Man, do I hate it when patients second-guess my diagnosis.

A guy came in yesterday with an open and shut case of bleeding hemorrhoids. Classic risk factors, classic presentation.

“Nah,” he said, “I don’t think it’s hemorrhoids.”

“Well”, I responded, “it could be a case of rectal polyps. I’ll need to do a digital rectal exam to know more.”

“Ugh! No! I don’t want that again!”

“You’re bleeding down there. I need to figure out why.”

“I had a colonoscopy five years ago, and they gave me a clean bill of health.”

“That was five years ago. A lot may have changed since then.”

“No. I don’t want the exam.”

I gave up. I ordered an occult blood test for him. I prescribed standard treatment for bleeding hemorrhoids. It’s up to him if he wants to adhere to the treatment plan.

If his occult blood test is positive, I’m going to refer him for a flexible sigmoidoscopy. But, man! Coming in for medical advice and then dismissing that advice out of hand seems like such a waste of one’s time. It was sure a waste of my time.

I was in the room while Mrs. Aristus watched "The Blue Beetle."

I cast a glance at it now and then. Looks like Susan Sarandon has decided to lean into the whole ‘evil, selfish rich lady’ thing.

Modern Automated Electronic Defibrillators all have one significant drawback:

When you hit the test button, it bellows: "STAY CALM!"

Now, how can I stay calm when you're bellowing at me "STAY CALM!" like Darth Vader?

Can't you just whisper it? Or maybe say it in Kathleen Turner's voice, or something?

We're already all on edge a little here...

I've got a new nickname!

All my life, my only nicknames have been the standard ones for 'Robert'; Bob, Bobby, etc.

Twice in my life, on separate occasions, and by completely unrelated people, I've had the nickname Sweet Pea.

The referral coordinator at my clinic has taken to calling me "Manhattan". She walked into the provider office once when a colleague and I were discussing our favorite cocktails, and she overheard us talking about bourbon, and how much we like Manhattans. So that's what she's calling me now.

Never been to Manhattan; I have nothing about me that suggests 'New Yorker', but now I'm 'Manhattan'.

I like it...

Manhattan, at your service!...

End of first month of three-days-a-week cardio and weightlifting.

Went into my closet and re-tried on all my favorite suits and sport coats. A little progress, but much more is needed.

Found one of my favorite pairs of dress slacks that I hadn’t tried first time around. Embarrassed not to be able to button them. Still got a ways to go.

Buttoning those. That’s the goal. No booze until I can.

I forgot how good it feels to be nice and pleasantly tired from a workout.

I love you all. Friday Night Buzz Threads will return…

Thank you again for all the Valentine hearts!

Anyone want to hang out and get high?

Got the house to myself for the day. So I am relaxing and trying something new: it's called Tiger's Blood. From a series called Supers by Juicy Joints. Anyone ever tried one before? I'm told they're pretty strong. But I have no particular place to go.

Might be nice to have some company while I try it.

Nearly had a perfect day in clinic yesterday, except for one patient.

I gave him some very substantive information about easier and more effective ways of treating his diabetes than his current plan. He asked me where I got so adept at managing diabetes. I told him about my years of work with homeless patients.

He evidently used that as an excuse to launch into a rant about undocumented immigrants, and how they are selling Fentanyl to everyone, and preventing his brother from getting his cardiac stent surgery.

I noped out of there pretty quickly. But for the rest of the otherwise rewarding and productive day, I found myself cursing this jerk for trying to ruin it. He must have missed all the gay pride and trans pride flags flying in the corridors of the clinic, announcing, in Lewis Carollian fashion "We're all woke in here!"

Asshole.

Having a weird morning. The first three patients on my schedule all have the same first name. Not a common one.

I guess the stars are aligning in a strange fashion.

Oh well; Friday. I can deal with it.

Looking forward to a long holiday weekend.

Adjectives matter, people. Especially in a clinical setting.

A colleague of mine just opened a chart for the patient her medical assistant roomed. The MA wrote the chief complaint: "Vagina is very irritable."

The jokes just write themselves...