I knocked on the door for nearly five minutes before Mark shambled out. He had gained a lot of weight. His skin was pasty. The cool hair, leather jacket and easy grin were gone, as was his confidence. He looked haunted. It was painfully obvious he was embarrassed about the way things had turned out for him. During the course of the conversation I mentioned the Asia trip a couple of times but it seemed to make him edgy, so I backed off. We sat on his front steps and small-talked about bands, motorcycles and the good old days for awhile.
Needless to say, it was an awkward reunion. I didn’t stay long. On the way home hard tears stung my eyes.
Dude, Where’s My Stethoscope?
By 1989 I had completed my basic four-year MD degree and was more than halfway through an additional three-year residency in family and emergency medicine. That summer I took a break from the crucible of my ER and ICU rotations and travelled to McMaster University in Hamilton, Ontario for a leisurely month of training in dermatology. The specialist to whom I was assigned was a leader in the field, so I got a lot of great hands-on experience.
One Friday morning I was busy working in his outpatient clinic. It was nearly noon and I was getting hungry. I had just finished dictating what I hoped would be my last note before lunch when Dr. Crowe tapped me on the shoulder. I groaned inwardly when I realized he was holding a chart in each hand.
“Two patients left,” he said. “One’s new and the other’s a follow-up. Which would you prefer?”
“I’ll see the new one.”
“Okay. Come and get me when you’re done.” He passed me the chart and ambled off.
The referring physician's letter indicated the patient had an eight-week history of an itchy, red rash that hadn't responded to steroid creams and two courses of Nix. Seemed straightforward enough. I opened the door and walked into the treatment room.
There were three people inside – a man, a woman, and a baby. I estimated both adults to be in their mid-30s. The woman looked downtrodden. The man was short, stocky and unfriendly.
“We’ve been sitting here waiting for half an hour!” was his opening gambit.
“Sorry, sir. The clinic was unusually busy this morning.”
“Are you the specialist?”
“No, I’m Dr. Gray, a family medicine resident.” I extended my hand; he didn’t take it. “I’ll see you first, then Dr. Crowe will be in,” I continued.
“More delays,” he grumbled.
“Where’s your rash?” I asked.
“All over.” He peeled off his tank top to reveal a spotty, red rash covering most of his torso.
“How long have you had it?”
“Doesn’t it say in the damned letter?”
I gave up on trying to elicit any further information and proceeded to examine him. The rash looked like scabies to me, but his family physician had already treated him for that without success. I cobbled together a differential diagnosis and told him I’d return with the specialist shortly.
“Better not be long! Doctors aren’t the only people who have things to do, you know!”
I located my preceptor and reviewed the case with him.
“I’ve got an extremely prickly 34-year-old man with a two-month history of an itchy rash all over his body. He looks like a pizza with legs. His family doctor thought it was either eczema or scabies, but Betnovate ointment and two rounds of Nix haven’t helped,” I reported.
“What else is on your differential?”
“Pityriasis, contact dermatitis, vasculitis, erythema multiforme, flea bites… .”
“Let’s go see.”
“Hi, Mr. Grendel, I’m Dr. Crowe. I've been hearing about this unusual rash of yours. Would you mind taking off your shirt again so I can have a look at it?”
“How many times does a guy have to get undressed before he gets a diagnosis around here?” he carped under his breath as he wriggled out of his wife-beater. Dr. Crowe studied the dappled rash for a few minutes. He looked fascinated.
“We’ll need to do a biopsy,” he concluded. “Dr. Gray here will do the procedure. I’ll stop by and have a look when he’s finished.”
Great… .
I earmarked a fresh lesion to excise and opened a biopsy kit. Before donning sterile gloves I took off my stethoscope and placed it on a nearby countertop so it wouldn’t get in the way.
The procedure went well. While I dictated my note at the main desk, the patient and his family packed up and left.
Approximately 10 minutes later I realized I wasn’t wearing my stethoscope. I checked my knapsack and searched the reception area. There was no sign of it.
“Could you have left it in one of the treatment rooms?” the clinic nurse asked. Of course! I went back to retrieve it. It wasn’t there. It took me a minute to figure out what had happened.
“That last patient took it,” I said.
“Who?” asked the nurse.
“The guy I did the biopsy on. Which way did he go?”
“I think I overheard him saying something to his wife about catching a bus.”
“Where do they live?”
She inspected his file. “Stoney Creek.”
“Where’s the bus stop?”
“You’re going after them? Are you out of your mind?”
“They swiped my stethoscope!”
She gave me directions.
They weren’t there. According to the schedule on the wall, their bus wasn’t due for another 45 minutes. Judging by the size of my patient’s belly, he didn’t miss too many meals. I headed for the cafeteria.
It was lunchtime and the place was packed. After a couple of minutes of searching, I spotted them eating at a table near the centre of the room. There were two large plastic bags on the floor at their feet. I circled in from behind, cleared my throat loudly and said: “Excuse me; I think you have something that’s mine.”
Mr. Grendel spun around. He didn’t look the least bit intimidated. Very bad sign.
“What did you say?”
“Hi, I’m Dr. Gray, remember? I think you may have accidentally taken my stethoscope.”
“I didn’t take any stethoscope,” he bristled.
I made another attempt to give him a graceful out.
“Sir, I think it’s possible that when you packed your things it may have ended up in one of your bags by mistake.”
He detonated. “I didn’t take your goddamn stethoscope, and I resent what you’re implying!”
Suddenly we were at the epicentre of a rapidly expanding shockwave of silence. Within a few seconds every conversation in the room had ceased. A thousand pairs of eyes locked onto us. I wasn’t wearing my name tag or my lab coat, so I’m sure half the crowd must have thought I had just escaped from the psych ward.
I glanced down at the pair of plastic bags on the floor. Several thoughts flashed through my mind. How sure was I he had stolen it? If he did steal it, which bag was it in? I had a 50 percent chance of guessing right. If I searched the wrong bag first, he’d kick up such a fuss I’d never be able to get anywhere near the second bag. How much trouble would I be in if I guessed wrong? Apology-sized trouble? Lawsuit-sized trouble? Should I just cut my losses and walk away? Just then an image of him gloating and strutting popped into my head. It was more than I could stand. I grabbed the bag closest to me and ripped it open.
I didn’t see my stethoscope, but the bag was filled to the brim with miscellaneous articles. In for a penny, in for a pound… . I started tossing the bag’s contents onto the table. A chorus of gasps rang out. Someone dashed to a nearby telephone and called security. I didn’t care anymore; I was determined to see this thing through to the bitter end. I continued hauling stuff out of the bag at a furious pace – chips, cigarettes, matches, gum, magazines, Kleenex, Pepsi, Kool-Aid, Carnation formula, diapers, baby wipes… .