Page 73 of The Devil You Know
Actually, maybe I shouldn’t be so enthusiastic. I don’t want another of these things.
“We both wanted to thank you,” he says. “You’ve helped me more than any other doctor I’ve ever been to in my whole life.”
“Really?” I’m so flattered. Maybe I’m really making a difference here at the VA. “What did I do that helped so much, if you don’t mind my asking?”
“You prescribed me Prozac!” he says.
Oh.
Mr. Hopkins spends the next ten minutes raving about Prozac. And apparently, his wife likes it a lot too, because not only is her husband a lot more mellow, but it’s also killed his sex drive. “She likes that I’m not always pestering her anymore.” Win-win.
My next patient is Mr. Herman Katz.
I know Mr. Katz is a nice man, but I can’t help it—I cringe when I see his name on the schedule. What’s wrong this time? Did he get a papercut? And is he worried the papercut is going to get infected? And that the infection will spread up his whole arm and he’ll need IV antibiotics? And then the IV antibiotics won’t work and the infection will evolve into a cancerous tumor? Is that what I’m going to be reassuring him about today? Because honestly, I’m not sure I have the strength.
“So what’s bothering you today?” I say to Mr. Katz.
“Well, Dr. McGill…” His bushy white eyebrows knit together. “I had this episode. It was sort of weird and I thought I should come get it checked out.”
“Sure,” I say. “What happened?”
“So yesterday,” he says, “I was mowing my lawn and all of a sudden… well, it was like this curtain dropped down in front of my left eye. And everything was dark for, I don’t know, maybe a minute. Then it just went away.”
Holy crap. I think Mr. Katz may have areal medical problem.
“Thatisa little concerning,” I say carefully. “Has this ever happened to you before?”
He shakes his head. “No, never. Do you think it’s something really bad? Do you think it’s cancer?”
There are things out there that are as bad or worse than cancer. Either way, that’s not what I think Mr. Katz has.Amaurosis fugax, or transient painless loss of vision in one eye, has a lot of causes, but based on his cholesterol and the contents of his grocery cart the other day, I’m betting that Mr. Katz had something called a Transient Ischemic Attack or TIA. That’s like a stroke that lasts less than a day (and usually much less than that) and doesn’t show up on imaging.
I’m not any great expert at the ophthalmic exam, but everything looks fine in his eyes. However, I notice that he has a whooshing sound or “bruit” over his left carotid artery. This is indicative of a blockage in the artery.
“I’d like to order some tests,” I tell him. “Including an ultrasound of your carotid arteries. And I’d like to refer you to our Eye Clinic.”
His eyes widen. “What do you think is wrong?”
“I think it could have been a mini-stroke.” Patients seem to prefer the term “mini-stroke” for a TIA. It’s asgood a term as any. “But I’m not sure yet. We need to check out your eyes before we jump to any conclusions.”
Honestly, Mr. Katz looks so worried that I want to give him a hug. Part of me wonders if he would have come here in the first place if he knew that I wasn’t just going to tell him everything was fine like I usually do.
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Between you and me, I strongly consider dumping the giant plant in the garbage on my way out. Except I can’t because it’s too big to fit in any of the garbage bins.
I lug it out to the elevator, my arms actually trembling with the effort of holding it. This thing iswayheavier than Leah. And there’s no good way to hold it without the branches and leaves smacking me in the face.
Just my luck, the first elevator that comes belongs to George the elevator guy. I consider making an about-face but I recognize in this one situation, it might actually be useful to have George pressing the buttons in the elevator for me.
I start to climb inside but George holds up a hand. “Wait,” he says. “I don’t know if I can let you in with that thing.”
I stare at him. “What?”
“You might need to take the service elevator,” he says. “It looks hazardous.”
He’s got to be kidding me.
“Please?” I say. “I’ll be really careful.”
