Monday 27 July 2015


When it comes to a healthy lifestyle, the phrase that I do my best to live by is "Practice what you preach."  Unfortunately I rarely live up to this lofty standard, and the phrase that much more closely resembles my reality is "Do what I say, not what I do."  Yes, I freely admit that I am terrible at taking care of myself, and even Mrs. Bastard's efforts often aren't enough.  She always encourages me to eat a balanced diet, exercise, floss my teeth . . . you know, all the stuff we all know we really ought to be doing but just don't.  Because of reasons.  Instead, my diet usually consists of skipping breakfast, a Coke for lunch (fuck you, Pepsi), and a ridiculous dinner that provides me an entire day's calories and several day's worth of fat and cholesterol.  Mmmm . . . fat and cholesterol.

Any semblance of real exercise has been difficult for me to achieve ever since I finished medical school.  I used to run or play basketball almost every day, but then life just . . . happened.  I got married, had children, and chose a career that precludes nearly everything other than my family.  I tried to keep up with staying active; I even tried yoga.  Yes, I tried yoga.  Fuck yoga.

These days the only exercise I get is running from idiot to idiot while trying to keep my head screwed on straight.  I can't say this actually gets my heart rate up very much, so in lieu of actual running, I decided some time ago to take advantage of my busy work situation.  Instead of taking the lift (elevator), I now take the stairs whenever possible.  It may not be much, but at least it's more than nothing.

Perhaps not surprisingly I've found that walking up from the ground level to the 8th floor has gotten progressively easier as time as elapsed (what an amazing thing), so I decided to start giving this excellent activity advice to my busy, overworked patients.  I thought the first time would go over well.

I thought wrong.

I was asked to see Otis (not his real name™) by one of my internal medicine colleagues due to severe abdominal pain.  It had come on rather suddenly and rapidly, encompassing his entire abdomen.  Though he had no prior similar episodes, he did have some rather pertinent medical history, including a myocardial infarction (heart attack) and subsequent coronary artery bypass graft three months prior.  As soon as I heard this, the alarm bells started ringing in my head:

WOOP!  WOOP!  Acute mesenteric ischaemia!  Acute mesenteric ischaemia!  Operating theatre, stat!

I feared that the blood supply to his intestine was compromised just like the blood supply to his heart had been three months ago.  The same mechanism that had caused the blockage in his coronary arteries may very well also be happening in his gut.  The treatment for ischaemia is the same everywhere in the body- get rid of the blockage before tissue starts dying.

For confirmation, I got him down to the CT scanner rather quickly, as I did not want surgery to be delayed.  However, what greeted me was a bit of a surprise, and not a bad one for a change.  His mesenteric (gut) vasculature had some atherosclerotic disease, but it was mostly open.  However, his ascending colon was inflamed.  His clinical picture was consistent with chronic mesenteric ischaemia, a longstanding decrease in blood supply to the intestine that had gotten slightly (and temporarily) worse.  Fortunately for Otis this is treated with supportive care and bowel rest rather than surgery.  Otis was unsurprisingly pleased that I would not have to whack out half his colon.

Over the next few days Otis improved rapidly and was discharged home with his colon intact.  He came back to see me in my office several days later for a follow-up visit, and he reported continued improvement.  After I finished my examination, I began discussing how his lifestyle choices, including smoking, poor dietary habits (ahem), and lack of exercise (AHEM), had all contributed to both his recent heart attack and subsequent intestine attack (yes, "intestine attack".  Why not?  It's the exact same as a heart attack, just with the intestine, damn it).

"Yeah but Doc, I'm really really busy.  I work 12 hours a day and I got no time for exercise."

Fully expecting that excuse (which I use with regularity), I immediately launched into my prepared activity speech.  As soon as I got to the "take the stairs and avoid the lift" portion, he stared at me intently.  And silently.

"Um, did I say something?" I asked him after an uncomfortable silence.

Otis continued to stare at me.

I started to fear that I had inadvertently said something patently offensive and started silently reviewing every word I had just said.  What was it?  What did I say?

And still he stared.

Just as I started to open my mouth to apologise for saying . . . whatever it was I had said, his lips curled into a smile.

"Doc, that would be kinda hard for me.  I'm an elevator repairman."

He laughed.  I laughed with him.  Because he actually was an elevator repairman.  Really, what are the odds?

For me: 100%.


  1. An MD once told my very deconditioned uncle-by-marriage that he should walk more and quit drinking.

    Problem was that my uncle had been a big-city mail carrier for decades. He walked all day long, and many oldtimers on his route greeted him with a beer and joined him later in the local old-guys' bar.

  2. I love his not real name! lol

  3. out of curiosity, had you been cognizant that "Otis" is a very respected name in elevators in the US?

    1. There's a very good chance that I may have been aware that Otis Elevator Company is the world's largest manufacturer of elevators. There's an equally good chance that I changed his name to Otis for that exact reason and was hoping the connection wouldn't ruin the surprise ending, which is, by the way, completely true.

    2. Hahaha as soon as I read Otis I knew the punchline. Doc usually does some form of foreshadowing then brings it back around.

    3. it didn't for me because of the other elevator connection.

  4. You have a typo that reads heart atatck after you mentioned intestine attack. Also want to say, long time reader and appreciate the posts. Sorry if this is a double post because I had to sign in after typing and not sure if it submitted the other or not. If it did just delete this one.

  5. That is a GREAT story! No one ever thinks about the people who repair the darn things until you find yourself using the clean elevator for everything, particularly filthy things, and you just know that no matter how soon they arrive there is a part that will take a week or more to arrive.

    I do hope Otis figured out a way to sneak in more exercise everyday though. We need more people with a good sense of humour in this world.

  6. I knew that you were a Coke guy, there's something manly about it! Fuck Pepsi!!

    You continue to fill my life with medical terminology i would never have learned otherwise!

  7. A longtime colleague of mine started his own business as an elevator designer and technician after working for years as the head of the elevator maintenance division at the local public housing authority, where we worked together. We'd always amuse our co-workers and residents whenever we happened to meet up out in the field with our standard greeting:

    Me: "Hi, Nelson! How are things going on the job these days?"
    Nelson: "Fine, same as has its ups and downs."

    Dumb joke, but it always got a laugh! :)

  8. Great post, as always! The first thing that came to mind, however, was a blog post you wrote called "Do as I say" In August 2012 (yes, I'm that dedicated to your blog). Do you think these two situations are different because of the difference in severity of the practice?

  9. Humping flights of stairs is a good form of exercise, but I hope DocBastard and his family take advantage of other ways to unwind. I like taking the family to the drive-in theater throughout their season. I hope they stay open until mid- to late-November this year. Sometimes you can see FOUR films for the price of one admission! Around here, if it's the first run and a likely to be a big winner overall, that runs me $10/person in the car. The drive-in theater has an excellent concession stand and that is where all theaters actually make the money necessary to keep it in business. So I don't mind paying up for the food. They even make food to order which is quite tasty.

    I hope everyone has a chance to go to a drive-in at least once. They're a lot of fun. "Mine" even has a playground for the kids, and kids-at-heart, that is open until they start the previews.


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