Friday, March 16, 2012

A Little Bit of Knowledge Can Be Very Dangerous

My promises to myself to write daily have fallen flat for the last few weeks.  At first I very successfully laid the blame at the foot of The Cold, thinking that I needed to rest while Lucy napped instead of write in order to ensure my immune system was strong enough to defeat the germs that were travelling through our house.  However, as with pretty much every infection I ever get, The Cold has found a new home in my genetically cursed sinuses and morphed into The Sinus Infection.  Since this is an annual or semi-annual event, I usually avoid taking antibiotics until The Sinus Infection has been in residence for at least a month.  By that time treatment is less a logical move toward health and more a desperate last resort to a) enable me to stop sleep sitting up or draped over a humidifier, and, more importantly; b) save my marriage.

Everyone knows that doctors make terrible patients.  Popular culture is rife with images of proud, egotistical doctors waiting too late to get treatment for serious illnesses because they refused to accept that they could be sick, or turning into completely incompetent babies when laid low with the smallest cold or flu.  My love, D, is no exception to the stereotype, although he could never be classified as egotistical or a baby.  He only ever goes to the doctor when forced and under duress, and then usually when I make the appointment for him.  When he injured his knee a moth before the Chicago marathon this summer I finally got him to see a Sports Medicine doctor by telling him they were having a free clinic at our gym, which happened to be on an afternoon that he had off.  Two months before we got married he took a short trip to Haiti and when he came back he had stomach problems for weeks.  But he was a medical student and didn’t have time to see a doctor, or go to the gym either.   So instead he left his stomach problems to resolve naturally and just lost ten pounds before the wedding.  Note: this is not a doctor recommended weight loss plan, nor a good way to endear yourself to your future bride.

There are a lot of reasons that Don doesn’t go to a doctor, reasons that I am sure many other doctors share.  One: he is a doctor, an Emergency Physician, and as such is trained to handle pretty much anything.  Barring the presentation of some very specialized problems or a significant trauma, he can handle most of the health issues that he and the rest of our family face at home.  So we go to the doctor for Lucy’s check-ups, when necessary for prescription refills, and when pregnant.  Two: he has NO time.  He is a resident physician.  They call them residents because they used to physically live at the hospital.  That is how much they worked.  Despite great strides made in the US to reduce resident work load to manageable weekly hours, he still works a LOT.  And when he isn’t working in the Emergency Room, he has weekly lectures, monthly simulation sessions, grand rounds presentations, research projects, studying for boards and other exams, etc etc to do.  Most doctors’ offices are open Monday through Friday from 8am until 5pm.  The chances that Don will have any time off during those hours are very slim.  The chances that he will have any time off during those hours that he would want to spend seeing another doctor instead of hanging out with Lucy and me or getting in a workout or talking to his family and friends?  ZERO.  If Don is sick, he’d much rather spend his free time (excuse me while I laugh hysterically here) just nesting on the couch watching Ratatouille with Lucy for the 718th time with a sock full of Vicks VapoRub wrapped around his neck.

However bad doctors are about being sick, I guarantee that I, a doctor’s wife, am exponentially worse.  Perhaps it is just me, or perhaps it is a function of being married to a doctor, but I guarantee that I am a ridiculously awful patient.  Don and I started dating the last week of college.  We have been together through his entire medical education process.  The first year of medical school I used to quiz him on anatomy and pathology as we drove back and forth to his families’ house or to see his brother David wrestle.  I had to learn the correct pronunciation of many ridiculous Latin terms.  In the process of medical school and residency and Haiti and having a baby a teensy, tiny bit of medical knowledge has soaked into my savage little mind.  There is has taken root, and grown into a very dangerous, and really annoying, beast.

I have said it before – an Emergency Physician’s job is to assess and meet the needs of the patient.  They do this based on a myriad of diagnostic tools: physical exam, medical history, patient charts, other doctor’s notes, tests, labs, etc.  If a patient comes into the ED with a preconceived idea of their own diagnosis, this makes it very difficult for the doctor, and sometimes very frustrating.  Even worse is when the patient comes in with an idea of their own diagnosis and treatment – sometimes it makes Don feel like people don’t view him as a trained professional with skills and knowledge to help him, but just an antibiotic or narcotics dispenser.  I know this, because this is exactly what I do, over a period of many days, when I am sick.

For example, go back and read the first paragraph of what I have written.  Look at how I was able to diagnose The Sinus Infection!  You may have suspected when you read that the first time that I had been to the doctor and they had done some sort of culture or test or looked into my sinuses with amazing scopes, but you would be wrong!  Oh no…I looked up my own nose with a tiny flashlight, and examined the color of my tissues and concluded that I had sinusitis.  Yes, I am that smart.  And also, I look at my own tissues?  Gross.  And when Don asks me how I am feeling, I give him vague and leading responses concerning my history of sinus infections and the number of tissue boxes I have been through and then it gets worse from there.

Now I am not saying that it is not good to be an informed patient.  Far from it.  Be aware of your own body!  Be aware of your symptoms and your medical history!  If you have done research on a problem that you have or think you have, make sure you talk to your doctor about and present your questions and concerns clearly…but do so clearly!  Don’t meter out information and questions in a way that you think will lead the doctor to the same conclusion that you have made in the four hours you have spent online at WebMD.  I caution because I care, and because I do this myself with a calculating efficiency whenever I see other doctors.  I write about this now because I would also do this to my poor, long suffering, husband, only he knew me well enough to get pissed off instead of call me in a prescription, and for that I am thankful.

To make matters even worse for Don, in addition to the scheming and manipulating and wild speculation based on dangerous knowledge, I have a somewhat hilarious kind of synesthesia (again, self diagnosed).  I feel some things in color.  When I have a cough, my chest is white.  When I have a soar throat, my throat is pine coney and green.  Sinus infections are an icy green.  In addition to that (yes, there’s more!) I am completely and 100% unable to give you a simple answer to a pain scale question.  You know that piece of paper in your doctor’s office that has the scale from 1 up to 10 with the various faces illustrating people in pain.  Face number 1 is smiling, eating brunch and drinking mimosas with friends, with no pain whatsoever.  Face number 10 is being tortured in a CIA black site in Southeast Asia.  You know the paper I mean.  That piece of paper makes me want to punch someone in the throat, which is what I almost do every time a doctor asks me the question “where is your pain on a scale of 1 to 10?”  This made for a very dangerous situation while I was in labor with Lucy.  There were nurses and midwives in danger of being throat punched all over that hospital.

Don fares only slightly better when he asks me this question.  My response usually comes through clenched teeth, as I fight to restrain myself from punching him.

“Well…when I cough its like a burning white pain in my chest.  Like a sixish at the worst at the peak of the cough you know.  But then my throat is a pine coney four all the time, except when I cough which is a seven, and oh, swallowing is very thick and grey and an eight sort of.  My ears also feel orange inside.  And my sciatica is acting up in my back leg knee.  It feels like lightning.”

At this point Don either walks away for a moment because I am being totally serious, and he is about to kill me, or he just looks at me and tells me I need to call my primary care doctor because he is not going to do this anymore.  Or, more probably, I have dissolved into nervous, hysterical laughter because I know I am driving him insane, and then he walks away to get me drink of water so I can breathe again.

Because this was becoming a vicious cycle anytime I would experience any pain or discomfort, I have recently begun taking some drastic steps to ensure that I do not drive my husband insane or remind him of his worst patients or ruin our marriage.  I have tried to come up with a script to use when I want Don’s medical opinion on something, a script that will not be leading or manipulative at all.  I had the opportunity to try it out in the car the other day, after using up the last of my fifth box of Kleenex since I first…started to need to blow my nose….two weeks ago. 

Me:  <<looking out the window pensively>> So…I have been thinking about how to ask you this question for the last five minutes, and I think I have it right now.  OK?”
Don: <<looking warily at me>> Okaaaay  Go for it.
Me: So…what do you think is wrong…no.  Damn it.  How do you think I…no.  No.  Argh.  OK.  What I mean to say is…Don.  Don.  What is your opinion on the current state of my health?
Don: <<staring at me, eyes wide, then breaking into hysterical laughter>> BWAHAHAHAHH ahahaha hahahahaa ahhhhhh ah…wow.  Ha.  You have an Upper Respiratory Infection.  Seriously though honey, I’m sorry you feel so crummy.  I love you.
Me:  Oh.  OK.  So…like…should I do anything?  I mean, is there anything you recommend I do, or not do, or something?  Or…take?  Not like antibiotics, or anything, but…you know.  Tea?
Don: You want me to prescribe you antibiotics, don’t you?
Me: NO!  No.  No I actually don’t want any antibiotics.  I just wondered if you thought there was anything else I could do to help the healing process.
Don:  No, not really.  Just keep on keeping on.  It’ll resolve itself in time.
Me:…..that’s what I thought.  I should get some more herbal tea.
Don:  Yes…that’s exactly what I said.  Drink more herbal tea.
Me:  I’m glad we had this talk.  That was good, wasn’t it?  Better communication.
Don: <<looking at me out of the corner of his eyes>> Yes.  Yes.  That was great communication, honey.  Great.

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