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.

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!

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.

Indecision

There's one thing I just don't have patience for - indecision.  This is more bothersome when dealing with sick people in the hospital.  This week's attending, a.k.a. boss,  is a new employee of  the hospital and doesn't want to commit to anything.  I understand her hesitancy. Being solely responsible for an entire team of residents and patients can be overwhelming. But, as the leader, we all look to her for the final word.  Which means, we need a FINAL word.

We spent such wasted minutes today on whether to give someone 20mg of a drug or 40mg.  After our fearless leader had changed her mind no less than 6 times I was ready to take a field trip to the dumpster. Anything would have been better than listening to the agonizing non important banter of what strength to use.  At one spot the attending turned and asked "well team, how many think we should send the patient home with the diabetes medicine?"  Are we voting now about patient health? All in favor of the blood transfusion say "I", those wishing him to bleed to death say "nay".  Not that drastic, but all this wishy washy conversation was so wasteful.

I think I actually prefer an attending that's wrong but decisive.  At least they commit and we can move on. If later we find that attending was mistaken, we learn - and again move on.  Indecision feels like being stuck in thick molasses. No matter how much effort, how many words, and how much time...no progress is made.

Saliva facts

I learned an interesting fact today - on average, adults produce 1.5 liters of saliva a day.  Picture it - that 2 liter of coke in the fridge, 3/4 full of spit....everyday we do this.

You may wonder why this is important.  It's really important to hospice docs and nurses, the people who take care of those in the process of dying.  Often terminal patients, when close to the end of life, don't do the simple things like swallowing anymore - we have reflexes that keep us breathing, and keep our hearts going when we're in those deep comas close to death - but the swallow mechanism is often absent.  There's that 1.5 liters that has no where to go.  We give special medicines to help stop the saliva production... thus the interesting fact of how much we make everyday!   Just to round off the saliva discussion - did you know that the tongue couldn't "taste" food without saliva...  a dry tongue will taste nothing.  

Fun facts to pass around and mull over during your next meal.

Elevator talk

What type of personality talks to strangers in an elevator?  I take multiple elevator trips daily, and am always shocked when people talk to me.  "Boy this weather! Of course I have to pick up my sister at the airport at 5 tonight, of all days!"  I smile at the woman telling this to me before she jumps off on her floor. 

One day a woman said, "whew, what a day!  My son was arrested last night, my husbands in the hospital and they just turned of my electricity because I was behind on the bills." 

"Well here we go, I'm hoping today my doctor tells me my tumor has shrunk with the chemo"  A man told me prior to my stop.  

I dislike these sudden bursts of intimacy.  What am I to say to such revelations?  Usually there's time for 1 or 2 words before the stranger and I part ways eternally.  "So sorry", "good luck" or "that's rough".   What compulsive urge is in them that causes this eruption of personal information?  Whatever it is, I lack it. 

Growing up

I've decided, being a resident is a lot like growing up.  As children we trust everything our parents tell us, without even acknowledging that they may be wrong. Their words are truth, and accepted as such.  Then we start growing up, and somewhere along the way, have that startling realization that they could be wrong.  Some innocence is lost when we find out that a lot of what comes out of their mouth is opinion, or their idea of the right answer, rather than fact.

The same thing happens in residency.  We start out, as interns, trusting and naive.  We assume that those staff and attending doctors that guide us are all knowing. The words uttered we take as truth.  We assume, like children, that medicine is black and white...and we are on our way to knowing the right answers.  Then we grow, and progress and it starts to dawn on us - that realization that the doctor training us could be wrong. At first it feels like our trust has been betrayed.  But then our brain's start understanding that it's more gray out there than black and white, and that what's often spoken as truth is merely opinion.

In that midway point now in realization, it's strange when the interns ask me questions expecting absolute truth. They still don't realize that it's just me...my opinion on the right thing to do.  "What's the precise amount of IV fluids to start on a 65 year old admitted with pneumonia?" they'll ask.  I do my best to say that there is no precise amount - just pick something - 100 an hour, 150 an hour, 70 an hour- does it really matter?  But they will wait for a definite answer, then write it in some notebook as if it were truth.  They'll soon learn, like children, that those ahead of us speak in opinions more than fact.