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Friday, January 16, 2009

Sometimes Being Sick Helps

We like to keep our personal lives and even our daily professional lives to ourselves instead of filling this blog with soap opera like ramblings. But there are times when the examination of self in response to our work as palliative care professionals becomes poignant. (For the best example read Drew's Old Milwaukee and Art Therapy post from Pallimed: Arts & Humanities*)

This past week I was sick. Very ill. In fact my whole family was ill, but my body faced the brunt of the symptomatic onslaught.

Fevers, chills, sweats while wearing sweats, and then having to get out of my sweats because of the sweat; anorexia (not nervosa) but with plenty of nausea (not vomiting), ageusia (lack of taste (for food not fashion)), odynophagia, dysphonia, insomnia, headaches. Weakness or asthenia, it really is all the same. Cough, ahem, with little production. Apathy and body aches, but nothing really hurt. Xerostomia, why did I once call you my favorite symptom? Forgetful and occasionally mildly confused with no sense of time, I was a living breathing review of systems.

And of course it was not any one symptom individually it was a recording studio soundboard of switches, dials and slides, varying the intensities to torture me all the more. As a movie finally ended and the room became more quiet, my mind attempted to rationalize and explain all my symptoms, and even somewhat delusionally made an appointment for me, the patient Sinclair with my alter ego, the Doctor Sinclair.

Doctor Sinclair: I am a symptomatologist, a palliativist if you will. I help other people feel better even when there is nothing you can do to alter the course of a disease. Do you have pain?

Patient Sinclair: No not really.

Dr: Are you hungry?

Pt: No not really.

Dr: Are you nauseous?

Pt: Not unless a food commercial comes on the tv, or my brain tortures me with thoughts of food.
Dr: Are you hungry?

Pt: No, and that is fine with me.

Dr: Well how can you help you, the other part of me?

Pt: You can just stop talking and leave me be.

Dr: Oh you must be depressed.

Pt: No just leave me alone.

As I processed this internal dialogue it became obvious how many times I have had this conversation before with patients. This revelation of how bad it can feel to be ill or to be dying since dying encompasses many of the same symptom, and feeling impotent, because there is no one symptom that trumps them all; this revelation is powerful to those attempting to heal others. In medicine, It can be helpful (but not neccessary) to feel the loss of your health.

In medical school, I suffered an intense but limited GI virus with plenty of vomiting. I had to skip a couple of my ED shifts, but when I came back and saw my first patient who had also been vomiting, my demeanor changed. No longer were my first thoughts penetrated with a clinician's diagnostic approach: How often? How much? Was there any blood?

I paused and offered a brief, "I'm sorry that happened. That had to be rough." After a smile and nod of validation from the patient, I continued. "May I ask you some questions so we might help you feel better?" From that began a new way of looking at the therapeutic relationship beteween doctor and patient.

So in my recent illness, while I cursed my microscopic enemies, I am also grateful for the occasional (but not too often, OK?) reminder of what it is like to lose your health. Paradoxically, my first day back today was as refreshing to my professional duties as coming back from a vacation.

*There are a lot of other good posts on Pallimed: Arts & Humanities too, so if you have not checked it out recently head on over, you will be pleasantly surprised.
**Per HIPPA law both patient Sinclair, and Dr. Sincair signed a relase form for this post.

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