PRACTICE DIARY

Chapter 43

 


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Fam Pract Manag. 2003 Mar;10(3):57.

A fool for a patient

Mark, a physician friend and occasional patient, had been experiencing gross hematuria after strenuous physical exertion for several years. Treating himself, he initially prescribed a renal ultrasound and PSA test; both were normal. He then found an article on exercise hematuria and decided that was what he had. This was reinforced in his own mind when he continued to bleed only after 30-mile mountain bike rides. But when he started to experience gross bleeding after shorter and less arduous rides, he became concerned. He cornered Myrna, the ultrasound technician, and asked her to take another look.

This time, she asked him to come in with a full bladder. “Great biliary system, beautiful pancreas, healthy kidneys,” Myrna exclaimed as she scanned his entire abdomen. But when she got to the urinary bladder, she paused. “There’s something there,” she said, “and I don’t think it’s a hematoma. You need a cystoscopy, ASAP.”

Mark had never considered a bladder problem; he was young and didn’t have any of the risk factors. But he saw the projections from his bladder wall that had worried Myrna and called Fred, the urologist.

“It’s probably just your prostate,” Fred said. “Ultrasounds aren’t very good for looking at bladders.”

“But I’m peeing blood,” Mark added.

“Oh, well then, how about next week?” Fred asked.

“How about tomorrow?” Mark countered.

Fred got him in two days later, and the news wasn’t good. “You’ve got three papillary tumors. You need a transurethral resection,” he said.

After procrastinating for years with a symptom that would have brought most patients in to see their doctor the next day, Mark couldn’t do it soon enough. He had his surgery three days later. Fred said the tumors were superficial, but Mark couldn’t sleep until he got the pathology report. It read, “Low-grade superficial papillary carcinoma. No muscle invasion seen.” It was the best news. Mark would still need intravesicular drug therapy and periodic cystoscopic monitoring, but he would live – with his bladder!

“You know what they say about physicians who doctor themselves?” I asked Mark shortly after his ordeal ended.

“Yeah, and the cobbler’s children have no shoes and the carpenter’s house needs repairs. I’m not going to worry about my health anymore; I’m going to let you do the worrying for me. How about giving me one of your comprehensive physicals?”

“It will be my pleasure,” I said.

Mushrooming

Looking for ways to get out of my recreational rut, I asked Ed, one of my patients, what he did in the winter to stay fit. “I go mushrooming,” he said. “It’s fun, and I can make as much as $800 a week selling them to the mushroom buyer.” Ed went on to tell me that over 90 percent of the mushrooms go unpicked because they’re too far into the woods. Well, I thought gleefully, maybe I can go after them on my motorcycle and make enough money to buy a new scoot.

For a country boy, I knew very little about mushrooms except that eating the wrong ones could get you into some very serious trouble. I needed expert advice, but not from one of those yuppie mushroomers who would drive up in their luxury cars on the weekend, step a few hundred yards into the woods and pluck something to toss in their designer tote bags. No, I needed a real pro – someone with nicotine-stained fingers and no teeth, who was depending on that day’s hunt to eat that night. I found him early one morning at the gas station on my way to work. He was showing off a choice fungus he had just picked to the attendant.

“Hey, what’s that?” I asked excitedly.

“A gamboni,” he said.

“Where do you find them?” I asked.

“Under pine trees,” he said.

“What’s it worth?” I asked.

“Nine dollars a pound,” he said.

“How much does that one weigh?” I asked.

“Dunno,” he said, “but four or five of ‘em should make a pound.”

That afternoon, after seeing my last patient of the day, I hurried home. I knew where there were a lot of pine trees way out in the state forest, so I borrowed my son’s backpack, took my wife’s small serrated kitchen knife and left on my bike with visions of fields of gambonis waiting to be harvested.

“Dinner tonight is on me,” I said.

Three hours later, I returned. “Look in the backpack,” I told my wife.

“It’s empty,” she said.

“Yeah, I know. This stuff is harder than it looks.”

A quick trip to the mushroom buyer clarified the issue. “Gambonis grow under pine trees but only within five miles of the coast,” he said. “There’s a mushroom workshop this weekend at the college. Why don’t you take it?”

“Good idea,” I said.

Dr. Brown, a solo family physician living in Mendocino, Calif., is a contributing editor to Family Practice Management. These excerpts from his journal illustrate the many characters, stories and lessons family practice has to offer. No real patient names have been used.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.


 

Copyright © 2003 by the American Academy of Family Physicians.
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