FIRST DAY OF RESIDENCY
Just got the call schedule for my first block.

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FIRST DAY OF RESIDENCY
Just got the call schedule for my first block.
Read more: http://bit.ly/1N8qAvH
According to Student Doctor Network, Most Medical Students Attend Harvard
http://gomerblog.com/wp-content/uploads/2016/01/sdn.jpg
Kansas City, MO – In a recent Census of US Medical Students report, published in JAMA last week, researchers wanted to see which medical school students were attending. Researches used the very popular forum website: Student Doctor Network, where many prospective medical students and active me…
Read more on http://gomerblog.com/2016/01/tudent-doctor-network/?utm_source=TR&utm_campaign=DIRECT
www.gomerblog.com
CRYING
Literally ded.
BAAAAhahahahahhahahaa! This is the kind of quality content I come to the internet for.
fucKINg CRyinG
typical SDN post: "hey guys I got a 44 on the MCAT and published two first author papers in Nature and have volunteered giving Pap smears to refugees since I was 12, do u think I'm gonna get in anywhere? Should I retake the MCAT?"
Channel one ounce of Sean Penn’s egotism. There is so much to be learned from the actor’s foray into geopolitically contentious journalism. Next time you find yourself claiming that you can’t try something new because you’d be terrible at it, read Penn’s Rolling Stone interview with Mexican drug lord El Chapo and remind yourself to let your ego soar like an owl that flies among falcons. Feminist bonus points for gratuitously mentioning your genitals in your recounting of the experience.
… and 8 other feminist resolutions for 2016 - NYmag.com (via annfriedman)
Trying to act with the confidence of arrogant white men is one of my 2k16 New Years resolutions.
False beliefs and wishful thinking about the human experience are common. They are hurting people — and holding back science.
The "learning styles" one drives me particularly nuts.
Hush...Don't Say a Word
The first time I cried, it was during clinicals. Ironic really, considering it was perceived a non threatening environment. Except I was completely threatened. The instructor was evaluating sterile wound care at the patient bedside, and after about three sterile fields that were ripped from the bedside table with a curt, “do it again,” I felt tears flooding my eyes. The patient, alert, looked at me with pity, fellow students surrounded the bed, silently writing notes - likely what they will do differently to avoid this catastrophic fail. Tears fell, as I finally met expectation, but there was no victory. “You shouldn’t cry in front of patients,” commented the Instructor. I vowed I would never show emotion again.
The second time I cried, it was during orientation in Med Surg, the fear of making a mistake, the pressure to take more patients, the demands of the preceptor, patients, and forgetfulness began to build up. The struggle to keep up with charts, meds, assessments, and the overwhelming impossibility of it all. Tears threatened at the nurse’s station, and before I knew it, I was whisked away by a nurse educator into a patient’s bathroom.. “Never let them see you cry.” She said, and left the room. I looked around, through the tears. At least she had the good sense to ensure it was a confused patient’s room. I wiped the tears that betrayed me again, and carried on.
The next time I cried, it was my first code. The patient was a DNR, but the family wasn’t sure. When he stopped breathing, they panicked. And so did I. But still, we coded him, and he survived. I held it together, as we tended to him, post cardiac arrest. I held it together while I thought about his broken ribs, hypoxia, and quality of life. I held it together while the family held hands in a prayer circle and reinstated the DNR. I lost it when I watched the heart rate on the monitor slowly go down, and I slipped out of the room silently to cry in the supply room.
I trembled, the first trauma patient I received in Pacu, a 90 y/o female, broken pelvis, s/p ped struck, after being dragged by a bus for five blocks. I trembled, as I fought to keep up with her rapidly depleting blood volume. I trembled each time she coded on that shift. I fought back the tears when she gave up the fight. “Don’t let anyone see you weak.” Said the charge nurse. And I cried the tears silently.
I felt a void the day I took care of a 17 y/o female who overdosed on energy drinks. I felt a void as we ran a marathon attempting to save her young life. I didn’t feel anything while we maxed out on pressors, pumped her with fluids, and she continued to decline. I felt detached while we invaded her body with a catheter to drain the toxins from her blood in emergent dialysis. I felt removed from the scene when she died, her family destroyed, and my fellow nurses wept at the climax of a heart wrenching day that resulted in defeat. I was her nurse, and I had failed her, but my eyes remained dry. Every so often there’s a patient that affects the unit, one that unifies the team, I looked around as though I was viewing it all from the gallery of an OR, and understood there was no shame in crying, and there was no shame in feeling empty - I remained silent, realizing a nurse didn’t have to justify being one or the other. Sometimes you needed to grieve to move on, and others you need to detach to survive it all.
It was late night in Pacu, when we received word we would need to accept a patient from the OR status post complication of a VATS. (Video-Assisted Thoracoscopic Surgery). A simple procedure had been complicated by an error that a 1st year surgical resident made - a catastrophic nick of an artery they couldn’t seem to repair immediately. The family was insistent that she suffer no more procedures or extraordinary measures. The patient was to come to a secluded room in Pacu, so the family could say their goodbyes. There is perhaps a million ways that a nurse and doctor may disagree, but it only takes a moment of commonality to bridge the gap, or remind us of our humanity. I stood with the surgical resident as the family surrounded the patient, crying and comforting one another and telling their loved one it was ok to let go. We stood together in the shadows of the corner, and the resident began to cry. I squeezed her hand gently, and felt my own tears fall in shared understanding. She wasn’t alone.
This is so well written, sad and beautiful at the same time. I find it toxic to ORDER not showing emotions, especially when death is involved. Such a wonderful thing you did for the resident. Thank you. <3
Is it really a minimalist Christmas morning if you don't brag about it on social media?
Why in the year of our lord 2015, can I not make Facebook stop informing of me child abuse cases via the trending news stories?
Is there not an app to replace them with cute animal stories?
OH MY GOD SO MUCH THIS. I actually meant to post about this earlier.
Hi, I’m Summer, and I’m going to post 87x tonight, I guess.
I was just thinking about this today when I read about the meth heads who killed their kid! So uplifting for the holidays!
Facebook trending news is like every terrible "if it bleeds, it leads" local news station all smashed into one. I want to turn it off!
I may just have a tiny lady brain, but I thought a "feud" required two willing participants. These comments, by contrast, are the product of an insecure, narcissistic schoolyard bully who is desperately seeking attention by saying the meanest thing he can think of.
Another woman utterly failed by our society’s devaluation of women’s reproductive health. We can’t wait around for male doctors to decide what we need to know. This is why we need to take control and educate ourselves about our own bodies.
and here’s some comments i saw under the post. why is this a pattern?? why is this a recurring theme?? why is this information not common knowledge? what the fuck are doctors doing??
This is news to me so let’s share it so people will know!
Gross tmi: but i passed a pretty big clot after having my daughter. It was about the size of a baseball. It actually hurt worse because while 15 hours of labor opened my cervix, i passed the clot in 30 minutes. I knew it was a possibility because of my midwife and reading, but everyone Ive told after this (mostly other pregnant women) were shocked that this could happen.
In our culture, it’s much more common to do deep research about what family cars we want to buy than we do about childbirth when we ’re pregnant.
Tmi: I passed a huge clot after birth in the bathroom of my hospital room and called the nurse sobbing because I didn’t know it was normal. She treated me like an idiot, but NO ONE told me it was a possibility. And the pain associated with healing for the first couple of weeks after birth was worse than the labor imo. Again, I had no idea. They didn’t tell me a thing besides “sitz bath regularly and change your pads.” Before discharging me from the hospital.
I was most definitely told about this in school. Fucking hell, 4-6 weeks of bleeding? My periods were/are bad enough, why the hell don’t we get told this?
I didn’t know it could last so long, wtf? Is the bleeding inevitable after birth?
Bleeding is inevitable after birth - your uterine wall is shedding a fuck ton of lining. It can last from three to six weeks (possible longer) and it tapers off.
More TMI - I passed a MASSIVE clot after my fourth birth. At this point I already knew this could happen - it’s normal. What I DIDN’T know, was that I had caused it.
My post birth contractions were so bad after the birth that it felt like full transition labor. And they don’t give you anything for the pain. So I used a hot water bottle, without the nurses knowing, and it caused me to bleed even more. I lost so much blood that by the first time they sat me up to go to the bathroom, I fainted. It took three more tries until I could sit up.
Anyway, that’s not the point. The point is, the next morning I passed a clot the SIZE OF ANOTHER PLACENTA I KID YOU NOT, and I know what is and is not normal. So I called for the nurse and through the door told her I had passed a huge clot, and her response was - “It’s not big. I know what big is.” She hadn’t even looked. So I rolled my eyes and said, “Yeah, no. It’s big, I’m telling you.”
So, sounding extremely put upon, she asked me to open the door. I did, and after a long pause she goes, “Okay, yeah, that’s a little big.”
YOU DON’T SAY.
The point I’m trying to get across is that this shit is so common - women not knowing this stuff is so expected, and it keeps getting reinforced. People don’t expect you to know anything, don’t teach you anything, and then make you feel like you’re totally ignorant and a burden for your lack of knowledge when THEY WON’T SHARE.
Fucking learn EVERYTHING you can when it comes to childbirth, girls. It is the single most empowering thing you can do for yourself. And if you missed something, that’s okay. But the more knowledge you arm yourself with, the more in control of your situation you’ll be.
A few post partum tips:
DON’T use a hot water bottle - lol.
ONLY pads - NO tampons. Tampons can cause severe infection, not to mention, you probably don’t want to be shoving anything up there any time soon.
If you’ve had stitches, sitz baths DO help relieve the pain. Another great pain reliever? Dampen some pads and freeze them. Let one thaw slightly and use it on top of another pad. This will help with the pain as well as reduce swelling. Change the pad out as soon as it’s thawed completely. This REALLY helps on the first couple days after giving birth.
If you pass a clot, don’t sweat it. Even the one I passed, which was fucking massive, just required that we keep an eye out to make sure it didn’t happen again. If it does, talk to your doctor.
Take a pain killer half an hour before nursing. Because YES - your uterus is contracting after you give birth, to get back to its original size, and nursing causes much stronger contractions. Taking nursing-safe painkillers won’t prevent the pain, but it will reduce it.
Buy disposable underwear for the first few days after birth. They will get VERY dirty. Or use your ratty old pairs that you’re ready to get rid of. Double up on pads - line them all the way up your ass-crack. I am so serious. And wear dark pants.
Pee in the shower. You do NOT want to wipe down there right after birth because ow. Peeing in the shower lets you just rinse afterwards. Especially if you’ve had stitches, peeing in the shower, with the shower-head rinsing AS you go, keeps stinging to a minimum. And fuck everyone else - keep on peeing in the shower until you feel ready to move back to toilet paper. Middle of the night and need to pee? Get your pants off - get in the shower and just go.
This is just a few things, but PLEASE feel free to send me an ask if you have any questions about ANYTHING childbirth/pregnancy/nursing related. I have four incredible kids. I’ve done it all - c-section, vacuume birth, episiotimy, stitches, with an epidural, without an epidural. I’m here.
More tips: GET A PERI-BOTTLE. If you have a hospital birth, they’ll probably give you one. If not, you can pick up any kind of small squeeze-y bottle (or even an empty, CLEAN CLEAN CLEAN spray bottle if it comes to it). It’s like a little portable bidet. Use it after you go to the bathroom, then pat dry. This way you don’t have to climb into a shower every time if you don’t want.
IME bags of frozen peas in your underwear with proper covering (you don’t want to get frostbite) are the best sort of cold compress.
Those contractions during nursing? They are v v important. They shrink your uterus, helping your body get back to normal faster (and helping you pass blood quicker). They hurt. Keep drinking red raspberry leaf tea (which hopefully you drank during your third trimester). It should help not only with the contractions, but with your milk supply as well. Take a nursing-safe NSAID if you can.
REST. I know this is especially hard for people who are already parents, for poor folk, for people with a ton of responsibilities in general. This is when you call in the cavalry, if you’re lucky enough to have support. FRIENDS AND FAM of birthing persons, leave the parent alone with their baby. Do a load of dishes. Pick up. Check to make sure the parent has their baby supplies handy (as in, within reach). Bring them food. The more they rest, the faster their body heals, and the shorter the bleeding period will be. If it tapers off and then ramps back up, YOU’RE DOING TOO MUCH. Slow down. This is the perfect time to learn that, as a parent, you can’t do it all. Always prioritise your kid. If there’s one time you’re allowed to just let shit go, it’s during your babymoon. (Google is telling me babymoon now means a trip you take with your partner before you have your baby. What. No. “Babymoon” means the first week after your birth. When the hell did that switch happen?) REST. REST. HOLD YOUR BABY. SLEEP. NURSE. EAT. This bonding time is imperative. You and your baby deserve this time.
@bellyhairs
….I know I keep reblogging this but people keep adding super important information.
I feel like no one tells women this stuff because if a woman was even a little on the fence about having a baby before this would kinda make them run for the damn hills.
…..you are correct, typing.
300% EXTRA SURE I’M NOT HAVING BABIES.
peri bottles, witch hazel or anti-pain anticeptic spray are your friends. Also passing large clots after birth is a WARNING SIGN. Bigger than a half dollar is a sign that you have not passed your entire placenta (this is most common in hospital vaginal births where the mother is not allowed to naturally birth the placenta and instead has it ripped out by the doctor) if there is any placenta left in your uterus you can get extremely ill. This happened to both myself and my mother in law
WOW I didn’t know any of this and I’m terrified of what more I’m unaware of about my own body :( Honestly when will we fucking abolish this taboo about the female body…
I had pretty great sex ed in school (lots of contraceptive information, and totally acknowledged that teenagers might have sex) and all of this is news to me.
And, as a 28-year-old person with a uterus, I’m extremely appalled I’m just learning this.
Long, but very important information, even for those who don’t plan to have children, because you will almost certainly know someone who will, and you might be able to to help them. Or at least increase your level of empathy for them.
The shit they don’t tell us.
i need more of this on my dash.
This is just second nature to me because of my job, but I don’t remember where I learned it all. I’ve had moms that have no clue that you bleed after birth. They thought they were dying.
Even as a nurse I didn’t know how long the heavy bleeding was supposed to last. I almost died because I was having a late postpartum hemorrhage and didn’t know it wasn’t normal to be bleeding that heavy for so long. I also thought I was supposed to be in that much pain–negatron something was very very wrong.
1. We need better sex education.
2. We need nurses to perform postpartum follow-up calls. Home health and well baby home check ups should be the standard of care for all new first time moms.
3. Don’t assume people who work in healthcare know things from nursing school/med school. I’m a telemetry nurse I don’t know shit about OB. Additionally we all know that when you are sick you forget everything.
4. Not sure if your patient knows the discharge teaching? TEACH BACK. Nursing teaching 101 make the patient teach you to ensure they know what to expect.
5. PADSICLES. I had my mom make these for me and they saved me. http://www.tallmomtinybaby.com/2014/07/padsicles-carefree-way-to-survive-birth.html?showComment=1406039146764&m=1#c4443844392759899903
Whoa. I’m a freaking fourth year med student having my first kid and I didn’t know some of this stuff!
Sorry to reblog this monster but YUP even as a med student I didn’t realize a LOT of what was happening. Amen @adenosinetriesphosphate - “when you are sick you forget everything.”
If I wasn’t so depleted and exhausted from labor and from trying to start breastfeeding, I would have figured out sooner that it wasn’t normal to have intermittent shaking chills, fevers, night sweats, nausea/vomiting, and contraction-level cramps. When I finally dragged myself back to the OB at 3 weeks postpartum (after lying in the fetal position unable to move during a weight check at the pediatrician's office) turns out I had endometritis from retained placenta. Oops! Once I was on antibiotics I felt SLIGHTLY more human and was able to realize how truly sick I had been. Even my med school friends who had come by to see the baby remembered me ashen gray, lying under a blanket on the couch, not wanting to eat anything, and just thought I was tired.
Also: I’ve said it before, and I’ll say it again. Miralax. Colace. Prune Juice. Repeat PRN. There’s nothing scarier than when you start to poop again after tearing a giant rip through your vaginal wall.
Have you experienced sexism in medicine?
Uh, nothing big, just your average stuff all women in medicine get:
patients assuming I’m a nurse because I’m female
being called honey / darlin / sweetheart / my first name / “lady doctor” when my male colleagues are called Sir or Doctor
getting frowns from my patients when I tell them I’m not married and don’t have children
being told I should smile more
Notice it’s all from patients who likely don’t know better. I don’t remember ever experiencing any sexism from colleagues or attendings. I know it happens though, because I’ve heard other peoples’ experiences.
Other Ladies of Medblr: what experiences have you had?
Constantly being asked what nursing school I go to.
Being asked when I’m going to manage to have and raise kids.
Being told I don’t look like a lady in my white coat.
Being asked if I’m going into Obgyn.
Being called a nurse when being spoken about to the rest of the team.
People assuming I’m good with kids- that’s a personal trait, not a girl thing.
Getting inappropriate comments from male patients of all ages after puberty.
Having nurses and doctors call me sweetie and honey. It’s not ok when you don’t also call my male partner “sugar”.
Being told to go to nursing school instead when I was applying to medschool. Being addressed as “sister” (a.k.a nurse) and being asked when the “doctor” will arrive. Being told by the surgical consultant who I used to admire that surgery is not a speciality for women and I should think about Family Medicine. Relatives assuming that I will obviously be doing OBG after internship. Being told by a fellow female intern that women make rubbish surgeons.
Fellow student in my anatomy group addressing me and the other female student as “bitches” and not understanding how sexist and unprofessional it is.
Introducing myself as doctor, finishing an entire admission history, physical, and plan, then asking when the doctor would be in.
While on medical school telling someone I was in medical school and being told not to call nursing school medical school.
Walking out of a room after doing a splint and being stopped by a tech asking if I knew when the doctor would be done and then staring me in disbelief when I said I was the doctor and I was done.
Walking into a room and introducing myself, shaking a mother’s hand and hearing her say into the phone “no I can keep talking, its just some nurse.” (Bonus points for being offensive to both female doctors and all nurses everywhere).
Parents who say “no offense, but do you have children?” As if my status as a parent affects my ability to practice medicine when my male colleagues never get asked.
Calling a consult who asks why a doctor isn’t calling.
@wayfaringmd do you think with more women doctors and more male nurses that sexism in medicine could end or at least be stifled?
I don’t think that having more female doctors and male nurses alone will fix things. Change will come once patients learn that anyone in the hospital can have any job.
And once people see women having careers and caring for their families and women who don’t want families living fulfilled lives.
And once people see men prioritizing family the way women have traditionally been expected to.
And once maternity/paternity leave becomes valued in our workplace.
And once men speak up for and support their female colleagues who are subjected to sexist comments and attitudes.
And once people’s eyes are opened to their own individual sexist attitudes and actions.
And once women understand and reject internalized misogyny.
And
And
And
Nothing I say is going to be new. But I think that it bears repeating and strengthening the message. Sexism in medicine is real. It is happening every day.
-being called nurse despite having a BRIGHT RED ID ON MY CHEST that says DOCTOR in capital letters. Our nurses have BRIGHT BLUE IDs that say NURSE in capital letters so there is legitimately no excuse if they are literate and have no eye problems.
-being interrupted, cut-off, or ignored far more often than my male colleagues
-having to call in my male seniors when nurses or other personnel refuse to follow my recommendations or written orders
-being told I’m “sacrificing a lot” “not being family-oriented” “when will you start a family?” “don’t you feel sad?” when my fellow single male colleagues are applauded for being “career-minded” “going for their dreams” “hustling like a boss”
-having to hide the fact that I’m an MD when I go out on dates because I’ve had SO many experiences of men immediately saying something negative such as “oh you must be a hardass” or “damn you didn’t sound that intimidating when we were texting” or some stupid sexy-doctor joke
-frequently being asked “so how does your husband feel about you being a doctor?” even though I am SINGLE and any husband of mine will be proud of me
-being told I was ‘over-reacting’ when I reported a sleazy attending when tried to grab my butt and made suggestive comments when I was a first year med student
-being hit on DURING an interview by the interviewee
-always having to refer to myself as “Dr. md-a” to get equal respect as my male colleagues who get away by being called their first names
-didn’t happen to me but here’s some other fun things that have happened to my female colleagues: having their boobs grabbed, butts slapped, called “honey”, “baby” “babe” “sweetie” “girl”, being called “Doctor Barbie” because she was tall and blonde, being told “you’re too pretty to be a doctor” having an interest in ortho surgery questioned because “you’re just kind of small to go into ortho, aren’t you?”
-being shamed in front of the attendings and residents at neuro clinic by the neuro chief for excusing myself for really bad period cramps “just pop a motrin like the other girls.” Luckily, when I reported this to the internal med chiefs they were livid (they are all dudes, and they stood up for me. Which I will forever appreciate.)
Bonus points to the man who tells me that “sexy doctor” isn’t on his fantasy list because “you’re sexy on your own, not because you’re going to be a doctor.” Double bonus points to the man who is proud of me for what I’m doing and how hard I work to do it, and doesn’t care that his education level and paycheck won’t match mine.
Triple bonus points to me for not punching every other guy I’ve ever dated for either fetishizing or doubting my abilities and future title.
I can’t begin to list the things I have experienced since I started med school and these ladies have done a fine job of listing almost everything.
Sexism is real and it exists in medicine, too. I have seen people I had the highest regard for say or do something which was outright ignorant. It doesn’t matter if they’re male of female, med student or a professor or a PhD, just doesn’t matter.
I am told “you can’t change it, it just exists in our society/city/country/world”. But change begins with you, and I am a firm believer in this. We can begin by educating ourselves on what is sexist and what isn’t and why, spread that information amongst our peers and people we meet everyday. We can do something, I know it.
I get touched by men a lot. Like on the back or arm or hand.
Being a pregnant med student has been…. An experience.
Most of the experiences above too. It gets old really fast. Some specialties were worse than others.
Everything I have to add has already been said.
My favorite is when I say I’m a medical student and people assume that I’m going to be a nurse.
Or when I tell people I don’t want to do neurosurgery anymore and I’m going into OBGYN and the response is that at least I’ll have time for a family!
December 19, the year of our Lord 2015
The day that my toddler revealed she knows the word “shit,” and likes to practice it loudly and repetitively.
Ugh, shut up, Rebecca.
Going to a surgery conference next month to present some research and the conference organizers just emailed about the annual competitive dodgeball tournament being held on the last night of the conference.
I’m on my fourth city this week, and I keep forgetting where I am. Not good. I am not meant for extended travel. One more interview until I get to go home to my puppy and bed for the weekend. And then do it all over again next week.
THIS.
The number of times I’ve been confused about what city I’m in are too high to count. I’ve also forgotten what day it is – and even what time zone I’m currently in.
Interview season is a serious trip.
In the course of a single conversation at an interview today I forgot what city I was in and the name of the person I was talking to (a friend who I have known for 5+ years).
Remember when one of your tumblr friends used to post asking for advice or recommendations? Like, what book should I read? And then you would click the notes and see what all your other tumblr friends had suggested?
Or when you would look at the notes on a friends posts and notice that someone else had said something really funny in the replies? So you went and looked at their tumblr and decided to follow them?
These things are dead and it’s sad.
@david
@staff, the paper airplane button isn’t a fix. We want to see replies ON the post. We want to see what other people are saying. Come on. Get it together.
@staff
#bringbackreplies
Is there a doctor on board?
Yesterday I had my first “is there a doctor on board the plane?” moment (on the way home from a residency interview, of course).
A flight attendant made the announcement and it took me a second or two to realize, oh, crap, I’m 6 months away from being a doctor and might be the only health professional on this plane. So I rang my call button while visions of me doing chest compressions in the aisle as the plane made an emergency landing in Topeka ran through my head.
Thankfully it was nothing serious -- a woman had fainted but she was totally fine. I checked her out (briefly), reassured her (and the flight attendants), and went back to my seat to continue watching Magic Mike XXL.
Putting on the white coat for the first time has become a rite of passage for medical students. Now some doctors want to retire white coats, despite their symbolism, because they might spread germs.
To white coat, or not to white coat?
Thoughts on this, fellow Medblrs?
I hate wearing a white coat. I haven’t worn one since I started in my new practice, both because I get too hot wearing it, and because I like to be a bit more casual with my patients. When I do wear one, it’s because I need the pockets or because I’m doing something messy and want protection, but even still, I generally roll up the sleeves. But my partner and my patients seem to prefer for us to wear a coat, so I may start wearing the one I bought recently. Most likely I’ll only wear it if I’m cold or if I dressed a bit too casually and need to swank things up a little.
What we really need is some sort of fanny pack for doctors. I just need something with some pockets. Lord knows the tiny lil pockets on women’s dress pants are useless.
Fanny packs for doctors need to be a thing. No one in peds wears white coats but where do you put your patient lists, phone(s), pager(s), pens, emergency granola bar, and Chapstick?
Plus I have seen WAY too many residents (and some attendings, shudder) doing the "pager clipped to the top of your boot" look, which, please just murder me on sight if I ever do.