I strained my back about two or three weeks ago doing some lunge-reach exercise with kettle bells. Locked me up pretty good. I’d sort of tweaked it a bit before that but was able to continue doing my regular workout stuff, but that didn’t allow it to get better and set me up for pulling a muscle or two a few days later. Joe told me I should rest for a week or two, and I listened a little bit. I mean, I stopped doing any lifting or pushups or pull-ups, but I got on the spin bikes and have been doing that every day for at least an hour or two. My back feels a lot better, and I’ve lost another 4-5 lbs. The upside, my abs stick out a little bit (or my belly sticks out less – same difference in my book); the downside, as my face has gotten a little thinner, my ears stick out even more. Not a good look for me.
I arrived at work the other day and only one other person was there – our supply person, who’s not a medical technician. I asked her where everyone ran off to, and she replied that they had just left for the Canadian gym. Someone ran into the clinic a few minutes earlier asking for medical help. They thought someone at the gym was having a seizure. I missed most of it, but apparently when Joe and the techs arrived, the woman was on the ground, gasping irregularly, and nonresponsive. Joe thought he lost her pulse, so gave her some mouth-to-mouth and they did some chest compressions.
By the time I arrived, the EMTs were there and had placed EKG pads on her. She had a pulse so they were just bagging her as some of the gasping breathing persisted. Joe told me that one of her eyes deviated out to the side. Apparently, the woman is a 33 year old American contract worker. She had diabetes and it hasn’t been well controlled, though she works out regularly. As it turns out, her blood sugar was fine when they checked it. We found out later that she had a hemorrhagic stroke, a brain bleed. I asked someone who works at the hospital and they think she died after they transported her out of here, but that's still unconfirmed.
Speaking of people who have recently died, there was also a soldier who recently died back in the States after he'd just returned from Afghanistan. Rabies will kill you dead without getting treatment. Guaranteed. Apparently, he'd been bitten by an animal while deployed, but apparently didn't tell anyone, which is obviously a bad idea. Now it's a "priority issue" for everyone because, of course, it has to look like we're all taking this very seriously. And it's not that I don't think rabies is serious, but everyone who in-processes here is warned that rabies is endemic to Afghanistan, so don't touch any animals. It seems like common sense. And it's one guy who wasn't very smart, but was very unlucky. That doesn't make it a high-priority issue (I still say that not getting your limbs blown off and/or killed dead by an IED still ranks as the highest priority issue here), but it does make it a seemingly extra-important issue because it was in the press.
Anyway, back to brains bleeding. I remember being in medical school and our team had an 18 year old patient who had a stroke. The kid was 6’5” or so and had a scholarship to play baseball in college – the “All-American” kid, everything going for him. He was working out one day lifting weights, next thing he knows his head hurts and he can’t move half his body. He’d ruptured a congenital aneurysm, or a blood vessel that has weak walls and sort of balloons out until it breaks. Scary to think about, that you might have a ticking time bomb in your head that could go off at any moment. I think that would be a hard thing for anyone, but particularly for people who are especially active.
Griff and I went skiing in Korea last year, and afterwards we were watching a movie called “Murderball”. It’s a documentary about a wheelchair rugby team. As they introduce the team members, they tell each guy’s story about how he became a quadriplegic. Some of the guys had freak accidents while biking or whatever, and in an instant could no longer properly control (to varying degrees) their bodies from the neck down. Well, after less than 15 minutes of hearing those guys tell their stories, and thinking about a few of the accidents I’ve had riding mountain bikes, I had a visceral reaction to it - literally felt sick to my stomach and became so depressed and scared that I had to turn it off. Really.
I remember talking to Mom years ago and she mentioned that she’d taken Maddy to the vet and had her put down. She had those horrible allergies and nothing was really working to relieve her symptoms. I asked her, facetiously, “How would like it if your children put you under for having allergies?” She answered, in Grandma Etta fashion, something like, “If I’m old and as miserable as that dog was, I’d do it myself.”
Old and allergies are one thing, and probably not justifiable reasons for putting your parents to sleep ("probably" being the operative word, though I'm open to debate), but I'm not sure how I would feel about being paralyzed from the neck down. My instant reaction is to say, “Just put me out of my misery.” Don't think I’d want to live like that. I mean, Christopher Reeves was inspiring and all to lots of people, but I don’t think I want to go through all of that. Plus, he was wealthy and famous and probably received extremely exceptional attention because of his celebrity and advocacy. I seriously doubt most quadriplegics have those kinds of resources available to them or get that amount of attention. I guess you can’t really know how you’d feel and respond except in the unfortunate case that it happens to you.
As you may have heard, the military quietly suspended the “Don’t Ask Don’t Tell” policy about homosexuals serving openly in the military. And while I absolutely agree that it was a way overdue policy change, I am still not gay, so this isn’t a coming out announcement. I know, I know. I’m a fabulous, nearly 36 year old male, not horrible looking, smart, fairly athletic, EXTREMELY charming, goes on hiking and camping trips with his buddy with the creepy mustache named “Griff”, hasn’t brought home a woman to meet the family, and is still single. I also know that Bill asked my buddy, Brian, whether he suspected I might be gay as we were traveling through Nebraska and stayed at their place on our way to California to start our respective residencies back when. So I get it. But that doesn't mean I'm gay; it just means that maybe I'm awful and girls don't like me, and that I'm a menace to society.
"USA! USA! US ... HEY there big guy!"
I do, however, find my job has me talking about and touching other men’s genitalia way more than I’d prefer; and I’d prefer not-at-all. I often tell people that my job isn’t all glamour and call-room hookups with naughty nurses. Sometimes I say, when someone asks about what I do, that I stick my fingers in people’s butts. For money. It’s part of my job, and it’s not all that great. Trust me.
Coincidentally, just the other day I had another man's penis in my double-gloved hands, freezing off little cauliflower clusters of genital warts. He explained to me that part of the reason he waited so long to be seen for this issue was that he was nervous and embarrassed that, when at "parade rest", his wiener is kind of small. So I proceeded to reassure him that there are men who are "show-ers" and those who are "grow-ers."
In a cold room, and at their smallest, the "show-ers" would seem to have the longer penises, but the "show-ers" don't get much longer when they get an erection. It’s basically “what you see is what you get.” On the other hand, the "grow-ers" are guys who are smaller when flaccid, but then get considerably larger when they're tumescent, i.e. sometimes big things come in little packages, no pun intended. All the while, I methodically applied a freezing solution to his phallus flower garden. Fortunately, nothing I did to the guy allowed us to find out how much of a "grow-er" he is, although I suppose applying a freezing cold applicator to his genitals might have had some beneficial effect to that end as well, thank goodness.
Also had a guy come in for breast tenderness just under his nipple. I stood behind him, with his shirt off, rubbing both his nipples (cause you have to compare the affected and non-affected side, after all) and said, "I really hope no one barges in on us right now. That would be some awkward explaining to do." Then I had to tell him that, unfortunately, I probably ought to examine his balls (breast masses can sometimes be associated with testicular masses). Sometimes I think I’m way underpaid for the crap I have to do.
And then there was one of the Canadian guys who works at the gym. He came up to me one day while I was on the spin bike, asking what hours I work at the clinic, and if he could stop by to chat. Most of the time when people want to “ask you a question” in private, it really means “I think there’s something wrong with my balls and/or wiener.” In Gono-Korea, we saw a lot of STDs. When guys would come to morning sick call with those types of complaints, the euphemism was “foot problem,” as in “Doc! There’s something wrong with my foot – my wiener is dripping all over it.”
Anyway, the Canadian guy thinks he got herpes from a girl he’s been sleeping with. He was telling me all about these painful bumps/sores that he has on the inside of his foreskin. I sat and answered his questions for the better part of an hour. At the end of our conversation, I told him that was way more time than I ever wanted to spend talking about his junk; and I'd prefer not-at-all. A few days later he gave me one of the better designed t-shirts from the Canadian Air Force run. And as I’ve said before, it’s all about the t-shirts. And donuts.
And then there are all the people with gastrointestinal issues. I admit, after I had those two weeks of diarrhea after returning from Nepal (during which time I was wearing sweatpants to bed in case I farted and shat myself in my sleep), I don’t have a lot of sympathy for people who come in and tell me they’ve had non-bloody, non-fever, non-cramping diarrhea since “this morning.” One guy came in complaining of blood in his stool (from hemorrhoids). He was thoughtful enough to take a picture with his iPhone and show it to me. Um ... thanks? People get pretty freaked out when they see blood in the toilet, so I usually reassure them that even a tiny bit of blood in the toilet bowel can make it look like a battle scene from "Braveheart" in there, or the opening beach scene in "Saving Private Ryan." I sometimes wonder what they do with those pictures afterwards. Hopefully they refrain from posting it to their Facebook page, though I wouldn’t put it past some of them: “Sergeant Johnson … had blood in his poop today! OMG! LOL! BRBPR!!*”
*(BRBPR = bright red blood per rectum)
I saw a girl the other night who was complaining of being really nauseous and vomiting several times before she arrived to see me. We've been seeing a good bit of gastroenteritis lately. I can't say whether it's something going around or not, but when you have lots of people working and eating in close proximity, and who maybe don't wash their hands as diligently as they should, it can obviously be passed around. I had her lay down in order to exam her abdomen (which wasn't overly concerning, though she was a bit tender over her stomach), but I guess that sitting her up made her a little dizzy and ratcheted up her nausea. She told me she needed to throw up, so I grabbed the garbage can. When I got it up by her face, she let go a salvo of yellow-green liquid vomit without any chunks. I held the garbage can and rubbed her back while she let it all out. I asked if she'd eating a yellow piece of candy, and she says she had an apple Jolly Rancher (or a Jolly Rogers, as Dad would say).
After she recovered, she asked, "How can you just stand there so calmly and rub my back while I'm puking right in front of you?" I don't know. It's like lots of other slightly unpleasant things that you just get used to, like changing baby diapers, or eating vegetables. Yeh. Kind of like that. I remember watching a friend get his ingrown toenail cut out in Lithuania, and I almost passed out then, but now I rip out toenails all the time.
I didn't always have even that much fortitude when it comes to vomit. The very first patient I worked with as a medical student had end stage liver disease (drugs and alcohol will do that), and he ended up dying; not a great start to my career. I went in one morning to round on him, and he was more disoriented and out of it than usual. As a brand-new medical student on my rotations, I wanted to be very thorough, so I made sure that I sat him up so that I could really get a good listen to his lungs, though it was probably unnecessary.
He didn't react to all the moving around so well, however, and he started gagging and dry heaving. That can be bad enough to witness as it is, but when you're right next to this guy who already smells sick and you're hearing the gagging amplified through your stethoscope ... ugh. That's when I got grossed out and had to make a quick run for the bathroom. At that time I learned from experience that bananas do indeed taste more or less the same coming back up as they do going down. My friend, Brian, laughed at me when I first told him, but then he was almost offended that it happened. He said something like, "A doctor puking because a patient grosses him out? That makes no sense! That's like a lawyer who doesn't know how to lie." I guess I've grown a little since then, and I don't mean that in the "grow-er" vs. "show-er" sense.
No comments:
Post a Comment