My best friend has never read a medical textbook, yet his story reads like a board question. "A 38 YO male with no PMH except for a congenital bicuspid valve develops fevers chills and night sweats over a four week period. He has had no recent travel or known exposures. Recently he went to the dentist for a routine cleaning …"
Like my friend, most hospitalists are in our 30s, successful by most definitions and consider ourselves to be healthy. Unlike my friend, we are familiar with death and illness, acclimated to a confusing health care system, and accustomed to watching our patients be assaulted by diagnostic and invasive procedures.
I first got involved in my friend’s saga when he texted me on his return from his internist’s office. "He doesn’t know what it is – he called it, ‘fever of unknown origin’, which I think is hilarious (reminds me of ‘Rodents of Unusual Size’ from Princess Bride). He said that I will just have to keep taking tests until they find it."
He called a few days later: "I talked to the doctor this morning and they said that my blood culture did come back positive for COCCI (whatever that means)." He was told to see an infectious disease doctor and had a transthoracic Echo ordered, which was reported to be normal. But the next day …
"They clearly saw a bacterial infection on my mitral valve during my TE echo today. They sent me home and told me to stop all antibiotics and eventually I’ll fight it off. Kidding of course – they’ve admitted me for tonight and we’re waiting for the infectious disease specialist to call back and give the order for the IV antibiotic."
He was sent home on daily IV ceftriaxone. All was well until the following Sunday when he called me because he developed red spots and pain in his feet.
Later that day he texted me from the ED: "I am throwing emboli and they are worried that a couple have hit my brain. I had a cat scan and they were concerned about the results, so now I have to have an MRI. Why I didn’t just have an MRI to start? Sometimes I can’t help but think it’s part of the conspiracy to have me see every doctor in the place, have every possible test and milk every dime from my insurance company (which will in turn bleed me slowly for every dime lost). I’m trying not to be cynical – the care here is excellent and everyone has been great – I just keep having this sinking feeling that I brought the car into the mechanic for a new muffler and I’m ending up with a rebuilt engine."
The next day: "This CCU is really scary. People have died on this floor this week and there are some very feeble grandparents hanging on for their lives. Sometimes if I concentrate, I can see the Grim Reaper himself walking up and down the halls, tapping his scythe on the linoleum … tap, tap, tap … tap, tap, tap. It is very annoying. So far he is ignoring me. This lady down the hall just went through a ‘code blue’. I heard a nurse cry for help and six nurses sprinted down there. I think she made it and Mr. Reaper has to bide his time."
On Tuesday: "I have been put through the ringer with these tests, etc.: 4 regular echos, 1 TE echo, 1 head cat w/wo contrast, 1 abdominal cat w/wo contrast, 1 MRI w/wo contrast, 4 x-rays, 1 picc line, Too many blood tests to count, Too many IVs to count. It really drains you after a while. I can’t imagine how much worse I would feel or what kind of shape I’d be in if I were 30+ years older (which most people are on this floor). I really feel sorry for them. I wonder if a practice could be started simply to help elderly patients through an ordeal like this – protecting them from unnecessary tests and procedures and using strategies to help make it a little easier … So far I’ve been able to shoo Mr. Reaper down to the other end of the hall."
On Wednesday, his surgeon takes him to the OR and salvages his valve. To my tremendous relief, here’s the next text I receive: "Dr. Smith [name changed] saved my life and my valve. Move over Johnny Bench….I have a new #1 hero."
As physicians, we probably don’t spend enough time thinking about what it would be like to walk in our patients’ shoes. Perhaps this is a normal and even healthy defense mechanism, given the nature of our jobs.
However, this odyssey struck a chord with me for reasons other than the fact that the shoes being walked in belonged to my best friend. I was impressed by how obvious it was to a young, otherwise healthy person that it would be phenomenally difficult to navigate illness if one were elderly and infirm.
We can’t overestimate how important it is to make every attempt to explain disease and treatment options to our patients. As my friend alluded to, and I am ever so cognizant of when my car needs repair ("So I need a new alternator, distributor cap, PCV valve and gasket? Sure – I’ll take three."): Nothing breeds hopelessness more than the feeling of loss of control. Obviously, we can’t mitigate much of the helplessness that severe illness brings, but we can’t lose sight of how important it is to explain why an extra test was ordered and how potential results will alter treatment.
Finally, my feelings mirror those described by Capt. Chesley B. Sullenberger II, the pilot who successfully landed his wounded plane in the Hudson. He said, " …the most touching sentiments I have received have been from other pilots. …. they have not felt proud to go to work – some of them for decades. Now, they tell me, they do."
While being a physician is still arguably the most respected job in this country, the merger of the practice of medicine with the business of medicine has taken a toll on most of us and, unfortunately, on our patients. The doctor who saved my friend’s life reminds me that my life’s commitment, caring for patients, could not have been more wisely chosen.