Strange Things Aren’t Getting Any Better…

 

I had a patient nearly succeed in killing herself recently, despite my best efforts to intervene. She is a type of patient that scares every doctor: She doesn’t like medicines or ‘chemicals’ that she doesn’t understand, but she takes 20 pills a day of various supplements and herbal remedies that she doesn’t understand.  She complains of an endless list of bizarre symptoms (her left eye cramps when she urinates or whatever), when the only diagnoses on her chart are fibromyalgia, irritable bowel syndrome, and anxiety.  She lists 14 drug allergies, but the symptoms experienced with those drug allergies don’t make any sense.  And worst of all, she says, “I know my body.”  I get chills just thinking about it.

That patient is dangerous, because one of these days, she’ll actually get sick, and I’ll miss a recognizable disease in all the random background noise of her being in touch with her body.  And then I’ll have to explain to the husband how his wife died of a bladder infection while under my care.

On her first visit with me last year, Karen opened the conversation:  “I’ve heard a lot about you.”

Me:  “Don’t believe a word of it.  Those people have no idea what they’re talking about.”

Karen:  “Everybody says you’re the smartest doctor in this part of the state.”

Me:  “Oh, well, those people obviously know exactly what they’re talking about.”

Karen:  “Good.  Because my previous doctors were all a bunch of idiots.”

Over my career, I’ve learned that that’s a bad sign.  Because when all her previous doctors were idiots, that means that I’m not just her new doctor, but I’m also the next idiot.  If no one else can meet her needs, then what are the odds that I’ll be able to do so?  So I keep my eyes open after I hear that.

She called me recently, saying that she felt terrible and that the medicines I was giving her were killing her.

Karen:  “I stopped that stuff you gave me a couple of days ago.  I felt just horrible.”

Me:  “Which medicine did you stop?”

Karen:  “I can’t remember.”

Me:  * pause *

Karen:  “I felt horrible.  That drug just didn’t fit with my system.  I know my body, and it was making me feel horrible.”

Me:  “How did you feel?  What exactly were you feeling?”

Karen:  * spends several minutes listing every side effect she’s ever read off of any warning label for any drug *

Me:  * interrupts Karen * “Ok, so you’re off whatever medicine that was now.  Ok.  So do you feel better?”

Karen:  * pause * “Well, I just stopped it a few days ago.”

Me:  “So you feel better now?”

Karen:  “No.  I feel horrible like I said.”

Me:  “Why don’t you come into the office, so I can figure out what’s wrong?”

Karen:  “I told you.  It was the medicine you gave me.”

Me:  “So you feel better now that you’ve stopped it?”

Karen:  “No.  I feel horrible.”

Me:  “So why don’t you come into the office, so I can figure out what’s wrong?”

And around and around we went.  I couldn’t get her to come in.  She didn’t need to see me, because “I know my body.”  I got her to promise to call me if she got worse.  And we hung up.  Both of us rolling our eyes, wondering what the other one was thinking.  I went to bed that night wondering if she was actually sick this time, or if she was just in touch with her body.

I don’t sleep much.

The next morning, her husband found her on the floor of their bathroom.  She was semi-conscious and didn’t know where she was, or who he was.  He called me, very stressed out, as you might imagine.  I had him call 911.  They took her to the ER.

I called the ER doc, to give him a heads up.  He asked what he should be looking for.  I said, “I’m really sorry, but I have absolutely no idea.”  He said “Thanks a lot” and hung up.  “Happy to help,” I mumbled, as I clicked off my phone.

They scanned her head, looking for a stroke or a bleed.  They did bloodwork looking for every disease under the sun.  They did chest X-rays, CTs, EKGs, and God knows what else.  She was extremely dehydrated.  Her pulse was racing and her BP was barely detectable.  So they were pushing IV fluids.  She was in kidney failure, probably from the dehydration.  She finally produced a little bit of urine, and they found a raging kidney infection with sepsis.

Once they figured that out, they called me to ask if she had any drug allergies.  I didn’t even look at her chart and said, “Nope.”  So they gave her two antibiotics (both of which, as it turns out, were on her allergy list).  They worked well, and today she is recovering nicely.  Thank God.

But she nearly died of a bladder infection.  That I could have found in my office with a $2 urine dipstick, and fixed with maybe $5 worth of antibiotics.  Except that I couldn’t have treated it, because she says she’s allergic to every antibiotic in the world.

Her hospital bill will probably be over $100k and she nearly died.  She was lucky her husband found her when he did.  And she was lucky the ER doc did such a nice job, so quickly.  Nice save, buddy.

I would have called him to thank him, but I didn’t want to have to listen to him asking me how a patient of mine nearly died of a bladder infection.

This story may sound odd.  But it’s not.

My patient may sound irrational, but she’s not.  At least, not any more irrational than the rest of us.

Black Lives Matter has burned down cities for over a year protesting how many blacks are killed by white cops.  While they ignore how many blacks are killed by other blacks.  While ignoring the social problems that lead to such violence in their neighborhoods.  While refusing to acknowledge that when a criminal resists arrest, he is engaging in a high-risk activity.

When you have a problem, it always feels better once you decide that it’s someone else’s fault.  But the catch is that at that point, the problem becomes un-solvable.  The first step to solving a problem is to take ownership of it.   Blaming others makes that impossible.  Which then makes it impossible to solve the problem.

It’s not that my patient’s illness is her fault, of course.  It’s just that she needs to play a role in fixing the problem, regardless of why it happened.  And if she refuses to do so, then things might get out of hand.

It’s hard to know who to blame for the problems in the black community, although it really doesn’t matter as much as we wish it did.  All that really matters is improving things now, regardless of how we got here.  And that will involve those in the black community playing a role in the improvements.  And there are many, many people in black communities doing exactly that.  God bless them.

This is why Black Lives Matter is so toxic.  BLM is not just unhelpful – it is setting back progress that is hard earned by those who live in these communities and want to improve them.

When BLM encourages blacks to blame others for their problems, then progress stops (even if others are partially to blame for those problems).  When BLM encourages blacks to be resentful and distrustful of whites, then it becomes more difficult for us to work together to improve anything.

Fear of others trying to help, because they might discover that perhaps your problems are at least partially your problems, is understandably met with deflection:

“It’s a Black thing.  You wouldn’t understand.”

“I know my body.  Your drugs are killing me.”

It’s very difficult to fix a problem that you refuse to acknowledge.  It’s very difficult to accept help from someone that you don’t trust.  So we take herbal supplements and we burn down cities.  These responses may not seem to be completely rational.

But at least we’re doing something, right?

Strange that things aren’t getting any better…

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  1. Arahant Member
    Arahant
    @Arahant

    Dr. Bastiat: Strange that things aren’t getting any better…

    Indeed.

    • #1
  2. Midwest Southerner Member
    Midwest Southerner
    @MidwestSoutherner

    Great post, Doc.

    Makes me appreciate even more our clients who tell us, “My business is broken and I don’t know how to fix it. Please do your thing ’cause you’re the expert.” Granted, our scenarios aren’t life and death… Mad respect for the care you so diligently try to deliver to your patients.

    Sidenote: When you mentioned your patient’s name is “Karen” two things popped into my mind:

    (1) Is that really her name or did Doc say that tongue-in-cheek?

    (2) I feel bad for the “nice Karens.” Especially because I did actually chuckle when I read the name in your post.

    • #2
  3. W Bob Member
    W Bob
    @WBob

    A few years back I developed erosive gastropathy in my stomach probably due to aspirin and naproxen. The symptom was butterfly- like nausea and intense anxiety which seemed to be centered in my gut. I took all the prescribed acid reducers over the next several months but the symptoms remained. A second endoscopy showed no problems in my stomach.

    Since then, Ive developed some kind of psychosomatic syndrome that seems to have developed from this initial problem in my stomach, which outwardly healed but left my stomach hypersensitive. When they say the stomach and the brain are connected, they’re right. I’ve experienced anxiety beyond anything I could ever have thought possible which feels like it’s centered in my stomach. I’ve had two more endoscopies since then, ultrasounds and MRIs. Six months ago I spent the night in the ER for chest pain which had been going in for a while and somehow seemed connected to the anxiety. They didn’t find anything wrong, even after a chest CT and stress echo.

    I feel sorry for your patient. I don’t know what caused her specific problems but I think I know what it’s like to be in her position.

    • #3
  4. Jim McConnell Member
    Jim McConnell
    @JimMcConnell

    An excellent analogy, Doctor.

    • #4
  5. Ekosj Member
    Ekosj
    @Ekosj

    Dr. Bastiat:

    Fear of others trying to help, because they might discover that perhaps your problems are at least partially your problems, is understandably met with deflection:

    “It’s a Black thing.  You wouldn’t understand.”

    “I know my body.  Your drugs are killing me.”

    It’s very difficult to fix a problem that you refuse to acknowledge.  It’s very difficult to accept help from someone that you don’t trust.  So we take herbal supplements and we burn down cities.  These responses may not seem to be completely rational.

    But at least we’re doing something, right?

    Strange that things aren’t getting any better…

     

    And America is headed down exactly the same path as your patient.   And will, like her, end up in a life-threatening crisis.    There is nothing that will be done in the next four years to halt that spiral down toward self-inflicted catastrophe.  And by that time it may be too late.   We’ll just have to pray that, when the crisis arrives, the ER doc is a good one.

    • #5
  6. Chuck Thatcher
    Chuck
    @Chuckles

    That chart of yours is a lie that was probably produced by a bunch of racists and is clear proof that racism is systemic.  And you should be ashamed of your racist posts on this racist website.

    • #6
  7. Bob Thompson Member
    Bob Thompson
    @BobThompson

    That’s interesting and informative, Doc.  I think I’m having some of that in a milder form in some of my progeny. I don’t think they get it genetically from me because I am basically never feeling bad. I have had two open heart surgeries in the last fifteen years but both derived from my having a bicuspid aortic valve that causes stenosis earlier than a normal tricuspid valve. I have, as my primary care physician, a doctor who has gone the concierge route after more than 20 years working at a hospital and teaching.  She won’t take Medicare and that is ok with me because after having my first general session with her I only go back if I am having symptoms for which I cannot guess the cause and I haven’t had any of that. If I know what I need, like say it is time for another colonoscopy, I go to the specialist who accepts Medicare, and then my supplemental kicks in and pays all the co-payment. I don’t need a referral to do that. 

    If I recall I think you are a cardiologist by training but now practicing in concierge mode. So do you have a more general medical practice now?

    • #7
  8. Full Size Tabby Member
    Full Size Tabby
    @FullSizeTabby

    You have great patient stories. Sometimes I think, “Dr. Bastiat must make them up.” But then I think back to the medical files I read 40 years ago (i.e., long before HIPAA) while helping my mother with some academic research projects, and I realize there are people like that. I have been glad that as a lawyer I have almost always represented businesses and not individual people. People are just too hard for me to deal with.

    • #8
  9. Bob Thompson Member
    Bob Thompson
    @BobThompson

    Full Size Tabby (View Comment):

    People are just too hard for me to deal with.

    Arn’t they all the same?

    • #9
  10. Jerry Giordano (Arizona Patrio… Member
    Jerry Giordano (Arizona Patrio…
    @ArizonaPatriot

    Good post, Doc, as usual.

    I’m not sure about this part (emphasis added):

    Dr. Bastiat:

    My patient may sound irrational, but she’s not.  At least, not any more irrational than the rest of us.

    Black Lives Matter has burned down cities for over a year protesting how many blacks are killed by white cops.  While they ignore how many blacks are killed by other blacks.  While ignoring the social problems that lead to such violence in their neighborhoods.  While refusing to acknowledge that when a criminal resists arrest, he is engaging in a high-risk activity.

    I’m not prepared to concede that “the rest of us” are as irrational as your patient.  I do agree that a number of other people, probably including many BLM types, are irrational to a degree comparable to your patient.

    • #10
  11. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Jerry Giordano (Arizona Patrio… (View Comment):

    Good post, Doc, as usual.

    I’m not sure about this part (emphasis added):

    Dr. Bastiat:

    My patient may sound irrational, but she’s not. At least, not any more irrational than the rest of us.

    Black Lives Matter has burned down cities for over a year protesting how many blacks are killed by white cops. While they ignore how many blacks are killed by other blacks. While ignoring the social problems that lead to such violence in their neighborhoods. While refusing to acknowledge that when a criminal resists arrest, he is engaging in a high-risk activity.

    I’m not prepared to concede that “the rest of us” are as irrational as your patient. I do agree that a number of other people, probably including many BLM types, are irrational to a degree comparable to your patient.

    I tell my patients to live a healthy lifestyle, and I’m 30 pounds overweight.  I eat & drink too much, and I’m disappointed when I don’t lose any weight.

    I’m a Cincinnati Bengals fan.

    I think that we can vote out congressional Democrats in 2022.  Because this time, they’ll count the votes honestly.

    • #11
  12. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    Dr. Bastiat: She doesn’t like medicines or ‘chemicals’ that she doesn’t understand, but she takes 20 pills a day of various supplements and herbal remedies that she doesn’t understand.

    Shouldn’t we let people like that die? Natural selection and all that?

    • #12
  13. Percival Thatcher
    Percival
    @Percival

    Arahant (View Comment):

    Dr. Bastiat: Strange that things aren’t getting any better…

    Indeed.

    Not so strange. There isn’t any money in making things better. The money is in ‘raising awareness.’ If you can get a gig raising awareness, you can rake in serious loot. Patrisse Khan-Cullors knows. That’s how she got the pad in Topanga Canyon.

    • #13
  14. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Henry Castaigne (View Comment):

    Dr. Bastiat: She doesn’t like medicines or ‘chemicals’ that she doesn’t understand, but she takes 20 pills a day of various supplements and herbal remedies that she doesn’t understand.

    Shouldn’t we let people like that die? Natural selection and all that?

    If I refused to treat self-inflicted disease, I’d be out of business.

    I do my best to treat everyone, regardless of the source of their problems.  I don’t choose.

    • #14
  15. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    Dr. Bastiat (View Comment):

    Henry Castaigne (View Comment):

    Dr. Bastiat: She doesn’t like medicines or ‘chemicals’ that she doesn’t understand, but she takes 20 pills a day of various supplements and herbal remedies that she doesn’t understand.

    Shouldn’t we let people like that die? Natural selection and all that?

    If I refused to treat self-inflicted disease, I’d be out of business.

    I do my best to treat everyone, regardless of the source of their problems. I don’t choose.

    • #15
  16. Ekosj Member
    Ekosj
    @Ekosj

    Dr. Bastiat (View Comment):
    I tell my patients to live a healthy lifestyle, and I’m 30 pounds overweight. 

    Years ago my Mom had a heart valve replaced.   Post surgery the Dr came in to read her the riot act about healthy diet / exercise / lifestyle.    We all knew that his words were wise, but it was hard to take him seriously with his belly straining at get out of his green scrubs and the pack of Marlboro Reds in the front pocket.    I guess he had his own cardiac surgeon on retainer.

    • #16
  17. Ekosj Member
    Ekosj
    @Ekosj

    Dr. Bastiat (View Comment):

    I’m a Cincinnati Bengals fan.

    I think that we can vote out congressional Democrats in 2022.  Because this time, they’ll count the votes honestly.

    Hope springs eternal.

    I know.   I’m a Knicks fan.   (Or was when I still watched the NBA)

    There was a great Bengals quip from a few years back.    At one point, about 10 or 12 of the players on the roster were in trouble with the police for one thing or another.  In a press conference the coach ( maybe the owner … no matter) had opined:

    ”They haven’t all been arrested for the same thing.   That would imply teamwork.“

    • #17
  18. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Ekosj (View Comment):

    Dr. Bastiat (View Comment):

    I’m a Cincinnati Bengals fan.

    I think that we can vote out congressional Democrats in 2022. Because this time, they’ll count the votes honestly.

    Hope springs eternal.

    I know. I’m a Knicks fan. (Or was when I still watched the NBA)

    There was a great Bengals quip from a few years back. At one point, about 10 or 12 of the players on the roster were in trouble with the police for one thing or another. In a press conference the coach ( maybe the owner … no matter) had opined:

    ”They haven’t all been arrested for the same thing. That would imply teamwork.“

    Yeah, that was a few years ago.  Nearly half the team was arrested at some point during the season.  The joke was that they were going to start playing their home games in the Ohio State Penitentiary.

    Not easy to root for the Bengals, sometimes.

    • #18
  19. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    Ekosj (View Comment):

    Dr. Bastiat (View Comment):
    I tell my patients to live a healthy lifestyle, and I’m 30 pounds overweight.

    Years ago my Mom had a heart valve replaced. Post surgery the Dr came in to read her the riot act about healthy diet / exercise / lifestyle. We all knew that his words were wise, but it was hard to take him seriously with his belly straining at get out of his green scrubs and the pack of Marlboro Reds in the front pocket. I guess he had his own cardiac surgeon on retainer.

    We often aren’t all that consistent when it comes to health.

    • #19
  20. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    Dr. Bastiat (View Comment):

    Ekosj (View Comment):

    Dr. Bastiat (View Comment):

    I’m a Cincinnati Bengals fan.

    I think that we can vote out congressional Democrats in 2022. Because this time, they’ll count the votes honestly.

    Hope springs eternal.

    I know. I’m a Knicks fan. (Or was when I still watched the NBA)

    There was a great Bengals quip from a few years back. At one point, about 10 or 12 of the players on the roster were in trouble with the police for one thing or another. In a press conference the coach ( maybe the owner … no matter) had opined:

    ”They haven’t all been arrested for the same thing. That would imply teamwork.“

    Yeah, that was a few years ago. Nearly half the team was arrested at some point during the season. The joke was that they were going to start playing their home games in the Ohio State Penitentiary.

    Not easy to root for the Bengals, sometimes.

    Why do sports stars do crimes? Wouldn’t they want to keep their head down and make money so they could spend the rest of their lives not poor. 

    • #20
  21. W Bob Member
    W Bob
    @WBob

    I use a doc who doesn’t take insurance too. He charges a monthly fee. I’ve heard there are patients who will call him once a month even if they don’t need medical service just to “check in”. Do you have anyone like that? Someone who feels he or she needs to get something for their monthly fee even if it’s just a quick phone call?

    • #21
  22. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    W Bob (View Comment):

    I use a doc who doesn’t take insurance too. He charges a monthly fee. I’ve heard there are patients who will call him once a month even if they don’t need medical service just to “check in”. Do you have anyone like that? Someone who feels he or she needs to get something for their monthly fee even if it’s just a quick phone call?

    I work for MDVIP.  We charge an annual fee, but we still charge for visits.  Of course, the visit is 30-60 minutes instead of 5-10, with a doctor who knows you, and knows what the heck he’s doing.  There’s no waiting, and we can always get our patients in right away.   And you’re right, all my patients have my cell phone number.  In general, they don’t abuse it.  But when they need me, they need me.  So I think they make an effort to not abuse it.

    • #22
  23. CACrabtree Coolidge
    CACrabtree
    @CACrabtree

    Dr. Bastiat (View Comment):

    Ekosj (View Comment):

    Dr. Bastiat (View Comment):

    I’m a Cincinnati Bengals fan.

    I think that we can vote out congressional Democrats in 2022. Because this time, they’ll count the votes honestly.

    Hope springs eternal.

    I know. I’m a Knicks fan. (Or was when I still watched the NBA)

    There was a great Bengals quip from a few years back. At one point, about 10 or 12 of the players on the roster were in trouble with the police for one thing or another. In a press conference the coach ( maybe the owner … no matter) had opined:

    ”They haven’t all been arrested for the same thing. That would imply teamwork.“

    Yeah, that was a few years ago. Nearly half the team was arrested at some point during the season. The joke was that they were going to start playing their home games in the Ohio State Penitentiary.

    Not easy to root for the Bengals, sometimes.

    With solid citizens like Pacman Jones and Vontaze Burfict, I don’t know why you’d say that.  From what I heard, they help Boy Scouts cross the street. /s

    • #23
  24. Hammer, The (Ryan M) Member
    Hammer, The (Ryan M)
    @RyanM

    Yep. My, goodness, yep. And I know that lady well…

    Thanks. Great post.

     

    • #24
  25. MarciN Member
    MarciN
    @MarciN

    I have had wonderful doctors for my kids and me and others. There isn’t a group of people I have more respect and admiration for.

    I can’t imagine accepting the responsibility that doctors assume. Thank you.

    • #25
  26. navyjag Lincoln
    navyjag
    @navyjag

    Damn, Dr. B.  I thought being a lawyer was tough when  you had a client who questioned your judgment. But not life or death stuff. Only money issues. Hang in there. One more reason I did not want to be an MD

    • #26
  27. Al Sparks Thatcher
    Al Sparks
    @AlSparks

    Dr. Bastiat:

    This is why Black Lives Matter is so toxic.  BLM is not just unhelpful – it is setting back progress that is hard earned by those who live in these communities and want to improve them.

    BLM alone would not be effective if there weren’t so many white people who “help” by pandering to them.

    Woke White people, as well as cynical progressive politicians have a large part of the blame for what they’ve done.  Given that they and BLM feed off on each other makes them particularly hideous.

     

    • #27
  28. navyjag Lincoln
    navyjag
    @navyjag

    Full Size Tabby (View Comment):

    You have great patient stories. Sometimes I think, “Dr. Bastiat must make them up.” But then I think back to the medical files I read 40 years ago (i.e., long before HIPAA) while helping my mother with some academic research projects, and I realize there are people like that. I have been glad that as a lawyer I have almost always represented businesses and not individual people. People are just too hard for me to deal with.

    Tabby, did you medical mal cases? Tough work.

    • #28
  29. navyjag Lincoln
    navyjag
    @navyjag

    Dr. Bastiat (View Comment):

    Jerry Giordano (Arizona Patrio… (View Comment):

    Good post, Doc, as usual.

    I’m not sure about this part (emphasis added):

    Dr. Bastiat:

    My patient may sound irrational, but she’s not. At least, not any more irrational than the rest of us.

    Black Lives Matter has burned down cities for over a year protesting how many blacks are killed by white cops. While they ignore how many blacks are killed by other blacks. While ignoring the social problems that lead to such violence in their neighborhoods. While refusing to acknowledge that when a criminal resists arrest, he is engaging in a high-risk activity.

    I’m not prepared to concede that “the rest of us” are as irrational as your patient. I do agree that a number of other people, probably including many BLM types, are irrational to a degree comparable to your patient.

    I tell my patients to live a healthy lifestyle, and I’m 30 pounds overweight. I eat & drink too much, and I’m disappointed when I don’t lose any weight.

    I’m a Cincinnati Bengals fan.

    I think that we can vote out congressional Democrats in 2022. Because this time, they’ll count the votes honestly.

    Only 30 lbs. overweight and a Bengals fan? Sounds like a tough life. Try drinking port and be a Duke fan.

    • #29
  30. navyjag Lincoln
    navyjag
    @navyjag

    Like my daughter.

    • #30