The Yale Journal for Humanities in Medicine
When Doctors Are Patients
Robert Scheig, M.D.
How times have changed! Superficial thrombophlebitis of my right calf in the 1960's was treated with 7 days of strict bed rest in hospital accompanied by warm soaks four times daily. Anticoagulation was begun with intravenous heparin and continued with coumadin for a year. The risk of a pulmonary embolus with its sequelae such as sudden death hung over the "informed" patient.
Wrong! Today an aspirin or, possibly, if terribly painful, a day or two of butazolidine, and it is over. Risk of emboli with superficial thrombophlebitis is virtually zero. I've now had about eight attacks, never went to bed, didn't even take an aspirin and am none the worse for wear. Until the last episode, recanalization of my varicositys took about three months. After the last bout the varicosities disappeared. I have no edema and only mild stasis dermatitis. My leg has no hair from wearing Jobst stockings for about twenty years. I no longer wear them. Four years ago I broke my other leg and was in a lower leg cast for the appointed time. Since, that leg has developed rather extensive stasis dermatitis and 2 plus edema. I'm told that is due to the fact that thrombosis of small veins occurs when in a cast. If so they surely did not recanalize in my case.
I did learn some lessons. I learned to shave an arm before putting on that old style tape. I learned that the use of a bedpan is no trivial undertaking, requiring great strength and balancing skills. Bedside commodes thereafter became my order of the day for my patients. Warm soaks kept on too long (as they almost always were) turn to ice. When I used them in the future I instructed the patient when possible to remove their own soaks when the heat had dissipated, as one could not rely on the nurse returning in time. I also learned how weak even a healthy person can get after such a short period of bed rest. At the time I did not realize the risks of long-term anticoagulation, but because I've carefully followed that literature since, I have learned that lesson well.
My physician was terrific. He visited me daily and kept me informed of everything that was going on. Knowing my paranoia, he told me on admission that I did not have cancer of the pancreas. Of course not, silly one. The phlebitis was not migrating nor in an unusual place. But how did he know and why did I accept his supposedly informed opinion. Perhaps because you are reading about probably the only person who, the one day of his life did not have a bowel movement, formed a differential diagnosis that included only cancer of the colon. It led to my first sigmoidoscopy - with a rigid tube - the very next day. My only excuse is that this event occurred while I was only a medical student.
In contrast to my physician, the house staff was scared to draw blood, take a history or do a physical. What should be done in an academic setting under those circumstances? Of course! Assign the case to a third year medical student! He (there weren't many female medical students in those days) was terrific. He took a super history, performed a great physical exam, of course with rectal, and hit my vein on the first stab. I've had a number of physicians as patients over the years and he taught me to treat them like any other patient. I also explain things to them in the same way and in the same detail as I do any other patient because they are as scared of disease as the next person and want someone else to think for them about their problem. In 1991 I experienced a much more serious problem. My wife was to attend her first national meeting to be held in Atlanta, Georgia the weekend of my 60th birthday. We decided, therefor, to spend the preceding weekend celebrating my birthday by going to Ithaca, NY to explore the city and Cornell, have some good food and wine, and stay at the Rose Inn, a well-known bed and breakfast. Friday night we went to a charming seafood restaurant and Saturday lunch a Spanish restaurant where we had a lovely flight of white wines to accompany our food. That night was to be the gourmet meal at La Couchon Rouge. I had ordered some clams and the sweetbreads. Between the appetizer and the entr=E9e I felt cold. When my wife said she was not cold I knew I was in serious trouble as I am always warmer than she is. The shaking chill confirmed that impression. I had to be helped to the car. Of course I said I would be ok and did not need to get medical attention. However, all the way back to the Inn I kept taking deep breaths and saying to myself "I don't have Jim Hensen's disease. I don't have Jim Hensen's disease." I had drenching sweats through the night but the next morning, while a bit weak, I felt well enough to drive most of the way back home to Buffalo. There, a surprise birthday party arranged by my wife and set up by her sister awaited me. I worked the room of 50 people pretty well, but was glad when they left, and went to bed early. I went to work the next day, had a couple of out of town trips including the trip to Atlanta. About a week and a half later I began having some tenesmus and frequent small bowel movements. By the beginning of the third week I felt sick, did see my physician, was scoped and put on antibiotics for what was thought to be acute diverticulitis. I went to bed took only clear liquids and began to develop a fever. After three days I seemed to be worse and went back to the hospital to see my gastroenterologist to be worked up. Over the next very few hours I was found to be obstructed by physical examination and radiological evaluation. I was explored and found to have a huge abscess from the diverticulum I perforated at dinner three weeks before. It was obstructing me at the level of the sigmoid colon. A partial resection and a diverting colostomy were performed in a 5-hour operation. My albumin on admission was 1.2! Talk about hypercatabolic! Six month later I was readmitted to be reconnected which was to be a snap of an operation. After about three hours the surgeon came out to tell my wife he wasn't sure he could bring the two pieces of bowel together again. Knowing my penchant for food and wine, my wife merely responded "If you don't, you'll have to tell him!" Four hours later I was hooked up.
What were some of the lessons?
First, doctors are often stupid about themselves. On any other person I would have made the diagnosis of sepsis in someone with the sudden onset of shaking chills, fever and sweats. Jim Hensen had just died so I narrowed my differential to Staph or Strep pneumonia and when I could breathe ok I ruled out that diagnosis without entertaining another. Although there was no abdominal pain at any time, the marked change in bowel habits, the tenesmus and the fever should have steered me to a diagnosis of a perforated colon. I doubt I would miss it in a patient. Of course my wife will never again listen to me when I say I don't need to see a physician. She has even made me get an annual physical every year since then.
The last few hours before the first surgery were sheer misery and I truly learned the efficacy of intravenous morphine. It truly does relieve pain and suffering.
Hospitals are horrible places to be sick and sometimes the people working there are quite sick. On admission, in great discomfort and with IV running, my admitting nurse observed that "It's good that doctors get sick once in a while. It'll teach you what patients feel." When I asked if the antibiotics had been put in the IV, she replied that at this hospital they wouldn't get there for 8-12 hours. Despite being semi-delirious, I put in an emergency page for my doctor. Fortunately he was and is a fiery Brazilian. The antibiotics were there in 10 minutes and I never saw that nurse again. I learned from this never to rely on others to carry out orders that I deemed needed to be carried out stat.
I learned that the morphine pump is a marvelous instrument. I used much less narcotic than I would have had it been ordered routinely. I learned that functioning with a colostomy is a breeze. I'll talk to anyone who needs to have one. In 6 months I had only one accident. The only other misadventure came when my 35-year-old son came to visit. He wanted to watch me change bags. He came into the bathroom with me and when I removed the bag and he viewed the stoma of the colon he fainted dead away. No one could help me get him up because his inert body was blocking the door.
I learned to get rid of gas while walking down the street and was comforted that I could, if I didn't like someone, pass gas in their face if I wanted to do so.
I learned once more how much my wife loved me and it strengthened our marriage even more than it had been. She, who has the greatest abhorrence for blood, pus, excreta or other things gut doctors hold dear, nursed me and never was deterred by the appliance attached to the front of me. I learned after major surgery that it takes a year to fully recover; though one is 90% there in about 3 months. I do indeed believe that there are some lasting effects from anesthesia. I was increasingly forgetful for a year and twice lost my keys, once after entering my own home. I never did find them even though I asked for help from Saint Anthony many times.
Once put back together I learned that I required Metamucil or Fibercon for about 6 months to give bulk to the stools. Starting at 4-5 pills per week and then tapering, Imodium was of great benefit but I needed the fiber and the Imodium for only about 4 months. Our bodies do adapt to many things!
I do not believe that physicians need to have illnesses themselves to have compassion and understanding of their patients. I do believe, however, that if they are observant when they are ill they will be able to learn lessons that they will be able to apply to the care of their patients in the future. I certainly can describe to medical students rotating with me exactly what thrombophlebitis and intestinal obstruction feels like. Indeed, I can do so better than any description that I have read in any textbook.
Published: May 8, 2000