Doctor as Patient

The following was sent in by a physician:

“The first sign of civilization is a human, or near-human, skeleton with a healed fracture of the femur.   This could never have happened if others had not carried it to safety and fed it and cared for it, for a long time.”

                                                                                                          Margaret Mead

This is what happens if you get very ill: You get a fever, a big fever, and you’re delirious and weak. Then you can’t swallow for a month, not food, not water, not anything. Swallowing your own saliva is so painful your life is a wince. Your poor wife drives you to the hospital in the middle of the night; they take a chest x-ray and send you home in a rainstorm.

You lose weight, Ten pounds, 20 pounds.  You look like a spider monkey.  All you want to do is close your eyes and sleep, forever.  Days, weeks go by.

You wind up in the hospital again. Where time stops and there is no night and day, only night,

Where they sentence you to solitary confinement for un-named crimes, and push food, mashed-up food molded to look like the fake food behind the glass in the diner, fake pork chops and broccoli, fake cake, and they take your clothes and strap you to a sweaty bed and make you piss into a bottle, if you can find it and reach it.  In short, if you get this illness, your life smells like piss.

If you get this illness, you learn that if you are sick enough, an angel from every country in the world and of every color in the world will appear to you in the night and hover over you.  Odwilla, so self-conscious about her Russian accent.  You have a beautiful accent, you should be proud of it, I tell her.  When I  tell her I’m having bad dreams, she says  “Were you in love in your 20”s?”  “Wasn’t everyone?,” I ask her, and she says, “Well, dream about that!”  All this at 3 AM in the darkest, loneliest room in the universe!

Gorgeous ebony Marina from Haiti, staring at me, kindly, as she takes my blood pressure, then announcing “You have beautiful eyes.” 

Julia, from Fresno, so efficient and comforting, gets me showered and shaved and somehow put back together, all with great affection and without pity or disgust.

Tombo from West Africa, huge and stern and no-one dying on his shift, not you either.And countless other angels from Cuba, the Phillipines, the Congo, Peru,

Cameroon, Massachussetts, Botswana, Mexico, Brazil, Cleveland, Latvia,

Ethiopia, Ivory Coast, nameless, sweet, wonderful angels, thank you, oh thank you, immigrants all, for saving my flickering life!

 If you get this illness, one day a pirate doctor looks into your ruined throat, grabs your tonsil with sharp pliers and yanks out a chunk of it.  For anesthesia, he enlists a beautiful black nurse whom he stands beside you and who squeezes your hand harder and harder.  It seems almost worth it, pulling her into the bed with me, but it isn’t.

The pirate backs up, looks you in the eye, and tells you that you have throat cancer, the worst possible way to die in this world.

Antibiotics are stopped, and lots of people in white coats tell you that you have throat cancer, the worst possible way to die in this world.

Antibiotics are stopped.  Hope is stopped.

You lay in a hospital bed in the dark and think you are going to die a rotten death.  Now.

Some kind of sinister air filter fills the room with a noise exactly like the inside of an airplane, and you are indeed, on an endless flight to nowhere.

You watch Jack Kornfield podcasts in the endless nights.

You are sent home to think all this over.

If you get this illness you find out what a steadfast, resourceful, devoted wife you have, what a stubbornly hopeful, courageous woman you’ve married, who, overwhelmed and alone, calls every retired doctor in the world and thinks and worries and sure enough, comes through with the thought that saves your life.

This wife says no, you are not going to die, you have an infection in your throat and you need to see an infectious disease doctor.

You pass out, lay on the floor unconscious, and your wife dials 911 and the paramedics take you back to the hospital.

The infectious disease doctor appears.

Scans, blood tests, ultrasounds, consultations, and still, after a whole month, you are dying and no-one can figure out why.

A giant lump appears in your neck, the size of a golf ball or a chicken egg.  This is removed surgically and sent off for more tests.  Preliminary testing shows that it is a golf ball, a Spalding, in fact, and the chicken egg theory is laid to rest.  

Still no diagnosis.

Imagine something slowly killing you, and no-one can figure out what it is.  No-one can name it.  This not-knowing is the worst of all maladies, and you have it.  

You are sent home to await test results.  The infectious disease specialist has an odd, tentative smile on his face.  You seem to improve on antibiotics.  You can swallow.  You have no fever. We’ll see.

Then the day before Thanksgiving, you get a message from the i.d. doctor that you have this crazy, rare illness called Tularemia.

Tularemia!  The i.d. doc thought to order this one in a million test, and sure enough, there it was. Francisella tularensis – – tiny pink dots barely visible with a microscope, one-celled little fuckers eating your life. 

You take a simple antibiotic pill twice a day (at a total cost of $47.00),

You kill the God-damned germ that was trying so hard to kill you.

You live.

You wander the house like a cat, searching for the best strip of sun to nap in.  You stare at the light on the back of a chair, at the radiant, exquisite grain of the wood.

Tularemia is a very bizarre, very rare illness.  Nobody gets it  – 100 people in the whole U.S. every year.  But that’s not the point.  The point is that I certainly would have died if a couple of good doctors hadn’t persisted and persisted.  There’s a lot in there about any terrible illness – – the helllish side of being in the hospiital, the amazing immigrant population of health care workers, the agonizing uncertainty of not being able to diagnose an illness that is clearly carrying someone away, the toll of such uncertainty on a spouse or partner.    I don’t know about you, but I’ve lost patients that could have been saved had we made the diagnosis in time.  Maybe the story would encourage doctors to persist, to doggedly hang in there with critically ill patients.  Maybe it would just give them compassion for very ill patients, as it’s given me.  And then there’s the simple fact that it makes a good story.

(EDITOR’S NOTE: IF YOU ARE A PHYSICIAN AND WANT TO SHARE YOUR OWN MEDICAL STORY THEN EMAIL ME).

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