Private Practice: The First Day - Conclusion: Patients Please!
We could never learn to be brave and patient if there were only joy in the world. -Helen Keller
As gorgeous afternoon clouds slowly tumble across the sky, sending playground lovers and other dreamers outdoors, we find our narrator trapped inside the cheerless halls of his office, struggling to finish this first day of the rest of his life, as it were…
Always one for gunnery sergeant-like efficiency, I like to read the charts of patients scheduled to see me in the office that day. I find it helpful in refreshing my memory and tracking down the little details of a case that may have been misplaced, such as labs, radiology reports, consults, H & Ps - even the charts themselves, contrary to what Mom always told us, sometimes get up and walk away, causing the doctor to sprinkle the air with certain agrarian phrases best left in the pigpen. One is always better off preparing for such contingencies in my opinion. Check, check, and double check - that’s the smartest motto.
Unfortunately on my first day in the office this little bit of clever thinking had about as much chance of reaching consciousness as the solution to Fermat’s last theorem. I stumbled into room after room with no clue as to what was really going on with my patients. For example, the first person I saw was a woman my partner had “referred” to me (just to give me something to do, I guess). She sat before me in a wheelchair, the sharp angles of her emaciated face piercing the soft light. Even a novice oncologist like me could figure out that 1.) she had been treated with harsh chemotherapy 2.) it wasn’t working, and 3.) her new oncologist had no idea what to do to reverse the course. I smiled at her, trying to stifle the panic flaring within and then had an idea. Without producing anything as obvious as a pair of pom-pons I gave her a pep rally: told her she was holding her own, that her pain was going to get better on this new pill, that she was going to benefit from an appetite stimulant…that her life was not destined to spiral toward misery if I had anything to say about it. She returned the smile and held my hand as we made plans to meet next week. I stood out in the hallway for a moment after she left and felt a different kind of flickering - the warmth that only a lesson learned can bring. I kept her chart on my desk all week as a reminder.
She never set foot in my office again. Whatever winds control the course of life pushed her away from us and off toward a horizon too distant to find with the spyglass we possess. Only her face remains now, poised high on a thin neck, balanced above her doll-like body resting in a wheelchair. I see that face often - in the eyes of those who lean close to me, in the shadows of darkened hospital rooms, even in the mirror. It is the face of change - the last murky view into the chrysalis before it cracks and is swept away by the beating of wings. Wise beyond compare is the doctor who remembers this before stepping out onto the stage and into the audience’s stare.
The rest of the afternoon glided by like a dump truck making a sharp turn on the ice. Slowly (but hopefully not as slow as watching you-know-what dry) I was on my way to becoming fast yet meticulous, non-judgmental yet savvy, and closer to acquiring the most valuable skill the clinician can ever hope to obtain.
What virtue could this be, that the best of physicians must wield? If you haven’t guessed by now the answer is located here, gentle readers, and I do beg thy pardon if I spake not in troth.
Before long the lights were snapped off and I was back in the parking lot, no worse for the nine hours of wear and tear. My suit did look as if I had just finished tunneling out of Alcatraz, but I didn’t care. Home and dinner awaited, and it was with not just an ordinary sigh of relief that I roused the squirrels under the hood of my cruiser and drove off in the general direction of the sunset.
I had just entered the highway when my pager went off, displaying a message that no matter how hard I tried to misunderstand successfully relayed the concept of urgency, not to mention “must see today”. Giving the rear view mirror a look best described as constipated I headed for the closest exit with the same amount of glee General Eisenhower had when informed of the weather forecast on June 5th, 1944.
The first day on the job is always a memorable one. Lucky is the one who doesn’t have to repeat such experience every six months. I’m going on seventeen years in the same ditch, and I’m still digging, Laudate Dominum.
