The nurse had a way of talking to my mother -- the pedantic tone of a crusty grade-school teacher. It grated on me like fingers across a chalkboard.
My mother lay in a hospital bed, tired, uncomfortable from abdominal pain, attached to I.V. lines. A couple of nights previous, while my family and I were relaxing on vacation in Los Cabos, Mexico, my brother had sent me an e-mail:
Mom's in the hospital with stomach pain. Give them a call to see what's going on.
She had started having gradually escalating stomach pain the night before to a point where her doctor sent her to the emergency room. We cut our trip short when we found out that a CT scan showed swelling in her intestine, possibly indicating colon cancer. They would have to operate and remove a piece of her large intestine to figure it out.
I arrived at the hospital the night before the operation. I was exhausted from the chaos of prematurely checking out of our hotel, rushing to the airport without a ticket, sneaking onto an evening flight, and eating no more than chips and candy along the way. None of that fatigue could compare with the looks of fatigue, uncertainty and pain on my parents' faces. My mother was tearful. She is 62 years and has the looks and energy of someone decades younger. Most people have trouble guessing her age. But that evening she looked older, and her voice trembled. It was late and all we could do was sit and wait for tomorrow.
I came back to the hospital in the morning to wait with my mom. I intended to request and review all of her test results, and obtain opinions from friends of mine who were gastroenterologists. Her doctors, with a surgeon in the lead, had agreed that given the situation, waiting for her pain and swelling to subside on antibiotics wasn't a good option. On the other hand, it's not a secret that surgeons look at the world from behind the handle of a scalpel. I was afraid they were being too aggressive.
My mother told me she had requested to have a look at her test results. So when I arrived, we called her nurse, who was young and stout, with a cherubic face. My mother asked nicely about getting her results. The nurse stopped, turned and looked at my mom with an annoyed, matter-of-fact countenance. "Now, didn't we already talk about that last night, love?" Her voice had more than a tinge of condescension. "When I get around to it, I'll bring the form for you to sign so you can get your records." Then, more loudly (my mother isn't hard of hearing), "OK?" She marched out of the room and on to other tasks.
Nurses are true heroes of healthcare -- they're the ones tending to each and every need of three and often four patients at a time. Those tasks range from the noble (holding a patient's hand or giving her a hug) to the technical (administering medications and managing I.V. fluids) to the mundane and even ugly (sponge baths and helping patients in the bathroom). It's demanding, hard work and most of the nurses I encounter are great, caring professionals.
My mother's nurse was not one of those. She reminded me of doctors and nurses who loved to talk down to me when I was a medical student and resident. Medicine tolerates those in greater power abusing or agitating those lower on the totem pole. But that shouldn't ever happen with a patient. And not with my mom.
I was irritated, but I decided to wait and see if the nurse would get us what we needed: a release of medical records. From my vantage point in my mother's room, I could see the nurse just sitting at her desk doing some paperwork. No urgency on her face, no extra speed in her writing to finish anything. About 30 minutes into waiting for what I needed, I went out and asked her politely if she had that paperwork. Again, she seemed defensive and dismissive in telling me that she would get around to it.
I decided to ask a few more questions. "So, could you tell me what the differential on her white count was? Was she febrile overnight? Any results on the stool occult blood studies? Did her doctor order a CEA [carcinoembryonic antigen] as well? Could you tell me those results?"
Nurse Cherub paused in the middle of her busywork. I knew she understood. "I can't tell you that until you sign the release. But if you wait a few minutes, I'll find the form for you to sign." Her tone had changed -- nicer, more professional, more courteous.
A few minutes later, she brought a release form for me to fill out. Just to make sure she understood, I added the M.D. to the end of my name. For the rest of her shift, she was more courteous to my mother and everybody who came in her room to visit.
I hate playing the doctor card. I see people use it all the time: "I'm a physician, can you please let so-and-so know that I'd like to have special treatment and consideration. And don't forget to make sure they call me 'doctor' when they address me. After four years of college, med school and extra years of training, I've earned it."
That sounds like a caricature but it happens a lot, including to me. Not long ago an optometrist (who was not an M.D.) called my office and yelled at a nurse that, yes, he was a doctor, and he would talk only to me. I took his call, and he wanted to know what kind of cough medicine to give his kid.
The fact that I was a doctor helped my mother in other ways during the difficult days of her hospitalization. Her surgeon showed me her CT scan to back up his judgment about the need for surgery (which required a little explanation to the radiologist, given most doctors don't show up to see scans in a T-shirt, shorts and sandals). I saw a sea change in her internist, who suddenly felt comfortable communicating with me in our common clinical language. He knew, I suppose, that I would be able to save him time and translate his assessment into plainer English for my parents.
And then there was my family. I wouldn't have gotten through med school and training without their unconditional love and support. It was time for them to get the return on their investment. My father, an engineer, kept wondering why the doctors didn't come each day at the same time, and why they were so difficult to get ahold of. For what it was worth at that point, I urged patience.
Medicine, I tried to tell him, is chaotic and messy. There are no equations or mathematical models to predict what's coming next. In an instant, a doctor's priority can change from an otherwise healthy patient who may have cancer to a another patient who is bloody and in pieces from an auto accident. If that's the case, then Mom and all of us just have to take a new number and go to the back of the line.
In the end, to our great relief, my mother didn't have cancer. A couple of days later, her doctors discharged her. The emergency was over -- at least until she was readmitted a few days later for an overnight stay with an infection from being in the hospital in the first place.
It's humbling, as a doctor, to be on the other side of things. I'd forgotten what it means to be close to someone very sick -- the intensity, the exhaustion, the uncertainty, the fear of what may come. We wanted to be smart, informed patients. We asked questions, sought answers and talked to other doctors. But clarity is a myth, and all we ended up doing was getting overwhelmed with opinions and second-guessing everything. We just had to do the best we could with what we thought we knew.
My mother consented to have surgery, a fairly routine one by many standards, and she recovered from it nicely. But I won't forget the look of horror and powerlessness on my father's face when he said goodbye to her as they wheeled her off to the operating room. How can anybody sane allow this?
In the end, I'd like to say that my experience on the patient's side of healthcare will make me a more compassionate, caring doctor. Will it? I hope so. On the other hand, like all difficult times, I'd rather forget the whole thing happened.
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