Oh the Things I've Learned

So it has been a while, I know, but its time to get back in the groove. Currently I sit in the Neurology call room desperately trying to avoid any and all patients... joking (or am I?!) It dawned on me the vast length of time that has passed since I last wrote and thus wanted to scribble a few notes before I am whisked away to save a life (ha!).


A few things I've learned whilst being here:

1. The amount of bow-ties worn in this area is staggering. By my unscientific calculation 1 out of 4 residents/attendings sport one daily! And as a side note, if one wears the 'pre-tied' variety you are promptly heckled and poked repeatedly with a really pointy stick.
2. Tobacco is not a drug, its a way of life. Being the stellar Jefferson grad that I am, I routinely ask about three cardinal sins - Alcohol/Tobacco/IV drugs - during my 'social' history-taking. What seems to be a reoccurring theme is the patient's vehement denial of all things alcohol (to the point you know their lying). But on the subsequent question of tobacco use, they respond, "Oh yeah, well of course doc," while looking incredulously at me that I asked such a ridiculous question.
3. There is no sport but NASCAR and invariably my patient "knows a guy."



I'll end with a recent 3am nursing call that had me chuckling (well actually I was quite peeved when it happened)... and I must mention, no disrespect meant.
Nurse: Dr. Mandichak, your patient in 42....
Me: ...yeah...
Nurse: ...her hand is cold.
---- silence ----
Me: umm... her hand is cold? Does she have a pulse?
Nurse: oh, she has a good radial pulse. Its just that her left hand is colder than her right hand... just thought you should know.
Me: well is she in pain?
Nurse: oh no, she's fine, she's sleeping actually, I just noticed her hand was cold.
Me: *click*


For the non-medical people out there, an acute cold extremity can be a scary thing and one would be concerned with an arterial clot, something that can progress to amputation in very little time, HOWEVER, a good pulse in that extremity definitively excludes such a diagnosis (btw you'd also note pain and parathesias).