What appears before us, in the exam room, in the hospital, in the OR, is an amazing human tapestry. We see people at their worst and their best. When they are most vulnerable and when they show incredible strength. When they are in the depths of despair and when they are enjoying some of the happiest moments of their lives. It is an amazing experience. Who else in society has the luxury to participate in people’s lives so intimately? And this is how we make a living! Wow.
In the course of sharing people’s lives, we in the health profession hear some striking comments. Words are spoken that can be at times humorous, at times touching. Sometimes paitents saythings — intentionally or not — that make me smile or even chuckle. When the day is long and the work pressures intense, the sparkle of these comments can help me keep plugging away.
Here are a few examples:
- A construction worker came in complaining “my arm and fingers go to sleep, usually at night.” I resisted the temptation to respond, “Well, isn;t that what they’re supposed to do?” and instead diagnosed his carpal tunnel syndrome.
- An elderly woman wanted me to know that her knee was sick. She reassured me the rest of her was healthy.
- I am always tickled when a patient responds to a review of systems question with “Not yet.” Have you had any chest pains? “Not yet.” Are you short of breath? “Not yet.” Any blood in your stools? “Not yet.” I am never sure whether these patients have a deeply ingrained fatalism, or just want to cover all their options. When I run into this situation, I sometimes keep asking questions until I get a different answer. One fellow outlasted me, responding quite seriously to 10 different questions with “Not yet.”
- I cannot even count the number of sore throat patients how have warned me not to get near them with that “tongue dispenser.”
- Some older folks talk about “drinking” their pills. “Do I drink the blue one once or twice a day?” When a patient askes this, I like to respond in kind. “No, please drink the blue one once a day.” One time this got me in trouble. The patient’s daughter, sitting in the exam room, was not amused after I twice used the phrase “drinking your pills.” She glared at me and said, “Mom, you swallow your pills. You don’t drink them.”
- A woman in her 70s, concerned about her memory, told me she was getting “forgettable.”
- Another elderly woman said she was afraid of getting “old timer’s disease.” I was able to reassure her that she did not have Alzheimer’s.
- One of my patients had a stroke two years ago, leaving her unable to speak, though she is otherwise alert and oriented. Her conly communication is nodding yes or no. She is perpetually smiling, as is her husband, who invariably comes in to speak for her. Each visit starts out with me asking, “How are you?” She always beams, nods her head affirmatively, and grabs my hand. At the last visit, though, when I asked her how she was, her husband spoke up before she could do anything, “Well, doc, she can’t complain.”
- A sweet, generally healthy man of 85 complained to me in earnest that his main problem was that he “walked like an old man.”
- I continue to be amazed by the number of patients whose hypertension or diabetes is hard to manage because. they tell me. they “hate to take pills.” Yet many of these same patients are very persistent in getting their Vicodin or Valium refilled. OK, I confess, one time I did it. I said, “But Vicodin is a pill.” The patient paused briefly, then said bluntly, “You don’t understand.” I think now I do.
- When I asked a new patient whether there were any significant illnesses in his family, he said, “No, doc, we have long jeopardy in our family.”
- An elderly woman with dizziness described what happened: “I got light-hearted, then I blacked out.” With her rate in the 40’s, she was probably right.
I love my patients. I have cried with them and laughed with them. So much of what we do in medicine is about relationships. When I give these examples of patients saying the darnedest things, it is not meant to be in any way patronizing or disrespectful. Finding the charm and the poignancy in our patients’ language can deepen our resonance with their experiences. It is one of the small treasures I take home at the end of each day.
(September 2003)