Tales from the Emergency Room (18 page)

Dr. Lawrence

As Chief of Allergy and Immunology at St. Agnes Hospital, I went to meetings for the national hospital accreditation committee. At one meeting a very elderly physician was conducting the proceedings. He asked us all to introduce ourselves and then he would ask questions about our service, how it was run, etc. When he got to me, I gave him my name and title, with a little tittering from the group. He then asked me how long I had been associated with the hospital. The group laughed because most of them knew my association was lifelong. I told him I had been born here. He paused a moment and then asked me the name of my obstetrician. By some miracle I actually knew the answer and I replied, “Dr. Lawrence.” He chuckled and said that he and Dr. Lawrence had been partners many years ago. He did not remember me and did not expect that I would remember him! The crowd of doctors was highly amused.

The HMO

For several years I was on the panel of a large HMO, but not as a “Preferred Provider”. I was not happy about this but my complaints fell on deaf ears at the insurance company. Then the phone rang with a call from the director of the HMO who was in need of an allergist to see a pediatric patient. Would I be willing to see the patient? This family had a PPO type policy. Of course I was willing to see the patient, but was unable to keep from once again indicating my annoyance with the company for not including me on the PPO panel. The rest of the story is obvious. I was immediately added to the panel and subsequently saw many PPO insured patients from the company.

Five Hips

Midway through his hospital stay for his first hip replacement, my father-in-law turned 65 years old. From then on, his dining room table was covered with papers relating to the surgery and who got to pay what. Left to his own devices, he finally got it figured out so that Medicare got to pay for his second hip replacement. I remember visiting him at the White Plains Hospital Medical Center where I was Chief of Allergy immediately after his first surgery. In my mind the new hip was probably made out of leather and wood. When I came into his room, I could see all the normal IVs running and the other wires leading to various machines. In addition there was one IV line running up under his sheets in the vicinity of his hip surgery. I was much concerned since infection at the operative site was a serious complication. Indeed, antibiotics were being dripped directly into the site of the operation. Eventually he was sent home with a perfectly good artificial hip, having undergone the first such hip surgery in that hospital.

A couple of years later he had his second hip done. This was titanium and very modern. No post-op problems this time but Grandpa fell one day and broke, of all things, the new hip! This was easily fixed by another replacement. New York State took away his disabled parking spot at the World Trade Center and he had to resume the old commute from New Rochelle by train. Grandpa Cunningham went to his grave having had a total of five hips in his lifetime.

$10.00 Brain Tumor

Everyone has heard horror stories about the antics of HMOs. One of my patients actually showed up in the office on the day I knew she was to have surgery. She had been prepped for surgery early in the morning and, while waiting, lying on the gurney outside the operating room, her doctor arrived to say that her HMO was unwilling to authorize her surgery. So, she left the hospital and came for her allergy treatment instead.

There was one comment however that about summed things up for me as far as HMOs were concerned. I heard a lady happily announce as she was leaving the office after paying her co-pay that, “I can have my allergy shots for $10.00 and I can have my brain tumor removed for $10.00!” Her point was well taken.

Killing Cats

One of my patients, a lovely unmarried lady, lived with three cats. She was extremely sensitive to cat dander. She even knew which cat caused her the most trouble and was able to remove him from her household. However, she continued to have severe symptoms and was treated with the cat antigen available at that time. No one thought it worked very well, but it did seem to help some people a little. Finally, a new cat antigen came on the market for immunotherapy. Rather than just the cat’s fur it was made from the pelt proteins and other cat proteins as well. Of course, the cats had to be sacrificed. My patient began treatment with this vaccine which was very potent and had to be administered with extreme caution. She did very well until one day, in the treatment room for her injection she suddenly burst into tears. As soon as she said it was about the new vaccine I knew what was on her mind. Cats would have to be killed in order to produce the new antigen and she felt that therefore she could not be treated with it. I happened to have had the same question myself and so I had learned from the manufacturer that the cats were all obtained after having been euthanized as part of normal animal shelter routine. After discussion, my patient finally agreed to continue treatment. Eventually she was getting treatment at widely spaced intervals and had no symptoms of cat allergy. She even offered my wife and me her house on Cape Cod to use when we wanted to get away but, since my wife is highly allergic to cats and was also receiving therapy, we were unable to take her up on the offer.

Abandoned in the Waiting Room

One of the several offices I had over the years had a waiting room which was not completely visible from the front desk. Waiting room visibility became a necessary design component of the offices after my partner and I had reviewed a legal case for lawyers involving a man who may have succumbed to a reaction to his shots from an office where not all the patients could easily be observed after their treatments. He had been found unconscious in his car at a stoplight in mid-town Manhattan after his treatment and died several weeks later.

However, we did have the office noted above for several years. We left a patient alone in the waiting room when we all left for the day. Thank heavens she was one of our favorite people, a patient long before and after this incident. She said she had finished waiting the prescribed period after her shots, lost in a magazine article and didn’t realize she was alone in the office until she went to leave. We did wonder the next day when we found that the door was not double-locked as it ought to have been. We were, of course, very apologetic and she took it in good humor. It became an office procedure to always check the waiting room before we left at the end of office hours.

A Difficult Child

I took care of a girl about 10 years old who was a terror about getting her shots. I’m not even sure how we finally got her skin tests done. Whenever she came to the office and came into the treatment room, she would scream bloody murder, never address me directly, squirming about so that I had to hold onto her as firmly as I dared to complete the treatment. I was never happy about having her in my waiting room. Her mother had been banished from the treatment room since her presence there made the child’s behavior worse.

One day I called her in for her shots and she walked calmly into the room, said hello and practically held out her arm for her injection. I chanced a query about how she was feeling and she replied that she had been doing very well. Of course, I immediately asked my nurse what had come over this patient. With a roll of her eyes, she told me that the little girl’s teacher was in the waiting room! Thus the sudden change in behavior. When she arrived the next week for her shots, she behaved perfectly even though her teacher was not present. I said to her, “I’ve got you now, don’t I?” She agreed that I did and she never gave anyone in the office the least trouble again.

The Shirt-tail

In my Manhattan office I saw quite a few people who were gay. Several of the men even “came out” to me over the years or shared with me stories of their struggles with their sexuality. Careful listening was all that was usually required of me, but, in later years of course, our dialogues always ended with my admonition to “be careful”. Richard was such a young man, very attractive and very well groomed. He was always cheerful and pleasant. One day he arrived in the office looking very down. I asked what was the matter since this was so unlike him. He told me that when he left home to come to the office he felt very good about the way he looked and this seemed to be confirmed by the glances of passersby on his way up Park Avenue. But, when he arrived in the vestibule of my building and looked down he saw that his zipper was open and his shirttail was sticking out through his fly! He was mortified and very unhappy when he came into the office. The way he told the story coupled with his unusual demeanor struck me as exceedingly funny and I couldn’t help but laugh. I assured him that I was not laughing at him but only at the situation and he was soon laughing along with me. I suppose that to this day he never steps into public view without checking to see that a similar problem does not arise.

Black and Blue

One of my favorite patients was a beautiful southern lady (from Magnolia, Arkansas) who was married to the CEO of a large national company. She was a long-time patient and was very active in hospital affairs as well. In that capacity she also knew my wife who was similarly involved. Thankfully, my patient had a lovely disposition and sense of humor. She received her allergy shots one Thursday afternoon. I next encountered her at the Hospital Ball at The Westchester Country Club on Saturday night. She was wearing a less than flattering gown with open sleeves draped from shoulder to elbow. As we passed each other in the reception room, she flipped up her sleeve to reveal to me a rather large black and blue area, obviously due to her allergy shot. And she said, “I was not planning on wearing this dress tonight!” As she continued on her way, I never even thought to be upset because I knew we would laugh about it at her next office visit. It would also give me a chance to advise her, as I did all my female patients who were going to be someplace where their arms would show, not to come for their treatments until after the affair.

Mrs. B.

When I had been in practice a few weeks, I was asked by a local physician if I would be willing to see an elderly lady who lived during the summer in her house in Scarsdale, N.Y. My job would be to make a house call once a week to take her blood pressure. I was to keep a record but I was never to tell her what the reading was unless she asked and then I was to give her a specific number. I agreed to all this because, in reality, her blood pressure was fine and varied in the normal range. It was the variation which caused her to worry, so I wasn’t to mention it.

The day of my first visit arrived and I went to the address I had been given. No one had told me that Mrs. B. was perhaps the wealthiest person in town and that her husband had managed one of the country’s largest tobacco fortunes and that he himself had endowed a medical school. She lived on 34 acres in the middle of Scarsdale in a mansion with 21 in help, including four full time grounds keepers. Several of them lived on the estate. Mrs. B. lived by herself in the mansion.

Thus, I was slightly in awe when I pulled into the circular driveway in my little red VW. Trying not to look overly impressed and clutching my little (brown) bag, I rang the bell. A nurse in uniform greeted me and introduced me to Mrs. B. in the grand foyer featuring an elegant circular staircase and art scenes painted on the walls. I was told we would be having our visit in the master bedroom. I was making my way to the stairs when, sensing that I was alone, I turned to see Mrs. B. and her companion standing in front of what I assumed was a closet door. Well, of course, this was the elevator complete with a lovely Louis XIV chair and quite large enough to hold us all.

Upstairs we adjourned to the bedroom which contained the largest four-poster bed I had ever seen. It actually had steps up into it! Over in one corner was a regulation-sized double bed where my new patient actually slept.

We went into an anteroom where I took my patient’s blood pressure and happily announced the results. At that visit, we two hit it off. She explained to me that her reaction to Medicare was that she was well enough off not to need it. And she paid her medical bills on time.`

I continued to see this lovely lady for 2 years. She invited my wife and me to accompany her granddaughter on a tour of the house and estate. There was Napoleonic silver service in the dining room and a butler who stood at her side to offer her dishes during her meals. It was a terrific demonstration of “how the other half lives”. Mrs. B. finally returned to New York City under the care of Dr. Coffin, a well known internist there. After Mrs. B. died, her estate was sold and divided into building lots for expensive houses. The mansion, however, is still in use as a private home. Driving past there now reminds me of a happy time in the early years of my practice.

The Golfer

I began seeing Mrs. B. right after I opened my practice, at which time I saw medical and allergy patients. Allergy referrals were sparse since the internists, many of whom I frequently covered for, were reluctant to send me allergy patients for fear that they would become my medical patients as well. Eventually I began doing allergy exclusively and business picked up.

One of my more notable patients, to me at least, was a lady who came in early on with a rash on the upper surface of her right index and middle fingers. She showed the rash to me at my desk and the two of us sat there looking at it. I thought, what had I been doing my last year in training, not to be able to recognize this problem. However, it clearly was a contact dermatitis. I do not play golf, but had seen people inserting their tees on the golf course. Inspiration hit suddenly. Yes, the patient’s skin did come in contact with the golf course grass when she placed her tees. I advised her to be sure that her skin was not in contact with the turf in future, gave her a little cortisone to rub into the rash and she departed having found the cause of her problem. I was quite happy with myself over this.