Sunday, November 7, 2010

Reflections of a Former Chief Resident: The Ultimate Excuse

(Art by Shel Silverstein)
"I cannot go to school today," 
said little Peggy Ann McKay,
"I have the measles and the mumps, 
a gash, a rash and purple bumps. . .

What? What's that you say? 
You say today is. . . .Saturday?
G'bye! I'm goin' out to play!"

~ from Shel Silverstein's "Where the Sidewalk Ends"
Back in the day when I was a chief resident, I used to hear all kinds of excuses. Most of the time, they were legitimate, but every now and then, they'd border on completely crazy. For those who don't realize exactly how the chief residents' facial expressions look on the other end of the phone when you call in (or call back after being "drafted" for a Jeopardy call) with "awww HELL naw"-worthy excuses. . . .I'll show you. . .it looks a little something like this:

"Awww HELL naww!!"

Case in point, right now, I'm reflecting on this phone call I received early on a Saturday morning circa 2001:

"Heeeeyyy Kiiiiiimmmm." (read with very dramatically raspy and quasi-sickly voice)

"Hey. What's up?" (read with superdry voice to squelch dramatically exaggerated and quasi-sickly energy.)

"I feel like I'm about to get a migraine. . .ooooohhhh. . . . so I can't come to work."

"ABOUT to get a migraine?"

"Yeeeeaaaaah. . . "

"Umm, so DO you have the migraine or not?"

"Not yet, but I know what it feels like when it is about to happen."

"Umm, so why don't you, like, take some medication now and come a couple of hours late?"

"I think it could make me drowsy."

"Does it usually? I mean, like, make you drowsy?"

"Not always, but sometimes. . . . I'm just not sure about taking ICU call today. . . . or in 4 days. . ."


As time has marched on, I have heard some more winners--one of my all time favorites being the one where the resident "accidentally" took two Benadryl allergy pills like, right before she was supposed to come in, and was just too drowsy to drive in to take call. . aww HELL naww!

Or. . .no, THIS is the best one. . . the one where this intern had terrible, terrible stomach cramps so terrible that he couldn't even make it out of the bed to even consider trying to come to Grady, yet I actually frickin' saw him with my own two peepers standing near the stairwell in the parking garage looking tearful while having some kind of heavy duty, love affair-looking discussion with another (female) resident.

Really? Wait -- did this dude just call off "brokenhearted?" Aww hell naw!

Listen. I don't mean to be insensitive. I, too, had my share of early morning internship tears over a wobbly love mix cassette tape (yes, I meant to say "cassette tape.") But I never called off for it. Nor did I insult my attending by making a call from what sounded like death's front door or at least an infirmary--when I was in the building!

So when he called in quasi-sick I said, "Uuuuhh, didn't I just, like, see you? Like here-here at Grady? Like here two seconds ago in the parking garage?"

And would you believe that he said, "Nuh uh, Dr. Manning, that wasn't me."

Wasn't you? Wait--is this dude trying to play me?

(throwing hands in the air and kicking over a chair) AWWWW HEY-UULLLL NAW!!

Now, let me just say for the record: The vast majority of the medical students and residents with whom I've worked have been absolutely spot on and professional with regard to disclosing the rare situations when they must miss work. But for those who just can't seem to get their excuses together, I offer you an alternative. Yes, against my better judgment, I will share with you what I have learned to be the one thing I could hear that would not lead to the hairy eyeball.

Yes, today I bring you. . . . .wait for it. . .wait for it. . . .

The Ultimate Excuse.

Now. Let's just be clear here. I don't recommend making excuses for absences. I suggest telling the truth up front, as it is always the easiest thing to remember. However, if you are going to fabricate something. . please. . . don't insult our intelligence. (Or as Harry says, "What do you think my name is? Boo Boo the Fool?")

For all of my non-doctor, non-medical student readers, The Ultimate Excuse works for you, too. I must add that my knowledge of The Ultimate Excuse is not because I have personally used it. It's instead because I've heard so many "Awww hell naaaw!"- worthy excuses spanning from my chief residency in 2001 to my current role as a residency program director that I feel 99% sure that I have damn near heard them all.

What makes an excuse The Ultimate Excuse, you ask? It's simple. The Ultimate Excuse must be:

Kind of unfortunate (enough to make people feel a little sorry for you.)
Self-limiting (meaning it will improve without a doctor or hospitalization.)
and, gender-neutral.

Most important, however, for an excuse to be The Ultimate Excuse, it must have one main quality--it MUST be something that NO ONE WILL ASK YOU MORE QUESTIONS ABOUT. Period.

Now with doctors, this is tricky. I mean, what kind of illness can you tell a doctor that you have that won't garner more queries?

"I have a horrible headache so I can't come in to take call."

"Is it a stabbing headache? A dull throb? Any visual changes?"

"Ummm. . . . ."

"Let me see what I have here in my purse. . . .great! Just found a sumatriptan in here. . . . this will work wonders. . . .see you in twenty minutes!"


And so. This is why you need to know about The Ultimate Excuse. Just in case you need to keep it behind a glass box that you can break open and use in case of emergency.

Oh yeah . . . The Ultimate Excuse also works wonders for legitimate problems taking you out of work, too. You know. . .the ones that could be slightly embarrassing like hemorrhoid surgery or mid-week laser hair removal for a female goatee. This calls for a zippy one-liner that welcomes no further comments. (Even from a nosy person like me.)

Is the suspense killing you? Let me give you a musical hint. . . .

This anonymous juvenile songwriter in my neighborhood put it so eloquently:

"Put yo' hand on yo' hip
Put yo' foot on the floor
Make a fifty yard dash
to the bathroom door. . .

People think it's funny
but it's really kinda runny. . ."

Yep. You guessed it. Diarrhea.

Diarrhea. . . . . aka The Ultimate Excuse.

Don't believe me? Try it this on for size:

"I can't come in today because I woke up early this morning with. . . horrible diarrhea. Man. . .like every 5 minutes! It's . . . .uh oh. . .hold on for a second. . . "

Genius, I tell you.

No one wants to know more details.
No one wants to discuss it upon your return.
No one wants to come by to see you.
No one wants to explore its legitimacy.


This is why I maintain that diarrhea is, hands down, The Ultimate Excuse.

And it's so versatile, too! It works equally well for:

Not wanting someone's bad ass kid to come over for a play date.
Not allowing someone in your house because it is a mess.
Not talking on the phone to someone you'd prefer not to speak with who keeps calling you.
A solid explanation as to why you missed the Tupperware Party, Silpada Party, Pampered Chef Party, insert any kind of retail party that you would prefer not to attend.

(Gasp. . .cannot believe I said that part out loud. This is hypothetical, people. I am not saying that any of this is from experience.. . . ahem.)

Hmmm. Though I have never attempted this. . . .Ladies, The Ultimate Excuse would likely work perfectly on those evenings that you are feeling. . .say. . . . .less than amorous. . . .(I'm just saying)

Aaahh yes. . . .Diarrhea--The Ultimate Excuse that shuts everyone up.

You never have to worry about those pesky exploratory questions:

"Is it runny? Watery? Gooey? Voluminous? Explosive? Malodorous?"

or follow up questions like:

"How is your diarrhea today? No longer runny? Watery? Gooey? Explosive?"

Instead, all you get (accompanied by zero eye-contact and barely even a hug) is this:

"Heeeyyy. . .errr. . . welcome back. . . . uuuhhhh. . . did you watch the Housewives last night? That NeNe is something else, right?"

"I was sick, remember?"

"Errr. . .oh yeah. . .ummm. . .would you. . .uhhh. . . like some hand sanitizer?"


See what I mean?

(You're welcome.)


The Ultimate Excuse is not for casual use. You can only have but so much diarrhea in a one year period. Overuse of The Ultimate Excuse will guar-OWN-tee you the following reaction from your chief resident, program director, boss or spouse at some point:



  1. That has to be the funniest thing I've read in a long time

  2. hahaha....i am trying to come up with another ULTIMATE excuse!! lol

  3. Love it! But you have now taken away the ultimate excuse from many a person...

  4. You know that's my favoritest Shel Silverstein poem...

  5. I trained at a GREAT community hospital where, thankfully, no one does this. Two recent examples:
    1. This past friday night, one of our interns woke at midnight starting to feel bad. He slowly felt worse and worse, with worsening abdominal pain that slowly concentrated itself in his right lower quadrant. He woke up saturday, and since he was on call that day, forced himself to eat something, then dragged himself in and actually rounded. Eventually, he talked to one of the upper levels to tell them he was worried that he might have appendicitis. By 4pm that day, his appendix was out.

    2. I know work as a hospitalist at the hospital where I trained in a group with several other docs. One of them I also graduated residency with. At the end of her pregnancy, on her last scheduled day of work, she started contracting at 4am. She STILL came to work, rounded, and did some discharges all while contracting every 3-5 minutes. She delivered her baby at 4:30 that afternoon.

    If ANYONe ever had a good excuse to miss work, those would qualify.

  6. See I wish that flew in my prior job. My boss got one too many of the "ultimate excuse" and so she put me in charge of being the immodium gal (I, who has to take a daily dose anyhow...) so that, I guess dried up (giggle giggle) the problem of fakers and non fakers alike.

    PS LOVE your blog! I am in transition in my life as to whether I want to go to nursing school. Only He the Almighty knows!


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