“What?”
It was starting to look like I’d soon be needing a translator for my translator.
“Did anyone in her family ever have bowel cancer?”
They had an animated discussion that went on for a full minute. I fidgeted in my seat and waited. Patience, Grasshopper. Finally Roy swivelled around to face me and relayed her answer: “Purple.”
I made a mental note to never use Roy as a translator again.
Patients Say the Darndest Things!
“Yesterday I went to the hospital and they did a PAP test on my throat.”
“What’s your pain like?”
“It’s magnetic.”
“Does it hurt anywhere?”
“In bits and pieces.”
“How high are your blood sugars?”
“Anywhere from 4-foot-7 to 6-foot-5.”
“What’s your diarrhea like?”
“It’s kind of juicy.”
“How bad is your pain on a scale of one to 10?”
“Not too bad – about a nine.”
“Hey, doc, would you be able to fill out this welfare form for me?”
“Okay. What’s your medical reason for not being able to work?”
“Umm… I don’t really have one.”
“My vision’s blurry, doc.”
“Did you see an optometrist?”
“Yes.”
“What did they say?”
“She gave me some new glasses.”
“Do they help at all?”
“They work great, but I keep forgetting to wear them.”
“I was watching television the other day and they said those cholesterol pills you put me on do something to the lining of the wall.”
“The wall of what?”
“I dunno; I wasn’t paying that much attention.”
“What’s your last name?”
“Vogl.”
“Is that European?”
“No, it’s German.”
“Don’t inject me with that cortisone stuff, doc. Twenty years ago they injected some in my wrist and it stiffened up so bad I could hardly use it!”
“That’s odd. Why did they do the injection in the first place?”
“It was getting stiff.”
“Did anyone in your family develop heart disease at a young age?”
“Yes, my great-grandmother.”
“How old was she when she started having heart trouble?”
“97.”
Certified drug seeker:
“Geez, doc, I’m taking way too many Tylenol 3s. Can I get some morphine instead?”
Teenager who’s been slouching around the waiting room playing Game Boy, eating Cheezies and listening to his iPod:
“I have a stomach ache.”
“How bad is your pain on a scale of one to 10?”
“17.”
“The maximum possible score is 10.”
“Oh, okay, I get it. Um, let’s see… I guess it’s about a 12, then.”
“The number can’t be any greater than 10, and a 10 would be like someone cutting your leg off with a rusty chainsaw.”
“Oh. Well in that case it’s a 9½.”
… and sometimes sleep-deprived nurses say the darndest things!
“Mr. Bryant, since you're having trouble peeing I'm going to put this catheter in you, okay?”
“Does it go in my nose?”
“Do you pee through your nose?”
Let’s Get Physicals
“I’m here for my yearly complete examination.”
“I think the wife booked me for a checkup.”
“I’m fine, but I need a physical for my class A-Z driver’s license.”
“I want to be tested for everything.”
“Can you book me for one of those total body scan things?”
The complete physical begins with a series of health-related questions called the review of systems. The goal of these questions is to ferret out occult disease. In my experience, patients’ responses tend to be influenced by two main things – their personality type and the reason for the physical.
On the one hand are healthy people who are seeing me solely because they need to have their mandatory job-related physical examination forms filled out. On the rare occasion that they actually do have an active medical problem, they go to great lengths to hide it from me. It’s not too difficult to figure out why – their livelihood depends on my giving them a clean bill of health. In these patients, the system reviews are shockingly brief:
“Have you been having any chest pain?”
“No.”
“Shortness of breath?”
“No.”
“Weight loss?”
“No.”
“Wait a minute – according to our scale, you’ve lost 40 pounds over the past three months.”
“Really? I hadn’t noticed. Probably just that stomach flu I had last week. Hey, how about those Winnipeg Jets!”
Neurotics who are in for “a good physical” represent the other side of the equation:
“Have you been having any chest pain?”
Mr. Somatoform gets that far-away look in his eyes. He strokes his chin thoughtfully as he contemplates the question.
“Now that you mention it, I did have an episode of chest pain not that long ago.”
“When?”
“Last Christmas.”
“Nine months ago?”
“Yes.”
“What sort of pain was it?”
“It felt like a bolt of lightning.”
“Where did you feel it?”
“It shot from my right armpit to the centre of my chin.”
“How long did it last?”
“About three-quarters of a second.”
“Has it ever come back?”
“No, it hasn’t. What do you think it was, doc? Could it have been a heart attack? Should I be seeing a cardiologist?”
“I don’t know what it was, but I’m pretty sure it wasn’t anything too serious. Let’s move on. Have you had any shortness of breath?”
“Funny you should mention that… .”
Ramblers are a breed unto themselves:
“Have you been having any chest pain?”
“Chest pain, chest pain… . I’m not quite sure how to answer that, doctor. I haven’t had any chest pain lately, but back in the winter of ‘64 old doc Tilley had to admit me to the hospital for two days on account of the fact I was getting a mighty peculiar discomfort – I can’t really say it was a pain, mind you, because it was more of an ache than an actual pain, sort of like a nagging toothache, if you know what I mean – right above this here rib. At first they thought it might be pleurisy because plenty of folks in our neck of the woods had been coming down with it right around the same time I took sick, but in the end doc Tilley figured it was just…uh…doctor?”
“ Zzzzzzz… .”
And let’s not forget the Chronically Vague:
“Have you been having any chest pain?”
“Uh-huh.”
“How long have you been getting it?”
“Huh?”
“How long have you been getting the chest pain?”
Mr. Isidore gazes at me with the eyes of a chicken. After half a minute of deep thought he responds, “Quite a while.”
“How long is ‘quite a while’?”
“Oh, I dunno. A long time.”
“Weeks? Months? Years, perhaps?”
“I dunno. Been quite a while, though.”
After I’ve completed the review of systems I usually leave the room while my patient changes into a gown. If I return to find they’ve put the gown on with the gap facing the front instead of the back, I automatically deduct two points. The same applies to people who still have their T-shirt on underneath the gown.
I start every physical by asking my patient to turn their wrist over so I can palpate their radial pulse. Due to the location of the artery, it’s easier for me to check the right wrist than the left. Inexplicably, 98 percent of patients offer me their left wrist. Why is that? I’m sure there’s a research paper for some starving university student in there somewhere. Similarly, when I examine patients’ necks I usually ask them to tilt their heads downward slightly to make it easier for me to feel the glands. Most people immediately hyperextend their neck, which results in them staring up at the ceiling. Go figure.
Some people have more earwax than Shrek. Every so often I come across an unexpected surprise, like the time I discovered a bunch of uncooked spaghetti noodles wedged into a young man’s ear canal. As it turned out, earlier that week he had used them in an unsuccessful attempt to curette out some earwax. Epic fail! Once I had to flush a fly out of someone’s ear canal. How the frak do you get a fly in your ear?