Rolling Stool Blues

        Before we get into an approach to chronic illness, I gotta tell you this story.

        And this time, I’m gonna give you the disclaimer first.  I am not making fun of my patients.  I respect their right to their opinion and try to work with them however I can. 

        As you get older you care for them even more than when you were young.  Of course, it ain’t quite the same intensity as you feel for your wife and children, but nonetheless, it is true to say you develop a genuine affection for them, especially the ones who have been with you for many years.  It is a lot harder for me to deal with death than it was as a young doc.  In residency, I liked my patients, but after twenty-five years, the bond is much stronger.

        And, I am not poking fun at any dreadful disease process.  I hate it when people come down with things that can’t be fixed.  You know the odds are high their life will undergo permanent change, and not for the best. 

         So, I don’t want to be disrespectful, but at the same time patients sometimes do the dang-est things.  This is one of those stories.  You could either get mad or laugh, and I try to choose the latter.

        You know those little rolling stools the doc uses to slide around in the exam room?  They are necessary for much of our work, and there are some exams I about can’t do without them. 

        For some reason I have had a time keeping my folks off those seats.  They aren’t safe, and children and the elderly can fall off.  We’ve never had anyone seriously injured, but my observation is the very ones who sit on them are often those with the highest probability of hip fracture. 

        Our exam room floors were the sterile linoleum type.  They were easy to clean, but I became concerned someone would get hurt when they fell.  When the nurse brought the patient to the room they would direct them to the proper chair, but once you are out of the room for even a minute, people would get restless and move around.

        One year I went on an all-out campaign to keep everyone off the rolling stools.  It was a miserable failure.  I went on for months, and kept up-ing the ante.  We started with signs in the waiting room, then the exam rooms, and then attached them on the top of the stool itself.  It reached the point where the seats were plastered with stickers and looked about like my mandolin case, which sports bumper stickers from our many travels and shows.  We came up with a variety of slogans.

        “DO NOT SIT HERE.”

        “FOR DR. BIBEY ONLY.”

        And finally, “WARNING: THIS SEAT MAY BE DANGEROUS TO YOUR HEALTH!  DO NOT SIT HERE!”

        It was to no avail.  No matter what I did, I’d come in the room, and some little lady would be seated on the rolling stool.  At times, we’d hear a loud noise, and rush into the room to find someone had fallen off. 

        I tried lectures, and came off as arrogant.  When my efforts to claim possession became too adamant, I sounded egotistical.  I guess it came out like, “How dare any other human sit in ‘my’ seat.”  I didn’t mean it that way.  I became discouraged.

        I did get two responses, though.  The first was from one of my old teachers. I saw most of my old grade school teachers for years, though most have now gone on.  One I am especially proud of just crossed the century mark.  Many of them look at me like they might pop my knuckles with a ruler if I don’t behave.  I see several from my middle school years.  I don’t know why anyone who remembers me from middle school would choose me as Doc, but they do.  Perhaps it is dementia.  Bless their hearts- what a horrible disease. 

       The first response I got was from one of those former middle school teachers.  I came in the room, and there she was on the rolling stool, propped up against the wall.  “Young man, you are going to have to do something about these seats.  They are terribly unstable.”

        I helped her to her feet, and pointed out the signs plastered all over the seat. 

        She peered at the messages over the half-glasses tethered around her neck, and then responded.  “Well, I didn’t see that.”

        I sighed.

        My second response was from a man.  When I came in the exam room, he was seated in the chair for the patients, and the  rolling chair was parked in the opposite corner of the room.  He could not have distanced himself any further without leaving the room.

        “Doc, say them chairs are bad for your health?”

         “Yes.  Yes sir, they are.”  I was pleased.  My plan was taking hold.   

        The patient looked around, and lowered his voice like folks do when they have a personal question.  “Doc, some of dem AIDS patients been sitting in them chairs?” 

        (My wife read this and said the title of this post should be “The Dumb *^^ Blues.”  She has a way of getting to the bottom of things.)

         I never brought up the issue again.  I took down all my signs, called off the campaign, and asked Dr. Lucas, Lynn O’Carroll and Myrd to pick us out some carpet for the exam rooms.  They had said for some time we needed to re-decorate and it seemed like the right time. 

        The carpet makes the work a bit harder for the cleaning crew, but at least now when folks fall off my rolling stool, it doesn’t sound so bad, and the floor isn’t as hard when they hit.  Still no broken bones, too, and I think we’ve improved our odds.

        So much for my skills as an educator.  How in the world do you teachers keep a whole class in line? 

Dr. B

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Marfar’s Birthday Weekend

        One thing I learned from my wife was how to celebrate.  Christmas goes full tilt from Thanksgiving to Epiphany.  And we don’t just have birth-DAYS, but birthday weekends.

       I was off duty all weekend, and as we say in bluegrass it was a large time.  The only ground rule was she got to set the agenda.   Seeing as she was the Birthday Girl, it was only fitting.  So, Friday night we started with a chick flick. (remind me to tell you about “The Mirror has Two Faces.”) 

        Saturday was the big show at the Senior Center with Guitar-ed and Feathered.  They all did wear black slacks, but dang if they didn’t choose fuchsia for their blouses.  I got off the hook, though, when I said my black on tan print shirt accessorized better with my complexion.  I had no idea what it meant – I read it on one of my lady readers’ weblog.  That seemed to impress the band,  and they went along with my chosen attire. 

       We went to the warm up room and I could tell right away this was gonna be a different sort of gig.  For one thing they were nervous, like a bunch of kids, and my guys have gotten over all that.  It was like way back when we first started out with all the nervous anticipation- made you feel downright young.  The atmosphere was quite unfamiliar- I’m not sure what those ladies wore for perfume but I’m positive it wasn’t essence of chewing tobacco, sweat and Old Spice.

        All ’em did just fine; both the lead and harmony work were on pitch, and they even started and ended together, an essential performance prerequisite.  As a tune rocks along, you can tangle it up some and get by, but if you wreck the ending people don’t forget it.  Marfar did extra good on the bass, and they let me sing one- it was a variety show, and I was sure enough that for them.    

        By the end of the show they indeed did have ’em all smiling.  My wife has some special way with elderly gentlemen- it never fails.  One of the seniors had been a bass player for Mac Wiseman on a swing through the Carolinas in the 50’s.  He dug my wife’s playing, and came up after the show to tell us a bunch of old tales.  Bluegrass people are about the same everywhere you go.

        That night we went to hear the River Band.  Somehow Sammy Shelton found out about Marfar and did a bar of Happy Birthday for her.  For those of y’all outside the bluegrass world, you just gotta hear Sammy- the cat rocks the banjo.  One thing even a lot of bluegrass people don’t know know is he is also a very fine electric Tele guitar man, and sits in with a number of country and rock bands when not on tour with the River Band.  (This is why he had to let his hair grow out so long.)  Neither a little rock ‘n roll or long hair bother the bluegrass crowd, though.  They are very tolerant people, especially if a man can pick like Sammy.

        Sunday we slept in (we had subs lined up for our church band gig) and ate cold pizza then went shopping first thing.  They had some fine specials out at the mall, and I got her the present I told you about- a GPS that talks to you.  It was her birthday present, but I figured it would save me some trouble down the bluegrass road.  You know men- they never want to stop and ask for directions!

        The whole thing inspired me enough to go be a doctor for another week.  Happy Birthday Weekend Ms. Marfar!

Dr. B

Bluegrass Documentary

        James Reams and the Barnstormers are a New York  group I was not familiar with, but then I don’t get out of the County much.  When I checked their web site they carry a heavy tour schedule; they just haven’t come through eastern N.C.  Their CD came across my desk last week, and it was quite good- very traditional hard driving bluegrass.  Their words describe the style the best- “edgy, emotional and exciting.”

        They are working on a documentary filmed at the International Bluegrass Museum in Owensboro, Kentucky, and it looks to be a dandy.  From what I can see the hard part will be what to edit out, ’cause they interviewed one bluegrass legend after another.  Check their web site for updates, my guess is when finished it is gonna be a keeper.

Dr. B

Bomb Shelter Co-ordinates

        I got my wife a new GPS for her car, and it is quite a gadget.  We decided to try it out, and plugged in the Bomb Shelter to see how it would react.

        I guess the world is closing in on us bluegrassers ’cause the thing made a pretty good run at it.  It got close, but then even its’ marvelous little computer brain began to get confused.

        “Turn left,” it said.  “No, right.”  Then, TURN RIGHT,”  followed by “re-calculate, RECALCULATE!!”

        Then it resigned itself to the same as we have said for years:

        “You can’t get there from here.”

        I take some solace in that.  For one thing, the military came up with all those co-ordinates anyway, so I have to assume the Bomb Shelter is a low priority target.  More than that, it remains a place where it is socially acceptable for me and all my bluegrass friends to be a bit contrary.  We have to be that to be bluegrass, and even the encroachment of all things few-fangled ain’t got us yet.

        I will tell you though, for negotiating one’s way through the rest of the modern world, the thing is right handy.  When it came time to go home, we plugged in our suburban address, and it was like a horse headed for the barn.  It delivered us right down to the last turn into the driveway.  

        I reckon come Monday I’ll go back to work and re-join the conventional world, at least for a week anyway.

Dr. B

  

Disclaimer/Philosophy/Jokes

        Now before y’all get too worked up over my muses and go call the Insurance Commissioner, let me tell you what you read here is only one doc’s opinion.  (Might not be bad to consider my thoughts if you have insurance company troubles, though.) 

        One opinion isn’t worth much, but I will tell you I have tended to my flock of patients without much trouble over the years, and I’ve been able to do O.K. on my Boards too.  I wish I could tell you I was brilliant, but I believe writers ought to tell the truth in fiction, and it just ain’t so.  

        The brilliant ones are rare.  They can cite the specific passage in the New England Journal applicable to a given physiological process, and they do so with PC precision.  A guy like me remembers which patient he saw, and that he read it somewhere.  I guess God put us all here for His specific reason, though. 

        When one of my patients says something like, “My knee be swolle,”  I know what they mean ’cause one summer I worked down at the factory where they gut out a living.  It was the year before I sweated out an “A” in fall semester Organic Chemistry.  That gig gave me a profound respect for the folks who worked there, and also the incentive to study like a wild man.

       When a patient tells a doc their knee be swolle, many a brilliant doc has replied, “Pardon?” and gone back to the Medical Center.  If a country doc can yuck it up with a patient who says the word swolle, and talk to the med center guy about persistent patellar crepitus, I reckon he/she is doing their job.  (I hope so, it is the only job description my resume ever seemed to fit.)  By the way, one time someone asked me to send them a curriculum vitae- what the heck is that?!-  I’ve never applied for a job except those summer factory gigs where they said sign here and handed you a shovel. 

        Maybe it is a bit of cognitive dissonance here, but I kinda like Sir William Osler’s take on all this.  He said, and I paraphrase, but this is close, “Seeing patients without reading books is like going to sea without  compass, but reading books without seeing patients is like not going to sea at all.”  Dr. Bob Leckridge from Scotland is professor and a scholar, not a country doc, but my bet is he’d agree with Doc Osler 100% on that.  (I’m gonna tell you though, Dr. Leckridge is a genuine Board Certified Med School Professor Country Doc- my highest compliment.  That is a rare breed indeed.)

        Anyway, a big part of my attempt to write comes from the desire to make a statement about who I was so when my time here is over my great-grandchildren can know me.  What I didn’t figure on was the opportunity to get to know so many other wonderful folks, and learn from them.  It has already been a fine ride- I appreciate you going with me.  Right quick you learn how much your readers mean to you.  Just as patients are to a Doc, without ’em it is time to go to the house.  Like the proverbial tree falling in the forest, for a mandolin player if there ain’t no people to hear it, there ain’t no music. 

        I am at the stage of life where a man tends to reflect back on what he has done.  You wake up one day and realize you ain’t ever gonna win the Nobel Prize and whatever you are is about what is was.   It is a bit sobering.  Some guys go crazy and leave their wives and try to become a race car driver or movie star or something.   None of that routine is for me. 

        I’ve had a few patients think I’m gonna hit the road with my mandolin, but they don’t understand.  I play the mandolin so I can keep on doctoring, not to leave it.  Besides, I know of at least five players in Eastern N.C. not quite good enough for the circuit who can blow me away.  We all gotta know who we are, and I got that much done in life.  I got that figured a long time ago.

        So, for me, I think I’ll stay a county doc.  I’ll take credit for being a solid doc who cares about his people, and who loves to read, but I can’t quite claim to be an intellectual.  Besides, if I was, my boys might make me give up my music, and I can’t have that.   

        My agent warned me against too many jokes, and I agree with him.  It can demonstrate a lack of originality- a death sentence for an unknown writer.  This one was too good to pass up, though, and I found it apropos to the post on how to deal with the pesky insurance companies, so I hope you’ll forgive me.  I won’t make it a habit.

        Didja hear the one about the three docs who died and went to heaven?

          Well, they got to the Pearly Gates, and St. Peter administered the rites.

        He asked the first doc, “What Sir, is your name, and how did you serve?”

       “My name is Dr. Bibey, St. Peter.  I was a country doctor.  I loved my patients, and I tried to treat ’em like family.  I warn’t perfect, but I tried my best to do right.  I never took anyone to collections, and took care of everyone and let the chips fall where they may.”

        “Well done, good and faithful servant.  Enter the gates to glory, my son, and you may stay for eternity with your heavenly Father.”

        “And you sir?” St. Peter asked the second Doctor. 

        “My name is Dr. Smith, Sir.  I was a surgeon, and I stayed up many a night away from my family to take care of the sick.  I was weary my whole life, but I did my best.”

        “Well done, my son.  Come in my good and faithful servant, you may now rest in peace for eternity.”

         “And you sir?”  

        “My name is Doctor Richman, Sir.  I was a cost overseer for Divided Health Care.  I saved the company millions of dollars, and the stockholders voted me employee of the year four times.”

        St. Peter appeared confused, and leafed through reams of paper before coming upon the name.  “Ah yes, Dr. Richman, here is your number.  47TY -88975-H 44.  You are pre-approved for three weeks and then you can go to h***!” 

        Note from Dr. B- I tried my best to let St. Peter cuss for effect, but I couldn’t bring myself to do it.  He would have been saying that in cyberspace for eternity, and I didn’t want to have to explain it to him someday.

        See ya’ Wednesday for my regular post.  If I run into something that strikes me before that I might jot down a mini-post or two. 

        It’s freezing here, but all my friends from up north talk about that eight degree business.  My feet are cold here in the South- I have no idea how you guys survive that.  Hope springs eternal, though.  I’m gonna order me some new grips for my golf clubs, ’cause spring thaw is just around the corner.

Dr. B

  

When You’re Smiling

        My wife’s band’s theme song is “When You’re Smiling.”  If they ever decide to choose a different tune, I might have to fuss, because it is so appropriate.  They play music for exactly the right reason- to have fun, and make people smile.  They are very good at it.

        Marfar is the ringleader, too.  When I was a young doc, I was so serious.  I thought if I read enough books and studied hard enough, no one in the County would die.  Of course that was too ambitious a goal.  I am still very serious about doctoring, but I’ve had to temper ambition with reality, and try to keep on smiling.  Marfar has always seen to that.  One of her few complaints about me was to say, “You aren’t laughing enough!”

        One of the things I loved about my wife right from the get-go was her laugh.  I’m not a good enough writer to capture it on paper, but right at the end there is a little lilt that makes it impossible for a fellow to be in a bad mood. 

        If you read “Birds of a Bluegrass Feather,” you know we have two tropical conure birds in our home, and she has them in on the act.  The birds talk a little, but as with babies, I have some trouble with translation, though my wife communicates with them with ease.  

        Two things the birds imitate are clear even to a man.  One is the door bell chime- they have it perfected.  The other is my wife’s laugh.  Birds can only learn what they hear all day, and they can mimic her with uncanny accuracy.  (If I were home all day, I guess they’d sound like a mandolin.)

        It is all good for a sometimes too serious doctor.  It ain’t possible to walk by a bird, have it laugh just like your wife, and hold onto a bad attitude.  I think she trained them like that so when she was not home, I’d have to keep things in perspective even in her absence.

        My wife is so smart, she’s even got me fond of those dadburn birds.  All I can say is she’s got the right theme song- keep on smiling.

Dr. B     

Heart Trouble and Insurance Woes

        Let’s see now, where was I?  Heart trouble, that was it. 

        Oh yeah, well most important, ole Snook did just fine, and he’s still edging me out of a cheeseburger every so often.

        He was lucky.  He gave a good history, I was there, and I knew how to maneuver his insurance company into doing right by him.  The job description for a modern country doc has changed some.  Your doc should still be Board Certified, have to desire to get to know you as a person and care about you like you were family. 

        Nowadays add another prerequisite, though.  Part of the task is to know how to be a street fighter with the insurance companies.  Dr Groopman spent a fair amount of time on algorithms and how they can be an impediment to care.  With that in mind, I thought I’d tell you how Snook got taken care of in spite of the meddlesome insurance bureaucracy.

        Monday after my round of golf with Snook, I ran into my buddy Boykins Douglas, our local cardiologist, on morning rounds.

        “Dawgless, what’s happening?”

         “Hey Bibey.  Y’all gonna do the heart gig again this year?”  We had played for the Heart Association for ten years running, although they would not allow a pig picking, our cuisine of choice.

        “More than happy to brother, you just gotta do me a favor.”

       “Sure thing.  Whatcha need?”

        “You know Snook, don’t ya?”

        “Sure.  If I had to depend on Snook to make a living, I’d have to find a new job.  That cat never goes to the doctor.  What’s up with Snook?”

        “New onset angina, at least I’m pretty sure.”

        I already had the Dawg’s attention.  “Any chest pain?”

        “Naw man, but he sure enough has exertional dyspnea. (shortness of breath)  We walked nine yesterday, and I wasn’t sure he was gonna finish.  Off twenty yards on his drives, too.  It’s atypical, but I’d bet 70% odds on it.  Don’t like it at all.”

        Dawg had gotten used to my bluegrass slang and encrypted medical lingo over the years, but he knew I knew my people.  “Will a treadmill do it, or you want to nuke him?”  (Slang for nuclear treadmill.)

        “I don’t know.  I gotta get it by his insurance company.  I’d vote for a treadmill with a bailout nuke if he can’t cut the gig.  I’m concerned about his exercise tolerance- he looked pretty short of breath yesterday.”

        “Where is he now?”

        “Home.  I tried to get him to come in yesterday, but no tickee.  I had some aspirin in my glove box, and started him on that.  He’s supposed to be on bed rest with bathroom and meal priveleges till I call him.”

        “Didja get him to give up cigarettes?”

        “I’m a doctor not a miracle worker, Dawg.”

        “I understand.  Get me a pre-auth.  (pre-authorization from the insurance company.)  I’ve got two caths this morning- I’ll come back from lunch early and do him at 1:00.”

        “Thanks Dawg, I owe ya one.”

        “Just get me a number.  I don’t mind doing a nuke for him, but I’ll catch hell from administration without prior approval.”

     “Will do.”  I scurried to the office.

      I gave our referral secretary the assignment first thing, ’cause I had a lot of folks waiting on me.  I saw the first few patients, and went to check on her progress.

        Annie had run aground.  “Sorry boss, they won’t even discuss it- no office notes.”

        “Well excuse me for no Dictaphone in my golf bag.  I keep Epi in there in case of a bee sting, but I guess I wasn’t prepared.”

        “They said they would consider it if you talked to the nurse directly.”

        “O.K., get ’em on the line.  I’m gonna see a few patients.”  I shook my head.  “Be prepared, gonna go back to “d*** Boy Scout school,” I muttered as I walked out the door. 

        “What did you say, boss?”

         “Aw, nothing Annie.  Just get her for me.  Snook’s on deck for 1:00.  I gotta get him covered.  He doesn’t need to get stuck with the tab.” 

        Directly Annie tracked me down.  “I’ve got ’em on hold, Dr. Bibey.  They say she’ll be right there.”

        I wrote the last script for the patient in exam room two.  “O.K., Ms. Bee.  You’re good to go for three months.  I gotta grab this call.  We’ve got a bit of an emergency going on.  If you think of anything else, tell Myrd.  I’ll be back in a minute- you can hop down.”

        “Young man, I do not hop.”

        “Yes, ma’am.”  I glanced at Myrd, who took the cue, and held Ms. Bee by the arm to help her off the exam table. 

        I went into my study, and closed the door.  Sometimes these discussions brought out a side of me I didn’t like, and I didn’t want my staff to see it.

        I held and listened to the canned company music.  Of course, bluegrass is my favorite, but jazz, big band, classical; anything but that dang elevator stuff would work.  I was already in a bad mood.

        “Dr. Bibey?”

        “Yes, yes.  Oh yeah, uh… thank you.”  Dang it, I had dozed off.

         “Please be aware this call may be monitored for quality assurance purposes.”

        “Yeah, O.K.  I got it.”

       “How may we help you today?”

       I wanted to say how ’bout you just give me a number for Snook’s nuke, but I knew that wasn’t gonna get the job done.  I tried to be professional.  “Yes Ma’am.  My name is Dr. Tommy Bibey.  I have a patient, Snookers M******.  He needs a nuclear treadmill today, pronto.  I need to get a pre-auth number.”

        “Let’s see Dr. Bibey.  I do not have any office notes.  We generally do not process these without supporting documentation.  If you will fax them to us, we will give it full consideration.”

        What to do?  Somehow I didn’t think this lady would take to the fact the diagnosis was made on the tailgate of a pickup truck.  Hated to do it, but it was time to lie.  “Well I’m sorry ma’am, but the transcriptionist is out today.  The dictation won’t be in until tomorrow.  I’ll be glad to fax it then.”

        “And do you have an EKG?”

        “Well, no ma’am.  I saw him yesterday.  I tried to get him to go in the hospital, but he wouldn’t do it.  You know how it is ma’am.  He’s a man- stubborn.”  The line was quiet.  No laugh.  Uh, oh.  I’m in trouble. 

        A tune started to gel in my brain.  “I got them mean woman blues, I don’t know what to do…”  Oh well, at least I wasn’t married to her.  Focus Bibey, focus.

        She droned on.  “Yesterday was Sunday.  Do you have office hours on Sunday?”

         “No ma’am.  It was a uhh…,  a house call.”  Dang it, another lie.

         “No office notes.  No EKG.  Dr. Bibey, I have to answer to my superiors.  I have responsibility for decisions.  They must be evidenced based.”

          Yeah, well it ain’t like no one’s checking behind me, I thought.

        “Does he have any chest pain?”  She went down her list.

        “Well, no ma’am.  Exertional dyspnea, though.”  I didn’t tell his drives were off twenty yards.  Somehow it didn’t seem the right play.

        “Let’s see .  Your secretary gave his age as 59 1/2.  He does not meet the criteria to approve cardiac imaging studies for exertional dyspnea.  Now, if he were female or six months older……”

        Oh, GG (Good Grief) lady, I thought.  I ain’t missed that question on the Boards in twenty years.  Gimme a break.  Somehow I held my peace.  “Ma’am who is your doc today?  Maybe I could talk it over with him.”

          “Let’s see.  That is Dr. Thompson.  He will be in at 2:00 if you would like to call back.”

        D*** it.  Too late.  Better reverse field. “Is that Dr. Paul Thompson, III?”

       “Yes, so you know him?”

        “Oh yes.  He is a good guy.”

       “He is?  How do you know him?”  She was surprised, and sounded quite skeptical.  Great – just the response I hoped for.  I’ll bet they had some run-ins over the years.  I had an opening, and I was gonna drive this truck on through it. 

        “Oh yes, ma’am.  Tell him Dr. Tom Bibey called.  We worked together on a case last year.  I couldn’t get a nuke on my man and he had an M.I. (heart attack.)  The patient did well, but the family was incensed.  They wanted to litigate against Dr. Thompson, but I helped him out.  His argument, and I agreed, was his nurse did not consult him in a timely fashion.  He  blamed her for the whole fiasco.  The only way he stayed out of litigation was to let her go.  It was a shame.” 

        Dang it, I hate it took three lies to get this thing through.  There was gonna be some powerful prayer time Sunday.  I hope the Lord’s interpretation would be the means justified the ends. 

        “I suppose I could approve a standard treadmill without any documentation.”  She was softer this time.  Still a mean woman, though.

        “No tickee.  I gotta have a bailout nuke in case he can’t cut it- he’s pretty short of breath- he might not have the exercise tolerance to make the diagnosis.  Boykins Douglas won’t pull the trigger unless he is not sure after the treadmill.  You have my word.”

        She hesitated.  I waited.  I almost played my next card and started to ask if Lori still worked there, but then she gave in.  “O.K., Bibey.  Your accession number is 5673-HYT- 685773.”

          “Thank you ma’am, and you have a good day.”  I’m glad I have honed my delivery as I’ve aged.  I do not wish to cuss in front of women, or anyone for that matter, and it wasn’t needed to get my job done for the day.  I’d go to church Sunday and ask for forgiveness for the stretches of the truth.

        I burst out the door.  Time to get back to work.  “Hey Annie, get Dr. Douglas’s folks.  Tell ’em I got their number.”   

        “Good work, boss.  How’d you do it?”

        “NAP, (bluegrass for not a problem) Annie.  Turned out she was a bluegrass fan.”

       “Well, I’ll be danged.”

        Well, I’ve already told ya the end of the story.  Snook flunked with ST segment changes in two and one half minutes, and the bailout nuke wasn’t needed to make the diagnosis.  He did well with his bypass surgery, and still clips me for a burger most of the time.  And good ole Dr. Bibey did go to church to ask for forgiveness.  It was granted, and he lived to fight another day.

        Next week, we’ll talk some about the Groopman hypothesis and chronic illness, then I’m gonna get back to music for a while. 

        Just remember to be aware that heart, and any acute illness for that matter, can be hard to figure.  All you can ask of your doc, and yourself, is to try hard.  None of us will be right every time.  I hope to continue to dodge major calamity, and if I’m wrong on some smaller things,  I’m gonna go down to the church house and ask for forgiveness.  It won’t be the first, or the last time. 

        See you in a few days, and take care.  Remember to hug your loved ones and stop and smell the roses along the way.  Old Docs develop a keen notion of how precious life is and how quick it can change, so enjoy.

Dr. B

Big Gig with Guitared and Feathered

        Neuse River has some big shows coming up this spring, and I’m gonna tell you all about them.  Right now, though, the  G and F girls are getting the nod for some local gigs, like the one they’re gonna do one at the Senior Center Saturday.

       Their last mandolin player got married and moved to Kentucky, so you know who they hired.  Given Marfar wants me to play the gig, I figured I’d better sign up.

        Being the mandolin man for the ladies is very different than my regular Neuse River gig.  Like I said before, they fix great snacks, tell all kinda funny jokes, and are much better looking than the Neuse River boys.  And they are so darn nice.

        Take mistakes for example.  When you tangle up a break in the Neuse River bluegrass band, them boys give you down the country.  “D*** it Doc, study your instrument.  What the h*** kinda break was that?”

        If you miss a note here, dang if these ladies don’t say somehow it’s their fault.  Beats all I ever saw.  I reckon it’s to make you feel better.  Heck, I missed my cue on “Sunny Side,” not one of them, but they apologized.  I wasn’t sure why.  It sure is a kinder, gentler bluegrass picking.

        The other thing I noticed was they were the personification of that word multitask.  In between tunes, there was all kinda discussion about sick kids, elderly parents and what’s for supper.  (Might have been about cranky husbands had I not been there.)  I was impressed and said I didn’t know how they could think about all that and play music too, and in the male bands I’d been in the guys usually just kept their minds on one thing.  They all took a look at each other and broke up with laughter.  One of em said, “You got that right Dr. Bibey!”  They all laughed some more and then took a break to eat some of my wife’s fine banana bread.  I never did figure out what was so funny.

        And if you and your wife do a duet on “Bye Bye Love,” you better do it with conviction, like if it was to happen it’d break your heart.  (It would.)  On “I’ve Been Living the Blues,” I do not recommend a line like “Since you’ve been gone, I’ve been walking around… with my head bowed down to my shoes,” without adequate emotion, as in “girl, if you wuz gone it would just flat out depress a fellow.”  I think the world of the Warbler or the Moose, but we ain’t close enough for it to matter much, even if good lead singers and banjo players are hard to come by.

       At the end of practice when everyone decides what to wear so as to be color co-ordinated, you gotta be interested.  I was just glad they didn’t choose fuchsia- I don’t think I have any of that and I’m not sure exactly what it is.  Black slacks I can handle. (I think I have some- Marfar said I do.)

       If you want to do extra good, promise to take your wife out to eat after the gig, and then take her to see the River Band- they’re gonna be in town and crank up just a few hours after our show.

        All in all, it was an excellent practice.  I think they are ready for their gig.  I have to tell you though, by the end I felt like a boy who had climbed up into the wrong tree-house, but it was still a fine time.

Dr. B

Medical Study

        If you want to be a doctor, you better like reading books.  I spent most of this evening curled up with a good one on traumatic bony injuries of all kinds.  Sounds like a romantic evening, huh?

        When you read all the ways an inebriated young male can ruin his life by plunging headlong into five feet of water, it does give you pause for thought.  Wonder what does possess a human being to do such a thing?  I dunno.

        I know I should be more serious; the injuries I read about are very sobering indeed.  As a family doc, you don’t see them every day, but you hate it every time.  Tonight, though, I’ve read so long I’m about to get giddy. 

        A redneck joke comes to mind, and since I’m a redneck I guess it is not too politically incorrect for me to tell it.

        What are the famous last words of a redneck boy?

              HEY,  Y’ALL!  WATCH THIS!!

     Sorry guys.  See you around Wednesday for more heart trouble thoughts, and I’ll try to get serious again.  And if anyone in your family has had an injury like this, I’m not making fun, but just trying to cope. 

        When I think back on my teenage years, I feel mighty fortunate to have gotten out intact.

Dr. B

Heart Trouble -HCDT

        Chest pain.  Everyone, even a thick headed insurance company med cost manager, knows chest pain could be a heart attack.  So, I’m gonna start out by telling you about no chest pain first. The bug-a-boo of heart trouble is the subtlety of the clues.  If that wasn’t worrisome enough, at times there are no symptoms at all.  I went to a recent conference on the subject, and there were two big shot Tobacco Triangle U. cardiologists frettin’ over this issue as bad as a lowly country doc.

        One Sunday afternoon a few years back, I decided to go up the golf shop and see if anyone wanted to walk nine.  I ran into an old friend, Snookers.  I won’t tell him his full name for now.  For one, it would be a HIPAA violation, as his name is rather unique and would be identifying.  He gave me full permission to use it, but I have some other motivations to protect him for now.  You see, Snook was instrumental in unraveling a medical mystery a few years ago, and I promised I’d keep his role under wraps until the book comes out.  So for now, he has to go by Snook.

        Snook and I go back all the way to childhood.  In some ways, we had little in common.  My yearbook byline read like thousands of other well scrubbed southern kids.  Band 1,2,3,4.  Honor Society 1,2,3,4.  You know the routine.

        Snook didn’t even have his picture in the yearbook, ’cause he was out gambling on the golf course the day they took the photos.  If any of his accomplishments had been documented, I guess it would have simply stated, smoked cigarettes, gambled,  and of course, golf 1,2,3,4.     

        We played on the team together.  Snook was the star. I was the sixth man.  One time I shot 39 on the back nine for the team to hold onto the Conference title by a shot, but my most valuable contribution was to coach Snook to a C minus in History so he could keep his eligibility.  We won the State that year, though I only got in one match.  Snook shot 64 the last day.  No one came within a half dozen shots of him.

        So, fast forward some quarter century.  Me and Snook are still buddies.  When I walked into the golf shop, he was giving the pro some pointers on putting. 

        “Hey, Snook.  Wanna hoof nine?”

         “Sure Doc.”  Snook put out his cigarette, and retrieved his clubs.  “Play for a burger?”

        “No problem Snook.  Four a side?” 

        “Come on Doc, Three is all you get.  I’ve been watching your scores on the sheet.  You’re doing good here lately.  Four?  No way, partner.”

           “O.K. Snook. Three it is.”  I’d contributed many a cheeseburger to Snook’s monthly meal plan, and had no reason to suspect any different outcome today.  We set out with no anticipation of anything other than a walk in the park.

        It was one of those gorgeous spring days that leaves you hard pressed to believe God could frown on golf, at least if you didn’t use those blasted carts.  

        As usual, Snook jumped out to an early lead, but seemed a bit off his feed.  Still, I was closed out by number eight.  Eight is our number one handicap hole, and requires a solid drive of at least 240 yards to reach the top ot the hill, then a mid iron over water to a sloped green.  The hole is a tough one, and has shattered many a dream of a good front nine.  We both hit good drives that carried the hill. 

        When we crested the hill, I got my first clue something was wrong.  First of all, Snook only outdrove me twenty yards.  It was usually more like thirty.  More worrisome was the fact he stopped walking, and it wasn’t to light a cigarette, but to catch his breath.

        “You O.K. man?”

        “Yeah Doc.  I’m fine.” 

        He didn’t look fine.  “Honest to God, Snook, you’re gonna have to give up those cigarettes.”

        “I’ve cut way back, Doc.”  Right.  We’d been through this routine before.

        “When did you start having to stop on eight to catch your breath like that?”

        “Just in the last month.”  He paused to catch his breath.  “I’m just outta shape Bibey, that’s all.  I didn’t work out much this winter.”  

        “I dunno ’bout that Snook.”  I checked his pulse, and it was regular.  There were a few beads of sweat around his temples.  We waited a minute and they cleared up.  “Any chest pain, coughing up any blood?”  I went through all the standard questions.

        “Naw, Doc.  Hey, I’m fine.”  

        “Let me walk in and get you a cart.”

        “Hell no, Bibey.  I ain’t no invalid.”

         We played in, and Snook collected his cheeseburger.  I followed him out to the parking lot.  We sat on the tail gate of his truck and I watched him change his shoes.  He still seemed a little short of breath.  I thought through his family history.  His mom was elderly, but spry.  His Dad had run off when Snook was twelve.  I still remembered that trauma, and didn’t want to bring it up.  His sister was healthy.  He did not have any brothers.  “Anybody in your family with heart trouble Snook?”

        “Naw, Doc. Booze and womens our only problem.”  He seemed more like himself.

        “You getting short of breath every time you walk up number eight?”

        “Pretty much, yeah.”

         “Does it get better when you rest a spell?”

         “Sure.  Don’t it for you?”

          “Look, Snook.  I don’t want to alarm you, but this could be your heart, man.  You want to go over to the ER?”

        “HAIL no.”  As opposed to Snook, I am no gambler, and I did my best to convince him, but he was resolute.  No hospital today.

         “Well, at least let me line up some tests.”

        It took some powerful persuasion, but Snook did go for his treadmill.  As you might guess, he flunked it and wound up with bypass surgery. 

         The moral of the story.  First of all, “Doctor, know thy patient.”  I don’t think the finest cardiologist at Tobacco Triangle U.  coulda won Snook over unless he happened to be a scratch golfer, and there for the opportunity.

        Second, and for purposes of our more general discussion of how country doctors think, know the heart.  Once a patient had some odd symptoms in her chest, and kept telling me, “But it can’t be my heart.”

        I got frustrated and said, “Ma’am.  I don’t care if every time you sip cider through a straw your nose twitches and your left ear wiggles, it could be your heart.”  I regretted it as soon as I said it, ’cause no one wants a smart ^** for a doc.     

        I was exaggerating, but not by much.  Remember the Groopman hypothesis.  For acute illness, think of what might kill you first, and then work your way down the list.  If we are paranoid and turn out wrong, we can visit on the front porch of the nursing home someday and laugh at the war stories.

        Well, old long-winded Bibey has gone on too long again.  I’m gonna tell you more about heart in the next segment.  After that, we’ll talk some about how country doctors think about chronic illness over a few posts.  So far no one has gonged me back to bluegrass music, but we’ll get back to that in short order.

Dr. B