I'm Unoriginal

Everyone, at some point in their blogging career, has to make a post about the crazy Google searches that bring people to their blog. Yes, friends, it's time to delve into the sitemeter.com goodie bag and dredge up material for me to make fun of. By the way, to all 9,000 people who have looked at my blog (or 1 person, looking 9,000 times, which is actually probably myself), thank you!

• "Dog has hyperactive bowel sounds"--um, ew? And I'm not a vet?
• "brbpr"--ah, a great mnemonic: bright red blood per rectum. Hope that was informative!
• "urologist exam" on blogspot search: why would you want to find a blog post about a urologist exam? Does that make you horny, baby, yeah?
• "office depot commercial here to lend you a hand"--god, I hate that commercial!
• "all the different continents"--I can't even FIND my blog using this particular search! And as I've only visited 2, I doubt I'm an authority on this topic.
• "shark mythbusters, dildo"--perhaps my favorite. Yes, it's a dildo fist in the Mythbusters Shark Week Special. I'm a bit confused by the extraneous comma in your search, however.
• "different continents" X 2--see above.
• "hypodensity of the kidney"--wish I could help you with that, but I doubt whatever page that brought you to was all that helpful.
• "dogs with hyperactive bowel sounds" on myway search: those poor, poor dogs.
• "medical architecture (nursing station)"--I liked that post, if I do say so myself.
• "mister man from greece"--...
• "i am 30 and still have no kids"--uh... that sucks? I'm sorry? Contact either match.com or your local reproductive endocrinologist.
• "picyures of peyronies disease"--I'm not sure what a 'picyure' is, but if you're looking for pictures, i hope you enjoyed my half-ass mspaint PG rendering of peyronie's disease.
• "golytely mask"--are you looking to wear a mask while you use golytely? It's not a bad idea, really. Unsure what you wanted with my blog, though, and again, I can't seem to find my blog using this search item.
  
• "thyroid spot of hypodensity"--I AM NOT A RADIOLOGIST. I just use big words so I look smarter.
  
• "crazy doctors"--One of my favorite non-sexual double entendres.
• "cystoscopy, pros and cons of being put to sleep"--Unless you have a serious problem with your urethra, just take some ibuprofen before you go and get it over with. No use taking the risks of general anesthesia for a 5 minute (technically) non-invasive procedure. Now a prostate biopsy, however, is a different story.
  
• "hate attending internal medicine"--If you hated your attending on internal medicine, I can only sympathize. If you simply hate being there on internal medicine, I sympathize with that, too.

If you made any of the above searches and are still here, I appreciate it, and I really don't care how you got here (except for that hyperactive dog bowel sound thing--that's just sick). Danke!

Almost Famous

I just received this email from a new third year medical student:

TS,

I apologize if this email is finding you at a bad time because I must admit that it is quite random. I know that you are a serious student and that you know how things work around here. Being that I am just now starting on the wards (I had Fun month first), would you mind giving me some solid TS quality advice on how to not only do well, but also on how to excel? I would sincerely appreciate it. If you think it would be better to talk about in person, please let me know what's good for your schedule and we can make something happen.

Sincerely,

Scared MS-III

I don't even know this guy. Apparently, my reputation precedes me among the third years. If only I felt as sure of things as they seem to think I am!

I just love that phrase "solid [my name] quality advice".

No Spoilers Here

My beautiful, beautiful book arrived on Saturday, just like Amazon promised. However, with my mother in law in town this weekend, and working on a presentation for ambiguous genitalia, and still trying to re-read the past books in preparation for the new one (I'm halfway through Goblet of Fire) I haven't gotten to read it yet. And that makes me sad. It's okay, my pretty book, I'm coming, momma hasn't forgotten you!

Kitty Update

Kitty now weighs 3.1 lb, up from 1.5 lb when we first took him to the vet. He's also developing unmistakable man-parts, so I think the vet guessed right. I had his claws trimmed today at the vet, thank GOD, so my legs can be unmolested for a few days at least. Here's a photo of him playing with J-Dog--they've finally reached somewhat of a truce, and occasionally bouts of play break out. It's pretty awesome!

Too Weird to Make Up

In one clinic afternoon, I saw two patients with Peyronie's disease. For those who don't know, Peyronie's disease involves a plaque of fibrous tissue which forms in the tunica albuginea, a thick band of tissue which wraps around the erectile tissue within the penis. The tunica albuginea is what provides an erect penis its stiffness and shape, and incidentally is what "breaks" in a penile fracture. When a plaque forms, it causes a change in curvature to the penis, often causing the tip of the penis to angle sharply away from the base. It's associated with varying degrees of painful erections, difficulty with intercourse, and erectile dysfunction.

To make the correct diagnosis, one must palpate the penis for any fibrous plaques. Then, schedule the patient to return to clinic for the next available penile doppler ultrasound, which will evaluate any arterial flow disturbance. While waiting for his appointment, have the patient take photographs of his erect penis and bring them to the next clinic visit. (Don't take those to the drug store!)

Finally, after one has determined the correct diagnosis, surgery may entail a penoplasty, plication of the plaque, and/or a penile implant to prevent curvature. ED may of course be treated with any of the medications advertised on television.

...

I mean, sometimes, even though the problem is serious, and the patient is frustrated by their sexual difficulties and pain, it's really hard not to giggle a little bit.

Good and Bad

Good: today, I cut open a living, breathing (anesthetized) human being. I got to wield a scalpel AND the bovie. What a rush!

Bad: when I came home this evening, I was so exhausted and hypoglycemic that I cried because my husband didn't answer his cell phone to come pick me up and I had to take the bus home AND I WAS SO TIRED, DAMMIT.

This represents my love/hate relationship with surgery. She is a cruel, cruel mistress, crushing you and beating you down, then giving you a little exhilaration just when you think you're giving up, dropping that retractor, taking off your mask so you can breathe, and getting the hell out of that OR.

Funny point: Most of the urologists I've met think that ENT work is disgusting. "Ugh, working with the MOUTH, with saliva and all the germs!" shuddered my attending.

And the Winner is...

I'm currently on my urology rotation, and I've had several signs that this is not for me.

a) I get really irritated when guys come into clinic and act like total wusses about itty bitty stuff just because it happens to involve their genitals. Dude, it's just a cystoscope. It's not that big, and it'll only last a minute. Have you seen the speculums (speculii?) they use on female pelvic exams? IT'S NOT THAT BIG A DEAL, YOU FREAKING WUSS.

b) Prostate exams.

c) Feeling like I have to apologize for spending extra time with a patient who was just told his prostate biopsy came back positive for cancer with a Gleason 9.

d) Trying to fake a smile for the patient every time my attending reaches down for a prostate exam and says "This is our most popular exam." Once, he even told the Spanish translator to translate this phrase into Spanish for the patient.

e) Hearing my second year resident recount his experiences with q3 call as a general surgery intern.

f) Getting bored in clinic, because I've already learned the majority of the questions to ask the patients. Kidney stone patient? BPH patient? Prostate cancer patient? Urinary incontinence patient with suprapubic tube change? Hematuria? Got it. I can even do it in espanol.

And last, but not least,

f) Standing in the OR during a NASTY open total nephrectomy for XGP, my inner monologue went something like this: "I'm tired I'm hungry my back really freaking hurts I can't see anything I sure hope this attending doesn't yell at me I hope the scrub tech doesn't see me leaning on the patient because I think my back is going to give out oh god my hips just popped again and I think I'm suffocating behind this mask and WHY IN GOD'S NAME IS MY ATTENDING'S IPOD FULL OF ALISON KRAUSS I AM GOING TO CUT MY FUCKING EARS OFF RIGHT NOW!!!!"

Therefore, I will be switching into psychiatry as soon as I can get my away rotation fixed up AND get all my fourth year rotations changed around. It also means, of course, that I will need to rename this blog. I'm thinking about "tinyshrink.blogspot.com" but if anyone has any ideas, please put them in the comments, as I'm all ears.

I'm stressed about all the crap I have to do to get this switch done, but I'm happy with my decision. The procedures are cool, and usually I enjoy clinic, but the mindset is still surgery, and while I used to like that, something has changed. I no longer think I can put up with not eating all day and getting to work at 6 am (which is nicer than general surgery!) and not leaving till 7 pm and never sitting down. I think I could be a good urologist, but I'm not sure what would be left of me outside of the hospital. My husband would basically be a single parent for a large part of the week, and it's very important to me that I have a family and that they know what I look like. I haven't cooked a meal since starting this rotation, and I've only worked out once. No time + mental and physical fatigue = fat, lazy TS with a dirty apartment. This isn't who I want to be.

I'm gonna be a shrink!

PS- It's not easy to type a blog entry when a kitten keeps pouncing your laptop keyboard, erasing your pictures and generally being a pain in the ass. It's a good thing he's cute!

An Ill-Advised Move

If you've kept up with the blog, you may have figured out that I'm a crazy dog owner. The kind who buys little gourmet treats every time they're at PetSmart for dog food, the kind who special orders fancy dog collars and leashes online, the kind whose dog has a special bed in every room of the apartment. We take pictures of him like this and show them off to people like he's our child:A couple of weeks ago, a friend of mine was taking out her trash and found a tiny kitten hiding under the dumpster, mewing loudly. She took it home, bathed it and fed it. She decided it needed a home and started calling around.After one person backed out, she contacted me to see if I wanted a kitten. Absolutely not, I said. We're dog people. My husband and I have always owned dogs. I'm allergic to cats, with hay fever and asthma within hours of contact. I do not want the cat--I was firm.She was persistent. You have a bigger apartment, she said; we already have a cat, we can't really afford it, and we don't really have room, she said. Just take the cat for a night, she begged me; I'd rather know the cat went to a friend than to a shelter.My husband said no, we don't want a cat, you're allergic, and what if J-dog doesn't get along with it? Absolutely not.And so, the great cat experiment began about two weeks ago. We brought home a tiny kitty, weighing about 1.5 lbs. He's probably a Siamese mix; he's got long beige fur with dark ears, legs, and tail, stripes down his legs, and bright blue eyes. He has a few annoying habits, like climbing up our pants legs, biting our toes, and eating dog food.We initially thought he was a she, and so we hunted for a girl's name. Since my husband is a space geek, we looked into moons, stars, and constellations. We eventually agreed upon Callisto, which is one of Jupiter's moons; we'd call her Callie for short. We bought a purple collar. The vet disagreed with us, though, and assured us that the rather ambiguous genitalia indicated an XY genotype. Thus, we switched to a name that satisfied both our geekiness AND kitty's masculinity.

So now I have a dog who's having accidents in a corner, snapping at a kitty who climbs my scrub legs and nips my chin. My bathroom is dominated by an enormous mechanical litter box, and some nights I can't sleep due to the kitty crying in the bathroom, but I can't sleep with him climbing all over me and biting me in the underarm.There are some moments, like when he purrs under my chin and nuzzles up to me to take a nap, which is where he is right now. Who knew kitties were so soft? Or that purring was so endearing? The dog is just going to have to lump it, at least until I go crazy with all the animals and I take them all to the SPCA.