Playing Doctor

Initial Visit?

Monday, January 31

If these walls could talk, I'd want them to shut up.

I found a very disturbing thing in my home about three years ago that was left by the previous owners.

When I first toured the house, there was a little Christmas tree sitting in the daughter’s room that remained up ‘all year long, because she loves Christmas.’ The next room was occupied by her mentally handicapped brother, whom she helped care for.

Once I moved in, I turned the daughter’s room into a computer room because they had these built-in cabinets. I decided to run some cables under the base of the bottom shelf, which lifted out quite easily, and I found the seventeen year-old girl’s trove.

There was a fertility tester. I was not even aware such things were commercially available. It was like a home pregnancy test kit. They were these little sticks that you peed on, and it told you if you were ripe. (It must have detected a LH surge, the time when women are most fertile) There were two of ten of them left.

I could not even begin to guess what was going through her mind. Was she trying to get pregnant? Was she peeing on them and then not using protection if it was negative? Either way, I felt sick thinking about it. I almost called the previous owners to tell them to have a sit down with her.

Friday, January 28

I'm Like a Fucking RadioShack

I bet you forgot about me, didn’t you? Anna and my sister both said I should disappear into the background and let this creation of mine tell his own story and amuse you.

They said I was annoying, that I was too Hemmingwayesque. If you ask me, any writing that includes the letters “esque” is not very Hemmingway at all.

But I disappeared here, for the past two months, letting him tell his own stories. I think they said I was annoying because I am the most honest man they have ever met.

A lot of questions have been posted recently, so I felt I should clear up a few things.


He has no control over the list. He does not know its whys and wherefores. He gets the lists and presents them as is. So you can ask about brooches, you can say it’s not fair. There isn’t anything he can do about it. Here is the back story.

The real decision makers are the illuminati. If you are unfamiliar with them, you can read a history of the illuminati, or if you prefer, a short history of the illuminati.

They have placed an implant in his head. He has a scar at the base of his neck, between the second and third cervical vertebra. He is not the only one. About five percent of his patients have them. He always makes mental note of their scar, but never writes it in their chart. The implants do not show up on CT or MRI. Even on autopsy, no pathologist has ever found anything. Of course, vertebral dissection is quite difficult; they could easily shred a small implant and not notice it. The funny thing is, the patients who believe they have devices in their head never have the scar. The insane are of little use to the illuminati.

The implant gives him headaches when the illuminati are displeased. He has tried the hats. They do nothing. Though his favorite is the thought screen baseball cap.

So through a long, tedious process that nearly got him killed—and, if told, would get him killed—he found a contact. He has only met him twice. The contact gets him the lists. They come with instructions on how to signal when he needs another list. He changes his behavior and the headaches go away.

For a while.

This Week’s Uncynical Image

I love this picture because of how great those guys were being. Ignoring that their buddies and others would say snide things, they jumped in that tub. They were having fun. I included it to force you to choose between placing an easy snide distance between yourself and these people, or letting your guard down and getting their joke.

Dating Someone on Parole

Look, he views you as someone sitting next to him at a bar. He’s quick with a joke or to light up your smoke, but there’s someplace that he’d rather be.

Wait, no. That’s Billy Joel.

But the point is, he’s telling you everything that he is comfortable telling you. No ‘deets’ on the parolee, who—as a technicality—doesn’t exist.

Thursday, January 27

Eight Disadvantages to Dating Someone on Parole

8) Three Words: Boring Prison Stories
7) Little possibility of romantic international travel
6) The nights after parole officer assessments: unbelievable violence
5) If you become too much a pain in the ass, you know somebody who knows somebody who might be able to, um, help them out.
4) They make wine by spitting in a urinal container of apple juice and hiding it under the bed for three weeks.
3) Every trip to the convenience store is fraught with anticipation
2) Always worrying you are going to get a shiv in the shower
1) They are unwilling to role-play Prison Sex Stories

Wednesday, January 26

Uncynical Wednesdays

Recently, people have been asking questions about Uncynical Wednesdays. To explain them, let me start by making sure we are in agreement about what it means to be cynical.

Cynical: Given to faultfinding, sneering, and sarcasm. Given to or affecting disbelief in man’s sincerity of motive: accepting selfishness as the governing factor of human behavior. Contemptuous and mocking disbelief. Synonyms include pessimistic and bitter.

That’s from M.W’s 3rd new international. (So if you want to quibble, write them a letter.)

About a year ago, someone called me cynical. I took exception to this and asked three friends over a beer if they thought I was cynical. Their answers came almost in unison: One said “well, you are a little cynical.” “A bit jaded,” the second offered. The last suggested, “not cynical, just an asshole.”

Comforting. Thus, I created Uncynical Wednesdays for myself.

So what is Uncynical?

It’s being a good sport. It’s giving people the benefit of the doubt. It’s not discounting your own better nature. It’s a willing suspension of disbelief and doubt.

It’s that moment when you’re pissed off, and someone is trying to charm you and doing those things that make you laugh, but you’re angry and not in the mood. It’s that instant when your scowl breaks and you chuckle. You might look away, but you laugh and forget your anger.

So here is your Uncynical Image, for this cold, January Wednesday:

And I have no idea who these people are, or what circumstances led up to this photo. So don't even ask.

Tuesday, January 25

The One-Eyed King

I was listening to the radio yesterday and a question occurred to me: Is Lincoln Park this century’s T’Pau?

  • Earnest sung lyrics over ‘jaded’ spoken word? Check.
  • Catchy—if disposable—music hooks? Check.
  • Destined for bin with “CD’s for $2.99!!!”? Check.

Looks like we have a match.

Monday, January 24

Eight Advantages of Dating Someone on Parole

8) No annoying job promotions that suddenly take them out of town
7) You can end any fight by storming out of the house saying “You stay here; I’m going to vote.”
6) Three Words: Prison Sex Stories
5) Your friends will envy your ability to say “Well if your boss is that much of a pain in your ass, I know somebody who knows somebody who might be able to, um, help you out.”
4) They can make wine by spitting in a urinal container of apple juice and hiding it under the bed for three weeks.
3) The nights before parole officer meets you for assessments: best blow jobs ever
2) Guaranteed designated driver
1) Three Words: Prison Sex Stories

Friday, January 21

The Headaches Are Killing Me

Believe me, after all the flack I got on the last list, I have been trying to tolerate them.

My nightstand has the empty bottles of aspirin to prove it. Motrin bottles roll out of my glove box, and I find myself fiddling with the Tylenol in my pockets at the beginning of the day, before they disappear into my dry mouth.

But it is starting to interfere with my concentration. So I put out the signal. This time I was to throw the potted clematis onto my front steps and leave the shards and dying flowers until I got my message. Last night I walked to the tennis courts in the nearby park. I pulled off the top of the end-post of the chainlink fence and there, rolled up, was the following list.

Frankly, I was a little confused when I read it, as it seemed we were doing a good job of following orders. Maybe it was the whole inauguration thing that was the problem.



Eartha KittHalle Berry
Quite determinationCynicism
Fantastic FourX-Men
John McCainGeorge W Bush
Josh RouseWhite Stripes
Sensible shoesHem Lines
Disaster TwinsTalented Siblings
The JacksonsThe Presleys
Burt ReynoldsClint Eastwood
Electric ToothbrushesElectric Hairdryers
Whatever it takes
Love Handles

Thursday, January 20

Into the Mouths of Babes

This picture greeted me on my bank’s log-in screen. I have never really understood bank marketing concepts. I get they are supposed to be about home and family and whatever, but the grin on this guy’s face is ambiguous.
When I was fourteen, I went to stay with my uncle to help take care of my two year-old cousin while my aunt was in the hospital giving birth to a new cousin. The two year-old had a cold, and I woke up around 2 am hearing a commotion downstairs in the kitchen. As I was walking groggily down the stairs I heard, “Drink it, you little shit.”
I walked into the kitchen to see my uncle had her sitting on the counter, trying to force her to drink a spoonfull of cough syrup. She was somehow wailing with her mouth closed. I poked her in the belly and she opened her mouth to scream, and we got the syrup down. Cough taken care of, we all went back to sleep.
Anyway, that’s what I think of when I see this picture.

Wednesday, January 19

Uncynical Wednesdays

Monday, January 17

Regulators and Bureaucrats!

I received this e-mail recently:

According to today's regulators and bureaucrats, those of us who were kids in the 40's, 50's, 60's, or even maybe the early 70's probably shouldn't have survived.

Our baby cribs were covered with bright colored lead-based paint.

We had no childproof lids on medicine bottles, doors or cabinets, and when we rode our bikes, we had no helmets.

As children, we would ride in cars without seatbelts or air bags.

Riding in the back of a pickup truck on a warm day was always a special treat.

We ate cupcakes, bread and butter, and drank soda with sugar in it, but we were never overweight because we were always outside playing. We were fit and trim because we exercised outside all the time!

We would leave home in the morning and play all day, as long as we were back when the street lights came on. No one was able to reach us all day. No cell phones.
(I removed the all-capital letters and the five exclamation points from the last sentence)

We played dodge ball, and sometimes, the ball would really hurt.

We fell out of trees, got cut and broke bones and teeth, and there were no lawsuits from these accidents. There were accidents. No one was to blame but us. Remember accidents?

Some students weren't as smart as others, so they failed a grade and were held back to repeat the same grade.

Tests were not adjusted for any reason.
Our actions were our own. Consequences were expected.

This generation has produced some of the best risk-takers and problem solvers and inventors, ever. The past 50 years have been an explosion of innovation and new ideas.

We had freedom, failure, success and responsibility, and we learned how to deal with it all.
And you're one of them! Congratulations!

People under 30 are WIMPS!

I'll add two more to this list:

Women would smoke and drink, even while pregnant. If they lost a baby, they tried again. If it came out retarded, they put it in a home and visited it on alternate Saturdays.

If you were in an accident or sick, and showed up to an emergency room and didn't have insurance, they turned you away! If you didn't plan ahead by buying insurance, well, "Consequences were expected."

I have an idea. Let's hear from some of you survivors out there this week.

Post about your survival experiences!

Friday, January 14

A Modest Proposal for the Tsunami Babies

I’m in the middle of rounds in the medical intensive care unit this morning and presenting a patient and looking in at his unconscious form through the window, and can see the television in his room. CNN is running a story about the Tsunami Babies. They’re giving facts and figures about how many children were orphans and the headline was “Children For Sale” or “Children On Sale.”

So I have been thinking about getting a puppy lately, but I am kind of a sucker for a sale price. I’m always able to rationalize the savings of buying something if it is half price even if I never would have purchased in the first place. It seemed to me that if I got a child that was a little older, it would be less work than a puppy.

I imagined the interview:

Adoption specialist: What age group are you thinking about?

Me: I don’t care. As long as they’re old enough to vacuum and do dishes.

But as the story continued, I realize they are not putting the Tsunami Babies on sale. This is what I picked up from the scroll and headings:

1) The child sex industry is Thailand’s second largest industry, topped only by its adult sex industry. Often literally.

2) 100,000 children each year in Indonesia are trafficked as child sex workers making them the number three export, topped only by precious stones and rubber based products. Often literally.

3) South Asia is considered a ‘pedophile paradise.’ A point they should likely play up to rebuild their ruined tourism industry.

But, apparently, the communist governments of these countries are not happy about these little symbols of free market capitalism and are not allowing people to leave with anyone under sixteen years of age.

Now, general economic questions aside, it seems to me that most of these children are going to be dying fairly shortly anyway. Why not send them into the sex trade industry? Better fucked and alive then ‘fucked’ and starving with typhoid.

Also, can you imagine what life would be like for teenagers who don’t have to worry about getting laid? With enough teenagers freed of this obsession, we would likely have enough spare brain power to solve most of the world’s problems.

But probably not, because with sex taken care of, they probably will spend that brain power trying to figure out how to score a six-pack and marijuana. Or in their case, how to escape from their thatch cages.

Anyway, with pedophiles putting the kibosh on The After Christmas Tsunami Baby Sale, its back to thinking about a puppy for me. And the patient that I am presenting is doing much better, thank you.

Thursday, January 13


So today was a good day.

When I got in, I got a call from the ED requesting me to evaluate a woman on bi-pap, an in-between tool between giving someone oxygen and putting them on a breathing machine.

I was told she was doing well, but when I got down there, I could see she wasn’t. I pulled a stool near her bed and wrote my notes while watching her. Things were wrong with her and I started correcting them. Early things. Easy to miss things. Before things go really bad things.

This is why it was a good day.

I caught them. She had started slowly circling the drain. I was the Dutch boy today. My finger went into the dyke before the water got too low to save the woman. She got better.

She was likely to die if things hadn’t been caught quickly, and I caught them quickly. On occasion one’s eyes can make the difference, and today mine did.

She will likely go back home tomorrow and resume her life.

So, today was a good day.

Wednesday, January 12

Uncynical Wednesdays

Tuesday, January 11

Venn Diagram of the Week

Jake's post today began with a multiple choice quiz with unintended implications. Someone caught it, and here is the Venn demonstrating its accuracy.

Not exactly the mental picture for a Gap ad.

Maybe a 1960's Brando, during his dirty, experimental phase.

Monday, January 10

m & m

At lunch last week, we had M&M. I am not talking about the tasty candy that melts in your mouth and not in your hands. Morbidity and Mortality is a conference where physicians discuss a recent case, usually one that went wrong on some level. The comment we often whisper to each other as we hear the story of the patient’s worsening hospital course is: “I wonder what the autopsy showed.” The patients presented usually have died by the time they make it to M&M.

The point of these conferences is for physicians to learn painful lessons from other physicians. Often they are good ones. Subtle things that would not necessarily catch your attention, but given a constellation of other subtle findings can lead to—voila—a diagnosis or different management plan.

It is never fun to present these cases. You are explaining to other physicians how someone under your care deteriorated or died. These conferences are to medicine what the confessional is to reality television, or perhaps the reunion wrap-up show. The action stops and we dissect what occurred. They take place in a sanctum where only other medical professionals are permitted.

Usually, we scour labs results, exam notes, x-rays, vitals, everything in the evidence to figure out what could have reasonably been done differently. The ‘defending’ physician points to the evidence to support why they did what they did. A tenuous position, since they already know the outcome, but they are not arguing they did the ‘right’ thing, only that it was a reasonable course. And usually, it was a reasonable course, just not a perfect one. These are not cases of malpractice. These are complex cases where tough decisions are made. Not for the weak of heart.

By way of example, fifteen years ago I was in Paris with my sister, who would wait for the Metro standing very close to the edge of the platform. When I am in an unfamiliar city, let alone country, I am always paranoid: Observing who is around, noting easy exits, potential dangers. When she would stand that close to the edge, I would feel queasy, imagining her losing her balance or being pushed before an oncoming train. What made this worse was imagining trying to grab her as she was regaining her balance, only to put her off balance again and her falling onto the tracks possibly because of my intervention.

These patients are all already falling when they come to us. We try to bring them back, but sometimes they end up hitting the tracks. These conferences are about trying to figure out what we can do differently the next time the situation occurs.

Friday, January 7

Normal! Not Sexy! Humor! Not Porn! Oh God, Why Won't You Leave Me Alone?

Do you remember a few weeks back when I railed against the pedophiles finding my site by searching ‘playing doctor,’ and I said I would not even use certain words anymore? In order to name them I substituted numbers for some letters.

Some asshole found me by searching the word “l1ck.”

Was this a robot fetishist?

Oh god, I just said fetishist, god only knows who will find me know. The internet is like Beetlejuice.

Dare not say anything three times.

Thursday, January 6

This is What I Know about Being Gigantic

When I saw someone found my website by searching for ‘Carson Daly's Penis’ I thought it was odd. I vaguely remember having to check the spelling of ‘Daly,’ but could not remember why. When I used the Yahoo site to search ‘Carson Daly's Penis,’ I understand why someone clicked on it, but jeez.

Talk about being taken out of context.

Wednesday, January 5

Uncynical Wednesdays

Tuesday, January 4

Up Yours, Reader’s Digest

About once a year Reader’s Digest does this nightmare article on how to manipulate your health care providers. When I have a rash of senior patients behaving in a truly bizarre fashion, I flip through the recent editions and sure enough, there is some article giving horrid advice.

A few years ago, they did a great piece on ‘How to See a Physician in Less Than 20 Minutes in the Emergency Room.’ I am going to leave alone the whole subject of people who hang out in emergency departments with such frequency to make this an issue. With a few exceptions, if it is taking longer than an hour to see a physician, it’s likely because you don’t belong in an emergency room: you belong at home and calling the next morning to get an appointment to your family doctor. But whatever.

Reader’s Digest advised people to tell the triage nurse that they were having crushing pain in their chest that radiating down their arm. I have no idea how many of these fools were screened out by the ED, but those that actually had cardiac risk factors got admitted to the hospital for a day or two.

Now, once you tell a physician that you have a problem; it is usually incumbent on the physician to decide if it needs further work up. Even if you tell the doctor your original complaint was a lie, at that point you are saying that you are a liar, and the physician has to decide which statement has more credibility, the ‘lie’ or the admission of lying. Because people can go home and die from heart attacks but not from being morally bankrupt, physicians tend to treat them as if they had the former and then send them home if they turn out to be the latter.

What really brought these people to the ED? Here are the ones I remember:

1) Stomach upset

2) The Sniffles

3) Blood pressure medication refills needed

4) One guy had been scheduled for surgical repair of his hernia, but it had been scheduled four weeks away and he was hoping to have it moved up. Unfortunately, his faking a heart attack made the surgeon delay the surgery until the patient could get clearance from a cardiologist who didn’t have an available appointment for over nine weeks.

5) One deserved a special prize. When he was found to have lied and had only a trivial complaint, he was discharged and told to report to his family physician the following week. He left the hospital, walked across the street and called Fire-Rescue from McDonalds. When they brought him back to the ED, he was recognized and then arrested for making a false 911 call.

Several wanted to leave the hospital ‘Against Medical Advice.’ This means the physician does not feel the work up has been completed and it is not reasonably safe for the patient to leave the hospital. For patients who have no insurance, no credit score, and no intention of ever paying any medical bill they receive, it is meaningless. They can sign a piece of paper after someone explains to them that leaving the hospital could result in their death or permanent disability and then walk out. But if you have insurance or Medicare, signing that piece of paper will absolve the carrier from paying for any of the hospital expenses accrued, which leaves the patient to foot the $10,000-$25,000 hospital bill themselves.
Most people who scour Reader Digest have insurance, so they got stuck with staying in the hospital until the cardiac workup was complete. Usually it only took 18-24 hours to perform, but for people who were willing to lie to speed up an ED visit, they were a particularly upset and pissed off bunch.

Monday, January 3

There Is No B

Perhaps I go on too much about Ryan Adams, but I just started listening to him 6 months ago and I feel like I did when I was 8 and my uncle gave me his entire Beatles record collection.

I spent most of the fourth grade playing the records and saying things like “yes, yes, yes, Mrs. Belen, that’s all very interesting about the Nina, the Pinta and the Santa Maria and your paper mache dioramas, but I can’t get over what Phil Specter is doing on Sergeant Pepper. This is Important. This also is a brand new world.”

I like to imagine that it was that puggish cheek that got me thrown out of the gifted program, but really it was more likely the unauthorized experiment I performed with the class hamster and turtle.

Let’s just say the results did not look like this.

What’s this? You don’t know Ryan Adams? Well don’t turn out like that poor, poor hamster. Go buy his music now. Or view his discography. Go on, Snap. Snap.

Saturday, January 1

Summary of New Year’s Eve

Too much lobster

Just enough Champagne

Not enough Beluga

Smart move of the night: paying my brother to leave the house and drive me home.

Best non-sequitur of the night: “I gave too much money to this monkey at the white trash fair. It was wearing this cute little hat. I couldn't resist it.”

Medical Records

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Season One