The Monkey’s Other Paw and Other Random Things

Grow a Pair

There he lies, six-foot-five inches of corn-fed American manhood, a horizontal slab of sinew and muscle with a chiseled chin, tousled hair, and perfect teeth whining like a little girl because the nurse is late with his pain medications.

For God’s sake buddy, didn’t you get the memo? Of manhood, stoicism is the better part and nothing makes your fellow unreconstructed white boys cringe quite like the sight of you, otherwise unhurt, sniveling like a teenage drama queen. It’s humiliating- maybe not for you but certainly for me because you’re supposed to be storming the beaches of Iowa Jima, not alternately crying and yelling for the dilaudid that someone was fool enough to give you the first time. We expected the wide-shouldered, aggressive dialogue of a 1940s war picture but you’re giving us Cage Aux Folles instead.

The Monkey’s Other Paw

What have you done with Mr. Jones? Where has he gone? Surely this drooling, demented husk staring disinterestedly at us from his ICU bed is not our husband, our father, or our brother. Come on now, they said we were lucky, lucky to get him back at all because very few people ever come back after ten minutes of cardiac arrest. That’s why we called you people. He was just laying there twitching and then he stopped so we figured maybe he needed to be at the hospital.

But that’s not him. It doesn’t even look like him. It’s like someone else is in his skin, some shambling seedy-looking stranger who just took a swing at me. And now he just sits there and gapes malevolently. It’s creepy. Like he was on the other side of the grave long enough for something to take his place. And all he can say is “next week.”

“How do you feel?”

“Next week.”

“Can we get you anything?”

“Next week.”

Don’t you recognize us?”

“Next week.”

Seriously. Where’s the joy? The elation has pretty much evaporated, especially since you’re now telling us that he’s not going to get better. What do you mean by that? You fixed his heart, why can’t you fix his brain? Do you seriously expect us to believe that he will be crapping into adult diapers for the rest of his life and eating mushy food shovelled into his mouth by some minimum wage orderly in a fly-blown nursing home? We’re not buying it. He was mowing his own lawn last week for Christ’s sake. Sure, he smoked a little and maybe he did drink too much but he was a great guy. You should have seen how he and Uncle Frank used to cut up. It was all you could do to keep from blowing beer out of your nose.

Man. The old-fashioned kind of death was better than this.

Too Big to Live

The seat of the wheelchair is about the size of the back seat of a typical compact car. Small for a car, you understand, but big for a wheelchair and some patients barely fit. I don’t know what we’re going to do in a few years because, like old groupers living umolested in the cool deep under the pier, once you top a quarter of a ton you have no natural predators. As we’re doing our part to hold diseases at bay, there seems to be no upper limit to the size of patients.

Which would explain the in-room cranes that are now standard equipment at the best hospitals. Like gelatinous cargo, the patient is suspended from a hoist on a sturdy frame while the bed is wheeled out from underneath. An obvious solution but one I had only previously seen at sawmills where the mighty portal crane lifts massive loads of timber from the backs of trucks.

It has to be humiliating to not fit into the CT scanner and to listen to the earnest doctors and nurses, without trying to be rude, plotting a strategy to deal with your immensity. And there is reproof enough for a thousand other petty sins written in the faces of the six strong people it takes to transfer you to the bariatric hospital bed. Even the cop lends a hand.

24 thoughts on “The Monkey’s Other Paw and Other Random Things

  1. Once medical science got to the point that doctors could save the low-hanging fruit, then they started going after the sicker and sicker patients, until there are situations that are…ridiculous.

  2. I love your line about the groupers under the pier. How to handle the increasing size of patients baffles me as well. When I see teens who already weigh nearly 400 pounds, I can only wonder what the problem is going to be like in 20-30 years when their metabolsim slows and they have even more sedentary lives. I have yet to see the crane in action because usually the “lift team” can handle it. But I’m sure I will see it dragged out one day soon enough.

  3. During my residency….for those who cannot fit into a scanner….we have sent them to the ZOO. Even the elephants need an MRI. And for those living in Buffalo, do not despair…Buffalo Zoo has a state of the art MRI at your disposal.
    Just prepare beforehand how will you break the news to the patient that he is going to the Zoo. And call the transport team, crane et al before the yeti breaks your neck!

  4. this post is so true and sad that i can’t decide whether to laugh or scream! i’m referring to the heffer part of it. i wasn’t sure what that first paragraph was referring to…”Cage Aux Folles”? i’m either culturally ignorant or maybe it’s a reference people older than myself would mostly understand. probably the former. but good stuff PB! ♥

  5. For the previous poster: “La Cage Aux Folles” was a French play and then a film in the mid-70s; in 1983, it became a Broadway musical and won many Tonys. A successful revival took place in 2004 and won some more Tonys. The leading characters are gay (the first B-way musical to feature homosexuals as the romantic leads); the story revolves around their relationship and their complicated family dynamics.

  6. I’ve seen the patients that require mutliple people to help move them. I have refused because I’m not blowing out my back *again* just to help haul someone’s largess. Certainly there are those that have some excuse, but the majority are just too lazy, too gluttonous, too selfish to do anything about it. Of course we should expect some nasty comments from someone about how mean doctors are to people who can’t help themselves (to anther piece of pie).

  7. Wow, I would honestly have a hard time keeping a straight face while I informed a patient that his/her MRI would be performed at the zoo. I’ve never heard of that before.

  8. Thanks for the study break. Nothing compares to grown men whining about their pain killers. When I was in nursing, I had several patients who would watch the clock and time their next dose of demerol. If the nurse didn’t come in exactly at 3:00PM, they would hit the call button to remind us that their pain pills are due right now.

  9. “Like he was on the other side of the grave long enough for something to take his place.”

    What a line. You are indeed a good writer.

  10. My grandfather is currently dying of metastatic lung cancer (and hopefully will finally die very soon) so I can look at families of patients who expect “everything” to be done from a perspective other than of a healthcare provider. My grandfather presented to the ER about a week ago because he was weak and couldn’t swallow and was diagnosed with fungal pneumonia and metastatic lung cancer that had gone (among other places) to his esophagus. The only ailments we knew he had before that visit were COPD and arthritis. The doctors in the ER decided to intubate, insert an NG tube, etc. Anyway, we had him extubated yesterday and he was put on 100% O2 by mask and kept comfortable and unconscious with drugs. Even on 100% O2, his breathing is labored and his O2 sat is nothing to write home about and dropping. The nurse told me today that the doctor and nutritionist would be by later to discuss what to do about his feeding and the nurse asked me what I thought. I said, “Worrying about feeding him right now is kind of like rearranging the deck chairs on the Titanic, isn’t it? Can’t you just remove his feeding tube and saline drip and keep him sedated until he dies? I can tell that his feeding tube isn’t that comfortable for him even though he’s sedated and since he’ll never wake up, all we can hope for is a quick death.” She looked pleasantly surprised and said, “Yeah, that’s what I was thinking too, but sometimes families don’t take that opinion well.” Ten minutes later his feeding tube was out and his saline drip was stopped. He’ll be receiving morphine and the occasional other drug to keep him sedated until he does die, but nothing else. So, finally being in the shoes of family members who have loved ones who are circling the drain, I can think of those people who would put their obviously dying loved ones through expensive, futile, and potentially painful procedures as some combination of nuts and selfish.

  11. “La Cage Aux Folles” was adapted into a movie. It was “The Birdcage” with Robin Williams.

    Taking them to the zoo huh? Tact is probably important…

    “Do you like animals?”

  12. Has anyone seen these “air hockey” pads for moving fat patients? Apparently you power it up and just sort of slide the person onto the other table.

    I wonder if anyone has ever looked at how abdominal obesity affects utility of the physical exam? Whenever I have to examine a real big’un I always write “liver/spleen nonpalpable” just to satisfy my own hunger for irony.

  13. we’ve developed into a nation of young, ‘disabled’ men who’s entire life is centered around obtaining narcotics for their ‘back pain.’ Our nation should be disgusted by these malingerers, not enable them to further slackerdom.

  14. I’m as much for stoicism as the next guy, but it’s probably easier to make fun of someone in pain as a provider than is seemly.

    To Half MD, why are you so quick to make fun of grown men who were in pain and wanted their pain meds as scheduled? My temptation is to wonder why the fat ass nurses can’t get their act together, exit out of free-cell, and do their job. The patient is in pain which a doctor diagnosed and felt was legitimate enough to prescribe for. At least he’s got an excuse for his behavior, what’s yours for the nurse not wanting to do the job promptly?

  15. The guy was a drug seeker. Period. And it is never all right for a man to whine, ever. Sorry. That’s just the way it is. Gay, straight, switch hitter…we have a responsibility as men not to be a bunch of pussies.

    And our nurses do not have fat asses (most of them are in pretty good shape), they work extremely hard, our ED is always busy, and if some drug seeker who is literally watching the clock for his next dose has to wait five minutes because my nurse is doing something important then so be it.

    I have the privilege to work with some of the best nurses in the hospital (in the ED and the ICU) and they are top notch.

  16. I’m sure the nurses are top-notch. I was irritated at the assumption that everyone watching the clock for pain meds is a drug-seeker. I’ve seen patients with legitimate pain wait much longer than 5 minutes past the scheduled time for pain meds. You didn’t even mention that the patient was a drug-seeker and then half-MD jumps on with the same story. If these are drug-seekers, then take appropriate action. If they’re in pain, then the appropriate action is to medicate them on schedule, isn’t it?

    I don’t believe in whining, but I also don’t believe that I’ve felt all the pain there is to feel in life. Maybe Marines have tapped the depths of pain and can confidently say they’re man enough to meet it all stoicly and that all other men should to. It’s your patient and your story, so you know whether the guy had a known cause for some serious pain and that makes a difference, but I’ll be damned if I’ll confidently assert that having inoperable cancer or a recently amputated limb can’t be enough to make anyone, no matter how bad ass he thought he was, whine.

    Sometimes pain is pain and no patient should have to just suck it up because of your vision of manhood.

  17. I thought it was obvious from my description and the fact that someone had screwed up and given him dilaudid made it obvious that he was drug seeker.

    And the guy who screwed up was me…because I always give the patient the benefit of the doubt in all situations, especially if I don’t know them. He said he was allergic to morphine, vicodin, and etc. It was only after I looked on the computer at his recent history that I saw what a bullshit artist he was (although the allergy thing tipped me off).

    And it ain’t my vision of manhood, it’s the universal vision of manhood where men are expected to act like men and suck it up when appropriate. I’d go so far as to say that civilization depends on fellows like you and me who shoulder their packs, fix bayonets, and laugh it off when it is all done. Not saying we have to be macho, because I am certianly not, just that a certain level of stoicism, self-sacrifice, and good humor in the face of difficulties used to be the default position.

    The patient in question had no medical problems and while I appreciate the subjective nature of pain, he should have been ashamed of his behavior.

  18. Besides, there is no difference between getting your pain meds “q3h” or “q3.01h.” It doesn’t wear off instantaneously on the exact three hour mark. The guy was just looking for his next fix and resented having to wait.

  19. If there is anything that turns firefighters off on doing EMS more than all the non emergent calls it is the rate of injuries caused by the sheer size of most patients. We had physicals last year and found 8% of the dept had hernias. Another 10% have had back injuries. These are guys (at least in my dept) who are in far better shape than the average and expected to work out on duty.

    Cardiac Arrest rule of 3s in EMS:
    -on the 3rd floor

  20. To Moose, et al;

    Having been a nurse (and now a physician), I see two reasons for a patient to be asking for pain meds at every scheduled interval:

    – the medication is under-prescribed and the patient’s dose should be increased, the med changed to a longer acting agent, or shorten the intervals to better control the pain.

    – the patient is a drug seeker looking for his/her next easy fix.

    YMMV, and I’m sure there may be other reasons. These are just the easy ones that come to mind.

    Once again, excellent work PandaBear!

  21. MD/PHD, I basically don’t believe even one word you typed. Grand children of dying grandparents dont usually refer to them as “circling the drain” like they are nothing but dirty dish water that now needs to be disposed of. This does however, sound like an uncaring medical professional statement.

    Also what is wrong with watching the clock to ask for your pain meds? I agree that sometimes it is pretty damn important to get your pain meds. When I had a total knee replacement I can promise you I was awake instantly (and in pian)while still in the hospital when those meds wore off. To be honest Im really sick of every person who is in pain being referred to as drug seekers. You go have a total joint replacement and then lets talk about pain control, or some nurse sitting on her ass eating cheetos, making you wait to get yours.

  22. Let me reiterate, our nurses do not sit on their asses eating cheetos. They work pretty hard and I don’t envy them. All I have to do is talk to the patients and do the occasional procedure, they do most of the real work.

  23. And Randall, the nurses cannot time their work to give a drug-seeker his fix exactly when it is due.

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