DR. BALANCED He is rare indeed. He laughs, smiles, cares about his patients, and is courteous to everyone, including the evil souls who represent pharmaceutical companies. His patients and staff love him. He finds time to play golf. I look at the many pictures of his family placed all around his office. I wonder how he does it. How does he manage to stay so happy within the confines of the modern medical system? It must be Valium, I think. Then I spy the most recent issue of Placebo Journal on his desk.
I am an ER physician working in a small community hospital in northwest Florida. I was working the 7 p.m. to 7 a.m. shift. I had discharged the last patient at 3 a.m. and headed for the call room. I lay down and dearly hoped that I would get some sleep. Two hours later, at 5 a.m., I got a call that we had a new patient I went into Room #5 to see a young man perched on the edge of the bed, sitting bolt upright. He was rubbing his hands together nervously when I walked in.
“Hi, I'm Dr. _____ Tell me what brings you in tonight.”
“Well,” he replied anxiously, clearly searching for words, “I guess you would say that I was sexually assaulted.”
I looked at this robust 27-year-old guy, who appeared to be about 6′ 2,” probably 220 pounds; broad shoulders, not an ounce of fat on him, and thought to myself, “Who could have overpowered this guy?” As unbelievable as his story sounded, I still had to play the role of compassionate physician.
“Oh, I'm terribly sorry. I can only imagine how upsetting that must be. What exactly happened?” Slowly he began, “I had been at the bar last night. I guess I left around 3 a.m. Driving home I saw a woman hitchhiking. Since it was cold out, I felt sorry for her and picked her up. I offered to drive her home and she began giving me directions. Turn left here, turn right there, and so on. Next thing I knew, we were in a pretty desolate location, and it was pitch dark.
“She then said, ‘Well, I guess you know what time it is.’
“What do you mean?” I asked.
“Then she pulled out a gun, pointed it at me and said, ‘Give me all your sh#t!’
“Realizing that I was being robbed, I reached into my back pocket and gave her my wallet.
‘You've got something else I want,’ she said. ‘Pull your pants down.’
“I was scared, but hey, she had a gun! So I pulled my pants down halfway to my knees. Then, she leaned over and ‘went down’ on me.”
“She gave you oral sex?”
I asked incredulously,
“Right there in the car … at GUNPOINT?”
“Yeah.”
Having trouble picturing this I asked, “How long did this go on?”
He hesitated, “Uh-h-h, 5, 10, 15 minutes.”
“What happened next?” I asked.
“She got out of the car, ordered me not to tell anyone, and ran into the darkness.”
You hear all kinds of crazy things in the ER, but I never heard a story like that. “You've called the police, of course.” I asked.
“Oh, no!” he replied, suddenly getting more nervous.
“Why not?”
“Uh-h-h-h, there's nothing for them to do. I mean, it's over and done. They can't do anything now.”
I responded by saying, “Look, the law requires me to call the police anytime I see a victim of violence or assault here in the ER. I will have to call the police. Besides, doesn't she have your wallet, your driver's license, and your credit cards?”
He thought about it a minute then said, “No. She went through my wallet, took out the only money I had -about five dollars - then gave the wallet back to me.”
This story was getting more ridiculous by the moment. Finally, I said, “Well, if you don't want to talk to the police, and if you were not injured, why did you come here? What do you want me to do for you?”
Then came the “answer.”
“I'm afraid I might have caught something. You know, an STD. So I want some kind of shot or a pill … so that I won't catch anything. When she went down on me she kinda chewed on me … kinda bit me a couple of times … I-I-I don't want to catch anything.”
Oh-h-h!! Now I get it!! Now I understand!!
This idiot paid some hooker for oral sex. Then when the deed was done he suddenly regained his senses and thought, “Uh-oh! I've done a bad thing!” Now he wants a “magic shot” to make it all go away.
One of my moral impurities is that of a great sense of humor. I was tempted to say to him “Hey count yourself lucky!! A strange woman gives you oral sex on your way home from the bar, only charges you five bucks plus a ride home, and you HAD to sit still for it because she was holding a GUN on you!! You can tell your wife, or girlfriend, (or both), that you had NO choice in the matter and that NONE of this was your fault. You HAD to go along with it because ‘your life was in jeopardy!!’ And of course, you couldn't disarm her even though she is sitting right next to you in the confined space of a car, FACEDOWN, WITH HER HEAD BURIED IN YOUR LAP. Oh, no. There was NO WAY to disarm her. Heck, I doubt if even Rambo or Bruce Lee could have gotten out of THAT ‘life-threatening’ situation!!” Despite the temptation, I kept my thoughts to myself.
Of course, as the doctor, I was obligated to perform an exam. His genitals were uninjured except for a slight red mark of the side of the penile shaft. The mark's length and width were consistent with that of a front incisor tooth. No skin was broken anywhere, no bruising, no other evidence of trauma, etc.
I explained that the likelihood of contracting an STD from oral sex was low. If he developed any symptoms of syphilis, gonorrhea, or chlamydia, he should return for treatment. To my knowledge, there have been no documented cases of seroconversion for HIV by oral sex. Furthermore, if he caught herpes, HPV, or hepatitis, there wasn't a whole lot to be done anyway. So the best thing for him to do was just lick his wounds (pun intended), hope he didn't catch anything, and learn from his mistakes.
My cruel sense of humor tempted me to offer this idiot emergency contraception … you know, the “morning after pill,” but I didn't think the hospital pharmacy would dispense it to a male.
Finally, as I was walking out of the exam room, I was tempted to ask, “By the way exactly where did yo drop her off?” After all, my shift ends in two hours.
Leslie was a young girl with an affinity for making accusations. Her stories were many, but most of the time they included being sexually assaulted. In this instance, Leslie made things worse by refusing to be medically examined. This is where our physician hero comes in. He was a good doc and extremely thorough as Leslie's charges were serious. This is where our story begins.
Leslie claimed to be 15 years old but looked suspiciously older. She stated that she was raped, bitten, punched, and pilfered (amongst other things). No one initially doubted our lady, as no one should with these kind of accusations. Unfortunately, Leslie's story didn't seem quite right. Her arms showed track lines consistent with drug use, but Leslie denied them all. She did have small lacerations, but they were what our doctor called a “self-harm” pattern. Her bite marks were similar to forcible pinching, probably done by Leslie herself. Hmmm. The rest of the exam became more and more difficult as Leslie stopped cooperating. Even when the doctor noticed “colored objects” in her vaginal area, Leslie would play no part in this charade and wanted out.
Eventually, the rest of the examination was forcibly done under anesthesia because the seriousness of the charges demanded a full report. Sure, it may seem weird that the colored objects that the physician first saw turned out to be NINE CRAYONS. Unfortunately, our little Munchausen didn't stop there.
Twelve hours after the anesthesia was given, Leslie seemed to have had grand-mal seizures that developed into a status epilepticus-like condition. This could have been life threatening! She needed an intensive care transfer and intubation. After being on the ventilator overnight, Leslie's blood was found to contain morphine and tranquilizers. This is when our physician got more curious.
Luckily, the police were very helpful in this case. A search showed that Leslie had made
many similar complaints around the country, most of which included being sexually assaulted and most of which included crayons. Where was this crayon bandit? Only Leslie knew and he must have been following her around. Leslie was eventually found to be 24 years old with tons of aliases. During other hospitalizations, she was found to have bad seizures also and they were caused by taking overdoses in the hospital. Sometimes she would cut herself to stay longer. Whatever it took, Leslie would do.
Like a typical Munchausen, Leslie denied the charges when confronted. She left the hospital against medical advice and did not take the crayons. When asked by the police where she was going, Leslie responded, “I'm off to the next big city.”
The story wasn't over. Our physician noticed that four months later Leslie was admitted to another hospital and received a laparoscopy for abdominal pain after being “sexually assaulted” again. This time a metal bottle top and clear glass was found within her vagina. Still not over. A few days later she was admitted to another hospital in a different county claiming her laparoscopy scars were due to being stabbed in the stomach by a person sexually assaulting her.
The whereabouts of Leslie are now unknown. The police are still looking for her because of theft and fraud charges. Therefore, if you find a patient with interesting objects inserted “down under” who can fake a seizure like nobody's business, we at Placebo Journal recommend you give them a call.
This story was liberally embellished from: Med. Sci. Law (1998), Vol. 38, No. 3
CONCLUSION
So that is it. You finished The Placebo Chronicles, which may be your first medical book. Okay, maybe you can't define this as a true medical book from a purist's perspective. Skeptics may point to the fact that real medical books are at least informative and educational. My response to them is that those same books are boring, tedious, and long-winded. Sure you didn't learn crap about practicing medicine from The Placebo Chronicles but will those other books ever make one of their readers incontinent because they laughed so hard?
In reality, your journey through The Placebo Chronicles was small glimpses through many different physicians’ lives. This book wasn't one story unto itself and that makes it difficult to bring it to a neat conclusion. I could try to end it like my old teachers used to do in medical school. They had a standard technique for finishing each class. First, they would sum up the all the important points they just lectured about. Second, they would reinforce how much we, as students, needed to know those points. Lastly, they would test us at a later date on something totally different from what they taught. It was their way of saying, “Screw you for sleeping through my class.” Or maybe that was just the way I perceived it.
Obviously I don't want you to feel the way those teachers made me feel. What I can do is thank you for your interest. We physicians are caretakers and as caretakers it is nice to see that those we take care of have some interest in our lives as well. I hope that the material in The Placebo Chronicles either made you laugh, smile, or in some way piqued your interest. I will still deem this book a success, however, if you are now able to empathize with the doctors you just read about. And if I make money from it. I hope that by living through their embarrassment, their pain, and their humor you can conclude that doctors are human with all the weaknesses inherent to everyone. We pretend to be creatures of logic, but in reality we are creatures of emotion (humor, sympathy, depression, and anger) just like everyone else. Ignoring this concept, which unfortunately many doctors around the world still do, only causes us more problems in the long run. Welcoming these emotions enables doctors to be better people, be better at their job, or to be at least somewhat sociable at the next party.
Before you leave this book next to the toilet, I ask that you do a couple of things. First, for God's sake, wash your hands. Second, try not to judge poorly any of the physicians who have written some of these stories. I know I try not to. I feel that until I walk in another doctor's moccasins, get another person's cavity fluid splashed in my mouth, or find some fresh infant stool left in my office trash can, I will continue to reserve any judgment on another doctor. I hope you can do the same; the judgment part, I mean, and not the cavity-fluid-in-mouth thing.
Lastly, I want to warn you about the future. The media, the politicians, and the cynics will always try to convince us that medicine is in crisis. I am going to let you in on a little secret: medicine has always been in crisis. Even in the Middle Ages when they were using leeches, some administrators were trying to save money by allowing only generic bloodletting. The only thing holding steadfast throughout time is that physicians have always been there to help people. Because of this, the medical system will survive and maybe more importantly, The Placebo Chronicles will have more stories to share with you in the future.
I have so many people to thank for helping get this book together. The Placebo Chronicles is a consortium of not only stories but the people who helped make them happen. Just because my name is on the cover doesn't mean that they shouldn't be recognized or paid. Since there is no way I will be doing the latter, I will try and make it up here. Hopefully that will get them off my back.
I want to thank my wife, Debbie, who has always been there by my side and has talked me out of quitting on multiple occasions. She has put up with more of my “projects” than any wife should have to. She never really believed that I was a real doctor. Now with the publication of The Placebo Chronicles she is probably going to feel justified.
I want to thank Gordon Marshall. He is the best graphic design artist and illustrator a rookie magazine publisher could ever have. I told you when we started that we would make it someday. Please don't leave me now that you are big and famous.
I want to thank my literary agent, Bob Mecoy, who felt even a family doctor could make it as a writer. The bigger question is can a writer make it as a family doctor? He hung on and pushed for a deal even when the going was tough. Promising the whole Broadway Books division that I would provide all their medical care was probably not appropriate, however.
I want to thank Reneé Catacalos. As a long-time friend and confident, she helped me market the Placebo Journal for only a small pittance. She is not only a public relations genius but also grammatical expert as well. Without her, my thoughts would not convert to paper nearly as well. I usually no write so good. See, I could have used you right there, Reneé.
I want to thank Charlie Conrad at Broadway Books for giving me a chance. I hope our relationship in this business continues for a long time. I could use the money. Being a family physician doesn't pay like it used to.
I want to thank Dr. Michael Gorback for his insane opinions and great stories. I never thought any other physician could be as weird as I am. I was wrong.
I especially want to thank Dr. Susan Summerton and Dr. Joe Ullman for contributing many of the X-rays and stories for this book. It is awesome to see radiologists with such a great sense of humor. Actually it is nice to see a radiologist with any sense of humor.
I want to thank my medical partners at Court Street Family Practice. Drs. Ray Stone, Carolyn Kase, and John Comis are not only great physicians but wonderful friends. Without your support I would have quit medicine or jumped in front of a moving train a long time ago.
I want to thank my kids. Jake, Lucas, and Niki are the true treasures of my life. Thank you for understanding the times I wasn't with you and for being quiet when “Daddy is working in his office.” Also, I want to thank you years ahead of time for not spending all my money on tuition, cars, or indiscretionary purchases.
Lastly, I want to thank all the doctors, too many to name, who have contributed stories to both the Placebo Journal and The Placebo Chronicles. This book will hopefully show to the world that doctors are human too. It will also be something for you to show your loved ones who thought you were uptight, humorless, and stressed out.
ABOUT THE AUTHOR
Douglas Farrago, M.D., is a family physician who started the bimonthly Placebo Journal in 2000. A frequent lec
turer and media commentator, Dr. Farrago lives in Auburn, Maine.
THE PLACEBO CHRONICLES. Copyright © 2005 by Douglas Farrago, M.D. All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the publisher. For information, address Broadway Books, a division of Random House, Inc.
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