said that counterfeit medicine was a major reason why malaria had become, over the past 30 years, Africa's biggest child killer, 'from an illness that used to be easily treated with medicines'.

Some of the fake drugs contain no medicine at all, but others have tiny traces of the real ingredients - which leads to another, potentially bigger problem as it allows the malaria parasite to build up resistance to the drug.

Read further here.

Hell's Teeth! What a catastrophe... especially in developing societies where there isn't enough money to correct the "mistakes" or alternatively sue the pants off the companies making these counterfeits. Me, I would kick them out of Africa - but there's no money for that even.

I can only begin to imagine what would happen if some idiot company started making counterfeit ARV's. We already have enough of a resistance problem.

The World Health Organisation (WHO) estimates that 10% of medicines available in developing countries is fake with prevalence higher where regulatory control is weakest.

All of a sudden, I'm grateful that our Medicines Control Council (MCC) are such painful, pedantic regulators! What the hell is going on north of the border?

Through the vagina to do what?!

Recently I read an article in the medical chronicals that blew me away. It was about a Doctor in New York (oh praise his alpha malesness) that is doing some experimental surgery... Wait for it... Trans-vaginal cholecystectomy!

Oh my. Maybe it is because I have a vagina that this shocks me, but can you really imagine having your gallbladder (which lies up under your right ribs) removed through your vagina. THAT'S A DISTANCE OF AT LEAST 25CM! And exactly what our trans-vaginal cholecystectomy pioneer dude is attempting.

The article claims that it will cause less pain, less scarring and quicker recovery! As it is, the conventional way to remove a gallbladder is via laproscope. So... you choose: 5 small (1-2cm) cuts in your abdomen or getting the think yanked through your love hole?

This just proves the point that male doctors have no absolutely no cooking clue about female systems.

Let's see how much he would like the surgery if we did it trans-urethrally (that's up the japs eye for our non medical readers).

The Google Diagnosis.

Har. Har. I don't get it.

Nanotechnology - and "poop out advertising"

Har. Har.



That's actually possible you know. Take a pill with non-dissolving plastic stuff. It would have to be pliable, but not create blockages. It could even have a pleasent wood fire odour.

Bloody science eh? (Yes, this is medicine if you thought the post was off topic!)

A little BOVRIL keeps the Doctor away?

What the HELL is this!?



Do they mean the cow? The sandwich spread? If its the cow, what must you DO to the cow? A little piece of "Bovril" keeps the ticker ticking?

Gross.

Generics... The Real Deal?

Attended a discussion group (as we all have to in the annual quest for CPD points) and the topic came up about generics. The good, the bad and the simply ineffective...

An article published in Clinical Drug Investigations was very interesting. It showed that even though generic companies claim to have the exact same drug, only cheaper - this is not entirely true.

The study showed that many of the generics companies were producing inferior products with many impurities, differing concentrations of the actual compound drug and differnt bio-availabilities.

Does that therefore taint the broad spectrum of "generic" medicine? After much discussion, we believed not. Most of us were of the opinion that some generic companies are good - they control the amount of impurities and produce good quality medicine.

In South Africa, there's a lack of study or legislation enforcing clinical trials on generics, so most of the time GP's have to go on experience. I have my own list of generic companies that I will use without reservation - and then there are those that I would avoid like the plague. I wouldn't even use them to treat the plague.

Moral of the story? In South Africa I think generics need to be scripted, not substituted. As in, if the Doctor PRESCRIBES the generic by name - fine. If a pharmacist substitutes a generic because of price, stock problems or personal preference - not fine.

Perianal WHAT?!?

Had to drain a perianal abscess. Standard stuff in a government hospital, but in private practice, it's a rarity. I had forgotten how ABSOLUTELY awful they are.

Imagine the smell of a rotten goose egg, mixed with 2 day old vomit, mixed with baby poo... That's about the introduction.

AND I kept a straight face and held down the gag reflex. I am a GOD.

Medical Video Art #2

Another one... This is more of a demo reel - I gather showing off 3D skills. I wonder where stuff like this would be used in the industry?

Medical Video Art?

Wow. This is impressive. I wonder what it means. SA Doc is asleep. Preparing for her birthday tomorrow. So I'm at a loss.

But it looks cool :)

We're back... above water

Shoe. It's been a while! Back from Sodwana. Diving was great. I'm still wondering why they say diving is not an "exact science". At 20m. You kinda want to be as exact as possible. Anyhoo, didn't die.


Some feesh.

Gone fishin' (or diving)...

Both SA Doc and I are hot-tailin' it to Sodwana tomorrow... No posts for 5 days - but if we get eaten by a shark - you can have the blog!

Actual writings in a Mpumalanga Hospital…

Yikes. SA Doc reckons this just can't be. The Eastern Cape, maybe? Or... maybe this is just generic and some horrible South African has unfairly slapped Mpumalanga into the mud :)

Funny though.

1. The patient refused autopsy.

2. The patient has no previous history of suicides.

3. Patient has left white blood cells at another hospital.

4. Patient's medical history has been remarkably insignificant with B only a 40 pound weight gain in the past three days.

5. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.

6. Patient has chest pain if she lies on her left side for over a year.

7. On the second day the knee was better, and on the third day it disappeared.

8. The patient is tearful and crying constantly. She also appears to be depressed.

9. The patient has been depressed since she began seeing me in 1993.

10. Discharge status: Alive but without my permission.

11. Healthy appearing decrepit 69-year old male, mentally alert but forgetful.

12. Patient had waffles for breakfast and anorexia for lunch.

13. She is numb from her toes down.

14. While in ER, she was examined, x-rated and sent home.

15. The skin was moist and dry.

16. Occasional, constant infrequent headaches.

17. Patient was alert and unresponsive.

18. Rectal examination revealed a normal size thyroid.

19. She stated that she had been constipated for most of
her life, until she got a divorce.

20. I saw your patient today, who is still under our car for physical therapy.

21. Both breasts are equal and reactive to light and accommodation.

22. Examination of genitalia reveals that he is circus sized.

23. The lab test indicated abnormal lover function.

24. Skin: somewhat pale but present.

25. The pelvic exam will be done later on the floor.

26. Large brown stool ambulating in the hall.

27. Patient has two teenage children, but no other abnormalities.

Scrubs Quotes - Vintage Dr. Cox

His little pellets, nay, pearls of wisdom keep us amused every Tuesday, nay, We-eh-eh-ednesday night. I though we should all learn from them :) More here.


[to an annoying patient]
Dr. Cox: Okay, think of what little patience I have as, oh, I don't know, your virginity. You always thought it would be there, until that night Junior Year when you were feeling a little down about yourself and your pal Kevin, who just wanted to be friends, well, he dropped by and he brought a copy of About Last Night and a four-pack of Bartels & James and woo hoo hoo, it was gone forever - just like my patience is now.
Jill Tracy: So you do scary little speeches. How adorable.


Dr. Cox: ...And bam! The shine's off the apple. And that's when you find out that that pretty little girl you married isn't a pretty little girl at all. No, she's a man-eater. And I'm not talking about the "whoa-whoa, here she comes" kind of man-eater. I'm talking about the kind that uses your dignity as a dishtowel to wipe up any shreds of manhood that might be stuck inside the sink. Of course, I may have tormented her from time to time; but, honest to God, that's what I thought marriage was all about. So much so that, by the end of that relationship, I honestly don't know who I hated more - her or me? I used to sit around and wonder... why our friends weren't trying to destroy each other, like we were. And here, it turns out, the answer's pretty simple: They weren't unhappy. We were.


Dr. Cox: It's time. Sit down, and listen up Newbie. I suppose you want me to say you're great? That you've raised the bar for interns everywhere?
J.D.: I'm cool with that!
Dr. Cox: Well, I'm not going to say that. You're doing ok. Someday you might even be better than that. But right now, all I see is a guy who's so preoccupied with wondering what everyone else thinks about him, that he doesn't have anytime to think whether or not he believes in himself. DID YOU EVER WONDER WHY I TOLD YOU TO WRITE YOUR OWN EVALUATION?
J.D.: I don't have a safe answer for that. I just figured that... you...
Dr. Cox: Clam up Newbie! I wanted you to think about yourself... AND I MEAN REALLY THINK!... What are you good at? What do you suck at? And write it down. Not so I could read it, or anyone else could read it. BUT SO YOU COULD READ IT! You see in the end Newbie, you don't have to answer to me, or to Kelso, or even to your patients for Gods sake! The only one you have to answer to Newbie, is you! There, YOU ARE evaluated. Now get out of here, because you truely make me so damn mad I might just hurt myself!


Dr. Cox: You'd better go ahead and enjoy this while you can, Bob, because if your evil genie goes ahead and grants your wish and I'm gone forever, then the only one you're going to be able to contend with around here is yourself. And when you really get to know *that* person, oh, dear God, you'll scream so loud that Satan will want to tear up that contract he made with you at birth just so he can get some sleep.


Dr. Cox: You know, the only way you could be more useless right now is if you actually were the wall. Now, it certainly is true that you'd at least be serving a purpose - specifically a surface for a jackass to lean against - but it could be argued that this is more useless than doing nothing.
[pause]
Dr. Cox: I know, it's a conundrum but don't you worry, I'll noodle it for you right here. Meanwhile, you just skip along, all right Shirley?


Dr. Cox: Ah, sorry to interrupt you there, Bobbo, but I gotta ask you a quick question. Now, when you were born, nay, *spawned* by the Dark Prince himself, did that rat bastard forget to give you a hug before he sent you along your way? Because you can't just let two good nurses go on account of feeling small and insignificant. And besides, with your money, you ought to be able to keep a little man tucked away in the closet, and bring him out whenever you wanna *knock* him around, huh?
[to the interns]
Dr. Cox: As you were.


Dr. Cox: You know, Bob, I've been thinking of all the times you manipulated me and toyed with me and I can't help but recall that children's fable about that race between the tortoise and the pain-in-the-ass-chief-of-medicine-that-everybody-hates. You see, Bob, the pain-in-the-ass-chief-of-medicine-that-everybody-hates kept running out in front of the tortoise and taunting him, but right at the end... oh, gosh I'm sure you remember what happened Bob, the tortoise bit clean through the Chief of Medicine's calf muscle, dragged him to the ground, where he and all the other turtles devoured him alive right there on the racetrack. It's a disturbing children's book, Bob, I know, but it's one that stuck with me nonetheless.
Dr. Kelso: Buzzy, buzz, buzz...
Dr. Cox: I... beg your pardon?
Dr. Kelso: Oh, uh, that's the sound of all the bees in your bonnet. And, Perry, even though I could give a rat's ass, I still think it's a pretty sound!


[an overweight patient has not been losing weight, despite Dr Cox's orders]
Dr. Cox: Lemme ask you a quick question: are you trying to make my head explode? Because you have no idea just how frustrating it is working your ass off trying to inflate a tiny little balloon inside somebody's clogged artery when all that person has to do, really is - oh, I don't know - go for a walk in the morning or choke down a fresh green salad. And you come back here looking like that? And, I know here, I know I'm supposed to be Dr. Give-A-Crap, but you wanna hear the God's honest truth? And this is a fact: you are what you eat. And you clearly went out and devoured a big fat guy, didn't ya?


Dr. Cox: Listen Vanessa Janice Tiffany Amber (in a sing-song voice)Thiessen. I'm gonna go ahead and give ya a little something I call Perry's Perspective. 1. If the guy in front of me in the coffee shop can't decide what he wants in the 30 minutes it takes for him to get to the register, I should be allowed to kill him. 2. I'm fairly sure that if they took all the porn off the Internet, there'd only be 1 website left, and it would be called Bring Back The Porn. 3rd, and most important, to be respected as a doctor, nay a man, you must me an ocean. You're born alone, you damn sure die alone, (looks over and speaks to a cadaver rolling by) isn't that right spike? My point is, and you may want to jot this down... only the weak need help.
J.D.: I should have that tattoed on my neck.