There's no surgery for that

"The patient reports a bulging desk."

And don't call me Shirley!

Speech Wreck inadvertently served up a timely little memorial to Leslie Nielsen today: 


"Shirley. The patient has had a prodrome of diarrhea for weeks, but more concerning is the onset of fever and epigastric pain..."




(Dictated was, "Surely, the patient has had...")

(R.I.P., Mr Nielsen, and thanks for so many laughs...)

Hurry, or you'll never catch them!

"She has IV fluid running at 125 miles an hour."

It sucks to be him

"He is allergic to diltiazem, oxygen, and prednisone."

Fun With Names, Thanksgiving Edition

--This actually has nothing to do with Thanksgiving, but it sounds cozy, doesn't it? 


Dr. Might Go Walls (orthopedic surgery)


Dr Brake Lining (nephrology)


Mr. Clinic Head 


Dr. Sputum Coming


Dr Serene

Okay, one CT, you want fries with that?

"We will have the CT scan from McDonald's sent to us for review."

Times are hard and funds are short

... so hospitals are exploring creative staffing options.


". . . .She suffered a fracture that was treated with closed reduction by the horse OPA in the emergency room."



We don't know what level of certification "OPA" represents, but we have full confidence in horses around here, so we're sure he did a pretty good job.




(Okay, okay, it was actually "...by the ortho PA." Spoilsport.)

No one can accuse this doc of not spending enough time with his patients

"Time spent preparing this patient for discharge has now been 41 months."

Caring, you know? It's all about the caring.

"He is critically ill. His prognosis is discarded."

Dangers of the passive voice and slippery articles

"The patient recently had a husband die."


This painfully passive-voice remark with it's odd use of "a" was thought about by me, and it was wanted by me to be finished in an interesting way, such as: 


"... but the patient still has two husbands who are not dead, so she is having her  garbage taken out by one and having her lawn mowed by the other." 


(In case it can't be noticed by you, the passive voice is much utilized by medical professionals but is detested here at Horse HQ.)

That's the third one this week; the rounding team keeps tripping over them

"The patient stated that the pain was like stabbing.  He was killed over on  the floor."



(Dictated: "... he was keeled over on the floor...")

With friends like this you don't need enemies...

(... but you might need psych meds).

"He is currently living with his skull friend."

("living with his girl friend" was dictated, sort of).

Speech Wreck knows more than you do

"Pneumovax is not safe." 


My goodness. I'll just send this important news out over the Internets, and we'll all be safer soon. Thanks, Speech Wreck!

Voice Recognition, Scottish style

A hilarious take on the horrors of letting Speech Wreck take charge of an elevator. (Mildly NSFW due to one slightly naughty outburst... --oh, and there's an irritating laugh track, too.)

In other developments...

"He then developed the development of leukocytosis."

Speech Wreck and found poetry

See, what happened is, this resident was dictating and hung up, somehow, but what he had actually done was put himself on hold. And, as also happens from time to time, the institution's recorded on-hold marketing spiel took over  the call. Which was being sent to the Speech Wreck server. 


For 36 minutes. Well, there was a little music, too. But mostly spiel. Over and over.


Speech Wreck didn't know quite what to do with the repetitive marketing spiel, so it created from it a rather fine postmodern existential poem. (I helped it with the formatting, 'cause poetry is important). The poem is about tongues, and Illinois (please note: The facility is not in Illinois), but that's just the surface stuff. Mostly it's about goals. And about being oriented. 


After you read this your goal will be to become oriented in Illinois. This is my dream.



00000 time a at 
in the oriented goals 
UA he time is a 0 lingual 
and really in the oriented goals 
outlined U the 90 he time and the lingual and is lingula 
in the oriented goals 
lying in the a UI time the OU but lingual and Illinois 
in the oriented goals 
MI in the UAUI spine strain use the O, but lingual and Illinois 
oriented bolus 
outlined in the AU she I spine strain use the ULO sublingual 
at goals 
and U she is in a UIO spine strain the ULO lingual 
and in the or goals 
and UAUI this time use the ULO lingual and 
he U oriented goals 
and EAU she IO this time. 
She the O lingual and, I, 
Illinois 
or 
goals 

Who knew it was so dangerous?

".... Will continue high risk oxygen and vancomycin."


Might want to call the lawyer first. Just sayin'. (Dictated was "hyperbaric oxygen").

Today is Dada-Day

(Every day should be Dada-day, really. Anyway:)


Dictating on the roof of the heart. She can generate thank you changes in her states. Cups to do what we have to the medics; research the discretion of the disk. Nature to see him out. Platelets of 290,000 with a normal death. Share in a crack boot for antiquite ill, Asian ambulating in my catheter. Pulmonary movements are slow and low. Except the patient does have a bad crack.

Another strange obsession

... sometimes it's beer. This time it's a whimsical interest in the name "Michael." And bilingual, too! 


"I closed it with Michael in the subcu." 


"Chest x-ray reveals evidence of Miguel abnormalities." 

She's asymptomatic, but I have a headache now

"I told her she is having asymptomatic symptoms."

Thanks for clearing that up.

Are you a good witch, or a bad witch?

"I am going to send her home with Glinda."


Oh, man, I hope the ruby slippers are still in the patient-belongings plastic bag thingie.

("There's no place like home... no place like home... " BTW, he dictated the silly doc-invented non-word "clinda," so he got what he deserved).

Colonoscopy is teh awesome!

"Total cool endoscopy to the cecum and terminal ileum."

Only Speech Wreck would think it's cool to have a medical instrument shoved up your... oh, never mind. 

Don't leave home without it

"She has her husband and her gallbladder at her bedside to offer support."

(Dictated: "... adult daughter...) Thanks to LG for this awesome Wreck.

Pleasant patient is pleasant!

"Mr Oldguy is a pleasant gentleman who appears somewhat confused but pleasant." 

Monday is Fun-Day

Fun With Names, that is. Let's see what we've got today:

• Pity the poor fellow whose name, apparently, is "Robert Underwear Fluids."

• "Dr. might go walls" of orthopedic surgery.

• "Dr Bender Clot."

... And, oh dear, there's so much that could be said about a guy named. . .  "All-terrain Johnson."

(Like, if only, instead, the poor guy had an all-terrain brain...)

This patient should really get out more

"The patient is seen today in the context of an outpatient fever and no ladies and jaundice."


(..."elevated LFTs and jaundice," but how boring is that).

You think maybe he should go with just the VapoRub?

(Patient with cold symptoms, etc.)  "He has tried toxin and VapoRub OTC."

Elitist bacteria

"...Esoteric coli sepsis."


Not for us common folk! (Thanks to T.J. for both wreck and caption).

Dr Obvious is in the house again, reminding us that gravity is still the law

"This gentleman fell 20 feet off a scaffolding on a construction project earlier today. He landed below."

That's odd; usually they have the opposite problem

"She has noted feeling sad and anatomic."

p.s. If you, too, think this hoodie is pretty cool, go here.

(Dictated: "... sad and anhedonic...")

Dr Obvious is in the house

"Chief complaint: Motor vehicle accident prior to arrival." 

TMI

(In social history): "He rubs with his wife."


It's good to know he doesn't rub alone; that would be weird. 


(Dictated: "He arrives with his wife").

Speech WRx--The All-Inhaler Edition!

1. Format motor humor 
2. Forward a little bit Carol Weiser** 

3. T-max twisting  

4. Spy Reeve 

1. formoterol fumarate 

2. Foradil Aerolizer 

3. Asmanex Twisthaler

4. Spiriva

  

** (note: This "name" came along as part of the random speech wreck; nothing to do with a real patient's name!)

Optimism is overrated

"He may return to the emergency department on an as-needed basis, versus not survive."

He presents accompanied by guacamole

"The patient also states that he is chili all the time."

Can you have too much of a good thing?

". . .generous general endotracheal anesthesia."

Poor Speech is a Nerf-ous wreck

"The patient will also be on amitriptyline for insomnia, but also for Nerf modulating effects. . ." 

Poor thing. Nerf stuff used to be sorta innocuous and squishy,

But now? Now Nerf has gone all weaponized and paramilitary. Note the kid's expression. No wonder she needs help sleeping. 

 

So much depends. . .

(Let's see if anybody gets it. The pic is a clue...)

"...Possible barrow reflex failure." 




(Dictated: "... possible baroreflex failure") 

She can't hear well and it's pissing her off

"... decreased hearing in the right kidney."

Was that rare, medium or well done?

"He was hemodynamically a steak, alert, and awake upon arrival." 

Now THAT'S a lotta blood

"Estimated blood loss: 5 miles."

The patient will be admitted to the S&M floor

". . . the pain has completely resolved at this time, and is nonreproducible by pleasure or movement."

Ewww. Just ... ewww.

" . . . vomiting fetal matter."

This one's from K., who comments, "..then student asks me how she is pregnant at 80..." The intended statement (vomiting fecal matter) is gross enough, then you have the speech wreck, and then the idiotic question on top of that. It's enough to make you want to... well, puke. 

An unusual respiratory exam

"She does have a few end-expiratory wheezes on osculation."

(Lest the error be less than obvious...)

The differential would include HUAS*

"PRIMARY DIAGNOSIS: Lower GI brain bleed." 






*Head Up Ass Syndrome

Sunday is Fun-Day!

(Fun With Names, that is). 


However this consult goes, we're pretty sure it will be interesting:
"The patient is to have consultation with Dr. Tingling in the morning."

And then there's "Dr. One-word Sentence". I. Wonder. What. His. Chart. Notes. Look. Like. 

Talk to the hand, I mean the --oh.

"Vagina was consulted for surgical management."




(Dictated: Gyn/Onc was consulted for surgical management.)

--Thanks to JW, who wisely pointed out that I won't be able to post an illustration for this one. 

Horse is on Hiatus

... We've had a computer hard drive failure here at Horse HQ, and we're scrambling to cope with that. Among the stuff lost is all of the backlog of material for this blog (aaauggh), so... well...if we can't rebuild the hard drive, which is currently circling the drain, we'll be back, but it'll be a while...

Om nom nom nom SLURP *hic*

"She does not report pain related to eating, except for a quart of liquor intermittently." 




(Dictated: "...a sort of flicker intermittently")

"There is a fracture. I need to fix it."

"I'm the registrar of Orthopedia." Y'all need to watch this. Soon. Now is good.

(Followup--several weeks later: This link has generated a lot of traffic, which I'm grateful for. But I also want to make sure that a tip of the hat is given to the genius of "SlowK", who created it, and to the folks at Xtranormal, whose site made it possible. There. I feel better).




(Thanks as aye to the ever-delightful Dr Grumpy for this one)

O noes! The hospital is under water again

"Dr Pulmo dictating a pulmonary consultation. Coral and a drowned referring physician." 

Dx: Chronic relapsing marriage, NOS

Not a blooper today; it's a subtle (and probably inadvertent) assessment. . .  


"The patient has been married 4 times. The longest time married was 10 years. He is currently divorced for the last year."

Is there a mouse in the house?

"... consider adding another medication to help stabilize his behavior, such as cheese."

I think you should look at it again. Really.

"Her right bloody amputation stump is well-healed."




(Dictated: "...right below-knee amputation stump...")