Playing Doctor




Initial Visit?

Thursday, January 19

The Geese of Beverly Road

Whoever said there’s no such thing as a stupid question was probably the one asking the question.

It must have been repeated by junior high teachers who were desperate for any interaction with students. It’s like Michael Jackson says, ‘if you repeat a lie often enough, people consider it to be true.’


I emerge from my encounter with the ladies forty-five minutes later, hen-pecked, chick-pea’d, and pigeon-toed. And while that doesn’t make any sense, neither did these ladies.

Now, understand, I’m used to dealing with people who finished school during the sixth grade. It’s not unusual for patients to tell me that they cannot read. These patients ask—comparatively—good questions: Am I going to die from this? Is there a cure? How long will I have to take these pills? Did I do something to bring this on myself? How can I ever thank you?

These women had clearly tried to figure out what was wrong with my patient, and had come up with some diagnoses that made less sense than a thalidomide baby at an arm wrestling competition.


We began with me explaining that the patient showed signs of severe immunocompromise, that he hadn’t been tested for HIV in many years despite risk factors—which I did not specify—and while I did not yet know what was causing his diarrhea, my larger concern were his lungs. I explained the two things I was most concerned about were Tuberculosis and PCP.

There was a moment’s silence. Then it began.

‘Could he have cancer?’

Well, yes, he could, I explained. I didn’t have any evidence of it, but it is possible that there was also an underlying carcinoma, as HIV patients are at high risk for some forms of cancer.

‘So he’s tested positive for HIV?’ one of them asked

‘No.’ I resisted the impulse to say that I had just explained that he had not been tested. ‘He shows signs of it, but we haven’t tested him for it yet.’

‘Why not?’

‘Because I’m in here talking to you first. We’re going to do a full battery of tests to sort out the diarrhea and the cough and everything else.’

‘Shouldn’t you be doing that now?’ another one asked.

‘The lab runs the test in the morning. I’ll have the orders written by then without difficulty.’

‘What about Hirschsprung’s disease? Have you considered that?’

This catches me by suprise. Hirshsprung disease is usually diagnosed several days after someone is born. It is not a subtle diagnosis and is usually quite evident for the entriely of one’s life.

‘Does he have a history of Hirschsprung?’ I ask

‘No.’

‘Well, Hirschsprung disease causes constipation, so I don’t think—’

‘It also causes malnourishment. Are you telling me he’s not malnourished?’

I begin to explain the way that Hirschprung disease causes malnourishment when another of the ladies cuts me off.

‘Could he have DiGeorge’s syndrome?’

I suddenly realized they had consulted a book of pediatric diseases. I attempted to smile beneficently.

‘No.’ I said.

‘Shouldn’t you run tests to make sure?’

‘Are his ears normal?’

‘Yes.’

‘Is he retarded?’

‘No.’

‘Did he live past the age of two?’

She looks at me, not saying anything.

‘He doesn’t have DiGeorge’s. But I tell you what: if everything turns out negative, I’ll do a chromosomal analysis for you.’

‘Why don’t you do it now, to speed things up?’


This continued for an excruciating forty-five minutes. I felt like Sebastian in Suddenly Last Summer. Thankfully my pager started going off.

I apologized for having to ‘cut things short’ and made my exit.

2 Comments:

1/19/2006
Blogger Spider writes:

"a thalidomide baby at an arm wrestling competition" - that is so wrong in so many ways, yet so damn funny!

 


1/21/2006
Anonymous duane writes:

Wow... I can't believe the level of deniability is so strong in so many people. Wow.

 


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