Thursday, March 20, 2008

Intersections Of Alternate Universes

Our scene: A medical exam room, Room # 2, that's quite a bit past its prime, but clean and reasonably well stocked with antique magazines proclaiming "At Home With Mamie Eisenhower" and "What Do Your Biorhythms Have In Store For You In 1977?" Seated is a young man, waiting to see the physician. He appears to be normal and sane. Enter our heroine with a pleasant "Hello" and an introduction. She sits and enquires of our young man how she can help, and listens politely.

Young Man: "I have a rash on my arm. It comes and goes and it won't go away."

Our Heroine: "I see. Does it hurt or itch? How long has it been like that?" (Etc, etc, many in-depth questions about the rash and the young man's life, career, and other assorted necessary questions.)

Our Heroine then proceeds to examine the rash, which looks like a classic spot of eczema (aka: atopic dermatitis). She is thorough in her exam and then sits down explaining eczema and its treatment and the expected time frame of outcome. She hands YM a prescription for the appropriate cream to treat it and discusses moisturizing. She then asks if there are any other concerns.

YM: "See, that's not it. I drank some hot tea from Fastfoodplace a few days ago and it didn't taste right. I got a bacterial infection from it and now it's in my blood and my body and coming out through my skin. I need a strong antibiotic for it."

OH: "Oh. OK. Let's talk about bacterial infections in the blood and skin and what you see with them." She then proceeds to briefly discuss this so YM can understand that the patch of eczema on his arm that waxes and wanes is in no way caused by bacteremia (bacteria in the blood) or its related conditions. She is not laughing nor joking.

YM (angrily): "Well, I see I will have to go all the way to Milwaukee to get competent medical care. This is from the bacterial infection I got from the tea. Just give me the antibiotic. I heard you were a good doctor and you clearly are not. I don't deserve to be laughed at. I deserve proper medical care."

OH (very calmly): "Well, it's certainly your right to go where you choose for your medical care and I'm sorry you feel that you are not being taken seriously. I take all the patients I see very seriously and give the best care I am able to. I realize that you disagree with me, but your rash does not require antibiotics."

YM (now frustrated and very angry): "How can you say that? You didn't even test me for infection. I want a urine test to show the bacterial infection in my body. You didn't even do a urine test! I want proper medical care, not some incompetent to sit there and laugh at me!"

OH (completely bewildered but trying to remain calm): "I can see that you're upset, but I can't treat you with something for which you have no medical indication. None of your symptoms fit with a urine or any other infection. Treating you with an antibiotic would not only not help you but would be potentially harmful and I'm not going to risk hurting you."

YM: "Well, I'm going to Chicago to see a real doctor, who'll treat me seriously!"

OH: "That's certainly your right. I'm sorry you feel that way. Good day."

Exit Our Heroine.

It is then that she realizes what has happened. It's the only explanation that fits. In that very small and unassuming exam room, there was an intersection of two alternate universes. In one were our two beings. In the other, were a person with necrotizing fasciitis or perhaps staph scalded skin syndrome appalled that the physician was trying to treat him with multiple broad spectrum antibiotics and possibly wide debridement (the cutting away of all potentially damaged tissue, to the point of removing healthy tissue so as not to miss any infection--very disfiguring in general) and hyperbaric oxygen therapy for what they felt was only a mild case of eczema. Horrifying, indeed. I hope the bad outcome is averted.

In my case, the only bad outcome was that YM stood at the desk and amazed our front and back office staff by first demanding and then filling out a complaint form about me and my substandard medical care. (An aside: Apparently the rules of grammar and spelling are only minimally similar to those of our reality.) After he left, I couldn't help chuckling a bit over the vagaries of the space-time continuum. After all, this was the first time that I knew of that a complaint was lodged against me for my personal care. For better or worse, I'm known as 'that nice doctor, who really listens'. I may not be that good, but, dammit, they can't accuse me of not seeming to care.

While I truly wish I'd been able to make the young man from the alternate universe understand what and why I was treating as I was, it was cool in a way.

Not every day this happens.


(Oh! And the next day, we found that he'd gone and filled the prescription for the cream. We knew this because the pharmacy called and said that his insurance wouldn't cover what I'd chosen and I needed to substitute a different cream. I'll take that to mean that the kink in our respective universes shook itself out and that the poor young man with the life threatening systemic bacterial illness is now recovering nicely with all the antibiotic therapy his reality can give, while the young man with the mild eczema, now back in his own plane, is rapidly improving under the appropriate cream, having avoided horrific and unnecessary therapies for his annoying but benign condition.)

Here's to all being right with the worlds and the universes being in their own spaces. I'll also be extra careful of where I stand in Exam Room #2. You never know when that may happen, again.

Note: Of course, most of the details of this tale were changed. I'm not a complete idiot, just a partial one. The substance remains unaltered.)

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Blogger Christina said...

Way to go Heroine, I wonder if he made it to Chicago to see an MD and pay all the tolls and parking to have the pleasure....

3:32 PM  
Anonymous Anonymous said...

Did he go to Chicago or to Milwaukee? I also wonder if he really knows the difference is not just a walk across the street. Let me know the next time he comes and I will have a nice conversation with the dolt.

The Ole RF-er

4:05 PM  
Blogger amymalia said...

Sounds freakishly like every hour of every day of my life, only, completely reversed. I live in that other world, the one where they DO have necrotizing fascitis AND tuberculosis AND septic bacterial meningitis and believe any/all of the above to be eczema.

Or maybe ingrown toe nails.

5:07 PM  
Blogger Rozanne said...

He does need another type of doctor--one of the head shrinker variety.

He's got at least a touch of something that is surely covered in the DSM.

Kudos to you for keeping your cool. I'd get very flustered were I in your situation.

6:58 PM  
Blogger CarpeDM said...

Wow! Didn't know you could get bacterial infections from tea. Huh. Will avoid that like the plague.

And gosh, I sure hope his dimensions work out for him soon!

12:27 AM  
Blogger Lioness said...

Oh good God. That is the very moment they yell "GET PSYCH HERE!" in ER, aren't you jealous of their resources?

It must be so frustrating, to know you are able to help easily, to know that what he has is actually treatable and not something far worse, and to have a patient react in that absolutely incomprehensible manner. (At least the idiot did get the cream.) And to lodge a complaint against you - you! - for lack of proper care is so ludicrous as to be absolutely hysterical. But yes, I'd be feeling utterly befuddled as well. The humanity!

5:01 AM  
Blogger Dumdad said...

Aren't there times you feel like fishing out your mobile phone and shouting into it: "Beam me up Scotty!"?

12:31 PM  
Anonymous Anonymous said...

Hi Honey! I have that EXACT SAME PATIENT! Except mine has contracted herpes and it is coming out on his skin - in patches that look AMAZINGLY like eczema. Hmmm. I, too, am an uncaring, substandard provider.
Oh well.
We do what we can.

12:50 PM  
Blogger Diana said...

Christina- You know, that and the gas to get to Chitown may have been the reason for filling my 'substandard prescription'.

Dad- Freudian slip. It's hard to keep the changed details straight. This is why I seldom lie. Too much work.

Amymalia- That's the horrible part about hospital work. They don't let just any disease in, just the really nasty stuff. Ingrown toenails with sepsis, anyone?

Rozanne- Yeah. I'm thinking a solid Axis 1 with psychosis and probably one of the less endearing forms of personality disorder for an Axis 2 diagnosis.

Dana- Who knew? Here, they tell you if the water's boiling (and you're in a first world country), you're safe. Guess we'd better be safe and just stick to denatured alcohol. Nothing would live in that, right?

Johnny- Green with envy. One of my best friends is a psychologist, but she was 5 miles away. Fat lot of good. That was just it. It was all so very surreal. I really started to question if we were even speaking the same language. Apparently not, as it turned out.

Dumdad- Heh. Actually there was a resident, the story goes when I was a student who worked out this thing with his fellow resident. After examining this delusional patient, he waved his voice pager (this was waaaaaay back in the day) over the patient's body and, on cue, the friend's voice came over the pager in a computer-sounding voice saying "There is no disease. There is no disease." Or something similar. The story goes that it worked.

Lisa- (Hi Honey!) NO WAY! He got all the way out to you? That's some drive. Uncaring, substandard providers of the world, unite! We've nothing to lose but our crazy patients.

1:08 PM  
Blogger Teresa said...

Of all the nerve! I do like the 'last laugh' punch line; YM most likely never went near Chicago or Milwaukee after going to the local pharmacy to fill the prescription so calmly written by the heroine.

11:20 PM  
Blogger Mother of Invention said...

I guess you have to be pretty careful with that sort of patient. They're looking for something to complain about.

When my diabetes was completely missed because no blood test or urine test was taken, parents in those days ('67) didn't complain or sue etc. They sure would now if they were to spend 7 days in a coma as I did.
My doctor did come by the hospital, where I was for 3 months, and sincerely apologize. I was 13!

2:36 PM  
Blogger listie said...

wow. I don't know how you kept your cool or kept your jaw from dropping to the floor.

10:49 AM  

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