They subsequently decided to up the ante: they unwound their bed springs and stabbed themselves in the abdomen. One guy came in with this piece of wire in his belly that was twitching at his pulse rate.I was sooooo tempted to tell him to come back when it was an inch deeper.
Night Stick
When I was a fourth-year medical student on the surgical service, we admitted a 22-year-old woman for persistent rectal bleeding. Nothing that her primary care doctor tried helped. Her radiological studies were all negative. While inhouse, she continued to bleed daily. We actually suspected Munchausen Syndrome but needed a way to prove it….
… We decided to mix a fluorescent dye in with her lidocaine jelly (which we were giving her for the anal discomfort). We then sneaked into her room in the middle of the night with a black light. This is what is used to make those old Elvis posters glow, etc.
To our disgust, her pencils lit up!!!
Needless to say, she was discharged in the morning
EDITOR'S NOTE - Now I know what the Number 2 means on the pencil!
It was the first week of my fourth year of medical school. I was assigned to do a one-week rotation on the Urology Service. Piece of cake, I thought to myself. No one expects you to know anything during a one-week rotation. Good thing, too, since despite three years of medical school, I still didn't know jack about the male genital/prostate exam. It's not my fault; it's a gender thing. Girl students can practice on girl patients, no problem. Girl students may not practice on boy patients, full stop. That is, of course, until you start your one-week Urology rotation, then miraculously you're supposed to know all about it. Hey, no problem, I read the book …
The first couple of days were easy: morning conferences and then stand around in surgery plastered against the wall out of the way. I wasn't asked to scrub in, I wasn't even pimped. Like I said, no one expects you to know anything on a one-week rotation. If you're lucky, they don't even learn your name.
Unfortunately, my comfortable anonymity ended Wednesday afternoon, Clinic Day. The patient was a 60-year-old man with prostate cancer successfully treated with radiation therapy the previous year. He was at the clinic for a routine every third month surveillance visit and all he needed was a PSA (blood test for prostate cancer) and a DRE (digital rectal exam).
Easy, I thought, I can pull this one off. I had been told ahead of time not to do the prostate exam until the resident was in the room. This way the patient only has to drop his drawers once. So, I gathered all the other information and presented him to the chief resident. So far, so good.
We entered the room and the chief handed me a glove and took one herself. She put K-Y jelly on her finger and handed me the rest of the packet. After informing the patient that he was getting “two for one today “ she performed the rectal exam and told me to do the same and tell her what I felt. On my turn I noted good tone, stool in vault and a small, firm but smooth prostate gland. No, there were no nodularities and yes it was symmetric. She nodded. Yes!, I thought. First impressions are so important.
Triumphantly, I withdrew my finger and pulled the glove off and as I did a spray of K-Y jelly flew across the room. I looked over at the chief and noted two large, brown-streaked globs of K-Y clinging to her cheek. Disturbingly, she did not raise her hand to remove the jelly. She just looked at me, brow furrowed, shaking her head in disbelief as if she was thinking, “And why did God send you to me today?”
Surprisingly, I did pass my Urology rotation. Or maybe not so surprisingly since the chief, I'm sure, didn't want me anywhere near her Urology Clinic ever again.
As a medical student in Philadelphia, the approach of my OB-GYN rotation filled me with nervous anticipation. At this early stage in our careers, facing the utter dread of being unmasked by a patient as the phony you knew you were, the idea of “clinical rotations” were anxiety-provoking anyway Add to the mix the awkwardness of the female pelvic exam and our group had more nervous energy than Robin Williams on amphetamines.
In order to prepare us for the experience, my school enlisted the aid of “Surrogate Patients” for the third years to practice the art of the pelvic exam. The group of around thirty students met at the hospital clinic and were divided into groups of six, each with a preceptor and a “patient.” The patients (whom we learned were paid handsomely by the school for their services) were made up of five militant, angry-appearing, army-boot-wearing 200-lb. women with haircuts like Drew Carey. The sixth was a very attractive woman in her mid-twenties. I had very mixed feelings when I was assigned to the latter. It was hard enough to try and be cool about this admittedly terrifying situation, but to have the woman be someone you could envision yourself hitting on at a bar?!?
Luck would have it that among my group of all male fellow classmates, I was chosen to go first. The woman/patient apparently felt it would be helpful to “coach” me through the experience and let me know how things felt from her end. She went through the basics, such as not to say the breasts “FEEL FINE” or “GOOD,” but “Your EXAM is NORMAL and HEALTHY” was acceptable. This I handled with remarkable aplomb. Then came the pelvic exam.
The speculum portion of the exam went well, as I went slowly and steadied my shaking hand.It did not help matters that the room was about 90 degrees, and I could feel the perspiration dripping down my face. The next part was the bimanual exam. She coached on, “Now examine my ovaries, you should be able to palpate my ovaries, because I'm thin.” My fear of somehow being sexually aroused by the experience was dissipating and I was concentrating with all the intensity I could muster to seem like I knew what I was doing. “There, do you feel my ovary?” I was not sure. I kept on adjusting the positioning of my hands in order to perfect my technique during this unique opportunity. With growing confidence, I exclaim,
“Yes! I think I have it!”
This high point was brief as my patient/ coach whispered “That's good. Now please take your thumb off of my clitoris.” With the reaction time of someone who just grabbed a hot potato, I yanked my hands out of the patient and fell backwards out of my chair as if I had been shot out of a cannon, to the raucous laughter of my classmates and preceptor.
I've wondered since this experience what kind of woman volunteers to subject k her privates for the awkward t fumblings of a doctor in training. Maybe they feel that they are contributing to the medical community. But perhaps it is simply to put a cocksure medical student in his place.
ZINGO!
Back in my medical school days I recall sitting and listening to seemingly endless lectures from faculty members in the huge tiered classroom that was my world for years one and two. We were like 212 large sponges absorbing every bit of knowledge, useful or useless, that was thrown our way. Sitting in plastic chairs in the dark room, lit only by the lecturer's slides (in the pre–Power Point era), we often struggled for ways to maintain interest and to basically stay awake.
We had our share of the “big ones,” anatomy, physiology, biochemistry et al. But along with those, thrown in by well-intentioned curriculum engineers, were the once a week “blow offs” like public health and medical jurisprudence. Even the most energetic (in other words, the ass kissers) of the 212 would be hard-pressed to stay conscious during one of these snore fests! So we, the most innovative of the 212, came up with a way to hold interest while these PhD's droned on about matters that would bore the most hardcore member of the NIH.
Say hello to Lecture Hall Zingo! Zingo was a game that anyone who was so inclined could play. It was very much like its semi-namesake Bingo. We would draw up little cardboard playing cards and for a mere dollar (remember, we were medical students) one could purchase a card.
Instead of a grid of random numbers, we placed in each box the name of one of our classmates. Of course, these students had no idea they were actually game pieces in our little adventure. No, these were the most special of the 212! These were the few, the proud, the PAINS IN THE ASS! You know whom I mean. Every class has them. These were the guys and girls who just liked to hear the so
und of their own voices and who would ask inane questions or make ridiculously obvious comments for no good reason at all. We had roughly 20 of these and I loved every one of them. For without them, we would never have had Zingo!
Anytime one of the Zingo-ites bleated out a question or comment, whoever had them on their card would scratch an X over their name. It may have taken a few lectures or maybe even a few days, but when a card holder had a vertical, horizontal, or diagonal line covered by X's he was a potential winner. I use the word “potential” here since simply having a winning card was only the first step in collecting the pot of Zingo money. To actually collect, the winner had to yell out the word ZINGO so that all in the room could hear it. This made for some of the funniest moments I will ever remember in class. Well, except for shooting orange seeds at the lecturer and scoring points for accuracy, but that will have to wait for another article.
QUE?
I was a lowly third-year medical student doing one of those God-awful, Saturday morning rotations which were “beneficial” for my education and allowed me to “appreciate the patient-disease continuum.” My torturous, lazy internal medicine intern was busy flirting with the ward clerk and I was hastily doing a history and physical on a middle-aged Hispanic man who spoke very little English. The history was endless and by now my time off had begun and I was still standing there in this dingy city hospital room. I began to rush through the review of systems.
“Have you had heart disease?”
“Que?”
I pointed to my heart.
“Problem here?” I asked helpfully.
“NO, no” he replied as he looked confusedly at my breasts.
“OK, anemia, convulsions, cancer, smoking?” I asked. “You have a cough. How about TB?”
“What? Why do you want to know that?”
I groaned. I would be here until Sunday. “Look you really ought to tell me. Do you know anyone with TB?”
He shrugged his shoulders. “Yes, I like to watch sometimes. Not too much, you know.”
Needless to say, his review of systems was actually negative.
I Could Sure Use
Some Fresh Air
Gosh darn dentists. Our Munchausen recently stated she had a procedure resulting in terrible complications. “Ariel” had her tooth extracted in another state and soon developed an abscess under her chin. She was 30 years old and worked as an emergency medical technician. For ten weeks, Ariel dealt with pain and swelling. Oral antibiotics didn't seem to help and she was subsequently hospitalized in order to adminis ter IV antibiotics. Her neck was drained and a tracheostomy was performed. Nothing seemed to help. Things were getting worse when our heroes, who reported this tale in the journal of ENT, received Ariel under their care. Her cellulitis was so bad that air was actually getting under the skin.
Ariel was on three antibiotics and one anti-fungal medication when the authors received her care. The whole right side of her face was extremely swollen and the air had traveled under the skin from her right eye all the way to her jaw and neck. The pain was extraordinary.
When she was first admitted there was no fever. Her white count was normal. CT scan showed extensive air all throughout the head and neck. A bone scan showed uptake in the right maxilla (below the right eye). Yet, with all the money spent on finding a cause for this interesting presentation, the answer still eluded our team of professionals.
The doctors were suspicious, however. No fever and no white count and no improvement with a full marinade of antibiotics? Something had to be wrong here. The costs were mounting. Consultants in infectious disease and oral surgery were brought in. Luckily, one of the physicians had recalled a similar patient that was presented at a regional meeting. Nothing beats good communication.
So as Ariel waited, the physicians continued to meet. Her white count never got higher. Her temperature never spiked. Soon her antibiotics were stopped and yet nothing changed. The doctors decided to become detectives and find out a little bit more about this patient from other hospitals she had frequented.
As luck would have it, the information started to pour in. Ariel had episodes of spontaneous pneumothoraces which required multiple operations for thoracotomies in the past. Constant admissions of subcutaneous emphysema (air under the skin) was her calling card. She claimed she would get air in her neck and chest even after a bout of sneezing. Talk about your allergies! When confronted by another hospital about needle marks under her left breast, poor Ariel ran away. Ariel was not gone for long though because other “incidents” would bring her in. A car accident revealed nothing major that needed hospitalization, so seven days later she shot herself in the chest. Some people really seem to like hospital food. The good news was that her wounds healed well enough from the gunshot so that she could be discharged only to be subsequently readmitted three weeks for abscess of her chest. Again, air was found under the skin of her left chest and incision and drainage was performed. This occurred many more times for Ariel. Sometimes air would be under her neck, under her armpit, or under her breast. Sometimes her whole lung would collapse.
On one crummy day for Ariel, the staff noticed her syringe tucked away nicely in her sock. This put Ariel in a terrible mood and she felt she had to leave the hospital when she was accused of self-abusive behavior. “How dare they question me?” she must have thought.
Our story continues with our local heroes reading the old records and deciding to confront Ariel themselves. With one motion, she pulled out her tracheostomy tube (Ouch!) and left the hospital against medical advice. Attempts to follow-up with her were useless. Ariel was gone and off to see the rest of the thousands of hospitals on her schedule.
The moral of this story: think twice when seeing a patient whose skin is so bubbly you want to pop it like those wrappers used to cushion packages.
Adapted from the Ear, Nose & Throat Journal. June 1998.
THE
RESIDENT
Let me first get this out of the way – residency sucks. It was the absolute hardest thing I ever had to do in my life. And I only did three years of it! Neurosurgeons spend seven years after medical school, most of it on-call, finishing up their residency. This is why they make the big bucks and why I think they deserve it.
When men and women graduate medical school they finally become real doctors. Prescriptions that they write for patients actually work without the need for someone else to co-sign for them. Patients called them “doctor” even when they were medical students, but now the residents don't have to correct them. They now have more power in the treatment of the human species than they ever had before. Unfortunately, all this glory gets diminished because of how extremely overwhelmed and overworked they are. Combine that with their inexperience and you have the perfect recipe for disaster.
Residents, in general, are not happy. There tends to be a pervasive unpleasantness about them. The main reason for this is probably the long hours they work. Putting in 80 to 100 hours a week is nothing unusual for these young doctors. In fact, the medical system in our country would be even more bankrupt if it didn't survive off the backs of these underpaid workers. Residents only get paid about $20,000 to $25,000 per year, which explains a lot of their bitterness. I mean, you do the math: 80 hours a week, 50 weeks a year – it's $6.25 an hour. And along with poverty, pressure, and paperwork, they invariably get the toughest patients to deal with in the toughest urban areas of our country. As you can imagine, this sets up our young doctors for some incredible experiences; some are weird, others are gross, but an overwhelming number are absurdly funny.
But it's not like they come out of this unscathed: The residents suffer personal consequences of all this hard work as well. A lot of them start losing their hair. Hygiene becomes a low priority for all of them. The hierarchy of command by the more experienced doctors can be tortuous for the younger ones. Like the military, each resident has the authority to boss around the younger ones under his or her command. In other words, shit rolls downhill and so do th
e grossest and worst parts of the job. They thought medical school was tiring, but as residents their fatigue is now at an all-time high. Even though they rarely sleep and are always on the move, they still end up gaining a lot of weight. Some doctors suspect that the real reason the hospital gives them scrubs to wear is to hide their growing waistlines. There are multiple contributing factors in all this weight gain – open access to the high caloric cafeteria, free meals from pharmaceutical representatives, and the constant temptation to scam food off patients’ plates. Not that any of this food is good, mind you. I remember that in Texas, where I trained, every table had a bottle of hot sauce on it to mask the horrible taste. They even served ox tails (cow vertebrae) at breakfast! I remember the looks I got when I asked the cafeteria workers for a dinner roll.
We don't serve rolls at breakfast. Are you crazy?” they asked.
“But you serve freakin’ ox tails?” I responded.
“You need to leave the line, sir.”
Residents have other issues to deal with as well. Much of it has to do with all the time that is spent in the prison … I mean the hospital. Too many of the residents lose their sense of reality and many end up losing their families. Marriages break up. There are those affairs that arise between residents or with other hospital staff. Many residents start fighting with one another over who covers which patients or who is doing enough work. Just as everywhere else in life, there are always those slack-asses who are great at gaming the system and scamming their way out of responsibility. The other residents hate them and this only makes for more conflict and worse working conditions.
When it is all said and done, however, the resident just wants to make it through so he or she can start a real job. They look forward to finally getting paid what they are worth. They look forward to repairing relationships with their loved ones. They look forward to starting over in a fresh environment. What is funny is that, years later, physicians always look back at residency as one of the most exciting times in their lives. They can recall 20-year-old outrageous encounters with patients like they happened yesterday. Instead of being scarred for life they got through some extremely trying times and lived to boast about it. It is these stories that help define them as doctors and storytellers.
The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge Page 6
