Tuesday, August 24, 2010


Michael D. Burg, MD
Fresno, Calif

JAMA. 2004;292:1935-1936.

I know you’re talking about me. I can hear you in here, in room number 3 near the nurses station. You’re talking about some of the others too but mostly you’re talking about me. There’s "the hip" and "the tweaker with the MI," a "bleed" and "high 5 with PCP." I’ve figured them all out while lying here. The last one gave me the most difficulty but I finally got it: HIV translates to "high 5" as in "high" and the roman numeral 5 combined. PCP is apparently some kind of lung infection. The "high 5" in your medical slang makes it sound like a reason to celebrate but it’s hard to believe that you think an AIDS diagnosis is grounds to throw a party. To hear you all jabber on here there’s plenty more just like them here in the ER, but those are the ones I’ve heard about so far.

I’m the "septic gallbladder." Occasionally one of you calls me just "sepsis" or "the gallbladder." Sometimes my title is "the nursing home patient" or "the old guy" with "septic" or "gallbladder" tacked on like an academic degree. You mix up the terms a bit, maybe to keep your clever chatter interesting to yourselves, but I can tell when you’re referring to me. No doctor has yet to call me "Mr Pruitt" or even "Robert." If you’d asked I’d have told you my friends call me "Pru." "Bob" would have been rude to my way of thinking, but considering the situation now I could hardly take offense. The last people to call me "Mr Pruitt" today were the ambulance drivers and the nurse’s aide I met when I arrived. They could teach you a thing or two about civility.

The first one of you who came to see me made a brief attempt at being the kind of doctor I’m used to. You never did introduce yourself or ask my name or how I was feeling but you got right to business, which I appreciate somewhat. That appreciation went away pretty quick though.

You assumed that because I am old and don’t speak much I must be deaf so you leaned in close and shouted in my ear, bellowing really. Your breath stank of barbequed potato chips and coffee. Don’t you own a toothbrush or some mouthwash? I remember thinking. I didn’t mind the wait while you ate dinner, so another few minutes to clean up wouldn’t have made any difference to me. You seem real busy out there. There’s lots of shouting mixed with the laughter and the jokes that float in to me from the doctors’ and nurses’ work area. But anyway, you did try. I tried too. You asked what hurts and I tried to tell you. I guess my age, my illness, and the Parkinson disease got the best of me. I couldn’t answer fast enough for you so you kind of groaned ("Oh jeez" is what I heard), muttered something like "goner" and "dog lab," and left the room.

You must have checked my medical records because when you came back in you had a medical student trailing you. You seemed to have me all figured out because you started showing him some stuff about me that interested you. You never asked my permission, you just started in doing it. The student seemed kind of ashamed but I knew he was afraid to say anything. He looked so young with his wide eyes, smooth cheeks, neat hair, and freshly pressed short white coat. You could take a few lessons from him about personal grooming.

Now at least I know I have something called cog wheeling and a Murphy’s sign. That second one hurt the first time you did it, but the medical student needed several tries—with your assistance—to get it right. That was nearly unbearable. He looked strong, like a college wrestler or something. He stuck around after you left and asked me lots more questions, but I was so fed up with you and felt so bad that I only answered a few of them. If you’d started off on the right foot, I’d have answered them all. I actually know my medical history right down to medications, hospitalizations, operations, the lot. You couldn’t be bothered to wait for me so forget it. I’ll let you figure it out on your own.

It didn’t used to be this way. Back in my day I could have told you to shove off and made it stick. I was once straight and tall and strong. I spent my life building things, first in construction—bridges, dams, and roads—then as an engineer. I had a family too. I married a sweet girl from my neighborhood and together we raised four boys. Sarah’s gone now but we had 54 great years together. The boys are gone too. Not dead, just moved away, Boston, New York, DC, Baltimore. They’ve got lives of their own. They’d care for me if I let them but I never wanted to leave Los Angeles for the cold of the East Coast. My life is here.

My friends used to be around but they’re long gone as well, either dead and buried or moved. I looked after myself as long as I could but after my fourth fall someone decided I was in too much danger on my own so I got "placed."

What a word, "placed"; it’s like I’m a used part on a storeroom shelf, "placed" there, gathering dust. So now I live in a nursing home. When I got sick and stopped eating they shipped me to your hospital and you’re my ER doctor; we didn’t choose each other; it just happened that way. Time, illness, and the damn Parkinson tremors wore me down; now you’re standing over me with your stinking breath and know-it-all attitude and no-time-for-answers medical so-called care.

You’re smart with the antibiotics and the IVs; I do feel a little stronger, thank you for that. An explanation about why the Tylenol had to be shoved up my rear end would have been nice but since I don’t speak well you guessed the rest of my mind had failed, so you rolled me on my side, no explanation, and did it. My temperature is down and I feel slightly better, but where did you (or did you at all) learn how to treat a human being? How about asking permission for things or giving an old man a chance to answer a few questions?

Keeping your voice down would have been nice too. The shouting in my ear wasn’t the worst of it, although that was bad enough. The discussion you had just outside my door with that nice young medical student about how I might "box" before the surgeons got to me was horrible. I’m not afraid to die; I nearly did once before, but the idea that my life was in your hands scared the hell out of me. You seem smart enough, but where’s your human touch, Doc?

I can’t imagine—and I really hope it’s not true—that all your days are like this. You’ve just forgotten that voices really carry in the ER, especially to those of us who have little to do but listen. What’s off-hand slang or shorthand lingo for you really packs a wallop when it reaches a patient’s ears.

Anyway, I’ve had my life. But I’m wondering: what kind of existence is this for you when you can’t even spend a few extra minutes listening to me or talking to me? I won’t keep you with my personal details; those are my memories anyway. I’ll give you just the facts if you want. I’m pretty weak and not feeling too well, so I’m not much in the mood for reciting a long-winded story. Someday if you’re lucky, somebody will ask you about yours. I hope you’ve got something good to tell so they’ll stay around long enough to hear it.

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.

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