Dude, Where's My Stethoscope? Read online

  At 5:00 p.m. we met to do sign-out rounds. When rounds were completed I picked up my knapsack and walked to the door with a relieved smile on my face. Survived my first day on the wards! Piece of cake!

  “Where are you going?” asked the resident.

  “Home,” I answered.

  “You can’t go home – you’re on call tonight. Didn’t you see the schedule?”

  My smile evaporated.

  “No, I didn’t. Live and learn, I guess. Who’s on call with me?”

  “Well, normally we put you newbs on with an intern or a resident, but right now we’re so short you’re going to have to take call by yourself.”

  That didn’t sound too enticing.

  “Who’s going to be my backup?”

  “Dr. Stone.”

  “Oh, that’s good.”

  “Not necessarily. He takes call from home, and he doesn’t like to be contacted unless it’s for something really big.”

  Oh, crap.

  About 10 minutes after they left I was paged to the pediatric ER to see a girl with a broken upper arm. I tried to recollect what the chatty plaster technician had told me earlier about casting a fractured humerus. Something about an army-navy sling with sugar tongs. Or was it sugar buns? Whatever. I doped out a reasonable facsimile and went to town. Putting the contraption on was quite a battle – the child was developmentally delayed and she kept swinging her broken arm all over the place. I could feel the bone fragments grinding against one another whenever she moved. I had to keep reminding myself not to wince. The final product was no Michelangelo, but I was pleased nonetheless.

  “Bring her to the fracture clinic next week for a recheck,” I said to her guardians in my most impressive doctor voice.

  “Why does she need to come back again so soon?”

  “Okay, make it a month.”

  Half an hour later I was back to see a teenage wall-puncher with fractured knuckles. I wasn’t sure about the angles the various joints were supposed to be cast in, so I perused the bible – Salter’s textbook – and started slathering plaster on. The end result was a hand cast the size of a boxing glove. It was a miracle the guy could lift his arm off the stretcher.

  “It’ll get lighter when it dries,” I chirped optimistically. “Come see us in the fracture clinic in a month.”

  “That long?” he said dubiously.

  “Okay, make it next week.”

  An hour later emerg called me to see a 9-year-old with a fractured femur. Geez, isn’t that the biggest bone in the body? I scurried into the plaster room to find a stoic but uncomfortable little boy waiting for me on a stretcher. His father lunged out of his chair and shook my hand like I was the Messiah.

  “I’m so glad you’re here! I’m Mr. Singer and this is my son Jake. The emergency room doctors didn’t want to give him anything more for pain until you assessed him.”

  “Oh. Well… .”

  “Have you had a chance to look at his x-rays yet? How serious is the break?”

  “Er… .”

  “Is he going to need surgery? Will you have to operate tonight?”

  “Um, well, I’m not actually the surgeon. I’m the medical student.”

  His eyes widened and he gasped. He looked horrified.

  “When will the surgeon get here?”

  “I’m not exactly sure. They tell me he doesn’t come in for every case. How about if I examine your son and then call Dr. Stone to see what he recommends?” Mr. Singer didn’t appear to be too thrilled with that plan. His nostrils flared and his eyebrows began to knit together ominously. “I expect he’ll come in right away for a major case like this, though,” I added hastily.

  After the examination I telephoned Dr. Stone. I described the fracture to him and asked if there was anything he wanted me to do before he arrived.

  “Oh, I don’t need to come in for that,” he replied. “Just put him in a Thomas splint and admit him to the ward. I’ll look at him in the morning when we do rounds. If you have any trouble with the splint, I’m sure the emerg doc will give you a hand. Good job! See you!”

  I returned to the cast room and sheepishly notified Jake’s dad that Dr. Stone would not be coming in after all. He was not the least bit pleased. His displeasure bloomed into near-wrath as he watched me fumble around with the splint, trying to figure out how to apply it correctly. Charlie Chaplin had nothing on me. Eventually the ER doctor noticed my unintentional slapstick and came to my rescue. He also ordered more analgesics for poor Jake.

  I hadn’t even started on Jake's admission paperwork when a razor-thin ER nurse with hair an aberrant shade of red stuck her head in the door and yelled in my general direction: “Hey, ortho! You better not go anywhere – an ambulance is coming in Amber Charlie Three with a girl who just jumped out of a third-storey window. They think she might have a broken back!”

  A broken back? What am I supposed to do with that?

  Sure enough, a minute later the ambulance attendants came bustling in with a teenager on a gurney. They had her trussed up tighter than a Thanksgiving turkey - spine board, cervical collar, sandbags, splints, tape and Velcro. The only part of her that wasn’t immobilized was her mouth, and it worked fine.

  “My neck hurts! My left leg is numb! I have to pee!” she squalled at the top of her lungs.

  While I was busy wringing my hands and trying not to hyperventilate, the ER doctor examined her in detail. When he was finished he came over to me and said: “She seems to be stable right now. She’s going to need baseline blood work, plus x-rays of her entire spine, pelvis, femurs, ankles and heels. She may also need to go down for a CT scan. Normally I’d look after everything, but I have to do a lumbar puncture on a septic baby and they tell me another ambulance is on its way in with a kid who’s been seizing for 20 minutes. Since this girl’s injuries are primarily orthopedic, I’m going to hand her over to you. Call in your staff guy and maybe even neurosurgery if you need backup.”

  If I need backup?

  My new acquisition resumed her litany: “My back is sore! My head hurts! Get me off this board!”

  I was in the process of trying to decide whether I should have my brain hemorrhage now or later when the Crayola redhead poked her head through the drawn curtains and bellowed: “Hey, ortho! We have two more consults for you! And that teenager you casted earlier is back with his dad – they’re saying his cast is too tight! What the heck kind of cast did you put on his hand, anyway? It looks like a freakin’ beach ball!”

  I could feel my eyes starting to bug out. I herky-jerked across the room like a defective marionette, scooped up the nearest telephone receiver and dialled Dr. Stone’s number. He picked up on the third or fourth ring. I could hear some trippy jazz music playing in the background.

  “Hello?”

  “I NEED HELP NOW!”

  He didn’t even ask what the problem was. All he said was, “I’ll be there in 10 minutes.” And he was.

  Even the Cool Kids Can Fall

  Mark was a crazy friend of mine back in the early years of med school. He was the most chill guy I’d ever met. The ultimate non-conformist, he did whatever he wanted, whenever he wanted to do it.

  On the day of med school interviews, Mark was one of the few applicants who chose not to wear a monkey suit. He showed up at the designated time sporting his trademark handlebar moustache, a couple of earrings, a CAT Diesel baseball cap, a leopard-skin muscle T-shirt, jeans and sneakers. He didn’t try to snow the panel with treacle about wanting to save the whales, either. Undoubtedly they found his attitude refreshingly different and he was accepted into medical school.

  During our first year Mark continued to be coolness personified. He was a knockout tae kwon do black belt. He dressed like a hard-core punker. He slam-danced to bands like the Dead Kennedys and rode the lightning with Metallica. In addition, he was a bright, energetic and thoroughly likable guy.

  Mark would bow to no Moloch. To that end, he quickly worked out a system for not letting medical scho
ol take control of his life. This primarily involved studying at home rather than coming to our downtown campus every day for lectures. If he showed up for a lecture and it turned out to be shite he’d usually be able to convince several of us to ditch the class and take off with him. We would invariably end up playing pinball or shooting pool in the student lounge. A couple of times a month our low-life crew would head over to the local watering hole to swill beer and watch strippers. Can you think of a more entertaining way to learn surface anatomy?

  Two-thirds of the way into first year, Mark started to run into trouble. His driving became more erratic. His amusing collection of unpaid parking tickets gradually morphed into a serious problem. He found it increasingly difficult to keep up with the demanding med school workload and his grades began to slip. At the end of first year he was told he’d have to write an exam during the summer holidays to determine whether he would need to repeat the year. He hit the books hard and eked out a passing grade.

  Unfortunately, things continued to unravel during second year and by the end of it Mark had become visibly disillusioned. He decided to take some time off to travel to the Far East and find himself. The faculty strongly recommended Mark wait until he graduated before embarking upon any long trips, but our turbulent anti-hero had already made up his mind. He bought a backpack and an open-ended ticket and set off for Thailand with high hopes. Nine months later a complete stranger returned.

  When Mark got back, the first thing evident was his pierced nose with its diamond stud. But right after that you couldn’t help but notice his eyes. They had become ancient. There was a huge emptiness behind them. When he looked in your direction you got the impression he wasn’t really seeing you, but rather that he was staring right through you into some other world. A bleak, unhappy place.

  Who knows what he was seeing? He didn’t talk much, and when he did his voice was toneless and subdued. He would often start a sentence and then stop halfway through it, as though his train of thought had derailed. Occasionally the old spark would briefly reappear and he’d go on a spiel about something in his usual manic fashion, but before long his words would trail off into silence.

  What had happened to Mark in Asia? Rumours began to swirl. Had he gotten into some bad drugs? I don’t think so – he had never been into anything heavy prior to the trip. Had mental illness struck? There were whispers of schizophrenia, bipolar disorder, PTSD… . No one but Mark knew the whole story, and he wasn’t telling. Each time we tried to probe deeper to find out what had gone wrong he retreated behind a stony wall of silence.

  That September Mark joined the medical class one year behind us to resume his training, but within a few months he had washed out miserably. He took some more time off to regroup and tried again the following year. Things went better that time and he was able to stay afloat long enough to complete the theoretical portion of the curriculum and advance to the dreaded wards.

  I don’t know how things are now, but back then the wards of our teaching hospitals were harsh environments where only the strong survived. Every four to eight weeks medical students were tossed into a new subspecialty ward populated with its own unique mixture of complex patients, overworked nurses and terse staff physicians. You had to land on your feet, integrate seamlessly with the new team and quickly learn the ropes. No one was assigned to hold your hand. No one wanted to hear about how sleep-deprived you were. Nobody was even remotely interested in the fact that studying for the mandatory bimonthly exams while working almost every day (in addition to being on call for 24 hours every three days) was nearly impossible. Even well-balanced, mentally healthy students often cracked under the intense pressure. Mark didn’t stand a chance. He went down without a trace.

  The last time I saw him was about 20 years ago. I used the phone book to figure out where he was living. It turned out to be his mother’s place in the north end of town. When I telephoned no one picked up, but I really wanted to see him so I took a chance and drove over to the address anyway.

  I knocked on the door for nearly five minutes before Mark shambled out. He had gained a lot of weight. His skin was pasty. The cool hair, leather jacket and easy grin were gone, as was his confidence. He looked haunted. It was painfully obvious he was embarrassed about the way things had turned out for him. During the course of the conversation I mentioned the Asia trip a couple of times but it seemed to make him edgy, so I backed off. We sat on his front steps and small-talked about bands, motorcycles and the good old days for awhile.

  Needless to say, it was an awkward reunion. I didn’t stay long. On the way home hard tears stung my eyes.

  Dude, Where’s My Stethoscope?

  By 1989 I had completed my basic four-year MD degree and was more than halfway through an additional three-year residency in family and emergency medicine. That summer I took a break from the crucible of my ER and ICU rotations and travelled to McMaster University in Hamilton, Ontario for a leisurely month of training in dermatology. The specialist to whom I was assigned was a leader in the field, so I got a lot of great hands-on experience.

  One Friday morning I was busy working in his outpatient clinic. It was nearly noon and I was getting hungry. I had just finished dictating what I hoped would be my last note before lunch when Dr. Crowe tapped me on the shoulder. I groaned inwardly when I realized he was holding a chart in each hand.

  “Two patients left,” he said. “One’s new and the other’s a follow-up. Which would you prefer?”

  “I’ll see the new one.”

  “Okay. Come and get me when you’re done.” He passed me the chart and ambled off.

  The referring physician's letter indicated the patient had an eight-week history of an itchy, red rash that hadn't responded to steroid creams and two courses of Nix. Seemed straightforward enough. I opened the door and walked into the treatment room.

  There were three people inside – a man, a woman, and a baby. I estimated both adults to be in their mid-30s. The woman looked downtrodden. The man was short, stocky and unfriendly.

  “We’ve been sitting here waiting for half an hour!” was his opening gambit.

  “Sorry, sir. The clinic was unusually busy this morning.”

  “Are you the specialist?”

  “No, I’m Dr. Gray, a family medicine resident.” I extended my hand; he didn’t take it. “I’ll see you first, then Dr. Crowe will be in,” I continued.

  “More delays,” he grumbled.

  “Where’s your rash?” I asked.

  “All over.” He peeled off his tank top to reveal a spotty, red rash covering most of his torso.

  “How long have you had it?”

  “Doesn’t it say in the damned letter?”

  I gave up on trying to elicit any further information and proceeded to examine him. The rash looked like scabies to me, but his family physician had already treated him for that without success. I cobbled together a differential diagnosis and told him I’d return with the specialist shortly.

  “Better not be long! Doctors aren’t the only people who have things to do, you know!”

  I located my preceptor and reviewed the case with him.

  “I’ve got an extremely prickly 34-year-old man with a two-month history of an itchy rash all over his body. He looks like a pizza with legs. His family doctor thought it was either eczema or scabies, but Betnovate ointment and two rounds of Nix haven’t helped,” I reported.

  “What else is on your differential?”

  “Pityriasis, contact dermatitis, vasculitis, erythema multiforme, flea bites… .”

  “Let’s go see.”

  “Hi, Mr. Grendel, I’m Dr. Crowe. I've been hearing about this unusual rash of yours. Would you mind taking off your shirt again so I can have a look at it?”

  “How many times does a guy have to get undressed before he gets a diagnosis around here?” he carped under his breath as he wriggled out of his wife-beater. Dr. Crowe studied the dappled rash for a few minutes. He looked fascinated.

  “We�
��ll need to do a biopsy,” he concluded. “Dr. Gray here will do the procedure. I’ll stop by and have a look when he’s finished.”

  Great… .

  I earmarked a fresh lesion to excise and opened a biopsy kit. Before donning sterile gloves I took off my stethoscope and placed it on a nearby countertop so it wouldn’t get in the way.

  The procedure went well. While I dictated my note at the main desk, the patient and his family packed up and left.

  Approximately 10 minutes later I realized I wasn’t wearing my stethoscope. I checked my knapsack and searched the reception area. There was no sign of it.

  “Could you have left it in one of the treatment rooms?” the clinic nurse asked. Of course! I went back to retrieve it. It wasn’t there. It took me a minute to figure out what had happened.

  “That last patient took it,” I said.

  “Who?” asked the nurse.

  “The guy I did the biopsy on. Which way did he go?”

  “I think I overheard him saying something to his wife about catching a bus.”

  “Where do they live?”

  She inspected his file. “Stoney Creek.”

  “Where’s the bus stop?”

  “You’re going after them? Are you out of your mind?”

  “They swiped my stethoscope!”

  She gave me directions.

  They weren’t there. According to the schedule on the wall, their bus wasn’t due for another 45 minutes. Judging by the size of my patient’s belly, he didn’t miss too many meals. I headed for the cafeteria.