MUSINGS * FLANERIES

Another day on call Conrad Schulte, MD It started innocently enough. I had just finished my 10th cup of Koffee Shoppe coffee and aside from a small intention tremor, slightly sweat-stained armpits and the beginnings of a callinduced scowl, I felt quite chipper, even if I wasn't thrilled about being confined to the hospital during another day on call. I was sitting there thinking how mentally alert I felt when I heard my name over the intercom. The nurse explained that a patient had been discharged and "had a few questions". Arggh! This was the kind of call I hated most because it always meant one of three things: the patient really had no questions, never had one, and never would in his life. But what the heck, he had put off leaving the hospital for as long as he possibly could. Since the housekeeping staff was about to board up his room, as he was the last tenant of a soon-to-be-unused wing, he might as well chew the cud with the on-call resident to prolong his stay by 5 more minutes. I can't begin to count the number of times I have received an urgent call to answer some life-and-death question before a patient leaves the hospital, only to encounter the following: en route to the patient's room I encounter

Conrad Schulte is in the second year of his family medicine residency at the Misericordia Hospital in Edmonton.

a large faction of hostile nurses who belittle me for being 21/2 minutes late. I wander sheepishly into the patient's room and find him lolling about on the stripped hospital bed, watching the soaps and feasting languidly from one of several barely touched fruit baskets.

if he owns 12 Rolls Royces and 15 BMWs, has taken the Number 27 to hospital. It does not matter where these patients came from. A case in point: We were in Tibet some years ago and after being on a mountain trail for some weeks and being at heights even

"Do I take the Number 27 bus, or would it be simpler to take a cab from here, Doc?"

I clear my throat. "How may I be of service?" "Uh, yeah, are you a doctor?" "Yes", I answer patiently. "Oh, then", he says, wiping the pear juice off of his chin, "Do I take the Number 27 bus, or would it be simpler to take a cab from here, Doc?" I don't know about you, but my medical school didn't offer a course on local bus routes. It should have. During my residency that has been the most common patient problem I have been asked to solve. I still don't know how a real, practising doctor bills for this service. By the way, I sincerely believe that the Number 27 bus route that services my hospital circles the globe. I know this because every patient I have seen,

that would cause an eagle's nose bleed, arrived at the home of a wise mystic. We started the usual spiel, "We've climbed the highest mountains, etc." He interrupted. "You know", he said, "the Number 27 bus stops just behind my shack." In disbelief we went around back. Sure enough. There was the bus and many people asking, "Is this the one that goes to the hospital?" Not long ago, a patient's wife presented me with a long, indecipherable list of questions that she wanted answered before her husband was discharged. I laboured over it well into the night and long after visiting hours were over and discovered one question written larger than the rest, in a dialect unique to a mountain town in to

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Lesser Harfalia. I ascertained that this was the most crucial question. I telephoned a friend expert in the language and read the question phonetically over the telephone. He spent 2 hours on the translation and faxed over his answer. There, in bold letters, was the question. What is the appropriate time to take the Number 27 bus? Cases in which the on-call resident is asked to assist patients who really do have bona fide questions are rare. However, when they do arise they will be of such profound depth and magnitude that you won't have the faintest idea how to answer. So what you do is shove your hands in your pockets, turn red in the face, and stammer madly about some totally unrelated topic. Here's an example. I was called to see a patient, a trapeze artist who was being discharged from an orthopedics ward, and while I'm sure the operation he had exists, it wasn't part of my vocabulary. -I entered the room, exuding confidence and scowling just a bit to let him know I was really busy. (I had been watching the soaps, but have learned that if you scowl a bit the patients think you're busy and you can get back to The Young and the Restless.) The patient's look told me I was the last vestige of hope he might come across before being thrust into the real world. "Uh, doctor", he started, "I just had the Fimmelman-Von Trapp-Landsteiner overshoot repair and juxtaposition done." "Yes", I responded sagaciously, immediately throwing up my defences by beginning the handsinto-pockets, face-turn-red manoeuvre. "Well, as you can imagine", he continued, "I have a number of concerns. I asked the surgeon already, but after having met you, I know that you can put it into simpler terms that I may understand." "Of course", I said kindly.

"I've heard", he said, "that this operation may affect my libido and in fact I may have some chance of experiencing a profound disorder of my liver metabolism in 2 to 3 months, and there is a finite possibility that because of this I may never be able to perform a triple backward somersault on the trapeze again. Do you think this could have been avoided by taking the anterior approach instead?" "Huh huh", I stammered madly. "Trapeze artist, eh? Have you ever seen those Russian bears? How in the world do they train them to walk that tight rope, I wonder? Well, anyway, I really gotta go. All the best and if you have any other questions, you should probably speak with your family doctor, huh, huh, huh." I broke into hysterical laughter and as I fled the red glow from my face illuminated three adjacent corridors. The scars from that fiasco still hadn't healed when I responded to a call to answer yet another patient's questions before his discharge. I fear these encounters in which I must come up with clever and meaningful advice on a one-to-one basis because they often take place in front of an audience of relatives and an eagerfaced student nurse, anxious for her first insight into the way a "6real doctor" functions. I entered the corridor and was chided by the nurses for taking 32 seconds to respond. I entered the room. There sat the patient and his wife. "How may I be of service?" I inquired, putting on my humble and -wounded puppy look, hoping that they might take pity and let me flee back to the soaps. The patient looked up at me and there was pathos in those eyes. He held out his quivering, rheumatic claw hands. He was a figure from an El Greco painting, and I was touched. He began to speak: "'Uh, Doctor, should we take the Num-

ber 27 bus, or would a cab be a better bet?" I was speechless. Stunned. That face, and yet those words. Such incongruity. I was dumbfounded, then annoyed, then enraged. My caffeine-induced tremor suddenly becomes the tremulousness of lunacy. My red face became a scarlet cape draped in front of a charging bull. My slightly sweating armpits were the steam engines of a mighty battleship. All of this pent-up energy was directed at this man, this pitiful excuse for a human being. I was about to let forth a nuclear onslaught of verbal intimidation when the attending staff physician entered. "Oh, have you two met?" he asked. "This is Mr. Smith. He has DeSotta's Stammerin-Flammerin disease, also called idiopathic malignant reverberation. This poor gentleman is doomed to walk the surface of this planet, saying the same words over and over again. 'Doctor, should we take the Number 27 bus, or would a cab be a better bet?' " He held me by the shoulders and looked me squarely in the eyes. "Can you imagine the hell this man is in?" I became even more speechless, even more stunned. His words were like two wet fingers snuffing out my nuclear wick. The physician left. I stumbled through an unusually long list of questions that the patient's wife produced before they left to catch a plane to Kathmandu. I then left, a thoroughly humble man. Tomorrow I will go directly to the library and read up on rare disorders. For now, though, I just want to go bury myself in some soaps and review the local bus routes. En route to the TV another call came. "Code one! Code one!" Good, I thought. Advanced cardiac life support. Finally something I can handle.m CAN MED ASSOC J 1990; 142 (6)

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Another day on call.

MUSINGS * FLANERIES Another day on call Conrad Schulte, MD It started innocently enough. I had just finished my 10th cup of Koffee Shoppe coffee and...
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