Wednesday, April 23, 2014

The real reason...

The administration has been undergoing a disagreement with the GI doctors at our facility that has left us without GI coverage recently.  The PCPs who admit to us are aware of this and have been dutifully been turning away anything that requires GI's input.  Some patients, however, have been less than honest about the reasons for their arrival.

Me:  "Okay, we have finished the transfusion you were supposed to get.  I think your doctor wanted to finish the workup as an outpatient so we'll be discharging you today."

Patient:  "But what about the blood in my stool?"

Me:  "You never mentioned this before.  Have you been having blood in your stool?"

Patient:  "Well, I knew if I told my doctor that, she'd try to send me to another hospital and I don't want to go somewhere else."

Me:  "Ma'am, we don't currently have the capability to work that up.  If you are bleeding from your colon, I'm going to have to send you somewhere else to be scoped."

Patient:  "But I don't want to go somewhere else.  I want to stay here."

Me:  "And I do not have a GI doctor that can do that."

Patient:  "Can't you like, fly one in or something?"

Monday, April 21, 2014


I was locked out of my submissions account until recently, so catching up on a couple:

GS:  "What brings you into the office today?"

Patient:  "I committed suicide last night."


Patient (phone call, New Years Eve):  "My cat pushed my percocet in the toilet.  I need..."

GS:  "Are you able to swim?  Because you're going to need to go after those."

Submitted by Girlscout MD.

Friday, April 18, 2014

Family history...

Me:  "Anything run in the family?  Diabetes, cancer, heart problems?"

Patient:  "Well, almost every man in my family has died of either a gunshot or in a bar fight."


Wednesday, April 16, 2014

Do a Google search for that term...

Patient:  "Was my husband out there?" *points to hallway*

Me:  "No, I didn't see him."

Patient:  "He gets fisted and can't sit still for long periods of time."

Me:  "I would imagine not."

I am still not certain what word she was trying to say, but I didn't stop to clarify her use of the term "fisted."


Monday, April 14, 2014

That is unheard of...

98 year-old patient with stage IV lung cancer, on home hospice, brought to the ER for.....?

Daughter:  "Well, she can't die at home!"

Friday, April 11, 2014

To my daughter, on the day of her "birth"...

I originally typed this note intending to post it on my own Facebook, but after discussing it with several female friends (all mothers), I opted for this format, since it allows me to keep my anonymity and hopefully avoid the disdain that some will certainly feel.  As I intimated a few months ago, my wife and I were expecting child.  She was born several months ago after attempting to give her mother preeclampsia, but without complication otherwise.  I wrote this because I searched online for similar confessions and most were met with disdain and suggestions that the poster(s) seek professional help.  For those people, know this:  you are not alone.  Not by a long shot.

This is my first letter (hopefully of many) to my daughter:

In my life, I have loved neither easily, nor often, as many an ex-girlfriend can attest.  As such, it was not altogether a surprise when you were born that I did not fall in love with you.  Not immediately, at least.  You were, as I relayed to a friend, an erratic alarm clock with a snooze button that you had to hold down for an hour to reset.  Newborns are hard to love, for a father.  You are essentially a living, breathing obligation that does little other than eat, sleep, and poop.  I tried to interact with you, but you seemed more interested in lights than humans, in general.  It was like trying to learn to love an inanimate object with severe needs that required my intervention, albeit an especially cute object.  Your mother, through that combination of hormones and magic known as “mother’s love” fell in love with you immediately, but even this did little to insulate her against your more demanding nights. 

The first night home you woke up every fifteen minutes for the duration of the evening.  After the eighth or so occurrence, a thought began to occur to me.  A dark thought…one that no one would ever express to humanity at large.  And yet, here I am, about to do just that.  As I stared at this helpless, wailing creature in front of me, that thought took shape, personified, and spoke aloud.  That thought spoke dark whisperings in my ear:  thoughts of violence, thoughts of harm.  Thoughts of harm to a being whose only crime was to be brought into this world, at my and your mother’s bequest.  My response to this was fairly dramatic, as it would be for anyone who does not make a habit out of dark ideas.  I prayed.  I prayed that I would not act upon the impulses I was feeling.  That I would not strike this helpless being in front of me.  And I didn’t.  But that did not stop the dark impulses.  Sleep deprivation is a powerful motivator, which may be why it is such an effective torture method.  During the colic stage of your development, even your mother was not immune, despite her hormonal inoculation.  She expressed her frustration in many ways, culminating in her request to “take this baby before I strangle her” during your second, colicky month of life.  Parenting is hard and you should know that you are loved no matter what the first part of this reads.  I am documenting this here to let you know the truth about what we were feeling during your first months of existence. 

In my professional career, I have made a point out of never lying to patients.  It is intellectually dishonest and unfair to them to lie and I have never forgotten that in my post-graduate years.  As such, when people at the hospital asked me how baby-rearing was progressing, I told them the truth:  I kinda, sorta, sometimes wanted to punch my baby in the face.  I made sure and clarified that I never did so, but I let them know that the thought was there.  Again, sleep deprivation is a rough, rough thing. 

Depending on when in your life you read this, you may or may not understand that every human has darkness inside.  Anyone who has lived a life examined (as I encourage you to) can tell you this about themselves.  Anyone who denies this is either a liar or is in far greater danger of being consumed by the darkness than those of us who are aware of it.  The biggest crime in life is in not knowing oneself, both your positive and negative attributes.  As such, when I began harboring such dark thoughts, it manifested itself as fear.  Fear that I am imperfect; fear that I would be the person who might harm a child; fear that I am a terrible parent.  In short, it is the fear that I am the Darkness.  Fear that I am the Thing That Growls from the back of my throat.  That may sound odd to you, but you should know that the Darkness is real.  The Darkness is ever-present.   And the Darkness is patient.

When I told the people who inquired the truth, a curious thing happened.  At first, there was the predictable, socially-acceptable response of gasps.  Responses of shock.  Responses of horror.  But then those responses faded from the faces of the people I told this to, only to be replaced with a far-off glance and a look of recollection.  Memory, especially as it pertains to one’s children, seems to be painted with a high-gloss lacquer and recalled through rose-colored lenses.  Good people, good parents began to recall to me horror stories of the early months of their own parenting.  One woman recollected to me that she had fantasies in which she placed her child in the oven and set it to broil.  Another told me that she had loaded her child into the car at age six months and was on the verge of driving him to the hospital to give him back when her husband intervened.  Yet another told me that she left her child alone for hours to cry while she drank a bottle of wine and turned up the stereo to drown out the wails.  I repeat, these are good parents.  Parents who unequivocally love their children; parents who show me pictures of their children at every conceivable possibility.  They love their children more than themselves.  Parenting is hard.

I was driving home from work one day when the thought occurred to me.  I recall distinctly thinking, “I can’t wait to get home to see my daughter.”  It was such an uncharacteristic thought up until that point that I almost pulled the car over.  It was an important milestone because it was the first time I realized that I loved you.  In order to realize what this day meant to me, we need to go back in time a bit.

In the summer of 2000, I was a recently graduated college student on the wait list for medical school.  Due to an administrative quirk at the time of my application, the method of determining entry was an odd one.  The medical schools had a type of affirmative action which meant that the more populated districts end up having a much harder time applying than people from less populous ones.  The end result is that you do not get the overall best and brightest, you get the best and brightest from each district.  This means that people with far lower scores and grades got in before I did, since I applied from one of most populous areas.  Life on the waiting list is nerve-wracking.  Since my future was in flux, I began making plans for an alternate life, one that didn’t involve a medical training.  Two days prior to the start of medical school, I was on the computer, looking up visa requirements to work on a vineyard in France.  A friend of mine from school and I were planning on working there for the next year.  The pay promised was very little, but a couple of bottles of wine per day and a life in another country were a very real promise at that point in my life, whereas medical school remained a far-off possibility.  I was going to do it.  Of this, I was certain. 

But then I received a phone call.  A very important one.  One that would change the very course of my life.  A member of the administration at the local medical school called to inform me that I had been moved from the waiting list to the active list.  Would I consider starting my training in a couple of days?  I, of course, answered yes, but I have often wondered what would have happened if either the phone call had not occurred or if I had said no.  Had I said no, I would not have met your mother, who I began dating after I found her working the desk at the hospital.  Had I said no, you would not have been born.  Of that, I am also certain.

I have often had fantasies about the life that went to France, about the life that involved picking grapes at a vineyard.  Would I have come back?  Would I have met and wed a French woman?  I mean, it is a stark contrast to my current life.  I would have been a migrant worker, albeit an over-educated one, in a foreign country.  Would I have learned French (not just my pidgin high school version)?  Would I have learned the art of wine-making?  Apprenticed at a vineyard?  The answer is that I do not know.  In my mind, I have played out the meeting of my current self with that more-traveled migrant worker over and over again.  In every iteration of that fantasy, he has offered me a choice:  we compare each other’s lives in detail, not a single facet withheld.  At the end of the comparison, the offer is made:  do I wish to switch lives?  Up until my drive home, that answer was always in up in the air.  Up until the day of my drive, the answer was uncertain.  And, to surmise, that is what that drive home means to me:  it is the day that I knew the answer to my question.  It was the day of your “birth” to me.  It is the day I knew my answer would be “No.”

I love you, my daughter.  I may express my frustration sometimes in the days to come, but that will never change.  Parenting is hard.  Don’t hold it against me.  

Wednesday, April 9, 2014

Useless conversation...

A major problem in any hospital that has a significant hospitalist presence is that it becomes a reflex to call us without checking the chart first.

Nurse:  "Your patient in 328 appears to be having an acute MI (heart attack)."

Me:  "Okay, get a 12-lead EKG and place a cardiology consult."

Nurse:  "Oh, it looks like cardiology is already consulted."

Me:  "Okay, well call them and see which one of us is seeing that patient today, then let them know."

Nurse:  "It also looks like you guys didn't admit this patient."

Me:  "So you called me about an acute MI on a patient who isn't ours and who cardiology is already following?"

Nurse:  *hangs up*


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