The Placebo Chronicles

by FARRAGO, DOUGLAS MDMARSHALL, GORDON W.

• ISBN13: 9780767919494
• ISBN10: 0767919491
• Edition: 1st
• Format: Trade Paper
• Copyright: 2005-04-12
• Publisher: Broadway Books

Summary

True Tales of the ridiculous, the silly, and the just plain weird cases doctors facelampooning the medical bureaucracy that makes practicing medicine and getting medical care such a headache. Doctors have a sick sense of humor. This is the deep, dark, and hilarious secret of the medical profession revealed by the irreverent Dr. Douglas Farrago in his popular satirical magazine,Placebo Journalaffectionately known by its thousands of fanatic readers as "Madmagazine for doctors" and called, byU.S. News.com, "raunchy, adolescent, and very funny." Now, inThe Placebo Chronicles, Dr. Farrago has compiled the best of the most outrageous and uproarious true stories to come out of the ERs and examination rooms of doctors all over the country. Submitted by actual physicians, these are the stories they tell each other at cocktail parties and in doctors' lounges, trading sidesplitting and truly unusual tales of their most embarrassing medical moments, the grossest things they've ever seen in medicine, their favorite Munchausen patients, and much more, including "The X-Ray Files"mind-boggling anecdotes and images of the oddest foreign objects doctors have removed from patients. Not for the faint of heart, the humor inThe Placebo Chroniclesis brutally funnyjust what the doctor ordered to guard against the ill effects of an M.D.'s worst enemies: the Medical Axis of Evil, a.k.a. drug companies, HMOs, and malpractice insurers. Fully illustrated with fake advertisementsfor pseudopharmaceuticals like OxyCotton Candy and Indifferex (the mediocre antidepressant)this refreshingly honest collection invites doctors and patients alike to share the laughter, a liberal dose of the very best medicine.

Author Biography

<p><b>DR. DOUGLAS FARRAGO</b> is a family physician who started the bimonthly<i> Placebo Journal</i> in 200. A frequent lecturer and media commentator, Dr. Farrago lives in Auburn, Maine.</p>

Table of Contents

INTRODUCTION	1	(3)
MEDICAL SCHOOL
Introduction	4	(1)
Stages of the Physician	5	(1)
Medical Students' Revenge	6	(1)
ER Stuff	6	(1)
Maggots/Magnets	7	(1)
Those Darn Narc Seekers: Talk About Blowing It	8	(1)
Smudge	9	(1)
X-Ray Files:
The Big One • Here Kitty, Kitty	10	(1)
Lord of the Rings	11	(1)
A Salute to the Barn	12	(1)
Medical School Mishaps	13	(1)
Why I'll Never Forget The Summer of '92	14	(2)
A Medical Student Translation Guide for Patient Complaints	16	(1)
Synchronized Swimming	17	(1)
PJ Consulting	18	(1)
Millennium Stethoscope	19	(1)
Picket Fences	20	(1)
Bot Fly on the Brain	21	(1)
Respect	22	(2)
Those Darn Narc Seekers: Perc or Drip?	24	(1)
My Favorite Munchausen: Lymphedema Lucy	25	(1)
Moody	26	(1)
True Tales of Mistaken Identity	26	(1)
Anomaly	27	(1)
FUBIGMI	28	(1)
Make Your Questions Clear	28	(1)
Escapee	29	(1)
Everyone Needs a Nickname	29	(1)
Going NUTS in Anatomy Lab	30	(1)
Cracking (Up) the Code	31	(1)
Medical Memories from the University State Pen	32	(1)
"Well, don't come to my house!"	33	(1)
Night Stick	33	(1)
The K-Y That Got Away	34	(1)
The Surrogate Patient	35	(1)
Zingo!	36	(1)
Que?	36	(1)
MYAGRA	37	(1)
My Favorite Munchausen: I Could Sure Use Some Fresh Air	38	(2)
THE RESIDENT
Introduction	40	(2)
Timing Is Everything	42	(1)
X-Ray Files: Drinking Buddies	43	(1)
Nightmares	44	(2)
Puzzling	46	(1)
"Get Me Out of Here!"	46	(1)
CYANARA	47	(1)
Those Darn Narc Seekers: Armed and Dangerous!	48	(1)
My Favorite Munchausen: Just a Stone's Throw Away	49	(1)
CHUX	50	(2)
A Sticky Situation	52	(1)
Trauma Alert	53	(1)
First Night	54	(2)
Pasta Anyone?	56	(1)
Ouch!	57	(1)
Bright Lights	57	(1)
Diener	58	(1)
Rub	58	(1)
UTERALL XR and PLACERTA LA	59	(1)
Potato Love	60	(1)
A New Year	60	(1)
Need a Bed	61	(1)
Now That's a Rectal!	61	(1)
Those Darn Narc Seekers: No Self Defecation!	62	(1)
My Favorite Munchausen: Rosey the Red	63	(1)
Digit of Death	64	(1)
New Medications for Smokers	65	(1)
Those Darn Narc Seekers: Hamburger Upper G.I.	66	(1)
A Little Premature	67	(1)
Shrunken Head	68	(2)
Problem?	70	(1)
Sleep Study	71	(1)
Teachable Moment	71	(1)
The Wig	72	(1)
NORDART Contraceptive	73	(1)
My Favorite Munchausen: Pheo, Phio, Pho, Phum	74	(1)
X-Ray Files: Throckmorten Sign with a Twist	75	(1)
PBJ	76	(1)
Are You an Investigational Whore?	77	(1)
Never Too Late	78	(2)
THE NEW DOCTOR
Introduction	80	(2)
"I Gotcha!"	82	(1)
Windy	83	(1)
Top Ten Clues	84	(1)
Just Can't Get Pregnant	85	(1)
Here's One Way to Beat the System	85	(1)
Those Darn Narc Seekers: Laboring Over Her Pain	86	(1)
My Favorite Munchausen: Paul the Popper	87	(1)
Language Problems	88	(1)
Voice Recognition Blues	89	(1)
Hot Diggity Dog!	90	(1)
Garbage Can Lady	91	(1)
Life on the Farm	92	(1)
In the Navy	93	(1)
"Committee" Committee	94	(1)
Too Personal	94	(1)
Out of Body Rounding	95	(1)
Make Money Naturally!!	96	(1)
X-Ray Files: Oral Hygiene	97	(1)
5 Effective Techniques to Help You Communicate with Pharmaceutical Representatives	98	(2)
Death by Moving	100	(1)
My Favorite Munchausen: Clipping	101	(1)
Power Lunch	102	(1)
Lucky	102	(1)
CAMELOFF	103	(1)
Flatus Maximus	104	(2)
A Problem Patient Comes and Goes	106	(1)
Hairpin Curve	107	(1)
A Bad Itch	107	(1)
A Stitch in Time	108	(1)
XRay Files: Remote Control	109	(1)
Strike a Pose	110	(1)
BILL MILLIONAIRE	111	(1)
Scooby Snack	112	(1)
True Anecdotes	112	(1)
A True Diagnosis	113	(1)
X-Ray Files: Make 7 "Up Yours"	113	(1)
My Favorite Munchausen: Insulin-Cravin' Sweet Teeth	114	(1)
8 CM - The Movie	115	(1)
Benzo Begger	116	(1)
The Timmy Fund	117	(1)
Those Darn Narc Seekers: Have Stones, Will Travel	118	(1)
Top Ten Ways a Drug Rep Pisses Off a Physician	119	(1)
X-Ray Files: Butt Light	120	(1)
SCAMBIEN	121	(1)
Those Darn Narc Seekers: Yellow Bill	122	(2)
THE EXPERIENCED DOCTOR
Introduction	124	(2)
RI Explains the 80/20 Rule of Medicine	126	(2)
Doctor, I Can't Keep It Up Much Longer	128	(1)
Be Careful!	129	(1)
Top Ten Things Your Mother Always Told You to Do That You Wish Patients Listened To	129	(1)
Physician, Heel Thyself	130	(1)
PJ Explains Bowel Obsession	131	(1)
Top Ten Ways to Get "Hunkered Down" Patients Out of the Hospital	132	(1)
Back in the Day	133	(1)
New Doc vs. Old Doc	134	(1)
Here Kitty, Kitty	135	(1)
INDIFFEREX	136	(2)
PJ Says: Suck It Up!	138	(1)
Cold as Ice	139	(1)
Creams Don't Work	139	(1)
The Doctor's Rules	140	(2)
Those Darn Narc Seekers: Jack'n the Back	142	(1)
My Favorite Munchausen: Something Doesn't Smell Right	143	(1)
"Hear Today, Gone Tomorrow"	144	(1)
Let Them/Her Eat Cake	145	(1)
Smelly Feet	145	(1)
PJ and a Barrel of Monkeys	146	(1)
XRay Files: Bright Idea One and Two	147	(1)
Not So Bright Idea	147	(1)
COPD Terrarium	148	(2)
List of Bad Prognostic Signs	150	(1)
Answering Service Tips	150	(1)
PJ Explains "Why HMOs Can Kiss My Bony White Ass"	151	(1)
Hospice Tales	152	(1)
GODIVAPHAGE XR	153	(1)
Stand Up! Quick!	154	(1)
Radiology Woes	155	(1)
Learn to Talk Administralian	156	(2)
PJ Talks About ED	158	(1)
Case Records of the Placebo General Hospital	159	(1)
Official Physician Hand Signals	160	(2)
ARE YOU SICK?	162	(1)
OXYCOTTON CANDY	163	(1)
Thoughts from an "Experienced" Doc	164	(1)
X-Ray Files: Bolt • Doh! • Bird	165	(1)
War Is Hell or What's That Smell?	166	(1)
A 2 A.M. Phone Call	167	(1)
Duct Tape	167	(1)
Diary of a New Drug Rep	168	(2)
PJ Explains: Smoke 'Em If You Got 'Em	170	(1)
Why Couldn't You Hate Me?	171	(1)
ALCOFERON	172	(1)
X-Ray Files: Easter Bunny	173	(1)
Medical Brush with Greatness	174	(2)
Get Off the Road	176	(1)
Is IT in You?	176	(1)
She Was NOT Out of Earshot	176	(1)
Top Ten Ways Physicians Piss Off Drug Reps	177
Dementia Safe INVISIBLE FENCE	176	(3)
X-Ray Files: Hungry Like the Wolf Cookie Monster • Kenny	179	(1)
Things I STILL Don't Understand After Being in the ED for 15 Years	180	(1)
Strategic Filibustering	181	(1)
Top Ten Things I've Always Wanted to Say to Patients	182	(1)
After 30 Years as an ER Doc: My Favorite True Stories of Medicine	183	(1)
More Than a Pen Whore	184	(2)
Gunpoint B#owjob	186	(2)
My Favorite Munchausen: She's No Coloring Book	188	(1)
CONCLUSION	189	(1)
Acknowledgments	190

Excerpts

Medical School

The long, grueling process of becoming a doctor begins with medical school. It’s four years of hell after college. It was the hardest thing that I had to go through in my young life until, of course, residency, which was even worse (you will read about that in the next chapter). Just getting into medical school is an incredible feat in itself, the first of many Darwinian trials an aspiring doctor faces. You need exceptionally high college grades, which isn’t easy because competition grows stronger and stronger. As time goes on, the weakest students give up and the strongest students hang around, totally screwing up any type of testing curve. The pressure to succeed is enormous. I remember the shock of my first chemistry class in college. There were five hundred people in it and almost all of them, including me, wanted to go medical school. Only ten or twenty would succeed. No one would have predicted I would be one of those ten or twenty. Not even me.

In medical school, the whole competition process starts all over again. The testing is outrageously hard and the hours are ridiculously long. The first two years, the medical student actually has minimal patient contact since he or she is wrapped up doing the basics of science including biochemistry, neurology, chemistry, histology, etc. When the “clinical rotations” start in year three, the real fun (or horror) begins. Here is where the student spends months at a time seeing patients in such areas as internal medicine, surgery, emergency medicine, and obstetrics. Finally, young men and women who are tired of just the textbooks get a chance to try to treat live patients. This is a real eye-opener for them. This is when they start to see it all and feel it all. This is where they learn to develop their defenses against the gross, the sad, the disturbing, and the outrageous. I am not sure if having such thick skin is a good thing for doctors or not, but it is our basic survival mechanism to deal with these types of things. Seeing children die, arms that were severed, hearts splayed open, yellow patients, green patients, and blue patients are shocking, but a reality nonetheless. Any time taken to wallow in their own pity only takes time away from seeing other patients. The student buries his or her emotions to do his or her job and learns a valuable lesson: Medicine is not pretty.

I remember in my first anatomy class there was this sweet girl who was initially very bothered by the cadavers. The school had done all the right stuff to slowly introduce the new students to their “bodies.” There were prayer sessions for those so inclined. There were warm-up periods so that people could acclimate to the cadaver. Still, people were squeamish, especially this one young woman. I didn’t pay her too much attention because I had enough work to do on my own cadaver. I had totally forgotten about this student until halfway through the semester when I saw her walking by, whistling, with a sawed-off leg over her shoulder like a slab of meat. I thought to myself, “Haven’t we got a little sassy?”

Now picture yourself as a medical student. See yourself trying to save a life all the while questioning whether you know what you are doing. You’re nervous and exhausted. You’re hungry and overworked.

All you care about is sleep (and hoping you don’t kill someone). As you become more and more disconnected from the real world, you fall more and more into the medical one. All you can remember are the basics of survival and those weird, gross or outrageous experiences that occurred during your dreamful “medical student” state. It is these patient encounters or stories, however, which you will remember forever. It is these stories you will collect like a hobby. They are ones you will never share with patients and only occasionally share with one another. They’re not for the faint of heart but they are yours and yours only – until now. The following stories are ones that we have pried, bribed, or extorted from former medical students who have endured this torture. Their collection is now, for the first time, open for your perusal, but it comes at a cost. After reading them, you may become thick-skinned yourself and for that we have but one cure humor. These doctors didn’t laugh about their medical student experiences at the time, but trust us, they are laughing about it now. We hope you can do the same.


STAGES of the PHYSICIAN

I want to help people.
I want to make it through this hell.
I want to make it through this hell without killing someone.
I may have killed someone.
I want someone to help me.

I want to make money.
I want to spend money.
I want to save money.
Where the hell is my money?
I need to make money.

I don’t know anything.
There is too much to know.
I will never know all of this.
I don’t need to know all of this.
I only need to know a little.
I don’t care if I know anything.

I want to be needed.
I love my white jacket.
I love the power of the pager.
I hate this f*cking pager.
I don’t want to wear a stupid jacket.
I want to be left alone.

This patient has some interesting problems.
This patient has some real disease.
This patient needs to be hugged and loved.
This patient has a lot of nothing.
This patient has Sh*tty Life Syndrome.
This patient needs to leave; I need to be hugged and loved.

Our OB-GYN rotation at a busy inner-city hospital was one of the most grueling of medical school. The residents were miserable and as all miserable residents do, they torture medical students for relief. One particularly sadistic senior resident was on call with us on Friday night, one of the busiest of the service. He would extract as much scut from us as possible and he was merciless in his criticism. Any procedure we would attempt was quickly taken over by this impatient resident. Since it was the last day of the rotation, I was eager to finish a call and never touch a speculum again. My medical student colleague, however, had only revenge on his mind.

At around 3 a.m., we were called to the ER to work up a morbidly obese patient with “itching down there.” After our thorough history and cursory physical, we called the senior resident. In his usually abrupt manner, he dismissively listened to our presentation and proceeded into the room for the exam. The patient put her legs on the stirrups, but as with most morbidly obese patients, there was no hint of the vagina except the odor and converging folds of endless flesh. Even the sweat in between the rolls of cellulite gave an additional pungency to the aroma.

“I’m sorry I’m so fat, doctor,” she kept repeating half sleepily. With much reluctance, we each held back a thigh so our fearless leader could plunge into the depths with his speculum for his examination. As our resident diligently probed flesh with his speculum, my medical student colleague looked up at me with a gleam in his eye and a wink . . .

Thwack!!

He had let go of his thigh and I instinctively did the same . . .

Thwack!!

I will never forget the seemingly headless senior resident flailing his arms trying to free himself from the deluge of flesh and odor that was delivered onto his bare cheeks. He was now cheek to cheek with our sleepy patient who barely reacted to the fracas. We quickly regained our composure and insincerely apologized to our resident, who tried his best to proceed with his exam. The rest of the evening just seemed to pass by effortlessly and our senior resident was much nicer to us for the remainder of the shift. _

ER STUFF
As a very green third-year medical student in Bellevue Hospital (NYC) emergency room, I spent much of the time wide-eyed and terrified. With its surreal mix of the heroic, overwhelming, and bizarre, Bellevue ER was a great place for memorable patients and events that have stayed fresh in my mind for years.

One shift I noticed a man on a stretcher having a grand mal seizure. This seemed to make absolutely no impression on the surrounding patients, or the staff for that matter. Just as I was really getting worried, a nurse strode past, said to the patient,
“Oh Jack, cut it out!” . . . and he did.


My story begins when I was a fourth-year medical student at a large inner-city emergency room. I was doing a required rotation taking twelve-hour shifts and working closely with an intern as well as an attending ER physician. I enjoyed the fast pace of the big city ER but did experience significant anxiety when a code was underway or an imminent or a major trauma was unfolding.

The attending wanted me to see patients, assess them, and formulate a plan. I went to see what seemed to be my 100th patient this shift. Ms. Greenjeans was a 76-year-old female who presented with nonspecific pelvic discomfort. She had the usual past medical history including diabetes, tobacco abuse, alcoholism and substance abuse, hypertension, renal insufficiency, etc. Her abdominal exam was unremarkable, but as we all know, “No abdominal exam is complete without a pelvic exam.”

The forty-bed ER was nothing more than a large room separated by pull curtains that do provide visual privacy but do not provide much privacy in regard to conversation. In other words, the whole ER including patients, staff, etc., can hear every word I say to the patient. Ms. Greenjeans was morbidly obese and hard of hearing so this pelvic exam would likely be difficult but, considering I had done two pelvic exams in my entire medical career (counting this one), I thought I could handle it.

Ms. Greenjeans was placed in the lithotomy position with lifting help from nursing (#1: because nurses are much stronger than doctors; #2: because all doctors have “a bad back”; #3: because this patient’s legs resembled large, soft, fleshy bags of cottage cheese). I reached for a speculum not realizing that they actually came in different sizes. By chance, I chose a medium-sized model and inserted it into the vagina. Unfortunately, due to the size of the patient, I could barely see the labia
minora.

The ER nurse who was chaperoning my exam recommended a change in equipment. I looked up at the nurse with total confusion on my face as she handed me a jumbo-sized speculum resembling a small fishing vessel or salad tongs. I again inserted the instrument to get a better look into the vaginal vault. Words cannot describe the horror, surprise, and disgust as I watched several hundred maggots squirming to exit to the outside world. I jumped back suddenly, nearly falling on my butt. “This could not be happening? Why me?” I quickly ran over to my attending to tell him the news; he casually walked over to the business end of the exam table and confirmed my diagnosis.

“Yeah, those are MAGGOTS.” He then informed me that I should tell the patient her diagnosis and then proceed with cleaning them out of there. Sounded like a plan, but, why me, why here, and why now? I stood up at the head of the exam table and in my best doctor voice I said, “Ms. Greenjeans, you’ve got maggots in your vagina.” Suddenly the busy ER seemed so still, so quiet. I was sure everyone in the department could hear my every word. Ms. Greenjeans looked at me with a confused look on her face. She then yelled at the top of her lungs . . .

MAGNETS
HOW THE HELL DID MAGNETS GET IN THERE?



Talk About Blowing It

He was a passive guy and very laid back. When I saw him on the gurney I was surprised how calm he was. The ER physician had called earlier in the afternoon and stated that Frank was back because of his nausea and vomiting. He had a history of multiple admissions for gastroparesis from his diabetes. He truly had the latter disease and was insulin dependent. The gastroparesis was in question and previous testing never proved it. He was in his forties and had an obvious history of polysubstance abuse as well. He loved to smoke and drink and failed detox on many occasions. He also had chronic back problems, as well as the abdominal pain he claimed to have from his gastroparesis. His primary physician was tortured by him because she couldn’t shed him from her practice. She had him on 60 mg of OxyContin three times a day and held him to a narcotic agreement/contract. He never overtly broke the contract, but when he would run out of his narcotic medication early he would coincidentally have severe nausea and vomiting and abdominal pain. Subsequently he would go to the ER for admission to cover those days he didn’thave the medication he needed at home. Since dehydration can make diabetes lethal, it would be inappropriate to just ignore his demands and send him on his merry way. Even though no one ever saw him vomit in the ER, there was no one who would question Frank and chance the possibility of malpractice.

I knew Frank was a fraud and told him right away that I wouldn’t give him any more medication to go home with when I discharged him. He didn’t bite. I was expecting a fight but he just nodded quietly. He then rattled off the combination of antiemetics and narcotics he needed intravenously while he was an inpatient. It made the admission pretty easy and I put him in the hospital in about 10 minutes. By the second day of his admission, I had taken him off all his IV drugs and put him back on regular oral pain medication. Once again, no complaints. In fact, he was as nice as pie. Since I had never met Frank before, I was amazed at how easy admission was going and started to second guess the accusations about him. I told him that he should be able to go home the next day and he agreed wholeheartedly.

The next morning I was seeing a patient on the floor below Frank when I received a page by the nurses taking care of him. Since I was coming up in about five minutes, I didn’t answer, figuring I would see the nurses personally. When I opened the stairwell door to enter Frank’s floor I saw a huge commotion. About four nurses were buzzing around his room and two were frantic by the phone waiting for my call. Then I noticed that security personnel were mingling around as well. This is not good, I thought.

---

Excerpted from The Placebo Chronicles: Strange but True Tales from the Doctors's Lounge by Douglas Farrago
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.