When An Arm Is Not An Arm

"Sorry to call you so late -- my arm is numb."

"Are your fingers blue?"

"No, they're normal."

"Is there any pain?"

"No."

"What do you mean by numb?"

"Well, I don't know.  It just feels funny.  It's my left arm.  Is it my heart?"

"Can you move your arm?"

"Yes."

"Where does the numb feeling start?"

"My fingers."

"From your fingers up?"

"No, from my fingers down."

"So it's not your arm, it's just your fingers?"

"Yes, but my fingers are attached to my arm."

"Yes, I know that.  But there's a difference between your arm and your fingers.  Did you do anything funny with your fingers recently?"

"No."

"Did you sleep funny?"

"No."

"Were you playing with a phone or a tablet?"

"Yes."

"With those fingers?"

"Yes, just before they got numb."

"How's the numbness now?"

"It's a little better.  It feels like it's going away.  Am I having a heart attack?"

"I don't think you are."

"Should I go to the ER?"

"If the numbness is going away, and it's just in your fingers, and you were just playing with your phone before they went numb, then, no, I don't think you need to go to the ER."

"What if I just want to make sure?"

"I'm not stopping you from going to the ER.  You know your own body."

"Okay, I'm going to go to the ER."

"Okay.  Thanks for calling."

A Recipe For A Urinary Tract Infection

Here is a recipe for a urinary tract infection.  It starts with a pot of boiling water.

"So, I wanted to try and figure out if there's something going on that's causing your husband to have repeated UTIs.  It may just be an unfortunate situation, because of his catheter use, but I want to make sure there's not something that we're ignoring."

"He does use a lot of catheters."

"Right, but you were trained by the nurse in how to do it correctly, yes?"

"Yes, she said I was doing it correctly."

"And you're using a fresh catheter every time."

"Yes, either from the package or after I clean them."

"I'm sorry -- you're cleaning catheters and then using them again?"

"No, I make sure to boil them."

"You boil them?"

"I put the catheter in a pot of boiling water, and then it is sterilized to use again."

"I think this may be the problem."

"But I do that with my jars for jelly and it's fine."

"There's bacteria on them."

"No, I boil them."

"OK, I'm not an expert in canning, but you need to not re-use catheters.  Use a new one -- fresh from the package -- every time."

"But catheters are so expensive."

"Hospital stays for UTIs are expensive too.  The catheters should be covered under Medicare."

"I need a prescription for more."

"That's not a problem."

"But they take up so much room."

"Yeah, there's nothing I can do about that.  Also, are you actually boiling used catheters in a pot you also use to cook with?"

"Yes, the pot I use for the jelly jars."

"What kind of jelly do you make?"

"Oh, all kinds.  Blueberry, strawberry, grape.  I can bring you a jar."

"No, please don't."

"I'm Hot"

"Hi, [Patient], this is [Anon Doc].  I got a message that you called."

"Yes.  I am feeling very hot!"

"Have you taken your temperature?"

"Yes, it's normal."

"Have you been feeling okay otherwise?"

"I guess so.  But my stomach is bothering me now.  I think because I am hot."

"Are you drinking enough fluid?"

"I don't know. Why am I so hot?"

"Have you been outside?"

"No, I've been inside."

"Is it too warm in your house?"

"Yes, the air conditioning is broken.  I called the repairman, but he isn't here yet."

"So it is hot in your house.  And therefore you are hot."

"Yes."

"And you called me... why?"

"Because I don't want to feel so hot."

"You're feeling hot because you're in a hot place.  Go somewhere with air conditioning and you'll feel better."

"But I have to wait for the repairman."

"Okay, this isn't a medical problem.  Keep hydrated.  You're hot because you're in a hot place.  Go to a cooler place."

"Can you prescribe me anything?"

"So you won't feel so hot?"

"Yeah."

"Air conditioning."

"Can you call it into the pharmacy?"

"No.  Go somewhere cooler.  Have a good day, and feel better."

Sleeping or Dead?

I walk into a patient's room, and he's sitting in the chair, slumped over, while his wife reads a magazine.

"He's just sleeping, right?"

"Oh, I don't know -- you're the doctor."


Probably not the best question for me to ask.  But, also, if you don't know if your loved one is sleeping or dead, perhaps you should check that instead of continuing to read a magazine.  In case you need some help telling the difference:

Is he moving?  Yes?  Sleeping.  No?  Maybe sleeping.

Does he respond when you call his name?  Yes?  Not dead.  No?  Could go either way.

Is he breathing?  Yes?  Sleeping.  No?  Dead.

Is his body cold to the touch?  No?  Probably sleeping.  Yes?  Probably dead.

Are his limbs stiff?  No?  Probably sleeping.  Yes?  Probably dead.

Does he smell funny?  No?  Probably sleeping.  Yes?  Could be either.

Has someone already declared him dead?  No?  Might be sleeping.  Yes?  Almost certainly dead.

Is there a coroner in the room?  Yes?  Probably dead.

Is someone asking him to fill out tomorrow's dinner menu?  Yes?  Could be either sleeping or dead.

"Is Someone Hurting You?"

"I'm noticing you have a bunch of bruises," I say to my fairly robust 92-year-old patient.  "I have to ask... has someone been hurting you?"

"Well...."

"You can tell me if something's going on, and we can try to help."

"Well...."

"Seriously, is someone hurting you?"

"When I was eight, there was this neighbor...."

"Um, we can talk about that if you want, but I actually meant more recently.  To cause these bruises...?"

"Oh, someone hurting me now?"

"Yeah."

"No, no one's hurting me.  I just fall a lot."

"You sure?  No one's getting frustrated and hitting you?"

"No!  I would hit back!"

"Okay, I just wanted to make sure."

"So you don't need to know what happened when I was eight?"

"Not unless you need to talk about it, in which case we can, or I can refer you to someone who you can talk to...."

"No, I'm okay."

"Okay, great.  Now let's talk about your medication list...."

Tell My Son. No, My Other Son. No, My Other Son.

"So, unfortunately the test results were as we expected, and you're going to need to see a specialist and figure out the best treatment."

"Would you mind giving my son a call and letting him know?  He's much savvier about this stuff than I am."

"Sure, but I think I spoke to your son the other day when he came to your last appointment, right?"

"No, that's my other son.  It would be great if you could give him a call, too, with the update."

"Okay, so I'll call that son, and I'll also call your other son."

"And my daughter."

"Can one of your sons update your daughter?"

"Well, one son isn't speaking to that daughter. And then I have another daughter who no one is speaking to, but it would be great if you could update her as well."

"I'm happy to talk to your family, but maybe if we could do it all on one conference call, or a family meeting if they're able to come in, or if one of them can be the point person -- it's just hard for me to take the time to call three or four different people with the same news.  I have a lot of patients."

"I was actually also going to ask you to call my brother.  He works in a pharmacy, so he's familiar with a lot of the medical terms."

"Like I said, it would be really great if I could call one person, and then they could tell everyone else the update.  If there's one child or sibling who can be the go-to person that I know to call, that would be the easiest thing."

"Right, except Janet isn't talking to Stu, and Stu isn't talking to Carol, and, really, they're only going to trust what they hear if it comes directly from the doctor. Oh, you need to call my boss, too, so I don't get penalized for taking today off for the appointment."

"I can definitely give you a note."

"No, he's going to think I forged the note, because of something in the past.  It would be much better if you called.  Also I need some refills that I was hoping you could call into the pharmacy."

"Do you have the list of prescriptions you need refills on?"

"I actually left that list with my cardiologist -- he said you could give his office a call and they would let you know."

"He couldn't refill them for you?"

"He said he'd rather leave it to the internist.  I also have an insurance issue -- they said the doctor can call and explain why I needed the scan in March, otherwise they weren't going to cover it."

"Okay, I can call the insurance company...."

"And if you could let my sister know after you've done that -- she's been handling a lot of my paperwork.  That would be great."

"I think I need a list of all of these names and numbers."

"My niece has all of that information.  I can't remember phone numbers anymore, but she said you can give her a call and she'll give you all of those details.  I don't want her knowing the medical stuff, though.  She's just dealing with the phone numbers.  And if you could minimize the test results when you talk to Janet, she's very squeamish with this stuff."

"Like I keep saying, one point person would be great."

"Oh, I almost forgot.  My brother had me take a picture of this mole he's got.  It's on my phone, he asked if I could show you."

"I really can't--"

"I don't need to know what it is, but I told him I'd have you give him a call--"

"I'm not--"

"Oh, also, my step-daughter, Sylvia -- her first language is Spanish.  So if there's some way you could get an interpreter on the phone when you call her.  Different father, she grew up in Mexico--"

"I don't think I can get--"

"Yeah, so I'll have the specialist call you once the results are in, and then you'll update my family?"

"He can--"

"Okay, great, thanks.  I really appreciate it."