5 Ask Them Out
This sounds very sick and perverted, but it works. Even if they are the same sex as you, just do it. Even if you are married and are forty years older than them, just do it. Nothing will make them more uncomfortable than that. If you are going to ask them out, be creative. Tempt them with a date to a topless bar. Ask them, “Have you ever been to a satanic church?” See if they want to go for a trip to the nursing home to see your grandmother. Inquire whether they want to join you in a high colonic. If for any reason, a drug rep says yes, take them to the mall and shop Victoria's Secret – for about an hour. If they are still with you, pick up a sexy piece of lingerie and ask the worker, “You think this will fit my mother?” This last part is foolproof.
We hope you use these techniques in order to enjoy your interactions with pharmaceutical representatives. Like the mail, this sales force will never stop coming. Like stepping on cockroaches while standing on a mattress, you can push as hard as you'd like, but L you are never going to kill them. Instead of fighting hard and i stressing yourself out, use the I above recommendations to make your life a little happier.
This is the strange but true tale of an extraordinarily obese middle-aged woman whom we will call Bertha. My partner admitted Bertha to the ICU for hypoxia (a lack of oxygen) and hyercapnea (an increase in carbon dioxide, meaning she wasn't breathing well) after she exhibited signs of altered consciousness at home. She was enormous at over 400 lbs. This was a big woman. She responded to the usual modalities and she was transferred to a general medical bed. There was something odd about Bertha. She would always lie on her side, never supine. She was stabilized and discharge to home was ordered. When the EMT people attempted to place her supine on a stretcher – she immediately syncopated and went into V-tach. A code ensued, and of course I was on call to administer aid. She miraculously responded to the “family joules” (getting shocked) and epinephrine and regained consciousness when placed back in bed on her side.
So, another course of ICU monitoring was initiated, she stabilized and went again to the general medical floor. The day of reckoning approached (i.e., her new day of discharge). Of course I was in charge again. I thought, how bizarre! What is the mechanism of her postural instability – acute hypoxia from monstrous mammary tissue causing lung compression or the sheer terror she must have had of the gurney shattering to smithereens after her weight was placed on it!
The afternoon came and I thought I was ready. A team of four EMT workers were prepared; they brought their biggest stretcher. I was there to lend assistance along with at least three other nurses and the patient's son. We successfully placed her on the stretcher lying slightly on her side. She was frightened but cooperating. Her vitals remained stable. Her pannus (folds of abdominal fat) hung over the seemingly narrow stretcher like a wet sponge.
I thought the aluminum frame of the gurney would collapse under the weight of our pitiful rider as it squealed down the aisle with the train of seven health care workers.
As the entourage reached the hospital entrance I took a right into the doctor's lounge, proud of my heroic accomplishment. Breathing a sigh of relief, I reassured my team I would stay on the premises until they drove off into the sunset. I congratulated myself on a job well done, certainly more conscientious than any of my partners could've performed. Then I heard the ominous “Code Blue! Code Blue!” over the P.A. followed by my beeper buzzing. My heart sank as my pride bubble burst. She went unconscious and coded just before the EMT people were going to shut the door of the ambulance! This time she didn't survive the code, hence the title of this article.
EPILOGUE: Her remains were so voluminous the hospital morgue didn't have the capacity to store her! Later I spoke with the funeral director who was to receive her remains in a capped pickup truck. He told me that it was common knowledge that Bertha had brought illness onto herself from self-destructive eating habits and this infamous episode would not surprise her neighbors.
Remember Bertha when counseling your patients on the consequences of obesity. Tell them if they won't bridle their passion for eating, the last thing they'll taste is …
CLIPPING
Mary was 37 and needed her knee done. Like many athletes, getting an arthroscopy was important so that she could get back to her favorite activities. The surgery was initially hailed as a success as the right knee went under arthroscopy and a lateral release for her chronic knee pain. Unfortunately, things turned for the worse soon thereafter.
It seems a synovial fistula (draining hole in her knee) developed at the site where one of the portals of the arthroscope had gone through. The physicians acted quickly by placing her knee in a cast and giving her antibiotics. What was felt to be another success (as the fistula did heal) was met with failure again. On three other occasions, Mary had breakdown of her knee with more drainage at the site. The doctors pushed hard to get Mary to be compliant with more hospital admissions for bed rest and plaster cast immobilization.
This was not to be.
During the next four months after the surgery and failure after failure, poor Mary agreed to have another surgery to repair the draining fistula. This time, however, our heroes got smarter and during the operation they really explored the knee for a cause of the problem.
Wouldn't you know it; a straightened paper-clip attached to a piece of string was found and removed.
Now how the hell did that get in there? Mary went on to have long-term antibiotics as her knee was now septic. Upon asking her where the clip came from, Mary turned ugly. She was defensive and insisted that somehow the clip was put in there by the surgeon. The surgeon disagreed, as placing paper clips attached to a string is not standard of care, even for some of the worst HMOs.
Finally, the struggle ended when Mary confessed her sins to a sympathetic nurse. She said she put the paper clip into the wound to block the hole so that she could go scuba diving. There was one problem with this story, however. Mary had never even scuba dived before. Maybe it is similar to that joke when a patient asks a physician, “After my surgery can I play the piano?” The surgeon responds, “Sure, are you any good?” whereupon the patient responds, “I've never tried.”
Mary is still receiving psychiatric treatment to this day.
This story was liberally embellished from: J.R. Coll. Surg. Edinb. 42, Aug. 1997, 252-53.
POWER LUNCH
One day when I was running behind (and what day was I not?), I only had one pregnant patient left to see. Being a nice boss I sent my office staff out to lunch. This 18-week primip (first pregnancy) had been having some significant nausea and vomiting earlier in her pregnancy, so I asked how she had been feeling lately. Almost as soon as she responded “Much better!” she proceeded to have projectile vomiting (pizza with the works) all over me, the exam table, the counter and the carpet. None of the vomit got on her, of course, which is one of the true hidden pluses of projectile vomiting.
After she and her husband left (as she declared that she now felt “Even better!”), it dawned on me that with no office staff around to help clean up, Yours Truly was going to have to clean it all up.
I realized that I had had a very helpful and valuable experience. Now when I lay in bed at night and think about the day, no matter how bad it had been, I say to myself, “Well, at least no one threw up on me today!” And then I think about ordering a pizza.
TALES FROM
COLLEGE HEALTH
I work at a college health clinic at a large East Coast university. I recently saw a local kid, a commuter student, for a sinus problem. He'd had a sinus infection about a month ago and was still having symptoms.
“What symptoms did you have?”
“Well, I had a sinus infection, but it got treated, and now I just have some symptoms left.”
“What did your doctor treat you with?”
“Weelll …[sheepish look] I took some old antibiotics that were left over. My mom said it was okay.”
“What did you take?”
“
It was cephalexin, I think.”
“How much did you take? What was the dose?”
“Weelll … [sheepish look] I'm not sure. I mean, it wasn't my prescription … [more sheepish look] it was my dog's. I mean, my mom said it was the same stuff that a people doctor would prescribe …”
“How many times a day were they for?”
“They were supposed to be twice a day, so I just took them once a day to be safe.” (“To be safe” being a relative term at this point.) Hmmm. I don't know why I asked, maybe to guesstimate the dose.
“How big is your dog?”
“Oh, about 100 pounds.”
“What is he, a Newfie? A St. Bernard?”
“No, he's a yellow lab.”
“I guess he's a big one.” Then I got a judgmental look on my face. “Look, I'm not so concerned that you're taking old antibiotics, but I AM concerned that your dog didn't get HIS full treatment course.”
“Weelll … [sheepish look] he actually passed on a while ago. These were just left over.”
So they didn't even help the dog, I thought.
There is a unique human condition which has afflicted us all, yet doesn't merit research dollars or articles in medical journals. It is known by a variety of names the world over, but scientific nomenclature favors the term “flatulence.” Indeed, there are legions of quietly distressed sufferers of this malady. Who among us has not experienced the occasional indignity of the escape of an errant passage of methane fumes, then glanced furtively around to see if anyone has noticed? Who in primary care or gastroenterology has not had a patient shamefacedly inquire about what they can do for their socially challenging “gas” problem? Many of my patients confess this most embarrassing secret to me, and all this time I thought it was just me so afflicted.
I have had a wealth of personal experience with this topic. Who hasn't? But I am the unlikely inheritor J of what my mother refers to as the “Choury bowels,” and my family can trace its flatulent past to nineteenth-century French ancestors.
Being thus accursed with this ignominious family trait, I had my first public experience with gas as an innocent sixth-grader. On this particular day, I had feasted on a large portion of my mother's greasy hashed-browns for lunch, then went to my piano club recital. I was seated in the audience listening to a fellow student perform when I suddenly noticed a rumbling in my stomach. Then a loud gust trumpeted from me and echoed off the fine acoustics of the recital hall.
I was horrified!
Somehow everyone managed to pretend they heard nothing. The pianist kept playing. Several minutes later, the unthinkable happened again. My colon threatened to erupt once more. I gritted my teeth and every muscle in my body, all to no avail. Another high decibel blast mingled with the lyrical notes of the Hadyn sonata. This was just too much for my musical grade-school colleagues to overlook. A chorus of snickers threatened to distract the performer. Then the two girls in front of me nearly collapsed on each other, shoulders shaking with convulsive laughter. I wanted desperately to slither out of the room. Instead, in my mortified state I sat rigid, stared straight ahead past the giggling girls and tried to pretend that those unmistakable noises did not emanate from me.
Somehow I gained better control of myself and survived the 1 remainder of my adolescence I unscathed by such improprieties. I In fact, it wasn't until my third year of medical school that I committed another serious error in judgment. I had undergone a rather depressing dateless spell for several years when I was invited out by a fellow medical student. I was so excited I even purchased a new outfit for the rare event. This was a departure from my usual medical school thrift, characterized by spartan budget and a steady diet of cheap canned goods. The night before the big date, I made the spectacularly regrettable choice of consuming an entire can of baked beans for dinner. The following afternoon, I was in a panic upon realizing that an inferno was raging in my abdomen and showed no signs of abating. I overdosed myself with antacids but they were pitifully poor protection against the gas which silently torpedoed from me. After my date picked me up I managed to control the situation until we arrived at the restaurant. But once we started eating, I could no longer stifle my gastrocolic reflex. Soon a particularly pungent cloud floated about me. I was aghast at the realization that my date could hardly mistake the odor, but he mercifully feigned ignorance of the whole malodorous affair. I tried to keep my distance from him and made several extended trips to the bathroom, all without success. As the evening closed on my all-time date disaster and he dropped me off at my apartment door, I could scarcely believe my ears as I heard him ask if he could take me out again.
He was truly a brave soul.
Steve stood alone, facing the crowd who had deemed it too noxious to stand next to him. He was publicly convicted of the malodorous deed while I let him take the blame and laughed along with the others.
But not everyone was fooled.
As rounds disintegrated into junior high league jostling, my senior resident aimed a withering glare at me.
Oh God, he knew it was really me!
Still the coward, I pretended not to notice and meekly rejoined my team at the next patient's room.
Not surprisingly, surviving the remainder of medical school proved to be a challenge for me. Yes, the academics were bad enough, but I also had to endure long rounds with my medical teams. Rounds held in closed conference rooms were the worst. I would secretly palm an antacid tablet in my pocket, then pop it into my mouth. I'd chew slowly, hoping no one would ask me a question while I had a mouthful of chalk. Walking rounds were less hazardous, but still presented a challenge at times. While on my medicine rotation, I ate peanut M&M's for dinner every night, not yet realizing that peanuts were a prime gas producer for me. One day on afternoon walking rounds, I felt the familiar borborygmi and I just had to silently let one fly. Much to my horror, the smell was terrible and traveled quickly. I stole a sidelong glance at my fellow med students. Everyone was standing in a semicircle attentively listening to our senior resident. As the foul odor disseminated amongst our team, it triggered a cascade of reactions. First the stifled snickers and finger pointing began. Then the three other third-year students moved en masse across the circle away from Steve, the only fourth-year student. Poor
After several more years of less harrowing experiences, I finally learned which foods to avoid before important dates, long hours of lecture, and later, extended office hours. I found industrial strength simethicone at the drugstore and dosed myself with it when necessary. Completion of my residency brought two welcome surprises with it. The first was that my gastrointestinal distress diminished with the decline of stressors in my life. The second was that I met a handsome Air Force officer shortly thereafter. It wasn't until almost a year later that I discovered that my prospective groom suffered a lifelong disability – congenital anosmia.
The man of my dreams had no sense of smell!
It was truly a match made in olfactory heaven. We were married soon after and now await the arrival of yet another generation of children with colicky, flatulent “Choury bowels.”
She was a new patient and I had not previously met her. After I entered the exam room and gave my customary greeting and introduction, she declared, “I'm a manic-depressive, adult attention deficit disorder, borderline personality.” Well, this is going to be interesting, I thought to myself. Yes, indeed.
After a rather elaborate history had been taken, I began the physical examination. The first thing that seemed odd occurred when I began the examination of her heart. As was customary (with respect to the average patient's modesty), I kept her front covered as I placed my stethoscope under her gown to lay it over the usual listening sites. This time, however, I got hung up on a chain that seemed suspended between her breasts, although she was supine at the time. After I disentangled my stethoscope and finished the cardiac exam, the mystery of the chain was solved. Like a main cable crossing the center span of a suspension bridge, her bridged towers were represente
d by (pierced) nipple rings on top of silicon foundations and the chain was strung across them. My first thought was, “OUCH, that must have hurt.” Seeing my obvious grimace, she assured me that it hadn't been that bad, and the purpose of the arrangement was to enhance (sexual) pleasure when the chain was pulled.
“OK now, let's quickly move on to the rest of the exam,” I thought. Nearing the completion of the exam, I felt relieved that she was seeing a gynecologist and thus didn't need to be examined by me in that regard. Alas, such was not the case. She hesitantly stated that she had a problem that she needed my opinion about. “Oh, what the hell - you've seen it all anyway “ and proceeded to yank the material of her short-shorts aside to expose her genitalia, complete with a clitoral ring. Did I know how to take the ring off? It was at this point that I wondered if we could get a security buzzer for the exam rooms like the bank tellers have. The story continues. It seemed that her husband got sort of “chewed up” the £ last time they had sex (in spite of their use of “Slick” brand personal lubricant), and so he wanted the ring removed. Observing the ring from a respectable distance, I demurred, stating it was way out of my area of expertise and as she was the first patient I had ever seen with such jewelry. I suggested that whoever had put it in would surely be able to remove it. If not that person, then perhaps her gynecologist could be of assistance. The bottom line was that it wasn't going to be me. I then excused myself (escaped!) while she dressed.
After that first visit, her subsequent visits always made me a little uneasy as I never knew what to expect. One time she came in and wanted me to run every test for VD on her that I could. She suspected her husband of being unfaithful and eventually they did get divorced, but not before she took her revenge. One time she tried to show my office staff a photo she found in her house of an unclearly identified male in an aroused state (“I know it's my husband because I recognize the lamp next to him”). Another time she claimed to have sent a postcard to his new location (living with relatives out of state), writing on it that he had better get himself checked for VD (even though all her tests had come back normal). It was at this time that I told her that her behavior wasn't appropriate and she needed to “move on.”
The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge Page 14