Thursday, December 20, 2012

low expectations

i asked my elderly patient how he was doing.  'great,' he said, 'i got up this morning...'  i was waiting for more, but apparently that was it.

Saturday, December 15, 2012

lesson for a young doctor

i was cleaning out some boxes in my basement today and found something i wrote my first year in medical school.  i had been assigned to a  family practitioner  for a week-long rotation and it was my first real glimpse into the realm of the exam room and the doctor-patient relationship:

The Woman With 37 Iguanas

The woman with 37 iguanas is one I will not soon forget.  I opened the exam room door and there she was, her seemingly miniature head resting on her over-sized body, and on top of her head a little upright ponytail like a fountain.  Red, orange and hot pink swirls covered her from head to toe, the fabric gaping between buttons over breast and belly.  Peeking from under her skirt were two petite feet.  I watched the gum stretch and snap between her teeth framed by bright red lips, themselves framed by her pale skin and shiny black hair.  She talked incessantly, interrupted only by the occasional redirection of Dr. H's questions.

She talked in circles, she repeated things, she overflowed.  Could she be allergic to the iguanas?  Does she need to keep taking her thyroid medicine?  Did I know that Robin Williams is bipolar?  Steve Martin?  Roseanne?  She bought 22 pairs of shoes last week.  I glanced guiltily at her feet as if to confirm this.  Yes, those shoes looked brand new!   Did she keep them all or take them back I wondered?

I couldn't help it.  I was drawn in by her bubbliness, her friendliness, her bizzareness.  I found my own mood rising higher, my thoughts coming faster, as if her mania was contagious.  She was a balloon and I was merely an ant on the string.  When we left the room Dr. H smiled at me knowingly, eager to see my reaction, amused at my need to take a deep breath and shake my head.  I knew then that Dr. H had wanted to give my this experience, this powerful pull on my psyche to say, Beth, it's unavoidable.  Your patients will come to you sad, angry, intensely happy, and you will find yourself drawn in all of those directions.  Thank you, Dr. H, for both the gift and the warning.

i think the lesson is this - as a doctor you are not a wall, you are not a repository, you are not even the same person each time you walk through the exam room door.  instead, you are like a well that ripples and reflects back when someone dips into it.  it is a great benefit to both you and the patient to tune into those ripples, they are telling you something.