Archive for February 2008

Country Doc Quote for the Day

February 29, 2008

        Oliver Wendell Holmes on a great U.S. President-  “He has a second rate mind but a first rate temperament.”

       Somehow as a busy country doc in the middle of a flu epidemic, I take comfort in that.  If that man can get us through the Great Depression and a World War, surely I can treat my sick people with compassion today, even if I am tired.  (I’m afraid the quote also describes this country doc.  I wish I were brilliant but it ain’t true.)

        See ya in the morning.

Dr. B


Advice Five Cents/Professional Courtesy Day

February 28, 2008

        Today I’d like get some advice from you guys.  I know medicine, and you folks know writers, so I hope you might trade out some ideas professional courtesy.  As always, my advice on the Net is free (watch out- you get what you pay for) and reading my blog costs the same, so I hope this is helpful.

        Along the way, I’ve written up a few posts that might help moms with young boys, so this one is for the girls.  And it might help the Dads too.  I have a little girl.  She’s grown up now, but I still understand the depth of that bond, and the desire to be protective.

        Probably most of y’all have heard of the Gardasil vaccine.  For girls from 9 to 26, this is a vaccine one should look into.  Without going into all the technical details it protects against infection from the virus that is associated with the development of cervical cancer later in life.  (Google their website- it is very detailed.)

        Given this is essentially a sexually transmitted disease, I realize some folks have trouble talking to their children about it.  Here’s how I sold one teenaged patient of mine on the idea.

         “Hey kid, you oughta take this Gardasil shot routine.  It is one of the few things in life that can keep you from getting cancer.”  (I took an early practice test on the subject and missed a question ’cause it was one of the few times the word ALWAYS was associated with the correct answer.  I’m sure it is not 100% but the Board was trying to make a point.  This thing works.) 

        “How does it keep you from getting cancer, Dr. Bibey?”

        “Well, cancer of the cervix is a female cancer, and it can come from having sex with a guy who has a certain kind of virus.  The vaccine can stop the virus from getting ahold of you.”

        “Dr. Bibey!  I ain’t having sex.  I don’t need it.  Don’t ya trust me?”  She was embarrassed.

        “Oh sure, kid.  I trust you.  It’s the rest of the world I don’t trust.  Someday down the road if you’ve got a husband with a wandering eye who runs around, this shot could protect you from some of what he is doing.  I’d go beat him up, but by then I’ll be over in the nursing home and too old to do it.”

        She laughed.  “O.K. Dr. Bibey.  If you think I need it I’ll take it.”  I think the image of old Dr. B duking it out with some young buck was what won her over.  You can only protect your people with the skills you possess.  Truth is it would have to be some kinda weakling of a twenty-five year old boy for me to whup nowadays, and it wouldn’t help her anyway. 

        Her mom agreed to the series, and we started that day.

        So y’all talk to your Docs about Gardasil for your young ladies.  Tell ’em Dr. Bibey sent you.

        Oh, yeah, I said this was professional courtesy day.  If y’all know of weblogs of Southern writers or humorists you think I should read, I hope you will let me know.  I have no idea what I am doing in this writer business, and I need all the help I can get.    

        In bluegrass we only steal from the best.  Don’t worry- I ain’t gonna plagiarize; it goes against everything I believe in, but I am curious about how other folks write.  My specific genre is Modern Medical Grit Lit, but I’d like to hear about any Southern Lit blogs you enjoy.  (For that matter if they write like my Northern friends, that is good too.)  If by chance you know of any other physician bluegrass fiction writers, that would be extra good.  I have a special interest in that area. 

        My agent has managed to get a few articles placed for me, and I figure the leads might give me a few other places to look into publication.  The 15% take for my agent is a bit slim, and I need to keep growing to keep him in the fold.  He’s got a young’un in college, and he has no choice but to be somewhat business-like.  (I drive him crazy with my meandering ways.) 

        Come to think of it, I believe his young’un is a girl.  If she’s in college she’s less than twenty-six years old.  I believe I’ll call him and offer them a free Gardasil shot- professional courtesy you know.  Every little bit helps.

        See ya this weekend.

Dr. B 

The Writing Business

February 26, 2008

         Before I start today, I want to thank The Laurel of Asheville for hiring me to do some pieces on bluegrass music.  The editor, Mr. Paul Howey, is a fine fellow who decided to take a chance on an unknown, and I appreciate the opportunity.  

        Mr. Howey wrote an award winning book on Pet Therapy dogs.  His book came out of empathy for a stray dog he happened upon in the Arizona desert back when he when he was living there.  He sensed the dog was special and indeed his intuition proved well founded- Freckles became a star in the field of pets and healing. 

        I’m lucky I ran into Paul, as he is an empathetic man with a soft spot for stray dogs and old Docs.  He is a busy editor, but took the time to make the piece magazine worthy.  It was my first good paying writer gig, and I’m glad Mr. Paul Howey was the man to give me a chance.  As we say in bluegrass, he’s a good’un.     

        Today I wanted to share some of the business aspects of writing and agents.  I am a Doc and an artist, not a business guy, but I am a fast learner.  In the literary world you gotta have an agent.  They come by all the best gigs, and they know the business end of things.  (Someone has to take care of Dr. B.) 

        Take today.  My agent found me a gig writing for a University Press up north.  They have a book compilation project on rural medicine in progress and wanted one chapter from a country doc who played bluegrass music.  (Can you believe my luck?) 

        My man has all kinds of writers in his stable and he chose me for the project.  I wonder what made him think of ole Dr. B?  Maybe it was ’cause my six word memoir is “World’s first physician bluegrass fiction writer.”  

        He really wants to see me get this gig, ’cause he says it will be a springboard for even bigger publications.  It is hard for me to imagine anything much bigger though.  Old Dr. B has spent his entire adult life as a country doc and bluegrass picker and now is gonna be rubbing elbows with University scholars.  Too dang much.  I hope they want to have a pig picking and a bluegrass band when their book comes out; I know all the best ones.

        When I got my Bluegrass First Class gig, my agent negotiated all the details, and it was impressive.  I couldn’t believe I was going to get paid all that money for having so much fun.  

        Right from the get-go he had me ready for the role right down to the little hat with the press ticket tucked in the band.  We had the run of the entire place and backstage access to all the shows.  To tell you the truth, as Buck Owens would say, I was just acting naturally; only difference was now someone was paying me to do it.  I had a little notebook I carried in my back pocket, but I forgot to pull it out.  It didn’t matter.  Who could forget the events anyway?  

        The writing business is new to me, but I have been around bluegrass music all my life, and I can see some parallels.  Both of ’em have a fair amount of overhead.  (One bluegrasser told me you don’t know what overhead is till your diesel fuel bill is in the tens of thousands of dollars.)  I remember talking to one boy who signed on as the bass man for a mid level band, and they went all the way to California and back on tour.  They flew in airplanes and stayed at fancy hotels, smoked fine cigars, and had steak every night.  (They warn’t the ground up kind either, but them good Delmonicos and such as that.)

        When he got home and got to figuring, he had fifteen more dollars than he’d left home with.  He called his old boss and asked if he could get back his job at the hardware store.  (He still plays but now balances a day job with weekend music work.)

        This writing gig, like playing music, is also a tough way to make a living, though I don’t think my overhead is in the same league with the folks on the music tour.  We did have a lot of expenses though.  At the end of the weekend, me and my agent sat down and went over the line item financials.  We got our press passes for free, and of course I understood all the travel expenses.  I didn’t realize he had rung up quite such a bar tab, and room service each day does tend to accrue.  I wasn’t sure exactly why his mama needed a room, but then he told me her sitter had quit her, and she was scared of staying alone, so I let it go.  The Doc side of me empathized with his circumstances.  (I never was much of a businessman.)  As we say in bluegrass, it was a large time, and I’m ready to go at it again. 

       They say the best Docs know they ought to be out making an honest living but enjoy practicing medicine to much to quit.  Music has always been that way for me too, and now so is writing.  (My wife says I’m gonna get all the way to the end and never go to work for a living.)  To play a whole weekend, get paid, make expenses, and have seventeen bucks left over was a huge success.  Maybe that is why I like to write so much- it’s a lot like bluegrass music. 

        So I guess I’ll persevere on as long as y’all will put up with me.  I am having too much fun to quit.

        See you this weekend.  Let’s see.  Medicine, music, writing or golf?  Hm, I’ll have to see what transpires between now and then.  One thing about it, when you don’t go to work every day, a lot of material surfaces on a regular basis.

Dr. B

Bluegrass First Class

February 24, 2008

             BluegrassFirst Class. (BGFC)  It’s 5:30 am Saturday and the music has almost died down for the first day.  This is my first chance to sit and write.  Some guy by the fireplace waits with me for the coffee shop to open and renders a fine version of “Whisky Before Breakfast.” The event is less than twenty-four hours old and we’ve taken in a half dozen acts, and been in a bunch of jam sessions.           

        The pros Saturday ranged from straight bluegrass of Dry Branch Fire Squad to the 50’s country influenced lead singing of Ricky Wasson with J.D.Crowe.  The new fiddle man for J.D. ripped through “Wild Fiddler’s Rag,” a most difficult tune.  (My favorite rendition is my Pecan Grove cousin’s mandolin version.) 

         Some of the ladies complain Rhonda Vincent has too much sex appeal for bluegrass, but you gotta hand it to her.  In spite of the glamour of a road weary schedule, she works hard to put on an energetic show, and stays after to speak to every fan wanting to meet her.           

         A little nine-year old angel of the Snyder family and her “older” brother (twelve) on the guitar stole the Saturday show, though.  How such young children sing and play at such a professional level is beyond me.  When you ask how she does if she shrugs her shoulders and has the shy reply of “I just love to play.”  It’s the bluegrass way.           

         The backstage jam sessions are almost as good as the main acts.  I played several hours with Al Wood, a mainstay Piedmont banjo man out of Statesville.  (Al has been around long enough to recall listening to the Grand Ole Opry in the early days of rural N.C. radio.)  I’ve got a bunch of his old records, and he can still pick with the best of ‘em.  His boy, Woody, can flatpick play and sing any style, but my favorites were the hillbilly jazz tunes and old Stanley Brother numbers.  The late night sessions are an education, and not only in playing music.  The conversation ranged from Les Paul’s development of the amplifier and multi-track recorder to Mozart’s girl friend ragging him to get a day job.  Be not fooled.  These folks are country, but far from unsophisticated.           

         The best times are back in our room headquarters.  My entourage is my family.  Tommy Jr. is coming along on the mandolin, and there ain’t no harmony like the family kind.  Marie is just a young’un who has barely seen a quarter century here on earth, and yet speaks eloquently of access to medical care for the underprivileged and mission work.  Dang if Marfar and I didn’t raise them right, but I am not sure exactly what it was other than to hold ‘em close, take them everywhere we went, and go to the church house to pray for guidance.                 

         Saturday rocked.  As a mandolin player, you can’t help but be mesmerized by a guy like Jessie Brock.  Fluid right hand, no tension, great tone. 

            Balsam Range was a surprise to some new bluegrass fans, but all of us old hands were glad to see Grammy winner Marc Pruett organize such a fine band.  Fiddling Buddy Melton’s high tenor wowed the crowd.  Brother, if his lead vocal on “Blue Mountain” don’t make you want to grab your best girl and hold her tight, ole Dr. B would recommend marriage counseling.  Tim Surrett is a master emcee- someone forgot to tell him you had to quit having fun if you turned pro.            

         III Tyme Out never has a bad line-up, but the current configuration is as tight as I’ve heard in years.  Russell Moore has long been one of the best lead singers in bluegrass, and the band is at its best with the return of mandolinist Wayne Benson.  The guy is on a constant quest to express his artistry via the mandolin; the type who is still eager to explore new passages with his morning coffee.  He closed out the night set with a mandola medley that had the house stomping and clapping like an old time tent revival. 

         If by chance you aren’t into bluegrass, go see III Tyme Out and ask ‘em to get the bus driver to sing the bass part with the band on an old Platters number.  They can do it as well as a fine Ocean Boulevard beach band.            

         Sunday morning.  5:30 am.  The morning gospel sessions are still a few hours off.  I write and sing harmony with a fine mando man named Merl and a lady Cajun fiddler whose name escapes me.  They have played all night.  My thoughts turn to Doc Watson’s set.  Doc personifies the best in traditional music.  Humble, unpretentious, yet a genuine world class virtuoso, he is kind enough to let us sit in on his front porch jam session with Jack Lawrence and Tony Rice.  And he sings with such honesty and emotion.  Maybe my friend Wayne Benson said it best- “When Doc sings, I believe every word.”           

         Me too, Wayne.  Doc’s the best.           

         I appreciate y’all hearing all about this.  It was my first paying writer assignment.  (The preview article is in the Laurel of Asheville, February, 2008 issue.)  Come Wednesday I’m gonna tell you how I got the job.  Just like picking music, it almost seems wrong to get paid for having so much fun, but I ain’t gonna turn down the gigs when they come along.              

         Well, gotta trade in the mandolin for the stethoscope.  My soul is recharged, and I can go back to doctoring and take care of some sick folks till the next gig.  Neuse River has our first spring outing next weekend.  Will keep you posted. 

Dr. B

Why my Wife Likes for Me to Play Golf

February 22, 2008

        Spring is about here, ’cause Ms. Marfar bought me some new golf shirts and encouraged me to get back at it.

        Part of it is that she knows it is the last thing remotely athletic I can still do.  Basketball and baseball are long over and football never was, (too skinny) but with golf I can still pretend.

        After a long winter of being cooped up, I get restless and need to be a little boy if but for a few hours.  She’s good to not protest it.

        I am a dumb man, but I ain’t all dumb, though.  I established a house rule a long time ago.  Whatever I make in bluegrass music or gambling at golf I leave at her place at the dinner table.  We only bet fifteen bucks, so on the best day you’re talking $150.00 or so if you clean house.  (When I lose we don’t talk about that, but she can tell within twelve seconds of me walking in the door.  I’m not sullen, but I ain’t bragging either.)

       All this behavior goes back a long ways, and the house rules have never changed.  The money is hers, but with only one condition.  She can not spend it on household budget items or for that matter on anything sensible.  (After all, I came by it playing so it’s only fair.)  It must be spent on her and her only.  I call it Marfar’s mad money. 

        I can’t lose.  If I don’t win on the golf course, I ain’t worked up about it.  It is only a game, and I’ve had a day in the sun.  Like the great Cary Middlecoff said, “I don’t worry over four foot putts.  If I miss, my wife still loves me and we’re eating steak tonight.”  And when I win Marfar seems to want me to play even more.

        Now before you go worry ole Dr. B is gonna get in trouble for gambling, no fear.  The high Sheriff and police play in our group, and they say the dollar figures involved are not enough to warrant any legal consequences.  Besides, I’ve noticed their wives encourage them to get out and mix it up with the boys too.  I think they’ve all been talking.

        Like I say, I’m a dumb man, but I ain’t all dumb.  Wednesday our group lost the front and the overall, but the wind got up and we rallied to win back nine with a gritty one over par.  I came home and put the thirty bucks on the table.  It ain’t much, but every little bit helps.  I have no idea what she might save it for, and don’t want to know. It might wreck a lifetime of a good negotiations. 

       Hey, I have a big event coming up- my first big paying writer gig- coverage of a regional bluegrass event.  Will tell you all about it in my next post.

Dr. B

Up all Night

February 19, 2008

       Years ago I was up all night taking care of an elderly patient.  This was before we had full time cardiology consultation in town, much less hospitalists, so if you wanted it done, you did it yourself. 

        My patient was 81 years young, and had an inferior M.I. (heart attack in the bottom part of the heart.)  Of course, there are no good heart attacks, but as far as they go inferiors tend to do reasonably well most of the time.  Everything seemed to be going along O.K. till around midnight, when she had a burst of V. tach and a cardiac arrest.

        It was a long night.  After several more defibrillations, it was good to see the sun rise.  I was more than happy to call in reinforcements, and sent her down the road to Sandhills U.  Back then they did not do much high tech intervention in a cardiac patient that age, and they treated her about the same as we would have at home.  As it turned out the stay was uneventful, but it was still good to get second opinion.  In a few days she was safe to go home. 

        When the rescue squad boys took her out the door to go to Sandhills she said, “Tommy, I sure hated to keep you up all night, please apologize to your sweet wife for me.”

        “No problem, ma’am.  She’s given me permission to stay out all night with all the women I want to as long as they are older than 80.”  (Now that I am older, I suspect my wife would change her mind, the age limit, or both.)

          We teased about it for years, and I would tell her the two of us just couldn’t go out at night any more.  She was too wild; we’d have to meet at the office during daylight hours. 

        She was a sweetheart, and I’m proud to say she lived another dozen years.  She did quite well until her last eighteen months when age and heart failure finally caught up with her.

        I thought of her today when I saw her son for a physical.  There is a special bond in those all night-ers, and I’m still tight with the whole family.  Insurance chart guys, and sometimes young docs, often do not understand how we know so much about our people.  It’s ’cause we don’t have to ask the family history- we were there!

Dr. B

Band Together For Butch

February 17, 2008

        My first mandolin teacher, Butch Baldassari, of Nashville, Tennessee is fighting a tough medical battle.  As a Doc, I don’t feel like I should write up all the details, but his story is well outlined on his website, SoundArt Recordings.  Also, our Mandolin Cafe keeps us posted with regular updates. 

        Butch was not only my first teacher, but for the mandolin community he is “America’s teacher.”  My guess is more mando students got their start from his mandolin intro series than any other source.  I recently picked up a few of his items I did not have, and his wife sent me a “Band Together For Butch” arm bracelet, which I now wear every day.  The bracelet has become the symbol of support for Butch in our little tight-knit community of mandolin folks.

        So, go over to SoundArt Recordings and visit.  As you know, mine is a 100% non-commercial weblog, but if you have an interest in what all the mandolin fuss is about consider picking up one of his CDs.  The family could use the support and IMHO (bluegrass for in my humble opinion) you will get more than your $15.00 in blessings. 

        When you look at his site you will see there is something for everyone.  Butch is great at bluegrass, but it doesn’t stop there.  He has CDs of mandolin orchestra, Christmas music, hymns, Irish, Celtic, and much more.  My personal favorite is the spare and humble “Appalachian Mandolin and Dulcimer.”  Butch grew up in Pennsylvania, but it sounds like it could have been recorded on a N.C. mountain front porch like some of locales I report from.

        Most of all, y’all send up some prayers for my old friend.  His illness falls into the category of “things old Docs can’t understand why it is that way,” and he and his people are in my thoughts and prayers.

Dr. B

Golf Nut

February 15, 2008

        Golfers, like musicians, tend to trust docs involved in their genre, so I have a number of golfers in my practice.  A lot can transpire on the golf course.

        For the most part when we play golf the boys are about the game.  Who wants to talk about constipation when a fifteen dollar bet is on the line?  Early on one fellow did ask me about his prostate problems on number thirteen.  I told him I had a glove (and not a golf glove) in my bag, and if he’d pull down his pants, I’d be glad to check him.  I noticed after that, no one asked any medical questions unless it was urgent.

        One day a young fellow showed up for the Saturday choose-up.  He was underage, but the boys wanted to let him tee it up, ’cause then we’d have five foursomes instead of having one group be odd man out.

        I voiced my concern.  I sat on the Golf Course Board, and knew quite well if he gambled it was a violation of County High School team eligibility rules.  My arguments were to no avail, though.  The boy wanted to play, and everyone else wanted to let him.  On top of that he didn’t feel well, and had some cramping abdominal discomfort.  Intuition spoke and I didn’t like what I heard.

        He wasn’t febrile, at least to touch, and the history wasn’t consistent with an appendix.  Everyone was clamoring to tee off, so I decided to pay the kid’s fifteen bucks myself and declare him a “competing marker.”  It was a category I made up, and I hoped the ingenuity might save him trouble later.

        I pulled him aside.  “Look, Richard, don’t ever pull this again.  You’ve got a shot at college golf, and you don’t need to take any chances with it.”

        “Yes sir, Dr. Bibey.  I promise.”

        I knew the boy hated to back down after he’d promised to play, so I let it go.  He was in my group, and I’d keep an eye on things.

        We closed the front two under, not good enough to win the side, but were determined to make it up on the inward nine.  By twelve Ricky began to flag.  “Doc, I don’t feel so good, my nut hurts, and I mean bad.”

        Now, very little will bring the choose up to a halt, but all of sudden the boys were worried.  Not only were we contributing to the delinquency of a minor, but he was sick too. 

        Weasel was the most concerned.  It was his idea to invite the kid to play, and he worked for the boy’s dad down at the Purina plant.  Weasel began to foresee how this could play out.  He didn’t need to be out of a job.  

        “You better check him out, Doc.”  It had been their problem; now it was mine too.

        “Boys, dang it, this wasn’t my idea to start with.  Dadgum you rascals.  Come on Wease, you gotta be my chaperon.”  I doubt it was a customary role for the Weasel, but I wasn’t gonna drag this boy down in the woods and check him alone.  I knew everyone trusted me, but it didn’t seem proper.  Weasel protested, but gave in when I threatened to tell his boss this whole thing was his fault.  How did these boys get me into these situations?

        Well, we went down in the woods, and Ricky pulled down his pants for me to examine.  D^*#, this wasn’t epididymitis, but a torsion.  Exquisite tenderness, acute onset, horizontal position.  Why in the world did I let this boy play?  What was I thinking?!

        Wease took one glance and about fell out, (medical for near syncope) and Ricky and I had to catch him to keep him from going down.  Now here I was out in the woods with an under-aged boy I had involved in a golf match wager, and his pants down no less, with the two of us holding up a near comatose half drunk middle aged man.  Now I had two patients, one of who was near passed out.  This did not look good.  

         Ricky pulled up his britches and helped me triage the Weasel.  He was breathing O.K. and his pulse was strong.  I felt like he would be O.K., but we propped up his feet with an old log and whistled for help.  (Remember the old Boy Scout adage- in shock, face is pale, raise the tail.)

        By the time the boys got there, Wease was already coming around.  We had been walking, but the next group had a cart, and they donated it as an ambulance.  

        This was before the days of cell phones, so we had to get back to the golf shop to use the phone.  I caught the urologist at the office, and he heard out the story.

        “Damn, Bibey.  Really, you are gonna have to give up those house calls some day.”  He was getting a big laugh out of the situation, but he had me send the boy over the ER, where they confirmed the diagnosis.  He went to surgery and did well.

        Now I know you didn’t need to hear all that to make it through your day.  I tell the story to remind you with acute illness, you can’t be too careful.  Had I assumed epididymitis it would have been a big mistake.   

        I know many of my readers are parents, especially moms, so if your adolescent males turn up with acute pain in a testicle, I hope you remember this story and get ’em in to the doctor.  If it is a torsion (a twist) the chances of recovery lessen with each hour that goes by, and a few days is too long.

        Now you might say “Well what are the consequences of missing it?”  In truth, perhaps not much.  The Good Lord paired organs for a reason.  The boy would most likely get along O.K. without one testicle.  And, I’m sure to a lot of women we ain’t that much worse off for a minor reduction in the world’s testosterone level, but I figure the boy needs to be given a chance to make his decisions for himself.  If later he doesn’t behave properly ’cause of testosterone poisoning, it ain’t my fault.  We all are responsible for our own actions and all I can do is play his odds for him to his best advantage.    

        Even more important than one testicle, though, was his golf game.  Many a grown man would give up a testicle to play college golf, and this boy had some game.  After it was all over, my best advice to him was to not take any more chances with his scholarship odds.  He went on to play college golf on a full ride.  That was probably more important in his life than saving the testicle, at least to most of the golf nuts I know.  

        To all y’all in the frigid Arctic, golf season is might near here in N.C.  I’m off, and believe I’ll hit a few in the morning. 

Dr. B  

Asthma and Pretty Girls

February 14, 2008

        Back in med school we wouldn’t admit it but we were all scared about half to death.  You couldn’t help but be intimidated.  There was so much to learn and most of us were too young to have any idea how to deal with people.  I think the trend nowadays is towards older students who have some life experience.  This is not a bad idea.

        I remember one green third year student asked to examine a young woman with asthma.  As it turned out, this was a quite attractive girl, and those flimsy gowns didn’t do much to hide the fact.

        The boy was quite unaccustomed to being around anyone who looked like that, much less being called on to examine her chest.  He placed his stethoscope with great caution, careful to avoid any notion of impropriety.

       He listened.  “Breathe in, and out,” he counseled in a most professional manner.  He did his best to divert his eyes from the obvious fact that God had been very kind to this young woman.

       The exam went on for a moment, then she asked a question.

        “Sir, aren’t you supposed to put that thing in your ears?”

        The boy was too embarrassed to go on, and left the room.  Someone else had to do the intake on that one.

        I think he went into Radiology.  

Dr. B

And the Winner Is….

February 12, 2008

        First of all the patient was the winner.  Like I said, I got a pound cake from her at Christmas so she is still O.K.  (I’m doing all right too- still getting pound cakes.)

        So, what did the x-ray show?  As crude as banjobilly was in his comment, he was on to a clue there.  What the x-ray showed, as billy had figured, was a CAMERA!  That thing was supposed to have come through a few days prior, and the fact it had not should have been my clue.  Not only did the x-ray show a camera, but  there were air fluid levels.  To a doc this means small bowel obstruction.  Now, there is an old saying in medicine, never let the sun set on a small bowel obstruction.  It isn’t always true, but I think it is fair enough to say a Family Doc should never let the sun set on a SBO without the blessings of a surgeon, so I knew a consult was in order before my patient left radiology.  Rocking Robert Linney came down and looked the situation over.

          “I’m willing to go get it Bibey, but I expect Sandhills would rather do the case since they are in the middle of it.”

        “Yeah, and I figure they might want their camera back, too.”

        “If they won’t take her, give me a holler, but I feel sure they will.”

        I got ahold of the intern and decided to have a bit of fun.  “Hey this is Dr. Tommy over in Harnett County.  How are y’all today?”

        “Good Dr. Bibey.”  Everyone down there knew me, not only was I a graduate but Neuse River was the go-to band for faculty pig-pickings.  (The Docs didn’t know much bluegrass, but could count on me to round up all the best without fail.)  “Whatcha got?”

        “I need to brag on Sandhills.  You know that new fangled camera you’ve got down in G.I.?”

        “Yes sir, sure.  I was on that rotation last month.”

        “Well tell ’em good ole Dr. Bibey said I sure am happy y’all got all that high tech down there, cause its sure enough made the  diagnosis for my patient.  I need to send her on.  She has a bowel obstruction, so she needs to go to the OR down there tonight, and not just me but Rocking Robert Linney thinks so too.”  Robert was well respected in the Eastern N.C. surgical community, and I knew his opinion would trump me, and more important, the intern.

        “Really, how’s that?”  

        “Son, I’m gonna make you a star today.  You tell ’em you talked to Dr. Bibey, and he was just a going in circles, but you extracted such a good history you know where to make an incision that guarantees the diagnosis, and you can do it without looking at the x-rays.”

        “How I am going to do that?”  I had him confused.

        “Don’t you worry about that.  When she gets there, you’ll understand.  Just tell him ’em Dr. Bibey knows and trusts his patients, and we’ve got ’em a diagnosis.  She’ll be NPO, and ready to go.”

        “I don’t get it.”

        “NTW, and lay money on it.”

        “O.K., Bibey, will do.  Send her on.”  I knew my patients, and he knew me.  He decided to have faith.

        I went back to my patient to break the news.  “Ms. Andrews, I think we are finally gonna resolve this thing.  Your camera is stuck, and I think whatever has it hung up is our problem.”

          “What do you think it is, Tommy?”

           “Well, I don’t know for sure, but I feel like we have to find out.  I’ve talked it over with Sandhills and they agree.  I’m sorry, but I think you need to go to surgery tonight.”

        “Do you think I’ll be alright?”  She seemed more relieved than worried.

        “Yes ma’am, I do.  One more thing.  You mind if I do a little art work on you?  I think it’ll help speed things up at the Medical Center.”

        “Sure, Tommy.  Anything you think that’ll help is O.K.”

        Well, I pulled out an erasable magic marker and drew an elaborate map right on her abdomen.  It was a beauty, complete with an arrow pointing to the spot which corresponded to the location of the camera on the x-ray.  Much like an anatomical treasure map, it was quite elaborate, and reminded me of the circuitous route I outlined in my high school English paper on the “Ryme of the Ancient Mariner.”  A prominent arrow pointed to a large ‘X” denoting the point of interest.   —> X- Albatross shot here. 

        In this case, the arrow pointed to the “X” and said, “Think carcinoid.” I signed off with “Bibey was here.”

        I kissed her on the forehead, and then tweaked her big toe.  “Good luck, kiddo.  You’re gonna be fine.  Come visit when you get back home.”  I read a long time ago about a patient who thought she was dying, but took heart ’cause a doc tweaked her big toe.  She figured no Doc would tweak her toe if she was doomed, and it encouraged her.  I’ve never admitted why I adopted the habit till today, but I always sensed some relief when I did so.  Besides, I reckon no Doc would draw a treasure map on your belly if they thought you weren’t gonna come home.  I think she got it, ’cause when they loaded her up in the ambulance she waved bye and promised me a pound cake.  

        Ms. Andrews went to surgery the same night, and as several of you guessed, had a carcinoid tumor just shy of her appendix.  They resected the tumor, and took her appendix out while they were there.  And, not just in this story, but in real life, the woman has sure enough lived happily ever after.

        The intern, by the way, followed instructions and won all his bets.

        Now for free tetanus shot contest.  Well, Ted and Irene were right.  Ted is a Professor, and like me, he tends to read a lot.  We have learned over the years not to let all that education get in the way of the simple truths of bluegrass music and its’ people.  He was afraid to ignore banjobilly’s homespun wisdom. 

        It’s sort of like the old saw about reading music.  A fellow asked a bluegrass man if he could read music, and he replied, “Well, a little, but not enough to hurt my playing.”

        Irene, as it turned out, had taken anatomy in college, so she was not relying solely on intuition.  She figured the camera was stuck, and came very close to the right location.  Ms. Susan also got it, though she came to her conclusion from a different angle- woman’s intuition re: the daughter in Tennessee.  mrschili, having studied Bibey’s peculiar writing style, figured it out from a literary point of view, and Dr. Bob knew all along but didn’t tell ’cause of HIPAA .  For that matter Ms. Pande was correct also; the thing was right near the appendix and it indeed had to come out pronto.  The fact the pathology did not end up as appendicitis is immaterial, ’cause Pande understood surgery was indicated that night.  Remember- she said, “Her appendix needs to come out, and don’t wait a day.”  

        Correctamongo.  Serendipity and the Good Lord have saved me before when I was not as close as she was pre-op, so I have to give her credit for a correct answer also.  When you think about it, the surgeons did not know for sure either prior to going in.  Sometimes knowing what you have do is more pressing than knowing why.  The situation had changed from chronic to acute.  I am thankful we didn’t stay in chronic illness mindset mode, and changed gears.

         banjobilly, crude as he is, made the right call.  One fellow wrote in and said, “I think banjobilly is right.  That woman has a camera problem.”  I asked billy what clued him in, and he said it was the one summer he worked as a plumber’s assistant, and had to fish all sorts of things out of septic tanks and toilets.  Like he said, “unless that woman has done s#&^ her a camera, she’s got a blockage somewheres.” 

        I’ve always liked banjobilly.  One should never discount folks ’cause of social status.  billy has virtually no book learning, yet he’s smarter than he looks, but the boy needs to work on that cussing of his.  I don’t want anyone to toss him out of bluegrass music.

         So, even though everyone thought about the problem their own way, in the end all my regular readers were right.  I guess they’ve been studying Bibey speak so long they are developing doctor intuition.

        Now all I gotta do is figure out how to explain all those free tetanus shots to Corporate.  I hope they ain’t gonna be mad.

        I know you wonder why I chose carcinoid.  Well, I have found through the years once you have gathered all your data, run all your tests, analyzed the thing from every scientific angle you can think of, and still have the diagnosis dangling in the wind, flip a coin and go with intuition.  The daughter from Tennessee thought carcinoid, so it was good by me.  And, I didn’t learn that from books, but from my wife, my daughter, and those office ladies.  They are the best.  To the patients’ daughters’ everlasting credit, she never said “I told you so” or complained I only made the diagnosis months after her.  She was just glad her mom was O.K.

        Gonna toggle back to music for a while, but I’m not done with chronic illness yet.

        If it don’t rain in the morning, I’m gonna tee it up with the choose-up boys.  Remind me to tell you about a golf tournament a buddy mine is trying to qualify for.  I’m not going to say much till I see if he gets in, but I’ll let you know.

Dr. B