Tales from the Emergency Room (15 page)

A matter of days after I opened my office, practicing internal medicine and allergy (I later concentrated in allergy) I was sitting at my desk within earshot of the secretary with nothing to do. This secretary had worked for the doctor from whom I was renting part of an office for many years. When I heard her say that my appointment book was full, I bounded out of my office to confront her. It took me a moment to grasp the scene. There she was thumbing rapidly through my nearly empty appointment book with the telephone receiver lying next to the book on the desktop. Suddenly, she stopped turning pages, glanced at the current day’s page and, picking up the receiver, announced that she had discovered a cancellation that very afternoon. The patient took the appointment. My secretary quietly closed the book and looked up at me with an angelic if slightly smug smile. What fun it was to be around a person who really knew the ropes!

A Stuffy Nose

The husband of a couple we occasionally saw socially appeared in my New York office complaining of a stuffy nose. It was very early in my career. I knew about stuffy noses, but then he informed me that this only happened when he was sexually aroused. This I was not sure about and so after he left having had a few of the usual preliminary skin tests, I ran to the books. The answer was quite simple. There is erectile-type tissue in the nose and when it engorges with blood it can actually produce nasal stuffiness. (This is why stuffiness can be a side effect of the ED drugs.) So, of course this was not allergic at all and was nicely handled with a nasal decongestant used before sex. Made me feel rather clever. Of course, I never mentioned the patient’s condition to anyone remotely connected to my social life.

MOMA

A little, elderly, very wealthy lady bustled into my office one day in high dudgeon. This by itself was alarming because she was so petite and always sweet-natured. I asked what was up and she replied that she had just come from the Metropolitan Museum of Modern Art. She spotted a featured painting which consisted of a large, pure white square with the tiniest of red dots in the center. This, she decided, was not art, modern or otherwise, and that therefore she would no longer be gifting the Museum. At a loss as to what to say, I suggested that maybe later she would change her mind, but she was having none of it. I didn’t inquire about her decision at later visits since she had been so upset by it in the first place and I never got to the Museum to see the offending painting.

Occupational Hazards

One of my favorite patients was a very attractive widow in her early eighties, looking as if she might be 60-65. She was quite well off and kept very active. I had three problems with her, however. She kept following me around the office and, on occasion, would simply walk right into my office while I was seeing another patient. My reaction when this would happen was amusing, mainly to the other patient. Another problem was over her bill. She complained to me bitterly one day about my fee. It was the Medicare allowed fee, about $35.00 less than it would have been otherwise. She had Medicare and all kinds of insurance supplementals. The same lady however, thought nothing of paying her ophthalmologist $8000.00 (!) more than the Medicare approved fee for cataract surgery. Not only was it illegal for the eye doctor to charge such an amount, but, it was illegal for the patient to pay it. When I asked if she was going to report the doctor she took issue with this idea saying that she loved the woman (her eye doctor) so much that she would never object to her bill. I’m afraid that I then took issue with her complaint about my bill. Not long after, she called from Florida to insist that I write a letter indicating that it was medically necessary for her to stay there for a longer period of time. I carefully explained that, since I had not seen her before she left and that no indication of any sort for doing this was recorded in her chart, it would be unethical at least and probably illegal if I wrote such a letter and the insurance company found that there was no record of this necessity in her chart. Unfortunately this did not discourage her from continuing as my patient or from following me around the office.

Drink Coaster?

Whenever it became necessary to identify the molds present in someone’s home, mold plates (basically Petri dishes) were obtained, exposed around the house, then re-covered and sent off to the company lab for identification of what grew on them. We had a good laugh with one patient over the use of the exposed mold plates. It seemed that his brother-in-law (of all people) was enjoying a drink at the house and decided that the mold plate on the table in the living room was a coaster for his drink. It was some time before my patient noticed the problem. He corrected his guest and then continued to keep the plate exposed. He carefully marked it and noted the problem to us. Molds were identified in that room, but we did wonder if this was an accurate discovery!

The Condom Lady

There was a very attractive lady whom I had gotten to know because she came to the White Plains office frequently with her daughter. Eventually, the young girl, equally pretty, went off to college and was discharged from care. Several years later, the mother arrived in my office in New York. She was there she said because she had a little problem, allergic in nature, which came up after she began dating a man about whom she was becoming quite serious. She said that if they become intimate, with the AIDS problem, she wanted to be able to protect herself. Unfortunately, she was allergic to latex. I naturally advised her about “sheep skin” condoms, but with the caveat that the AIDS virus might not be stopped by these. She immediately began to smile when she realized what I had to say next, that her friend would have to use a latex condom under the natural one. At that point we were both chuckling. But then we had a really good laugh when she asked what would happen if he was allergic to latex as well. The idea of using three condoms at one time struck both of us as hysterically funny, but she seemed satisfied with the consultation.

About a year later, while I was standing on the buffet line at a hospital medical center annual ball, I felt a tap on my shoulder. When I turned around, there was my patient, on the arm of one of the leading physicians in town. Over the years, he had sent me many patients and I had cared for some of his family members. I knew he had been widowed and was remarried. When I saw who my patient had been referring to at our consultation, I was even more amused. Had I known, I could have assured her that she had no need to worry about her new gentleman friend. As it was, the two of us greeted each other without going into gales of laughter. I have wondered if she ever told her new husband about our consultation. My wife, of course, knew both people involved and she was privy to the whole funny story.

Flu Shots

Once again it was the flu season. A group of friends spent a long weekend every year at one friend’s beach house. We called it “The Adult Weekend”. One of the wives in the group, who was a patient of mine, had already had her flu shot in my office. I knew that all the others thought themselves too busy to take time for the shot. So, I brought along vaccine and needles in a brown paper bag. As soon as everyone had arrived and we were having the first drink of the day, I announced that they should all line up for their flu shots. Such a commotion! Well, they all did line up and had their flu shots except, of course, my patient who expressed herself thus, “Well, Goddammit, if I had known I could have gotten a free shot I never would have had one in your office.” Everyone knew that she did not spend any money out of pocket coming to see me professionally, but that did not keep her from railing on about it to the accompaniment of howls of laughter!

The Affair

Though young, he was one of the leading doctors in my community. He was a well known prima donna, as are many doctors, barely noticing my presence at conferences and meetings. He was married to a colleague of mine who was much involved in the politics of medicine. (Women doctors married to successful men, often other doctors, are able to run their practices without much attention to what income they earn. The reverse is true also, of course.) At a luncheon meeting in another town, I noted a very attractive woman pass by our table. I was seated so that I could see into the rest of the restaurant. Soon, I saw my colleague’s husband circle around the room and come up behind my chair. He whispered into my ear not to tell his wife that I had seen him here. The other people at the table looked at him curiously as he left, but the only note that was made of it was that his wife was not at our meeting as she would normally be. From then on, this physician greeted me warmly whenever he saw me, which I found greatly amusing though I remained thoroughly annoyed that I was expected to keep his secret. Just before I sold my practice, I joked to my wife at breakfast that, if the offer I was expecting was not satisfactory, I should perhaps suggest to the philanderer that he buy my practice for his wife. My wife was scandalized to be sure but we both found the idea amusing.

I’m a Surgeon!

Another example of high regard for one’s self occurred one night when I was on my way home from a social occasion, which involved a young physician whom I had not seen before or since. I was driving over the Hutchinson River Parkway when I noted what looked to be an accident on the roadway below. I pulled to the side of the road, about to have a look down below when another car with MD plates pulled up behind me. The occupant of this car rushed to have a look too, nearly knocking me over and then sprang down the bridge embankment all the time yelling, “I’m a surgeon, I’m a surgeon!” With rescue vehicles arriving and such an enthusiastic doctor on the scene, I felt my presence was not necessary. So, I continued on my way discussing with my wife the impertinent young man, who, from my license plates knew that I was also a physician. How he knew I was most assuredly not a surgeon I do not know.

The Food Challenge

This is another hard to believe story, but true. A mother brought her early-teen aged son in because he had been diagnosed as allergic to wheat. He did have allergic symptoms whenever he ate food containing wheat. His mother decided that he was merely faking the problem and that he was not allergic to wheat at all. We arranged to do a double-blind wheat challenge, very carefully. It became apparent quickly that the boy was allergic to wheat and that a really severe enough reaction might be fatal. And so, the mother and her son were educated extensively on how they should manage his diet. Luckily, this was a very smart kid who was interested in staying out of allergic trouble. He had none, but about a year later he showed up again with his mother, who by this time had grown tired of trying to keep wheat out of his diet. She insisted that he be retested. This time, we used a small amount of wheat to test him and he immediately developed symptoms. My main concern now was the boy so the discussion of his diet involved mainly him. He was quite happy to follow a wheat-free diet and not take any chances. His mother was not happy, but eventually he went off to college, quite able to manage what his mother had been so unwilling to do for him.

Marie

Since I was usually able to spend a fair amount of time with my patients, I came to know some of them quite well and often we became good friends. They would tell me stories about their own lives. Some are worthy of repeating.

Marie has been a patient and then a good friend of mine for many years. She is now a retired schoolteacher, linguist and world traveler. At one time airport bombings were all the rage. She and a friend arrived at Leonardo da Vinci airport in Rome one day at Christmastime. As they were standing on the passport inspection line, an airport employee said that another line was opening up in a different location if they were interested in speeding up their arrival in Italy. So they moved away from where they had been standing, where, almost immediately, a terrorist bomb went off, killing many. Marie and her companion dove under a banquette near a window where they stayed for several hours. Then, they were put on a bus, to sit some more. Eventually, military people boarded and examined everyone and everything on the bus. Finally, passport checks having been forgotten, their bus was allowed to depart for downtown Rome and thence to their hotel. Marie was always somewhat over-concerned for her health, but this episode did not deter her in the least from traveling. I kid her to this day about how close she came to disaster, but that she had managed to survive the airport attack even without my reassurances.

Because of her health concerns, I sent Marie to one of the finest internal medicine specialists in New York City. He had been a college and medical school classmate of mine and was in the enviable position of being able to limit the size of his practice. I practically begged him to see Marie as I had done with a few other patients. Years later at our college 50th reunion, I asked him to remember me to the patients I had sent him whom he was still seeing. He said, “I can’t.” Taken aback, I wondered why. He said that then he would have to sit and listen to them explain how wonderful Dr. Hermance was. Indeed, a fine compliment from a fine physician.

The Cardinal’s Sister

Miss L was, as she often said, an “unplucked rose”, which amused me no end. She came from a family of high achievers, a Cardinal of the Church, a famous thoracic surgeon and a judge among others. She functioned as the hostess for her brother the Cardinal, in the Midwest, so she was frequently off on another trip to make arrangements for or to travel with her brother. Two stories she told me stand out.

Miss L. was accompanying her brother the Cardinal and his valet on a trip by air. At the airport, she went through the metal detector first and the valet came next, both without trouble. However, when His Eminence passed through the gate, all the bells and whistles went off. He emptied his pockets, took off his watch, etc. and still the metal detector went off. This took several passes thru the machine before the valet suddenly started pawing through the Cardinal’s clothes until he found the Miraculous Medal he had pinned to his undershirt that morning. After it was removed the Cardinal was, quite miraculously, able to pass the metal detector test.