Weird Medicine: The Podcast - 339 - The Therapeutic Baptism

Episode Date: December 6, 2018

Dr Steve tells a holiday story. Feat. Dr Scott and Dr Ryan. Premium.doctorsteve.com is back online, if you had a sub, it has been canceled and you need to reinstate it. If you didn't, now is a good time! Don't forget: STUFF.DOCTORSTEVE.COM and SIMPLYHERBALS.NET! Learn more about your ad choices. Visit podcastchoices.com/adchoices

You're listening to Weird Medicine with Dr. Steve on the Riotcast Network, riotcast.com. I've got diphtheriae ho-ho-ho-ho-de-hom. I've got diphtheria crushing my esophagus. I've got Zabolivis stripping from my nose. I've got the leprosy of the heartbound, exacerbating my incredible woes. I want to take my brain now. Plastic width of wave, an ultrasonic, ecographic, and a pulsating shave. I want a magic pill for my ailments, the health equivalent of citizen cane.

And if I don't get it now in the tablet, I think I'm doomed, then I'll have to go insane. I want a requiem for my disease. So I'm aging Dr. Steve. It's Weird Medicine, the first and still only uncensored medical show in the history of broadcast radio, now a podcast. I'm Dr. Steve with my little pal of Dr. Steve. Scott, the traditional Chinese medical doctor, gives me street credit with the wacko alternative medicine assholes. Hello, Dr. Scott.

Hey, Dr. Steve. And also in the studio today, we have Dr. Ryan. It's probably somewhat premature to call you that. I guess so a little bit. He's a medical student, but he's a pretty fart smeller. I mean, smart feller. This is a show for, well, welcome, Ryan. Yeah, glad to be here.

Just chip in whenever. You bet. What's that? This is a show for people who had never listened to a medical show on the radio. If you've got a question, you're embarrassed to take to regular medical medical provider if you can't find an answer anywhere else. Give us a call at 347-7-66-4-3-23. That's 347.

Take it away, Ryan. 22 penis. Oh, no. Oh, dude. At least he listens. It's true. It's 347. Poo-Head.

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You can get some free meals, and it's really incredible. Fun thing to do, cook with your family and try some new things. All right. Oh, and by the way, premium. Dottersteve.com is back up. I had canned it. I'm an idiot. I'll talk about it later in the show.

But everybody's subscription got canceled. And if you're interested in getting the archives of this show, go to premium. Dotrsteve.com and sign back up again. And I promise I won't do this to you again until I have a stroke or I die, something like that. And I apologize. I'll try to put some more premium stuff on there. But it gives you access to all the archives. all the shows going back to the beginning so premium dot dr steve.com so that reminded you know you were so

you know excited to have the right answer we had this guy in my class i'm not going to say his name because he's a practicing physician but um we all he was what we at that time called a gunner do you guys have those for sure okay so i didn't know if he still and he was quite the brown noser and really kind of nobody in my class liked him. I got along with him. He was my lab partner for a while, so we got along. I mean, we studied together first year and stuff. But as time went on, you know, as I made other connections, I sort of backed away a little bit.

And he was, you know, it was kind of sad because he was sort of alone at the end, but he brought it on himself. Yeah. You know, he would do things like when we were in fourth year. um we had a guy in my class that had gotten held back but it wasn't common knowledge so and his name was denomi and uh so this guy is in the lab with me and this denomi guy comes in with two tubes of blood because back then we had to draw the blood in the hospital we didn't have phlebotomy teams and this guy that i'm talking about just looked at him and went come on denomi why don't you get a third year to do that and the way he said third year with such disdain even though it was really only like two months since we ourselves had been third years. And so he was already dumping on people. And what was worse was we all loved this Denomi guy, and he actually was a third year because he wasn't in our class anymore.

So it was just bad all around. So anyway, we were all hoping, kind of hoping for something with, you know, this guy would get his comeuppance. Well, we had a professor at the University of North Carolina. His name was Newton Fisher, and he had an IQ of about 220. Oh, wow. And he was our E&T professor. And back then, if you got head and neck cancer, they would just take your head and neck off, you know.

Oh, yeah. And the pictures that he would show us were just horrific. I mean, they looked like that movie Dr. Sardonicus or something, you know, where just half of the face is gone. And you see the teeth and the terminates and stuff, you know, from the outside. I mean, these people looked horrible. And so Newton Fisher would get up in front of us in this lecture, and he would show us a picture of someone with half their face removed. And then he would go, if you miss this diagnosis, I will despise you. And we were all sort of shaking in our boots, but kind of laughing at the same time.

And this guy I'm talking about was sitting right in the front row. Okay, there was him and then four rows. of nobody, and then the rest of us, right? And then him. And Newton Fisher was up on this podium, you know, on a little stage up above. So you had to, if you were on the front row, you had to crane your neck, like, if you're at the front row of the movies, right? So then he shows us another slide. If you miss this diagnosis, I will despise you.

And, again, we're all sort of shuddering, but, you know, laughing at the same time because it was so, I mean, it was just extreme. It was bizarre. And he does this two or three more times. And then all of a sudden, in the middle of his lecture, he just stops cold and looks down at this guy. And he goes, your beatific smile is insipid, sir. And then just goes back on with his lecture. And we just were like, ah. And we still, to this day, I mean, our skit for the next three years had that line in it.

Your beatific smile is insipid sir. because we had an end-of-the-year skits. So if you look on this guy's health grade, you know what health grades is? Sure, of course. If you look on his health grades profile, it's just scrolled. I would love to give his name out

so that our listeners could look him up. But when we are done, I will show you. I'm ruining the joke because I always tell this story to my medical students and stuff. And then I'll scroll down and about five down. There it is. your beatific smile. At three stars, your beatific smile is insipid sir, signed Newton Fisher. That's the list. Yeah, it sounds like things haven't really changed much for medical school.

No, no, no. And as soon as I got it up there, of course, I called my best friend from medical school. And I said, go, go check the, you know, so-and-so's health grades right now. And we were still laughing just like we were, you know, 30. When was that? 30, God, 35 years ago. Oh, no way. Yeah, that's hilarious. That's pretty cool. That's pretty cool.

But anyway, so you just sort of reminded me of that when you were so. Was it his beatific smile? I've got the right answer to each. Well, we're, if anything, used to getting all the answers wrong. Yeah, right, right. That's the first lesson you learned. Well, that is, okay, so I'm in surgery, right? And they would pimp us with these questions, and we would never know.

It's like, when was this surgery first performed and all this stuff? And I'm like, hell, I don't know. Who cares? I can tell you what that is. I'm looking at, but I don't know any of this stuff. So I finally realized that the professors were getting this stuff straight out of this one particular surgical textbook. So I had to do a colisestectomy the next day. And so I read up on it.

I read up on the history who did it first. And, you know, I don't know, William Osler. Who knows? But, and he did. He asked me, you know, well, who first performed this? And I said, oh, that was so-and-so in 19, whatever, and he was. And he was like, oh, very good. And then just started to mercilessly ask me questions until I couldn't get one.

That's the end game. The end game is to do the Socratic method until you have no answer. Exactly. So just get the first one wrong the first time. And then you're done. You're done. Then you're done. They know you're a dumb ass.

And they'll move on. And they'll move on. because they don't really expect you to know it anyway. No, not at all. You know, so they're just effing with you. The other thing that you'll learn is this thing called the attending syndrome. I'm sure you've already learned that, where you go in and talk to a patient, and you come out with one history, and then the attending goes in,

and the patient tells them something exactly the opposite. Completely different, yeah. It's so much more fun to be the attending in that situation, because I can just go, ah, don't worry about it. Crap happened to me all the time when I was in medical school. so what are you going to do i am going into primary care i'm going to be a family medicine doctor out in the small town oh really do you know which small town or just any small town not yet you know i'm from texas so it's likely i could end up a million small towns my families are there but um i could

i could go anywhere man i'm i'm just excited to be a doctor now yeah if you okay well that's good that's good and i'm glad you are because really only people who are called to do this should actually do it. But, because if you're doing it for the money, you're doing it for all the wrong reasons. But I, you may be okay with this, but I had to live in a different town than I practiced in for a while. Sure. Because when I lived in the same town that I practiced in, I couldn't go to the street fair. I couldn't go to the grocery store or Walmart without somebody, well, did you get my mama's lab test back?

It's like, first off, who the hell are you? And by extension, who the hell is your mama? And I can't talk to you about it here anyway. Yeah, I don't know. So I sort of had that thought at first when I was thinking about, especially wanting to go to a small town. Yeah. And I thought a lot about, do I want to see people in the grocery store or at baseball games or whatever that I know? Some people love that.

And I think I thrive on it, but I haven't experienced it fully yet. So right now it's the goal, but I may get out there and do some rotations and find know that it's not for me. I see. My main thing, I don't know if you're a churchgoer, but I didn't want to go to church with people I was treating. So I did go to church in a different town, even when I lived in the same town. Well, I think that's just a good strategy if you're in medicine or not.

Yeah, I think so. You don't want to sleep where you, you know. Yeah, yeah, yeah. Yeah, that's a nice way to say it. Yeah. Exactly. All right, good deal. All right.

Hey, check out Dr. Scott's website at simplyherballs. dot net oh it's simply herbals i read it wrong it's right close for like the thousandth time and i don't forget to listen to our podcast wherever you listen to podcasts and um we are right now oh i guess we can't plug this well yeah we can because um some people hear this before but uh this saturday night dave cecil and live at the beer run you better get there not only to see him while you still can in such a small place but as long as the beer run is actually still open Right, so I was open, right. Because we, holy moly, this should have been a lot easier than it was.

But all of a sudden now we have to serve food. And it's like we weren't really equipped for that. We just want to sell beer. We just like to sling beer. People sit around. They relax out and by the river. Yes. Play a little music.

That's it. Period. We don't want to be, you know, restaurant tours. Oh, my God. When we have a restaurant. When we have a restaurant right next door, literally attached to us. Literally, same front door. It's bizarre, isn't it?

I guess we can't talk about any further on that, but it is. People are crazy. Hey, but if they're in town, we are there now. Yep. Well, we. Dr. Stephen, I may be opening up just in case anybody wants to come check it out. Let's hope not. That means Dave got stuck coming over the mountain in the snow.

That's true. That's true. That would be bad. to snow this weekend. Hell, it's snowed like crazy this morning. Yeah, but I mean, it's supposed to actually snow this weekend. So, uh, but we're going to do podcast, um, at two and we'll broadcast it live on our YouTube channel. And then, um, we will, uh, have the, um, live event December 8th at 7 p.m. at the beer on.

So if you're listening to this before then, uh, feel free to come. And admission is free. And if you come, introduce yourself as a little. listener, Scott and I'll buy you a beer or two. Always drink responsibly. Always drink responsibly. Yeah. And a beer will be cold and the music's going to be hot. Yeah. Whatever.

So we are back. I came this close to making the show disappear. I actually talked to Jim McClure said, just get ready. When I say the word, I need this to be like it never happened. What is that service pro or whatever like it never

happened? And And I talked about being depressed, and I was depressed, but it turns out I was blaming it on GVAC, but really what it was was I had reactive depression. So let's talk a little bit about clinical major depression and reactive depression. Now, Ryan, have you guys talked about the difference between those two things? A little bit. I'll follow along and pipe in if I didn't. Okay. I was going to have you discourse on it.

But, you know, reactive depression is a depression that has a known cause. And, you know, regular depression is what we call idiopathic, meaning the doctor is an idiot and the patient is pathetic, but it really means we just don't know what's causing it. And it's a change in brain chemistry. And the weird thing is, is that reactive depression causes the same changes in brain chemistry. So if you drive your serotonin levels in your brain down, you'll get depressed. If you get depressed, you'll drive your serotonin levels down. So, you know, it just works going in both directions. But I finally analyzed it that the real reason that I was depressed was, and this is sort of self-referential,

I was going to have to make the show go away because I was taking a job. with a fortune 500 company well guess what i'm not going to i am i have realized that i am not made for corporate life no on that level i was supposed to be a regional executive and um and dealing with corporate culture drives me crazy now um and when i realized that i was going to have to make the show go away i got depressed and that made me want to make the show go away and that made me want to make the show go away because I just felt like I didn't have it in me anymore. And so I'll tell you a little bit about this. You know, I went to this interview, and they were so uncoordinated.

And you know what a detail-oriented person I am, Scott. When we do the comedy shows, I've got this list of a thousand things to do. You've got a notebook, yeah. I do. Literally. And I do most of it myself. I'll delegate some of it. like Diane deals with picking up the comedians at the – because she's a supermodel.

You didn't get to meet her, but, you know, an aging supermodel, but a supermodel nonetheless. And she, you know, she picks them up, and I can count on her because she's a party planner for the company that we work for, or a meeting planner. But, you know, I'm just very detail-oriented, and I think of every single thing that can go wrong, which is good because then I make sure that I've got – backup plans and safety nets and stuff like that so but i go to this thing now this is a fortune 500 corporation and my first interview started at seven in the morning and then uh the fourth one of the morning the guy wasn't there so he called me on the phone talked to me for an hour very nice guy and then i'm sitting there it's noon and am i supposed to get my own lunch is somebody bring it, am I missing a lunch meeting because I've been to interviews like that where they have

everybody gets together and they all eat lunch together, see how you can socialize and stuff. And nothing, nobody, I'm sitting there, I'm sitting there, it's 10 after, 15 after, this is going to sound trivial, but this wasn't the only thing. That's a huge red flag. You know, so I went down, I knew where human resources were. It was on the floor below. So I went down to that floor and I found the HR person. I said, am I supposed to be somewhere?

And they're like, no, not that we know of. So I was in downtown Nashville. So by the time I realized that I had to go get my own lunch, which I'm not a big baby. This is not a princess in the pea situation. But it is common courtesy to offer somebody a bottle of water or if it's lunchtime, offer them lunch. And so I just went down to what's the big street in Nashville? Down by the Ryman? Broadway.

Broadway. So I just went down there. By the time I got down there, I didn't have time to eat. You know, by the time I would be late for my next interview. So I had another four interviews to do. So I just walked in a big sort of walked around the block and came back. Again, no one asked me, hey, did you get something to eat? Do you want a bottle of water?

Nothing. They would show up for their part of the interview and leave. Okay, so that was bad enough. I had been talking to the CEO for months, and, oh, I'm going to call you on Friday. Oh, I, you know, I got, let me call you on Monday. Okay. Oh, something came up. I let me call you on Tuesday.

And this went on for three or four weeks. Now it's like, come on. If you really want to talk to somebody, you could. You're going to make time. You make time to talk to somebody. So I, um, at, you. They offered me the job, just, you know, I was fine. You know, I'm thinking, I don't know if I want to work with these people.

And they were very, very corporate, despite being so disorganized, you know. And so they offered me the job. And that's when I started going through this depression because it's nice to be wanted. And I really kind of wanted to do it because I wasn't thrilled with my job at the time, although that's gotten a lot, lot better. and so I was going to take this job and that's when I went through all this business I'm going to have to shut it down and I got it was sort of rolling around

and got me more and more depressed so I called the CEO and I said listen I got to tell you something I know you guys did a background check on me but something you may not be aware of is that I have a show on Sirius XM I also have a show on a on the riot cast network

and I advise behind the scenes on the Jim and San and used to do on Opian Anthony, and I do a little bit on the Howard Stern Show. And he said, this makes you even more interesting to me than you were before. I wouldn't worry about it, but I'll check into it and make sure it's not going to be a problem with the corporation. And I'll check back with you on Monday. This was on Friday. So three days, I figure, yeah, okay, you know, we'll just see.

And if they say they can't live with it, then I will officially make it go away if I want to take this job. five weeks later don't hear a thing nothing nothing and at that point my job had kind of fixed itself we went through a merger and and I'm very happy with the direction my job is going in now that's 180 degrees from where we were we oh yeah yeah yeah so yeah I'm very very happy with it so uh you know my depression lifted because I realized I don't want to give this up. I don't want to give up weird medicine. I don't want to be a corporate and wonk. No. I cannot work with people who are like that. No way. You know?

Because I'm not like that. You know, as goofy and odd as I am, you know, I return people's phone calls. Yes. You know, hell, I return the, I message the people that send us voicemails. this show you know yes so and it and it irritates me if I send somebody an email with a bunch of information and I just get nothing back now there are a few people in my life that still pull that I never do I'll at least say I got it I got it working on you sure I just realized I could just be courteous I couldn't work with them just to be courteous I think and uh you know I've

known you for a long time I know you well enough that's that I really do believe that would have been a terrible yeah terrible marriage well I'm an ex-hippie Ryan's never seen this I'm going to show you a picture of me in 1977. Okay. And then you will, if you go online and go to the Mando Birch YouTube thing, that's on our YouTube channel, you know, Dr. Steve's college band gets shit on or something like that. This picture is on there so you can see. But that was me in the 70s. Oh, wow.

That hair. I know. So I went from long, straight hair down to my accent. ass to a permed mullet in the 80s to where I am now, which is just gray-headed old man look. The permed look was fabulous, man. I've seen those pictures there. Permed mullet. Fabulous.

But anyway, so, yeah, so we're back. I am anticipating doing some great things on this show. We're going to do a show. We're going to, next week for our holiday show, we're just going to have day. Ciesel in and we're going to do an hour with him just because I can. Right. And then after that, we're going to get back to doing the show the way we used to. And when Don Wickland was running the channel, we were going to do a lot call-in live shows on Saturday night. And I would like to talk to Jim McClure about maybe doing that. We would incur some

expense. It requires them to have an employee there running the board on their end. and making sure the phones are working and all that stuff. So I don't know if they want to spend that kind of money on us or not. They certainly are... You and I would have to get a little bit of a raise, you would think. No. No, they would probably just not pay us and use the little money that they do pay. To the person answering the phones.

Right. So anyway, yeah, when PA John and I first, this is way before your time, you were probably 12 at the time. first, did our first show at the Sirius XM Studios. It was such a success that we walked out of there. And Anthony Coombe is the best first show I've ever seen. People, you know, loved it. The phone banks were just slammed.

We had to bump our first guest, which was E-Rock, which was hilarious. And we walked out of there and looked up at the Parker Meridian, which is, you know, a nice hotel on 57th Street and saw all the condos on the top. You know, the penthouse was like, which one of those should we buy? And then, yeah, and then the next four years we did the show for free, for flat nothing. I mean, it cost us money. I'm just barely finally recouping the amount of money we spent on flying up there to do it. Oh, wow.

And putting people up. I mean, one year we took five people up there. We took the whole crew, double vasectomy shit, and Jefferson the Scheister and P.A. John and Chespain Rob, even. Justin Rob. You never met him. Never met him, huh? That was before me. Did you ever?

I've been around for about 10 years. He heard of chest pain, Rob. No. He was a regular on the show, and the reason he got called that, what a dumb ass. He, he one day got chest pain, right? And he went to the emergency room, and he got checked out, and everything was okay. But he went home that night, and that night he's taking his shirt off, and there's an EKG lead on his chest. And his wife says, what's that?

Well, the rest that, you know the rest of the story. story. He never told his wife he went to the emergency room because he was having what he thought was Angina. And she didn't have sex with him for a month. She was so fucking mad at him that he had just done this on his own. And so anyway, he got the name Chesapeen Rob. That's awesome. Yeah, he was a good guy. And now he's a, he's a paramedic somewhere. Oh, is he? Yeah. So he went from doing this to being a paramedic, which I thought was pretty cool. Now, tell us how we influenced your journey through this medical school thing. Absolutely.

Well, eventually we'll answer probably one phone call. Well, I started medical school about, you know, three and a half years ago. And when I was starting my studies and stuff, I wanted to have something other than a book to read, to get some learning in. And so I was a big podcast guy all through high school and college. Yeah, yeah, back in the day. Usually music, podcasts, books, things like that, not so much comedy or anything scientific. Yeah.

But I started Googling just for some, to find some medicine type podcasts that I could listen to and hopefully learn a thing or two. And then I stumbled upon y'all. Really? I was just kidding when I said, please tell us how we influenced your career. Well, it was mainly, I think I learned how to talk to patients, like how to answer questions. Like, I'm being serious because I think that a lot of people in my class struggle with that. They don't know how to dump things down to a level or just simple. things down to them.

Not even dumbing them. Yeah. Just speaking like a human being. Exactly. Exactly. I'll give you one tip too before you go on. There are two words that we use that mean exactly the opposite. And you might have heard this on the show that of the meaning that our patients use it for.

That's positive and negative. Sure. So if you have a positive outlook, that's a good thing. If you have a positive balance in your, in your, um, Checking account, that's a good thing. If your biopsy is positive, that's a bad thing. We had somebody just the other, who was that, that was in here that said that maybe they weren't here in the studio, but it was somebody in my life said that their mother called them

and said, oh, thank God. They called me from the doctor's office, and they said my influenza test was positive. She thought that meant she didn't have influenza. Because, of course, well, it's a good thing. It's positive. So we would, and negative, the other thing, you know, negative means bad things in our patient's lives. But when we say it, like if the biopsy is negative, that's a good thing.

So, you know, it's like Orwell's newspeak, you know, everything is backwards, you know, hate is love and war is peace and all this stuff. And so I highly recommend that all physicians use the words normal and abnormal instead of positive and negative. But anyway, go on. Yeah, well, but yeah, your classmates suck at this. Yeah, and a lot of us do, I think, because we learn this whole new language when we start school. And you want to use it. Exactly.

And we want to sound smart and sound fun. Yes, I did the same thing. But then it's confusing because it's confusing to us as learners and then to our patients who haven't been through medical school. It's also confusing. And so just learning how to simplify things and talk frankly and straight with people. I think they appreciate that. And so I really appreciated listening to y'all over the last few years and just finding those common things that people have questions about or don't want to talk about and just being able to answer questions in a straightforward, uncensored kind of way. And being comfortable talking about things that people aren't comfortable talking about.

Like a lot of doctors are not comfortable talking about death and dying. Why? Because they're going to die just like everybody else. and they're just as freaked out about it as everyone else. So, you know, I think I went into palliative medicine to deal with my own issues of mortality. Sure. Yeah, I really do.

But, you know, doing it and doing it often and screwing it up and then doing it better, it's just like being a comedian. You know, these comedians will tell you they'll get up and they'll start telling jokes and they'll see what little part of that joke worked, and they'll keep that and then change the rest until they get the whole thing working.

And I've noticed I work the same way. You know, I have this spiel about Code Blue that I have worked on now for 35 years, and I've finally got it to where it's almost perfect, you know. But it does take, and I've noticed over time that it changes subtly as I see, oop, now that, it didn't quite land, but if I said it this way, it landed better and all that stuff, and you put it all together. So it's an ongoing thing. You'll get better at it as you go, if you can.

care about it. A lot of doctors don't care about it. I hear residents talking to be, well, you know, you've had a, you know, a primary myocardial infarction of the left anterior descending artery and the patient's just looking at them. Or, you know, here's a good one for you. If you're talking medical stuff or, sorry, pain stuff, we will always in medicine convert everything to oral morphine equivalents. So if you've got somebody that's on a dilauded or hydromorphone pump and they're getting 12 milligrams an hour, let me work this out. Well, let's say 12 milligrams a day. That's going to work out easier for me. That's 240 oral morphine equivalents per day, right? If you say that

to a patient, they're going to look at you with the blankest stare because they're not going to have any context. But if you say that's the equivalent to 24 Lortab tens, if they've ever taken any pain medication, they know exactly what you're talking about. Then they'll go, oh, God. Yeah, it's in terms they know and familiar with. Yeah, yeah. So when I'm talking to physicians, I'll talk in oral morphine equivalents. If I'm talking to patients, I'll talk in Lortab 10 equivalents.

Sure, sure. So stuff like that. But anyway. That's awesome. Well, good. Well, I'm glad we were in some way able to, you know, have some influence on you. And critical thinking is one of the things that I'm really big on. And a lot of our colleagues are dumbasses.

They are. The ones out there that are putting people on, you know, Z-Pax for colds and stuff, they're dumbasses. Use some critical thinking. Learn how to talk to people. Well, they want it. Well, okay. So what? You know, they want Xanax and Percocet, too.

You don't just write that? It may I make an observation, too. Of course. For the soon, you know, the young doctor is what, to me, the most important thing is being a great listener. Sure. Okay. My grandfather went blind from glaucoma and cataracts in his older days and he was living. Oh, the weather.

But have you seen the weather out there today? Exactly. So I used to sit around with him and just close my eyes and listen, you know, because we'd listen to the baseball games or whatever. Yeah. And I think that's a huge thing about, you know, when you're having patient interaction is actually listening and what they're fucking telling you. Because 9 out of 10 times, they're going to tell you what's wrong with them. Exactly. They just don't know how to articulate it specifically.

They don't know exactly the terms to put in, which is our jobs, right. But being a great listener, in fact, a book I'm reading right now is called Zen and the Art of Listening. And it's fabulous. I would suggest you. Scott actually reads books. He makes a really good point. I saw a person die because people were not. listening to him.

He came in to the emergency room saying he had a sore throat. And so part of this is, you know, patients just don't present in a textbook way, but what he meant was, I'm having left-sided chest pain and it's radiating to my neck. Well, they put him in the, you know,

acute ambulatory side thinking he had strep because no one asked any other questions. Just, oh, sore throat, you go over there. And, you know, when they came in to see him, he's dead. So, wow. Well, I'll tell this story. I guess we're not going to answer any questions today. We're just going to talk about this.

I do have one great topic, though, if we need a topic. Okay, well, I had this example of people not listening to somebody. Oh, yeah. I'm a second year resident. And at that time, it was just the resident and the attending. And the attending was in the office. So I was there by myself, and they called me to the emergency room to see this guy. who, um, I should, this is sort of my Christmas story, uh, who, uh, had been in the emergency

room multiple, multiple times complaining of a demon and his abdomen. And they would give him a shot of thorazine and they'd send him home. Well, they knew he had hepaticellular cancer. Mm-hmm. Okay. Um, uh, but, you know, this demon in his abdomen, he would complain of that. They just thought he was what we would call encephalopathic or just talking out of dang hit. So I give him a shot of Thorazine or Hal Dahl, which is a, you know, for people

who are psychotic and send him home. Well, when I went down to see him, it was obvious I wasn't going to be sending him home because he had a blood pressure of 70 over nothing. He had a fever of 104. And he had this hepatocale cancer, and it was pretty obvious he wasn't going to make it. So I was going to admit him, and while I'm talking to him, I said, my standard code blue thing, you know, if you die, do you want us to do chest compressions on you? And he's like, yeah, yeah, yeah. And I said, you know, if you died, you want us to put you on life support. And he's like, yeah, yeah, yeah. You got to do everything. You've got to keep me alive. Keep me alive no matter what. And I'm like, okay. Well, I didn't really have the tools to deal

with it at the time. So I just said, okay. So I just write the order full code. And I'm writing all these orders up sitting next to his bed in the emergency room, and everything was on paper back then. And during this time, he's yelling, you know, Lord, don't send me into that lake of fire, and then he would sing these hymns, you know, gospel hymns at the top of his lungs. And so I'm taking him up to the unit. They were pushing him up on the bed, up into the unit. And we get up there, And he's modeled. I mean, he is so obviously going to die. And the nurses up there were like, why are you bringing him up here?

He's going to die. I know, but the only place I can do the things that he wants me to do are in the intensive care unit. So I've got this is where the only place I can do it because there are certain medications you can only give in the intensive care unit, including what we call pressers or medications to keep blood pressure up and things like that. So I get all that stuff going. and he immediately lapses into a coma, or he becomes unconscious anyway, and I can't rouse him. So when he did that, I did the most reprehensible thing I've ever done in my career, which was as soon as he couldn't defend himself, I went running around trying to get somebody around him to make him a DNR. In other words, so for the people who don't know, a DNR means do not attempt resuscitation.

It just simply means if somebody dies, we let them go without doing all that stuff that we do, like you've seen in the movies. So, and by the way, at the best of times, in Dr. Ryan's case, if he were to die right now, God forbid, and we did CPR on him and did the full board thing, he only has a 15% chance of surviving. So you can imagine what this guy's chances were. Well, anyway, so I got a hold of the patient's friend that brought him in. She said, I'm not making any decisions.

Call his brother. His brother lives in Cincinnati. and you can talk to him about it. So I call the brother, tell him the whole story, and he says, I'm not making any decisions till I see my brother, I'm on my way, click. So we're on the hook for at least 24 hours until the brother gets there. Oh, geez. During this time, the patient would lapse into unconsciousness, then wake up, sing hymns at

the top of his lungs, yell, Lord, don't send me into that lake of fire, and then go right back into being unconscious again. So the next day, he survived the night, the next day, because I was pretty good at what I was doing, and the next day the brother shows up, and he goes into, you know, I explained the situation to him, he goes in to see the brother, the patient, and he just walks in without even saying how do he do, he goes, brother, do you want to live? And I'm like behind him going, God, don't add, who would say no to that? You know? And he goes, yeah, yeah, I want to live. And so I kind of over, I couldn't keep my mouth shut over the shoulder of the brother, go, do you want to live like this, though? And he's like, no, no, I don't want to live like this. So we, I'm still confused. I walk back. And remember, this is, I'm at the beginning of my training. I'm a senior resident, but a very newly senior resident. And so I sit back down with the brother out in the little chapel area, family meeting room. And he says, you know what's wrong, don't you? And I'm like, no.

I know I do not. If you do, please enlight me. And he said, my brother's never been saved. And he thinks, at first I kind of interrupted him, I said, look, anybody that sings that many hymns and talks to God as much as he does, believe me, he's been saved. He said, no, no, no, no. What I mean is he's never been baptized. And he thinks if he dies before he's baptized, he's going to go to hell because he thinks that that pain in his liver, is a demon that's holding on to his liver and is going to pull him into hell when he dies. Oh, wow. So, at that moment, I had a flash of insight at that moment. I realized several things. Number one, that this guy's

was being treated for his religious beliefs in the emergency room with Haldol and Thorazine, right? Oh, no, yeah. He and Joan of Arc had something in common. They both, everybody thought they were crazy. He had a legitimate, I mean, it's legitimate as any other religious belief, belief, that,

But this demon, you know, the pain in his abdomen was a demon going to pull him into hell. And the other thing I realized was what I was really dealing with was a problem in problem solving. No one had talked to, no one had listened to this guy, you know, including me. And here's how his problem solving went. I've never been baptized. If I die unbaptized, I'm going to go to hell. I don't want to go to hill. therefore I must never die

whereas I thought what might be slightly more functional having been in this job for a whole year but knowing that when none of us get out of here alive was I've never been baptized if I die unbaptized I'm going to go to hell I don't want to go to hell therefore I need to get baptized sure so break the chain yeah so I you know I ask the brother you think you know if I got him baptized here

he'd be cool. He's like, well, yeah. So I called the chaplain, and he was like an Anabaptist or something like that. I'm not even sure what that is. But he, I said, can you baptize somebody in the hospital? He said, I can baptize somebody anywhere. Okay. So I said, well, I got one for you. So he came up there into the intensive care unit, said, I'll just be a minute, shut the door, and it got really, really loud in there, like really loud. Not like, go. out or anything like that, but more, wait a minute, I can do that better. Get out. It wasn't like that.

It was more like very charismatic. They were both very charismatic. And the patient was, you know, singing hymns at the top of his lungs. And the preacher was really loud. And then all of a sudden it got really quiet in there. It was so quiet. And the preacher came out and he said, well, I'm done. I'll see y'all later.

And I was like, who was that masked? Because when we walked in, the patient was so quiet, I thought he had died. Wow. You know, it was even more quiet than he was when he was unconscious. But when he was unconscious, even then, he was conflicted, right? Sure. And but now he wasn't anymore. And the brother walked in, and the patient was just sitting there looking up at the ceiling.

And the brother said, how you doing, buddy? And the patient said, I want to go home. Wow. And, you know, we sent him home with the hospice. It was, you know, a short, you know, she had a short length of stay, so it was a late referral. But he was on minimal pain medication. I happened to see the woman that brought him in about, you know, afterward. And he died three days later in pain was never, ever in issue again.

She said that was the happiest she'd ever seen him. So this was a situation of what we call pure spiritual pain. which is pain that can't be treated with a pill. A medicine, yeah. Yeah. And nobody, including me, were listening to him. And if I hadn't wanted to get him off my service so bad, because that's what you want to do when you're a second year, I probably wouldn't have spent the time to figure it out myself, you know, in hindsight. And I didn't think it was that big of a deal at the time until we had a – all of the programs here have a program psychologist.

And he caught wind of it. And he just went, damn, dude, that was a hell of a thing you did there. And it was like, really? And because, you know, when you're a resident, it's buff and turf. You're trying to buff these patients up so you can turf them to somebody else. And I turfed him. I buffed them up and I turfed him to hospice. You know, that's really, I was in that mechanistic sort of mercenary mode, you know.

and I didn't really think about it as being a great thing until about two weeks later. And then when I really sat back and reflected on, I was like, wow, you know, we really can have a big effect. Yeah, I think it's just a great lesson. No matter if you're in medicine or whatever, just take the time to stop, stop, slow down for a minute and just listen. I think you'll discover some things about yourself or whatever situation you're in. And I think that's why home visits are valuable, too, because when you see somebody in your office, they're going to be one way. but you're kind of treating them in a vacuum and when you see them in their environment

you know in art we always talked about it like if you're going to draw a hand right you're drawing the hand in contrast to the background sure you can't draw the hand I mean you don't see a hand just isolated in space in in space you know you see it in relation to its background and when you see patients at the home you're seeing them in relation to their background or you know what's going on around them absolutely it's extremely valuable

so anyway there you go great story there's your story if i had uh sherwin sleeves uh the la la song behind me it would have been perfect um speaking of surewin sleeves by the way uh those of you out there who are fans of the good mr sleeves uh should check out two things get on youtube and search for Sherwin-Sleeves plays Minecraft because it is that my kids think that's the funniest video they've ever seen because it's Sherwin-sleeves like this old man character and he's playing Minecraft and he just keeps getting killed and he's spinning around in circles

and talking to those pigs that run around and he's like, am I to communicate with you, my friend? You know, good Lord, and he's dead again. these slimes. Oh, I do not like these slimes. That's just the greatest. Okay, so that's the first thing. The second Sherwin-Sleeves thing that you need to check out is the show on Amazon Prime called Patriot. Patriot is written and directed every episode, written and directed by Steve Conrad, who is got to be the hardest working guy in TV because, I mean, he goes to all the locations, films every episode, writes every episode, the whole. whole thing is his baby. But one of his co-writers is none other than Sherwin

Sleeves, which explained to me why the songs are so effing odd in this show. Sleeves had to have something, his real name is Sean Hurley, had to have had something to do with the songs. This guy is a CIA agent, and he can

only express himself in song, and so the songs he talks about, and so in the second season, particularly, the songs do all the exposition they tell you what he's going to do when he's going to do it but they're these kind of pop folk songs but they're just crazy and he's talking about bashing people's heads in and you know he's sad because he had to shoot that guy and all this kind of stuff it's just the craziest damn thing so Patriot is absolutely well worth it if you're if you can handle

some surrealism okay that's cool I need to check that out yeah yeah it's great so anyway something all right well good bin number one thing don't take advice from some asshole on the radio. We've got four minutes. We can get one in. Yeah. Let's see here. Hey, Dr. Steve.

It's Mike calling from New York. I'm listening to the podcast about squirting. That's Frankie Five Angels. I think you need to do your experiment one last time, put this to rest. You test it and you found the prosthetic-specific antigen as well as creatian. But if you take that same porn star and test just her urine and see if it can change the prosthetic specific antigen, perhaps somehow her body is producing and expelling that in a mental way. Yeah, no, he's right.

If you're going to do the study correctly, so what he's talking about was Harry Fish on Howard Stern tested a porn star's squirtage for creatin and saw creatin and concluded it was just urine. And then we did the same experiment and tested it for prostate specific antigen and concluded that it can't just be urine. He's right that it would have been much more conclusive if we had catheterized her or had her do a clean catch prior to doing this that showed no prostateic specific antigen in her urine. now oh boy um we didn't do that because um they're in the normal person there's no prosthetic specific antigen in their urine so unless you uh do a prostate exam on them and she didn't have a prostate so but uh yeah he is absolutely right that would have been that would have been that would have been a conclusive study so ryan i don't know if if you're aware of this i've talked

about a couple of times on the show you um there was a study where they used an ultra ultrasound probe that showed that women with empty bladders who squirt voluminous amounts actually produce a large amount of very dilute fluid that if you want to be technical you can call it urine because it is produced by the kidneys and expelled by the bladder but it is this particular fluid is only formed during sexual stimulation and is incredibly dilute, which explains why when men, you know, imbibe in this delightful fluid from the gods, say that it doesn't taste anything like they would think urine would taste like. Sure. You know, it's a very insipid kind of taste. And 50% of women up to, well, it's anywhere between 7 and 50% will do that. And then between 7 and 50% will also excrete a milky fluid from their skeins glands,

which are the analog to the prostate gland of the man. And that's where the confusion comes from, because some people do both. You know, if it's 7 to 50%, there will be a certain subfraction of women who will do both. They will imagine like a quarter or something. Coital, right, right. They will have coital incontinence, and they will have female ejaculation at the same time. And no matter what it is, it's not, quote, unquote, just piss. If you want to call that piss, you can, but it is a different fluid than the waste product

that they produce in normal metabolism. So there you go. So shit on everybody who says it's just because it's been in. All right. So we're back. And we'll be doing a special show next week. And then we may be off for the holiday somewhere in there.

I don't know what the schedule is. But starting, you know, late December, early January for the next year until October, until our contract runs out, we're back. So thank you all for being. with us. Thanks to Dr. Ryan, good luck in your endeavors. If you decide to match here, of course, you're always welcome on the show. As a matter of fact, we'll make you a regular. Just got to keep it on the DL with your faculty. You bet you. Thanks always go to Dr. Scott. Thanks again, Ryan.

We can't forget Rob Sprantz, Bob Kelly, Greg Hughes, Anthony Coomia, Jim Norton, Travis Teft, Eric Nagel, Roland Campo, Sam Roberts, Pat Duffy, Dennis Falcone, Hugh Jassel. Ron Bennington, Fez Watley, and Eton Twads, whose early support of this show never has gone unappreciated. Listen to our SiriusXM show on the Faction Talk Channel. Sirius XM, 103, Saturdays at 8 p.m. or 9 p.m. Eastern, one of the other. Sunday at 5 p.m. Eastern, on demand, and other times at Jim McClure's pleasure. Many thanks to our listeners whose voicemail and topic ideas make this job very easy.

go to our website at dr steve.com for schedules and podcasts and other crap until next time check your stupid nuts for lumps quit smoking get off your asses and get some exercise we'll see you in one week for the next edition of weird medicine You know what I'm going to do.