Wednesday, September 18, 2013

One calm summer night

Hey all,

      DWD is working on the final touches for Houses of Common. Will he notice me divulging that I overheard something about a January 2014 release date? Not until after I post this. Since I can't toilet paper the house, those spilled beans are my trick-or-treat trick, Mr. D!
      I'm obviously looking forward to Halloween. So in addition to impersonating Ms. Pranksturtle, I channeled some EdTerr Apin Poe as I searched DWD's hard drive. I found something in his C://ShortStories/Macabre folder. Inspired by one of my favorite poems, Richard Cory, and despite the risk of a HIPAA violation or a lawsuit from the estate of author Edwin Arlington Robinson, here's some flash fiction for ya!

      Happy Halloween,

October 18th, 1897
    To the New England Medical Association, in response to allegations of negligence.
    From Dr. Dean Gardiner, MD

Dear Sirs,
    I have read the complaints against me from the Cory family, and have consulted my attorney in drafting this letter. It is my intention to show I, in due diligence, examined findings and pursued suspicions skillfully. I was, alas, too late to have averted tragedy.
    Never is it easy to have our human fallibility so potently shown us. Understandable is the reaction of those close to the incident, and despite this inquiry, I bear no ill-will to those in grief. My appeal is therefore two-fold. May the committee reviewing the incidents make note of the patient's symptoms and complaints, both admitted and intentionally cryptic. May they also consider my efforts in finding balance between medical authority and patient autonomy.
    Enclosed are my notes from the last meeting with my former patient, Mr. Richard Cory.


DATE: June 19th, 1893
PATIENT: Cory, Richard

Patient is an age 35 male present, with out complaint, for annual exam.

PAST MEDICAL HISTORY: Childhood illnesses, no surgeries

Single, no significant other, no exposure to venereal infections. Attorney by trade, heir to local factory. Smokes pipe tobacco five to seven nights weekly, and has three to four drinks nightly. Denies any medications or allergies. Consumes daily castor oil. Reports no weapons in his home.

REVIEW OF SYMPTOMS: No complaints, eleven body systems

VITAL SIGNS: Height 73”
Weight 155#
Blood pressure 140/92
Heart rate 95
Respiratory rate 30

Healthy male. Alert and oriented. Pleasant speaking voice with no pressured speech. He is very articulate but with a voice less modulated than expected. Mood is slightly dysthymic and affect is flattened, but this is likely a product of the patient's position and training. His clothing is commensurate with his considerable wealth and schooling, though slightly more refined than is typical for his socioeconomic status.

Normocephalic, no sinus tenderness to percussion.
Sclera are not injected nor icteric. Pupils are equal, round, and reactive to light and accommodation. Extra-occular motion is intact.
Nasal turbinates are not swollen, no deviated septum, no discharge.
Oropharynx shows no lesions, erythema, swelling, nor discharge. Tonsils are present with no swelling.
Normal canals and tympanic membranes.

Supple with no tenderness. Normal active and passive range of motion. Trachea is mid-line. No lymphadenopathy.

Regular rhythm with tachycardia. No murmurs, gallops, nor friction rubs noted in sitting position. Patient declines supine examination. Carotid and radial pulses normal and bilateral.

Thorax is symmetrical. Good air movement in both lungs, with no rhonchi nor wheezing

Hyperactive bowel movements. Patient declines further exam.

Patient declines genitourinary examination.

Patient prefers no musculoskeletal evaluation.

Cranial nerves are grossly intact.
Cerebellar function intact.
Romberg testing is declined as patient reports “feeling awkward”.

Patient reports a good social network.
He denies feelings of guilt or hopelessness. No anhedonia, avoidance behavior in social situations, and no psychomotor retardation. He states concentration and appetite are normal. He has no history of harmful ideation or attempts at self-harm.
Patient's eye contact is diminished during this portion of the interview. Pupilary dilitation noted.

Patient prefers to remain clothed. No lesions noted on the hands or face.

Normal history and physical.
Some concern exists for dysthymia versus depression. This may be interrelated to alcohol consumption, perhaps to social isolation.

I recommended the patient decrease alcohol to two drinks nightly, and not on nights consecutive.
He's encouraged to call upon local clergy for counseling. He is dubious as to the need, but I encourage such an open discussion with no worry of judgment. He is willing to consider it, largely based on a recent event in which he went downtown. He noticed people on the pavement looked at him. He felt self-conscious “from sole to crown”. In short, he feels people expect him to be everything, or wish that they were in his place. He suspects it's the recent short and cloudy days, and expects to feel more himself during the nights of calm summer.
Patient will return in two weeks to discuss progress.

End dictation.

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