Category Archives: Rants

You kids get the hell off my lawn!

The Harder They Fall

Doctors make lousy patients.

I spent half the summer extolling the virtues of adequate hydration to pregnant woman whose urine specimens were as dark as Granny’s sweet tea, but then ignored my own advice.

Every August our church holds an outdoor mass at a local farm and family activity center owned by one of our parishioners. Several of us arrived early to move picnic tables and set up stands for hot dogs, drinks and dessert. The guys hauled out the four rusty barbecue grills made from steel drum halves and filled them with charcoal. The farm donated several dozen ears of corn which we soaked in Rubbermaid garbage cans half full of water.

We soaked the charcoal with lighter fluid and lit the grills about a half hour before Mass. If the coals didn’t seem hot enough, someone would squirt more fluid onto them, creating a fireball.

“Hey, I heard you’re not supposed to do that.” *wink wink, nudge nudge* Another shot of fluid and another fireball.

We loaded the grills with corn just as Mass started, turning the ears with gloved fingers as they roasted. I had my trusty grill tongs, one in each hand, and my heat-resistant gloves, which last year I discovered don’t work when wet. The heat became so intense none of us could stand close for very long.

The sun was hot and the sweat slithered down my neck. My arms started feeling heavy after about forty-five minutes and I knew I should probably drink some water. I trudged over to the table our family had commandeered and sucked down the rest of my McDonald’s iced tea from a large Styrofoam cup.

Now, I travel a lot for my work and often miss church functions. I didn’t want to seem like a slacker so I refilled my cup with water and headed back to the grills. Everyone else congregated around the covered wooden corn stand, sucking down bottled water. One would have thought that was an obvious sign from God: “Get out of the sun, dummy!”

I was staring at the grills, watching the corn husks charring, the heat blasting my face, when the world faded to black, and I felt the ground sneak up behind me. I imagined the cup was a stationary pole and grabbed for it as I went down, crushing it in my fingers. I thought This is going to hurt…and you’re going to look really stupid.

I grazed my shoulder on the antique plow surrounded by flowers, hit the grass and decided this was as good a time as any for a nap…

I heard voices which sounded far away.

“Hey, are you OK? What happened?”

“I think Jimmy must have pushed him.” There were a few chuckles but their concern was evident.

“He’s pretty warm. Someone get some water and pour it on his head and cool him off.”

“Do you think we should call 911?”

A small crowd had gathered. I still had my eyes closed when someone doused me with a couple of bottles of cold water. It felt good but I was still pretty toasty and asked for another bottle which I poured on my chest. A woman’s voice above my head asked, “Does anyone here know his medical history?”

By this time Peg had arrived and said, “I’m his wife.”

The other voice persisted, “Does anyone know if he has a heart condition?”

“I’M HIS WIFE!”

Lady if you don’t back off Peg is going to hurt you. Don’t poke the bear!

I opened my eyes and was looking up The Voice’s blouse. She was leaning over me, holding a tablecloth for shade. I said, “I’m still pretty hot.”

Someone handed me an open bottle which I poured onto my chest. I reached out for another one and lowered it to my mouth, I took a few deep gulps but then, momentarily forgetting I was flat on my back, lifted the bottle straight up and waterboarded myself. I struggled to turn on my side to drain my nose.

“What’s happening? Is he having a seizure?” The Voice again.

No, you idiot. I’m drowning.

I rolled to my side, snorted a few times and lay back. The Voice said, “His breathing is labored.”

“No, I’m not in labor.” This got a chuckle from everyone who knew me, but she didn’t and said, “He’s delirious.”

“Do you think we should call 911? Do you have insurance?”

Peg said, “Yeah, we have crappy church insurance,” which is true. Every year the premiums go up along with the deductibles and co-pays while the coverage gets more stingy.

“No, I’m fine. I’m just hot and a little dehydrated. Let me sit up for a few minutes and I’ll be OK.” I mentally imagined the cost of an ambulance ride and an emergency room visit; the dial in my head was running faster than a gas pump set for five bucks a gallon.

I heard a familiar voice at my feet. “I’m a personal trainer and my sister is a lab tech! We need to get his legs above his head.” She grabbed my feet and started lifting.

Oh God, no. That is the LAST thing I need.

Peg said, “Don’t do that; he has a bad back and you’ll hurt him.”

Listen to the lady and get your hands off me.

She persisted despite my wife’s objections and I foresaw another rumble.

Peg said, “Put something under his knees if you want but don’t lift his legs up.” One of the guys grabbed a couple of empty charcoal bags and chucked them under me. The personal trainer dropped my legs but tried another well-meaning but ridiculous intervention.

“I’m going to put a couple of bottles of water inside your groin. That will help cool you off.”

You gonna do WHAT??? Jesus, just leave me the fuck alone!

“We really should call 911.”

I knew I wasn’t going to win, but I didn’t want to give in and muttered, “Let Peg decide.”

She gave the OK and later told me, “I did it because if I said no they would have thought, ‘Gee, what a heartless bitch; she won’t call an ambulance for her poor husband.’ You’re a physician and I play one on TV but they aren’t going to listen to either one of us.”

So the call went out and about five minutes later the local ambulance and fire truck pull into the grounds. I’ve never understood why a fire truck always comes along since there’s nothing burning.

One of the paramedics asks how I’m feeling and The Voice says, “He’s cold and clammy.”

No shit. I’ve had four bottles of ice water poured on me.

Peg intervened, gave them a brief history, and I crawled onto the gurney. I’ve ridden in the back of an ambulance with a patient but I’ve never been the one being transported. Once inside they started asking me the usual questions: name; medical illnesses; allergies and any medications.

“Ranitidine; enalapril; aspirin; antihistamine and something for my prostate. It’s…uh…that blue one.” I couldn’t remember the name; maybe this was more serious than I thought.

“Ok, we’re going to start an IV, put some pads on you and do an EKG and check your blood sugar.”

They took their time, for which I was grateful because there’s nothing worse than trying to start an IV on someone with collapsed veins in a moving ambulance that rides like a 4X4 over railroad ties. We finally started moving and I watched the picnic grounds recede out the back window which reminded me of riding in the rear-facing third row seat of a 1960s-era station wagon.

The firemen,  having nothing better to do on a Sunday afternoon,  stayed around for another hour, feasting on roasted corn, sampling the desserts and socializing with the crowd. There’s much to be said for small-town life.

Peg arrived at the hospital long before the ambulance left and asked about me at the emergency room reception desk.

“We don’t have anyone here by that name.”

“Are you sure? I watched the paramedics put him in the ambulance.”

“Oh, wait. We had a call about a man who collapsed at a picnic. The ambulance should be here shortly.”

While she was waiting a man dressed in pajamas and carrying an old-time doctor’s bag walked up to the desk and said, “I’m Doctor Moore and I’m here to check into the hotel.” A woman behind him said, “No, I’m his sister and he’s here to see the psychiatrist.”

Just another day in the emergency department.

The ambulance pulled into the bay about ten minutes later. They pulled the gurney out and I shook hands with the paramedics before they wheeled me into an ER room. The nurse gave me a gown, asked me the same questions and said, “The doctor will be in shortly.” She hung a new IV bag before she left.

Someone brought Peg to my room; her sister showed up a few minutes later. They caught up on what happened after I left; I wondered where my barbecue tongs and gloves were.

The ER doc, a Denis Leary clone, came in a few minutes later and cut his spiel short when he found out I was a fellow physician. He ordered blood work and a 12-lead EKG, even though the one in the ambulance was normal, because there are protocols to follow and asses to cover. I’ve done the same even though I often think it’s a colossal waste of money.

Lab and EKG techs came and went. I dozed; they talked.

Then the woman who gets the insurance information entered. She may seem a humble employee, but she is the Most Important Person in the hospital since the hospital doesn’t get paid without her efforts. One would think the administrative suite would treat her like royalty, but to them she’s just another FTE, an interchangeable cog in the machinery.

My sister-in-law looked at the woman, paused for several seconds and said, “You look familiar.”

“So do you.”

“Do you go to Our Lady of Perpetual Trepidation?”

“Yes, I do.”

Suddenly it was Old Home Week and they chatted while I snoozed on the cart.

I was ignored for the next two hours.  The nurse was staring at the computer screen when Peg went to tell her my IV bag was almost out. About 30 minutes later I needed to go the bathroom. Peg went back to the desk, found the nurse reading a book and the doctor futzing on the computer.

“My husband needs to use the bathroom. Do you have his labs back so we can get out of here?”

The ER doc came in after my potty break. My labs and EKG were normal – big surprise. He asked if I had a primary physician and I just snorted. (I told you doctors made lousy patients). We talked about ER patients and how he had to work another 20 years before he could retire. We finally left with instructions to make a follow up appointment with the primary care physician on call that day, something I had no intention of doing.

It’s probably just as well. Peg did some online research and discovered he was a Family Practice doc with three judgments and a state reprimand in only 11 years of practice. But that’s a story for another blog post.

A woman called the church office on Monday.

“I heard Peg talking about taking her husband to the emergency room and she seemed really worried about the cost. Do you think we should start a GoFundMe page for them?” Our insurance may not be the best, but it is far better than being uninsured

I got the tab a week later:

Ambulance ride: $1047
ER visit:    $5681
ER Physician charge: $651
Humiliating yourself in front of a crowd: Priceless!

In Honor of Labor

Something to ponder on this Labor Day.

Bedford is a pleasant town nestled in the rolling limestone hills of South Central Indiana, about twenty miles from Bloomington, Hoosier football, and the site where Breaking Away was filmed. There are some good local restaurants—Smokin’ Jim’s BBQ is a must—along with every fast-food franchise known to man. The people are friendly, kind and they work hard.

I missed the Holiday Inn Express’s free breakfast Sunday morning, so I headed for the reliable alternative, McDonald’s. The Egg McMuffin is a decent, balanced breakfast: protein (lean meat, fried egg), fat (a slice of American cheese), and carbohydrate (a toasted whole-grain English muffin) totaling 290 calories. I get two, dump one muffin and one cheese slice, combine the remainder and I’m good for a few hours.

I pulled into Mickey D’s and counted sixteen cars in the drive-thru lanes. I thought the counter might be faster, so I parked and went inside. It wasn’t any better.

Seven people were in line. There were three trays on the counter waiting for orders and one take-out slip. The monitor above the product rack showed twelve drive-thru orders, and I could still see a line of cars through the window.

Seven people working their butts off behind the counter.  The man at the register was in his late 50s or early 60s, as was the woman who wheeled a couple of three-gallon iced-tea buckets towards the back.  Three young men were putting breakfasts together as fast as they could. One middle aged woman put orders into bags or on the trays while another manned the register at the window.

I got my order after about 10 minutes. There were fifteen more people in line and another sixteen cars in the drive-thru lanes when I left.

There have been a lot of smarmy comments about “Sally McBurgerflipper” wanting fifteen bucks an hour for doing jobs those critics think should be done by lazy, sullen teenagers wanting pin money.  But the average age of fast food workers is 29. Many of those people have more than one job and have families to support. In rural areas, Wal-Mart and fast-food might be the best options for those who aren’t college material. Those jobs are relatively immune to economic downturns, but that is little consolation when there are 30 applicants for one job.

I’ve done more than a few minimum-wage jobs. I was a busboy at a bowling-alley restaurant for 75¢ an hour; I got a raise to 90¢ after a month. I was an orderly at our local hospital when I was 17, making about $2.50 an hour. One of my jobs was digging impacted stool out of a neurologically impaired man. I was a stocker at the student bookstore in college.

Any honest work, no matter how menial or humble, is good work. Every job is worth doing well and those who work hard deserve to be treated well. I always kept in mind the advice my family doctor gave me when I told him I wanted to go to medical school:

“Whatever you decide to do, do your best. If you want to dig ditches the rest of your life, be the best damned ditch-digger that ever lived.”

I have more respect for Benny, the guy at the McDonald’s I go to every Sunday, than I have for some rich bastard on Wall Street who wrecked the economy and then had the balls to ask the Feds to bail his sorry ass out.

I respect one of my church’s parishioners who, after thirty years in IT became a casualty of the recession. He got a job at J.C. Penney and is far more reliable than many of the much younger employees. He interviewed for a job in his field when the market started to improve a couple of years ago, but the boss said, “I can hire someone right out of college and pay him a third of what I’d have to pay you.”

I’ve nothing but contempt for the CEO who, no matter how well the people actually doing work perform, believes “it’s never enough.”

Never make assumptions about the people in whose shoes you’ve never walked. You might find yourself among them someday, feasting on your own rhetoric.

Happy Labor Day.

Growing Old: A Warning

You’re young and you pray to God it will never happen to you. Like Pete Townsend, you think “hope I die before I get old.” Well, it’s not likely, but it isn’t all that bad. How you look at things changes as you get older.

  • You can blame being a cranky son-of-a-bitch on getting old when, really, you’ve always been a cranky son-of-a-bitch.
  • You lose all your filters and just don’t give a shit what anyone thinks. Except for your wife. You will always care about what she thinks because she is far more likely than your offspring to pick your nursing home. Be careful before you bite that hand.
  • You will finally understand that age and treachery will always overcome youth and skill and you won’t hesitate to use the latter, judiciously, of course.
  • That waitress may have bodacious ta-tas and a fine ass that make your loins stir, but she’s got Jell-O between her ears and your loins will soon be napping. Yes, she can ride you all night, but will she ride in the ambulance with you when you have a heart attack? Or will she be willing to wipe your ass when you are too old and feeble to do it yourself. The woman you’ve been married to for fifty years will do it without thinking.
  • Good sex is based on quality, not quantity, but a good night’s sleep trumps any sex every time.
  • You turned into your father when you asked your kids, “What is that crap you’re listening to?” But the music your kids and grandkids listen to really is. Whining coffee house singers pale next to Jagger, Plant, Daltry and Bowie. Aretha Franklin, Gladys Knight, Diana Ross and Grace Slick would eat alive those breathy waifs who sing as if they have chronic lung disease. So would Frank, Dino, Tony, Mel, Nat, Bobby, Sarah, Carmen, Ella and a whole bunch of guys and gals you thought you were too cool for when you were a teenager.
  • You suffer from CRS (Can’t Remember Shit) Syndrome because your brain is a sink with a broken garbage disposal. It’s filled with mostly useless crap that crowds out important stuff like: Why did I come into this room? Where’s my cell phone? Occasionally, flipping the switch stirs the garbage long enough for answers to filters through.
  • You will tell younger people stories they’ve heard several times before, even though you swore you would never do that when you got old.
  • You proudly tell everyone about your colonoscopy and think anyone who’s afraid to get one is a pussy. You really liked your colonoscopy, mostly because they gave you really great drugs and you can’t remember any of it. Kinda like living through the late ‘60s.
  • Everything has been aching for so long that you don’t notice anymore. You have little patience for people under 40 whining about a cold or a stubbed toe and growl, “Suck it up!”
  • You will look back on your youth with amazement and shame, pondering how stupid you were to think you knew everything. You’ll have far more questions than answers and discover the answers are far more elusive.

When you’re young you think you have all the time in the world. Make the most of it because the ticking gets faster and louder. You hit 35; you’ve got a mortgage, a family, and a mountain of debt. Then you blink a couple of times and find yourself on the downside of fifty, sitting on the couch watching TV, wondering what the hell happened to the last 20 years, and thinking, “Golden years,” my ass!

Less is More …More or Less

NOTE: I left my writers group over creative differences. They demanded “more emotion” in my writing, but when I gave them the following, they didn’t like it. Be careful what you wish for.

In 1992 John Grey told us “Men are from Mars, Women are from Venus.” This revelation did not surprise any man— most of them didn’t read the book in the first place—but it was a shock to most women. Yes, men and women are different but despite the latter’s fervent wishes to the contrary, we men are fairly simple creatures who don’t require endless analysis to understand.

Men learn quickly that women are mysterious, complex creatures but not much else. We know they have boobs. We know they possess that Holy Grail “down there,” our bumbling quest for which is eternal. And we know that saying the wrong thing however innocent will get us into a shitload of trouble. We also like to piss them off sometimes by doing something they expressly told us NOT to do, because it’s fun in an adolescent way. But we’ve reconciled never understanding the female psyche and moved on.

Women find men to be exasperating, lacking in self-awareness, and devoid of that most-coveted but rare attribute, “emotion.” That’s not entirely true. We understand and express a few emotions—anger, humor, sarcasm, lust, and the overwhelming joy that comes from vicariously crushing your buddy’s dreams in sudden-death overtime.

We bury our feelings in alcohol, drugs, work and manly pursuits like football, hunting and Call of Duty until ulcers or a heart attack grant us a reprieve from our stoicism. We don’t run naked through the forest howling at the moon, join drum circles, or pour our hearts out in embarrassing songs like “Sometimes When We Touch,” the sound of which still makes me cringe.

Men don’t want to get in touch with their inner child; we’d rather have had the opportunity to yank the little bastard out to warn him about the shit he’s gonna face in life. We do not want to wallow in, nor publicly express, the soul-searing pain most of us have experienced during our lives, having learned a long time ago that doing so invites the rebuke, “That sounds like a personal problem to me.” Or, as a woman I knew in college told me, “Nobody likes a downer,” a gut punch that said in no uncertain terms, “You’re on your own.”

In the 1980s, women said they wanted men to be like Alan Alda, comfortable with emotional intimacy. Not true! Women really wanted men who acknowledged women’s emotions, not men with their own matching set of emotional luggage. “How can you take care of me when you are sad/depressed/angry/scared/hopeless?” So, in order to successfully navigate the minefields of personal relationships, our innermost feelings stayed buried, taken out occasionally in front of a therapist for a hundred bucks an hour, or with a bartender for far less.

I spent the first forty-some years of my life wearing my emotions like a badge of desperation, an emotional train wreck. I look back on those times with a great deal of shame and humiliation. I may not live there anymore, but I remember the address. And the phone number.

All that changed when the pain of my affliction outweighed the stigma of acknowledging it and I sought absolution through Prozac, leveling out the highs and lows. I abandoned New Age music’s comforting vulnerability for jazz’s impenetrable complexity. I bade farewell to Bogie and Bergman, embracing the likes of Stallone and Stone. Disengaging from my emotional side made coping easier. I saved my soul but lost a part of me, for better or worse.

Writing may be therapeutic for many—in the past it has helped me—but I’ve achieved a balance I’m reluctant to disturb. I am neither Henry David Thoreau nor Nicholas Sparks. I do not want to “lead (a life) of quiet desperation and go to the grave with the song still in (me).” I don’t want to resurrect demons previously banished or go back to the edge of the abyss. Mostly I don’t want the existential vulnerability of my previous life. I’ll walk down old paths carefully, breaching some walls while leaving others undisturbed, but in my own good time.

Yes, men and women are different. We have feelings but we’d rather die than admit it, so please stop asking us. Our inner child will thank you.

Talking to the Wall

Physicians don’t listen for shit, even when the patient is another physician.

I spent two hours in my own ER after doing a Cesarean section in a hot operating room. I was sweating like a pig and starting to get shaky, even though I’d had breakfast a few hours earlier. Thinking my blood sugar was plummeting, I wandered out to the nurse’s station and asked for a sugared pop (which tastes like pure syrup when one is used to diet).

Joy, a nurse with a very kind soul, thought I looked like crap and took my blood pressure. She got a panicked look in her eyes because my diastolic was 108. I’ve been on medication for about 12 years and my pressures are usually fairly normal at home. She took it again suggested I go down to the Emergency Room.

I said, “I feel fine. How about I go lay down for a few minutes?”

“So we can find you dead in the call room? How about the ER?”

I objected again so she grabbed the guy who’d done anesthesia for my Cesarean. He listened to my heart, looked at my blood pressure readings and said, “You really should go to the ER. I know the doc down there and I’ll give him a call.”

I relented. “OK, I’ll just mosey on down there.”

The nurses all said, “NO! We’ll get you a wheelchair and take you down. And if you don’t behave, we’ll call Denise to do a one-on-one with you.” Denise is another nurse and doesn’t take crap from anyone! I thought I’d be safer in the ER.

They wheeled me out of the unit, into the elevator and down a very long hallway to an ER bed. The ER nurse had me change into one of those idiotic gowns, then hooked me up to a monitor and a blood pressure cuff. She asked me the usual questions: Did I have any chest pain? Was I taking any medicine? Did I have a history of hypertension? Heart disease?

The ER doctor came and I repeated the same information, adding I was taking medication for my blood pressure; that I couldn’t take it at night with the drug that helped me pee because my blood pressure would plummet and I’d fall on my face; that I wasn’t diabetic but that I’d had a can of sugared pop shortly before coming down.

He listened to my heart and lungs, ordered an EKG, a chest X-ray, and blood work and told me he’d return when all the results were back. Standard ER protocol. I figured all the results would be normal.

The nurse started an IV and drew a few tubes of blood. Then someone from Imaging (the X-ray Department to anyone my age) snapped a chest x-ray. She apologized for the cassette being cold, but it felt really good on my back. I thought about the good old days when x-ray departments had 55 gallon drums of discarded films. Now everything is digital and viewed on a computer screen.

A Cardiopulmonary tech did an EKG, which read normal sinus rhythm—big surprise. Yes, the EKG machine reads the strip and makes comments. After that Dave from Respiratory Therapy came by with an albuterol solution because my lungs were a little tight.

“Have you ever done a nebulizer treatment,” he asked.

“Yeah. I have Symbicort—“

“That’s not a nebulizer med.”

Dammit, let me finish my sentence. “—albuterol inhaler and albuterol solution for my nebulizer.”

“So, you know how to use it?”

Yeah, it’s like taking hits off a bong but I’m not about to tell YOU that.

I laid on the gurney, pondering what my wife would say when I told her I’d been in the ER as a patient. I’d left my personal cell phone upstairs in my locker so I couldn’t call her, which was probably just as well.

The ER physician came in about 90 minutes later. All the results were normal, except for my non-fasting blood sugar of 174, which was not a big surprise after ingesting 39 grams of pure sugar. My blood pressure had returned to more normal levels. He told me to take it easy the rest of the day.

All was fine until I got the discharge paperwork which the following diagnoses:

  • Acute generalized weakness
  • Near syncope (fainting)
  • Chronic diabetes
  • Uncontrolled hypertension

WTF??? I didn’t have “generalized weakness” and I didn’t come anywhere near fainting. I’m not a chronic diabetic. I’ve checked my glucose levels frequently at home and if anything I’m prone to hypoglycemia if I don’t eat for several hours. (My record low was 54). My blood pressure came down to normal after lounging on the gurney for two hours. One makes a diagnosis of hypertension with several blood pressure readings over several days, not a couple of hours. If I had to guess, I think he assumed “fat Hispanic guy; must be diabetic, hypertensive, non-compliant and a walking heart attack waiting to happen.”

The next day I had the nurses at the office check my blood pressures, which were normal every day. I bought a glucometer and poked my fingers five to eight times a day, dutifully recording what I’d eaten and when along with my blood sugars, all in a nice Excel spreadsheet. My fasting blood sugars were just a bit high (101-103), but they normalized when I had a protein snack before bedtime.

Patients have complained to me that their doctors didn’t listen to them. Well, they are probably right more often than not, and for that I am truly sorry.  And now I understand.

Photo Credit: Canstock Photo