I’m counseling a clinic patient this afternoon about obesity and her high cholesterol, and as we’re talking she reaches into her purse…

And pulls out a hot dog. Wrapped in foil, but still… a hot dog. And she unwraps it and starts eating. While we are talking. About her eating habits.
I am literally dumbstruck. This does not happen often. I inform her that she can not have a hot dog in the middle of clinic. Doubly so while I am telling her to lose weight.

“I didn’t get a chance to eat lunch.”

That is entirely beside the point. you can eat before or after your appointment but not during.

“I didn’t get the french fries. I’m trying.”

There is a fundamental connection here being missed. I tell her again she will have to put it away, or throw it out.
And then she stuffed the entire thing into her mouth, chewed it up, and swallowed.

“You didn’t give me much of a choice.”

Ah, clinic.

“Of all the patients in all the clinics in all the world, she had to walk into mine”

During my intern year oh so long ago (over a year! ) I recall seeing an elderly lady who was visiting me for high blood pressure. She mentioned that she wanted to start taking cozaar, a specific anti-hypertensive drug to control her blood pressure. Scrolling through her medications, I saw that she was already on an ACE inhibitor, a similar class of drug and so asked her why she wanted to switch. Was she having side effects? did she feel her bp wasnt controlled?

It turns out all her friends were taking the same drug for their hypertension so she thought she should be on it as well. I explained to her that just because all your friends are doing something is not a good enough reason for me to change your medications. Then, because I was an intern and had to run all my cases by the clinic attending physician, I left the room to go present the case, explaining my absence with a simple “I am going to confer with another doctor and return to let you know the plan.” The plan was exactly what I had told her to continue her regular medication but it still had to be presented.

And that was the end of it.

Until about a week ago, when I learned that that patient had gone home and googled me, found out I was a freshly graduated intern (not that I was trying to keep it a secret) and felt that I handled the situation inappropriately, both in my flippant response and my apparent self doubt, as I told her the plan then said I had to check with another doctor for something as simple as a prescription question. She then lost all faith in my diagnostic abilities and decided to go see another physician at a later point to follow up.

How did I learn all this?

The patient is the grandmother of my current girlfriend

Talk about your chance encounters.

2 fascinating patient encounters recently:

1)A 40 year old black gentleman, former (only by age) gangbanger and with a friendly but colorful dialect was in the hospital for reasons that are unimportant. However, while taking his social history, I happened to ask him if he had ever had any sexually transmitted infections

“ah shit n*gga, er I mean doc, you mean like that clap on clap off shit? Hell yeah, I had pus all comin out my junk like “blau blau” bu then they got some antibiotics up in this bitch and now it’s all good.

I should add that when he said blau blau, he also thrust his pelvis forward as if he was using his genitalia as a sidearm. It was one of the few moments in my professional career where I seriously doubted my ability to keep a straight face.

2) Another gentleman came in with severe burns on his arm. When asked how such a thing might have occured, he related that he had been in the midst of a domestic dispute with his baby mama. She became angry and hit him with the smoove. 

Dr J “What’s a smoove?”

Pt “You know, a smoove, that thing you use to smoove out your clothes”

Dr J *facepalm*

In honor of this here talk like a pirate day, I thought I be telling you landlubbers a story about me latest scalliwag of a patient. Naught but 3 moons ago, I be having a man come visit me for scurvy. He also be mentioning that he wanted to quit smoking before it be sending him to davy jones locker. So I wrote him a shipoard pass for nicotine patches. He set out to sea and was told to follow up on his next leave. Earlier this week he be returning to me galley for a follow up. I asked him how his smoking be. 

Pt: “Arrr, doc, i be thinking these nicotine patches you be giving me no have worked. I still be smoking and now me left eye be infected”

DrJ: “Listen ye salty sea dog you- wait, what? Why would your eye be infected unless…?”

That’s right me mates and lasses. This gentleman, like a true pirate, had been wearing his nictoine patch OVER HIS EYE for three months. And nobody had said anything about it to him. 

While the accents may have been changed for today, the above story be totally true. Enjoy the rest of your talk like a pirate day!

Yo ho, yo ho, a pirate’s life for me!

We pillage, we plunder, we rifle, and loot,
Drink up, me hearties, yo ho.
We kidnap and ravage and don’t give a hoot,
Drink up me hearties, yo ho.

Yo ho, yo ho, a pirate’s life for me!

We extort, we pilfer, we filch, and we sack,
Drink up, me hearties, yo ho.
Maraud and embezzle, and even hijack,
Drink up, me hearties, yo ho.

Yo ho, yo ho, a pirate’s life for me!

We kindle and char, inflame and ignite,
Drink up, me hearties, yo ho.
We burn up the city, we’re really a fright,
Drink up, me hearties, yo ho.

We’re rascals, scoundrels, villains, and knaves,
Drink up, me hearties, yo ho.
We’re devils and black sheep, really bad eggs,
Drink up, me hearties, yo ho.

Yo ho, yo ho, a pirate’s life for me!

We’re beggars and blighters, ne’er-do-well cads,
Drink up, me hearties, yo ho.
Aye, but we’re loved by our mommies and dads,
Drink up, me hearties, yo ho

Yo ho, yo ho, a pirate’s life for me!

Aaargh! Happy Talk Like a Pirate day, mateys!

I recently reached another significant marker in my career as a physician. I received my first gift from a patient.

I have been following this lady with fibromyalgia since my first day as an intern. She is one of the few patients I see who I actually have any continuity with. And the reason for that is because like many fibromyalgia patients, she comes into the doctors office for an appointment approximately once a month for varying complaints. The kicker is that she has a fear of doctors, needles, and anything medically related in general, making her condition that much more onerous.

Every visit would turn into a friendly argument. She would have a complaint, I would recommend tests, she wouldnt get them, I would lecture her about smoking, she would tell me politely to stuff it and so on and so forth. This particular visit started no differently, but about halfway through she took out a card and box and handed it to me.

I hadn’t saved her life. I hadnt cured her of any disease. I hadn’t done any tests that led to a one in a million discovery and diagnosis. All I had done was lecture her every month for the last year on smoking, and provided the occasional prescription refill.

The card was a simple thanks for understanding my fear and feelings, and attached to the gift was a tag addressed to Dr J from “A stubborn patient,” a humorous understatement at best. The gift was a small glass and gold bear with a stethoscope which now sits on my desk.

I was touched. Several of my other doctor friends had told me during their intern year of receiving cards, cookies, gifts, etc from their patients and admittedly I was a little jealous at the time, wondering if either my patients were unappreciative of the efforts I expend to cure, treat, or sometimes just put up with them (hey, pobody’s nerfect) or if I was just an unlikeable or interchangeable doctor. And to receive a gift from a patient who I not only had not made an extra effort to be friendly to, but instead has treated slightly paternalistic as I saw her repeatedly for similar complaints…

…well, I guess I should stop trying to guess what people want from me, and just do what I think best. It seems to be working out pretty well thus far.

-Dr J

I have my own panel of patients now…which is kinda neat, admittedly.

To elaborate, every thursday afternoon, I have what is called my “continuity clinc”. It is supposed to teach you how doctors follow up their patients over the long term, providing continuity of care…one doctor, one patient, no illness left behind yada yada yada. What it has actually been for the most part is an urgent care center where once a week I see patients with simple complaints like pap smears or colds or medication refills because their regular doctor isnt available to see them.

But in the last month or two I have been starting to slowly get my own panel of patients, people for whom I am their primary care doctor, their gatekeeper to hospital medicine. If they need a referral, it comes through me…if they want to see how their blood pressure control is, I am the one with whom they make an appointment. It’s rather empowering, and makes me feel just a tiny bit more like a doctor having a group of patients to whom I can point out and say “these? they are MINE.”

And of course at least half that panel is spanish speaking only as I am one of only 3 residents and apparently only 20 some odd physicians in my hospital who speak enough spanish to carry on a conversation in it. Which I find staggering, as I work in California where white people are actually a legitimate MINORITY now. (and yet still no affirmative action grants and loan forgiveness for us, go fig.)

However, I like the added challenge of speaking with a patient in a foreign language. It turns even the most mundane visit (i need a refill of my blood pressure meds) into an exciting conversation and telenovela (PERO DOCTOR, NECESSITO LA MEDICINA POR MI CORAZON Y PRESION!).

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Speaking of Mi corazon, i am going to go off on a brief tangent here about Valentine’s day. I am not super anti holiday, but neither is this my favorite holiday as I tend to spend it alone for one reason or another. However, several friends and I have a singles tradition as it were whereby those of us unable to secure dates for the occasion will instead stop by hallmark, pick up a nice, generic card and then bring it with us…

…to the local strip club. Where following several rounds of drinking and leering, we then each present a different exotic dancer with a valentines card to let them know that their hardworking efforts at putting themselves through school are appreciated by somebody.

I like to think that we help to improve their day just a little bit, like hugging your garbageman or leaving a surprise cupcake in the mailbox for your postman…it’s all about catching people by surprise.

Of course one friend who is new to this tradition called me up the other day to happily decry…”dude, I was in the grocery store walking past the card aisle for valentines and I started feeling all bummed that I didnt have a gf and then I remembered…strippers!”

And just like that valentines day will never be a day of misery/frustration/longing for a certain subset of the population again.

marriedtothesea.com

Clinic Today was rather uneventful…just a case of headache for one person, and constipation in another. Sent them hope with suggestions for aspirin and a colonoscopy. See if you can figure out who got what