The Patient in Room Nine Says He's God

by Louis Profeta

  We got the bubble-headed bleach-blonde who comes on at five,

  She can tell you ’bout the plane crash with a gleam in her eye.

  It’s interesting when people die…

  Give us dirty laundry.

  Unfortunately, someone forgot to tell Ted Turner and his like that, on occasion, the laundry needs to be washed. We have become mentally soiled with the stream of bad news that permeates the airwaves, the constant political bickering of the left and the right, the endless hours of economic woes, impending disasters, ‘food Nazis’, and boundless statistics portending our doom, that the sins and the weight of the world make those of us looking to connect with others physically sick.

  So when a person comes to the ER with symptoms that, in most probability, are a somatic form of depression, it could be that at some level I am confirming their biggest fear: that life sucks, that the world is a big septic tank of despair. Their anger may be that one last attempt to deny their own self-imposed reality. Show me a person who fills their body with booze, cigarettes, drugs, and junk food; and in time, I’ll show you a broken shell of a body, regardless of that person’s mind. Show me a mind that is filled with reality TV, 24-hour news with its countless images of death, world despair, famine, poverty, and war; and in time, I’ll show you the broken shell of a spirit, regardless of that person’s body.

  So, how do we solve this epidemic of depression? Is crop dusting with Prozac really the answer? How do we stop the illness before it progresses to doctor shopping and a litany of non-diagnosis? How do we encourage people to turn the damn TV off, close the paper, and just for a while live in the moment? In classic Judaism, it is expected that on the Sabbath, one does not watch TV, work, turn on the lights, and so on. I like to think that God had the 21st century in mind when he said: now is a time to rest, to refresh your soul, to take stock of what is important. Now is the time for love, for prayer, and for family. After all you are human, and in time if you truly want to feel really connected, you will on occasion need to wash the laundry.

  Chapter Thirty-three

  “The Best Doctor in the World”

  A few years back, a well-known thoracic surgeon, “one of the best in the world,” they say, came to our emergency room with his young son, who had the unfortunate experience of getting a fishhook stuck in his leg. He insisted the patient be seen only by him; after all, he was “one of the best in the world,” they say. He hurriedly directed the nurses to retrieve a plastic surgical tray, a scalpel, forceps, a good light source, wound cleanser, sterile gloves, lidocaine, and a host of drapes and ancillary equipment he would need to perform this delicate, subcutaneous, barbed foreign-body extraction. He orchestrated the department and the techs with maestro-like precision, everyone doing their part with speed and synchronicity that can only be described as magical. While he was busy flittering around the department, directing the woodwinds and prompting the snares, I snuck into the room. With a quick fisherman’s trick, I snapped the hook out of the young man’s leg. Not a whimper was heard.

  The surgeon scrubbed, gloved, and gowned, and with grand flare, entered into his patient’s room. I, on the other hand, on that less-than-busy morning, went back to my task of doing the crossword, pausing to contemplate number four across: a six-letter word for peace. Shortly thereafter the surgeon exited with a perplexed stare above the surgeon’s mask.

  “How did you get that out?” he confusingly inquired of me.

  “I’m not telling you,” I replied without even looking up. A palpable pause hung in the air.

  “No, really, no joking, how did you do it?” he implored with more urgency.

  “Listen,” I said, looking him straight in the eyes. “Five minutes ago, you thought there was absolutely no way that anyone other than you could possibly know more, or perhaps have greater insight as to how to treat this patient. And now, after the fact, you want the benefit of my knowledge, my help, and my expertise? You want to tap into my years of training and intellectual sacrifice that ended up with me being here at this point of time saving your child from certain peril? I don’t think so.” I smiled sarcastically.

  He laughed a bit and acquiesced to my good-natured ribbing, yet remained anxious for the opportunity to learn two lessons, one being the string technique of fishhook removal. I have not teased him about it since. After all, he might have to bail me out some day.

  It has gotten to the point that no one can just go to a doctor anymore. That person has to be the best. After all, who in their right mind would go to any physician unless they are absolutely the best? So, with that, our community has the world’s best oncologist, cardiologist, general surgeons, urologist, pediatrician, and on and on and on. In fact, I think our hospital alone has at least fifty of the best doctors the world has ever seen. You would think with all the ‘he’s-the-best, she’s-the-best praise’, Indianapolis would see more ill pilgrims than the Fountains at Lourdes. However, that is not the case. Why? Because just one state over you will find the absolute best oncologist, cardiologist, general surgeon, urologist, internist, and pediatrician in the world.

  I did my medical school training at Indiana University and my residency at the University of Pittsburgh. While in medical school, I was in awe of the knowledge and diagnostic skill most of my clinical teaching physicians held. We were young, naive medical minds whom were easily impressed. The talk among the students was that ‘Dr. A’ was world renowned. ‘Dr. B’ was one of the most famous in his field. Everyone in America knew ‘Dr. C’, he had published the most medical literature. You have to get a letter of recommendation from ‘Dr. D’, because everyone knows he is clearly the best in the world. To us, it was as true to fact as the number of bones in the human body. But surprisingly, after moving to Pittsburgh for my residency years, a mere five-and-half-hour drive to the east, no one knew Doctors ‘A, B, C, or D’. And if they did, it was because they had trained together, or perhaps read some study co-authored by that doctor. Oh sure, occasionally, some bit of notoriety did make ‘A, B, C, or D’ stand out. Perhaps they found the most appropriate treatment for a certain kind of cancer, authored an important chapter in a national medical textbook, or served on the governing board of their respective college of medicine. But at no time was the adjective phrase of ‘the best in the world’ used to describe them. That moniker was saved for about fifty physicians at the University of Pittsburgh.

  If you gathered a Jew, a Catholic, a Buddhist, and a Muslim together in one room and asked them to pick the best religion in the world, you’ll get four different individual answers. Ask them to pick the worst and you’ll get hundreds of answers. Just as it is futile to try to establish the best faith, it is pure folly to label any physician as the best, though it does not prevent us from trying. Hospitals pay a fortune gathering patient satisfaction data, manipulating statistics, and posting billboards and advertisement proclaiming:

  “Number one in cardiac care”

  “The most trusted name in medicine”

  “Doesn’t your child deserve the best?”

  “Midwest GI number one, when you can’t go number two”

  These same hospitals and watchdog groups pay very close attention to statistics detailing surgical infection and complication rates (morbidity), death rates (mortality), patient complaints, and malpractice, trying to manipulate the data to show that they are the best. But did you know that some of the highest morbidity and mortality rates clearly come from some of the ‘world’s best surgeons and most prestigious medical centers’? How could that be, you might ask? It’s because they tend to take care of the sickest patients and the ones most likely to suffer from complications. For example, take the thoracic surgeon who only does redo-coronary artery bypass grafting. He or she operates primarily on patients who have had prior bypass surgery, and usually a host of other illnesses. Naturally this leads to higher complication rates, higher incidents of post-operative fatality. How do you evaluate the success rate of an infectious disease specialist who practices in
a community that is impoverished and without mass transit or adequate Social Service assistance? Certainly patient medication noncompliance and poor follow-up care lead to a higher death rate for that physician’s patients. Or how about an ER physician who works at half the speed of his colleagues, sees a fraction of the number of patients, and hand selects the easiest cases from the to-be-seen-rack? Surely statistics would come to support that that person is ‘the best’.

  I have had the opportunity to moonlight (work part time) in rural ERs throughout Pennsylvania and Indiana. For the last 14 years I have practiced in a large, big-city, teaching hospital. I am disturbed when a physician from a big city or major tertiary referral medical center rolls his or her eyes and comments about some patient coming in from ‘Podunkville’, or ‘St. Elsewhere’, offensive tag lines used to describe any facility (especially rural or poor healthcare facility) that are not their own. They usually make some crass remark about how the doctors there “Don’t know shit.” They puff out their chest and sigh in disgust at the imposition of having to accept a patient who needs the services of a more specialized facility. That physician will then operate or treat the referred patient. He will bill for his or her services, and usually get paid. The physician will then dictate a consult letter to the referring ‘don’t know shit’ physician, which will have key lines which read, “Thank you for entrusting me with the care of your patient,” or “Thank you for your kind referral of this gentleman or interesting case.” Unfortunately, that physician will do all of this while bad-mouthing the same physician or medical center to his subordinates. It is a verbal salvo aimed to demonstrate that “I am the best in the world.” In reality, most of these tertiary medical centers and their corresponding practices would not be able to function financially if it were not for the referral base of the rural hospital system. What is more disturbing is the filtering down to the residents and medical students, creating a Third Reich mentality of academic superiority and the false poisoned notion that ‘Dr. Mad Dog’ is somehow the best. In actuality, he merely represents the worst that medicine has to offer.

  The reality of the situation is that you can bet that for every patient transferred to the ‘ivory tower’ institution, there are twenty others that some ‘Podunk doctor’ has cared for, cured, rehabilitated, and operated on without the help of the academic center. In addition, I can tell you without any hesitation that very few of these Gestapo physicians would be able to walk in, operate, and keep pace with the rural surgeon who practices without the benefit of three OR nurses, float techs, surgical backup, resident labor, and a host of consult services that a large hospital provides. In addition, many of these physicians are so specialized and so focused that they have in all actuality lost the ability or desire to care for the common malady, the fishhook in the thigh. Fortunately, those self-congratulatory physicians are the exception and not the norm, but they do create an educational tumor that needs excision.

  By now you are probably convinced that the rural, small-town physician is the best. I spoke with Dr. Doug Smith, one of our urgent care physicians who used to be in family practice in a small rural community. He jokes about how patients in small towns are no different from our population. They will look you in the eye with absolute conviction and tell you that every doctor in their community is a quack…except their physician, of course. Their doctor is the “best in the world.”

  It is evident to me that everyone knows ‘the best doctor in the world’. It’s their doctor. So, if everyone’s doctor is the best doctor in the world, how does one truly find the ‘best-best doctor in the world?’ Is it by virtue of the most publications, the highest cure rate, the lowest mortality rate, or the fewest number of malpractice cases? Is it by virtue of peer review, financial ability to advertise, largest marketing budget, or nicest cookie platter delivered on the holidays? I don’t know the answer to that, but I’ll let you in on a little secret: If you want to know who the best-best surgeon is, ask the OR nurses and the anesthesiologists. They’ll tell you. Inquire about who gets the most bent out of shape, throws equipment, curses, and yells at the nursing staff, medical students, and residents when the going gets tough? That’s the one you want to avoid. The others are the best in the world. Who is the ‘best-best physician’? Ask the ER doctor. They’ll tell you who answers their pages in a timely fashion, readily listens to what the ER physician has to say, and easily makes follow-up appointments available for their patients in the ER. Which physician comes in expeditiously without argument when it is suggested they do so? Those are the best doctors in the world. That kind of attention translates to care for the patient in the hospital, the office, and the community.

  I have come to realize one thing: Choosing the ‘best-best doctor’ is like choosing the best religion; it is thirty percent timing, thirty percent trust, thirty percent faith, and ten percent luck. Add an extra hundred percent if they take your HMO.

  My children recently asked me, “Daddy, how many ER doctors are there in your group?”

  “Something like 25,” I answered.

  “Who’s the best?” my youngest asked.

  Naturally, I said, “Me, if you catch me on the right day.”

  “What do you mean?” my twelve-year-old questioned.

  “I mean, if I’m swimming in Lake Monroe and a snapping turtle floats up and latches onto my balls, whoever is in the ER at that time… well, they’re the best doctor in the world.”

  Chapter Thirty-four

  Can You See God Through a Video Lens?

  A while back I was camping with some friends in the Quetico Provincial Park in Southern Ontario. For anyone who has any taste for the outdoors, this is one of those places that you have to go in your lifetime. It is a series of lakes, rivers, streams, and tributaries that course through the Canadian territory and intermingle with thousands of lakes in the Northern Minnesota Boundary Waters. You can drink fresh from the streams; eagles catch the air currents over pine-covered forests. Moose and deer wade through the shallows, and black bears survey the landscape. In the morning a fine mist hangs over the waters like the scent of a loving wife, hugging the surface in a gentle embrace. It is a world of loons, frolicking beavers, wild blueberries, and has some of the finest walleye and smallmouth bass fishing in either country. The rocky landscapes are dotted with vistas like Indian paintings, where each view and secret cove is more spectacular than the next. And if it were not for the hordes of biting black flies, I would say it is the closest place on earth to Eden. It is a sacred land with only the soft splashes of canoe oars, a sanctuary devoid of any motorboats. It was on one such trip that I saw God, and the best part about it is that I had five witnesses.

  We had been canoeing and fishing all day; it was comfortably cool, the dusk was settling, and we had finished tying up the canoes, cleaning the plates from our dinner of fresh fish and wild rice. We had chosen a campsite at the end of a small lake, fed at one end by a good-sized river and emptied at another by way of a very large waterfall. The current leading into the falls was quite strong and dangerous, and we would never consider navigating our canoes in the vicinity of the fleeing water. We were perched on the cliffs overlooking the falls below us and the lake in front of us. The roar of the falls was amazingly peaceful, and the mist carried up by the force of thousands of tons of water pounding on the rocks created a gentle humidity that covered us like a blanket of cool summer wine. As the day closed, we sat upon the rocks, sipped Scotch whisky, and smoked a few cigars. I suspect each of us was, for a brief time, reflecting upon how beautiful the scenery was, how perfect the day had been, and how at that pinnacle moment of our union with nature that it could not get any better. We were wrong.

  Movement in the woods next to the falls caught our eye; just below us we could make out a large animal, moving beneath the trees, a deer or a moose perhaps. That’s when a huge timber wolf climbed out of the forest and stood on a large rock, jutting into the lake framed against the mist of the waterfall. We sat there stunned, not wanti
ng to move, not wanting to say a thing. It sniffed the air, cocked its ears a bit, and then bobbed and tossed its head back, flattening its ears and gazed at the sky. She was a wild debutante displaying her finest, as if to say, “I know you’re watching.” It gently toed the water, then cautiously waded in and swam across the river a mere twenty yards in front of a waterfall that could have certainly swept this gorgeous creature to its death. But it swam across on a straight line, undeterred by the flowing current, barely even being nudged off its course. Reaching the opposite side, its paws struck the sandy bottom, and the wolf slowly climbed out lifting her legs in a gentle dance to dry land. Her silver coat shook and diamonds of water flew into the air splashing gems against the rocks. And without so much as goodbye, she faded into the pines, silver, to brown, to dark.

  For a moment none of us spoke, we just looked at each other. The first phrase muttered was, “Oh my God.” I had tears welling up in my eyes and I was not alone. This was my version of Michelangelo: my Pieta . . . my David. As I sit here typing, I can still smell the waterfall; I can hear its rumble and feel it beating in my chest. Each movement of the wolf is ingrained in my mind; I know it like I know each freckle on my child’s nose. I close my eyes, and I sit here years later, and it is still as beautiful, still as amazing as ever. And I still find myself thanking God for that moment.

  “I wish I had my camera out,” said Mike.

  “Why?” I asked, incredulously.

  “You know, so we could have a record, showed it to some friends.”