Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Sunday, February 26, 2006
    Vade Darren McGavin

    Vampires couldn't stop him. Werewolves couldn't stop him. Zombies? He got the best of them. Even the Bumpuses' hounds stealing his Christmas turkey couldn't keep him down for long. (No one ever better delivered the line "We. Are going out. To eat.") But time eventually caught up to him: Darren McGavin died yesterday at the age of 83.

    McGavin was marvelous (if a little overage) as the eccentric father in A Christmas Story, but he excelled as Carl Kolchak, the lead character of Kolchak: The Night Stalker. My sister and I used to watch this in reruns on the late show while babysitting and then turn on every light in the house out of sheer terror. Last year I found Night Stalker on the SciFi channel and have enjoyed rewatching the shows. Seen today, they're quite hokey (Kolchak using a tape recorder and typewriter to write his stories looks positively antique, and most of the monsters just... aren't that scary any more) but still worth watching. The scenes set in the office showing Kolchak interacting with his co-workers are priceless, especially the shouting matches with his editor Tony Vincenzo (played by actor Simon Oakland).

    As I watched show after show, it became clear that Kolchak's office was his family: you never saw where Carl lived, he had no girlfriend, and he wore the same outfit in every episode. (Did he ever do laundry?) He lived for his job. And the shows aren't without suspense. The highlight has to be the "Zombie" episode, the climax of which has our hero wedged into a car trunk basically on top of the (dormant) zombie, desperately trying to kill it by filling its mouth with salt and then sewing the lips shut. But before he finishes, the zombie's eyes pop open. Thirty years later, I still jumped in my seat when I saw this.

    Darrin McGavin was a gifted character actor who appeared in dozens of movies and several other TV shows, but for me, he'll always be running around in a seersucker suit with a hideous straw hat and a recorder on his hip, trying to crack the latest series of "mysterious deaths" and driving the cops of Chicago crazy. Rest in peace, sir, and I hope you don't rise from your grave.

    Wednesday, February 15, 2006
    Sleep, Interrupted

    It's always hard to function post call. Last night I got three admissions between 5 and 6 p.m. - good; I didn't get any others. The phone calls, however, persisted all night. I got another ER call an hour after I got to sleep, which destroyed my chance for any quality sleep the rest of the night. I was deeply asleep and it seemed to take forever to realize that the pager had gone off. It turned out to be an "FYI" call only, so at least I didn't have to go back to the hospital.

    At two a.m. I got another phone call from a girl who'd been having heavy gynecologic bleeding for a week, so of course decided to call in the middle of the night. Her dilemma: should she go to the ER or call her doctor in the morning? Resisting the impulse to say "How the f*%# do I know?", I mustered enough coherence to discuss her symptoms with her. (She decided to wait.)

    I had a meeting scheduled at the hospital today. I was too tired to go, so called in "sick." Bad doctor.

    Saturday, February 04, 2006

    So tomorrow's the Super Bowl. (GO STEELERS!)

    If you're going to a party, or hosting one, you might need a side salad. Potato salad is one of those things that I always think I'm going to like but often don't. Potato salad needs attention; it can be bland, which I really dislike, but it doesn't have to be. In a cookbook I recently bought called What to Cook When You Think There's Nothing in the House To Eat (I really like this book, by the way; it's out of print but still available on Amazon), I found a recipe for something called "Russian Potato Salad" which has become my recipe of choice. It's easy and delicious, and NOT bland.

    First, take a couple of large potatoes and boil (this can take up to thirty minutes). Cool, peel, and dice. Add finely diced dill pickle and onion - the recipe calls for a quarter cup of each but I use more. The onion can be regular or scallion (green onion). Add a cup of peas (frozen are fine) cooked until just done and cooled under running water. Bind the salad with mayonnaise, thinned with a healthy dose of lemon juice. I like to throw some Dijon mustard in as well. This salad does not need salt but does need pepper. You can use white pepper, or fresh-ground black pepper if you prefer. The original recipe also calls for hard-cooked egg, which I usually leave out, but if you want to put it in, hard-boil an egg and finely dice the white and add to the salad; then sieve the yolk over the top of the salad. It does make a nice presentation.

    Thursday, February 02, 2006

    This is one of the funniest things that's ever happened to me, from back in the dim mists of time when I was a resident.

    One of the teaching attendings at my hospital had a significant interest in a nursing home in the city (this all took place in San Francisco). In order to make this facility more attractive to potential patients and their families, he decided to offer twenty-four-hour medical coverage. This meant he had to hire slave labor (i.e., us). For reasons which I now forget, I was the resident he picked to organize this program... actually, wait, I think he paid me to get the thing off the ground. Yes, even back then I was a slut for extra work. V.'s favorite nickname for me is "Leather Girl," but we'll go into that some other time.

    Anyway. The on-call residents were housed in a room off the physical therapy department on the second floor. It was poorly organized, a large room that was partly office space and partly storage. The staff parked a spare hospital bed in a corner and that's where the on-call docs slept. Next to the bed, behind a screen, was stored a lifesize Resusci-Annie doll sitting up in a wheelchair. That's where it lived between CPR classes; you could see its feet, clad in sneakers, peeking out from under the curtain. The effect was creepy as hell, something like having Talking Tina sitting next to you all night, but we got used to it. It's hard to be scared of anything in a dark room when you're chronically sleep-deprived.

    My job was to recruit residents to the on-call program and train them. I organized one or two walk-through orientations, but after a few months I just started phoning it in - I'd have the docs call me on their first visit to Geriatric Manor and tell them what the drill was and what to expect. So now you can visualize what happened during this conversation...

    Hapless Resident: "Hi! I'm here and I'm in the call room. What's the routine here? Is there anyone I should round on?"

    ... about two minutes of boring medical chat..

    HR (in a completely different tone of voice) "Wait. What's that?"

    Me "Wait! Don't look! Don't look!"

    A hideous, high-pitched scream.

    I started laughing like a maniac.


    Last week our X-ray technician came marching up the hall toward me, waving a set of films. She was somewhat upset: "They won't take this film! They say I did it wrong, and I didn't!"

    I didn't recognize the name on the films. "Is this my patient?" I asked.

    "No, but it's a pre-op and the radiology department is giving me a hard time. They say I put the markers on the film backwards, or something."

    I glanced at the chest X-ray in question and immediately got her point. Normally the heart is situated to the left of center, with the apex pointing to the left. (To the reader's right; the convention is to look at the film as if the person were standing in front of you.) This film showed the heart neatly reversed, pointing to the right.

    "Ahh. Dextrocardia," I purred. "I haven't seen this in a long time."

    I now had a small audience of medical assistants and office staff staring at the film. "What's that?"

    "Dextrocardia," I explained, "is when the heart is on the opposite side of the chest. A guy in my med school class had this." (True.) "Send the film back," I added, "it's OK."

    ADDENDUM: I had just posted this when I checked back with the technician; it turned out it wasn't dextrocardia after all, she had just taken the film using a different technique due to the patient's size. We all got confused (including me). Still, I hate to waste a good post, and it could have turned out to be dextrocardia - you do see anomalies once in awhile. Has anybody out there seen dextrocardia or situs inversus on a routine X-ray?

    Do Not Be Whipping It Out

    If you're a new patient, and you've scheduled an appointment for some completely innocuous reason like a sore throat or a pregnancy check or a bladder infection, and you get me in the room and then PULL IT OUT...

    "It" being a two-page pre-employment health clearance form requiring a full history and physical including vision check and multiple blood pressure readings in both arms...

    ... you will get the bum's rush.

    That is all.