I was chatting with a colleague at a birthday party the other day. This physician said something interesting. His wife added to it. They mentioned how he does not list his telephone number in the phonebook. He tries to avoid going to the grocery store at peak hours. He chided his wife because she bought some tobacco at the checkout counter. She was buying it because someone had suggested putting it around her plants to make them grow better. She wanted to try that out. He was afraid of being recognized and what people might think.
As I finish my second year in practice after residency, I am beginning to understand. Being a doctor is a 'full-time' job. It is however, more than that. One's patients view one as someone with whom they can share their suffering, pain, fears, depression and the medical problems that may be the cause of the result. Often, people are inclined to run a medical problem by you. Family and friends count on you as their go-to person for medical problems. Even if they don't, as a medical profesional, one feels obliged to pitch in and help. Slowly, one's identity in the eyes of many merges with one's profession of being a physician.
As a person, one may want to protect some time 'away' from this identity. As a medical student and resident, I often wanted to be known as a doctor in public so I could help if it was needed. I often wondered why older physicians tended to be more discrete about their identity as doctors. I misinterpreted this as their unwillingness to step up to the plate and help if needed. I now know that this is not true. I have seen doctors quietly come forward and do what needs to be done. I guess I understand now that sometimes a doctor wants to just be a regular person and not feel the weight of being the reliever of suffering or the sympathetic listener or the ...doctor. Most physicians struggle with guilt, as it is, that they are not doing enough for their patients or they are not sympathetic or empathetic enough. So this is difficult to talk about. It is an internal conflict between the desire to be there and make a difference and the need for recharging one's own reserves. I think this is why doctors are private people. My number is still in the phone book.
Saturday, June 18, 2011
Cystic fibrosis
One of our beloved physicians retired. He used to (single-handedly) take care of the cystic fibrosis patients that come to us for their care. After he left, we decided that the kids would be cared for by one of my pediatric colleagues, while I would take over the care of the adults.
I had taken care of CF kids during residency. I thought I knew what I was getting into. I had never been involved with taking care of them as adults.
Cystic fibrosis, for those who do not know, is a genetic disease cause by a mutation in a gene that codes for a chloride transport protein. It manifests as increased, thickened mucus in the lungs, sinusitis, diarrhea (from destruction of the pancreas, so it does not make enough digestive enzymes) and often sterility. Because of its genetics, there are often multiple members of a family with the disease. They need frequent hospitalizations -- at least twice a year -- for intensive antibiotics, chest physical therapy, oxygen therapy and pulmonary therapy.
The first patient I got to care for in the hospital was a pleasant 40-something female. Her lung function tests indicated she was advanced in her disease. In the 'old' days, CF patients would die before reaching adulthood. They are living longer. However, by the time they reach their 40s, they die if they do not get a lung transplant. Studies focus on pulmonary function tests (PFTs) and have correlated FEV1 (measured in percentage of predicted) with life expectancy. A FEV1 of less than 35% indicates a life expectancy of less than 3 years generally. When I admitted her for her bi-annual CF 'tune-up', we got a PFT. Her FEV1 was about 25%. That meant that without a lung transplant she would die in a year. I could see the terror in her eyes. There was no hiding her fate from her. She knew her disease, had watched siblings die and knew the end was near.
Fortunately, she was put on the transplant list and received her lung transplant in time. I had the pleasure of taking out her sutures in the office a few weeks ago and listened to clear lungs.
Another CF adult I inherited was a wayward 20-something. He had had the misfortune of having a childhood cancer, in addition to being the only one of several children in that family with CF. This young man was not very interested in CF bi-annual hospitalizations. He had not come since he was 16. In the years that followed he developed a dreaded lung infection with a bacteria called Burkholderia. This organism is so deadly that CF patients with it are not allowed to attend Cystic Fibrosis meetings for fear that others with CF will contract the infection and may die from it.
I did his PFTs and they had declined from the 70s to the 50s in the space of 4 years. I had to sit him and his parents down and have a hard conversation. I pointed out that at his rate of decline and with Burkolderia, if he continued to live as he did, he would be dead in about 5 years. I had his parents in tears, while the patient looked stoically on.
Fortunately, he stayed the length of time in the hospital and we got his PFTs up to the 80s by intensive antibiotics and much needed pulmonary therapy, with which he cooperated and complied. We pushed death back, I think.
With kids with CF, it was bi-annual CF tune-ups and antibiotics. With the adults, there is watching the PFT decline predictably and waiting for death. I had not expected to be dealing with that. Still, I will care for them -- encouraging, goading, exhorting, doing whatever it takes to extend life.
I had taken care of CF kids during residency. I thought I knew what I was getting into. I had never been involved with taking care of them as adults.
Cystic fibrosis, for those who do not know, is a genetic disease cause by a mutation in a gene that codes for a chloride transport protein. It manifests as increased, thickened mucus in the lungs, sinusitis, diarrhea (from destruction of the pancreas, so it does not make enough digestive enzymes) and often sterility. Because of its genetics, there are often multiple members of a family with the disease. They need frequent hospitalizations -- at least twice a year -- for intensive antibiotics, chest physical therapy, oxygen therapy and pulmonary therapy.
The first patient I got to care for in the hospital was a pleasant 40-something female. Her lung function tests indicated she was advanced in her disease. In the 'old' days, CF patients would die before reaching adulthood. They are living longer. However, by the time they reach their 40s, they die if they do not get a lung transplant. Studies focus on pulmonary function tests (PFTs) and have correlated FEV1 (measured in percentage of predicted) with life expectancy. A FEV1 of less than 35% indicates a life expectancy of less than 3 years generally. When I admitted her for her bi-annual CF 'tune-up', we got a PFT. Her FEV1 was about 25%. That meant that without a lung transplant she would die in a year. I could see the terror in her eyes. There was no hiding her fate from her. She knew her disease, had watched siblings die and knew the end was near.
Fortunately, she was put on the transplant list and received her lung transplant in time. I had the pleasure of taking out her sutures in the office a few weeks ago and listened to clear lungs.
Another CF adult I inherited was a wayward 20-something. He had had the misfortune of having a childhood cancer, in addition to being the only one of several children in that family with CF. This young man was not very interested in CF bi-annual hospitalizations. He had not come since he was 16. In the years that followed he developed a dreaded lung infection with a bacteria called Burkholderia. This organism is so deadly that CF patients with it are not allowed to attend Cystic Fibrosis meetings for fear that others with CF will contract the infection and may die from it.
I did his PFTs and they had declined from the 70s to the 50s in the space of 4 years. I had to sit him and his parents down and have a hard conversation. I pointed out that at his rate of decline and with Burkolderia, if he continued to live as he did, he would be dead in about 5 years. I had his parents in tears, while the patient looked stoically on.
Fortunately, he stayed the length of time in the hospital and we got his PFTs up to the 80s by intensive antibiotics and much needed pulmonary therapy, with which he cooperated and complied. We pushed death back, I think.
With kids with CF, it was bi-annual CF tune-ups and antibiotics. With the adults, there is watching the PFT decline predictably and waiting for death. I had not expected to be dealing with that. Still, I will care for them -- encouraging, goading, exhorting, doing whatever it takes to extend life.
Time off - part 4
Here is Piyali, Simon and me at the exit of the cave.
The next day, Piyali took me to see Marshall University. We drove around Huntington and she showed me the stadium (of 'We Are Marshall' fame). Here she is in front of the Marshall University buildings where we going to see Simon and her labs.
It was a true 'vacation' for me to 'forget' medicine for a while and immerse myself in science. Simon patiently walked me through his research. He works on cell communication in Drosophila. Here he is in his lab, 'posing' for my photo -- looking at his beloved Drosophila.
After we finished with his lab, we went over to the medical school and checked out Piyali's lab. She showed me her research work. Here she is at her lab work bench.
The next day, Piyali took me to see Marshall University. We drove around Huntington and she showed me the stadium (of 'We Are Marshall' fame). Here she is in front of the Marshall University buildings where we going to see Simon and her labs.
It was a true 'vacation' for me to 'forget' medicine for a while and immerse myself in science. Simon patiently walked me through his research. He works on cell communication in Drosophila. Here he is in his lab, 'posing' for my photo -- looking at his beloved Drosophila.
After we finished with his lab, we went over to the medical school and checked out Piyali's lab. She showed me her research work. Here she is at her lab work bench.
We had a wonderful tirpanyaki lunch at a Japanese restaurant down town.
It was a short break, but lots of fun.
Time off - Part 3
Stalagtites and stalamites join to form pillars, here's one :
Our next stop in the national park was a natural bridge. This is -- as the name suggests -- a bridge over a river or stream that formed naturally. Here it is:
The ceiling of this bridge was spectacular. Here it is:
At the end of that day, we all came home and slept well. It was a fun day.
Our next stop in the national park was a natural bridge. This is -- as the name suggests -- a bridge over a river or stream that formed naturally. Here it is:
The ceiling of this bridge was spectacular. Here it is:
At the end of that day, we all came home and slept well. It was a fun day.
Time off - Part 2
Huntington, West Virginia is at the edge of the border of West Virginia, where it joins Kentucky and Ohio. In fact, downtown Huntington is at the edge of the Ohio river and one can stand on the bank of the river and see Ohio on the other side. This is me standing with Ohio in the background.
The second day of my trip, Piyali, Simon and myself drove to Kentucky to the Carter Caves. This was the entrance to cave we went into and our guide. I LOVED the accent of the Kentucky folks!
The cave was beautiful with many natural formations related to the process by which caves are formed. Here is one.
Caves are formed by stalagmites and stalagtites -- limestone dissolving in the water and forming extensions of the ceiling and floor, respectively.
These are stalagmites.
The photo below shows a large stalagtite.
Here is Piyali and Simon inside the cave.
More in Part 3
More in Part 3
Time off - Park 1
During the Memorial Day weekend, I had time off. So, on Saturday morning, I jetted off to visit a friend I had never actually met in person. Piyali Dasgupta have been friends for about 10 years now. We talked on the phone and emailed each other through the years -- she living in various places in the U.S. pursuing her career and me going through medical school, residency and now working here. She recently bought a house and invited me to visit. I was looking forward to meeting her in person. Both she and her boyfriend are professors at Marshall University, so a side treat would be to visit their labs and learn about their research.
Piyali has a beautiful house in Huntington, WV. She told me that the state bird of West Virginia. On her back porch, she has a bowl of birdseed and practically all day, I could see these beautiful birds come to feed. They were very shy so photographing them was difficult. This is the best I could do.
This next picture is taken through the netted window.
More in Part 2
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