just drop the references to “The Price Is Right” and Diane Parkinson. And I don’t care who you see first, but Mr. Swensen has the first appointment.”
“Who did you say was in my office?”
“A Merck rep. She’s been here before. She’s just your type, blonde and big boobs.” Diane glared at Moe for a moment, then she was gone.
Moe bent over to turn off the light switch to the microscope. Impulsively, he slid open the cabinet drawer just below the scope, the one Diane used for personal items. At the back of the drawer, Moe spotted a brown plastic medicine vial. Feeling a little guilty, he grabbed the vial and read the label. Dan Henrie—Coumadin-5mg—Sig, one po qd.
Coumadin! He’d completely forgotten Diane’s husband was on Coumadin. For atrial fibrillation, or something. What was that vial doing in Diane’s drawer? Better not jump to conclusions, Moe thought. Probably, she was just getting Dan’s prescription filled at the hospital pharmacy. But—but Casey had been murdered with Coumadin! With his mind grappling with the possible implications, Moe replaced the vial and closed the drawer.
“Dr. Mathis!”
Moe jumped. He hadn’t heard Diane return.
“Don’t you think you had better start seeing patients? We’re already backed up.”
Slightly unnerved, he waved at Diane and quickly retreated from the lab. Had she seen him rifling through her drawer? So what if she had. After all, it was still his office. But was it just a coincidence that Diane had Coumadin in her drawer? Probably so. A lot of people had access to Coumadin; it was a pretty common drug. Even so, it made one think.
Standing before the first exam room, Moe reviewed the chart of Howard H. Swensen. Mr. Swensen was sixty-seven years old and still an active land developer and real estate broker. He had a medical history of gout, high cholesterol, hypertension and bladder tumors. Mr. Swensen had no known allergies, and his medications included Allopurinol, Lipitor, Lopressor and Cardura. I’ve been in the business too long, Moe mused. I can pretty much fill in the blanks on Mr. Swensen right now. As he often did, Moe began a game of patient sleuthing. Undoubtedly, because of his surname and the gout, he has a fair, florid complexion with blond hair and probably some graying due to age. Also the gout, high cholesterol and the hypertension all indicate he’s probably overweight. He has to be a smoker, or at least had been a smoker, because of the history of bladder tumors. And, he probably has some prostatic enlargement due to his age and because Dr. Holman has chosen Cardura along with Lopressor as the drugs to treat his hypertension. Moe sighed, then entered the exam room; no surprises here, Mr. Howard H. Swensen was exactly as Moe had imagined.
“Morning Mr. Swensen, I’m Dr. Mathis. How are you today?”
Howard Swensen fidgeted in his chair and tugged at the loose skin hanging from his neck. “I don’t know, Doc, that’s what I’m here to find out. That’s why they pay you all the big bucks.”
Moe always found that answer irritating, particularly on a day like today, but he maintained his composure and sat on a stool facing Mr. Swensen. He glanced through Mr. Swensen’s brand new chart. “Dr. Holman sent you to see me because a blood test, the one that checks on the prostate, came back a little high. Do you know much about the PSA blood test?”
“I’ve read a little about it in the Mayo Clinic Newsletter, Doc.”
Add that to the list of Mr. Swensen’s characteristics, some education and at least a passing interest in medicine; Moe was impressed. Maybe he would have to change his first impression of the man. “Well, let me take a little time and tell you about the PSA, what it means, and where we go from here.”
Moe had recited this PSA narrative so many times he could literally mouth it, while in part thinking about other, more personal things. “The PSA is a relatively new blood test. I guess it’s been around for about ten years now, but has only been in widespread use for the last seven or eight years. PSA is short for prostatic specific antigen. Although it’s a blood test designed to pick up on cancer of the prostate, it’s not always accurate. In fact, the more experience we get with it, the more inaccurate we realize it is. However, it’s accurate enough of the time that it makes it worth doing. In other words, it’s not a totally worthless test.” Moe droned on, but had fleeting thoughts of Cozumel. Three weeks from now, he was leaving for Cozumel. And no pretense of going to a meeting. This was all vacation. It was about time that Rusty had a turn watching the store.
“A PSA of 8.7 is not sky high by anyone’s standards, but is high enough to warrant further testing. By further testing, what I mean is to perform an ultrasound of the prostate.” Judy would be going to Cozumel with him. They would do some diving and get caught up on some rare and much needed personal time. There had been a real dearth of that lately.
“Ultrasound has certain advantages over just the finger exam of the prostate. With the ultrasound, you can see the whole prostate, including the interior of the prostate, whereas with the finger exam you’re just feeling one surface, that being the surface next to the rectum. If there is anything suspicious, you can also biopsy using the ultrasound and place the needle, with pinpoint accuracy, right where you want. In fact, what’s recommended now days, even if you don’t see a suspicious area, is that you biopsy each section of the prostate. From your point of view, an ultrasound feels just like having a finger exam of the prostate. The whole procedure takes about five minutes. Obviously, it’s up to you, but I think we should go ahead with the ultrasound, Mr. Swensen.”
“You mean, you biopsy through the rectum?” Mr. Swensen grimaced slightly.
“Yes, that’s why Sally gave you some antibiotics to take when you made the appointment.”
“Whatever you say, Doc, but I can tell you right now, I won’t like it.”
“Well if you do, we could set aside some time and do it once a week,” Moe laughed, then stood to leave. He was beginning to like Mr. Swensen.
As he left the exam room, Moe was met by Diane who directed patient flow like a traffic cop. She suggested that he see the bed wetter in room two while she was getting the procedure room ready for Mr. Swensen’s ultrasound. Diane also reminded him of the Merck lady in his office, and at this point in time he was running approximately an hour late.
Moe made quick work of the bed wetter. Treating non-disease always irritated him. Then he trudged back his private office and his obligatory visit with the Merck drug detail lady. It was an unwritten law, no visit, no free samples.
Connie Swensen stood as Moe entered the room. She was a pretty, shapely woman of thirty-something, with flawless make-up, meticulously dressed and natural blonde hair. Today, she was wearing a light gray skirt and a loose, low-cut, gossamer white blouse. In spite of her captivating, albeit slightly cosmetic appearance, she had intelligent, blue eyes with just a hint of sadness laced in the lines of her face. This trace of sorrow tended to offset her Barbie Doll appearance and gave her the more tangible image of a real person. Faintly, Moe caught the bouquet of designer perfume.
Moe shook Connie’s hand as she offered him a Merck pen. During the exchange, the pen inadvertently clattered to the floor. Bending at the waist to retrieve the pen, she exposed the tops of her ample, bulging breasts straining against a delicate, white lace bra. Moe couldn’t help but notice. And though he realized this was part of her sales pitch, it always seemed to work. He consistently gave her more time than her male colleagues, and subconsciously, Moe knew he would favor her company’s products.
“How are you today, Dr. Mathis?” Connie said brightly, settling
