Dude, Where's My Stethoscope?

by Gray, Donovan

  “Probably at church,” was her response. On a Monday night?

  “Which church do you go to?”

  “The one with the cross on it.”

  I had no choice but to take her to the arena with us. Normally I read medical journals while my girls skate. Not that day!

  “Excuse me, can I run over there?”

  “Sure, Frieda.”

  Two minutes later: “Excuse me, can I run over there again?”

  “Sure.”

  “Excuse me, can I hop down those stairs?”

  “Go for it, Frieda.”

  “Excuse me, do you think my mom will be home when skating finishes?”

  “I sure hope so.”

  “Excuse me, I’m getting cold.”

  “Here, Frieda, you can wear my coat.”

  “Thank you! My hands are cold, too.”

  “Would you like to borrow my mitts?”

  “Thanks!”

  “No problem.”

  “Um… .”

  “Yes, Frieda?”

  “I have to pee.”

  Sigh… .

  A couple of months ago Frieda set the record straight regarding the nefarious Harry Potter.

  “Excuse me?”

  “Yes, Frieda?”

  “You know the Harry Potter movie?”

  “Yes?”

  “It belongs to SATAN.”

  “What?”

  “It belongs to SATAN.”

  “Well, we sure liked it.”

  “Oh. Was it funny?”

  “Yes, it was.”

  “Oh. I never saw it.”

  Last week Frieda’s family pulled up stakes and left our small town in search of greener pastures. On the morning of their departure Frieda came over with a batch of freshly baked cookies and a homemade thank-you card. Inside the card was a crayon drawing of me and four little girls driving down the road in a minivan. The girls were all holding hands, and everyone looked happy. Even the sun was smiling.

  We’re going to miss you, Frieda.

  Chiaroscuro (Light and Dark)

  What’s worse, preparing incessantly for a war that never comes, or maintaining a state of blissful ignorance and getting caught flatfooted when the bombs start falling?

  Educating my children about racism may help reduce its sting when they finally encounter it firsthand, but it will also hasten their loss of innocence. I’ve always been of the opinion that if my kids have to learn certain unpalatable truths about race relations, I’d rather they get the facts from me than from some bozo on the playground. I can mete out the required information in carefully measured doses, which is obviously far superior to having someone unexpectedly dump the entire toxic payload on them in one fell swoop.

  Gradual desensitization makes more sense than abrupt immersion, doesn’t it? Sure it does. Unless… . Unless the anticipated immersion never occurs. What if I’m preparing them for something that’s never going to happen?

  I’m black and my wife is white. Although our three daughters are of mixed racial heritage, history tells us that society will view them as black. Jan and I aren’t sure about how best to prepare them to cope with racism. I favour taking a no-holds-barred, worst-case-scenario approach and teaching them everything up front. She prefers the concept of letting them gradually come to their own conclusions.

  I don’t want my daughters to develop an unnecessarily jaundiced view of the world, but I don’t want to see them get blindsided, either. What’s better, idealism or pragmatism? Should I hope for the best or plan for the worst? Tough choices. But then, no one ever said parenting was going to be easy.

  Lost in Translation

  “What we’ve got here is failure to communicate.”

  - Captain, Road Prison 36, Cool Hand Luke

  I have a patient named Irmgard who doesn’t speak any English. The first time I saw her in the office she brought her friend Roy to translate. The conversation went something like this:

  “Hi, I’m Dr. Gray.”

  “Roy.” He shook my hand, then pointed at his comrade. “Irmgard,” he said. She waved. I waved back.

  “Could you please ask her what’s wrong today?”

  They conversed in their language for a while, then Roy turned to me and said something like: “Hibida bibida pain hibida vonch stomach hibida shrek tang two weeks.”

  “What?”

  “Hibida bibida pain hibida vonch stomach hibida shrek tang two weeks.”

  “Um…She’s been having pain in her stomach for two weeks?”

  “Yes.”

  “Has she ever had this before?”

  They spoke again. He looked at me and shook his head, “No.”

  “Has she had any change in her weight or blood in her stools?”

  They conferred. At length he told me: “Hibida bibida same stretch munch nona lollapalooza.”

  “What?”

  It was starting to look like I’d soon be needing a translator for my translator.

  “Did anyone in her family ever have bowel cancer?”

  They had an animated discussion that went on for a full minute. I fidgeted in my seat and waited. Patience, Grasshopper. Finally Roy swivelled around to face me and relayed her answer: “Purple.”

  I made a mental note to never use Roy as a translator again.

  Patients Say the Darndest Things!

  “Yesterday I went to the hospital and they did a PAP test on my throat.”

  “What’s your pain like?”

  “It’s magnetic.”

  “Does it hurt anywhere?”

  “In bits and pieces.”

  “How high are your blood sugars?”

  “Anywhere from 4-foot-7 to 6-foot-5.”

  “What’s your diarrhea like?”

  “It’s kind of juicy.”

  “How bad is your pain on a scale of one to 10?”

  “Not too bad – about a nine.”

  “Hey, doc, would you be able to fill out this welfare form for me?”

  “Okay. What’s your medical reason for not being able to work?”

  “Umm… I don’t really have one.”

  “My vision’s blurry, doc.”

  “Did you see an optometrist?”

  “Yes.”

  “What did they say?”

  “She gave me some new glasses.”

  “Do they help at all?”

  “They work great, but I keep forgetting to wear them.”

  “I was watching television the other day and they said those cholesterol pills you put me on do something to the lining of the wall.”

  “The wall of what?”

  “I dunno; I wasn’t paying that much attention.”

  “What’s your last name?”

  “Vogl.”

  “Is that European?”

  “No, it’s German.”

  “Don’t inject me with that cortisone stuff, doc. Twenty years ago they injected some in my wrist and it stiffened up so bad I could hardly use it!”

  “That’s odd. Why did they do the injection in the first place?”

  “It was getting stiff.”

  “Did anyone in your family develop heart disease at a young age?”

  “Yes, my great-grandmother.”

  “How old was she when she started having heart trouble?”

  “97.”

  Certified drug seeker:

  “Geez, doc, I’m taking way too many Tylenol 3s. Can I get some morphine instead?”

  Teenager who’s been slouching around the waiting room playing Game Boy, eating Cheezies and listening to his iPod:

  “I have a stomach ache.”

  “How bad is your pain on a scale of one to 10?”

  “17.”

  “The maximum possible score is 10.”

  “Oh, okay, I get it. Um, let’s see… I guess it’s about a 12, then.”

  “The number can’t be any greater than 10, and a 10 would be like someone cutting your leg off with a rusty chainsaw.”

  “Oh. Wel
l in that case it’s a 9½.”

  … and sometimes sleep-deprived nurses say the darndest things!

  “Mr. Bryant, since you're having trouble peeing I'm going to put this catheter in you, okay?”

  “Does it go in my nose?”

  “Do you pee through your nose?”

  Let’s Get Physicals

  “I’m here for my yearly complete examination.”

  “I think the wife booked me for a checkup.”

  “I’m fine, but I need a physical for my class A-Z driver’s license.”

  “I want to be tested for everything.”

  “Can you book me for one of those total body scan things?”

  The complete physical begins with a series of health-related questions called the review of systems. The goal of these questions is to ferret out occult disease. In my experience, patients’ responses tend to be influenced by two main things – their personality type and the reason for the physical.

  On the one hand are healthy people who are seeing me solely because they need to have their mandatory job-related physical examination forms filled out. On the rare occasion that they actually do have an active medical problem, they go to great lengths to hide it from me. It’s not too difficult to figure out why – their livelihood depends on my giving them a clean bill of health. In these patients, the system reviews are shockingly brief:

  “Have you been having any chest pain?”

  “No.”

  “Shortness of breath?”

  “No.”

  “Weight loss?”

  “No.”

  “Wait a minute – according to our scale, you’ve lost 40 pounds over the past three months.”

  “Really? I hadn’t noticed. Probably just that stomach flu I had last week. Hey, how about those Winnipeg Jets!”

  Neurotics who are in for “a good physical” represent the other side of the equation:

  “Have you been having any chest pain?”

  Mr. Somatoform gets that far-away look in his eyes. He strokes his chin thoughtfully as he contemplates the question.

  “Now that you mention it, I did have an episode of chest pain not that long ago.”

  “When?”

  “Last Christmas.”

  “Nine months ago?”

  “Yes.”

  “What sort of pain was it?”

  “It felt like a bolt of lightning.”

  “Where did you feel it?”

  “It shot from my right armpit to the centre of my chin.”

  “How long did it last?”

  “About three-quarters of a second.”

  “Has it ever come back?”

  “No, it hasn’t. What do you think it was, doc? Could it have been a heart attack? Should I be seeing a cardiologist?”

  “I don’t know what it was, but I’m pretty sure it wasn’t anything too serious. Let’s move on. Have you had any shortness of breath?”

  “Funny you should mention that… .”

  Ramblers are a breed unto themselves:

  “Have you been having any chest pain?”

  “Chest pain, chest pain… . I’m not quite sure how to answer that, doctor. I haven’t had any chest pain lately, but back in the winter of ‘64 old doc Tilley had to admit me to the hospital for two days on account of the fact I was getting a mighty peculiar discomfort – I can’t really say it was a pain, mind you, because it was more of an ache than an actual pain, sort of like a nagging toothache, if you know what I mean – right above this here rib. At first they thought it might be pleurisy because plenty of folks in our neck of the woods had been coming down with it right around the same time I took sick, but in the end doc Tilley figured it was just…uh…doctor?”

  “Zzzzzzz… .”

  And let’s not forget the Chronically Vague:

  “Have you been having any chest pain?”

  “Uh-huh.”

  “How long have you been getting it?”

  “Huh?”

  “How long have you been getting the chest pain?”

  Mr. Isidore gazes at me with the eyes of a chicken. After half a minute of deep thought he responds, “Quite a while.”

  “How long is ‘quite a while’?”

  “Oh, I dunno. A long time.”

  “Weeks? Months? Years, perhaps?”

  “I dunno. Been quite a while, though.”

  After I’ve completed the review of systems I usually leave the room while my patient changes into a gown. If I return to find they’ve put the gown on with the gap facing the front instead of the back, I automatically deduct two points. The same applies to people who still have their T-shirt on underneath the gown.

  I start every physical by asking my patient to turn their wrist over so I can palpate their radial pulse. Due to the location of the artery, it’s easier for me to check the right wrist than the left. Inexplicably, 98 percent of patients offer me their left wrist. Why is that? I’m sure there’s a research paper for some starving university student in there somewhere. Similarly, when I examine patients’ necks I usually ask them to tilt their heads downward slightly to make it easier for me to feel the glands. Most people immediately hyperextend their neck, which results in them staring up at the ceiling. Go figure.

  Some people have more earwax than Shrek. Every so often I come across an unexpected surprise, like the time I discovered a bunch of uncooked spaghetti noodles wedged into a young man’s ear canal. As it turned out, earlier that week he had used them in an unsuccessful attempt to curette out some earwax. Epic fail! Once I had to flush a fly out of someone’s ear canal. How the frak do you get a fly in your ear?

  When the ear exam is finished, I’m ready to inspect the throat. I stand in front of my patient, aim a flashlight at their mouth and ask them to open wide. Three-quarters of people open their eyes widely instead of their mouth. Research paper!

  Occasionally a detailed eye exam is required. Some people are unbelievably calm when it comes to having their eyes checked – irritating drops and dazzling lights shone directly into their pupils don’t faze them in the slightest. Others are eye wimps – the instant the ophthalmology tray is brought out they reflexively scrunch their eyelids shut so tightly a crowbar couldn’t pry them open. It usually takes a fair bit of cajoling before these folks will allow me to proceed. Years of examining eyes have taught me that there are four cardinal directions: up, down, left and the other left. “Okay, Ms. Knowles, please look to your left. No, the other left.”

  Next comes the throat. When I push down on someone’s tongue with ye olde glorified Popsicle stick and ask them to say “ah,” it’s not because that’s how I get my jollies. Saying “ah” makes the soft palate rise, which makes it easier for me to visualize the back of the throat. Half the time I ask patients to say “ah,” they either straight-up don’t do it or else they try to fake it. What? Do they think I won’t notice? Hel-lo, McFly, I’m right here! I notice! Say “ah!”

  I just love it when someone a foot and a half away from me spontaneously ejects their dentures to show me a lesion in their mouth. Isn’t there some sort of unwritten rule of social conduct that stipulates prior to popping out one’s false teeth, a person is supposed to give innocent bystanders fair warning? I’m still waiting for the day somebody asks me to hold their drippy dentures for them.

  Chest auscultation is always interesting. When asked to take deep breaths, many people take one deep breath and hold it. How is that supposed to help me? Sometimes I’m tempted to sit back and wait to see how long they’d last. And then there are the times when patients seem to forget how to breathe and I end up having to remind them to exhale after each inspiration. “Deep breath…exhale! Deep breath…exhale!” When I get tired of repeating myself I say, “That’s good! Just keep doing that, okay?” Seems to work.

  While I’m on the topic, what mysterious force compels people to start talking to me while I’m auscultating to their chest with my stethoscope? At least once a day I’ll be straining to decipher a subtle heart s
ound when suddenly “My great-grandmother died of a heart attack when she was 98!” explodes into my eardrums. Now that’s annoying. Minus 10 points.

  The umbilicus is the centre of the abdomen. Heck, it’s practically the centre of the entire body. You’d think people would make an attempt to keep it clean, right? Maybe even treat it to a little soap and water once in a while? Don’t count on it. I’m here to tell you that the hygienically-challenged walk among us. Some belly buttons are so full of dirt, you could plant an oak tree in them. Others contain enough lint to fill a Beanie Baby. Wash your belly buttons, people! This has been a public service announcement… .

  Centuries ago, when I needed to evaluate male patients for groin hernias I would insert my gloved finger into their inguinal canal and ask them to cough. This inevitably resulted in them coughing all over me. Nowadays I say, “Please cover your mouth and cough.” My patients often look a little baffled when I make this request. Maybe they’re thinking, “You mean I don’t get to cough on you anymore? Bummer!”

  Sooner or later all good things must come to an end. Once the examination is over we discuss my findings as well as any recommended investigations and treatments. When we’re finished most people say thanks, walk out and shut the door behind them. I’m never quite sure why they close the door. Perhaps they think I plan to teleport out of the room. Fortunately, I’m not claustrophobic. I finish my charting, reopen the door and mosey on down the hall to see what new challenges await me.

  Survey Says…

  My desk is littered with surveys. We rural physicians are a hot research topic these days – everyone wants to know what makes us tick. I imagine the brainiacs in their think tanks across the nation scratching their heads, vexed and perplexed.