Newman's Notions | September 2020 | FREE
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Little Red Stethoscope and other tales

Read some hospitalist fables for the modern era.

Little Red Stethoscope

Once upon a time, there was a physician assistant who worked in a hospitalist program. She was one of the few people who actually enjoyed using the little red stethoscope present in all the isolation rooms. It wasn't the advanced auscultation functionality of the scope, but rather the color, which matched the bright red lipstick and shoes she always wore, that made her happy. It was sometimes hard to hear using the suboptimal scope, but it was a premier scarlet fashion accessory. She thought it was too bad the isolation gowns couldn't be red as well. She even went so far as to get a classic stethoscope in bright red to use in non-isolation rooms. But she had a special place in her heart for the little red ones.

Illustration by David Rosenman
Illustration by David Rosenman

One day she entered the room of a patient admitted with unexplained hypertension, cardiomyopathy, and worsening sleep apnea. He was in isolation for a previous multidrug-resistant infection and was pharmacologically immunosuppressed due to his medications for lupus. She obtained the key pieces of his history and then began her physical exam.

First she noted his prominent orbital ridge and exophthalmos. She remarked on his big eyes and suspected a visual field defect and possible thyroid disease. Then she noted his big ears and hands. He really hadn't noticed the gradual change, but mentioned that he couldn't get his ring off anymore. Finally she examined his mouth. His tongue was large and lolled from his prognathic jaw, and his teeth seemed large and spread out.

Later that afternoon, she sat puzzling with her consultant, Dr. Woodsman, over the case. As she removed food from her lunch box, she considered the differential diagnosis. The patient's macroglossia and cardiomyopathy suggested amyloidosis, but it seemed there was something else. It hit her. She would order an insulin-like growth factor level and an MRI. She was sure her patient, Mr. Wolff, had acromegaly.

City Doc, Country Doc

Once upon a time, there were two cousins who attended college together, then went on to the same medical school and internal medicine residency. One ended up in private practice in a small town and worked in a solo practice covering patients at a critical access hospital. The other one completed a hospital medicine fellowship and worked as a hospitalist in a world-famous academic medical center. One day the city physician went to visit his cousin in the countryside. He watched his cousin manage all the patients in the 20-bed hospital on his own. He observed him successfully run a code on a patient with a cardiac arrest, and later that day, take care of a busy outpatient practice. He was amazed by the morass of insurance company paperwork his cousin had to wade through. By the end of the day, he was exhausted from just watching.

The next week the country doc went to visit his cousin at the academic center. He sat through a journal club where they dissected an article using advanced evidence-based medicine analytics that he hadn't thought about since medical school. They made rounds on extremely complex patients and coordinated care with many specialists. There were plenty of patients, and each was more complicated than the next. He saw many more zebras than horses. By the end of the day he was exhausted. Over a cold drink that night, they both agreed on one thing—the other cousin worked way too hard, and neither could imagine doing his job.

The Nurse Who Cried RRT

Once upon a time there was a nurse named Barney who worked night shift. He was frequently nervous about his patients crashing, especially a sick one he had right now, Mr. Wolff. He also had to admit that he got guilty pleasure waking up the house staff to ask questions. He was awake, so why should they be asleep in a call room? It seemed like it was at least once a shift he called a rapid response team (RRT).

Mickey Jones had been the hospitalist covering Barney's ward all week. Every night Barney would call an RRT, and Mickey would come running, getting to the room just before the RRT to explain another false alarm. One time Mr. Wolff had a heart rate of 30—it was an inaccurate reading from atrial fibrillation. Another time the hypotension was a misfiring sensor. And once the patient was “comatose,” but really just asleep.

On the fourth night, Dr. Jones had just taken his shoes off in the call room and put up his feet. He was watching the last five minutes of a funny medical show when he heard an RRT called overhead from his ward. He watched the show's conclusion, then ambled over to find his patient being intubated, and Barney doing CPR. Dr. Jones ruefully took over the compressions.

Other fabulous favorites

The Emperor's New PPE: A leader was fooled by nonexistent protective clothing.

Snow White and the Seven Specialists: Doc was the only one she could trust to make the diagnosis.

The Three Little Administrators: When CMS comes calling, you should be in the hospital made of bricks.

Peter Bedpan: When he lost his bedpan, Peter had to find his nurse, Wendy.

HIPAAstiltskin: Could the student discover the patient's name without violating HIPAA?

Sleeping Beauty: How would they get that sleeping intern out of the call room?