Category Archives: Awkward moments

Ban Ki-moon likes my tie

My roommate Jordan recently sang the German national anthem for the German Consulate’s party at Central Park’s boathouse.  I think it may have been for  German Unity Day, October 3.

As a member of the Metropolitan Opera’s Lindemann Young Artists Development Program (and, like Renee Fleming, Susan Graham, and Ben Heppner, a winner of the prestigious Metropolitan Opera National Council Auditions), Jordan seems to get more singing engagements around town than I, with my two years’ experience in church choir during high school.

In any case, Jordan nearly left the apartment that evening wearing a brown tie with a navy suit.  Doing the only compassionate and reasonable thing, I stopped him.  He seemed to be under the impression his suit was brown, and after a confirmatory call to his girlfriend, realized I was, indeed, correct.

While Jordan searched for an appropriate tie, I realized that most of his ties were brown, so I pulled out a few of mine to show him.  There was the conservative red-and-navy striped tie, the rather loud orange tie with light blue stripes, and the demure blue tie.  He selected the last one.

The singing went well.  Jordan’s fairly comfortable with German, so while waiting for food afterward, he struck up a conversation with some German girls.  They seemed friendly, even flirtatious, perhaps not realizing Jordan’s girlfriend was waiting back at the table.  One of them told Jordan she’d written a song with the English title, “Why I like German boys.”  Jordan, thinking the conversation was taking an odd turn, smiled politely until they asked what part of Germany he was from.  “I’m not from Germany.  I’m American.”  The girls were surprised.

Only later did Jordan realize that the girl’s telling him about the song, “Why I like German boys,” was a rather robust failure of an attempt to flirt.  Not only did she not realize he has a girlfriend, the song’s title only confused him rather than clued him in to her interest.

The highlight of the evening for me (who wasn’t there) came when Ban Ki-moon himself complimented Jordan on his singing.  My tie came within inches of the Secretary-General of the United Nations!  I think Ban Ki-moon really wanted to compliment the tie too, but was too shy.

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Well, if that’s how you feel…

Since the person who is covering the inpatient chronic pain service was post-call today, I rounded on the service.  Tomorrow I’ll go to my usual assignment of the week–pediatric pain.

The first patient I saw is being treated for cancer.  He looked fairly comfortable, sitting in bed, basking in the sunlight streaming in the window, listening to music through headphones.  In an instant, I thought he looked awake and alert and had a pleasant appearance.  These are all important things to notice when seeing patients with chronic pain.  The physical exam starts from the moment the doctor walks in the door.

As I walked in, I said, “Good morning Mr Jones, I’m Dr H with the Pain Management Service.” All the body language clues I’d already noted did not prepare me for the first words out of his mouth. “Here’s another doctor.  Good-bye!”

I must say, I was rather taken aback.  I’d tried to sound cheery and energetic, and his first words to me were blatantly sarcastic.  Trying not to be overcome by countertransference, I responded in a nonaccusatory and neutral tone.  “Well, Mr Jones, if you want me to leave now I will, but I was hoping to talk with you about your pain medicine.  Will you tell me how you feel?”

I found it confusing when he said in a puzzled tone, “No, I don’t want you to leave.  My pain is pretty well controlled on the medicines.”  He suddenly seemed very pleasant again.

It all came together when I realized that he wasn’t listening to music when I first came in; he was talking to his daughter on the phone with an earpiece, and he immediately hung up with her upon my entrance!

Later in the day, I found it particularly gratifying to evaluate a new consult for a patient with cancer with bony metastases.  The primary team had her on an odd jumble of multiple long and short acting medicines: fentanyl patches, extended-release oxycodone, immediate-release oxycodone as needed, hydromorphone intravenously as needed, and a lidocaine patch.

After doing a quick history in Spanish, I reviewed the current regimen and simplified it considerably in my recommendations: Continue the fentanyl patch for baseline pain control.  Start a hydromorphone PCA (Patient Controlled Analgesia) with an optional nursing bolus for uncontrolled pain.  Start scheduled acetaminophen to decrease opioid requirement.  Apply the lidocaine patch to most-affected area, 12 hours on, 12 hours off.

This way, we can measure how much hydromorphone she requires in a day (based on how much she doses herself) and later convert the medications to a combination of long-acting and short-acting oral medicines for a home regimen.  Pretty straightforward, but it’s nice knowing that she will likely be comfortable tonight in the hospital because of my recommendations.

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The Age of Turbulence

While my elderly first patient of the day took a quick trip to the lavatory before I brought her back to the  operating room, I noticed her husband was reading Alan Greenspan’s recent book, The Age of Turbulence. The avid Mulberry Street reader will remember this book from my November 19, 2007, post in which I repeated a reviewer’s remarks, “…nobody ever accused Mr Greenspan of being a lively speaker, let alone a born storyteller, and no reviewer could approach this volume with anything but a heavy heart and a sense of duty.” 

I commented to the husband on the book, and before I could repeat the clever phrase from the review, the husband said, “Oh yes, we’re good friends with Alan.”
* * * * * * * * * * * *
When I was looking for a picture for this post, I ran across this one of a younger Alan Greenspan. This was taken probably some 30 years ago, back when he was 80.

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Another OB story

Dr S, the chief of the obstetrical anesthesia division, has been promising to tell us the story about F.C., an interesting patient of his from several years back. He didn’t have the time today to tell us the story, but instead related another interesting anecdote.

The day started normally with a couple epidurals for women in labor, overseeing a cesarian section, the usual. He was called to one of the labor rooms with another epidural request. When Dr S walked in, however, he noticed the patient lying stark naked in bed, in labor. A little unusual, perhaps, but nothing too remarkable. After all, patients are very frequently naked in the operating room, though we try to keep at least part of them covered when they’re awake.

The vibe here was different. Dr S soon picked up on why when he looked up and saw the patient’s husband sitting in the chair beside the bed…also completely naked. They were evidently the “crunchy granola types” and preferred the “natural approach.” (Why they were in a top-tier medical institution requesting an epidural rather than squatting at home on the kitchen floor with a bucket of warm water, a pair of gleaming scissors, and some fresh clean towels, I cannot say.) After taking a moment to register the situation, Dr S regained his cool and explained the process, benefits, and risks of an epidural to the patient, who wished to proceed.

As if that weren’t weird enough, the story doesn’t end quite there. The patient then requested that Dr S remove his clothing before he placed the epidural. This was part of the” natural approach.”

This led to a series of musings:

  • Hospital policy does not explicitly require that one wear clothing while placing an epidural. It does require gloves, a hat, and mask, though. Would the family object to the hat and mask?
  • What, if any, extra documentation would be required? “Patient identification confirmed. Risks, benefits, and alternatives discussed. Consent for epidural obtained. After proper hand hygiene and removing my clothes, the patient was placed in the sitting position. Sterile prep and drape…”
  • Was the husband sitting on a towel?
  • Where would one put one’s pager?

In the end, and probably in part because of the multiple quandaries raised by the circumstances, Dr S told them no, he would remain fully clothed for the epidural.

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Open mouth; insert foot

Two, yea, three things of note happened whilst on call last night.

  1. I finished a case around 2330 and crawled into bed at midnight. The pager was silent. I awoke at 0757, three minutes before my alarm was set to go off. I got more sleep on call than on any night for the preceeding two weeks. That’s how a call should be!
  2. While stopping by another first-year resident’s operating room (for reasons that do not need discussed here), the surgeon asked for 4000 units of intravenous heparin. Because I was standing between the resident and the cart, I opened a syringe, drew up 10cc of the standard concentration of heparin (1000 units per cc) and was about to label it when the resident took it from me. “What’s this?” he asked. “Heparin.” “What concentration?” “The normal–1000 units per cc.” “Then why did you give me 10cc’s?” “Because the surgeon might ask you to give more later.” Without a word, he then proceeded to open the cart’s drawer, and pulled out another vial of heparin. “Was this what you used?” “Yes.” At this point, he looked into the trash, rescued the empty vial from which I’d drawn up the syringe, and compared it to the one in the drawer. At this point, the surgeon asked if the heparin was in yet. Only then did he administer it!
  3. I was talking to a patient whom I was originally going to take care of, but who was now going to have anesthesia administered by another resident. She’d requested that I take care of her (since she’d had me twice before) but it didn’t work out. We were in the preoperative holding area, and she was going to have her surgery in an hour or two. Feeling a little bad, I gave the nearly-eighty-year-old’s hand a squeeze and said, “If you’re still around tomorrow, I’ll come by and see you.” The double entendre, unfortunately, was lost on no one!

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Jonathan 2.0

Ruder. Brasher. Speaks his mind. A real New Yorker. At least that’s what I’m striving for.

Especially when I notice a sign at The Fairway grocery store (essentially a cheaper Whole Foods in Harlem looking out right on the Hudson River) display with several kinds of extra-virgin olive oil and some small bread slices for sampling. It read, “Please be considerate: dip your bread only once.”

“Why would they even need to post a sign like that?” I thought, lifting a piece of bread dripping with green, ripe oil to my mouth. As I took a bite of that full-bodied richness, I noticed the woman next to me with a piece of bread with a bite taken out of it. It all happened in slow motion: her moving the bread toward a bowel of olive oil. My thinking, “This can’t be happening.” Her dipping the bread, bite side first, into the smooth, thick liquid.

I was appalled. Horrified, more by her manners than by her generosity with her own cooties. As she walked away and I closed my gaping mouth, I realized that I missed a perfect chance for confrontation. She deserved public rebuke. It was my duty to perform the civil equivalent of a citizen’s arrest. “EXCUSE ME, ma’am!” (Ma’am can come off as a bit condescending in the Northeast) “I can’t believe what you just did! You are rude!” Her chastening would be completed by the sudden sensation wet liquid fat in her face–flung there by me–which would then drip down and stain her dress in great moist globs.

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Overheard at the hospital,

or “What not to say to patients.”

Before I recently sedated a patient for his endoscopic retrograde cholangiopancreatography (henceforth ERCP), the gastroenterologist was reiterating the logic of the plan to the 80-year-old patient.

“We have to put in the biliary stent first. If we were to place the duodenal stent first and then your biliary system becomes obstructed, that would be the straw that broke the camel’s back. I mean, that would be the final nail in your…(awkward pause)…roof.”

Probably best to stay away from death metaphors in the hospital setting.

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