Monday, August 20, 2012

Physician, heal thyself

People often tell me how lucky I am to be a doctor when my family members get sick.  I'm not sure what exactly about it they are envious of.  Clearly, it is easier for me to understand what is going on and appreciate the abilities and limitations of what our health care system can do.  Medicine these days has become a language unto itself so being bilingual is beyond helpful. And, truly, I'm sure there are some professional courtesies given to me, sometimes almost subconsciously, that I don't even really realize.  But there is a large part of being a physician that makes being a patient, or even worse the family member of a patient, a lot more difficult than I think most people realize.

Of course, I have never really known it any other way and, so, I am by no means complaining.  I have just had a series of events lately that have landed me on the wrong side of the doctor-patient relationship of which I am accustomed to generally being the controller and it leaves me contemplating the patient side of things. 

All medical providers should have to be patients, in various capacities, on regular intervals.  It provides an empathy and a humility I do not know how else to learn.  It also deepens our understanding and appreciation for the art and logistics of healing, none of which are taught in medical or nursing or PA school.  For instance, I was hospitalized in February with a fairly common intestinal infection.  Granted, I complicated it slightly by being 32 weeks pregnant at the time, but I have personally treated many people in the hospital with that very same infection and knew it perhaps better than my treating physicians did (given they were all OBGYNs).  I knew the symptoms, the treatment, the duration, the complications. I could quote statistics on rates of recurrence and transmission. I even had a fairly good concept of the pain it could cause, given that I've seen it enough to gauge the level of discomfort most people have.  What I failed to appreciate was what it means to a person to be isolated in a hospital room for a significant length of time.  To be woken every few hours day and night for blood draws or baby monitoring or vital signs or trash collection or room cleaning or meal delivery / pickup.  To be away from family, friend, work, my own bathroom.  It was eye-opening.  

And then jump to today. My mother went in this morning for scheduled open heart surgery to correct an overgrowth on her heart wall that was discovered in the last few years.  We have known this was coming and I have taken care of numerous people who have had very similar procedures to this.  I have know medically what this all means for a long time.  But, what I failed to ever find out was what happens when the doctor leaves the room. What does waking up with a tube in your lungs, IVs coming out of your neck and arms, drainage tubes and wires coming out of your chest, and a catheter in your bladder mean to someone who just had their sternum cracked open and then sewn shut?  What does being totally completely naked (no supportive apparati like glasses or underwear) in a strange room with all new faces while being in significant pain feel like?  What do families worry about, have questions about?  What do patients and families need to hear?  

I am very lucky to know what I know.  Walking into Mom's recovery room today was not nearly as jarring or scary to me as I'm sure it would have been to most people.  Somehow, I can see beyond all those tubes and wires and monitors and know that, assuming all goes as planned, she will very quickly return to the fully functional (and hopefully much improved) woman I have always known her to be.  But there is also an element of me that kind of yearns to just be a layperson.  I intentionally didn't tell any of the staff I am an MD but, in a strange way, we are hard to stay hidden for long.  And the tone changed when they discovered my secret. Not in a perceptible way to probably even my brother who was in the room but enough that I realized I was changing the environment just with my presence. For the better?  Probably.  I'd at least like to think so.  And anything that gets my mother that extra boost to recovery, the better.  But I find it difficult to be just a doctor or just a patient and so I end up in this very strange gray zone that is altogether uncomfortable in a lot of ways.  I know exactly what to say to get medical personnel to respond but I also know exactly what to say to get medical personnel to respond.  I liken it to that scene in Bruce Almighty when Jim Carrey's character has to take over for God for a day and just grants everyones' prayers.  All hell breaks loose and he very quickly realizes having everything the way you want it isn't always the way that works out the best.  

There is a reason why physicians should not treat their family members or themselves because we lose objectivity and can start to want everything to be perfect when we all know perfection is rare and often a sign of ignorance.  So I struggle with what I should say or not say and that makes me knowledgeable but powerless and with a very large stake in the game.  It is altogether an uncomfortable place to be.

Not nearly as uncomfortable as my sweet Momma today who has been a fantastic patient and truly the type of woman I would love to treat, if it weren't for her being the person who created me and all. We are not out of the woods yet, but the most uncertain part is largely over and now we're getting down to the business of healing, which is largely uncharted territory for me and some pretty darn good CME (Continuing Medical Education).  

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