I thought it was common knowledge

It's not often that a medical student gets to drop a Knowledge Bomb™ on a senior resident, so I think it's only fair that I take a minute to gloat.

Myself and the rest of the Orange call team (aka Orange Crush, aka Agent Orange, aka Orange-you-glad-I-didn't-say-banana...all names that are used by me exclusively, I should point out) were having dinner last night in the old cafeteria. Somehow, the conversation turned to Hannah Montana - most likely an off hand reference which I turned into a full-fledged conversational tangent.

One of the senior residents gave a quizzical look and inquired, "Who's Hannah Montana?" And I responded thusly:

Hannah Montana is Miley Stewart. But that's a secret. You see, she's leading a double life: by day's she's an average middle school student named Miley Stewart, but she's also a pop superstar performing under the name Hannah Montana. Miley is a brunette, and she puts on a blonde wig to disguise her identity when she performs. She doesn't want her personal life ruined by her fame. The actress is Miley Cyrus, who is Billy Ray Cyrus' daughter. That's right, the mullet man himself has a spawn.

I swear that is, to the best of my recollection, what I said to two interns and two residents last night. I think I might have also claimed to be the president of the Miley Cyrus Fan Club, Arizona Chapter. Ask Lyle, he was there.

I remember my senior resident, who is med/peds, laughing but I don't remember how the others responded (I was floating away in the children's television wonderland that is my brain). They probably think it's weird that I know so much about a TV showed aimed almost exclusively at pre-teen girls. Well you know what? I think it's weird that they have performed so many digital rectal examinations and question people about very personal poo habits. So m'leh!

Soon thereafter somebody made reference to the Wiggles, and they all turned to me like I was the expert. Let me tell you, I did not disappoint.

The Wiggles* are a group of Australian singers who dress in bright clothes to sing and act on a children's show. They all have higher level degrees in Childhood Education and development, or something similar, so they cater the show towards what they've learned. Kids love their songs. There's all kinds of supporting characters, like Dorothy the Dinosaur and Captain Feathersword.

Again, nearly word-for-word what I told them. I'm not sure if it was my exhaustive knowledge of kids TV or my reference to Captain Feathersword, but they just started laughing. Good times...

So the take home lesson is that not everything you need to know to make a good impression during you clerkships is in your copy of Pocket Medicine. It's in my copy of Pocket Medicine...mostly because I scribbled drawings of TV shows on all the pages. Which was a little awkward when I tried talking to my future nieces/nephews about "Spongebob Hepatitis-pants." Sorry, kids...

And before you ask, the answer is yes - I only wrote this post so I could put Hannah Montana's name in my blog to get more hits from Google. As soon as Google picks up this post, you won't be able to search for "Hannah montana rectal exam" without my blog shining brightly at the top of the list. Ooh, better yet, search for "Hannah Montana rectal Wiggles."

* yes, I can speak in italics

Humor aplasia

On the old blog, I outlined an encounter with Dr. Attending during my psych rotation which posited that Dr. Attending did not have a sense of humor. Well I recently learned that this phenomenon is not limited to the world of psychiatry.

Dr. Attending ended IM morning report with a discussion of "evidence based medicine," which in layman's terms means "don't do anything unless other people have done it first." Through a series of tangents and several lorzepam, Dr. Attending landed on the subject of The Placebo Effect. At that point the following exchange occurred:

Dr. Attending: The placebo effect is very powerful, and evidence to support it has indirectly shown up in eastern medicine for thousands of years. The problem is, nobody will do any studies to prove it because there is nothing you can patent so nobody stands to gain.
Montgomery: Yeah, and if you're testing the placebo effect, what would you use as a control group?

Well the other student laughed and the FP intern laughed (I like FP docs, they're usually happy), but the resident and the attending...not so much. In fact, Dr. Attending literally fired icy daggers at me with his eyes. Tough crowd.

I like to think I'm learning a lot about the practice of medicine during my third year, but at the very least I'm spending tens of thousands of dollars a year to polish my stand-up routine.

And one for the road
My patient had neutropenia, which means he didn't have some of the cells necessary to fight infection. When you get a blood count, it'll show the number of segs (more mature) and bands (less mature) neutrophils. Well, Mr. Patient has almost no segs. Which prompted me to say, "sounds like he has seg agenesis." That's bad even for me, good thing I just mumbled it.

Cotarded

I've been trying to come up with a good first post for this new blog and I think I've finally got one. I decided my first post should chronicle another first: my first big mistake during my clerkships.

It was during my psychiatry clerkship, which let me say was surprisingly enjoyable, and i was working on admitting a new patient. The reason for admission is irrelevant, but for the sake of completeness let's just say he had Koro. The following conversation transpired:

Montgomery: Have you taken any psychiatric medications in the past?
Patient: I tried Celexa for a while.
Montgomery: Did it work for you?
Patient: I suppose, but I stopped taking it because it made me feel like a zombie.
Montgomery: (obviously intrigued) Really?? You felt like the walking dead, doomed to roam Earth for all eternity with no memory of your former self, killing everybody you encounter?
Patient: Well...no.
Montgomery: You had an insatiable craving for human brains?
Patient: No!
Montgomery: If not brains per se, a craving for human flesh in general?
Patient: No.
Montgomery: You felt as though your major organs had ceased to function and your body no longer had needs such as food or oxygen?
Patient: Of course not.
Montgomery: You felt your body was in a constant state of decay?
Patient: Are you serious?
Montgomery: You felt that your bite would make others become like you?
Patient: Please stop.
Montgomery: Well why don't you just tell me how it made you feel like a zombie!
Patient: I felt like my emotions were blunted and I was just going through my day-to-day without any feelings.
Montgomery: Are you *censored* kidding me? That's how you define "like a zombie?" Have you ever seen a *censored* zombie? Obviously *censored* not! If you're going to feed me *censored* lines like that *censored* *censored*, you can just get the *censored* out of my psychiatric unit! *censored*!!!

Needless to say, I got in a little trouble. But I learned my lessons
1. Everybody on antidepressants feels "like a zombie," but it has nothing to do with undeath or consumption of human flesh.
2. Yelling at patients is a no-no.
3. If you're going to kick a patient out of the psychiatric unit without approval from the attending, don't scream and throw a chair at them on their way out. Makes things a little obvious.
4. It's surprisingly easy to stick a syringe into a solid wood door from halfway across the unit.