An Anorexic’s Nightmare

I’ve been out of touch.

Quite literally.

My waking hours are wasted spent “running to doctors,” as my grandmother of blessed memory would have put it.

So many doctors, so little time.

And the striking thing, the thing that literally renders me speechless, is that none of them ever touch me.

Not even with gloves on.

They “listen” to my heart and lungs through the three layers of clothes on my torso: camisole, tee, and blouse. 

I’ll let you in on a trade secret: the stethoscope has to go on bare skin.  Otherwise all you hear are three layers of cloth moving against each other: scritch, scritch, scritch.

They don’t look into my eyes, nose, or mouth, although volumes are written there.

Nor do they palpate my abdomen, which, if they did, would give them a surprise, since I have a couple of tender masses in there.  In fact, my erstwhile gastroenterologist, who had it firmly in her mind that I had IBS before she examined me, mashed into my belly like a jackhammer, and while she watched me peel myself off the ceiling, she mumbled, “Hmmmm.”  Yet she did not question her diagnosis.  I fired her.

I got a shock the other day when I requested a copy of my latest MRI from a specialist who had only touched the affected part of my body one single time, out of the several times I’ve seen him.  On that first visit he did pretend to listen to my heart and lungs.  I had a sweater on that day in addition to the above mentioned layers, so his exam was extra special.

When I picked up my MRI report, the receptionist handed me a copy of the clinic notes from my most recent visit.

It said:

“Well developed, well nourished white female in no acute distress. 
Pupils symmetrically reactive.  Cranial nerves grossly intact.  Trachea midline without deviation.  No jugular venous distension.  Heart: S1, S2 normal, no friction rub or gallop.  Lungs clear to auscultation and percussion without wheeze or rales.  Abdomen soft, non-tender, no masses…..”

In short, whether or not you know the jargon, here is an entire “normal physical exam,” none of which was ever done. 

This is the gift of EMR, Electronic Medical Records.  It provides a default “normal” physical exam, altered only if the provider inputs other findings.  One would think that this amounts to falsifying medical records, wouldn’t one?

When I was a medical student, we (or at least I; I can’t speak for the other students) practiced this catechism of normal findings, writing it longhand over and over until I had it memorized in my sleep.  That way we knew what was normal and what was not.

There were two differences, though: in my day we actually wrote things in paper charts.  We had to write really fast, so our notes looked like this:

“WDWNWF in NAD C/O SOB x4H”

Translation:

“Well developed, well nourished white female in no acute distress complains of shortness of breath for the past four hours.”

The other difference is that we actually laid hands on the patient.  We had them undress and put on a gown so we could lay the stethoscope on their chest and close our eyes and listen for those subtleties and nuances of the music the heart makes.  I remember silently cursing chest hair: scritch, scritch, scritch….

And if we didn’t examine something, we wrote: NE (not examined).  But we were not allowed to not examine something, unless the patient objected, in which case we wrote:  PUC (Patient Uncooperative)!

Although we are no longer allowed to describe physical findings in strings of acronyms (although we are apparently allowed to falsify that we actually examined the patient), there is one acronym I will never let go of, especially now that I am getting some practice being a patient.  It is:

WNL

Which is supposed to stand for

“Within Normal Limits”

When I was a student we had an inside joke that WNL actually stood for

“We Never Looked”

Only nowadays, it’s no joke.

Oh yes.  The Anorexic’s Nightmare.

I lost two inches because my spine in collapsing.  Therefore, my BMI is now 25!!!!   I’m suddenly overweight! 

How did this happen?

It’s not fair!  It was that rice I ate yesterday.  That must have been it.  Oh, wait!  I ate a cookie!  Gaaaaaa!  And I’m not bulimic, so I can’t do a thing about it! 

Gaaaaaa!!!

Rant on the Insidious Appearance of the Penultimate Comma

Yes, I know this is a blog on mental health, not on grammar.  However, a phenomenon has crept into the written English language that threatens my mental health, since it causes me to scream every time I encounter it.  It is the Penultimate Comma, which is a comma that appears between two modifiers preceding a noun.  It looks like this, when used properly:

“A big, black dog.”  (You could also correctly write “A big black dog.”)

When used improperly, it looks like this:

“A white, Cadillac convertible.”

What’s the difference?  It’s very simple.  If you can hypothetically insert the word “and” between the two modifiers, you can substitute a comma for the “and.”

As in: “A big and black dog.”  You wouldn’t necessarily say it that way, because it sounds awkward, but it’s grammatically correct to do so.

However, to say: “A white and Cadillac convertible” sounds bizarre, if not ridiculous.  

I know from whence this grammatical misconception arose: school children of this, and sometimes the previous, generation have been taught that if you can say “A white convertible” and also “a Cadillac convertible,” then you should go ahead and insert a comma between “white” and “Cadillac.”  This is wrong.

Why?  Because, dear readers, it sounds utterly absurd.  That is why.  If you read it out loud, placing the pause of the comma where it is written, you will see.

Another incorrect example:  “An expensive, Tudor house.”  No, no, no!  Yes, it is an expensive house, and it is also a Tudor house,  but it is “an expensive Tudor house” and that’s that.

Another correct example:  “An expensive, garish negligee.”   Why?  Because you can say “An expensive and garish negligee.”  Very simple.

How do I come by the audacity to write this vituperous essay on the Penultimate (next-to-last) Comma?  It is simply a product of thirty years, more or less, of editing various  book manuscripts and hundreds of medical and scientific papers, as well as a couple of dissertations.  I learned by Experience.  Period.