3. The I’m-Here-Because-My-Doctor-Prescribed-Regular-Exercise Gang
This group is distinguished by their silver hair and Olivia Newton John-style headbands. Hey folks, what’s up with the cheesy 1975 fashion accessory? Not even the steroid-gargling Conans sweat enough to require headbands!
4. The Average Joes
Middle-aged schlubs like yours truly half-heartedly fighting the Battle of the Bulge. Most of us are getting our butts kicked.
A couple of months ago I attended a story-reading event put on by Ellen’s grade six class. It was held in the McNally Robinson bookstore café. Each student sat at a table with members of their family and awaited their turn to go to the podium and read a story they had written. Near the end of the evening I spotted a familiar face in the crowd. At first I couldn’t quite place him, but a few minutes later I realized he was one of the Schwarzeneggers from the gym (see category 2 above). He was sitting with one of Ellen’s classmates. Based on their respective ages, I concluded that he was probably her father. Ellen mentioned the girl’s name was Nicole. I filed the random bit of information away under Miscellaneous and turned my attention back to my family.
The following week I was at the gym flailing away at some god-awful pectoralis-strengthening contraption when the fellow I had noticed at the bookstore sat down on the machine opposite me.
“Hey,” I said, “Do you have a relative in grade six at École Française?” He looked at me blankly. Undaunted, I pressed on. “I was at the story-reading at McNally Robinson with my daughter last Friday and I thought I saw you there with one of her classmates.” He continued staring at me like I had two heads. I swear, he wasn’t even blinking. That must hurt your eyes after a while. Eventually I shrugged my shoulders. “Sorry, my mistake. It’s just that I was almost positive I saw you sitting with a girl with wavy red hair near the front of the café. My daughter told me her name, but I can’t remember it now. I think it started with N.”
The vegetative look persisted. Clearly our “conversation” was on life support. It was time to pull the plug.
“Must have been a doppelgänger,” I concluded. I was about to move on to the next machine when his eyes suddenly registered a glimmer of recognition. A split second later they widened excitedly and his mouth formed the universal ‘O’ of surprised discovery. It’s a miracle Archimedes didn’t appear in a puff of smoke and yell “Eureka!”
“Oh, you must mean Nicole! Yeah, yeah, we were there! That was us, all right! Yeah!”
“So, how are you two related?”
“She’s my daughter.”
Is There a Doctor on Board?
I fly fairly often. As a result, I’ve heard the dreaded refrain “If there’s a doctor on board, please identify yourself to a member of the cabin crew” more times than I care to remember. The last time it happened I was wedged into a window seat. By the time the pleasant but glacier-slow elderly couple sitting beside me managed to extricate themselves from their seats and let me pass, several people had already beaten me to the scene. A woman in her early 20s was slumped in the aisle near the back of the plane. She appeared to be unconscious. In addition to the usual rubberneckers and gawkers, she was surrounded by a trio of flight attendants and a distinguished-looking gentleman in horn-rimmed glasses. As I threaded my way through the rabble I reflexively began working on a list of potential diagnoses and their respective treatments. There were several things I would need to determine as quickly as possible. Was she breathing adequately? Did she have a pulse? If so, was it regular? What was her blood pressure? Could she have had an arrhythmia? A seizure? Ruptured ectopic? Diabetic coma? Chances were it was just a simple faint, but even if it was, did she injure herself when she fell? It all started with a set of vital signs, but there was just one problem – I couldn’t get past the flight attendants and the Peter O’Toole look-alike. He seemed to be holding court.
“To the trained eye, this is quite obviously a textbook case of vasovagal syncope,” he pontificated, “which of course is the proper medical term for the phenomenon you will almost certainly recognize by its far more colloquial name – a fainting spell.” He beamed. His audience was enthralled by the impromptu lecture. No one seemed to be examining the woman on the floor, though.
“Excuse me, I’m an ER doctor,” I offered.
“Not to worry, my young colleague; everything’s under control. I’m a doctor, too,” he responded. He turned back to the attendants. “Vasovagal syncope is usually the result of – ”
“Sorry to interrupt,” I interrupted, “but is she breathing okay?”
“Breathing?” he said. “Breathing? Um… .” He bent down and shook her arm. A few seconds later she stirred and let out a groan. “Yes, of course! She’s breathing superbly!”
“Oh, that’s a relief,” I replied. “What’s her pulse?”
“Pulse? Er… .” He began fidgeting with his tie. I was just about to step past him when the woman opened her eyes and sat up.
“I think I just fainted,” she announced. “I do that every now and then.”
Our patient was fine. It was time for me to return to my seat. Before I left, though, I was dying to know something. I turned to the other physician.
“Just out of curiosity, what type of medicine do you practice?”
“Psychiatry.”
Fit for Duty
A couple of weeks ago I did another rural locum in northern Ontario. My first patient of the day at the No Family Doctor clinic was a scruffy-looking fellow in his late 20s.
“Hi Mr. Capgras, I’m Dr. Gray. How can I help you today?”
“I need you to sign this form saying I’m healthy.”
“Who is it for?”
“The military. I’m applying to get in and they want confirmation I’m fit for duty.”
“Are you healthy?”
“Yep. You just need to put your initials here and here and sign at the bottom.” He very helpfully offered me a pen. My Spidey senses started tingling. I deposited the pen on the desk and scanned through the form. They did indeed want verification he was in good physical and psychological condition. Unfortunately, that’s pretty hard to do when you’ve only known someone for half a minute. He seemed to be in reasonable physical shape, but did he have all his marbles? I recalled an old pearl of wisdom from medical schooclass="underline" When in doubt, ask the patient.
“Perhaps I should be more specific. Do you have any physical health problems?”
“Nope.”
“What about mental health problems?”
“Not really… .”
“How about in the past?”
“Um… .”
Pearl of wisdom from 15 years of clinical practice: When all else fails, check the chart.
“Do you mind if I quickly review your file?”
“Er… .”
I opened it and started leafing through. It didn’t take long to spot certain glaring trends.
“Gee, it says here you’ve had long-standing issues with panic attacks, substance abuse, alcoholism, obsessive-compulsive disorder and multiple personality disorder.”
“Really?”
“It also mentions at least five different admissions to psychiatric hospitals within the past two years.”
“No way.”
“Way.”
“I forgot.”
“According to the most recent discharge summary, you just got out last week.”
“Oh.”
A slightly awkward silence settled over the room. Finally my patient cleared his throat and spoke.
“Does this mean you won’t be able to sign my form?”
Ode to a Carrot Juice Enema
I’m sure there must be some good naturopaths out there, but I’ve yet to run into one. How’s that for an opening salvo?