Posts Tagged ‘Marlboros’

Application of medical first principles on a Tuesday in Keosauqua

December 21, 2010

Why do doctors go gray?

Is it all work and no play?

     Life can be a ball,

     Though you’re working on call,

Just don’t give in to dismay.

When I’m on call, nights or weekends, I get a lot of calls from people who have self-diagnosed an antibiotic deficiency and want a prescription called in.  Pain with urination, sore throat, and cough comprise the most frequent complaints.

I would like to say I don’t ever yield to the request, but on rare occasions I do.  I weigh the risk to the patient of treatment with an exam versus the risk of treatment without an exam.  Most of the time I’m pretty rigid, but flexibility sets in during extreme weather.  Last year a blizzard descended on Sioux City when I had Christmas weekend on call.  On a day when it took three hours to get from my garage to the street, I said “Yes” a lot.

Most sore throats do not benefit from penicillin.  Most pain with urination is not urinary tract infection.  Most earaches do not come from ear infections.

Today I saw four patients with painful urination, abrupt onset, accompanied by blood in the urine.  One had a urine infection.

I work very little to write out a prescription for three days of antibiotics; I work a great deal more explaining why the patient shouldn’t take antibiotics.

Of the last nine patients with pain in the ear, one had an actual ear infection.

Three other patients, all smokers with emphysema, came in short of breath today; they all left with prescriptions for antibiotics and inhalers.  One got a prescription for prednisone (a steroid).

On six occasions today I added up the costs of peoples’ bad habits.  “OK,” I’d say, “How much are you paying a pack for Marlboros/a bottle for Mountain Dew/a cup of coffee/a pack of generics/a case of beer?”  I got out my calculator and said, “Dang!  Eight hundred dollars/twelve hundred dollars/nine thousand dollars a year!  They must pay you well!  I’m a doctor and I couldn’t afford that.”

People who work with livestock in general and horses in particular don’t complain much, and if they do, I’d better listen.  I applied that principle twice today.

Three folks with mental health histories were in today; their complex medical problems took time.  I considered the principle that craziness doesn’t protect from physical illness.  I have a lot of lab results pending.

Four patients let drop the fact that a close relative had died in the last six months.  I listened and I sympathized.  I remembered the ten months after my mother died, when penicillin injections kept me going during a succession of eleven culture-proven strep throats.

Depressed patients get sick, and sick patients get depressed.


Basic economics for fourth graders, yoyos, and life lessons

April 26, 2010

On a beautiful day in the spring

I play with a toy on a string

            I teach kids not to smoke,

            So they’ll live long and not croak,

And have plenty of money for bling.


I am playing with a yoyo in front of a crowd of about  fifty fourth graders, teaching them economics, and in the process saving lives and stamping out disease. 

I start out by asking if they’ve ever heard the saying, “You can’t have your cake and eat it too.”  They all have heard it, and when I say “Raise your hand if you DON”T know what it means,” all the hands go up. 

The essence of economics, I explain, is that if you choose to do something, you choose not to do something else.  Then I hold up a cheap wooden yoyo, I do a few tricks, and I compare the cost of the yoyo to the cost of a pack of Marlboros.  Currently the smokes run $5.87 a pack, and I paid $3 for the yoyo fifteen years ago.  I pull out a $15 yoyo and I do a few more tricks.  I hand my calculator to a nerdy (I can use that work because I am a nerd) looking kid in the front row and have him calculate the Marlboro equivalency. 

I turn out the lights for the next one, it’s an $18 yoyo.  It is not particularly a good player but the kids love it because it lights up in the dark.

Then the $25 and the $32 yoyos come out one after another.  With each increase in yoyo price comes an increase in yoyo quality.  The kid who is running the calculator gives me the number of packs of Marlboros (much like the number of days of smoking) that could have been bought with the price of a yoyo.  I tell a few stories about the yoyo that I’m using and then I ask the kids which they would rather have, the cigarettes or the yoyo.  Invariably, they choose the yoyo.

I bring my Radian out from the vest pocket of the fishing vest I use for my yoyo shows.  I don’t particularly like the Radian though I can make it sleep for decades; it’s very difficult to make return.  But I do a long, involved series of tricks without rewinding.  I flub the retrieve but the kids don’t notice.  Then I announce the price, $105, and the students gasp.

I now have seven yoyos lined up on the desk at the front of the room.  I open up an octagonal cardboard box just big enough to hold a yoyo.

“This is a Samurai,” I say, “It’s a $200 yoyo.  If you can get one.  My wife bought it for my on our anniversary four years ago.”  Then I do The Matrix.

My hardest trick, The Matrix goes flawlessly through two rounds.  I can hear the breathless tension as the children watch the action.  The yoyo thumps firmly back into my hand and the room lets out a sigh of relief.

My calculator crony figures the yoyo would cost the same as 34 days of smoking.  When polled, the class would really much rather have the yoyo than thirty-four ashtrays full of cigarette butts and the health consequences of smoking. 

I explain why teenagers start smoking at age 15 and why they start with Marlboros.  I talk about the animal experiments, which completely grosses them out.

They call the program Tar Wars, a way of getting doctors and nurses out into the schools to try to get the message out:  DON’T SMOKE.

I have a great time at it.  I make the teaching tool concrete enough to be age appropriate.

Afterwards one of the students tells me about an uncle who died of alcoholism at age 36.  He had been dying of liver failure till he got into a fatal car accident.

Drama and irony.

At the end of a very long day I go to one of Sioux City’s best restaurants for a very good piece of beef and a lecture on some of the more esoteric physiologic points of blood pressure control.  I enjoy the science review, but I find the potatoes lukewarm, and the propaganda transparent.  After the internet broadcast a noted endocrinologist from Omaha gets up to speak, adding nothing new.  My words to the fourth graders come back:  If you choose to do something, you choose not to do something else.  I give him ten more minutes and I quietly stand and exit by the back door.  I have a lot of other things I could do with that time.