Post-Apocalyptic Medicine Made Ridiculously Simple


The Setup: We had to write an essay in which we apply the Hippocratic Oath of Medicine (do good, best of my ability, blah blah) to 8 patients we saw over the year. Boring, right? I took some liberties. Haven't written creatively in some time - you may not get all of it. I hope they don't boot me out.

All four massive tires chirped briefly as he upshifted the Turbo into 3rd and side-stepped the clutch. The golden Porsche surged forward again, thrusting relentlessly to 120 mph. 11:07 am, Dr. V was late, again, just like a real doctor. His first patient was scheduled for 11:00 am. The engine wailed as the tach climbed past 6000 rpm. Fortunately, traffic was sparse. Actually, traffic was always sparse. In fact, traffic was always the same, essentially unchanged since about 1:00 am, January 1st, 2000--about 3 years ago. Thank God the missiles didn't come during rush hour, he thought, as he topped out at 192 mph, weaving briskly between a scrapped Volvo and the charred remains of a GMC Suburban. On the plus side, there were no more CHPs. On the minus side, of course, there were no more teachers, students, waitresses, engineers, friends, relatives, humans, or mammals of any kind, pretty much. With the radiation, even insects had it rough. Gas was free. Food was all-you-could-eat all of the time, but the selection was generally limited to canned and dried goods that hadn't spoiled yet in what was left of the supermarkets. Top Ramen was plentiful.

Yeah, Y2K was a bitch. The media hype proved accurate, and in fact, turned out to be a gross underestimation. The computers were, indeed, confused. Two simple digits! The experts tried to fix the problem. They made their predictions, but they overlooked one vital thing. Perhaps, they knew they couldn't stop it, and so, elected to keep it silent. Let them party like its 1999, they thought. It didn't matter now. Everything was automated, for safety, and so, despite heroic efforts, within several hours, the planet was done--well done. Worldwide, survival was probably about 1 in 10,000, although Orange County was a little higher. The Eskimos probably faired all right, but who knows?

Dr. V was one of the lucky ones. To this day, he can't explain how he survived. He wasn't really a doctor and his real name was too complicated to remember, but he went by "Dr. V". He did not have a medical degree, but he did have a year of medical training from UCI's College of Medicine, and under the current state of affairs, it would have to do. Now, many would correctly speculate that post-apocalyptic Irvine is a pretty dull place to live. It was dull to begin with, though, so the absence of people walking about, socializing, was not, in itself, unusual. Amazingly, the left-turn intersection arrows continued to function perfectly in their intrinsically irritating way. The smell did take some time to get used to. It was the rancid humidity of a hundred thousand corpses, incinerated instantly from head to toe, decaying on the streets, sidewalks, stores, restaurants, and homes. Dr. V imagined he was at a family BBQ. Of course, he couldn't remember his family. Perhaps he had repressed the memories to protect his delicate psyche from the emotional trauma that accompanies the idea of a close family member lying stiffly somewhere, with the flesh melted from their bones. Fact is, when he had regained consciousness and found himself alone, in the Berke, amidst the smoldering death, all he could recall were two bits of information he'd picked up in medical school. The first tid bit was a condition called Winged Scapulae, a mythical condition--mostly Urban Legend, in which a person loses the innervation to their serratus anterior muscle, causing a posterior protrusion of the scapulae when they push forward with their arms. Fortunately, the second item proved more useful.

Somehow, the nuclear blast had cemented one other thing clearly into Dr. V's mind and it is this second thing that pushed him to rebuild his life and dedicate it to the restoration of society. What Dr. V remembered most clearly, aside from Winged Scapulae, was: "The Oath for Doctors of Medicine". It rang through his head like a bad poem; like a Neil Diamond song. It became his guide--his dogma. It was the only thing he could rely on. He would turn to it for answers and wisdom. It was his magic 8-ball, his ten-or-so commandments. With its verses in mind, he opened a medical clinic for survivors so that his ability could "be shared with humanity." To be sure, there were others like him. These were the rare souls who'd been lucky enough to weather the hellish eruption and had a constitution resistant to the massive levels of radioactivity.

Now, one may wonder how much good a single individual can do with such limited knowledge, but consider this: The destruction was quite thorough, and engulfed in those searing flames, along with everything else, was the ill-fated concept of managed care - sent back to hell from whence it came. In the new world, there were no formularies, guidelines, restrictions, oversight committees, resource review boards, and, best of all, lawyers. At this point, some might go so far as to argue that a fiery consummation would be worth it, if it would just eliminate all the lawyers, but be certain that, like the cockroach, one would survive and breed, and sue for damages. So, in this new era of unregulated health care, one can imagine how an independent pseudo-physician armed merely with the Oath of Medicine and some medical reference materials (e.g. Netter's Anatomy and perhaps, Post-Apocalyptic Medicine Made Ridiculously Simple) could achieve patient care on par, if not superior to, that performed by the former brilliant physicians that had been shackled and suffocated by over-regulation. This is the context in which Dr. V found himself "practicing the profession to the best of his ability."

Dr. V roared into the lot and pirouetted to a stop with a forceful yank of the emergency brake. Nice ride, tomorrow he would try the Ferrari. As he walked into the office, he noticed several patients already waiting--times were not so different, he thought. He had eight appointments today but since he only had about five hours until golf, he bumped half of them to the following day. The first patient was a Mrs. Sandi Somerset, a 39 year old white female complaining of excessive fatigue. Dr. V greeted her and listened patiently as she explained to him that she felt bad about the way she looked, cried easily, and felt inadequate as a housewife. Now, at this point, one might be tempted to explain to such a person that she should be lucky that parts of her body weren't randomly falling off and that if she would be so kind as to leave and never come back, one could tend to people with more pressing problems. However, Dr. V did nothing of the sort, for he knew his Oath and it was quite clear about such nuances. It stated that a doctor "will endeavor to alleviate [patients'] fears, and recognize that occasionally the most meaningful treatment may be to listen with kindness and understanding." This was just such an occasion and Dr. V resolved to sit there attentively and listen with kindness, until his ears bled if necessary, to make Mrs. Somerset feel better. The Oath further reminded him that his "empathy should never be subservient to his skill and knowledge." He had the time, of course, since HMO's, like smallpox, were now a thing of the past. Actually, within about forty minutes, he was able to console her, empathize with her, assess her degree of depression and come up with a plan to help her lose some weight. She left feeling better than when she came in, and all it took was some patience and understanding.

The next patient was Mrs. Mary Morgan, a 51 year old female complaining of chest pains. Through experience, Dr. V was able to immediately rule out Winged Scapulae. Further investigation revealed a patient with classic risk factors for a severe myocardial infarct. Here again, the Oath laid out the proper course of action, instructing Dr. V to "use his skills and knowledge to aid in the prevention, diagnosis, and treatment of medical diseases." Mrs. Morgan had eaten too many donuts and smoked to many cigarettes. Her heart was a time bomb and Dr. V had to diffuse it. Here was an opportunity to prevent a severe disability by educating the patient on health maintenance and Dr. V took it. He instructed the patient to cut out the junk food, quit her stressful job, and take up a relaxing hobby of physical exercise that would benefit the city - grave digging.

The third patient proved to be a more difficult situation. In came Mr. Jesus Perez, a 40 year old patient complaining of severe cough. After briefly having Mr. Perez lean against a wall with both hands (you can never be too sure), Dr. V delved deeply into Mr. Perez's medical history and found a heavy smoker with significant occupational exposure to carcinogens. In short, here was a patient with the early manifestations of a rapidly progressive terminal disease. The problem, and it seems to be the rule, was that Mr. Perez was not ready to die. He had plans to visit his family in Mexico. Would this be a good time to let him know that he had a much better chance of seeing his family in the afterlife? How was Dr. V to broach this delicate subject? Here is where the Oath gets a little hazy in its advice: It tells the doctor to "treat patients with dignity...and to value life while striving to understand the process of dying." Well, this patient was certainly dying, but what was Dr. V to say? Couldn't he just prescribe some Robitussin and schedule the patient for another appointment for a month from now hoping that ëthings would work themselves out'? Certainly not! The good doctor clearly recalled some lines about "helping patients understand the disease, treatment, and prognosis." He had to be kind, but Dr. V owed his patients the truth, and so, with great empathy, he dropped the load on Mr. Perez, figuratively. To his surprise, Mr. Perez smiled. He stood up to leave, choosing to live out his final days in what was left of Las Vegas, and with a heart-felt handshake added, "Thanks for being straight with me, doc! Besides, you're probably right. Chances are, they're already dead, what with the nuclear winter and all."

It was turning out to be an outstanding day. Barely past 2:00 pm and only one more patient to see--for an instant Dr. V felt, for lack of a better word, Dermatologistic. The fourth case was an interesting one. The patient was Mrs. Jean Stevens, a 24 year old lady who hadn't had a period in three months. What complicated the picture was Mrs. Stevens sordid past. She was a wild girl in her younger days and had put herself at risk for HIV. She'd changed her ways, as of late, and had met a swell guy, Jim, whom she intended to marry. Now, in true "Jerry Springer" format, Jim did not know of Jean's glory days and she preferred to keep it that way. Furthermore, she seemed in denial about her unwanted potential pregnancy. Dr. V recognized the sensitive nature of the issues involved and wisely chose to forgo the standard examination of the long thoracic nerve (C5,6,7) to a more appropriate time. The Oath emphasizes the patient's right to "respect and privacy." "Keep their trust and preserve confidentiality," it demands. Jean wanted to keep things private, but she was putting her boyfriend at risk for contracting HIV. Dr. V performed some quick tests and confirmed that Jean was indeed, pregnant and positive for HIV. The situation was becoming dire: On the one hand, Dr. V has a very delicate patient situation, and on the other, O. J. (now there's a lucky guy) was meeting him for golf at 4:00 pm!

Fortunately, Dr. V had other resources. He was a former UCI medical student, and thus, had his finger on the pulse of ëEvidence-Based Medicine'. He excused himself to his office, where he had a functioning T1 line, and within 15 minutes, discovered that, not only had a cure for HIV been discovered in November of 1999, but also, that its only significant side effect was the induction of abortion in pregnant females. What was even more incredulous (but true, nonetheless) was that the cure could be prepared from household cleaning products and Top Ramen. Needless to say, Mrs. Stevens was ecstatic.

With that, Dr. V called it a day. He walked Mrs. Stevens out and climbed into his recently acquired benchmark of automotive engineering. This was the life, he thought, atomic holocaust not withstanding. Unfortunately, things turned for the worse shortly thereafter. Arriving at Torrey Pines in La Jolla at a quarter past four, Dr. V was shocked to find the body of his golfing partner, O. J., several meters removed from his head. It appeared to have been some sort of freak golf ball washing accident. What a shame, he thought, it could not have happened to a better...nevermind. The drive back was a melancholy one for Dr. V, what with O. J.'s gruesome dismemberment on his mind. He spent the rest of the night at home, relaxing, eating noodle soup from a styrofoam cup.

Dr. V left early the next day, briefly stopping by Fletcher-Jones automotive to ëborrow' an SL600. It was sunny after all, and proper etiquette dictated a convertible. His first patient that day was Dr. Michael Taylor, a 57 year old alcoholic physician. Of course, the Oath dictates that Dr. Taylor be referred to as a ëphysician with alcoholism', since labeling people by their disease process is derogatory, and "a patient's sense of self-esteem is essential to good health." Dr. Taylor was visiting for a pre-op assessment because he needed a hernia surgery. Unfortunately, Dr. V could not endorse the procedure on account of the patient's failing liver. Dr. Taylor was dismayed at first, but felt better after a couple of drinks.

The next patient was Mrs. Blanca Cortez who came in to complain about her five year old daughter Jessica. Jessica had been acting very listless lately and just "wasn't herself". After taking a careful pediatrics history with special attention to her household environment and possible hazards and exposures, Dr. V asked Mrs. Cortez, "When Jessica is lying around on her elbows, watching TV, do her shoulder blades protrude excessively?" "What?" "Nevermind." Dr. V suspected lead toxicity, but he was not sure, and since the Oath dictates that a physician be "humble enough to call for assistance when necessary", Dr. V made the appropriate referral and added, "In the meanwhile, tell Jessica to stop eating lead."

The third patient that day was Mrs. Amber Lee, a 28 year old lady presenting with isolated neurological symptoms of weakness and unilateral facial pain. Her symptoms were quite puzzling. Dr. V prescribed some pain killers and referred her to an expert. The beauty of non-managed care was that doctors could actually refer patients without fear of corporal punishment. This gave Dr. V a chance to meditate on "the wisdom of teachers" and freed up some time for "striving to further his education and develop habits to promote his intellectual growth" as the Oath would have him do. This was, naturally, an excellent opportunity to review the musculature of the lateral thorax.

The last patient was Martha Smith, an elderly woman with arthritis, diabetes, and hypertension. She needed help taking care of her husband James, who had progressive Alzheimer disease and was becoming unmanageable. Her last doctor had passed away six months ago of radiation poisoning and many of her records were unavailable. This proved to be Dr. V's trickiest case. After going in circles for half an hour and not getting any consistent information, the good doctor began to suspect the truth. Mrs. Martha Smith's husband did not actually have Alzheimer disease! In fact, Mr. Smith had been dead for three years, like 99.99% of the rest of the world. It was the dear old lady who had Alzheimer disease. She'd invented the whole story about her husband because she was lonely, demented, and wanted attention. Also, her former doctor did not actually die of radiation poisoning; he committed suicide to escape her relentless crusade. Dr. V would never have caught on to this and would have faced the same potential fate if not for the last line in the Oath of medicine, way down at the bottom, in fine print. It reads "Don't Trust Your Patients, They're All Nuts! Shhh." Fortunately, Dr. V was an astute student of the Oath. After further investigation, he discovered that Mrs. Smith was healthy as a horse, aside from her dementia. She was feeding her antihypertensives to her parrot and building little igloos out of her diabetes medication. In fact, her only medical problem, to Dr. V's utter elation, was--- W I N G E D S C A P U L A E !!! Oh glory, hallelujah! Now, if he only knew how to treat it!


© 1999