Doctors have four moods curious, annoyed/tired, sad and confident/excited. We are curious as we gather information about new patients or problems. Sometimes we are sad because there is nothing we can do for our patients so we are sad with them. Sometimes we are exhausted by our patients or annoyed because they just donâ€™t understand that either we canâ€™t help them because they wonâ€™t help themselves or we simply not the right sort of doc for the job. Lastly there is the confident excited mood. This is how we feel when a patient with a problem comes to us and we either figure IT out or better yet we can help them, make them better.
I traveled 14 hours round trip to play patient today. I squirmed there on the stool waiting with mother and sister for the verdict. As I habitually have since childhood I had dressed nice today, combed my hair back. I sat there and tried to read neurology and supress my curiousity of the open doors with other waiting patients and keep myself from fidgeting from anticpation and the constant gnawing of my left hip. The fellow came in and took the history. As I recited the truth about the hip pain the little student doctor in my head knew exactly what was a red flag hearlding surgery. I interviewed myself I gave a concise chief complaint, history of present illness, what makes it better vs. worse, what I had tried, my past medical history, etc. He leveled with me on the x-rays. I had already seem them I knew and before I knew I found myself explaining with him to my Mom how bad it was. The language flowing off my tounge: narrowed joint space, osteophytesâ€¦.
The attending came in and he was completely different than the first time I had met him 4-5 yrs ago in which he spent four mins with me in haste made a comment about getting a baseline. This time he looked right at me with that look. The fourth mood the one where a doctor sees a sick person and knows Ahha this is somoene I can make well. For some reason this unnerved me completley and made me feel disoriented . He shook hands all around as I scrambled up from the stool to the exam table giving him a sit. He looked at me and said how is life. It was a loaded question. I talked about med school and pediatrics and we tangentially talked about the step 2 board study book I was clinging to as if somehow would keep me afloat, then I cut to the chase and recited the history with its red flags.
He sat down and said it sounds like if you lived closer and I seen you more often we would have already done this. We talked about doing a regular hip vs. resurfacing (not a good option with my bone consistency (jello)). And before I knew it we were there and I was a bit tachycardic because I was 24 and looking at a hip replacement and even though I had driven 7 hours for this I somehow found myself fumbling and unprepared. A million things were happening all at onceâ€¦ I started having surgery rotation flash backs and flash backs from childhood and had a million questions and didnâ€™t know how to process it all. It just tumbled out, if I have such low bone consistency doesnâ€™t that put me at risk for shorter lifespan of a hip prosthesis. He gave me THE LOOK and said his goal was 20-30 yrs and as he was sure I would tell my patients think of this as a postive, some that is going to change your life for the better not ruin it. He took out a pin and gave me his home phone number to call at my convience when he could answer all of my million questions with out the constrains of clinic.
I was shocked, he was breaking one of the cardinal rules of medicine. Maybe it was because I was baby doctor (a student doctor and a doctor who doctors babies J )or maybe because he saw the look of skepticism in my eyes or maybe he does this for everyone (doubtful) or mabye it all went back to the fourth mood. It was his way of telling me what to do but in a professional way that didnâ€™tâ€™ tell me what to do . He offered me a steriod shot, told me that he didnâ€™t trust anyone but himself in doing it and that I should try it especially if I really wanted to wait 10 months till after the match. He said he could do it NOW and I thought what the heck at this point I am carrying around a half dead hip.
So I am whisked into the treatment room, left alone and strip my pants off and lay on the fluro table with a gown over my body. I stare at the celliling for a while and focus on breathing. The tech and the doctor come in and what was a 35 min procedure at Wake was done in 45 seconds.I told him that the doc at Wake had said I had strange anatomy and he proceeded to tell me to tell my attending there that he was wrong my anatomy was not that odd at all, he made several jokes at his expense until he noticed me watching his every move intnetly and told me to look away because it would make me nervous. I explained I was sick and twisted and like to see what was coming at me. He cleaned the area and completely left out the lidocaine and the contrast and thrusted a large bore syringe into my joint space. I sat up and he shook my hand again told me I could come back in three mons for another shot and that I should call him.
And then I am driving back the insane drive through mountains and ponder that fourth mood is about trust buliding. Its what allows our patients to trust us with scapels and needles and poisions. It works better when our patients donâ€™t know what coming and when they donâ€™t really know what they are signing up for. But you see once you know the technique, the tatic, once you know that behind the curtain is not a wizard but a man, its hard to believe. Its hard to say yes give me respiratory depressing poisions, take out my femoral head, replace with some forgien body that you say is going to positively change my life that I say is an infection, a femur fracture and a huge risk to my walking life in the making.
There is no choice really, the surgery means Africa and hiking and roudns without pain and internship year and walking at graduation without cringing.
But I am still skeptical.
Igoranace is bliss. Knowledge makes simple decisions fraut with reality.