Dr. Pannikatakus

Guest editorial by World – famous  psychiatrist to physicians,
 Dr. Pannikatakus

I hear from physicians what, to no one else, they tell. Their secrets. Their fantasies. Their failures. Their sick little ideas.

Case # 69

“I was sent,” he snarls, this doctor. He is not a physician, I learn, but a surgeon. In this country, they license them the same. “Physician AND Surgeon” says the license. It’s confusing. But I digress.

       “Ordered to come here,” he spews. “For the Public Health. Three sessions. So let’s get it over with, and you write to the Authorities that I came, and we’ll be done. Understand?”

       “You are,” I say calmly toward his face, so flushed and hot I see steam rising from his sweat, “accustomed to giving orders, no?”

       “Damn right. I’m a – ”

       “Sit down, please,” I interrupt him. “On the couch. In this office, the orders I give.”

       “It all started,” he begins, eventually, after a few more exchanges where, to him I make clear who is boss, “in the hospital. Late. Midnight, I think. I’d just finished an emergency torsion of the testicle, and was in the cafeteria, getting coffee from the machine. You know, for the drive home.

       “The place was deserted. Except for this one guy. He was pushing an I.V. pole, his ass flapping in the breeze.”

       “Asses can flap?” I blurt.

       “The gown,” his eyes rise up and roll like exasperation. “The gown flaps. Don’t interrupt me. So, just as he’s passing me, he collapses. I look around for a doctor. An anesthesiologist. Even just an Intern. Hell, I’d have taken an E R nurse – if she was cute. But no one. The place was like a morgue with dispensing machines. This guy drools some saliva on the floor and his I.V. line pulls over the pole.

       “Shit ! I think. Now I’ve gotta see if I remember any of that CPR crap. You know, this is not like on the table in the O.R.”

       “No,” I say to fill the brief silence. “It is not like that. Continue.”

       “So, he’s not breathing. No pulse. It’s - what do you guys call it? Cardiac arrest. So I can’t do CPR alone there until the 7 A.M. shift comes in, can I?”

       “You said you don’t know CPR, did you not?”

       “Well, there was that problem, too. So anyway. No way to call someone. Hours until someone might stumble by. So I get this brainstorm.”

       Oh, oh, I think.

       “Brilliant idea. Which makes sense ‘cause I’m a brilliant surgeon, you know.”

       “Continue,” I say during the silence he creates, waiting, I assume, for applause.

       “Anyway, I slice open his chest, reach in, massage his heart and, Boom! He wakes up!”

       “Good,” I say. “You save his life.”

       “Not yet. Every time I take my hand out, it stops again and his brain goes back to sleep. I need help, but there’s no one around. So, here’s the really brilliant part - - - .”

       Another silence.

“Continue,” is all I say.

       “And do you think he appreciates my brilliance? That I saved his life? No. After he recovers, he goes and gets a lawyer and sues me for mental torture or some such. Reports me to the licensing Board. So here I am.”

       “Tell me,” I say, into the silence, “tell me your greater story of this brilliant idea.”

       “I squeeze his heart until he wakes up again, then I take his right hand, put it down into his chest, around his heart, and I tell him to squeeze. Once a second. I tell him I’m going to get the E.R. doctor. And I warn him not to stop squeezing, or he’ll black out and die.”

       “What did he say?” I ask.

       “Say? He said what I told him to say. He said ‘thank you, Doctor’.”

Case # 42

Into my consultation room she comes, this doctor. All riled up and fidgeting.

“I don’t understand people,” she fumes, pacing back and forth on my new oriental rug.

“Lie down,” I say. “On the couch. Tell me about it. Tell me your greater story.”

“How can people be so stupid choosing a doctor?” She rants. “They certainly don’t decide the way we physicians decide.”

“You are thinking, perhaps, of a specific ‘people’?” my incisive skill directs her.

“My own sister,” she blurts. “She has some menstrual pain – don’t we all? – and she called me for advice.”

“Good,” I say to encourage. “Good. Go on.”

“So I told her to go to an Ob-Gyn doctor. I gave her three names. All good physicians whom I know. They are well trained and scientific. They would pursue testing in a logical sequence and find her diagnosis. I’ve watched them do it for others before.

“But. Does she go to one of them? No. Some girlfriend of hers tells her about this – - – this – - – surgeon. I know him. He just LOVES to cut. Cut, cut, cut. Cut and stitch. Then bill the insurance. Bill, bill, bill.”

“Yes,” I interrupt gently. “Yes. But tell me,” I say, “about your sister.”

“So she said to me: ‘he’s a nice guy. Everyone likes him.’ ”

Here I see that my patient has spittle flying from her lips.

“ It’s true he’s a nice guy,’ I told my sister, swallowing my vomit, ‘but that has nothing to do with medical skill.’ ”

“ Then my sister said: ‘my girlfriend went to him. And you know what he did?’ ”

To myself I think:  I can guess, It all, I have heard. But I don’t say anything; I just let her tell me. That is how I am trained.

“So my sister told me that he operated on her girlfriend, and that, after surgery, he sent her the most beautiful bouquet of roses.

“ ‘Roses!’ my sister said, all starry-eyed.  ‘For a patient! How many doctors do that? What a good doctor,’ she said to me. ‘What a nice guy.’ ”

“I tried to tell her: No, I said. Sending roses is not a medical skill. It’s a marketing ploy. You need a good doctor, not a good schmoozer.”

“The right thing, you said,” I reassure her. “So what makes you so upset?”

“She went to him anyway. He opened her up. No work-up. No tests. Just – - – zip – - – slice – - – mess around inside – - – stitch.”

“ Did he send flowers?” I ask before I can shut myself up.

“Oh, yeah. And he gave her his elbow to help her walk down the hall, instead of having the nurses do it. And you know what she said? ‘What a good doctor,’ she said. Like she never heard a word I told her.”

“Is she better?”

“Of course not! Once the pain of surgery disappeared, she found the menstrual pain still there. Right where she left it.”

“Unhappy,” she must be.

“Oh, no. She told me she wasn’t going to mention it to him. You know why? ‘I don’t want to disappoint him, he did such a good job’ she said. ‘Such a good doctor.’ So now she’s asking if there’s a cure for menstrual cramps.”

Here, my patient is up and pacing on my new rug again.

“If I need a physician, I want competence. Knowledge of the scientific process. A diagnosis before treatment. Don’t you?”

“Me?” I ask “You ask me?”

“Yes. You. If you needed a physician, you wouldn’t choose by personality, would you?”

“Of course not,” I say. “A scientist, I am.”

“These Quacks are a Public Health menace,” she mumbles.

Her anger, I can sense it cooling like lava into the ocean. “So what did you tell her?”

“I gave her a bottle of Black Cohosh. I figured, what the hell. She believes in this kind of stuff, and, unlike the surgeon, at least it won’t hurt her. But I feel like such a Sell-out.”

“But you did no harm,” I reassure her. “Time’s up. Come back next week. Several sessions, you will need.”

Case # 286

I tell you now about the case of Dr. R. He comes to me, Dr. R., lies down on my leather couch and I put a box of Kleenex on his chest.

“I’m conflicted,” he says to me. “I always do what’s best for my patients, but sometimes they don’t appreciate my efforts. Like Mrs. La Barge.”

“Tell me,” I say in comforting voice. “Tell me about this patient, La Barge.”

“She asked her husband to take her, for their anniversary, to the French restaurant in town. Nice place. They serve the old style haute cuisine. She wore a new dress. It was loose fitting in the style of – what do they call them? ‘Mumu’s,’ I believe. Like a colorful tent.

“The waiter seated them, but Mrs. La Barge complained about the chair. It was uncomfortable, she said. One glance at the seat, completely swallowed up beneath Mrs. La Barge, was all the waiter needed, to know what to do. He brought her a wider chair with heavier legs.

“She ordered the Boeuf Wellington with extra Bordelaise sauce and foie gras. Her husband requested a bottle of Pinot Noir. She arranged her pills in front of her, next to her glass of water, like soldiers defending a fortress.

“The waiter returned. ‘I’m sorry, Ma’am,’ he told her, ‘but you’ll have to change your order. Your doctor called and you can’t have the pastry wrapped beef. May I suggest the Chef salad?’ ”

“And this,” I ask Dr. R., “she did not like?”

“She  just doesn’t understand Full Service Medicine. What should I do? Let her kill herself?”

“That would be against the Oath of that other great Greek physician,” I warn him. “Come back next week. We talk again.”