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Not My Doctor
By Delbert Blickenstaff
Bob arrived ten minutes early for his appointment with Dr.
Madison. He was anxious to find answers to questions about his
symptom of vomiting at 2 AM. That’s why he asked his family physician
to refer him to a specialist, a gastroenterologist.
As Bob sat in the waiting room, thumbing through a back issue of
National Geographic, he reviewed his medical history: coronary artery
bypass surgery, total right knee replacement, and right hip fracture.
He had sailed through these storms with a minimum of discomfort. He was
not afraid of anything Dr. Madison might propose.
“Mr. Grant, the doctor will see you now. I’m Gayle, Dr. Madison’s
Physician Assistant. Please follow me.”
“Gladly,” thought Bob. But he answered “OK.” Gayle stopped him in the
hallway to get his weight. 160 lbs. Then she led him into an exam room
where she checked his blood pressure, pulse, and temperature, all
normal. She took a brief medical history which she entered into her
computer. She seemed very efficient, thought Bob.
“The Doctor will be in shortly,” said Gayle, as she left the room. And
she was right.
Dr. Greg Madison entered, introduced himself and shook Bob’s hand. He
appeared to be in his mid-fifties, and very confident.
“Gayle tells me that you’re having episodes of vomiting. Tell me about
them.”
“OK. Over the past few months I’ve been awakened between 2 and 3 AM
with sudden onset of nausea. I’m able to make it to the bathroom where
I vomit pure bile.”
“I see, and how often has this happened?”
“Five times. And what I can’t understand is how that bile can empty
into the duodenum, pass up through the pyloric sphincter and into my
stomach so I have to vomit it up. There’s no food, no blood, and no
pain involved.”
“Well, Mr. Grant, digestion is a very complicated process. First the
food mixes with the Hydrochloric acid in the stomach, and then it
passes into the small intestine where it mixes with bile from the gall
bladder and the digestive enzymes from the pancreas.”
“Wait a minute, Doctor, why are you talking to be about digestion of
food? I told you this vomiting takes place at 2 AM. My stomach has
emptied itself of food. What I vomit is pure bile.”
“I’m just trying to give you a broad picture of a very complicated
process. I know it’s difficult for a layman to understand. Maybe we
should schedule an endoscopy.”
“Well Doctor, maybe I should have informed you at the beginning that
I’m a retired physician, and before I earned my MD degree I earned a
Master’s degree in Physiology. So I may know as much about digestion as
you do. And you haven’t helped me a bit. I hope you do a better
job of listening to your next patient.”
Bob stormed out, not even stopping at the front desk to see if his
Medicare would take care of the office visit.
Delbert Blickenstaff, M.D.
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