The Goat

Dr. Osler is a senior physician who is quite brilliant. Today Dr. Pasteur and I were observing him in his clinic.

There was some downtime and in the physician’s workroom Dr. Pasteur was talking about a girl he had dated, whom they referred to as ‘the goat.’ I asked why they called her the goat.

“Because when she laughs, she shows her gums like a briar-eating goat,” he explained. “That and she likes anal sex.”

“Nothing wrong with that,” I said.

“No,” Pasteur said, “But she isn’t clean down there.”

So we all laughed and talked until the next patient showed up. It was a gentleman whose breathing was so bad that he was confined to a wheelchair.


I’ll digress from the story to explain a clinical tidbit here. People with lung and heart problems have a hard time doing the typical activities of daily life because of exertional dyspnea. That is, they get out of breath whenever they attempt to do much of anything at all. We can grade this by a variety of things. Can they walk one block without stopping? Can they walk to their car from their house? Can they walk to their kitchen? Can they get out a chair and take a shower? Can they brush their teeth?

The biggest problem for them is when you don’t exercise because you get out of breath, your muscles get out of shape. When your muscles are out of shape, you need to breathe harder to exercise. When you can’t breathe harder, you are not able to do things you could when your muscles were in shape. When you are not able to do those things, your muscles get in even worse shape, and you need to breathe harder to do even less. This downward spiral continues until the patient dies.

The surest way to kill off a patient is to get them a mechanical wheelchair. But they will love you for it because they will be able to do things without working as hard. Unfortunately, it is being forced to work that slows down the progression of their illness.


This man’s wheelchair was not mechanical, but was still a concern. Dr. Osler asked if he would be interested in pulmonary rehabilitation classes, which is physical therapy and exercise.

“Oh no,” the man said, “I get plenty of exercise.”

“Well sir,” Dr. Osler said, looking at the man slumped in his wheelchair, his toes blue from lack of oxygen despite the tank hooked to his nostrils, “Don’t take this the wrong way, but you don’t look like you get plenty of exercise.”

“Sometimes I walk my wheelchair at the flea market,” he said.

“And he helps me take care of my goats,” his wife said. “I raise pygmy goats.”

“Any of you want a goat?” he offered, looking at the three physicians. Both Osler and Pasteur were trying not to chuckle at the coincidence. I perked up.

“Dr. Pasteur,” I said, “Would you be interested in a goat?”

“They are clean as a whistle,” the wife said. “They are even paper trained.”

Dr. Pasteur was staring at the ground and Dr. Osler buried his face in the chart. I decided to press the issue.

“Her goats,” I said with a benign smile, “are clean as a whistle.”