View from the Other Side

I have a work routine. I dress in scrubs, sometimes a white coat. I talk with patients, extract their symptoms, do an exam and formulate a problem list. This is usually followed by ordering some labs, sometimes X-rays, and starting treatment. I chat with friends. I have my perspective, this is my side and that’s where I live.

I have never been a patient. I’ve never been on the other side. Until recently....

I was visiting my parents in Birmingham and we were having a "fun day". We ate greasy hamburgers for lunch, had afternoon coffee and met my sister and her family for some spicy Chinese food. Fun enough?

In the past few years I have had some stomach problems, initially self diagnosed as indigestion, later as gastritis and finally an ulcer. The cause of my stomach problem is all on me. Fast food is often my best option and I have a daily habit of a 6 pack of diet coke. Not to mention my job can be a little unnerving at times.

So on February 6th I woke up at two in the morning in excruciating pain. I basically felt like I had been stabbed in the stomach and someone was twisting the blade. I drank a half bottle of pepto, no luck. I took a Prilosec, no help. I drank milk. I drank water. I tried to make myself puke. Nothing helped and my pain was only getting worse. Changs sweet and spicy chicken is having its revenge. Damn the Asians!

It’s funny (not gay), when you are at your weakest moments, how your imagination can run away with you. Is it my stomach? It's never been this bad. Could be gall bladder. Could be a kidney stone. Probably not appendix, but could be. This is killing me. Could I have a gall stone lodged in my common bile duct? Possible. Could I be developing pancreatitis? That's really pain full and this is really pain full. That could mean surgery. Could I have a perforated ulcer? This is actually my worst fear. That's definitely surgery. This is not going well.

So I come to the first decision every person on the other side (the patient) makes. They decide to come to the hospital. This was not as easy as I thought.

It's the middle of the night. I'm not at home. I am about to ask my 74 year old mother to drive me to the ER. I'm in agony. This completely sucks. After 30 more minutes of anguish I decide there is no other option.

I have one friend who practices in Birmingham. I call and of course she is not on shift. At this point is doesn't matter. If I am leaking my stomach contents into my peritoneum there is only one place I'm going in Birmingham: UAB.

I arrive and am quickly triaged. I go straight back. (Usually not a good sign). I meet Dr. Buckman. He is about my age. He knows I am a fellow pit doc (that's slang for ER doc. If you really want to be in the know refer to the ER as "the pit". Usually because the ER is always located on the bottom floor of the hospital but also considered by many as a place of primordial ooze that some of the most basic forms of life miraculously survive. Anyway, it is 4am now and Buckman looks a little tired. I give him a succinct story about my symptoms but leave out my list of possible diagnoses. That's his job. I should stay out of the way.

He examines me and says "I think you've got a perforated ulcer". Oh great! This Buckman is a real wordsmith. So much for sugar coating.

That means major surgery. I'm 300 miles from home. I've got obligations this weekend and I'm back on schedule in the ER starting Monday. I am not prepared for this and my entire career is based on being prepared for an emergency. It's just not a good time.

Buckman plays his trump card, "Well, if you've got it, there are no other options."

I know he's right. There is an unintended psychological warfare going on in the hospital. I am in severe pain. I have on a hospital gown and a pair of boxers. One person walked in while I was changing and I'm pretty sure at least 3 people saw me naked. But since I've got this burning fire poker in my belly, I could hardly give a care. I'm pale and feel lousy. I don't know any one's name. Someone whom I have never met and who has never met me could be opening my abdominal cavity in the next few hours. I am at their mercy. I feel helpless.

So to make a long story short, I ultimately did not have a perforated ulcer, just an ulcer. I got outstanding treatment and was discharged in a much improved condition.

As for my treating physician, Dr. Buckman was a flat out stud. I knew he was concerned. Not by what he said but by what he did. He showed up in X-ray after I had my films done. Later I saw him again in the CT scan control booth looking at my images as they were being developed. He didn't have to do that, but he knew that something could be bad and he didn't sit around and wait on the answers to come to him. He actively sought them out. It's those kind of actions that separate the great from the good.

Barbara, my nurse, was fantastic. Like all great ER nurses she has the most face to face time with the patient. She started an IV, was quick with the meds and double checked the doses at the bedside in my clear sight. I only got a small dose of pain medicine (my request) but she hooked me up to the monitor just to be safe. I (and she) knew that probably wasn't necessary but still it was comforting. She wasn't taking any chances and I really appreciated that. I joked with her and she joked back. I was facing a crisis but I was confident she knew my case and was looking out for me. She was a pro.

There is a thing called "The Patients Bill of Rights". As a physician, I have always rolled my eyes at this idea, thinking what is the point? I am on the patients side. I want to get the diagnosis right. I want them to get the right treatment. But now I know the Patients Bill of Rights is not about me, it's about the patients' trust.

So I have written the ER Patients Bill of Rights:
1. The Patient has the right to be afraid. We know that you don't know us and that is naturally frightening in this critical time.
2. The Patient has the right to be believed. I will believe you are sick.
3. The Patient must know that the doctors and nurses are asking them for their trust.
4. The Patient must trust that I will do the best for you to come up with the right diagnosis. Not of of fear of being sued, but because I want you to get better.
5. We (including you) are part of a team. We must all work together and do our best to solve this problem.

*This Bill of Rights may not apply to everyone. If you come in weekly and have cried wolf too many times, you have betrayed our trust. And this is a two way street.

So what have I learned from being on the other side?
It's miserable. But when it's miserable I want to be the kind of doctor that (and I can't believe I'm saying this) is a comforter. It's not just getting the diagnosis and providing treatment. It's about reaching out and really helping someone in a time of need.