Author: wellthy

Humor is good medicine. I always tried to inject a little humor into every visit. Making patients smile or laugh, even for a moment, made them feel better.  Sometimes, I flopped.  Everybody has a different sense of humor.  On an occasion, the patient, having been lifted by laughter, responded with a joke of their own. 

When patients relaxed and started telling their own jokes, I would get a glimpse of who they really were.  Assessing a patient’s sense of humor quickly showed me a side of their personality that the standard review of personal history and their health inventory would have never revealed.  Sometimes sharing jokes created a bond/rapport with my patient.

Sometimes, I discovered a side I was uncomfortable with.  Either way, joke telling is revealing.  Towards the end of my practice, I used joke telling as a diagnostic tool and, on occasion, as a teaching tool.

As a child, one of my favorite jokes was the following:

The president of Mexico and the United States were at a conference in New York.  While on a break, they went to the bathroom, standing at the urinal (I’m sure Donn was in the urinal).  The president of the US finished urinating first and as he was walking out, the president of Mexico said, “Mr. President, in Mexico, they teach us to wash our hands after going to the bathroom.”  The US President responded, “Mr. President, in the US, they teach us not to pee on our hands.”

At the time, I thought it was hysterical.  I ignored the fact that it presented a degrading view of Mexicans.  Later in life, I went to medical school in Mexico.  In addition to finding out that Mexicans were an intelligent, loving, family-oriented people, they gave me the gift of a medical degree. 

Mexico taught me humility.  Mexicans showed the faulty base on which many of my prejudices were built on.  Forgive me if I’ve told this story before (I have CRS, “can’t remember shit”) but it’s important to tell here.  I was driving into Guadalajara, returning to school after summer break ended when my car broke down.  I was in the middle of nowhere.  The Green Machine, their roadside assistance truck, eventually found a water pump and installed it.  When it was time to put water in my car, they dished it out of a rusted oil barrel. I turned to my passenger and stated, “I don’t want that shit in my car” at the same time a kid walked over to the barrel, scooped up a cup of the brown liquid and drank it.  This family was sharing their drinking water with me.  These were not criminals and rapists.  These were the kind of people you would want for neighbors or family.

What I used to consider funny now is often not funny.  Yes, I still tell jokes at the excuse of ethnic groups or gender, but I tend to tell jokes about my own ethnicity.  As to gender, women know how much I appreciate them, so they are fair game.  I do wonder if our president washes his hands when he leaves the men’s room.  After all, he won’t wear a mask.

EVEN IF YOU DIDN’T PEE ON YOUR HANDS, WASH THEM!  MASKS ALONE ARE NOT GOOD ENOUGH. And, identify and eradicate your own prejudices.  Don’t let a journalists color your vision with their ability to slant the news.

Here’s your daily music and a joke. 

Three old Jewish guys were sitting around the breakfast table talking about their sexual prowess.  The first guy brags that, in the middle of sex, he uses a feather that causes his wife to moan and groan loudly ending in an incredible orgasm.  The second guy says he’s sure his wife moans and groans more than the first guy’s wife.  He says he uses Japanese wonder balls to bring his wife to a screaming climax.  The third guy says, if you think your wife moans, groans and screams more than mine, you are wrong!  He says he’s done 1-2-3, then gets up and wipes himself off on the curtains.  “You should hear her scream!”

I started out intending to write a fairly negative article about telemedicine and then got hijacked by the TV show that was playing in the background.  First and foremost, I think face to face encounters are necessary at least 80% of the time in the medical field.  There are multitude of reasons why an in person medical encounter is essential and the number one reason is developing that “caring” relationship I discussed many times in the past.

Second on my list is obtaining an adequate physical exam.  While telemedicine is in its early stages, home diagnostic equipment already can provide the phone doc with BP, pulse rate, temp, weight; and my bet is that, in the not too distant future, a telemed doc will be able to see inside your throat, ears, nose and listen to your chest and abdomen.  Of course, a Facetime rectal (I’ve got to come up with some other term) is going to be a little more uncomfortable; and a pap, well, I’ll leave that to your imagination. Treatments will be defined by protocol.

In the future world of telemedicine using the home diagnostic equipment described above, will you really need a doctor, or will a computer program suffice?  When I think about it, and I do, a computer could do just about everything I did with the exception of caring for you, as an individual.

It’s my core belief that the true art of medicine is in the ability to develop multiple, caring/trusting, relationships. 

Now back to that TV show playing in the background.  I must confess, I’m a Judge Judy junkie.  There’s just something about watching an authority figure put aside political correctness and call an idiot “an idiot and a stupid one to boot.” I love the fact that she doesn’t take shit from anyone and her judgements are final.  She’s also quite humorous!  You rock, Judge Judy!

So, what’s Judge Judy got to do with telemedicine?  Well, the case she was hearing pertained to a internet scam based on developing a trusting/ caring internet relationship.  As I watched this woman make a complete fool of herself, I thought about a patient who sent hundreds of thousands of dollars to a Nigerian address because of a similar scam.  Researching this scam made it apparent that caring/trusting relationships can be made over the internet and maybe, just maybe, telemedicine can replace the conventional doctor patient relationship I hold so dear.

NAH!  That’s bullshit.  Telemedicine may be good for small things and routine follow-ups, but, for the stuff that really counts, in-person care will always be preferable and, in most cases, necessary.

Here’s your music for the day and a joke. The Judge said to the defendant, “I thought I told you I never wanted to see you in here again?” 

“Your Honor,” the criminal said, “that’s what I tried to tell the police but they wouldn’t listen.”

I employed MDs, RNs, NPs, LPNs, MOAs, PAs, Lab and X-ray techs and had the privilege of working with some pretty incredible people.  When interviewing for a clinical position, my number one goal was to hire true care givers.  While I could train anybody to do a strep test or a urinalysis, I could not train a person in the art of caring.  Either they were caring individuals when they walked through my door, or they weren’t.

I interviewed Kathy in my family room.  The office was still under construction, so I did all of my hiring at home.  I fell for Kathy on our first interview.  She was an X-ray tech who ended up being a manager, purchasing agent, nurse and lab tech.  She taught me the importance of recognizing an employee’s ability, not the letters after their names.  I thought I would have to close the office when Kathy left. Obviously, I learned to function without her.  That lesson would serve me well, as other remarkable care givers came and went over the 35 years I practiced in LZ.

When I opened the office, my physician mentor told me I should plan on keeping staff members for no more than 2 years.  From a strictly business point of view, having a transient staff decreased payroll and employee benefits thereby increasing the bottom line.  I’m happy I ignored his advice.  Many of my employees were with me over 20 years and, as stated previously, became family.  The other thing he told me turned out to be true.  There are two types of answering services:

1. BAD
2. WORST THAN BAD

That’s why I gave patients my cell number.  There was a major drawback to giving patients my cell number and it’s not what you think.  The problem was that patients wouldn’t use it.

Me – “Why didn’t you call me last night when the chest pain started?”

Patient – “I didn’t want to bother you or wake up your wife.  I figured it could wait until the office opened.”

I truly appreciated the concern the patient had for my family and me but would have rather been awakened at 3 am rather than going to the CCU at 7 am.

Like my frontend staff, my clinical staff often caught flak for long waiting times.  Unlike my frontend staff, they did get a fair amount of kudos for the care they gave once the patient was in the exam room.  Over the years, they literally saved 100s of lives.  I would be in another exam room when the staff knocked on the door (or curtains during the first 5 years) and advise me that the patient in another room needed to be seen immediately.  Sometimes, I got pissy thinking my staff member was over reacting.  Nine times out of 10 they were right, and the paramedics ended transporting the patient to the hospital.  Seven out of ten times the severe indigestion was a heart attack.

Of the many talented people I worked with, Mary Krock MD, Maki O, Barb M, Ewa, Olga and Barb W stand out.  Each developed close ties with our patients.  Each stepped up into leadership roles when necessary.  Each grew in their abilities to the point that, when they left, I wondered if I could go on.

Maki was a special case.  I actually did her high school physical and mentored her during her physician assistant training.  We had a blast working together.  She had a great sense of humor and a phenomenal work ethic.  When she told me she wanted to live in Alaska, I thought she was joking.  When I realized she wasn’t joking, I cried.  Now, thinking about Maki instantly puts a smile on my face.

Ewa was a medical office assistant whose work ethic was second to known.  When she took on a task, she perfected it.  From an inexperienced young MOA, she progressed over the years and eventually took over the management of my Concierge practice.  Many of my Concierge patients stayed in the program so they could work with Ewa.

The other staff member that deserves special mention is my wife.  Most patients thought Dawn was my wife.  I’m not sure why but suspect it was the way she said “no” to me or ignored me.  Renee the boss.  She ran the business side of the practice so that I could concentrate on patient care.  Like the other staff members, she had a host of letters after her name including MBA, Certified Coder, Masters of Speech, etc.  She was the keeper of the books; and, when there wasn’t enough income to pay the bills, she figured out how to keep the doors open.  When there wasn’t enough income to pay Christmas bonuses or give the staff raises, she took the hit!  I COULD ALWAYS DUCK THE ISSUE BY SAYING, “ASK RENEE”.  Yes, I was the good guy and she became the de facto bitch when necessary.   

One thing you should never do is count someone else’s money.  Most people assume docs are rich.  Family docs make an OK living working 80 hour weeks but rarely get rich.  Since Covid hit, primary care physicians are going broke. 

Nonetheless, the assumption that the boss is making a fortune at the staff’s expense is certainly false in the medical world.  There were times over the years when Renee paid the staff first and there was nothing left over for us. (Please pay your docs before anyone else and, for sure, don’t tell him/her about your fantastic vacation to Ireland when you owe the office $500.) 

The rest of the LZ family was made up of the patients.  As a young man, I had planned on settling on the outer banks of North Carolina.  I love water, fishing and boating.  I got trapped in LZ and it was the best thing that could have happened to me.  My patients were the best in the world.  Overtime, they became family members.

Here’s your music for the day and a joke.

A father buys a lie detector robot that slaps people when they lie. 
He decides to test it out at dinner one night. 
The father asks his son what he did that afternoon. 
The son says, “I did some homework.” 
The robot slaps the son. 
The son says, “Ok, Ok, I was at a friend’s house watching movies.” 
Dad asks, “What movie did you watch?” 
Son says, “Toy Story.” 
The robot slaps the son. 
Son says, “Ok, Ok, we were watching p*rn.” 
Dad says, “What? At your age I didn’t even know what p*rn was.” 
The robot slaps the father. 
Mom laughs and says, “Well, he certainly is your son.” 
The robot slaps the mother. 

Over the 35 years I practiced medicine in Lake Zurich, I was lucky to work beside some of the most caring and talented people in the field.  In many ways, we became a family.  We worked together, ate together, laughed and cried together.  We each had a role in caring for our patients, some behind the scene in the back office, others in direct patient care.  I’ve been telling my story; but, realistically, my story would not have existed without my supporting staff.

My front desk was like the palace guard.  They assessed patients from the minute they walked through the front door.  They registered new patients and updated the established patient’s record every time a patient walked in. The demographic information they collected was important as, without it, I wouldn’t be able to contact you with critical findings that showed up the day after your appointment.  The insurance information they collected told me what rule book we were following and kept the office in the black.  Patients never understood the importance of the data the front desk collected.  Some patients got downright pissy. The front desk took a lot of flak.

“I just gave you my insurance card last month!  Why do I have to give it to you again?  I just filled out those papers last month, why do I have to do it again? (At my last visit to my urologist, I told the nurse I was seen 6 months ago.  It had been 3 years, Oops!).  I’m sure my wife paid the bill.  All you care about is money!  I just want to ask doc a question, do I really have to register? It’s been 20 minutes; how much longer do I need to wait to see the doc? 

The longer the wait, the pissier some patient became.  Some actually got hostile.  Some made the check-in staff cry.  Thankfully, there were the Shirley and Mels of the world who, at every visit, made sure the staff felt appreciated.  They became part of the family.  Shirley and Mel had a fantastic garden and they would bring fresh vegetables for the staff.  They were old with poor eyesight and arthritis and tended to let their cucumbers and squash stay on the vine too long.  Their cucumbers were humongous and could have been used as a club to beat the pissy patients into submission (I actually thought of clubbing a patient who made Dawn cry).

The collections team got the most abuse.   A medical practice needs money to pay the bills, payroll, buy supplies, etc.  We carried hundreds of thousands of dollars on the books and too often, had to fight to get paid.  The person responsible for collecting that money took a lot of crap form patients.  What patients failed to understand was that sitting at that desk was a loving, caring individual who would bend over backwards to make accommodations for the patients she came into contact with.  If a patient was broke, she would write off their bill or set up a payment plan for as little as $5 a month.  She was also afraid of anything that crawled or flew. I had a lot of laughs at her expense.  Once, we had a mouse in the lunchroom.  I’ll never forget the look on her face as she stood on the chair as if the mouse was hunting for her.  All the little creature wanted to do is pay its bill. I miss her!

The back office was the home of the coders.  Dealing with insurers is like dealing with Satan, herself.  Yes, the devil is a female.  She was CEO of Blue Cross for a while.  When the insurance companies took over my world, they did it with codes and fancy words.  I became a “provider’ and my job was to distill everything I did down to a series of numbers.  A short visit became a “99212”.  There were numbers for everything.  Getting those numbers rightwas a bitch.  It was also expensive.  Behind the scenes were the unsung heroes who coded and recoded each visit so we could get Satan to approve your test/procedure or to fork over what she owed us. It wasn’t easy.  Coding demands are increasing and, in some reports, account for 40% of your doc’s time.  What a pity!

Today, my point is that there is a lot more to a doc’s office than meets the eye.  There are hardworking, caring individuals who keep the office open and functioning.  They need to be treated with respect.  They are there to make sure you have a place to go for medical care.  They have rules, set by their employers, that they must follow.  Please don’t take out your frustration with the medical system on them.

Be a Mel and Shirley, not a Pissy Patsy.  You don’t have to bring them cucumbers (although they are always happy to be fed) to get good care. I don’t think I ever told them how much I really appreciated them.  I truly appreciated them, and I miss them!

Tomorrow, I’ll write about the clinical staff and the role they played in our lives.

Here’s your music and a joke.

A man and his wife were sitting in the living room discussing a living will. “Just so you know, I never want to live in a vegetative state, dependent on some machine and fluids from a bottle. If that ever happens, just pull the plug,” the man says. His wife got up, unplugged the TV and threw out all the beer.

Since retiring and moving to North Carolina, I’ve realized that one of the key tenets of medicine is wrong.  I was taught to keep a professional distance between my patients and myself.  Supposedly, if you are married to or friends with a patient, you can’t be objective. Therefore, you are not supposed to be friends with your patients, and you are not supposed to treat your family.

Looking back in time, I wonder how different life would have been if we had been friends in addition to doc and patient. I’ve certainly enjoyed and now miss the meals I’ve shared with some of you since retiring.  Two of my patients have become my best buddies and we talk by phone often.  They are the reason for this article.

I know I’m playing the “Should have, Could have” game I’ve written about in the past but I’m realizing how many friendships were stifled by a stupid rule of medicine.  Frankly, the more I knew about you and cared for you, the more objective I became.  The key word is care.  Medicine without care is by its very nature, “careless.” Caring for you meant I had to be more objective, cover every possibility.  It meant staying awake at night going over your chart, looking for the answers that would protect you.

It was not uncommon for a patient to tell me a story of how they perceived that a physician had hurt them or a loved one.  Often, the question was, “Should I sue them?”  The answer to that question was easy.  I explained that if the doc made a mistake while he/she was “caring” for the injured party, they should not sue.  Humans make mistakes and docs are human and you want a human taking care of you.

If the doc made a “careless” mistake, then he could be sued.  So, does your doc care about you or are you just a number on a chart?  So, if your sense is that your doc doesn’t care about you, find a new doc.  Remember, the definition of careless: without care and that carelessness leads to mistakes.  If I had a patient I didn’t care about, I invited them to find another doc.  Yes, there were people who were impossible to care for.  Interestingly, they often were married to individuals who were easy to care about.

Maybe things in medicine have gotten so bad because docs are trained to keep a professional distance and not show their emotions. I think my patients know how much I cared about them and their families.  Certainly, many of you have seen me cry.

At first, I was embarrassed when I cried in front of patients.  I was supposed to be the strong, authoritative personality who had the right words at the right time.  I fought the tears and gave my support to what ever my patient was going through.  As I matured, I realized that trying to hide my emotions was counterproductive.  When telling a family their loved one had passed and their loved one was someone I had cared for over many years, it took too much energy to hide the tears that so needed to flow. So, I let them flow and cried with the family. Eventually, the nurses joined us, and the process of mourning ensued.

Does your doc care about you? I bet you know the answer.  When I interviewed new specialists who moved into our community, the first thing I looked for was not their credentials, it was how caring they seemed.  I didn’t need the smartest specialist.  I needed the most caring specialist.  The most caring specialist would always come up with the solution to my patients’ problem, he/she just had to work a little harder to find it.  In the end, the caregiver who cares trumps the whiz kid who doesn’t.

Does your doc care about you?  Do you care about your doc?  If the answer to both questions is yes, then I think it’s fine to be friends.

Here’s your music and a joke.

My best mates and I played a game of hide and seek. It went on for hours… Well, good friends are hard to find.

Sometimes, a true friend offers a paw instead of a hand.

Crocodiles are easy. They try to kill and eat you. People are harder. Sometimes they pretend to be your friend first. – Steve Irwin

I used to love this time of year.  The kids were actually excited about back to school shopping.  I was excited about back to school exams.  School physicals were really fun.  Other than some apprehension about “shots,” many of the kids looked forward to coming to the office.  In the early years, there was even time to practice a little magic and there was a TCBY on the corner near my office that gave me prescription pads for free frozen yogurt for kids receiving shots.  The trade, one shot for 1 TCBY, went over really well. School physicals were $5 with summer specials coupons.  Hard to believe, isn’t it?

Preventative care was the heart and soul of my practice.  While recent articles have implied that physicals are useless, they are wrong.  Having the time to review diet, exercise, family life, safe sex, immunizations, etc. was invaluable.  Reviewing the kid’s vaccination status and discussing the benefits of Gardisil, an HPV vaccine, was critical.  Today, we need to discuss Gardisil.

HPV is best described by the word, “nasty!”  Its cardinal sign is venereal warts that grow on the genitalia and elsewhere.  It is one of those presents that you never want to receive as, once you have it, it tends to recur on a random basis. To make matters worse, when a young man or woman has it, I have to inform them of a list of rules and information that is truly earth shattering. I also have to worry that my patient will become suicidal and more than once, I’ve had to put kids on suicide watch.

Me – “Johnny, you have venereal warts on your penis and in your pubic area.  They are caused by a virus called HPV. They are contagious.  You will need to let any future sex partner know that you have them.  Condoms will protect others from lesions on your penis but not from those in your pubic area.  Some individuals will clear the virus but you can’t count on that.  As to the ones present today, I can freeze them, and hopefully, they’ll go away.  There are other ways to destroy the warts including coating them with acid and using an immune modulator cream.  (Coating your penis with acid sounds fun, right?) Oh yes, one last thing. Some strains of HPV are associated with cancer.”

Now, do you understand why young patient might contemplate suicide?  Yep, it’s easy to see how that could occur.  What’s not easy to understand is why parents refuse to protect their children against HPV.

Parent – “Is it mandatory?  I’ll think about it and discuss it with my husband.”

Me – “While it’s not mandatory, it is very necessary.”

Parent – “My daughter is only 17.  She’s not sexually active and won’t be.  We raised her right.  She’ll be a virgin when she gets married.”

I wanted to ask the mom if she knew what the definition of a virgin was but didn’t.  Just in case you don’t know, a virgin is the ugliest kid in first grade.  Unfortunately, it’s not LOL time. Kids are becoming active an earlier and earlier ages. Instead, I replied:

“Hopefully, her husband-to-be won’t have HPV.  It would be a cruel joke if she maintained her virginity only to get HPV on her wedding night!”

The TV commercials were tear jerkers, ending in a teenager asking, “Mom, dad, did you know I would get cancer?”  I had three patients with HPV related cancers.  One would have been too many, three was miserable. They were older adults who did not have access to the vaccine.

You can read more about HPV on Mayo Clinic’s site.  Please discuss this article with your children.

Here’s your music for today and a joke.

There is a cucumber, a pickle, and a penis. They are complaining about their lives. The cucumber says, “My life sucks. I’m put in salads, and to top it off, they put ranch on me as well. My life sucks.” The pickle says, “That’s nothing compared to my life. I’m put in vinegar and stored away. Boy my life boring. I hate life.” The penis says, “Why are you guys complaining? My life is so messed up that I feel like shooting myself. They put me in a plastic bag, put me in a cave, and make me do push-ups until I throw up.”

First, let me explain that I don’t know who Don is.  But I often asked/wondered who Don is and what the heck Don did to piss off someone.  Bear with me for a moment while I give you a little background.  Old men pee a lot!  Old men on diuretics pee even more.

On our four-and-a-half-hour trip to Atlanta to see Jeremy, I made 3 pit stops.  Don was in two of the bathrooms I used.  Men’s bathrooms have urinals and often, in the urinal, is a rubber mat that is supposed to control splatter and keep cigarette butts and assorted garbage from clogging the drain.  Don’s name is on a large number of urinal mats in US bathrooms.  For some of you, this may be TMI (too much info).

Which brings me to my question: Who is Don and what did he do that was rewarded by having strangers pee on him, over and over again?  We all know that family feuds are the worst.  Did Don piss off his father, brother or sister?  IF so, I’d love to hear the story!  Did Don win a particularly nasty divorce only to have his EX start a company that manufactures urinal mats named Don?  If she did, I think she would have drawn a target over Don’s name to make sure he got the point!

Yep, at 3:30 in the am, my mind can go to weird places.  Every time I aim at Don, I smile, wondering what the hell he could have done. I also wonder whose name I would place on the mat if I owned the company.  What do you think Don did to deserve such treatment?  Whose name would you put on the mat if you owned the company?  Childish, huh? Certainly is!  Sometimes, childish can be fun!

Here’s your music for the day (got to go?) and a joke.

There were three boys all in third grade: an Asian boy, a Spanish boy and a redneck. They were trying to think of games to play at recess when the Asian boy got an idea. “I know,” he said, “we can play ‘Who’s Got the Biggest Pee Pee'”.

“How do you play that?” asked the redneck.

“It’s easy,” said the Spanish boy, “we can play it next recess.”

So when recess time came, the three boys went outside. “Alright,” said the Spanish boy, “Let’s play.”

The Asian boy explained that all you have to do is pull down your pants and whoever has the biggest pee pee is the winner.

And so the Asian boy pulled down his pants and the other two boys were impressed.

Then the Spanish boy pulled down his pants. His pee pee was about the same size as the Asian boy’s.

As the redneck boy pulled his pants down, the other two boys stared in awe.

“You win for sure,” they both said.

Later that day the redneck boy went home and his mother asked him, “So did you make any new friends today?”

“Yup. I played this game called ‘Who’s Got the Biggest Pee Pee’ and the other boys said I won. Is it because I’m a redneck?”

His mother laughed and replied, “No sweetie, you won because you’re 23.”

Continuing from yesterday, I want to share my own personal theory of chance.  Many times, when a patient gets a diagnosis of cancer the first thing they will want to know is how long do they have left.  The oncologist will discuss survival rates in terms of months or years and will ultimately give them a percentage alive at x years.  The next thing that happens is they see me.

“Doc, I’ve met with the oncologist and surfed the internet, and things are dismal.  They say I’m not likely to be alive this time next year.  What should I do?”

Me – “Personally, I don’t believe in looking at odds. Realistically, the odds of me being alive this afternoon are 50/50.  Either I will be alive, or I won’t.  They’re the same for you.  Either the chemo and radiation treatment will work, or they won’t.  Life is a roller coaster ride, once you’re on it, you have to take it to the end.”

“Doc, what if the treatments make me worse?  They say that 20% of patients won’t tolerate the meds.”

Me – “Again, either you will tolerate the treatment, or you won’t.  We’ll have to cross that bridge if we get there. They say that living in the past causes depression and that trying to live in the future, causes anxiety.  They are right!  The hardest thing you have to do is work at not creating future scenarios in your head.  They serve no purpose and cause immense anxiety.  In this case, anxiety is your enemy.  You’re on this coaster for better or for worse.  I’ll take the ride with you and hold your hand till the end.  Hopefully, the highs won’t be too high, and the lows won’t be too low.”

My 50/50 theory assumes that everything is a binary choice; either it will or won’t be.  No matter how well you plan, once you start the journey of life the only firm rules are that the course your coaster takes is uncertain. It would be great if you could enjoy the ride, taking each high and low point as they come, without becoming too anxious about what lies around the next corner.  Unfortunately, anxiety over what’s around the next corner often steals your ability to savor life and rarely does anything positive for you.

In the case of my patient with liver injury, I often wonder if rather than saying that there were 7 cases in the world literature, I had said that the odds were 50/50 (either the patient would be number 8 or not), what the patient would have done.  Oops, there I go living in the past.

At this moment in time, the world is anxious.  Journalists pontificate on what Covid is going to do.  They have models predicting who shall live and who shall die.  They act like they know where the ride is taking us.  They don’t!  They have been wrong all along, simply adjusting their future predictions and forgetting their past ones.  Scientists are just as baffled.  Of course, the internet knows everything and everything you can imagine is published as facts on the internet.  It’s been consistently wrong as well.

I keep hearing an old jingle in my head.  It goes:

Buckle up for safety, buckle up.  Buckle up for safety, always buckle.  Show the world you care by the mask you wear, buckle up for safety always buckle, buckle up.

My advice is to buckle up!  Put your mask on, sit as far away from others on this roller coaster called life, and get ready for a long ride. As the coaster goes upwards preparing for a plunge don’t be too nervous. Following a plunge, things normally level out for a while before the next rise and fall, and the next, and the next…..

Here’s your music and a joke.

Psychiatrist to his nurse: “Please just say we’re very busy.  
Don’t keep saying “It’s a madhouse in here!”

Dog Rules for Stress – If you can’t eat it or play with it, then pee on it and walk away.

It’s really strange.  We spend more than half our lives planning and saving for retirement, then we retire and, in my case, wish we could go back to work.  I’ve seen this phenomenon before and mentally, was prepared for it. My plan was to never retire. I told my patients I was going to die in the office.

Someone said, “Man plans, God laughs.” God must be laughing!  Two nights ago, I got a real treat. No, not that!  What I got was a chance to see my patients in my old office for an entire night, in my dreams!  I was back in my element and happy.  Aside from being the first full night of sleep I’ve had in many years, it was a great trip down memory lane. 

One of the patients I saw took me back in time to the earliest days of my practice and one of my best lessons in practicing the art of medicine.  The lesson is particularly important as it pertains to what is happening in our country today. It has to do with the concept of informed consent.

Everything I did as a physician carried risk.  Every test I ran had the risk of being falsely negative or falsely positive.  Every time I drew blood, I ran the risk of injuring a nerve.  Every medication I prescribed came with risk of side effects.  When the risk was large, no matter how rare, it was my job to give my patient a thorough “informed consent.” 

In this particular case, my patient wanted a medication for a cosmetic problem.  The medication was thought to be somewhat effective for the patient’s condition but there were seven known cases of liver failure in the world literature.  If you asked me, one case was too many, but my patient insisted that seven cases in all the world literature were odds she was willing to take.

Well, I gave textbook perfect, informed consent.  I even had the spouse read the warnings and quizzed my patient and my patient’s spouse about their expectations and their understanding of the risk of taking it. My patient also consented to a monthly liver test just to be safe.  My patient became patient number eight.  My patient’s liver not only failed, it self-destructed.  Two liver transplants later and things stabilized.

The lawsuit came shortly afterwards.  I had done such a good job of giving informed consent and documenting it, that the suit was dismissed.  I actually wish my patient and their family had won. They needed the money and their lives were certainly ruined.  What I now know is true “informed consent” is a great idea. It’s also a fallacy!  My patient could not possibly have envisioned the shock and awe caused by the total destruction of their liver.  The patient and their spouse could not fathom being number 8 in the world.

Flash forward to today:  Those people who are taking hydroxychloroquine prophylactically cannot possibly imagine what life is going to be like after their heart is injured.  Parents who send their kids to school or Pom Pom practice cannot possibly understand what having a child dying alone in the ICU is going to do to their family.  Generation X and Millennials who ignore social distancing cannot possibly believe that a viral infection in the year 2020 will give them organ failure in the year 2030.

Consider document to be your informed consent!  I know you will scoff at it, discounting it as simple paranoia. I know that some of you will play the odds and continue life as usual.  Just remember that you’re betting with your life.

Here’s your music for the day.

I’ve always had a love hate relationship with vaccines.  Those of you who are my age will remember standing in line and being given a sugar cube saturated with the polio vaccine.  I loved that experience.  Then there was the line I hated!  Yep, we stood in line a second time and had another polio vaccine.  Only this time the nurse used an air gun to inject the vaccine in our arm.  I hated that one.

While vaccines protect you from many viral infections, on rare occasions they can cause significant problems.  In the early years of my practice, the Pertussis vaccine caused high fevers and scared parents.  That vaccine is no longer used, and its replacement rarely causes problems of significance.  In fact, I have not seen a significant vaccine reaction in 30 years.

Even though I’ve not seen vaccine related problems, I’m still cautious with new vaccines.  Those of you who came to my office for a flu shot always signed an informed consent form prior to receiving your shot.  The flu shot is reformulated yearly.  While I have given the same tetanus vaccine for 30 years and know exactly what it is going to do, the flu vaccine is new every year and therefore does not have a track record.

When new vaccines arrived, I always waited 6 – 12 months before administering them.  I wanted to see how the general population did on the particular vaccine.  Sometimes a vaccine looks good in the research stages but when given to millions doesn’t look so hot.  When we are lucky enough to have a Covid-19 vaccine, I won’t wait! I’ll be the first in line.  Sure, I’ll be a little apprehensive, but I’ll trust the researchers and get vaccinated.  If there are side effects, I’ll deal with them.

While I’m no longer afraid of needles, a sugar cube sure would be a sweeter option.  I’ll also recommend that my readers get vaccinated as well.  Remember my favorite blessing?   May you be so blessed as to never know the disease you prevented.  

Until we have a vaccine, wear a mask, wash your hands, keep your distance from others and try not to go crazy.  Exercise as much as possible.  Rather than doing bench presses, I’m doing 20 repetitions of refrigerator door openings and closings 4 times a day. It’s a very rewarding exercise!  I’m also doing sprints at least 4 times a day.  Unfortunately, Renee is faster than I am, and I rarely catch her (I get a bonus cardiac workout when I catch her)!

Here’s today’s music and a joke.

“The doctor said he would have me on my feet in two weeks.”
“And did he?”
“Yes, I had to sell the car to pay the bill.”