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Tag Archives: Random Thoughts

How to heal the human soul?

When I started writing this blog, I wanted to give people something to smile about. Maybe something to show people that medicine can be difficult, but it can also be a lot of fun. Last night one patient reminded me that medicine isn’t always so fun. A poor old guy got brought in by ambulance after pulling out his dialysis catheter. He got mad and did it on purpose. Told his wife he didn’t want to live anymore and just yanked it out. “Why did you do it?” I asked, already knowing the answer. He looked me square in the eye and matter-of-factly said “I’m sick of living, doc. I’d just rather be dead.” I asked him what his wife thought about all this. “It’s not about her, it’s about me. I’m a burden to her. Look at me — I’m 67, have diabetes, have the shakes from Parkinson’s, am half blind, and have to be on some dialysis machine three times a week just to keep me alive.” “Sure, things may seem bad,” I said, “but don’t you have grandkids? Don’t you want to be a part of their lives?” “Yeah, yeah, you’re not the first doctor to ask me about my grandkids. I hardly see them anyway. All they know is that their grand-dad is sick.” “Besides,” he said, holding out his shaking hands, “look at these hands — I can hardly feed myself.” Then, raising his voice, he lamented “It takes me an hour to shave using a rotary razor. Life just isn’t worth living anymore.” “Well don’t you have any hobbies you enjoy?” I asked, starting to grasp for straws. “No. And I’m done talking to you. Don’t ask me any more questions, because I’m not going to answer them. We’re through.” “But…” And then I was cut off by that pervasive stare. He held a finger up between us, and I couldn’t tell whether the shaking was voluntary or involuntary. But he got his point across. I hung my head in defeat, patted him on the shoulder, and walked out of the room. I had the nurse give him some IV Ativan to help him sleep. Not sure if that was more for his benefit or for mine. I can sew up a laceration like Betsy Ross sewed the flag, diagnose a bazillion types of rashes, bust an MI or stroke within 10 minutes of the patient hitting the door, but I can’t heal the human soul. Damn.

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"Floor Throwing"

Want to get out of the waiting room more quickly when you’re in the ED? Throw yourself on the floor. A patient who has been to our hospital 350 times in the past 8 years (that’s as long as we have been logging the visits) for complaints such as headaches (don’t worry about tumors – you’ve been radiated enough to cure any of those that might pop up) and back pain (no, mild bulging discs that haven’t changed on the last 12 MRIs are not a medical emergency) came during a very busy time. Isn’t it funny how severe pain incrementally increases on subsequent visits? If “0” is no pain and “10” is the worst pain in your life, how is it that someone’s pain can be a “10” on their last consecutive 27 ED visits? I have to raise my eyebrows when someone with 350 hospital visits for pain complaints rates their pain as a “10” on a 1-10 scale. Then the next day, after depleting the hospital reserves of Demerol, this poor soul is seen lifting grocery bags 4 at a time into the trunk of her new Cadillac. But I digress … Not only were there no beds in the ED, there were no seats in the waiting room. She had to sit in a wheelchair. With a 10 out of 10 headache (that is worse than the 60 or so previous headaches for which she has sought treatment in the ED in the past 8 years), she didn’t like that very much, so she threw herself out of the chair and laid on the floor. Of course, that created a problem because several of the patients who were waiting ahead of her then came up to the registration window and said “there’s a woman lying on the floor out here.” What those people didn’t realize is that this woman who was gaming the system just gamed them as well. She just jumped the line. She is about to cut in front of everyone. Yes, ladies and gentlemen, you’ve been waiting patiently but because the amount of circulating narcotics in this woman’s bloodstream has hit a critically low level, she will now be seen immediately – ahead of you. The nurse came out to the waiting room and told her “Ms. Hammer, get up. You’re too heavy and I’m not going to try to lift you.” Of course, she got right up and sat back in the wheelchair. Then she was wheeled back into the ED with a smug little grin on her face. Bottom line: floor throwing works

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Chinese Pager Torture

OK, while I’m at it, I have to add one of the terms I created. No offense to the Chinese on this one. Even Wikipedia isn’t sure how the Chinese got implicated with this term. According to Wikipedia, Chinese water torture occurs when “water is slowly dripped onto a person’s forehead, driving the victim insane.” Chinese Pager Torture occurs when a doctor slowly keeps getting pages all through the night until the doctor goes insane. Here’s an example as described to me by a colleague (I embellished just a little): 9:00 PM – Put kids to sleep. 10:00 PM – Go to bed. 10:30 PM – Get a page just as entering REM sleep. Patient is having a colonoscopy in morning and wants to know what type of laxative to take. Have patient read instructions to you. Explain what citrate of magnesia is. Call in prescription to pharmacy because patient wants to make sure he is getting the right laxative. 11:00 PM – Go back to bed. 11:15 PM – Get another page just as entering REM sleep. Patient’s girlfriend was just diagnosed in the ER with gonorrhea and wants to know if he should get checked. Refer patient to office. Patient does not want to go to office because he has been intimate with office nurse in past. You just want to go to sleep. Refer patient to ER. 11:35 PM – Call from answering service. Patient has called several times and threatened to sue them if they don’t put her through to physician on call. States she ran out of her blood pressure medications three days ago and now feels that her blood pressure is high. Wants physician to call in prescription so she can pick it up at pharmacy tonight. Call patient back. Ask patient why she feels her blood pressure is high. She states that her husband saw the blood vessel in her temple pulsating and that always happens when her blood pressure is high. Tell her she will have to wait until the morning and see her physician in the office. She threatens to sue you if she has a stroke. Pull phone away from ear and make face at phone receiver miming the words “Blah Blah Blah.” Look up the ER call schedule. You don’t particularly like the ER doc working tonight. Send patient to the ER, too. Get temporary bit of satisfaction for payback to ER doc from previous bogus chest pain admit. You’re officially getting slaphappy. 12:10 AM – Page from patient who is having chest pain and sweating. Beeper wakes baby up. Patient wants to know if it is OK to go to the ER. Tell patient he needs to call ambulance immediately. Patient asks if you can call 911 for him. Tell him “No . . . hang up the phone and dial 9-1-1.” Patient’s wife, who was apparently listening in on extension, suddenly yells at you for having a bad attitude. Get ticked off, hang up the phone, and go to the internet to look up laws on eavesdropping in your state. 12:40 AM – You’re officially wide awake. You have rocked the baby back to sleep and put her in bed. Now you can’t go back to sleep and are sitting upright in bed staring out the window because you know the pager is going to go off in the next 10 minutes. You just know it. 12:55 AM – Page from the hospital. Begin to wonder if you are psychic because you can predict pages within 5 minutes. Start to think that the nurse was probably paging ...

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Fretching

Ever have someone complain of vomiting? Just like your car works fine when you take it to the auto mechanic, vomiting patients never seem to vomit when you see them. Well one lady today decided she wanted to drive the point home that she was *really* sick. So she began retching loudly over and over again as if she was going to vomit. Everyone ran around pulling the cabinets apart looking for a vomit basin. They found one, rushed to hold it under the patient’s chin, and then she hawks up a little loogie and spits in the bottom of the bowl. Everybody just threw up their arms in the air, rolled their eyes and walked away. No ma’am, that’s not vomit, it’s saliva. Possibly a small amount of sputum mixed in, but the predominant composition is saliva. After the patient left, I commented about how the people who retch never seem to get up any stomach contents. My nurse called the process “fretching” – fake retching. Congrats, Colleen – your new word is the first post on the blog. Will submit this to Websters for their consideration next year. Update: Although not contained in the dictionary, the word “fretch” has been used before. Rats.

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