The Toilet Excuse? Really?

“I need more drugs because I had a heart attack yesterday and in my monumental pain I flushed my Percocet down the toilet.”

I stare.

 

AWwww, MAN, I don't know WHAT happened, man.

“No really.  I’m serious.  I don’t know what’s going on with my heart and I accidentally flushed my drugs down the toilet when it was causing me, like, serious pain.  I REALLY need some more.  I’m in like 24/10 pain.”

 

“That’s a pretty strange fraction.”

“Well, that’s how bad it is.”

I hope my eyes are at least a little more than half-closed, “Dude.  That’s your excuse?  Really?  That’s the best you have for me?  Flushed?”  My ever-blindingly cheerful mood deflates a bit.

“Well, it was the case manager who told me to come to you for more Percocet.  I tode her Dr. SW101 isn’t cool with narcs, so I figured you wouldn’t go for it, but she told me to try.”

“So, the NURSE made you do it?”

“No…well (looks hopefully at me), uh, maybe?”

 

Dr. SW101 set me UP!

He did utter one truth, I’m not cool with writing for unfathomable doses of highly-addictive, mind-altering substances that have outrageous street value and regularly cause the utter destruction of families, careers and lives.

 

He’s right.  I’m not cool with that.

Sometimes it feels like I’m just sitting in my clinic handing out bullets…each one stamped with “If this causes a disaster of any kind, please blame Dr. SW101.  His bank account number is 7749220485, and you can find his children at 13 XX street, usually after 6pm.  Punish him accordingly for making such a mockery of his Doctor’s Oath, society, God, the memory of Elvis, Stonehenge, Hello Kitty, Gooeyducks..and everything else even remotely sacred to humanity.”

But I’m used to that.  I’m used to being the candy man.  What I’m NOT used to, is being taken for so dimwitted that the medical equivalent of ‘the dog ate my homework’ excuse might work on me.

“You’re really using THAT one on me?”

“Look man,” (whips out his Blackberry Smartphone, provided free of charge by the Army to help with his healing), “I got pictures of the pills in the toilet.”

I decline the visual.  Don’t even need it.

“You’d need to pin my face to a cork-board with something in the range of 34,000 thumbtacks to talk me into giving you more narcotics with that lame excuse.”  I say.  What I DON’T say is that aside from fighting the good fight against blatant drug addicts (I do take care of true heroes; he’s not one of them), I’m just flat-out annoyed at the excuse.

“Frankly, you’re story is miserable.  Put in a little work, and you might score a few hits out of me for creativity.  I’ve been known to drop a few Vikes on someone just to tribute their impeccible style alone.”

“Style?”

“Yeah, you know, do some deep-thinking before you try get me to double your daily horse-halting, blue whale-euthanizing, brontosaurus-stupefying doses of addictive opiates.”

“Liiike, a better story?”

“Yep.  I loovvve fiction.”

“Um, like what?”

“The doc I’m replacing was partial to “I washed ‘em in my uniform”, so I’d say that’s a little, uh faded haha no pun intended *aHEM*, sorry, not making light of your “pain” or whatever, just a little side-joke for this glorious Army morning.  Anyway, where was I?”

“You were helping me come up with a story to score more narcs out of you.”

“Oh YEAH.  Thanks!  Let’s see, maybe I can help you….next time, try something along the lines of:

 

They're real. Seriously.

After a valiant but ultimately tragic battle, a saber-tooth tiger ripped your friend’s head off.  In desperation, you heroically dispatched said wildcat with your bare hands (careful with the back).  Then, without pausing to consider yourself, you gave him your ENTIRE BOTTLE of pills strong enough to drive the entire population of Gambia into rehab.

 

Unfortunately, when he swallowed them – since his head was removed from his body – your pills just dropped out on the ground, all slimy and spit-covered and quickly dissolved.  Thinking fastly, you propped his body up and then held his head over what you figured was the esophagus part of  your life-long friend’s neck so the remaining few pills – “Damn you, Johnny, swallow! – dropped out and settled into one of his neck-tubes, hopefully not the trachea.  Then you got him to a local ER, where they skillfully re-attached his head.

ONLY THEN, after your friend was recovering (he just might pull through, snif), did you think of yourself, realizing that you were, in fact, out of drugs for your endless back pain and heart attacks which you’ve been suffering from since you were born, 20 years ago.”

“That would work?”

“No.  But honestly, that story has more credibility than, ‘I flushed ‘em, brah, gimme some more.”

8 Pigeons? I’ll Check the Regs…

I love urban legends:  The one about the killer calling the babysitter from inside the house, or the acne that turned out to be a quivering pod of spider eggs.  You know, all those.

But my favorite is the one about how you can cause pigeons and seagulls to explode by giving them Alka-Seltzer.  I’m serious.  EXPLODE.

This myth is cool for the science-fair, medico-extravagance of it.  But I also harbor a fairly pathological grudge against seagulls.  Sure, their winsome cry carrying on the breeze hearlds the nearness of the endless sea.  Thousands of poems and stories and paintings concern themselves with these ocean-going fowl.  But I lost all romance toward the seagull when a GIANT group of them ate an entire bag – including the bag – of Chips A’hoy cookies while my buddy and I were surfing once.  I’m STILL looking forward to eating those cookies, and that was 8 years ago.

Why do they explode?  Apparently, birds have a one-way alimentary tract, which means they can’t burp.  Give them something effervescent, all that gas has nowhere to go aaaaand – POW! Alice, straight to the moon.

You can understand, then, why my favorite patient currently is a guy who actually tested this one-way-no-burp-POW! theory.  For all my grudges against the birds, I’m still too much of a softy to actually blow them up.

Not Jake, though.  He went for it.  And still doesn’t feel bad about it.

He went with pigeons – same class as seagulls, if I was the ornithologist in charge – and trying out the theory got him kicked out of the Army.  ’Course, he tried it on 8 birds at the same time.  After he stuffed them into his commanding officer’s new Chevy Tahoe.

“So, it really works, then?  They blow up?”

“Yeah, it works.”  He said, looking bored and chewing on a cuticle as I nearly wept with laughter.

“They ALL exploded in your commander’s car?”

 

Uugggh, did you eat a bunch of those little white crackers too?

Suddenly he perked up, eyes sharp and intelligent, “Nah, not all of ‘em.  Some just shit all over the place.”

Imagining his commander’s reaction the next morning after finding the most colossal mess of all time, just brightens my day every time I think about it.

 

By some miracle, this guy got away with his life after that episode.  More miraculously, after getting CHAPTERED out of the military (basically a court-martial without the court or jail), he got back into the Army just a few years later. “On a wavier for bi-polar disorder, in remission.”  He said with a wicked smirk.  ”Needed a paycheck.”

I can only imagine the ever-positive recruiter.  ”Oh, well, 8 pigeons?  Only 8?  I’ll check the regs…there’s probably nothing in there that expressly forbids entry into the military for blowing up birds.  No problem, man.  I’m sure we’re good.  Now, I can’t promise you a bonus, you understand..”

Now he’s on his way back out of the military, via my unit.  He’s wry, filled with black, intelligent wit and flat-out hates authority.  I’m not sure I’d call this a mental disorder… but in the Army, a guy like this is nothin’ but stark-raving nuts.

Of course, once he gets bored…he’ll be back.

 

POOF!

 

 

20

Giant Party at the Brandenburg Gate

20 year ago tomorrow, the Berlin Wall was breached.  The first East Berliner to make it across – legally – was a woman named Angelika Wachs (news to me…old hat to everyone over here).

Algelika Wachs

My favorite band of all time – U2 – performed a live show in Berlin this past Thursday to start the festivities, which will continue through this week.  We live 3 hours from Berlin, and may as well still be in Olympia, unfortunately.  The celebration isn’t history…but it will get close and I’d love to be there.

The U2 show was free.  All you had to do was get a ticket via the internet.  And you had to do it within a 3 hour time-span because that’s how long the 10,000 available tickets were available.  Being a free concert, you might find the need for tickets a bit ironic.

Even more ironic:  if you didn’t have a ticket, you couldn’t see the show.  Why?  Because MTV (the show’s producers) had erected – you guessed it – a WALL to obscure the performance.

Danger: Broccoloi

 

An R-rated food. Must be 17 or accompanied by adult to eat safely.

Highly-intelligent child holds up half-eaten stem of steamed broccoli:

“Dad, will this make me dead?”

 

Family doctor Dad replies, “ABSOLUTELY, son.  Some stuff just wasn’t meant to be eaten by 3-year old boys.  Put it down quietly before you mom sees, and go get the chips.”

Collapse!

I'm SO sick...can't taxpayers just pay for my life?

Patient: “I think my body is shutting down” (but really I just want you to write me a doctor’s note saying I never have to go to work again d/t incurable back pain)

Me:  ”No, you’ll be fine. And sorry, but you need to go to work.  Neurosurgery won’t see you any more.  Pain management won’t see you anymore.  Things are as good as they’re gonna get.”

Patient:  Ok.  Well, thanks for try…try…uh….”

Stands half-up, then collapses on the floor.  ”Unresponsive”

Nurse:  OMG!  Call the ambulance.

I lift up her arm, hover it over her face, let it drop. “Limp” arm performs a curious “S” shaped drop maneuver, conveniently missing her face.  Vitals: 121/87, HR 84

Me: “You’re fine, ma’am.  Just let me know when you want to wake yourself up and get off the floor of my office.  I’ll be over here charting.”

Patient:  Suddenly revives…miraculously.  ”What hap…happened?”  Gets off the floor and returns to her chair.

Me: I have no idea.  See you in two weeks.

Her little episode didn’t even make it into my note.

Numb and Numb-er

I’m happy to announce that I now drive a Mercedes-Benz.  It’s true.  A real in-the-steel-and-glass Mercedes.  The model is a C-180, which is the 4-cylinder, 4-door model.  The smallest engine they make (great gas mileage).  To boot – it’s green, my favorite color.

I’m a doctor now, people.  Apparently helping sick people entitles me to the high-life.

Truth is, here in Germany, the term “hooptie” is a known, legitimate noun.  The term is used to describe nice German cars that are (usually) bought by Americans and then run into the ground.  You can pick up BMW and Mercedes hoopties for 500 euros.

 

Mine looks just like this one...but way cooler.

My car isn’t exactly a hooptie.  In the States, it would probably have cost at least $5,000, maybe more.  I don’t really know because I’ve never been in the market for Mercedes-es.  But I got mine here for a few thousand bucks.  It’s still in good shape and as long as I take care of it (an expensive proposition in Germany), it should get me around for at least a few years.

That is…unless it takes a few years until my new monument to affluent living is allowed to take me anywhere.

Take the Army’s torrid and longstanding love affair with bureaucracy and combine it with 1000 years of rulership of the masses in Europe, you get the process I dealt with just to be allowed to drive a car.

Buying the car is easy.  But in this Germo-Americo Funkenthink, the quagmire starts there.  You first need a special driver’s license, which requires a half-day class and then a 130 question test ( which I immediately failed by about 15 questions).

You also have to have insurance on a car before you actually register it.  And, the car needs to be inspected.  But you can’t drive it to the inspector’s unless you have it registered and insured.  But if you fail the inspection, you’ve just registered and insured a car that sucks.  So, you have to de-register it (I did that – twice – before I settled on the Mercedes).  De-registering requires a trip to the local customs office (American) plus a second trip to the other customs office (German, 35 min drive), numerous forms, money, waiting and…all the while you still need the insurance.

So, I’ve been a little reticent to drive much unless I have to.  I’m always wondering if I actually have all the paperwork and proof that will allow me to stay out of jail were I to get pulled over.

Instead, I came up with an alternative (heh, heh):

Through some highly unfortunate events in my brother’s life, I ended up with his Harley motorcycle.  Now, make no mistake – I owe him for this very expensive bike.  It was a ‘take-care-of-my-hoss-for-awhile’  kind of proposition.  Of course, being a deeply loyal brother, I immediately agreed to “help out”.  But, not being a big Harley-lover, I…well, I sold it.  And I bought a BMW motorcycle instead.  Initially, I sold it to help fund out trip out here, and a portion of the Harley money was a HUGE help in getting us here.  That said, I GUESS whatever money we had left over should have been sent back to my saintly bro.  But with all these fantastic German road machines around, you sorta just get Beemer Fever.  What was I supposed to do?

And anyway, my bro is about 10,000 miles from me.  Is he really going to come get me when he realizes I sold his Harley?  I mean, c’mon, I did the guy a favor!  BMW vs. Harley is a no-brainer.

 

Mine's just a LITTLE less shiny and has panniers.

So I now fly along the German Autobahn on a R1150 RS BMW.  Riding a bike like that, in this part of the world (any part of the world if you worship BMW bikes) is an experience that is hard to replicate.  Harder to describe.  At 80 miles an hour, I blow by stunning autumn trees, taking in their blurred resplendence in shimmering hues of gold and yellow and red.  ”My” bike purrs along effortlessly.  When I lean over the gas tank and duck behind the faring, the engine sounds something like a sewing machine, but even softer, maybe more like two feathers rubbing together.

There’s only one problem…Germany is COLD.  The other day I left for work in the dark, road sparkling with frost, at a temp of -2.5 Celsius.  Buh-rrr.  And this is only OCTOBER.

The night before, I had received a notification in the mail that my car did not have the correct license plates due to a dating error in the – you guessed it – insurance policy.  So, should I be pulled over in my esteemed Mercedes for any reason, I could expect to be hog-tied, whipped and sent back to the States crisply folded into a shoe box.

Thus, while my longsuffering wife dealt with the paper-pushers in Hiedelburg, I rode the bike to work, frost and chill notwithstanding.  I do have some decent riding gear I picked up when I first got the Harley.  I have a jacket with armor in the shoulders and arms, and pants with knee and hip pads.  I have big thick gloves – also a “gift” *ahem* from my bro – and good riding boots.  All the gear is made to withstand serious wind and rain.

 

"Got a little nippy back there going through the pass, eh Har?"

But I’m not sure any gear will hold up for long when receiving a direct 80 MPH sub-freezing air blast for 40 straight minutes.  Mine didn’t.  By the time I got to work, I was so cold most of joints wouldn’t bend.  I walked into the clinic like I was in a body-cast.  I don’t think I even spoke to my first 3 patients that day because I couldn’t unclench my jaw.  I just nodded compassionately with my hands buried in my armpits and gave ‘em whatever drugs they wanted.

I probably should have just sold the Harley and given whatever money we didn’t need back to my brother.  But instead I chose to buy a Beemer with the extra cash and freeze my face off in Germany.  If you love BMW motorcycles, you’ll understand completely.  You’ll probably applaud me for such a wise and intelligent idea.

I’m cheering, anyway.

Sunday Church, German Autum

Unforgettable….

At Least Insurance Is Unhappy

The day that medical insurance execs and medical malpractice lawyers are screaming that their sky is falling, is the day that the U.S. has gotten serious about health care reform.

It sounds like half that equation is at least whining, so maybe some modicum of real reform is coming.

If You Want to Learn English…Move To Germany

The German village where we now live – Bruchmulbach – is surrounded on all sides by American military bases.  And we’re not talking quaint Alamo-throwback musket armories, either.  The bases around here are the real deal.

Ramstein – 10 minutes from us – is the largest Air Force base in Europe.  A totally self-sufficient fenced city, the installation comes complete with a 2-level mall, restaruants, sports bar with the requisite 38 flat panel high-def T.V.’s, 18-hole golf course, fast food, a police and fire force, grocery stores, gas stations, brand-new 10 million dollar pool facility (I’m lovin’that), preschool through high school and a wide array of corresponding sports teams, as well as a full-sized airfield with trans-continental military flights leaving and arriving daily.

Just up the road from us is Landstuhl Regional Medical Center, which is one of the largest military hospitals in the world and one of the largest hospitals in Europe, military or civilian.  As mentioned recently, I got lost in there and wondered if I would ever escape without the assistance of a space-time wormhole (I did, but it was close).

Oh, another thing your tax dollars fund is a complete bussing system to get all the civilian kids from their outlying German villages to the schools on the bases.  This made our initial choice to put all the kids in base schools a pretty easy one.  Teachers are shipped from the States all credentialed and up to the exacting standards of the U.S. Dept. of Education.  Schools have playgrounds and dry-erase boards and gyms and cafeterias.  The whole thing.

Little America.  Right here in the south of Germany.

But just the other day, I saw a patient who has lived in Germany for 40 years…and doesn’t speak anything but rudimentary German.  Clearly, you can live an entire life here and never really learn the local language, the customs or the culture.

The military, actually, is trying for this.  Most of their people have been moved here, will move again in 3 years, and so the more like America their lives are, the better it is for these families.  You even spend U.S. dollars on the bases, even though everyone for hundreds of miles in every direction uses Euros.

But for people like me, who came here volitionally and want to intersect with this new world, this re-creation of where I just came from, isn’t such a welcome thing.  Cindy Lauper had some chops 20 years ago, but do I really need to hear “Time After Time” as I drive across the pastoral German countryside on my way to work?

Since the bases here are such a huge part of the local economy-  wait, amend that: They ARE the economy here.  They’re it.  We’re talking millions of dollars every year from these military operations.  As a result, along with all the completely Americo-centric base workings, the local area totally caters to Americans too.  As soon as you say you want to speak English around here…they just switch over from their German to usually a very well-learned English.  Walking down the street in Portland, if some guy came up to ask you a question and said he only speaks German, could you switch over and cordially address his needs in his own language?

I couldn’t.  Not in ANY other language on planet earth.  MY ways are the ways of the world, right?  I should mention, in my defense, that for a few ultra-geeky years in Jr. High I might have had some hope using Klingon, but again, we’re talking about this planet.  And if I did meet a monolingual Klingon speaker in downtown Portland, we’d have much bigger problems than mere cultural ignorance.

Anyway, our big decision (among what seems like a gagillion of them lately) was to pull the kids out of their American schools…and HOMESCHOOL them.  That’s right.  We’re pullin’ em out.  They can learn the 3 R’s in the AM, and work on German during the afternoons.  I’m hoping to find some nice German grandma who misses her kids to come over 2-3 times a week for cheap to tutor them as well, and we just bought Rosetta Stone, homeschool edition (created for monolingual parents with visions of grandeur).

If I leave here bankrupt and sick with some strange German microbe that ate the flesh off my face and all tips of my body…but my kids learned fluent German, I’ll be perfectly happy with our time here.  I promise.  No complaining.

Don't worry about German, kids, just keep up with your AMERICAN

The military base schools have a German “appreciation” class, but they should be ashamed of it.  It makes no attempt to actually teach the German language.  It’s just meant to let kids know about life in Germany (makes sense, if you live in Thailand).  The first class consisted of some guy opening up his laptop and reading off Bill Gates quotes – in English – about following your dreams and not letting anyone tell you you’re a loser.  Frankly, if enough people tell you you’re a loser – in, say,  French, German, Farsi, Hindu, Arabic, Japanese, Chinese and Russian – at some point, we Americans might want to listen.

And, when approached critically, I have to say that much of American school is laughable.  So much time is spent lining up, obeying, filling out forms and being entertained…I’m not sure that kids learn much at all.  We’re certainly not keeping up internationally (AGAIN!  Health care, education…what ELSE can the rest of the developed world do better than us?).

Hey man, I'm an ARTIST, man!

In France, for example, every village kid is entitled to real, genuine, music training in their local villages.  As part of their taxes, every kid gets a solid hour a week of actual music theory.  I’m talking just the bookish part of music for an hour every week, no instruments.  The boring stuff.  The hard stuff.  The stuff nobody has to learn in the States unless they REALLY want to do it, go to college to learn it, and spend 2 years on lower-level classes before they’re allowed to jump into the real thing.  This is America!  Learning is FUN!

Back to France:  THEN, kids get an hour a week of training on an actual instrument.  This would be the fun part.  The payoff for muddling through a weekly hour of theory.  They learn with a private instructor, in small groups of 4 or 5.  THIS is the way to actually learn music.  For American taxes, kids get some goofy music appreciation class where 55 kids sit around listening to “Bridge Over Troubled Water” while making sure to keep their legs crossed.  In my 6th grade music class, I got to listen to a recording of Janis Joplin mumble in a drugged stupor on stage until she collapsed.

It’s true that our 4 kids could end up total imbeciles.  I don’t think the U.S. Education system is totally worthless, and there are some good things about the schools that we will lose.  We worry about that.  But I think, given the options, that our Rosetta Stone + Grandma approach holds out at least as much hope of truly teaching our kids another language and culture than what is offered on the military bases.  With good curriculum and focus, we should be able to get them up to speed on the academic topics too.  We aren’t the first one to plow this field.

Then again, we’ve been at it a week.  I’m still all filled with principle and certainty.  We’ll see where we are in a month.

Get On the Plane!

Jerry reluctantly entered the WTU, the unit I oversee as a doctor, just recently.  This soldier has achieved about as much as anyone in the non-officer ranks can achieve.  He’s been in the Army for 24 years.  After 20, you can retire with full military benefits, but this guy hung on by voluntary extension for another 4.

He entered my unit because of a health problem list that runs to 6 or seven issues.  The primary ones being kidney disease and hypertension.  He’s had both for years.  All untreated.

“Why haven’t you taken care of this stuff?” I ask, ready to get all righteous on the Army.

“Well, you can only do what you can do, sir.”  He says, politely pretending that I would outrank him if actually a soldier myself.

“Um, do you know how long you’ve had hypertension, and how bad it’s been?” I say, trying a different angle.

“Listen son, I know exactly what my blood pressure was averaging before my last deployment downrange.”

“How many times have you been deployed?”

“3.”

Making no effort to hide my surprise, I reply, “You’re peeing out half a bicep in protein every 24 hours, your blood pressure is 190-101 today, and you’ve been deployed 3 times?  Each time for over a year?”

“Son, when the time comes, you gotta get on the plane.”

“So, you knew about all of this prior to deployment?”

“Which time?”

“ANY time!”

“Well, sir, yes I did.  But I told my men, ‘When it’s time, I’ll be getting on that plan.  If I don’t, I’ll be dead.  If YOU don’t get on that plane after me…I personally hunt you down, I will find you, and then YOU’LL be dead.”

“There’s doctors downrange, though, right?  Couldn’t you be seen by one of them?”

“Look, I cain’t treat myself too well with the boul-ets whistling over my head.  And I’m not gonna tell nobody that I got problems at a time like that.  They’ll send me back home and leave all my boys there to fend for themselves.”

“Right.  What was your blood pressure prior to your last deployment?”

The thin, muscular man thumbs through a huge stack of medical papers, “Hmmm.  I remember that day.  Headache, bad.  Seeing spots and stuff.  Hmmm.  Oh, here it is:  224/112.”

“That was your blood pressure before you left for a war zone!!??“

“Son, you won’t understand because you ain’t never worn no uniform.  But when the plane is for you…you get on that plane.  It’s pretty simple, really.”

“Do you think, just maybe, I can get you to take some blood pressure pills now?”

“Oh sure, doc!  You bet.  Army brought me back safe and sound, see?  Doing fine now.  I’ll take them pills.  Hooah, boy!”