Thursday, April 20, 2006

Stories

If I had the time, I would read the stories of my patient's lives. In the rush of a busy clinic day, it's easy to forget the pages of events that make them who they are.

One gentleman threw out a teaser last week. I just decided to take the time to enter in, and what a story he told. Mr. Rob W is a 69 year old African American and one of my more healthy patients.  Runs still 3 times a week, stays trim and in shape. Back in the 1950's he ran track in high school, and ran very fast. He was recruited by several schools, but decided on Pitt State based on 1 simple experience.  The Pitt sate coach invited him to come run in an AAU competition in Indiana. He wnet, and he won the 100 yd dash, and on the way home the whole team stopped in a local diner to celebrate.  The entire team was white, except for Rob, who remember wasn't even on the team. When they entered the diner, the coach made a point to have Rob sit with him. Rob was confused, but obliged. It wasn't long before the owner of the diner came up and calmly told Rob he was not welcome in the diner, as they didn't serve colored folk.  Rob was unaccustomed to this, but quietly got up to leave. The coach grabbed his arm and rose. "Alright boys, we'll all be leaving now" and immediately, all 30 team members rose to exit.  The owner, shocked, quickly changed his mind, "I suppose we'll have to change our policy for you all"  Rob decided at that moment he'd run for Pitt State.  He knew this coach would be his advocate, and watch over him.  

He went on to tell me of breaking color barriers in track and field...of meets in Texas, where he was the first black athlete to run on the track field.  But also of towns in Texas, where he wasn't even allowed off the bus, or wasn't allowed to shower after meets in the locker rooms.

He ran against the greats, like Bobby Morrow and Dave Sime who won a gold medal and silver medal respectively in the 100m at the 1956 Olympics. He went on to place 1st in the central intercollegiate conference championships 3 years in a row (55-57) and was elected into the intercollegiate athletic hall of fame. 

In his time he was one of the fastest men on earth, and here he sat, humbly in my little clinic room. When I take the time to hear the stories that knit together my patients lives, I am always blessed.


Monday, April 10, 2006

Boundaries

There are some important “side effects” to consider when patients are also co-workers.   The hospital I work at is so large, that it goes without saying that I see some of my patients on a daily basis.  This can be rewarding, as a small town doctor must feel, getting to catch up in the hallways or in the cafeteria.  It also lets me witness some of their habits, which I’m sure they hate- as I walk by them on their smoke breaks, or see them grab that extra cookie at lunch. 

There is of course a huge negative to all of this.  Certain astute patients have figured out how to get my pager number.  Doctors guard their pager numbers as something sacred. It is instant access, at any time.  Because these numbers are shrouded with privacy, when I’ve had a patient, who for instance is also a nurse, page me with a personal health question, I feel violated.  Boundaries are a part of every relationship in life, and are especially important in the doctor/patient relationship.

Some might think this extreme- but if even a couple hundred patients of mine could call me anytime – I’d have calls of “doc I’ve got a headache”, “my temp. is 101, what should I do?” “Hey, I need a refill on my meds” every evening.  It’s not how I want to spend my precious little time at home!


Tuesday, April 4, 2006

Choice

At 61 the swollen glands under her arm and knot in her breast were concerning.  She somehow ended up at a rheumatologist, who told her he thought she must have metastatic breast cancer.

The lump kept growing, despite ignoring it.  Eventually she ended up in our clinic.  Mammograms were ordered confirming her fears - breast cancer. 

She, however, decided not to see an oncologist.  She said that she'd seen her mother and grandmother die of breast cancer, despite treatment.  She'd watched friends, sick from chemotherapy, still dying.  As every patient has the right to do, she refused any further treatment.

Unfortunately, whatever notion she had of quickly dying in her sleep from this ravaging disease, didn't happen.  Instead, the tumor, now softball size worked it's way to the surface and fungated.  It's a term that looks as bad as it sounds.

This I've seen in other countries, and am including a picture I took of a woman with a fungating breast cancer in Papua New Guinea. Most people don't have a chance to see and smell cancer, because usually it's confined within our bodies.  But it smells, and leaks fluid, and worse, is a visualization of the cancer that lives within.

This woman has changed her mind now on treatment. Tho, much too late.  We'll help take away the mass, but can't take away the cancer.

Honestly, it surprised me to see a tumor left to grow unheeded by treatment. It's not something you see everyday in the united states. Unlike places such as New Guinea, where lack of medical care allows tumors to progress this far, it's eerie to think this happened because of free choice- we let our patients have the ultimate say.