There was a comic when I was a kid called “The Strange World of Mr. Mum.” Each strip featured an impassive gent in a small fedora who looked on, mum, at the odd things that always seemed to be going on as he passed by, like two masked crooks robbing each other at the same time.
Now and then things happen in my office that make me feel like Mr. Mum. I share them here without comment.
Tim, a 30ish architect with sandy hair, had petechiae around his eyes. I asked him whether he had been coughing very hard or straining at stool. Negative.
I mentally ran through other possibilities. Let's see, too old to be a baby born with a cord around his neck. … Tim broke into my reverie.
“Doctor, could walking on my hands across the office have anything to do with this?”
“Well, yes, Tim. Would I be out of line to ask why you walk across your office on your hands?”
“Oh, I just do it sometimes.”
Lynn flashed me a conspiratorial look. “Could your student leave the room?”
“Of course.” I shooed the kid out, wondering what private matter she had to discuss.
“I'm thinking of getting plastic surgery,” she said. “Tell me, who did your face?”
“What?!”
“No, really, just between us, I won't tell anybody. Who did your face?”
I managed to regain enough composure to say that I guessed I was flattered, but nobody did my face. She looked skeptical.
I didn't share this interchange with my student, who wouldn't have believed it anyway.
At a local medical conference, the guest speaker was giving us a heads-up on ICD-10. “It's going to be a lot more detailed than ICD-9,” she explained, adding that ICD-10 is slated to become mandatory in October 2013. (I heard some murmurs that October 2013 might be a good date to retire.)
The speaker flashed several examples of new ICD-10 codes on the screen. “For instance,” she said, “this is the code for a benign lesion of the left eyelid. And this [next slide] is the code for a benign lesion of the right eyelid.”
A doctor raised his hand. “What difference does it make which lid it's on?” he asked.
Some people just don't get it.
My heart sank when I entered the exam room and saw a young woman with grotesquely enlarged, hollowed-out earlobes that literally hung to her shoulders. What could she possibly want me to do with them?
Sue was quite pleasant. “See, this is how I make them bigger,” she said. “I make a cut at the top, and then put in a larger and larger coin to make the hole bigger until the skin heals around it. Now the earlobes are as big as I want them.” Well, yes.
“But here's my problem.” Sue pointed to a slight protrusion of tissue at the cavity's upper pole, at 12 o'clock. In other words, her problem was not the huge hole—the hole is what she wanted—but the scar at the top that impinged on the cavity and marred its perfection.
“In that case,” I said, “I can help you. I'll inject some cortisone into the bump and flatten it.”
“Fantastic!” she exclaimed. I gave her the shot and asked what her career plans were.
“Social work,” she explained.
Bob, in for a skin check, had a healing scab on his forehead. “Looks like you ran into a pipe and didn't duck fast enough,” I suggested.
“Not exactly,” said Bob. “I was making squid and shrimp pasta in the microwave. When all the pieces got nice and plump, I decided to test whether they were done, so I stuck a fork into one of the squid, and it exploded. Guess I was lucky it didn't get my eye.”
Microwave-induced exploding cats are said to be urban legends, but now you know, gentle readers, that exploding squid have been sighted. So don't forget to ask about them when you take your histories, as well as about whether your patients walk on their hands across their offices (or stand on their heads doing yoga).
I'll take my fedora off, for now.