The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge Read online

  I dedicate this book to my father, Allan G. Farrago.

  Some of my fondest memories of you are when I made you smile.

  You died too soon. I miss you, Pop.

  CONTENTS

  INTRODUCTION

  MEDICAL SCHOOL

  Introduction

  Stages of the Physician

  Medical Students’ Revenge

  ER Stuff

  Maggots/Magnets

  Those Darn Narc Seekers: Talk About Blowing It

  Smudge X-Ray Files:

  The Big One • Here Kitty, Kitty

  Lord of the Rings

  A Salute to the Barn

  Medical School Mishaps

  Why I'll Never Forget The Summer of ‘92

  A Medical Student Translation Guide for Patient Complaints

  Synchronized Swimming

  PJ Consulting

  Millennium Stethoscope

  Picket Fences

  Bot Fly on the Brain

  Respect

  Those Darn Narc Seekers:

  Perc or Drip?

  My Favorite Munchausen:

  Lymphedema Lucy

  Moody

  True Tales of Mistaken Identity

  Anomaly

  Fubigmi

  Make Your Questions Clear

  Escapee

  Everyone Needs a Nickname

  Going NUTS in Anatomy Lab

  Cracking (Up) the Code

  Medical Memories from the

  University State Pen

  “Well, don't come to my house!”

  Night Stick

  The K-Y That Got Away

  The Surrogate Patient

  Zingo!

  Que?

  Myagra

  My Favorite Munchausen:

  I Could Sure Use Some Fresh Air

  THE RESIDENT

  Introduction

  Timing Is Everything

  X-Ray Files:

  Drinking Buddies

  Nightmares

  Puzzling

  “Get Me Out of Here!”

  Cyanara

  Those Darn Narc Seekers:

  Armed and Dangerous!

  My Favorite Munchausen:

  Just a Stone's Throw Away

  Chux

  A Sticky Situation

  Trauma Alert

  First Night

  Pasta Anyone?

  Ouch!

  Bright Lights

  Diener

  Rub

  Uterall xr and Placertala

  Potato Love

  A New Year

  Need a Bed

  Now That's a Rectal!

  Those Darn Narc Seekers:

  No Self-Defecation!

  My Favorite Munchausen:

  Rosey the Red

  Digit of Death

  New Medications for Smokers

  Those Darn Narc Seekers:

  Hamburger Upper G.I.

  A Little Premature

  Shrunken Head

  Problem?

  Sleep Study

  Teachable Moment

  The Wig

  Nordart Contraceptive

  My Favorite Munchausen:

  Pheo, Phio, Pho, Phum

  X-Ray Files:

  Throckmorten Sign with a Twist

  PBJ

  Are You an Investigational Whore?

  Never Too Late

  THE NEW DOCTOR

  Introduction

  “I Gotcha!”

  Windy

  Top Ten Clues

  Just Can't Get Pregnant

  Here's One Way to Beat the System

  Those Darn Narc Seekers:

  Laboring Over Her Pain

  My Favorite Munchausen:

  Paul the Popper

  Language Problems

  Voice Recognition Blues

  Hot Diggity Dog!

  Garbage Can Lady

  Life on the Farm

  In the Navy

  “Committee” Committee

  Too Personal

  Out of Body Rounding

  Make Money Naturally!!

  X-Ray Files:

  Oral Hygiene

  5 Effective Techniques to Help You

  Communicate with Pharmaceutical

  Representatives

  Death by Moving

  My Favorite Munchausen:

  Clipping

  Power Lunch

  Lucky

  Cameloft

  Flatus Maximus

  A Problem Patient Comes and Goes

  Hairpin Curve

  A Bad Itch

  A Stitch in Time

  X-Ray Files: Remote Control

  Strike a Pose

  Bill Millionaire

  Scooby Snack

  True Anecdotes

  A True Diagnosis

  X-Ray Files: Make 7 “Up Yours”

  My Favorite Munchausen:

  Insulin-Cravin’ Sweet Teeth

  8 CM – The Movie

  Benzo Begger

  The Timmy Fund

  Those Darn Narc Seekers:

  Have Stones, Will Travel

  Top Ten Ways a Drug Rep

  Pisses Off a Physician

  X-Ray Files: Butt Light

  Scambien

  Those Darn Narc Seekers:

  Yellow Bill

  THE EXPERIENCED DOCTOR

  Introduction

  PJ Explains the 80/20 Rule

  of Medicine

  Doctor, I Can't Keep It Up

  Much Longer …

  Be Careful!

  Top Ten Things Your Mother Always

  Told You to Do That You Wish

  Patients Listened To

  Physician, Heel Thyself

  PJ Explains Bowel Obsession

  Top Ten Ways to Get “Hunkered Down”

  Patients Out of the Hospital

  Back in the Day

  New Doc vs. Old Doc

  Here Kitty, Kitty …

  Indifferex

  PJ Says: Suck It Up!

  Cold as Ice

  Creams Don't Work

  The Doctor's Rules

  Those Darn Narc Seekers:

  Jack ‘n the Back

  My Favorite Munchausen:

  Something Doesn't Smell Right

  “Hear Today, Gone Tomorrow”

  Let Them Her Eat Cake

  Smelly Feet

  PJ and a Barrel of Monkeys

  X-Ray Files: Bright Idea One and Two

  Not So Bright Idea

  COPD Terrarium

  List of Bad Prognostic Signs

  Answering Service Tips

  PJ Explains “Why HMOs

  Can Kiss My Bony White Ass”

  Hospice Tales

  Godivaphage Xr

  Stand Up! Quick!

  Radiology Woes

  Learn to Talk Administralian

  PJ Talks About ED

  Case Records of the Placebo General Hospital

  Official Physician Hand Signals

  Are You Sick?

  Oxycotton Candy

  Thoughts from an “Experienced” Doc

  X-Ray Files: Bolt • Doh! • Bird

  War Is Hell or What's That Smell?

  A 2 A.M. Phone Call

  Duct Tape

  Diary of a New Drug Rep

  PJ Explains: Smoke ‘Em

  If You Got ‘Em

  Why Couldn't You Hate Me?

  Alcoferon

  X-Ray Files: Easter Bunny

  Medical Brush with Greatness

  Get Off the Road
<
br />   Is It in You?

  She Was Not Out of Earshot

  Top Ten Ways Physicians

  Piss Off Drug Reps

  Dementia Safe Invisible Fence

  X-Ray Files:

  Hung-ry Like the Wolf

  Cookie Monster • Kenny

  Things I STILL Don't Understand

  After Being in the ED for 15 Years

  Strategic Filibustering

  Top Ten Things I've Always Wanted to Say to Patients

  After 30 Years as an ER Doc: My Favorite True Stories of Medicine

  More Than a Pen Whore

  Gunpoint B#owjob

  My Favorite Munchausen:

  She's No Coloring Book

  CONCLUSION

  Acknowledgments

  So, you think you know a little about

  a physician's life, huh?

  You think just because you have seen a reality program showing an open-heart surgery or a baby being born that you know what physicians are going through? Well, I am here to tell you that you don't know diddly-squat. You are missing a big piece of the picture. Most physicians are on an emotional roller coaster that gets wilder each day. Did you know that forty percent of doctors feel burned out? Did you know that one in four doctors are on a medication for a psychiatric illness? What does this mean to you? A lot. With all this stress comes great stories!

  For the past two years Placebo Journal has been chronicling these stories. Placebo Journal is the only medical journal that makes its readers laugh and allows its contributors to vent their frustrations. Since most Placebo Journal readers and contributors are physicians, I feel that in some way the magazine has been providing a sort of therapy for this class of struggling professionals. Interestingly enough, however, as the number of humorous, gross, amazing, and interesting stories has grown, so have the numbers of laypeople who read them and love them. Sure, much of it may make their stomachs queasy, but like driving by an automobile accident, they can't look away. So I decided to open up the Placebo Journal’s story vault and publish The Placebo Chronicles. If you're a regular reader of Placebo Journal, you'll know my ulterior motive is to make some extra cash – Medicare and HMOs pay like crap nowadays.

  You may be asking yourself, “Is it okay for my doctor to laugh at his experiences, especially if they involve me?” Not only is humor in medicine okay, but I think it is desperately needed. “Humor” and “medicine” may not seem like two words that go together naturally. But humor may be the only way for doctors to survive the increasing pressures of the medical profession. Our jobs as physicians can sometimes be dehumanizing and we may end up getting thick-skinned in order to survive emotionally. The problem is that physicians are, in fact, real people with real emotions. They are human like most of you (there was a joke in there somewhere). Just because they took the Hippocratic Oath does not mean they promised to become RoboDocs. In fact, many of the same things that rattle your cage rattle theirs. You know that aunt who drives you crazy with her complaints about every ache and pain? Remember where you always tell her to go? To the doctor! Well guess what? She drives her doctor crazy, too.

  The stories and opinions in The Placebo Chronicles come from physicians around the country. All of them are true. Forget Marcus Welby MD, St. Elsewhere, or even ER. You want reality? Well, this book is it. These are the stories that doctors tell each other while sitting in the doctors’ lounge. These are the stories that doctors laugh together about at parties. These are the stories doctors commiserate about when considering switching careers.

  If you want philosophic advice, beautifully

  written prose, or thought-rovoking concepts,

  then you need to look elsewhere.

  If you want to laugh at the medical system as we know it and don't mind the offensive, you will love this book. We have stories from each stage of a doctor's life: medical student, resident, new doctor, and experienced doctor. We have stories about problematic patients: narcotic seekers and Munchausens. We will show you how doctors relate to HMOs, pharmaceutical companies, and much more. Plus, we have some pretty interesting X-rays that will beg the question, “They put what in where?”

  Why the name? The Latin definition of a “placebo” is “to give pleasure to.“ Interestingly enough, just like a placebo pill, our journal sometimes produces a positive effect from something of very little substance (as you will soon see). Also, like the placebo, many times it does no good at all. Whether it's a placebo or not, I have found that editing this rag has been the best thing for my own mental health. It is the psychotherapy that my HMO has repeatedly declined to cover. You see, I was burning out. I slowly began to recognize the subtle signs. For example, I found myself buying lottery tickets to give to patients so that I could bribe them to go away and leave me alone. At other times I was pitting my male patients against each other in a cruel game of “bobbing for Viagra” using a bucket in my waiting room. I needed help. The answer I found was to share my stories, as deranged, unprofessional, and embarrassing as they might be, with other doctors. I realized that I was not alone out there. These shared experiences became the Placebo Journal and, now, The Placebo Chronicles.

  Now let me be serious for a moment before you read on. We don't mean to denigrate the practice of medicine, our patients, or other physicians. We do mean to show the human side of the medical profession. Sure, we may mock or laugh at the mentally challenged, but what else are you going to say about hospital administrators? We don't print any stories in which a patient's care was compromised. Sometimes, however, you will find the stories cross the line of good, or even marginally acceptable, taste. They are crude, funny, and a telling commentary on the mental state of physicians today. Live with it. It's not like we write about doctors having sex with their patients. We are leaving that for the veterinarians.

  Bottom line: There is no mission to change the world and this didn't take years of preparation, hundreds of focus groups, and tons of venture capital to get started. The concept is simple; I want to make physicians laugh at themselves, their patients, and at medicine in general. Without some sort of outlet such as humor, doctors run the very real risk of becoming desensitized to the human element in this profession. And without empathy, patient care standards suffer. Doctors who laugh regularly have a better shot at delivering good, compassionate care than those who are burned out, overwrought, and taking themselves too seriously.

  Placebo Journal, and now The Placebo Chronicles, answer the command “Doctor, heal thyself.” Now you get a chance to enter this secret world and laugh along with your doctor. Just don't bust a gut doing it – he's overworked already.

  Douglas Farrago, MD

  MEDICAL

  SCHOOL

  The long, grueling process of becoming a doctor begins with medical school. It's four years of hell after college. It was the hardest thing that I had to go through in my young life until, of course, residency, which was even worse (you will read about that in the next chapter).

  Just getting into medical school is an incredible feat in itself, the first of many Darwinian trials an aspiring doctor faces. You need exceptionally high college grades, which isn't easy because competition grows stronger and stronger. As time goes on, the weakest students give up and the strongest students hang around, totally screwing up any type of testing curve. The pressure to succeed is enormous. I remember the shock of my first chemistry class in college. There were five hundred people in it and almost all of them, including me, wanted to go medical school. Only ten or twenty would succeed. No one would have predicted I would be one of those ten or twenty. Not even me.

  In medical school, the whole competition process starts all over again. The testing is outrageously hard and the hours are ridiculously long. The first two years, the medical student actually has minimal patient contact since he or she is wrapped up doing the basics of science including biochemistry, neurology, chemistry, histology, etc. When the “clinical rotations” start in year three, the real fun (or horror) begins. Here is
where the student spends months at a time seeing patients in such areas as internal medicine, surgery, emergency medicine, and obstetrics. Finally, young men and women who are tired of just the textbooks get a chance to try to treat live patients. This is a real eye-opener for them. This is when they start to see it all and feel it all. This is where they learn to develop their defenses against the gross, the sad, the disturbing, and the outrageous. I am not sure if having such thick skin is a good thing for doctors or not, but it is our basic survival mechanism to deal with these types of things. Seeing children die, arms that were severed, hearts splayed open, yellow patients, green patients, and blue patients are shocking, but a reality nonetheless. Any time taken to wallow in their own pity only takes time away from seeing other patients. The student buries his or her emotions to do his or her job and learns a valuable lesson: Medicine is not pretty.

  I remember in my first anatomy class there was this sweet girl who was initially very bothered by the cadavers. The school had done all the right stuff to slowly introduce the new students to their “bodies.” There were prayer sessions for those so inclined. There were warm-up periods so that people could acclimate to the cadaver. Still, people were squeamish, especially this one young woman. I didn't pay her too much attention because I had enough work to do on my own cadaver. I had totally forgotten about this student until halfway through the semester when I saw her walking by, whistling, with a sawed-off leg over her shoulder like a slab of meat. I thought to myself, “Haven't we got a little sassy?”

  Now picture yourself as a medical student. See yourself trying to save a life all the while questioning whether you know what you are doing. You're nervous and exhausted. You're hungry and overworked. All you care about is sleep (and hoping you don't kill someone). As you become more and more disconnected from the real world, you fall more and more into the medical one. All you can remember are the basics of survival and those weird, gross or outrageous experiences that occurred during your dreamful “medical student” state. It is these patient encounters or stories, however, which you will remember forever. It is these stories you will collect like a hobby. They are ones you will never share with patients and only occasionally share with one another. They're not for the faint of heart but they are yours and yours only – until now. The following stories are ones that we have pried, bribed, or extorted from former medical students who have endured this torture. Their collection is now, for the first time, open for your perusal, but it comes at a cost. After reading them, you may become thick-skinned yourself and for that we have but one cure – humor. These doctors didn't laugh about their medical student experiences at the time, but trust us, they are laughing about it now. We hope you can do the same.