Month: June 2011

Oh, Larry, I hurried over to the hospital as soon as I heard. It’s so good to see you!”

Larry turned his head and squinted at the visitor. Before he could smile, a fit of coughing overtook him.

“You don’t have to say anything, you need to rest. Do you want me to get you some water?”

A string of faint yellow saliva dangled from his lower lip. It wobbled as he shook his head. Closing his eyes, Larry murmured, “It’s nice to see you. I’ve been thinking about you.”

Another fit of coughing shook his thin frame. The Maserati Quattroporte blinked its headlights in concern. The engine revved as it looked around the room for tissue. As the Maserati was about to roll out of the room to ask for help, the Stock Options ran into its rear bumper.

“Larry!” the Stock Options exclaimed, pushing past the car. Larry groaned, rubbed his ribs, and shifted in bed. The Stock Options flung themselves into his lap.

“The Monogrammed Shirts told me what happened! I’m so sorry! Is everything okay?”

Larry held the Stock Options between his thin fingers and nodded. “I’m fine.”

“I’ll have to tell the Beluga Caviar and the Rolex Watches! We heard about the accident from the Gulfstream Jet! Everyone is so worried, they’re all heading over here to see you.”

Larry closed his eyes and winced. It hurt to breathe. Through gritted teeth, he asked, “The Summer House in Bridgehampton. It knows, right?”

“Yes, yes,” the Maserati said. “The Summer House is driving in right now. Probably stuck in traffic trying to get into the city.”

Exhaling, Larry sunk into the pillows on the bed. The Maserati brushed Larry’s hair out of his face. The Stock Options gently squeezed his fingers. He was falling asleep as the Callaway Golf Clubs stepped into the room.

When patients are in the hospital, their stuff won’t visit them. People who love them will.

I was one of them just two weeks ago, he thought as the interns approached him. They think I know what I’m doing just because I’m the senior resident.

His interns had admitted ten patients that night. They did the best that they could, but often needed his help. And then there were the two codes. He was tired.

The interns and medical students gathered around him for “pre-rounds”. He wanted them all to have updated information about the patients before meeting with the attending physician for “rounds“. With one hand he pulled a folded sheet of paper out of his long white coat. His other hand grasped a pen that was poised to write.

“Who is this?” he asked, pointing into a room. The intern who admitted the patient shuffled through her papers, pulled out a sheet, and began to rattle off the pertinent details about the patient. Everyone else looked at her, turning away occasionally to yawn into their hands.

“Thanks,” he said, walking into the room. They followed him in. He spoke quickly: “Hi, Ms. Patient. My name is Dr. Resident. I work with Dr. Intern here. Do you mind if I listen to your heart and lungs?”

Ms. Patient, who was poking at the slurry in her breakfast bowl with a plastic spoon, nodded.

She was in the waiting room for an hour. For the five hours she was in the emergency room, a woman in a neighboring space screamed in agony. Her nurse here had asked her many of the same questions asked of her while in the emergency room. She tried to sleep on the lumpy bed that was regularly inflating and deflating, but the beeping machines in the room and the discomfort in her chest would not let her rest.

She was tired.

After pulling the stethoscope down from his ears, Dr. Resident said, “Your lungs are a little noisy, but everything else sounds good.”

The squad of white coats surrounding her bed nodded.

“That’s good,” Ms. Patient murmured. Dr. Resident nodded and walked towards the door.

“Dr. Resident?” she called out.

Yawning, he snapped his mouth shut before turning around.

“Yes?”

“They did an X-ray this morning. Did it show anything?”

Dr. Resident nodded. “Yeah, they saw something, but they’re not sure what it is. It’s probably just a pneumonia, but it could be cancer. We’ll know more later.”

He breezed out. Her mouth opened slightly as she watched him leave. The interns and medical students all looked at each other, but not at her, their eyes wide and lips tight. They filed out silently after him.

I am nearly through Gayle Greene’s book, Insomniac, which is part memoir, part science writing, about insomnia. Greene identifies her target audience in the first chapter: people who experience insomnia, physicians and others who treat people with insomnia, and people who conduct research on insomnia.

As such, those who are not in her target audience might find themselves nodding off while reading the book. She describes the nightly (and daily) experiences and effects of insomnia, the known science and research of sleep, and available treatments. There’s a fair amount of neuroscience in the book—though, thankfully, Greene is a literature professor and writes with skill and clarity. If only all scientists could write like literature professors.

Her descriptions of physicians who expressed disbelief towards patients with insomnia caught my attention. She gives examples of physicians who blame patients for their symptoms. Others suggest that patients must be “wrong” because their reported symptoms don’t match what physicians learn in textbooks… or because the symptoms don’t show up in textbooks at all.

Those physicians imply that patients are making stuff up. They sound like arrogant windbags. I winced when I read their comments.

Of course, we physicians would like to think that we would never say things like that. Those physicians are the big jerks. We’d like to think that we are always empathic, compassionate, and nonjudgmental.

I would be a fool to believe I am never one of them.

The further I progress in my career, the more I realize how little I know. Older, wiser physicians who have mentored me have consistently commented, “As you get more experience, in some ways you will have less confidence. You will wonder what the heck you are doing.”

True dat.

We physicians should strive to accept what our patients tell us. If we don’t know the answer, if we don’t know what’s going on, if we aren’t sure how to proceed, we should acknowledge and accept that uncertainty as ours. Blaming patients—directly or indirectly—doesn’t help anyone. The vast majority of patients don’t make stuff up. They want to get better. And if they could get better without us, they would certainly choose to do so.

I believe patients are the best teachers in medicine.

As an intern, I told a patient one morning that I would visit him later in the day. Various tasks yanked me throughout the hospital as the hours passed. While packing my bag to leave for the day, I remembered what I had said to him. I wanted to go home. I felt exhausted.

He won’t notice if I don’t come around. He won’t remember what I said. And out the door I went.

The next morning, the patient scowled at me.

“I’m upset with you. You said that you would come back. You didn’t. Don’t say you’re going to do something if you’re not going to do it.”

My face flushed. I learned that a caring physician consistently follows through with her promises.

As a fellow, a patient told me about his experience with Familial Mediterranean Fever. In medical school, we viewed this rare condition as a piece of trivia, not a disease we would ever see.

“My body aches in a lotta places,” he said, pointing at his belly, then his knees and elbows. “My chest hurts. I get fevers that suddenly start and stop. Thank God for colchicine. I haven’t had a bout in years.”

I nodded, more to the memory of myself as a medical student. I learned that patients often give colorful descriptions that are more memorable than the bland definitions written in passive voice in textbooks.

Patients have taught me the power of human resilience. A patient, recently diagnosed with stomach cancer, contemplated how he wanted to spend the rest of his life: Volunteer at the local soup kitchen. Continue to coach the Little League team as long as he could. Help his girlfriend start her business.

“I’m not dying of cancer,” he said. “I’m living with it.”

Another patient shared her anger towards and frustration with psychiatrists. She endured many humiliating experiences while detained in hospitals against her will.

“They didn’t believe anything I said. They talked about me as if I wasn’t there. They took away my rights, they took away my life,” she said, “but they never took away my dignity.”

Patients have taught me that they are people who add joy to the lives of others, possess skills and talents that many of us will never have, and provide useful perspectives about health and illness. They remind me that they are not simply diseased organs, malfunctioning systems, or wordy labels. They correct me when I talk at them as if they are only an illness; they look annoyed when I overlook or undervalue their ways of coping with their struggles.

Patients can teach us so much. We must pay attention.