Sunday, October 9, 2016

why we need to hear your story

True story:

Almost twenty years have passed since I was sued for malpractice.
It was a classic case of a “missed diagnosis”—colon cancer in a young woman with no personal or familial risk factors for the tumor. In her case, it lurked just out of reach of the flexible sigmoidoscope, back in the days when flexible sigmoidoscopy was considered the standard of care for young, low risk patients with minor rectal bleeding. In this population the most likely culprits were hemorrhoids, fissures or small inflammatory polyps. Colonoscopy was considered overkill in cases like this. It was expensive and insurers were reluctant to cover it. Out of pocket expenses for the patient could run into thousands of dollars. In addition, it entailed the risks associated with anesthesia and perforation. 

So I performed a "flexi" on her.

I felt confident in my skill and thoroughness when I explained to the patient that she did, indeed, have internal hemorrhoids which were the likely cause of her bleeding. Nevertheless, I gave her careful instructions to follow up with me for further evaluation if the bleeding persisted or worsened. In fact, I provided her with three test kits to run at home for what is referred to as occult bleeding—blood in the stool you can’t see but can test for. In either case, she would need a colonoscopy.

I never heard from her again. In fact, her name never came up until two years later when I received an official summons that began: “YOU HAVE BEEN SUED IN COURT.”
By then, she had undergone surgery, radiation, and chemotherapy to no avail. She died after a long, painful struggle with the disease, leaving behind three teenage children and her husband.

To make a long story short, the case was settled out of court with the help of a topnotch expert witness. Serendipity may have been on my side as well. Before he went into malpractice law, the prosecuting attorney had been a friend of mine. We attended the same church, our children played sports together, and we had entertained him on more than one occasion in our home. I have always wondered if he went easy on me. Fortuitously, the day of the deposition, he was suffering from a back injury making it impossible for him to grill me for ten hours without food, water, or bathroom breaks as was his customary practice. My malpractice carrier handled the out-of-court settlement. Things could have been much worse for me.

But that’s not the point of this story.

The point is this: my patient’s fate found a permanent home in my heart. Today, for example, I thought about her when I drove to a nearby state park and hiked the lakeside trail through the woods…under a ridiculously clear blue sky, in the warm sunshine, against the gusty wind. I think of her when the snow falls, turning the world soft and silent. I think of her, her children and her husband on the very days I am most grateful to be alive. I am reminded that she’ll never enjoy another sunrise at the beach, another sip of wine or another good strong cup of coffee. She didn’t live to see her grandchildren come into the world...

...which probably explains why, twenty years later, her spirit lives on in my heart. Whenever I feel gratitude or joy or pure pleasure I think of her and all that she has missed. It never fails. It keeps me mindful. It keeps me humble. It makes me sad.

That’s my story. What’s yours? If you are prompted to share it with us, you can use the comment field below, or contact me and we’ll work something out.


Sunday, October 2, 2016

why you can't make this stuff up

Don’t let the term “narrative medicine” intimidate you. This is a broad and inclusive writing niche. You don’t have to be a physician to practice it. In fact, you don’t have to be a health care provider at all to share your story with the world. Nor do you have to be a patient who survived a serious illness or encountered a life changing injury to engage readers with your experience, thoughts and feelings about it.

Perhaps you work in the hospital laundry and never have direct contact with patients at all. What if you were sorting through the surgical scrubs that came down from the OR one day when a half-burnt joint fell out of a pocket? Which bleary eyed surgeon did that come from? Or, imagine you’re a janitor called to fix a leaky faucet in the middle of the night. When you walk into the room, the patient is breathing quietly. Then you hear a groan and his breathing stops.

Oh, you have stories to tell all right.

If you’re a patient, tell us what went through your mind the day the chest pain started. What worried you about it? Why didn’t you go to the ER sooner? Tell us what it was like to wait in the ER for hours before someone came to set your child’s broken wrist. What did you see there? An angry drunk in handcuffs escorted by the police? Drops of blood drying on the floor? The surreptitious pinch on her behind the doctor gave the receptionist when he thought no one was looking?

What is it we like to say? You can’t make this stuff up.

Now, let’s add another layer.

What if the surgeon who is scheduled to replace your aortic valve in the morning was up all night because that afternoon his son totaled the car on his way home from school? What about the ICU nurse who found the cigarette burn on the shirt her ten year-old wore to school yesterday? What about the single mother who works in food service with the dull ache in her low back and unpaid bills collecting on her kitchen counter? What are their stories?