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Life

The Impatient Patient

Pushing back at doctors has been good for me.

By David Berner 26 Oct 2005 | TheTyee.ca
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Early this summer, I underwent an angioplasty procedure at Vancouver General Hospital. A wire mesh stent was inserted in a blocked artery. The experience forced me to reflect on my curious relationship with the medical professions over the years. How do you interact with your doctor?

"Good morning. I'm Dr. Smith. I'm an anesthesiologist and I'm working with Dr. Jones. Would you come with me?"

Dr. Smith takes me into a small consulting room and asks me to sit opposite her.

"What are we doing here?"

"Well, as I said I'm working with Dr. Jones."

"I don't need an anesthesiologist. I'm a heart patient. I've come to see Dr. Jones. He's my cardiologist."

"Yes, of course. But I am a resident and I will be doing the pre-interview."

"Look, I appreciate that this is a teaching hospital, but I've had a heart surgery recently and I need to talk to my cardiologist about some serious concerns, and quite frankly, I don't have the patience or stamina to tell this story twice. First, I'll tell you and then, five minutes later, I'll tell the cardio all over again."

"Well, it'll be good for me and good for Dr. Jones and, in the long run, it'll be good for you if we start."

"Alright. Well, I have two concerns. I believe that, in spite of having a stent put in the blocked artery, that I still have angina, and I would like to negotiate cutting down on some of these medications I'm on."

"But I'm sure you can see that those are contradictory issues. If you still have angina, we wouldn't want to cut down on the medications."

"Yes, I understand that. They are contradictory, but they are nevertheless real."

"Let's start with your first concern. Why do you think you still have angina?"

"For two months now, ever since the angioplasty procedure, I have had consistent, unremitting pain in my shoulders and arms all the time.

So, the pain increases when you exert yourself?"

"Did I say that? Did I say anything about exertion? I said 'all the time.'"

"Well, I must tell you, Mr. Berner, I don't feel comfortable talking about reducing your medications under these circumstances."

"I beg your pardon?"

"I'm just not comfortable thinking about cutting…"

"Excuse me, Doctor. Let me assure you that my very lowest concern this morning is your level of comfort."

"What?"

"I'm a heart patient and I want to see my cardiologist."

"Is there some problem, Mr. Berner?"

"Yes, it's the same problem I told you about when I walked in here five minutes ago. I DON'T WANT TO TALK TO YOU. I WANT TO SEE MY CARDIOLOGIST, DR. JONES!"

Dr. Jones was quick to join us. He solved both of my concerns in one fell swoop.

"David, you don't have angina."

"I don't?"

"No. You have mialgia. The statin drug you are taking - simvastatin - to lower cholesterol levels is attacking the fibers of your muscles in your arms and shoulders and we're going to take you off it at once."

"That's great!!"

"O.K. Good."

"Two questions."

"Yes, David."

"Will I drop dead from heart attack as soon as I stop taking this drug?"

"No. Why would you think that?"

"Because all the literature that comes with these drugs says I might."

"No. You'll be fine. What's your second question?"

"Why was I taking this shit and putting up with constant pain for two months in the first place?"

Later, I apologized to the young resident doctor, admitting that, in spite of the sunny weather and the wonderful work I had been doing and the fact that I hadn't died on the operating table or needed a quadruple bypass and that I was swimming and playing tennis again and that my sex life had returned with a vengeance and that I had the great love and affection of friends and family, that in spite of all these blessings, I was suicidally depressed. And snappy. And ready to bite off the head of any poor, unsuspecting soul who might cross me. Add that I was a colossal pain in the ass and the first to admit it.

"BUT…you are the famous cardiologist, Dr. Jones and you told me right here in this office two months ago when we first met that I needn't worry because you were going to take care of me. So, when I come in here for an appointment with you after two months of unexplained pain and depression, it's you I want to see, not a resident."

It was at this point that Dr. Jones revealed that one of the other drugs I was taking causes depression and that we could now cut that one in half. And the 325mg. aspirin could be reduced to an 81mg. baby aspirin. And the Ramipril that I was taking for high blood pressure didn't need to be renewed when it ran out because, in fact, I've never had high blood pressure. Except, of course, when I don't get my princely way in a doctor's office.

Degrees of trust

In the weeks following this encounter - weeks, it should be told, of diminishing pain and sunnier dispositions - I thought about certain through lines in my life and I realized that I have always had an 'interesting' relationship with the medical profession. I am not madcap enough, hippie enough, revolutionary enough to assume that the medical profession is fundamentally corrupt and that only Echinacea and St. John's Wart will save me. Ninety-nine times out of a hundred, I am a compliant and obedient patient. Yes, Doctor. Thank you, Doctor. On the other hand, I am a thinking person and I do believe that this is my body and my life and sometimes I just simply cannot buy into the party line. Sometimes - not often, but often enough to have made a serious difference in my life experience - sometimes, I simply do not accept what the doctors are telling me. And that's when I have to make some difficult decisions.

Some stories to illustrate.

When I was five years old, I broke my leg. When the doctor was preparing to remove the full-length cast, he suggested to my mother that I should probably wear a special shoe. My mother went home and sought the advice of her father, a man who had come from Russia to sew furs together into jackets and coats in the back room of a shop on Portage Avenue in Winnipeg. My Zaida (grandfather) listened to my mother (May they both rest in peace.), took a drag of his ever present Players plain cigarette and said…

"Well, it seems to me that if David wears a special shoe, he might grow a special foot."

The shoe was a non-starter. Never happened.

In my early twenties, I had come to Vancouver to listen to jazz and abuse substances and swim in the streams of free love. Soon, my throat was closing and I was soaking through the bedsheets with a dangerously high fever. I was young and alone in a new city and I certainly couldn't claim a family doctor. I walked in off the street to someone's office near Broadway and Main. He told me at a glance that I had Bilateral Somethingorother, which was a fancy expression for Tonsillitis and that it was no problem. He could fix it right here in the office.

"Here? The office?"

"Oh, yes. We just use a local."

"A local anesthetic?"

"Sure. For the gag reflex."

I was so quick out the door, I may have left some of my essence in his chair.

I dashed back to my little apartment, looked up Ear, Nose and Throat magicians in the Yellow Pages, and, by the next afternoon, I was telling the kindly Dr. Badger in the old Georgia Medical Building my story. He just laughed.

"You know, David, most of my colleagues are idiots. They don't keep up with the journals. Here's how this works. First we put you under a general anesthetic. The, when you're asleep, we do add the local to stem the hemorrhaging in adult patients. Simple."

And that's exactly what he did. At St. Paul's Hospital, a few days later, they sent me shushy-bye-byes; I woke up, had some ice cream and went home. End of story. I still shudder thinking about a guy putting a needle into the back of my throat and then carving me up while I'm sitting in his office like this is a trim and a shave. I don't think so.

A shocker

In my mid-thirties, my aunt Toby phoned from Winnipeg to advise me that my mother's psychiatrist was considering Electro Convulsive Therapy for my mother. My mother was brilliant and wonderful and different. But she needed neither psychiatry nor shock so-called therapy. I asked Toby for the doctor's name and phone number.

"Ah, Mr. Berner, how may I help you?"

"Well, actually, Doctor, I've called to help you."

"Oh?"

"I understand that you are considering Electro Shock Therapy for my mother."

"Yes."

"O.K. I need to tell you something that I think you'll find useful and important. And I'll speak very clearly and slowly because I want to be sure that you understand what I'm saying."

"Alright."

"O.K. Doctor. Here's what you need to know. If you consider proceeding with this course of action - shock therapy, electro, or insulin, or any similar barbaric torture - there will not be enough insurance on this Earth for you to ever practice medicine again. You will be selling shoes at The Bay. All of your years of study, all of your memberships at the golf club and the curling club will be gone. You'll never pay off your debts. Doctor, did you understand what I just said?"

"Thank you, Mr. Berner."

My mother wasn't subjected to this or any other medieval torture disguised as help and she lived very happily and successfully in her own apartment for many, many years after this incident and died in her sleep sitting up in her favorite chair with a book in her lap.

Well, what do you know?

About eight years ago, my family doctor (a good man and a good doctor, who is still my family doctor) told me that a recent blood test indicated that I had "hyperparathyroidism" and that I should see an endocrinologist. The endocrinologist confirmed, after yet another blood test, that I indeed had hyperparathyroidism, and that I should hurry across the street to St. Paul's to see Dr. Cutter (I made that up.) to schedule surgery at once.

"Tell me about the surgery, Doctor."

"Well, Dr. Cutter will open up an area just below your throat where the four little parathyroid glands are. He'll find that one of them has a benign - never malignant -- tumor, and he'll cut that out and in six months you'll be better."

"Better than what?"

"Pardon me. Better than what? I have no symptoms of anything. I am asymptomatic."

"Yes…but when you get older, you could get osteoporosis."

"Ha! Isn't that a definition of old age, Doctor, osteoporosis? I most likely will get osteoporosis if I'm lucky enough to 'get older.'"

"Yes, that's true."

"Now, look, Doctor. Let me lay some cards on the table."

"Yes?"

"In the two weeks between the first time I saw you and today, I went to the library and I did some research."

"Really?"

"Yes. And this is what I believe I learned. Tell me if I'm wrong."

"O.K."

"First, you don't really know how the parathyroid glands work, do you?"

"Well…that's true. There's still much that we don't understand, yes."

"And second, hyperparathyroidism or its signs could be caused by aluminum toxicity. Is that right?"

"Yes, absolutely."

"Well, for many years now, Doctor, I have been chewing 2 Gaviscon tablets before I go to bed for a reflux stomach. And Gaviscon is loaded with aluminum. (In the intervening years since this story, Gaviscon has now been re-formulated without aluminum.)"

"Ah, I see."

"So, what is the alternative to surgery, Doctor?"

"Watchful waiting."

"Which means?"

"We take a look at you every six months or year and see how you're doing."

"Now, you see, Doctor, you're talking to a middle-aged, fearful, neurotic Jewish man. 'Watchful waiting.' Now that's a phrase I can embrace."

The moral of these stories is this: I may be a headstrong pain-in-the-ass; that's always possible. But, I am also involved in my own health care. I want all the information I can get. I want to understand to the best of my ability what the heck is going on. It's the only way I can make truly informed choices. Almost all of the doctors and nurses I've ever met are, quite simply, brilliant. And, like me and you, they can be fallible and wrongly informed on occasion. That's why it's my duty to KNOW.

David Berner is an actor and hosts a radio talk show on CKNW 980 AM weekends 3 to 6 p.m.  [Tyee]

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