Laughter is the Best Medicine

One of the most common sources of amusing stories is the misuse of medical terminology by patients and staff. One day I was taking care of an elderly man and his wife never left his side. As with all patients, I encourage them to have their living will, health care proxy and code status in order. Code status refers to what you want done in the event your breathing or heart stop. Younger people typically are full code status meaning they want everything done including intubation (artificial respiration on a ventilator), electric shocks in an attempt to “restart” the heart and chest compressions to simulate circulation. Some people have a code status of “DNR/DNI” which means Do not Resuscitate/Do Not Intubate. This is typically seen in severely ill or the elderly who do not wish to undergo the brutal process of resuscitation and end up stuck on a ventilator for their final minutes, hours or days.

In this particular case, the patient was hard of hearing and his wife was of great assistance in screaming my questions into his right ear and throughout the entire Emergency Department. She may have also been heard in another zip code. When I asked the patient if he wanted artificial respiration should he stop breathing he yelled “I can’t hear you.” Before I could respond, his wife screamed “DO YOU WANT ARTIFICIAL INSEMINATION?” The patient, staff and at least two states heard her question. It was one of those rare moments I was speechless and was hastily trying to find a way to correct the situation. That is probably, I hope, the only time that phrase has been uttered in an ER. I mean I have never encountered a situation where a patient needed to come to the ER to be emergently inseminated to become pregnant. If it did happen somewhere let me know as I would be impressed.

The patient perked up and said “HELL I HOPE NOT!” In full disclosure, I find it very hard to stifle a laugh no matter what the situation is (provided I am not insulting anyone or hurting their feelings) and doubled over and had a great belly laugh as I could see the entire nursing station look up in surprise. Again, you pretty much hear and see the strangest things if you spend time in the ER, but I doubt this has ever come up. So, I made sure I corrected the terminology so he understood that we would not be treating his emphysema with an infusion of semen. I’m all for being open to alternative and innovative therapies but this particular one would not make the cut in my book. In the end, EVERYONE was smiling and laughing and the patient made his choice regarding code status.

In medicine, errors occur every day. Given my propensity to pick on political correctness, I will occasionally refer to medical errors as “therapeutic misadventures” just because as a culture we are constantly relabeling words and phrases and I have a ball with poking fun at the thought and speech police. We have a propensity in this society to soften language and terminology to make it more digestible, as if that will somehow lessen the gravity of the situation. The strange thing is by changing the label, nothing gets done as the same errors happen and all we did was change the name. It would be like switching the labels on urine and blood specimens. All that would happen is that urine would be known as blood and blood would be known as urine. It would not change the fact that the fluids don’t change, just the name on the sticker put on the specimen. I guess I pick on political correctness as it is an exercise in futility.

If just the name “therapeutic misadventure” led to an initiative to increase patient and staff safety, I would be all for it. Some errors are truly tragic, and some are just strange, and yes at times, even amusing. Given I structured this portion of the website to provide you with a laugh and positivity, I will discuss some outrageous medical errors where the outcome was ultimately, and fortunately, positive and everyone got a laugh, including the patients.

I was preoccupied with the daily duties of drawing blood, filling out the lab slips, cleaning the room, and bringing in the new patients to realize the physician I was working for was more scattered than usual. I was brand new to the field of medicine and working for $9 per hour as a medical assistant while attending graduate school.

Maria, my boss and the office manager, by far one of the most competent and savvy leaders I have met to date, put me with the new practice physician a month earlier to get him organized. I remember thinking as the month went on, “Wow, this guy seems a bit disorganized for a doctor.” I became accustomed to keeping an eye on him and making sure he called everyone back and filed his paperwork correctly. I also ran interference when his bedside manner slipped to unfathomable depths. However, despite all of that, nothing could prepare me for what happened next.

Dr. M had three rooms, creatively named rooms 1, 2 and 3, running at the same time in this busy outpatient practice. He was zipping in and out of each room, shouting orders when he said, “Room 3 needs an enema.” Given the patient was a female, I asked my friend and colleague Eva to give the enema. About ten minutes later, Dr. M. emerged from room 2, chart open, papers flying everywhere. “Hey, room 1 needs an enema now!” Again, I grabbed Eva as it was a female. “What the hell is it with this guy and enemas?” she asked. Dr. M went into room 3 (patient enema number 1), while I stayed in the hall, trying to organize the chart from the previous patient.

About five minutes later, a Hispanic woman emerged from room 1, grimacing and doubled over, saying, “Bano Bano” (The translation is “Bathroom, bathroom!”). I showed her to the bathroom as she limped, grimaced, gurgled, farted, and hopped down the hall. This struck me as a bit curious, but I went about my business until Dr. M emerged from room 3. There was a mess of papers and charts I had to clean up, so my attention was briefly distracted. Dr. M went briefly into room 1 and, not seeing his patient, asked, “Where is my sprained ankle patient?” At that point, it hit me in one overwhelming wave of absurdity.

I realized that Dr. M. had been so absent-minded and rushed that he mixed up rooms 1 and 3. He gave them both enemas when the patient in room 3 was the only one who required that invasive and intimate intervention. It turned out the Hispanic lady from Guatemala was a housekeeper who had sprained her ankle. Unfortunately, she had a bottle of water fired into her colon accidentally. That led to cramping, an overwhelming desire to expel the contents of her bowels, and a long, panicked limp and hop down the hall.

At that point, I had to go hide in the broom closet with a rapidly beating heart, trying to comprehend what we had done. Eva had to take over my duties (pun intended) as I gathered my wits. I kept thinking that when this woman returned to Guatemala, she was going to tell the folks down there about this exciting new breakthrough. She would note that the proper treatment for musculoskeletal injuries was placing a plastic bottle filled with water in the rectum and shooting if off like a cannon. Hey, it was the United States, so it must be a good idea. Heaven only knows what they will do for more serious injuries such as broken bones.

It also demonstrates the absolute power we put in the hands of those in the health care field. At what point did that patient say, “Hey, this is wrong”? I mean, let’s say I was at my dentist, and he asked me to pull down my pants so he could check me for a hernia. At some point, I would question his request and say, “Hey, thanks for going the extra mile, champ, but I am here to have my teeth cleaned.”

As for the humorous aspect, life is too short, and in medicine, you must find humor, or you will lose your mind. Even the Guatemalan patient laughed after all was said and done. She was quite a good sport, given she had a large amount of water accidentally and vigorously shot up her backside. To say I would have been annoyed in her position would be the understatement of the year. I mean, this was not a case of mixing up papers and placing them in the wrong chart. This was a legitimate case of assault with some sodomy thrown in for good measure. Things like this are what trigger international incidents. To the best of my knowledge, they have not made a Hallmark card to address such an error. If there was such a card, she deserved the extra-large version and the world’s largest “I’m sorry” fruit basket.

It is essential to note that these things happen in medicine all the time, and all physicians make mistakes. Fortunately, some of the mistakes cause no harm and make for some very unique stories. The main thing to keep in mind is to learn from these mistakes and put measures in place to prevent this from happening again. Then again, in this case, it was so wildly outrageous that I doubt it was repeated since that time. This was the perfect storm of coincidences that allowed for something like this to happen. But I have to admit, when I assumed the role of physician, every time I ordered an enema, I double checked the chart and verbally confirmed the name of the patient with the nurse.

Given I had an interesting time with Dr. M, I will share another story. Although Dr. M was not the best physician in my opinion, he did teach me some valuable things that I continue to use today. This particular story involves a lesson on what not to do. I brought a twenty-four-year-old female into the exam room, and while preparing my blood draw tray, I noticed she had a wandering eye (called strabismus).

Now, I found the best way to deal with this issue is to look at the bridge of the nose, so you don’t get distracted following the eye as it wanders about on its own. I know everyone has had experience with this. Typically, both the patient and the provider are uncomfortable in the end. Thus, my strategy has always been, and still is, to pretend it’s not there.

Well, Dr. M. entered the room while I was gathering up my blood draw tray and, out of nowhere, asked, “Hey, what’s going on with that weird eye?”

I stopped dead in my tracks and just looked up at him with a mixture of shock and awe on my face.

The poor girl stuttered for a moment and then just said, “I have a wandering eye.” I left the room and went out in the hallway to contemplate what I just witnessed. “Did that guy really just do that?” I asked myself. As a doctor, he knows exactly what her condition was, so why the hell would he say something like that? When I had to go back in and draw her blood, I did not know what to say and just played it off, like nothing ever happened.

I never did see that patient return, and I can’t say I blame her. But there is always a lesson to be learned, and although this was just practical common sense about how not to behave, it did illustrate the importance of bedside manner.

Dr. M was not always like that and was, for the most part, always pleasant to his patients when he was not having them sodomized with water cannon enemas (please see the enema story in Chapter 2 of Laughter is the Best Medicine, above). It does give me a bit of a laugh when I think back to that strabismus incident. When you are a physician, you should never say certain things such as “What the hell is that?,” “Oops,” and “Eww.” I have been responsible for all three statements on occasion as I am nowhere near perfect. I will get to those stories later.

It is amusing and baffling at times to look back just ten years and see how much medicine has changed. For example, I give you the sigmoidoscopy. Now, this little gem of a torture device was used as recently as 1999 and at the start of the twenty-first century. The sigmoidoscope was a sixty-centimeter-long tube that was inserted into the rectum and advanced forward to give the user a fiber optic view of the sigmoid colon…and the recipient a painful event he or she would never forget.

Ideally, it was a way for physicians to spot polyps and not do anything about them, apart from having the patient repeat the dreaded prep process and get a colonoscopy—a much longer tube, except this time, they put you to sleep, and the gastroenterologist specialist using it could actually do something about it, such as removing the polyp. Now, the prep process consisted of having the patient drink a gallon (yes, I said gallon) of a salty solution amusingly called GoLYTELY the night before. The result was a phenomenal extravaganza of cramping and projectile diarrhea that would literally clean the patient out, so the physician could get a better view.

Now it was my job to retrieve the sigmoidoscope and wheel in the torture cart upon which it sat into the patient’s room and exchange pleasantries. Now, it is indeed hard to exchange pleasantries and keep the patient at ease when they are looking at an enormous sixty-centimeter tube that is about to be unceremoniously shoved up their rear end. If it is their first time, they are terrified of the unknown, and if it is their second time, they are terrified of the known. I lost either way.

Anyway, I was working with my mentor, who practiced both endocrinology and primary care. Believe it or not, this procedure was performed by primary-care doctors until someone stepped up and said, “Hey, colonoscopies work better when they are in the hands of someone who does this all the time. They go up deeper, can bring out specimens for biopsy, and the patient is unconscious, which cuts down on the screaming and thrashing.” This brilliant change in protocol happened while I was in medical school in the early 2000s. However, while I was a medical assistant, the sigmoidoscopy reigned king.

Now when I was being trained by my good friend Michelle on how to assemble and, unfortunately, disassemble and clean the scope, I had to be present in the room. On my first “observation,” I must admit I was truly horrified. I was no stranger to weird events as I had worked several years in a psychiatric hospital on locked wards as a psychiatric technician. In that job, every day brought some unbelievably strange occurrences, such as a patient who was addicted to eating his own (and other people’s) feces and other unbelievable episodes of insanity and violence. Basically, it gave me an overall general picture of what can happen to human beings when brain chemistry is not totally balanced.

In short, nothing surprised me. I remember I became so desensitized to things that when someone flipped out in a restaurant or on the street, I did not bat an eye as I was used to witnessing aberrant human behavior daily. My friends were baffled as I coolly looked on during these incidents without flinching. Anyway, I thought that experience would prepare me for medicine, and it did, except in certain cases such as this.

In my first observation, I was not warned what the response would be, but it did not take a genius to figure out what was about to happen. The patient had their little gown on (often stained with feces as the GoLYTELY was still working its magic, and patients were basically oozing when we saw them). They got up on all fours on the exam table, and my mentor would casually ask, “Ready?”

Ready is what you ask someone before you pour ketchup on their fries. Hallmark never quite found a phrase to say to someone before they got one of these. Anyway, he would point the scope my way, and I would lube up the tip with K-Y Jelly (it was the least I could do), and he would begin to insert the scope. At some point, the unique feeling of “Hey, there is something in my butt” gave way to screams as the scope needed to make the turn at the first bend in the colon and keep moving forward.

To this day, I can pretty much pantomime what stages the patient would go through. Once the first bend was encountered, the patient would yell, “Oh!” Then as the physician advanced the scope, they would grab the sides of the bed with their hands and let out a longer “Oh….” An inch after that, everyone became religious— “Jesus, God! Oh, just stop!” And then, the inevitable, “Get that thing out of me. I can’t take it anymore. I’m serious!” At which point, they would go from all fours to performing a perfectly orchestrated lift and twist yoga position, which I term “defecating phoenix,” to get a look at the doctor. At this point, it was my turn to gently reassure the patient that everything was okay besides the fact that the enormous snake-like tube sticking into their colon was now somewhere in their abdomen, causing excruciating pain and cramping.

The doctor would then become annoyed and say, “Well, if you move, I can’t get a good view.” I kept well out of striking distance from the patient, as I can assure you the first action I would take in that situation would be to throw a punch, elbow, or kick. Finally, he would announce, “Okay, I’m coming out,” and out he came. At this point, it was my job to have a drape sheet ready to catch the lube-and-feces-covered scope on its way out and wrap it up on the cart. He would (wisely) leave the room at that point, and I would be stuck with a hand full of butt-tubing and an exhausted, sweaty, panting, sodomized patient. Now, having a quiet moment, I would say, “You did great” (which they did…this was a ritual of adulthood, which would make some of the most strenuous training programs in the military or certain tribes in Africa and South America known for their rituals of adulthood wince). And then, I would go clean the fecal matter off the scope.

This job was certainly where I earned my spot at the table. A large percentage of med school students go right from college into medical school. They did not have the honor of working their way up the ranks. I would not have substituted this training for anything else in the world. I learned much about interpersonal skills from both the physician’s perspective and from the ranks of a medical assistant.