more from the bad doctor files

I sent a student who had been in a car accident this weekend to see her doctor yesterday.  She had been rear ended hard enough to take the rear fender off her car and to misalign her trunk.  She’d been complaining of a headache and nausea and one of her eyes looks like it’s dark, like a mild black eye.

She writes to me later:  My doctor told me to take some advil and that the headache should go away in a few days.

Ok, so maybe she doesn’t have a concussion.  Maybe it’s from having been married to an ER doc and the child of an ER nurse that I think someone who has a car accident should get some damned films.  And maybe that’s not a sound basis for judgement.  But you know, in the 7 years I was with him, the ER doc husband had two patients with badness that he missed or nearly missed.  One was a patient with a dissecting thoracic aneurysm who collapsed in the parking lot after being discharged from the ER.  The other was a lady who had hit the steering wheel with her face and torn her nose…essentially lifted it right up off her face.  Husband MD didn’t notice this until he had already signed her discharge papers and was about to let her go when he thought “Hmmm, that little cut on the side of her nose that I thought was from a torn out nose ring seems to be on both sides of her nose…I wonder what happens if I push on her nose – OH HOLY SHIT!”

I sort of assume that if wanting to be sure you don’t miss the hidden trauma isn’t motivation enough, the fear of lawsuits should help you along the rest of the way to investigate and not send your patient out into the world with something that could be alarmingly bad.

But then that’s just me apparently.

say Aaaaa…owwww!

Saw my doc today.  And yes, that was an awkward conversation.  But he handled it very well.  Only made one joke, and

photo of mouth with two large overlapping weals with defined edges on hard palate, multiple smaller raised bright red patches on soft palate

yes, this hurts

that was after I made one.  “Well that sucks,” he said.  And added “Literally”.  Then he took pictures of the top of my mouth.  His came out crappy so I promised him I’d send him the lovely ones I took.  My experience with Lyme Disease has left the following lesson indelibly seared into my mind:  Got a rash?  TAKE A PICTURE.

So regarding everything else that plagues me and over which I have no control, labs were normal this time so yay, I probably don’t have a wee tiny tumor hiding out somewhere making me feel like crap.  Still feel like crap though.  He sent me off with a referral for a better GI doctor (thank god), a promise to call the endocrinologists at the B.A.T.H. where I went last summer (who had dismissed me with advice to keep a food journal and see a nutritionist for the hypoglycemia, ignoring everything else).  He wrote in my note:  “I’m sorry that the endocrinologist at ______ did not answer the question that you were sent there for.  I will talk to them personally to see if we can get them to look at the issues.”    And I have some vitamin recommendations, trying oral (vitamins) again since I can’t miss work for IV right now.  We’ll recheck the levels later.  Got to see my hands and ears do their flushing thing.  He checked the temp…”wow, your left ear’s two degrees hotter than your right”.  Yes, it felt that way.  But my temp is a lovely 98.6.

Before wrapping up, he asked if there was anything he can do for me, and not in a customer service call, insincere way.  He sounded like he meant it.  But I douldn’t think of anything off the top of my head, other than “magically make me feel better”.

Ah, well, I do like my doc.

aller-gee

Did you know that you can be allergic to semen?  I didn’t know this earlier today but now I do.

Let’s just say I’m thankful for magic mouthwash…and that this is going to be a rather awkward conversation with my primary care physician.

Scanner, here I come

One of the ways I feel better about the – shall we say “extracurricular” crap I take at work is to sometimes put office equipment to less than official use.  My justification is this:  Work crap makes me sick.  I need to then copy more medical records for the appointments I need to go to because their crap makes me sick(er).  Ergo, copying medical records is work related.

Yeah, pretty flimsy I know.  But, it has improved my knowledge of our office machinery.  E.g. I now have a higher level of expertise at scanning to file as email attachment than anyone else in my office.

So since we’ll have some down time soon and since this and last week I was put through the wringer at work, I’m may  to avail myself of the opportunity to get to know the scanner’s duplex input modes a little better.  Mwahahahahahahaha!

how the hell do they do it?

Yesterday, I called my doctor’s office twice.  The second call was admittedly very sheepishly made.

Call #1, on my coffee break, was to ask if I should make an appointment to go over the latest round of tests he ordered.  I was told yes, and set it up for spring break – when it would have a less dramatic impact on work.

Call #2 was made after lunch when the sore throat that has been nagging at me for the last two days went into overdrive.  Let me clarify.  It’s not a sore all over throat.  It’s one sided tonsillitis, it’s chronic, and it can go from zero to 80 in a day once it gets going.  Last time, it turned into an abscess so I try to keep on top of it when it gets going.  So yesterday, when I found that it hurt to swallow, to chew, and I was having chills, I called.  Yes, he could see me.  At 7:30 PM.

I rolled in at about 7:25 and waited about an hour in the waiting room.  Then another wait in the exam room.  The nurse chatted with me about my cat (my husband had his iPod out which had a picture of our recently departed long loved cat on it), looked at my bright red ear and hands and said “Do they always do that?”  “Yup.  They’re worse in the evenings.  And it’s worst when the weather’s changing,” I told her, not wanting to add an evaluation of these symptoms to the late night mix.  “Feet too?” she asked, looking concerned. “Yes, but this is old news…not what I’m here for right now.”

She left. While I was waiting for the doctor, I could hear him in another room with a patient, chatting and laughing his rather contagious laugh.  “Ok, so what’s up?” he said when he came in to my room, and started flipping through the many pages of lab results on the front of my chart.  “Sore throat,” I said.  He laughed, said “oh my god, something SIMPLE!” but kept looking at the labs. I said “We’re going over all that crap,” gesturing to the labs “on St. Patrick’s day.  Today’s just sore throat.”  Flip flip flip… “You just can’t help yourself, can you?” I asked.  “Nothing too odd, I think the gastrin’s not back yet,” I told him.  “Really, it’s ok to save that for later.”  And so we proceeded to history, exam, and throat swabbing stages in rather quick order.  Penicillin, do I want something for pain?  “I have viscous lidocaine, I think I’m good”.  “Really?  You don’t need anything else?” he asked.  “No, I mean I have a topical pain med and I can take advil and tylenol, what else would someone take?” I asked.  “Vicodin,” and something with codeine, he added.  “Nah, look, I don’t like narcotics.  I don’t like how they make me feel so I try not to take them.”  “Ok.  I just don’t like people to be in pain,” he said.  “It’s ok, really.  I may be calling you about a thrush or yeast infection in a few days so maybe you can make a note…and maybe be ready to call in some diflucan, but otherwise I think I’ll be ok.”

I  can’t imagine how they can be anything other than depleted and wretched when still seeing patients at 9:00 PM on a Friday (I got out at quarter of nine, and the last patient had just been slotted into a room).  Even if this guy doesn’t figure out what all is causing these annoying symptoms of mine, he and his staff have my respect for being able to handle my stupid sore throat at nearly 9:00 PM on a Friday night with thoroughness and good cheer.

sleep, please?

Not so much.  Not lately.  I wake up, rather routinely now, at 4:30 AM.

And I am finding that it is affecting my memory, my recall to be specific.  Last week, I was able to successfully drift back to sleep by conjuring an image in my head and concentrating on it deeply.  Random image of the morning was a donut.  I imagined the donut, trying to see it clearly and concretely as if it were real.  I am not a concrete visual thinker so this is not an easy task for me.  The donut in question was chocolate dipped with sprinkles.

Last night, or rather about an hour ago, I found myself awake again and thinking thoughts of work because that is where my mind normally drifts on work days.  “Donut!” I told myself in my still sleepy haze.  I tried it.  The donut appeared – I must have started to fall back asleep because then dreams started to intrude.  My boss, some irritating people at work, and in this mix of directed visualization and half dream, I lashed out at the annoying people with the only thing I had.  DONUT!  I felt myself throw it at them in my mind.  Ha!  I will give you donut!

The absurdity of this all woke me right up.

Shit.

I tried a different one, a box.  Nope, it rapidly became clear that box isn’t good because it reminded me of the prop used by someone at a very bad talk I attended yesterday at work.

Um, I tried belt then out of desperation – first seeing a belt stretched out in front of my hanging there in the nothing and when that didn’t work, I imagined wrapping it up around my hand and feeling and looking at the leather’s grain, the edges and the length….but by that point, I was fully awake.

perfect

Sometimes, a perfect moment comes along.  It’s so nice when it happens.

The past few weeks have been difficult.  I’m feeling pretty bad physically and work is stressful.  My boss seems to be entering into a “last hurrah” stage.  She’s on her way out but is going down kicking and screaming.  The kids are having some tough times – we’re all blaming Northern February plus mid second semester stress.  Midway through the second semester, it becomes clear that whatever your hopes for the school year, you are on a path – largely irrevocably – to them being realized or dashed.  For a lot of students, this is about when they realize that they are not doing well at all and that it is rapidly getting too late to pull it together and save the year. For a lot of kids, this is when it is clear that academic probation, withdrawal, or dismissal is looming and they have only a few weeks to reverse or correct it – if that’s even possible.  We had two students transported for psych evals last week, one I know closely and I grieved for because my time in college (round one) was full of such turmoil and misery.  A close friend of the student’s had had a suicide attempt and it sent the student – who was already having some difficulties – into a tailspin.

Yesterday, another student who I’ve worked closely with came and found me on my lunch break.  I had gone and hidden out in a less frequently used, private room where we have our dictation software set up.  “I’m eating lunch” I told him warily over a mouthful of sesame noodles.  “I just wanted to use the computer, I can wait til you’re done, it’s ok,” he told me.  He stayed and chatted with me, telling me about a class he’d just left where he kicked ass on a presentation.  “We were supposed to present something for 2 to 3 minutes,” he said, adding that most students did song lyrics.  He chose a poem, and proceeded to recite part of it for me, the rest I looked up.  It is perfect for right now.

    Max Ehrmann  

    Desiderata

    Go placidly amid the noise and haste,
    and remember what peace there may be in silence.
    As far as possible without surrender
    be on good terms with all persons.
    Speak your truth quietly and clearly;
    and listen to others,
    even the dull and the ignorant;
    they too have their story.
    Avoid loud and aggressive persons,
    they are vexations to the spirit.
    If you compare yourself with others,
    you may become vain and bitter;
    for always there will be greater and lesser persons than yourself.
    Enjoy your achievements as well as your plans.

    Keep interested in your own career, however humble;
    it is a real possession in the changing fortunes of time.
    Exercise caution in your business affairs;
    for the world is full of trickery.
    But let this not blind you to what virtue there is;
    many persons strive for high ideals;
    and everywhere life is full of heroism.

    Be yourself.
    Especially, do not feign affection.
    Neither be cynical about love;
    for in the face of all aridity and disenchantment
    it is as perennial as the grass.

    Take kindly the counsel of the years,
    gracefully surrendering the things of youth.
    Nurture strength of spirit to shield you in sudden misfortune.
    But do not distress yourself with dark imaginings.
    Many fears are born of fatigue and loneliness.
    Beyond a wholesome discipline,
    be gentle with yourself.

    You are a child of the universe,
    no less than the trees and the stars;
    you have a right to be here.
    And whether or not it is clear to you,
    no doubt the universe is unfolding as it should.

    Therefore be at peace with God,
    whatever you conceive Him to be,
    and whatever your labors and aspirations,
    in the noisy confusion of life keep peace with your soul.

    With all its sham, drudgery, and broken dreams,
    it is still a beautiful world.
    Be cheerful.
    Strive to be happy.

    Max Ehrmann, Desiderata, Copyright 1952.