Dr. Pannicattackus ©

Dr. Pannikatakus



Guest editorial by World – famous  psychiatrist to physicians,
 Dr. Pannicattackus

I hear from physicians what, to no one else, they tell. Their secrets. Their fantasies. Their failures. Their sick little ideas.





Dr. P. on Vacation



Onto his boat, he invited me, my friend, the Captain.


While, thru my brain, the problems of my patients still swirled, the sea became foam where the hull sliced. The sail, making love to the wind, snapped, fluttered, then swelled into its graceful curve.


Something on the water, like a handful of diamonds tossed into the air, caught my eye. On the wave from our prow, it swam.


“A porpoise,” I told the Captain, “I have not seen for a long time. Too many hours in my office. Too deeply, I swim, in my patients’ problems.”


The Captain smiled.


The sun, upon our heads, burned down. The sea glittered. Our boat, glowing white, swam, like the porpoise. My hat, I adjusted.


“From the sun, I hide,” my thoughts spilled as words. “All day long in my office. Still behind the buildings when I arrive, it is just coming up. My notes, I finish, and it is already disappearing beyond the trees at dinnertime.


“I have been missing it, the sun. But, the ones who help others, I am helping. The doctors who heal, I am every day healing. This is my life.”


The Captain nodded.


Into a cove, we sailed. The sea flamed red. The sun, on the horizon, vibrated. Its roundness wrinkled. Then, like a drowning patient, it sank. Two anchors, the Captain had me drop, so we would be secure for the night.


Up, I looked, as we ate dinner. Uncontaminated by city lights, the blackness showed its beauty of stars like some Ethiopian princess with jewels.


“The Big Dipper, when I was a boy, I could always find. But, years it has been, since I looked up at night.”


The Captain put down his plate and pointed. With his finger, he traced. My eyes followed. Then, from the thousands of stars, like an inspiration crystallizing from the chaos of each day’s cacophony of thoughts, it was there.


“We shouldn’t get too carried away,” the Captain spoke, “with our sense of importance.”


Stung, I felt. But he wasn’t looking at me, just the sky.


“The sun creates the atoms from its furnace,” he reminded me of Physics. “All the stars are doing that. Every star above us,” he reminded me of Astronomy.


“We are just atoms,” he continued. Beneath us, washed softly the ocean, and the boat rocked. “Our atoms are arranged, temporarily, into molecules.”


Organic Chemistry. Ugh.


“The molecules are laced together – even more temporarily – into cells. And all of that is awash in salt water.” Now my Physiology, I remembered.


“Mostly the salt water,” he finished. “That’s us.”


“No,” my Psychiatry rebelled, “more, we are. Consciousness, we have. In this, I am an expert.”


“True,” the Captain’s salty voice spoke in the night as our boat splashed the sea beneath us. “Our atoms are energized by the Cosmic Consciousness of the sun - - - ”


He paused. Except for the little sloshes, silence beneath the black sky and above the black water. A deep breath, I took in. My pulse, I felt for at my throat.


“ - - - for a while,” he finished. “Just a while.”


And a Terror, I felt, so alone within the heaving and rolling blackness. So beyond my grip on the hard objects I had, into my life, arranged.


Then, slowly, a peace, into me, flowed like some liquid. It enveloped my atoms, soothed my molecules, moistened my cells.


And, until I felt the desire for sleep, the boat swayed. 





Dream Analysis


The patient clutches his temples :  I get headaches. I think that it’s too much Medical knowledge stuffed into a rigid cranium over the years. 

I ask :  Do not, these headaches, sometimes go away?

Carefully, he shakes his head :  When I die. But then the knowledge goes, too.

From his hands, he lifts his head and stares into the distance :

Seems like a horrible waste. All that knowledge, accumulated over a lifetime, evaporates into the vacuum of the universe. And not just mine – a small loss from a small mind – but everyone’s.  Back the full 200,000 plus years. Like when restaurants throw away food, prepared but not ordered, into the dumpster at closing. 

We warn our child multiple times not to touch the hot stove, only to watch her scream in pain upon doing it anyway. That’s been our species’ method of learning. No matter how often wisdom and hard-acquired knowledge is shared, we always have to try it for ourselves. It’s flabbergasting that we didn’t go extinct thousands of years ago.

Tell me more, I urge.

I fall asleep worrying about it.  Into the land of  gossamer mists which condense and evaporate into fleeting dreams.

A temple.  Thirty-foot tall fluted Greek columns hold up a roof of stone.  A breeze sweeps through the temple from an Eastern sea and wafts out over a Western ocean.  From the temple, built on a hill of flowers, you can smell the fragrance of our salt-flavored origins mixed with the perfume of heliotropes.

Within the temple, Knowledges mingle. They are small clouds, forming little groups for discussion, then drifting off to another group of Knowledges, or they go seeking a swallow of wine. At first my dream tries to shape them as brains, but even asleep, I reject that.  No one has proven yet that the brain is the seat of the soul.

Like those puffy enhancers of the summer sky, Knowledges float on the eastern breezes, fuse with others, and become part of something larger. Then they disconnect to drift as small individuals again, morph into dogs, birds, sailing ships, Rorschach psycho-ghosts, Koch’s postulate, Osler’s sweeping declaration about syphilis, or the river which is never the same twice.

Also under the temple’s roof, there is a conveyer belt.  It hums along at a slow but deliberate rate, carrying fetuses.  Little proto-humans, curled comfortably within transparent egg-shaped membranes.  As they flow along the belt toward their births, Knowledges diffuse themselves through the passing membranes, and pre-load the non-blinking fetuses.  No one Knowledge imbues its entirety into a given fetus; most fetuses receive portions of several Knowledges.

At the end of the conveyor belt, each fetus is launched out over the Western ocean to be born, pre-loaded with lifetimes of human knowledge.

This is so much more efficient.  So superior to Nature’s plodding, two steps forward, one back system of evolution.

Then, my dream wisps and re-forms, cloud-like, and I’m back to the familiar terrors:  running as fast as I can from some monster. Running, yet not moving. Or falling… falling… falling from the top of El Capitan. Or, worst of all, wandering down Fifth Avenue totally naked.




The Doctor’s Doctor



Into my office he comes, this Family Doctor with a face so sad.

“I guess I’m grieving,” he shrugs.

“Someone who was to you, close, has died?”

“Someone,” he nods, “and some-thing. Something close to both of us.” To himself, he points his index finger, but then to me, also.

“Tell me,” I urge, “about this thing of mine which you say has died. But tell me also, about the person of your grief.”

He begins:


I feared that something was wrong deep inside me.  I had a vague sensation in my chest – not pain, really – but not right. I usually dismiss pain, like the arthritis in my knees from skiing. And I tried to ignore this thing, too. Told myself it was irritated nerves from my sore back. But this discomfort was in the wrong place.

  Maybe just acid splash into my esophagus?  But no relief from antacids. Now it was getting hard to ignore. Certainly it wasn’t angina. Was it? Started getting nervous. Nor the build-up toward a heart attack?

I was anxious, I admit. 

“Anxiety,” I assure him, “I can fix.”

“No you can’t,” gently he smiles. “Not anxiety about heart disease. So, I tried, for two or three weeks to convince myself that my anxiety was heightening this sensation in my chest. Or - - - maybe the sensation was, in reality, just the anxiety itself.  

“But there was a certain illogic in that circuitous reasoning, and it became clear that only my Cardiologist could relieve my growing dread. With a real diagnosis.”

“Ah, yes,” I sigh. “At self-diagnosis, we physicians are just as bad as any other patient.” 

“Worse,” he throws back his head. “So I made an appointment.”

He continues:


Being in my physician’s exam room carries me back to when I attended medical school. Actually, it carries me back even further: 

my physician graduated from Medical School when I was still in sixth grade.

He carried my chart into the room in his left hand, preserving the right to grasp mine in greeting.  There’s only one person I know whose hand is softer  (she’s back home, waiting for a report).  He sat, and pulled a pen from his white jacket.  No computer in this room.  His attention was entirely on me.

“What brings you in?” he smiled, chart folded on his lap, eyes on his patient.

I revealed my paranoia. I told him I have this chest discomfort, and, in the same sentence, dismissed it as probably just my imagination.

He smiled.

“Where is this ‘discomfort’?” he asked softly.  “What brings it on?  How long does it last?  Where does it radiate?”  He made me paint him a picture of the pain.

He scribbled a brief note, then re-focused on me.

“How’s your eyesight?  Any hearing problems?” and he began the Review of Systems that will methodically take him from my head, through my lungs, heart, intestines, kidneys, joints, muscles, nerves, blood vessels, down to my toes.

“I’m not scheduled for a physical,” I warned him, knowing how long this classical Review will take.  “Just a quick visit.”

“I know,” he smiled. 

And he navigated through a methodical and unhurried verbal exploration of my entire body. 

Then the exam began. Ophthalmoscope to my eyes; otoscope in my ears; tongue blade and “Ah-h-h.”

His soft hands slid from behind to cradle my throat. “Swallow,” he directed.

And I did, making my thyroid gland move up and down beneath his fingertips.

Next, he listened with his stethoscope to my neck.

“Hold your breath, please.”

I’ve done this with many of my own patients, listening for a slight turbulence, a bruit, deep within the carotid arteries which feed the brain.  Air moving through the trachea is so loud, it’s hard to hear the blood flow unless the patient holds his breath. I listen for such turbulent bruits on any patient who has hints of stroke symptoms. 

He, however, listens to everyone’s neck.

He checked my blood pressure in both arms, to confirm that there’s no difference between the blood flowing to my left arm and my right. Looking for the slightest hint of occlusion in arteries.

Then he laid a finger of his left hand on my chest, and tapped against it with his right index finger, eliciting a hollow “thud” from my chest. “Take a deep breath, please,” and he moved the percussing finger down my thorax, following my diaphragm.

“Exhale,” and he chased my diaphragm back up, measuring the distance.

Young doctors these days would just order a CT scan.

His hand pushed softly deep into my abdomen, feeling for spleen, liver, kidneys, tumors.  He was slow, methodical, focused.  He found no spleen. The surgeon who was planning to cut me open and remove it, had pushed on my abdomen, too.  But that push was cursory, quick, distracted.  A tedious ritual he was expected to perform. Truth is, I wonder whether surgeons ever find anything until they cut.

He explored slowly over my feet, feeling for pulses on the dorsum on each foot, and behind both ankles.

“Good pulses,” he nodded.

He finished with the traditional hernia and prostate exams.  “Feels normal,” he made a point of reassuring me. Then he turned his back to wash his hands, and to provide me privacy for pulling on my pants.

After obtaining and examining an EKG, he waited until I’m fully dressed, sitting on the exam table, ready to listen.

“I think you’re fine,” he smiled, “I’ll order a treadmill if you want. But we’ll need to use radioactive tracer in your case.”

“Up to you,” I allowed.

But he read me.  “I’ve seen ten people with chest pain this week so far,” he began what sounded like social chatter.  “Of all of them, you’re the least likely to have heart disease.  But I want you to be comfortable.  I’ll order it if you wish.  I just hate to see you exposed to radioactivity unnecessarily.”

“Well, you could just skip the treadmill and do a cath.”

He shook his head slowly, almost sadly.  “That’s an in-patient procedure.  Hospitals are dangerous places.”

I thought about how long his stethoscope had lingered over my chest.  How he’d listened when I laid flat, when I rolled onto my side, when I sat up.  How this fifteen minute visit had already consumed an hour.

“If you got a chest surgeon in here to cut me open, you could see my heart,” I broached.

“Yea-h-h,” he waded in, wondering where I was going.

“Do you already know what it would look like?”

He smiled as people do when reflecting on their lives, and liking what they recall.

“Yeah,” he said softly, “I do.  I’ve been there in surgery with hundreds of my patients.  I’ve gotten so I know.”

I hated to leave, but I had to let him get home for dinner.  It was way past five. Besides, he’d given me what I needed: reassurance, which had already dissolved the chest discomfort.

He’d also given me a taste of the rapidly disappearing skills from that epoch when physicians sleuthed out diagnoses hidden deep within people, using their ears, their fingertips, their eyes, and even their noses.

Skills which imbue, in the patient, a level of confidence that one can only get from a real physician.





Case of Dr. Paracelsus        


        Sometimes, my files I review. For lawyers, I must of course, when, like hyenas, they circle. And when, against my metaphorical doors, they batter. But a few files I review because they haunt me. Like the case I call Dr. Paracelsus.

         From his practice, he took time out to minister to the broken bodies of poor black people, far away. He thought it would make them happy. This, my brain can understand. But him, it made miserable in his soul. And my heart struggles to understand this. For that reason, I read again his file.


         Me: Angry, you seem

         Paracelsus: Sorry. Ah done thought it was showin’ like tortured.

         Me: “Tortured” we will call it, then. Why?

         Para: Went to Haiti. After the earthquake. To hep the people. One of my patients called me as her “hero.” The local newspaper tol’ me they wanted to run a big article on my “mission trip” when I come back.

         M: Good, that is.

         P: I confess as how I did feel proud of myself.

         M: Interested to hear this, I am. How did it appear, the island?

         P: Half an island. The freed slaves of Haiti don’t even get a full island in their Sea of Hurricanes. Their capitol, the main city, had streets like riverbeds – littered with chunks of concrete and rubble. In low spots, was puddles of sewage festering beneath the hot sun, waiting for some motorcycle to splash them over the pedestrians. Goats roamed freely in the city, grazing on the weeds what people call their yards. You look up, and overhead, there’s this dense, chaotic spiderweb of wires.

         Men were of thin bodies with ripped muscles, and they busted up the collapsed concrete walls with sledgehammers, then carried away the chunks in wheelbarrows like as if they’d found gold.

         I learned, you don’t just see Haiti, you hear it and feel it and smell it. There is this “crack” and “crinkle” as tires crush plastic bottles into the street stones. And all around you is an incessant cacophony. Haiti is sticky on your skin and thick in your hair. It has the smell of open fires burning trash in the streets – including small mountains of of plastic.

         The mission organization drove us to another town up in the rice-growing region. Four nurses and me, with boxes full of donated medicines. Mostly they was outdated pills from people’s medicine cabinets.

         Now, the people in the capitol was poor. But they tried their best to dress nice. I seen ladies in high heels walking through sewage in the streets. But up in Saint Marc, they was, as my grandmommy used to say, “poorer than snake shit.” Mostly barefoot, ragged clothes soaked of sweat.

         Kids there swam in a canal of foamy grey-colored water amid the floating plastic junk and who knows what else. Same canal where women scooped water for cooking.  Looked to me like they were re-creating Africa.

         M: the world’s first successful slave revolt, I once read, is how we got modern Haiti.

         P: True. They are the descendants of wretched slaves, freed at last, struggling to survive on a tore-up island. But when they came to our clinics, the adults wore their Sunday best. The young girls wore their purtiest dresses, with ribbons in their hair. And they wore shoes – polished, without scuffs. They smelled of sweet perfume.

         We saw over 200 patients a day. In crude churches, they hung sheets from rafters for a bit of privacy. But some of that privacy, I’d rather not to have had sometimes. The first morning two of the patients – both younger than 30 – were coughing up blood. They was surely more emaciated than most Haitians.

         M: Tuberculosis, perhaps?

         P: Of course. Far more advanced than you’d see in the U.S. and at its most contagious. I confess I moved back both times as far as I could while still being behind the sheet with them. We have good medicine for that in the States. Medicine that would make them less contagious and also cure them. Save their lives. But I found none of those in the medicine boxes.

         M: Unfortunate for the patients.

         P: Yes. And either for their families or their communities, one. I gave them what I had - cough medicine - and prescriptions for the drugs, but they’re right expensive. Even for us Americans. They just went home, I’m sure, still spreading the disease and, eventually to die of it.

         M: I see why, tortured, you are.

         P: Oh, you’re jus’ gonna throw that skunk on the table, are you? Well, no you don’t see. Not yet. At our next clinic – it was a hot, thick, humid afternoon - even before we was set up, a teenaged girl huddled like a fetus on the steps of the church, barefoot, blocking the doorway, wheezing loudly. Sorriest little girl I seen yet. She had so much trouble breathing, that she couldn’t speak. Snortin’ like a mule, she was. In the U.S., she would have been I.C.U. material. I was afraid she was fixin’ to die on us.

         I rummaged thru our dis-organized boxes until I found a couple of half-used inhalers. I had a nurse to sit with her, giving her inhalations every minute or so while I saw other patients. Eventually, she improved. I sent her home with what remained of the inhalers and some antibiotics.

         M: Good. Cured, was your patient.

         P: No. Rescued her from that one attack, is what we done. She’s doomed to have many more, too poor to buy the medicine to stave off the attacks. Too poor to buy the inhalers to rescue her. I’m afraid she’ll suffocate to death someday.

         M: Frustrating.

         P: But here’s the case what haunts me in dreams. He appeared before me looking healthy and well-dressed. Just 5 years old, wearing a dark suit, polished shoes, shirt and tie. His hair was neatly combed. He sat on his mother’s lap.

         He was born with a prolapsed rectum, his mother told me. Haitian surgeons fixed it – sort of. But he still has “accidents.” The kids in school mock him. “If he drops out of school, there is no hope for him” she said. I looked into her young woman’s eyes and I saw how thoroughly life had already thrashed her. And I saw how much she wanted to help him escape what he was born into.

         When we returned to the capitol, I went to the University hospital in Port-au-Prince. “Don’t do that surgery in Haiti,” the sweat-soaked Miami surgeon warned me. “He’ll be pouring out pus.”

         When I got back, I called the University of Miami, the University Medical Center in my state, a big Children’s Hospital, even the Shriners. They all said, one way or another, “no.”

         So I just slunk back to my practice and resumed my life of ministering to fat diabetics, cigarette-smoking asthmatics, giving tranquilizers to neurotics, and arguing with people what complain of cold symptoms about why they don’t need antibiotics.

         Third day back, one of my patients come in with a ‘pacific request for this new medicine. Quite expensive. Serious side effects. No better than what I had her on. I ‘splained all that. But she insisted.

         “I have a right to that medicine,” she said. “On T V, they say I just ask my doctor and I get the prescription. If you won’t do it, there are sure enuf other doctors in town. Do your job!”

         That nite, the ad come on my T V. Lovely pictures of a young woman transformed from unhappy to joyful. Playing with her golden retriever. In the background, they whispered about liver damage, kidney failure, heart attack, death. “Ask your doctor,” they finished up, “if this crap is right for you.”

         M: You paused. Do you, my diagnosis, await?

         P: I already know the diagnosis. I, like you, went to Medical School to learn what 3,000 years of Western Medicine can teach us. So I could hep people who need hep. But look how I’m spending my years, my medical education, while over in Haiti – and who knows how many other places on God’s green earth -  they could actually use medical care. I don’t need a diagnosis, Dr. Panicattackus. I need the remedy: an explanation of just what am I accomplishing in my life?



Case # 44


Into my office she limps. Like some puppy with whipping, as you Americans say.

         “I have lost my confidence,” she tells me. “I need you to find it and give it back.”

         “Tell me,” I gently coax her, “your greater story.”

         “The pressure! The pressure!” She begins, with her head falling, boulder-like, into her hands. “On call every three days. Motorcycle accidents. Grandpas with broken hips. Football players coming to me in wheelchairs with knees like basketballs.”

         “Is this not,” I ask, “the wrong sport?”

         She lifts her head to stare at me like, some idiot I am.

I shrug. “What do I know of your religion of sports? Please. Continue.”

         “The life of an orthopedic surgeon is very hard,” she tries to set the scene, “different from you psychiatrists.”

         This insult, I let it pass. As I am trained to do.

         “To relieve stress, I run. When I sweat, things feel a little better.”

         At her body I look. Trying to imagine it – all of it - running in the park. The vision is disquieting. “Some people,” I explore a point, “when they have stress, they eat.”

         “I do that, too,” she confesses. “So one day, standing at the operating table, my heel begins to hurt. Soon, my foot. I need to finish that operation, and two more, standing on one foot. I found it impossible to hurry to my office due to the pain.”

         “Is this not,” I politely inquire, “plantar fasciitis?”

         At me, her eyes glare. “That diagnosis is myspecialty,” she points her finger toward her ample self. “Aren’t you supposed to listen?”

         I shut up, and she continues.

         “No time to go see a colleague. Anyway, I know what it is. So I gave myself a shot. Two, actually. Torodol in my hip and steroid in my foot. Unfortunately, I guess I didn’t clean the skin enough because four days later, my hip got painful, and an abscess grew there. Like a big, ripe tomato.”

         Lunch, I will skip today, I think.

         “So I gave myself another injection. Antibiotic. In between patients on a very busy clinic day. Who has time to see a doctor? Anyway, I know what I’m doing.

         “All of a sudden, I felt flushed, itching, very uncomfortable. My patient told me I looked red. Sure enough, in the mirror, my face is all red. I itched everywhere. But it was a busy day. I had to work. So I just took a few Benedryl to get thru the day.”

         “A few?”

         “Maybe too many. I laid down on the exam table for a three-minute nap and the nurses were finally able to wake me up an hour later. I was way backed up.

         “Anyway, I’m crippled in surgery with a painful left foot, and a painful right hip. I made patients angry about the delay in my office. My nurses are wondering what’s wrong with me. And, as a surgeon, I need faith in my ability. But, because of this, I don’t feel certain anymore.”

         “I see,” I say.

         “Right now,” she adds. “Don’t feel certain right now. Help me, she commands.”

         “A psychiatrist, I am. You need an Internist. Or maybe just a family doctor.”

         “I work with those guys!” She almost yells. “I can’t let them see me like this. They’ll lose trust in me.”

         “So,” I bore in skillfully, “hide the limp, do you, when you see them coming?”

         Her head, she shakes. “That’s hard to do.”

         “Then, already they know that a problem, you have. If you go to one of them and ask for help, is that not like when they ask you for your help with their patients?”

         “Well - - - ”

         “And respect you, they will, that you can ask for help. Just as, coming here to me, I respect your courage.”

         “You do?”

         “Yes,” I nod. And smile. “Our time is up. Go find a good doctor.”

         And she leaves, limping, poor lady. I remember what they taught us in medical school:

         ‘The physician who treats himself has a fool for a patient.’

         But are we not, all of us, once in a while, fools?





Case # 106


His wheels, I hear, squealing into my parking lot, ten minutes after his appointment time. Then, a big thump, I feel. I peek out the window. Mercedes Benz grill, buried into my oak tree.


“You are late,” I say, when finally he walks thru my door.


“I’m always late,” he mumbles. “There is never enuf time.”


“Sit,” I tell him. “And reveal to me your greater story.”


“I’m acting strange,” he says, looking a little scared. “Like driving faster than usual.”


“This, I have noticed. What else?”


“Like not doing a complete check before I take off in my airplane. I took off for Boulder with half empty fuel tanks.”


“This is unlike you?” I encourage.


“I’m a Cardio-thoracic Surgeon. I do heart transplants. I’m an expert at details.”


“And this oversight, you have corrected?” I inquire, knowing that he has not – he is, after all, in my office. It is a professional ploy for getting, more quickly, to the point.


“I had to make an emergency landing,” he shakes his head of carefully cut blonde hair. “I almost crashed - ”


Silent he goes, so I encourage again: “But you did not.”


“It worries me; I realized that I wouldn’t care if I had. And there’s another thing. A month ago I was talking to a new patient. I asked this routine question: ‘how much do you drink?’ and he replied to me ‘just socially. I’m a Social Drinker.’ ”


The look in his face, I recognize, so I say “this, we have heard before. We are physicians.”


“Yes,” he acknowledges. “Heard it before. But I always make them quantitate: ‘when was the last day you recall that you didn’t drink?’  Know what he said?”


I know, but I just smile to urge him.


“He couldn’t remember. Three or four drinks a day for as long as he could recall. ‘You’re an alcoholic’ I told him. ‘Stop drinking for a month and then come back. Then we’ll see about operating.’ ”


“Like a surgeon, you speak. But this is not why, to me, you have come.”


No. It’s because, after work that day, when I finally got home at ten thirty at nite, I had a drink to relax. As usual. Then another. My whole family was asleep, as usual. I had a third. Then it struck me. What I’d said to my patient. So I tried to recall the last time I went 24 hours without a drink.”


“And this, you could not remember?”


He shakes his head. His eyes become sad and drop toward the floor. “I’m an alcoholic,” he mumbles. “And I think I’m trying to kill myself. One of the state’s most renowned Cardiac surgeons and I’m in this black hole.”


He looks up and into my eyes. Like scalpels, his eyes look into me.


“Why?” he demands I tell him.


“This is,” I reassure him, “very common. Over 40 % of physicians – and also surgeons – are, because of the hours of work and missing their family, burned out. Often, to alcohol it leads. Sometimes, toward suicide, also.”


“But I have to work those hours.”


Like a lawyer, he sounds, pleading his case.


Have to?” it is a professional trick. Repeat, to the patient, his words.


“I barely get by, financially. I need to work more.”


“Fun,” I say. “When is the last time you had it?”


“Last time I had fun?” he ponders. He thinks, in silence, a while. “We took a vacation three years ago. ” He is almost embarrassed at his answer.


“You have children?”




“How old?”


Again he is silent a while. Finally: “I can’t remember.”


His cell phone rings. He reaches for it.


“Do not answer,” I order him. “To voice mail it may go.”


“But it might be - ”


“No buts!” I use the American slang. “Here are your prescriptions: first – one electronic holiday a week. No cell, no pager, no computer.”


“Impossible,” he shakes his head.


“Do it!” I use another American slang. “Just do it.”


He rolls his eyes as if to say, an idiot, this psychiatrist is.


“Two – it is not more money you need, it is time. So number two prescription – spend less.”


A small snort he blasts from his nose.


“And three – you must sign this document, promising me not to kill yourself before our next meeting. My number, I give you, in case you need to call. Day or night.”


“What if I’m on my ‘electronic holiday?’ ” he says like some joke.


“You ask your wife to call,” I say. “I bet, to your wife, you speak less than you wish.”


“That’s true,” he nods sadly. He turns his eyes down again. His wet eyes. “So I’m not alone in this?”


“Many physicians, as I told you, have these problems. Public Health surveys tell us this. But you will get better, “ I promise him. “And happier. In two days, I see you again.”




Case # 69

“I was sent,” he snarls, this doctor. He is not a physician, I learn, but a surgeon. In this country, they license them the same. “Physician AND Surgeon” says the license. It’s confusing. But I digress.


       “Ordered to come here,” he spews. “For the Public Health. Three sessions. So let’s get it over with, and you write to the Authorities that I came, and we’ll be done. Understand?”


       “You are,” I say calmly toward his face, so flushed and hot I see steam rising from his sweat, “accustomed to giving orders, no?”


       “Damn right. I’m a – ”


       “Sit down, please,” I interrupt him. “On the couch. In this office, the orders I give.”


       “It all started,” he begins, eventually, after a few more exchanges where, to him I make clear who is boss, “in the hospital. Late. Midnight, I think. I’d just finished an emergency torsion of the testicle, and was in the cafeteria, getting coffee from the machine. You know, for the drive home.


       “The place was deserted. Except for this one guy. He was pushing an I.V. pole, his ass flapping in the breeze.”


       “Asses can flap?” I blurt.


       “The gown,” his eyes rise up and roll like exasperation. “The gown flaps. Don’t interrupt me. So, just as he’s passing me, he collapses. I look around for a doctor. An anesthesiologist. Even just an Intern. Hell, I’d have taken an E R nurse – if she was cute. But no one. The place was like a morgue with dispensing machines. This guy drools some saliva on the floor and his I.V. line pulls over the pole.


       “Shit ! I think. Now I’ve gotta see if I remember any of that CPR crap. You know, this is not like on the table in the O.R.”


       “No,” I say to fill the brief silence. “It is not like that. Continue.”


       “So, he’s not breathing. No pulse. It’s - what do you guys call it? Cardiac arrest. So I can’t do CPR alone there until the 7 A.M. shift comes in, can I?”


       “You said you don’t know CPR, did you not?”


       “Well, there was that problem, too. So anyway. No way to call someone. Hours until someone might stumble by. So I get this brainstorm.”


       Oh, oh, I think.


       “Brilliant idea. Which makes sense ‘cause I’m a brilliant surgeon, you know.”


       “Continue,” I say during the silence he creates, waiting, I assume, for applause.


       “Anyway, I slice open his chest, reach in, massage his heart and, Boom! He wakes up!”


       “Good,” I say. “You save his life.”


       “Not yet. Every time I take my hand out, it stops again and his brain goes back to sleep. I need help, but there’s no one around. So, here’s the really brilliant part - - - .”


       Another silence.


“Continue,” is all I say.


       “And do you think he appreciates my brilliance? That I saved his life? No. After he recovers, he goes and gets a lawyer and sues me for mental torture or some such. Reports me to the licensing Board. So here I am.”


       “Tell me,” I say, into the silence, “tell me your greater story of this brilliant idea.”


       “I squeeze his heart until he wakes up again, then I take his right hand, put it down into his chest, around his heart, and I tell him to squeeze. Once a second. I tell him I’m going to get the E.R. doctor. And I warn him not to stop squeezing, or he’ll black out and die.”


       “What did he say?” I ask.


       “Say? He said what I told him to say. He said ‘thank you, Doctor’.”





Case # 42

Into my consultation room she comes, this doctor. All riled up and fidgeting.

“I don’t understand people,” she fumes, pacing back and forth on my new oriental rug.

“Lie down,” I say. “On the couch. Tell me about it. Tell me your greater story.”

“How can people be so stupid choosing a doctor?” She rants. “They certainly don’t decide the way we physicians decide.”

“You are thinking, perhaps, of a specific ‘people’?” my incisive skill directs her.

“My own sister,” she blurts. “She has some menstrual pain – don’t we all? – and she called me for advice.”

“Good,” I say to encourage. “Good. Go on.”

“So I told her to go to an Ob-Gyn doctor. I gave her three names. All good physicians whom I know. They are well trained and scientific. They would pursue testing in a logical sequence and find her diagnosis. I’ve watched them do it for others before.

“But. Does she go to one of them? No. Some girlfriend of hers tells her about this – - – this – - – surgeon. I know him. He just LOVES to cut. Cut, cut, cut. Cut and stitch. Then bill the insurance. Bill, bill, bill.”

“Yes,” I interrupt gently. “Yes. But tell me,” I say, “about your sister.”

“So she said to me: ‘he’s a nice guy. Everyone likes him.’ ”

Here I see that my patient has spittle flying from her lips.

“ It’s true he’s a nice guy,’ I told my sister, swallowing my vomit, ‘but that has nothing to do with medical skill.’ ”

“ Then my sister said: ‘my girlfriend went to him. And you know what he did?’ ”

To myself I think:  I can guess, It all, I have heard. But I don’t say anything; I just let her tell me. That is how I am trained.

“So my sister told me that he operated on her girlfriend, and that, after surgery, he sent her the most beautiful bouquet of roses.

“ ‘Roses!’ my sister said, all starry-eyed.  ‘For a patient! How many doctors do that? What a good doctor,’ she said to me. ‘What a nice guy.’ ”

“I tried to tell her: No, I said. Sending roses is not a medical skill. It’s a marketing ploy. You need a good doctor, not a good schmoozer.”

“The right thing, you said,” I reassure her. “So what makes you so upset?”

“She went to him anyway. He opened her up. No work-up. No tests. Just – - – zip – - – slice – - – mess around inside – - – stitch.”

“ Did he send flowers?” I ask before I can shut myself up.

“Oh, yeah. And he gave her his elbow to help her walk down the hall, instead of having the nurses do it. And you know what she said? ‘What a good doctor,’ she said. Like she never heard a word I told her.”

“Is she better?”

“Of course not! Once the pain of surgery disappeared, she found the menstrual pain still there. Right where she left it.”

“Unhappy,” she must be.

“Oh, no. She told me she wasn’t going to mention it to him. You know why? ‘I don’t want to disappoint him, he did such a good job’ she said. ‘Such a good doctor.’ So now she’s asking if there’s a cure for menstrual cramps.”

Here, my patient is up and pacing on my new rug again.

“If I need a physician, I want competence. Knowledge of the scientific process. A diagnosis before treatment. Don’t you?”

“Me?” I ask “You ask me?”

“Yes. You. If you needed a physician, you wouldn’t choose by personality, would you?”

“Of course not,” I say. “A scientist, I am.”

“These Quacks are a Public Health menace,” she mumbles.

Her anger, I can sense it cooling like lava into the ocean. “So what did you tell her?”

“I gave her a bottle of Black Cohosh. I figured, what the hell. She believes in this kind of stuff, and, unlike the surgeon, at least it won’t hurt her. But I feel like such a Sell-out.”

“But you did no harm,” I reassure her. “Time’s up. Come back next week. Several sessions, you will need.”


Case # 286

I tell you now about the case of Dr. R. He comes to me, Dr. R., lies down on my leather couch and I put a box of Kleenex on his chest.

“I’m conflicted,” he says to me. “I always do what’s best for my patients, but sometimes they don’t appreciate my efforts. Like Mrs. La Barge.”

“Tell me,” I say in comforting voice. “Tell me about this patient, La Barge.”

“She asked her husband to take her, for their anniversary, to the French restaurant in town. Nice place. They serve the old style haute cuisine. She wore a new dress. It was loose fitting in the style of – what do they call them? ‘Mumu’s,’ I believe. Like a colorful tent.

“The waiter seated them, but Mrs. La Barge complained about the chair. It was uncomfortable, she said. One glance at the seat, completely swallowed up beneath Mrs. La Barge, was all the waiter needed, to know what to do. He brought her a wider chair with heavier legs.

“She ordered the Boeuf Wellington with extra Bordelaise sauce and foie gras. Her husband requested a bottle of Pinot Noir. She arranged her pills in front of her, next to her glass of water, like soldiers defending a fortress.

“The waiter returned. ‘I’m sorry, Ma’am,’ he told her, ‘but you’ll have to change your order. Your doctor called and you can’t have the pastry wrapped beef. May I suggest the Chef salad?’ ”

“And this,” I ask Dr. R., “she did not like?”

“She  just doesn’t understand Full Service Medicine. What should I do? Let her kill herself?”

“That would be against the Oath of that other great Greek physician,” I warn him. “Come back next week. We talk again.”