Fred is fifty-eight years old, and he has been hospitalized for chest pain; I was asked to see him in consultation. The pain had resolved in ten minutes but since he was driving past the ER, he stopped in. The ER physician admitted him because of his complaint and his prior history. Fred had an artificial heart valve inserted five years previously and had been on the blood thinner Coumadin ever since. He smokes two packs of cigarettes daily, takes aspirin daily and also takes four to eight Advil tablets daily for bone pains left over from his accidents. I must explain that poor Freddy is totally disabled from an industrial accident fifteen years earlier resulting in the loss of his left hand. That accident was not the source of his pain, however. Fred was in a motorcycle accident last year. It seems that a truck pulled in front of my one-handed Harley driving patient causing him to “hit the road” in every sense of the phrase. He suffered a crushed ankle, several broken ribs, and a concussion. That sort of thing hurts. I was tired, but I was able to summarize the situation for the patient, the wife, and the nurse. My plan is probably what caused the wife to negatively appraise my bedside manner. I said, “Let me get this straight. You are a one-handed heart valve recipient who disregards warning labels by taking Coumadin, aspirin and Ibuprophen at the same time. After you take your meds, you jump on your Harley and have another accident causing you multiple injuries, all of which you survive. Now you have a brief episode of chest pain and would like my opinion. Is that about it?” Fred replies, “Everyone has to go sometime, doc. I’m just living.” I finished rounding on Fred with the following,” Hell, Fred, the fact that you are still alive is a tribute to your amazing good luck. No medicine in the world could do more than that guardian angel on your tattooed shoulder. Get out of here! As you leave, you might reconsider the risks of: smoking two packs per day, chasing your Coumadin with aspirin and Advil, and the one-handed Harley driving trick. Good night.”

Now, you be the physician. Be caring, sensitive, clear, supportive, and positive to dear Fred. Offer some tests and a plan which includes the latest in medications, but keep moving as we still have other patients to visit. Let me see. We have to visit Mrs. Jones and Mr. Rogers. They both have colitis. It seems they were given some antibiotics and developed severe diarrhea. They can be cured but it will take some time. We have to visit Mr. Davis who has a bleeding ulcer. He has been taking Goodie Powders for chronic headaches. Ms. Anvil has AIDS; Mr. Caruso has alcoholic pancreatitis; Mrs. Johnson is dying of lung cancer. Never smoked. With so many sick patients to be seen, all doctors make rounds and bravely attempt to formulate curative plans. Oftentimes we can help. Sometimes we cannot do very much good at all. That is when we notice that there are never enough guardian angels. That affects bedside manner more than anything else. There is usually not an angel around when you really need one. In the absence of enough angels, we ask patients to be careful, be attentive to your healthcare needs, and don’t push your luck. Fred has taken one of the angels and most of the luck.