Tales from the Emergency Room (17 page)

The Chihuahua

A tiny elderly lady never arrived in my office in Manhattan without her cloth tote bag. It was quite large. She never made any fuss over it, just placed it on the floor beside her chair while she received her injections. One day I got a glimpse of the bag’s contents and discovered a Chihuahua inside. Of course, animals of any kind were not allowed in the office, but, before I said anything, I inquired of my partner if he knew about this. Of course, he had known about it for years and was surprised to learn that this was a new finding for me. He noted that this was one of his longest-term patients and he could not (would not?) bring himself to say anything to her. Neither did I, and so she and I continued to get along just fine. I know we had a great relationship. At the time the movie “I Am Curious Yellow” appeared in a theater on 57th Street and there were always long lines outside the movie house to see this “pornographic” film. One day my little lady, who passed the theater on her way to the office, announced to me that, “If all those people had any sense they would all be home ‘doing it’ instead of standing on that line!” Made my day.

Billy

I have been called by many names, among them, Bill, Billy, Billy H., William, Willie, Hermie, and Doc. The names that people used were determined by when we were best acquainted. So, if I heard myself referred to as Billy, it was likely to by someone I had gone to elementary school with. One of my patients was a friend of mine from kindergarten through high school. He was the coach for two of my boys who were baseball players. He is a great big, lovely man and often his visits to the office would turn into reminiscing if we had the time. In the waiting room, whenever he would see someone he had not noticed on prior visits, he would launch into stories about Billy. His favorite one revolved around the fact that I was not an athlete and when teams were being made up during gym, or even just casually, Billy was always picked last. (And usually sent out to play right field.) My patients all thought this was very funny and responded to him and to me with comments about how lucky it was that I was not their surgeon, and the like.

The International Doctor

The first medical problem that my grandson developed while he and his family were living in Lagos, Nigeria was malaria. Despite extensive precautions and preventive medicines, he was diagnosed at the tender age of 12 months. So, one day I found myself talking by phone with the Chief Medical Officer of Mobil Oil. Of course, I had studied the disease in school but I had never seen a case. When I heard about Benjamin, I hit the books fast and soon found myself consulting with said medical officer holding a book in one hand and the phone in the other. Benjamin recovered with the correct medicines and then was well until he developed a variant of tuberculosis in the lymph nodes in his neck. Same doctor, same scenario, but this time Benjamin’s mother had to bring him to us in New York. (Mobil wanted to send mother and son to London for treatment, but my daughter-in-law saw to it, in no uncertain terms, that they would be going to New York City!) My colleagues in White Plains were simply terrific about caring for Benjamin. Eventually, despite massive drug treatment facilitated by some dedicated pharmacists in town, he wound up having surgery at New York Medical College where I was an adjunct professor. No complications ensued. His father was transferred to Dallas, TX soon thereafter where Benjamin’s problem recurred. He was operated on again, again without complications or significant scarring. This time the problem was eliminated. We often chuckle at Benjamin’s medical history which he will have to write down with every visit to a new doctor, including as it does two very third-world medical problems.

My last foray into international doctoring came when Benjamin’s sister, Meghan, developed intestinal amebiasis and salmonellosis at the same time. By now the family was in Doha, Qatar. Once again, she was treated successfully but not before she became a very sick little girl. Her treatment continued and was completed in the States. Scary moments for the family given that the patients were so far from our American medical system. A good thing was that the Emir’s son was Meghan’s friend and classmate at the American School and the medical staff assumed that she was “under the protection of the Emir”. She received the very best “boutique” medical and nursing care!

Bora Bora

One of my patients was a very wealthy woman who was allergic to her dog. She was receiving treatments for this, and doing fairly well. One day she announced to me that she always had trouble in the apartment in Manhattan and almost always at her country house, but that she never had trouble in the house on Bora, Bora. “Bora, Bora?” I exclaimed incredulously. I really felt like laughing out loud, but I managed to keep my face on and wondered if she had her dog with her in Bora Bora. Well, of course, she did not take her dog there and so, of course, she had no allergies while on the island. One of the reasons that this struck me so funny was that my partner, a world traveler, had never been to Bora Bora and I knew that he would not be able to keep from asking her all about the place.

Grass Pollen Allergy

When I was about 12 years old, earning my living by mowing lawns, I developed a severe allergy to grass pollen. This made spring a miserable time for me. Antihistamines and air conditioning were virtually unheard of in my circle, and so I was not happy. During college I used Pyribenzamine to control symptoms, but it made me groggy and so I supplemented this medicine with NoDoz to get through the spring semester. This continued unabated until service in Springfield, Missouri. I had two years free from symptoms because, I guess, the pollen there was sufficiently different so that my immune system didn’t recognize it. Finally, when I started practice, my partner would give me shots, carefully. I tested highly positive and so, while we liked to get patients up to doses of 10,000 to 20,000 units, the highest I ever got after three years was 350 units. Despite this I had complete resolution of my symptoms. Now, some 40 years later, I am once again experiencing mild spring hayfever. The non-sedating antihistamines work wonderfully well, but there are times when I have to retreat to an air conditioned space for relief.

The Non-compliant Crowd

One of the most difficult problems in medicine is non-compliance by patients with their doctor’s orders. Two cases in particular stand out for me.

A lady in the New York office was a nurse at a hospital in Manhattan. She had terrible asthma. Every few weeks she would show up in the office in severe trouble. She would get emergency treatment and then a plan for her long term care. She always required oral cortisone for treatment in high, decreasing daily doses. I think she never missed a day at work even when in severe distress. She lived alone. I knew she stopped taking her meds as soon as she felt better, but I couldn’t see how she benefited from this (secondary gain). Finally, I called her daughter about this problem. She noted that she knew her mother was non-compliant, that she had tried to help with the problem to no avail. And so, the woman’s cycle of wellness and profound distress continued until I retired. I hope her next doctor had better luck with her.

On the other hand, there was a woman in the White Plains office who had the same pattern of non-compliance. Sometimes it was difficult getting her out of trouble with her asthma. One day I decided to try to get to the bottom of this problem with her. To my surprise when I questioned her about it, she readily noted that the only attention she got from her husband was when she began to have severe breathing problems. So, this lady actually had something to gain from not using her medicines correctly and thereby getting her husband to notice her!

Names

I have had two patients by the name of Elspath a name I had not heard before. I saw a young Spanish woman whose name was Eufrasia, spelled slightly differently than my mother’s name, Euphrasia.

I assumed of course when Ms. Musumecci told me she was getting married that she might like her new name better. That was until she told me that she was going to marry Mr. Schiavoni. We laughed over that and then again several years later when she told me that she really had wanted an hyphenated name, she being a young business woman. She regrettably had to reconsider this desire after her wedding.

I have seen two patients with the last name Loony. One was, one wasn’t. My partner’s friend had a normal name, Harry and an astonishing, not to say off-putting, last name. When they met while traveling in Europe, Harry noted that he had changed his name legally. My partner was nonplussed when his friend told him his new, first name, was Howard. His last name remained unchanged.

Seen outside the office, some patients are difficult to attach a name to. My partner met a young patient of ours in Heathrow airport. (This young man was the only person I ever cared for who refused to have his injection site cleaned with alcohol.) Half way across the Atlantic Ocean my partner finally remembered his name.

There was the patient whose name was Jack and whose mother insisted he be called by his nickname-John!

And then there was Mrs. J., an operatic voice teacher who came to the New York office and, rarely, to the White Plains office where my wife worked for many years. At the Ritz hotel in Barcelona, in the elegant dining room there, sparsely populated this evening, I spotted Mrs. J. and her husband. I asked el mesero in Spanish, what their name might be, since I couldn’t remember no matter how I racked my brain. No deal—not allowed to give out guest’s names. Then I asked my wife who said, “I work in the White Plains office. I cannot be expected to know the names of New York City patients.” So, there we sat, until quite some time later my wife said, “That will be Mrs. J.” I knew she had it right and went over to their table and was greeted with hugs and kisses and much chatter. Los meseros looked on which I was glad to see.

And, while I was in the service, Ms. Klahn married Dr. Klan becoming Mrs. Klahn-Klahn.

My wife’s OB-GYN doctor in Springfield, MO, was Dr. M.D. Bonebrake, M.D. Why he wasn’t an orthopedist, despite the spelling, none of us could figure out.

Then, of course, when Dr. Doctor showed up at my training hospital, the emergency in-house call had to be changed from “Doctor, Doctor” to “Doctor Quick”.

Gingersnaps

A young man about 16 years old came to the office, referred from a nearby hospital emergency room. He had been there several days previously when he was treated for acute anaphylactic shock. He was employed at the pool at a local country club for the summer. In the past, he had had acute allergic reactions to ginger and was careful to avoid any foods in which ginger appeared to be an ingredient. His reaction this time began shortly after eating lunch supplied by the country club. He had not sustained a bee sting and so the possibilities for trouble seemed related to his lunch. He had had a hamburger which he remembered as being excellent along with some other fixings. He had had all of these things before with no problem. We asked him to have the club chef describe the contents of the hamburger. The chef allowed as how he always put some finely crumbled gingersnaps into his ground round when making hamburger patties. I don’t think my young patient’s summer was ruined, but he was careful thereafter to eat meals that he brought from home!

Marrying Harry

Over the years I saw many clergy persons. One of my favorites was a nun who was quite young when she first became a patient in the White Plains office. One day, after her shots, she said that she was glad not to have had to wait long to be seen because she had to hurry back to the convent so as not to miss the vote. The vote was to decide whether or not to shorten by a very small amount the skirts of the habit her order wore. I wondered whether or not her side (to shorten) would win and she replied, “No, all those girls who should have married Harry 40 years ago will vote against it!” And right she was, the habits stayed long.

Several years later, the New York office, my secretary came into my office to say that there was a pleasant looking woman wearing a colorful summer dress standing at the front desk. She said that the woman claimed to be a nun. I knew in an instant who it would be, and sure enough, there stood my nun grinning from ear to ear. I allowed as how her side, it seemed, had finally won and we had a good laugh over Harry before we settled down to discuss her medical business.

Check Bouncing

Especially in the New York City office many patients were young, professional women. One day, I heard my secretary discussing a check from one of these ladies which had bounced. I knew she had bounced another check in the past, so I was intrigued by the conversation. The patient carefully explained that on the first of the month she always paid all her bills and that a check rarely bounced at the same business two months in row. Our suggestion was that for the foreseeable future she should make sure to pay our bill first, a day before the other bills in the hope that our check would reach the bank while there was still some money in her account. I guess she did—we had no further problem with her payments.

Penicillin Allergy

Reactions to penicillin can be fatal, often swiftly so. A case in point was a nurse I saw after she had had a near fatal reaction. She knew she was highly allergic to the drug so much so that she would arrange to be away from her nursing station if penicillin was being readied for a patient. Her young son was given penicillin to take and when she went to give him his first pill, she shook it out into her hand. She knew immediately that she was in trouble. She was able to grab the telephone as she slipped to the floor and punched operator. Before she lost consciousness, she was able to tell the operator her address. (This was before 911.) Fortunately, help arrived soon enough to revive her and she recovered fully in the hospital. When she was referred to me we discussed treatment options, limited mostly to avoidance. I was not about to test her even in a hospital setting, and so she began taking her allergy problem even more seriously than she had in the past.