The Patient in Room Nine Says He's God
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“Stop him.”
“Sir . . . STOP, stop, hold on a minute.” I quickly moved over to where he was standing with his wife. I stood for a second and just sort of stared, not sure as to what to say. In my head I clearly thought I heard a voice telling me to stop him, a voice as clear as if someone stood next to me and shouted into my ear; this was not to be ignored. And in the same instant, I knew deep down what is was. In all honesty I was a bit freaked out and asked a slew of questions: Who was it? Was that me? Or was it something I imagined or overheard? It was just a simple “Stop him.” No bolts of lightning struck the ER; he had no yellow halo of celestial color around him; I didn’t see an image of baby Jesus or the Buddha in a water stain on the floor; it was simply a voice, but it was as real to me as the keys I now type out this account on.
I stammered a bit, falling completely out of the superior doctor’s role. I felt like a juvenile in the principal’s office (a feeling I once knew all too well). “Sir, can I ask you to do me a favor? I have been very busy tonight, and I did not give you the attention that I think you deserve. I know you have been here a long time, but if you go back to your room and let me start all over, I’ll waive the bill.” He had no reservation whatsoever and was easily escorted back to his room.
The nurse peered at me as if I were crazy. “You’re going to start all over with this guy, a new chart, vitals, everything?”
“Everything,” I said. “Something doesn’t make sense . . . just trust me.” She shrugged her shoulders, gave me one of those looks, and nodded.
One hour later I had this man in the intensive care unit on high-dose heparin with a diagnosis of a massive pulmonary embolus: a condition that would most likely have killed him shortly after leaving the ER.
I went home and reflected on how close I came to contributing to this man’s death, to playing a part in making his wife a widow, and leaving his children fatherless. And I thank God for giving me the ears to hear and the ‘common sense’ to accept the improbable.
I still on occasion hear that voice but it is much softer now, sort of a gentle prodding that says, “Slow down, you’re in a hurry. You’re not listening to your patient. It’s your patient who is asking for help, not you.” Who is speaking? Well, I think it is God. You may think it’s my subconscious mind. Maybe they’re one and the same. Either way, perhaps we all have to listen a little more. I just wish I could completely convince myself of it. In the mean time, I’ll keep working on using my ears more and closing my mouth. I’ve noticed it’s quieter, anyway.
Chapter Thirty-one
The Rich Get the Worst Medical Care
Control is hard to give up, no matter what you do for a living. But, if you are in charge of a lot of people, are used to getting your own way, and you are someone who causes people to jump whenever you snap your fingers, it’s even harder. In an uncertain world, one thing is for certain: the medical care you receive will suffer because of it. I bet I have done more than 2,000 rectal exams in the past 15 years. Considering the fact that my index finger is only four inches long, I have performed a digital exam on more than 220 yards of rectum throughout my career (a very long par three, to be exact). One thing I have noticed is that I can’t tell a rich asshole from a poor one. That is, until they open the other end of their digestive tract, and start talking.
“Sir, how long have you had chest pain?” Sweat poured from the fifty-something, graying man with manicured nails, Italian loafers, and a smoking-hot secretary.
“Just call Dr. Doolittle. He’s my heart doctor [gasp] . . . just call him.”
“Sir, he’s not a cardiologist. He’s a surgeon. Now, listen. How long have you had pain?” I implored him further, the EKG showing diffuse ST elevation, indicating an impending heart attack.
“Get my cell phone . . . Annie,” he said, rolling his sallow eyes toward his secretary. “Just call him . . . Dr. Doolittle . . . he’s a friend of mine. We’re golfing buddies; he’ll know what to do.” He writhed around in the bed, clutching his chest even more, refusing the IV until his friend was called, and requesting a Vicodin for the pain.
“Do you have a heart history, high blood pressure, diabetes?”
“Call Dr. Welby, he’s also a friend of mine . . . tell him Jack’s in the ER. He’ll know who to call; I play golf with him, too.”
With a rising sense of urgency, I further explained, “He’s an orthopedist, sir. Listen to me. We need to get a line in you and . . .”
“Listen, just call one of them; Dr. Welby, Dr. Doolittle, or Spock . . . I know him, too. He’s a good friend.”
“Sir, he’s a pediatrician.”
“I don’t care!” he snapped at me, his voice rising above the din of the emergency room. “JUST DO IT!”
Everyone fell silent as a long pause hung over the room. That was when I looked him straight in the eye, leaning close so as not to lose his attention. I locked him into my gaze and spoke just above a whisper, “If you don’t stop . . . shut up for five seconds . . . and let me take control and do my job . . . you are going to die. Do YOU understand what I am saying?”
He looked at me in astonishment, a mask of terror now gently turned into one of relief spreading across his face. He nodded silently in acquiescence, finally surrendering. Minutes later, the pace in the ER was at full speed. Lines were placed; nitroglycerine, heparin, aspirin, and oxygen were administered. He was expedited to the emergency angioplasty where the cardiologists, whom he did not know and hadn’t golfed with, were able to open the vessel and save his life.
He sent me one heck of a gourmet gift basket a week later.
Far too often the rich get the worst medical care. For the most part, they have no idea that this is the case. With wealth comes easy access, and anything easy is hardly ever worthwhile. Easy access is an assured recipe for drug addiction and inappropriate diagnostic testing. I am saddened at how many people with authority and people of wealth fall victim to prescription drug abuse, unnecessary medical tests, inappropriate operations, and unwarranted diagnostic workups.
I am certain it exceeds the general population, but how exactly do you do a study? They get a doctor into their confidence (they golf, dine, or travel together), and a casual phone call becomes a request for a sleeping aid, a pain pill, and since they are friends, the request is of course seamless in its simplicity. One phone call results in a bottle of Ativan, another call results in an MRI, and a third nets epidural steroids and a bottle of Vicodin with three refills. In time, the requests pile up and the hapless doctor is caught up in a web of addiction, diagnosis, and medical procedures that take on a life of their own.
The doctor enjoys the perks of having such an influential friend, while at the same time aware that he is being all too cavalier in the practice of medicine. In time it all catches up to them when that patient finds their way to the ER suffering from withdrawal, an overdose, or some complication relating to an unnecessary operation or diagnostic test. By that time this patient of privilege has fostered relationships with a number of physicians, calling them all by their first name and inviting them to their suite at the arena or the party that everyone wants to attend. They will cultivate, nurture, water, and grow an entire garden of physicians: the internist, the orthopedist, the ENT doc, and the ER standby. Neither the doctor nor the patient means for this to happen; it just happens. At one end the patient is in search of control over that which they have little control, i.e., their years on earth; while at the other end, the doctor is in need of a sense of importance, confirmation that they are one of the best in their field. After all, they are so and so’s doctor. This happens because these patients are also simply better able to take charge of the situation than the physician. It is the nature of the beast; it is why they are so successful, and it is the precise reason why they have more unnecessary testing done, more operations, more second, third, and fourth opinions, and ultimately higher narcotic addiction potential.
So, when the patient is finally admitted with an overdose, a su
icide attempt, or in a withdrawal state, I’ll typically call around to the local pharmacies and make a list of all the prescriptions filled and who wrote them. Usually, there are five to seven doctors in the web; each one of them is overprescribing narcotics on an individual basis, let alone as a group. I’ll call each one of them privately and tell them that I think their patient is addicted to narcotics, and that I have asked Social Services to see about their addiction and about getting the patient some help. Here is what is amazing: None of the physicians are ever surprised.
“I suspected as such.”
“Yeah, I was concerned about the same thing.”
“I thought so.”
“You know, you are probably right . . . a good thing they came in.”
While all suspect a problem, rarely do they approach the patient with that prospect. They want someone else to do their dirty work, to take control of the situation, to alleviate them of the burden. And when it finally happens, they are usually relieved to be rid of this ‘friend’.
Fear of losing control or the need for maintaining control: It’s what drives so much of our decision-making, but once relinquished it is also a profound relief. I believe that is one of the reasons people have a hard time finding God. It is because at some level they have to give up control and say, “I’m in your hands.” Me, I’m horrible with it, and I admit it. I am one of those fly-by-the-seat-of-my-pants spiritualists who tend to only invoke God when things are going badly, or when I truly need someone else to take control. Sitting back and keeping my mouth shut at my kids’ baseball games, and not playing the role of coach, was as hard for me as a root canal without anesthetic. So, I am no role model for this exercise, but give me a few more years.
Of late I have made a profound attempt to invoke God’s name a little more, even if it means just asking for help in placing an IV, calming a patient, or dealing with the quirks in my interpersonal relationships. In a sense, I am giving up a degree of control and asking for help, playing second fiddle to a higher power. I have found it unbelievably refreshing, though I still feel like a hypocrite, since I don’t do it all the time. My sense is that God doesn’t even care: for Louis, it’s a start.
Chapter Thirty-two
Crop Dusting with Prozac
Why not? We add fluoride to our drinking water, ten essential vitamins and minerals to our kids’ cereal, and iodine to our table salt. Why not crop dust with Prozac, or at least add it into all of Starbuck’s mocha java lattes? Toss a sprinkle into the 7-11 cherry slurpy-machine slush, and the filtered end of Marlboro Lights: I figure that would cover a solid 75 percent of the population.
I’m not making fun of depression; on the contrary, I think that it has reached epidemic proportions and has become the great masquerader of medicine. Ask any ER physician who is the most difficult patient to care for: it’s not the combative alcoholic, the infant with meningitis, or even the gunshot victim. It’s not the car accident survivor with multiple fractures, or the drug-overdosed patient. It’s the forty-year-old woman with a history of migraines, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, mitral valve prolapse, and a whole host of drug-related allergies.
As much as you try not to be prejudicial, you know what is in store for you. You muster all of your empathy, you put on your best compassionate face, you practice your “I seeeee’s” and your “Oh myyyyy’s,” but you know this will be a no-win situation before you ever even meet the patient. The history will be extensive with complaints pertaining to nearly every imaginable organ system: chest pain, headaches, muscle pain, abdominal pain, ringing in the ears, blurred vision, palpitations, nausea, poor appetite, fatigue, irregular periods, and on and on. The symptoms will be completely nonspecific, spanning the spectrum of illness from malaria to cancer, from heart disease to pregnancy. The blood tests, CT scans, X-rays, and EKGs will yield nothing. The patient will once again become frustrated at your perceived lack of medical insight and will launch a verbal salvo of how they have seen Doctors ‘A through M’, and they have not been able to figure out what is wrong. That is when you casually mention stress or depression being a potential factor. Then, all hell breaks loose.
“Ma’am, I’ve got good news! All of your tests look great. You’re not having a heart attack, no anemia, your white blood cell and thyroid tests look great; there’s no sign of anything serious going on.”
“Well, there has to be something. I don’t understand how I can feel so rotten; I’ve been to Doctor ‘A,’ Doctor ‘B’, and last week I saw Dr. ‘R’, and Dr. ‘P’ sent me back to Dr. ‘A’, but ‘A’ says the problem is clearly something Dr. ‘B’, or perhaps Dr. ‘K’, should take care of.”
“I see . . . oh my, I can imagine how frustrating that must be for you. What does your family doctor say about all this?”
“He doesn’t know anything; I stopped going to him because he thinks it’s all in my head, and I know it is not all in my head.”
“I see . . . hmmmm . . . well, let me ask you something; you have all these tests, nothing ever shows up, no matter what doctor, so where do you go from here?”
“What do you mean?”
“I mean, you’ve already spent years chasing a diagnosis that has never materialized, and in all likelihood I doubt you’ll ever really get one. And, let’s face it: you’re not dead, and nothing has fallen off of you. Sure, someone will eventually tell you that you have fibromyalgia or chronic fatigue syndrome, or perhaps even some odd form of multiple sclerosis, but you’ll never really get any better. I think it is possible that your family doctor was correct, that this could be a physical manifestation of major depression.”
Now in ER heaven, her response would be:
“You know, doctor . . . you may be right. What do we do next, is there a medicine for depression I can start, or can you recommend a therapist or psychiatrist? What do I need to do to get better?”
But, most of the time, this exchange happens in ER hell:
“I am not depressed. I don’t know where you went to school or who you think you are, but you don’t know me. I am sick; this is a real problem. Get out of here. I am not going to listen to you anymore. I want your name; I’m complaining to your boss about you!”
And that is why these patients go on year after year without ever getting better, being funneled from one doctor to another, and shuffled from specialist to specialist, and from clinic to clinic. In time they will collect diagnoses like some collect Hummel figurines, shopping for a doctor to give them that one diagnosis that they can hang their hat on, that one illness that will explain all of their maladies to them and allow them to avoid the real issue: that they are major depressed.
As sexist as I sound (and I don’t mean to be), this symptom complex is typically feminine. Why? I don’t know, but I have my theories. Men seem much more amenable and even relieved to learn that depression or anxiety is causing their symptoms. We ignore pretty much every ache and pain until the last possible moment. This is probably due to the fact that the specter of illness hovering over the guy’s head is coronary artery disease, a heart attack, and a quick death. We don’t want to know. It’s what’s in our psyche: here one minute gone the next. We tend to walk through life at times feeling like we’re in a sniper’s sight. As a man, I know that we’re idiots when it comes to our health. We always think we’re going to die. Every cold is a death sentence, every episode of vomiting a tumor, but we’ll wait until tomorrow to get it checked out. We are the walking dead; thus there is a level of profound relief in knowing it is ‘just stress’, or ‘just anxiety’, or ‘only a panic attack’. We also don’t mind losing as much. Guys are very forgiving of each others’ ‘perceived’ character weaknesses, and we don’t view anxiety or depression as such.
Women, on the other hand, are more attentive to those lumps, bumps, aches, and pains. They can recite the statistics and health risks that threaten their own bodies. And besides, they have to hurry up and schedule their chemotherapy, because Jimmy has travel socc
er next week and Suzy has a dance class. You see, the specter of breast and ovarian cancer justifiably weighs very heavy on their psyche. From a preventive medical standpoint, this is good. But the constant bombardment in the media of the high risks of these cancers—along with the rise in female coronary artery disease, obesity, spouse abuse, and the illness de jour ads in every woman’s magazine—has scared women to death. Check out any supermarket tabloid rack and you’ll understand. It is not enough to be a mother, a wife, a career woman, and to raise a family; they need to have a malady to truly make them a success, to be a survivor, a modern woman of the 21st century.
I think deep down inside, that most of these women know intuitively that their problem is not life threatening. They seem to have a much better awareness of self, better insight into the workings of their own body. It’s like taking a test in school; when you miss an easy answer and it costs you the ‘A’, you don’t feel stupid, you feel angry. I think women get angry because they feel like they should have seen it coming, or can’t come to grips with why they feel depressed, especially when they ‘have it all’. To a woman, being told they are depressed is like telling them that they are a failure.
While as men we’re just damn glad that we’re not having a heart attack and can wolf down another piece of cheesecake. Besides, by the time prostate cancer typically becomes an issue, we’ve forgotten what we used it for anyway.
This leads me to the question, “Why is there so much resistance to depression for being the underlying cause of all their symptoms?” I place the blame for this resistance squarely on the shoulders of one person: media mogul Ted Turner.
As I have said throughout this book, there seems to be a God-given need to be connected to the world, to feel that you are part of something bigger than yourself. But with the advent of 24-hour cable news networks and their scrolling teletype with NEWS ALERT in bold letters, that connection has increasingly become a world full of suicide bombers, missing children, tsunamis, tribal wars, and amber alerts. It is reminiscent of the Don Henley song, Dirty Laundry :