“Not that I can think of.”
I couldn’t make sense of it. Allergic rashes as startling as this one usually have a readily identifiable precipitant. Examining him didn’t reveal any further clues. I asked his nurse to start an IV and administer some corticosteroids and antihistamines. Two hours later he was looking and feeling much better. I decided to allow him to go home on oral medications, provided his mother promised to bring him back in the morning so I could recheck him.
The next day it was his dad who accompanied him. Once again he was covered head to toe in the same horrific scarlet rash. I asked his father if he could think of anything his son might be reacting to.
“Well, I suppose he could be allergic to those magic markers he was playing with yesterday,” he speculated. “He got marker all over his body – his arms, legs, face, belly…everywhere! The rash started about an hour after that.”
“Ah, that’s probably what triggered it,” I said with satisfaction. Another mystery solved.
“I don’t really see how, though,” he continued. “He’s played with those markers lots before, and besides, the ink wasn’t on his skin for very long. The minute my wife saw what a mess he was she marched him straight up to the bathroom and washed it all off.”
“Hmm,” I said. “Perhaps it’s not the markers, then. Could it be the soap she used that irritated his skin?”
“Oh, she didn’t use soap, doc.”
“What did she use?”
“Fantastik.”
“She used Fantastik?”
“Yeah.”
“Are you talking about the spray-on cleaner? The stuff you clean countertops and stoves with?”
“Yeah, that’s it. She sprayed him down in the bathtub and then scrubbed the marker off with a rag. That stuff really works!”
“That stuff is corrosive! It dissolves glass!”
“Hey! Maybe that’s why he’s been so itchy!”
The Drug Seeker
The first two lines of the triage note on my next patient indicate he wants a prescription refill. That sounds like an easy one. Scanning a bit further down I see the word “painkiller.” Uh-oh. Next comes the word that throws up more red flags than a parade of matadors: “OxyContin.” My heart sinks. I compose my face into something appropriately neutral and walk into the cubicle. Not too far in, mind you – I like to have an unobstructed escape route in situations like this. Just in case.
Patient X looks pretty much like I expected. He’s in his late 20s with grubby jeans, a frayed black leather jacket and tattoos crawling up his neck. He also has the obligatory “OZZY” tattoos on the knuckles of both hands. I make a mental note to get myself an incredibly original masterpiece of body art like that in the near future. I’m sure it’ll turn me into an unstoppable babe-magnet. What cute chick can resist a guy with “OZZY” tattooed across his knuckles?
“Hi Mr. Piltdown. I’m Dr. Gray. How can I help you this evening?”
“I’m in some serious pain, man.” Hmm… .
“Where is your pain located?” Please don’t tell me “everywhere.”
“Everywhere.” Damn, I asked you not to tell me that… .
“What do you usually take for it?” Surprise me and say Advil!
“OxyContin.” Oy vey… .
“That’s a pretty strong painkiller. Have you tried anything else for your pain?” Like maybe heroin?
“I’m allergic to everything else.” Wow, what are the odds?
“Who usually gives you your prescriptions?” A guy in a trench coat?
“Dr. Feelgood at the health clinic in Buffalo Groin, Saskatchewan. I just got off the bus from there and they can’t find my suitcase. It had a six-month supply of my pills in it.” They lost your luggage on the bus? Really? When did Air Canada join the bus industry?
“What other pills did you lose?” I really shouldn’t ask that, but sometimes I can’t help but be curious as to how far they’ll go with a story that’s already more improbable than anything Lewis Carroll ever wrote.
He lights up. He senses a patsy!
“Uh, just my sleeping pills and my Ritalin and my nerve pills and… .” And a partridge in a pear tree?
When I was younger and more foolhardy I used to tell these critters I had some difficulty believing their sketchy stories and was not comfortable filling their Fantasy Island drug wish lists for them. That usually spawned a whine-fest that would inevitably degenerate into either grovelling or death threats. Once I was rooked into calling someone’s out-of-province doctor to verify his story. His girlfriend’s dog had eaten his pills, as I recall. I wonder how it got the cap off? Must have been related to Lassie.
“Hello?” I began.
“I told you man, quit bugging me! I’ll have your money by next week at the latest!”
“Um, is this (416) 867-5309?”
“Oh, sorry dude, I thought you were someone else! Wazzup?”
“My name is Dr. Gray and I’m looking for a Dr. Jenny.”
The person at the other end covered his receiver for a moment and gave a few phlegmy coughs. When he started speaking again, his voice had magically descended an octave.
“Hi, this is Dr. Jenny speaking.”
“Never mind.” Click!
Trial and error has led me to an expedient solution to these encounters: “I’m sorry, but I don’t prescribe OxyContin to any emergency room patients ever, and I don’t make any exceptions to that rule.” The vast majority of miscreants seem to accept this. I guess they can tell when the jig is up. Oh well, all in a day’s work in the ER. I wonder who’s behind the next curtain?
Two-for-One Special in the ER
It was another barmy Monday morning in the department. I picked up the next chart and reviewed the triage note. Mrs. Stewart, an 85-year-old woman with a rash. I knocked on the door and entered.
An elderly, blue-haired woman was seated on the stretcher. There was also a woman in her mid-50s standing in the far corner of the room. I nodded at the younger woman before turning to face my patient.
“Hi, Mrs. Stewart. My name is Dr. Gray.”
“What?”
“I said my name is Dr. Gray.”
“You made a special tray?”
“MY NAME IS DOCTOR GRAY!”
“Oh, hello Dr. Gray. Please call me Grace. Would you like to see my rash?”
She lifted the back of her shirt to reveal a diffuse, non-specific, red rash. Damned if I knew what it was.
“How long have you had this rash?”
“What?”
“I SAID, HOW LONG… . Never mind.” I addressed the younger woman. “Do you know how long she’s had this rash?”
“I’m sorry, doctor, no.”
“Is she on any medications?”
“I don’t know.”
“Has she ever had a rash like this before?”
“I really have no idea.”
I was beginning to develop an irresistible urge to roll my eyes.
“In what way are you two related?”
“We’re not.”
“Oh, are you just a friend?”
“I’ve never met her before in my life.”
“What?! Then why are you both in the same examination room?”
“I’m not sure, doctor. Half an hour ago a nurse brought me here and told me to wait. A few minutes ago a different nurse brought her in. I think maybe someone made a mistake.”
Good thing Mrs. Stewart hadn’t come in to get her hemorrhoids checked!
PART TWO
Ma and Pa Kettle: The Rural Years
Ch-ch-ch-ch-changes
In the fall of 1990 my good friend Barb the hairdresser announced she had found the perfect girl for me.
“Yeah, right, Barb,” I replied dryly. I’d witnessed some of her previous matchmaking attempts. Not good.
“No, trust me, you’ll like this girl! She’s really cute and she’s got a great sense of humour!”
“Okay, if you say so. What does she look like?”
“Five-fo
ot-four with light brown hair and greenish eyes.”
“What does she do?”
“She’s an elementary school teacher.”
“Sounds promising. What’s her name?”
“Janet.”
After a few phone calls, Jan and I scheduled a blind date at a nearby Perkins restaurant. The day before we were to meet she came down with a wicked flu. She considered cancelling, but ultimately curiosity got the best of her and she decided to proceed. Aside from her having shaking chills (plus Barb and my buddy Raj unexpectedly sliding into our booth halfway through the meal to mooch some fries and inquire how the date was going), everything went pretty well. We agreed to continue seeing each other.
Meanwhile, back at the ranch, I had come to the conclusion that although I enjoyed working as an ER physician in Winnipeg, I wanted to see what life was like on the other side of the urban/rural divide. Several telephone calls and reconnaissance trips later I accepted a position as a family doctor in a small town in northern Ontario. I shipped a few moving boxes, loaded up my MR2 and headed east in July of 1991.
Making an abrupt transition from a city with a population of 600,000 to a remote hamlet of 6,000 is much like doing the legendary Polar Bear Dip – extremely shocking at first (what do you mean there’s no Starbucks here?), but then you quickly grow accustomed to it. Then you die of hypothermia. Kidding!
My new gig was a bona fide cradle-to-grave family practice. Technically it was a solo practice, but I shared ER call and hospital responsibilities with a congenial group of four other family doctors plus a general surgeon. On a typical weekday I would do rounds on my hospital inpatients early in the morning, perform a couple of minor procedures in the emergency department, and then go to my office for a full day of scheduled appointments. When the office wrapped up I would usually return to the hospital briefly to check on my inpatients’ progress and review the results of any tests I had ordered earlier. On weekends I’d do my regular hospital rounds first and then spend some time at the local nursing home.
Being responsible for my own inpatients was a deeply rewarding experience, but I won’t pretend it was all rainbows and lollipops. For one thing, it meant visiting the hospital 365 days a year unless I happened to be out of town. In addition to commanding a significant chunk of my time, it paid poorly. Despite these drawbacks, there was one very big plus: it allowed me to care for my patients when they needed me most, i.e., when they were sick enough to warrant hospital admission.
Every Wednesday and some weekend days I’d be on call for the ER for 24 consecutive hours. In order to accommodate my ER obligations, my receptionist always booked a lighter office on Wednesdays. This allowed me time to shuttle back and forth between my clinic and the emergency department. The ER tended to be reasonably quiet between 6:00 and 8:00 p.m., so most evenings I’d be able to sneak back to my apartment for supper and a power nap. After that I’d return to the ER and see outpatients until midnight. The void between midnight and 8:00 a.m. was highly unpredictable and ran the gamut from wonderful to bloody awful. On a good night there’d be no outpatient visits after midnight and I’d be able to get a solid six or seven hours of shut-eye. More often than not, though, people would continue trickling into the department well into the wee hours and my sleep would get hopelessly fragmented. Once in a while I’d get no sleep at all. That gets old very fast. It’s hard to face the new day when it feels like your head is screwed on backwards.
Aside from missing the action at my old ER in Winnipeg, I was pretty much hooked on my new job right from Day One. There was something immensely satisfying about sending an acutely ill patient from my office to the ER, meeting them there to start treatment, admitting them to the medical ward, rounding on them daily until they recovered and then having them follow up with me back at the office. It was like being an office-based practitioner, an ER physician and a hospitalist all rolled into one. Of course, it’s not like I invented that particular enterprise. Most rural (and some urban) generalists have been playing endless variations on that theme ever since Og fell off the first stone wheel and got rushed to the Healing Cave back in 20,000 BC.
Jan and I conducted a long-distance relationship during my first year in Ontario. In July of 1992 we tied the knot and she joined me in my northern adventure.
Devolution
For the first few months after we got married, whenever I was telephoned at home in the middle of the night to go see patients in the emergency department Jan was the epitome of concern. The instant I hung up she would ask me if I had to go in. I’d fill her in on the details as I stumbled around in the dark looking for my clothes. Before I left she’d always say she hoped it wouldn’t be long before I was back. When I eventually returned home and crawled under the covers she’d wake up and murmur something appropriately sympathetic in my ear. Ah, those were the days.
As time passed she gradually stopped asking what I was being hauled out of bed to go and see, but she never failed to say, “Do you have to go in, honey? That’s too bad.” It became a comforting little ritual.
One night I answered the phone at 3:00 a.m. and glumly listened to the ER nurse explain that she needed me to come see some intoxicated yo-yo who was going to require a truckload of stitches. When I hung up Jan rolled over and said, “Do you have to go in, honey? That’s too…zzzzzzzzzz… .” As I lumbered out the door I thought, “Uh-oh. Things are definitely slipping.”
After that she completely quit waking up for those maddening nocturnal phone calls. I can’t really say I blame her – it’s probably a sanity-preserving defence mechanism. It certainly preserves her sleep! You could nuke the house next to ours and she’d snore right through it, guaranteed. Some nights I’m recalled to the emergency department three or four times after midnight. Our alarm clock invariably goes off 20 minutes after I’ve limped into bed for the final time. Jan usually sits up, stretches luxuriously and announces, “What a great night! You didn’t get called once!”
“Great night,” I croak incoherently.
A few days ago our prehistoric bedroom telephone finally gave up the ghost, so we replaced it. The new phone rings like a klaxon from hell. Last night I was on call. This morning Jan didn’t look quite as well-rested as she usually does.
“I don’t like that new telephone,” she complained. “It woke me up!”
I had to work hard to keep the grin off my face.
The Big Smoke
Not long after we moved to northern Ontario, Jan and I decided to spend a romantic weekend in Toronto. We planned to fly out after work on a Friday evening and attend The Phantom of the Opera, then spend the next day shopping. Saturday night we’d have supper at a cozy restaurant. On Sunday afternoon we’d pack up and fly home.
First we made our flight and hotel arrangements. Next we phoned the theatre to purchase tickets. They cost a small fortune, but we’d heard so many wildly enthusiastic reviews about the show we would have gladly paid double the asking price.
The last thing we needed to organize was our Saturday night soirée. Being recently displaced prairie folk, neither of us had the faintest idea where to go in Toronto for a good meal. We solicited advice from our co-workers and one of Jan’s colleagues recommended a restaurant he and his wife liked. Jan asked if I’d need to wear a suit or jacket and was assured dress pants with a shirt and tie would be more than sufficient. We called the restaurant and made reservations for 7:00 p.m. on the Saturday.
A couple of weeks later we packed our bags and left for the airport to begin our much-anticipated weekend in the Big Smoke.
After checking into our hotel we spruced up a bit and caught a cab to the theatre. The lobby was packed with excited people. Through one of the doors nearby I glimpsed a portion of the stage as well as the first few rows of seats. I surveyed our tickets: row K, centre. This is going to be great - 11 rows from the stage!
We joined one of the queues and slowly inched our way to the nearest door. I handed the usher our tickets. He looked at them, frowned deepl
y and passed them back to me.
“Is something wrong?” I inquired.
“Sir, these are for row K, upper balcony. This entrance is for the seats on the main floor.” He said “upper balcony” like it was some kind of STD.
I quickly re-examined the tickets. Of course he was right.
“Which line should we be in?” I asked.
“Over there.” He pointed to a long line at the far end of the lobby. Jan and I mumbled apologies and shuffled over to the proper line-up. Eventually we made it to the balcony. I looked down at the stage and was disappointed to see the view wasn’t that great. Oh well, 11 rows from the front of the balcony will still be okay. When we got to row K I motioned to my wife and started to edge in.
“Wait a minute, this isn’t right,” said Jan. “This row is full.”
“Really?” I backed out.
“Look,” she continued, her eagle eyes fixed on the dark nether regions at the rear of the theatre. “Right now we’re in the main balcony. Our seats are in the upper balcony!”
I thought back to what the usher downstairs had said. Jan was correct. Row K? More like K2! Our seats were going to be so remote, we’d need Sherpas to find them. We steeled our jaws and continued on our quest.
A couple of postal codes later we arrived at row K in the upper balcony. It was one row from the wall at the very back of the theatre. The only people behind us were a few pimply high school kids. They were busy having a lively discussion about the latest Guns N’ Roses album. I turned my attention to the stage. From our vantage point it was about the size of a shoebox. A well-decorated shoebox, but a shoebox nonetheless.
The show began. The people onstage looked like ants. Singing ants! What a concept! But why were they so fuzzy? It suddenly occurred to me that in our haste to get to the show on time I had left my glasses back at the hotel.
“I can’t see a thing!” I complained to no one in particular.
“Shh!” the high school students chorused.
A few minutes later an usher came by hawking programs. I was tempted to ask him if he also sold high-altitude oxygen bottles, but I knew Jan would slap me silly if I did.
Dude, Where's My Stethoscope? Page 4