Max Eduardo from Milwaukee, WI wrote in a fan mail the following:

“We appreciate all the recent updates but what the hell dude, where are the humor posts you are known for?!?! Did you get depressed on us or something while doing your doctor thing? Where’s the music? Just miss the humor posts, they were full of win.

-Max

P.S. We miss the music, where is it?”

Well, I must admit, I’ve written too much about serious stuff lately so back to the drawing board we go!

I’ve been privvy to many strange smells in my lifetime and I can attest that I can let some whopper farts loose at times, however nothing stacks up to the pure stinkpower of Medicine. Only in medicine can you smell the worst of the worst. Read on to find out the nastiest smells you can find along with nicknames and advice to fall back on to avoid being on of these people.

C. Diff Surprise: A 8/10 on the stink-o-meter. C.diff is a bacteria that colonizes the GI tract sometimes after antibiotic treatment. You see it alot in nursing home patients who get admitted to the hospital. C. Diff smells like 4 parts liquid diarrhea, 2 parts sulfur and 1 part of vanilla to create a slighty sweet but nausea inducing putrid cloud of death. It permeates the nostrils immediately and penetrates through most surgical masks. Never ever place vicks under your nose to mask the smell as the vicks just carries the smell further back and amplifies the nausea. (Personal experience). Usually preceded by a liquidy sounding fart and followed by a cascade of watery poop hitting the floor or a bedpan.

What to do:
1) Run away immediately and page a nurse for clean up on isle two.
2) Prescribe Flagyl
3) Wash your hands immediately 2-3 times to avoid getting c.diff yourself.
4) Thank the good Lord that you don’t have C.diff
5) Page your intern or medical student STAT to go check out said patient for “learning purposes”

Essence of Psuedomonas: 9/10 on the stink-o-meter, usually found in an abscess during surgery or in a morbidly obese Diabetic patient. Psuedomonas hits you with a very sweet smell initially followed by a stinch that likens to an aborted panda fetus or bear crap after ingestion of raw sewage or Taco Bell food. I’ve seen psuedomonas smell close down an entire block of OR rooms at one of the hospitals I worked at due to causing employees to spontaneously blow chunks.

What to do:
1) Run away if possible.
2) If you are stuck in surgery, it is not acceptable to vomit as surgeons are supposed to have acquired anosmia (no sense of smell), so grab onto the sterile field and think of a happy place. If this does not work, inhale the bovie smoke. It may smell like burned flesh but it beats smelling psuedomonas.
3) If possible, page the intern to come “incise and drain” this abscess STAT for “Learning purposes”. Hell, bring the medical students too. Make them take a deep whiff to destroy their poor virgin nostrils. Then see #1.
4) Order antibiotics for patient
5) Write an order for Febreeze then turn off your pager.

Eu de Po-Po Schmutz: For those who have not caught on, I am talking about “feminine odor.” Ranges from 5-10 on the stink-o-meter. Factors that contribute to the severity of the smell are as follows: If your patient presents and states something like “Mah junk iz messsed up Doc!” or has flies rotating around her, you can expect a 10. Date of last shower is also an important contributory factor. Expect a 10 if it is greater than 1 week in time. For those of you who need documentation for the number scale, here it is. This is ripped straight from the “New England Journal of Rejected Resident Studies”

Severity of Smell

5# Theme Park Urinal Cake
#6 Dead Cod
#7 Raw sewage
#8 Necrotic Colon
#9 Aborted Panda Fetus
#10 Liquid Death or Big Momma’s Butt Crack

What to do:
1) Avoid using a clothespin if possible, try to suck it up. Using a Clothespin is bad form.
2) If doing a pelvic and/or speculum examination, get in, take your samples and get out as quick as possible. The longer you take, the more smell particles that are released into the air. At a certain level, your next patient may get nauseous from lingering smell or even worse, HAZMAT team will have to be called to decontaminate the room.
3) Ask your medical student if he wants the experience of doing a pap/pelvic examination. Be sure to stand in the corner of the room and step in if he/she is taking too long to avoid complications as mentioned above in #2.
4) Prescribe a bar of soap if indicated.
5) Wear a gas mask, tell your patient that you have the swine flu and it is for her own protection.
Bathroom Stench: 4-10 on stink-o-meter. Factors depend on many things including location of bathroom, it’s normal occupants, size and proximity to cafeteria food. The worst bathroom smells are from either the hospital cafeteria bathroom or the OR Men’s Locker Room toliets. Out of the two, the OR men’s locker room is the worse. Most surgeon’s are anal retentive and feces is not an exception. They will hold it in for hours as they slice and dice around their surgical fields, letting their poop intensity and ferment in it’s stinkiness. In the 7 minutes they have in between cases, they will invade the 2-3 lonesome stalls in the corner of the Men’s locker room and let loose from the caboose in a cacophony of intestinal fortitude. If farts had a Forte, this would be it. Add that to the fact that the surgeon is usually stressed out from his case and has massive parasympathetic discharge coming on which results in instant diarrhea.  The end result of course is that the unsuspecting resident or medical student comes in to change into their scrubs, or even worse, use the adjacent urinal.  It can range from nausea inducing to instant ejection of stomach contents.  I was privvy to this on one of my urology rotations at the end of my 4th year.  One of my attendings was dropping some kids off at the pool and I swear his ass exploded.  What followed was the stench of a dead cow. Be warned.

On the other hand, the cafeteria bathrooms generally aren’t quite as bad but they can be horrendous.  The cafeteria where I work has really good food but they don’t skimp on the grease.  Nothing says  diarrhea like Crisco in your bowels.   Although generally not as bad as the OR bathrooms, there can be some whoppers, especially on Taco day.  Generally if you are in medicine, this should only be a 5 or 6 on your stink-o-meter.  If you get nauseated in the cafeteria bathroom, then maybe you should give up and be a radiology tech or even better a radiologist.

What to do:
1)  Try to avoid these bathrooms or use a private bathroom if necessary.
2)  Lysol spray if available in the room, otherwise hand sanitizer smell should suffice.  Mask that smell yo!
3)  Drop down on the floor, remember heat rises and poop smell is the same.
4)  Sit down in the stall next door and make a worse smell yourself.
5) Page your medical student STAT and tell him that a case is pending and that he needs to use the restroom ASAP before the case.

More to come,

Richie

Miraculously, I survived my 4 months of hell doing Peds Clinic/Peds Wards, Inpatient Surgery and Internal Medicine Wards back-to-back.  My longest shift was a 35 hour call (which I fudged my hours on hehe).  Looking back, on Peds I worked 60 hours Friday-Monday for two weekends and took a total of 14 calls.  I took 8 overnight calls during surgery.  3 overnight calls during IM and 4 short calls till 9PM.   That was alot of hours

I can say with confidence that I know what sleep deprivation is now.  You haven’t lived until you are forced to do a procedure on someone after going 30 hours without any sleep.   It’s kinda like being drunk without any shred of happiness.  Your mind is fuzzy and you are just trying to keep moving.  I have run off of the road twice driving home from call and luckily havent caused a wreck yet   The good news is that life should get a little bit better starting June 1st.  Ya see, I’m starting my PGY 2 year a month early due to someone taking a leave of absence.  This is a good thing and a bad thing.  The good thing is that they are letting me keep my week of vacation during that time and it is during a difficult rotation.  The bad part is I was scheduled for outpatient surgery during my last intern block which is fun and a cakewalk because you get to do all these cool surgical procedures by yourself and work Monday thru Friday from 8AM-4PM on average (A dream).  Instead I am doing pediatric wards and there are only two interns, which means many nights I will be alone running the floor and doing admissions by myself (Scary thought).  To add insult to injury, I will have to goto FM clinic after working a night shift for the morning.  So much for a nice easy ending for my intern year   No one said it was going to be easy though.

However, right now I am on OBGYN catching kids.  I have been on night float (5:30pm-7:30am) shift all week long and am “flipping” over to days by working a 24 hour shift today.  No one told me that weekend shifts start at 8am and I showed up 2 hours early this morning(Doh!).  I am very tired today, especially since my sleep schedule is completely screwed up.  I will be on day shifts next week (6:30am-6pm) and then flip back to nights again the following week.  Luckily the OBGYN staff at Carilion are actually pleasant to work with so it lessens the stress somewhat.  I have done 10 deliveries so far and I have an 11th pending right now in labor at the time of this writing.  I’ll probably pick up a couple more on this shift.  I’m still feel like I am learning the ropes but I am beginning to catch on.  Just need to do plenty more cervical checks. :/

Part of me is missing the safety net of being an intern but the vast majority of me is thinking “Good Riddance”.   I am looking forward to some lessened hours and increased responsibility in my 2nd year.  I’ve had really good evaluations thru my first year thus far but I am starting to lose steam I feel.  My health has been declining also.  I have gained 35lbs since starting internship, placing me close to a whopping 200lbs.     I start nutrasystem on Wednesday of this week for 6 weeks to aid in weight loss.  It’s nigh impossible to exercise when you are working 80+ hours a week, especially at odd hours.  You literally have zero energy and I always feel fatigued.  So if you are wondering why there is no music, you can rest assured the reason is that I’d rather sleep and spend what little time I have with my wife.

Maybe in a couple months, I’ll start being a happier person again and writing more humorous, crazy posts.    I am convinced Internship causes depression.

So it’s been awhile since my last post.  My wife so graciously has posted a happy birthday message for me.   Yep I’m 29 now!  I got some interesting emails this week from old Everquest players who were surprised to see be in medicine now.  Yeah, I remember playing Everquest with my friends and talking about taking my MCAT and applying to medical school.  Now here I am, Dr. Richie Truxillo the 1st year Resident, seeing patients prescribing meds and pretty much playing doctor everyday.  My my it’s been a long road.

This first month has really been an introduction month.  Patient care during the mornings (and occasional evening) with didactic teaching sessions in the afternoons.  I start working at the Salem Veterans Hospital on the 28th on the Internal medicine service and then the ICU/CCU.  So I’m getting hammered with experience right out of the gate.   Still, I enjoy it so far even though the hours are going to be long.  My main concern is getting to see my wife everyday and spend time with her.  I’ve also gained some weight and trying to get it off is awful.  In fact as soon as I finish this post I’m hopping on the Bowflex and then doing 30 minutes of cardio either with Taebo, my bike or Wii Fit (havent decided yet hehe).

I’ve made a couple posts on Realdealmedicine.com but thus far haven’t reached my goal of a post a day.  I celebrated my birthday this past Sunday even though it was on Monday.  Patty is out of town this week in Myrtle Beach with her family/  On monday I pulled 12 hours and came home to my solo dinner of 2 angus burgers I cooked on my new grill.  The phone rang and I turned my back for 2 minutes.  My dogs stole my dinner off my plate and gobbled it up just in time for me to turn around.  30 seconds later they gave it back to me as they barfed it ALL up on my kitchen floor.  The smell was horrid, like the smell you get when you eat chinese food and afterwards take a laxative to clear it out.     Anyway, my birthday dinner ended up being a bowl of frosted flakes   Such is life though! ha!

I’ve also found I don’t consider the little things anymore when I am tired.  Like this morning, I got up and let the dogs out to pee.  I walked outside in my underwear and waved to my neighbors and said hello.  Didn’t think anything of it! hehe  I guess it was a little drafty.

Well I need to cut this short.  I’ve got some studying to do and my gut isn’t going to get any smaller by sitting here at the computer desk.    Leave some love on the comment box!  And Patty, if you read this, I love you and miss you.  Crap!  I just forgot, I gotta take the trash out too!

Yes, that’s right folks!  Today is July 14th and it’s Richie’s Birthday today!!!  (this is the wife by the way).  And here is the question of the day…….

HOW OLD IS RICHIE TRUXILLO?

Post a comment and see if you can guess….some of you may already know.  I’d love to see how many of you reply, and how many of you know the answer!!!!

Make sure you tell him Happy Birthday!  He’s working so hard as a first year intern, but I know he loves it!

Have a GREAT week!

~patty

So graduation came and went, like a summer thunderstorm.  Some of my faimly came to watch me graduate and my best friend and his wife hooded me.  When I was up on stage, as soon as I was hooded, the wind blew really hard and knocked part of the stage down.  If anyone has video of that happening while I was up there, please send it to me!  I will pay to have the video shipped.   It’d be great Youtube video fodder!

I have sent out thank you cards to everyone who has given me a gift for the wedding and for graduation.  I’d like to take a moment and thank all of you publicly for your gifts as they have made moving to Roanoke and buying our first home possible.    Thank you all so much!

It is June 26th, 2008 today.  I’ve been in orientation for what seems a week and a half now.   I have re-certified in Basic Life Support, Advanced Cardiac Life Support and Pediatric Advanced Life Support this week.  In addition, I’ve been to orientation for the Salem Veterans Hospital, the new EMR for Carilion (EPIC) and a short blurb on Carilion Clinic.  Tonight, we have the picnic where I can hang out with the new residents and meet their families.  It’s a pool party, looking forward to that

The Ebay stores are doing well.  I also am getting ready to crank up the seperate “Real Deal Medicine” project shortly, which will be blog posts based on what I learn during my rotations thru residency.  This is to serve a dual purpose:  1) To keep me honest on reading while solidifying knowledge by recording what I learn and 2) Provide somewhat of a knowledge base for med students and residents in layman’s terms.    There’s alot of information out there like emedicine and Harrison’s, but not really anything that breaks information down into layman’s terms.  You will find the project at realdealmedicine.com

All in all, things are going well.  I’ve got some other things coming down the pipe but looking forward to starting residency soon.   I am tired of being nervous about it and just want to sink my teeth into it and get this show on the road.

Yep, the dream *is* real!  Here’s the degree to prove it

>???????? I am, sitting in the WVSOM library computer lab, blogging about graduating from Medical School.  It sure has been a long road overall but ya know, I’d do it again.   This week (Grad Week) has been an exercise in futility with endless surveys and people asking for our feedback.  It’s funny because I am sure the same feedback is submitted every year but no one ever listens! haha.  Remember this, WVSOM operates on the all mighty dollar and they will only make changes for students if it benefits their bottom line in the longrun.   Therefore, I believe the end of year surveys are useless and just serves as a chance to milk some last few minutes from us.  Well, the financial aid hour was useful, just boring.  It’s funny that the same people who griped and complained about things the first two years came back and complained about the past 2 years. Which proves my point:  People never change.  It’s an amusing observation.

Anyway, I’ve been sleeping on the floor in my friend’s hotel room because I am broke.  Not broke because I didn’t budget, but broke because I am buying a house.   I won’t get my first paycheck till July 15th so part of me is secretly longing for that day to come, even though I’ll be working my arse off. 

Anyway, I just want to give a hearty thanks to everyone in my life who has supported me throughout these 4 years, especially my Mom and Dad, without their encouragement I’d have been down and depressed my first two years.  I’d also like to thank my loving wife for her support. Lastly, Mike Peterson and Erik Buzzard who’s friendship I’ll never forget through school.

It’s funny, after graduation, odds are I will never seen most of these people again.  Yet we weathered probably one of the most inhumanely stressful things one can go through.  Adversity has a way of making bonds in times of need but as residency rounds the corner, there will be new challenges and new bonds formed.  I am hoping I will make new friends at Carilion Clinic in the residency program and have the same bonds I shared in medical school.   

My best friend and his wife was nice enough to take one of their few days off to come down for graduation and hood me when I receive my degree.  A big hearty thanks to best friend, Jade Hoy and his wife Malissa!

So anyway I’ve been sappy now.  I’m going to get some sleep.  Graduation is two days away and I have ALOT to do and no time to do it

Hope you all are well!
-Richie

Ah, yes! They say that the most stressful things in life are 1) Buying your first home, 2) Getting Married and 3) Graduating from Medical School and 4) Starting Residency Well I’m doing all 4 in a three month period! Crazy eh!?!

Anyway, I know before I get a comment that says “This thread is worthless without pics!” here are a couple photos of the new place. We will move in around June 16th, give or take a few days. At that time I will bid farewell to the fine state of West Virginia and hello to familiar territory in Virginia (which they say is for lovers..but that is like saying “West Virginia: Open for Business!”).

In other news, my music is now available for free download/on-demand streaming at the website: http://www.last.fm Enjoy!

As promised here are a few photos from our wedding and honeymoon Cruise on the Celebrity Century! I’m busy working on my network of Ebay stores and my quest to buy our first house together. Hopefully you all are doing well! I got the itch to write some music but put it on the backburner for now.

I’ve purchased a new domain for my new project: Generating Income Online. I’m hooked because I’ve made about 250 bucks so far these past couple months with affiliate marketing. Next month looks to be a 150% increase thus far.

Ok here are some pictures to whet your picture-seeking appetites for now

I just moved all of my sites from Aplus.net (crappy server speed) to a new hosting provider with good speed.  It will take a couple days to get everything back up and running.  In the meantime, relax and enjoy things.  Married life is great so far and I had a wonderful honeymoon cruise.  Some pictures will be coming soon

-Richie