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The Visit

The Visit

In anyone's life, there are very few experiences that sets their life path in one direction or another. Sometimes we experience a death of a family member or experience an illness that limits our ability to enjoy our everyday life or maybe we win the lottery and become the next rags to riches story in America. But not every major life event has to be a larger-than-life occurrence. Sometimes it is a humble encounter that separates our worldview's cognitive projection from reality.

On my recent return home to Detroit, Michigan, I had the honor of attending my eighty year-old uncle's cardiologist's appointment. Yep. I was on vacation, and he asked me to attend his appointment with him. So I did.

When we arrived at his doctor's office, the large brick structure was as generic as any other medical professional building. There were long hallways with multiple doors separated by twenty or thirty feet each. The hallway ceilings were low and the recessed lights were dimly lit. Once we walked into his cardiologist's space, we were greeted by a receptionist. We sat down. The waiting area was a very sterile environment. No paintings on the walls, no comfortable chairs and it was as big as a match box from the 1920's. It was quiet and uncomfortable.

A nurse opened the office door and ushered us to our room. She was a tall middle-aged woman who had a pair of scrubs on that she could have worn ten years ago. Her clothing was not inappropriate, it was just a few sizes too small.

As my uncle and I sat down in an exam room that was more suited for being a closet than a place where a physician interviewed and examined patients, she started asking questions about our intentions for the visit. I had no expectations. My uncle wanted to know why he had so much shortness of breath when he climbed stairs or walked fairly medium to long distances. The nurse was rude. It surprised me a bit since I believe healthcare workers should be extraordinarily kind, or as courteous as possible. My uncle brought out a list of medications, their dosages and the time of day he took them. The nurse argued with him as he explained that his doctor told him to take them this way. That interaction would never be tolerated at The Stone Institute. That nurse would be somewhere else making people uncomfortable and defensive about doing what they have been told. When she left the room, I asked my uncle if she was always that way. He replied, "Always. Can you believe it?"

About 30 minutes later, a man dressed in a white coat with what appeared to be merit badges up and down his jacket sleeves walked into the office wheeling a computer on a stand. His name was neatly monogrammed on his starchy white coat. He was in his mid-forties, he sported short salt and pepper hair gray hair and his blue eyes were a bit muted. He sat down, started his computer up and started speaking to both of us as if we were in the third grade. He did not introduce himself. I have come to realized that the common courtesies of human interaction have long passed us by. So I did not hold his rude behavior against him.

He asked my uncle why he was in the office. My uncle just replied with a short, to the point comment. "Because you scheduled me here for today." My job was to write down the pertinent information in their exchange. A spectator in a foreign land bearing witness to a doctor and a patient: medical school all over again. But this time it was different. I was not a subservient student without a voice. I chose to stay quiet, listen and observe.

The doctor questioned my uncle and the usual expected comments emerged. The physician went into his fairly simple and common spiel about my uncle's condition and that the mere fact remained that my uncle was eighty years old and he was fraught with the kinds of challenges that an octogenarian could expect. He related his recent testing showed that my uncle had moderate pulmonary hypertension and his dobutamine stress test showed that he had a strong heart. There was a small segmental defect in my uncle's stress test meaning that he had an old, non-contributory injury to a small portion of his left ventricle of his heart many years ago.

He then asked why my uncle failed to get an ENT and Gastroenterologist to evaluate him since his last visit. He began to scold my uncle for not following his instructions. His  opinion was that gastrointestinal reflux from my uncle's stomach was playing a huge role in his shortness of breath. He shook his finger at my uncle as if my uncle was in kindergarten and demanded he schedule a visit to the specialists as soon as possible. He spouted off that my uncle most likely had Barrett's esophagus which would lead to cancer. Imagine a cardiologist telling my uncle who only has shortness of breath while walking and climbing stairs that, most likely, he is suffering from acid reflux disease that is activated with exercise. Really? At the same time discounting the big pink elephant in the room: his moderate to severe pulmonary hypertension.

As an aside, he told my uncle he that fit the class I criterion for the standard usage of statin drugs to lower his 233 cholesterol. When my uncle told him he reacted harshly to statin drugs, he ignored my uncle, and related he would use a different, newer, more expensive drug.

Well, it was about that time I had had enough with this pompous cardiologist who spoke to both of us like school children. Without going into detail, I began my usual dissection of his rationality related to his theories on reflux, shortness of breath and pulmonary hypertension. He finally started to realize that I wasn't some scribe sitting in the office, I actually spoke fluent physicianese. He pulled the I'm the doctor card out and played it numerous times until I finally revealed I was a doctor with a different worldview. He sat in a stupor. He could not discuss the ramifications of my uncle's true disease (pulmonary hypertension) and continued to spout off statistics and theories that probably came from the Ladies Home Journal. He said things to my uncle that were simply untrue and absurd. He wasn't going to repeat any studies on my uncle for two to three years which meant he thought my uncle had less than two to three years to live.

I held my ground. The cardiologist held his delusions and mistruths. He finally scampered out of the small battleground, wounded and upset saying that he could not spend any more time with us, he had already run over his allotted time.

When my uncle was walking back to the car after we left the cardiologist's office, he turned and looked at me, "You just fucked it up again! Now I have two doctors who don't give a shit about me. I've got a return appointment with this guy in a year. My other doctor you spoke to on the phone scheduled me for eighteen months from now." He laughed and said, "Thanks. I needed him to hear I had a nephew who wouldn't take his crap."  

The cardiologist was rude, dismissive and in a hurry, his office staff should be out pumping gas in a service station and the best advice he gave my uncle was to walk and condition himself to enjoy the things he likes to do in the outdoors (because he was eighty years-old). That cardiologist does not believe my uncle will be living more than a year or two more, that is why he was so dismissive and trying to punt him to several other doctors. Once he learned that I was a physician who cared deeply about my uncle, his best option was to pass the hot potato (my uncle) around the medical community and stay as distant as possible from him. Thank goodness.

I haven't witnessed physician-patient interactions in a long while. The first time I really got involved with my grandmother's care, the physician I argued with gave her two blood transfusions against my wishes which ultimately caused my grandmother to go into congestive heart failure and subsequent death (as a result). At least this time, I won't have to stop the doctor from doing anything that would execute my uncle.

If this is what everyone goes through when they have to see a physician because they are ill, I am greatly saddened by it. I may not have the answers to many of the problems we all face related to our health, but I doubt anyone will be treated with more respect, compassion and dignity than me and my office staff.

One of the most important tidbits of information about my Uncle's doctor: I looked at his medical biography. Thank god he didn't go to Michigan State! He went to medical school at Wayne State University. He's no Spartan! That's for sure.

Doc

Posted by Amanda Sanders at 12:15 PM
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