| so i run down the hall and grab the hospital chart. it didn't help that they hadn't pulled it for me so i couldn't prepare yesterday afternoon, like i did for the other patients. it didn't help that he was more than an hour late to our appointment and it really didn't help that the other two patients i still had to see were also a half hour late so now i had three patients all piled up in the last half hour of clinic.
so i flip though the hospital chart and there's my note. he got his prostate checked by the last doctor, who referred him to urology. he's got a pretty big alcohol history-- a six pack a day for forty years, yep there it is: that explains the sodium. there's his new labs, where i check him for everything under the sun that could possibly cause liver damage and find out, surprise surprise, that it's the booze (and only the booze)-- not booze plus alpha one antitrypsin deficiency, not booze plus hemochromatosis, not booze plus autoimmune hepatitis or viral hepatitis: just booze.
and like an idiot i told him so.
i walk into the room, into the teenager stare, and start in on the lab tests. i usually let patients tell me why they're there. sometimes they have no idea-- i gave them an appointment, they came: it's as simple as that. if i knew i wielded such incredible powers i would be busy controling people in the street: do my bidding you masses! dance for me!
sometimes they tell me they want their meds refilled.
sometimes they start in on their terrible, intractable, incurable all over body pain.
this guy just sits there.
so i start in on the tests.
i get this far:
so i sent you to sports medicine last time and it looks like you missed the appointment, so we'll have to re-send it. looking at your prostate test, the enzyme's still elevated, so we still need to get you to see the urologists because you need a biopsy. i've got a friend in urology-- i'll call her and get you pre-approved. your liver tests are still elevated, alcohol pattern, we knew that. the rest of your liver tests are okay, though, so we need to get you vaccinated against hepatitis.
and he explodes.
it falls into a few general themes:
1) my liver? my liver?!! why didn't you tell me four months ago there was something wrong with my liver? you guys don't know what the @$*&^ you're doing
2) if i need a vaccine why didn't you vaccinate me four months ago
3) those surgeons still didn't send me anything. i know you guys are busy but still...
(i'm kind of impressed that i have such control over other people-- clearly it is my fault the surgeons haven't scheduled your appointment, but i digress)
4) and i called you and called you and you never got back to me
(this is fair-- we don't have what could be called by any stretch of the imagination and "answering service": we have a line that is always busy with a mailbox that is always full. we use the urgent care part of the clinic and follow-up appointments as a sort of patch for this completely broken loop)
at this point, i'm in flop sweat. there's a terminator-style pop-up menu of stuff i did for this guy the one time i saw him and i'm reviewing it for what did i do wrong? why is he so mad at me?
it doesn't help that it's halloween and i'm dressed-- tastefully, i assure you-- as a dinosaur.
and i'm thinking: it's over. i can't help him. he has effectively blocked me from fixing him. and i'm probably blushing to go with the flop sweat. and i have no idea what look is on my face but it's probably not helping.
so i go into reflection mode, like i've been trained:
you sound angry-- you bet i'm angry
and frustrated-- you'd be frustrated too if you were sitting where i'm sitting
it sounds like you feel like you've been lost in the shuffle-- exactly
and i leave it there. like i've been taught. don't try to fix the feeling; let them feel it.
except i'm having feelings, too. someone just sat there in my exam room and told me that i wasn't taking good care of them. and i'm running the terminator menu in my head and i can't remember why i didn't vaccinate him last time, but i also know that giving people shots is not a screaming emergency-- it's the sort of thing you do over a few visits and the fact that you think to do it at all means that you are taking good care of people. and i'm vaguely remembering that our last visit was hijacked by a battle of wills over his chronic hip pain which i successfully diagnosed, so i ask him about his hip.
5) and that medicine you gave me didn't work
so i explain the next medicine we're going to try, not an easy pick, as he's got high blood pressure and a bad liver, but i pick a good one.
and i go into the head to toe physical, which is awkward, but at least familiar-- i could probably do a head to toe physical in a dead sleep. and i order the vaccines. and i'm filling out the paperwork for his follow-up appointment and i ask him if he'd rather see another physician. i try to make it sound neutral.
he divorces me.
my first divorce.
and it was like falling through a trap door. i didn't see what i did that pissed him off until i was complaining about him a couple of hours later and my professor tells me i hit him where it hurt: i told him that all that drinking had done damage-- that the thing he was most afraid of happened.
and then he made it happen for me. |
