Thursday, October 15, 2009

Allergies and National Pride

Mr. Johnson came in a few weeks ago with shortness of breath that had been going on for three months and an extremely weak answer to the question, “And what is the medical emergency brings you to our Level II Trauma Center at 2 AM today?” His care was routine, but every now and then when interviewing a patient you come up with a gem. Looking at his chart, he claimed an allergy to American Cheese.

Granted, allergies mean different things to different people. Some people may consider an expected side effect as an allergy. Drugs such as erythromycin and narcotics are known to cause gastrointestinal effects such as nausea and vomiting. Other allergies may be a result of more patient-specific intolerance of the medication at a certain therapeutic level, such as patients who become excessively sleep or dizzy at a certain dose of anti-hypertensive drug but do fine at a lower level. (Interestingly, before drug levels became available some drugs were dosed by side effects. The right dose of digitalis, a drug used for heart failure, was the dose one step lower than the one that made you throw up.) A true allergy is a full-fledged joyride for histamines, mast cells, basophils, and lots of other mediator you’ve never heard of, all heading down the autonomic highway. The patient with true allergy develops hives, shortness of breath, and swelling throughout the body but most dangerously around the lips and tongue that can result in total airway obstruction. And when one has a true allergic reaction to one member of a family of drugs, we will shy away from any of the members of that family in order to avoid precipitating the same reaction with a chemically similar agent. (Knowing this, some of our drug seeking patients manage to have allergies to all but their drug of choice. On the other hand, when they say they are allergic to codeine abut can take the closely related oxycodone just fine, that’s doesn’t add up, either.)

I’ve been accused of sometimes thinking way too much, and so the allergy to American cheese caused me great mental consternation. You just knew he had to be faking this, because everyone is aware that hypoallergenic plastic is the major component of American Cheese (just as velvet is the prime constituent of Velveeta.) So I wondered if he had any problems with foreign cheese? No, he was probably happy to feast on foreign cheese, especially of those countries that failed in their duty to join the Coalition of the Willing. Little pansy countries in Europe that get their cheese not from big strapping corn-fed cows in industrial-strength hermetically sealed dairies but from little scampering goats of questionable manhood that frolic about the hillsides to the sounds of Zamfir and the Pan Flute (“He’s sold more records within the NATO alliance than David Hasselhoff!”).

Yep, that was it. Clearly he despised our country, our government, our way of life, the very foundations of our land. But he was smart: he knew that to air his wrath publicly would put his life in jeopardy, so he subtly declared his hatred of all things good and noble and American (because all three words mean exactly the same thing) through his alleged allergy to our cherished national processed food product. No doubt he was the kind of guy who probably kept saying French Fries when any Real American called them Freedom Fries, the same Real Americans who would also eat Freedom Toast in the morning and ask thier girlfriends to wear lacy Freedom Maid costumes for Halloween. And he had some nerve with that attitude in Daytona. Down here, in the wake of 9/11 there was a joke…no, not really a joke, but a statement of fact…that hitting NYC bought the terrorists time to hide while the media reacted, the government examined it’s options, and a response plan was put intoplace. If they had hit the Daytona 500, all the survivors would have filed out of the track, got their firearms down from the gun rack in the back of the truck, and called two buddies to put three extra can of gasoline and a really big cooler in the bass boat. War’s over.

(Speaking of foreign things, one of my colleagues has made a new rule. He will not see patients with foreign bodies unless the offending object has a green card. And if there’s no green card, he plans to extract misplaced item, enclose it in a box, and ship it back to whatever country it might belong. Which is exactly what we were going to do during my internship to an illegal immigrant who had been in a chronic vegetative state and on a ventilator in Kansas City for over a year. A senior resident, an intern, two students, a Ryder truck, and lots of oxygen tanks...but that’s another story.)

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