Telling a good tale enables the rest of us not only to laugh, but to be better doctors. We are proud that we were able to pry out some of the best of those anecdotes and put them here.
I remember it like it was yesterday.
I was on my “nights” rotation and was only an intern. They had paired me up with a second-year resident, Mike, who was known to be a little earthy, crunchy, and way too relaxed. At our residency, we didn't have call on our Internal Medicine rotation except for 36-hour stints every few weekends. Instead, we rotated through for a week of nights that started on Monday and ended on Friday morning. The two residents would come in at 5:30 p.m., stay up and work all night, and then leave the next day at 8 a.m.
We received Mr. Bell
on a Monday night.
It was actually going into Tuesday morning and the ER called and stated that this unas-signed patient needed to be admitted. After failing in trying to block this admission with every excuse possible, Mike and I went down to put him in.
He was in his nineties
and severely demented.
He lived at the Alzheimer's unit of the local psychiatric hospital and was septic. He was febrile and had severely low blood pressure. His baseline mental status was that of a wine cork. Talking to his caregivers at the other hospital showed that he was noncommunicative, did very few activities of daily living (except sit and feed himself), and had no memory of his family. We knew this because I called and talked to his sister. She was in her late eighties and actually came into the hospital with her husband. She told me that her brother had had no idea who she was for many years.
My senior resident and I had a pow-wow and came up with a plan. We figured that this guy is a goner. He already had bacteria seen in his blood on first look by the lab. Anybody who is febrile with a dropping blood pressure and blood that looks like bacteria soup has a mortality rate near 100 percent. We explained that to his sister and her husband and we all came up with the conclusion that comfort care would be the most humane plan. Humane to Mr. Bell and humane to Mike and me, who could sprint back to bed for 20 minutes of shut-eye after minimal work.
Putting this guy in the unit for sepsis would cost thousands of dollars to the taxpayers and even worse, keep our asses up all night with phone calls from brutal and tortuous unit nurses. We all decided that comfort care would include no IV lines (and therefore no antibiotics or fluid).
We would transfer him to PO3 (a regular medical floor), which was affectionately called the “Killing Fields” only because patients with comfort care usually were sent there. Okay, because the nurses there were old psychiatric nurses and they didn't have a clue how to do much more than crochet at night.
Mr. Bell was transferred to PO3 and I beat Mike on our sprint to the other side of the hospital where I long-jumped into my bed. I did get a few minutes of sleep that night but stopped in on PO3 to see if Mr. Bell had already expired. I needed to update the new team that was to pick him up. I passed his room and he was lying in bed and not moving. No oxygen. No IV fluid or antibiotics. Nothing at all …
… but he was still breathing.
That night when I came on, the resident in charge of his care stated that Mr. Bell was still alive. Mike and I wondered how the hell this could be. How long can someone live without any fluid much less being septic?
I worked hard that night and forgot all about him. Tuesday was moving into Wednesday and I realized that morning that I had not received the death call yet.
I went over to PO3 and looked to see if a chart was still outside the room (signifying that they cleaned out the room if it wasn't). To my disbelief the chart was there and so was Mr. Bell. Thirty-six hours with no fluid and infested with blood-borne pathogens and this guy looked like a Yogi in deep meditation.
I didn't know if he was still febrile because we cancelled all vital sign checks. The nurses there loved when we minimized their work.
This is when the dreams began.
Nightmares actually.
As I slept during the day at home, which wasn't easy to do comfortably, I dreamed that Mr. Bell was asking for water. It was killing me.
When was he going to kick off?
I truly believe we did the best thing. Even his sister said that he didn't want to live this way … being demented.
When I returned Wednesday night, I found out that Mr. Bell was still alive. This guy was torturing me! Mike and I debated again how long one can live without water. We found out that he did receive one shot of Rocephin in the ER prior to admission. I recommend we all get a shot of Rocephin when we are about to die. Seemed to have been ambrosia to Mr. Bell.
Wednesday night moved into Thursday morning and again I visited my old friend.
There was this motherfu%#&%, lying in a trance, but alive and breathing.
My rotation had one more day.
The nightmares continued.
“Water? Just a sip of water?” Now I was starting to stress. I was caught between guilt and anger. On one side I questioned my decision and on the other side I was ready to kill this bastard myself. Off I went to the last night on call. I didn't even ask if Mr. Bell was still alive. He was.
We then started to joke (all the day residents on Internal Medicine, Mike, and myself).
Should we leave some food or water next to his bed? Milk and cookies, like you do for Santa? Should we start antibiotics or food or pound him with a megadose of morphine? Soon the nurses asked me the same question. I jokingly said that if this guy gets up and asks for a drink, give it to him.
My last night was a bitch, but I made it through the week. I went to PO3 to see my old friend and say goodbye. Of course the damn chart with his name was still outside the door. Over 100 hours without fluid and he was still alive.
As I turned to walk in his room, I realized things had taken a turn for the worse. There was Mr. Bell sitting up with the morning breakfast platter on his lap, sipping a small glass of OJ. I didn't give him time to turn and look at me as I didn't want any more nightmares.
As far as I know,
Mr. Bell is still
alive today.
Like the movie Highlander, he may never die. I say this because someone who reads this story may someday take over his care. For that person, I recommend fresh squeezed orange juice with a slice of buttered toast. Just the way he likes it.
PUZZLING
As a third-year family practice resident, I started as chief of the medical service at our local community hospital. One of my patients was a middle-aged gentleman who was in for puzzling chest and upper abdominal pains. The previous team and their attendings, despite a battery of tests, were unable to ascertain the source of his pain.
Well, I sauntered in to work with him feeling, as a senior resident, that I could solve this man's problem. I did solve it, but in an unexpected way.
I did my complete history and was finishing up my physical with the mandatory rectal exam that every good house officer must do.
Suddenly the door flew open and
nurses, residents, and a code cart
burst on the scene.
When I asked what the heck was going on, I was told that at the moment I was performing the rectal, his monitor tracing suddenly registered 4 mm of ST depression! He was having a heart attack. Case solved.
“GET ME OUT OF HERE!”
I was in the last couple of months of my internship at a county hospital in Texas. I hated that hospital and those ringing bells on all the floors which would drive anyone mad. One day I got off the elevator and turned the corner to see a handful of visitors briskly walking away from a man who was very quickly approaching me. He was a patient and seemed to have just disconnected his chest tube. There he was holding it in his hand and this thing is sucking air and gurgling.
“Can you help me take this out?”
“Sir, I said, this is sewn in, let's find your doctor.”
I escorted him to the nursing pod and I was not surprised to find out that none of the nurse
s knew who his doctor was. Next, we got on the elevator to go to the surgery clinic on the first floor. I walked into the back with him, hoping someone would claim him. A frazzled-looking surgeon with glasses rushed forward and screamed “Mr. Jones, you are ruining my management of you!”
Mr. Jones’ reply … “ Big whoop.”
EDITOR'S NOTE: Maybe we should treat patients as people and not as diseases.
Armed and Dangerous!
Mr. Jayner was not a very complicated 38-year-old new patient. He supposedly had bipolar disorder (like who doesn't) and had come to me for back pain. A neurosurgeon gave him a discectomy nine months earlier, but he still had pain (now that was a big surprise). Two motor vehicle accidents later and this guy decides that I was to be his new source of pain meds.
I didn't know him from Adam, but since the neurosurgeon wouldn't give him his drugs anymore, I was to feel lucky that he was at my doorstep. That same surgeon had referred him to a physiatrist but it “didn't work out” according to the patient. After thoroughly degrading the physiatrist in front of me and calling him a quack, Mr. Jayner innocently mentions that only hydrocodone and OxyContin work for him. It must be hard for some people, with so many great medications on the market, to have your choices narrowed down to two.
I left the room and called a doctor he had seen before. He informed me that Mr. Jayner had just come out of jail and was not to be trusted. In fact, he had been abusive to his staff and they would not deal with him anymore.
When I examined him I found his acting ability quite good, but his findings quite benign. I gave him my talk about narcotics and abuse and said he didn't need this type of medicine. Funny thing, he didn't take it very well and gave me the line that we all hear, “Then what am I supposed to do for my pain.” I offered the usual assortment of NSAIDS, but he laughed that off. Fortunately, I was able to free myself of Mr. Jayner and get him out the door, but not before he gave me lots of guilt, as well as mild threats.
Within two days he was calling our office and cursing out my receptionist. As our usual practice, we told him that we do not tolerate this type of behavior and therefore we would not deal with him anymore. He continued to make his empty threats until we hung up. I never heard directly from Mr. Jayner again. An operative note from another neurosurgeon in town showed that months later he had surgery once more and then he was sent home on painkillers. Follow-up notes showed that he was doing “beautifully.” I actually felt bad. It seems that I misunderstood this guy's pain and misjudged him. I guess sometimes we need to be a little more understanding of people, no matter what their past issues are, even if all the red flags of narcotic abuse are flying mightily in the wind.
Seven months later, a DEA agent and a United States Marshal showed up at our door looking for his records. I was off that day but called as soon as I could. It seems that good old Mr. Jayner does indeed have a little problem with narcotic abuse. He was recently bugging the ER for meds and when they refused and told him to leave, the police were needed to calm him down and subsequently arrest him. There also was this slight problem of anger control. In fact, Mr. Jayner was now on the loose again and was wanted for the shooting of a patrol officer. Luckily the bullet missed the cop's head by two inches and ended up plugging his patrol hat instead. The hat flew off like one of those cheap special effects you see in those old Western movies.
Anyway, Mr. Jayner didn't seem to get the rehabilitation he needed and had come out of jail to cause more problems - one of them being bothering me for narcotics. The other issues include alcohol abuse and domestic violence. He was now on the lam. The cops just wanted to know if I had seen him and warn me to be wary, as he could be armed and dangerous. They left me with a warm, loving feeling inside which proves that I am always at risk on this job. So, as I now leave this office and walk alone in the darkness to my car, I feel good that Mr. Jayner could be right around the corner looking for someone else to shoot. The NRA may recommend having small arms on my person, but I would have to refute that. A bullet wouldn't be able to stop Mr. Jayner. Pockets full of narcotics, on the other hand, would be like feeding candy to a baby. Beat that Mr. Heston!
JUST
A STONE'S
THROW AWAY
Lilith was a 38-year-old female with a terrible problem.
She kept getting bladder stones!
Prior to coming to our heroes, Lilith was admitted four other times for the same thing. The first time she came in, two stones were found on the X-ray (the size of very large grapes). The second time there was only one bladder stone, but it too was large. A few months later another grape-sized stone was spotted and wouldn't you know it, there were two more located seven weeks later.
Each time Lilith would have to endure a painful procedure for her recurrent lithiasis. A suprapubic cystolithotomy was the method of choice and thankfully it got the job done. Lilith braved each operation with good will and cheer, only to have the problem pop up again in the near future. Were these physicians missing something? The answer is yes and no.
Lilith came in for the fifth time four months later. The doctors were puzzled. Urine cultures were done but came back normal. Cystograms showed a normal urinary tract. Even an endocrine consultant gave no clue as to what was going on. Analysis of the stones showed them to be made of calcium carbonate. What the heck was going on here?
Then it hit them - our authors had the brilliant hypothesis that stones this big would have ripped up (or at least dilated) the uterus on their way down from the kidneys. And this was not the case with Lilith.
Lilith was married but childless after nine years of trying. When confronted, our little sterile Munchausen denied everything. When pressed further, however, Lilith confessed that she was putting the stones into her bladder through her urethra (Ouch!) but she only did it because of problems with her husband and their inability to conceive. Some would say counseling or fertility pills would have worked better. To give Lilith the credit she deserves, she was the first person ever recorded in medical research to actually put stones up her … well, you know. Secondly, a two-year follow up with Lilith showed that she had given up her little hobby. Good job Lilith!
Before we end, I am sure you are asking, “Where did Lilith get her stones from?” Good question. Analysis showed that Lilith's stones were the same as those found on the bottom of a local river. Think of that the next time you are skipping them across the water.
The above is all TRUE but sarcastically and liberally embellished from: Acta Urologica Belgica 1998, 66, 4, 33-35.
My story begins when I was a second-year resident in family practice. I was training at a large tertiary care hospital that was located rurally. I lived out of the way in a small town of about 1,500 people and became known as “Doc” by all the locals. I was confused when my neighbor walked up to me one day and told me she saw my picture in the “paypah.” Later I found out that my picture was placed in the newspaper by my residency to acquaint the residents to the community. I enjoyed the rural lifestyle, which required self-reliance, while I also worked as a medical resident continu-I ally operating out of my comfort zone on a daily basis. To be honest, I mostly enjoyed my time off, which included playing golf, skiing, and hiking every chance I got.
The following events started when my best friend from high school was visiting one fateful Saturday. He was here on his annual fishing trip, which included a couple rounds of golf followed by a long ride to a remote fishing camp that can only be accessed by boat. Basically, once you make it to the fishing camp you are stuck there for at least a week. His base camp had only generator power, which meant that it was lights out by 10 p.m. He would have only one pay phone at his disposal, but the reception was extremely poor. In other words, when Bill got to his destination there was no one there to help him.
Bill and I were finishing up our second round of golf when he stated that he felt nauseous and had been having some pain and pressure in the perineal region. I tried my best to ignore his symptoms (and not laugh too much).
Why is it that people feel they can
tell you anything just because
you're a doctor?
I encouraged him to have another beer to see if that might help his pain. He laughed and proceeded to drink several cold ones without much effect except, to my expense, tremendous bloating and flatulence. The last part actually brought tears to my eyes to the point I thought he might have something infectious in his colon – possibly fungal.
We had supper that evening and Bill became more nauseous and uncomfortable as the evening progressed. He then revealed to me that he does in fact have a long history of festering boils that come and go and tend to manifest in the groin, axilla, and posterior auricular regions. He has seen a surgeon multiple times for incision and drainage and it sounded as though Bill might have hidradenitis suppurativa. I went to bed that evening without difficulty, amazing even myself at how quickly I could forget someone else's discomfort.
Damn, I was becoming a doctor!
Bill awoke Sunday morning looking ill and felt he could not eat breakfast. He said “The pain and pressure feeling has gotten significantly worse and I now feel a bulge under my sac!” I realized at this point that I could no longer ignore my friend in need. I also thought ho interesting it is the way patients describe their anatomy, especially the scrotum.
The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge Page 7