Monday, April 1, 2013

Change the world.

If I could reach the stars I'd pull one down for you
Shine it on my heart so you could see the truth

~ Eric Clapton

When we saw you last week, you looked miserable. Two different doctors had seen you before at two different hospitals. One had checked you out and told you without even batting a lash: "This is a surgical problem. You need to see a surgeon." And yes. You are kind of afraid of surgeons because surgeons do surgeries but you were miserable enough where you'd do whatever was needed to take care of this.


So you diligently scraped your money together and paid that co-pay and saw that surgeon. You sure did. And guess what? That surgeon said, "I'm sorry but this isn't a surgical problem." And you? You were too miserable and too tired to say what you really felt. That is, until you saw us.

I looked carefully at you and this problem. My resident did, too. I had a pretty strong opinion about what it wasn't more than what it was. And my resident agreed that what this wasn't was a surgical problem. So what we said to you was just that. "This isn't so straightforward of a diagnosis, sir. But to us it doesn't seem to call for surgery."

And that's when all of the miserable-ness came to a head and erupted out of your mouth like Mt. Vesuvius.


Which startled us both but shouldn't have since it was obvious that you were not only miserable but also frustrated.

The thing was and rather is. . . . I don't know. At least, I don't know for absolute sure what this is. I don't. But I couldn't see how an operation would help this. That's about as far as I got.

And you? You were nice about that f-bomb but very deliberate about it. You meant what you said and wanted an answer. You were tired of being punted about like some kind of Nerf football.

"Okay. So let me explain to you everything we're thinking about and what we've been talking about outside of your room."  That's what I said to you because I needed you to know that even though I wasn't sure, your problem and your misery wasn't something that I was approaching all willy-nilly like it didn't matter. Because it did.

And it does.

That explanation I gave you included a differential diagnosis of things we thought your symptoms might represent. I told you what features were in favor of certain things and what was against those same possibilities. I brought in a colleague who was working in the clinic with me that day to also examine you. I wanted to get another brain involved, too. And then we ordered some very thoughtfully selected tests to start working closer toward finding out what-the-eff kind of problem you have.

We also gave you something for pain.

You came in for follow up just as we'd asked. I passed that open door and saw you sitting on the edge of the seat. I crossed my fingers behind my back hoping that you would jump up and start dancing because you felt so much better.

Finger crossing is so overrated.

"How do you feel?"

"The same."

"The same?"

"The same. Still miserable."

"I'm sorry."

"Me, too."

"Did the pain medicine work?"

"I couldn't afford it."

"What? You didn't get it?"

"I couldn't afford it, I said."

And how I felt when you said that could be its own entire separate discussion. Suffice it to say, that I felt like an April fool because giving you a medicine that you couldn't pay for was a failure on my part. Yep.

My resident and I sat down and talked to you about everything. We reviewed the lab tests and explained that none of them gave us an answer. No. We still weren't sure what-the-eff kind of problem this was. Now we just had added to the list of what it wasn't.

I even stepped out and paged one of my senior colleagues who wasn't even in clinic at all with me but elsewhere in the hospital. And that senior colleague came down and examined you just like I'd asked. He, too, generated a differential diagnosis of what it could be but admitted that he wasn't fully sure. Not sure at all.


I  did appreciate the way he treated your problem like it was a problem and not like it was some kind of "cool" exercise geared at "stumping the professor." Instead, he was gentle and empathic because he was senior enough to know miserable-ness when it was staring back at him. That, too, could be its own discussion.  


So I sat across from you and held your hand. And I admitted that I still did not know exactly for certain what this was. But that, I promise you, that we are working very hard to find out so that we can get you feeling better. I also apologized for letting you leave with a medicine that your prescription formulary didn't include. Then, we called two more specialists and told them all about you to get a solid next best step. And that step? A test to get a sample to see for absolute sure under a microscope what this could be. Or maybe sure, depending upon the yield of the test.

"Is that a surgical procedure?" you asked.

"What's that?" my resident replied.

"The biopsy thing."

"Ummm. I guess you could say that."

"So I do need something surgical."

"Hmmm. Technically yes."

My resident glanced over at me but all I could do was press my lips together and sigh.

"I'm sorry we don't have you feeling better, yet," I said. "I really, really am."

And you smiled best you could and replied, "I like that y'all seem to want me to feel better just as much as I do. That make a difference to me. Look like y'all really thinking about me and trying to get to the bottom of what's happening and you ain't gon' give up until you do."

"We are, sir. I mean, thinking. And we aren't, you know, going to give up, sir."

"I can tell. And look like something 'bout that make you feel better all by itself. At least, a little bit better. Like we in this together."

And to that, my resident and I just smiled. Because with that simple statement you'd made us feel better, too.

We planned those next steps and wrapped up the visit. No. We didn't change the world with this encounter or the last one. But this time? We wrote for medications that you could afford and promised you that we wouldn't give up on you or your problem.

And we won't which means. . . just maybe. . . .we will change something.

Happy Monday.

Not sure why this is playing on my mental iPod but it is. I love Clapton and everything about how he sings this song. I hear this chorus in my head often at Grady Hospital hoping that someway, somehow I can do or say something that changes a piece of the world. 


  1. I so often wish for doctors like you.

  2. I can't tell you how many times I have gone to a doctor (and you know that's very difficult for me) with something that is impacting my life only to be told, "No idea," and then sent home to feel foolish and condescended to. And still troubled with a problem which I eventually learn to just live with.
    So. Yes. I am with Angella. I am hoping for this patient that the problem can be figured out and that relief can be found. Because some problems cannot be lived with indefinitely.

  3. The same thing happened recently to my mother. They kept pushing her around and sending her home for a bladder infection. But my mom was persistent (with little to no health insurance) and came across a team of doctors like yours and found out she has bladder cancer. It took her an entire year for her diagnosis. We are working through this and it is very difficult. We had a little scare about 2 weeks ago, but thanks to God and your blog, that I asked the right questions and knew what I should expect. Your blog gave me the strength to take up for my mother when I knew that she couldn't. The internist saved her life this time. So yaaaaa you guys! Now to the oncologist and surgeons.

  4. Dear Dr. Manning, whenever I'm doubting myself and wondering what I'm doing with my life, I always try to come back to your blog. *This* is the kind of doctor that I want to be. Thank you.

    -Emily, MS3, Pritzker School of Medicine


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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