Consider This

To anyone who has been awaiting this entry- my apologies for my absence. I had to think through my goals for this blog a bit and also figure out a few technical issues which are now resolved. Welcome back!

I met the most amazing woman this afternoon in the hospital. She is 67 and looks 45. She is beautiful in spirit and in person. Her husband was kind and concerned (appropriately) about the pain in her abdomen. She has been bleeding with every bowel movement for 3 weeks. She has lost 15 pounds since this began. She is in crampy pain and she is uncomfortable. She can hardly walk due to the pain and she is weak and her blood counts are low from the bleeding. She has ulcerative colitis. We have started steroids and she will improve- but not before the steroids make her jittery, and sleepless, and not hungry, and if she’s unlucky, even psychotic. But despite all of that- she is very much herself and wishes to go home as soon as possible so she can see her daughter and help her buy a crib for her first grandchild. She was a teacher until she retired. And she has a glow about her that radiates something warm, kind, knowing. The truth is, this is not her first flare. She takes all of her medications. She may or may not respond to the pills and IV streroids and she may need an operation which would cure her- but leave her without a colon and instead with a permanent ileostomy (a bag for her feces) either temporarily or permanently.

So think about this: One day you get sick. Not a flu- or a cold- but painful, bloody diarrhea. You go so many times to the bathroom in a day that you have to move your desk closer to the bathroom. You are afraid to tell anyone except your husband. Six months later you gather the courage to seek medical help. You undergo a colonoscopy and no one tells you that the prep the night before is much worse than the study. Weeks later you get a call that you have colitis. A year later, after the drugs that several doctors have tried for those 12 months don't work you are given a choice: Be sick with a chance of rupturing your bowels at some point, losing weight, an increased cancer risk, infection risk, risk of pain, etc. or have a surgery that leaves you with a bag that many patients find humiliating- but most learn to live with. After all, that bag fits snugly under a shirt- and many of you have passed someone with an ileostomy on the street today without knowing it.

These are the choices we present to patients every day. And I marvel at the braveness by which people make their choices. It's no easy task, being a patient. It may be the hardest job in the world. Doctors struggle to define who does it well. To some of my peers, the "good" patient is "compliant" and "listens." I find those doctors arrogant. For me, the best patient is one who chooses to be informed (when that is possible) about their choices- and then makes a choice for themselves based on what they believe is best. People are too different to lump into "good" and "bad" and sometimes doctors need to remember that someone who doesn't agree with THE PLAN may still be right. This is part of the confusing relationship that is doctor/patient. We are there to inform you and serve your body best. Your job is to trust us- but not blindly- and to use the information as best you can. In so many ways this relationship can go awry- and I struggle every day with various patients to make certain I am doing right by them despite how they may act, what they may say, (or do).

Tomorrow I am going to recommend surgery to my new patient. From our early discussions it sounds like she will agree that this is best for her based on her support structure, religious beliefs, views on health care and her body, access to ongoing care, desire to be better, ability to tolerate a surgery, and other factors that she and I will weigh together when discussing the matter. And no matter what she chooses, I will honor her wishes, and support her. After all, honor is exactly what doctors should be striving to uphold.