Oops

When all of your patients are doing okay, there isn't much to write about.  As I see more and more of my outpatients, more and more often, I've been noticing there's a big range of home health aide competence, from the ones who barely know their person's name to the ones who take notes, actually pay attention, and act in a warm, caring way toward the patient.  I think it's a pretty painful job, being a home health aide, especially to a demented person who doesn't have a non-demented spouse involved as well.  It's a lonely job, certainly.  And it's very easy to do it poorly, and hard to do it well.  If you are an aide, and you're bringing your person to the doctor's office, you should probably clean them a little bit first, brush their teeth, put fresh clothes on them -- or you seem like a bad aide.  If you ask questions, especially about medication dosing, you seem like a good aide.  If you wait in the waiting room, and act like the doctor's appointment is your time to make a call on your phone, you seem like a very bad aide.  If you bring a medication list, you seem like a very good aide.

Actually, it doesn't just apply to aides.  If you bring a medication list -- an accurate medication list -- to the doctor visit, you win.  The number of people who don't think that knowing what medicine you're taking is a good idea when you visit a doctor for the first time is really staggering.  If I could pass one health care related edict, I think it would be that people should be mandated to bring medication lists everywhere they go.  And if you've typed up a list of your medical conditions, surgeries, hospitalizations, names and phone numbers of the other doctors you see -- well, I want to give you a lollipop, because you are making your doctor's job a lot easier, and increasing the odds that you get decent medical care.

Also, if you're not the patient -- and you'd be surprised how often this happens -- if you're not the patient, I don't want to take your blood pressure, or weigh you, or answer your own medical questions.  Home health aide, if you need someone to listen to your cough, make an appointment with a doctor for yourself.  Spouse who is not my patient, please don't ask me to check your blood sugar.  And no one is getting a medication refill except the patient I'm actually seeing.  That means your sister, in another state, no -- I'm not calling in her refill, not even if you put her on speakerphone.

Who's On Tonight?

How you know you've been working in the hospital too long:

"Are you going to watch the Tony Awards?"

"I didn't know they were on."

"What are you talking about?  I e-mailed you about them."

"What?  No you didn't."

"Sure I did.  You wrote back and said OK, I didn't know.  But I told you, so now you should know.  Are you OK?"

"Oh."

"What?"

"That explains your e-mail.  I thought you were telling me Tony was on tonight."

"Who's Tony?"

"I figured he was a resident.  I didn't know.  That's why I said I didn't know.  I figured you were telling me Tony was on call tonight.  And that I should know who Tony is.  Even though I don't."

"No.  I was telling you the Tony Awards were on TV.  Do you want to come over and watch them?"

"Not really.  So who's on tonight if not Tony?"

"There is no Tony."

"Oh, yeah."

"I think you should come over."

Wrong Liver

"So, your father is scheduled for surgery tomorrow -- I don't know if the surgeon has been by yet to answer any last-minute questions, but if you have any concerns--"

"I just hope this goes better than last time he had surgery."

"What happened last time?"

"They removed the wrong liver."

"He only has one liver."

"Well now he does -- that's right."

"No, he only started with one liver.  There is only one liver."

"Now, sure.  They didn't even apologize."

"They couldn't have removed the wrong liver.  People have one liver.  And his liver wasn't removed."

"Not the remaining one, no -- I should hope not!"

"He did not have his liver removed."

"Not this one.  The other one."

"He only has one liver."

"Exactly, that's what I'm trying to tell you."

"No, there's something confusing here -- when you're born, you have one liver.  Just one."

"So then you know what he's gone through."

"I'm not talking about me.  I'm talking about everyone.  One liver.  There's no wrong one and right one.  There's just one."

"His was the wrong one."

"Okay, forget it -- that's not even the surgery we're talking about.  You know that he's having surgery on his left hip tomorrow, right?  The surgeon explained it."

"And how many hips will he have afterwards?"

The Diabetic 87-year-old who's 63 and not diabetic.

"Doc, we didn't see you yesterday."

"Yeah, I was off yesterday.  But someone should have stopped by -- there's always a doctor covering."

"Someone did, but we didn't like him."

"Why not?"

"He came in and thought our mother was 87 and diabetic."

"He must have had the wrong chart."

"No, he said that was in the chart.  He showed us."

"She's never been diabetic, right?"

"No."

"That's weird.  I don't know how that happened, but I'll check the chart and fix any mistakes I see."

"Also... you don't think she looks 87, do you?"

"Of course not... but it's hard to judge people's age when they're sick.  Everyone looks older than they really are."

"So how old do you think she looks?"

"That's not a fair question, because I know she's 63."

"But if you didn't know."

"I'd say she looks like an ill 63 year old, unfortunately."

"She used to look 40."

"She used to be 40."

"But you're sure she doesn't look 87."

"Yes."

"Good, because then there's no biological way I could be her son."

The Patient Advocate

Sorry for the gap in posting.  Was on vacation this week, with limited Internet access.  And no pager.  Fortunately.  Back for the holiday weekend.

"I'm told you wanted to transfer your mother?"

"Yeah, we were talking to the patient advocate and she told us we should."

"What?"

"We were telling the patient advocate that we were worried about our mother, and she said there are better hospitals in the area, and we might want to transfer her to one of them."

"The patient advocate said that?"

"Yep."

"Interesting.  So when did you want to transfer her?"

"Now."

"Did you talk to the other hospital about accepting the transfer?"

"No."

"Have you looked into an ambulance to get her there?"

"No."

"Is there a particular doctor you know over there?"

"No.  We were hoping you could take care of all of that for us."

"We can certainly work with the other hospital to arrange the transfer, but you need to contact a doctor over there and start the process."

"Do you have the phone number of a good doctor there, who would be better than you at treating her?"

"Honestly, I don't know anyone over there."

"I guess we can just ask the patient advocate."

"Okay."

The Physical Therapist Is A Fictional Character

A family asks to talk to a doctor.  I'm just a consultant on the patient, but I'm there, so I'm the one they get.

"Doc, we're frustrated because he's been here a week and still hasn't seen physical therapy."

"I do see that the order was put in five days ago.  I can put in a call to physical therapy and see why they haven't come yet, but I'm not sure what else I can do about that."

"That's not an answer."

"No, it's not, but let me give them a call and see if I can get them to come sooner than they might otherwise."

"It's been a week."

"I understand."

"Is there actually physical therapy, or is it just a lie you tell people, so we stop asking about it?"

"There is actually physical therapy.  I've met some of the physical therapists.  They are actual people."

"Hard to believe that."

"I understand that you're frustrated."

"When we asked the nurse, she said she'd never seen physical therapy come see a patient."

"I have to imagine she was joking."

"She didn't seem like she was joking."

"Then maybe someone misunderstood.  I don't know why physical therapy hasn't come yet.  I assume they're very busy.  But I don't know.  I will call them."

"You'd better do more than call them."

"I will talk to the physical therapy director."

"While you're at it, can you talk to the director of nursing and get us a new nurse?"

"I don't know that I can get you a new nurse.  If you're having a problem with your nurse, you can ask to speak to the nurse manager."

"More people to speak to?  This is ridiculous.  I want to speak to another doctor."

"I can have another doctor speak to you.  I'm not the primary doctor for your father, but I am familiar with his case.  That's why they had me talk to you.  I know you're frustrated.  You have a right to be frustrated.  Do you have any medical questions?"

"Yes.  Why does he need physical therapy when he's walking fine?"

"I thought you were upset he wasn't getting physical therapy."

"No, I'm upset that we were told we're entitled to physical therapy, and we're not getting it.  This is a different question, about why he would need physical therapy."

"Perhaps he doesn't, and that's why physical therapy hasn't come."

"If we're entitled to physical therapy, we want physical therapy.  If it's part of the package, we definitely want it."

"There's not a package.  Your father is supposed to get the treatment he needs."

"We also need some more of those toothbrushes that were in his room."

"You can ask the nurse for toothbrushes."

"We don't like the nurse."

"I don't have any toothbrushes."

"When is physical therapy coming?"

"I'm going to have you talk to a different doctor."

"I'd like to speak to the [p]resident"

I'm on call in the hospital and I get paged that a patient's family wants to talk to me about a patient I consulted on earlier.  I stop by the room.

"Are you the president?"

"Pardon?"

"Are you the president of the hospital?"

"No.  I'm the fellow who saw your mother earlier today."

"My wife has a brother who is a doctor, and he told me I should always make sure I speak to the president, because the president will be most familiar with the patient."

"I think you probably misheard.  He probably said resident."

"No, he said president."

"I think he said resident."

"Why would I want a resident of the hospital to know about my mother's condition?"

"Residents are the doctors who are most involved with the medical plan.  I was a resident until last year, and now I am a fellow.  The attendings are the doctors in charge of the decision-making.  That's just the hierarchy of the team.  The hospital president is not involved in patient care."

"He should be.  I want to speak to him, like my wife's brother said."

"I'm sure he said resident.  I can get the resident to stop by after rounds."

"The young woman we spoke to before?"

"Probably."

"She didn't seem like she was the president of anything."

"She wasn't the president, she was the resident."

"I'd rather wait for the president."

I Have Most of My Parts

96-year-old patient.  Female.  Complaining of stomach pain.

"I'm just going to see if there's any tenderness, okay?"

"I didn't know you were going to be touching me."

"I'm sorry, is that okay?"

"Yes, but I would have put on a little more makeup."

"Let me know if you feel anything."

"Oooh.  Yes, that hurts."

"And how about here?"

"Yes, that hurts too."

"I didn't see anything in your chart... have you had any surgeries in that area?"

"Surgery?  Like what?"

"Have you ever had any ovarian issues, have you had a hysterectomy, anything like that?"

"Well, I don't get my period anymore."

"No, I wouldn't expect that you would."

"And the doctor said I can't have any more children."

"Right, but is that because of any procedure you may have had, even if it was years and years ago?"

"Now that you mention it, I think they did take something out."

"Do you know what they took out?  Did you have a hysterectomy?"

"To be honest, I don't know.  I'm not really sure what's inside me anymore."

"Okay, I'm going to send you for a scan to see what's inside of you, and to make sure there's nothing concerning going on.  Obviously we don't want to look for problems at your age that it's better not to find, but I just want to see if we can figure out if there's a reason why you're so tender down there."

"You don't think that doctor was wrong and I'm pregnant."

"No, I don't."

"Okay, that's a relief."

Yes, I know that word.

"Doctor, I've been having terrible itching."

"Where is the itching?"

"My anus."

"Okay, how long has this been going on?"

"A while.  There is also some leakage."

"Oh."

"Yes, s*** is coming out.  I know that's not a medical word.  Do you know that word?"

"Yes."

"So you know what I mean when I say s*** is coming out of my anus?"

"Yes, I know what you mean."

"Because I don't know the medical word, but I wasn't sure if you would understand what I mean by s***."

"I understand what you are saying."

"Yes, it is leaking out of my anus."

"Okay."

"The s***."

"I got it.  I can give you a cream."

"To put in my anus?"

"To put on the skin, for the itching.  And I'm going to refer you to a gastroenterologist for the leakage.  I hope you feel better."

"I just feel like I'm always covered in s***."

"I'm sorry."

"You know what I'm talking about, right?  Even though that's not the medical word."

"Yes."

"Okay, I just wanted to make sure."

"Take care."

Opening Questions To Bad Conversations

"Do you know where the morgue is?"

"Wait, how many pills did you give him?"

"Does the patient have any family you think might be likely to sue?"

"Oh, so this was the patient you were talking about?"

"Did it always look like that?"

"Was there a patient in here earlier?"

"Do you know if she's an organ donor?"

"Is there a way we could get that cleaned up before it causes any more problems?"

"Has it smelled this bad for a while?"

"I'm sorry, your fever was what?"

"Did you see if the teeth are in the closet?"

"You don't happen to know if your father had any undocumented allergies, do you?"

"So no one had checked his pressure since... Tuesday?"

"Your malpractice insurance is all paid up, right?"

"Are you sure that was a doctor who works here?"

"Did you mark the leg that was supposed to be cut, or the one that wasn't?"

"Are you sure it always looked like that?"

"You went to the bathroom how many times?"

"You haven't gone to the bathroom in how many days?"

"Wait, can you say that again, but trying not to slur your words?"

"Is she always this difficult to rouse?"

"Did you ever follow up on that?"

"Did you notice that last time you saw her?"

"Do you think the med school would even want a body in this condition?"

"Do we have beds that can support that much weight?"

"Did I just step in what I think I stepped in?"

"Did all of that actually come out of your body?"

"Does anyone know where the crash cart disappeared to?"

"Oh, was I supposed to be running this code?"

Seeing Patients Is For Losers

"So, have you thought about what you want to do after fellowship?"

"Of course it depends on the jobs that are out there... but I think I want to find something that's mostly outpatient."

"Like, private practice?"

"Yeah, maybe."

"Ugh.  So you just want be a... clinician?"

"I find it more satisfying than inpatient-- you get to form actual relationships with your patients when they're not acutely ill...."

"No research?"

"I'm not opposed to research.  I just don't know that I'm passionate about it."

"So you really just want to see patients... in an office...?  That's so, I don't know... unambitious.  That's really why you went to medical school?"

"I guess so, yeah."

"Ugh.  Seeing patients is so annoying.  I can't believe that's really what you want to waste your time doing."

"I don't think it's so completely a waste."

"You know what I mean."

"Sort of."

"Well, whatever, I guess if I hear of anything ridiculous like that, anyone looking, I'll send you an e-mail."

"Thanks."

"You do realize we're probably hiring a whole bunch of people to do inpatient hospitalist stuff, right?  Mixed with research and some teaching?"

"Yeah, I heard about that."

"And you'd rather see patients."

"I think so, yeah."

"Whatever, it's your life."

Aside from the dementia...

"...so, aside from the dementia, your mother's doing pretty nicely, all things considered."

"Great.  I just wanted to ask if you could write a letter to her boss saying she's healthy enough to work."

"I'm sorry, what?"

"A short letter -- her boss wanted to see a doctor's note to just make sure she was OK to work."

"Your mother works??"

"Yeah, she's a secretary at a law firm."

"She's 88 and demented."

"Yeah, it's okay, she brings her aide."

"She brings her aide to work?  I'm sorry, does her aide do the work?"

"No, she just helps her."

"I'm sorry, I must be missing something.  Your mother doesn't recognize you.  She didn't realize this was a doctor's office.  I'm kind of floored to imagine she could do the job of a secretary."

"It's a low-volume desk."

"Still...."

"Look, I just need you to write a note saying she is physically healthy enough to go into the office, with her aide."

"I'll tell you, you are right that she is physically healthy enough to do that.  But she's not mentally equipped to still be working in any capacity that requires her to remember things."

"I think that's for her and her boss to figure out.  He just needs to know that she's not at risk of anything medically."

"I can write some kind of note saying she's physically healthy, but I can't write a note recommending she have a job in an office."

"That's okay.  The physically healthy part should be fine."

"I'm sorry, I have to ask-- why does her boss keep her on the payroll?"

"He's also 88.  He likes the company."

"Okay.  That's fine.  I'll write the note and be right back."

"I was wiping my mother, and..."

"I was wiping my mother, and..."

"Yeah?"

"...and I found, you know those plastic things they put on clothing to keep people from stealing them?"

"Like, an anti-theft tag?"

"Yeah, the long, plastic things, with the metal clip that attaches to the clothing...."

"Okay...."

"Yeah, I found one of those when I was wiping her."

"Like, coming from inside of her, or like she had sat on it or something like that?"

"No, definitely from inside her."

"Those things are not small, right?"

"No, about three inches.  And sharp on the edge."

"But no bleeding, and everything else normal?"

"Yes, everything fine."

"And you're sure she didn't sit on one, and it was just stuck on her?"

"Yes, I'm sure."

"So you're saying you think she swallowed one, and it passed through her?"

"I don't know!  Is that what you think?"

"There doesn't seem to be a lot of options if you're saying she passed it in her stool.  It had to come in from one end or the other."

"Oh, interesting."

"Did you recently remove something like that from any clothing in the house?"

"No, we don't steal clothing."

"I'm not accusing you of stealing clothing.  But it would have had to have come from somewhere."

"I don't know.  She never leaves the house."

"Well, if there was no bleeding and everything is normal, I wouldn't worry about it."

"I saved it.  But I accidentally left it at home.  Should I bring it next time?"

"That's okay.  I think you can throw it out."

"In the regular garbage?"

"I suppose."

"So you don't want to run any tests on it?"

"No.  If she's not having any problems, I think we can just chalk it up to an inexplicable accident, and cross our fingers that it doesn't happen again."

"You don't think it poisoned her?"

"Is she behaving strangely?"

"No."

"I think she'll be okay."

"If I find another one, what should I do?"

"If you find another one, you should look around the house for the source of these things."

"Do you think I need to call the plumber?"

"What?  What would the plumber have to do with this?"

"I don't want these things to stuff up the toilet."

"Okay, let's just try and pretend none of this happened, and move on to the next issue."

Refills for everyone

"My mom needs refills on a bunch of her meds."

"Okay, that's fine, let's go down the list and I can give you prescriptions."

"[drug]"

"Great."

"[drug]"

"Great."

"[drug]"

"Great."

"Percocet."

"Wait, why is she taking percocet?"

"Her last doctor prescribed and just kept refilling."

"How long ago?"

"Years, I think."

"How many is she taking?"

"I don't know.  She doesn't have any left." 

"How often is she taking Percocet?  I don't think she needs to be taking Percocet."

"Just in case.  When she has pain.  She's barely taking any."

"I think we should try and not have her taking Percocet."

"She doesn't take them, okay?"

"Then you don't need the refill.  What's next?"

"You can't just give her some in case?"

"You just said she's not taking them."

"Yeah, but sometimes I'll take them."

"What's the next drug on the list?"

"Just a few Percocet, in case of an emergency?"

"Look, I'm pretending I didn't hear what you said, because you're not my patient, and I'm not prescribing your mother this drug.  We can make this a bigger issue, or we can just move on to the next drug."

"Okay.  [drug]"

"Great."

"[drug]"

"Great."

"Oxycodone."

"Okay, I'm going to go get my attending.  Give me a minute.  Thanks."

"Young and Rich"

"So, Mrs. Patient, it was great to meet you, and I'll see you in six weeks for a follow-up... and hopefully everything is stable until then."

"It was nice to meet you too, doctor.  Oh, how I wish I was young and rich."

"I wish I was young and rich too."

"You are!"

"Medical school is expensive."

"You're a doctor.  I bet you make a million dollars a year."

"I'm a fellow.  I make a lot less than a million dollars a year.  And even after fellowship, I will make a lot less than a million dollars a year.  I'm not complaining, but, a million dollars, that's not what's going on here in the clinic for anyone."

"My cataract surgeon told me he makes a million dollars a year."

"Your cataract surgeon sounds awesome."

"No, he is great.  I can see now."

"I'm glad.  I'll see you in six weeks."

"You will be making a million dollars by then."

"I don't think so, but thanks."

"No, I will send you my friends."

"I appreciate it."

"They have good insurance."

"That's great."

"No, really.  Better than mine.  No co-pay."

"I'm glad.  I'll see you soon."

"Wait-- you know I have co-pay, right?  I have to tell you-- I can't pay my co-pay.  You can send me bill, and I will try to pay it, but I can't.  You still see me?"

"I really don't deal with the billing.  I'm just a fellow.  I see whoever shows up in my office, I promise."

"So you still see me?"

"I have no idea what the clinic does when people don't pay their co-pay, honestly.  If they let you in my office, I will see you, I promise."

"Yes!  Now I definitely send you all of my friends."

"Great.  Thanks."

Prostheses by Phone

"I wanted to know if you had the phone number of the prosthesis place."

"What place?"

"I wanted to order one."

"That's not how it works.  You need to talk to your surgeon, and he'll connect you with the people who can fit you for the prothesis, and do the training and rehab you'll need...."

"I thought I just call a number."

"And they send you a leg in the mail?"

"Yeah.  I thought maybe they'd want to know my height, so I was going to ask you to measure me."

"It's more complicated than that."

"So if I go to my nephew's wedding this weekend, I probably won't be able to walk?"

"No."

"Oh.  I didn't want everyone to know I had to have my leg amputated."

"Unfortunately, it's a longer process than that.  They're going to know."

"Could I maybe get a fake prosthesis, and just pretend it's real?"

"A fake fake leg?"

"Yeah, I guess."

"I wouldn't know where to send you for that.  Maybe a costume shop?  But you're still going to need the wheelchair."

"I can't just get a pair of crutches or something?"

"I don't think you'll be able to maneuver on them without a lot of physical therapy."

"I have a couple of hours free tomorrow."

"No, it's a longer process than that."

"And will insurance cover something like this?"

"The therapy?  It should."

"No, the costume shop."

"No."

"What if you write a note?"

"I don't think so.  Sorry."

"Do you think a costume shop would deliver?"

"I really don't know."

"Do I need a referral?"

"No."

"Maybe my surgeon can give me a spare leg he has in the office?"

"I guess you could ask."

"Great, thanks."

The Earring

"Hey," said one of my medical students.

"Hey.  What's going on?"

"I have a weird situation."

"Okay...."

"I lost an earring this morning.  It's my mother's earring, it's expensive.  I've looked everywhere... and I think I might have lost it while examining a patient."

"Okay...."

"I remember scratching my ear while I was in with Patient Jones.  And ever since then, I can't find the earring.  So I think I might have lost it in Patient Jones's room."

"You mean Patient Jones who just died, five minutes ago?"

"Yes, I mean Patient Jones who just died, five minutes ago."

"So you think it's in Patient Jones's room?"

"I think it may be in Patient Jones's bed.  I was wondering if you thought it would be okay for me to go in and take a look."

"While his family is there, with the body, saying goodbye?"

"Before they wheel him out, yeah.  Is that too weird?"

"It might be too weird."

"Maybe if there was a way we could ask the family to step outside for a moment, something medical we have to do, and I could take a quick look?"

"You're saying 'we' like I'm part of this plan."

"You won't help me?"

"What if you just go in and take a quick look and see if you see it?"

"But I want to be able to turn him over if I don't see it, maybe see if the earring slipped underneath him."

"I don't know."

"Come on, it's from my mother."

"I guess you can go in and ask the family if they happened to see an earring... if they seem composed...?"

"Will you go in with me?"

"I guess...?"

"Great.  Thanks.  I really appreciate it."

***

"Excuse me, Mrs. Jones?  This is going to sound like a ridiculous question, but did you happen to see a silver earring in your father's bed?"

"No.  Wait.  Actually, we did see something silver.  We weren't sure if it was a piece of medical equipment."

"No, it was my medical student's earring."

"Oh.  Well, here, here it is.  It does make more sense as an earring than a probe of some sort."

"No, no probes.  Thank you so much.  And, again, I'm so sorry for your loss."

The Leg.

"I was really sorry to have to call you this morning to tell you that your mother passed away.  I know we all expected this, but I'm sure it's still very difficult."

"Yeah, sure, do you want her leg?"

"I'm sorry, what?"

"Her leg.  The prosthesis.  We were thinking we'd donate it, if you guys want it."

"I mean... it was fit directly to your mother... I'll have to ask someone else if there's any use for a used prosthesis...."

"Do you have a form so we can get a tax deduction for it?"

"I don't have a form, no."

"It's probably still worth almost as much as it was new, right?  Do you know what she would have paid for it if not for the insurance?"

"No."

"Do you think you could find that out?"

"Uh...."

"We also thought we'd donate her walker, if that has any value."

"We could probably use the walker for patients who don't yet have their own...."

"Great, can the hospital pay us anything for that?"

"No...."

"And we pre-paid for another week of television service.  How does that work?  Do you give us back that money, or are we allowed to take the TV for a week?"

"I'm pretty sure you can't take the TV.  You can ask the billing office about getting the money back."

"Great, great.  Do people get buried with their teeth, or do you guys want those too?"

"We don't need her teeth."

"But could we get a tax deduction if we leave them here?"

"I don't think that's something we usually deal with...."

"Is she still getting lunch?  Because we're kind of hungry, and I guess we could all split it if it's going to come anyway."

"No, they stop serving meals after a patient dies."

"Okay, well, just in case they've already set up the tray-- we'll still take it."

"I'll let them know...?"

"If there's a way to take it to go, that would be even better."

"I don't think...."

"Also, I assume she didn't eat much of her breakfast-- do we get a credit on the account for that?"

"Her meals were covered in the overall cost of her stay."

"Oh, is she still being charged for the room until we leave?"

"I don't...."

"It's fine, we're going.  We left the teeth on the pillow.  Take care, doc."

"Sorry again for your--"

"Bye."

Getting Dumped

Sorry for almost a week since the last post.

Patient comes into clinic.  "So, how's the wound looking?  You've been seeing Dr. Dressing, right?"

"Sort of."

"What do you mean?"

"I've been trying to get another appointment, but he's refusing to see me."

"Refusing?"

"His secretary said that she wasn't allowed to make another appointment for me.  I saw him three times.  The wound was doing better.  So I want to see him again.  But they won't let me!"

"Do you have any idea why?"

"I don't know.  I had to cancel an appointment last-minute because the weather, but I can't imagine what else."

"And they didn't say?"

"The secretary said she couldn't talk about it."

"That's very strange."

"I know!  I was hoping you might able to call and get them to see me."

"I can call and see what's going on, but I can't promise that he'll see you.  I can try to get you a referral to someone else, though."

"I want to see Dr. Dressing.  He was making things better!"

"I'll see what's going on."

I give Dr. Dressing a call.  "Hi, this is a little awkward, but I heard from Patient Ulcer that your office won't schedule an appointment for him?"

"Yeah, he missed 11 different appointments.  I really can't deal with that in my practice."

"11 is a lot."

"No kidding."

"Do you know of someone else he might be able to see?"

"I actually referred him to my least-favorite colleague.  Patient Ulcer should see her instead."

"Okay, I'll pass along the name.  Thanks."

I call my patient.  "I spoke to Dr. Dressing.  He said you missed 11 appointments and he gave you another doctor's name.  Do you still have it?"

"I did not miss 11 appointments.  It was only 10."

'That's a lot of appointments to miss."

"I didn't feel like going to the doctor.  And what's the big deal?  I miss appointments with you all the time."

"I don't get paid based on how many patients I see."

"Then I'm just making your life easier by not showing up, aren't I?"

"Not really."

Hospital Visitation Policy

1. Visiting hours are 10AM-12PM and 2PM-8PM, unless you look like you know where you're going and don't stop at the security desk.  A visitor's badge is required, except it isn't.  Only two visitors per patient, except for people who don't ask about the two visitors per patient rule, in which case, one thousand visitors per patient are allowed at any given time.

2. No children are allowed to visit patients, especially adult children, because they are the most irritating visitors.

3. If you are sick, please only visit Mrs. Terrible in room 934.  It would be great if she caught something.

4. Do not bring outside food into the hospital, unless you value the health of your loved one, in which case you should bring enough outside food that he or she can skip our meals.  Also, you should probably bring outside food for yourself, because if you eat the cafeteria food, you will likely end up joining your loved one as a patient.

5. The bathrooms are only for patients and those who are lacking a sense of smell.

6. Hospitals are busy places and patients are often on the move.  If you arrive and your loved one is not in his room, it is probably because he died and we forgot to tell you.  If you see any of his belongings, there has been a mistake -- patient belongings are immediately removed from the room by thieves when the patient is taken for tests.

7. There is a lost-and-found in the backpacks of most of our hospital interns.  There, you can find chargers for every possible type of cell phone and mobile device, along with hundreds of pairs of dentures.  Feel free to browse.

8. Everyone you see in the hall is a doctor, and specifically the doctor who treats your loved one, so we will all be able to discuss every detail of his case, calmly and patiently, if you stop us while we're on the way to resuscitate his neighbor.

9. The people with mops and buckets are the most informed doctors of them all, and will be glad to tell you whether your loved one took his medication today, or give you an update about his currently-happening surgery, since they also have devices implanted in their brains that allow them to see into operating rooms six floors beneath them and telepathically communicate with the surgeons performing the procedure.

10. Yes, we do make extra lunches for family members.  You may eat as much as you like and we will be happy to bring you more.  We can even cater to your food allergies and entree preferences, since we are here to serve you, the visitor, even if it's at the expense of our patients' health.

11. Please only discuss interesting parts of your loved one's medical history while in the hallway or elevator.  We are tired of hearing about their diarrhea.

12. Discharge will always happen exactly when we planned it a week ago, even if there have been complications in the interim.  So, yes, please come to the hospital prepared to take your loved one home, especially if you haven't talked to his doctors in days and know he's on a ventilator.  We'll even send you home with a few extra lunches.

13. Your loved one's doctor works twenty-four hours a day, seven days a week, and spends most of his time lurking just around the corner, waiting for you to need something from him.  So, yes, please get very irritated if he can't be found in three minutes when it's midnight on a Sunday and you want to find out whether that cookie your loved one got on his meal tray three days ago was actually sugar-free, or the nurse was just saying that.

14. Wear your most expensive white outfit when you come visit, because there's no way you will ever accidentally touch anything dirty.  This is a hospital, after all.

Enjoy your visit, and please come back soon.

Dead. Or not.

TO: All
FROM: Anon Doc

Hey, I just noticed in the system that Patient XYZ is listed as deceased, but there's no note.  Does anyone know what happened?  I saw him two weeks ago and he looked good.  Thanks.

TO: Anon Doc
FROM: Attending

Oh, wow, I saw him that visit too.  He did look good.  I wonder what happened.  Do you mind calling his family?

TO: Attending
FROM: Anon Doc

Okay, I'll give them a call.  But it's weird there's no note, right?

TO: Anon Doc
FROM: Attending

Maybe the family called but didn't give any information.  Let me know.

TO: Attending
FROM: Anon Doc

I just called.  He answered the phone.  Not deceased.  I asked how he was doing.  He said he was fine.  Said I was just calling to confirm his next appointment.  Do you know how to change his status in the system from deceased to alive?  I'm not sure how to do it.

TO: Anon Doc
FROM: Attending

Not sure, sorry.  Glad he's alive.  Maybe ask the helpdesk.  Thanks.