As patients, we really just want answers. When my hunger pangs vanished (see previous post), I sat in the hospital waiting for follow-up cardiac testing. My mind became liberated to think of the possibilities of what my doctor would find or what would happen to me during the course of my evaluation. This is probably the hardest time to be a physician wearing the patient gown.
Ignorance is bliss, so they say. And they would be correct. As an emergency physician, I’m trained not just to recognize what my patient likely has, I’m also to be an expert concerning the worst possible diagnosis, and the worst possible complication. So, that’s how my brain is wired when encountering the health care profession as a patient. In most of these situations, armed with neurons that assess for every possible bad outcome, then, yes, ignorance would be bliss. However, it’s impossible to unlearn those many years of formal training and the experience that has contributed to the salt-and-pepper gray hairs on the side of my head.
As a patient, I was moved through normal hospital flow. I waited in the ED for more testing to be done. I was given updates about my tests. I was moved to PCU for monitoring overnight. I knew that a heart cath had my name on it the next morning. I was able to hold strong as family members came by. Then, I had time to sit and contemplate. What will my cardiologist find? Will there be a huge complication during the procedure? Surely not, they do these all the time.
At some point that evening, I got to speak to my 11 year-old son by phone. Keeping him in the dark may have sounded like, “well, they’re checking out my heart.” While I downplayed the situation, I did explain that the doctor was going to go in with a catheter to make certain my heart was ok, that my blood flow was good. He seemed to mostly buy my nonchalant description, until his voice cracked, and my voice, maybe, and then only ever so briefly, may have betrayed my confident exterior. Very, very briefly, of course.
The next morning, my cardiologist explains the risks of the procedure. I do this regularly with my patients to obtain informed consent. As a part his full disclosure, I am informed that my risk of dying during the procedure is less that 1 in 2,000 – 3000. That’s great, I think. Unless I’m the unfortunate 1. But, obviously I’ll take my chances and agree to proceed.
As I mentioned above, patients want answers. Doctors are not always equipped to provide those answers, despite the best of efforts. At the end of my evaluation, I was informed that my cardiac cath was normal. Normal? But, I had chest pain! While running! But, my EKG was abnormal! But, my heart enzymes kept rising! Nope. My arteries were normal. That’s wonderful news, but what landed me a night in this inn?
Maybe it was spasm of a small artery. Maybe it was a tiny tiny clot or plaque in a tiny tiny artery that we can never see by cath. Take an aspirin daily, and keep running.
While I’m not at all disappointed in the results, I can understand how a non-physician could be somewhat put off by such a huge ordeal resulting in no definitive answers. Me? I’m glad my arteries are clean. Knowing the piping is wide open, I was able to shave 24 seconds per mile off my personal record during a 4-mile run the following week.
So, when your doctor can’t find an answer, it may be because there isn’t one to be found. We aren’t gods, despite what our egos sometimes tell us. We can’t know every little thing that happened. What we can do is to try to make sense out of the information that is in front of us, and provide the most plausible explanation and treat accordingly.
These days, I run, I haven’t missed one dose of aspirin, and I try to get my patients food as quickly as is reasonable. Personally, I found food a double-edged sword. Once my hunger was gone, I lost enough distraction that I had to sit with my own doctor thoughts and consider the life-altering findings that were waiting for me the next day, or contemplate the endless complications that could leave me comatose or dead. Perhaps I would have been better off fasting.