1:45 PM
7 November 2003
Magnolia House
Richmond, VA

The Hat was taking notes as the doctor was making a house call, seeing a patient in her assisted living house.
"So when was your last seizure?"
"Oh, a few weeks ago. I was in bed at the time, so it wasn't that bad."
"And your last fright?"
As, the patient thought for a moment, The Hat shot the doctor a questioning glance. "Fright?" he mouthed.
"History of psychosis," the doctor mouthed back, as the patient began responding.
"Just last month. Men came into my room in the middle of the night. I don't know what they were doing here, but they were looking through all the closets and drawers. I pretended I was still asleep, I was so scared."
"Any passing out?"
"Some light-headedness, but I'm not passing out anymore."
"What are you doing when you get light headed? Are you getting up? Walking around?"
"No, nothing like that. It can just happen when I'm sitting watching TV."
"How is your walking doing?"
"Well, I got the motorized scooter for long distances, but I can get around the house good with my walker."
"Let's see you in the walker."
The patient reached for her walker, and with some effort, got out of her chair, and began to slowly go across the room. Her right leg bent inward at a weird angle, and she had to struggle to get her left leg around her bend in knee when she walked.
"Why is you leg bent like that?" The Hat asked her.
"Oh, I fell on it about ten years ago. It hurt, but I just fell down from standing, so I didn't think I could have possibly broken it. Then, it just healed like this. So I guess it was broken after all. Darndest thing."
The Hat raised an eyebrow. "Did you see a doctor about that? Did you know it could be repaired with surgery?"
The patient shook her head. "The doctors said that they didn't want to operate on me with my bad heart, especially since I could still walk a little."
A few minutes later, in the car with the doctor, The Hat asked, "I know she was on a lot of medications, but why isn't she on an osteoporosis med as well?"
"Oh?" the doctor said, not taking her eyes off the road.
"Yeah, if the severe kyphosis [bending forward of her upper back] wasn't indication enough, how about that pathological leg fracture from a couple years ago."
"Oh."
"No, seriously, I did an orthopedics rotation last year, and I saw way too many elderly people people come in, bad hip fracture, poor post surgical recovery, going into a nose-dive course of moving into a nursing home after being golfing and gardening just weeks before. And between this woman's heart history, psychotic episodes, and seizures, not to mention her bum leg, she's a hip fracture waiting to happen. I think she should get some osteoporosis meds while she still has some mobility left."
"I'm glad to see you are genuinely concerned about her welfare, but there are other things to think about. First, her pathological fracture was ten years ago – how much bone density do you think she can regain? Also, it's a fight with her all the time to take new pills. I count my blessings she takes the ones she's on – I hope. So adding something of questionable benefit at this point just isn't a good idea.
"But good job thinking about. With time, you'll be able to take it to the next level."
As the road passed by outside the window, The Hat sat back in his seat, and stared out the windshield.

Dusk settled over the forest canopy.
As the camera proceeded through the leaves, cricket and bird noises became more prominent.
Lightning bugs flitted over a small pond.
Across the pond, The Hat could be seen walking among the trees, investigating some of the ripening fruit beginning to sag the branches.
The camera finally settled, and focused on Ptery the Pterodactyl, who was wearing a flower chain over his head. He was seated on an old tree stump with an orchid shoot growing out of it.
"In the symphony of life," Ptery began, facing the camera, "one pattern re-emerges frequently, and independently.
"Symbiosis.
"Small animals pick parasites off larger ones in return for protection.
"Bees pollinate flowers for food.
"Ants manage colossal fungus farms.
"It seems that life is geared towards mutual interdependence.
"The players and events of life cannot exist in isolation, but feed off each other, building ever higher and higher.
"The skein of time is braided, tightened, and brought back on itself full circle.
"CAWWWW!" came from the forest behind the dinosaur.
Ptery looked over, as birds flew from branches, and a crow cawed back at The Hat.
The Hat, in return, flapped his arms like wings, and shrilled his own hideous caw again.
Which obligated the crow in response.
This continued several more times.
Ptery turned to face the audience. He rolled his eyes, and his shoulders heaved with a tremendous sigh. "Yeah, there's an evolutionary dead-end."

The Hat

Ptery the Pterodactyl

The Yuppie

The Pager

The Palm Pilot

/\/\ Continuing
__/____\____________
|HEHA| Adventures

Today's Episode:
"Triple Helix: The Braiding"

Guest Starring

Patient

Doctor

Crow

Team Doctors

Nurse

Elective Coordinator

Radiology Coordinator

5:45 PM
10 November 2003
Secret Lair of The Hat

The Hat walked into a busy command center, and dropped his briefcase in a comfortable chair. He made eye contact with the Yuppie. "The rotation director approved a change in my presentation topic for tomorrow. I'm going to discuss osteoporosis."
The Yuppie shook his head. "We discussed this. You're leaving in two days and change to New York for your first residency interview. You have to prepare for that. Go with the topic you've already finished. Don't waste time like that."
"I'm not wasting time! I think the house calls team isn't treating osteoporosis aggressively enough. And I've read up in it over the past two days. I think there's something to be done even for patients who've already lost significant bone mass. I would be derelict of duty not to do this."
The Yuppie rolled his eyes. "Whatever. Just try not to fall too behind on the time-table I've established. Oh yeah, you start your Ultrasound rotation next week. You better get the number and call them, find out when and where you report."
The Hat nodded, and sat a work station. He typed for a few minutes, before his face fell.
He looked over the screen again, to see if the information would somehow change.
"Uhh ... Yup ... problem ..."
The Yuppie sighed theatrically. "What now, you mental midget?"
"Ultrasound is apparently under the Ob-Gyn department. 'Students will learn to perform ultrasound examinations on pregnant patients, calculate fetal age, and determine fetal health. Required text provided. Examination at conclusion.'"
The Yuppie raised an eyebrow. "What were you expecting?"
"Radiological ultrasound. You know, 'is that belly pain an inflamed gall bladder?', 'is there fluid around the liver?', that kind of thing."
The Yuppie stopped a random figment walking through the room, holding a manila folder. "What do you think of when you hear 'ultrasound'?"
"Looking at babies in the uterus." He went on his way.
"You!" the Yuppie shouted, pointing across the room. "What do you think of when you hear 'ultrasound'?"
The figment pointed at his belly. "You know, babies in the tummy."
The Yuppie poked The Hat firmly in the chest several times. "Even your own bloody figments know better than you. So what are you going to do now?"
The Hat grinned sheepishly, as the Yuppie continued to glare at him.

8:15 AM
11 November 2003
Electives Coordinator Office
Medical College of Virginia

Individual hairs had been intermittently springing from the coordinator's otherwise impeccable coif from the time The Hat had walked in. Their rate had accelerated from the moment he opened his mouth.
They showed no sign of slowing down.
She sighed as she reached into a file cabinet. "You need to have the Ob-Gyn coordinator sign this 'release from elective' form. Then, you need to have the Radiology coordinator fill out this independent study elective form."
The Hat thanked her effusively, and backed out of the room nervously.
She pulled out a compact mirror, and began to futilely try to pat down the upcast hairs.

9:59 AM
House Calls Conference Room

The House Calls team was seated around a large table.
As one of the doctors continued discussing a patient she visited the past week, other doctors began to come into the room.
The Hat raised a eyebrow.
The Pager vibed. "You think the Geriatrics consult service was invited to hear your talk?"
The Palm Pilot vibed. "You're KIDDING, right? A-ha-ha-ha-ha-ha-"
The Hat snapped its lid shut, and put it away.
"We'll be just another minute," a nurse reassured the growing collection of doctors.
Soon, the patient discussion had finished. The doctors verified that they had no further patients to discuss, they began to get up from the table, and the consult service began to take seats at the table.
The Hat made eye contact with the program director, and pointed to his chest.
"Oh, your presentation. Well, consults team has their monthly conference now. Maybe you can talk next week."
"This is my last day."
The director looked stunned for a moment. "Oh. Maybe not. Sorry." With that, he left.
The Hat began to collect his handouts. He glanced at another sheet of paper on the table, and frowned.
"They had time to discuss a recipe for oyster stuffing," he muttered, as he left.

10:15 AM
Dept of Radiology

"We don't have a medical student elective in just ultrasound," the coordinator told The Hat.
"I understand," he replied. "That's why I want to make an independent study elective in that area. Do you know which doctor I should talk to?"
The coordinator looked through some binders. "I guess this is the one. But she's not in today. She'll be back tomorrow."
The Hat presented a toothy grin. "I'm leaving tomorrow. Going on an interview. I'll be back next week. Which is when I want my rotation to start."
Ticking clock. The sun reflected off the tall buildings outside the window.
"I suppose," volunteered the coordinator, "that I could leave a message for her."
A moment later, The Hat left, and closed the door behind him.
The coordinator breathed a sigh.
Suddenly, a hair jolted up from her head with a cartoonish "sproing!"
She pursed her lips, as she cautiously felt about her head.

6:56 PM
Secret Lair

"Oyster stuffing!" The Hat told the Yuppie, as he walked into Ops.
"I don't have time for your nonsense contests," the Yuppie scowled at The Hat, as he thumped on a clipboard. "I've been double-checking the luggage. You're missing the letter."
"My place in the hierarchy is right below oyster stuffing! What letter?"
"The one you, your rabbi, and the Emergency Medicine director at MCV worked on together, you know, for like a week! The one that tactfully discusses how you've hamstrung your career aspirations with your religious lifestyle."
The Hat rolled his eyes. "Oh that. I'll print a couple out and stick them in my briefcase."
"Right now!" the Yuppie spat out, pointing his pen at The Hat.
"I'm going. Oyster stuffing! Really!"
The Yuppie shook his head, as The Hat walked off.
As the screen faded to black, white lettering appeared: To Be Continued ...

Want to contact Greg? E-mail him at Greg.Neyman@gte.net.