I dedicate this book to my father, Allan G. Farrago.
Some of my fondest memories of you are when I made you smile.
You died too soon. I miss you, Pop.
CONTENTS
INTRODUCTION
MEDICAL SCHOOL
Introduction
Stages of the Physician
Medical Students’ Revenge
ER Stuff
Maggots/Magnets
Those Darn Narc Seekers: Talk About Blowing It
Smudge X-Ray Files:
The Big One • Here Kitty, Kitty
Lord of the Rings
A Salute to the Barn
Medical School Mishaps
Why I'll Never Forget The Summer of ‘92
A Medical Student Translation Guide for Patient Complaints
Synchronized Swimming
PJ Consulting
Millennium Stethoscope
Picket Fences
Bot Fly on the Brain
Respect
Those Darn Narc Seekers:
Perc or Drip?
My Favorite Munchausen:
Lymphedema Lucy
Moody
True Tales of Mistaken Identity
Anomaly
Fubigmi
Make Your Questions Clear
Escapee
Everyone Needs a Nickname
Going NUTS in Anatomy Lab
Cracking (Up) the Code
Medical Memories from the
University State Pen
“Well, don't come to my house!”
Night Stick
The K-Y That Got Away
The Surrogate Patient
Zingo!
Que?
Myagra
My Favorite Munchausen:
I Could Sure Use Some Fresh Air
THE RESIDENT
Introduction
Timing Is Everything
X-Ray Files:
Drinking Buddies
Nightmares
Puzzling
“Get Me Out of Here!”
Cyanara
Those Darn Narc Seekers:
Armed and Dangerous!
My Favorite Munchausen:
Just a Stone's Throw Away
Chux
A Sticky Situation
Trauma Alert
First Night
Pasta Anyone?
Ouch!
Bright Lights
Diener
Rub
Uterall xr and Placertala
Potato Love
A New Year
Need a Bed
Now That's a Rectal!
Those Darn Narc Seekers:
No Self-Defecation!
My Favorite Munchausen:
Rosey the Red
Digit of Death
New Medications for Smokers
Those Darn Narc Seekers:
Hamburger Upper G.I.
A Little Premature
Shrunken Head
Problem?
Sleep Study
Teachable Moment
The Wig
Nordart Contraceptive
My Favorite Munchausen:
Pheo, Phio, Pho, Phum
X-Ray Files:
Throckmorten Sign with a Twist
PBJ
Are You an Investigational Whore?
Never Too Late
THE NEW DOCTOR
Introduction
“I Gotcha!”
Windy
Top Ten Clues
Just Can't Get Pregnant
Here's One Way to Beat the System
Those Darn Narc Seekers:
Laboring Over Her Pain
My Favorite Munchausen:
Paul the Popper
Language Problems
Voice Recognition Blues
Hot Diggity Dog!
Garbage Can Lady
Life on the Farm
In the Navy
“Committee” Committee
Too Personal
Out of Body Rounding
Make Money Naturally!!
X-Ray Files:
Oral Hygiene
5 Effective Techniques to Help You
Communicate with Pharmaceutical
Representatives
Death by Moving
My Favorite Munchausen:
Clipping
Power Lunch
Lucky
Cameloft
Flatus Maximus
A Problem Patient Comes and Goes
Hairpin Curve
A Bad Itch
A Stitch in Time
X-Ray Files: Remote Control
Strike a Pose
Bill Millionaire
Scooby Snack
True Anecdotes
A True Diagnosis
X-Ray Files: Make 7 “Up Yours”
My Favorite Munchausen:
Insulin-Cravin’ Sweet Teeth
8 CM – The Movie
Benzo Begger
The Timmy Fund
Those Darn Narc Seekers:
Have Stones, Will Travel
Top Ten Ways a Drug Rep
Pisses Off a Physician
X-Ray Files: Butt Light
Scambien
Those Darn Narc Seekers:
Yellow Bill
THE EXPERIENCED DOCTOR
Introduction
PJ Explains the 80/20 Rule
of Medicine
Doctor, I Can't Keep It Up
Much Longer …
Be Careful!
Top Ten Things Your Mother Always
Told You to Do That You Wish
Patients Listened To
Physician, Heel Thyself
PJ Explains Bowel Obsession
Top Ten Ways to Get “Hunkered Down”
Patients Out of the Hospital
Back in the Day
New Doc vs. Old Doc
Here Kitty, Kitty …
Indifferex
PJ Says: Suck It Up!
Cold as Ice
Creams Don't Work
The Doctor's Rules
Those Darn Narc Seekers:
Jack ‘n the Back
My Favorite Munchausen:
Something Doesn't Smell Right
“Hear Today, Gone Tomorrow”
Let Them Her Eat Cake
Smelly Feet
PJ and a Barrel of Monkeys
X-Ray Files: Bright Idea One and Two
Not So Bright Idea
COPD Terrarium
List of Bad Prognostic Signs
Answering Service Tips
PJ Explains “Why HMOs
Can Kiss My Bony White Ass”
Hospice Tales
Godivaphage Xr
Stand Up! Quick!
Radiology Woes
Learn to Talk Administralian
PJ Talks About ED
Case Records of the Placebo General Hospital
Official Physician Hand Signals
Are You Sick?
Oxycotton Candy
Thoughts from an “Experienced” Doc
X-Ray Files: Bolt • Doh! • Bird
War Is Hell or What's That Smell?
A 2 A.M. Phone Call
Duct Tape
Diary of a New Drug Rep
PJ Explains: Smoke ‘Em
If You Got ‘Em
Why Couldn't You Hate Me?
Alcoferon
X-Ray Files: Easter Bunny
Medical Brush with Greatness
Get Off the Road
<
br /> Is It in You?
She Was Not Out of Earshot
Top Ten Ways Physicians
Piss Off Drug Reps
Dementia Safe Invisible Fence
X-Ray Files:
Hung-ry Like the Wolf
Cookie Monster • Kenny
Things I STILL Don't Understand
After Being in the ED for 15 Years
Strategic Filibustering
Top Ten Things I've Always Wanted to Say to Patients
After 30 Years as an ER Doc: My Favorite True Stories of Medicine
More Than a Pen Whore
Gunpoint B#owjob
My Favorite Munchausen:
She's No Coloring Book
CONCLUSION
Acknowledgments
So, you think you know a little about
a physician's life, huh?
You think just because you have seen a reality program showing an open-heart surgery or a baby being born that you know what physicians are going through? Well, I am here to tell you that you don't know diddly-squat. You are missing a big piece of the picture. Most physicians are on an emotional roller coaster that gets wilder each day. Did you know that forty percent of doctors feel burned out? Did you know that one in four doctors are on a medication for a psychiatric illness? What does this mean to you? A lot. With all this stress comes great stories!
For the past two years Placebo Journal has been chronicling these stories. Placebo Journal is the only medical journal that makes its readers laugh and allows its contributors to vent their frustrations. Since most Placebo Journal readers and contributors are physicians, I feel that in some way the magazine has been providing a sort of therapy for this class of struggling professionals. Interestingly enough, however, as the number of humorous, gross, amazing, and interesting stories has grown, so have the numbers of laypeople who read them and love them. Sure, much of it may make their stomachs queasy, but like driving by an automobile accident, they can't look away. So I decided to open up the Placebo Journal’s story vault and publish The Placebo Chronicles. If you're a regular reader of Placebo Journal, you'll know my ulterior motive is to make some extra cash – Medicare and HMOs pay like crap nowadays.
You may be asking yourself, “Is it okay for my doctor to laugh at his experiences, especially if they involve me?” Not only is humor in medicine okay, but I think it is desperately needed. “Humor” and “medicine” may not seem like two words that go together naturally. But humor may be the only way for doctors to survive the increasing pressures of the medical profession. Our jobs as physicians can sometimes be dehumanizing and we may end up getting thick-skinned in order to survive emotionally. The problem is that physicians are, in fact, real people with real emotions. They are human like most of you (there was a joke in there somewhere). Just because they took the Hippocratic Oath does not mean they promised to become RoboDocs. In fact, many of the same things that rattle your cage rattle theirs. You know that aunt who drives you crazy with her complaints about every ache and pain? Remember where you always tell her to go? To the doctor! Well guess what? She drives her doctor crazy, too.
The stories and opinions in The Placebo Chronicles come from physicians around the country. All of them are true. Forget Marcus Welby MD, St. Elsewhere, or even ER. You want reality? Well, this book is it. These are the stories that doctors tell each other while sitting in the doctors’ lounge. These are the stories that doctors laugh together about at parties. These are the stories doctors commiserate about when considering switching careers.
If you want philosophic advice, beautifully
written prose, or thought-rovoking concepts,
then you need to look elsewhere.
If you want to laugh at the medical system as we know it and don't mind the offensive, you will love this book. We have stories from each stage of a doctor's life: medical student, resident, new doctor, and experienced doctor. We have stories about problematic patients: narcotic seekers and Munchausens. We will show you how doctors relate to HMOs, pharmaceutical companies, and much more. Plus, we have some pretty interesting X-rays that will beg the question, “They put what in where?”
Why the name? The Latin definition of a “placebo” is “to give pleasure to.“ Interestingly enough, just like a placebo pill, our journal sometimes produces a positive effect from something of very little substance (as you will soon see). Also, like the placebo, many times it does no good at all. Whether it's a placebo or not, I have found that editing this rag has been the best thing for my own mental health. It is the psychotherapy that my HMO has repeatedly declined to cover. You see, I was burning out. I slowly began to recognize the subtle signs. For example, I found myself buying lottery tickets to give to patients so that I could bribe them to go away and leave me alone. At other times I was pitting my male patients against each other in a cruel game of “bobbing for Viagra” using a bucket in my waiting room. I needed help. The answer I found was to share my stories, as deranged, unprofessional, and embarrassing as they might be, with other doctors. I realized that I was not alone out there. These shared experiences became the Placebo Journal and, now, The Placebo Chronicles.
Now let me be serious for a moment before you read on. We don't mean to denigrate the practice of medicine, our patients, or other physicians. We do mean to show the human side of the medical profession. Sure, we may mock or laugh at the mentally challenged, but what else are you going to say about hospital administrators? We don't print any stories in which a patient's care was compromised. Sometimes, however, you will find the stories cross the line of good, or even marginally acceptable, taste. They are crude, funny, and a telling commentary on the mental state of physicians today. Live with it. It's not like we write about doctors having sex with their patients. We are leaving that for the veterinarians.
Bottom line: There is no mission to change the world and this didn't take years of preparation, hundreds of focus groups, and tons of venture capital to get started. The concept is simple; I want to make physicians laugh at themselves, their patients, and at medicine in general. Without some sort of outlet such as humor, doctors run the very real risk of becoming desensitized to the human element in this profession. And without empathy, patient care standards suffer. Doctors who laugh regularly have a better shot at delivering good, compassionate care than those who are burned out, overwrought, and taking themselves too seriously.
Placebo Journal, and now The Placebo Chronicles, answer the command “Doctor, heal thyself.” Now you get a chance to enter this secret world and laugh along with your doctor. Just don't bust a gut doing it – he's overworked already.
Douglas Farrago, MD
MEDICAL
SCHOOL
The long, grueling process of becoming a doctor begins with medical school. It's four years of hell after college. It was the hardest thing that I had to go through in my young life until, of course, residency, which was even worse (you will read about that in the next chapter).
Just getting into medical school is an incredible feat in itself, the first of many Darwinian trials an aspiring doctor faces. You need exceptionally high college grades, which isn't easy because competition grows stronger and stronger. As time goes on, the weakest students give up and the strongest students hang around, totally screwing up any type of testing curve. The pressure to succeed is enormous. I remember the shock of my first chemistry class in college. There were five hundred people in it and almost all of them, including me, wanted to go medical school. Only ten or twenty would succeed. No one would have predicted I would be one of those ten or twenty. Not even me.
In medical school, the whole competition process starts all over again. The testing is outrageously hard and the hours are ridiculously long. The first two years, the medical student actually has minimal patient contact since he or she is wrapped up doing the basics of science including biochemistry, neurology, chemistry, histology, etc. When the “clinical rotations” start in year three, the real fun (or horror) begins. Here is
where the student spends months at a time seeing patients in such areas as internal medicine, surgery, emergency medicine, and obstetrics. Finally, young men and women who are tired of just the textbooks get a chance to try to treat live patients. This is a real eye-opener for them. This is when they start to see it all and feel it all. This is where they learn to develop their defenses against the gross, the sad, the disturbing, and the outrageous. I am not sure if having such thick skin is a good thing for doctors or not, but it is our basic survival mechanism to deal with these types of things. Seeing children die, arms that were severed, hearts splayed open, yellow patients, green patients, and blue patients are shocking, but a reality nonetheless. Any time taken to wallow in their own pity only takes time away from seeing other patients. The student buries his or her emotions to do his or her job and learns a valuable lesson: Medicine is not pretty.
I remember in my first anatomy class there was this sweet girl who was initially very bothered by the cadavers. The school had done all the right stuff to slowly introduce the new students to their “bodies.” There were prayer sessions for those so inclined. There were warm-up periods so that people could acclimate to the cadaver. Still, people were squeamish, especially this one young woman. I didn't pay her too much attention because I had enough work to do on my own cadaver. I had totally forgotten about this student until halfway through the semester when I saw her walking by, whistling, with a sawed-off leg over her shoulder like a slab of meat. I thought to myself, “Haven't we got a little sassy?”
Now picture yourself as a medical student. See yourself trying to save a life all the while questioning whether you know what you are doing. You're nervous and exhausted. You're hungry and overworked. All you care about is sleep (and hoping you don't kill someone). As you become more and more disconnected from the real world, you fall more and more into the medical one. All you can remember are the basics of survival and those weird, gross or outrageous experiences that occurred during your dreamful “medical student” state. It is these patient encounters or stories, however, which you will remember forever. It is these stories you will collect like a hobby. They are ones you will never share with patients and only occasionally share with one another. They're not for the faint of heart but they are yours and yours only – until now. The following stories are ones that we have pried, bribed, or extorted from former medical students who have endured this torture. Their collection is now, for the first time, open for your perusal, but it comes at a cost. After reading them, you may become thick-skinned yourself and for that we have but one cure – humor. These doctors didn't laugh about their medical student experiences at the time, but trust us, they are laughing about it now. We hope you can do the same.
The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge Page 1