Reasons I Love My Job: Vocal Cords

The other day, I had a lovely older woman in her 80s as a patient. She spoke with the sweetest Southern drawl. A native of Kentucky, she told me, and her voice was like a smooth bourbon. She had bright blue eyes, high cheekbones, a petite frame, and her mind was sharp. I could tell she had once been a great beauty. She was prim and proper, the picture of Southern gentility. All her statements were adorned.”Thank you, darlin’.”  “Please, sweetheart would you mind…” And so on.

When it came time to review her discharge instructions, I had pictures of her procedure to show her, as we do with all our patients. One of them was a picture of her vocal cords. She pointed to that picture, and said to me in her sugary Southern twang, “That looks like a twat.” She then looked saddened. “Mine doesn’t look that good anymore.”

I lost it. I laughed so hard, I had to leave the patient’s bedside to collect myself. It was the last thing in the world that I was expecting from this grandmotherly figure. When I returned, her daughter in law was extremely apologetic. “I am so sorry! I don’t know what got into her!” I told her not to worry. Her mother-in-law had made my day. And you know what? I never thought about it before, but she was right. It does.

Not what you think it is.
Not what you think it is.

 

 
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The Common Cold: Suck It Up

the-common-cold-common-cold-demotivational-poster-1260239029If you are a healthy adult with nothing wrong with you, and you get a cold, do NOT call your doctor.  Seriously. It’s a cold. Yes, your nose is congested, your throat is sore,  you’re coughing up your left lung, and your sneeze has enough wind power to generate electricity. I know you’re miserable. Colds suck royally. And you know what? Your doctor can do absolutely nothing for you. As advanced as medicine is, there is nothing, nada, nyet, rien for your cold. You can take a myriad of dizzying choices of over the counter medications that clear up your stuffy nose and stifle that cough but bottom in line is that you just have to ride the sucker out. Furthermore, if your gunk is coming up green or yellow, that does not mean you need an antibiotic. That’s just your white blood cells, your own personal little army, fighting and dying in the valiant cause of curing you of your cold. Again: you do not need an antibiotic. A lot of people will get antibiotics anyway from their doctors because the doctor is sick and tired of hearing you whine and complain. You are doing a huge disservice to yourself and the world by helping create superbugs that are resistant to antibiotics, so when you really do need an antibiotic, it’s going to be powerless to help you.

Here’s the kicker.  Inevitably, after you start taking the antibiotic, you start to feel better so naturally you think to yourself: Hey, that doxycycline cured me! No, it didn’t. You would have gotten better anyway because time + rest = only cure for the common cold. I could have given you sugar pills or wrapped sausages around your neck and guess what? You would have started to feel better in 7 to 10 days anyway!  Why? Because that’s how long the average cold lasts. Most colds are self-limiting. It was only a coincidence that you took the antibiotic. You know what you should do? Drink lots of fluids, especially warm ones. Gargle warm salt water. It’s gross but it helps that sore throat. Take something over the counter that is specific for your symptoms. Be wary of the multi-drug over the counter formulations that treat multiple symptoms. For example, if you have a stuffy nose but no cough, just take a decongestant like Sudafed. Be especially careful with those multi-drug cold formulations that contain acetaminophen. For example, don’t take Tylenol (acetaminophen or paracetamol) on top of Nyquil. Your liver will be very angry at you. You don’t want your liver to get angry.

Caveat: What I have written here does not apply if you are the very young, the very old, or you have other things wrong with you like asthma, COPD, or other comorbidities. If you’re pregnant, call your OB to find out what meds, if any, you can take. You’re the ones who should call. Here’s a pretty good guide for when to call your doctor with a cold if you are an otherwise healthy adult. And lord help me, if you’ve had this cold for 3 days, you’re 27 years old and otherwise completely healthy, and you call me at 4:55 pm on a Friday, I am going to still be polite and nice to you because I’m not mean to my patients, but I’ll be thinking not so nice thoughts about you. So there.

ImageI spoke to a patient today in his mid 70s. Depressed.  Denies suicidal ideation. No plans. The holidays trigger memories of his son, who died at the age of 30. The pain in his voice is as palpable as a pulse. I try to maintain professional composure and not allow my emotions to show. It’s hard to keep the tears from my eyes, but I believe I’m successful.  I picture my little ones for a nanosecond and I can’t imagine. I don’t want to imagine. Burying one’s child is the worst emotional trauma a person can undergo.

I’m agnostic, but I also believe in respecting my patient’s beliefs. It’s not about me and my personal opinions. “Are you spiritual, sir?” I ask.

“Yes, I go to church every week. I like my church, and the people there are really nice.”

“Where do you think your son is?”

“In heaven.”

“He’s watching out for you?”

“Yes.”

“Would he want his father to be sad?”

“No, no, no.”

I start feeling like Ricky Gervais in the Invention of Lying (good movie, although if you’re the religious sort, I don’t recommend it. You will be deeply offended, more so than you are right now.) I don’t believe what I’m saying, but if it makes my patient feel better, what’s the harm?

“Someday, you’ll be reunited in heaven, won’t you?”

“Of course.”

“That’s something to look forward to, isn’t it? Let’s just not make it today, alright?”

He laughs. “No, not today.”

“Good, “ I reply warmly. “You can call us anytime, alright? If these feelings return, we’re for you. There’s always someone on call.”

“I guess I need a lot of people watching out for me, “ he says wistfully.

“That’s why we’re here.”