The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge

by Douglas Farrago M. D.

  Thanks for the help, assh#le!

  I was a fourth-year resident doing ER rotation at George Washington University in about 1984 when I picked up a Middle Eastern patient in Room 4. His history was kind of unusual. He was in renal failure and was fed up with using dialysis. Upon hearing that GW had a few good transplant surgeons of Middle Eastern background, he decided on his own to grab a jet and fly on over for his transplant. He hadn't been worked up, referred, matched, or anything. He sort of treated the situation just like going to the store. He arrived having not been dialyzed for several days. He simply came to the ER with a translator from his embassy expecting to get admitted and transplanted. This gentleman did not look very good at all. He was very weak and his skin was a combination ofyellowandtan.

  I was there with a nurse getting a good history and preparing to examine him when he started to vomit. This wasn't your usual vomit. This stuff was really copious, nothing was digested, and it just struck me as unusual. He'd eaten a load of linguine or something on the plane and it was so sudden and voluminous that I grabbed a bedpan to handle the load. Then…

  smack in the middle of the emesis,

  was one particular piece of linguine that was bigger, thicker, and sort of brown on the end. Even worse, it started moving about like a cobra. This, I assure you, may be fairly common in certain locales, but Foggy Bottom, DC, is not one of them. The nurse's eyes, as well as mine, were as big as saucers. The patient looked sort of bemused, but not particularly shocked.

  When he finished singing lunch, I staggered out to Dr. Mark Smathers, the attending. I tried to interrupt the four phone conversations he was having at once.

  “Dr. Smathers,” I said. He waved me off with a hand gesture.

  “Dr. Smathers!” I said with more urgency. Nothing. Finally I faced him and blurted out,

  “The patient in room four just puked up a ten-inch-long ascaris.”

  He immediately put down all four phones, looked at me with equally astonished eyes, and without missing a beat, said,

  “Take it up to pathology.”

  I used two cervical swabs like a pair of chopsticks, picked up the worm and

  dropped it in a urine cup.

  At that point I walked it up to pathology. There was a bored path student on work-study checking in specimens who didn't even look as I dropped off the cup. When I told him what was in it, he jumped out of his chair like I had just given him a shrunken head. Upon returning to the patient, he and his translator both had inquisitive looks on their faces. The translator said, “He vants to know vot heppent to de vurm.” It almost seemed as if he was missing his close friend or something.

  I thought this is one of my greatest medical stories and definitely wanted to share it. When I told it to one of the female residents in my class (sort of the med school equivalent of putting a frog in her desk in grade school), she coldly turned toward me and said, in that obnoxious voice of hers, “That's a quite common occurrence in areas where parasites are endemic.”

  My only prayer is that someday she has a nice bowl of moving linguine made especially for her.

  Diener

  I spent some time as a pathology resident before I decided to be a “real doc.” One hot, bright July, I received a page commanding that an autopsy was to be done. Autopsies and the rare frozen sections, to be looked at under the microscope, were the only pages path residents had to answer (the good old days!). I gathered up the diener, but couldn't find the body. A diener is some kind of German word for “helper.” The dieners are the guys who do the dirty work on the autopsies while the path resident supposedly does the intellectual stuff.

  It was an old medical school with multiple hospitals and morgues so we started to make the rounds. Finally we decided to look in the oldest, most unused morgue, and what do you know, there the body was! All four hundred pounds of it on the top shelf! I, being skinny, but confident, assured my muscular deiner that I could hold up my end, but alas, I couldn't and while trying to lower the body, four hundred pounds of dead, cold meat hit him square and put him down! While he was screaming under the body, I saw what would have prevented the whole mess if the light hadn't been so dim: an electric winch on the ceiling! So I buckled the winch cable under the body but got the deiner's arm in the process! After a couple more tries, the body rose up, and just as he was crawling free, I found out, unfortunately, that I had accidentally hooked the cable through another shelf holding two more bodies and tore it from the wall!

  Two more bodies landed on top of my moaning deiner!

  I was laughing so hard that I almost couldn't pull the bodies off of him, and, after propping them up against the wall in a sitting position, off we went to do the grossest autopsy I have ever done in my life. Four hundred pounds of frozen lard.

  Rub

  Toward the end of my rotating “transitional medicine” internship, I was working in the Emergency Department. I picked up a chart for a teenage female with a chief complaint of pain with urination. In medical school, I had been told that cystitis (bladder infections) commonly occurs in women at the time when they first become sexually active. The patient was sixteen, so everything seemed to fit.

  I went to the waiting room and called for the patient. Her mother came along unbidden as I lead her to the gynecology room. I introduced myself and began to ask about the history of present illness. Actually, I was stalling for time while I tried to think of a tactful way to tell the patient's mother to leave the room so that I could take an accurate sexual history. I asked relatively inane questions such as … “How long have you had this pain?” and “Can you describe the pain?”

  “Can you describe the pain?” elicited more than I was mentally prepared for. My attractive young patient replied by describing her symptom with the phrase, “Well, you know how it feels when somebody rubs your clitoris too hard?”

  I don't know if my attempt to maintain a nonchalant expression was successful or not as I nodded silently. At least I knew that I no longer had to worry about how to dispense with the patient's mother, who was still sitting in the exam room with us. Actually, being male, I have absolutely no earthly idea what having one's clitoris rubbed too hard feels like.

  The female chaperone, who was in the room with me, refused to further my medical education when I asked her about it at the nurse's station.

  hile doing a night shift in the ER (urban community hospital) during my family practice residency, I had the opportunity to care for a middle-aged woman whose chief complaint was “potatoes in my pajama.” This was as close as I could get to standard English. Her speech may have been affected by the large doses of psychotropic drugs she was on. As she indicated to the nursing staff that this was a “female” problem, I found her in the pelvic room. As the history was pretty much unintelligible, I got right into the exam. There were indeed potatoes (wedges)! Even worse, they were sprouting inside her vagina (or in her case, in her pajama). Their degree of sproutedness (and other olfactory input) indicated they'd been there for some time. I of course asked her “why did you put potatoes there?” To paraphrase her reply, it was her method of contraception. Probably pretty damn effective too, I'll bet.

  EDITOR'S NOTE:– Wouldn't her partner be uncomfortable with a potato? Actually, I wonder if he should just break up with the girl and have sex with the potato on its own. Seems like a lot less hassle.

  A New Year

  As a family practice intern, of course I was on duty for every holiday. I spent New Year's Eve on the “Labor Hall” that year. I thought, “Hey, if you have to be on duty why not try to deliver the FIRST BABY OF THE YEAR?!” I had lots of potential candidates and I delivered one infant at 11:30 p.m., but it wasn't close enough. Then another patient began pushing which got me excited all over again.

  Now at that time, the University Hospital didn't publish the births of unwed mothers (which were a large portion of the deliveries). The next baby was born at 12:04 but to an unwed mother. We couldn't tell the world about that child, which meant
I still had a chance to attain my goal. I went to the next room to deliver a woman who was also pushing and made sure that she was married.

  “Oh yes,” she said.

  “Great!” I thought to myself, “I've still got a shot at it.”

  So I sent the husband off to change into scrubs and took the patient into the delivery room. After I draped her, I told the nurse to go get the husband and LET’S HAVE A BABY!

  The patient said “Dr. Ray, I've got to ask you something.”

  “What's that ma'am?”

  “Do I still get all the free stuff for the first baby of the year if the baby is not my husband's?” she asked.

  The loud clunk we heard was the husband who had just entered the room doing a face plant on the floor.

  The baby was delivered uneventfully, fortunately.

  Need a Bed

  While running the FP medical service as a third-year resident at our community hospital, I had the privilege of working with many great local attendings. One morning I received a call from one of our best and busiest attendings asking me to do an admission for him. It seems that one of his chronically ill patients needed a hospital bed. I greeted the patient on his stretcher with his orderlies at the elevator door on the second floor. Surprisingly, Mr. L was kicking and screaming to the best of his frail abilities, yelling at the orderlies to let him go and that he didn't want to come in to the hospital. The orderlies were dutifully trying to calm him down …

  “There, there, Mr. L, sir, we'll get you to your room and take good care of you.” As I began my history it soon became apparent that Mr. L had indeed called his doctor's office to request help with the purchase of an actual hospital-style bed to use in his home to make it easier for him to be cared for there. The message as it reached his attending was interpreted as Mr. L needing hospital admission, and he got all the way to the floor before we figured this out!

  Needless to say, my phone presentation to my attending was thoroughly enjoyable.

  I am employed as an academic attending physician in a community hospital with a residency training program in emergency medicine. One night, as I had received sign out from the day shift attending, a pleasant Latino gentleman came to triage complaining of chest pain. Mr. Sanchez, as we will call him, was whisked to a small exam room off the side of the emergency department. A tech was muttering about having to do an EKG “stat” as Mr. Sanchez stated that he had been having chest pain for more than five hours. At one point, the tech even turned to the nurse and remarked, “Like he's really having the big one. What a waste of time.”

  Well, true to form, patients will always be the wiser and he was having the proverbial “BIG ONE.” The tombstones in the inferior EKG leads were pretty self-explanatory. After a cursory review of the EKG with the intern, I ordered aspirin, beta-blockers, nitrates, and thrombolytics. I asked the intern to start three IVs and do a stool guiaic (checking for blood).

  As I was seated ten feet from the patient writing the orders, the intern embarked upon his tasks. The intern's name was Dr. Block and he was a gentle soul, but had a rather dominating presence, being about 6′ 3″ and solidly built. While I'm scribbling orders and calling the cardiologist, I hear the tech shout (yes, the same one who questioned the chest pain prior to the EKG), “Doc (me), I think you better get here. Quick!”

  As I ran to the patient's bedside I was a bit surprised to find the intern still wearing a surgi-lubricated glove with a stool specimen on the index finger and the patient now in ventricular fibrillation. This rhythm means imminent death. A couple hundred jolts of electricity with the defibrillator and Retavase was just what the doctor ordered.

  Mr. Sanchez sailed through with flying colors but the intern to this day is still a bit leery of doing rectal examinations. It will take time for him to realize that he doesn't have the “finger of death.“

  I was a young intern on the internal medicine service. I had a lot to learn. I still believed everyone. Why would some people lie? JOAN was unassigned, which meant she didn't have a physician to take care of her while she was an inpatient. Her lower back PAIN was severe and she looked like death warmed over. I jumped in on the case with vigor and ran every obscure test known to man. Nothing came back positive to find the cause of her pain. She would cry when answers weren't found. Her husband pressed hard for someone to do something. That someone, that Hero, that fresh new doctor who was to find an answer was me.

  She was in her thirties and was seemingly incapacitated, at least during the times that I saw her in the hospital room. She laid there l getting narcotic after narcotic for a whole week. She was in so much pain that at times she defecated on herself because she couldn't get up to go to the bathroom. My buddies on the service said I was being fooled. “She is a narc seeker. Get her out of there.” I even went to the chief of the medicine service for support and presented the case one-on-one. His response, “Munchausen.” The only other test he could imagine getting was urine porphyrin to rule out an even more obscure disease. We were a send-out lab and it was going to take time (it eventually came back negative). With much prompting, I eventually was able to nudge Joan out of the hospital and back home. Of course, she did go home with a boatload of narcotics.

  When she appeared the next day for readmission (and out of narcotics), I could have gotten someone else to cover her care. I was leaving for the night and was also finished with the medicine service. The next crew was coming on and would have taken her. But I was “her Hero” and her doctor. I was going to save her. I said to myself, “Only I can take care of Joan.” I called in orders for a morphine drip and later that night went to go meet her on the floor in her room. I was a proud man. I felt good about myself as I walked down the long corridor to where she was. I was finally a doctor and this person needed me.

  Prior to entering the room, I saw some flowers in a garbage can near the nurse's station. I picked one out and made my way in. When she saw me and saw the flower, it was too much for Joan. She burst into tears. It warmed my heart. I knew the next words were going to be something like, “You are the best doctor” or “No one would believe me but you. Thank you!” Instead, Joan began to tearfully scream, Is all a lie. I just wanted the drugs.” I learned a valuable lesson that 6 day. Forget about being the greatest doctor. It's an illusion anyway. I ignored everyone else's warning. Hell, I was blinded. She could have snorted eight pounds of OxyContin with remnants all over her face and I would have missed it. I left Joan that night and thought I never would see her again.

  A year later while shopping at a local clothing outlet, I was! sitting in my car waiting for my wife. Out of nowhere comes Joan and her husband walking right toward my car. She looked happy. She wasn't in any pain. I was in pain. Another year of residency, however, had taught me well and I was also wiser now. As she looked up at my car, I immediately did the professional thing and dove down into the passenger side to hide. My pain was better and I didn't even defecate on myself.

  ROSEY THE RED

  “Rosey” was 17 years old and very bothered by the fact she was always spitting up blood. Wouldn't you be? The otolaryngology clinic couldn't find a reason for her dilemma. The diagnostic tests including abdominal ultrasound, rectoscopy esophagogastroscopy and thoracic CT scan, were all normal. Being anemic with a slightly low hemoglobin kept everyone puzzled. The hemato-logic clinic thought they would get to the bottom of things, but alas, it was not to be. No local source of bleeding and no malignancy could be spotted. As the hemoglobin dropped more (below 7), five units of blood were pumped into Rosey to make her well.

  All anyone could come up with was good old-fashioned iron deficiency anemia and therefore more tests were run - a good thing too. A chest X-ray, thoracic CT (repeated), and CT (repeated), and digital subtracted angiogra-phy were performed, but gave no new i answers. Luckily a labeled RBC scan, two endoscopies, repeated bronchoscopies, and a partridge in a pear tree were added to the work-up. Unfortunately, they came up empty as well.

  As she continued to spi
t up more blood, she received more transfusions. This was a nice trade off. Funny thing, no one ever actually saw Rosey spit up the blood. They just kept finding blood on her dressings. Eerily, Rosey was very blasé about the whole thing, and though it crossed the mind of the clinicians that she might be faking, they couldn't find an injection site or ecchymosis that would lead them down that road.

  Was it another true mystery of science? We think not.

  Interestingly enough, as they tried to discharge Rosey she would always have another “bleeding attack.” Like fly paper, they couldn't dislodge themselves from this patient. Finally, one astute examiner found a scar on her elbow.

  It seems Rosey had an affinity for needling herself on this part of her anatomy.

  A more in-depth and less costly search showed that she coincidental-ly had a bloody syringe in her pants. Some people have all the fun

  Rosey finally fessed up to the whole charade, but blamed it all on her family problems. Maybe not getting enough toys on her birthday made her want to bloodlet herself. As far-fetched as this may sound, she never did follow up with outpatient psychotherapy.

  No one knows where Rosey is today, but we at Placebo Journal recommend you watch your rising medical costs when rubbing elbows with this wonderful patient who could be roaming through a town like yours.

  Gurkan, et al. Aust NZ J Med 2000; 39.

  Resident physician's salaries in the early 1960s were meager at best.

  Although technically illegal, supplementary income was necessary for those of us tottering under the weight of educational loans. After-hours jobs were passed on to underlings by those graduating residents leaving the Medical Center's walls for “The Real Dough,” as we so crassly put it. Doing insurance physicals in Detroit's less desirable areas was a common misdemeanor, since insurance companies’ physicians did not care to venture there. Actually practicing in an overburdened general practitioner's office was close to felonious.