Showing posts with label doctor and patient relationships. Show all posts

"Are you here all by yourself?" Her kind smile let me know that she was somebody's grandmother. Her tired eyes told me she was some young patient's grandmother.

I nodded yes, and gestured at the empty seat at the round table I was at, letting her know she could sit there. My attention turned back to whatever it was I was doing on my laptop, something that wasn't really busy enough. She plugged in her cellphone in the outlet on the colorful blue pillar near us. I figured she was just waiting for her grandchild's appointment to be over, maybe she was waiting for the Valet to bring the car around, her phone made trilling alerts. I continued tapping away, letting the familiar noises and framed Dr. Seuss pictures fade to the background in my mind. The old woman became a part of that background in my mind too.

"My granddaughter just got out of surgery. She had surgery on her back, I just came down to sit for awhile. To get away from her room, it's just so hard to see her in so much pain." I looked up from my screen as she spoke. Her elbows rested on her knees as a maroon cellphone, the kind of model where a keyboard slides out, shook in her hands. I closed the lid of my laptop and listened.
"I'm sorry to hear that. But I can understand it can be exhausting sometimes, all of this. It's good for you to take a break every now and again." She set her cellphone down on the table as she slid fingers in the space between bifocals and her eyes, she rubbed them like she was trying to see past an illusion.
"My son is in there with her right now. And he keeps sending me these texts letting me know how she is doing, the pain that she is in. No one calls anymore, everyone just texts and I hate texting." She smiled at me, knowingly because she knows that I probably hate talking on the phone and prefer texting. But I listened because it seemed that is what her she needed most.

"My granddaughter she is 17 but, mentally she is really probably about 14 or so. She had surgery on her back because she has ..sholi..sholio..something? Her back has a terrible curve in it. I am not even sure how it's pronounced."
"Oh scoliosis?" I respond. She nodded eagerly, and I took that as an opening. An opening that maybe I could venture in, although in truth I had no idea what I was getting myself into. Or, more importantly - what she was following me into.
"I have a brittle bones condition, so my bones break easily. I was basically born with scoliosis. I'm a little familiar with the back surgery because some of my friends have had it, they put a lot of hardware in there. My friends all seem to be happy with their operation."
"Oh bless your heart. I know this was probably the right decision for her but it's still hard to see her in all of that pain." I could only nod. Au Bon Pain smelled like it was baking another batch of buttery croissants behind us. A child screamed for a balloon. I saw the tip of a red shoe from the hospital clown from the corner of my eye. Her tired sighs, interrupted by the trilling noise of text message alerts, were loudest to me.

"Have you been going to Children's Hospital for a long time?" She asked me.
"Yes, I was diagnosed here. Although today was my last appointment with my pediatrician, I'll be headed to a less colorful and fun doctor's office next time." I said, trying earnestly to kid.
"Oh my! That's quite some time! My granddaughter, this is the second time she has been here. She was originally at the Children's Hospital in Florida."
"Well, you know they do say that Boston is the best place to be for children's medical care." My loyalty to the hospital, despite all of its changing construction and branding, was something I was proud about. A pride that I wanted her to find some comfort in.
"I know, I know. And I am sure the surgeon did a fine job on her. He really seemed to know his stuff, he seemed like he knew what he was doing."

Conscious of all the reassurances she had probably already been receiving, whether it was the ICU Nurse, the attending, the surgeon, the on-call staff, the pain management team..I didn't want to repeat the same words I myself have heard so many times before. It occurred to me that perhaps this somebody's grandmother wanted to be listened to by a patient. Someone who had experienced the care her granddaughter might not be capable of communicating right then.
"I've always felt safe and like my doctor would do a good job when I'm with them. At the very least, I have always gone home feeling better."
"Thank you. Thank you, that's kind of you to tell me. Well, I should probably be heading back up there again. Now you take care of yourself okay? Stop breaking so many bones!" She smiled at me as she reached over to unplug her cellphone charger and began wrapping the cord around the charger.
"I'll do my best. I hope your granddaughter has a quick recovery, I'll be thinking of you today."
"Bless your heart again dear, you have a wonderful day."

Admittedly I had ended my last appointment with my pediatrician feeling underwhelmed about where I was headed for primary care. Probably a hospital that was much less colorful, something less exciting and energetic, certainly nowhere that had cartoons playing on the t.v. in the waiting room! But as I thought about how my physician was telling me about "more adult care.." I realized that even if I don't feel totally enthused by the prospects, there are clearly those around me who see that I'm ready to move along: on to the care I will be receiving, and the kind I know I can give in return.

Deciding whether or not to do surgery requires a lot more than just the puzzle pieces doctors can offer. There's this whole other side to what goes into patient decisions based on cultural values, religious beliefs, and even family dynamics. Unlike the medical piece these other aspects don't usually have as quantifiable an existence. You can't really measure how much religious belief should sway parents to go ahead with surgery during certain religious holidays. You can't exactly pin point how much cultural value is going to influence the kinds of foods a patient can have after surgery, or who is present in the operating room during the surgery. I know that these other variables might not rank as high on the 'critical' scale when considering an operation, but nevertheless when a medical team is working with a patient and family members, these undoubtedly need to be factored into their over all care delivery. 

It's almost a misnomer isn't it? A patient patient. I think if you totaled the number of hours I have spent in the Waiting Room, the sum would be enough time for me to circumnavigate the Earth.
How many of us have spent exhausting hours twiddling our thumbs as we waited for the doctor? How many of us have played the game where you think, maybe if I don't keep looking down the hall he'll magically arrive? Or you begin to think up all the worst case scenarios has she forgotten that I'm still here? My last resort is to just close my eyes and take a nap, everything comes faster when you sleep.

There's no doubt that it can be unbelievably frustrating when you're waiting to see a doctor or nurse. Especially when all I  need is just a signature on this note! Or just an authorizing signature to re-fill this prescription! And when you're sitting there in pain or discomfort every second feels like an hour.

What I've learned is that patience is not so much waiting around for someone to come, but instead free time for yourself. The more we think when is that doctor coming? My appointment was nearly an hour ago! The more energy we spend on needless worrying and anxiety. The fact of the matter is: Throwing a thousand questions into the air about why your name hasn't been called isn't going to make the doctor or nurse come any faster. Going to ask the front desk about how many people are ahead of you, or how much longer will the doctor be might be a little more productive - but even so not by any drastic or noticeable measures.

Instead, use that chunk of time you've been given for yourself. (After all, if you think about it, it is YOUR time!) Read a book, work on knitting, play a game, watch T.V., think about what you need from the doctor, prepare your questions, think about what still needs to get done at work, go over study questions for that test, take a nap, play hangman, devise a strategy for the impending zombie apocalypse, tell your parents all the popsicle flavors you want right after surgery, etc. Time is whatever you make of it; we can choose to make time infuriating and become slaves to it, or we can choose to use time for our own benefits. We can decide to think "the doctor is late and that means I'm going to prepare to yell at her the second she appears" or "the doctor is late which means I'm going to sit here and finish reading this chapter." It's all a matter of choice and perspective.  

Will doing something else while you're waiting actually shorten your waiting time? No. Will distracting yourself make the doctor notice that you've been sitting there for thirty minutes? Probably not. But I am certain that utilizing your time for you will make a visit to the doctor's office less butt-numbing, less frustrating, and maybe a little less agonizing for you.

I'm not always the best at paying attention to the part when healthcare providers are talking to me.  (Truthfully? I struggle with paying attention in general... well hello ADHD, aren't you shiny today?) 

It seems that during the part of the appointment where they say "So what this means is...." triggers some kind of chemical reaction in my head. Eyes glaze over, I rest my chin in my hand, I look at the coiled wire of the blood pressure cuff and wonder "how long could I stretch that out to?" "what am I going to have for dinner?" "Is it still raining outside?" "It was so much fun at bar trivia last night, I'll have to remember to keep that team going." "Am I going to run into the super creepy hospital clown when I leave?" "How does one go about making sangria?" 
"...any questions Sandy?"
"Umm no.." I reach over and take the prescription, or sit there and wait till the cast has dried, or I smile blankly back at the slew of medical stuff that was just thrown at my ears. Yet again.

So with that in mind I thought it'd be fun (maybe even helpful?) to make a list of the most commonly stated medical speak that I've heard, and then translate what that means in my only-half-assed-focused mind:


THEM: We're looking at probably a 3 to 4 month healing time for this fracture
ME: Great. I hope I have enough plastic bags and rubber bands at home for showering

THEM: This will help you get to sleep better
ME: It'll be more fun to be on that during the day..

THEM: Don't take this with alcohol
ME: Totally doing it

THEM: Call the front desk to schedule the surgery, my secretary will have my schedule
ME: When's my next school vacation?

THEM: This is only going to hurt for a few seconds. I'll be quick, I promise
ME: Lies. Lies. Lies. Outside the hospital walls a few seconds does not equal 3 minute 

THEM: Don't scratch
ME: Only if you don't breathe

THEM: How many servings of fruits and vegetables do you eat each day?
ME: Dammit why don't they have a picture of the food pyramid in here? 

THEM: On a scale of 1 to 10 with 10 being the worst pain, how is your pain?
ME: 15. Stop standing there asking me dumb questions, hurry with the painkillers!

THEM: So we'll have a follow-up appointment in 2 weeks, you can schedule it on your way out
ME: On my way out I'll be leaving and scheduling diddly squat 

THEM: Do you need a note for school? 
ME: Yea I need to be excused until June, just in time for the last day of school party 

THEM: Are all your vaccinations up-to-date? 
ME: Oh yea, absolutely 200% up-to-date

Did I miss any? Let me know in the comments! (Side note: I don't necessarily encourage the above..)

Fewer days are more exciting for me than the day I get my cast off. Roughly ten days before The Big Liberating Event is to happen I start a count down and tell all my friends, including all the strangers I meet who ask me "how did you break your ..?" Without even answering their questions I am usually quick to spit out "I get it off in 10 days!"
So when the day arrives, and the doctor flicks the x-ray up onto the screen - I am just chillin' like a villain, lying flat on the examination table: my hands are tucked behind my head, leg is propped up onto a pillow, and my toes are wiggling impatiently. By this time the cast has usually become a lot looser, and I try flexing my ankle  a few millimeters at a time - smiling happily when no sharp pains trail after my impatient movements.

He gets up from the computer where he has been peering over the x-ray for a few minutes.
"So there's still a very small sliver of a crack left." He tells me, and waits a few seconds for the news to sick in. I stop wiggling and prop myself up on my elbows, suddenly all eyes and ears on edge.
"I think in about another two and a half weeks or so.." But his voice escapes me and falls into some noiseless vacuum where all bad news any doctor has ever had to say goes.
But today was supposed to be the day! Nothing hurts! I can wiggle! And.. secretly... behind my parents' backs I had even been doing my own transfers on the leg, without any pain! This is blasphemy! Sham! The disbelief continued ranting and raving inside of my head.
I am no longer 3 or 4 so I know it wouldn't do any good for me to voice my disappointment. It was clear as day on the x-ray, in literal black and white, the facts were there: the bone hadn't healed completely yet.
After some discussion we decide to go with a bi-val cast, something that I still have to wear all the time but would be able to take it off for baths and showers. He looked at me sternly,
"You'll still have to wear this all the time because the bone isn't strong enough without the support yet." I nodded grudgingly.

Having your hopes dashed can be disappointing regardless of the situation. But in the medical world I have learned a few things about the delicate presence that hope can have. Here are a few of my observations --

Hope is the thing with feathers:

• Hold onto it with or without the facts. In the incident above the hope I had that my leg was healed didn't match up with the black and white image. But that doesn't mean we should give-up the hope! Usually it just means we need to be patient, allow the body to heal more or try a different course of medication. Whatever it is, holding onto that hope allows you to have a kind of standard in which to compare real-time results with. If the test results match up to the hope that you held onto then that might be a good thing, if it doesn't match-up then that helps to inform your next decisions. It serves as a kind of benchmark or check-point for progress, and the best part is that you won't ever be wrong.
• There is always a friend in it. Once you've grasped it then you know that its energy and motivations that hope can exert has no depth. This is important because often times things can get scary and precarious in the midst of confusing medical activity, and when there is uncertainty the environment can be intimidating for everyone involved but particularly for patients. However, if you keep hope near there will always be at least one consistently reliable component in the whole scene that you can look to as a familiar face in an otherwise uncertain crowd. 
• It is low-maintenance. Just have it drifting around in the back of your mind, or even write it down on a scrap of paper if you have to - but that's all you need in order to lay claim to your hope. There is no added cost, no health insurance policy to sneak it through, or extra amenities that it requires. Hope is just there at the ready for you.