Intro

Intro

People, especially those who have been patients enjoy talking about doctors. How often do you hear "he or she is a brilliant doctor; he or she taught all the other doctors how to do that, they're the best in their field."These are all important attributes but the most important qualification that always accompanies the description is that the doctor has or doesn't have a bedside manner. You usually hear "he's a great diagnostician, surgeon, etc. but lacks a bedside manner." You seldom hear "he doesn't know a damn thing but has a great bedside manner." A bedside manner seems to be a deal maker or breaker in many situations with most patients preferring the brilliant doctor with it over the one without it. How can we guarantee that more doctors will have it? I don't remember a course in bedside manner when I went through medical school, although I understand more schools are now introducing classes on developing patient interpersonal relationships (which I think is the same as bedside manner). The real question is whether you can teach this in a few classes? I don't know of any way to test for it before you get accepted into medical school . It certainly isn't reflected by the (MCAT) medical college admission test scores, college grades, extracurricular activities or honorary premed society awards. So how can you ensure that all those brilliant doctors graduating from medical schools, completing internships, residencies and fellowships will have it before they enter practice. The grueling schooling and training that is endured and that demands the self-discipline to isolate oneself from society's everyday interpersonal relationships isn't exactly fertile ground for developing a bedside manner or a personality.

I welcome any suggestions on how we can improve on a doctor's bedside manner. I don't have a clue on how to accomplish this so I'll try to entertain you with stories about my experiences from years of medical training and practice that may have molded my bedside manner or a lack of one.

Monday, June 16, 2014

Lucy in the Sky without Diamonds


I return now after a bumpy year to continue on my quest for describing a bedside manner by telling true stories about medical doctors that reveal their human side. This story may not do that but is interesting anyway.




Having completed my medical residency training in the 1960s, a tumultuous period in America, “Make Love, not War” was the mantra that permeated the culture of the “Flower Children.” Like the beat generation before them, they desperately tried to break away from the conservative practices that this country sanctioned. I had minimal exposure to the Flower Children’s period since I chose to study medicine. I appreciated the exceptional music of that era from Bob Dylan, The Beatles, Jim Hendrix and others that captured the ethos of that period. At that time, I remember attending a medical meeting in San Francisco near a park occupied by the Flower Children. They were a colorful group dressed in different outfits with a mix of loud and dazzling colors. Assembled in a disorganized and non-intrusive manner making no deafening noises or booming music and generally no hoopla, they appeared peaceful and non-threatening. They seemed to be a generation that preferred to demonstrate their independence in colorful clothing, hairstyles of different colors, music, and drugs. They were devotees of drugs that produced psychedelic effects and hallucinations which transported them away from the chaos created by their elders. This story is about one of their favorite drugs, LSD, lysergic acid diethylamide. Unlike heroin of the prior generation that dulled the senses, it produced a heightened feeling of being alive with the ability to communicate with an imaginary world of visions, almost spiritual at times. The standard anti-anxiety drug used by the population also evolved in this country from  housewives on Miltown in the 1950s, followed by Librium in the 1960s, then Valium and the current flavor of the decade, Xanax. The Flower Children were not alone as disciples of psychotropic drugs.

One morning on medical rounds with my new intern, Jim, I learned that one of the patients admitted the previous evening to my medical service was a medical student. It was rumored that he had achieved the highest or one of the highest scores on the MCAT (medical college admission test). He had graduated from Harvard and was a follower of Timothy Leary, the infamous proponent of LSD. This wondrous drug was claimed to have many beneficial psychological effects. Our patient was admitted that evening with the diagnosis of labyrinthitis, an imbalance of the middle ear causing dizziness or vertigo. Neither Jim nor I admitted him since were not on duty that night. The new patient was in the first bed on a large open ward of male patients on the seventh floor of the hospital. The location of the bed was close to the nurse's station so they could keep an eye on him. Jim had examined him earlier that morning prior to rounds, and he was puzzled by the diagnosis. Admitting a patient with that diagnosis to a hospital, especially a city hospital handling life-threatening illness, was unusual. More commonly the emergency room discharged a patient home with this diagnosis with a handful of sea sickness tablets. The other thing confounding Jim was that his physical examination was normal. There were no physical signs suggesting the diagnosis of a middle ear imbalance. Jim also remarked that his patient who I will call Jack for this story had a strange affect and did not speak or answer questions. Jack was restrained in bed with an apparatus that allowed movement of his arms and legs. Restraints should not have been necessary for this diagnosis unless the patient was confused which is not usual with just a middle ear imbalance. The restraints allowed some movement while keeping the patient in bed.  We assumed they were needed to prevent a confused and dizzy medical student from falling out of bed. After all, it was for the patient’s protection and God help the resident who doesn’t appreciate the need for preventing such accidents especially when caring for a medical student. With new patients, I usually examined them after completing rounds to allow more time for taking a history and performing a physical examination.  Jim and I were examining the fourth or fifth patient on the ward when we heard a commotion with loud noise coming from the first bed. Jack had taken off his restraints, jumped over the bed rails and headed to the nearest stairwell. I told Jim to take the fastest route to the ground floor and block Jack’s exit from the hospital. Jim as a recall was a rather muscular fellow with a physique resembling a football tackle. Our patient was a tall, gaunt guy who could be easily stopped. I followed my patient who had had a head start. In the stairway, I could see him on the fourth-floor landing looking down at Jim, who amazingly had reached the ground floor. I yelled to Jack to return to bed and reassured him that we would not harm him. There was no answer, and he had moved out of sight. All I could hear were clanking noises like metal pots banging together. The empty green oxygen tanks were stored on the stairwell landings. It soon became apparent that the sound was produced by Jack dragging an empty tank along the stairwell railing. At the time, these tanks were about 4 to 5 feet in height and heavy even when empty. Jack was attempting to lift the green tank and hurl it down the stairwell at Jim.  I yelled to Jim to get away from the stairway and call security.

Security did rescue Jack and he was taken to a locked psychiatric ward on the hospital grounds. The following day, I heard that he was transferred to another psychiatric hospital in the city that was not affiliated with our hospital or medical school. I heard that the other hospital had discharged him three days later. I wasn’t expecting to hear more about Jack. However, on the fourth or fifth day following his release, I walk in the ward and found the staff huddled together looking at something on an empty bed.  As I approached, I asked what was happening and they held up a newspaper. The headline on the first page of the paper read LSD killer in large bold print. Jack after leaving the other hospital had returned home and killed his mother in law. From what I recall it was a gruesome murder in which he stabbed her more than one hundred times. Not exactly a rational way to handle a troublesome mother in law.

Following the murder, the buzz in the news was that he had a history of taking LSD and continued using it before he was hospitalized. It was all a bad trip (a term that was used to describe the opposite of a high) that made him murder his mother in law. Another theory was that he had experienced an acid flashback, which is a sudden, unanticipated event that can be terrifying. This “Flower Child” drug could make you do terrible things and not just make love. For several months, various theories were bandied about by a generally uninformed public. The final verdict was that Jack was a very smart paranoid schizophrenic who could get high grades on tests and high from drugs, but his twisted psyche prevented him from becoming a doctor.

Unfortunately, there were no tests at the time to screen for severe psychiatric disorders in medical school applicants. Passing the MCAT test provides important information about one’s intellect but nothing about their personality. The problem is that there is no easy way to open a window into a person’s psyche or soul to enable us to determine the amount of mental stability required to become a doctor. That said how can we predict a physician’s bedside manner?

Monday, April 15, 2013

PLEASE DON'T SHOOT THE INTERN

After graduating from medical school, I chose to complete my medical training in a city hospital . I thought it would give me the greatest opportunity to see a wide variety of patients and some freedom to learn medicine without it being prescribed by private practitioners who were afraid of allowing interns or residents to care for their patients. Obtaining ones training in a city hospital wasn't a free for all by any means but it did provide more freedom to get hands on experience compared to simply learning by following example.One of my most memorable experiences was rotating in the emergency room. The emergency department was a large unit divided into several different regions for surgical cases, acute medical cases, female and male walk in or wheeled in cases and an obstetrics section.

One evening I happened to be assigned to the male medical section and as usual it was full of the sick, the not so sick and those that thought that maybe they were sick. There was very little sorting of the patients by the severity of illness at the admitting desk that was manned by a receptionist with the help of an orderly who was busy transporting patients. My dull gray room was busy that night with patients seated on uncomfortable metal chairs lined up against the far wall. My office and examining area was supplied with a stretcher, sink and desk against the opposite wall and separated from the waiting patients by only by a drawn curtain . As each patient was examined he would give up his seat to the guy in the adjacent chair and so forth with everyone moving over one seat to make room for the next client. It was sort of a musical chair type of operation without the music. That evening after examining a patient I drew the curtain open and looked around the room before calling for the next victim. I saw an elderly gentleman who by comparison appeared relatively well dressed , with a shirt, a tie and clean pressed pants. He was seated at least 10 to 15 chairs away from the launching chair and sat there quietly with his eyeglasses fogged up and forehead covered in beads of sweat. I walked over and without saying a word placed my hand on his forehead . He was burning up with a fever and I helped get him up and walked him over to the examining area. I asked him to undress and pulled the curtain shut. While I was asking him to tell me about his illness, the curtain was pulled open and a not so well dressed gentleman entered demanding to be examined first. I explained that the sick old guy looked like he was ready to pass out and required my attention ahead of all the other patients. The not so well dressed man said he was there before the old man and I would have to exam him first. I told him to wait until I finished with the current patient and I would then be happy to see him. At that point he put his hand in his pocket and withdrew a small revolver, pointing it at me. My life didn't pass in front of me but it seem like an eternity before I could respond. He coldly stated that he would kill me if I didn't do what he said. In my initial panicked state, I thought about all the time and effort that had been wasted  studying for my brief medical career which would soon be over. I gathered all the courage I could muster and coolly told him that if he killed me I wouldn't be able to examine him and make him feel better. He stood there for awhile thinking and then told me that there were people in the room who were threatening his life and his visions advised him that I had to examine him before they killed him. Well it was clear that I was dealing with a psychiatric patient. I told him to give me the gun for safekeeping and if necessary, I would  protect him from the other men who frightened him and would examine him as soon as I helped the old fellow off of the stretcher. After he handed me the gun, I asked him to wait on the other side of the room. I quickly drew the curtain and with trembling hands grabbed the phone off the desk and quietly called security for help. All the while I hadn't thought about the patient on the stretcher who when I turned to him continued to quietly sit there with the same frozen expression on his face. I shrugged my shoulders and figured he hadn't passed out because of a surge of adrenaline that he probably experienced from observing the whole event. I then described the intruder to security so they could identify him and take him to the psychiatric unit. I handed the gun over to them, finished administering to the patient with the fever and called for the next patient.

I never gave this incident much thought other than feeling sorry for the patient with the gun and the terrible fear that he must have been experiencing to threaten a young inexperienced intern to exam him and cure him of his frightening hallucinations. Fortunately I haven't had any more experiences like that.

Friday, April 5, 2013

BUG CURES STROKE

As a 3rd or 4th year medical student in the Washington, DC, I had a clerkship in the Veterans Hospital. A  private girls school that had been built in 1930 was converted to a Veterans Hospital after World War 2 and existed as such when I was in medical school in the 1960's. The patient rooms were essentially the dormitory rooms to which very little had been added.The rooms were not air conditioned and in the summer they were hot and sticky. One evening on a hot and sticky summer night, I was assigned a newly admitted patient to work up. It was a Friday night when many of the weekday patients had been discharged home and there were available hospital beds. Weekends happened to be the time when many homeless veterans would present to the emergency room to recover from their week long lack of adequate nutrition after consuming too much cheap alcohol.

 My patient was admitted with a preliminary diagnosis of stroke. He was a middle age male who was unresponsive to verbal stimuli and couldn't give a history of his illness. He lay in the bed with his eyes closed, stable vital signs and was breathing comfortably. On examination, his limbs were flaccid and fell to his side when examined but they responded normally on checking their reflexes. As I was completing the examination of his abdomen while standing next to his bed with my back to an opened window, I heard a strange fluttering sound coming from the window. A large brown roach about the size of a baseball landed on the his exposed abdomen. He immediately opened his eyes wide, arched his back upward off of the bed appearing to levitate as he rose upwards and jumped out of the bed to run out the room. I ran after him shouting for him to stop so I could  finish my examination but he escaped down a stairwell and I lost him. To my dismay I had to report to the intern that I could not finish my examination because it was interrupted by a roach that seemed to cure the patient's stroke but I lost the patient .The intern informed me later that security had found him and I could finish my examination. Even though their was no evidence of a stroke, the hospital staff would observe him over the weekend with  or without a stroke. Admitting the homeless on the weekend kept them off of the streets, nourished, washed and dried out (detoxed). It was also a way to keep medical students on their toes.

I doubt that there are any therapeutic roaches curing strokes these days in our modern VA system.

Thursday, February 21, 2013

DOCTOR IVAN THE GREAT



As a medical student I followed Ivan around from patient to patient on the University Hospital medical ward  and enjoyed watching his enthusiasm for taking care of patients. His commitment  evaluating each new patient was so palpable that the patients had the feeling that they were getting the best care that was possible. Some of the doctors including his fellow interns and residents considered his eagerness was just one-upmanship but the patients loved him. Because of his bedside manner I thought he was great and call him Ivan the Great, as did his patients.

One particular patient stands out as illustrating some of the conflict that can occur when an intern matches wits with a senior staff physician. An elderly female patient was admitted who was known as a Grand Matron of High Society. She was celebrated for raising enormous amounts of money for her favorite religious charity. She was often  featured in local newspaper articles on the gala events that she sponsored . Her private physician was  primarily known for his practice that catered to the social set and was a priggish fellow with a definite overbearing manner. Ivan was the admitting intern that day who evaluated his patient. I've forgotten the name of the attending physician but for the sake of the story, I'll call him the Prince. He was in many ways the complete opposite of Ivan  but both had comparable huge egos.The patient had been experiencing difficulty walking and had fallen several times. Because of her advanced age, it was thought that she was experiencing multiple small strokes due to hardening of the arteries in the brain. Ivan did his usual thorough evaluation and entered his findings in the hospital chart along with a concise differential diagnosis listing three different possible diseases or disorders. He ordered the laboratory work and some X ray examinations that evening.

That evening the Prince came in to check on his patient and review her hospital chart. He quickly excused himself from the patient's room and ran to the doctor's conference room searching for Ivan. Ivan was not on call that evening and wasn't in the hospital. He became ballistic ripping out Ivan's history and physical report from the chart. He got on the phone and found the medical director in his office. With the interns report in his hand he rushed into the directors office to show him what Ivan had written. The director carefully read the two page report and asked the Prince what was the problem . The physician was all flustered and stammered demanding "do you see what the first diagnosis is!" The director's answer was yes and he added that Ivan's examination was consistent with the diagnosis. The physician in a very imperious tone exclaimed that it was impossible since the patient was a pillar of her church and a spinster who had never married. The diagnosis which hadn't been confirmed as of yet by any tests would ruin her if it became known he shouted. The director telephoned Ivan and told him to come in and rewrite his examination and list his first diagnosis  as the last one in his differential list of probable diseases. He also warned Ivan that when a sensitive diagnosis presented itself he had to call the admitting physician to discuss it with him first rather than surprising him with it the next morning on hospital rounds.
The next morning everyone was waiting for rounds to start and the fireworks to begin when both Ivan and the Prince were examining this patient. Ivan had the foresight to stop by the lab on his way to the ward and get the results from the blood work that had been drawn the night before. In the hallway that morning there was the expected confrontation of the two who were quickly escorted to the conference room to avoid a brawl occurring in the view of the patients. The Prince told Ivan that his insensitive diagnosis of  a dreaded social disease was totally inappropriate for this sweet old lady whose sole problem consisted of trouble walking. He added that only an arrogant moron that enjoyed grandstanding would come up with this diagnosis before all the tests were evaluated. At that point Ivan quietly withdrew the lab reports from of his pocket and showed him the positive screening test for syphilis. The attending quickly attributed it to a false- positive test and  said it was impossible for this religious old maid to have syphilis of the nervous system or neurosyphilis in medical terminology. Follow up tests confirmed the diagnosis and a further history confirmed that in her youth she had been sexually active. Neurosyphilis usually develops decades after the initial exposure and can result from a failure to diagnose syphilis at an early stage or from receiving inadequate treatment for it.

I often think about Ivan and wonder what kind of physician he became. He had the temperament of a surgeon but would have been a brilliant internist. Had he maintained the skills he developed when dealing with patients and his incredible bedside manner?


Thursday, February 14, 2013

DOCTOR IVAN THE TERRIBLE


One of my first clinical tours of duty was on the Internal Medicine ward at the University Hospital. I was nervous about showing my ignorance of clinical medicine in front of the icons of medicine, the academic full time staff. I was assigned to an intern whose name was Ivan. He was a tall fellow with chiseled facial features and thick black eyebrows that gave him a menacing appearance. His greenish-brown eyes however suggested a gentler and mellower person. I was impressed by the energetic and confident way he examined patients and how focused his diagnoses were. Whereas most of the interns would write a laundry list of diagnoses after examining a patient, Ivan would limit his differential diagnosis to two to four disorders at best. They would be listed by their likelihood with the most likely first. Because of his ability to give patients a thorough examination and produce relevant diagnoses, the private physicians frequently requested him rather than the other interns to work up their newly admitted patients. As a rule, the interns were chosen on a rotating basis and not requested. He was also the intern who produced the most autopsy cases making him the pride of the director of medicine. Autopsies were very important in academic teaching programs since the number of autopsies was listed in directories that evaluated the programs and described them for prospective interns and residents. The program with the most autopsies usually attracted the best and brightest interns and residents since it provided the greatest teaching experience. It may seem counter intuitive that the greater the number of autopsies the better the medical program but the number of autopsies only reflected the number of deaths in which autopsies were obtained. A program with fewer deaths could have performed more autopsies than one with more deaths.The autopsy, also known as the postmortem examination, is the gold standard for determining the patient's underlying disease, the effect of any treatment and the cause of death. It is extremely important for confirming that the diagnosis and treatment were correct and why the patient died. Each week the interns and residents were required to attend the mortality conference where the autopsied cases were reviewed and discussed. CT, MRI and PET scans weren't invented or used for this purpose until much later. Today the autopsy continues to remain the most objective way to obtain this important information.

I was Ivan's gofer and followed him around like a groupie followed his rock star, hoping that some of his light would shine on me. One day after arriving on the ward I found him in an empty patient's room pacing back and forth and mumbling to himself . The patient's bed had been made but there was no patient in the room since he had died during the night. I thought Ivan was upset about the patient's death and I went over to console him. I told him that after all, there was nothing that could be done to save the patient. The patient was terminal and expected to die. He looked at me as though I was crazy. He said he wasn't grieving the death but was upset that the family had refused to consent to the autopsy. He tried every maneuver to persuade them except one. I asked him which one he hadn't used and he didn't answer. I asked him again without a response and finally after several more attempts he answered. He said he could only tell me if I agreed to keep it a secret and not tell anyone else about his method. Without a thought about what I was agreeing to, I gave him my word. He went on to tell me that particularly for patients who had died after surgery, the family would be told that as a last resort, the doctors used a special treatment placing a large amount of gold in the body to cure the disease and save the patient's life. There was another route, he explained, for inserting the gold in patients who hadn't had surgery, but I'll spare you the unpleasant details. I couldn't believe what I was hearing as he continued to tell me that if an autopsy wasn't performed and the gold was not removed, the family had to pay for the gold.  I was speechless and dumbstruck. Now it was apparent why they called him Ivan the terrible and I had naively thought the other interns were just jealous.

A few years later when I was an intern, I had a similar problem trying to persuade a family to consent for an autopsy on a family member I had treated who had a complicated hospital course and I really wasn't sure why he died. The family adamantly refused on religious grounds. I tried to explain that the results from the autopsy would help us understand more about the disease and could help other people with the same problem. I thought about Ivan and his crazy method but didn't have the nerve to use it. I clearly remember the second meeting that day with the family who was accompanied by an elderly rabbi. It was a bitterly cold winter night during a snow storm in the dark and shabby lobby of a city hospital where the family told me emphatically that their rabbi had agreed with them, not  to consent. The angst I felt that night was only tempered by the strength of their religious conviction that required an old rabbi shivering from the cold of winter to prove it to me. Obtaining a consent for an autopsy has never been easy but none has been as memorable or difficult.

Wednesday, February 6, 2013

Medicine in Black and White with shades of Grey

Take a look at the video bar and you will notice that the first video is the Benny Goodman quartet playing Moonglow. Benny Goodman was one of the first white bandleaders to hire a black musician. That muscian was Lionel Hampton, the jazz vibraphonist that later became famous with his own orchestra. This was a time when all bands were either all white or all black like the Paul Whiteman and Duke Ellington orchestras. This little-known bit of music history occurred before baseball and schools became integrated. Benny Goodman was a man who could see value and talent despite skin color and beyond the social strictures of the day regarding mixing black and white.

While in medical school I sat next to a student named Frank in histology class. He became one of my closest friends. Histology is the study of the microscopic appearance of normal human tissues. Each student had a microscope and a  Histology book with pictures of  the microscopic slides that he or she used to identify the tissues that they examined with the microscopic. One day the professor was comparing in great detail, a picture of  the microscopic cells from a part of the body in the  book with the special color qualities of the slide that was being viewed with the microscope. Frank leaned over to me and asked me to point out the color that was being described. I thought this was strange since it was fairly obvious from its picture in the book. I looked at the slide using his microscope to see if he was comparing the picture to the correct slide. Everything looked ok and I asked him what his problem was. He told me in a hushed voice that he was color blind and had to learn the different colors in shades of grey. Since I was a medical student without any clinical experience I didn't give it a second thought and was totally oblivious of the potential problems, if any, for a color blind doctor.

Many years went by and I had lost contact with Frank while we completed our internships, residencies and military service in different locations. While I was in practice in Florida I learned he was practicing in Los Angeles and we resumed our friendship. I then learned he had become an up and coming plastic surgeon who catered to a Hollywood clientele. I was flabbergasted. When I had the opportunity to see him in person during a car trip to LA with my wife and kids I questioned him about his color blindness. Specifically, how he was able to perform surgery without being able to see the color of tissues he operated on, like the arteries, veins and nerves. He calmly told me it was no different than driving a car and being able to tell a red from a green traffic light . He became a very successful plastic surgeon despite his color blindness and was a great surgeon and friend.

I guess the lesson I learned was that we need to look beyond color to be successful in life and can overcome   what other people may think are impediments to personal accomplishment and success. I recently received an email that quotes a Ben Herbste and sums it up better that I can. He stated "The greatest waste in the world is the difference between what we are and what we could become."

Thursday, January 24, 2013

Human Anatomy Lab

Nothing you experienced in college lab courses could ever prepare you for human anatomy lab in medical school during the 1960s. Sometime during the first few weeks of medical school in Washington DC on a hot sticky September day the first year medical students received an introduction to anatomy lab. Without any forewarning we entered a large room with 20 or so metal tables with human cadavers covered with sheets . The lab wasn't air conditioned but the large windows that extended to the ceiling were numerous and opened. The stench of formaldehyde was overwhelming, hurt your eyes and induced nausea. Many of the students rushed to the windows to hang their heads out for fresh air and many of them vomited out the window. The class was divided into teams of 5 or 6 students for each cadaver. Since there were about 10 women in the class they got there own tables with female cadavers. Don't forget, this is the 1960s we're talking about. The instuctor was a short stocky man with a thick German accent and thick eyeglass lenses that made his eyes look like they were popping out of his head. He looked like the German prison camp commandant in the movie Stalag 17 or the TV series Hogans Heroes. When he approached you, you weren't sure whether to click your heels and salute or greet him normally. Cadaver dissection wasn't pleasant but we adapted and soon developed ways to lighten things up, with meaningless gags and practical jokes. Every anatomic region you dissected had to have labels that you pinned to the tissues so that the instructor would know you had identified the anatomic structures correctly. Usually the instructor would randomly without any warning, choose a table to exam . Most of the labels had been placed the day before and many mornings you would find that someone had switched some of them and moved them around inappropriately. It wasn't unusual to see a label for an eyeball in an armpit.It was all taken in stride and laughed about.

One memorable occasion involved a cadaver table of the female students. Generally  you arrived in the lab and removed the formaldehyde soaked sheet from the cadaver and inspected your previous days work. This particular day shortly after arriving in the lab we all heard a sudden loud scream coming from one of the female students tables. As the other women gathered around the table there was the roar of laughter and giggling coming from all the female students. Otto our instructor ran over to the table to see what was going on and suddenly turned beet red. He began jumping up and down waving his arms over his head trying to calm the ladies down and get the attention of the rest of the class. I thought I had heard him yelling ACTHUNG, ACTHUNG but  I was later corrected. He was yelling  " attention" in English but I couldn't understand him given his thick accent and my imaging him as the German commandant. In the middle of this ruckus, one of the taller gals at the table grabbed the unexpected object placed in the crotch of the female cadaver and raised it over her head, waving it back and forth. Looking at the major practical joker in the class she yells out "Freddy I think you forgot to take your penis with you last night". The class erupted in laughter and Otto could not take command and admonish us for acting so poorly.

I'm sure the next day we got an ear full from the anatomy professor but I probably was asleep in class and don't remember. I usually fell asleep during the boring anatomy lectures  The story is true but the names have been changed to protect the innocent and not so innocent.

For all those with a bedside manner out there,  please feel free to entertain me (?us) with your surprising stories from the healing professions that may have improved or diminished your bedside manner.