Dr. Henry “Indian” Jenkins

        I’ve got a patient over in the County Nursing home named Dr. Henry Jenkins.  It used to be called the County Home.  (Lester Flatt sang it as “The Poor House.”) 

        His is a true story.  Before you go and think this is a HIPAA violation, I want you to know I have his full permission.  In fact, he is gonna help me write it.

        Henry (we call him Indian or Indie for short) was a doc here in town for a long time, and he had a big following.  It wasn’t the society people who went to him though; folks with even a smidge of status chose one of two established groups in town.  Indie was one of those Docs who never cared a thing about money or any social status.  He believed the poor would always be with us, and it was his job to look after them.  

        Now before you get the notion the Indian was some kinda Mother Teresa, well he warn’t, and not by a long shot.  You see, Henry was one who liked to take a nip every so often, and he had chronic back troubles.  Rumor was he took the occasional Vicodin, but I was his Doc and never prescribed it for him.  If he did I don’t know where he got it.

        But while Indie had his flaws, he was a likable sort.  He sawed an extra good old time fiddle, and we fell in together ’cause of it.  It worried my mama something awful, but I thought Henry was a better Doc than what his reputation indicated.  He did care about his people and had a soft spot for the downtrodden I found admirable.

        I reckon a lot of Docs have a bit of nurturer role in ’em, and I’ve wanted to help Indie stay on the straight and narrow from the time I finished med school and came back home.  It wasn’t an easy job.  Indie stayed in trouble a lot, and had not a sole ally in proper society except for me.  (I guess a lot of folks considered me to be on the fringes of it given I remained friends with the likes of Indie.)

        As I said, he had substance abuse issues.  He was just flat out an alcoholic, but he wasn’t a drunk.  He never went to work intoxicated, and over the years I got him whittled him down to no more than one on the job.  It was the best I could do.  People still complained, but Indie was smarter after a nip than a lot of Docs in a sober state.  The way I saw it, he was doing more good than harm.  Few agreed.

        And Indie wasn’t much to get into women troubles.  Well, there was the one French foreign exchange student, and boy was she a looker, but….. well, that is another story.  Ms. Jenkins issued the ultimatum on that one, and I sided with her.  Henry was sore about it for a while, but he got over it.  Other than his pal Blinky Wallendorf we were his best friends in town, and the only ones with any hope to pull him out of a jam.         

       When a Doc like Henry gets in trouble, it is lawyer trouble.  And like everything else, Henry did it in a big way.  When his friend Blinky Wallendorf died, Indie attracted more attention from men than Pamela Anderson would if she walked into Harnett Billiard and Bowl and ordered a cheeseburger.  And all of ’em were lawyers.  Bunches of ’em.

        These days Indie is old and worn out.  I’m still his Doc.  Every Monday after Hospital Staff meeting, I’ll visit him at the Nursing Home.  He loves to reminisce of the old days.  The only thing he has left from his office is the old plasticized skelton that resided in the corner of his study for as long as I can remember.  Everyone thinks he keeps it there to remind him of his doctor days.

        I know better.  Indie used a bone scalpel to fashion a lid out of the cranium.  When you lift it up, inside the skull two small paper cups and a couple boot leg sized bottles of his favorite Jim Beam rest where the brain once resided.  I don’t know who supplies him, but his liver is already shot, so I guess it doesn’t make much difference now.

        One time he dropped one of the bottles.  It crashed on the cold tile floor and shattered.  The echos drifted down the hallway like a gunshot.  I managed to sweep it all up before the staff got there to check on the commotion.

       Indie offers the same toast ever time.  (Bluegrass folks are people of ritual)  “Bibey,” he’ll say.  “I don’t know how you done it.”

        “Me?  It warn’t me, Indie.  It was your cousin, that Navajo.”

        “He ain’t my cousin, brother.  No one knows the Navajo.”  Then he’d turn up his shot, and we’d laugh like h**!.  I’d place the paper cups back in the skeleton’s skull till the next Monday.   I don’t think anyone ever knew, and I doubt they figured out the Mandolin Case either. 

        Indie is getting weaker, and his memory has started to fade.  Mine is real good, and I have it all written down anyway, but I promised Indie I would not share the whole story until he is gone.  I am sad to say that time is near.  I wish he could go on forever, but none of us do, and he made me promise to show what happened before I’m gone, so I’m gonna do that.

        Besides, if I didn’t Indie’d cuss me in heaven for all time and I can’t have that.  We were too good a friends.

Dr. B   

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MerleFest- Mandolin Disney World (and more)

        For an old mandolin player MerleFest is better than Disney World.  So many choices, just not enough time.  There is more to it than just mandolins, or just bluegrass.  At MerleFest you can take in a Marty Stuart country show, (he is a heck of a mando man too) or Roy Bookbinder blues.  Anywhere a banjo player jams with a rock ‘n roll xylophone artist and a jazz clarinetist is eclectic if nothing else.

        I like the workshops.  Claire Lynch led the vocal one.  I could never sing like Ms. Lynch, but I enjoyed the harmony part pointers.  She said, “If you can sing your part, you can find work.”  I took comfort in that.  A bluegrass band is much like a good baseball team, where everyone brings their strength to the table- the trick is the blend.  I knew from the start I was no star, and I had to work to even be a serviceable part singer.  With  Ms. Lynch’s comments, it occurred to me I had found my part in the music world a long time ago, and I was thankful to have it.

        The mandolin workshop was led by Tony Williamson, a mainstay of the mandolin community for many years.  Also on stage was new face for me in the mandolin word, a Miss Rebecca Lovell.  This kid could play!  Anyone who says bluegrass ain’t gonna attract any young people best take another look.  The lovely young lady was the first woman to win the Merle Fest mandolin competition.  She is one of those folks God put on Earth whose talent will make our journey more bearable.      

        Tony Williamson is an old hand, but still a world class player.  I was intrigued with his back up work- intricate passing chords in the Texas tradition.  Someone asked where to go to learn the material, and we were surprised to learn no one had a definite reference for it other than in Mr. Williamson’s brain.  The suggestion was made to do a DVD on the technique.  I have struggled for years to get a small part if it, so an instructional piece on the subject is one I’d love to see someday. 

        MandoMania was Saturday’s highlight.  Tony Williamson again played and moderated, and the best players in the world were gathered on one stage.  (I direct you Ted Lehmann’s blog for pictures, he always posts the best collection.)  Sam Bush, Mike Compton, Tim O’Brien, all my perennial old favorites, along with the new Miss Lovell, and another teen-aged sensation Sierra Hull, just tore it down.  My favorite new man on the national scene was Darin Aldridge.  This guy played with as fine a tone as anyone I’ve heard.  He is a top ten in the world mandolinist.

        It struck me how there is room for all sort of folks in the mandolin world.  Bluegrass superstar Sam Bush was there with Tony Williamson, flanked by two talented teen-aged girls, one from Tennessee and one from Georgia. 

        The bluegrass is a small world after all.  Here was a young woman, Miss Lovell, who studied classical violin and piano as a child, and Darin Aldridge, who grew up in the small town of Cherryville, N.C.  His training was on the road- he went to work right out of high school and toured with Acoustic Syndicate and then Charlie Waller and the Country Gentlemen.  Their backgrounds could not be more diverse, yet both jammed along at the highest level of artistry.  

        Later, I got caught out in an afternoon thunderstorm, and ducked into a building for cover.  ( I have always been a rational sort- I did not want to be remembered as the country doc who got struck by lightening in a port-a-john.)  Mr. Aldridge was there with his band the Circuit Riders, and I stopped to take it in.  These guys just cooked straight up bluegrass for a full hour.  Perfect harmony- dead on picking.  I pondered how many years of practice went into the refinement of that talent.  It didn’t happen overnight.  Representatives of the Red Carpet were so taken by their show they turned down their beds and put chocolates on their pillows to acknowledge best performance by a new band at the Festival.

        We try to catch Doc Watson every time we can, and took in both his Saturday night and Sunday morning show.  I have every album Doc ever did, but but my favorite is his gospel work.  His version of “What A Friend We Have in Jesus” moves me every time.  Honest simple elegance- pure Doc.  Doc once said he would rather be remembered for being a good human being than for his guitar picking.  It says much about him- he is one of the best in the world, yet remains genuine and humble. 

        After Doc’s Sunday gospel set, we caught one more from my favorite new MerleFest artist, Darin Aldridge.  This time he did some tunes with his fiance, Brooke Justice, and she is a gem.  They said they have a gospel CD due out in a month.  They have a MySpace page. I’m gonna check it out and see if I can review it.  I sense, as the song said, they have “only just begun.” 

        When I left out for MerleFest a few days ago, I was one more tired little doctor/writer.  My agent recognized it, and suggested I take a break and recharge.  His advice proved wise.  I had a weekend to reflect on where to go next. 

        Right before I left, he told me a big editor from New York might read my book rough draft when I finished it.  I was shocked, and even scared.  I mean, how in the world is an unknown country Doc gonna attract the attention of a big city editor?  They get thousands of manuscripts every month and I’m sure Tommy Bibey ain’t on their mind one bit.

       I almost panicked.  I couldn’t write that good.  I had to get better, and real fast- like tomorrow.  What was I going to do?  So far, my agent has been smart.  I followed his advice, and turned to the music for inspiration.  Over the weekend it came to me.

        It’s like Ms. Lynch said.  “If you can sing your part you can find work.”  All I can write about is the life of a country Doc.  I can only try to be like Doc Watson- true to to myself.  If no one publishes a word I write, then it wasn’t meant to be, but all I can be is what I am.  I gotta be like that Darin Aldridge, who is from a little town but not scared to have big dreams.  So, I’m gonna just have to write about what I know and hope for the best.

        Now my blog is six months old, and has ten thousand hits.  You guys have now persevered through the world’s longest “About the Author.”  Now I am comfortable enough with you to let you inside my world as a Doctor.

        So, with my next post, I will introduce you to a friend of mine, Dr. Henry “Indian” Jenkins and start to show you around.

        See you in a few days. 

Dr. B

My Mandolin Case

        Now I know you must wonder what a doctor could possibly find important enough about a musical instrument case to warrant tying up some .00000000000000000000000000000000000001 percent of the Internet.  I have several very important reasons.

        If you are observant, you can learn an awful lot about someone if you study their case.  It will tell much about their philosophy.

        Next time you are at a bluegrass festival, check out an instrument case.  I have three, but my favorite is an old Calton fiberglass one.  It does have a cover, which has reduced its exposure, but in spite of the protection, it has been battered, bruised and scuffed up something awful over the years.  Maybe it ain’t a pretty face in the crowd, but it is very strong, and has been quite loyal.  One only has to crack the lid, and the smell of wood glue, barbecue and a tinge of Old Spice wafts out.  The smell floods my brain, and renders me a Pavlovian Dog ready for the show date.  My mandolin rests inside.  Protected by the case, it has only minimal blemishes to show from twenty-five years on stage.

        Almost everyone in bluegrass will place stickers from an assorted variety of venues on their case.  The pros traverse the country, and their cases reflect their wide travels.  A doctor’s life keeps you close to home, and mine is more of a statement of local culture.  You know- bumper stickers that advertise “Live at the Nursing Home” or “4th Annual Liver Mush Festival.”

        There are a couple that mean a lot to me.  One is from the AAFP (American Academy of Family Physicians) that states “Your Family Doctor Cares For You.”  I like that one.  I need to call the Academy and see if they still print it.  Mine has been on my case for twenty-five years, and though it is tattered and worn, it still reflects my philosophy.  Should it wear out, it would have to be replaced.

        That one is my favorite, and the foundation, but others have been layered in a haphazard patchwork fashion over the years, and can partially obscure it if you don’t look real careful.  There is one for Weber, my favorite mandolin builder.  Another recognizes my membership in the IBMA (International Bluegrass Music Association.)  I stuck my jury duty summons on to remind not to go back until I have to, but go when I am called, and there is one from a show Alison Kraus did in Raleigh when we got invited backstage to visit.  I tell you, the woman is even prettier in person than she appears from the stage, and a very sweet spirit.  Remind me to tell you what she did for a young patient of mine that night.  

        Of course, some of it is whimsical.  It wouldn’t be bluegrass any other way.  I got a nice one from the lab at the hospital.  It sports a skull and crossbones and says, “BioHazard.”  It is fun to watch the adults notice the warning and shoo their children away.  I often wonder.  Do they think I carry a transplant kidney in the thing?  Another one we got from the Nuclear plant.  “CAUTION! RADIOACTIVE MATERIALS.”  That one works even better.  

        There is one that says “I love my Eagle Scout” and another touts “First Place- Weekly Reader Contest.”  I have stickers from a number of touring bands I have gotten to know over the years, and ones to advertise local fund raisers like Relay for Life and the American Heart Association.  (We did the annual chicken picking for them for many years.) 

        My favorite radio stations get some play.  One, ENCW 77.8, played Neuse River for years when  our CD came out.  I never forgot them.  My kids thought it was very cool to have old Dad on the radio. If you can be cool to a middle schooler, you’ve struck a lick, and I couldn’t have done it without bluegrass and ENCW77.8.  Right about the time the Internet got started our little CD was on this stream radio deal, and we were heard around the world.  One month we were number twenty-seven on the Finland Bluegrass Survey.  It was an Andy Warhol moment, I tell you.

        Outside of the AAFP one, perhaps my favorite came from a patient.  He suffered an unfortunte neurological event that took away his ability to speak.  We were devastated- he is a good friend and was a fine singer.  His wife grieved so, and I worried over it too.  He didn’t want me to fret, and would write to reassure ME that he was O.K!  The patient is a bluegrass guy, and one day he showed up with a new bumper sticker for my mandolin case.

       NTW (not to worry) he wrote, as he handed me the latest addition for my case.  The sticker said “What if the Hokey Pokey is What it’s all About?”  He smiled at the thought.

        How can I worry much about trivia when I have brave patients like that? 

        There is much, much, more I am going to tell you about cases, but I am out of time today.  One of my patients, a farmer, said “Dr. Bibey knows something.  He just ain’t telling everything yet.”

        I find old farmers to be perceptive beyond what folks sometimes recognize.  Remind me come the first of the year to fill you in on more details.  I won’t let you down.

Dr. B

 

P.S. Gotta get some work done on my computer or get a new one- I think I’m about to wear this one out.  Will be back on line soon.    Dr. B

   

 

Marquee at the Walmarks

        If you want to know when you’ve made it in the County, here’s how you can be sure.

        It ain’t if you’ve saved forty-eleven lives or memorized the New England Journal of Medicine.  And it is unrelated to perfect attendance at the Rotary Club.  Teaching Sunday School won’t hurt, but by itself won’t cut the gig.  Even helping little old ladies across the street might go unnoticed.

        I am here to tell you though, if you ever get your name on that Billboard right there at the Walmarks, then by golly you have arrived. 

        You see, Walmart is a big thing in these parts- it was our first fancy store we got brought in from the outside world.  I love the story (plagiarized from somewhere else) about the lady who said she liked Family Dollar, ’cause you didn’t have to dress up like when you went to the Walmarks.

        Neuse River did a fall festival last year, and we were advertised on the Walmart Billboard.  In fact, we got top billing over the annual Kiwanis Club pancake supper, and we were genuine stars for a full six weeks. 

        I heard it most every day.  “Dr. Bibey, I seen your name on the Walmarks sign.  You gonna quit doctoring?”

        “No sir.”  I could almost turn on my internal mental cassette recorder.  “I still like doctoring.  Don’t worry, I ain’t giving it up any time soon.”

        “You boys is gonna go to Nashville soon, ya’ll’s gonna be on the Opry.”

        “Truly sir, we ain’t that good.  Trust me.”  and so it would go.

        That night though, I had to go by Walmart to pick up a prescription.  As I sat in traffic and waited to turn at the light I looked up at the sign.  NEUSE RIVER LIVE AT THE FALL FESTIVAL. – Dr. Tommy on the Mandolin.  I hate to admit it but I got a bit of a kick out of it.  Just think of it- my name on the Marquee at the Walmarks.  And mama said my mandolin was going to get me in trouble some day.  I was gonna call her when I got home.  I figure I had arrived ’cause I don’t see how it could get any bigger than that. 

Dr. B

B.G.P.

        We have a guy here in town who has been a fixture at River Run Golf Club for as long as anyone can remember.  He is the only fellow I know who only has initials- B.G.P.  But, that ain’t just his initials; it is his name- B.G.P.- just like that.  That’s how he is listed the phone book- not that you’d have to call him, ’cause if you want to get up with B.G.P., or B.G. (or just G.) for short, all you gotta do is go out to the golf course- that is where he lives, except to go home for supper.

        I know folks from the city might not believe anyone would have a name like B.G.P., but he does.  It is even on his driver’s licence that way.  I mentioned him back on the post about the real Dr. Bibey.  B.G.P. retired from the cement block factory years ago.  Along with my buddy Snookers, he is my golf hero.

        When you play golf with a guy like B.G., you learn something new every time out.  “Boy,” he’ll say.  “You see that willer tree down there on the right?”

        “Yes sir.”

        “Well, I guaran-dang-tee you there’s water down there.  Don’t hit it right on this hole.”

        Sure enough, when you crested the hill, there’d be a stream right by the willow tree.  B.G. claimed willows grow best near the water, and he was usually right.

        Or on number thirteen he’d point at the County Water Tower off in the distance.  “Now Doc, you keep it left of the water tower here or she’ll shore nuff trail off into the woods.  Don’t try to cut the dog leg.”  I watched many a young’un think they could ignore his wisdom and cut the corner, only to roll off in the trees just as B.G. predicted. 

        B.G.  was the one who got me started in the River Run choose-up.  I had just come back to town and was hitting a few balls on the range.

        “Hey, boy.  Ain’t you the new Doc in town?”

        “Yeah.  Tommy Bibey.”  I extended my hand to shake and howdy.  “My daddy is Dr. Bibey Sr.”

        “Know him well, he used to do my plant physicals.  You got a game?”

        “No sir.”

        “Good, ’cause I done put you in our group.  You’re riding with me.”

        I was concerned.  “How much do y’all play for B.G.?”

        “NAP, Bibey.  You’re good.  Gotcha covered.”

         “B.G. now you better not be betting on me, man.  I’m way off my feed.”  I’d just gotten out of residency, and to say my game was rusty was charitable at best.

        “I know that Bibey.  You’re the “D” man.  We’re gonna carry you today.  You can make it up to me.

        Make it up I did.  I was a busy young Doc, and could not begin to play as much as these guys.  (Of course, they play four days a week, I have no idea how they find they time.)  The first year, I never was on a winning team.  I came to understand the meaning of the phrase “I’m gonna make a contribution to the B.G.P. retirement fund.”  I became Doc to almost everyone in the choose-up except B.G., who never went to the doctor.

        All this went on a decade.  One Sunday, my wife and daughter were out of town, and Tommy Jr. and I decided to play hooky from church and go play golf.

        We ran into the golf shop and B.G. spotted me.  “Hey, Bibey.  You ain’t never here on Sunday.”

        “The wife’s outta town.  The cat’s aways so…”

         “Look at this here knot.”  B.G pulled up his golf shirt.  “You ever seen a belly button like that?”

          Hm.  It was definitely pooched out, mostly inflamed and red, but a touch blue.  Not very tender.  A bit firm.  I didn’t like it.  “Yeah, several.  We need to run a few tests.”  I hoped it wasn’t one of those weirdo Sister Joseph’s nodes.  Probably just an umbilical hernia.  Sure was hard though.  “You throwing up any?”

        “Nope.”

        “Any pain?”

        “Hunh-uh.”

        “O.K.  Come in  tomorrow around two.  Tell ’em I sent you.  Come a little early- they’ll have to do some paper work.”

        “Can’t you just give me something for it?”

        “Gonna have to figure it out first, G.”

        “You’re just want to get money back I’ve won off you.”

        “G.G., G.  You’ve beat me out of three hundred bucks this year.”  It’d been a bit of an expensive golf lesson, but worth it.  My handicap was back in single digits.  “Man, just come to the office, I don’t care if you pay me or not.”

       B.G. did show up, and I was not encouraged by my first round  of tests.  His hemacult was positive.  We got lucky on the belly button, in good light it looked more like a cyst.  A biopsy showed a nonspecific inflammatory process, and it cleared up with time.  Still, I was left with the blood in the hemacult. 

        The heck with HIPAA, it took the entire choose-up group to convince G to have a colonoscopy.  It is a good thing; he had an early colon cancer.  Ole B.G.P. was lucky, the belly button was a red herring- something that led somewhere else by accident.  The cancer was confined to a big polyp and we got a cure.  I reckon the Good Lord will forgive me for skipping church that day, but I won’t make it a habit- I don’t want to push my luck.

        Another fifteen years have passed, and I still play golf with B.G.  He still has not been back to the doctor, making him one of the most efficient consumers of medical care anywhere in the country.  We were teamed together last week.  I missed a birdie on eighteen, or we’d won the back outright.

        “Sorry, G.  Dang it, it should been in.”

        “NAP, Doc.  I figure you’re one up on me after that belly button deal.”

        “I dunno, G.  Maybe we’re slick.  (Golf talk for even.)  I don’t think you ever paid me.”

         BG had a wide grin.  “I reckon so, Doc.  How come the hell you missed that putt?  I toldja it breaks away from the water on eighteen.”

         “Sorry G.  I’ll  get it right next time.”  We walked back to the cart and sat down.  G always drives- he doesn’t trust doctors.  “Hey G., you’re about due for a physical.  You oughta get one every decade whether you need it or not.”

        “Hell, Bibey, you’re just trying to get my money.  All you doctors is just alike.  You gonna be here next week?  I got this cat coming in from South Carolina and……”   

Dr. B

 

Smarter ‘n a 5th Grader

        There is some show on T.V. these days called ‘Smarter Than a Fifth Grader.’  I have to confess I watch little television, so I haven’t seen it.  Maybe I need to watch, though.

        Not long ago I saw a patient with malignant hypertension.  I was very worried about her.  When we started out her BP was 240/120, and I was afraid she’d have a stroke before I got it under control.  It took some time, but I began to breathe a sigh of relief once we got down to the 150/90 range. 

        She was on two meds.  As much as I hated to do it, a third was indicated. 

        “Tell you what Ms. Little.  I hate to have you on so many pills, but we still need to be a bit lower.  You still following your diet?”

        “Yes, sir.  I ain’t had no salt a’tall.”

        “O.K.  Let’s add this- one twice a day.  I need to see back in two weeks.  We’re getting there, though.”

        When she returned in two weeks as instructed, she was weak and dizzy.  Her blood pressure was 90/50.  “Gee, Ms. Little.  I’m sorry.  I guess I overshot it, maybe we better cut this one pill down to one a day.”

        “Could my dog have anything to do with it?”

        “How’s that?”

        “My granddaughter said I needed to get a dog.  She said ever since her Paw-Paw died I ain’t got nobody to look after, and a dog would help me.  She read it on the Internet.”

         “Hm.  Well, I sure don’t see how it could hurt.  What kinda dog didja get?”

        “She’s a mutt.  A real sweetie, too.  I love that little dog, I tell ‘ya.”

         “Well, Ms. Little.  I do believe that is a good idea.  How old is your granddaughter?”

        “She’s in the fifth grade.” 

        Dang, scooped by a fifth grader.  Maybe I’d better watch more T.V.  “O.K. Ms. Little.  Tell you what.  You cut out that last medicine.  And hold onto that dog, too.”

        I saw her back in two weeks.  She is 118/74 and feels great.  From now on, I’m gonna remember two scripts and a dog might trump three meds and no pet therapy.  I can’t afford not to be as smart as a fifth grader.  It might be bad for my reputation.

Dr. B

         

       

 

 

Fish Camp Jam Camp/Today’s Show Date

        You remember the young couple I mentioned some time back who were following the bluegrass tour on an extended honeymoon?  We met them back at the Tobacco Triangle Bluegrass Festival.  (See the post- it is filed under memorable gigs)  They held onto my card, and looked me up on their way to Merle Fest Jam Camp.  Cory and Lorena.  What a sweet couple of kids.

       I took ’em out to the Fish Camp to eat.  They were from way up North, but they dug into those salt and pepper catfish like they’d been living here all their life.  

        After supper, we pulled out the instruments and lawn chairs, sat out in the parking lot, and played till dark thirty.  Cory was a fine banjer man, and Lorena was a real good singer and played mandolin, so I switched over to guitar for the session and Ms. Marfar played the bass.  We found some harmony lines and had a right good picking.

        B.G.P. drove by and stopped for a minute.  “Hey Doc, you coming to the New Year’s barbecue this year?”

       “Wouldn’t miss it.  Hey, this is Cory and Lorena.  They came all the way from New Jersey to pick bluegrass music.”

        “Well, y’all found the right man.”  

        Someday I’m gonna go to New Jersey and check out the bluegrass music scene up there.  They promised to show me around when I do.  It’s the bluegrass way.

         Today Neuse River has a gig- Uptown Spring Fling.  It is our first outdoor gig (the old-timers used to call it a show date) this year.  Between it and all the dang pollen, I know another spring has arrived sure enough.  

         Doctor tip for the day:  If you have restless leg syndrome make sure to check a serum ferritin level- it as all the rage this year- quite in fashion.  (I just threw that in so y’all wouldn’t forget I was a Doc.  I don’t want to give up my day job.  If you heard my barely get by monotone you’d agree 100%.)

         Will report back to you soon.

Dr. B 

       

Patient Speak

        At least for a country doctor, it is best to use patient speak, as opposed to doctor speak, when you talk to your patients.  I found this out early in medical school on daily rounds.

        Sometimes the attending would come in the patient’s room with a big entourage, and speak “at” the patient, instead of with them.

         “Mr. Charles has an ejection fraction of twenty-five, but minimal peripheral edema, and no jugular venous distention.  His current respiratory compromise is more likely on the basis of his obstructive pulmonary disease.  I would pursue bronchodilators but not at the expense of diuresis.”  This would go on for a few minutes, and then the attending would wheel around and  walk out the room, his entourage right on his white coat-tails.

        As the lowly med student we were left behind to get our history for the day.  I sat down to listen.

        “Hey, Doc,” said the patient.  (I was just a med student, but even at that stage, I had come to cherish the title and respect the obligation that went with it.)  “What wuz he talking about?”  He handed me a can of Planters.  “Care for some nuts?”    

        “You better leave these with me, man.  That salt’s gonna swell you up.  Makes the water build up in your lungs.”  I sifted through the can for the cashews.

        “Really?” 

        “Yeah, no kidding.”  I handed them back.  “I ain’t gonna take ’em all, but you better go light.  They can go against you.”  You’ve got the head of your bed up, you having much trouble sleeping?”

        “Yup, I can’t lay flat Doc, sure enough.” 

        I checked his chart.  “Looks like you didn’t pee much last night.”

        “Shoot fire, I told that nurse I needed that water pill, they didn’t give me one.  It was right at shift change.  I think she had boyfriend troubles.”

        “Tell you what, let me call the intern and see if I can make sure you get it today.”

        We got him the missed diuretic, and the breathing treatment recommended by the professor on morning rounds.  By that afternoon, the patient was better.  The attending was pleased, and everyone complimented him on his brilliance.  (Rule number one in med school- always make the attending look good if you want to graduate.)

        All this talk about patient speak reminds me of an old story that came out of out of Hawthorne Gray School of Medicine.  It is apocryphal, but makes the point.

       An old country preacher had prostate cancer, and wanted to get his treatment at the medical center.  The attending saw him, and recommended surgery.  “Reverend, in the morning we are going to proceed with an orchiectomy.”

       “Doctor, whatever you say is fine with me. You doctors at Hawthorne Gray are the best doctors in the world.  I trust you, and will do what you  recommend.”

        “Excellent.”  The Professor handed the patient a consent form, and the preacher signed it.

        The resident was not so certain the Preacher got it.  “Preacher, I want to be sure you understand.  In the morning, they are going to remove your testicles.”

         “Whatever you doctors say is fine with me.  You doctors at Hawthorne Gray are the best doctors in the world.  I trust you.”  The preacher handed the signed consent form back to the resident.  “I am ready.”

        The doctors left.  The med student was worried. He was not at all sure the preacher got the message, and decided to speak to him one last time.  He pulled up a chair.

        “Parson, (the med student was a bluegrass boy) I want to be sure you heard them right.  In the morning, they’s gonna cut your balls off.”

         “The Hell they are!”

        In my line, as country doc, I gotta go with patient speak over doctor speak.  I sure don’t want to be misunderstood, especially over such an important issue. 

Dr. B

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

    

 

 

The “Four A’s” of Medicine

        I saw a patient last month, and her situation reminded me of the four “A’s” of medicine.  The lady stopped me at the grocery store to ask a medical question.  She was not my regular patient, but had seen a Neuse River show, and knew I was a Doc.

        It took three sentences and four questions to know what she described had potential serious consequences.  For reasons I don’t understand her regular doctor could not see her for a month, even though she gave his staff the exact history she told me.  (They wouldn’t let her speak to the Doc or even give the message to the nurse- I promise you Lynn or Myrd woulda known exactly what to do.)  I was reminded of the old “Four A’s,” some of which I learned from my Dad.

        I suspect the “A’s” are also important in many other professions.  They are, and not necessarily in order of importance, Ability, Accessibility, Affordability, and Affability.

        I can only speak to being a general Doc with any authority, and I realize with different specialities the order of importance might change some.  We used to have a Neurosurgeon at the Medical Center who was gruff and bordered on mean, but the guy was such a good surgeon I didn’t care.  My patients would often complain, but I reassured them.  “Look, he’s there to take out your astrocytoma, and he is great at it.  Ya’ll don’t need a Family Neurosurgeon, he’ll turn you back over to me as soon as you are over the surgery.”  On the other hand, if your Family Doc ain’t at least somewhat of a friend, I’d think that over.

        I have one consultant, a lung specialist, who is notoriously difficult, and I use it to my advantage.  He is extra tough on the smokers, and if I can’t get someone to quit, I’ll threaten to send them to him.  “Now Ms. Smith, your lungs are getting worse.  If you can’t quit smoking, I might have to send you over to Dr. Rales for a pulmonary cussing out consult.”

        “Oh please don’t, Tommy.  I promise I’ll stop.  Give me a script for that Chantix you’ve been talking about.  I’ll see you next month.”  I try to give my folks good advice, but I never could bring myself to be mean about it- I left that to ones who did not deem all the “A’s” to be important.  

        It did occur to me with the grocery store case, though, that ability might not always be number one.  The Doc whose office turned her away is a very bright fellow.  I’m certain he knows the answer to the question at hand.  I bet he never knew anyone asked it.  (Of course, if every time his staff asks him to disrupt his appointment schedule he chews them out they might quit asking- I do not know the circumstances.)  But even if he is smarter than me, he sure missed the diagnosis, or even any chance to make it.  So, in this situation, accessibility trumped ability.

        I am a gregarious sort of fellow, and have more friends than any one man deserves, but I don’t rank affability that high.  I’ve had a number of people come to see me ’cause they like my mandolin playing, and that is an error.  If that were a good criteria, they should choose Darrell or Ben as their Doc, not me- I can not begin to approach their level of play.  This time the mandolin did come in handy, ’cause the woman felt comfortable enough to approach me at the dog chow aisle. 

        As far as affordability, with all the high tech demands we have now, I find it more difficult than ever, but I try to keep the costs down.  Most of patients think I’ve been fair enough, but sometimes when I see the bill they get I don’t know if I’d go see me for that!  Certainly for the indigent, or even the middle class folks with one serious illness and no insurance, the system is broken.

       Well, going back to my lady at the grocery store, she did fine.  The diagnosis was a TIA (trying to have a stroke) but she had some surgery and dodged it for now.  And to be honest, she might have been O.K. without intervention, but I wouldn’t have rolled the dice on my own people if they had her symptoms.  (Another rule I have: try to do for your patients like you truly believe you would do for your own family- can’t go wrong there.)

        Ya’ll think about those “A’s.”  I’m curious as to your perspective.  Which ones do you find important in your Doc and why?

        My agent said I was gonna learn a bunch from my readers.  So far, that has proved true, so I will be interested in your responses.

        And for mrschili, how the heck do you write the “A’s?”  Is that right?  I had no idea.

Dr. B