I had a good week at work this past week. In the world of medicine, that’s a rarity these days. Not that I don’t feel good about what I do. As a physician, not a day goes by when I don’t help someone. I earn a good income and feel good about providing well for my family. I exercise my mind with diagnostic challenges and do endoscopic procedures that, like any good video game, are still fun after 25 years. Sadly, the meddling of insurance companies and government and the poor state of our economy have combined to ruin the doctor patient relationship. When caring and trust are replaced by indifference and mutual mistrust, practicing medicine is like any unpleasant job where you are just happy to have the week end.
My week ended with a funeral. I don’t normally attend patients’ funerals. As a specialist, I don’t usually form close, long-term relationships with my patients. I see them once and maybe again 5-10 years later. Also, if there’s a funeral, someone, including me, is going to think that if the patient’s dead, the doctor is somehow to blame. When I was ready to back out on attending this funeral, Barbara reminded me that even though I only knew the woman for one month, I have known the family for many years. She says funerals are for the family. I went to high school with one of her sons in law and have stayed friends over the years. I have seen his family grow, and have gotten to know and like his wife and her family in a hello at poolside kind of way. I never met her mother until she arrived from Florida and ended up in the Stamford Hospital ER with GI bleeding. I was consulted to diagnose and treat the bleeding, but once I read the medical reports the family brought up from Florida, I knew that the bleeding was only one manifestation of a widespread, rapidly growing and soon to be fatal malignancy. Over the next month I helped the patient, a retired nurse, and her family anticipate, understand and deal with issues such as nutrition and pain control. When other physicians promoted aggressive therapies, I made sure the patient and family stayed focused on realistic expectations and goals. When I made a house call last week I sensed a calm sadness in the patient that was mirrored in her two daughters. I was not surprised that she passed a few days later. I was surprised, though, to receive the news in a tearful bedside phone call from her daughters and husband. They called to thank me for my medical expertise and human kindness. They thanked me again at the funeral, the husband with a very public bear hug and a card that he put in my pocket. It was good to see a family so full of love, to know that I helped them and to be recognized and thanked for what I do.
Usually there’s no love and no thanks. It’s up to me to know I do it well and do it right. Earlier this week I did not give into pressure from a hospital internist and oncologist and refused to surgically put a feeding tube into the stomach of a terminal esophageal cancer patient. His problem wasn’t that he couldn’t eat; his esophagus was kept open by a stent. He was just in too much pain from a spine that had been replaced by tumor. I felt good about recommending high dose pain medication and Hospice care.
Midweek I refused to prescribe a new medication over the phone to a patient who I hadn’t seen in a year, who had stiffed me for her copay, who said she was out of work and couldn’t afford to see me, whose insurance wouldn’t pay for her old medication and who needed medication “now!” because she was going on vacation. I got her to come into the office, pay her year old copay and make an appointment. In return, my secretary gave her samples of her old medication to last her a week. I’ll likely never see her again, but got a kick out of her chutzpah and 20 bucks to boot.
At the end of the week I performed a difficult colonoscopy on a bleeding 73 year old, located and stopped his bleeding and saved him from having half of his colon removed. Despite being a working professional, he had little insight before or after as to the significance of his bleeding. He expressed no gratitude afterwards, only irritation that I had him admitted to the hospital for observation. Still, I know that I did good.
Some career choice, huh? And that’s what I call a good week! No regrets. I like what I do. So, can someone out there tell me how we got into this healthcare mess? Let’s talk about it sometime, say over a game of tennis. I like the weekends too.
