Dr Strangeness

He saved my life several times

A bare lightbulb, a mirror and skill

My college roommate became a Doctor. I remember him telling me (and I repeat it back to him from time to time) “I would rather be a good doctor than an excellent physician.”

There seems to be a very inaccurate notion about healthcare in the USA and the defect knows no bounds.

The notion that we have The Best Healthcare in the world. The notion that the healthcare is based on technology or procedures is also defective on it’s face. There are few measures by which the USA achieves ‘better’ status than other places. I have friends that worked their entire lives and have to choose between medicine and food. That’s not great healthcare.

During this c-19 scare i’ve heard many people dismiss the medical care available in China, Italy, Europe as somehow substandard. “That could never happen here!” It’s an arrogant and ridiculous statement, especially now that it is happening here.

I suffered terrible headaches since i was 7 years old. Sinus headaches, Cluster headaches, Migraine headaches, TMJ headaches and sometimes all at the same time. I would lie in bed with a wet rag on my head after taking a handful of painkillers marveling at just how exquisite the pain was. My hair follicles individually hurt, my teeth throbbed, it was incapacitating sometimes for days.

I was speaking with a friend of mine that got pneumonia in Indonesia in January. It wasn’t c-19 but he got very sick. The people in the hotel he was in were freaked out. He thought that was very funny. He made a “comment” about the Indonesian doctor that examined him, that seems endemic to a defective American mindset. He told me that there was no confirmation with an x-ray, but Dr Wu listened to him breathe with a stethoscope and told him he had pneumonia. My friend considered the diagnosis suspect and unconfirmed, but took antibiotics he had with him.

If a doctor listens to you with a stethoscope i’d be pretty damn confident he knows what pneumonia sounds like. The only reason we use x-rays to confirm here in the states is so the doctors can cover their asses against predatory malpractice attorneys looking to second guess them for sport and big bucks.

i have a strange relationship with doctors. It’s all about attitude, theirs and mine. For the doctors that consider themselves gods, i’m their worst nightmare. With the doctors that treat me as a partner in my health and care – it’s practically a love story.

When I was 26 i was having a non-stop sinus infections. i was running a 103.5 fever for 3 months and 3 courses of the same anti-biotic – which was having no effect. My PCP, Dr G, was at NYU Hospital, which has served me well over the years, most of the time. He referred me to a surgeon at NYU. Dr J. was a ranking attending in a white smock in a fancy office with the standard gatekeepers. He looked up my nose with a state of the art rubber hose fiber optic gizmo and saw a brand new turbo-Porsche up there pronounced that I had polyps and would require surgery. He also took a culture and sent me for an MRI of my head. Told me to call him in a week.

I called him back in a week (my 13th week with 103.5 fever) and he said I had polyps and would need surgery. I’d never had surgery, nor had i ever been hospitalized. However at that point both of my parents had died after multiple brutal surgeries for cancer. No mention of my fever, the culture or anything else. I asked if I could come in and review the MRI with him. He would only do that if I scheduled the surgery and then grudgingly. On week 14 of my sinus infection I saw him. He put the MRI up on the wall and waved his hands in front of it and said “there are the polyps” and took it down. I asked him if he was going to operate on an infected area – to which he replied, that’s how we make it better.

Two weeks later I walked into surgery. The doc came in and I told him i felt worse, I felt like I was dying and was still running a 103 degree fever and was really quite concerned. I will NEVER forget his words.

“It’s purely routine, Mr. Scolnick, purely routine.”

I don’t know about you, but I’m not going to let anyone get inches away from my brains with sharp instruments with an attitude like that.

I got up from the gurney. He said what are you doing? I said “I’m out of here.” He got very angry and told me I can’t do that, no one ever walks out on surgery. I told him, “well, then I’m the first.” I left.

Since those days I’ve noticed that hospitals have much tighter protocols and they now have you strapped down and IV inserted and anesthetized before you even get to operating theater. But i’m old and wiser now and would never let something like that happen again.

My brother, who works at the opera, told me about a great ENT that everyone raves about and he takes care of all the opera singers – and ambassadors. I made an appointment the next day. Well, it wasn’t really an appointment. A man’s voice on the other side of the phone just said “can you come in tomorrow morning?” He took my name, no particular time.

I walked into his office. It was an ancient brownstone decorated in eclectic art deco from the 1920’s – mostly in pink. It looked more like The Adams Family living room than a doctors office. This odd old doctor with a leather strap around his forehead with a mirror mounted on it invited me into the exam room. No gatekeepers, no assistants, he even answered the phone himself while he was working on me. In fact the rotary telephone was about the newest technology in the place.

In the exam room stood ancient pink medical cabinets and what looked sort of like a barbers chair.

“Come, sit in the BIG CHAIR, Daniel, and tell me everything that has happened to you.”

I didn’t want to tell him about the Dr J. and the aborted surgery. I just wanted his unvarnished opinion, and I was feeling a little bit like I was out of the frying pan into the fire. Maybe I shouldn’t have walked out of the other doctors Operating Room after all. I told him about the ongoing infection and the failed anti-biotic.

He pulled his mirror down, turned on a bare light bulb and held it behind my head and looked up my nose. He took a culture and said: “call me back in 3 days.”

I left, a little shaken. He wasn’t what I expected a world class, Park Avenue doctor to look like, act like or be equipped like. I called him back first thing in the morning 3 days later. He answered the phone (now i recognized his voice) and he said “can you come right in? “now?”

I was there in 20 minutes. He invited me in and told me to sit in the BIG CHAIR again. He immediately put a piece of paper in my hands and pointed to the specific lines of the lab report and said “you have a strep infection of your sinuses and from the report there is only one anti-biotic that is effective against that strain.” He went to the ancient pink medicine cabinet and took out a box with a course of Cipro and handed it to me. Told me to take the first one right then.

I was shocked, for several reasons. I took the Cipro, then I told him about Dr J and the polyps. He said “I didn’t see any polyps up there, but let me look again.” and he did. “I still don’t see any polyps.” I had my doubts that he could see anything with a bare light bulb and a mirror. Shouldn’t he be using a fiber optic cam? “you said they took an MRI, do you have it with you?” I did, and gave it to him. He put it up on his screen “Hmmm, where did you say they took this?”. NYU. “This MRI is excellent. They take very good MRI’s at NYU, But I STILL don’t see any polyps.”

I went home and within six hours the fever had broken and my head was clearing up. 3 days after I saw this doctor. 13 weeks of modern state of the art medicine, nothing. 3 days and this good doctor did something the fancy shits didn’t do. HE READ THE RESULTS OF THE CULTURE.

When I next saw my PCP, i told him that this ENT wore a leather strap around his head with a mirror attached to it and used a bare lightbulb. Dr. G, my PCP, asked me: “Do you know why he does that?” No I don’t. “So he can see”.

Ultimately I did have surgery, but it was to trim the turbinates, not remove polyps.

Not having learned my lesson, I asked Dr. S what kind of instruments he was going to use to perform the surgery. “Fine surgical instruments, Daniel.”

“Are you going to use lasers?”

“No. I have a drawer full of equipment like that, never found it useful.” and he opens a drawer in the pink medicine cabinet with all kinds of modern looking equipment tossed haphazardly inside. “Lasers destroy tissue, I save tissue.”

I had the surgery and my lifetime of recurring sinus infections were over.

Dr. S. retired many years ago, but not before, through his diligence, he found two other conditions, that had nothing to do with his specialty, that he immediately identified and sent me to have examined. It was purely routine to treat me, just some retail customer off the street, with care, love, empathy, sensitivity, diligence and extraordinary skill. To Dr. S that type of care was purely routine. It’s who he was and what he did. He literally and routinely saved my life, several times. He was also open to me for advice and he interceded on behalf of one of my loved ones, who wasn’t his patient.

Give me an Indonesian doctor with a stethoscope over an x-ray any day.

Or a good doctor with a bare lightbulb and a mirror.

This old, eclectic ENT with a bare light bulb and a mirror who bothered to read the lab results and gave me the appropriate 3rd generation anti-biotic in as short a time window as possible, blew away the highest technology NYU hospital could offer. They are just not in the same class.

It’s not the tools, it’s the person using them.

I’d much rather have a good doctor than an excellent physician.

I am grateful that I have several good doctors in my life.

To you, my good doctors, It seems inadequate to say, but.

Thank you.

I am grateful for our relationship.

Dan

Categories travel

7 thoughts on “Dr Strangeness

  1. Your second doctor’s office sounds as if it was much like my Dad’s office in Jamaica, Queens. Well, except for the pink cabinets. My Dad had been an ENT specialist before WW2. I seem to recall mention of Brooklyn Eye & Ear (which closed in 1975). After the war he went into private general practice.

    As to the use of auscultation alone for diagnosing pneumonia? I suspect it is a vanishing skill.

    Liked by 1 person

    1. i’ll bet it’s a vanishing skill here in the states. I’ll bet not so much elsewhere.

      any doctor in the 60’s would recognize the measles in a heartbeat. today’s doctors would have to reference several books.

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      1. OMFG!
        You wrote “any doctor in the 60’s would recognize the measles in a heartbeat”

        I don’t recall exactly when this occurred, late ’60s or early ’70s? Nor am I sure what hospital in Queens it happened at! Apparently a much younger doctor was puzzled by a child’s symptoms. My Dad took one look and said “that’s the measles!”

        My Dad also had his own X-ray machine and read his own X-rays. Many doctors now do not at all look the X-rays nor MRI nor CT films themselves. They rely on the radiologist’s readings. My Dad had retired by before MRI & CT scans became commonplace.

        Before I wrote my original comment I did a quick look at information online. I ignored any hit not from a medical facility or society origin. Found strong recommendations for use of chest X-ray for confirmation of CAP (Community Acquired Pneumonia). I did not read into the detailed reasoning of the various articles!

        That said, from listening to a series of podcasts called “This Podcast Will Kill You” I understand that certain viral pneumonias have a very distinct appearance on X-rays. Normal lung tissue is nearly invisible to X-ray and shows up black; pneumonia, the collection of fluid in a lung, normally shows as white in the lower portion of a lung, with the rest showing black. These viral pneumonias give the entire lung a granulated appearance (similar to privacy glass). The specific pneumonias I’m thinking of are SARS and MERS related. I suspect COVID-19 is another. I do NOT have any idea if this distinction can be made with stethoscope and auscultation. Nor do I really know if it would make a difference on treatment. Although antibiotics are useless against a viral infection, they are sometimes given to prevent a secondary bacterial infection.

        BTW – Erin & Erin of TPWKY did a segment on coronaviruses released on February 4th. This week (March 23rd) they released a six part update which I have not yet had time to listen to. Their delivery might be off-putting to some people. I find them downright informative!

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  2. Oh for god sake, yes. Dr. S was a clear, no nonsense one and done kind of doctor and a happy one. I love this story, I know this story, I have lived this story…and not with just one doctor, or area of my body. I could give you chapter and verse, many verses, lots of verses. I won’t. “I Know The Cow” but I am not the guinea pig, nor the annuity.” Great blog.

    Liked by 1 person

  3. There are those who want to be Doctors for the simple reason that they love science and how things work and figuring out what is wrong when they don’t work. It’s a challenge and a skill. You had an ENT like that and I’ve heard the story before. It reminded me of when I was working in research and developing Posiitron Emission Tomograohy for it’s use in heart disease. It was very important to get the entire heart into the imaging field, especially the apex. Ultrasound didn’t have the uses it has today and locating the apex from the outside was a challenge but I had a talent for having delicate fingers to percuss the chest wall and an ear to detect the slightest difference in sound. Fingers to pick up the vibration and an ear to listen. My old fashioned techniques and ability beat ultrasound everytime.

    Liked by 1 person

  4. I had a doctor like that once. He was a great man, his name was Dr Jacoby. He passed on quite some time ago. His favorite expression was “I treat Patients, not symptoms”

    Liked by 1 person

    1. I think that’s a common theme among good doctors. they’re treating patients, not symptoms, not conditions.

      in my 40’s and 50’s I thought I had reached the pinnacle of self-management. Now in my 60’s I have several “good doctors.” when they get together the treatment plans go 4 dimensional.

      there’s always more to learn.

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