Trannies, Brought to You by...the Feds!

Anesthesiology elective at the VA: We're in the OR, and the next surgery is a bilateral breast augmentation...the patient is a male-to-female transgender currently on hormones.

Within the span of just one hour, the plastic surgeons give the patient some fabulous 330cc silicone breast implants (a C cup in non-medical speak). The patient had requested the 450cc implants (a D cup), but his/her anatomy didn't allow for implants of that size to be inserted. It was difficult enough getting the 330cc ones in.
[plastic surgery intern: Why don't you just make the incision bigger?
senior resident: Because then we wouldn't be plastic surgeons!]

As the surgeons are completing their closing sutures, various nurses and doctors keep sneaking into the OR to peek at the final product. A scrub tech gently squeezes one of the newly structured breasts to get a sense of the texture. Transferring the still-anesthetized patient onto the guerney, some of the staff note his/her hot pink panties; they peek underneath the panties to reveal a very well done gender reassignment genital surgery.

Imagine, the feds are actually footing the bill for this stuff! Who says the government doesn't take care of its veterans...

Mucho Mucho Dolor

You do not know the true meaning of pain until you find yourself in the middle of a subinternship in the high risk obstetrics ward at a posh private hospital. Imagine your chief resident is a puffy-faced fascist named Satin (he pronounces it sa-TEEN, you prefer to pronounce it satan) who revels in terrorizing medical students. Your patients are upper crust ladies on complete bedrest, seething with hormones, bellies growing with multiple gestations courtesy of in vitro fertilization. They bring their own private masseuse, pedicurist, manicurist, gourmet chef. They hate you. They demand to know why you and the nurses keep barging into their rooms to take vital signs, manage fetal monitoring, check on their preterm contractions [Newsflash: This is a hospital]. You are looking at your watch and counting down the days until graduation.

Someone comes into labor & delivery, insistent on having a Silent Birth. Scientologist? Perhaps, but after 20+ hours of failure to progress, what she ended up with was a Silent Caesarean Section.

Eggs on Toast

Two jumbo grade AA eggs were prepped and draped in the usual sterile fashion. The eggshells were cracked against the rim of a 0.75 quart stainless steel mixing bowl, releasing the albumin and yolk directly into the bowl.

Albumin and yolk were beaten until frothy with an 8" stainless steel whisk, then poured into a warmed and oiled 11" cast iron skillet. The eggs were scrambled until fluffy, then sutured to a waiting slice of freshly buttered toast using a horizontal mattress stitch with 3-0 absorbable chromic gut. Meticulous hemostasis was obtained. Salt was then applied. The eggs tolerated the procedure well.

Dish towel, spatula, and knife counts were correct x2.

Let Me Clinically Evaluate You

What It Says: This student completed a 4-week clerkship on our service. Her performance was satisfactory.

What It Really Means: Was this the short one, the one with glasses, or the one who attended every conference where food was served? I don't recall spending more than 5 minutes with any of those pesky med students...

What It Says: The student was attentive during rounds. Her fund of knowledge was average.

What It Really Means: Where's my Rolex? Did it fall into the surgical field during that last exploratory laparotomy?

What It Says: Her attitude and enthusiasm need to improve. She certainly would have learned more if she had read more.

What It Really Means: All this writing is making me hungry. Where's that steak I ordered?

Evil Mollusk Has 2 Pimps

One of the mainstays of medical education is a process colloquially known as pimping.

There is good pimping and bad pimping. In my unscientific, unrandomized, and noncontrolled trials thus far, the bad pimps seem to outnumber the good pimps by 3 to 1.

Good pimping: Your pimp asks you questions with the intention to teach, helps you hone your critical thinking skills, broadens your understanding, helps you realize you know more than you suspect. You learn to approach relevant medical questions systematically with purpose and focus.
Example: Right after the baby has been delivered, umbilical cord clamped & cut
Question: What are some signs that the placenta is ready to come out? Answer: There's a gush of blood...the umbilical cord becomes easier to pull...
Question: Why would the uterus feel globular at this time? Answer: It's contracting in order to dislodge the placenta.
Question: Why is it important to apply suprapubic pressure while pulling on the umbilical cord? Answer: To prevent the uterus from inverting as the placenta comes out.

Bad pimping: Your pimp asks you questions to humiliate or fluster you, or to show off how much they know. They rattle off a barrage of random and obscure questions that are not helpful.
Example: a neurologist who favors flagrantly esoteric questions about rabbit experiments that are in no way related to the patient you are discussing.
Question: In the seminal [insert name of famous neuroscientist] experiment of 1974 in which EEGs of rabbits were recorded, what was the most common waveform? Answer:Uh...with all due respect, sir, most of my patients are humans.

Holy Carnivorous Cajuns, Batman!

Scene 1:
I'm all dolled up in a sterile gown and my size 6-1/2 sterile gloves. It's the first time I get to use a scalpel (#15 blade), a bovie (for electrocautery), and sutures (3-0 chromic gut with tapered needle) all in one procedure. And the body part in front of me is...a PENIS!

A collective shudder is palpable among the males in the OR. Our 45-year-old patient requires a circumcision because he has developed phimosis & cannot get his foreskin to pull back.

Male scrub nurse: I'm so glad my parents had me circumcised when I was a baby!
Male urology resident: Ditto for me!

Scene 2:
The patient is resting in the recovery room.
Urology resident: The procedure went very well, and you'll be healing nicely in the next couple of weeks.
Patient: Did you make it bigger?
Me: That costs more!

He nicked The Ureter

In the realm of gyn surgery, The Ureter takes on almost mystical significance: Muscular tube just 3 millimeters in diameter! Propels urine from kidney to bladder! Runs precariously close to the uterus! The Ureter can easily be nicked by an overzealous surgeon during procedures such as hysterectomy.

I can't think of a single intraabdominally-approached gyn surgery in which an attending did not pointedly remark, "Look, [insert medical student's name], there's The Ureter".

Enter Dr. Austin Powers, International Man of Self-Aggrandisement. All pimped out in wool crepe trousers decked with sky blue pinstripes matching the precise hue of his Egyptian cotton shirt. Pimp Daddy. Pimpmeister. Pimp-o-rama-ain't-no-drama-wit'-yo'-mama. But I digress.

Long story short: he nicked The Ureter. No one said a word. If a resident or an intern had committed this folly, there would have been sharp reprimand and serious retribution. Instead, a SWAT team of urologists descended upon the OR and everyone donned lead-lined vests for the fluoroscopy-guided repair.

There was no further mention of the incident with The Ureter. His lecture on female pelvic anatomy was subsequently cancelled. Rather fortunate for me, as I would most likely have succumbed to my irrepressible urge to display this:

Contaminated

"You're contaminated!" says the OR nurse as my double-gloved fingertip accidentally wanders one centimeter south of the top surface of the operating table. She banishes me from the OR and I am relegated back to the scrub sink, destined to begin the elaborate scrub ritual once again. I start cackling inexplicably as I recall a streaming instructional video detailing the mysterious nuances involved in staving off contamination before surgery. You start with the requisite scrub brush, hermetically sealed in a little plastic package and permeated with the industrial cleaning solvent of your choice: povodine iodine, extra foamy soap, or the strange red stuff that resembles sweet & sour sauce. After scraping under each fingernail with the plastic stick, you scrub the tips of your fingers with the brush side (30 circular motions for each hand). Only then can you advance to the spongy side and start the serious scrubbing.

There is something uncommonly obsessive-compulsive about surgical scrubbing. Each finger has 4 planes, and each plane must be scrubbed 20 times. The palm of your hand has 3 planes, each of which must be scrubbed 10 times. Your forearm is divided into 3 parts, each of which is also scrubbed 10 times. Is the American Psychiatric Association aware that surgical scrubbing falls under the definition of compulsions as repetitive behaviors (e.g. handwashing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly?

I am tempted to make an anonymous phone call (handkerchief placed over my mouth in order to disguise my voice) to the Obsessive-Compulsive Disorder Police to turn these people in. For the sake of their mental health, of course.

"You're contaminated!" says the OR nurse as my double-gloved fingertip accidentally wanders close to the imaginary line extending from the sterile blue drape behind which the anesthesiologist is seated.

Bite me.