As a group doctors tend to be firm and certain in their statements.  We often speak as if our information came from on high.  This manner of speaking can be fine for inspiring confidence in our patients that we know our stuff and the patient can be assured.  Sometimes our patients reveal our ignorance, or arrogance to them and ourselves.

About my third year in Jal, NM, a regular patient and mother of one of my son’s friends came to see me.

“Hello, Claydean, what’s up with you today?”

“I’m getting the chicken pox again Elwood,” and she showed me a couple of skin spots that indeed looked like chicken pox.

“No, you  only get chicken pox one time and then sometimes you get shingles from that same virus, but you don’t get chicken pox more than once.”

“Elwood, I had chicken pox when I was young and I’ve had it another time about 4 years ago and now I’m starting up again, you can see for yourself-here and here and here.”   

She showed me her spots and I doggedly insisted that it had to be some similar appearing dermatological condition but it most assuredly was not chicken pox.  We would watch and see how the situation developed.

Two days later she appeared in my office febrile, looking quite ill and with classic chicken pox widespread on her skin.  I sheepishly had to admit her diagnosis had been correct and my ignorance was exposed.

Over the next 6 or 7 years she presented with chicken pox two more times.  On one of the 2  occasions she was quite febrile, weak, and unable to eat.  She had a headache and a stiff neck. I admitted her to the hospital, did a spinal tap and her spinal fluid showed she had a viral meningitis, almost certainly from the chicken pox.  She recovered and still consulted me for various ailments, but I always remembered how wrong I had been on that one occasion.

I have not encountered recurrent chicken pox in a patient since then, nor did I ever have a colleague admit to seeing someone with repeated chicken pox attacks.  The advent of and effective chicken pox vaccine reduces the likelihood of this situation recurring.

Some years later in Yuma, AZ. I was severely schooled again.

I had been treating a longtime patient for high blood pressure and added Inderal (propranolol) to har program and her blood pressure responded nicely.

However one day she told me she wanted to stop the medicine, that it was causing her to lose her hair and indeed her hair was noticeably less abundant and she was sure the Inderal was causing the hair loss.

I assured her that was not the case.  However she returned a couple months later and said ,”Elwood, you need to get me on another medicine for the blood pressure because I’m not going to keep losing my hair from the Inderal.”

“ I just don’t think it’s the Inderal,” I said with great misplaced confidence.

“Go get your PDR,”  she told me (The PDR-Physician’s Desk Reference was a large printed book of most of the drugs we prescribed.  It was in widespread use in pre internet and Google days to help physicians learn more about the meds they were prescribing.)

I went into my office and returned with the PDR.

“Now go to the page on Inderal,” she instructed me. 

I did.

“Now go to the second paragraph and read to me what it says,” the lady who had done her own research told me.

And there on the printed page was the information that Inderal can indeed cause significant hair loss. 

Much chagrined, I realigned her drug regimen for hypertension.

She continued to see me for the rest of my practice time in Yuma.

I asked her one time why she had continued to see me when I had been so obviously wrong.

“Because you were willing to listen to me and learn something instead of ignoring me.”

Sundown, Texas is a town not known to many people outside the Texas South Plains area and former residents of the town of about 1500 people southwest of Levelland, Texas.  I remembered the town during much of my medical career because of a house call I made with Dr. Clarice Phillips, a GP in Levelland and one of my preceptors during my senior year in medical school.

About 7 weeks into my 12 week stint in Levelland that cemented my desire to be a country GP Dr. Phillips informed me., “We’re going out to Sundown today, Elwood to see Mrs. Smithson,”

He took along his doctor’s bag and a wrapped autoclaved set of tools for our visit.  We passed by many fields of cotton and maize and a few oil wells pumping away, and reached a farmhouse just on the edge of Sundown.

We got out of the car with me carrying the instrument package and Dr. Phillips his bag.  Mrs. Smithson was sitting in a rocking chair on her porch.  She had grossly swollen feet and legs and a protuberant abdomen. 

I was introduced to Mrs. Smithson and Dr. Phillips and she chatted about the weather, the lack of rain, how the cotton and maize had fared this crop year and a bit about how she was feeling.

Dr. Phillips examined her, used her lap blanket to partially cover her, and exposed her distended abdomen to us.

“We’re going to need to drain you again, Emma.  Where’s the basin?” he asked.  “Usual place,” she said.

Dr. Phillips went into the house and came out with a large, enameled basin and placed it on the porch floor between her legs.  He unwrapped the instrument package on a chair placed near her, pulled on sterile gloves, and put some iodine-like liquid on her lower abdomen.  All the time he kept up a running conversation with Mrs. Smithson with asides to me as to the cause of her ascites (the term for the accumulation of fluid free in her abdominal cavity) and the swollen legs. He placed a little anesthetic in the skin of the lower abdomen right in the midline, took a scalpel and made a nick in the skin and then picked up the trocar (in this case a metal hollow tube about twice the circumference of a pencil), attached a piece of rubber tubing and ran it to the basin.  Then he plunged the tube into her abdomen and the fluid began to flow into the basin.

The conversation resumed and after about 20 minutes it stopped with the basin nearly full and the flow finished.  Dr. Phillips removed the trocar, put a gauze pad over the wound and some adhesive tape.

“Emma, where do you want me to put this stuff this time,” he asked.

“Oh, I think they both need some today,” she said.

Dr. Phillips took the basin to the porch railing, leaned over and poured a measure of that nutrient rich fluid into the luxuriant rose bushes on each side of the steps.

Shortly we took our leave and returned to Levelland for afternoon clinic.

In subsequent years I was in situations where it was necessary for me to perform a paracentesis (the medical term for the procedure I described above).  I always remembered that first time on the porch in Sundown, Texas, and followed the guidelines Dr. Phillips had laid out for me.

Eventually medical advances in treatment and the availability of specialty trained physicians took away the need for me to perform the procedure.

However, one day in Yuma, AZ, some 30 years and 850 miles away I was seeing a new patient in my office. During the interview I noticed his “accent” and asked him where he had been raised.

“West Texas”

“Where in West Texas”?

“A little town called Sundown”

I told him I knew where Sundown was and recounted the above story.
“I think that was my grandmother.  She always had the prettiest roses and my mother said it was because granny had a special water she put on it, but I never knew what it was.”  We discussed his age and the recollections and there is no proving that Emma Smithson (a pseudonym) was his grandmother, but it was likely true. I like to think so.

On the Saturday of Labor Day Weekend in 1958 in Schurz, NV, I tripped, fell and shattered my knee cap.  The orthopedist removed much of the bone fragments and screwed two pieces together to give me a functioning kneecap.  He warned me this would probably be good for two or three years at most.  Eventually I need removal of the remaining knee cap 20 years later.

After the surgery in 1958 I was in a long leg cast and mostly confined to bed for 10 days.  

I returned to Schurz and resumed clinical and administrative duties.

I began to have symptoms of urinary frequency and extreme urgency and some back pain.  One day it became evident I had formed a kidney stone which was now trying to pass.  I was taken to Reno to the then Washoe County Hospital and admitted for pain management as the stone passed and to be evaluated for kidney damage.

An Intravenous Pyelogram (IVP) was performed, a medication is injected into the vein by a physician because the drug has to be monitored closely.  I was lying on the table trying not to writhe from the pain of my stone passing and not paying much attention to my surroundings as the radiologist was injecting the contrast material.

Suddenly I realized he was talking to me.  “Who are you? What’s your name again?  Where do I know you from?  I know I know you.”

We went through our biographies and finally realized he had been a resident in radiology at UTMB Galveston when I was a senior medical student at the same establishment at the same time and he had read some x-rays with me.

That had occurred some 1968 miles away and 3 years previously.  I would say he had a good memory.