Man vs. Mule

port hole in old ship 

“Doc, I don’t want to have any more tests. Hell, I don’t even want to take any meds. If I die, I die. I ain’t scared of meetin’ my maker.” 

“Well, I understand about not being afraid to meet your maker. I know you have a strong faith in God. For my part, I am not afraid to have you die, either. I hope for your sake that is what happens. What I am afraid of is having you have a stroke that is not bad enough to kill you, that leaves you paralyzed and unable to train those mules that you love so much.” 

He had already had about three transient ischemic attacks (TIAs) in the past six months. They were signaling something bigger approaching.

His wife, sitting in the corner, piped up, “I sure as heck ain’t wipin’ yer butt for ya! You have a stroke and I’m puttin’ yer sorry butt in a home.” 

They both laughed. 

I laughed. 

“Seriously, though, take this blood thinner and start this cholesterol medication.” My hand hovered over the computer send button.

“No can do, Doc!” 

“Ok, fine.” I deleted the prescription. “You are stubborn as those mules, aren’t you?”

“Yes, ma’am!” He grinned his proud, lopsided grin and followed his wife out the door. He slapped her on the butt as they rounded the corner and I heard her giggle.

His boots were always caked with mud and chunks fell off as he walked leaving a trail to mark his existence. My staff always cussed his name as they rushed around to sweep up the detritus before someone else saw and noted it on their patient satisfaction survey…

Next time I saw him, he was in a wheel chair. His wife had ended up having to wipe his butt for him. What they had was true love, after all. 

Now he could no longer say no to the medication he was given every day to prolong his life and by golly his wife insisted that he get it.  

He lingered like that for years.

Then he was gone.


From the Guest Room

bathroom in an old train car

Monster by Kevin Morris

As a child I feared a monster tall,
a grotesque shadow on the wall.
I hurried to obey it’s every call,
Fearing lest it my life forestall.
Now I see a thing lothesome and small,
A ball of dirt upon the floor.
The monster’s presence can harm me no more,
Soon it will pass through death’s waiting door.

Some months back I did a guest post over at Kevin Morris’s blog. My first guest post ever! Today you all get to enjoy the reciprocal first guest post ever at Behind The White Coat, the poem above by Mr. Morris. Please check out his blog here!


Cambodia 398

“Doc, let me give you a tip. When you are talking to them about it, don’t sound upset.”


“Don’t sound upset.”

“Upset? When did I sound upset?” 

“The other day when you were talking about the way they were handling documents.”

“I WAS upset. They keep doing that no matter how many times I talk to them without sounding upset. THEY ARE JUST NOT LISTENING. I don’t do that all the time, do I?”

“I’m not keeping count…”

“Ok, but I wasn’t yelling or making accusations or throwing things or cussing. I let them see a glimpse of how crazy this makes me feel.”

So I have been thinking, what is wrong with showing emotion? Should we not show anything but positive emotion? Should we cocoon ourselves in a fake PolyAnna land where we all go skipping along singing about the birds and the trees? Sterilize the world of all negativity?

I have been telling my kids that anger is not the problem, it is what you do with it that matters. Is that wrong? Should I teach them to supress it or how to use it constructively and respectfully? 

I just don’t know anymore….


Cambodia 546

“I went to the drive through and got the biggest thing of popcorn chicken they sold and I ate every last bit of it in the car.” She had that numb, dead look in her eye that I had seen before. “Then I pulled over on the side of the road, stuck a finger down my throat, and made myself throw it all up.”

“You’ve done this before?” I asked in disbelief. “You are bulemic?”

She nodded. “Since I was a teenager. I hadn’t done it in a year or two, though.” I had been seeing her for over ten years and not an inkling of this was ever spoken of before. 

No clue.

“Why did you do it this time? What the hell happened?” 

“That new pulmonologist you sent me to? She’s as skinny as my pinkie. She says to me as soon as she walks through the door, before we talk about anything else, ‘You are obese! You need to lose weight. The only way you will be able to lose weight is by having bariatric surgery.'” 

Tears were starting to roll down her face. I handed her the Kleenex box.

“The thing is, Doc, she doesn’t know me from Adam. She has never met me before. She didn’t even try to get to know me. She just looked at me like I grossed her out.”
“Did you do any more binging and purging?”

“Every damn day since that appointment.”

Years of slowly getting her to change her diet and lifestyle, getting her to start exercising (using that nifty mini-elliptical machine I wrote about before), getting her to lose weight in the healthy way…. It had translated into her actually losing weight for a few months. Twenty pounds.

ALL down the drain. 

Often, when we think we have someone’s best interests at heart, we have no clue what they really need. It is easy to forget that a few words can tear someone down so thoroughly, so quickly. Thirty seconds to undo 11 years of work is a sobering thought. 

With the ACE study linking severe obesity (and even autoimmune diseases) to childhood trauma, evidence now of a genetic link to being overweight, the realization that the bacteria in the gut are different in people of different sizes…. There is much more at play here than someone simply having a sloppy lack of self control. 


Remember kindness. Always, always kindness.

You Misdiagnosed Me…


Sometimes finding the right diagnosis is a process. The horses must be ruled out before we can go looking for the zebras. Or, maybe you are not far enough in the disease process to present the right symptom clues.

Do you know how many things can cause fatigue?!?!?

We do our best. No physician wants to miss something. 

Call it pride if you like. We want you better because we don’t like to watch you suffer but also because it makes us look good.

We don’t have a crystal ball. 

Personally, I would pay through the nose if you have a lead on a good one…

Sometimes we get it wrong. 

We are imperfect humans, after all.

That does not mean we don’t care.

Let it Fly!

The pants I wore yesterday were not flattering at all. Not one bit. I knew this when I put them on. I didn’t like them when they arrived on my doorstep after ordering them online and I do not like them now.

In fact, they have been taking up space in my closet for nigh on two years now because I could not ever bring myself to wear them out in public. As it turns out, it is very, very difficult for me to get rid of things I have never worn. I feel terribly guilty (Perhaps a throw back to the fact that as a kid my clothes all came from Goodwill?) so I hold onto them in the hopes that something someday will change. 

Maybe they really aren’t that bad? I only have to wear them to find out. Yet, I have pants that I really do like so I wear them instead. But still, maybe? And so on and so on.

Dust collects.

After going through my closet last weekend, I decided to go ahead and just wear the stupid things so I could get it over with.


Of note, there is nothing like a bad pair of pants to throw you completely off your game and no manner of fancy panties can remedy that fact.

Those pants have now gone off to the throw away bin. I will not inflict them upon someone else! 

Hold On To Your Pants!

 Old steam engine at the depot. 
I have been going through my closet with the intention of updating my look for the clinic.

There are two things I have to say:

#1, Thank the heavens above that wide leg cropped pants are now back in style. I loved them then and I love them now.

#2, Thank heavens I did not throw out the ones I used to wear 7-8, even ten years ago. (How long ago was that exactly, anyhoo, and can I call them “vintage” now?)

Woohoo for clothes hoarding!!!!

Also, if skinny jeans come back around, I will be completely out of luck…


“Well then, doc, I think I need to tell you something….”

“Ok.” I waited. I could tell from the look in her eyes this was going to be bad.

“So, I was having a cavity taken care of a few weeks ago when the dentist stuck herself with the needle. They told me that I had to get tested for diseases. So I did. I had my blood drawn. It came back positive for HIV.” 

She paused for a moment not sure what to say next.

“So we need to set you up with an infectious disease specialist, huh?”

“Yeah.” She ran a hand through her hair. “I need someone who is really good. I’m scared.”

She looked normal. She didn’t appear ill. There was nothing about her that screamed out, “I am high risk for HIV!” 

She never would have known about the HIV if her dentist had not made a mistake and then admitted it and then gotten her tested.

And there was now a dentist somewhere who was worried that she might have contracted HIV herself. Was she taking meds? Losing sleep? 

I remember listening to a physician who said she had contracted HIV from a needle stick. She was talking to us in medical school about the importance of safety measures on sharps, of being careful. We all thought she was such a loser. We would never make such a stupid mistake. It would never happen to us, you know?

Until it does.

We all get stuck.

Three times for me, so far. I remember each. Once while placing a central line in a gravely ill patient with sepsis. Once in the OR during an abdominal surgery (the surgeon’s fault actually, I was assisting). Once after injecting a joint in the office.

There is the wait. What is lurking, hidden in that blood? My blood? Pain. Sure it hurts. But will I die?