He went to the garage, taking another cat with him, I guess thinking of the canary in a mine idea. He and the cat sat in the car with the engine running, and as he got sleepier, the cat became frantic, keeping him from relaxing adequately. He then started to get nauseated, so he shut off the car, and he and the cat went back into the house.
Then he decided to slit his wrists, but after a few ineffectual superficial cuts (it hurt!), he tried stabbing himself in the chest, resulting in another superficial wound, which also hurt (but at least no cats died this time).
He then thought about the electrical appliance in the bathtub idea, and so filled the tub, brought the toaster into the bathroom, making sure he had an adequate extension cord, got in, and plonked in the toaster. The circuit breaker tripped, and that was it.
At that point, he evidently decided that it was not a good day to die, and so he came to the ER, had his wounds stitched and bandaged, and I admitted him to the ICU, thinking that this was probably the strangest, most pathetic story of suicide I had ever heard.
The next day, on early rounds, he was sitting up in his bed eating breakfast, and I told him that ‘ we would arrange for a psychia- I trist to see him as he was no longer in any medical danger. left the room to make some notes in his chart when he called me back with a loud “Hey, Doc.”
As I stepped in, he pointed to the bacon and eggs he was eating from the regular diet I had inadvertently ordered, and said: “Hey Doc, I'm supposed to be on a low fat diet! Are you trying to kill me?”
P J SAYS:
SUCK IT UP
In my day, there wasn't so much complaining. Okay, maybe there was, but people at least kept quiet about it. Nowadays everyone and their uncle has a problem that is in need of a treatment and they want it right away It now seems that it is so acceptable to have a disease or syndrome that physicians are making new ones up just to make their patients happy … or to shut them up.
How all of a sudden depression becomes an epidemic is beyond me. Has the world changed that much? I think not. We just have more specialists. Every one of their recommendations states that this country's depression is undertreated. With every other patient on an SSRI already, how could that possibly be? If everyone including neonates had a 100 percent antidepressant use, I wonder whether these specialists would finally say that general practitioners are finally doing a good job. I bet they would just find something else to bitch about. Pretty soon HMOs will be checking the doctors’ charts like they do for immunizations to see that all their patients are on something to make them happy.
Now pain specialists have gotten into the game. They state that pain is the fifth vital sign. I have no freakin’ idea what the hell the other four are. They expect nurses to ask every patient about their pain and mark it in their chart. Pretty soon the nurses will be lying like they do about respiration rate. Respiration rate, there's one of the four other vital signs. Anyway, just like respiration rate, doctors will ignore it until lawyers start to sue. If it was up to lawyers and pain specialists every patient would be on narcotics until they were gorked out of their heads. Not too gorked or again the lawyers would sue. Do you see the constant theme here? Lawyers always sue.
What is wrong with just
plain old sucking it up?
Not every patient needs antidepressants. They need to get their damn life together. They need to stop smoking and drinking. They need to start working, start eating better, start exercising, and start concentrating on the good things in life. No one was guaranteed happiness in the Constitution but instead “the pursuit of happiness.” Patients just need to get off their asses and pursue it. Sure there are bad things that happen to them. There are bad things that happen to me (I'm a skull).
If there weren't bad things, no one actually would know what a good thing was because there would be nothing to compare it to.
Sure patients have some pain. Are they doing anything about it? I am not talking about metastatic cancer pain here. I am talking about the pain of life. How coincidental that the higher the stress in the life the higher the pain. How many patients are just fat and out of shape? When they don't move more than from the kitchen to the crapper then their bodies get more obese and their muscles just shrivel away. It's a vicious cycle and the only one that can fix it is the patient. Not the doctor. Not the antidepressant. Not the painkiller. Only the patient - who has to suck it up!
Okay, some people do have severe pain and severe depression but not 50 to 90 percent. Please.
Could it be that these same pain and depression specialists are just in pain about their career choice and now are depressed about what to do about it? I have the same advice for them. Suck it up! And leave the rest of us alone.
The other day I came home after a miserable weekend on call where I covered ER and inpatient service at my local hospital. When I came home, my wife was writing something in a notebook that I found hysterical. After reading it, I proclaimed that this was definitely Placebo Journal material. It is something I wish I could publish in our newspaper. It goes like this …
1 I am not on call 24 hours a day, 7 days a week. Do not call my home to ask if I am on call either!
2 I have a personal life, and many times I do not give a rat's ass about your piddly problems.
3 DO NOT confront me in local or non-local establishments about you or your family's
Abdominal pain
Allergies
Cough
Colds, congestion
Depression
Anxiety
Personal or marital problems
Med refills
Constipation
Free consultations
Weight loss/gain
Diabetes
Hypoglycemia (no such thing anyway)
Blood pressure updates
Pregnancy related problems
Off the cuff Viagra prescriptions
Nausea, vomiting
STD
Heartburn
Mama in the nursing home
Bleeding
Strains, sprains, or pain
Bipolar disorder
Self-diagnosis you want me to validate
Referrals
Why you can't pay me
Why you still are coughing up a lung, but can't stop smoking
Drug problems
Rashes anywhere on your body.
4 I do not see hospital patients unless I am on freakin’ call. If it is not my call night, I don't give a damn if you are the President's mom, DON't EVEN ASK!!!
5 Repercussions for these infractions include:
a. My wife can be a real bitch, and I will have her rail on you.
b. You will receive a $50 per minute itemized billing sheet. And if you don't pay, refer to the above!
6 Do not bring any relatives with you to your office visit, and try to sneak in a free visit using the “oh by the way …” method. This is a very serious aggravation for me; it might set off my heretofore latent bipolar mood disorder. (It's very popular to have it now, so I should jump on the bandwagon.)
7 If you have an appointment with me, you are expected to arrive on time. NO EXCEPTIONS. “No-shows” are billed at double rate, payable in cash to my wife. If you are late to your appointment, you are SOL, and will still be billed. Again, payable in cash to my wife.
8 My phone rings 29 times a day, at least, and that is after hours. I have installed a state of the art feature that requires the caller to dial in his credit card number for $20 a minute. I hope this will significantly cut down on the calls from acquaintances and neighbors who think they have carte blanche access to free advice.
9 DO NOT come to my front door either!!! I have trained rottweillers, pit bulls, and brahma bulls. Also, there are armed booby traps, if you don't drown in my alligator-infested moat first.
10 Furthermore, do not complain to my office manager that my wife gave you a “go to hell” look last Saturday when you came to our table while we were having lunch with our three young boys, and de
cide to go into graphic detail about your vaginal bleeding (true story). You were VERY lucky that she only looked at you and did not subsequently beat the living hell out of you.
11 I have frequent memory lapses. So do not expect me to recall:
Who the hell you are.
Who your daddy is (I don't care).
Your every illness, medication, and dosage.
This is why we have a damn medical chart. I do not know what in the hell that little white pill you take every morning is. All pills are white, pink, blue, orange, and typically are round, or possibly square or triangular. Maybe you think I am a f#cking genie in a bottle? Oh, wait, maybe I am, and then I can grant your three wishes:
XANAX
SOMA
VICODIN
Here is a recent example that may help you:
For the first time in nearly four years, I called in sick with a fever of 104 degrees. Of course, by noon, I had already gotten several phone calls from you people with complaints in far lesser severity than what I was suffering. Believe it or not, I get sick too. But, I do not immediately report to the ER with my sore throat, or headache, especially at 4 a.m.!!
I look forward to providing medical care to you and yours. Our physician/patient relationship should be one of warmth and kindness, if the above-mentioned guidelines are strictly followed.
Respectfully,
Your Small Town Doctor
(as written by his wife)
Editor‘s Note: It could have been written by my wife as well.
JACK’N THE BACK
Trader Jack was a worker's comp case with post-laminectomy syndrome, which is a politeterm for failed back surgery that we use in order to not piss off the spine surgeons who refer thesem esses. He underwent the usual round of epidurals, nerve blocks, trials of co-analgesics, etc., without relief. I started him on chronic opiatetherapy, and methadone seemed to work the best for him.
Eventually he wasn't satisfied with that and we had a few go-rounds about whether to increase his meds or try something more aggressive. He had a successful spinal cord stimulatortrial, and that was followed by a permanent implant. Then he was pretty much on autopilot, using the stimulator, with methadone for breakthrough pain. Or so I thought.
One day I happened to be looking out the window into the parking lot when Jack pulled up … on his motorcycle. I asked him about how a guy with so much back pain could ride a Harley.
“Oh, riding my Harley makes my back feel good!”was the response.
This is a guy who is on the government teat with social security and disability.
I pulled out my trusty spinal cord stimulator programmer and interrogated his unit. On these models you can get a report of total use since initial activation.
Trader Jack was using his stimulator one percent of the time. I asked him about this.
“I only use the stimulator when I'm at home,”he explained.
“Jack,”said I, “even Dick Cheney, who is always running off to hide in ‘undisclosed locations,’ is home more than that. I think it's time to tinkle in this plastic cup.”
Well, Jack threw a fit. He refused to give a urine specimen, but he also refused to leave with-out a refill of his methadone. Finally I told him he could (1)leave, (2) give the sample, or (3)be escorted out by the police.
He gave a urine sample, which came back on our office testing kit as negative for methadone and positive for opiates and THC. I figured Trader Jack was swapping methadone for Vicodin and so I refused to give him a refill.
As with most sociopaths, he was very angry with me for catching him and he changed doctors.
When the new doc requested our records, the last office note was prominently displayed on the top of the pile.
I never heard from the “Trader” again.
Ashshlyn was 52 years old and suffering. For five years she had dealt with a vaginal discharge that would not go away. Do you know how hard that must have been? No one seemed to be able to cure her ills. Sure, her symptoms were compli cated. Sure, the discharge was “different.” But shouldn't Ashlyn be afforded the proper medical treatment to alleviate her complaints?
Here is the scoop. Ashlyn had a brown to black vaginal discharge. It supposedly didn't smell. It supposedly didn't itch. It did cause vaginal discomfort. Even worse, it stained all of Ashlyn's underwear which was not only embarrassing but quite costly.
Ashlyn's medical history She was married with i four children.
She didn't drink, but she did smoke about 20 cigarettes a day. She had had an appendectomy, a D&C, a vaginal prolapse repair, a tubal ligation, and a hysterectomy. All pelvic exams were normal and vaginal swabs were negative. Her underwear did have an “unnatural black discoloration of the crotch area.” Hmmmm.
Ashlyn also had some other history. Between 1981 and 1994, she had 65 specialist consultations including the likes of gynecology, urology, rheumatology, and cardiology. Extensive workups of the blood as well as radiological procedures never turned up anything. The 16 hospital admissions all were diagnoses-free as well. Oh yes, there were the 12 minor surgical procedures that turned up empty for pathology also.
One of the investigators got suspicious and decided to smell the underwear. This, it seems, was in the interest in science. We are not proponents of all physicians smelling the underwear of patients as this can be construed as, well, unprofessional. In this case, however, our heroes made an interesting finding.
The garment smelled like cigarette ash.
Off to the lab our heroes went (with the underwear) and the results soon came back. The toluene extract of the stain matched that of cigarette ash.
Our little Ashlyn seemed to have found a new way to put her cigarettes out. Who needs ash trays when your vagina will do? As they say in those cigarette commercials, “You've come a long way baby!”
As weird W as this may sound, Ashlyn denied the whole thing when confronted. To this day, the authors state she continues to see specialists for persisting® urinary symptoms, rectal bleeding, etc. Unfortunately, none of those specialists were psychiatrists. / The authors warn others of the financial burden that people like Ashlyn (Munchausens) put on the system. We agree and hope physicians out there get a little suspicious when someone asks for a nicotine inhaler to be used vaginally.
Taken with liberties from European Journal of Obstetrics and Gynecology and Reproductive Biology 72 (1997) 105-106.
“HEAR TODAY, GONE TOMORROW”
I am an otolaryngologist in a medium-sized town. There are plenty of industrial jobs in the area. A 20-year-old male, whom we will call Mr. Blake, came to my office complaining of hearing loss in his right ear. He stated that it was due to a blow to the head that occurred at work. Off the bat he was setting this up to be a worker's compensation case.
On exam, his right tympanic membrane looked completely normal. An audiogram did show a slight sensorineural hearing loss, but the different parts of the exam just did not align properly. The audiologist was the first to be suspicious and made me aware.
When I reported the results to the patient, I used my usual strategy of telling him that the abnormalities of the test could be our fault. Maybe we didn't explain the instructions well or didn't motivate him to try hard enough. After putting him at ease, I invited him back to repeat the test on another day. In my experience, patients either never return (because they were faking) or return and get a totally normal exam (because they were faking).
Our friend returned for his second appointment. I gave his ears another look-see to make sure there wasn't any pathology I missed on the prior appointment (there wasn't). His canals were clean and his tympanic membranes were normal and mobile. Mr. Blake asked me again what had gone wrong with the first audiogram. I further explained that the different parts of the test just weren't consistent with each other. I directed him to my audiologist to repeat the exam once more.
After an hour and a half, I realized that he hadn't returned to my office. I called the audiologist to see what was going on.
It seems Mr. Blake made it down the hallway, but not before stuffing a little piece of cotton in his ear. This was picked up by the audiologist who looked in his ear and then questioned him. He responded that I knew of the cotton, so she repeated the test again showing the same results as the day before, a slight sensorineural hearing loss. The patient left the audiologist with his chart and results right after the test, but somehow never made it back to my office.
The staff and I felt good that we had picked up this malingerer. We all laughed as we thought of him being too embarrassed to come back. Wouldn't you know it, Mr. Blake returned later that afternoon. He raced into the office and threw the chart on the receptionist's desk and ran out again. He must have been scared about stealing a medical chart, even though he was fine with ripping off his company. Anyway, the chart was complete except for one missing item - the audiogram.
Oh what a tangled web we weave when first we practice to deceive!
We have all heard about trying to “get the monkey off your back.” It is an overused cliché in sports. In medicine, we need to investigate this phrase a little more closely. These “monkeys” are actually issues or problems. Patients come into our office with these monkeys all the time. They don't have just one of them either. Many times they have a barrel of monkeys and they want the physician to take them.
The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge Page 18