Category Archives: The Barbarous Craft
I may be an asshole, but I think doctors should get paid for their work whether they cure their patients or not. There. I’ve said it.
Because if we cured every last one of our patients, we would be gods, and then you would have to pay us in the tribute of our choosing.
Devotion.
Prayers.
A fattened calf or three.
Virgins.
Virgins.
That bill looks a shade more reasonable now, doesn’t it? I believe I’ve made my point.
D.
Woodland dentist defends chest massages as appropriate procedure.
I hope he gets away with it. After all, ENTs treat TMJ, too.
Hat tip to Superpunch.
D.
I got a massage today. Not for any particular reason; I guess the October Special (one hour for thirty dollars) was reason enough. I hadn’t had a decent massage since my previous masseur went off to Mykonos to make his fortune.
Massage used to be a lifesaver for me. Until I discovered exercise, massage was the only thing that helped my lower back pain. Now that I exercise regularly, massage is little more than a treat.
It didn’t used to be that way. During residency, if I popped good money for a massage, it meant something horrible had happened. Maybe I had pulled a 40-hour stint on three hours of sleep, or maybe one of my senior residents had lit into my ass over something inconsequential. Or, as happened right before my first massage, maybe I had almost killed a patient.
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Oh, you say, but it’s only doll shaped like a cute li’l miniature baby.
No, it’s not. It’s a doll shaped like a 14 centimeter-long premature infant. That’s an 18-week gestational age, not-quite-200 gram premature infant. According to the site I just linked, the survival of premies 21-weeks gestational age or younger is 0%. Zero. So the person in the ad is holding a doll shaped like an infant that has no chance whatsoever of living to see his first birthday.
The manufacturer, Ashton-Drake Galleries, calls their creations “Heavenly Handfuls” and “Tiny Miracles.” One of their dolls is the “God’s Greatest Gift Tiny Sleeping Baby Figurine.” I hear choir music.
Is it just me? Do you have to be a doctor to see in this “tiny miracle” a world of parental grief, the suffering of a truly helpless and hopeless infant, and medical costs that could easily bankrupt a family?
No, I’m not the only one. Follow that link (a blog entitled “A Little Pregnant”, circa 2005) to witness this cruel joke of a doll as well as the blogger’s photoshopped spoof. From A Little Pregnant’s comment thread,
You forgot to mention that the baby should come with realistic hardened skin patches and white scars on its cheeks, from the surgical tape used to hold the baby’s oxygen tubes (CPAP and canula) in place. And underneath the adorable cap–which should, of course, be a tube of stockinette pulled off a roll and tied with curling ribbon–there should be another IV bruise, from the head IV done after all the little arm and leg veins had bruised and collapsed.
EXACTLY. But I doubt the target audience, whoever they might be, would think of that.
It gets worse. Far, far worse. Another “artist” apparently creates lifelike dolls to memorialize deceased preemies. The doll is described as “reborn” and has been given what I suppose might be called a “rebirthdate.” The “artist” is proudly Pro-Life.
Reality check: here is a premature infant born at gestational age 27 weeks, weight 280 grams.
I’m suspicious that the Ashton-Drake people have a political agenda, but I can’t prove it; so, for the time being, I can’t make this a Pro-Life (hah! riiiight) vs. Pro-Choice issue.
It’s a simple matter of poor taste.
D.
Some lessons I can’t seem to learn, no matter how often life provides me the necessary raw data. I should have figured it out as an eight-year-old, son to a mother with myriad health problems, most of them imaginary.
I can’t make it all better.
Some patients come away from my office happy: the ones with wax impactions or swimmer’s ear, folks with deviated septums, nasal passages full of polyps. Those folks are better for having met me. But the people who need help the most are the ones for whom I’m the most powerless.
Today, I diagnosed a bad chronic illness in a very young patient. (Doctor-patient confidentiality prevents me from giving you the details.) Suffice to say, I know full well what this patient is facing.
What can I do? I can make the diagnosis. I can share what I know about the disease. I can line up the necessary specialist consultations. But I can’t cure my patient — I can’t make it all better. I can’t even take the fear away, because I know a lot about this illness, way too much to allow myself to build false hope.
Ages ago I learned that sometimes, just being there is all I can do, and sometimes, that’s enough. I know this. And yet on a deeper level, every single damned time this comes up, I want to make it all better.
I’ll argue with anyone who says this is a feature of a good doctor. Wanting to solve the unsolvable might make me a fine medical researcher*, but it does nothing to help my patients.
D.
*and we all know how well that turned out.
So a new patient storms out of the waiting room before he ever signs his paperwork. In fact, that’s the precipitating factor for his hissy fit — “MY LAWYER TOLD ME TO NEVER SIGN ANYTHING!” After cussing out my office staff (yes, he was verbally abusive), growling, fussing, and fuming for several minutes, he leaves.
And I think: Cool. This problematic, unpleasant dude weeds himself out before he becomes my patient.
And that’s the coolest thing about this situation: he’s not my patient. I have no doctor-patient relationship with him. I can talk about him all I like, and I’m not violating confidentiality rules. Not that there’s much to say; you’ve heard the whole story.
I suppose I should be more compassionate about this situation. Maybe he really does need an ENT. Maybe he’s too senile to understand why his doctor sent him here, or maybe his doctor is an uncommunicative cuss who never told the patient why he (the doc) made the referral. Maybe this old guy will experience untold suffering as a result of missing today’s visit.
Call me a heel, but all I see is one less headache.
***
Here’s a dirty joke for you.
This husband and wife have always had sex with the lights off. Pitch dark, that’s how he likes it, and she has been happy to oblige.
Lately, however, she has begun to wonder — why all the secrecy? What’s he hiding from me? So one night, in the midst of a good rogering, she reaches up and turns on the end table lamp — and finds him holding a dildo!
“A dildo,” she says.
“Ah, yup,” he says.
“Is that why we’ve always had sex with the lights off?”
“Ah, yup.”
“Would you like to tell me why?”
“Sure,” he says, “when you explain how we got three kids.”
D.
What is it with some of these old people? I’m talking about the 80-and-above crowd, the ones who think their prejudices are nothing more than cute eccentricities. Like my grandmother, who once told me, “I hate the Chinks, ever since they bombed Pearl Harbor.”
Or that old geez back in San Antonio — have I told you this story? — who regaled me and my Chinese resident with a ni**er joke. Our gaped-mouth expressions didn’t slow him down; damn it, he was ridin’ this one all the way to the punchline. Yee-haw!
Two patients in as many weeks have dropped the J-bomb on me. Not Jew, although that happens with fair regularity, too. Jap. One guy, dripping with pride, “shared” that he had told off his “Jap doctor”:
I told him, “I took care of you people in the War and I have no use for you now.” He just said, “We’re through here. ‘Bye.”
And another guy “shared” that his request for benefits had been denied “by a Jap.”
“I guess since I killed so many of ’em in the War, they’re getting back at me now.”
Uh-huh. Really.
I told him (unfortunately, sans hyperlink) that many Japanese-Americans had served their country bravely during the war. His response? “Yeah, well.”
When these bigots show me their colors, do I shoo them from the office? No. Do I deny them any of the benefits of my service? No. That would be unprofessional.
But will I go the extra mile for them? No effing way. I do what the doctor-patient relationship requires me to do and no more.
/rant.
In other news: Watch Countdown with Keith Olbermann tomorrow night. In his Special Comment, Keith is gonna call for the resignations of Bush and Cheney! His Special Comments are always worth watching again and again. Afterwards, I’ll try to find it on YouTube ASAP and post the link.
UPDATE!
Here it is: Olbermann’s ultimate rant, linked at Crooks and Liars.
D.
Live-blogging tonight: 7:30 PM PST, or thereabouts.
We were watching the end of Dirty Dancing this afternoon, and I said, “Whatever happened to Jennifer Grey?” She was adorable in that movie. Can’t say I ever thought much of Patrick Swayze, but Jennifer? Yum. Guess how old she was in that movie. Don’t cheat, guess. I’ll tell you later.
“I think her career tanked after she got her nose job,” Karen said, which sparked my interest, given our discussion of noses in yesterday’s post. So I decided to see what I could learn on IMDB and Wikipedia. Now remember what I said — don’t cheat. Think back to Jennifer’s role in Dirty Dancing and guess, damn it, guess!
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When I bought The 2007 Guide to Literary Agents on Barnes and Noble’s website the other day, the site suggested I look at Noah Lukeman’s The First Five Pages, A Writer’s Guide to Staying Out of the Rejection Pile. Sounded worthwhile, so I bought it, figuring if it could teach me even one new thing, it would be worth the purchase price.
The author is a literary agent and former editor. His goal is to let you, the writer, know what criteria an editor or agent uses to toss manuscripts into the round file.
While evaluating more than ten thousand manuscripts in the last few years, I was able to set forth definite criteria, an agenda for rejecting manuscripts. This is the core of The First Five Pages: my criteria revealed to you.
Here’s the first part of the table of contents, with my words of explanation in brackets. Part I is called “Preliminary Problems”:
Presentation [manuscript format]
Adjectives and Adverbs
Sound [rhythm]
Comparison [use and misuse of imagery]
Style
Part II is “Dialogue,” Part III, “The Bigger Picture” (show vs. tell, characterization, pacing, etc.) I suspect I’ll have much more to say about The First Five Pages as I work through it, but here’s my early opinion: this book looks like a keeper. I’ll keep you posted.
And since I got slammed at work today and I’m having trouble keeping my eyes open, this is all I have for you tonight. Sorry!
In fact, this day reached such an acme of suckitude, I was tempted to begin a new Thirteen: Thirteen Unglamorous Things about my Profession.
1. “I hope you don’t catch what I got,” she said after coughing in my face.
2. “Cover your mouth when you cough,” the child’s mother said after her old-enough-to-know-better child fired off his fifth snot rocket.
3. “I didn’t mean to do that,” my nosebleeder said, gazing with wonder at the pointillistic spray of blood across my eyeglasses and facemask.
4. “GhhhRRRAAARGgggllll omigod RAARGH RAAAAAAAARGH,” my nosebleeder said as we both discovered what had happened to all that blood she’d been swallowing over the past four hours.
Ugh. I don’t think I could manage thirteen of these without making myself sick.
D.
I had a counselor in junior high who took one look at my aptitude test scores and told my parents (and me): He can be anything he wants. For some reason, I thought that would stick with me for life, and I suppose I still believe it*. I try to reinvent myself every ten years or so. What will it be when I turn fifty — playwright? Bungee jumper? Aging midget porn star?
My counselor and my parents never taught me that as I got older, as I made one decision after another, I would box myself in. Throughout college and med school, I had a vague notion this was taking place. But every single one of those decisions seemed like the right thing to do; and even with Monday morning quarterbacking, it still seems like I made the right decisions.
I’m in a thoughtful mood because of today’s post from Blue Gal. It’s a poem, and the author has given permission for folks to reprint it on their blogs, provided we keep the author’s byline. Join me below the fold for poesy and a bit of discussion.
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