Thirteen patients

Apropos of yesterday’s discussion, and in the absence of any other bright ideas, I thought I would remember a few patients today. We’ll begin with me and go from there.

1. Me. I loved my pediatrician, Dr. Johnson. I especially loved taking off all my clothes whether he asked me to or not. When I became 9 or 10, my parents decided I was too old for a pediatrician and switched me to their GP, a guy I never liked. There’s something wrong with a dude who thinks it’s necessary to give a kid a rectal exam every time he sees him. But did my mom ever question him on this? Nope. And did he bother to wipe away the lube afterwards? Nope. The bastard.

2. My first history and physical was on a VA patient, a Korean war vet in his 50s who looked like your typical Silicon Valley businessman. We were instructed to ask everything. EVERYthing. And it was embarrassing as hell for this young med student to take a sexual history, and somehow worse still to ask whether he did any illicit drugs.

Imagine my surprise when he told me he did a few lines of coke every weekend with his pals.

3. Not long after, I had another patient, a young man with Wernicke-Korsakoff syndrome due to alcoholism. He was in his 30s but he looked 50, and the only word he could say was “Beer.” Ask him how he got here, and he would smile, shrug, and say, “Beer beer beer.” Kinda funny, but really very sad.

4. Another Wernicke-Korsakoff patient: funny thing, both this guy and patient #3 weren’t depressed about their conditions. I wonder if that’s part of the psychosis — if so, it’s a bit of a blessing. (Alzheimer’s patients, for example, are often extremely depressed in the early and mid stages of the condition — understandably.) Anyway, this was back during the first George Bush’s presidency. When we did a mental status eval, we would ask questions such as, “What year is it?” “What city are we in right now?” and “Who is the current president?”

On that last question, my patient responded, “President Bushwhack.”

Obviously of sound mental status, politically speaking. Made me wonder if he was faking the rest of it 😉

5. She wasn’t even my patient. But she was eleven, had a family who loved her, prayed for her at her bedside every day, left prayers for her written in Hebrew, and she died of meningococcal meningitis. Life really isn’t fair.

6. I took care of her lacerated scalp following a traffic accident and she became my private project from then on. She wanted a new nose, I gave her a new nose. She wanted Julia Roberts’ lips, I gave her Julia Roberts’ lips. In exchange, she dressed like a vamp and shared Madonna’s photography book with me, the one with the airbrushed anus.

Nothing ever happened between us, but I suspect we both thought about it.

7. Skip back to med school for a moment. She was a young mom with a loving husband and she had a nasty breast cancer. (Yes, they’re all bad, but some are worse than others.) She wanted my opinion: should she do chemo, or not? My usual protestation (I’m only a med student, I don’t have the knowledge base to answer that question) didn’t wash with her. She wanted to know, if I were her, would I do it?

She couldn’t ask her family or friends. They only wanted her to live, and they would have had her do anything to get those extra few percentage points’ chance of cure. She needed to ask an impartial individual.

I told her I’d do the chemo. I wanted her to live, too.

8. I would be remiss if I didn’t link back to my dos piernas story. Considering the fact I based my romance on a real event (a med student who couldn’t manage to place a urinary catheter), that dos piernas story could probably inspire a trilogy.

9. During internship, every call night the nurses asked me to push Dilantin on Mr. M. He had been unresponsive since the mid-70s; for the past 17 years, all he ever did was grunt in response to pain. Every so often, he would get pneumonia or a bed sore and find his way back to County.

His head looked like a basketball that had seen too many decades on an inner city ball court. Scarred, patched, a war zone unto itself. He was a bull of a man, too. His family kept him well-fed through that feeding tube.

During the last month of my internship, he woke up, just snapped out of it wanting to know where he was, what had happened. I can’t begin to imagine his or his family’s emotions, but for us docs who had taken care of him, it was eery. He seemed like a time traveler . . . and, you know? We didn’t know whether to be happy or sad for him.

10. Flash forward five years. When I was one month out of training, this patient came to see me in the private practice office asking for a third opinion. Two ENTs had told her she needed sinus surgery: the self-perceived ‘top sinus surgeon of LA County’, and one of the top academic sinus surgeons in the area. All I knew was that she’d had an abnormal finding on her sinus CT, discovered when she’d had a head CT for her headaches.

So she had seen some of the best talent in the area and they both agreed she needed surgery. What could I possibly add to this discussion?

I took one look at her CT scan and started laughing. She didn’t need surgery — she just needed an honest ENT. Her only abnormality was a maxillary sinus mucus retention cyst. These are incredibly common and rarely symptomatic.

Moral: don’t hesitate to get those second (and third) opinions, people.

11. You occasionally save lives in medicine — it’s inevitable — but you don’t expect to forget the patients you save. She approached me in a local restaurant, said, “Are you . . . are you Dr. Hoffman?” I’m thinking, What did I do wrong now? Nothing, it turns out. I had ordered an MRI scan on her five years ago and discovered her benign (but life-threatening) tumor. I’d changed her life. And now, I didn’t even recognize her.

12. Sometimes you know in your bones that it’s bad. The sound of a patient’s voice, or a constellation of symptoms that can only mean one thing. Worst of all is when the patient is a child and you hope you’re wrong but you know you’re not.

One came in soon enough that a prompt diagnosis made a difference.

One didn’t.

13. He had a terrible diagnosis, the worst. The one that kills you within a month no matter what you do — surgery, chemo, radiation, this tumor laughs at everything and grows. And grows.

I brought him and his family into the office and told them everything. I asked my patient if he had any unsettled family business, like estranged family members he should square with. He didn’t, but he did have a son in Europe in the military. I wrote a letter. We faxed it to the son’s C.O. If I remember correctly, his son was back home within the week.

He died soon thereafter, as expected. There was nothing I or any other doctor could do about it. And yet I feel more pride in that case than in anything else I’ve ever done in medicine.

Leave a message in the comments, and I’ll give you some cool linky love below.

Kate’s 13 favorite pictures

Darla’s beautiful and neurotic mind

Trish’s 13 in-yo-faces

D.