Tales from the Emergency Room (24 page)

The Weather Report

While we were driving through South Carolina one warm summer day, the weather lady came on the radio. She gave the current statistics and then said, “And tonight it will be dark!” My wife and I looked at each other and burst out laughing. No doubt that was the lady’s last day of work and she was having some fun on her way out. I did not pull anything like that when I retired from practice.

 
Reflections

The Practice of Medicine

In general, the education of doctors in pre-med is lacking. The quality of the courses they take before medical school is, or ought to be, excellent. The problem is with the pre-med curriculum. By the time many pre-med students are college seniors, there is little else that they are able to do but to continue on to medical school. So, while much is made of having a well-rounded education in college, this often turns out not to be the case. In my class in medical school, we had one student who did not have a college degree of any sort, and another who was an expert in Elizabethan literature. Both very learned people who seemed well prepared for medical studies. Most of the rest of us had a college education in general science with an emphasis on biology and chemistry. Since the first most important academic course in medical school was biochemistry, mastering that course alone might have been sufficient to allow some college science courses to be to be taken instead in general education; English, literature, the arts, history, etc. I think by now that may often be the case. One can hope.

Medical Student Behavior

Recently there have been reports of bad behavior by medical students on the Internet. These often take place in the social contact websites. Some schools are putting out guidelines for internet behavior to their students. As one medical facility doctor noted, outrageous behavior by medical students has been around much longer than the internet, but really should be kept under control. My medical school class approached bad taste on one occasion in a parody of some of our medical school activities. It got rave reviews from students and professors, however. The main problem concerned how to keep the grapefruit attached to “Mrs. Cumming”, whom I had the great good fortune to portray. But, in my medical school at least, there were very strict rules of behavior in force which we followed quite conscientiously.

A Learning Experience

Many years ago an old friend of mine underwent a radical mastectomy. She did well even in the days before chemotherapy and radiation. Eventually, however, she needed to have her other breast removed as well. By then additional treatments were also employed. When she was about 80 years old she required a pacemaker. In the hospital, the young doctor arrived to measure her for the device. He finally settled on a location for it and was preparing to leave, when my friend asked if he had any idea what her prosthesis was like for her to wear. He admitted that he did not, so my friend’s daughter brought it out from the closet. He was floored by its weight and size and knew immediately that a new measuring job was required for the pacemaker placement. He also allowed as how my friend had taught him an important lesson, one which his professors had not and one that he would never forget while preparing patients for surgery, especially when mechanical devices and incisions were involved. My friend is now about 92, doing just fine and wearing her prosthesis quite comfortably.

Primadonnas

Many physicians fancy themselves to be more important than they really are. This can lead to their being insensitive. One such physician, a pediatrician, encountered my wife in the hospital where she was visiting with our son before his operation for a hip disorder. We knew that this was a serious condition, requiring him to have a pin placed in his upper leg bone. I knew that it often developed in the opposite leg also, but my wife did not. The doctor asked why Billy was there, announced that the condition would probably be repeated in the other leg, and left the room. This left my son startled and my wife furious with the doctor for having upset both of them unnecessarily. Fortunately, he did not require another operation but was left with one tiny bit shorter leg.

On the other hand, many doctors give freely of their time to help in educating the public medically. A case in point was a local cardiologist who spoke to our Rotary Club about the signs and symptoms of a heart attack. One club member at lunch that day began to experience some of the symptoms described the next morning while he was still in bed after his wife had left for work. A review in his mind of what he had heard the day before caused him to call a neighbor for help. The Club member, another old friend of mine, was transported to the hospital not far away. He had cardiac arrest in the Emergency Room, was resuscitated and treated successfully with the methods then current. Today, he is in his mid-eighties, still playing golf and I’m sure still thankful for the good doctor at the Rotary lunch.

Teaching Aids

Remembering the names of things and how they work is important in any learning situation. Here are a few things I learned in medical school:

The Boxcar Theory—Bowel function, especially in the large intestine was easier to picture as peristalsis caused by one” boxcar” after another being propelled along the intestinal tract.

Parasitology Pearl—One studies the mite bite site of the house mouse louse.

Wrist Bones—Never Lower Tillie’s Pants, Mother Might Come Home. (Navicular, Lunate, etc.)

Cranial Nerves—On Old Olympus’ Towering Top A Finn And German Viewed A Hop. (Olfactory, Optic, etc.)

The tincture of time—on letting things improve by themselves.

The first rule of medicine—If what you are doing is working, keep doing it.

The two most alarming words in medicine—Oh, oh.

Keeping Secrets

Very early in my career I learned that it is nearly impossible to keep an illness secret.

One evening at a dinner party a high school classmate of mine, by now a prominent lawyer in town and our host, made a cryptic comment to another guest, also a classmate of mine and now a well-known physician, about his, the lawyer’s, health. I knew he had been under the weather but no one had any idea how sick he really was. Shortly thereafter, I happened to see his wife standing under the New York Hospital sign while I was travelling south on the IRT subway. Right then, I knew that my friend was seriously ill. After he died, I was informed by several people and by way of a newspaper article that no one in our town knew about his illness except for his wife and the other doctor at the dinner party. I had kept my suspicions to myself and no one knew how and why I had figured things out. He died at age 32 of Hodgkin’s Disease, almost certainly curable today.

Another time after I had parked my car near The Roosevelt Hospital very early in the morning, I practically bumped into a good friend and former patient just outside the Janeway Cancer Treatment Center. To my question about what he was doing there on the street, I got a vague answer about meeting a client. I didn’t put two and two together until about two weeks later when I spotted my friend at the same time in the same place. He didn’t see me and I made sure he didn’t, but I knew then that there was a problem. He died a few months later in his forties from a brain tumor. No one in town supposedly knew about his illness and I was not about to inform anyone otherwise.

The moral, I guess, is that keeping such information secret is not likely to work very well and makes it less likely that the patient will be able to benefit from an active support group.

Placement Tests

I think it was sometime around sixth grade that we took standardized placement tests, I suppose to see what sorts of occupations we might be suited for. I would do best as a secretary or a bus driver! I thought this was funny then and I still do of course, but my father, a school teacher, was horrified. The test results were wrong but I am a little compulsive about paperwork and could probably drive a bus if I had to.

In high school, I took Journalism and fourth year English at the same time and scored well in English on the New York State Regents Exam. I also took German 2 and 3 at the same time, doing well on both Regents exams. So I just knew I would be placed well beyond beginning level in these two subjects in college. Who knew? I landed in English 1-2 where my instructor complained that my writing style was too much like the “inverted triangle” used in newspaper reporting where the most important facts are put at the beginning of the article, becoming less important as the piece unfolded. But, I was placed in Advanced German Literature. Here I was in real trouble almost immediately. I was not alone. Fortunately, we had a kindly professor who made things as easy as he could for us. Even when I had to write my final semester exam entirely in German, I somehow muddled through.

The Grave Site

Since, according to a little old lady I used to care for, “more people are dying now than have ever died before”, my wife and I finally purchased a grave site in Dover, DE. My wife keeps a sign in the laundry room which says. “It’s Not Easy Being a Queen”. At the cemetery we found a nice location for our grave. We then realized that it was on the corner of William Street and Queen Street. We were particularly amused by the reaction of our son since he will be passing this location frequently in his patrol car. My wife’s comment about the fact that we will be buried one atop the other is TMI according to the kids.

Pet Peeves

Some people are so adept at disguising how unintelligent they really are that I get annoyed, mostly with myself, for not figuring this out quickly. With one patient, her lack of intelligence hit me one day while I was treating her. I mentioned this to my secretary who had no idea that I hadn’t known this as long as she had.

Some things people tell me also bother me. An example is the lady who announced at the outset of her initial visit that her dog did not bother her since it had “human hair”! I had to invent a non-peevish response to this on the spot.

And then there is, “Why didn’t you come for your visit last week?” “I was too sick to go to the doctor!”

Friends who are patients sometimes call me at home with a medical problem, and then complain that they couldn’t reach me. Well, of course they couldn’t since I wasn’t there. I explain as gently as I can that they should call the answering service which will always be able to find me.

I don’t pretend to have a great fund of knowledge outside of my field, but I do know when I am hearing statements of “fact” that are just plain nonsense. For the most part I have learned to keep my mouth shut when this happens, but occasionally I hear misinformation that actually could be harmful and then I speak up, as tactfully as I can.

“No shows” are patients who have appointments but don’t come in and don’t cancel the appointment. This was rarely a problem before I retired but is quite prevalent where I am now. Attempts to reach these people or to charge a fee for these missed appointments largely fail.

“Allergy” can be a sort of dumping ground for patients’ problems which are difficult to diagnose, and irritates me when I am expected to treat things like Alzheimer’s Disease, all manner of odd food intolerances and a whole range of non-allergic skin diseases. However, in fact, my career blossomed after I sent a patient back to the ENT doctor who sent her to me because he could not tell what was wrong with her and it had to be “allergic”. He had an enormous practice in town and had never sent me a patient before. So I did all the usual things including skin testing, and I could not find anything wrong which could be attributed to allergy. I was quite disappointed when I sent her back to the ENT doctor with negative findings. I could have easily said that she needed allergy shots, but I never did business that way. He called a few days later, told me that he had reexamined the patient and had found an anatomical abnormality that he missed initially. He complimented me on my diagnostic honesty and from then on sent all of his allergy work to me. A real coup for me.

Other problems include not receiving reports from physicians I have sent to other doctors, being called down because of the oral cortisone medications I need to use in higher doses than referring physicians would prefer, and having repeatedly to reeducate emergency room doctors on the correct treatment for allergic, sometimes life-threatening, emergencies

A Future Physician

Just the other day I looked up from writing some instructions for her mother and saw my five year old (“I’m almost six!”) patient with my stethoscope in her ears, placed correctly. As I went back to my writing, I felt my stethoscope pressed on my back. My patient, quite emphatically, said, “Breathe!” I did as I was told, as noisily as I could so that she would hear something through my clothes. When she was done with her exam, I asked her if she was going to be a doctor. “Probably,” she replied and went off to get her lollipop. Who knows, maybe someday she’ll write some tales about her life in medicine.