Yes, each day in the clinic has its frustrations. But it has rewards as well, things on which, when evening comes, I sometimes dwell. I want to share with your some of these small twinkling lights, which I occasionally contemplate late at night.
One thing I like is seeing patients who should be dead.
Like the man who was in a true locked-in syndrome for five weeks in 1988 and still walks in for his six-month checkups with no complaints many years later.
Like the woman who was in a coma for viral encephalitis for three months as a teenager and now comes in occasionally, bothered only by the health issues of a typical healthy 28-year-old.
Like may patient who has lived with HIV for more than 15 years on no treatment and with a normal T helper count (this occurred before treatment for HIV became available).
I like seeing patients who surprise me.
Like the plain and simple man I’ve taken care of for 18 years. One day I found him looking at The New Yorker in the exam room. He said he reads it and The Atlantic regularly and he wanted my opinion on The New Yorker‘s latest piece on electronic voting.
Like the reticent, unassuming patient I’ve seen for years who I discovered one day was a Harvard Ph.D.
Like the perpetually dissatisfied patient who, after years of carping, sent me a warm thank you note out of the blue for something I did that was really inconsequential.
I like things like that.
I like it when patients tell me secrets — especially on their first visit.
Like the patient I’ve known for less than three minutes who tells me of problems in her marriage she cannot even tell her best friend.
Like patients who expose the most intimate parts of their body to me after five minutes’ acquaintance because they know they can trust me.
I like seeing patients who stimulate me to learn new things. Like the lady I saw recently with pseudohypoparathyroidism.
I like it when I can pacify an angry patient in 20 minutes and have him say “thank you” when I leave the room. I feel like a lion tamer and it sometimes makes me swagger.
I like seeing patients who grew up, as I did, in Kansas. We share stories about Kansas thunderstorms no one else can understand.
I like it when patients try to empathize with me.
Like when a patient says, “Doc, you’re looking good today,” on days when I’m really totally exhausted.
Or when a patient says, “Doc, you’re looking tired today,” on days I’m really totally exhausted.
I like to see patients in their 80s and 90s who are unafraid of dying. They are a mystery I have not yet solved. I relish each visit with these time travelers, hoping one day they will help me understand.
I like it when patients and families trely on me to help them approach dying with grace and dignity. I like the tension created inside me between my feelings of of being needed to help with this most difficult of journeys, yet feeling humbled by me inability to truly comprehend death. Do you understand this tension? Do you feel it too? And like it?
I like it when patients trust and believe in me so much they forgive me when I make a mistake. Especially when the mistake is so serious it is one for which I can never forgive myself.
I like it when patients call me “Doc.” It is an amazing salutation, three letters that encompass endearment, familiarity, and trust. There is no other such word in the language. I like that word a lot.
I especially like it when a doctor asks me to be his or her doctor, or the doctor for a family member. There is no higher tribute.
When the day is done and evening comes, I often pause to reflect on things like these.
(September 2004)