I went to Grand Rounds today* at our nearby non-major-world-religion-affiliated hospital, where the speaker gave a talk on transgender medicine. Interesting stuff, especially the historical bits in the beginning.
It was a mixed crowd. At least one residency program rotates their docs-in-training through this hospital, so there were lots and lots of young faces. Neat! Have I mentioned how much I miss teaching and just being around residents? I do. Anyway, I spotted a few of the local docs, some young, some old. Some very old. Some docs when they retire, they hang up the stethoscope for good; some docs keep coming back to grand rounds because, well, I guess they love medicine and they like to keep up with new things. I can appreciate that.
One old guy must have been pushing ninety — tiny, hunched over, but with a briskness to his step. After the talk, he left the conference room with some of the other retirees, and said to one, “They never taught us about THAT in medical school.”
I felt like telling him, “I graduated in ’90, and they never told US about that, either!”
Add transgender to the list of Things Not Even Deserving One Hour of Lecture Time, along with nutrition and . . . well, sex. Did we get any talks at all on sex? I remember one of my female friends asking a lecturer about dyspareunia, eliciting titters from some of the students and sidelong glances at her blushing boyfriend. But that wasn’t even a lecture on sex; I think it was a lecture on genital anatomy. And NO, that does NOT count as a lecture on sex.
Sometimes I think we’re still a very provincial, puritanical nation, even in our institutions.
One lecturer even saw fit to warn us of the dangers of provincialism. Here’s the story he told the class:
This was some years ago, when most gay men outside of San Francisco remained closeted. A fellow from one of the suburbs an hour away used to come into town on the weekends, do his thing, then on Sunday evening return home, where he worked the usual Monday-through-Friday nine-to-five job. One Monday evening he developed severe abdominal pain and drove himself down to the local hospital’s ER.
The man’s abdomen was tender but not yet rigid. Who knows what the ER doc was contemplating — perhaps a general surgery consultation to evaluate the patient for appendicitis. That, at least, would have made some sense. But the patient made the mistake of telling the doctor the truth. “We were fisting,” he said.
After explaining to the doctor what this meant, the doctor decided his patient was delusional and gave him a fat shot of thorazine, which knocked the patient out. They kept him on thorazine for the next day or two . . . however long it took for the supervising physician to note that his patient had gone into septic shock. By the time anyone realized what had happened to the man, it was too late.
I took this story to heart as a cautionary tale. A doctor’s ignorance could be deadly to his patients.
Which is why, of course, I try to keep informed on all of the newest paraphilias 🙂
D.
*The idea being to shmooze the local docs . . . but they were all far more interested in the speaker than in me, a new face in the room. Oh, well. I’ll try again in a couple of weeks.
No, not a post about Palin v. Biden. What were you thinking? We’re talking about me. That’s what this blog is about, after all. Me me me.
Here’s the issue. The getting-to-know-me page over at doctorhoffman.com looks like this. Karen wants to nix the photo and replace it with, say, something like this.
“No one wants to think their doctor is a seventeen-year-old boy,” Karen says. Even Doogie Howser was in his twenties, right? But I like that old photo. As I was telling our audiologist today, that’s my mind’s picture of me, not the dude you see above.
Not only that, but I think the photo of the little pisher is amusing. It has personality. It’s fun. And as I told one of my patients last week, “I’d rather be a bit unprofessional and have fun than be professional and boring.” I had been joking around with her about something or another, and she seemed to be enjoying The Wonder of Me, so I wasn’t too surprised when she agreed with me.
I can be irrepressible at times. This isn’t always a desirable quality for someone in such a grimly serious profession.
True story: many years ago, a woman came to see me for a wart inside her nostril. When I told her it was a wart, she said, “A WART? How the hell did I get a WART up my NOSE?”
I didn’t even think before answering.
“Oh, I don’t know . . . where have you been putting it?”
Fortunately for me, she laughed, and the State Medical Board was none the wiser.
The boss and I got to talking about ear candling today, and I told him about Quackwatch, which has an article about candling that always makes me want to holler, “NAILED!”
If you’re not familiar with candling, here’s the concept: a practitioner (certified earconologist — but I’m getting ahead of myself) puts a coiled, wax-lined paper tube into the patient’s ear, lights the distal end, and lets the thing burn down a good way, taking care not to let the patient’s head catch fire. In some descriptions I’ve read, the practitioner positions the patient on a massage bed in a dimly lit room, no doubt with patchouli burning and Yanni playing in the background. For this, he charges thirty to sixty dollars. He cuts open the candle stub to reveal all the wax and ill humours the candle has sucked from his client’s head.
If the client has the temerity to point out that the material in the candle looks nothing like the stuff at the end of his Q-tip every morning, the certified earconologist makes up some crap about the candle pulling all of the yeast out of his client’s body. No fooling — patients have told me this.
Needless to say, the whole thing is a ridiculous con which bases its entire therapeutic effect on the fact that it is, indeed, relaxing to lie still for a number of minutes in a quiet room, in a comfortable position, with soothing music in the background, without a care because at least for the time being someone ELSE is making decisions for you. (Hey, that’s why I enjoy massages!) And how great is it for the certified earconologist? Unlike my masseuse, the earconologist needn’t break a sweat. He’s . . . um, I guess he’s monitoring care. Yeah, that’s it.
Dr. Roazen, author of that great Quackwatch article, has been updating her debunking. She now links to a website with information enabling you, too, to become a Certified Earconologist. (My favorite part? For only $125, you can get a medical degree of sorts. I wish someone would have told me about it over-$70000-and-seven-years-of-my-life ago. And whoever runs this site is above all a responsible practitioner, no sleaze: “Ear Candling can not be done safely without the use of an Otoscope as it is impossible to examine the inner ear cannel without one.“)
There are even easier jobs out there, though. Consider Touch Therapy, where the practitioner doesn’t even need to touch the patient, only his aura. How cool is that? I can only begin to imagine the conversations between the touch therapist and his receptionist . . .
Tough one, Dr. Walnut?
That’s the understatement of the decade. Her chi was in shreds! I had to apply every ounce of my prana to get her Anahata recharged. I think my Sahasrara is still up her Bindu!
Oh, you poor dear. By the way, I renewed your subscription to Popular Anthroposophy.
Thanks. Fix me a hot cup of ginseng tea, would you?
Packing the office and home will take two days. After that, there will be a day to load, a day to ship . . . altogether, it’s a four-day affair, and we’ll have our stuff back on Saturday. Then we have to unpack & get internet service before Balls & Walnuts will be back in full swing.
I’ll see what I can do from the Blackberry, but I have a sneaking suspicion I’m going to be busy.
***
Today was my last day seeing patients in Crescent City. I came here ten years ago with my wife and not quite three-year-old son, escaping Texas to find a cooler, fire ant-free environment for my family. We’ve loved being here. Honestly, I didn’t think we would ever leave.
I remember my first patient, a crusty gal whom I still see every few months. I wonder if she’ll follow me to Santa Rosa. Several of my patients say they will, and some have even set up appointments. But I guess it’s asking too much of people — after all, it’s a six-hour drive.
I’ll write more about this when I have some perspective. For now, an observation: except for childhood, this is the longest I’ve lived in one place; it’s also the longest I’ve ever worked at one job.
Edited to add: It’s 11:14 PM. Only 46 minutes left of call in this community. Oops, make that 45. After that, several weeks will pass until I’m on call again.
What the hell will I do with myself?ÂÂ
You knew I couldn’t leave Crescent City without
. . . one last narrowly averted airway disaster. I guess the Fates figured I still had a few hairs left to lose (or turn gray).
. . . one last patient who made us glad we keep disposable plastic sheets on our exam chair. Actually, we’ve had TWO of these people, and I’m still seeing patients until the 12th. Somehow, I think we’ll go through a few more of those sheets.
. . . one last brainsucker. For the fourth time, why are you here to see me today? Hint: it should have something to do with your ears, your nose, or your throat.
. . . one last (but not least) misguided attempt to convert me.
Several years ago, one of our local primary care docs died in a kayaking accident. He was one of these sweet, gentle men whom you couldn’t help but like, and it turned out his patients adored him, too. I went to his memorial, and the outpouring of love from his family, coworkers, patients, and colleagues was impressive.
I remember thinking, more than a little selfishly, “If I died suddenly, I doubt I’d get one-hundredth this kind of response,” and, “You have to be a primary care doc to earn this much affection*.” I figured I would never know, short of a Mark Twain-esque visit to my own funeral. But at the time, I never thought I would leave this area. Which is kind of like visiting your own funeral, if you think about it.
So, yeah, I was wrong. And while the outpouring still hasn’t ranked with what Wayne got, I think my “one-hundredth” is a low-self-esteem underestimate. One-tenth, how’s that? Which is still WAY more than I was expecting.
Aside from the quilt (and that photo really doesn’t do it justice), I’ve gotten cards, hugs, countless guilt trips, a potluck today, more hugs, and a cool digital frame with a slide show just for me.
The steady onslaught surprises, overwhelms, stuns me. I clean ears. I take tonsils out. I don’t deliver babies, I don’t take the pain away from the beloved grandmother in her final days, I don’t counsel the teenager who is too afraid to talk to her parents about her drug problem or her sex life . . . do you see where I’m going with this? How does a booger doc warrant this sort of feeling?
It may be a question of personality. I talk to people. I don’t crank them through in two minutes. Our office works very hard to get people seen on time (it’s rare to wait more than five minutes in my waiting room, yesterday being the freakish exception), and we follow up on damn near everything. So maybe people respond to the idea of a doctor/office that cares, regardless of the fact it’s (usually) something non-life-threatening at stake.
Or perhaps the things I treat ARE a bigger deal than I give them credit. It’s all well to say that “life-saving” is more important than “life-improving,” but if you’re miserable with your sinuses or your reflux or your hearing loss and someone like me makes your life better . . . well, okay, I can see where that would earn brownie points.
Perhaps people regard quality of life as more important than quantity?
Thanks for bearing with this guy’s ego-show.
D
*And not just any primary care doc. Wayne was special.
My last OR day is 7/30. My last day in this office is 8/15. My first day in Santa Rosa is 9/2.
I get annoyed when patients assume I’m retiring. Either (A) they think I’m old enough to retire, or (B) they think I’m rich enough to retire. Neither is true, although (B) would be nice. Sadly, I chose the wrong field for early retirement. I wish I had been one of those lucky sods who hit it big during the internet boom, one of the ones who got out at the right time. If I had, I wonder what I would be doing with my riches and leisure time right now? Because I’m a working boy, after all; no Long Island Ice Tea on the 40-foot sloop for me.
So: what early retirement really means is the freedom to do the work I love and not have to worry about making a living. I suppose I could write part time, maybe keep up some sort of boutique medical practice on the side. I like medicine, but the 9 to 5 (or more often, 8 to 5 or worse) five-day-a-week grind is tiring.
I’ve often thought it would be fun and challenging to establish a medical consultancy practice catering to folks who feel that everyone else has given up on them. I wouldn’t be able to fix most of these people, but I could promise them that I would research their situation and come up with a plan of action that would have the best chance of producing results. I would run a cash operation and bill by the hour like a lawyer.
Yeah, that’s the dream. It’s sort of the opposite end of the spectrum from my present reality. Fact is, from medical school onward, a large fraction of my time has been devoted to indigent care. While I don’t mind this, at some point I have to step back and take a look at what it’s costing my family.
Even in this idealized practice, I could, of course, donate a portion of my practice to charity cases. Ten percent is the figure most often quoted as the amount necessary to facilitate an untroubled night’s sleep. I’m doing a LOT more than that at present.
Meanwhile, I’m doing the 8 to 5, and that’s not going to change any time soon. I’m afraid 8/15 can’t come fast enough, though. (Sorry, patients!) The steady rain of guilt has turned into a torrent. The guilt has matured, in fact. Used to be, I felt guilty for leaving my patients. Now I’m burnt out, guilt-fatigued, unable to feel much genuine guilt when patients insist, “Noooooooo, you caaaaaan’t leeeeeave!” And that makes me feel guilty in a different way, since I don’t seem to be capable of acknowledging their feelings with any true empathy. My honest reaction is, “Yeah, yeah, life’s a bitch. Next!”
Isn’t that awful? And yesterday, the daughter of one of my patients brought in a “crazy quilt” she made to thank me for the care I’d given her mom. It took her six months to make this. Six months. She started it even before she heard I was leaving, and she didn’t stop it when she did find out.
