On a damp, overcast Friday morning, I was wandering around the downtown area of a nearby city with my camera. I found an interesting scene and photographed it, carefully adjusting my camera’s settings and the composition until I felt I’d conveyed what I’d felt when I saw it.
Lowering my camera from my eyes, I realized that, for the first time in months, my mind felt clear and my heart felt open. This realization struck me so hard that I sank onto a park bench. Tears of relief and sadness leaked from my eyes.
“You need to give me the name of a different specialist,” Ashley asserted.
For several years, Ashley, age twenty-nine, has been my patient at the residency practice where I work as a family doctor. Our relationship is not entirely comfortable; after visits, she frequently seems dissatisfied, yet she refuses to see anyone else.
Ashley’s body is a source of distress to her, often developing various pains and discomforts that fade away without explanation. In search of relief, she asks for many tests, but often, when I recommend a treatment, she refuses it or has difficulty tolerating its effects. When we talk, she’s usually very guarded about any aspects of her life besides those directly related to her symptoms.
I often feel ambivalent about ordering tests for Ashley, because all tests carry risks. Mostly, the risks are small. But one big and worrisome risk is the possibility of an incidental finding–something unusual that requires further testing and that would have posed no problem had it gone undiscovered.
I first met Marie five years ago. A petite, soft-spoken woman in her thirties, she was the patient of one of the residents whom I supervise at our community hospital. Marie worked in housekeeping for a large corporation; she and her husband, a bus driver, had a six-year-old son. Now she was twenty-six weeks (six months) pregnant with their second child.
Marie’s blood pressure was markedly elevated (168/120), she had fairly high amounts of protein in her urine, and her baby measured small on the ultrasound. These pointed to severe preeclampsia–a serious complication that can quickly worsen, leading to kidney damage, seizures or even death for mother and child, and that can only be cured by delivering the baby.
The resident and I reached a swift, unanimous decision: Marie’s pregnancy was far too high-risk for our hospital. She needed to be transferred to the University Hospital across town–“the U,” as it’s known. And the baby would need to be delivered soon.
On the Friday before Christmas, I received an unusual gift.
Like any job, being a primary-care physician has both challenges and rewards. The challenges are many, and the rewards are often fleeting–a smile or a “thank you” from a patient or coworker, for instance. And I’ve found that being a teacher of medical students and residents brings an additional layer of rewards and challenges.
One Friday before Christmas, these arrived in an especially potent mix.
I am a family physician. Like most of my colleagues, though, I must sometimes step out of the comfort of my clinical role to take on the role of patient or family caregiver.
Generally, these trips to the other side of the exam table inspire a fair amount of anxiety.
During visits to the doctor, I find myself noticing many details and comparing the quality of care to that in my own practice. I worry about how the doctor will relate to me–will I be viewed as a knowledgeable colleague, or as someone who knows relatively little? Will my background be treated with respect? Will my needs as a patient or caregiver be acknowledged? The uncertainty eases only when the physician wins my trust by showing both competence and caring.