Blue Whiskers

"Doc, I've been finding blue whiskers in my mouth."

"What?"

"In my mouth. Blue whiskers.  I'm not sure what they are.  What does that mean?"

"I have no idea what you're talking about.  Blue-colored hairs? Growing out of where?"

"My mouth. Bright blue."

"How long are they?"

"Not too long.  They almost don't even feel like hair.  They're thick, almost like plastic."

"When have you been noticing them?"

"Usually when I brush my teeth."

 "What color are your toothbrush bristles?"

(big pause)

"Ohhhhhhhhhhhhhhhhh!"

Hot Water For Your Fall?

I return from two weeks of vacation (sorry!) to get a call from a patient:

"I fell."

"Oh no!  What happened?"

"I tripped over a box of potato chips."

"A box?"

"You know, from Costco, a big bulk box of chips."

"You shouldn't be eating chips, you know-- the salt is no good for your heart failure."

"No, these come in bulk, they're cheap."

"Cost isn't the problem."

"It certainly is-- food is expensive!  Not at Costco, though."

"I was just saying you shouldn't eat chips."

"Well, I can't let them go to waste!  I have so many!"

"Whatever-- you said you fell?"

"Yes! In my kitchen! I fell over the box and hit my hands!"

"Are they okay?"

"They hurt. I wanted to know if I should put them in hot water."

"You should put ice on them."

"Not hot water?"

"No, why would you put them in hot water?"

"I thought hot water, with some yeast and sugar.  That's what my mother always did."

"No, I think that's how you bake bread, not how to keep down swelling."

"Oh. You sure?  Ice?"

"Yes. Ice. Come in for an xray if you think anything may be broken--"

"The chips!  They're like crumbs. I fell right on top of the box and crushed it."

"I meant your hand. The bones."

"No, I don't think I have bones there."

"Okay, I'll see you at your next appointment."

Rash

"I wanted to call to say I have a rash on my chest."

"All of a sudden?"

"I think so."

"Can you describe it?"

"It's red and pimply."

"Did you put anything new on your chest? Any creams or lotions?"

"Just food."

"Why food?"

"It dripped."

"What food?"

"Soup."

"What kind?"

"Pea."

"I'm not sure why that would cause a rash."

"Wait, it was lentil."

"Still not sure why it would cause a rash. Why don't you come in and I'll take a look."

"I was hoping I wouldn't have to."

"It really should be seen."

"Oh, I also have 102 temperature."

"Yeah, you should come in."

"You want soup? I have extra."

"No thanks."

"Can't I Just Drop My Mother Off At The Hospital And Make You Deal With Her?"

"Hi, I got a message that you wanted to talk to me about your mother, [my patient]?"

"Yes, thanks for calling me back. You know, my sister and I are having a very difficult time with her."

"Yeah, her mobility is not great-- but overall she's doing pretty well for 95. Mentally intact, overall she's stable, it's mostly just her getting around, really."

"All she does is sit on the couch. We need to make sure she eats, make sure she's looked after -- it's not easy for us to afford help, you know."

"She does have an aide for part of the day, yes?"

"Yes, but it's not cheap. And we can't afford it forever."

"I'm not sure what you're asking me for -- certainly I can put you in touch with social work and they can see if there are any services she might be eligible for."

"She complains a lot, too, my mother.  She's not very satisfying to talk to."

"Trust me, for 95 she is doing really well."

"I guess my sister and I were just wondering if there's a program where we could drop her off at the hospital and, uh, you guys deal with her."

"Um... She doesn't need medical care... I think perhaps you're talking about a nursing home?"

"No, no, we could never afford that.  I meant we bring her in, and because she isn't totally herself, you take care of her."

"You want to commit her?"

"I don't know what the right terminology is... we just want you guys to be responsible instead of us."

"So you want to abandon her?"

"Again, not sure of the right term. But is there a program like that?"

"Your mother does not need to be institutionalized. She's doing quite well. She's functional and stable."

"Right, but we aren't really that interested anymore, so we thought maybe you could take her."

"There is no such program--"

"Don't people drop off babies?  Something like that."

"No. There is no program. I'll see you at her next appointment."

Swollen

"Doc, I'm worried because my lymph nose is swollen."

"Your what?"

"My lymph nose.  I'm all congested, and it hurts when I sneeze."

"Point to me where you're feeling swelling... ... ....  Those are your sinuses."

"Yeah, my lymph nose."

"Take some ibuprofen and see how you feel."

"So you don't think it's lymphoma?"

"No."

"Or cancer?"

"No."

It Helps to See the Patients

"Hey, [Anon Doc], it seems like you're always pretty busy in clinic."

"Yeah, you're not?"

"Not really.  I probably don't have my patients come back often enough.  I usually just give them a year of refills and tell them only to call me if there's a problem."

"Oh...."

"I call them every couple months to check in...."

"..."

"Turns out a lot of patients lie on the phone.  Or think they're doing well when they aren't. Turns out a lot of my patients have died. Totally weird, right?"

"Maybe it means what we do actually matters?"

"Oh, I don't know. I think it's just luck of the draw with the patients."

Don't Ever Tell My Father to Call 911

TO: Fellowship Director, Department Head, Hospital CMO

CC: Anon Doc

RE: My Father

I am writing concerning your fellow, [Anon Doc].  My father is (was) a patient of his. Over the weekend, my father called -- and of course, as usual, [Anon Doc] did not pick up the phone and my father, who has difficulty speaking clearly, had to leave a message.  My father tried to explain to the (seemingly uneducated) phone operator that he was having trouble breathing.  Ten minutes later, [Anon Doc] finally calls back and tells my father that if he is having trouble breathing, he should call 911, and that he can be seen in the emergency room, but that he himself could not see my father until Wednesday, FOUR WHOLE DAYS AWAY.  

I am an attorney and very familiar with doctors and how they should behave.  I have had previous conversations with [Anon Doc] about how we want to avoid my father going to the hospital-- and certainly not via ambulance!  He should NEVER tell him to call 911. I am lucky my father knew not to listen.  What is the point of having a doctor if he is only reachable after leaving a message and waiting for a call back? In an emergency, the ten minutes it took him to call are CLEARLY unacceptable. I have repeatedly asked [Anon Doc] for his cell phone number and he has declined to give it to me.  I am an attorney and I give my cell phone number to all of my clients whom I am confident will not abuse it.  

To wait FOUR DAYS to see a doctor in an emergency is unacceptable.  It is also unacceptable that [Anon Doc] has hired such an uneducated person to answer his phone.  

I thought you would all want to be aware why my father is leaving the practice.  

I am an attorney, and will not hesitate to take legal action if something happens to my father before we can find him a new doctor.  

"No one called me back"

"Doc, I left a message with your answering service on Saturday and no one called me back. All weekend I waited-- and nothing. You know, I've recommended this practice to friends, I've told people how wonderful, how responsive you are, and then to wait for a call back and not get one is really disappointing. You didn't know if it was an emergency or what, you didn't care to check if I was okay. I should tell your supervisor.  Better yet, I should find a new doctor. I hope you have some sort of explanation for this."

"I did call you back.  We spoke on Saturday. You told me about your rash. I said I'd look at it today."

"Oh... yeah, wait, I think you're right."

"..."

"Still, you should have called me back faster."

Side Effects

"I had the shingles vaccine last week and I think I have shingles now."

"That would be unusual. Show me what's going on."

"I have diarrhea."

"Okay...."

"So do I have shingles?"

"No. Shingles has nothing to do with diarrhea."

"Can it start with diarrhea?"

"No."

"So if I have diarrhea, it probably isn't shingles?"

"Not shingles."

"Maybe it's the laxative I took because I was constipated?"

"Sure...."

"And I was worried when I was constipated that might have also been shingles?"

"Do you know anything about shingles?"

"No.  Can it start with a headache?"

"No."

"I was also having a cramp in my foot."

"Try rubbing it."

"I thought it might have been from the vaccine."

"Did you get the vaccine in your foot?"

"No, my arm. But it was the same side of the body."

"It's An Emergency!"

I'm on call, and get a page.  I call the call center.  "Patient says this is an emergency.  Would not say what the emergency is."

That's always fun.

I call back.  The phone picks up, and I hear the patient say, "Hello?"  I respond.  I hear nothing.

"Hello?"

"Hello?"

She hangs up.

I try again.

"Hello?"

"Hello?"

She hangs up.

I try one more time.  Same thing.  I call her daughter, since the number is in the chart.  I get her voice mail and leave a message.

Her aide's cell phone number is in the chart too.  So I try that one.

"This is [me].  I got a call saying there was an emergency?  Are you with her now?"

"Yes.  I don't know.  She called you?"

"Yes."

"Okay, let me check."

I hold for a minute.  The aide comes back.

"Yes.  She says she did call you.  The emergency is that her hearing aid isn't working, so she can't hear anyone on the phone."

"I don't know what I can do about that, unfortunately.  Tell her she shouldn't call the doctor and say it's an emergency unless it's a medical emergency.  And if it's a medical emergency, she should call 911."

"I will tell her.  Can you get her a new hearing aid?"

"Where did she get this hearing aid?"

"Sears."

"Then she should probably call Sears."

"Okay.  I will tell her."

"We're Waiting To Bury My Parents"

"Quick question, doc.  When do you think I'll be strong enough to climb stairs?"

"Oh, I think that may be a little too ambitious for right now, given the amputation. You'll get fitted for a prosthesis, but it'll be a lot of therapy, you have to build your strength back up, it may be quite a while."

"The reason I ask is because my siblings are waiting for us to all be together so e can finish burying our parents."

"Huh?"

"They've been stored for a while awaiting internment--"

"Interment--"

"Right, what I said.  And so I need to be able to go."

"You could go in a wheelchair..."

"No, there are stairs."

"At the cemetery??"

"No, in my brother's house, where I'd stay."

"Maybe you could stay in a hotel?"

"No, I could never do that.  But you think I could tell them I can come out there next summer?"

"I don't know. It's too soon to know the extent of your recovery."

"I think they're charging a monthly fee."

"Who?"

"For the storage."

"I don't know. I don't know that I have an answer for you."

"Maybe my brother can move."

"I don't know how to help you here.  I'm sorry, I really am."

"He Probably Won't Kill Anyone"

Another fellow stops me in the hall.  "I see you're working with [resident] this month."

"Yeah."

"Watch out. His clinical judgment isn't the best."

"How bad are we talking?"

"Well, he probably won't kill anyone."

"Probably?"

"Yeah, probably.  They're trying to get him to transfer to a different hospital."

"So he can probably not kill anyone there?"

"Yeah, but, you know, some places are really desperate for residents."

"Residents who probably won't kill anyone."

"Right.  They have him doing some easier rotations, in case it's the hours that are messing him up.  He's at the nursing home next month."

"An easier place to probably not kill anyone."

"An easier place to probably not be blamed for it."

"I Drink Just Enough"

"So, Mrs. Patient, I see in the notes that you came in as an urgent visit last month and saw Dr. Colleague."

"Sorry."

"No, no reason to apologize. I'm glad you got seen. But it says in his note you had rib fractures, and you said you fell?"

"Yeah, but I'm okay."

"No, it doesn't seem like you were okay.  It sounds like a social worker spoke to you."

"Yeah, she was crazy. She thought my husband was hurting me."

"It does seem alarming, with the rib fractures...."

"I told him-- I fell."

"Multiple times? The fractures are on both sides."

 "I may have been drinking."

"We've talked about how you drink too much. It's clearly harming you."

"I drink just enough. I stop when I feel like I've had enough."

"Or when you fall?"

"No-- that's why I fell twice."

"You need to drink less.  I can refer you for help."

"I should see that other doctor instead. At least he just thought my husband was hitting me and didn't care about my drinking."

"I'm sure he cared."

"I don't know. He looked like a drinker to me. You don't. I bet you don't even drink."

"Not when I'm working, certainly."

"That's the best time to drink.  You can't tell me patients like me don't make you want to drink."

"..."

"See?  Would I make sense like that if I was drunk?  I'm fine."

"..."

"Okay, I'm a little drunk."

The Twizzler Vaccine

I recommended the shingles vaccine to a particular patient. She said she would think about it.  I told her she can get it at the local chain pharmacy if she didn't want to come all the way back to the clinic.  She calls me yesterday:

 "I don't know why I listened to you."

 "What's wrong?"

"I wasted an hour at CVS looking up and down every aisle and could not find the shingles vaccine."

"No, you have to ask the pharmacist and he or she will administer it. You can't just buy it."

"NOW you tell me!"

"I'm sorry I wasn't clearer."

"Plus I ended up buying Twizzlers and they got stuck in my teeth and pulled out a filling.  So now I have to go to the dentist.  I should send you a bill."

"You probably should avoid the Twizzlers anyway because of the blood sugar issues we talked about..."

"You're the one who sent me to a store filled with candy. I only bought them because Twizzlers sounds like Shingles."

"So you thought the vaccine was made of licorice?"

"No, I'm not an idiot.  I just got hungry."

"Okay. You can go back and ask the pharmacist for the vaccine when you get a chance."

"Never."

This thing still on?

Okay.  Cautiously wading back in here, though I'm not sure anyone will still be reading. Or how to find the people who were reading before and get them back.  (If you can help with that, please do-- I'd appreciate it.)  A conversation led to a bit of an understanding.  It's okay to do this as long as I understand that one day maybe it won't be, and I don't cause a problem if someone decides this is worth caring about and wants me to stop. So here I am. You missed a fair bit, but it's probably easiest if I just jump back in, as if I never left.  

"You're Dr. [me], right?"

"Yeah."

"I'm Judy, from the development office."

"Okay."

"You never responded to my e-mail."

"Sorry?"

"I sent an e-mail last month asking about some of your patients?  I just thought I'd follow up in person."

"I'm sorry -- I don't remember --"

"An e-mail asking if any of your patients might be good candidates to give a gift to the hospital?  You know, based on your understanding of their circumstances?"

"Oh, yes, now I remember."

[The e-mail went something like this:

Dear Fellow,

We are in the process of reviewing some patient records to see who might be worth reaching out to in order to inquire about a potential gift to the hospital. Please advise as to any knowledge you may have about each patient's financial circumstances or any lapses in care that may make them unfavorably inclined to respond to a call from us:

Jones

Miller

Family of Peterson (was his death preventable by us?)

Rogers

Smith

Family of Turner (do they blame us for his fall in the hospital?)

Wilson (there are two of this name in the system-- is yours the one who lives in [fancy suburb]?

Young 

Thank you for your help. Any details we can use in our calls would be appreciated. If you have any other patients, living or deceased, you think would be amenable or have amenable families, please advise. Also let us know any potential issues you can foresee, or situations that we may need to address before they are willing to donate. 

Thanks, 

Judy]

"Sorry, I just wasn't comfortable discussing my patients like that."

"Oh, don't worry. We only use the information for fundraising."

"No, I understand that. Sorry."

"This is a really important initiative.  Can I resend the e-mail?"

"Sure."

"Great. Thanks for your help."

"Is there a bonus program? Like, do I get a percentage of any money you raise from my patients?"

"No!  That would be unseemly."

"Oh."

Break in the action

"I know who you are."

"Huh?"

"We know about your blog.  I think we'd prefer you stop posting for a while.  Not that there's necessarily anything revealing about what we've read -- I think it's the attitude more than the specifics, if that makes any sense.  And we know it's stylized for the blog, and different from you the person, but still.  We're not going to force you, and we're definitely not all on the same page about this, but if you wouldn't mind, maybe stop for a bit, if that's okay?"

Apologies for not sharing that news sooner, but I wanted it to settle for a bit.  I've been continuing to write, privately.  And maybe there's a way to share that more wisely, here or elsewhere.  And maybe there's a way to adjust what I've been writing here -- I'm having a conversation later this month about that, so there may be new posts then.  And maybe sooner, depending.  But for now, there's this post, until I take it down, which may be soon.  I don't know.

"I'm not sure if it's urine"

Sorry for the lack of posts. Was on vacation, somewhere with less Internet than I expected.  Of course, two weeks away and I came back to all sorts of fun messages from the fellow covering my pager. 

"One of your patients kept asking where you went on vacation and why doctors are allowed to take vacation when their patients are sick.  He called every day asking the same question."

Anyway... my first patient back in clinic:

"My body is leaking."

"Uh... from...?"

"You know, where I pee.  But it's not pee."

"Is it blood?"

"Oh, no, definitely not-- wait, are white blood cells clear? Because maybe it's those."

"No, it's clear?"

"Yeah."

"Then I think it's probably urine."

"No, my urine is more of a brownish."

"It's not yellow?"

"Well, I guess you could call it yellow."

"I think you're leaking urine.  Let me send you to a urologist.  Does this happen often?"

"Usually after I shower."

"Are you drying yourself off?"

"I guess."

"Are you sure this isn't just water from the shower?"

"Maybe?"

"Okay, why don't you try drying that area better and see if there is still wetness. If so, I'll have you see a urologist."

"Thanks, doc.  You know, this only started when you were out on vacation.  I tried calling and I got some other doctor I didn't know."

"Okay. I'll see you in six weeks."

Water Makes Poop

"I've been going to the bathroom too much, doc."

"Um, how often is too much?"

"Every day."

"I think that's okay."

"Not for me.  I don't like to go so often.  Is there a way to make less poop?"

"No.  I mean, everything that goes in has to come out."

"I think it's because I've been drinking too much water."

"No.  Water becomes urine."

"No, I think in me it becomes poop.  Because I don't really eat that much.  But I still poop a lot.  So it must be the water turning into poop."

"No."

"I think it does for me.  Maybe that's just how my body works."

"No."

"So you're saying if I eat less, I will poop less?"

"I guess.  But I'm not saying you should eat less.  You need to eat enough calories.  I don't want you to starve yourself because you don't like going to the bathroom."

"It would be nice to never have to go."

"I'm going to refer you to a gastroenterologist."

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."