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.

MedStory - Medical Search Engine

MedStory. It's not that new - but new enough to have the funny mark called BETA. Andy tells me that means "still buggy". So I checked it out.

Medstory is quite cool. It offers fairly good search results - that seem at first glance to come from reputable sites. It also offers an alternative search into research articles. That function should make the students happy, or anyone doing basic research for medical projects.

The problem with Google is the crap between the good stuff. And if you don't have a considerable degree of medical experience, it's often quite hard to tell the two apart. See our post on Googling your Symptoms.

It also cross correlates your search results to drugs, conditions, research centres, genes and a couple of other things.


It also (if you call now) cross correlates to NIH grants, News Media and Clinical Trials.


But the problem with all search engines that approach this topic remains. The site is only as strong as it stupidest user. Medicine is broad and easy to misunderstand. These engines have got to be so careful... one stray result and one stupid user could result in misinformation. My job, my responsibility, is about providing people with the correct information.

To the extent that tools like this help, great. To the extent I get more patients though my door connecting their toe itch to cancer. Well.

HIV: An MTV Advert?

This is being email around a bit at the moment. Allegedly, it's an MTV advert that got banned pretty quickly by the US Government. Whether that's true or not, I'm not sure... but the message is pretty strong.

(text next to building)
2863 people died.

(text next to man)
40 million people are infected with HIV worldwide.
The world united against terrorism.
It should also be united against AIDS.

It was actually part of a series - according to the email. World Hunger. Unemployment etc. Can anyone confirm whether this was an actual campaign? Or just a product of the overactive net?

HIV people CAN have children...

There are two myths I want to debunk.

1. HIV people are just going to die.
2. HIV people don't deserve to have children because they'll just pass on the virus.

Just chatting to friends, it amazes me sometimes how ignorant we all are about HIV. That includes certain Doctor friends - and I'm not harping on about promiscuous behaviour. I'm talking about the understanding of where modern medicine has got us. Basically, to the point where people who are infected with HIV can lead normal, healthy lives. And have children if they want to.

This all sparked off from an article I read in the Sunday Times on the 18th March 2007. I can't find it now - but it basically covered the heart-warming story of an HIV positive couple, living in a Cape Town township who were too poor to afford the correct medical means to have a baby when you're living with the disease - but did the best they could.

They both took ARV's, got their viral loads as low as possible and had a baby. An HIV negative baby.

Now, the proper way to do it would be full doctor co-operations, ARV's, sperm washing and in vitro, optimal birthing conditions and PMTCT care (Preventing Mother To Child Transmission). PMTCT includes the use of Nevirapine (or other), formula feeding and other safety precautions. These decrease risk - right down to 1% or less if followed correctly. It's a decision the parents have to make, nobody can make it for them.

The couple from Cape Town couldn't afford the sperm washing and in vitro. Luckily everything went well.

So, even though this is not the entirely safe way to go about things - surely it acts as a beacon of light to the ignorant amoung us. HIV people can lead normal lives, have children and live a long time with the correct medication. It's not a death sentence.

The sooner we realise that, the closer we come to de-stigmatising the disease that is not going to go away.

I'm just little me. Hopefully someone will listen.

A Doctor's Hangover Cure

I read about so many hangover cures. Raw eggs, McDonalds, Bloody Mary's (with vodka) and other such trivialities. But nothing beats the good 'ol cure I learnt at Baragwanath.

Jet Fuel.

Ingredients:
* 1 x drunken sod
* 4 cups IV saline + glucose
* a pinch of Vitamin B Co
* a teaspoon of B12
* a teaspoon of Thiamine
* a dollop of CalMag (calcium + magnesium)

Administer all with 14 guage jellco - that's like the shotgun approach to needles.

Right as rain in no time. I've offered it out - while the hungover boys watch sport, I'll catherterise them and hook them up to the IV. They refused. Don't know why?

First Year Med Student Definitions...

Our hardcore SA med students could not have been responsible for these. Must have been the Americans. We were? Really? Oh dear.

The body: "The body consists of three parts - the brainium, the borax, and the abominable cavity. The brainium contains the brain; the borax, the heart and lungs; and the abominable cavity, the bowls, of which there are five - a, e, i, o, and u."

Respiration: "When you breathe, you inspire. When you do not breathe, you expire"

Respiration: "Respiration consists of two acts: first inspiration, then expectoration."

Cardiovascular: "The three kinds of blood vessels are arteries, veins, and caterpillars."

Gastrointestinal: "The alimentary canal is located in the northern part of Alabama."

Dentistry: "A permanent set of teeth consists of eight canines, eight cuspids, two molars, and eight cuspidors."

Orthopaedics: "The skeleton is what is left after the insides have been taken out and the outsides have been taken off. The purpose of the skeleton is something to hitch meat on."

Reproductive medicine: "Artificial insemination is when the farmer does it to the cow instead of the bull."

Reproductive medicine: "To prevent contraception, wear a condominium."

Reproductive medicine: "Many women believe that an alcoholic binge will have no effects on the unborn fetus, but that is a large misconception."

Haematology: "Before giving a blood transfusion, find out if the blood is affirmative or negative."

Eyes and nose: "To remove dust from the eye: pull the eye down over the nose."

Eyes and nose: "For nosebleeds, put the nose lower than the body until the heart stops."

Eyes and nose: "For a cold: use an agoniser to spray the nose until it drops in your throat."

First aid: "For fainting: rub the person's chest or, if a lady, rub her arm above the head instead. Or put the head between the knees of the nearest doctor."

First aid: "For asphyxiation: apply artificial respiration until the patient is dead."

First aid: "For drowning: climb on top of the person and move up and down to make artificial perspiration."

First aid: "For dog bite: put the dog away for several days. If he has not recovered, then kill it."

How you start a career in medicine...

Dear SA Doc,

Living with a doctor is a trying, gruesome experience. And while it has its pharmaceutical benefits - it remains a puzzling past time. Just why, why did you put up with 6 years of studying, 2 years of community service and then sick people (30 times a day) for the rest of your working life.

Perhaps this will help. Got it off Diane's blog.


SA Doc replies:

"Sane. Very hardworking. Nice Attitude. Hate Adults. Oh shit... I should be in Paediatrics."

Try it out - which part of this bizarre career would you end up in? SA Doc obviously needs a change :)

More McHumor - Mutant Genes

Har. Har. Mutant Jeans. :) Check more of these out here.

Myprodol is NOT some wonder drug

People. Myprodol is NOT some wonder drug. It is Panado, Brufen and a bit of codeine. Those are garden variety meds. It's. Not. Pethidine.

Ooh. Pethidine.

(Read more about Myprodol here)

Men and Their Penises.

I think its very funny when men come to the practice, sporting problems with their nether regions. They, the nether people, come in two varieties:

ONE. So self conscious about having a doctor examine anywhere below the fluff, that they barely open their pants to show me the goods. What do they think? I'm going to jump them, or laugh? Are they worried about getting an erection? Or are they good, ol' fashioned shy? Maybe it's because men don't often have to show their dangly bits to anyone besides their mother... I can't treat it, if I can't see it!

Women on the other hand, have to endure at least yearly checkups, lying spread-eagled on a cold bed doing the nasty with steel speculums. Do you see us worrying?

TWO. So overconfident about his manhood that he parades it around like a clown on a bicycle. Even after I've examined him, this specimen proudly stands around, pants at ankles, admiring me and his raging boner. Pull your pants up, dude. What do they expect? A measurement? An opinion?



Kind of like the guy above. Sigh. Men are bizarre. I should have been a Gynae.

Housisms...

We've put up a hang of lot of House MD quotes. Almost 50 to be exact. He is just that cool. And NOW... we find a site that just has it all. The kind lad posted a comment on the last House article and I reckon he deserves a punt.


Visit his site here.

House MD - Quotable Quotes #2

The last in the batch. Drip. Drip. Sarcasm. Ain't it cool?

Dr. Gregory House: [to the crowd in the walk-in clinic's waiting area] Hello, sick people and their loved ones! In the interest of saving time and avoiding a lot of boring chitchat later, I'm Doctor Gregory House; you can call me "Greg." I'm one of three doctors staffing this clinic this morning.
Dr. Lisa Cuddy: Short, sweet, grab a file.
Dr. Gregory House: This ray of sunshine is Doctor Lisa Cuddy. Doctor Cuddy runs this whole hospital, so unfortunately she's much too busy to deal with you. I am a board... certified diagnostician with a double specialty of infectious disease and nephrology. I am also the only doctor currently employed at this hospital who is forced to be here against his will.
[to Lisa]
Dr. Gregory House: That is true, isn't it?
[to crowd]
Dr. Gregory House: But not to worry, because for most of you, this job could be done by a monkey with a bottle of Motrin. Speaking of which, if you're particularly annoying, you may see me reach for this: this is Vicodin. It's mine! You can't have any! And no, I do not have a pain management problem, I have a pain problem... but who knows? Maybe I'm wrong. Maybe I'm too stoned to tell. So, who wants me?
[nobody moves]
Dr. Gregory House: And who would rather wait for one of the other two guys?
[everybody raises their hand]
Dr. Gregory House: Okay, well, I'll be in Exam Room One if you change your mind.
Dr. Lisa Cuddy: Jody Matthews?
[Jody raises her hand]
Dr. Lisa Cuddy: Please accompany Doctor House to Exam Room One.


Dr. Lisa Cuddy: It takes two department heads to treat shortness of breath? What, did the complications increase exponentially with cup size?


Dr. Cameron: You want me to tell a man whose wife is about to die that she may have cheated on him?
Dr. Gregory House: No, I want you to be polite and let her die.


Dr. Eric Foreman: You assaulted that man!
Dr. Gregory House: Fine. I'll never do it again.
Dr. Eric Foreman: Yes you will.
Dr. Gregory House: All the more reason this debate is pointless.


Dr. Gregory House: Ah, a rash, call a dermatologist. If it's wet, keep it dry. If it's dry, keep it wet. If it's not supposed to be there, cut it off. I never could remember all that.


Dr. Gregory House: Like I always say, there's no "I" in team. There's a "me" though, if you jumble it up.


Dr. Cameron: [discussing a patient's diagnosis] What about sex?
Dr. Gregory House: Well, it might get complicated. We work together. I am older, certainly, but maybe you like that.
Dr. Cameron: I meant maybe he has neurosyphilis.
Dr. Gregory House: Heh, nice cover.


Dr. Eric Foreman: You are aware of the Hippocratic oath, right?
Dr. Gregory House: The one that starts, "First, do no harm", then goes on to tell us: no abortions, no seductions, and definitely no cutting of those who labor beneath the stone? Yeah, took a read once. Wasn't impressed.


Dr. Wilson: Did you know your phone is dead? Do you ever recharge the batteries?
Dr. Gregory House: They recharge? I just keep buying new phones.