Tuesday, June 23, 2015

Six Months and a Carpenter's Stethoscope


Disclaimer: Pardon the hiatus. I find I am out of practise with writing down stories of life and work. 

June 16, 2015


Yesterday marked the six-month anniversary of starting a new job in a very big, primary care clinic. More than sixty doctors, nurses, and physician assistants care for thousands of outpatient in the rapidly expanding urban medical complex where I work.

Did I mention it’s big? It’s a vast labyrinth of medical services. I often find myself feeling like the mouse-doc scuttling around in a medical maze and discovering a delightful piece of cheese tucked away in a hidden corner of the system.  I am constantly greeting new faces and finding new pieces of “cheese” within the clinic.

Although my work environment is a dramatic change since relocating to the Northwest there are many additional cultural differences to decipher: Church. Local community. Politics. Socials. It’s another foreign country, in a way. Portland is a ‘hipster’ city where food that is cooked without meat is no longer termed “empty”. Instead eating establishments proudly proclaim “gluten-free”, “vegan”, and “organic”.  Being a vegetarian is not on the extreme end of the spectrum. It’s more on the moderate end of a very broad spectrum of dietary preferences.  

The vast dietary spectrum of preferences if relatively an easy cultural adjustment – instead of green leaves floating in palm oil there is organic kale salad with alfalfa seeds and thistle milk or something along those lines. The bigger struggle for me has been to find a sense of belonging and assurance that I’m still ministering to others and leading a worthwhile life. I find it challenging to feel like I’m a part of a bigger picture. I have an inner, subconscious sense of losing an exclusive membership in a noble club. I find pieces of my heart sometimes shifting around uncomfortably like a loosened shingle, pulsating against the battering of life’s storms. One end is still fastened firmly to the practical, logical area of my brain and affirms that I’m still doctoring. I’m still performing a necessary service to those suffering and sick and in need. But a portion of my emotional, irrational subconscious wobbles with uncertainty and doubt when adversity and discouragement pour down in a deluge of negativity. I waffle at the fringes, constantly questioning myself:
Am I still serving God in a secular clinic?
Are my skills as a physician needed in a country with so many doctors?
Am I utilising my time appropriately seeing so few patients in comparison to Cameroon standards?
Without the external affirmations one receives as a missionary, can I believe in my calling here?
Do I believe in my heart that I’m currently where God wants me?
Do I believe He’s called me to such a large, institutionalised office to serve as His ambassador of love?

Lately I have found my creative writing energy sapped. I don’t find it easy to outline interesting and noteworthy aspects of my work. I am not involved in the same severity of life and death struggles that clawed at my work while in Cameroon.  I am surrounded by ailing people but of a different type. Sick but a different kind of sickness.

I discovered when I first met Mr AT that he had been having ankle pain for years. It had been worse lately with all the activity necessary in his new job as a construction worker. He’s already been appropriately treated with the anti-inflammatory medications (Aleve, Advil). He had an ankle brace. Work notes that dictate modified work activity had been written. Physical therapy had been offered although he couldn’t find the time to attend such therapy sessions due his demanding daytime job schedule.  

“What are you hoping to get out of your visit today?” I searched his face for a truthful explanation. I dreaded his answer though as I was pretty sure I knew what it was going to be.

“Well, doctor, I guess I was hoping maybe you could just fix things, make all the pain go away.” Mr AT laughed nervously and gave an apologetic shrug.

I return his laugh with an echoing helpless shrug. “I wish I had my magic wand and could fix all your problems. It sounds like you already know what you need to do to fix your ankle though. You’ve just told me that your ankle is fine on the weekend after you rest it.”

He nods.

I continue. “Either you need a new job, one that doesn’t involve all the heavy labour that you’re doing; or, you need a younger body, a new ankle. I’m not sure how to give you either of those though.”

Mr AT gave a rueful smile. He understood I couldn’t satisfy his wish to make all his problems disappear. I could listen. I could empathise. I could affirm him in what he already knew. But, I couldn’t cure him of chronic ankle pain. In the end, we agreed upon the imperfect solution of partially masking the pain with pain killers while he promised to try eating healthier and losing weight – two modifiers that were controllable unlike his job duties and taxing work schedule. It was a temporary patch and not completely satisfactory for either of us. I would have loved to have taken away his diseased ankle and vanquished his pain forever. However, such was not going to happen. It wasn’t even possible under the circumstances to enact physical therapy and a different job. Those were the long-term solutions he really needed for ankle healing. Such situations leave me feeling helpless and frustration. I wonder if this is really what God is asking from me: to temporarily placate people’s pain brought on by poor lifestyles and bad luck?

Work days in Cameroon could be long and emotionally challenging. A frenetic pace from 8 o’clock in the morning with staff worship until the last patient of the day was served. Some days were certainly busier than others. It was hard to quantify the hours spent in the hospital and clinic. Now my days are more regimented. No early morning doorbell signalling a hospital emergency or midnight obstetric summons. Four days a week I walk to work, closing the door behind me at 6:30 in the morning and generally wrapping up the last of my charting and phone messages by 6:30 at night. Long days but defined “off time” away from sick patients and clinic duties. No call except the occasional urgent care shifts. So why is it that I feel less productive overall? Why do I feel like I accomplish less outside work than when I lived and breathed hospital air in the same mission compound? I am still sorting out that answer. Twelve hour days, four times a week, should give me plenty of free time, right?

Perhaps part of the reason for my lassitude outside clinic is due to the emotional tragedies that siphon off energies previously used in other pursuits.

Madam T came in for anxiety and depression. It’s a very common problem in Portland. People are “weird” here but also rather prone to worry-laden depression.  As I sat down to listen to Madam T, the floodgates opened and she spilled out a story of woe rivalling Lemony Snicket’s [series of unfortunate events].  Reflective empathetic statements of compassion are appropriate in such times and yet incapable of dispelling the sad consequences. Life is unfair. I wished for a loving community safety net that I could toss her into for that moral support she needed. Does they exist in Portland? Are there communities that have the resources to help such sad souls in need of a friend? Traditional medicine is not designed to manage the intricacies of psychiatric depression and anxiety. It’s frustrating.

“I know I need to call the mental help line, I just don’t have the energy,” Madam T laments.

I nod. “I wish circumstances were different for you. If I could change them for you, I would.” I pass her the box of tissues so she can wipe her tears and blow her nose.

By the time we part with appointments scheduled to touch base again on the telephone, I find myself relieved to escape. The atmosphere is full of suffocating despair.  I feel for her but I don’t want to absorb all the misery and bitterness she carries. I rather doubt that I’ve done anything clinically to improve her health. I’m not sure if we’ve connected at a therapeutic emotional level either. She’s still shedding tears when I exit. Is this what God has planned for me? Are these the type of encounters He wants me to keep muddling through year after year?  My emotional fatigue level leaves a huge margin of doubt on the reasonable longevity of such a plan.

And so as six days have turned into six weeks and now six months since beginning my new job in Portland, I find that the saying is true: ‘the days are long but the years are short’. It’s hard to imagine that it’s been six months. It feels like forever and yet it feels like I’ve only just begun. I have so much still to learn.

I’m still a novice with most things at work.
I am still part of the “newbie” group of primary care providers.
I still haven’t found my place in the community.
I am still a stranger at church.
I am still finding those friends that you can just “pop on by for a drop of tea and encouraging hug”.
I am still searching for a small group to nourish my spiritual fellowship needs.
I am still learning how medical services like chiropractors, massage therapists, and acupuncture work.
I am still adjusting to all the naturopaths and alternative healers available.
I still have “I miss Cameroon” days
I still refrain from mentioning my time in Cameroon for fear of being forever labelled  “the doctor from Africa”
I still worry about losing my identity as a physician with a mission heart.
I still fight against the temptation of self-pity when I work long hours without the same affirmations that come from working internationally
I still have grey days of depression and self-doubt about the future
I still am figuring out what my calling in Portland is these days.

There are a lot of unknowns. In the midst of the unknowns I have hope. God has been a guide for me in the past; I have faith he will continue to mentor me here in Portland.

Jesus spent 30 years in Nazareth, first growing up as a boy and then working as a carpenter. He spent three years in active, public ministry. Thirty years sawing wood, carving wood, pounding wood, smoothing wood, and sweeping wood dust off the floor of his tiny shop. He could have been doing spectacular, crowd-pleasing miracles like curing world hunger, walking across oceans, raising whole cemeteries, and eradicating leprosy and blindness. He could have reached more people, ministered to more sick, done more impressive feats of glory, fed millions instead of thousands, if he’d left Nazareth at 20 years instead of 30 years of age. Was it really that important to craft another kitchen table, another oxen yoke, or carve that one-hundredth window frame? Jesus spent the majority of His ministry plodding along, a faithful carpenter with the lathe and the hammer in the mundane duties of life. Perhaps I’ve re-entered the proverbial carpenter shop? Crafting another wooden stool might be compared to reassuring another sniffling American that it’s a viral respiratory infection. Hanging out in the carpenter shop chatting to a few clients over the latest design in wooden ox yokes might be like sitting next to a tearful, depressed Portland hipster and offering encouragement and a box of tissues. Our small, insignificant mundane acts can still be sacred acts to God. Perhaps?


“That we ought not to be weary of doing little things for the love of God, who regards not the greatness of the work, but the love with which it is performed.”

― Brother Lawrence, The Practice of the Presence of God

Wednesday, April 15, 2015

The Elusive Magical Fairy Wand


“Reputation is what others think of us; character is what God knows of us.”
― Shannon L. Alder


Let’s face it, if medical professionals depended on the fickle fancies of their client-patients’ enthusiastic affirmations of ‘job well done’, we’d be in trouble.

Even theoretically, few would claim it’s possible to satisfy every customer, every time. People are fallible human beings with wishy-washy whims. Most of the time we don’t even know what we want. In an age of instant gratification with expectations of continual entertainment, it’s simply not possible to meet the standards. Healthy, happy people are often disappointed. How much more difficult it is to satisfy sick clients in mental and physical pain?

Perhaps if doctors had magical wands that they could wave in a graceful arc with cascading, twinkling fairy-dust floating down over the sick patient and instantly erasing all illness…  Unfortunately, I haven’t come across such a wand. However, if anyone does, please let me know!

So, it is not easy working with people who are suffering every day. I like to see people smile. I like to cheer people up. Generally speaking, I chose a profession in medicine because I wanted to make a positive difference in the world. Without my magical fairy wand though, I seem to encounter an awful lot of disgruntled, unhappy sick people.

Madam X sat across from me with a frown and crossed her arms. “Doctor, I’m sure there’s something wrong. I’ve gained 10 pounds and I haven’t changed anything in my life. I’ve never been this heavy before. I do the same things. I haven’t changed my diet. There’s something wrong with my thyroid.”

I glanced at her recent blood work on the computer and tilted the screen for her to view the results. “Your thyroid test was normal last month,” I reassured.

“That test isn’t always accurate though, doctor. I know there are other tests to check my thyroid that are better.” Madam X leaned back and stared defiantly at the normal lab results.

“Umm, this blood test for thyroid problems is very accurate.”

“I had a friend who’s test was normal but then her doctor ordered some other thyroid testing and they found out she had low hormone levels.” Madam X scowled. “Doctor, there is something wrong. This weight is not normal for me.”

“All your recent blood work is normal. Sometimes as we get older, our metabolism slows down a bit and it’s easier to put on weight. Diet and exercise are still the best ways to control weight and stay healthy.”

Mrs X shifted in her chair. She was clearly not convinced. “Doctor, there’s something wrong in my body that is making me gain weight.”

I shrugged. “I’m sorry. I know it’s not easy. We can talk about some ways to improve your diet and increase your activity. There are classes and groups you can join. I can suggest some local gyms.”

“No, I’m not interested,” Madam X replied. Her tone was increasingly becoming more frustrated with the way things were going. “I know how to eat and I already walk enough at work. There’s something else wrong inside my body. You’re just not willing to order the right tests.”

She left angry and frustrated. “I’m just going to have to find help elsewhere,” she gave me a pointed glare as she packed up her purse and put on her coat.

Clearly, not a happy customer.

Madam Y dangled her legs at the end of the exam bed while she fidgeted with the elaborate beaded necklace that hung round her neck. “What a beautiful necklace,” I exclaimed as I shifted our consult from the initial verbal history of the problem to the physical exam portion. Her earrings were beaded in a matching pattern with her necklace.

“Thank you, doctor,” she turned her head for me to examine the opposite ear. “My daughter makes them.”

“You have a talented daughter, very artistic,” I added.

She nodded in agreement while I listened to her heart.

“Does it pain anywhere where I press?” I asked while I palpated her abdomen to ascertain spleen and liver size.

“Right there,” she indicated as I put pressure over the lower portion of her stomach, below her umbilicus.

“Oh?” I hadn’t expected a positive to my query, having already gone through a review of problems:  high blood pressure, migraines, and sinus allergies. I felt my pulse do a double skip. Pain in the stomach can be a bottomless pit of inquiry (pun intended). A million different things can cause stomach complaints, everything from benign indigestion to life-threatening colon cancer.

“Yes, doctor, sometimes I get this annoying pain, not really painful but, well, sort of uncomfortable down where you were pressing.” She sat up as I finished poking around on her belly, having ensured there were no big masses or obvious fibroids.

I waited for her to continue.

She shrugged with a noncommittal smile. “It’s probably nothing, doctor, but I just worry, you know. It’s nothing new. Just every now and then. I keep forgetting to mention it to the doctor when I have my appointments.”

I nodded.

“Probably has more to do with when I eat too much or have too many sweets.” She folded her hands and gave an embarrassed laugh. “I know it’s not good for me but when I go out to eat. I always have dessert.”

I went throw my list of ‘red flags’ -- danger symptoms that could indicate a patient has some perilous medical condition potentially going on in their bowels. Madam Y thankfully didn’t have any of them.

“I can’t find anything on the exam or in the symptoms that you’re having that indicate we need to do more testing. From what you’re telling me, there are no signs that anything like a nasty cancer is causing the stomach pains.” I mentally reviewed my internal checklist and again came up negative for anything concerning. “You might want to keep a symptom diary and jot down when the pains come and see if there are any particular situations or foods or patterns to the pain.”

She was quiet.

I waited for her to disagree with my predictions and recommendations.

Madam Y looked down at her slightly protruding abdominal fat roll. With a wry grin she let out a sigh. “You’re right, doctor, I really just need to eat better. I eat too much. I don’t like the added weight. I’ve sort of ignored it but I know I should be more active at the gym and cut down on my calories.”

“Choosing more healthy foods and getting more exercise is always a good idea,” I encouraged Madam Y with her inner health resolutions. “Exercise is the best medicine. It’s the closest thing there is to a panacea. It’ll help the weight and your blood pressure and reduce your risk of diabetes later on in life. Exercise is good for digestion too. I bet it will reduce the stomach pains.”

Madam Y nodded resolutely. “You’re right.”

I have never considered myself to be a great cheerleader. No pom-poms or fireworks. I smiled and nodded my affirmation then closed out her visit and went to print off her the summary. As I rose to exit she suddenly stood up. “Oh, doctor,” she exclaimed with a huge smile, “thank you so much. I just love you!” She rushed over and enveloped me in an unexpected hug.

My eyebrows nearly jumped off my face in surprise! (Thankfully, they are still attached. I checked afterward.) To say I was shocked is an understatement. I was certainly caught off guard. Not the reaction I was expecting. I’m not complaining either, mind you.

“You’re welcome,” I stammered back in response as she released her hold of me.  

Clearly, she was a happy customer.

Happy and satisfied versus frustrated and angry. I really can’t take credit for either reaction. There are too many other variables within a person’s life that affect the outcome in our clinic visits.

Madam X and Madam Y, with their contrasting attitudes, are a reminder that satisfaction comes from within. It’s a mind-set that we choose. I cannot look to customer satisfaction surveys or patients’ words of affirmation. Medicine is fraught with sickness, suffering, and people with emotional and physical pain. The courage to carry on in the midst of it all comes from outside my work.

I work for Christ, and, well, He’s already given me His stamp of approval.


1 Peter 4:11

Do you have the gift of speaking? Then speak as though God himself were speaking through you. Do you have the gift of helping others? Do it with all the strength and energy that God supplies. Then everything you do will bring glory to God through Jesus Christ. All glory and power to him forever and ever! Amen

Monday, April 6, 2015

Broken


It's not always easy to love others with the same love that Christ gives to me.


Broken  People

I’ve been back in the States and practising medicine in a traditional primary care outpatient clinic now for three months. One of the most common questions that I am asked, “What’s it like being a doctor in America again?”

Good question.
Complicated answer.

I’m not sure my language skills can quite express the every-changing kaleidoscope of reactions that whirl through my brain each day. There’s a lot I like about working in the U.S. again; there are other aspects I quite dislike.

One of the biggest challenges has been to find the assurance that my work as a primary care physician in an affluent society is worthwhile.

“I’m still searching for meaning in my job,” I reply to my colleague who asks me how it’s going over a lunch meeting.

He nods and listens as I continue.

“When I read about my colleagues that are still in Africa; read their blog stories; or exchange internet messages about the frustrations and difficulties of practising in resource-poor setting like Cameroon, Chad, or Malawi, waves of nostalgia and inadequacy wash over me.  I’m no longer the leader of the team. I’m no longer seeing 30 or 40 outpatients in a day PLUS managing a hospital and labour and delivery service. I feel so tiny when I think about the small number of people I see in clinic now and the minor ailments I attend to during the day.”

“For example, I saw a patient with insomnia and restless legs at night that had elevated blood pressure today. Compare that to a typical patient in Cameroon with severe anaemia and malaria that’s underweight with HIV and tuberculosis.”

“Give me some patients who are really sick,” I’ve said more than once in the past couple months.

At night I pray, “Lord, please help me not compare. Help me with my pride that tries to boost my inner ego by comparing herself to others and then gets discouraged when she perceives others are better and doing more important tasks.”

All around the world physicians are fighting against illness. Spiritual sickness. Emotional turmoil. Physical ailments. Mental distress. There is no comparison. Missionary doctors in Africa are under certain stressors like limited diagnostics, untrained staff, and organisational politics. Missionary doctors in America are under another set of stressors with paperwork, legal issues, and insurance limitations.

Ministering to the suffering is a challenge everywhere. I pray for my colleagues in Africa that God will give them patience in dealing with inadequate electrical power and corrupt political officials while at the same time I pray for my colleagues in America as they deal with twisted insurance prerequisites and drug addicts.

One young woman came to me last week. We’ll call her Veronica, although of course that’s not her real name.  She had a festering wound on her buttock that she’d just been seen for two days prior.

“Have you been taking the antibiotic that was prescribed?” I inquired as I looked over at Veronica, shifting uncomfortably on the exam table, dressed in a gown with a sheet over her lap.

She grimaced and I noticed little sweat beads across her forehead. Her blood pressure was a bit high too. “Yes, Doctor, but I’m not any better.” She shook her head for emphasis. “The pain is unbearable. I can’t sleep at night.” Tears welled up in her eyes as she spoke of the suffering. “I just can’t take it anymore.”

I bent over to examine the infected area on her body.

“Ouch!” she jerked away involuntarily as I touched the sore, red, spot on her skin. “Sorry,” she apologised and braced herself as I took another try at examining the infection. She winced but managed to hold still the second time.

The skin was red and inflamed and acutely painful. Without proper treatment of the infection, it could spread to the rest of her body, potentially landing her in the hospital on IV treatment if things weren’t taken care of today. I wondered why the original medications hadn’t seemed to help her. On reviewing her case, it appeared that appropriate measures had been taken. She should have been getting better by today.

“Given the fact that you’re still not improving even though you’re been taking what normally is the right medicine for this infection, I’m going to change the antibiotic,” I informed Veronica.

She nodded, grim-faced.

“I’m going to order an ultrasound exam to make sure the infection hasn’t formed a pocket of pus deep inside that might need draining too.”

Again, she nodded her understanding.

“And because I want to make sure this infection gets under control as quickly as possible, today I’m going to order for the antibiotic to be given as an injection.” I paused waiting for her response.

“Ok, doctor,” she nodded in agreement.

Satisfied that I was making the correct medical decision based on her symptoms, her exam, and the failure of her infection to respond to the initial first-line antibiotics prescribed a few days earlier, I went about typing in the orders into the computer.

“But, doctor, what about the pain?” she broke the monotone of my typing.

“Are you using ibuprofen and Tylenol?”

“Yes, but its not enough. I can’t sleep,” she winced again as she shifted her weight.

“OK, well,” I glanced at the last prescriptions given a couple days ago by the urgent care doctor, “I’ll refill the Vicodin (narcotic) pain killer that you were given before. Take it with the ibuprofen though,” I instructed.

“OK,” she relaxed.

“Now go do the ultrasound right now and get that first injection of the antibiotic,” I cautioned as she prepared to leave.

She shook my hand and thanked me.

I handed her the prescription for the Vicodin and the instructions for the ultrasound and injection.

That was the last I saw of her.

I waited for the ultrasound report. It never came. I looked her up in the computer system. She’d never gone for the test. I noticed that the Vicodin prescription had been picked up. The antibiotic prescriptions had not been filled.

I hate being snookered.

My first reaction was anger. It made me angry that Veronica would lie  and manipulate me and the medical system just to get a few narcotic pain pills. Later, I felt rather sorry for her. She wanted those pain pills so badly that she was willing to put her own physical health at jeopardy by neglecting proper antibiotic treatment for a real infection. 

Veronica was actually sicker than I’d originally assessed. It wasn’t an obvious illness amenable to a few tablets of antimalarials or antibiotics though, sadly. It was a deeper illness of the mind. Addiction.

Unfortunately, addicted and twisted minds wrapped up in a milieu of complicating psycho-social factors are not easily ‘fixed’. It takes more than a primary care doctor and a 10-minute clinic appointment to help heal the underlying suffering. Perhaps that’s why there is so little personal job satisfaction in these situations. It’s easier to prescribe a cream for the scabies rash or a worm tablet for the tummy ache or a course of Coartem (antimalarial) for the malaria.

Broken people are all around. In Africa. In America.

Perhaps some different flavours of illness hit my radar here in America versus Africa. I am trying not to compare though. Illness comes in all colours, shapes and sizes. I am continually astounded by the magnitude of broken souls that I meet.

It doesn’t matter whether it’s Africa or America, Asia or  Australia. People come with deep, penetrating wounds – raw and festering – expunging shame, guilt, depression, anxiety, unfaithfulness, and violence.


The song “people need the Lord” seems rather appropriate. God is teaching me to avoid the comparison game that only brings discouragement to my heart. Instead He is telling me to simply go forward and treat each person, whether it’s one or one-hundred, with the same love and grace that He extends to me.

Isaiah 61: 1-4 

The Spirit of the Sovereign Lord is on me,
because the Lord has anointed me
to proclaim good news to the poor.
He has sent me to bind up the broken-hearted,
to proclaim freedom for the captives
and release from darkness for the prisoners, a
to proclaim the year of the Lord’s favour
and the day of vengeance of our God,
to comfort all who mourn,
and provide for those who grieve in Zion—
to bestow on them a crown of beauty
instead of ashes,
the oil of joy
instead of mourning,
and a garment of praise
instead of a spirit of despair.
They will be called oaks of righteousness,
a planting of the Lord

for the display of his splendour.

Wednesday, February 18, 2015

The Foot Mystery


A/N: Not everything is as it appears at first glance, sometimes you have to dig deeper...


She was in her early forties, a tad overweight due to a penchant for that extra bite of chocolate or cookie that invariably sneaks into the office where those of the female gender congregate.  Her smile was infectious though and her easy-going manner lightened the atmosphere in the examination room as I settled onto the doctor’s stool at the computer screen.

“Good afternoon, Mrs H**,  my nurse tells me you’ve been having a boil on your foot recently,” I looked over at her and then down at her right foot.

She nodded in affirmation to my query.

“She also mentioned that you’ve recently taken some medication for it but it’s still not going away?”
Mrs H again nodded. “I just finished the antibiotic. Some of the redness has disappeared but it still pains and the swelling doesn’t seem to be getting any better.”

I glanced over the urgent care note from a few days ago. ‘Diabetic foot wound’. Ah, so Mrs H had diabetes. I wondered how well controlled her blood sugars were. Perhaps the foot wasn’t healing because her blood sugars were too high or she had some sort of circulation impairment in her feet? “Are you taking your diabetes medicine?”

“Yes,” she answered, and then added, “my sugars are always good too, 90s to 100 when I check them.”

“Excellent!” I praised. I noted in her electronic chart that her last haemoglobin A1c (a measure of how well her diabetes was under control) was 6.8 – collaborating with her reported fasting blood sugar readings. My theory about a non-healing foot wound due to poor control of diabetes disappeared. Poof! Gone. Time to figure out another reason that her foot wasn’t getting better.

“Are you having any fevers?”

“No,” she shook her head.

“How did this boil on your foot begin?”

“Well,” she began with an embarrassed shrug. “A couple weeks ago I got angry at my husband and kicked the door. I noticed pain in my foot and later it got all red and swelled up. A boil developed on my foot and then sort of burst when I pressed it. Pus came out. That’s when I went to the urgent care doctor and they gave me the antibiotic for the infection.”

“Ah,” I typed a few notes down in the computer. “So this all began a few weeks ago and the antibiotic helped but didn’t completely clear up the infection?”

Mrs H looked down at her sockless feet resting on the blue paper as if for confirmation of the fact. Noting the swelling on her right foot, she nodded in agreement with my summary.

Internally I summed up my understanding of the situation with Mrs H. Diabetes. Abscess on foot. Took antibiotics. Not better. Still painful too. Hum?

“Well, Mrs H, if it’s ok with you, I’ll take a look at your foot?”

She affirmed her consent with a nod. “It hurts here.” She leaned over from her seated position and indicated the top portion of her right foot.

“Ow!” she drew back when I pressed over the bones in her foot. I wondered if she might have fractured a bone when she kicked the door.

“Did they take x-rays of your foot last week when you went to the Urgent Care?”

“Yes, they said everything was fine. The bones were not broken,” she reassured me.

I continued to palpate around the small swollen area on the top of her foot. The good news – there wasn’t a lot of redness so the antibiotics had apparently done their job in eliminating the irksome bacteria. The bad news – there was still obviously a swollen small lump and pain on the foot.

“It feels like there’s something under the skin where you have the boil,” I looked up at Mrs H. “Any chance you might have caught a splinter when you foot hit the door?”

Mrs H thought for a moment and shook her head. “No,” she paused and then her face lit up, “my mom pulled a splinter out of my foot when I was a child.”

“Oh, what happened?”

“My brother and I were jumping on the bed. My foot got cut on the bedpost when it hit it as I fell. I told my mom there was something stuck in my foot. She said she pried out a piece of wood when she bandaged my foot.”

“Interesting,” I tried to figure out how a story of falling off the bed at the age of five related to her current problem of foot pain forty years later.

“You know, doctor, this foot has always acted up. I used to tell my mom that I thought there was still a splinter in my foot but she could never find anything when she poked around.”

“Oh?” Apparently there was more to the history with her foot than I’d originally assumed.

“Yes, doctor, my right foot has always been prone to getting a boils.”

“So this isn’t the first time you’ve had an abscess on this foot?” the light was beginning to dawn on my consciousness.

“Now that you mention it, I had something like this last year too.”

“And you’ve been seen at the doctor’s office before for this abscess and they’ve never found anything?”

“I just take the medication and it seems to go away but never completely. I get pains in the foot on and off. I have to wear shoes with socks because I can’t stand for the straps from sandals or slippers to rub on the top of my foot.”

The story was becoming more complicated. More than a one time infected skin abscess. “Do you mind if I numb up this area on your foot and see if there’s anything I can find? It feels like there’s something like a splinter or toothpick in your foot.”

Mrs H agreed to my exploratory mini operation. After numbing the area with local anaesthetic, I nicked the skin over the strange solid thing that I’d felt on my exam. If nothing showed up on x-ray, it must be something organic stuck in the foot. With a fine forceps I dug into the tissue and snagged the object I’d felt.

“It looks like you’ve been keeping half a toothpick in your foot,” I pronounced to Mrs H with a triumphant smile. I held out the forceps that now grasped almost an inch long wooden splinter extracted from her foot.

Mrs H adjusted her glasses and leaned forward for a closer examination.

“It looks like you were correct. You did still have a piece of that bedpost in your foot. You want to take it to show your mom that you were right?”

Mrs H laughed. “After all these years…”

“You’re foot should heal up properly now. Without that piece of wood irritating the tissue, you shouldn’t have any more problems.”

“Wow, doctor. That’s great.” She continued to smile, still somewhat in shock, I think. She had me put the wood in a plastic wrapper for her; and in fact, did take it home. I can only imagine what she told her family.

Moral:
1.     Things are not always as simple as they might appear at the onset of a clinical situation
2.     Don’t try to keep a splinter in your body for years – it festers!


“Why do you see the speck that is in your brother’s eye, but do not notice the log that is in your own eye? Or how can you say to your brother, ‘Let me take the speck out of your eye,’ when there is the log in your own eye? You hypocrite, first take the log out of your own eye, and then you will see clearly to take the speck out of your brother’s eye.” Matthew 7:3-5


“As you slide down the banister of life, may the splinters never point the wrong way.” –Irish Proverb


**All identifying data including specific circumstances altered to protect identity.

Tuesday, January 27, 2015

Be Kind To Doctors


Actually... be kind to all those we meet... the ripples of kindness should not be underestimated...



Contrary to popular media, doctors are human too. Doctors are born, live, and die just like everyone else. There is nothing inherently magical in the preparation of physicians that mould them from soft and fleshy homo sapiens with tender souls into hardened robots with scientific logic. In fact, doctors may be more fragile than the average population if one were to consider the statistics. Increased burnout. More depression. Higher rates of suicide.

And yet, the fa├žade persists.

On the outside, you probably won’t see a difference. I doubt it’s possible to observe the slight tremor of my hand as I log onto the computer or the subconscious tremble as I ask what I can do for you as your primary care doctor these days. I hope you won’t notice actually. You can’t see the emotional scars that I carry from working in the field of medicine and occasionally getting caught in the crossfire of a frustrated injured patient hurtling arrows of hurtful accusations at the profession, or having a previously healthy man die underneath my hands doing CPR, or failing to resuscitate a tiny stillborn baby. Some arrows hit harder than others. More recently you might have heard the pieces come cascading down in a tumbling avalanche of shattered glass in fact. Those were the broken bits of my self-confidence and belief in the goodness of humanity slipping into a million tinkling shards that were washed down the drain by a flood of invisible heart tears.

Yes, doctors are humans too.

In spite of our outward professional personas of academic intelligence and logical reasoning fraying at the edges by a frenetic schedule of sick patient-visits and overwhelming written documentation, physicians are every bit as human as the breastfeeding mother in the nursery or the elderly man who sheds tears over his wife in the ICU. Doctors find themselves in those situations too – perhaps  they’re at a disadvantage because some have sat on both sides of the fence where a certain amount of “ignorance is bliss” might have helped.  

White coats and name titles like M.D. and D.O. do nothing to protect us against the stinging angry words of unhappy patients. 

“I find your attitude rude and arrogant!” the patient stormed out of the examination room.

“I’m so sorry. I truly didn’t mean it that way. I was just trying to provide the best health care for you…” my apology backpedalled aimlessly into the dust as the door shut against the agitated figure of the elderly patient. Her abrupt departure was unexpected to say the least.

My initial reaction was shock. What?! Did she really just leave?

Within seconds this morphed into a more enduring crush of nascent confidence. My stomach plunged to dark rocky depths in the split second it took to log off the computer and realise there was nothing I could do to placate the agitated patient-client. She was gone. Redemption disappeared at the slam of the door.

“Um,” I turned to the nurse helping me that day, embarrassment and shame slowly dawning upon me. “What should I do?” I asked her. “My patient just walked out on me. She said I was rude.” It hurt to admit anyone would ever say such a thing about me.  I like to believe that I am generally professional and able to communicate at least on a doctor-patient level with almost anyone. Clearly I’d struck a sore nerve. I had offended the patient. It was a miscommunication yet still it hurt.

It was an error in communication that ruined my day. As much as my intelligence assured me that I was still a competent doctor, I couldn’t shake that small nagging aura of foreboding. Someone out there hates me. Cognitively I know I will never please everyone but my heart still wishes such wasn’t the case.  In spite of my best efforts, I wish I could please everyone. My logical brain can accept that not everyone will be happy with my care. Statistically, I realise there will be a percentage of patients that are unhappy with my professional services for one reason or another, likely having nothing to do with my competence. Still… and yet… I felt horrible.

Yesterday a patient came to see me. “You’ve restored my faith in this organisation” she’d informed me. Her genuine gratitude brightened my day.

Others this week have smiled and thanked me for taking the time to listen to their concerns and answer their questions. “Is there anything else I can do for you?”

“No, doctor, you’ve taken care of me,” they’ve answered with smiles of relief that someone had taken the time to address their concerns. Now the multitude of their accolades was drowned out by the stormy waves of self-doubt. Why did one dissatisfied client erase so many positives? One angry customer nearly destroyed me. The peace of inner assurance in my abilities as a physician slipped away, overshadowed by the heated accusations of one unhappy customer.

Professional decorum dictates that I maintain a semblance of composure and immunity in such situations though. Tears were not appropriate. Other sick patients waited to be seen. There were many more hours to go until I could stop work. Life continued in spite of any personal feelings. “I feel terrible about this,” I lamented to my supervisor and again to my colleague.

“It’ll be ok. It’s happened to all of us,” my colleague gave me a sympathetic shrug. “Don’t worry about.”

“I know,” I gave a wan smile. “I still feel bad. It’s hard to hear how people misinterpret one’s good intentions …” my explanation trailed off. My colleague nodded. He understood. Neither of us needed to elaborate. I don’t know any physician who finds it easy to brush off the false accusations or dissatisfied frowns of short-tempered, angry sick patients.

Working with a population that is sick and frustrated with a complex healthcare system that treats them as a number and not a person, is inherently fraught with misunderstandings on all sides. Communication is never perfect and when physical illness is involved even less room for forgiveness is present. So why, in possession of this knowledge, do I feel so awful when someone is dissatisfied with my service or misinterprets my good intentions?

“I feel terrible.”

“I understand. I hate confrontation too. Even though I might not appear to mind, I still find such encounters difficult,” a more seasoned colleague tried to comfort me later.

“We’ve all had such patients,” another friend commiserated with me when I related my discouraging encounter. “It won’t be the first; it won’t be your last.”

I nod. What she says is correct. Still, it’s not terribly encouraging. Some days I think I must have chosen the wrong career. Perhaps I’m too sensitive. I wonder if I should gone into the food service business and found a job at Baskin Robbins scooping out ice cream to gleeful ice-cream fans or tossing pizzas for cheese and mushroom enthusiasts.

“I still get sweaty palms and palpitations when I have to confront certain patients. I know I’m doing the right thing by not prescribing their opioid pain medication but I still find such encounters very stressful.” It’s a common lament from many of my colleagues. On the outside, such doctors might appear strict and unyielding but inside most hate having to say no.

I don’t know any physician who finds it easy to disclose a terminal diagnosis to a patient and their family. It’s one of those inevitable responsibilities that fall upon a doctor; one that we shoulder as bravely as possible, but, like any human, not one we ever feel happy about. It’s not easy dealing with disappointed, suffering, disillusioned populations. And yet, physicians are asked to do such all the time. Mostly we manage. We muddle through as best we can – reassuring each other we’re doing the best we can while we reaffix our masks of professionalism at the beginning of our shifts. Underneath we are human though.

Yes, I realise people will get upset at just about anyone and misunderstandings happen under the best of circumstances. Still, I just want to say, please be kind to doctors. Physicians are humans too. We have feelings. Underneath our comforting smiles, cold hands (warm hearts), and white coats, we bleed blood crimson red just like everyone else. The tears that stain our hearts are not always visible to the public but that doesn’t make them any less real.

As I type these last lines I realise that the call to kindness is universal. It’s not just physicians who are fragile human beings that, in spite of their imperfections, still need that genuine kind attitude and loving concern. Each one of us carries those wounds in our hearts, invisible to the superficial gaze, yet very much real and so easily raked raw afresh. The Golden Rule comes to mind again.
“Treat others as you wants others to treat you.”

Kindness flows outward in a ripple of influences that shimmers beyond our imagination.

Be kind to doctors. Be kind to everyone. Be kind to yourself.

“Be kind to one another, tender-hearted, forgiving one another, as God in Christ forgave you.”

Ephesians 4:32