Vinson: Diagnosis by Observation: the 10th Round

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It was a nice spring day, and a psychiatrist, a neuro surgeon, and an orthopedic surgeon--each considered a world-class physician in his particular field--were sitting at a trendy sidewalk café, sipping expensive 'Blue Mountain Coffee,' imported from the Blue Mountain region of Jamaica, in the Caribbean. Having become bored with chess tournaments and Mensa Club 'brain games,' they had assembled for the 10thand final round of a game they had created: 'Diagnosis by Observation.'

The rules for Diagnosis by Observation went like this: As they sat on the sidewalk, the three would observe an-agreed-upon male subject ambulating down the sidewalk. Using only visual observation, each doctor would offer his diagnosis to the other two colleagues. After all three had revealed their diagnoses, they would approach the male subject and query him regarding his ailment.

Still, the doctors used the following monikers/handles when competing in Diagnosis by Observation: The neuro surgeon was 'Hippocrates'; the orthopedic surgeon was 'Einstein'; the psychiatrist was 'King Solomon.' It was mandatory that each refer to the others by the respective handle during game time. The doctor who guessed correctly was declared the winner. Thus far, the three doctors had met nine times, and each had won three times, leaving a three-way tie.

What had started out as an innocent outlet for stress, though, had become so competitively tense their professional and personal relationships had been irreparably strained: Their families no longer socialized with one another, and there was a divisive rift among staff at the hospital where the three doctors worked. For sake of the best interest of the collective whole, they had agreed to cast aside their egos (as much as possible, anyway), and not only would the 10thround be the final round, he who won the 10thround would be declared the winner.

THE 10th ROUND ...

Down the cobblestone sidewalk came a white man, average height and weight, early-mid 30s. Clean shaven with a crewcut, he was neatly dressed in Tony Bahama khaki pants, a pastel blue, Casablanca button-up shirt, and Sperry Top-Sider shoes, no socks. However, it was obvious this particular man was suffering drastically: He was taking extremely short steps, shuffling along at a snail's pace. His head and shoulders were slumped. His facial expression was somewhere between that of a lost puppy and someone who'd just seen a ghost. The three doctors quickly agreed the bourgeois preppy would be their subject, and thus began the 10thand final round of Diagnosis by Observation.

"He suffers from Head Ptosis, also known as Floppy Head Syndrome!" Einstein proudly declared. "The cause of Head Ptosis can include hypothyroidism, disorders of the spine, and cancer. Actually, it's a rather easy call, one even a first-year resident would catch."

"I unequivocally disagree," countered Hippocrates. "I wager he suffers from Sciatic nerve damage and is on a heavy dosage of OxyContin. Symptoms typically include burning or tingling down the leg, weakness, numbness, and difficulty moving the leg or foot. More than likely, his Sciatic nerve problem stems from back surgery or a car accident. Treatment of extreme pain via opioids explains the horror-struck look in his eyes. More than likely, he has run out of medication, is suffering from acute withdrawals, and has hit the streets to score a fix--a total Schizoid!"

"Hold on, Einstein," interrupted King Solomon. "Though a bit on the young side, it's diagnostically obvious our male subject has suffered a mental breakdown and, resultantly, is in a state of depression so severe that it has rendered him borderline catatonic. Regarding his meds, I don't take issue with the opiate theory, but anything A-Z in any pharmacy is a possibility."

With all three diagnoses in, the three confident physicians rose from the table and approached the basket-case preppie, now about 25 feet from the outdoor table at which the three doctors had sat and observed. Though barely moving, the study subject stopped cold in this tracks, his facial expression remaining as was.

Each doctor verbalized his specific diagnosis to the pitiful subject. The male subject retorted with, "We're all four wrong."

"How so?" asked Hippocrates, a bit insulted that a disgusting lay man had dare correct his Ivy League pedigree.

"I concur," piped in Einstein. "Not only did I graduate top of my class at Vanderbilt Med School, I studied at the University of Frankfurt, Germany."

"Excuse me," challenged King Solomon, who was still a legend at UCLA's David Geffen School of Medicine. "There are only three of us. Are you in such an altered state that you count four of us versus three?"

Explained the subject, pointing with from one-to-the-other with his right index finger: "You thought I suffered from a neck-back injury. And you thought it was my Sciatic nerve. Still, you thought I had a nervous breakdown--and I thought I just had gas!!!"

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Mike Vinson
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