The Smoothie Bomber

I set a bomb off in my office.  

No, not one of those spray can things that takes out insects.  

A real, internal pressure sudden explosion device from a metal container.  A wide mouthed aluminum bottle, to be specific.  In my personal office.  In our brand, spanking new, UT Regional Health Center building, no less.  

It has been eighteen months now so this story can be told.  It began in January 2015 with a desire for a healthy lunch smoothie made in my grind-up-a-brick blender.  Ice, spinach, apple, banana, blueberries, yogurt, soy protein and chocolate milk.  A dash of chia seeds to give it a punch.  Poured into the aluminum bottle with the wide plastic cap and carried to my office.  Placed in my small refrigerator next to my desk.  

And there it sat.  

For a month.  

An announcement came that the administrative hierarchy of UT Medical Center would be touring our new building on a Monday in February.  I decided to tidy up my office so as to not look like an ungrateful ogre in the newest building of the UT system.  This included trying to open the smoothie (I figured it was not longer edible for consumption after one month) and pour it out.  

The lid wouldn’t budge.  Not even a bit.  

Not a problem, I thought, just set it next to my leather bag to carry home and open tonight.  And there it sat - in the heat - for about seven hours.  

Fermentation is the process of turning sugar into alcohol and creating carbon dioxide gas as a byproduct.  Evidence shows that human beings have known of this process since nearly 7,000 BC.  Winemakers have this down to an artform and they also know that proper venting is necessary.  

That fact clearly didn’t cross my mind that morning.  Our dignitaries were to arrive at 2 PM.  

I was in an exam room with a patient about 1:30 when I heard a very loud sudden noise followed by something clearly falling.  My immediate response was stereotypical, “what are they doing out there….?”

After I finished with my patient I opened the door into my office (the staff said they had no idea what that noise was) and saw the entire back corner of my office, window shade and ceiling covered in apparent evidence of a sewer line rupture - wait- I am on the second floor and there is no sewer line above here - say, what is that plastic cap doing on the other side of the room?

I dawned on me what happened.  The entire liter contents of my smoothie had exploded up the wall, blown two ceiling tiles out of their frame and continued on up another ten feet to the roof of the building above my office.  My shelf was covered.  My bag was covered.  My desk looked like a kindergarten experiment.  And it smelled, too.  Sort of like a sweet green spinach apple wine. 

It was 1:45 and our guests were due in fifteen minutes.  I couldn’t contain myself after the sight of it all and started laughing.  I was laughing so hard my nurse came to look and stood there with bug eyes at the spectacle.  I couldn’t stop laughing.  The irony of being the newest physician on staff in the newest building at UT and exploding a smoothie bomb in my office was simply too funny.  And right before the tour.  What was there to do now? 

There was nothing to do.  It was beyond recoverable.  The only option I had was to stand in my new crisp white coat outside my office with the door closed - the only door closed on the tour, by the way.  I politely greeted our long line of guests as they strolled by in their suits with a smile and “thank you” for their support.  

A few asked about my piano in my office and if I could play a bit.  “No, I’m so sorry,” I explained, “I simply don’t play when patients are here so they don’t complain about waiting.”  It worked.  

My door stayed closed the rest of the day, too.  The staff was curious about the smell, but beyond my nurse, they never knew.  They just assumed it was another one of the smells of working in a medical building.  

I returned that night at nine o’clock with my step ladder, cleaning tools, and rags.  I scrubbed the walls, cleaned up into the attic above my office, soaked up the stains in the carpet, removed the stains from the shade, cleaned and replaced the ceiling tiles and restored my desk to professional status (sort of).  Occasionally I will still find a small stain on the far wall as a reminder.  

The next day I told my office manager and she gave it a quick inspection.  There really are no secrets for long in any office so I decided confession was best.  She ordered a new ceiling tile for the one that took the direct hit of the bottle cap.  She laughed, thankfully. 

I still enjoy making my smoothies (the chia seeds are key). BUT, I am now required to pour out my smoothies if not consumed within one week.  That’s fair.  

For a college chemistry major, that smoothie was humble pie.  

Eric J. Littleton, M.D. (@DrEricLittleton) is a musician and Family Physician in Sevierville, TN.  Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com

The Roller Coaster Stone Treatment

The days of freely choosing to ride roller coasters in this country may soon come to an end.  

Why? It all begins with a study on whether or not roller coasters can treat kidney stones.  In the latest issue of The Journal of the American Osteopathic Association, Urology Professor Dr. David Wartinger from Michigan State University College of Osteopathic Medicine states his research demonstrates riding a roller coaster can cause small kidney stones to pass.  

No. Really. He was investigating a report by an individual who claimed riding a roller coaster caused three stones to pass over three separate rides.  

The setup for his investigation involved creating a realistic model from a 3-D printer of a renal system and three different sized stones in the system.  Finding a patient with a kidney stone who is willing to ride a roller coaster while in pain is a tricky thing to do.  

Dr. Wartinger then obtained permission to ride Big Thunder Mountain Railroad roller coaster at Walt Disney World in Orlando for twenty trips per stone.  That would be sixty trips on a roller coaster at Disney World in the name of scientific research.  The 3-D model of the renal system, no doubt an odd site even at Disney, was cleverly concealed in a backpack. 

I don’t intend to question another man’s motives, but clearly Dr. Wartinger has obtained a new 3-D printer for his office and taken a nice trip to Disney World all paid for by someone else and in the name of science.  Clever.  Very clever.  

After sacrificing for the sake of medical research and riding sixty trips with the backpack, the research team found that regardless of the size of the stone, it passed 17% of the time in the front of the roller coaster and 64% of the time in the back of the roller coaster.  

A 64% chance of passing a stone riding in the back of a roller coaster?  Patients with kidney stones will line up for that.  

Anyone with kidney stones knows they are the great equalizer.  Women who have birthed babies and passed kidney stones almost always tell me childbirth is less painful.  Patients will have their own therapy routines when the pain starts.  Several cups of coffee and a beer.  Ride the lawn mower.  A liter of water and long walk.  Ride around in a British sports car (bad suspension) on streets with potholes.  They will do nearly anything to get a stone to pass.  

But now, thanks to this research,  Big Health Insurance Company (Big HIC) and government will get involved.  “You like your roller coaster? You’ll get to keep riding your roller coaster.”  Right.  

Since riding a roller coaster will be considered a form of treatment, the FDA will require each roller coaster to be certified as a “Renal Stone Extraction Device.”  This will require reams of documents on the data collected, protocols for how the patients will be treated, and a recertification process involving even more paperwork.  The FDA will need to personally inspect the ride, of course.  This increases costs. 

Big HIC will agree to contract for a very large amount of money per ride to treat their patients, but then begin denying any rides to their patients without a prior authorization (PA).  The PA will require a several pages document detailing what “conservative measures” the patient has tried to pass the stone first.  

Coffee?  Fluids?  A change in diet over several weeks?  Was a CT scan done to confirm at stone present?  Previous treatments used?  Any oral medications attempted?  More time.  More costs. 

Then, as part of the process, the Big HIC will insist that the patient first try the bumper cars, the kiddie roller coaster, and that interactive-moving-seat movie theater ride thing that can jar a tooth filling loose. No success?  Submit another form.  More time.  More costs.  

Finally, after an approval “within 72 hours of submission,” Big HIC will approve one trip around the coaster with a PA number.  Just one.  The appointment will be made and the patient will show up.  

The PA number will not have been forwarded to the ride operator who will then have to call and get the PA number to enter into the computer to authorize the ride.  Delays.  Increased costs.  Suffering patient.  

Because the roller coaster is now a “Renal Stone Extraction Device” individual privacy shells will need to be installed in the cars to maintain patient privacy while riding the coaster.  The patient will have to fill out several pages of forms prior to riding and get their little souvenir wrist ID bracelet.  They will be required to wear the little flimsy half gowns with the back side open revealing nearly as much of their buttocks as some of the teenage boys in line.  

After the ride the patient will be required to ride in a wheelchair back to their car to guarantee no falls.   Big HIC will have a team of inspectors who will show up at any time (demanding a ride, no doubt) to insure all policies are in place to their satisfaction.  More paperwork.  More costs.  

The roller coaster owners will then collect data on how successful their coasters are compared to the competition, how friendly their staff is to the patient, how few have complications during treatment, and how wonderfully beautiful their roller coasters are.  They will pay a consulting company to analyze the data and award them a “5-Star Rating” for excellence with their “Coaster Stone Treatment Team.”  Intense advertising will follow. 

More costs.  More paperwork.  

As a result, the kidney stone treatment ride will cost nearly $15,000 per ride, but the patient’s copay will only be an amount nearly the same as park admission before Big HIC got involved.

And the patient, who is the one suffering, has the least amount of voice in the entire process.  

That needs to change.   

Eric J. Littleton, M.D. (@DrEricLittleton) is a musician and Family Physician in Sevierville, TN.  Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com