A Life Set to Music

        My whole life has been set to music.

        A couple weeks ago a patient came in, and “On Come Y’all be Faithful” started running through my brain as I watched her walked down the hall.

        When I went in the exam room intuition was confirmed.  In ten seconds I knew she was having a G.I. (gastrointestinal) bleed.  She has a complicated medical history, and I went through the process to get the entire story, but the diagnosis was made right off the bat.

        How?  Legitimate question.

        “Ms. Smith, the last time you had this bleeding was on Christmas Day wasn’t it? “

         “No, Tommy.  It was Christmas Eve.”

         “How long has that been?  Ten years?”

        “No, it was 1994.” (O.K. I was off a few years.)

        “Does it seem the same?”

         “Yes sir, I’m afraid so.”

        One thing I have learned.  If a patient says they have the exact same thing they had before, you better pay attention.  They are right until proved otherwise.

         And she was correct.  It was indeed a G.I. bleed just like in 1994.  In six hours she was getting shocky, but she was in an I.C.U. bed so it was no sweat.  Today she is back home.

        Now I’ll have to fight with her insurance company to get her P.P.I. medication; they will resist you every time, ’cause it is expensive.  (Cuts into those multi-million dollar bonuses.)  Oh well, I know how to do that too.

        I don’t remember for sure but I’d bet “Oh Come, Y’all be Faithful” was playing at the house that night she showed up in the E.R way back then.  We might have been working it up for church for all I know.  So, when she came to the office last week, my gut said the diagnosis was a G.I. bleed when she walked in the door.  The reason I had the intuition was ’cause my whole life has been set to music.  It is one reason I have been so lucky.

        I don’t know what song will play today, but there is a good chance I’ve heard it before.  And given I love both my music and my patients, I’ll bet I ain’t forgotten the tune, either.

Dr. B

    

 

 

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16 Comments on “A Life Set to Music”

  1. Ted Lehmann Says:

    T.R. Reid has been appearing all over public radio talking about last night’s Frontline program and his new book on universal health care. He details health care programs in The United Kingdom, France, Germany, Taiwan, Japan, and a couple of other countries. He keeps asking docs and adminisrators, “How much does the patient pay?” and “How many bankruptcies are declared by citziens for medical reasons in your country?” The anwer is always 0.00. He doesn’t paint a picture of countries where everything works perfectly, but despite the problems, it seems nearly criminal that we’re the only advanced nation in the world where a doc would have to fight to get a medicine because it’s expensive and necessary. I’m eager to read his book, but in the end, we, as Americans, need to ask ourselves whether we see health care as a right or a luxury for those of us who can afford the best. His stats about our position in the world for overall health care and infant mortality are really scary, especially when you consider the places where we’re truly outstanding. – Ted

  2. drtombibey Says:

    I will follow this with interest Ted.

    In our system we have zero incentitive for prevention.

    When people are terribly sick, we have some of the best technology in the world, but one has to be an expert to learn how to access the system. (Docs are transformed into savvy street fighters for their patients, rather than providers of medical care- not what they went to school for, I promise.)

    We pay mid level managers in the insurance industry better to deny care than we pay some bedraggled half worn out Pediatrician to try to provide it.

    It is all very strange to me.

    Dr. B

  3. mrschili Says:

    Doc, I”m eager to attribute your internal soundtrack (in this case, anyway) to divine guidance. It happens to me all the time – the Universe gives me clues in whatever way it thinks I can receive them – it’s the god/dess’s way of poking us and telling us to pay attention.

  4. drtombibey Says:

    mrschili I agree 100%. Many, many, times I have made the right diagnosis ’cause divine guidance told me I’d better reconsider.

    Dr. B

  5. Billy Says:

    I am more interested in talking about Ted’s comment about T R Reid’s FRONTLINE show last night. I didn’t understand why he didn’t visit Dr. B. He knows the problem first hand.

    The show was very interesting and insightful for someone who has never been to those countries to see what their medical system is like. Key idea I caught:
    “The United States does not have a medical care system — it has a medical market.” —- “In Japan because the rates paid hospitals is regulated by the Gov. hospitals are in danger of going broke. In the United States people go bankrupt because of hospitals.” —- “In the rest of the world, health care is a basic right. Just like education, right for an attorney, pursuit of happiness etc.” “Universal Health Care does not mean that it is Socialized Medicine, in many countries it is not socialized, but it is a right for all to have.”

    Thanks Ted for you comment. Dr. B — you should see the show.

  6. amberfireinus Says:

    Ok… Im hooked. You made it to my blogroll. I can tell this is going to be a fun read…

  7. drtombibey Says:

    Billy,

    Two readers can’t be wrong- this is one I have to see.

    Will get up with Ted for more info.

    If I read it once in Med School I could make a “C.”
    Twice was good for a “B.” If I found time for three it was an “A.’

    Now that I am older, and wiser, good advice x 2 should be enough. Where do I catch the show?

    Dr. B

  8. drtombibey Says:

    Ms. Amber,

    Hey thanks kid- I always enjoy the comments and insight.

    Dr. B

  9. Lisa Neal Says:

    Great stories! I agree about music, and, in fact, wrote about how jingles are evocative in http://elearnmag.org/subpage.cfm?section=opinion&article=90-1.

    If you like music so much, have you tried dancing?

  10. drtombibey Says:

    Dr. Neal,

    Hey thanks. I’m not a real good dancer, but I did dance with my wife at at my son’s wedding. Even an old Doc like me is sentimental about things like that.

    As a bluegrass mandolinist, I’m afraid the Lord put most of the rhythm in my hands. Sometimes folks will request square dance numbers, and we have a caller who comes with us for those gigs. Of course, while the dancing is going on we make the music.

    It has all been great fun, and I plan to spend much of my spare time over the next decade documenting the events.

    Dr. B

  11. amberfireinus Says:

    Dr. B.,

    By your responses to my comments, I think you have the impression of me being young. I passed that stage long ago.

    Also, in reading your comments back to me, I realised that you really had little idea where my medical knowledge comes from. I have been studying Neurology for 10 years now due to several rare diagnosis that I have for myself. Doctors are stumped now to figure out what is wrong.

    http://amberfireinus.wordpress.com/2008/02/07/there-is-a-reason-that-they-say-that-doctors-practice/

    My knowledge of Neurology is out of self preservation because if I don’t choose to help myself and understand my body, then the doctors will be less able to help me.

    Anyway, thought I would clear that up for you.

    Amber

  12. drtombibey Says:

    Hey, Ms. Amber. Looking at your little avatar logo, I might have gotten confused. I wasn’t meaning to be disrespectful. Also, compared to me most people are young nowadays anyway!

    You certainly are young in the way you express yourself in your writing, and I mean that as a compliment.

    I am sorry you have neurological troubles. They can be vexing for sure.

    Come visit the blog when you can. I only made a “B” in Neurology, and probably don’t have the answers, but at least I am good for a laugh and diversion from reality for a while. (Again, though, all my stories are based on my real experiences. While the names and identifying clinical circumstances have been changed, the dynamics are true.)

    Dr. B

  13. amberfireinus Says:

    Dr. B

    Hey, I figure I can help add to your medical entertainment. For I have stories and a perspective from a patient to share!

    I didn’t come here to ask for help. I just knew you’d have great stories to tell about your patients in a country practice. I can only imagine the funny things you see each day.

    Then to my surprise I found you to be a fellow musician soul. How wonderful indeed.

    Anyway… I added you to my blogroll. I can’t wait to read and enjoy!

    Warmly,

    Amber

  14. drtombibey Says:

    Ms. Amber,

    All good. Comment freely- I have a feeling you have much perspective to add.

    If something surfaces that helps you in some way, that would be a wonderful bonus.

    Blog on kiddo. (You are just a young-un!)

    Dr. B

  15. rahmama Says:

    Hi Dr. B-
    Glad you found my blog. Just started it last week.

    After reading a couple of your postings, I think you are quite multi-talented. Love your writing. Am also intrigued by the bluegrass song title, “Oh Come, Y’all be faithful”. Can you sing us a few lines?

  16. drtombibey Says:

    Oh it is just the bluegrss version of “Oh Come all Ye Faithful.”

    If I was to sing it for y’all I’m afraid no one would ever come back to my blog. I’m afraid my singing voice is my Achille’s heel in music. After a lot of practice I did finally become a decent enough part singer, but the Good Lord clearly wanted me to keep being a Doc.

    I sing the baritone part, but some would say it is the monotone.

    Dr. B


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