(I can’t concentrate. I admit it. Sorry. -PB)


So I was absent for about a week from my blog and my daily readership actually went up. Clearly there is some optimal number of posts per month that will maximize daily hits and I am usually exceeding it….or maybe if I stopped posting altogether my sitecounter would explode. The end is coming, actually. I can feel it. I don’t know what more I can say about most things without doing some research and producing the kind of footnoted and referenced articles that would delight about six of you and bore to tears the rest. Either that or I could get overtly political which would probably increase readership but I am trying to avoid that kind of thing. I’m not even following the election that closely. I like John McCain of course (without feeling the need to take my ball and go home if he doesn’t exactly mirror my opinions), feel a little sorry for Mrs. Clinton, and think that Mr. Obama is the quintessential empty suit, full of rhetoric that signifies nothing except to draw attention away from his doctrinaire leftists opinions.

I marvel at how quickly the leftigentsia have turned against the Clintons and are only just now discovering that they are both totally corrupt and infinitely corruptable. It’s as if all over the United States old grizzled reporters are slapping themselves on the forehead and saying, with sheepish grins spreading across their once credulous faces, “Man, they sure had us fooled!.”

And I confess some distress. Is being a war hero important this time around? It’s hard to keep track. It was the last time, I’m sure about that, and the Lord Marshal certainly made a big deal about the medals that he threw away…or didn’t. To make matters more confusing, at one time being a draft dodger was de rigueur and then a few years later flying a jet fighter in the Air National Guard wasn’t. All I know is that of the three candidates left in the race, all of them were surrounded by communists when they were young but only one of them fought back.

But I digress. I mightily appreciate all of you who take the time to read my excessively verbose ramblings. I’m not whining, just informing, but producing a blog is hard work. It can be a chore, actually. If I haven’t posted for a while I get the nagging sensation that I am neglecting something important and, although I enjoy writing, I don’t always have the time and feel somewhat pressured to produce. Ridiculous, isn’t it? Except for some minor advertising revenue from Google and the good people at Epocrates, nobody is really paying me that much to write and although it might cause a small stir in a tiny corner of the vast internet, when I disappear no one will be worse for the wear.

I Kept My Mouth Shut

I had a trauma patient the other day who quickly informed me that he was a chiropractor and then rattled off the cervical vertebrae he believed to be injured just to show us that we were dealing with a medical professional and not some yokel. He had fallen off of a ladder and bumped his head. After the usual “pan scan” that the trauma surgeons order on everyone regardless of mechanism or history he was given a clean bill of health and discharged from the department. We usually send these minor trauma patients home with a small prescription for vicodin or percocet even though all most people really need for this kind of thing is some motrin. I have been sticking to the motrin lately because we don’t have to give narcotics to everybody. He flagged me down before he was discharged and demanded something stronger for his pain. I smiled politely and wrote him a prescription for Vicodin. Chiropractor, heal thyself. Doesn’t he have any colleagues that could, I don’t know, adjust him or something?


Speaking of chiropractors, I have had a run of patients lately who are under their treatment. I keep my face blank and my tongue still but most of them feel the need to apologize which shows you that even most of the chiromancer’s customers suspect that the they are being hornswoggled by this century’s equivalent of the Patent Medicine Man. Look, its not rocket science. You can’t cure an inflamed gallbladder or a pulmonary embolism by adjusting the spine. You can’t actually adjust the spine either because, while I am second to none in admiration for the typical chiromancer’s knowledge of spinal anatomy, all of those ligaments and muscles that they rattle off prevent the kind of movements that they claim to induce. Hell, in my line of work we call chiropractic “spinal adjustment” by its correct term, “trauma,” and it is only the inability of most chiromancers to generate motor vehicle collision-type forces that keep them from hurting more patients than they actually do.


Despite what Dinosaur thinks, I can tell the difference between an elderly patient who can benefit from medical care and one upon whom dollars fall as ineffectually as autumn leaves on a rusty old car propped on blocks waiting for the time when the junkyard shall give up her wrecks. And I believe I have repeatedly come out in support of providing expensive, high-tech medical care to the elderly. My in-laws for example, two of the finest people you could ever meet, are still in total command of their mental faculties and have benefited mightily from a couple or three artificial knees and the attentions of a cardiologist or two.

But just the other day I had three critical/trauma bays occupied by three patients with a combined age of 288. To keep clear of HIPAA I will just say that between them they had three legs, one working kidney, and the combined ejection fraction (a measure of cardiac output) of a healthy two-year-old. None of them had moved purposefully for the better part of a year and they probably had enough viable brain tissue between them to fit out two border collies or one pharmaceutical salesman of average intelligence. And they were all “full code” and headed to the ICU for an all-expenses-payed sojourn into the belly of our completely out-of-control health care system where I have no doubt that at least one of them will be “saved” and sent back to the warehouse until the next time.

Look, I understand what Dinosaur is saying. But I also think that he doesn’t spend a lot of time with patients at the futile end of the spectrum. I don’t believe anybody is advocating severely rationing care for the elderly like they do in the vast Freeloader Dependocracies Across the Water (although this kind of rationing is inevitable) and I don’t think withdrawing futile care will solve all of our money problems but, my Lord, it would be a start.

My Daughter

My eight-year-old daughter. God bless her. One of her little friends was over and kept calling me “Mister” Panda. My daughter finally had enough and said, “Um, my daddy didn’t go to four years of Evil Medical School to be called ‘Mister.'” We are all huge Austin Powers fans.

(This is the same little girls who, when she was five, was told by her mother that I had been a Marine and, having heard it imperfectly, spent the next year telling her little friends that her daddy had been a “ballerina.” )

34 thoughts on “Randapanda

  1. “Not one of them had moved purposefully for the better part of a year and they probably had enough viable brain tissue between them to fit out two border collies or one pharmaceutical salesman of average intelligence.”

    Chalk up another audible laugh, Panda.

    Don’t give up, you’re just hitting your prime and the idiot population isn’t shrinking fast enough. There are still plenty of people to convince…

  2. You mean Marine does not = Ballerina? All my illusions shattered. Thanks Panda. 😉

  3. Hey Panda, don’t dissapear anytime soon… your ramblings give me a breath of conservative fresh air in the ever-growing extreme leftist fog that has become most college campuses (not that I’m necessarily conservative, but I am sick of hearing that things will somehow “change” with any one of the three stooges we end up electing).

    (Whoa.  Mr. McCain is not a stooge.  He’s not nearly as conservative as I am but then very few people are.  He’s not perfect but he has demonstrated unquestionable valor in the past and has a fairly solid legislative record which even includes some of that bipartisanship that everybody drools over.  He also has tremendous appeal to independent voters and the so-called Reagan Democrats, more than enough to offset any losses from the minority of petulant conservatives who don’t have the maturity to work with what they have rather than wish for a perfect candidate.  -PB)

  4. Yeah, screw this “end” thing. When you’re (I’m) in that little corner of Al Gore’s very own intarweb, you leaving is a big deal. (But yeah, sometimes, nothing new under the sun…)

    Apologies if I’ve missed this, but was there previously a clinical 20 questions?

  5. I just hope you keep on blogging — about whatever you want to talk about. This place is a haven of intelligence, common sense and clear writing, almost unique on the internet.

    Also, I agree with you about McCain, and I love …of the three candidates left in the race, all of them were surrounded by communists when they were young but only one of them fought back. I’ll be quoting you!

    (Don’t quote me.  I think Jonah Goldberg at the National Review Online said it first. -PB) 

  6. Ha, your eight year old sounds a lot like my 40 something French professor from college. She hit us with a similar line the fist day of class. I wonder…have you ever used such a phrase or corrected someone when it wasn’t really necessary? I’m not suggesting there’s anything wrong with it- if you’re going to work your whole life to hold a title you might as well use it >). On the other hand I think it’s a little difficult to do it without sounding pompous.

  7. RandomMSII on April 23, 2008 3:35 am

    “You mean Marine does not = Ballerina? All my illusions shattered. Thanks Panda.”

    I always thought that Navy guys loved to have Marines on board ship so they would have someone to dance with…

  8. Perhaps ur daily readership went up because some of us have been tuning in to read ur write up on the USMLE.

    So a good strategy for increasing daily visits might be to divide ur posts into series like the pre-clinical series.

    Anyway i enjoyed the above post. It appears in the US a lot of money is spent keeping alive people that should be allowed to die with dignity. Where is the quality and meaning in a life spent hooked to a machine?

    In my country if you live to be over 70 u are basically in overtime. Herioc efforts will not be spent keeping alive a vegetable. The American health care system will do well to stop offering 4 free this kind of service.

  9. Panda,

    I’m an interventional pain doctor in private practice. My stock and trade is chronic pain patients. I’m curious to know to what extent do Emergency Medicine physicians are aware of outpatient opioid prescription contracts. We admonish our patients to not go to the ED for chronic pain exacerbations, but it seems there are always a few who think that they can get a few extra percocet by visiting the ED. Do you routinely ask your back pain/headache/fibro patients if they are under the care of a pain physician and have a opioid treatment contract?

  10. Hey Panda, don’t get me wrong, I like McCain better than the other two but my primary concern is our ridiculous national debt (not health care, war on terror, housing crisis etc) that will be crippling to the future generations of this country. None of the candidates have seriously addressed this issue, yet each one of them will be increasing our national budget whether through unprecedented entitlements or an increasingly expensive war that has no end in sight. Over 25% of our tax dollars are merely paying the interest on our debt; sooner or later it is going to become an impossible burden.

  11. I don’t share your political views but love your writing, especially as a break from the neverending barrage of powerpoints that is the second year. So, thank you.

    I am sure other issues will arise for you to take on, and I hope you keep the blog going. But I see what you are saying. The whole chiropractic thing, for example, is at about GCS 5 and will be dead shortly if beaten any further.

  12. “All I know is that of the three candidates left in the race, all of them were surrounded by communists when they were young but only one of them fought back.”

    Best summary of the current presidential race I’ve seen yet!

    Keep blogging Panda. You put out good stuff…for a ballerina!

  13. I died a little inside when I realized that your daughter’s friend wasn’t actually calling you “Mister Panda” but “Mister Jones” or “Smith” or whatever your real name is.

  14. And I quote:

    He [the chiropractor] flagged me down before he was discharged and demanded something stronger for his pain. I smiled politely and wrote him a prescription for Vicodin. Chiropractor, heal thyself. Doesn’t he have any colleagues that could, I don’t know, adjust him or something?”

    LOL, too bad you didn’t get that on hidden camera. It would make an excellent YouTube video. 🙂

  15. “All I know is that of the three candidates left in the race, all of them were surrounded by communists when they were young but only one of them fought back.”


  16. “and they probably had enough viable brain tissue between them to fit out two border collies or one pharmaceutical salesman of average intelligence.”

    I have to agree it doesn’t take much brains to be a pharmaceutical salesman. But, as a retired pharmaceutical salesman with no artistic skills (My first choice in a career was to play piano in a whore house)and a dread of manual labor, I had no choice but to pursue a career in Rx sales. It was either that or become a Democrat and go on welfare

  17. Some of us would definitely miss your blog if it were to disappear. I don’t think I’ve missed an entry in two years.

  18. Panda, this seems a good time to thank you for your writing. Several months ago I was considering a career in medicine and started reading medical blogs for a glimpse inside the system. Your blog was just what I was looking for: the straight dope, well organized, well written and witty. I read every entry, from the first to this one.

    What I’ve learned here has helped me make an informed choice not to pursue an MD. I’ll keep reading as long as you keep writing. Thanks.

  19. I realize your comments are intended more for entertainment than literal accuracy, but the comparison between us and drug salesmen goes a little too far.

    It’s true that drug reps have been observed to mimic certain behaviors such as handshaking in order to increase their popularity. And through positive reinforcement, they can even be taught to repeat simple sterotypic speech patterns such as jokes and off-label drug indications.

    But there’s really no comparison between such operant conditioning and the higher cognitive function required for activities that are actually useful such as herding livestock or hunting.

    You’re (best) friend,
    Secretary, Border Collies of America

    (Bad Dog!  No!  It’s “Your,” not “you’re.” Shame! Bad Dog!  -PB)

  20. I am probably guilty about sending readers your way…my child is pre-med and I recommended your site (and the FAQ re: med school interviews…hilarious!). Child loved your posts and passed them on to friends.

  21. “Bad Dog! No! It’s “Your,” not “you’re.” Shame! Bad Dog! ”

    Easy for you to say, typing in your native language — and with opposable thumbs.

  22. Panda,

    Do what you have to do, of course. Even if that’s practicing medicine. However, I feel it necessary to say that you are the finest medical humorist I have ever read, and like all great humorists you are a keen observer of the human condition. If you should feel it necessary to stop blogging (and I can certainly understand that feeling), please do not stop writing.

    And, if I were ever to be a stabbing victim, I would be truly honored to have you do my chest tube.


  23. You should write a book though. I’d definitely buy it for say, $15, even if some of it consisted of re-worked blog entries (Dawn of the Dead is a MUST – I’ve linked many people to it).

  24. As someone who has shared some of your life experiences I have found your blog to be inspirational and a reference point. I have learned a great deal from your writings. When you do hang it up ( or drop your pack) I will certainly feel a loss.

    anyways thanks
    dylan childs (frmr Sgt 0311 and current M2)

  25. don’t go panda! just scale it back a bit.

    What if we appeal to your vanity by spreading the word and making the site more popular?

  26. I really hate to be a nag, knowing that you obviously have a life and all, but were you ever going to reply to that e-mail I sent you about ho to balance one’s career and enjoyment of life? I feel that could be a nice topic to hear your thoughts on.

  27. Panda you need a scribe! Imagine having all your t-charts filled out completely, as you work. All done by a pre-med student willing to work for minimum wage. When I scribe for docs they NEVER have charts to lock unless the patient is still awaiting dispo when I leave (they stay after). And these charts are 90% done already.

    Saves the docs 2-3 hours work over the shift, they pay $100. You should look into it, see if there are any pre-med students in your town willing to do it.

  28. I get called ‘doctor’ all the time at my job even though I am mater’s level social worker. I correct people but it seems that if someone ‘needs’ to call me doctor, they are going to do it no matter how many times I correct them. But being called doctor does nothing for my ego than being thought to be a ‘bodyguard’ by my kids’ friends one day. I didn’t correct them!


    (Well, yeah…but it does nothing for your ego because you aren’t a doctor.  Big difference. -PB) 

  29. I remember awhile back you said you’d have your wife write a few posts. Any chance of her describing her side of your life in medical school, residencey? Just a thought.

  30. Sir,

    If I’m not allowed to leave the medblogosphere, you aren’t allowed to leave the medblogosphere.

    Please stay.


  31. PB, As a med student who recently completed my requisite psych rotation at the VA for 6wks, I have serious trepidations about electing a president who was a POW for 5 yrs and remained in solitary confinement for 2 of those 5. I have total respect for the service and valor of John McCain, but I don’t believe you can endure this type of treatment and come out unscathed psychologically. He is famously short-tempered and impulsive. This is not a quality that I want in someone who has substantial control over the free world. I am underwhelmed by the other candidates, but I’ve seen the psychopathology that developed in many of our veterans who served in Vietnam and were not POW’s and shutter to think about what McCain has to do in order to get to sleep at night. Respectfully, MD2B

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