Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Friday, April 14, 2006

    As promised.

    Each of my exam rooms has a bulletin board in it, usually reserved for unexciting reminders to patients such as "Please Turn Off Your Cell Phone" and "Please Bring All Medications With You At Each Visit." Lately I've tried to jazz things up (and give patients something to read) by posting newspaper articles on health-related issues. Today I walked into an exam room to find my patient standing at the board reading an article entitled "Caring for Ill Spouse Takes Toll on Health."

    "You know, this is so true," she said, gesturing to the article. "My stepmother died of a heart attack just a week after my dad died, and she'd been taking care of him for years." She sat on the exam table and continued her story. Her father had been in decline for years with Alzheimer's disease and multiple other health problems and spent the last month or so of his life in the hospital. "She'd walk into the room and he'd throw things at her. At the end he was begging her to kill him."

    I told her the story of a patient I'd had years ago, who walked into my office for the first time with a massively swollen stomach; it was clear that she had ascites. This woman's husband had just died of a chronic illness, and she hadn't been to a doctor in years. The moment I saw her I knew something was very wrong. It turned out to be metastatic ovarian cancer; she lived less than three months. She'd been ignoring her symptoms to take care of her husband.

    "Yes, yes," said my patient. "My stepmom was running back and forth to the hospital, living on doughnuts and Chinese food! We kept telling her to take care of herself, but she wouldn't. After he died, she told me she felt like she'd lost her right arm and that she didn't have anything to live for. Then a week later - it was the last night of shiva - she'd been saying all day that she didn't feel well and that she felt 'pressure in her breasts.' They found her on the bathroom floor in the middle of the night."

    She continued, telling me how guilty she'd felt. "I should have taken her to the hospital. I should have insisted, but she wouldn't do it."

    I listen, nod, tell her how coronary artery disease in women often goes unrecognized. "If this ever happens again," I reassure her, "you'll know what to do."

    She nods. "I feel better. I've talked about this before, but this really makes me feel better."

    Her reason for coming to see me? A minor one - she wanted some blood tests - but the real therapy today was giving her a chance to vent. I'm grateful that I had the time to listen.



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