My Physical

questionAfter waiting in waiting room, then in examination room and being grilled by his assassin of a nurse, good doctor showed up. He was a serious looking guy. He acknowledged my presence without even looking up with a curt node. He kept on looking at his papers with an expression of concern. I had a feeling he was trying to find some imperfection in my perfect physiology.

He had the kind of personality that will even find a way to ruin a twin delivery with something like, “Congratulations you have twins but they ate their 3rd sibling.”

He just kept on looking into these papers. Occasionally he will mumble an “hmm” or “oh”. What could it be that this great scholar had found out simply by looking into these papers? Finally he looked at me. He gave me a kind of quick look over that a customer gives a piece of meat at a deli.

I tried to break the ice by pointing out that his kids are very adorable. He looked somewhat puzzled. I pointed out to the picture on the wall. He told me they are not his children. It turns out that this was a UN poster for hunger among children. The kids were of 6 different races as well. I apologized sincerely. I am sure he thinks I am some kind of a smarty pants. I made a mental note of putting my glasses on next time.

He asked me a whole bunch of questions. They all would be considered a serious violation of me and my privacy if he was not a doctor. Their obsession with bodily fluids, cavities and orifices is second to none. He kept on asking me if I have seen blood in one or all of these areas.

Then he gave me the good news that I will have to undergo a lot of routine screening. I will be screened for diabetes, cholesterol, kidney disease, liver diseases and anemia. If I want he can check my prostate “good old-fashioned way”. To leave no doubt in my mind about what the “good old-fashioned” way was, he raised his index finger. I told him I don’t know what this particular organ is supposed to do but I am sure it is fine.

After this he went to give me a whole lot of advise about things which you are supposed to know by the time you come out of high school. Only in US, a doctor will be considered a “good doctor” by insurance companies for talking about it for 15 minutes and then checking 200 boxes and writing 4 pages about it. The advise went something like this:

Eat greens, wear a seat belt, stay hydrated, get enough fiber, exercise, lose weight, don’t text and drive, don’t eat and drive, don’t drink and drive, don’t fall asleep and drive, look for blood in urine/stool/spit/sputum, don’t have a seizure and drive, don’t drop dead while driving, get vaccines, take Aspirin, eat fish and have safe sex with strangers. I told him I am married. Is he advising me to have sex with strangers as long as it is protected? I also told him that my wife might not approve of it but if it is something life saving then what choice do I have? He corrected himself and apologized for not realizing that I was married.

To be continued…

I

Visit to Doctor’s Office-Weight Loss Series

After spending some quality time in depressing surroundings that is a doctor’s waiting room, my name was called. I was ushered to an examination room. Calling it a room was fairly generous. It was the size of a vertical coffin. If that alone did not make you claustrophobic, they had all other angles covered.

The interior of coffin was done in shades of suicidal gray and deathly pastel. The overhead lights were those bright fluorescent types that they banned even in former USSR. There were all kinds of artsy posters on the walls. This eye-catching artwork had a practical purpose though. It warned that you could have colon cancer, breast cancer, prostate cancer and few other types of cancers. You ignorant soul might not even know about it. All you have to do is to ask your good doc for screening for these things. He will arrange for all your body orifices to be probed thoroughly so that this cancer will have no place to hide. They also had a very serious looking guy pointing a finger at you and asking, “have you had a colonoscopy”?

You could also have diabetes, high blood pressure, depression, mini stroke, diverticulosis, abnormal cholesterol or heart disease. You might have low testosterone, low estrogen, low bone mass and anemia. On a different note you could also have heart failure, kidney disease, hepatitis or skin cancer.

It also reminded reader that you should inform doctor if you don’t feel safe at home, had unprotected sex or have suicidal thoughts. Especially if you had suicidal thoughts after having unprotected sex. Because let’s face it; HIV is fairly manageable now a days.

The nice Nurse was an old-fashioned, old world nurse who still had the head thing and all. She did not believe in smiling or laughing. She handed me one of those nightmarish hospital gowns that open in back and never have all the straps in place. I made the regular lame joke that generally I am paid for this kind of thing. Either she did not find it funny or she wanted to put me right in my place. She gave me kind of the look that a Mummy (Egyptian type, not your own) gives you when you crack a joke.

I told her that I do not see the need to put this garment on, as I am here for a quick physical only. Apparently there is nothing like a “quick physical” and doctor would prefer me in this “thing”. She left the room and I did change into the “thing”. Just to make this an unforgettable experience, they even had a mirror in the room.

With my last shreds of dignity snatched away from me, I decided to make most of what I had been given. As a token of my protest against this objectification of my body, I decided to keep the socks on. I really cut a fairly depressing figure in this flowery loose robe. A knee-length robe with socks is never going to make you front cover of GQ. I decided to take the socks off. The reflection in mirror was even worse. I put them on again. But then I was worried it would add weight, I took them off again.

Nurse is back. She took my weight and all the usual stuff that they do. She told me I have great veins. I thought it was a compliment till I realized that she was planning to draw some blood. With her demeanor I was not sure if she would use a syringe or simple suck it out of my veins. I told her I am absolutely healthy. But doc would still want to check my cholesterol and thyroid hormone levels. I have already waited close to 45 minutes in waiting room, 25 minutes here, filled out my life story in all kind of forms and this healer is nowhere to be seen.   To be continued…

Physical prior to Physical Trainer.

As my physical trainer is hell bent on getting me to see a doc prior to initiating my exercise, I had to call and make an appointment. One of the things that strikes you when you visit a doctor’s office is how healthy people are. Not a single person in waiting room looked sick to me. in fact they all seemed to be having a jolly good time. Some of them seem to have become friends by waiting long periods of time in same doctor’s office over the years. I can smell an occasional romance blossoming amid walkers and under the sweet smell of chlorhexidine, hand sanitizers, death and dementia.

The other thing is amount of information they want. Your name, gender, DOB, address, Insurance, ethnicity, religion, spouse’s name, emergency contact etc. This is followed by next layer of welcoming material. These include forms about status of your health. This is a masochist’s dream come true.

Do you feel safe at home? Do you own a gun? (What if I own a gun and still do not feel safe? Are they going to get me an army tank?). Do you wear seat belt? Are you sexually active? Do you have STD’s? Have you noticed any blood in your saliva, stool, urine and sputum? (Some elderly couples seem to do this as some kind of a trip down the memory lane). Do you feel threatened at home or work? Do you use drugs? Have you had sex with another man? (No, but if doc suggests it then I might give it a thought). To be honest, I stopped reading the questions after first few and just circled the whole page and wrote a big NO.

As there is always a long wait, they have quality entertainment. There is a TV which seems to run only lifetime channel. There are some magazines with such exciting titles as “beautiful home”, “home and garden”, “retirement” and “golden sunset” (which apparently is even further down retirement road and for someone who is seriously considering dying). They have flyers about retirement communities, diapers for incontinent, potty chairs, colostomy bags at discounted prices, straight catheters, walkers, canes, special shoes and god knows what else. If you did not have depression before you come here, you sure are going to walk away with one.

The other problem is that some of the folks who are here seem to consider it as a social event. As soon as you sit, they start chatting up. They will say two polite things and after that it is all about their own health. They all believe in uniqueness of their complicated cases and challenges they have presented to medical world. I have a hypertensive on one side whose BP is not being controlled by collective might of American healthcare, pharmaceutical industry and three different pills. He seems almost proud of this. This dude apparently has to come in twice a week for just a BP check. He has been on every category of medications. Either he develops side effects of his “man parts” not working or it does not do anything. I told him may be he should just give up. Life is very over-rated and death is a golden sunset. I handed him the magazine with same title.

There is a lady who is talking to another lady about her Insurance problems, weed problems in her garden, husband losing memory, frequent UTI’s, not being able to sleep and her daughter living way too far. She is gifted (or cursed) with a high pitch voice that can drive you homicidal, suicidal or both. I honestly believe she should not be allowed anywhere near a medical facility. I can also understand her daughter choosing to live away so far. How long do I have to be here?

John Doe (Part 9): A Medical Orgy

doctorsToday is a busy day. The cancer doctor is in. He informs me that if I am found to have prostate cancer with metastasis to lungs, he will use a chemotherapy regimen called CAT (Cisplutonium+ Atronucleum+Tarcilium). If I am found to have lung cancer with mets to prostate, he will use BRAT (Bullonium+Robushium+Assonium+Tarcilium). If they can’t figure out what is what, then he might use BRATCAT altogether. He pleasantly informs me that though this powerful combination of medications will cause nausea, poor appetite, infections, ulcers and nerve damage but my “survival” will improve to 27% from 23.75% over 5 years.

But off course he first needs Urologist to biopsy my prostate and the lung doctor to see me. He also needs heart doctor and kidney doctor to give clearance for chemotherapy. It looks like every doctor is waiting for 3 other doctors to do their part before they can do anything.

Suddenly angry surgeon is back with her full team. She wants to know why they are talking about chemotherapy when gall bladder is still sitting in there, waiting to explode like a rotten kiwi. And if he is going to go for a prostate biopsy, why can’t she and Urologist “double tag” me and do both these things at the same time. She orders her assistant types to call Urologist assistant types. The Oncologist tells his assistant types to call kidney doctor’s assistant types.

Nurse informs them that I have been declared suicidal again by Psychiatrist. Angry Surgeon is real angry now, “these shrinks are out of control.” She asks another assistant to call shrink. Oncologist asks his assistant to call heart doctor so they can find out if my heart is strong enough to undergo gall bladder surgery, prostate biopsy and chemotherapy with CAT or BRAT or BRATCAT.

Kidney doctor comes in with his team. Surgeon asks him, “are his kidneys gone”? He informs her that he can’t say anything till 24 hour urine is collected and all kind of tests are run. The cancer doc wants to know if patient can at least tolerate chemotherapy. He feels I definitely need chemotherapy even if they have to put me on dialysis. The heart doctor’s assistant calls back. His boss is at some charity golf tournament and can’t be disturbed. Angry surgeon had a husband who used to play charity golf. She kicked him out and now he is on charity himself.

The Shrink is back. He is clearly intimidated by angry surgeon. She tells him that he needs to fix me whatever “mumbo jumbo” he needs to do. Otherwise there is no one to give consent for the surgery. The urologist comes in with his team. He has some long tubes in his hands. “Does he still have the obstruction? I can pass a catheter.” I can only imagine where this thing is supposed to go.

They talk some more about me. They decide to page Radiologist to further discuss those thousand CT scans that they have done on me so far. He doesn’t call back. They call him this time. The Radiologist is not happy. He is not used to being disturbed after 4 pm. He is “out” already and cannot look at CAT scans. He tells them that this “32 hours work week” is taking a toll on his life. He might not be able to do it much longer if he has to work 32 hours a week, 40 weeks a year. He loves medicine and taking care of patients but he can’t kill himself for them. Angry surgeon tells him that he does not take care of any patients, he just read films. He tells them to call “Nighthawk”. This is apparently some Radiologist thousands of miles away in foreign lands.

Now I truly have become an international case. I have 5 specialists and an army of trainees right at bedside and yet they need another one from another country. Thankfully they have decided to postpone this discussion for next day.

John Doe’s Psychoanalysis

Credit to mytherapy.com

I still have a sitter who is monitoring me 1:1 in case I run away and start humping Petunias again. At this time I am not sure which of my organs are alive, dead, partially working, hibernating or ready for donation. I have been here for 24 hours and I am not sure if I need to donate organs or need organs.

There is another gentleman who has just entered my room now. He comes in, looks around, walks out and then comes in again. He repeats this whole cycle again. He seems to be in some kind of agony (only later did I realize that he always looks same). He has somewhat of a strange disposition. He is balding in front, has long hairs in the back, has earrings, purple shirt and a flowery tie. Either he was a hippy or trying to be one in reverse. His glasses and pants both seem to be falling down at the same time. He tries to balance them alternately. He is also carrying some hundreds of loose papers.

He told me he was here to help me. He would be my Psychiatrist. I told him I would be his Neurosurgeon. He got very puzzled. He showed me his I.D. He really was a Psychiatrist. After this he pulled out one sheet from hundreds of loose papers.

P: Can you tell me about your childhood? What are your memories? How was your relationship with your parents? How was your relationship with your siblings? Were you married? Are you married? Are you single? Are you divorced? Are you in a relationship now?

P: Are you sexually active?

Me: I feel lucky if I can find the damn things to pee on cold days.

P: Have you been attracted to men?

Me: No, just to my TV.

P: Do you have any fetishes? Why were you being intimate with Petunias?

Me: Because I could not find any Lilacs. Are you married doc?

P: Yes, I am! In fact I just got met someone last year and married her. I have 4 children.

Me: How is that possible?

P: They are all her children. She was a patient of mine. Two of her children were patients of mine as well.

Me: But isn’t that unethical?

P: It would be if she continued to be my patient. But she fired me. Her children also fired me. We met 6 months later in “run for kleptomania” and got married. We both even did not remember that we were doctor and patient.

Me: That’s strangest story I have ever heard.

P: I know it’s kind of romantic. She’s also 18 years older than me. In fact her oldest son and me are exactly same age. Is that not a coincidence?

Me: What do I have? What is your plan for me?

P: Well you have early dementia with depression, deviant sexual behavior with impulse control issues and possible anti-social personality disorder. Off course there could be an organic or metabolic underlying condition as we are not done with all testing.

Me: How do you plan to treat me?

P: Just like everyone else. We will start with one anti-depressant, one sedating anti-depressant and one anti-anxiety medication. As these will make you sleepy, I will start you on a stimulant. As stimulant can increase your BP, I will ask Cardiologist to start you on anti BP medication. If you go into a maniac phase with anti-depressant, I will start you on Lithium. If Lithium cannot control it, I will start Olanzapine. If Olanzapine make you too depressed, I will add another anti-depressant. If that makes you more sleepy, I will add another stimulant.

Me: Are you serious? That’s like at least 3 more pills on top of 6 that Cardiologist has me on.

P: These medications are not just for acute improvement. They cut down your suicide risk from 13.6% to 9.8% over next 10 years.

Me: Oh God! I just don’t want to live in this crazy world anymore.

P: (loudly) He is suicidal! Restrain him! Bring the sitter back!

John Doe-Has A Gallbladder?

Credit to horsey-healthcare

The next person to visit is a surgeon. She also has a team of her own following her. She means business. “Have you passed gas.” I did not know how to answer this charming question. “Why do you still have a gallbladder?” I was born with one I guess. “Why has it never been taken out?” She seemed real angry. I am not sure if it is me or the gallbladder.

The nurse informs her that patient only has some stones in gallbladder and as per radiologist there is no obstruction. “”Are you going to tell me what a radiologist thinks? They don’t know nothing. You know who becomes a radiologist! Don’t you!” I feel she thinks even lesser of radiologists than gallbladder.

She made sure I stay hungry, “In case we have to open him up and take that damn gall bladder out”. I don’t think even the priest can save my gallbladder now. She wanted complete control of situation. She changed iv fluids because the other doctors, “Don’t know what they were doing.” She wanted Anesthesiologist, “In case we have to go in rather quick”. She wanted to write something in my chart but her pen didn’t work. She threw the pen, nurse ducked while changing fluids without even looking up. It looks like staff has had good practice of ducking to avoid things being thrown. One of her interns mumbled something. She yelled at him about not being so stupid that she loses faith in mankind.

I have another doctor in now and it is not even 11 in morning. As usual he has a team of his own. He informs me that he is here to find out what’s wrong with my kidneys. He was very interested in my urine. Majority of time he was there he kept on looking at urine in my catheter. He was personally offended that it was yellowish brown and not light brown. I swear that at one time he was trying to smell it. He did not want to waste even a drop of my urine. He wanted my urine to be collected for 24 hours. He instructed nurse that every drop I drink or pee has to be accounted for. He wanted to know about frequency, urgency, strength of stream, incontinence, turbidity, night-time urinary activity and everything else about my urine. He wanted another ultrasound of my kidneys because “one never knows”.

I asked him what’s wrong with my kidneys. He went into a very lengthy explanation. He spoke for 5 minutes. I don’t remember or understand most of what he said. However what I could make out was: kidneys, no urine no good, failure, ultrasound, CAT scan, more testing, dialysis, more testing, urine, kidneys, failure, golden urine, more testing, protein, more testing, kidneys and some more testing. It appears once you have kidney disease the treatment is more testing.   to be continued…

John Doe- A Doctor for his heart

Image credit to http://www.tauindex.com

The first doctor to see me today is a Cardiologist. I immediately knew he was a Cardiologist because he had a Rolex watch and monogramed shirt. He also had a whole bunch of people following him. These were his students, assistants, in-training doctors called Residents and fellows. His assistants introduced him to me. Apparently no Cardiologist worth his salt introduces himself. In the meantime, he changed the TV channel so he can keep an eye on stocks.

Me: Do I have a heart attack?

Doc: It is quite possible!

Me: Well, I did or did not.

Doc: We will have to do an Echocardiogram.

Me: They already did one in ER. Besides they did an EKG.

Doc: The ER Echos are worthless. EKG is even more worthless. We need a new Echo. If that does not tell us, we will pass a tube down your throat and get better pictures from inside. If that still does not tell us, we will do an echo while doing a stress test. If that still does not tell us we will pass a catheter in your groin and look into arteries of your heart. If your arteries are blocked, you will need a stent put in to open those arteries.

This guy sure has a plan B,C, D and Z. I have a feeling that he will keep on looking till he finds what he wants. I asked him when will he do this test.

Doc: I will not be the person doing that. I am a non-invasive Cardiologist. We will have our Echo specialist read the Echo and if a Cathertization is needed, interventional Cardiologist will be doing it.

Me: Are you telling me I will need 3 different heart specialists to tell me if I have a heart attack or not.

Doc: But before that we will need clearance from your kidney doctor, lung doctor, Surgeon, Neurologist and Psychiatrist. We don’t want to take any chances.

After this he ‘”examined” me. He carefully placed his stethoscope on my chest in a manner such that his shirt sleeves won’t be ruined. He asked his students to listen. They discussed the “findings”. They kept on saying words like murmur, irregular and dilated. I asked him what is wrong. “Oh, it could be anything. We will have to wait for Echo results”.

He tells me my cholesterol is abnormal and will need to be treated with 2 different pills. My BP was low on admission but is high now. I will need another pill for that. I will need Aspirin and another medication of the same type. I will also need something that is good for my BP, heart and kidneys.

Me: But that is like 6 pills. I have never taken pills in my life.

Doc: Well, all these medications reduce your risk for heart diseases from 38% to 33% over next 10 years.

Me: You want me to take 6 pills a day for 10 years at age 82 to reduce my risk by 5%!

Doc: It is your choice. But it will be against medical advise if you don’t. If you are found to have heart disease and need a stent, you will need 2 more pills. That will reduce your risk by another 0.5%.