I have been at my new job in private practice for about 6 weeks now. I've taken over for an incredibly well-respected physician who retired after 30+ in practice and his patient base is both loyal and skeptical of a young new whippersnapper. Most of my visits have been routine physicals and follow ups where half of the time is spent convincing them to give me a chance. Surprisingly, it hasn't been as hard of a sell as I thought, given that word of mouth spreads fast in this town and I managed to win over just enough of the die-hards that the rest of them are mostly convinced before they get their gown-clad rear on the paper-covered table. I'm absolutely loving private practice where patients, for the most part, care about their health and want to be active participants in their own lives. But today was a banner day for me.
My last patient of the morning (let's call him Bob) was scheduled for fatigue. That's one of the top dreaded chief complaints for all physicians, right up there with chronic back pain, fibromyalgia, and insomnia. When I saw him on my schedule listed as "severe fatigue for >1year" I wanted to make like a tree and leaf the building. I was running 15min behind already and my rumbling tummy could already smell the food in the lounge. Plus, glancing at his chart, he'd already seen his cardiologist, his pulmonologist, his urologist, and his gastroenterologist for this same complaint and each of them had done very extensive workups that were all, mostly, negative. So, obviously, walking in to see a 65 year old man who had seen 4 specialists already with no diagnosis thus far, I wasn't feeling terribly confident that I, the newbie, was going to have much luck. And he admitted to me when I first walked in the room pretty much that same sentiment. But strangely enough, within about 3 minutes, I got the flavor that this guy was depressed. It wasn't obvious - he's a jokster and was very upbeat, but there was something about the way he looked at me when I asked him, "How's your mood been lately?" that set off my internal Warning!-bullshit-ahead bell. I pressed a little harder and he shrugged off most of my questions with jokes until finally I said, "Bob, I think you're depressed. That's why you're so worn out." He thought about that for a long minute before he started to tear up and very quietly said, "Dr Shaw, I've thought that for a very long time but was too afraid to tell anyone." I then asked him if he'd ever thought about killing himself and he said, "I am a gun collector. I had over 150 guns in my house. I got rid of them this month because I was going to use them to blow my head off but I think about killing myself all the time...I can't believe you asked me that. Thank you." Well knock me over with a feather. We made a plan to start him on an antidepressant and contracted a safety plan for when he starts to have the suicidal thoughts. We shook hands on it and I walked him to the door when he turned to me and said slowly, deliberately, with emphasis on each word (and I'll never forget this for all the days of my life) "Dr Shaw, you're going to be my doctor." And, as this very large burly man that smelled of Old Spice and woodsmoke hugged me, he whispered "And I think you just saved my life." Well if that doesn't make my 23yrs of education worth it, I don't know what does.
As if I didn't get the message then that being a doctor is truly my calling, my nurse grabbed me as I was rushing out of the office at 5:45pm late to pick up my kids to say that a lady I had seen last week called from her hospital room to thank me for saving her life. She had wanted me to call her in an antibiotic because she was convinced she had bronchitis like she gets every winter but I declined and asked her to come in for a visit because I didn't like the way she was describing her symptoms. Fortunately she did come in and sure enough she was rather pissed, at first, that I was making a big deal out of her chest pain and not just giving her the antibiotic she was sure she needed. She grumbled all the way to the CT scanner until the radiologist informed both her and me of her massive evolving pulmonary embolism. She called me from her ICU bed to say thank you.
I was born to be a mother and a wife and a doctor. And, as difficult as each of those jobs can be, both individually but also in combination, I could not ask for a better life than this one that I've living.