Behaving badly

Usually when I have a stupid patient story, I like for it to be mine.  Though I have posted numerous submissions from readers, I prefer the stupid patients to be my own so that I have first-hand knowledge of the events and can elaborate on (read: embellish) them.  But oh do I have a good one today.  It's definitely a stupid patient story, but fortunately it isn't mine.

Wait, "fortunately"?  You just said that you prefer the stupid patients to be yours, but you're glad this one isn't?  What?  Be consistent, Doc!

I'll explain.

I've written before about doctors behaving badly, and boy did they ever.  In case you missed that little escapade, a man (identified only as "DB") undergoing a colonoscopy had used a small voice recorder in order to record the verbal instructions he was given before his procedure (in case he forgot them later).  He accidentally left it running and ended up recording the entire procedure.  While he was asleep his anaesthesiologist made several nasty and very personal remarks towards him, including insinuating that he was gay, saying she wanted to punch him in the face, and calling him a wimp and a retard.  She also falsified his medical record in the process (recording that he had haemorrhoids when he did not) just for good measure.

Despite the fact that his procedure went well and there was no real medical malpractice, DB sued her and was awarded $500,000, and rightfully so.  Her behaviour was atrocious, unprofessional, and has no business happening in a healthcare setting.  Ever.

Well, it happened again.  Sort of.  This time the patient is 44-year-old Ethel Easter (her real name) from Texas.  Her surgeon was recorded making disparaging remarks about her while she was asleep.  Sort of.  Only this time, Ethel is the bad guy.

Wait, what?  He said bad things about her, and SHE is the bad guy?

I'll explain.  Again.

First, a little background.  According to news reports (including dramatic news coverage with dramatic sound bites and dramatic interviews of dramatic Ethel), Ethel went to see the unnamed surgeon for a hiatal hernia, which she said made her "terminally ill" (no, it didn't).  She was told she would have to wait two months for the surgery (totally believable), but because she was having pain after eating, she didn't want to wait and apparently threatened to call a lawyer and lodge a complaint against the surgeon (100% believable, though she denied this - more on this later).  According to Ethel, the surgeon yelled at her, "Who do you think you are?  You're gonna wait like everybody else" (yeah, sure he did).

Ethel reportedly lost trust in the surgeon and was so shaken by the interaction that she did the right thing and chose another doctor to entrust with her life.  Right?  RIGHT?  HAHAHAHA no, of course she didn't.  No, instead she did what any reasonable person would do in this situation - she went ahead with the surgery and hid a voice recorder in her hair because, according to her, "I was afraid that if I didn't make it nobody would know why, and I wanted them to know it was because he didn't care about me as a person."

Wait wait wait.  Just . . . wait.  Let's pause here a moment so I can make my first completely unbiased (not really) evaluation of Ethel, shall we?

• Hiatal hernias are common, often asymptomatic, and are always treated medically first unless there is a surgical emergency (which hers clearly was not).  I'm assuming that her GP treated her with the appropriate H-2 blocker and/or PPI, which failed.  They are not fatal unless they strangulate, which is rare.
• She was so uncomfortable with and unnerved by the surgeon and was so worried that she would die under his care that she figured, Hey, I'll just record him.
• The surgeon wrote in her permanent medical record (a legal document, mind), that their interaction raised "red flags" about her attitude.  Therefore he was obviously concerned about how she treated him from the start.

Oh, I like her already.  But just you wait, it gets worse.  Much worse.

On the recording just after Ethel went off to sleep, the surgeon mentioned their first consultation and said "She’s a handful.  She had some choice words for us in the clinic when we didn’t book her case in two weeks.   She said, ‘I’m going to call a lawyer and file a complaint'".  Ethel, of course, denies ever saying that.  The anaesthesiologist (presumably) replied, "That doesn’t seem like the thing to say to the person who’s going to do your surgery."  No, it certainly isn't.  Don't piss off the person who is responsible for your life.

Now is this inappropriate talk for an operating theatre?  No, not even one iota.  This is normal shop talk, and we talk like this all the time.  And the rest of the banter on the recording is just that - banter.  For example: a female in the room makes a comment about her belly button.  Someone calls her "Precious", which she believes (with no verification whatsoever) is a reference to the 2009 movie about an obese black girl but could just as easily be a reference to the One Ring from Lord of the Rings or just an ordinary term of endearment.  The surgeon says "I feel sorry for her husband," which I would too (this is really the only thing said that I would consider over the line, but only just).  Something is said about touching her, but based on the limited information available, it doesn't sound remotely sexual (which she claims it is, of course).

To top it all off with some nice cherry-flavoured bullshit, Ethel also claims that the doctor "jeopardized my life" by giving her a dose of Ancef.  "It’s just by the grace of God that I’m even alive right now.  It was an unnecessary risk that he took with me," she said.  Ancef is an antibiotic in the beta-lactam class, which includes penicillin (to which Ethel has a mild-moderate allergy, not a serious one).  More on that in a bit.

What Ethel happens not to mention in any of her interviews is that the surgery was uncomplicated and apparently a success, because I'm 100% certain that she would have screamed otherwise from the rooftops, and saying that her surgery went well would have definitively undermined her "Oh woe is me" credibility.

Now that we have more details about what was said, I'll give a few more thoughts.

• Did the surgeon actually yell at her?  I highly doubt it.  I have no doubt he said something like, "You'll just have to wait like everyone else", but I'd bet my life savings he didn't yell.  Regardless, is that insensitive or unprofessional?  Absolutely not.  She was not critically ill and there was no surgical emergency, so the surgeon was simply telling her that she was no different than his other patients and her case would not be more or less important.  That's called being fair.
• The surgeon did not put her life at risk by giving her Ancef.  There is only a 10% cross-reactivity between cephalosporins and penicillin (if that), and true penicillin allergies are rare.  She had a mild reaction to something after the surgery (which could have been any of the medications she was given) which was treated in an emergency room.
• The mild disparaging remarks about her body are par for the course in the OR.  I've written about it before, and yes it's true - we absolutely do make comments about your body when you're asleep (most but not all of them innocuous).  You know who else does that?  EVERYONE.  Put microphones on people sitting at a café, and I guarantee with 100% certainty that you will hear much harsher comments made about the people walking by.  I'm guilty of that too, as are you.  If you deny it, you're lying.  Is it unprofessional?  Maybe.  Are we going to stop?  Nope.  Are you?  Nope.
• Ethel was (and is) looking for a payday.  It is perfectly clear that her first interaction with the surgeon didn't go her way, she was angry that she wasn't given priority over the doctor's other patients, and she wanted to catch him in a "Gotcha!" moment.  She failed at that but is publicising this episode anyway simply to gather support for a lawsuit.  She is dramatising this in a ridiculously histrionic fashion, saying that her hernia was "terminal" (NO IT WAS NOT) and that the mild allergic reaction put her life in jeopardy (NO IT DID NOT).  
• She had a successful and uncomplicated surgery, but I'd also be willing to bet that she was hoping for some kind of complication.  I admit this is (obviously) pure supposition, but while I'm betting my life savings anyway, I may as well add this one in too.
• If I hadn't already bet my life savings twice already, I would bet it again that she will sue the surgeon, the anaesthesiologist, the hospital system, and/or everyone else in the room.

Perhaps I'm looking at this from a biased point of view.  Maybe Ethel was truly scarred by what she heard.  I suppose it's within the real of possibility that she only had angelic, pure motive for hiding the recorder in her hair.

I doubt it.

Jail

I've never been to jail.  I've never been arrested.  I've never been detained or questioned by the police.  The closest I've ever been was a citation for speeding nearly 20 years ago, and that's the closest I ever intend to getting incarcerated.  It just doesn't sound like much fun.  My perception of prison is limited to how it is portrayed on television and in movies, but despite the fact that Andy Dufresne came out clean on the other side, I can't imagine having a good time there.

Despite that, the threat of prison time isn't the main reason why I live my life the way I do.  Mainly it's because I think being a good person is better than being an asshole.  But I suppose if I were an asshole, I wouldn't think that way and wouldn't really care.  It's a bit of a Catch-22.

After my recent experience with Terrence (not his real name™), I have to assume (or at least hope) that assholes who don't give a shit about being good citizens have some fear of prison, though it obviously isn't enough to keep them in line.

I don't really consider myself a judgmental person, but sometimes I just get a feeling on people.  When Terrence first rolled through the door just after midnight, my first (admittedly judgmental) thought was "This is not a good guy."  I can't say exactly why I thought this - perhaps it was the look of utter nonchalance in his eyes, perhaps it was the way he refused to make eye contact with anyone.  Perhaps it was the way that he was cursing at the medics and nurses who were trying to take care of him.  But maybe it was his shiny new stainless steel bracelets attaching his wrist to the stretcher.

Yeah, it was probably that last one.

The police officer to whom the handcuffs belonged trailed closely behind, and the medics looked almost as displeased as he was as they gave their report.

Medic: Hey there Doc, this is Terrence, 21 years old, healthy.  He and his 4 friends were involved in a car accident.  They hit another car, and then they all got out and ran.
Police (scowling): Yeah, 7 blocks,
Medic (annoyed): Anyway, no loss of consciousness . . .
Police: Obviously.
Medic: (really annoyed): ANYWAY, he has no complaints other than some pain in his lip where he has a laceration.
Police (eyes shifting): That was, uh, from the accident.

According to the officer, the accident was relatively low speed, not enough to cause major damage to either car.  Then the 5 guys inside all got out and ran in different directions.  Terrence was reportedly the driver, and he was definitely (obviously) the slowest of the group.  He was surprisingly unwilling to give us any details of the accident.

Shocking.

Regardless, I examined him from head to toe, and the only thing that hurt was a 1.5 cm laceration of his lower lip.  No other bruises, lacerations, abrasions, or deformities.  Nothing hurt when I examined it.  I turned to the officer, who was still huffing and puffing a bit, and asked him if Terrence would be leaving with him tonight.

"You're damned right!  This asshole made me run 7 blocks!"

The ability to run 7 blocks rules out the vast majority of serious injuries, so luckily Terrence had done a lot of my job for me.  A few X-rays and sutures later and Terrence was ready to leave.  Or so I thought.

All of a sudden his chest hurt.  Supposedly.

This is a classic move that prisoners often use to get out, at least temporarily.  They know that chest pain is not something that will be taken lightly, and they use this knowledge to their full advantage.

Now at this point I had two options - 1) assume that Terrence was acting like the asshole that he obviously is and was faking his symptoms because he knew exactly what was about to happen to him, or 2) act like a professional trauma surgeon and make sure he didn't have any injuries.  I reluctantly chose option 2.  A CT scan of his chest, abdomen, and pelvis was . . . ready?  Completely normal.  The nurse automatically did an EKG (despite Terrence referring to female dogs repeatedly) which was, shockingly, also normal. 

Twenty minutes later Terrence was remarkably pain free, able to walk, and was out the door with his new best friend and a free ride to jail. 

I like to think that the lip laceration actually was from the car accident.  But after witnessing Terrence's behaviour, I somehow doubt it, nor would I be disappointed by it.  Even I have to look the other way every now and then. 

April 1

Oh happy day, happy day!  Yes it's April 1 again, my favourite day of the year again.  It's the only day of the year when you can literally get away with anything as long as you scream "April fools!" directly afterwards.  Want to tell off your boss?  "Fuck you, boss!  I hate you, I hate this job, I hate fucking everything so I fucking quit!"

. . .

"Hahaha!  April fools!  No but seriously, you're a big giant douchebag.  April fools!  I hope you die by falling into a giant pit of broken glass, king cobras, and arsenic.  Haha!  April fools!"

Anyway, I happened to post a lovely picture of a chiropractor doing an adjustment on a duck (no April fools) to Twitter earlier today:

In case you can't see it due to the mouthful of coffee you just spit all over your screen, that is actually a picture of an actual chiropractor actually doing a chiropractic adjustment on an actual duck.  I'll repeat for those of you still cleaning your screens: A CHIROPRACTIC ADJUSTMENT. ON. A. DUCK.

Seriously folks, the picture just captions itself. 

The response has been, ah, rather amusing, to say the least.  So in the spirit of today, here are my favourite captions and responses.

Chiroquacktor doing the appropriate quack adjustments. https://t.co/6olnSrS7ex

— YourBaby'sBestShot (@BabysBestShot) April 1, 2016

@DocBastard Well if it walks like a quack, talks like a quack and practises on a quack...

— Fly Pastafarian (@FlyPastafarian) April 1, 2016

& no ordinary duck....but a very handsome - well dressed & highly educated duck... https://t.co/y884k8Wu9z

— Are We There Yet? (@KBCanB) April 1, 2016

And these people constantly beg to be taken seriously as health care professionals https://t.co/kRN3sg6evh

— GeekPharm (@geekpharm) April 1, 2016

@DocBastard The look on the duck's face says it all, "What the fuck are you doing to me, you QUACK!"

— Mike Ashworth (@MikeAlphaOne) April 1, 2016

@DocBastard @mark_lynas This really fits the definition of quack medicine.

— Bob Duke (@DukeofWaiheke) April 1, 2016

I imagine the duck speaking in the voice of a serene Japanese salaryman. https://t.co/qM1WRZEuLP

— John Cullen (@nellucnhoj) April 1, 2016

I like the way the duck appears to be going ,'Yes, AND?' https://t.co/soAlx2lyn8

— Mark (@markusparkus75) April 1, 2016

@DocBastard @tokyo_sexwhale Hahaha good April fool. Almost had me until I remembered chiropracters aren't real.

— Danny (@skirmishmonkey) April 1, 2016

@DocBastard @whippletom Isn't 'real' chiropractor a bit like saying 'real wizard' though?

— Haralambos Dayantis (@HCDayantis) April 1, 2016

@DocBastard @vcocozza76 Chiroquackter.

— Cameron is a Pie (@GallusEffie) April 1, 2016

@DocBastard Well, I hesitate to say this, but the duck told me it did cure him. 😊

— Marijke (@Marijke51) April 1, 2016

@haplesspete Duckluxation? @reasonable_hank @DocBastard

— Rob (@HisRobbness) April 1, 2016

@HisRobbness Oh wait, how about some (D)Reiki Massage? @reasonable_hank @DocBastard

— Hapless Pete (@haplesspete) April 1, 2016

It was a close race, but here are the runners up:

@DocBastard @TomChivers I’m an honest practitioner m’llard!

— Sir Na₂Ca(CO₃)₂•5H₂O (@Gaylussite) April 1, 2016

@DocBastard here's an orthopaedic surgeon doing emergency surgery on a 🐔after she was mauled by a 🐶for comparison pic.twitter.com/FpQ8bQFb3f

— Lilly Evilfatcat (@lillyevilfatcat) April 1, 2016

@DocBastard @neverjessie Donald took to the treatment like a duck to homeopathy

— Beef Twister (@WildBilbo) April 1, 2016

@DocBastard @GhostOfPJK so, they say quacks don't echo but I can def see two quacks there and only one duck

— justin larkin (@redstarcycles) April 1, 2016

And the winner:

@haplesspete Guaranteed to cure any Mallardy @HisRobbness @reasonable_hank @DocBastard

— NotAlwaysPCBunny (@nogodsnowars) April 1, 2016

Happy April Fools Day!

ICD-10

Everyone in the medical world knows that medical coding is a pain in the ass.  To anyone not in the medical world, you'll just have to trust me - medical coding is a pain in the ass.  We go by a list of codes called the International Statistical Classification of Diseases and Related Health Problems (no seriously, that's actually what it's called) that is maintained by the World Health Organisation and has been updated periodically since its creation in 1949.  The 9th version contained about 13,000 codes (yes, 13,000) for every diagnosis imaginable.  Well, almost.  Obviously they didn't think 13,000 was quite detailed enough because the 10th version, which was completed in 1992, expanded this to some 68,000 codes.  A total of 27 countries over the flat plane of the Earth use ICD-10: the Czech Republic adopted ICD-10 in 1993, UK in 1995, Canada in 2002, France in 2005, and the USA came in dead last in 2015.

Come on United States, it's like you're not even trying.  Fahrenheit?  Really?  Inches?  Gallons?  Do try to keep up with the rest of the world, America.  I bet even the eels from Ceti Alpha V use metric.

Anyway, some examples of codes that I use are S06.0X1A (Concussion with loss of consciousness of 30 minutes or less), K35.3 (Acute appendicitis with localised peritonitis), and S36.116A (Major laceration of liver).  But while perusing this thoroughly entertaining (not really) book you can also find codes for everything from W55.21XA (Bitten by cow) and W61.33XA (Pecked by a chicken) to Z63.1 (Problems in relationship with in-laws).

Ha ha!  Hilarious!  Pecked by chicken!  Problems in relationship with in-laws!  Don't we all!  Ha ha!  Good one, Doc!

What's that?  This sounds ridiculous and these codes couldn't possibly be real?  You think I made these up?  Then I challenge you to click the links and enjoy now having the knowledge that someone at WHO thought that there was adequate reason for these codes to exist.

Trauma is a bizarre world.  The patients are bizarre, the stories are bizarre, the injuries are bizarre, the situations are bizarre, and nothing seems to fit into any kind of pigeonhole of any kind ever.  Of course I'm exaggerating for the sake of drama and interest, because otherwise who the hell would read this crap.  In reality the majority of my patients are car accident and fall victims who have minor bumps and bruises and go home.  

But we do get the truly strange, the outlandish, the "What The Fuck Happened" cases from time to time, and those are the ones that stand out and are highlighted here.  Obviously.

This one fits.

Alan (not his real name™) was kind enough to relate a story that happened to him and a few friends recently.  I'll preface this by saying that Alan and his friends are university students, and as anyone who ever went to college knows, college students are stupid immature and impulsive, and anything can happen.  Anything.

Hey, Doc, I first heard of you via comments from FML and recently started reading your blog. I've enjoyed it very much and wanted to share with you a story that happened during my freshman year of college. 

My suitemate and I got back to our dorm around 3 AM one morning.  My roommate Brandon (not his real name™) was in my room with two other friends.  When we walked in, Brandon was sitting on his bed, and Aaron was sitting on my bed, talking.  Brandon walked over to us when we came in, and started talking to Mike.  At this point, I had my back to the others, and they filled me in with what happened after. 

Apparently before I got back, Aaron had taken Brandon's can of Febreze and was using it on his shoes (he's a soccer {that's football for the rest of the world} player).  I then hear Aaron say, "Hey, Brandon, look what I have!"  Then Brandon replied, "Give me that back!"  I then heard a thud. 

I turn around and see Brandon lying on the floor face-down.  I initially thought that he was just playing around, as is usual for him.  I said, "Ok, Brandon, get on up."  Upon receiving no response, I shook his shoulder.  "Brandon. Brandon!" Still nothing, so I turned him over, only to see blood coming from his forehead.  "What did you guys do to Brandon?!?" I exclaimed.  Aaron then explained that after Brandon demanded his Febreze can back, he tossed it to him under-handed.  Brandon apparently dove towards him, thinking that Aaron wasn't going to give it to him.  Somehow, the Febreze can connected with his head, and it knocked him out completely.

Try as we might, we couldn't rouse him.  Eventually, a fire EMT crew showed up and managed to wake him momentarily.  Shortly after, a few policemen showed up along with a regular EMT crew.  The police of course were grilling all of us concerning what caused it, repeatedly asking if we were drunk or high (which none of us were, though understandably we had a hard time convincing the officer otherwise).  Brandon ended up being taken to the hospital.  Though I'm not sure where exactly he was hit, apparently according to the ER staff it shouldn't have knocked him out, especially for as long as it did (nearly half an hour), considering what he was hit with, and how weakly it was thrown.  They all had a good laugh when they found out that the object that he was knocked out with was a pink Febreze can.

I diligently searched the approximately 947,502,485,503 ICD-10 codes, but I was unable to find "Concussion due to mildly thrown aerosol can".  What I did find, however, surprised me a bit:

• Y93.D1 Injury while crocheting and/or knitting
• W56.22XA Struck by orca
• W56.11XA Bitten by sea lion
• V97.33XA Sucked into jet engine
• X52.XXXA Prolonged stay in weightless environment
• V95.42XA Forced landing of spacecraft injuring occupant
• W61.11XA Bitten by macaw, {not to be confused with}
• W61.12XA Struck by macaw, {not to be confused with}
• W61.21XA Struck by other psittacines (does anyone other than the ICD-10 authors know what a 'psittacine' is?)
• W22.02XA Walked into lamppost {which is more of a problem in Narnia, I presume}
• Z99.89 Dependence on other enabling machines and devices {which I would like to assume means "Addicted to iPhone" but which actually refers to ventilators}

and my personal favourites:

• R46.1 Bizzare personal appearance
• V91.07XA Burn due to water skis on fire

These codes are 100% real.  I will repeat: "Forced landing of spacecraft injuring occupant" and "Burn due to water skis on fire" are real diagnosis codes.  For the record, I have used exactly -0- of these in my practice and don't expect to use any of them ever.  Although I will confess that I didn't know R46.1 existed until I wrote this post.  

I may have to start using that one now that I think about it.  It may actually come in handy with my idiots.  I mean patients.

No, I meant idiots.

Jahi McMath update...not really

I'll be honest, this isn't much of an update.  Though the case of Jahi McMath has not exactly come to a halt, it is grinding along at what is apparently the normal pace for American legal proceedings.  There have been no real advancements made in the legal trial, though there has been the usual and expected back-and-forth crap that I admittedly do not fully understand.  Demurrers have been submitted and denied by the judge, whatever the hell that means (Scarab?  Help?)  The legal details (including the most recent judgment allowing the family to prove she is "alive") can be found at Professor Thaddeus Pope's Medical Futility Blog here.

The other "development" is the posting online of several supposedly recent pictures of Jahi.  We'll start with these two:

I believe both of these were taken by the woman who has been braiding Jahi's hair (please someone correct me if I'm wrong).  The first thing that struck me is the strategically (and rather obviously) placed "JAHI IS ALIVE" bracelet next to her head.  That bit of propaganda is about as subtle as Donald Trump. 

The next interesting feature is that neither picture is taken head-on.  In both she has her head turned to the side.  That may be telling or it may be completely irrelevant, but it seems to tie into the next thing I noticed.  The final interesting thing was the discoloration on her philtrum (the groove above the upper lip).  At first I thought it was a shadow, but on closer inspection it looks the same in both pictures.  There also appears to be some darkening of her lips, though as we all know her mother Nailah likes to play dress-up and puts makeup on her, so it may just be dark lipstick.  I'm not sure which option is more disturbing.  Regardless if that discoloration is real, it is not a good sign.  The skin of the face has a very rich blood supply, so necrosis of that area would be indicative of something very bad happening, and taking the pictures from that angle would minimise the visual impact.

The other picture making the rounds is this one:

Again, I don't know when this was taken, but to me it looks older.  At least it's a head-on shot.  First of all, notice how her eyes are still closed as they are in every picture taken of her since she died.  Despite the claims that she is getting better, she has clearly not opened her eyes.  If she ever did, I am 100% certain that the pictures would be online instantly.  But what most people are talking about in this picture is the supposed lower lip piercing:

As disturbing as this entire case has been from the very beginning, I highly doubt this is actually a lip piercing.  It looks to me more like a reflection off her lip gloss.  But considering how irrational this family has acted, nothing would surprise me at this point.

Reach

When I started this stupid blog, I could have never imagined the reach it would have.  I'm pretty sure I've said that before, but whenever I try to use my brain to dredge up old memories, something newer and more useful probably gets jettisoned, so I try to do that as little as possible.  While searching the bowels of my memory I may accidentally forget how to take out a spleen or something.

Anyway, when I say "reach", I don't mean geographical reach.  At least not this time.  I've covered that in my hypocritical various milestone posts.  Rather, I mean the impact that it could potentially have in people's lives, beyond trauma, beyond surgery.  But Veronica (not her real name™) kindly emailed me and did the work for me.

Hello Doc.   

I found your blog while looking for information on Jahi McMath.  I kept reading because I found it interesting and educating.  You said you like to get responses, so I am giving you my response. 

I am 50-years old and have had pain in my joints since I was 10.  Diagnoses ranged from "I don't know" to systemic sclerosis.  Every doctor had a different answer.  When I was 40 it was discovered that I have celiac disease.  That made my doctor at the time start looking hard at my immune panel. 

I was sent to a rheumatologist who kept testing me for lupus.  I don't have lupus.  Whenever I questioned a new symptom, he would wave his hand and say it was nothing.  Swollen joint?  It's nothing.  Scaly patches on my leg?  It's nothing.  Scaly patches on my forehead?  It's nothing.  After reading your blog, I went to my primary care physician and requested a referral to a different rheumatologist. 

I saw the new doctor.  She read the entire new patient form and paid special attention to the list of diagnoses and how long I had been complaining of pain.  She *looked* at the swollen joints, all of the scaly patches, and even the severe dandruff.  She said she suspects psoriatic arthritis, and sent me to a dermatologist. 

The dermatologist looked at my skin, took a sample for biopsy, and reassured me that the patches looked nothing like cancer.  The tests he did all came back negative, reinforcing his belief that I have psoriatic patches, which he expects to see on patients with psoriatic arthritis. 

I know that psoriatic arthritis is a painful condition.  I have had pain for 40 years.  I know that the pain will only get worse, that it cannot be stopped.  I am fine with that.  Medicine cannot cure everything yet.  I am disgusted that it took so long for someone to *listen* to me and *look* at me.  My medical history told the new doctor what was wrong.  Now she knows what treatment needs to be done. 

I would still be with the original rheumatologist if I had not read your blog.  If I had not read your words about doctors listening to patients, I would not have requested transfer to a different doctor.  Thank you for that. 

To add to all of that, I have complained about severe pain, numbness, and immobility in my right shoulder for 19 years.  6 doctors in 3 states have seen me for it.  I have had physical therapy, drugs, and even told it was all in my head.  As it turns out, the rotator cuff requires surgery to be repaired.  The new rheumatologist is the only one that ordered tests to actually see what is happening in the joint.  It could have been fixed 19 years ago, but doctors just didn't look or listen. 

Thank you for posting your blog.

While I would never be so arrogant to claim that she's better because of me, I . . . actually, you know what, goddammit yes I will.  For once, I will take credit.  Ok ok, maybe Veronica is not actually better, but at least she now has a diagnosis.  And that's something, right?

What surprises me most about this is that Veronica's first doctor thought it was lupus.  He should have known that it's never lupus.

The Thank You Project

WARNING: Grab a box of tissues or a handkerchief (does anyone use those anymore?) or a towel or something absorbent, because you will cry before the end of this.  You have been warned.

This isn't my story, but I feel like it should be.  Karen (not her real name™) wrote me with a link to a video to me over a year ago, and it has unfortunately been buried under my "stupid patient stories" list until now:

Dear Doc Bastard, 

You write about your important cases and tell such great stories, yet you have mentioned that some patients never even showed up to their post-surgery check-ups.  Has anyone ever come up to you months or even years later to thank you for helping them? How did or would you react?  What's your opinion of patients overall, and do you think many patients realise just how much doctors such as yourself do for them?  

I'd be really interested to know if you've seen this video, and wanted to suggest that you could write a short blog post either about it or at least inspired by it, like about gratitude or something like that.   

Thank you so much for being such an inspiration to so many doctors, aspiring doctors and just generally kind human beings.  It's funny that despite your slightly crude online persona, you still seem like a very kind-hearted man and you inform everyone about important safety issues - I myself have made sure to always wear my seatbelt in the car ever since I read your first post about it. 

I hope Mrs. Bastard and the little bastards I'll admit it feels strange calling them this when they must be such fantastic kids) are doing well and that your work is going smoothly.  With much admiration and the kindest regards, Karen (not my real name™)

It's been on my "Write About This, Dammit" list since then, but I haven't been able to get to it.  But that list has shrunk over the past few weeks, so I finally have the opportunity.  The story went viral back then, getting covered on national television shows and various other news outlets, so I'm way behind the game here.  Nevertheless I still feel like story this deserves to be covered here in case anyone missed it.

I've written before about the impact of saying "Thank you" to your doctor, but this takes that concept to an entirely new level.

In 2004 Kellie Haddock (her real name!) was in a car accident with her husband A.J. and their 14-week-old son Eli in Orlando, Florida.  A.J. tragically died in the accident, and baby Eli was airlifted to Arnold Palmer Hospital for Children with serious injuries, including intracranial bleeding.  Though the paediatric team at the hospital worked tirelessly to treat Eli and his trauma-induced seizures, Kellie was told that even if he recovered he would most likely never walk.

Less than a week later, Kellie took Eli home.

Fast forward 11 years, and Eli has made a full recovery.  He's now a happy, healthy tween, Kellie remarried, and her new husband adopted Eli.  While this may seem like a nice, heartwarming story, it fortunately doesn't end there.  Ten years after the accident, Kellie was inspired to track down every member of the medical team that made Eli's recovery possible - first responders, the flight medic, the respiratory therapist, nurses, doctors . . . everyone - in what she appropriately called the Thank You Project.

In pointing out exactly what's wrong (but what could be right) with the world, Kellie said, "We rarely take the time to notice when people are doing things right.  I want to be a person that points out when someone does something right.  How much better would the world be if we all spent more time focusing on what’s right instead of what’s wrong?"

So Kellie found them all, arranged to meet them, and then threw an elaborate dinner for everyone.  And all of them got to meet Eli, now a very bouncy (and very normal) 11-year old.  Tears flowed, as would be expected.

I feel happy when I get even a simple "Thank you" from a patient or family member, elated when I get a hug, and absolutely on top of the world when I get a card or a fruit basket.  So I cannot even begin to imagine how honoured all these people felt when Kellie found them.  Kellie went way above and beyond as her way of saying "Thanks", but if everyone made even a tiny fraction of the effort that Kellie did, just imagine the possibilities.

Here is the video that Kellie made with the assistance of Strongfilms, a professional video company.



Thank you Karen for sending this to me.  And thank you, Kellie.  Thank you for saying "Thank you."  That means more than you will ever know.