Archive for the ‘Advice- Five Cents’ category

The Ranks of the Rinky Dink/Hoop Jumping 101

January 6, 2009

        Like all modern professions there is a certain amount of hoop jumping that goes with the territory.  Some of it is a bit silly, but I figure you gotta roll with life.  I take it for what it is.

        For example, we Docs have to periodically take some on-line kind of test to prove we know our business.  This is no problem for me.  I never forget a patient, and if you know them you can figure out the right answers to the questions every time.  

        I decided to have a little fun this last go-round.  I was done with the simulation in no time flat.  To tell you the truth, I am concerned for any Doc who can’t blaze through that no sweat.  Here ‘s where the fun came in.  After you got all the basics down, you could start to enter questions the computer had to answer.  I started out with the easy ones:

        “Does your head feel bigger than a peck bucket?”

        “I am sorry, I do not recognize.”

        “O.K.  Your  knee be swolle?”

        “Sorry- do not recognize.”

         “Let’s talk about your diet.”

        “O.K.”

        “Last time you were in you said you had three thirds of a biscuit for breakfast.  Any change?”

        “Pardon?”

        Pretty soon the machine began to beg me to leave.   “You may exit the simulation.  You may exit now.”

       “Hell, no.  I have some more questions for you.”

       “Pardon?  You may  exit now.”   Then, “Congratulations, you have passed this clinical simulation.”

        “Wait a minute.”

         “Have a nice day.”

         Of course, this all has little to do with doctoring, but everything to do with life lessons.  I have learned to deal with people, and if you make enough of a pest out of yourself those kind of folks will go away.  And too, I have to give my kids a lot of credit.  They are computer geniuses.  As for me when I was a kid I used a slide rule, and as I have said before a bluetooth was something in need of a dentist, but this old man is adaptable.

        I can jump through hoops with the best of  em.  It’s like GOEMA, the government office for the elimination of medical abbreviations.  To stay in compliance, I have to join the ranks of the rinky dink to continue to play ball, but I do.  For my efforts I get to be a doctor.  Other than being a husband and father, it was my most sacred privilege on earth, so I do what I have to to keep being Dr. B.

Dr. B

The Ultimate Music Fake-out Mandolin Method

November 23, 2008

        O.K. here it is in one easy lesson.  How to play the mandolin and fake out the world.  I know- I’m an expert!

        Now before we go any further, this will not work for doctoring.  In fact, if your doctor gestalts his way around his right brain like this to prescribe your medical treatment, RUN!

        First of all, as we have discussed, don’t forget the mandolin is tuned in fifths.  Do not confuse this with corn liquor quantities, and whatever you do don’t partake of Galax strawberries.  (That is another lesson- they are soaked in moonshine)  Smell ’em if you aren’t sure – it’ll remind you of lighter fluid.  Don’t go to a doctor who’d eat them by the way.

        Now that you know the thing is tuned in 5ths, you have it made.  Unlike how that ‘B’ string on a guitar runs me crazy, the whole dang mandolin fretboard has geometric symmetry.  (It don’t change)  So, once you learn a chord all you gotta do is move it up two frets and lo and behold you are in a brand new key- ex. ‘G’ to ‘A’.)  It is so easy Bill Monroe made it against mandolin law to use a capo.)

        So find a “G” chord, then if you can count from one to seven you got it, at least if remember the phrase one major, two minor, three minor, four major, five major, six minor (relative minor- important there) and 7 is a diminished deal us bluegrassers don’t use much except for guys like Mike Marshall, and probably that Thile guy too.

        The modes are another lesson.  My daughter knows all of ’em , but here’s how to get by.  Think Ionian (ie start on the 1st note of the scale) for most of your western music like bluegrass and fiddle tunes, and the 5th note, or mixolydian, for your darker songs.  Tim Stafford of Blue Highway says most bluegrass bands have at least one murder tune per set to get all that traveling out of their system.  Use you mix mode there, and use a lot of Monroe down strokes.  Shawn Lane does the style very well- musta come from hanging out with Stafford.  Alan Bibey is great on those too.

        And if you get lost just learn to use the Penatonic scales (Five notes, not five sides as in Pentagon for heaven’s sake) and hang out with David Grisman or the Grateful Dead crowd, too.  Gris is an all time expert on the method and will point you in the right direction. 

         If your goal is for a bunch of women to chase you play those big rock n roll Barred Power chords.  They work best if you let out your mandolin strap a few notches so the thing hangs around your knees- a bluegrass Mick Jagger like Sam Bush comes to mind- he rocks.

        Only problem is that doesn’t work so well for gray haired doctors who wear pagers and shirt pocket pencil protectors.  Somehow it doesn’t come out sounding the same- better not give up my day job.

        The only thing I’ve found tough is to get my fingers to walk the talk- that has taken some practice, and is gonna take some more.  As they say about the PGA tour- those guys are good.

        More theory later.  Sorry to cut the lesson short, but my lovely daughter is here to visit and I don’t get to see her enough.  Talk to you soon.

Dr. B

Mandolas/Medicine/Dr. B’s music lesson

September 14, 2008

        Now I know you must wonder.  What the heck do mandolas and medicine have in common?  Well, it is more than you might think.  And after you read this post, you’ll forever remember more about mandolas than you wanted to know.  But just remember.  Like medicine, half of what I’m gonna teach you is wrong.  I just don’t know which half.

        To keep straight the difference in the two, all you have to do while you play is think of a mandolin with a thyroid condition, in particular a hypothyroid mandolin.

       You see, a mandola is shaped just like a mandolin except it is larger, a bit heavier, and has a bigger waist.   Also, it’s voice is lower.  And my hand tires faster on the mandola, so the fatigue factor is there too.  I don’t know if mandolas are more intolerant of cold than mandolins, but I do not recommend you leave either out in the car any longer than you would a baby, which is zero time.  Hypothyroidism offers no protection against extremes of temperature.  Instruments, fine as they are, can be replaced.  Babies- well, take no chances with them. 

        To be exact, a mandola is but a mandolin tuned one fifth lower.  For those of you who had kids in school orchestra, it is the exact same relationship of a violin and a viola. 

        Now before you get confused about fifths, in bluegrass music a fifth can also refer to a quantity of corn liquor, but in the case of mandolas it does indeed refer to music theory.  And by the way, I do not recommend children who play violins and want to try the viola be told about corn liquor- bad doctoring there.

        Here’s how it works when you play.  Make you a ‘G” chord on your mandolin.  Now close your eyes.  Get your assistant to hand you a mandola.  Now make the ‘G’ chord again, but when you open your eyes and see you have a big ole hypothyroid mandolin in hands, and if you memorized lesson one, just think one fifth (not booze) lower, and voila, you know you have made a ‘C.’  (Chord, not grade)

        Then, as you pick along, all you have to do is pretend your are working out of ‘G’ when they call for a ‘C’ tune.  Same thing for “D”- think ‘All I gotta do is make ‘A’ noise.  Now, to be sure you are with me, I am talking an ‘A’ note, not to be confused with ‘A’ style mandolin.  Or, if they want a ‘G’ tune play outta ‘D’ position on your mandola, etc.  However, this only works if you are a mandolin player at heart.  If mandola was your first instrument reverse all that.  And if the tune clips along pretty quick, you have to think fast. 

        To go back to the mandolin construction styles, (space limitations prohibit adequate room for discussion of playing style in this post- maybe later) there are two basic ones, the ‘A’ and the ‘F.’  (there are more but I don’t want to confuse everyone on the first lesson.) 

        The ‘F’ mandolin is so named for the little curly cue scroll and it has apertures called F holes.  The ‘A’ style mandolins are named for for the round body shape and not for ‘A’ holes.  Bluegrass is fine people and we don’t have any of those.  Well, once there was a band that was mean to folks, and everyone took to calling them ‘The Bluegrass Holes.”  They broke up.

        Now that I’ve posted my first (? last) on-line lesson, I will tell you I once told my teacher I might take up giving lessons myself, and he recommended against it.  I’m not sure why.

         If you want to hear a good example of mandola work, listen to Wayne Benson of Russell Moore and III Tyme Out.  His version of ‘John and Mary’ is the best one I’ve heard.

        The reason all this works for me is I never got around to reading music.  Most of the guys I pick with don’t.  One year the Philharmonic came to town and a real nice lady asked Raymond the fiddle man if he read music and he said, “Not enough to hurt my picking, but I do read ‘Rasslin Weekly.”

        Now the disclaimer.  The demographics on bluegrass indicate a very high educational level.  But it also is true that we don’t just march to a different drummer, we didn’t even know there was one.  So, if we seem a tad different we are, but we’re harmless.

       Hope you enjoyed the lesson.  See ya,

Dr. B

Rorschach, the Maniacal Mutt

July 30, 2008

        For a while we got into Brittany Spaniels.  My son was just a toddler, and we answered the ad with every intention to bring home a male dog.  The boy took one look, latched onto the one he liked, and cradled her in his arms.  We were in the dog business.  He named her Fancy right on the spot.  The name stuck.  

        The dog was aptly named.  She was very regal and proper, but not a bit spoiled, a wonderful pet who stayed close to home and played in the yard with the kids.  The night she died was hard on all of us, but especially so for Tommy Jr., who was a teenager by then.  I knew, and the vet confirmed that no more could be done, but that boy sat up with the dog all night.

        ‘Fancy’ was the only registered dog we ever had.  She was such a fine animal, and dispelled every stereotype about purebreds as nervous and ill tempered, so we decided to let her have a litter.

        She had six, and all of them found good homes, except one little rascal we couldn’t give away.  While the other pups would nurse quietly, this one ran around in circles and had to be bottle fed half the time to survive.  My wife saw it coming.  “That dog ain’t right,” she said.  Marfar named the dog Rorschach, after a big ink blot splotch on his back.  It was prophetic- the dog’s only distinction was a bizarre personality that would have intrigued Sigmund Freud.

        Names often tell a lot.  If you wanted a hero dog in a story, you would never name it Rorschach.  You’d go for a name like “Ranger Dog.”  Try this sentence out.  ‘Ranger Dog jumped in the lake, nuzzled the child by the nape of the neck, and pulled her to the safety of shallow water.’  Makes you want to cheer.  Try that with “Rorschach.”  It doesn’t fit.  In fact it is laughable, and so was Rorschach if he hadn’t been ours.

        What Rorschach lacked in brain activity, he made up for in sheer power and determination.  As he grew into his full size this became apparent, and the kids shortened the name to “Sharky,” a name they could take some pride in.  (But mama, who’d want a dog named after crazy folks?)

        Rorschach couldn’t stand to be penned up for a minute, and loved to roam.  One night he broke away and I had to go deep in the woods to find him.  It was cold and I was tired.  I could hear his lonesome howl off in the distance.  The only bright spot in the adventure was a full moon that illuminated the woods so well I almost didn’t need a flashlight. 

        I found him where he’d run under a fallen tree.  The stake he had pulled up trailed behind him and had wedged in behind the log he’d run under.  All the knuckle-head had to do was reverse field and go back under the log, but no, I had to troop around half the night to find him.  When we got home, the kids petted the dog and snuggled up to him.  “Oh Sharky, we were so worried!”  I went and took a shower.

        We even tried an invisible fence.  After a few shocks, the crazy dog learned to back up several paces to get a running start.  He’d put his shoulder down like a fullback, and then run headlong into the electric field.  He’d make it through to the other side, yelp at the top of his lungs, then realize he’d made the jailbreak and the high-tail it for the woods.

         When Sharky would go missing, the first place I’d check was the farm just down the road.  Sharky was a bird dog, and he’d get into Farmer Wilson’s chickens.  I guess you can’t get above your raising and it was natural for him.  I’d get out my wallet and pay up for the losses.  It was a regular ritual, like bail for a drunken Otis Campbell on Saturday night, and then I’d take him back home to the children.  Wilson was fair about it.  He never exceeded market price even though he had me over a barrel.  He had grandchildren, so I guess he understood.  “Besides,”  he’d say.  “It beats all the work to take ’em to market, Doc.”

        One winter Sharky had an abrupt change in personality.  He didn’t try to break through the electric fence, and seemed short of breath when he walked.  When he has content to lie by the fireplace to stay warm, I knew he was in trouble.  The vet confirmed the diagnosis of congestive heart failure, and Sharky didn’t make it through the winter.  But while he was here he burned bright and found his way into the family history book as our most eccentric pet.

        Sharky was a good’un, but here is my advice.  If you have one in the litter with a big ink blot on his back, name him something like “King,” give him to a farmer, and tell him you can guarantee the dog will chase the crows out of his cornfield with inexhaustible contentment for all his days.  It’ll be the truth, and you and the dog will both be better off.  Some critters just aren’t born to be domesticated, and Sharky was one of ’em, but we did the best with him we could.

Dr. B

Rudy the Red Rocking Horse

July 28, 2008

        Years ago my children had a red rocking horse we named Rudy.  Rudy had a hard life.  Not only my young’uns but all the neighborhood kids didn’t think twice to hop on the horse’s back and spur him on without mercy.  Over time the coat on that poor paint pony cracked and peeled, and he lost the lower half of his right rear leg in some long forgotten accident.  Rudy was suspended on a couple of rusty springs, and he became quite creaky with age.  I guess he had a bad case of wear and tear arthritis, ’cause he strained with a God awful noise.

        Back in those days, Neuse River practiced at my house.  Whenever we’d crank up, the kids never failed to jump on and rock to the music.  Man did Rudy make a racket.  As long as I live, I’ll never hear “Reuben” without Rudy’s eek eek eek eek sound track in my head.  My boy is a fine bass player.  He keeps perfect time, and I think it is from all those years of rocking on Rudy while Moose picked ‘Reuben’ on the banjo.

        Moose thought the same.  (So much so that I’ve often thought he built his picking barn where we now rehearse to escape Rudy.)  One day he was by the house, and noticed the horse was gone.  “Hey Doc. Whatever happened to old Rudy?”

        “Gone to the great glue factory in the sky, Moose.”

        Moose laughed at the memory.  “I gotta tell ya Doc, that pony like to have drove me crazy.  Eek eek eek eek.  Mercy.”

        “Yeah Moose.  That was one bad animal, no doubt.  But you gotta admit- a man who can keep time on ‘Reuben’ while the kids rock on a horse with bad springs is a player.”

        “I reckon.”

        One day Neuse River had a practice scheduled at the picking barn. I got there early so me and Moose could set up the sound equipment.  We opened the door and a familiar sound drifted out of the barn.

        “Oh, no,” said the Moose.  How could it be?

        Eek eek eek eeeekkkk……

        “Daddy, Daddy.  Look what Dr. Bibey brought us.  He’s just the horse I always wanted.”  Little Janie was in love.

        “Honey, you don’t understand.  We can’t keep up a horse.  Who’ll feed him….” Moose began to protest.

        “But Daddy, look- he has a hurt leg.  Dr. Bibey says if a family
doesn’t adopt him he’ll end up at the glue factory in the sky.”  Her lip pooched out.  “Pleease…?”

        Moose is a hard bitten bluegrass boy, but there ain’t no way to say no to a tow-headed blue-eyed cherub like that.  Janie brushed a ringlet of curls out of her eyes, held back a tear, and awaited the verdict.

        “O.K. Sweetie.  O.K.”  Moose knew he warn’t gonna win this battle.

        “Oh thank you daddy, thank you.”  Janie ran over and hugged the Moose’s leg, then hopped back on Rudy and began to rock.  Eek eek eek eeek.

        I handed him a small can of three-in-one oil.  “He don’t squeak so bad if you oil him once a month,”  I advised.

        Moose started to respond, then gave me a disgusted look and muttered a few words about how my mama wore combat boots.  We proceeded to get ready for practice without another word.

        Years went by and Simpkins, our bass player, got married.  (The last one to fall- see ‘Bluegrass Bachelor Party.’)  He hadn’t been married two months when the Moose called.

        “You know Bibey, I guess now that Simpkins is married they’ll have some young’uns someday.”

        “Yeah, I guess so, Moose.”

        “Don’t you reckon they’d want to adopt Rudy?  My kids are fixing to go to college you know.”

        “Why don’t you just send him to the glue factory, Moose?”

        “Are you kidding?!  Janie would pitch a fit.”

        “Hm. I understand.  Yeah, I think Simpkins would make Rudy a good home.  We need to raise some more good bass players.”

        I called my kids to let them know- Rudy lives on.  They were pleased.  I always was a good Dad, and I think the last thing they want is that dang squeaky horse at their place.

Dr. B

Coca-Cola Klepto

July 9, 2008

        A post from Auntie (mrschili’s sister) got me to thinking about our office, and inspired today’s entry.  Someone was stealing her salad dressing out of the refrigerator at work.  From her story, and the responses, I’d say this is a universal problem, and it reminded me of a similar problem in my office.

        Every day at 3:00, unless there is a desperate emergency at hand, Dr. Bibey proclaims, “School’s out!” and we take a break for a Coca-Cola.

        This behavior goes back to grade school.  I’d get home and my mom would let me have one Coca-Cola before I went out to play.  They were the ones in those little green bottles.  She’d pour ’em up over ice in these metal glasses that’d get real cold and condensation would form on the outside.  I’m telling you, when I was a kid, I thought a well struck golf ball, a Martin guitar, and an ice cold Co-Cola were the three best things in the whole wide world.  They still rank mighty high.

        Anyway, my co-workers know I don’t ask for much, but a sure way to get a hound dog look outta me is to say we’ve run out of Co-Colas.  They don’t let it happen often.  When Paig semi-retired, she told the new office manager, little Marcie Presto, “Dr. Bibey ain’t hard to please.  Just don’t let him run out of Co-Cola.”  She hasn’t done it yet.

        Years ago, though, we’d get down to the last one, and someone would open it up, drink about ten percent, then put it back in the refrigerator.  I had too much on my mind to play Sherlock Holmes, but I had an idea who it might be.  I suspected a single perpetrator, but never could prove it.  Without fail, they’d drink ten percent, about down to the top of the label, and then place it in the back right corner.  (Like I couldn’t find it.)  It would sit there and mock me.  It was water, water everywhere and nary a drop to drink or however that old English saying goes.  (mrschili, help me out here!)  I coulda taken it better if they’d downed the whole thing and thrown the bottle away.

        We only have a few cardinal rules at the office.  Each time someone breaks one….  well, those folks don’t work with us anymore.  The number one absolute rule is not to put one’s personal needs above the needs of the patient.  Once an employee wanted to leave early on a Friday.  This former employee told a patient he didn’t need to come in to the office that afternoon, but did not consult the clinical folks for a decision.  (A major no-no.)  I won’t tell you the details, but the patient 100% needed to see a doctor- the employee gave bad advice and it was against office policy.  She did so to convenience herself. 

        My patient was lucky, the problem that could have resulted in a serious outcome.  They healed, but it wasn’t cause of what I did for them come Monday, I assure you, but only due to the grace of God. 

        I was furious, and told her so.  The employee left work that day and didn’t return.  After that employee never came back, I noticed I never had a Co-Cola theft again.  You can’t trust someone who’d steal your Co-Colas.  She was the one I suspected all along, but I didn’t have enough evidence to fire her.  (My employees say Dr. Bibey will somehow forgive if you drink his last Co-Cola, but don’t roll no dice with his patients.)

        Over time in an office, people’s character traits emerge.  It is much like being married.  After a while you know all about your people- maybe not as well as your wife, but just shy of that.  I’ve been lucky- mine are the best.  In all these years, I’ve only had one Co-Cola thief, so I count myself blessed.

           All I can say Auntie, is watch out for whoever is steals your salad dressing.  They might not be as bad as a Co-Cola klepto, but it sounds like they to are up to no good.  You can tell a lot about folks who steal the things that get you through the day.

Dr. B

Exact Transcription

June 27, 2008

        Except for patient and institution name changes this is an exact transcription of a patient encounter.  It was from a month ago, though, ’cause I did not want to take any chances with a violation of her privacy.   

        “Ms. Smith, What’s your trouble?”

        “Lordy, Lordy, Dr. Bibey.  It’s my old bladder.  I went up there to Tobacco Triangle and they say they can’t operate no more.  They knowed you.  They said you’s a good doctor, and you’d know what to do.”

        “O.K.  Let me see if I got a letter.”

        “He said he’s gonna call you.  Did he not call?  He said he knowd you.”

          “Thank you ma’am.  No, I don’t think he called.”

        “He said he knowd you.”

        “I understand.”  I flipped through the chart.  “So how’s your bladder?”

        “Oh, I’s up all night.  Could you give me that white pill you gave me whenever your kids came out to the farm and looked at the donkeys?”  (My kids are now grown.)

        “Gee Ms. Smith, that was a long time ago.”  I remembered the donkeys, but I could not recall the name of the medicine.  “What was the name of it?”

        “Oh I don’t know, ain’t you got a list?  It was that white one.  Hmm.  Maybe it was pink.”  She turned to the lady who brought her.  “Was it white or pink, honey?”  Her friend shrugged her shoulders.  She didn’t know.  “Oh, Dr. Bibey.  You know.  That little bitty pill.  It was my when my cousin came in from Greensboro.  The one that died.  What was her name?”

        “I ain’t sure Ms. Smith.”

        “Well, It don’t matter, it think it was pink.”

        Did it start with a “D?”  I asked.

         “Yes sir, I think so.”

         “Well, let me check a specimen.  We’ll see.”

        I checked her and a urine specimen, too.  The diagnosis was bladder infection.  (I think.)  It is now a month later and she is fine, so I guess I was right.

        I tell you guys all that to make sure you know I am in a glamorous business.  It is just like on T.V. huh?  I guess I have job security; few want my job.  It does take a strange sort of personality to sort through all this for decades and not fall asleep at the wheel and miss an aneurysm when it surfaces.  To do it, you’d have to be some cat who wanted to live in the country and pick bluegrass music for a second job.  Sometimes I’m not sure there are enough of them out there, but I persevere on ’cause I think that is what I was put here to do, and I don’t question it.  And I didn’t have it too bad.  To paraphrase John Hartford, at least I didn’t spend my life working in tall buildings- it woulda never done for me.

Dr. B 

D.P. – What It Is Is (But Sometimes It Ain’t)

June 7, 2008

        Dr. Dee had a patient with appendicitis who had pain on the left side instead of the right.  He did a fine job ’cause he did not succumb to diagnostic perseveration, or D.P.

       D.P. is a common error, and one that is easy to fall into.  In it, you hold onto your original hypothesis at all costs.  At first for all the world the patient seemed to have diverticulitis, but after a couple days it didn’t add up, and Dr. D reversed field and considered appendicitis.  A CT confirmed the suspicion, and the patient did well.

        In medicine what is is most of the time, but one has to keep in mind what is sometimes ain’t.  At times folks don’t understand, but it is why we are very reluctant to ever assume much or diagnose over the telephone.  Nothing strikes fear in me more than to have someone call and say, “well, I’m ‘pretty sure’ I have a stomach virus.”  (One time when it turns out to be an aneurysm will make a believer out of you right quick.)

        Knock on wood; tomorrow might be the day I have a disaster, but I have been saved more than once by not falling into diagnostic perseveration.  Most of the time, I got it right ’cause I came, I saw, and I reconsidered a few times in the interview.  Often it is because the patient gave me the clues that made me chunk my original theory about what was wrong. 

        There is an old saying in medicine:  “If all else fails, ask the patient.  (like reading the directions, I guess)  They will usually tell you what is wrong.”  That has proved true over and over for me.  They might not say “I think I have scleroderma,” but they will sure enough tell you the symptoms that will lead you down the right path if you don’t forget to listen.

        For Dr. Dee’s patient, it is a good thing he listened.  What it is is, but it wasn’t.  Thank goodness his radar was up and he was not bitten by D.P.  The patient was happy about it too.

Dr. B 

Black Widow Spider Bite

May 31, 2008

        When I first started practice, I had a lady in the Emergency Room with a  black widow spider bite.  It was my first case of that.

        I checked her out, got her out of pain first, then found an Emergency Medicine text.  I opened the book to the page on black widow bites, flopped it open on the foot of the bed and commenced to follow a written protocol.

        The lady was groggy from the pain medicine but said, “You reading that book makes me nervous.”

        I replied, “Well, I tell you what ma’am.  I believe you’d be more nervous if I wasn’t reading the book.  This is my first one of these.”

        I think if she hadn’t been loaded up on Morphine she mighta bolted, but she stayed and got better, though I can’t say for sure it was my treatment.  Mostly it was morphine and time.  Half of what I did that day is no longer in evidence based medicine vogue.  (Not that what is in fashion today will be twenty years from now either.)

        She didn’t much want to hear it, but I think patients and Docs both are better off for us to admit up front what we don’t know and do the best we can.

Dr. B

Depression, Dementia and a touch of ADD

May 25, 2008

        There is an old saying in medicine.  (I know a bunch of ’em.)  If the  PATIENT says their memory is not as good as it used to be, they often have depression.  If a FAMILY MEMBER brings a patient to the office and says the patient’s memory is not as good as it used to be, the diagnosis is often dementia.  Like all old sayings in the doctor world, it isn’t true every time, but it is a good place to start. 

        Some time back Neuse River did a gig at the school house.  We opened for Mark O’Conner.  The Moose hammered Sally Goodin (some say Sally Good’un) extra good and Mr. O’Conner jumped on the stage and jammed along with us.  Great stuff!

        Moose always does attract a lot of attention.  I’ve played music with him a quarter century and beautiful women follow us everywhere we go.  (His wife are daughters are quite attractive, as are my Marfar and Marie I might add.)

       Let’s see now, where was old Doc?  (This is the ADD part)  Oh yeah, after the show a lady came up and told me she was concerned about her parents.  I had not seen them in some time, but the daughter said the mother had become demented, and the Dad was about to worry himself to death over it.  She thought he was depressed over his wife’s illness.  We talked about it for a while, and I urged her to have them come in first of the week.

        When the couple came in, I asked the husband how things were going.  “Doc,” he said.  “I’m worried to death about my wife.  Her mind just ain’t no good.  She leaves the pots and pans going on the stove and gets lost going to the post office- I’m afraid she’s getting old timer’s.”

       “How are you?”  I asked.

        “I ain’t so good either.  I can’t remember nothing.  I reckon maybe I’m getting it too.”

        You know the rest of the story.  I checked it all out to be sure, but the wife indeed suffered from dementia, and his diagnosis was depression.  We got him lined up with a lot of support, and a little medicine, and he is much better.  She is holding her own, but that dementia is a wicked disease.  

        I am lucky Doc.  Sometimes I think I have a bit of ADD, but the compensatory mechanisms of music and knowing my people have saved me.  As it turns out, the daughter made the diagnosis for both of her parents; all I had to do was listen.

        I guess if you make the right diagnosis, folks will forgive you for the derivation you worked off of to get there.  I sure hope so, cause the only way I know how to figure out what is wrong with my people is to let them tell me. 

        And the only way I don’t forget is to remember the tune I associate them with.  I might be a touch ADD, but I know my people, and the music that goes with ’em.  Once I “learn” ’em, either the song or the patient, I don’t forget- they are too important.

Dr. B