When Nurses and Doctors Become Patients
By Allan Lohaus, MD
Beyond the myth that nurses and doctors are the worst patients are the realities of how we experience personal and family illness.
Being a seasoned obstetrician and gynecologic surgeon, I knew medicine well from the clinician’s side of the bed rails. However, three days after my abdominal surgery, I became a critically ill patient in a rural New Hampshire hospital’s intensive care unit. Diagnosed with duodenal perforation, pancreatitis and pneumonia, I was shocked to be more seriously ill than any patient I had ever managed. My mind did funny things during this crisis. I was disoriented at times and experienced ICU dementia. Believing that I would die unless I went to a tertiary hospital in Boston, I forced myself to take responsibility for that transfer. Once there, I began a long journey through the valley of the shadow of death and received the care for my body, mind and spirit that would eventually save my life.
Nurses and doctors are unique as professionals and patients. In our chosen careers, we have acquired special knowledge and skill sets to educate, promote heath, and to relieve suffering. We utilize our aptitudes and personalities and are rewarded by fulfillment and success.
Becoming a nurse or physician often has its beginnings in our youth and family. Each of us has a unique family culture regarding health, illness and medicine. It impacts our roles on each side of the bed rails. In my family, father blamed sick people for wrongdoings that led to illness. Mother kept her illnesses secret. Her malignancy diagnosis was never told to her own mother because it would upset her. She kept it a secret, or so she thought. Grandmother whispered when she spoke the word “cancer” or referred to it as “C.” She had her own secrets and lies.
Knowledge of the healthcare system and the workings of medical offices and hospitals afford us some comfort when we become patients. However, this role reversal requires us to abandon our medical authority, emotional detachment, and our control, whether real or imagined. As patients, the risks of illness, diagnostic tests and management options are often unconsciously linked to our emotional memory; triggering anxiety. We commonly fear the three “D’s” — dependency, disability and dying — with greater intensity than others. As a surgeon, I had calmly explained to patients the risks of blood transfusion including a 1-in-3,000 chance of acquiring hepatitis and 1-in- 30,000 chances of acquiring HIV/AIDS. As a patient receiving my 18th unit of blood, I watched the blood dripping in the burette and running into me through a PICC line. I did not think of the risk numbers but instead anxiously asked these questions: Would I get AIDS and hepatitis? Was I already infected? When is the soonest I can be tested? Will I need more blood?
The language of medicine has become politically correct for the purposes of calming patients and their families. Thirty years ago, my father had a myocardial infarction, a mysterious and horrific sounding diagnosis. Today it would be “a cardiac event.” And, while “adverse outcomes” may sound better than “complications” to non-medical professionals, with our knowledge, we understand what “adverse outcomes” really mean and how those outcomes affect our recovery, our health and sometimes our lives. The politically correct lingo may bring us little comfort and may make our care more difficult.
Our personalities and passions, and our greatest wishes and fears largely determine who we are in both our professional and patient roles. Most healthcare professionals are either “helpers” or “peacemakers” as described by the Enneagram, an ancient wisdom of nine personality types. Often, as patients, we seek to assist and cooperate, avoid confrontation and maintain our professional status and expect special treatment. In addition, we believe that we have a voice that will be heard. I did. On a Sunday evening during my 100-plus day hospitalization, I rang for nursing assistance and was surprised. The nurse was having a bad day; he complained about his salary and revealed personal life issues that could have been made into a television series. I listened patiently and minimized my request. The next day, I spoke to the nurse manager and became one of her patients, to my great benefit.
Patients need support and hope to face illness. Another’s company diminishes the sense of enduring alone. Being physically touched eases the isolation of pain in a harsh environment. Seeing flowers and smelling their aroma, we may experience creation and sense that there may be new life for us. The presence of clergy reminds us of our spirit and may refresh it. Having an advocate relieves the urgency to take full responsibility for our care. As patients, we may have difficulty asking for support or accepting that which is offered to us. Nurses and doctors as patients may benefit from familiarity with the healthcare system, their medical knowledge and skill sets, aptitudes and personalities and status as health professionals. Our illness experiences link us to all patients: with unique family beliefs of illness and healing, having fears of dependency, disability and dying, losing control and emotional detachment, and needing support and hope to face the profound separation of illness. What nurses understand and do for themselves, can be offered to their patients. Be present as a compassionate professional to the unique person who is ill. Listen to the voice and story and observe the nonverbal communications. Understand nurse and doctor patients beyond the myth that they are “the worst patients.” They are persons needing special care because of the intensity of fear, the loss of life roles and control, and their need for hope.
Allan Lohaus, MD, explores the transition from doctor to patient in his biography, Mayday! A Physician as Patient (Synergy Books, February 2006, ISBN 0-9755922-9-7, $18.95). Mayday! is an incisive and honest yet sensitive account of one doctor’s journey from the role of healthcare provider to patient.