American College of Physicians: Internal Medicine — Doctors for Adults ®


A looney tenens

From the March ACP Hospitalist, copyright © 2013 by the American College of Physicians

By Eric Newman and James S. Newman, MD, FACP

I was hideously short on the old cashola. I had made some very bad investments in gold futures, and my attempts with railroads, gun clubs and saloons had also been complete failures. I always had my medical degree to fall back on, but I'd never managed to keep a clinical job long-term. My temper always got the best of me. I seemed to always be in the middle of some kind of controversy.

I tried to get myself revved up to get back to the medical world. “I'm the roughest toughest meanest ol’ hombre to sling a stethoscope,” I said out loud to myself. “Time to stamp out that ol’ varmint, disease.” I called one of my old medical school chums, a plastic surgeon to the stars, and he steered me towards Loco Tenens. He assured me that they weren't too stringent on the background checks. I stroked my long mustachios, unkinked my diminutive legs and hit the keyboard. My Internet connection was down, dagnabbit.

Courtesy of James S. Newman.

Courtesy of James S. Newman.

I showed up the next Monday morning for a weeklong shift as a hospitalist at the Acme Medical Hospital and Spa. I had almost completed my internship, so how hard could a week as a hospitalist be? After a long Sunday night of “red-eye,” the bright colors and merry Muzak were grating on my nerves. I would not lose my cool this early in the game.

I entered the lobby and was met by the administrator. “Yo Sam. What's up, Doc?” he chuckled. “Call me Elmer.”

I stared at him. He was short, macrocephalic, hairless, with a speech defect—my kind of guy. He explained that there were many celebrity patients here who really wanted to maintain their anonymity. I could understand. I was hip with HIPAA. I took my patient list and began rounds.

Suddenly out of nowhere a young guy in a white coat and, disarmingly, a sombrero came running up to me. I had trouble understanding his accent, but I think he said, “I'm your physician assistant, Gonzales. Call me Speedy.” His pager went off, and he was gone before I could say a word.

My pager also went off. It was my first admission. I pulled up his history on the electronic medical record. Mr. W. Coyote. He had been admitted 27 times already this year. I couldn't believe it—talk about readmission rates. I scrolled through the discharge summaries. Most were trauma. I wondered about suicidal ideation. How could he have “fallen” off a cliff 15 times? Then hit by an anvil, injured in an explosion, hit by a truck—how unlucky could one person be? Why was he on a hospitalist service, anyway?

I walked in the room, and it looked like the orthopod had already had his way with him. He was in a cast from head to toe, his leg in a bed sling. He was working his PCA pump hard. He demanded I change his pump from morphine to hydromorphone. I asked how he knew the difference between meds. “I am a genius,” he exclaimed. He might have been a genius, but blast his scuppers, he was also a klutz.

A visitor rushed in and his cell phone beeped twice loudly. My patient flew out of his bed and landed on the floor. Great, a sentinel event was all I needed. I sat down to do the orders, but my PA ran by. “Already done,” he said in passing. No complaints from me.

The next patient, another celebrity, had been in for a few days. He had a history of trichinosis, hyperlipidemia and leptospirosis and now had presented with high fever, cough, runny nose and chills. I gowned up and put on a mask. I recognized his porcine eminence immediately, by his familiar round pink face, massive gut and stutter. The diagnosis was obvious to me, swine flu. I'd wait till he was better to ask for an autograph.

Another room, another patient. The room smelled quite hideous. Mr. P.L. Pew was in for species reassignment surgery screening but had been found to have rabies. I didn't like the way he was eyeing me and got out of there as quickly as possible.

Before I entered the next room, the administrator came up to me. “This is the most impawtant patient we have, so pwease tweat him wight. Be vewwy vewwy powite. Weah hunting donations, heeheeheehee.” He wandered off, rubbing his hands together. Made no difference to me; a patient was a patient. I entered the room.

“What's up, Doc?” the patient quipped, munching on a carrot. Coming from him it was the real deal. His skin was dry and had an orange hue, and he had extensive hair loss, but these were chronic conditions. I thought he'd better cut back on his carrots. Seemed like classic hypervitaminosis A. But that was not what he had been admitted for. He had chills, conjunctivitis, fever, headache, myalgias, skin ulcers, dyspnea, diaphoresis and weight loss. Somehow I knew what was wrong. I ordered a PCR for tularemia. I strongly suspected rabbit fever.

The day went on. An older woman (“Call me Granny”) with an osteoporotic fracture of the spine. A patient named Sylvester with feline leukemia, and his tiny “partner” who was suffering from psittacosis.

It was getting to be a long day. I was getting flustered and tired and the night doctor was late, but he eventually sauntered in. He was a tall white cocky Southern boy. “I might have to skip tonight, son,” he quipped. I glared at Dr. Leghorn, my blood pressure rising. “That's a joke, I say, a joke, son.” He patted me on the top of the head. I needed to get out of there before I blew my stack. I could even feel the steam coming out of my ears.

I survived the week, and all I can say is, “That's most definitely all, folks.”

Mr. Newman is a sophomore at Marquette University in Milwaukee and a lifelong acolyte of animated mayhem. Dr. Newman is a hospitalist at Mayo Clinic in Rochester, Minn., and the editorial advisor and humor columnist for ACP Hospitalist.


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