Surgical Vignettes

This afternoon, we were giving a patient anesthesia, and then his anal sphincter relaxed and he pooped all over the operating table.  Haha, poop!

The phone went off in OR 26 after our first case.  I picked it up to hear a telemarketer say, "Here's what healthcare providers DON'T want you to know."  How did they dial an inside number at the hospital, and do they realize that they called a room full of healthcare providers?

This morning, we removed a melanoma from the tip of a patient's nose and grafted on donor skin from a cadaver.  The patient was Caucasian.  The donor was African-American.  Oops.  At least it's only a temporary fix until we can do an autograft two weeks from now!

Not So Bad

After all of the horrors I'd heard about Plastic Surgery, it hasn't turned out to be half bad.  I actually like the doctors that I'm working with, despite the circulating rumors.  While they are too busy to sit down for teaching sessions like the ones I had during my Psychiatry and Neurology rotations, they are still eager to explain procedures as they're doing them.  And, for better or for worse, there's not nearly as much drama between the doctors as there is on Nip/Tuck.

As the anesthesiologists were extubating one of our patients this morning, he suddenly sat up and coughed a ton of phlegm... right onto my face.  Gross.

Oh, and Sunny, this is for you:


Today is just the first day of my two-week Plastic Surgery rotation, and I'm already pretty sure that this is not the field for me.  We had to get there for rounds at 6:15am this morning, followed by three surgeries, followed by clinic, followed by conference.  I was let go at 7pm, so I took my time and had a nice dinner... before heading straight back to the hospital to meet my new patient, read up on his chart, and prepare for tomorrow's surgeries.  And now, it's 10:50pm, and I'm finally home for good.  Lucky me, I get a whole five hours of sleep before I get to the hospital at 5am to preround!

Okay, enough whining from me.  On the bright side of things, I had a great weekend.  In addition to hiking Old Rag, going to FratCameron's FratParty, and general lazing around, I fulfilled the promise I made to Catmo that I would watch the pilot episode of The Gates as soon as I finished my Neurology Shelf exam.  This shouldn't be to anybody's surprise, but I think it's totally awesome.  It's a True Blood-like story taking place in a Desperate Housewives-like setting.  How could anybody complain??

Neurology Recap

- Diseases like stroke can be solved in a very systematic manner.  Figuring out where to localize the lesion is almost like putting a puzzle together, and the process of doing so can be a lot of fun.
- A lot of cutting-edge research is being done in the field, such as alternatives to tPA therapy for ischemic stroke, better abortive therapy for migraine headaches, and preventative therapy for multiple sclerosis with less side effects.
- Everyone I met in Neurology is very passionate about teaching, which is something with which I can identify.  Three cheers for academia!

- Many neurological diseases have no cure, especially the degenerative ones such as amyotrophic lateral sclerosis (Lou Gehrig's disease), myasthenia gravis, and Parkinson's disease.  It can be emotionally tolling to see your patients worsen with each clinical visit and to hope for maintenance as opposed to improvement.
- The inpatient days are extremely variable.  We would have days when we were absolutely swamped with new admissions and other days when we would literally have nothing to do after completing rounds.  There is little consistency in workload each day.
- Pretty much everyone goes on to do a fellowship.  That's another two years of training on top of the four you are required to do for your residency.  That's... a lot of learning.

Best Neurology pun I came up with:
Pain in the nerve root?  That's just radiculous!

Next up: surgical subspecialties.  Prayers are appreciated.

Medical Specialty Aptitude Test

Only ten hours until the dreaded Neurology Shelf exam, so logically I decided to stop studying and take the Medical Specialty Aptitude Test.  I remember taking it when I first started medical school, but I can't for the life of me remember what the results were.  Oh well, as of tonight, my personality matches up best with the personalities of doctors in the following fields:

5. Occupational Medicine.  I honestly don't even have any clue as to what this is.  Any ideas?
4. Dermatology.  Ha!  As if I even had a chance of making it in this field.
3. Emergency Medicine.  Now things are gettin' cookin'... I could actually see myself doing this.
2. Family Practice.  This is what the idealist in me wants to do.  Here's to hoping that I'm still an idealist after I graduate from medical school.
1. Pediatrics.  Whoa, that came out of nowhere.  I've never really even considered Pediatrics.  I hate to see sick kids, and I'm pretty sure that if I became a pediatrician, I would just go home and cry every day after work.  But time will tell, won't it?

Alright, off to learn some more Neurology.  Can somebody please tell me why I waited until last weekend to start studying for this exam??

Google Analytics

For all of you readers who have admitted to me at some point or another that you "stalk" my blog, I have a secret to tell you: I've been stalking you, too.  Yes, I assure you, the feeling is mutual.  As I have mentioned before, I use Google Analytics, a service that, as its name implies, analyzes my website traffic.  For example, did you know that:

1. Idiopathies has been visited by someone in every single state in the good ol' USA except for the states of North Dakota and New Mexico?  Why, why won't they show me any love?

2. 49.41% of visits to Idiopathies are made using the Firefox browser?

3. The average visitor spends 1 minute and 11 seconds on Idiopathies?

4. The most visits that Idiopathies has ever received in one day was 161 hits?  This occured on January 20, 2009, when I wrote this post on Rev. Joseph Lowery's benediction during President Obama's inauguration.  121 of the hits that day were from Google searches on his speech.

5. Idiopathies has had 2,388 visits from the Google search engine and 2 from the AOL search engine?  Interesting search terms that have brought visitors to Idiopathies include: "nosheen jc chasez" (49 hits), "p'eau d'orange" (31 hits), "fucking pi kapp boys" (21 hits), "a person's fortune in the first is always the most profound, and sometimes even people's heart forever into the insulation" (2 hits), "i caught rabies" (1 hit), "19 and growing a beard" (1 hit), "" (1 hit), and "my parents did not pick me for thanksgiving" (1 hit).  Yeah, not sure why people were searching for some of those terms or why they were subsequently directed to my blog.

Elevator Express

I was running a little late to work today, but luckily there was an elevator on the first floor as soon as I got there just waiting for me.  And, there was nobody else around.  And, nobody got onto it along the way.  What I'm trying to say is that I had an entire elevator to myself from Floor 1 to Floor 6.

I know this probably doesn't sound very exciting to those of you who don't work in the hospital, but I am not exaggerating when I say that this is the first time in the four weeks that I've worked at the UVA Hospital that the elevator hasn't stopped at every other floor.  It was, in a word, magical.


I need it.  No, seriously.  I'm tired of not being able to see anything when I'm not wearing my glasses.  Case in point:

Last night I woke up in the middle of the night and saw someone sleeping next to me.  I immediately bolted out of bed because WTF I don't remember going to bed with someone else what is happening did somebody slip Rohypnol into my Vitaminwater??  Then I looked again and realized that it wasn't another person, but my roommate's dog Marley.

The End.


Happy Father's Day!  Sadly, I wasn't able to spend it with my own father, since I had to come back to Charlottesville last night in order to go to work this morning.  But I did get to have dinner with another special someone: Dylan!  And his "new" girlfriend, Caylyne.  I put new in quotation marks because I think they've been dating for a while, but it's the first time I've gotten to meet her.  It's also the first time I've gotten to see Dylan since we graduated.  I blame this entirely on Dylan, since he hasn't been back to visit UVA in over two years.  Needless to say, there was much reminiscing to be done over our Hot Sicilian and Mesquite Chicken Club sandwiches at Durty Nelly's.

Many of you may recognize that photo from the coffee mug that Christin made me.  Sadly, it's one of our less ridiculous photos together.  I'm choosing to ignore our very special friend, Kathryn.

Wedding Bells

It's that time of the year again: vows are being made, rings are being exchanged, and knots are being tied.  I just got back from playing for Wen and Eric's wedding back in Richmond, and I must say, it was a lovely ceremony.  And the music was spectacular, if I do say so myself.  The actual wedding took a little longer than most, since it was done in both Chinese and English, but who can complain when the reception was filled with ridiculously delicious food?  Not I.

On my drive back to C-ville, I got to thinking about all the weddings I've played for in my life.  Here are, in no particular order, my top three memorable weddings:

Janice and Danny.  The two met through First Year Players, a student-run theater group at UVA.  Instead of using cliche wedding songs like Trumpet Voluntary, Canon in D, and Jesu, Joy of Man's Desiring, Janice and Danny appropriately decided to use songs from various plays that meant something to the both of them.  The prelude pieces were all songs from musicals that they had worked on together, Janice entered to Processional and Maria from The Sound of Music, and the wedding party recessed to Oklahoma from... well, Oklahoma!

Caroline and Erik.  Coming from a very musically talented family, Caroline would have nothing but the best at her wedding.  Like Janice, she decided to opt out of the traditional wedding repertoire and chose more unique pieces, albeit still in the classical genre.  The bridesmaids and groomsmen entered to The Wedding March from The Marriage of Figaro, Caroline walked down the aisle to Autumn from The Four Seasons, and the recessional piece was Kreisler's Liebesfreud, a violin and piano duet.  Talk about a classy affair.

Jane and John Doe.  I don't even remember the name of this couple, because I didn't know them personally.  They hired me because I was the church pianist at Mount Hermon Baptist Church at the time, and I never saw them again.  I couldn't have been more than 14 or 15 at the time because, as I recall, my mom had to drive me to the wedding.  The only reason this wedding stands out in my memory is that the ceremony was supposed to start at 2pm, but the bride, groom, and entire wedding party didn't show up until 2:20pm.  Here's to hoping that Jane and John are still together...

Champagne Supernova

I did a lumbar puncture today!  I know, several of my friends have been performing surgeries and delivering babies, but since I've been on Psychiatry and Neurology the past two months, the only procedure I've gotten to do so far was removing a Foley catheter.  So this is a big step for me.  For those of you who don't know, a lumbar puncture is a diagnostic procedure in which a needle is used to remove cerebrospinal fluid from the sac that contains the brain and the spinal cord.

Before I walked into the patient room, I prayed outside the door that the procedure would go well.  I was terrified that either (1) I wouldn't be able to penetrate the dura and arachnoid mater or (2) I would pierce the spinal cord and end up poking all the way through her intestines... which is actually impossible to do with a three-inch needle.  Thankfully, the procedure went well, and Dr. Southerland even went as far as to e-mail the rest of the team to let them know that I got a champagne tap (no red blood cells in the first two tubes) this morning in clinic.  As a reward, Dr. Chatman is bringing me a bottle of actual champagne on Monday!

Sam [jokingly]: These are the vials of your cerebrospinal fluid that we collected if you'd like to take a look.  It's clear because it's actually from the faucet.  We just numbed you up and didn't do anything.
Dr. Southerland:  And that's why it's called a spinal tap.

ZOMG he is so much punnier than I will ever be!



Oh, and my student's name is Cyrus.  For some reason I was thinking it was Miles or something like that.  Probably because when he first told me, the first thing that came to mind was Miley Cyrus.  Gah, what have I become??

The Student Has Become the Teacher

An undergraduate student is shadowing the Stroke Team for the remainder of the week, and for some reason Dr. Solenski suggested that he work with me.  I tried my best to explain to him what was going on throughout the day, which isn't saying a lot, since I'm usually clueless as to... well, just about everything.  It is kind of fun to be shadowed, though.  For once, I know more than somebody else in the hospital.  Sadly, since I do all of the grunt work, like checking to make sure the labs are ordered, helping nurses transport patients, and calling outside hospitals for old medical records, there is nothing for me to give my student to do.  I hope he's not bored out of his mind and completely turned off to medicine by the end of this week.

My only problem is that I can't seem to remember his name...

I Am Not Alone

For the first time since I started third year, I no longer have to work by myself!  After being the only medical student doing Psychiatry in Roanoke during the first block and the only medical student in the NOPU during the first half of this block, life had started to become a little lonely.  Luckily, I started working on the Stroke Team with Laura today.  Luckily, she knows way more about inpatient neurology than I do since she just came from the General Service, so I totally mooched off of her brainpower all day.

Now, if I could just finish my essay on the way Tourette syndrome is portrayed in the song Symphony of Tourette by the Manic Street Preachers.  Yes, I'm really writing an essay for my Neurology rotation.  Wait, does UVA School of Medicine have a second writing requirement too!?

I & O

I was fortunate not to have to work this weekend, which cleared my schedule to allow me to accompany for the Heritage Theatre Festival Kick-Off Event last night.  It had been a while since I've had to sight-read 15 songs in one day, and the old saying "Use It or Lose It" certainly proved true.  But, I somehow managed to finagle my way through all of the songs (except for A Little Priest from the musical Sweeney Todd, which luckily one of the cast members already knew how to play, letting me off the hook).  In the end, I had a lot of fun, and I managed to make some much-needed money.

Obviously I immediately squandered all of that money today.  I had brunch with Kathryn at La Taza, during which she regaled to me tales of the recent Southeby's auction, The Collection of Patricia Kluge, which sold 933 items for $15,158,201.  How someone acquires 933 items in their lifetime is, truly, beyond me.  You can check out a video introducing the Albemarle House estate and some of its many treasures here.

Then, Neil coerced me into seeing Splice at the movie theater.  Neil, I will never forgive you for wasting $7.50 and 104 minutes of my life.  In spite of garnering a 74% on Rotten Tomatoes, it was absolutely one of the most absurd and poorly executed films I've ever seen in my entire life.  Seriously, if you're still considering watching the movie, at least wait for it to come out on DVD.

Finally, Bassem and I took Pete out for a farewell dinner at Christian's Pizza.  I know, we're almost too classy.  Pete, my roommate of two years, is moving to the state of Washington tomorrow.  I wish him all the best, and his presence on Valley Road will be greatly missed.


Today, the wife of one of our patients was complaining about how the patient was having trouble with his... err... "male equipment."  I'm not really sure what this had to do with his cluster headache appointment, but somehow we started discussing different things that could be done to improve the quality of their sex life.  She was bemoaning the fact that his sex drive was decreasing while hers was increasing, when she suddenly slapped my thigh and declared, "I should probably just give up on him and become a cougar!"  Awkward.

Almost as awkward as becoming an Internet meme.

New Every Two

I finally qualified for a new cell phone with my Verizon Wireless plan!  And boy, did I need one.  My old phone was completely falling apart, and my new one is just so... well, new.  My one complaint is that I have to program in all of those words that I commonly use but aren't in the T9 dictionary.  Words like "Mulholland," "Boylan," "Coupes," "Biltmore," "WOTF" and "lissencephaly."  Okay, maybe not that last one.

Now, can someone figure out how to make the weather stay at a high of 80 degrees every day?  Kthxbai.  Hmm, I need to add that one to my T9 dictionary as well.

Ear Candy

Ever since I came across DJ Earworm's United State of Pop 2009, I've been waiting for more.  I don't know what it is, but there's something about pop song mashups that immediately makes them ten thousand times better than the cheesy originals.  And so, after a long day of work and a not-so-long night of watching Kick-Ass for the second time (I know, my life is so hard), I present to you: DJ Earworm's Like, OMG Baby (Captial FM Summertime Ball Mashup).  Now go forth and party.

It's Funny

It's funny that I refer to my rotations as "work."  Sure, I no longer spend all day in the classroom or at the library, and the things I do are closer to what a real doctor does than before.  It's just that I don't know anybody else who pays $40k a year to go to work.

It's funny that I pretend to know what I'm doing at work.  Today, I worked up a patient in the Emergency Department and decided that he had experienced a transient ischemic attack instead of a full-blown stroke.  I recommended that he be discharged from the ED instead of admitted to the stroke unit.  Well, the CT scan showed quite the opposite, and needless to say, he was admitted into the hospital.  At least the resident agreed with my assessment, even if it was completely wrong.

It's funny that instead of reading Case Files Neurology, I just watched another episode of V.  Sigh, when will I ever learn?

Vanity Plates

Earlier this week, Nick sent me a text message saying that he had found my car.  I wasn't sure what he meant until I saw the attached photo:

This unexpected picture text sent me into a frenzy.  What if all of my desired vanity plates have already been taken!?  I checked the DMV website, and the following Virginia plates are still available.  Now I just have to decide which one to get...


What I Learned Today

1. I was not the first person to make the Wong-Armisen connection.  I looked at the bulletin board in the Resident Workroom and saw a giant picture of Dr. Wong next to a giant picture of Fred Armisen that someone else had tacked up.  Hilarious!

2. In addition to hypoparathyroidism, there is such a thing as pseudohypoparathyroidism.  It is a disease in which the patient has carpo-pedal spasm, tetany, muscle cramps and seizures.  Lab values show low serum calcium and high phosphate, but the PTH level is actually high due to the hypocalcemia.

3. In addition to pseudohypoparathyroidism, there is such a thing as pseudopseudohypoparathyroidism.  It is a disease in which the patient presents with the same problems as a patient with pseudohypoparathyroidism, but is biochemically normal.  Also, holy moley, that word is 30 characters long.

First Impression

I'm working in the NOPU for the first two weeks of my Neurology clerkship.  First of all, it's pronounced "no poo."  Seriously.  Second of all, I don't have to get into work until 8am, I get an hour off for lunch, and my days generally end at 5pm, unless we're running behind schedule.  So maybe Neurology isn't so bad after all.

In honor of my new resident who reminds me of Fred Armisen from Saturday Night Live, here are a few of my favorite Armisen videos.  You may have seen them before, BUT WHAT DO I CARE!?  WATCH THEM AGAIN, YOU HORRIBLE INGRATE!!