Reflection

My preceptor for the afternoon was a female surgeon, obviously supremely competent and almost aggressively confident.  Her black pumps came to a sharp point at her toes and her black hair was pulled back into a no-nonsense ponytail.  As the medical student assigned to her for the day, and on only my third day of rotations, no less, I sensed right away that I could only hope to stay out of her way and not piss her off, at best.  But I needn’t have worried; she hardly seemed to register that I was even there.  This made for as close to the ideal fly-on-the-wall observation opportunity as I was likely to ever have. 

~ ~ ~

The patient was a gentleman who came in with his wife.  They were an extremely gracious, polite, and terrified-looking middle-aged couple.  The wife was slim and fragile; she wore a form-fitting, animal print sweater on top of slim-cut black pants.  Her jewelry looked heavy and expensive.  Her makeup was just slightly too enthusiastically applied; her heavy black eyeliner made her large eyes stand out even more, and meticulously applied lipstick tried hard to make her thin lips look fuller than they were.  He was soft-spoken and nervous, although he seemed like the kind of person who would not naturally experience nervousness often.  His impeccably ironed button-down was tucked into blue jeans that fell to spit-shined loafers and his thinning hair was parted deeply to the side and carefully combed.

The surgeon introduced herself, and the wife spoke first.  Her words rushed over each other.

“Thank you so much for seeing us, we are so glad to meet you.  We just have so many questions for you.  I have been doing some research online…” and she pulled out a stack of articles she’d printed off, all manner of information from all manner of sources that likely ran the gamut from reputable and reliable to the opposite of reputable and reliable.  She’d read everything she could find about her husband’s thyroid cancer.  She was as familiar with the basics of different treatment options as she was with the horror stories – the worst outcomes conceivable, both actual and imagined.  Her hands fluttered as she spoke, flipping through the deep pile.

The surgeon all but rolled her eyes as she opened the patient’s chart on the computer in the room.

“Alright, when do you want to schedule the surgery?”

“So, will you be the one doing the surgery?” the wife asked.  The surgeon nodded over her shoulder, saying yes without glancing up from the chart. 

“Oh, we have just been so worried ever since his biopsy came back positive.  We aren’t sleeping, we aren’t eating… it’s been two weeks, and both of us are losing weight…” the wife’s brow wrinkled and the already-red rims of her eyes now brimmed as she exchanged glances with her husband.

The surgeon spun around.

“What are you worried about?”  The question did not sound kind.

The patient and his wife both stopped, taken aback.  They looked at each other and then at her, expressions bewildered.  “Well…” he started, and paused for breath.

“It’s cancer, right?” his wife said, her voice betraying her confusion.

“Yeah, and we just take it out, and it’s fine,” the surgeon made no effort to slow down or modulate the tone of her voice, to accommodate for the fact that her patient and his wife had misunderstood the nature of his disease, to allay their worst fears or take the time to provide reassurance.

Such was the couple’s relief upon hearing for the first time that they didn’t need to worry and that everything would be alright that not even the surgeon’s bungled delivery could overshadow it.  She hardly spent five minutes with them, making sure to get consent for the surgery and a date agreed upon.  They both thanked her profusely as she shook their hands cursorily and walked out; they even thanked me, the silent bystander, smiling gratefully, tears in their eyes.

~ ~ ~

As I watched this scene unfold, cringing inwardly and feeling badly for this sweet couple and the brusque treatment they received at the hands of their surgeon during a very distressing time, I realized something else: it was entirely possible that the surgeon did not even realize what was going on. 

There was no extra reassurance that everything would, in fact, be all right.  There was no recognition that getting a positive biopsy report must have worried them, no validation that the word “cancer” carries frightening implications.  No comforting after what had obviously been a harrowing two weeks.

It might have been that the surgeon had had a bad day, or week, or year; doctors are human, after all.  It might have been that the surgeon did realize that this couple had simply not been well informed and that, for whatever reason, she just didn’t have the time or the patience or the emotional reserves to treat the case with the care it deserved.

But it might have been that she wasn’t just refusing to gently explain to her patient and his wife that the cancer was not life-threatening, that it was totally curable, but that they had been rightfully distraught by a scary-sounding diagnosis.  Indeed, it might have been that she noticed none of the subtext.

In the end, I am not sure that the reason matters.  It was a missed opportunity to really connect with and care for her patient.  She will no doubt be able to remove his cancer and help him make a full recovery.  But she will not play any part in his healing.

~ ~ ~

Easier said than done.  A truism in most circumstances, and I will humbly admit that it is almost certainly truer in this situation than many others.  Without a doubt, my current vantage point makes it much easier to see patient interactions with greater perspective.

In these first few weeks of clinical rotations, I have often made mental notes to myself regarding physician behavior.  Some of those notes have read like this: remember this!  DO THIS when you have patients of your own!  And some of them go something like this: do not EVER treat a patient this way.  Oh, and try not to let anyone else around you treat patients this way, either.

Hopefully, these observations will become valuable lessons.  Because if I don’t learn them, then my time and purpose in going to medical school will truly have been wasted, and the reasons will have nothing to do with whether or not I will be able to cure my patients’ medical ailments.