Patient: “I think my body is shutting down” (but really I just want you to write me a doctor’s note saying I never have to go to work again d/t incurable back pain)

Me:  “No, you’ll be fine. And sorry, but you need to go to work.  Neurosurgery won’t see you any more.  Pain management won’t see you anymore.  Things are as good as they’re gonna get.”

Patient:  Ok.  Well, thanks for try…try…uh….”

Stands half-up, then collapses on the floor.  “Unresponsive”

Nurse:  OMG!  Call the ambulance.

I lift up her arm, hover it over her face, let it drop. “Limp” arm performs a curious “S” shaped drop maneuver, conveniently missing her face.  Vitals: 121/87, HR 84

Me: “You’re fine, ma’am.  Just let me know when you want to wake yourself up and get off the floor of my office.  I’ll be over here charting.”

Patient:  Suddenly revives…miraculously.  “What hap…happened?”  Gets off the floor and returns to her chair.

Me: I have no idea.  See you in two weeks.

Her little episode didn’t even make it into my note.