It is your destiny...

Ouch

2010-08-23T20:55:00.001-07:00

The tragic, but darkly humorous, consequences of slipping while trying to jump a wrought-iron fence.

Another one

2010-01-10T19:09:00.000-08:00

This is another wild and crazy image from the radiology department. This comes from a patient who had a collapsed vertebral body in the thoracic spine. The patient had previously had surgery to repair an aortic aneurysm - the dotted circle is a cross-section of the prosthetic aortic graft. The big grey thing in front of the dotted white circle is the heart.

The needle enters the collapsed vertebral body. We took samples to look for evidence of infection or tumor. In this case, the bone was not so much a sheet of bone as a bunch of bony fragments held loosely together with inflammatory tissue, so it was easy to get the needle through. Had the bone been more solid, we would have used a bigger needle and a mallet.

You can see the spinal cord unusually well - it is the darker area within the lighter area of the spinal canal, looking almost like an eye. This is not what the spinal cord normally looks like on a CT; usually the spinal cord and the fluid surrounding it are nearly identical in color. But, this patient had a myelogram prior to the procedure, in which we do a spinal tap and inject material that shows up well on x-rays. Thus, on this image we get a really good shot of the spinal cord.

Not just a pretty picture!

2010-01-08T20:41:00.000-08:00

For those who think that radiologists sit around all day looking at pictures, I invite you to consider the attached picture. This is a patient who had a mass in her neck just behind her throat. This is what I did to get a piece of it: under CT guidance, I stuck a needle through her cheek down to the back of her throat just in front of her spine. The following is one of the images from the procedure. It is a slice through the patient's head.

Note that the carotid artery is directly adjacent to the mass. This is not an activity for the faint of heart or the weak of sphincter.

Food for thought

2009-12-16T11:25:00.001-08:00

A sad commentary from a nurse's assessment of a patient in her 60s who is 5'6" and weighs over 400 lbs:

"Patient presents with a pannus that extends past her knees when standing." ("Pannus," for the uninitiated, refers to a roll of fat that hangs down from the abdomen over the lap. It comes from the Latin word for "apron," which is appropriate, though more than slightly disgusting.) "Patient is morbidly obese to the point that she cannot provide basic hygiene beyond washing her face. A strong foul odor fills her room and the surrounding hallway."

The strong foul odor comes from the flesh under her pannus, which is essentially rotting due to being constantly moist and dirty.

This is an example of the unfortunate effect of having easy access to a lot of cheap food that is bad for you. Everywhere else in the world, the poor are thin because they have no food. Here in the US, the poor are fat. And, the concomitant health problems that stem from the obesity epidemic are having and will continue to have serious effects on the cost of health care.

The CDC reports, to nobody's surprise, that the average BMI in the US has increased since 1960 for both men and women from 25 to 28 (click here for the report).

With that appetizing image in mind, Merry Christmas! See you at the salad bar...

Red Ryder

2009-11-28T09:49:00.000-08:00

This young man didn't listen when his mother warned him what would happen if he got that BB gun - that he would shoot his eye out.

Fortunately, his vision is still intact, and it doesn't look like his eyeball was penetrated. He does have some retinal hemorrhage, which will hopefully resolve.

Family togetherness at Thanksgiving

2009-11-27T00:26:00.001-08:00

"Patient presents to the Emergency Department with mouth pain after an argument with his sister during which she hit him in the mouth with a bottle. His right three front teeth are chipped. The patient is tearful, but more upset about his appearance than the pain. He admits to drinking alcohol tonight."

Don Juan

2009-11-26T06:35:00.000-08:00

"27-year old patient jumped from a window onto a balcony below when he heard his girlfriend's dad's voice coming to the bedroom." Don Juan here barely even qualifies as young - though his girlfriend still lives at home, so she may be. He broke his ankle very badly on that jump, which is no less than he deserves, the cad. The ten shots of vodka he drank doubtlessly affected his balance.

Am I My Brother's Keeper?

2009-11-23T03:03:00.000-08:00

This patient's brother won their argument in dramatic fashion. Youch!

Unbelievable...

2009-11-23T02:51:00.001-08:00

This is another history from my favorite type of patient:

"Patient in his 40's who 'accidentally' ingested Drano that he thought was alcohol."

And another:

"Woman with psychiatric history was visiting her boyfriend in the ER when she became aggressive and loud, yelling at the nurses, and was placed on a 5150 hold by the Sacramento Police Department."

For the uninitiated, a 5150 hold refers to the section of the California Welfare and Institutions Code that allows a policeman or clinician to place a person under involuntary confinement for up to 72 hours. The person has to be a danger to him or her self, and/or others and/or gravely disabled.

Her boyfriend was a patient in the ER as well, by the way. I am not sure what his issue is. He is probably not the guy who drank the Drano, though.

Crush

2009-11-22T21:46:00.000-08:00

Ouch! This poor guy got his hand caught in some industrial machinery. Be careful out there!

Season's Greetings

2009-10-31T00:00:00.000-07:00

This is the position in which this poor patient's hands are fixed, which is what happens when rheumatoid arthritis is poorly controlled.

High four!

2009-10-05T15:47:00.000-07:00

Give me five!...er, four!

Car vs. house

2009-10-04T15:34:00.001-07:00

This is what can happen when the car you are joyriding in runs into a house while you are running from the police.

One of these hips is not like the other. The head of the patient's right femur (the one on the left of the image) is inside the pelvis, which is, as you might imagine, a suboptimal location for the femur.

It turned out that the patient was bleeding extensively from the left side of his pelvis, and needed the arteries that were bleeding blocked off. This was done by feeding a small tube through an artery in the right groin, putting the tube into the artery that was bleeding, then putting metal coils and small fragments of material that encourages clotting into the artery.

Two thumbs up

2009-10-03T11:59:00.000-07:00

Self-explanatory title for this post.

One of the many weird skeletal malformations that can occur.

Subtle Finding

2009-08-30T18:54:00.000-07:00

This is something subtle I saw the other day:

Now - the question is this: does this patient have arthritis? Those joint spaces look a little narrow.

Har! I kid. Who cares about the joint spaces - what the heck is that thing on the patient's thumb?!

Answer: This is a squamous cell tumor. The patient initially noticed a small spot on her thumb several years ago, and went to a doctor. The doctor cut off the lesion and pronounced the patient cured. Unfortunately, the lesion slowly grew back over three years or so, and the patient did nothing about it, even though it was so huge, ulcerated and disgusting that she was unable to use her left hand. The thing also wept fluid; she had to keep it covered so it wouldn't stain her clothes, tablecloth, furniture, etc.

Ultimately she had the thumb amputated. They are looking at using one of her toes to give her a replacement thumb, since having an opposable digit is such a nice feature of the human hand. I am excited to see the radiographs of that. If I see those images, rest assured that they will show up here, as well.

In the meantime, remember that you need to follow up on things. If you have something cut off your skin and it just doesn't look right afterward - for example, if it grows to the size and shape of a potato - get it checked out.

Recurring theme

2009-02-22T12:34:00.000-08:00

In keeping with the recent theme of this blog, here is another case I saw today.

A 44-year old man who had been in a motor vehicle accident in which he suffered severe brain damage - with consequent developmental delay - came in after being "found down" in the street. The medical record provides an understated description of what I am sure was an impressively squalid appearance:

"A 44-year-old gentleman who came in after being found on the street... Patient fidgety and agitated... [patient] states he was trying to get home and 'decided to crawl'... Patient stated he wanted the police to give him a ride home. He was somewhat confused and disheveled... Drinks alcohol on occasion. Has a history of IV drug abuse... In general, he is a somewhat disheveled gentleman covered with dirt [who is] not wearing any socks or shirt on a rainy day."

He complained of pain that worsened when he stood up. Urine testing showed that he had a raging urinary tract infection.

We got X-rays of his pelvis, which showed the following from the front:

from the side with the patient on his side:

and from the side with the patient on his back:

There are a few interesting things to note from this exam:
1. 4 round bright white things in the middle of the pelvis on the frontal view that change position on the view with the patient on his side and move to the back of the pelvis in the side view taken with the patient on his back. This suggests that those 4 round things are inside the bladder, and are rolling to whatever part of the bladder is closest to the center of the earth.
2. A large gray round thing in the pelvis that probably represents a large fluid-filled bladder.
3. Multiple round bright white things that project in the place where we would expect to find the urethra.
4. Plates and screws in the bones of the pelvis - mementos of the patient's previous auto accident.

Seeing all these things, I let the ER know that this guy had metallic foreign bodies in his urethra that are obstructing his bladder. Some of the metallic foreign bodies are actually inside his bladder.

On further questioning, it turns out that this guy had, for reasons that are unclear, put magnets up his urethra.

I guess he was bored, and didn't have a pencil.

Urology was called, and they tried to remove the metallic foreign bodies in the ER, though according to the medical record, they "[had] some difficulty." They took the patient to the operating room for definitive treatment with an endoscope.

And, for the record, this is the same guy who dropped all the eggnog in my last post.

Snort, chuckle, snort

2009-02-13T14:20:00.000-08:00

This is a classic case. This man came in after doing something stupid while intoxicated on cocaine. Can you guess what stupid thing he did, and where?

Physician's prayer

2008-12-28T16:43:00.001-08:00

Sir Dr. Robert Hutchison's Physician's Prayer
— written on the walls of Children's Hospital, London

" From inability to leave well enough alone,
From too much zeal for the new and contempt for what is old,
From putting knowledge before wisdom,
Science before art and cleverness before common sense,

From treating patients as cases, and from making the cure of the disease
more grievous than the endurance of the same.

Good Lord, deliver us."

Get bent

2008-12-13T19:59:00.001-08:00

This is an unfortunate gentleman who had a previous femur fracture that got fixed with a rod down the middle of the bone. He got hit by a car a few years afterwards and bent the rod.

Fashion Statement

2008-11-04T17:46:00.001-08:00

This is not a fashion statement. This is what can happen when your nail gun ricochets.

Season's Greetings

2008-10-28T13:53:00.001-07:00

This reflects perception more than reality, but still funny.

Fun Story

2008-10-21T20:03:00.001-07:00

"21-yr old man who was in the passenger seat of a car arguing with his mother, who was driving at 35 mph. He became upset and demanded that she let him out of the car. When she refused, he opened the door and jumped out." He wound up fracturing his left elbow pretty badly. The bummer is that the interesting part of the story - what they were arguing ABOUT - may never be known.

Road warrior

2008-09-24T17:51:00.001-07:00

For those who haven't heard, I have been riding my bike to and from work - about 10 miles each way - for the past couple of weeks. I have loved it - I feel like I get good exercise, I have felt invigorated when I get to work and when I get home, and have felt like my thighs are each getting to be the size of my waist.

Well, all that has come to a crashing halt. I was riding my bike home last night, and got in a wreck.

The way it happened was this: I was riding home on a relatively low-traffic road in Sacramento. I came to an intersection where the cross street had a stop sign and I did not. A lady in a late-model Mercedes stopped at the stop sign, glanced both ways, did not see me, and pulled out in front of me. I hadn't planned to stop, since I had the right-of-way. Despite slamming on the brakes, I ran into the side of her car on the driver's side.

My bike tore the driver's side rear-view mirror off the car and made a big dent in the driver's side fender. I flew off the bike, landed on the hood, then rolled off onto the ground in front of the car, taking off the hood ornament on my way. I was glad she stopped - she could have run me over.

I got up slowly, and had the following injuries, some of which are seen in the picture, though Amy points out that the picture does not do my road rash or the gauges in my fingers justice:

- Scrapes on the middle, ring, and small fingers of the right hand.
- A large road rash across my right forearm.
- A swollen, scraped right shoulder right at the point of the bones at the top of the shoulder.
- Two small scrapes across my right forearm.
- A swollen scrape across my left forearm.
- A scrape across the back of my left upper arm.
- A scraped, bruised right knee.

I also have a scraped and dented helmet, and a sore ego (as well as a sore bottom).

Thinking back, I realize that I don't remember visual images of the whole accident. I remember thinking "Oh no! I'm going to hit that car!" and yelling out loud "Noooo!" Then, I have the recollection of a series of thumps (probably me flying onto, then rolling down the hood) and a bigger thump as I landed on my right side on the ground.

Another bicyclist who had seen the accident stopped and gave me her business card, in case I need to get corroboration for my story.

The lady felt awful - she was more shaken than I was, as might be expected for one who has seen a grown man go flying across the hood of her car. She called her husband, who courteously brought his pickup truck and gave me and my somewhat-worse-for-wear bike a ride back home.

When we arrived, a troop of worried girls came out to greet me. My three-year old wore a grave expression, and kept coming up to point at my bleeding knee with both terror and fascination. My wife reports that she has been perseverating about her daddy, repeating over and over that "Daddy has big owies!" and looking out the window for me.

My wife gave me the "I told you so" look when I got home. She has never felt safe about me riding a bike, and now feels vindicated and upset that I didn't listen to her warnings. I feel wretched, but not nearly as wretched as I would have felt if I were paralyzed or dead.

I showed up to work the next day, showing off my bruises and scrapes (and kind of enjoying the attention - this story gets better every time I tell it). My father-in-law, attorney that he is, points out that I am not being a very good client - I should have stayed home, with my neck in a soft collar, moaning and groaning.

I think my days as a road warrior are over. Like Chief Joseph of the Nez Perce, "I will fight no more forever."

Stories

2008-09-06T02:20:00.000-07:00

Best story from today:

"67 y/o woman fell down at home and was unable to get up. When her family came to help her, the family dog, a pit bull, bit her on the face."

Some guys have all the luck

2008-09-01T16:50:00.000-07:00

This 19-year old man was "minding his own business" when he heard four gunshots and felt sharp pain across the front of his chest. He saw some small wounds on either side of his chest, and drove himself to the hospital.

His blood pressure and pulse remained normal. He had no trouble breathing.

A CT of his chest showed the following:

The dark spots across the front of his chest are specks of air in his pectoralis major muscles. There were skin defects at the upper right and left chest, but no other injuries. Basically, the bullet did the following, missing everything else important:

Histories

2008-08-31T19:46:00.000-07:00

My favorite histories from the ER today:

"23-year old man who arrived at a party and shot several of the partygoers. The other partygoers responded by assaulting him, beating him about the head, chest and abdomen with hockey sticks and cricket bats."

"36-year old man who was attempting to shoplift some alcohol from a liquor store when another patron tackled him. He presented after he fainted while in police custody."

Yup, those are my patients!

Anti-smoking ads

2008-08-30T21:01:00.001-07:00

These are some of the most clever advertisements I have ever seen:

Singing Cowboy

Focus on the Positive

Miscarriages

Hitchhiker

Knife and Gun Club

2008-08-21T18:35:00.001-07:00

When I am working in the Emergency Department, I see the CT scans and X-rays of nearly every injury that comes into the hospital. I am getting really discouraged by the superabundance of some specific injuries:

Gunshot wounds to the spine. Way too many teenagers and young adults are forever paralyzed from the neck or mid-chest down as a result of careless or, more likely, malicious people shooting them. I'm not sure what these patients were doing to induce others to shoot them, and I really don't care that much. Although I am sure that a significant proportion of those who are shot were engaged in illegal activities at or shortly before the time they were shot, it doesn't make me feel any better about these patients whose lives are now infinitely harder than they would otherwise have been.

To wit, they will, for the rest of their lives, have no bowel or bladder control. They will need surgery to enable them to put catheters into their own bladders or to divert their urine into a hole on their abdomen so that it can be collected in a bag. They will either need surgery to divert their feces into a colostomy or will need their diapers changed for the rest of their lives.

Of course, they also will be unable to move independently for the rest of their lives.

I am further disgusted that these patients are now wards of the state. You and I, the taxpayers, are and will be paying for the lifelong care of these patients - for both the cost of their surgeries and the salaries of those who change their diapers and roll them around in bed. It sickens me that these patients are only unable to care for themselves because some other person made a rash and/or evil decision to pull the trigger of a gun.
Gunshot wounds in general. Way too many people get shot around here. Gunshot wounds are devastating injuries, shattering bones and organs alike, and causing all kinds of mayhem. While many people survive their injuries, those who get shot in the head tend not to.
Motorcycle accidents. These are a touchy subject for many motorcycle aficionados, but let's get real - every day I see horrible injuries sustained by people who are doing innocuous things on a motorcycle. For example, this man was riding his motorcycle at 10 miles per hour.

He got clipped by a car, which shattered his left foot. He had to have his leg amputated below the knee.

No matter whose fault it is, a motorcycle accident will always leave the motorcyclist in a world of hurt.
Lung Cancer. This is another subject that gets me somewhat upset. Way, way too many people are dying early because of smoking and its deleterious effects. Take, for example, this woman. An ordinary chest CT would have lungs on both sides of the chest, with the heart on the patient's left.

This woman's heart has been displaced into the right side of the chest by this enormous aggressive mass that replaces pretty much her entire left lung.

It is also making its way out of the chest cavity by bulging out between the ribs. What a crummy way to die.

Anyway, those are four of the most preventable problems in our society, and we see far too much of them. I wish, like Alma, that I could cry repentance with the voice of thunder, that all men everywhere might repent, that there might not be more sorrow upon all the face of the earth.

EtOH

2008-08-10T15:40:00.000-07:00

After an experience I had the other day, my conviction that alcohol is not for the body and not good for man is much stronger.

I was reading CT scans from the emergency room, and a young man came in who had been backed over by a slow-moving car. His pelvis was smashed to smithereens, and he suffered facial fractures.

I was chatting with some of my associates about how he could have sustained such an injury, when it occurred to me to ask if his blood alcohol level had been measured when he came to the ER. It was twice the legal driving limit. I am sanguine that the blood alcohol level of the driver that backed over him was also quite high.

The next patient was a man who had fallen off his bicycle while attempting to get on it. Passersby noticed that he was struggling to get up and summoned the police, who brought him to the hospital. His alcohol level was 4 times the legal limit.

The next patient had been assaulted and stabbed. He was also drunk.

For the next several patients, I inquired as to the alcohol level of the patient. Every one of them had been too drunk to legally drive when they arrived in the emergency room - meaning that their blood alcohol level when they were injured was even higher.

Now, there could be a number of confounding factors in this sample; perhaps the emergency room has a lower threshold for ordering CT scans on drunk patients because the physical exam is less reliable, or maybe it was random chance. However, it is clear based on my experience that being drunk is a risk factor for being irradiated if you go to the emergency department. I would also suggest that, based on the mechanisms of the injuries I described above, being drunk is a risk factor for being injured.

So unless you want me to see some really embarrassing pictures of your insides, it's best not to drink alcohol in Sacramento or its environs.

I like the looks of these

2008-06-07T21:46:00.001-07:00

bakingsheet: SHF #7: Graham Crackers

Homemade Graham Crackers
1/2 cup all-purpose flour
1 3/4 cups whole-wheat flour
1/2 cup sugar
1 teaspoon baking powder
1/2 teaspoon baking soda
1/2 teaspoon salt
1/4 teaspoon ground cinnamon
1/2 cup cold butter, cut into 1/2 inch cubes
2 tablespoons honey
2 tablespoon molasses
1/4 cup cold water
1 teaspoon vanilla extract

In a food processor, mix together the flours, sugar, baking powder, baking soda, salt, and cinnamon. Add the cold butter and process until the mixture resembles coarse meal, about 30 seconds or so. Add the honey, molasses, water, and vanilla. Mix until the dough startes to come together in a ball, another 30 seconds. Scrape dough out of the mixer.
Between 2 sheets of waxed or parchment paper, roll the dough 1/8-inch thick. Chill for at least 1 hour, until firm (I chilled for several hours).
Preheat oven to 350F. Retrieve dough and roll it a bit more if it is not yet 1/8-inch thick. With a sharp knife or pizza cutter, cut into 2-inch squares. Arrange the crackers on parchment lined baking sheets. With a toothpick, prick several holes in each cracker.
Bake for 15 minutes, until lightly browned at the edges. Remove from the oven and let cool on the pan.
Yield: 48 crackers

Note: If you cut the dough through but leave the squares together, you can break them up after they're baked, just like a store-bought graham!

Literal...

2008-05-14T10:23:00.001-07:00

Libby, my oldest, has the tendency all four-year-olds have of taking everything I tell her very literally. This sometimes has untoward consequences. A few weeks ago, we were heading to the library to check out some books and movies. We had not taken the girls in a while, so we were explaining the principles of appropriate library etiquette. Libby asked why we need to be quiet in the library. "Because," I replied, thinking quickly and trying to be clever, "if you aren't quiet the librarians tie you up."

"Why?" - of course, the standard response.

"Because there are people trying to study, and they need it to be quiet."

She nodded slowly, letting this idea sink in.

I forgot all about this conversation until last night, when, in celebration of my birthday, we went out to dinner, shopping, and finally to the library. It was very late (7:00) by the time we got there. The girls are usually being bathed by that time of day, and their ability to cope with stress was at a low ebb. Immediately the girls began fighting over the library computer, shrieking, and generally being naughty. Audrey had to be taken outside for an attitude adjustment within a few minutes, but she returned a tiny bit calmer and quieter.

Libby, not to be outdone, began screaming at the top of her lungs at Audrey a few minutes later. Amy had had it. She took Libby by the arm and marched her for the door. Libby, terrified, began yelling, "No! I don't want to be tied up!"

All heads turned toward Amy as she walked out the door, a determined look on her face, with a terrified, struggling child at her side. "Where on earth did Libby get that idea?" I wondered, still with no recollection of our prior conversation, and mortified that all the library patrons now believe that Amy and I punish our children by tying them up in the basement or something.

When we got home, Amy asked Libby why she had said what she did, and she said "Daddy told me they would tie me up." The recollection of our prior conversation came flooding back. Oops.

Amy glared at me. "You can't tell them things like that! You need to clear anything you tell the kids with me first."

I'm kidding about that last sentence, but I am sure that is what she is thinking.

Guns and coumadin don't mix

2008-05-11T13:59:00.000-07:00

This is a patient who came in after reportedly shooting himself in the forehead with a 25-caliber handgun. He was reportedly taking coumadin, an agent that is used to keep the blood from clotting.

Incredibly, when he arrived in the emergency room he was alert and conversant with the ER staff. They saw the entrance wound on his forehead, but couldn't find an exit wound.

The first image they took was an x-ray of the skull.

The white thing just at the level of the nose is the bullet. The little arrow on the forehead is a marker that the emergency room put on the patient to show where the entrance wound was. It also shows the skull fracture that ensued from the bullet wound.

When he became unresponsive, they rushed the patient to the CT scanner to get a better idea of what was going on in his head. This is what they found initially on the "scout radiograph" - the initial image they take to plan where they will take "slices" with the CT scanner.

This is a side view of the skull. Again, the dot on the forehead shows where the bullet entered the head. The bright thing in about the middle of the head is the bullet, which is embedded in the soft tissues at the back of the patient's mouth. The dark oblong shapes in the middle of the head should not be there - those are indicative of air within the space that should be filled with brain or cerebrospinal fluid.

This is a slice through the patient's head at the level of the forehead sloping back just above the ears. The black dots throughout the head are collections of air that are moving around within his shattered skull. The white rounded area near the top of the image is clot and blood within the brain, marking the path the bullet took as it went down through his forehead, through his nasal cavity, and down into the soft tissues at the back of his mouth.

This image shows the exact path that the bullet took. It is a side view through the head showing the wound (at the upper left of the image) with the bone fragments traveling diagonally downward until you get to the bullet (the bright rectangle at the bottom center of the image).

Suffice to say, this was a non-survivable injury and the patient soon succumbed to increased intracranial pressure - probably from bleeding into the space that should be holding his brain. Gross!

So much stuff!

2008-03-18T20:42:00.001-07:00

I came home from work the other day and started unloading the pockets of my scrubs onto the kitchen counter. My wife stared as I pulled out more and more things - it was reminiscent of the scene from Mary Poppins when Julie Andrews starts pulling potted plants and hat stands out of her carpet bag. Eventually, my wife shook her head and said, walking away, "you need a purse."

This is a picture of the things I carry on my person at all times. Clockwise from the top: my radiation badge (essentially a piece of Kodak film that gets tested every three months to see how much radiation I have been exposed to), my keys, my ID badge, my wallet, my cell phone, my pager, my little pre-inked stamper to put my name and ID number on orders that I write, and my car keys. In the middle are my iPod and pen.

Valentine's Daddy, part deux

2008-02-28T22:12:00.001-08:00

This is the letter I received in response to my last one:

February 20, 2008

On behalf of our President and CEO, thank you for your letter of February 15th regarding your recent shopping experience at our _____ Market on _____ Drive. We are pleased to know that you found the quality and price of your purchases favorable even though your check out experience was less than satisfactory.

We appreciate fully the concerns you expressed regarding the magazine covers displayed at the cash registers. While it is important for us as a retailer to offer a variety of magazines and other publications that represent our customers' diverse interests, it is also important for us to exercise good judgment in our display of such merchandise. As a standard practice, we offer a 'vanity' shield at all magazine display racks and ask our store directors to place the shield over magazines with questionable or prurient covers. Generally, our store directors do a very good job in shielding these covers but, as you know, this can oftentimes be a matter of subjectivity.

Your idea of having a family-friendly checkout aisle is a great one and continues to be an item of discussion in our business. In the meantime, we extend our apologies to you and your daughters and assure you we will ask our store directors to be more attentive to our display of magazines so that a visit to our stores is not an unpleasant one.

Sincerely, etc.

Valentine's Daddy

2008-02-16T17:06:00.000-08:00

This is a letter, slightly edited, that I sent to the CEO of one of the grocery stores where I shop regularly. Tell me what you think:

-----
Dear Sir:

I am a regular customer at the _____ store located in the _______ area. Yesterday – Valentine's Day – I went to that same store to purchase some last-minute items for my wife and for my two daughters. A couple of weeks earlier, I had brought my wife some flowers, and my daughters were excited that I might do the same for them.

I found a large and varied display of flowers, and was pleased with their quality and price. After getting a few other items, I went through the checkout stand and noticed, as I have many other times, that there are a number of magazines displayed near each checkout stand. The covers of most of these magazines are plastered with pictures of scantily clad women in alluring poses, many of which are frankly pornographic.

As I went through the checkout aisle, averting my eyes, I thought about an article I had read earlier that day about the harm done to women – particularly young women – when society convinces them that the most important attribute they can possess is "sexiness." I thought about the numerous times that I have brought my girls through those same checkout aisles and been embarrassed to have them see such exploitative photographs.

I hope to raise my girls in such a way that they will know their own inherent worth. It is not easy to teach this concept in any circumstance, but particularly difficult when objectification of women is so prominently – indeed, unavoidably – displayed.

Please make arrangements – such as removing the magazines from at least one checkout aisle in the store – that will make shopping more family-friendly. It occurs to me that having such a family-friendly checkout aisle in every one of your stores would be a valuable advertising advantage.

Sincerely, etc.

If you think you are having a bad day...

2008-01-27T12:59:00.001-08:00

This is one of a number of images of a patient that I saw in the emergency room the other day. That is, I saw the images. I did not actually see the patient, and I am kind of glad.

This 22-year old man allowed a homeless man to stay at his house. The patient had a disagreement with his guest - I have a sneaking suspicion that alcohol was involved in the disagreement, as the patient's blood alcohol level was twice the legal driving limit when he arrived at the hospital - but regardless of the cause, the homeless man shot the patient at close range with a small-caliber weapon. The patient presented complaining of being unable to see.

The attached image is from his CT scan. The marked circles are the approximate locations of his eyeballs; the arrow shows the path of the bullet. He had no injuries to his brain, but both eyeballs were shattered and full of air, blood, and bits of bone and metal.

Surgery revealed irreparable posterior eyeball lacerations with protruding tissue and multiple metallic fragments inside both eyeballs.

Whenever you feel like you are having a bad day, just remember that it could be worse - you could be this guy. I shudder to even look at these images.

Stick It!

2007-11-10T09:36:00.000-08:00

My dad just loves to give me grief about my belonephobia. With good reason; in grade school I fainted while touring a blood bank with my class.

A few years ago, while I was living at home, I figured I would show Dad a thing or two and get him to stop teasing me, so I went with him to donate blood. When we got to the donation center, I filled out the questionnaire about my health and personal habits, and was doing OK. Then, the lady pricked my finger and congratulated me on having enough iron in my blood to donate. I suddenly got the horrible sensation that my visual field was narrowing and got lightheaded. The lady, who was writing something on the sheet of paper, looked up and found me lying on the ground, my feet up on the chair, looking pale and sweaty.

The nurse ran back to where the actual donors were sitting and said "We have someone down on the ground out here!" My dad, who was already back there with a needle in his arm, immediately knew what was going on and burst into laughter. Apparently the experience made an impression on the donation center, because when my sister went there years later to donate blood, they remembered me and were very amused to learn that I was in medical school. Suffice to say that my Dad mentions this experience at every opportunity.

So, yesterday I figured I would exorcise the demons of phlebotomy from my system and donate blood at a church blood drive. I came armed with a book and determined that I would not look as they stuck me with the needle. I also warned everyone that I talked to - the secretary, the clerks, the other donors - that I have a history of vasovagal responses.

It was "Soup and Homemade Bread Night" at the church where they were holding the blood drive. I came, ate some bread, and filled out the same FDA-mandated paperwork about personal habits and health. When it came time to poke my finger, the pinprick was not that bad - probably because I was reading Freakonomics the book at the time and doing my best to ignore what was going on. They pronounced me fit, and it was time to get blood taken.

I warned the phlebotomist that she and I would both be happier if she just let me lie down. She laughed and said that she couldn't get the needle in my arm while I was lying down, but that she would tip my feet up as soon as the needle was in. She called another phlebotomist over to distract me while she put the needle in, and it was not as bad as I had been anticipating because I was busy ignoring it. She covered my arm with a sheet so that I couldn't see what was going on, and left me to my book with an admonition to let her know if I got lightheaded. I got through nineteen pages and learned about cheating in Sumo wrestling matches, and before I knew it we were done. She asked me which bandage I wanted on my arm - I chose tan because it matched the rest of my ensemble - then she pulled out the needle and we were done!

I stayed in the chair for a while reading, then got up and ate a lot of good soup - there was a butternut squash soup that was really good, as well as some chili and minestrone soup. After I had stayed for the requisite 15 minutes (they want to make sure the donors don't faint), I left. My first act was to call my dad and shamelessly gloat.

Medicine Man

2007-11-04T13:58:00.001-08:00

Yesterday my wife was sick with a urinary tract infection when I woke up. She was having burning with urination, and was feeling miserable. She took some pyridium, which is a local anesthetic that works on the urinary tract, and called her doctor for treatment. They had her go to the medical center to leave a urine sample, presumably so that they could check to make sure it was an infection and to get a culture of the bug. It took her almost three hours to get there, leave a urine sample, and get out, which seems to be an unreasonably long time for 20 seconds of actual peeing-in-a-cup time.

After she got home, we waited for several hours, then I finally called the hospital and asked if they were going to call in an antibiotic or what. The doctor called back and said yes, she has an infection for which she needs an antibiotic, so the doctor called our designated pharmacy with a prescription. A Rite Aid pharmacy called us shortly after we talked to the doctor and asked to confirm my wife's information, which we thought was a little odd, since she had filled prescriptions there before.

When I showed up at the pharmacy, the clerk said that they had received no prescriptions for anyone of my wife's name. I asked the pharmacy clerk if they were sure that there was no prescription called in to Rite Aid, since we had gotten a call from someone who claimed to be a Rite Aid employee; the clerk - somewhat snippily - said "positively not - our computer systems are all linked together, so we would know if another store had filled it."

I called the hospital, explained the situation, and gave them the number of the correct pharmacy. They called back and told me that they had passed the message along to the doctor, so the prescription should be coming in soon. Shortly thereafter, the doctor called me to say that she had called the number the nurse gave her and it was a private residence - the nurse had passed the incorrect number to the doctor. So, I had to give her the correct number of the pharmacy. The snippy clerk meanwhile came by and informed me that he had called the other Rite Aid pharmacies in town, and they denied having received any calls leaving prescriptions for my wife.

After giving them what I felt like was a reasonable time to fill the prescription, I went to the desk only to find that, surprise, the insurance company was refusing to pay for the prescription because it had already been filled earlier that day at - surprise, surprise - another Rite Aid pharmacy. Had the snippy clerk been there who originally assured me that by no means had a prescription had been called to a Rite Aid pharmacy, I would have been sorely tempted to slap him.

This would be a good time to mention that I had gone to the pharmacy with the girls in anticipation of a quick trip to get them out of the house and to give my still-under-the-weather spouse a quick break. I wound up spending the two hours it took to finally get the medication sorted out meandering through the pharmacy looking at the Christmas decorations that, for some reason, are already up for sale; helping the girls try on silly sunglasses that are way too big for them and taking pictures with my camera phone (see below); and playing with little motorized massage toys that the girls really got a kick out of (good Christmas gift idea for the girls!).

In any case, I have learned my lesson - next time I will just bust out my medical license and order an antibiotic for my wife rather than going through the 10-hour process of getting the antibiotic through the conventional health care system.

The world of barium

2007-10-03T22:49:00.001-07:00

Double contrast barium enemas, I have decided, are among the most innately beautiful of the radiology studies we do. A colleague and I were discussing how some of these studies are nice enough to hang on the wall. See the following:

My daughter

2007-09-29T22:37:00.000-07:00

As a radiology resident, there is so much that I am expected to know. In essence, I need to know everything that an internal medicine doctor knows, and everything that a surgeon knows, plus some detailed anatomy. Wow. Thus, it is expected that I will read for 2 hours every night.

My oldest daughter, Liberty, likes to spend time with her daddy, and thus likes to spend time reading the same books.

She also likes to study other books that I have, such as surgery textbooks from medical school. She particularly likes orthopaedic surgery, and recently tried to perform some on daddy.

It is your destiny...

Ouch

Another one

Not just a pretty picture!

Food for thought

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Family togetherness at Thanksgiving

Don Juan

Am I My Brother's Keeper?

Unbelievable...

Crush

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Recurring theme

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Histories

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So much stuff!

Valentine's Daddy, part deux

Valentine's Daddy

If you think you are having a bad day...

Stick It!

Medicine Man

The world of barium

My daughter