Different conversation

Back in October, I admitted a patient to the general medicine service with a three-week history of abdominal pain and progressively yellowing eyes. She was a large, pleasant, quiet black woman who was almost always accompanied by her husband, a broad man with laughing eyes and a white beard who wore an old-fashioned train engineer's cap. Her history was suspicious for pancreatic cancer, as was the flurry of radiologic studies and biopsies that followed her admission.

On a Saturday morning shortly before I finished the rotation, I had a long conversation with the patient and her husband. During this conversation, I told them that although a diagnosis was not yet confirmed, cancer was one of the more worrisome and likely diseases she could have. They were both quiet, and his eyes became wet. That afternoon, on my way out of the hospital, I saw her husband alone in the lobby. He took me by the elbow and asked if he could speak with me. Of course, I said.

We sat on a bench in a quiet hallway nearby. He had questions about some of his wife's studies, so I drew him some pictures and explained the tests until he seemed to get it.

Afterward, he asked, "Doc, what's your specialty?"

"Um, nothing yet," I said. "I'm still too early in my training to have a specialty."

Then, in the space where I was anticipating a small flood of gratitude, he asked, "What do you know about honey?" Over the next thirty minutes, he shared with me his bizarre and rambling theories about the healing properties of bee products as influenced by his readings of the Bible and the collected works of Louis Farrakhan. The conversation was a bit surreal and the logic impossible to follow, but I sat through it.

I later asked myself why; although I love talking to my patients, I'm normally very good at weaseling out of long, tangential conversations, especially ones that involve the Nation of Islam. I suppose I listened to him because I felt bad about telling him that his wife might have cancer.

Now, four months later, I am on a rotation in the intensive care unit (where, by the way, I am happy as pig in slop). This morning, we got signout on a patient whose name I knew instantly--it was the lady with pancreatic cancer, and there was her husband at her bedside once more, wearing the same funny cap.

I was instantly glad I'd sat through his entire half-hour of crazy without finding an excuse to leave. I'd happily sit through another hour if it meant avoiding the very different conversation that we'll probably have tomorrow.

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Your ability to empathize with someone whose outlook is so at odds with your own is admirable. On a more literary level, your ability to deliver a clear message while leaving much unsaid is nothing short of masterful. Anyway, I have been a fan of medical literature for a long time (Oliver Sacks, Richard Selzer, Atul Gawande), and I look forward to a book by you some day. Of course, I'll have to be able to discern the style, since a name is absent. :)

I hear your about the pig in slop in the ICU. It's bad, bad for my future as a well-rested human being. But I'm SO happy to hear that you're happy to be back in the adult world!! And amen to the "book by you some day" comment from penseroso!

Sheesh, don't they teach you any of the human side of medicine?

The next time the whole family is in the ICU, just make a point of saying to one of the other residents, "Of course, she would never have had to come to the ICU if we had just treated her with BEE POLLEN!" in a loud, sarcastic voice. Do it at a distance, but make sure the volume is high enough to be overheard. That will ensure that he doesn't waste any more of your time with his crackpot theories.

Of course, you don't want to make enemies out of them, so bring up some packets of honey from the cafeteria and leave them on her night stand.

Hey, plenty of healing power is to be found in honey. My grandfather was a bee keeper and he was never sick a day in his life. Well, except for the cripplingly bad back pains. And the copious amounts of alcohol he used to numb the back pain. Come to think of it he did get sick quite a bit but his Germanic stoicism had him work through everything. But it was the honey ... was VERY healthy for him! Really!

I'll offer a third voice in support of a book. And I can hear you already, "I'm still young. I haven't done anything worth writing about." And I would disagree, of course.

I'd point out that you have some amazing life experience to share. That your path has been an example of self-determination, of choices and experiences leading you to become a doctor on your own terms. And your slice-of-life style of essays would be an engaging format for younger readers. That as a primer your course through life, mistakes and all, would be an inspiring read for young women seeking their own future.

But no pressure. ;-)

Besides, it would be a perfect morning read accompanied by a cup of tea with honey. And we all know how healthy honey is.

What not to become as you grow in your chosen field. Best to you.

By Chrysalis Angel (not verified) on 31 Jan 2007 #permalink

Empathy is an art as is Medicine. You have already mastered writing and it appears that you are well on your way to mastering the Art of Medicine. RCTs, scientific method etc. have their place in medicine, but they are an incomplete picture. Human beings are much more than a collection of scientific analysis and study they bring other dimensions which set them far above any other creature. Your exploration and insight into these dimensions will serve you and hopefully others very well.

Everyone just settle down. There is no book, no book deal, no novel, no screenplay, and no agent. I have a job, kids.

Thank you, regardless, for the generous and kind comments.

Reading this entry, I'm wondering if we are at the same hospital...I could swear I took care of this woman today.

Hmm. Although you don't look familiar to me, it's certainly a possibility. Far more likely is that there are several women in this country who have both pancreatic cancer and wacky husbands who wear funny hats. Regardless, thanks for the comment, and good luck!