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

by Douglas Farrago M. D.

  We admitted a lady to the gynecology ward for vaginal bleeding. She filled out her paperwork and acknowledged that she was being admitted for “Bleeding from my Virginia.”

  She was such a sweet (although under-educated) woman that I couldn't bring myself to correct her.

  While taking a family history, a man told me that his sister had “cancer of the cologne.” My immediate supposition was that it probably smelled better that way.

  A rather backwoods appearing woman informed me, as I was about to listen to her heart, that she had been told by previous doctors that she had a “heart wormer.”

  After confirming that what I thought I'd heard was indeed what she had said, I wondered if having her see a veterinarian might be more appropriate.

  VOICE RECOGNITION BLUES

  I had recently obtained voice-recognition software for my computer and was dictating a note about a patient's visit. A lady had come to the office for a follow-up visit to evaluate how she was doing with her pessary. Pessaries are used in women who have a prolapsed vagina and need something to keep it from coming out all the time. They either use the pessary or get surgery. The software unfortunately misunderstood some of what I said:

  “Patient comes in for a pussy check. Has no complaints. On exam, her pussy appears to be appropriately placed and functioning well. Her pussy is removed, cleaned and replaced without difficulty.”

  More recently, a different patient was interested in artificial insemination. Her note read:

  “Patient presents requesting information regarding artificial insemination using donor seamen.”

  I recommend proofreading all your voice-recognition notes as some editing is definitely required.

  HOT DIGGITY DOG!

  evening on my ER shift, the head nurse came at me, chart in hand and devilish grin on her face. “This one is a special for you, doctor!” Assuming I was in for big trouble but not knowing exactly for what, I perused the chart. My eye fell on the chief complaint: “Hot dog stuck in vagina.” The nurse asked if she should accompany me while I got the history, but I decided I'd do that portion alone.

  On the table sat a middle-aged, bottle-blonde, chubby woman who appeared a bit restless. I introduced myself and proceeded to get some details.

  “Well, uh, you know, my husband has been away for about six months and, well, uh, you know, I needed some relief so I was ‘doing’ myself with this hot dog when I lost my grip and it went up inside. And I can't get it out! Oh, I can get my fingers on it but I keep losing my grip and now I've got myself sore from pulling on it!”

  I kept a professional demeanor and got the nurse for an exam. Standard speculum exam of the vagina was normal: normal vagina, normal cervix, no foreign object. Bimanual exam confirmed this but, as my gloved fingers moved her cervix, she said, “There! You've got it - I can feel it!”

  I gave her cervix a gentle tug and asked her if this was what she was feeling when she was trying to pull out the “hot dog.” “Yes,” she replied, “can you remove it?”

  After explaining to her that what she was attempting to do was essentially a trans-vaginal hysterectomy, I reassured her that there was nothing within her lower reproductive tract that needed removal. She then asked in all sincerity, if the hot dog “could have gone up further.”

  We held a quick anatomy lesson, focusing on the diameter of the typical cervical canal versus the diameter of the typical hot dog. Naturally, she then asked me the question I couldn't answer: “Well, then where IS the hot dog?”

  I could only speculate as to where the weenie could be, figuring that as long as it wasn't inside her, there wasn't anything further I could do.

  IT was my first year of residency and I was on the OB-GYN service. To “gain more experience” we were sent to the ER for all problems related to this very special field of medical endeavor.

  Late one Saturday night, the beeper went off and when I returned the call, the ER nurse reported that a young female complaining of vaginal bleeding was waiting for my evaluation. As I proceeded to the ER, my mind went through the multiple possible causes of vaginal bleeding, but I have to admit that I hadn't come up with what I was soon to be confronted with!

  I entered the exam room with a nurse to find a “professional sex therapist” from the inner city neighborhood of our hospital.

  She was some what reticent to describe her problem and so we helped her get into position for examination (a position apparently not foreign to this young lady).

  Upon insertion of the speculum and focusing the light on her introitus, I was presented with

  a brown

  furry-appearing

  object and an

  intense odor

  that drew an exclamation of surprise and revulsion from the nurse standing behind me.

  Being the professional that I was, I turned and drew a deep breath and then armed with a ring forceps to prod the beast, went back in for another look. As I grasped the brown fuzz within the vagina it began to break away and behind it deeper in the vault was more. Piece by piece I was able (with much breath holding) to extract the first of seven,

  yes seven, tampons!

  Intermingled within the brownish oozy mass, I also encountered a whitish suspiciously stretchy material. It was, yes, you guessed it,

  the first of two condoms!

  I never did discover any bleeding but there was considerable vaginitis evident after the foreign bodies were all removed. When I left the room to go write a prescription for the patient, Garbage Can Lady got dressed and was gone before I returned.

  EDITOR'S NOTE:

  We frequently get stories about retained tampons so they are not very interesting to publish. This one with seven, however, breaks the new world record and therefore we felt it needed to be published. Here's a toast to you, Garbage Can Lady!

  I always thought these types of jokes were funny but never believed they were true. I mean, is it anatomically possible? Isn't it just folklore and legend? Well, more about this later.

  Mr. Harold was 83 years old and extremely hard of hearing. I didn't know him as I was covering for my partner who was off for the day. The ER gave me the heads up that this gentleman had something wrong with him neurologically. He had woken up feeling “drunk” and had to lie back in bed quickly because of imbalance. His son and wife were very worried and called the ambulance later that morning to get him seen at the hospital.

  … she knew why her husband was sick.

  The ER doc said the patient was swaying to his right and kept losing his balance. His finger-to-nose testing was also off on the right. All other parts of the exam were normal including X-rays, labs, and CT of the head. By the time I saw the patient his symptoms were gone. This was late on a Friday and I admitted him overnight to have some ultrasound done on his carotids and an ECHO for a probable TIA (transient ischemic attack, or mini-stroke). Of course, the best laid plans…

  He seemed like a nice guy. When he did hear, he answered the questions correctly and without any mental status changes.

  My partner began seeing him on the following Monday and was told by the weekend cover that this man was ready to go. When he was examined and being packaged for discharge, he casually mentioned that when he got home he was going to blow his head off. Where this came from no one knows. He didn't look depressed to me when I saw him.–

  He was smiling and ready and excited to get out of the hospital. Maybe it was the hospital stay itself that was driving him to suicide or maybe he had other issues.

  The patient was transferred to the psychiatric floor to be seen by the appropriate specialists. Prior to his being transferred, the nurse on the floor called my partner. She stated she just received the weirdest call. The patient's wife stated that she knew why her husband was sick. For twenty years he had been

  “screwing all the animals

  on the farm. He screws the cow,

  the pigs and the sheep!”

  This story is interesting on many levels. For one, why does t
he wife think his illness is due to having sex with the farm animals? Secondly, why does the wife let him have sex with farm animals? Does she still have sex with him knowing that he courts the sheep and longs for the pigs? Third, why does he want to blow his head off? Does he miss Claribelle, the cow with the pretty face? Maybe Claribelle is cheating on him with the bull or even worse, his neighbor Clem. Fourth, can he get an STD from having sex with these animals? Fifth, what the hell do we as physicians do with this couple? My partner took this information into the patient's room the next day and was intending, out of morbid curiosity, to see what makes his farm animals so attractive. Rushed for time and probably struck with a brilliant flash of repulsion, he never addressed this issue. For the time being, Mr. Harold will continue to have his way with the “girls” in the barn and all we can do as physicians is to let the world know.

  A small penis, infection (Two problems, I guess)

  vitamin c defieiency. withering away, dying!

  Diearea since been on ship. Today blead when went to towlet

  Dick hurt (Then stop touching it!)

  Right ear infliction

  Pankeritous

  Pulled growns

  Human Bite on thumb (He wasn't kidding; another sailor deliberately bit him.)

  Check up. And I have a not on my Ass

  Ame cavrd in my ey (What?)

  Jock inch (I wouldn't brag about that)

  Prisner (I don't believe that's medically treatable.)

  Fell down stares on my ass

  Need a penis (dick) check (Thanks for clarifying.)

  Urinavee Infection (Like a humvee infection?)

  Check my hymrode's

  Coins on feet (Put them back in your pocket.)

  Round ball on side of penis (Basketball injury?)

  Fungs on back and chest

  Head cold thort – hard to shalow

  Sore heil

  Takeing a shit is verry painfull (Ouch!)

  Would like to see dr. Colon check on my Bronguitis

  Blood coming from the erectum

  Physical For mess crank. – Get X-Ray on Tail Bone

  I'm gonna die! Have the shipyard Flu.

  Seaman is yollow (Those crazy Navy guys.)

  Gasarithis (Not a clue.)

  Cracked my gord! (Laceration on head.)

  Sicle (i.e. Runny nose, watory eyes, small Headache, some chills, slight cough, phlegm)

  I have a pain and my chest

  Skin earatation

  I would like to get some Qual Lotion an have a Urine Analisis test for any desies (What?)

  Throughing up diarea (Talk about your bad breath!)

  Noaritis (Got me.)

  Vensial warts

  Around my cruch is eretated

  Sore Thorght

  Problem breathing Bronqul Passages clogged and pain on heal of food

  I have a groth on my scrodum

  Jockage (A great magazine name!)

  My Back heart'so (Actually this one is pretty descriptive)

  Check out Health Records for Ass Medical Officer (That has to be a tough job.)

  I use to have venerolgytis and I think I got it again (For God's sake, not again!)

  Uron anilizes

  Shoulder in joint, Right leg not, would like a X-ray (I would get that one quickly.)

  Towcell (Not a clue what this is.)

  Spitting up yellow flame (That has got to hurt!)

  Burning pain in my reactum (He was from the reactor department.)

  Hershey squirts

  Eskima (An Alaskan disease?)

  TOO PERSONAL

  After seeing the same female patient for different sexually transmitted diseases over several months, she finally presented to me complaining of a retained tampon. She informed me that although she had been on her period, she had managed to get lucky the night before after a trip to a local bar. Now after her wild night with her new suitor she was afraid the tampon was stuck. After several minutes with the speculum and ring forceps, I managed to extract the offending hygienic product. After its removal I asked her why she hadn't had her partner help her remove the tampon. Her response,

  “I didn't know him THAT well!”

  We are not here to knock the occupation of the pharmaceutical representative. They can help in a many situations and they do have a job to do. Many of them are young and right out of college. Stepping into the real world after being brainwashed by their companies just sets them up to get their asses ripped by overworked physicians. Sure it is easy to get rid of them from your office. You could have a “No Rep Policy.” You could put up hurdles that they could never overcome. You could just be rude and vicious. We do not believe in these techniques. Why be a jerk when you can have some fun? So the question is: how can you get rid of some reps without being mean or resorting to violence? Here are five easy and fun ways:

  5 EFFECTIVE TECHNIQUES

  TO HELP YOU COMMUNICATE WITH

  PHARMACEUTICAL REPRESENTATIVES

  (WITHOUT BEING MEAN OR RESORTING TO VIOLENCE)

  1 The “Three-Year-Old” Technique

  How many times do you get stuck in a conversation with a drug rep that you cannot get out of? You want to be nice (you really do), but they keep pushing. You want to give them a quick thanks, but with verbal gymnastics you are caught in a debate about minutia. You can't remember studies. You can't even remember your spouse's name because you're busting your hump trying to see a full schedule of patients.

  The “Three-Year-Old” Technique is a metaphor for talking to a little child. Recently, my daughter was explaining some story about being at a big slide and running around. I tried to tell her that I wasn't sure it was me that was there.

  “Remember, Dad?” she said.

  “No, I can't remember,” I responded.

  “We had fun at the place.”

  “I am not sure. What was it about?”

  She would scream back that it was a big slide and there were balloons. I said, “Honey, maybe Mommy was with you but I was at work or something.” The more I debated the more she got upset and dug her feet in.

  Then I said, “Oh, you mean the big slide? With all the balloons?” She smiled and said, “Yeah, remember?” I said that I did and we changed the subject without any more fuss.

  Now here is a typical interaction with a pharmaceutical representative that sets you up for failure: “Doctor, remember the last time we spoke and I gave you that article?”

  “No, I can't remember.”

  “Well I left it on your desk.”

  “I am not sure. What was it about?”

  “It was about how our medication is more efficacious than our competition's medication.”

  “But all the drugs in that class of medication are basically the same.”

  “That's not true. Remember that our medication has fewer side effects and almost 2 percent more drop in systolic blood pressure than the others.”

  “Is that really significant?”

  “If you remember, that article stated …”

  In the above conversation, you may be stuck losing precious minutes of your life whereupon cutting your own jugular may be your only viable option. By using the “Three-Year-Old” Technique you can make this interaction quick and painless. Let's see that same conversation again:

  “Doctor, remember the last time we spoke and I gave you that article?”

  “ Yes.”

  “What did you think about the drop in blood pressure and the fewer side effects?”

  “Oh, you mean lower blood pressure (the big slide)? With the fewer side effects (all the balloons)?”

  “Yeah, remember?” I said that I did and we changed the subject without anymore fuss.

  2 Making Irritable Bowel Syndrome Your Friend

  Don't let this demon of a disease be your enemy anymore. Use it to your advantage when you see a pharmaceutical representative. Every time you see one, start to cramp. Bend over and shake. Rub your side. How many times have you held back your flatulen
t urge anyway? With this technique, you let it rip! Wiggle and wriggle and then excuse yourself to go to the bathroom. Just like you can't prove your patients have anything real, neither can the drug reps. After a while you will have trained yourself to just point to the bathroom as soon as you see the rep and they will just know where you are headed (even if it is a small white lie). Even better, you can start getting creative. You can buy a can of “Fart Spray” at the local magic shop and spray it in your office. Invite the drug rep to come in and really try to get into a deep conversation. Watch them squirm. This technique will be so much fun that you will look forward to the cohort of detailers that comes your way. Since they all know each other, the word will spread quickly and they will hate having to see you because you either will be running to the bathroom or embarrassing them. Save your best tricks for when their boss comes in with them. The beauty of this whole technique is that if you actually prescribe enough of their drug they are forced to come see you.

  Now who is bothering whom?

  3 Pretend You Are a Mime

  Everyone hates mimes.

  4 Show Them Your Beautiful Mind

  Schizophrenia is a terrible disease and not something to joke about. It is, however, very effective in making pharmaceutical reps leave. Next time one of them comes in, thank them for bringing their “stuff.” Bring them aside and ask if they were followed to your office. Question why they know your “numbers.” Baffle them with remarks like, “I have been hoarding your medicine at home in case the j invasion occurs. Can you send more directly to my house?” You need to be subtle and not laugh or let them know you are joking.

  When they ask if you are putting them on, you need to stand your ground and say things like, “So I guess you are on their side? They got to you and you don't even know it” or “You are not fooling me, Lord Kaslov. Maybe we need to settle this once and for all.” Then just walk away slowly staring at them the whole time. Don't smile. Immediately knock on the door of the next patient's room and walk in. Prep your staff to tell the rep that you are having some “problems” and I guarantee they will never come back to talk to you again.