13. Someone Famous

There are 9 of us in the department, and when a new patient makes an appointment, she has the option of first looking at our photos and a "bio."

T. said she picked me because I looked like someone famous, in this case Dr Zorba from Ben Casey. She is not the first patient to have made this connection. Other patients have mentioned Billy Crystal or Dr House. I like to think that I have the authority of Dr Zorba, the bedside manner of Billy Crystal and the medical knowledge of Dr House. Though I wouldn't mind if I just brought Ben Casey or George Clooney or even Matthew Fox to mind.

12. Who's Paying the Bill?

The Mirena IUD embeds a hormone inside a plastic T. Inside the uterus the hormone both suppresses the uterine lining and thickens mucous in the cervical canal, while the "T" triggers an inflammatory response. A three-act contraceptive, good for five years. At about $500, that's $8 a month for very effective birth control. So L. has a Mirena inserted, paying just a $15 copay for the office visit. Three months later she and her husband decide to try for another child and has the IUD removed. The IUD of course is discarded. How will health care reform fix this?

11. It's Not About the Money

After the delivery, I returned to the ER: J. is 34 and childless, with two weeks of pain and fever and a large pelvic cyst which is probably a tubo-ovarian abscess. With antibiotics and the cyst drained, she'll be okay. She just can't pay a hospital bill that may reach $10,000, which the hospital will just pass on to its insured patients, leaving J. with a bad credit rating. So? It's not like she's in the market to buy a house. But let's say that health care reform would give her access to outpatient health care. Would she have gone in earlier? Would earlier invention have protected her fertility, which I expect is now non-existent? Health care reform is not about money, it's about health.

10. I Think So

Down in the ER admitting a patient (more to follow), and a young woman is brought in on a stretcher, obviously in labor. Not my patient, but hey, I'm there, so I check her--complete dilated and ready to push. Just like on TV: straightaway we wheel her towards the elevator, grabbing a "precip" pack on the way (the basic instruments for a "precipitous" delivery). We manage to avoid an elevator delivery, but just by a few minutes. Afterwards, someone asks a pretty obvious question (I think they were working up to something more): "Were you in labor at home?" Her reply: "I think so." Well, yuh.

9. Bizarre

Remember the 50-something who came in with what she thought was a labial wart (and knew that genital warts are STDs)? It looked looked like a wart but sounded like herpes (itching, tender); biopsy showed herpes; so I tested her herpes immunity which suggested exposure in the distant past. I explained (trying to be as discrete as possible) that this could have been the result of a peck on the cheek from a cousin with a cold sore, that found its way down south. Granted this is unlikely, but the appearance of a herpes lesion is no reason to reevaluate a marriage. Dirty socks on the floor, yes; recurrent herpes, no. Her reply? "Bizarre"

8. Will the Real Father Please Stand Up

A. is a 20-something Asia-born dealer at a casino. And pregnant. Soon after breaking up with a white boyfriend, she started going with a Cambodian and is not sure who is the father. She's okay with not knowing: "they're both good guys."

M. is a 30-something former exotic dancer who supported a deadbeat husband and three kids for years until she decided that she couldn't keep on dancing for much longer. She decided to become a security guard, which requires some course or certificate which she duly earned. In the process of this mid-course correction she also kicked out her spouse--but not before having sex with him one last time. A week later she was in bed with his brother. Now she's pregnant. I'm not sure if current DNA testing can tell who's the father. But that's the least of her problems. She's pregnant and looking for a job as a security guard, wondering how she's going to support her family.