Dr Carlin Intro

Once a prison inmate presented to my ER with a five-inch “shank” (homemade knife) jammed into his right temple to the hilt—and he lived to tell about it.

That caused me to later reflect: “Carlin, you’ve seen things that almost no-one else in the world has ever seen. Maybe others would be interested in hearing some of the unusual—or even the not-so-unusual—cases, and in relating and sharing some of their own.

So, the idea of this blog was born—a place where an Old Timer like me can relate and share medical “war stories”—mine and others’; a place for posting practical, common-sense remedies, and a source of medical edutainment and humor. A doctor can learn a lot by simply observing and being aware of what is going on—actually examining the patients—including having the “stethoscope in the ears” (hence the title of this blog).

“Doctor Carlin” was a Family Practice doctor (also doing OB) in a medium-sized Arizona community for 15 years, then switched to Emergency Medicine in mostly-rural hospitals all over South Texas for 4 years and afterward continuing in central Arizona until retirement.

A colleague once told me, “Yeah, I wanted to be a doctor from the time I was a little kid.”

Not me. Dr Carlin had not considered becoming a physician.

My Dad was a cattle and sheep rancher. I grew up knowing that he had had a dream and passion for Bridge Engineering and that he’d completed a year and a half of Engineering at a university. Then the Pearl Harbor attack, December 7, 1941. Since his background was farming/ranching, while everyone else was rushing to enlist to return the fight and exact revenge on the perpetrators, Dad was mandated to leave college and go home to the ranch to help raise food for the troops and the rest of the country. He never got back to college. I grew up wanting to go into Engineering, so I could fulfill his dream.

As I neared High School graduation, it seemed that all of my closest friends had college scholarships for one course of study/college or another. But not me. I’d already been accepted to a university—of course into their College of Engineering. But somebody forgot to tell me that if you want a scholarship for college, you have to actually apply for one. I hadn’t—I was without. Then, two days before graduation, I found out that the local Mothers’ March of Dimes organization had offered a scholarship for $150—but it was only for a Pre-Med student who was actually registered in Pre-Med, taking Pre-Med classes and everything!

I thought about it for about three minutes. Then I lied: “Yes, I AM a Pre-Med student.” On the spot, I filled out the application—and since I was the only one applying—they awarded it, handed me a check made out to my college, and the scholarship was announced along with those of my friends on graduation night as I crossed the stage.

Three months later, March Of Dimes check in hand, I went in to officially register in college classes. Now, I had a dilemma—continue with the lie and my Engineering direction, or personal integrity—meaning I’d have to register in Pre-Med and actually take the classes (at least for a quarter, to keep up the façade while spending the tuition scholarship money). I chose the latter, intending to change majors back to Engineering at the beginning of my second quarter. So, in the company of 450 other new Pre-Med students, I began classes in the fall of 1966.

I soon found that the Pre-Med curriculum was challenging! But, notwithstanding my (typical Freshman) immaturity, I was keeping my head above water in my class/labwork. So, I decided to keep plugging away for a 2nd quarter. I began to notice that Pre-Med students were dropping out of the program like flies and switching to other, less demanding, majors. It became a challenge to me—by the end of my first year, I had decided, “I can DO this!” My lean towards engineering became less, then none at all. For the first time in my life, I began entertaining thoughts of actually being a doctor. I stuck it out. By the time I graduated (with a double major—Pre-Med and Journalism) in 1970, there were only 20 of the original Pre-Med students who graduated in Pre-Med—the rest went to other majors. And of those 20, only 5 had been accepted to Medical Schools, anywhere in the world. Of the 15 others, two had been accepted into Dental Schools and the rest graduated with a nearly-useless Pre-Med Zoology B.S. degree (many of them were accepted into advanced-degree programs and may have subsequently re-applied to medical schools). (to be continued)

Diabetic Foot; Gangrene

Diabetic Toe Gangrene

Charles was dumbfounded when I told him he had gangrene in his left big toe. He’d had pain in that toe for several days and earlier, some redness, but, being a lifelong stoic, he hadn’t come to the ER until the redness of that toe became blackish purple and the tip of the toe became rock-hard.

Unfortunately, that wasn’t all the bad news I had for Charles that night. Gangrene of a digit doesn’t usually happen spontaneously—so we must look for a cause. His cause was diabetes. He had never been diagnosed before—Charles hated going to the doctor—he’d had symptoms of frequent urination, severe thirst and ravishing appetite for several months—all pointing to elevated blood sugar—in the ER his was over 600 (normal is 70-100). At 62, because he had ignored the messages his body had given him before the toe gangrene began, Charles was relegated to living with and treating (or not) his diabetes the remainder of his life—however long that may be.

I spent a goodly time talking to Charles and trying my best to convince him—or at least scare him to take the problem seriously and become pro-active (healthcare buzzword) in learning how to give himself insulin shots and eating healthily (although, the healthy-diet talk loses something in the translation when it is being administered by an overweight doctor). I related horror stories like John, a diabetic fellow I knew in South Texas who had had both his hands and both his feet amputated and was on dialysis 3 times a week for 4 hours at a time (he was completely dependent on others for his every need).

I started Charles on insulin, began fluids and made arrangements for him to be admitted to the hospital that night. The next day his left great toe was amputated at the first joint.

What happened after that, I will never know. ER docs almost always lose follow-up with patients—that’s a good thing—and bad (if things go well and their health problems are taken care of or get resolved and we don’t see them back, it’s good, but if they become like John and have to often return to the ER [we used to call them “frequent flyers”], it’s bad). Hopefully, Charles followed up with his primary Dr and used his own agency to do his best to control his disease. I really hated being the bearer of such ominous news to Charles that night, but if he’d waited another week, his whole foot could have been his loss instead of just part of his toe.

ER Docs often get to bear bad news to patients and family—but that’s a topic for another time.