Beyond the Oath

PGY-2/OGME-2. Family Medicine. Other interests: cycling, beer, politics, music and general humor. Disclaimer: The opinions and statements herein are strictly personal and should not be considered as related to my employer or necessarily endorsed by my employer.

[beyondtheoath]

The start of a journey

So, about 8 years ago I was diagnosed with Hashimoto’s thyroiditis, which means my body has created antibodies that decrease the effectiveness of my thyroid. I take levothyroxine daily because of this. It helps with my mood (I get really depressed when I don’t take it for a period of time), as well as increasing my metabolism.

That’s the problem with this medication, though. There was a time when I was a svelte 165lbs. I gained nearly 30 by the time I was diagnosed. You see, Hashimoto’s is more common in middle-aged women, not 21 year old men. No one looked for it. It was my diet, they kept saying. Changed things, but the pounds kept coming.

When I started on levothyroxine, however, I noticed that my metabolism kicked into overdrive. Yes, I was theoretically burning what I was consuming, but then I was constantly hungry. And the weight continued to add up.

When I started intern year, I more or less stopped the levothyroxine because it was hard to stay on schedule. Well, I restarted it after about 7 months away when the mood symptoms were creeping back and becoming a nuisance.

Guess what? The constant hunger came with it and the weight kept coming back up. I’m not going to stop medication that has such an important impact on my day to day wellbeing.

I tried eating a high protein diet, which helped control some of the hunger, but it was still very much present and still I was gaining weight.

In short: I need to control the food cravings. So I took a step I hadn’t before: I spoke with my doctor. Being a physician myself, I know of the various medications and treatments available to help with obesity, and given the myriad negative health outcomes linked with obesity, it was time to take action.

So I started taking phentermine yesterday. This medication is definitely not for everyone, and I am very hesitant to recommend it to many people. After a day and a half, I already can say there is a difference in the hunger. I still need to eat, obviously, but I’m not feeling that urge to snack.

Starting weight: 232.8 lbs. Goal: 200 lbs. I’m not looking to be rail thin, but I need to be closer to a healthy weight.

[beyondtheoath]

After everything my wife went through these past few months, she decided to get a tattoo to celebrate conquering her personal mountain. This is the result.

[damnedifyoudeeohh-deactivated20]

5 points to Hufflepuff! …No, don’t worry, all male medical professionals are in Hufflepuff, and all females are in Ravenclaw. Hospital administrators are all Slytherins. And no one in medicine is a Gryffindor.

one of my very jaded attendings (via damnedifyoudeeohh)

Oh but this is so true tho

(via descantforhope)

One of the female interns gave me crap for proudly being a Hufflepuff. But little did she know....

[tastefullyoffensive]

[prismatic-bell]

HERE’S THE THING THOUGH

I used to work for a call center and I was doing a political survey and I called this number that was randomly generated for me and the way our system worked was voice-activated so when the other person said hello you’d get connected to them, so I just launch right into my “Harvard University and NPR blah blah blah” thing and then there’s this long pause and I think the person’s hung up even though I didn’t hear a click

And then I hear “you shouldn’t be able to call this number.”

So I apologize and go into the preset spiel about because we aren’t selling anything, etc. etc. and the answer I get is

“No, I know that. What I mean is that it should be impossible for you to call this number, and I need to know how you got it.”

I explain that it’s randomly generated and I’m very sorry for bothering him, and go to hang up. And before I can click terminate, I hear:

“Ma’am, this is a matter of national security.”

I accidentally called the director of the FBI.

My job got investigated because a computer randomly spit out a number to the Pentagon.

[kuroba101]

This is my new favourite story.

[therobotmonster]

When I was in college I got a job working for a company that manages major air-travel data. It was a temp gig working their out of date system while they moved over to a new one, since my knowing MS Dos apparently made me qualified.

There was no MS Dos involved. Instead, there was a proprietary type-based OS and an actually-uses-transistors refrigerator-sized computer with switches I had to trip at certain times during the night as I watched the data flow from six pm to six AM on Fridays and weekends. If things got stuck, I reset the server. 

The company handled everything from low-end data (hotel and car reservations) to flight plans and tower information. I was weighed every time I came in to make sure it was me. Areas of the building had retina scanners on doors. 

During training. they took us through all the procedures. Including the procedures for the red phone. There was, literally, a red phone on the shelf above my desk. “This is a holdover from the cold war.” They said. “It isn’t going to come up, but here’s the deal. In case of nuclear war or other nation-wide disaster, the phone will ring. Pick up the phone, state your name and station, and await instructions. Do whatever you are told.”

So my third night there, it’s around 2am and there’s a ringing sound. 

I look up, slowly. The Red phone is ringing.

So I reach out, I pick up the phone. I give my name and station number. And I hear every station head in the building do the exact same. One after another, voices giving names and numbers. Then silence for the space of two breaths. Silence broken by…

“Uh… Is Shantavia there?”

It turns out that every toll free, 1-900 or priority number has a corresponding local number that it routs to at its actual destination. Some poor teenage girl was trying to dial a friend of hers, mixed up the numbers, and got the atomic attack alert line for a major air-travel corporation’s command center in the mid-west United States.

There’s another pause, and the guys over in the main data room are cracking up. The overnight site head is saying “I think you have the wrong number, ma’am.” and I’m standing there having faced the specter of nuclear annihilation before I was old enough to legally drink.

The red phone never rang again while I was there, so the people doing my training were only slightly wrong in their estimation of how often the doomsday phone would ring. 

[arctic-hands]

Every time I try to find this story, I end up having to search google with a variety of terms that I’m sure have gotten me flagged by some watchlist, so I’m reblogging it again where I swear I’ve reblogged it before.

[voroxpete]

But none of these stories even come close to the best one of them all; a wrong number is how the NORAD Santa Tracker got started.

Seriously, this is legit.

In December 1955, Sears decided to run a Santa hotline.  Here’s the ad they posted.

Only problem is, they misprinted the number.  And the number they printed?  It went straight through to fucking NORAD.  This was in the middle of the Cold War, when early warning radar was the only thing keeping nuclear annihilation at bay.  NORAD was the front line.

And it wasn’t just any number at NORAD.  Oh no no no.

Terri remembers her dad had two phones on his desk, including a red one. “Only a four-star general at the Pentagon and my dad had the number,” she says.

“This was the ‘50s, this was the Cold War, and he would have been the first one to know if there was an attack on the United States,” Rick says.

The red phone rang one day in December 1955, and Shoup answered it, Pam says. “And then there was a small voice that just asked, ‘Is this Santa Claus?’ ”

His children remember Shoup as straight-laced and disciplined, and he was annoyed and upset by the call and thought it was a joke — but then, Terri says, the little voice started crying.

“And Dad realized that it wasn’t a joke,” her sister says. “So he talked to him, ho-ho-ho’d and asked if he had been a good boy and, ‘May I talk to your mother?’ And the mother got on and said, ‘You haven’t seen the paper yet? There’s a phone number to call Santa. It’s in the Sears ad.’ Dad looked it up, and there it was, his red phone number. And they had children calling one after another, so he put a couple of airmen on the phones to act like Santa Claus.”

“It got to be a big joke at the command center. You know, ‘The old man’s really flipped his lid this time. We’re answering Santa calls,’ ” Terri says.

And then, it got better.

“The airmen had this big glass board with the United States on it and Canada, and when airplanes would come in they would track them,” Pam says.

“And Christmas Eve of 1955, when Dad walked in, there was a drawing of a sleigh with eight reindeer coming over the North Pole,” Rick says.

“Dad said, ‘What is that?’ They say, ‘Colonel, we’re sorry. We were just making a joke. Do you want us to take that down?’ Dad looked at it for a while, and next thing you know, Dad had called the radio station and had said, ‘This is the commander at the Combat Alert Center, and we have an unidentified flying object. Why, it looks like a sleigh.’ Well, the radio stations would call him like every hour and say, ‘Where’s Santa now?’ ” Terri says.

For real.

“And later in life he got letters from all over the world, people saying, ‘Thank you, Colonel,’ for having, you know, this sense of humor. And in his 90s, he would carry those letters around with him in a briefcase that had a lock on it like it was top-secret information,” she says. “You know, he was an important guy, but this is the thing he’s known for.”

“Yeah,” Rick [his son] says, “it’s probably the thing he was proudest of, too.”

So yeah.  I think that might be the best wrong number of all time.

Source:  http://www.npr.org/2014/12/19/371647099/norads-santa-tracker-began-with-a-typo-and-a-good-sport

[md-admissions]

A children's book for grown men that answers the age-old question: Where does your penis belong?

A children's book for grown-ass men

AHAHAHAHAHAHAHAHAHAHAHAHA

Ahem. I’m okay now.

[damnedifyoudeeohh-deactivated20]

Yeah so I’m pretty sure the CDC is smarter than the Trump administration. Can’t use the word “transgender”? Let’s find a new word that describes the same populace. Can’t use the word “fetus”? I’m pretty sure we can come up with a synonym. I’m just saying, the English language is pretty vast… I think the CDC, which holds some of the nation’s top scientists, can figure out how to get around this regarding budgets.

[beyondtheoath]

I’m using fætus now.

And non-cisgendered.

[ninjatengu]

My new favorite words

Vulnerable Entitlement Diversity Transgender Fetus Evidence-based Science-based

[beyondtheoath]

“While we at the AAFP represent family physicians, our highest priority is improving the health of patients, families and communities. When the top public health agency in the country is - in an unprecedented move by the administration - required to temper its reliance on evidence-based medicine, the health of the public is at risk.”

[beyondtheoath]

Fuck them. Fuck them all. I previously have been a very measured voice of opposition, but now it becomes personal. “Policy analysts at the Centers for Disease Control and Prevention in Atlanta were told of the list of forbidden words at a meeting Thursday with senior CDC officials who oversee the budget, according to an analyst who took part in the 90-minute briefing. The forbidden words are “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.” In some instances, the analysts were given alternative phrases. Instead of “science-based” or ­“evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes,” the person said. In other cases, no replacement words were immediately offered.”

[beyondtheoath]

Me, Too

Every day we learn of a new man who has been accused of sexual misconduct. It is sad to see how rampant it is, but at the same time, it is no surprise. Yes, I am a man and frankly was mostly blind to it, but more and more in the last few years, I have seen the blatant sexism throughout my professional sphere.

There was the urologist who turned to the nurse after doing a penile implant and asked if it “looked good enough” for her.

There was the surgeon who directly stated to me that the female students on service with me were good, but would be better nurses.

I have literally stood there and watched my senior resident be called a nurse despite her having introduced herself as Doctor.

I personally know women who have been pressured into sexual acts as part of their job.

Unfortunately, I am complicit in standing by and not speaking up when these things happened. And that makes me guilty as well.

I really do regret not standing up for my female colleagues more. Even though I knew that none of what I saw was acceptable, I was also in a position where speaking out could hurt me professionally as well.

THIS IS HOW MISOGYNIST CULTURE PERSISTS.

When we stand by and don’t speak up, despite the risks to our own careers, we perpetuate the situation.

So I will be more assertive in fighting back. Because in order to build the society we want, we all have to work together.

[theambulancegoesweewoo]

When you go to take the patient’s BP you head “BLOOP BLOOP BLOOP”

How do you treat???

[drdessertfox]

With Beta Bloopers, obv

[beyondtheoath]

Sunset in 3 Pictured Rocks National Lakeshore, May 25, 2017

[md-admissions]

It’s time for the Christmas issue of BMJ!!! Which means one thing: mega-nerdy, sassy, medicine articles to lighten the mood. This one had me cackling. 

[cranquis]

I’ll be cutting out the Conclusions and taping them to our bathroom mirror:

“Lying on the couch, not getting out of bed, or receiving assistance with activities of daily living could also be evolutionarily behaviours that protect against predators. Perhaps now is the time for male friendly spaces, equipped with enormous televisions and reclining chairs, to be set up where men can recover from the debilitating effects of man flu in safety and comfort.”

[beyondtheoath]

My wife and I often joke about Man Flu because it’s usually the opposite in our house. Except a few weeks ago when I had hemoptysis from bronchitis. I was miserable then.

[beyondtheoath]

On being a patient

Someone once told me that the best doctors have also been patients. This, I believe, is very true.

It helps build empathy when you send your patient for a test. You can better explain what certain tests feel like, or help dispel fear about that CT scan. You can better relate to taking medication every day and understand how/why people forget doses.

I am 28, just shy of 29. When I was born, I had a congenital deformation of both of my legs where they were internally rotated at the knees by 90°. The surgeon who fixed them said that it was a chance I wasn’t going to walk normally, but that fortunately never panned out.

I used to have numerous incidents of reactive airway disease. I was hospitalized usually twice a year from it when I was in primary school. There was one case where I was at my pediatrician’s office and had a coughing spell so serious that I went apneic. I was about 7 at the time. I remember starting to cough and then being in an ambulance. I don’t remember the interim where I turned pale and cyanotic per my mother.

When I was 15, I discovered a lump in my left testis. Freaked me out, understandably. Fortunately it was a varicocele that was easily repaired. But then I developed a hydrocele that had to be repaired. Then I had a surgical site infection. That was brutal.

At 21, I was diagnosed with Hashimoto’s thyroiditis. I had gained 40 pounds in a matter of 3 months. My TSH was 33. I have been on replacement hormone ever since. Still haven’t lost that weight sadly.

In short, I understand the fear in my patients. I have had nearly every test a male could have done. I take daily medication (when I remember).

Being a patient can be very scary, but having true empathy for your patients can be just the thing they need to get them through.

[beyondtheoath]

“Rest” Indiana Dunes State Park, May 13, 2017

[beyondtheoath]

Virology: A Primary Care Tale

The following story is completely true. Everything happened exactly the way it is retold here. No exaggeration or paraphrasing at all. Not even a little bit. Pinky swear.

Mother: The kid's fucking sick

Dr. B: We did the damn-doo and it's all negative. He's got a fucking virus.

Mother: But whenever he gets fucking sick he doesn't fucking feel well and it usually gets worse and worse for like 4-5 days before he starts to fucking feel better.

Dr. B: Yeah. That's classic fucking virus shit right there.

Mother: So you're not giving him a fucking antibiotic?

Dr. B: No.

Mother: But I'm a fucking nurse and when this shit happens in the nursing home we start passing out the antibiotics like they're singles at the strip club.

Dr. B: Great. I'm a fucking pediatrician. I only fucking take care of kids. I have no fucking clue how shit works with altacockers but I'm pretty sure insane shit like that is why we have multi-drug resistant superbugs killing motherfuckers.

Mother: How's he fucking gonna get better if you don't fucking give him antibiotics.

Dr. B: Rest and fluids. And lots of hand washing so he doesn't give that shit to literally everyone he fucking touches. Seriously, that little shit has eaten 3 buggers since I walked in the door. Big ones, too. Like, probably spoiled his dinner big.

Mother: This is fucking ridiculous. He needs the fucking antibiotics. I fucking know my son and you're gonna give him this shit. How can you fucking let tell me hes not sick and do actual nothing about it.

Dr. B: I didn't fucking say he wasn't fucking sick. Clean all the fucking shit out of your fucking ears. I said he had a fucking virus. That means he's fucking sick. to get better he needs to get some fucking rest, stay fucking hydrated, and wash his fucking hands.

Mother: That's some grade A bullshit right there. I'm gonna fucking throw a goddamn tantrum now.

Dr. B: Good luck with that shit. [Walks out]

[beyondtheoath]

Our marriage summarized in 2 pounds of ham