Pseudoseizures

Now people, this diagnosis is a pain in the ass. Pseudoseizures are events that look like seizures to non-medicos. But, guess what, they aren't actually seizures. The kids fake it. They might night mean to fake it - they're acting out against intolerable stress - but basically they're hamming it up.

Not a popular diagnosis. Picture this converstation:

Me - The EEG was negative; no seizures were seen. Your child had three events during the EEG. Therefore, given the normal EEG, your child is having psuedoseizures.

Parent - Does that mean she's doing this herself?

Me - Yes. She isn't doing it deliberately, but the jerking movements she makes are essentially voluntary.

Parent - ^%$#&^%( *&(&^$^%$#^%%(*&^*&% $&%^$# %$#EWS FGBVFGVB OIU^T*&^%# @$#EWQ@RE#$^%

Yeah. It goes just about that well.

It just sucks. If someone has abnormal, seizure-like movements during the EEG, but still has a negative EEG... seizure disorder has been ruled out. Period. One cannot seize without abnormal electrical activity in the brain. Period.

And teenagers are bad at faking. For whatever reason, kids with pseudoseizures always sort of twiddle their fingers during the 'attacks'. Let me tell ya, people seizing DON'T waggle their fingers in the air. Nor can they walk. But really, it's the finger twitching that gets me. Where do they get this stuff?

BoSox Win the World Series!

Time: 2pm the day of game 4

Setting: Streets of Houston

Me: walking out wearing an old Red Sox t-shirt with "5 Garciaparra" on the back

Random guy: "Wow, that shirt is awfully popular right now." (Looking at the front of my BoSox shirt.)

Me: "Good thing I've had it since Nomar actually played with the Sox." (He left the Sox in 2004. I've probably had the shirt since about 2001.)

Guy: "Oh."

I hate stupid boys who assume females cannot be genuine sports fans. I hate Houstonians who think that the Red Sox Nation is made up of people who don't actually follow baseball. I hate anyone who thinks that I'm a freeloading fanboy type.

Go Sox.

Now for the off season - the Astros are going to suck, 'cause the management doesn't have its shit together. The Red Sox will probably be alright... provided they sign Lowell.

Enough of that, though. The Sox won the World Series, I got to see two (2!) games at Fenway this season, I saw Papelbon and Dice-K pitch, and we threw an awesome Halloween party last night. Life is good!

Retarded

In Houston, MRSA accounts for 60% of all the S. aureus in town. For those not in medicine:

1. MRSA = methicillin resistant Staphlococcus aureus = very bad bacteria that can kill you if not treated properly.
2. MRSA will not be killed by the old school antibiotics like Augmentin, Keflex, etc.
3. Good pediatricians should know the above information.

But hey, if you're not from around here, or didn't train around here, the MD might not know. Fair enough. However, ONLY A RETARD gets mad when I alert you, as the primary pedi, about the above facts.

Hey buddy, if you wanna get sued (and/or kill the patient) 'cause you're too proud to listen to some FRIENDLY ADVICE that's not my problem. I'm still gonna admit your patient, treat with appropriate antibiotics and disregard anything stoopid coming out of your mouth. Don't yell at me. I'm just trying to help.

Hold music

Note: this a post I started months ago. I was going through my posts creating labels, and decided to finish it.

There are few things worse in life than hold music. There are many varieties: easy listening, informative, piped-in radio music, classical. But do you know what's worse than hold music? No hold music at all. Then you have to keep checking the phone's display to make sure that they dumbshits on the other end haven't hung up on yo ass.

Damn it!

So I'd written up a clever, funny new post.

And then blogger.com ate it.

Stoopid blogger.

The problem is - I'm not feeling funny anymore. How can I be funny when the funny is gone? Should I make fun of my patients? ("docta, my child has right breast swelling... yes, docta, she's 11 years old... yes docta, she's had a recent growth spurt... yes docta, I remember how my breasts developed back in the day, and I remember my breasts (or soon to be breasts) were tender... but no docta, there's no way my child could have a similar experience... she's not old enough! Yes docta, I was the same age when it happened to me... ") Should I make fun of my husband? Eh no. Bad for marriage, bad for me. Make fun of friends? 'Cause I'm working so much (yay!), I haven't seen enough of them to make fun.

Well, I guess I'll just settle with being not funny. Lord knows, life is funny enough.

Hopefully I'll be able to pull some of that into my blog soon.

Extra Peace and chicken grease,
doctawife

I miss baseball!

One of my favorite things that I ever wrote was my "Rules of Baseball Viewing." I reference those rules nearly every day - well mostly I reference rule #1. Rule #1 was "Sit the fuck down."

Rule #1 was created after a rather unique Fenway baseball experience. Sometime early in the 2003 season, Hubbie and I sprung for some wicked awesome seats at Fenway. (The section just behind home plate, but not where the really really rich people sit - just barely behind that.) We got there early, and a huge number of Fenway Faithful were seated around and behind us. No one really in front of us - those were the rich people seats.

The game started, and we were happy. We were at Fenway, the BoSox looked good, it was too early in the season for any of the players to be really hurt, Legal Seafood was selling chowda, and we had beer. Yay for us.

Until, midway through the inning, two women wandered in front of us. Since we were in the middle of the section, this was a feat. I mean, who goes to the center of a section and THEN decides to stop? Oh yeah... these two ladies! And not only did they wander in front of us and stop, they stopped to have a little conference - right there, blocking the view of home plate.

Needless to say, Hubbie and I were annoyed. 30 seconds passed. We hollered a relatively polite "down in front!" Not too loud, just enough to startle someone into action. It didn't work. Next came a more strident cry from the two of us. After all, they were blocking home plate. We couldn't see the pitches! And we'd paid $45 per seat, damn it! But alas, no response.

And then, the crowd behind us clearly gave up on the idea that these two women would buy a clue at Kmart. From behind us (with my own enthusiastic contribution) came a resounding, deafening, "DOWN IN FRONT!"

Next was the amazing part. The women turned around, seemed totally bewildered, and said, "But we're the cousins of the first baseman!" The instant thought of EVERYONE else in the crowd was, "If your cousin is the first baseman for the Boston Red Sox, you all should freaking know better than block the view from the good seats behind home plate, biznatches!"

And in the next instant, we all yelled, in unison, "DOWN IN FRONT!"

But at least for that season, we all loved Kevin Millar anyway. Despite his 'cousins.'

Down with the negative!

The license... IT IS HERE! Here in my sweaty little hands, quivering with its own suppressed fury, beautiful in its supreme unimpressiveness lies the panacea to all my ills. Or at least that's the theory.

So, starting today, I get to throw myself back in the mix. I spent most of today filling out so many forms that I swear I thought my eyes were going to bleed. Frankly, dear reader, I didn't give a flying pootenany. I was at work! And by and large, people were happy to see me.

Meanwhile, the Texas State Medical Board has been attracting negative attention from the press and the healthcare bigwigs about the delays in licensure. Go journalism! Go activitism! Go greedy capitalism! 'Cause really, that's why people are getting so pissed off. The docs can't get paid 'cause they can't practice, the hospitals and clinics are losing money because the docs aren't seeing patients but can't hire someone else because the doc either has 1) a binding contract with the employer or 2) a specific skill set not already available. Texas has one of the lowest per capita densities of doctors, yet we have this HUGE backlog of docs waiting to work in Texas.

Does this make sense?

Oh yeah, this is Texas. I forgot.

There is no point

Every time I try to get my life fixed, someone gets in the way. At least I'm not alone - go here to find out part of why I'm so screwed.

Another part of why I'm so screwed is my case manager, who seems to be not so good at her job. Given what the article says, that may not be her fault, but at this point I'm not sure I care.

Waah!

Our spiffy new plasma TV arrived today - CRACKED! The driver had just left the complex when we unboxed the big beautiful BROKEN beasty.

We're both ready to cry. Hopefully the return process won't be too painful. Although how you return something that weighs ~80 lbs. I don't know.

Waah!

Okay, it's been a week

Today was supposed to mark my return to doing my job - the job I've trained for since I was in high school. But no - the Texas State Medical Board is punishing me. I can't even tell you, dear reader, how much this hurts.

I just want to crawl under a rock and... I dunno. I don't want to die. But I do want all of this to go away. I want to do my job again. I don't want to be a burden anymore.

Is that too much?

Not dead, I swear

But I am depressed 'cause I can't work right now. Well, I could work - flip burgers, file things, lay tile - but I can't work. The state of Texas is holding my license hostage.

So I'm stuck.

Since I don't want to get up in here and write about how lame my unemployed life is every day, I haven't been posting.

Sorry.

Doh!

Here was the plan this morning:

- dress in the cute new *white* short skirt I bought yesterday
- get the hair cut and highlighted
- find a Windows computer (grr - Macs rule! And the USMLE does NOT because their practice CD isn't Mac compatible) and do my stupid practice questions.

What happened:

- changed into scrubs
- went to clinic (oops - I'd forgotten about that!)
- Aunt Flo came to town (wouldn't that have been freaking grand in a short white summer skirt, hmm?)
- found a Windows machine and did my stoopid test questions.

Hopefully the rest of the week will go more smoothly.

Universal experiences

It doesn't matter what specialty we're in, all residents share a common experience. My favorite is the following, "That's against policy."

What policy? Where is (insert Shatner-esque pause here) this policy? Can I see (pause) this policy. And yeah, I know, even if the RN can't produce the mysterious policy, she won't do what you ask anyway. Just in case the order does violate the policy.

This is why I end up stealing things to better patient care. There is a policy at the community hospital that no bedside testing can happen anywhere (except the ER). I mean, I can't even dip a urine in the freaking NICU or PICU.

Yeah, so, when I'm senior in the NICU I run down to the ER, steal a bottle of urine dipsticks and carry them around. Need to know if that kid with short gut is malabsorbing and that's why he's fussy and distended? Dip the ostomy output! I just saved the patient a full sepsis workup and serial X-rays. Yay me!

All 'cause my residency has taught me to lie, cheat and steal. Awesome.

And while you're at it, check out www.pushfluids.com. They're funny.

Back to the Dreaded Community Hospital

Actually I've been working here all December, but it didn't start to really irritate me until yesterday. I returned to Houston from visiting my cutie-patootie nephew in Dallas to work a 8p-8a overnight shift. Not a great way to start, but I got a nice snooze in the car.

The shift started fine. I like the people I was working with, and their medicine isn't crazy. But then the 21 years of constipation began for Ron, and Berkley and I got reminded why - generally speaking - humans are scum.

Between the two of us, we took care of two young women barely into their teens who had been raped by some pissant of a man. One of the girls attacked this asshole as he raped her friend and they both escaped.

And you know what? One of the girls' mothers didn't show up for three hours 'cause she was 'busy'. What the fuck? No wonder this girl was wandering around the streets of Houston - and not the best part of Houston at that - at 11pm.

But anyway, that kind of stuff is somewhat out of the ordinary, at least for the pediatric side of this hospital. The 21 years of constipation, however, aren't.

Question - if you have had abdominal pain (due to constipation that you already know about) for ten years, why come to my ER at 3am? On a Sunday night? What's, say, five more hours? You know, when you can visit your regular doctor? And if you had two children - one with seven years of constipation, one with four years of constipation - would you come to the ER at 5:30 am?

If it's my kid the answer is hell no! The best part was none of the patients wanted the one thing that would make their pain go away, at least until the next build-up of stool. So they all left in as much pain as when they showed up. Great use of resources.

Here's another one for you:

If my child has a temper tantrum, do I
a) slap him upside the head
b) take away his TV privledges
c) put him in time out (provided he is over three years old with one minute of time out per year of age)
d) call 911?

That's right - the answer is d! (A true story - someone really did call 911 for a temper tantrum. Sheesh.)

Well, I gotta go. I've got a 15 year old to see with... abdominal pain!

To the man in the van...

Yes you. The jackass in the white van with handicap plates...

Please, get off the valium. The accelerator is on the right and the speed limit really is 35 MPH.

And what the fuck is up with your spare tire? You have a hubcap on your spare tire. Why? For the love of all that's good and holy, WHY? And why does it have to look like a spare prop from Krull?

Good gracious, man. Get a life.

Randomness

So tonight is my last nightriding shift for the month at the local community hospital. Of course, that means things had to get eventful. As you might have guessed from previous posts, the night is usually pretty quiet. Most patients have problems that really coulda waited until the light of day, but somehow fever and earaches just MUST been seen EMERGENTLY 'cause it is an EMERGENCY.

Not so with this patient. This one came in fighting to breathe - respiratory distress with grunting and decreasing mental status, to be medical about it. So the baby is sick as snot, and is getting all of the attention. Which is fine, nay, appropriate.

Unfortunately, this pisses off some of the other patients. Actually, not the patients, but the patients' parents. "Why isn't my child being seen - isn't s/he an emergency as well? Why does that patient get all of the attention? Huh? My baby is CLEARLY more important BLAH BLAH BLAH." All of this while the child is sitting comfortably eating Cheetos.

Right about now is when I want to scream, "Be fucking happy that your kid isn't dying. 'Cause guess what, that other one IS! Not metaphorically, not in a symbolic sorta way, but in a right-now-lets-intubate-and-maybe-start-pressors-and-give-blood-products kinda way. You know, the stuff you do right before starting fuckin' CPR."

But I don't. Why? 'Cause we're all better doctors, and better people, than that. People get frustrated. People get tired and I'm sure that a child who has been screaming for 72 hours grates on the last nerve like a monkey on crack. So I can understand being irate.

And just as an aside, who the fuck calls 911 for a crying 12 month old? No fever, not sick looking, got better with Motrin, totally consolable. By the time EMS arrived, Mom reported that the child was back to normal. Isn't that about the time that you call EMS back and tell 'em to forget about coming?

Oh well.

Unfixable

I'm sorry, there are just some things I can't fix in the pediatric ER.

If your family is wicked dysfunctional... DON'T GO TO THE EC AT 3AM! Are you suicidal? Are you homicidal? Psychotic? No? I can't do anything for you! Actually, I lie - I can help you get an appointment with the friendly neighborhood psychiatric clinic. And yes, if I help you make the appointment, you will get seen sooner than your average schmoe. But really, that's it.

But damn, don't expect me to fix 16-fuckin-years of dysfunction in one 2 hour ER visit.

It might seem like I dislike psychiatry. Not true. I like my psyche-delving friends. However, I hate ER psychiatry - 'cause I can only do two things. Number one - send you to the local mental hospital. Number two - send you home with nothing. Very few people meet criteria for door number one, so most people leave more upset than when they got here.

Lovely, no?

I'd much rather see (yet another) kid with gastro. Puke - generally fixable. Family dysfunction - generally not.

Been a while...

Sorry about that. Life got in the way of blogging, and hey, just 'cause I vowed to use this forum to write more, doesn't mean I'm gonna. ;)

Last night I tried to be a good doctor and generally ended up pissing everybody, including myself, off. This community hospital EC always seems to work that way. Resources are limited, patients want more than I can give, staff members don't like doing anything at all out of the ordinary and everything takes way way way too long. I sorted things out. I made a plan. Who knows if anyone gives a shit. The patient (and her parents) certainly didn't seem to care. The fact that it was fuckin' four in the morning didn't help any, either.

On a lighter note - go Red Sox! They have been winning and, wouldn't ya know, the Orioles have been losing. We're now on top of the AL East. I know we haven't even gotten to the All-Star break, but hey! I believe. I think we could perhaps make like the Patriots and get two in a row...

And please, can we take a second and revel in the badness of the New York Yankees? Doesn't it just warm the very cockles of your heart? Jeter is frustrated. Steinbrenner is blowing a gasket. Heaven on earth, I tell ya. Now if only the Pedro would start to slump, my baseball life would be nearly perfecto.