November 5, 2008

"Wow, I had no idea med school was so bad for you."

Medicine is full of ridiculous moments. To me, and my extremely sarcastic sense of humor, its one of the many (or few) areas of medicine that remain dear to me.

Queue Situation #1:
Patient Zzzz comes in for his routine physical (good for him!). He has had no significant medical issues, but his wife has a primary complaint, among many, that her husband snores so much that it seriously disturbs her sleep. The patient has gained 40 pounds in the past 2 years and is about 70 pounds overweight. He is pre-hypertensive. He complains of lethargy. He eats poorly and doesn't exercise.

Patient Zzzz: "So what can I do about the snoring? Isn't there some drug out there that can help me?"
MedZag/Preceptor: "We can install a noisy machine in your bedroom to help you sleep better. But your wife will likely complain just as much, and counteract said effects of restful sleep. Try exercising and losing weight."

Patient Zzzz: "So what about feeling tired these days? Isn't there some drug that can boost my metabolism?"
MedZag/Preceptor: "Well there's always methamphetamines. But if you're opposed to injecting your medications, or smoking them off of a knife, you can try exercising and losing weight."

Patient Zzzz: "My blood pressure has never been high. Why all of a sudden? Isn't there some drug you can give me to bring it down?"
MedZag/Preceptor: "If it stays elevated or continues to climb up, yes. In the meantime, you can try exercising and losing weight."

Patient Zzzz: "Wow, I had no idea gaining weight was so bad for you."
*MedZag smacks face with Phizer clipboard*

Queue Situation #2:
It's 11:37am. MedZag is in one of those wonderful "small groups" that medical school curriculum directors have some strange fetish with these days. Topic of the day: reading radiological images of the chest. After slogging through your typical lobar pneumonia, bronchiolar pneumonia, and miliary cocciciomycosis pneumonia (ok, maybe not so typical), we reach the highlight image of the day. The small group facilitator clicks his snazzy InFocus clicker and a spiral CT chest image comes onto the screen. The group gets to work analyzing the image. Mediastinum... clear. Outside the lungs... clear. Lurking in the lower right lobe is a fascinating bright "opacity." The group diligently examines said "opacity," and discerns that it is a cavitary invasive lesion of the bronchus. It was invasive. It was big. And the local lymph nodes were enlarged and bright. Likely diagnosis: squamos cell carinoma of the lung, a nasty lung cancer highly associated with smoking. We discussed his prognosis, which was poor. We talked about how bronchus epithelial metaplasia from smoking insult can lead to the development of SQCC. The group excitedly gives its diagnosis to the facilitator.

Facilitator: "Well duh. You all forgot the most important finding on the CT scan. Can anyone tell me what it is?"
Group: *best stoned pufferfish impression possible*
Facilitator: "Look in the upper right corner of the image."

There, sitting on the upper right corner over the CT cross-sectional slice, was a section through the pack of cigarettes sitting in the patient's front left pocket. Yup, here we are reading this poor guy's catscan, talking about how screwed he was from years of smoking, and the dude went into the scanner with the smokes still in his front pocket.

"Wow, I had no idea smoking was so bad for you."

Ah, medicine.

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