Friday, June 15, 2018

new scutmonkey: the 6 stages of overnight call

This may be a slight retread if you follow me on Twitter, but one particularly bad night on call about a month ago, I posted a poll surveying the worst overnight call phenomena. After that...well, after that it was just a matter of drawing the thing.

Here, panel by panel:

For those who are curious, I've been meaning to get back into cartooning for a while now (despite the long hiatus I've actually drawn comics...well, basically my whole life, since I was a very small odd child with too few friends and a bit of a defensive sense of humor to match), but as I noted previously, making these comics does take some significant amount of time. I mean, at least the way I do it, which is extremely analog and old school, it involves many inefficient, labor-intensive steps.

Joe actually got me one of those Wacom tablets about a year ago because I've been yammering about drawing more since forever. He thought, quite logically, that a tablet might be a good tool that could input the my drawings directly into the editing software. It was such a thoughtful gift, but...I don't know. There's something about the tactile sense and resistive friction of drawing with specific tools, and I'm picky enough as it is about my writing implements.

I did try to do a sort of quick and dirty YEARS ago, with this "colonoscopy face" comic...

...which I deliberately did on a yellow notecard just to force me to treat the exercise it casually. I briefly considered doing more things like that--just casual, tossed off, straight ink to paper, no erasing, no post-processing cleanup, nothing. But the fact is that I don't like things that are careless and tossed off. I want to do things how I want to do them, and how I want to do them necessarily takes a certain amount of time. It just does.

Anyway, everyone has their weird outlets. Writing and drawing stupid comics are mine. I hope you liked this one.

Thursday, June 07, 2018

shiny new scutmonkey: patient allergy stratification

I don't even remember when the last time it was that I made a new comic (I suspect it was right before I submitted the manuscript for my book to the publisher,* so that would put me in the last few weeks of residency, roughly a lifetime ago), and I don't want to make a big thing about this, because the comics...are really pretty stupid. But anyway, here's a new one.

The comics really do take a lot of work, which is probably why I haven't made a new one in just about a decade. There's the sketching and the penciling and the inking and the erasing and the scanning and the cleaning up and the titles and cropping. To think, I used to go through this entire process every single weekend for three years when I was in college and the cartoonist for the Wellesley News. This makes me realize that back then, when I thought I was busy, and had so little free time? I had nothing but time. Kids...don't know stuff.

Anyway, it's many years later now, and I am old, and semi-responsible, so I feel the need as an attending to say: Allergies are real, and can be serious. Listen to your patients. Use common sense, but respect the histories they are giving you.

However, sometimes funny things are funny. Maybe this comic is one of those things. And maybe now you understand why I was on that fine point mechanical pencil bender.

And here, so you don't hurt your eyes (we're all a decade older now, aren't we?), I have it panel by panel.

Happy trails.

* My editor ultimately decided not to include the comics with the book, which...look. At the time, I was a little disappointed, because I'd worked hard on them. But even at the time, I knew it was absolutely the right call. Strong work, Emily Griffin.

Saturday, June 02, 2018

eraserhead 2.0

Just a quick update:

I went to my local art supply store today and got this, the Pentel GraphGear 500 with 0.5mm lead. (I deliberately went to the architecture/drafting section, where they sell all the weird rulers, figuring there I would be among my people.) It's pretty nice. It made suffering through the rest of my Biostats problem set a relative pleasure. (I shouldn't overstate things. I finished the problem set. Period.) The pencil feels good (despite having a non-padded metal grip), the balance is satisfying, and the eraser and lead are of nice quality. I would have preferred a metal body (while the weight is overall substantial, only grip and tip are metal, while the body itself is made of plastic), we can't always have everything we want, at least not in this price range. Or, I guess I could spring for the Pentel GraphGear 1000, which has an aluminum body through and through, and must be nicer if for no other reason than 1000 is twice as much as 500, right? MATH.

If I'm willing to splurge beyond the Pentel GraphGear 1000--and I'm not sure that I'm totally willing to go here yet, since I do tend to lose things, and I also have clumsy kleptomaniac kids which is why I can't Have Nice Things--I might go this route:

The rOtring 600 Drafting Pencil. I was originally looking at the Uni Kuru Toga Roulette (by the way, if you ever feel like you're a little too fanatically ardent about your pen and pencil choices, go look at the literally THOUSANDS of reviews on JetPens and realize you're not alone) but after hearing a few opinions about how the rotating lead-handling mechanism felt "spongy" and "bouncy" I was like NO THANK YOU MA'AM and turned my gaze towards to rOtring. Again, it's a textured metal grip, which I'm not crazy about--I really don't write as much with pencil as I once did, but I still do want to guard against sore spots and grip fatigue, in case I devolve into pathologic graphomania somehow--but the reviews seem good, and from a purely superficial standpoint, it really does look like a handsome writing implement with a price point to match. Anyway, I'll keep it in mind. I turn 40 in a few weeks, and if I decide to treat myself, maybe I'll go for it.

(Yes, I did say that I would consider treating myself to a mechanical pencil on my 40th birthday. Carry on.)

As I mentioned in the comments section yesterday, we are taking a trip to Japan in July, so if there's some crazy Japanese Hotness Mechanical Pencil (or any kind of Japanese Hotness office supplies of any flavor) that I absolutely need to source while I'm in the country, please do let me know. I know it's a family vacation and we should be visiting temples and eating sushi and doing karaoke or some shit, but hey, let's keep an eye on what's important. How else am I going to source cutting edge retractable click eraser technology except in Tokyo, I ask you? It's not possible. In America, we just have to use those giant pink hard trapezoid erasers like a bunch of savages. I know, it's tragic.

Friday, June 01, 2018


I want to talk about mechanical pencils for a second. No, I don't have many friends, why do you ask?

So I'm in the market for a new mechanical pencil. I would like to use it for math-ish homework, but also for precision line drawing--not so much shading, so a firm fine-ish point would be better. The platonic ideal I have in mind is a pencil I used ages ago as my primary drawing tool, but I've moved literally 6 times in the past 12 years and I can't for the life of me find the one I used to use. (Yes, I've looked. Yes, I only had one.) But here's a description. It was a metal-bodied mechanical pencil, which likely held 0.5mm lead (my preferred note-taking lead in med school). It had a nice weight to it, and though it was a narrow barrel, it had a wider foam rubber grip that made it easier to hold. The grip was SOFT but NON-TEXTURED (I cannot emphasize this enough) so that it relieved grip fatigue but also did not produce any unpleasant pressure points. The hold of the barrel on the lead was firm, so it did not have any unsettling give to it like some tips do (are you familiar with mechanical pencils that have some "bounce" to them when you write? That's some bullshit) and because of this it delivered exquisite control over the line. The eraser was but a nubbin, but it was a dynamo at erasing fine lines, and if you used it judiciously for detail work, it would last for quite a while. I can't remember the brand of this pencil--I want to say it was either a Zebra or Pentel, but neither maker has anything on the market at present that looks quiiiiite like what I'm looking for.

Here are some other pencils I've used in the recent past.

The Bic disposable mechanical pencil. I've used these since college. They're...fine. I'd use it for taking notes that I didn't need to be particularly neat. It wouldn't break my heart to lose them, and so I did, often. But the barrel is a little small and hard, and my hand would get tired often if I used them for prolonged periods. Also, the eraser is shit.

This Pentel twist-erase situation. They're OK. The barrel is nicer (wider, and though the rubberized grip is ribbed, it's not ridged in an way that hurts your hand), and it sports nice long eraser refills. It clicks lead from the top, not like those pencils that have their clickers on the side, where the grip is, like some kind of LUNATIC PENCIL which doesn't understand that THAT'S WHERE YOU HOLD THE PENCIL WHEN YOU WRITE, WHY WOULD YOU PUT THE LEAD ADVANCEMENT BUTTON RIGHT WHERE YOU'RE HOLDING IT TO DO WORK? (Sorry. I have Many Pencil Opinions.) But the lead it comes with is garbage (yes, I know I can swap the lead out) and something with how the mechanism holds the lead it place feels not quite firm, like there's some wobble or give to it. Again, it's OK. I use it to do my stats homework. But I miss my old pencil.
These pencils are garbage, which is why I get them for my kids. (She said lovingly.) They cost $20 for a million of them and they come in that fat lead that is harder to break. I also keep a bunch of them in a jar on the piano, so that kids who come over for chamber music rehearsal can use them to mark up their music. If someone takes or loses these pencils, I could not give less of a shit, but I will not touch them to do my own work. They also have that illogical side lead advancement mechanism, because TRASH.

So I was looking at this pencil (the Pentel Graph Gear 1000 Automatic Drafting Pencil in 0.5mm), because it looked like it might have some of the features I was looking for, but...I don't know. The eraser is spot on, and in fact makes me think that the pencil in my memory was a Pentel. But the nubbled grip and the textured metal looks...painful. The pocket clip looks kind of high profile, or prone to breakage. And the price tag. I can't remember how much my original Platonic Ideal mechanical cost (and in fact, I might not have purchased it at all in the first place--it's entirely possible I stole it from Joe and just kept it because MARRIAGE) but for upwards of $9, would I be too worried about losing it to use it? Probably I could find it cheaper off Amazon (Amazon does tend to charge a markup for teeny weeny cheaper items that cost more to ship than to buy), lazy. I have also glanced at some of the pencils on JetPens, but some of the nicer ones cost, like, $20-$30 each, so if they're not going to make me breakfast in the morning, they're really going to have to be something special. (Which is not to say I am not open to being convinced--I have a gaping soft spot for office supplies.)

Tell me what pencil I should buy. Thank you for your pity.

Tuesday, May 29, 2018

one flew over

So we had this bird nest in our garage. Our nanny first noticed it a few weeks ago, high up on a shelf something like eight, nine feet up, propped on a shelf against a corner, atop of a pack of Costco bulk terry cloth towels. We've had a broken window in the garage for...I don't know, probably going on a year now (don't judge), and I suppose it was only natural that at some point, a bird might find its way indoors and make itself at home.

"What kind of bird?" a few people at work asked me when I brought it up, but I couldn't really say, since I never actually saw anyone in the nest. For all I knew, the nest could have been there for months, and I just never noticed it sitting there, high above my head.

However, the nest apparently did have an inhabitant, and around Mother's Day, she let us know.

This also gave me a slightly more specific answer to the "What kind of bird?" question, because at least now I could say, "The kind of bird that lays eggs that look like that." 

The consensus in the anesthesia lounge, both from the build of the nest and the speckling on the eggs, was that these were Carolina wrens. There were five little eggs tucked in there, the size of those Cadbury chocolate eggs with the candy shells sold around Easter (they're what M&Ms should ideally be, in my opinion--better chocolate, thicker shell), and while it certainly made me somewhat monstrous for thinking of this mother bird's clutch of eggs in terms of snack food, I'm sure in the wild, outside of the safety of the high shelf in our garage, the eggs would be a snack for someone.

I had no idea what the gestational age of a baby bird is, particularly when the species is unknown. So I checked on this clutch of eggs a few times, but not daily, as I didn't want to spook the mom (again, I'd never seen her in the nest, for all I knew she'd already abandoned the eggs that the creepy Chinese lady kept peeking at), and anyway, it's not like anything interesting was happening.

Then, one weekend about a week and a half ago while I was in New York, I got a picture text from Joe. 

"I'm not sure if they're dead," his text read, "they're not moving. Maybe the garage was too hot for them?"

Since I was not there, I couldn't really weigh in, and I certainly couldn't tell from the photo. What could we have done, anyway? Put a little mirror under their beaks to see if it fogged up? Put on teeny tiny EKG leads? Put them on ECMO?

"Don't touch them," is all I could think of to reply, "and don't show the kids, it'll make them sad." It was a still photo, but Joe assured me that a video would look no different. And hell, babies that you can't see moving or breathing at all? Sounded pretty dead to me.

When I got home at the end of the weekend, the first thing I did (well, in truth it was maybe the third thing, after putting down my luggage and going to the bathroom) was stand on a chair, put my camera on a selfie stick telescoped out as long as it would go, and take a picture of the nest.

They were not dead. 

I exhaled a long breath I didn't realize I'd been holding in up until that moment.

When I took the MCATs back in--good lord, I think it was the summer of 1997--I remember this one section in the "critical analysis and reasoning" section. This is the part of the test where they give you some deathly dense and deliberately boring excerpt of technical writing and ask you a lot of questions about it afterwards to ascertain that you were able to not only stay awake, but actually retain and synthesize the information. (While this might be a reasonable test for how you would fare in med school, I will venture to say that it has only marginal bearing determining how good of a doctor you might eventually become.) Anyway, most of the sections were, as I said, deliberately inscrutable--an excerpt from a technical manual about how to extract aluminum via electrolysis, for example--but some reading selections were sort of interesting, probably by accident. 

This one I recall was about the breeding habits of certain birds in which "obligate sibicide" was the norm. Meaning: the bird will lay two or more eggs, and as a necessary evolutionary flourish, survival of the fittest, the stronger siblings will kill one or more of the weaker ones. Always. As a rule. I obviously didn't retain too much of what else I had read (though, to be fair, it was more than 20 years ago), but I figured, hey, five eggs is a lot of eggs. Probably by design. It was probably normal to lose a few by attrition. It's likely what we should expect, in fact.

I checked the nest every day (at this point Joe had set up our tallest ladder by the shelving and just left it there because apparently I was becoming the goddamn Birdman of Alcatraz and the ladder was heavy) but I would always approach with this vague, atavistic dread that at some point I'd happen onto one or two or five dead baby birds.

But there were no dead baby birds. Every time I peeked at them (just peeked, never touched), I did a quick head count. I couldn't tell them apart, I didn't name them or anything, I wasn't crazy--but just a quick head count. One, two, three, four, five. Every day, all five were there. 

Sometimes they would be in a different order, sometimes a few of them would be hiding in the back, but always, every day, five of them. They grew.

And grew.

And grew, until their ceiling hung with vines, and the walls become the world all around.

Yesterday, when I went to peek at the birds, it started to look a bit crowded. There was that adolescent gangliness to the brood--they still all seemed content to stay inside, they had a few tufts of baby down showing through, but the nest suddenly seemed like all arms and legs. 

And then this morning, just like that...

...they were gone. 

Joe caught a glimpse of one of the no-longer-babies early this morning, hopping around on a cardboard box by the recycling bin, virtually indistinguishable from the adult birds we'd seen about, but for the few sprigs of downy fuzz it had yet to shed. But by the time I got home from work, none of them were left. The garage was suddenly very quiet.

I'm not totally sure why I'm telling this non-story. After all, it's not really that interesting--lots of people find birds nests near their houses, baby animals come and go all spring and summer, the "empty nest" analogy as applied to human children is trite and hoary, and something I honestly don't really know about yet. (Soon, yes. But not yet.)

I think it was my reaction to the birds. The way I automatically assumed the worst. I think this happens at work a lot--in fact, I think the reason I sometimes assume the worst is because of the work I do. It's like a protective mechanism. You learn the statistics, you recognize patterns, you make predictions, you prepare yourself. Hope for the best, sure; but always, always, always prepare for the worst. Prepare yourself for the bad outcome and you'll never be surprised or disappointed. It's the bad outcomes you allow to blindside you that will truly break your heart.

But you don't always get a bad outcome. Even sometimes, when you should get a bad outcome, when you fully expect don't. You're surprised the other way. People beat incredible odds. Genuine miracles happen. 

When I was a resident doing a rotation in the cardiothoracic ICU, there was a saying we'd murmur to each other back and forth on rounds, under our breath. Well, it was maybe not even so much a saying so much as it was a known phenomenon. "You fly or you die." Patients who had major cardiac surgery seemed to have two paths. Either they would do great--they would fly--or they would limp out of their moment of crisis, hobble through the next few days and weeks, accruing one complication after another, and eventually, succumb. It wasn't absolute, but it held true enough that it was accepted as near uniform fact. You fly or you die.

Life is not nearly as uniform or algorithmic as we would sometimes like it to be, of course. The comfort of a logically predicated outcome and the inurement against heartbreak can sometimes close you off to the possibility of an improbable result. Worse yet, sometimes one becomes so jaded against good things happening that the possibility of a good result seems less likely than it should.

I'm not saying that having five baby birds born in our garage and having all of them survive to leave the nest is an improbable result. From most of my limited conversations with other people who've had firsthand experience in such matters (so...two conversations, then) this in fact seems par for the course. 

But maybe that's not the point either. Maybe the point is just that surprise and delight can sometimes go hand in hand. And that delight can be found in the most improbable places, exactly when you least expect it.

Thursday, May 24, 2018

vintage scutmonkey: psych

OK, I think this is the last of this throwback series. It also happens to be the first "Scutmonkey" comic I wrote (even before "The Twelve Types of Med Students," even*), and I finished it about a month before I graduated from med school. It seems that the Wayback Machine doesn't archive every last image in a deep side branch of your main blog, which is why half the panels are kind of greyscale and janky (photos of a photocopy, you know). But hopefully it's all still legible.

Two small points. One is that I think it's not necessarily the kind of topic I'd write about so freely now, because, you know, mental health awareness is important and sensitive and all that. But for what it's worth, every single patient interaction or expressed delusion in this comic was absolutely true, almost to the word (if somewhat condensed in certain cases). Actually, all of it is true, right down to what people wore. (I was mesmerized by the chunky pendants and flowing tops my course director wore and therefore studied them in great depth before drawing them...badly.)

Second point. The building we used to refer to as the "old Psych Institute," shown in the first and last panel of the comic, is now the School of Public Health at Columbia. It's the exact same building--it even still reads "Psychiatric Institute" in the carved stone arch over the door--but, you know, they put up a new sign at eye level. So the one part of this comic that's not true is that I never went back. I am back, and the location seems like a tiny bit of poetic justice.

* Edited to add: I was wrong. I looked at the dates and I finished "The Twelve Types of Medical Students" 2 days before I finished this one. I had likely started this one first, though, because, you know, it took longer.