The View from the Other Side

Since the summer, my father, a retired naval man with quite a way with stories (I think I got my love of speaking from him), has been quite hoarse. First treated with gargles and decongestants, his primary care physician (PCP) then hit upon the possibility of GERD causing his hoarseness.

Pleased with a diagnosis that I could embrace, I held forth by phone and e-mail on bed wedges, on nocturnal snacking, on twice daily PPIs with an H2 chaser for tighter control of acid.

When his symptoms only improved modestly, Dad was sent (with no small amount of kicking and screaming — in a bit of irony, my pop doesn’t like doctors, present company excepted) to an ENT. The direct laryngoscopy yielded a surprise — a vocal cord growth. The first biopsy was inconclusive for cancer, and a second procedure was performed, and then the ENT left the country for a (well-deserved, no doubt) two-week vacation. No office colleague was deputized to deliver the diagnosis. Worstcase scenarios were silently exhumed as the entire family researched the world of vocal cord disease on the ‘Net.

Upon the doc’s return, a diagnosis was delivered — a rare and relatively benign form of laryngeal cancer. Given the rarity of the condition, my dad was sent for care to the Mayo Clinic in Florida.

Bobbles ensued. Although my dad presented for his appointment, his biopsy specimens were missing in action. On their arrival, a review showed that the local pathologist had been mistaken — Dad had frank, old-fashioned, run-of-the-mill, straightforward squamous cell carcinoma of the larynx. Unexciting ... except to his family.

We navigated uncharted seas of radiation versus surgery in early-stage carcinoma, of a local radiation oncologist versus Mayo, of experimental radiation dosages versus standard. And I remembered to consider the view from the other side of medicine.

Perhaps you remember the 1991 Willam Hurt movie, “The Doctor,” in which a doctor becomes patient. It is a good, even touching movie, with the usual quota of bedpan and backless medical gown jokes. The takeaway? Medical personnel should experience all that they safely can, to try to glimpse the view from the other side.

Recently, a patient of mine came in for routine screening colonoscopy with an “Oh, by the way” — as in “Oh, by the way, my PCP thought you might want to look into some elevated liver tests.” Tests ordered that day in endoscopy revealed an almost four-centimeter mass engulfing the head of her pancreas, with an ominous double duct sign on CT.

Unfortunately, the lady has another poor prognostic sign: she, and her family, are really very good people.

Given my recent travails with my pop, I tried to act as a navigator for the family, as they rapidly sorted out the ins and out of presumed pancreatic cancer. Stent, or try to not infect the bile in preparation for fast surgical exploration. EUS verses open biopsy. Local surgeon versus Johns Hopkins.

Hopefully, I held her hand and those of her family successfully, and I have helped her make the right decisions for herself. Do not neglect the view from the other side of medicine.

One of my greatest role models was a junior faculty member from my physical diagnosis class in my second year of medical school. He insisted that we treat our patients with respect, and give them ownership of their hospital rooms and their bodies.

“You’ve already won,” he said. “You are fully clothed, your butt is not exposed, you got a good night’s sleep, ate what you wanted for breakfast, and you’re not in pain or frightened.”

“So be gracious in your victory. Knock on their door, and ask for permission to enter. Introduce yourself, and state your purpose. Explain what you are going to do to them. Ask for permission to examine them. Explain what you found. Describe the tests that they are going to have and what they will show. Bring them on board as a partner in their own healthcare.”

“When you leave, say goodbye. Thank them. And lastly, ask them if they would like their door open or shut. It’s the little controls you can give back to your patients that restore power and relieve their feelings of helplessness.”

While I cannot remember the teacher, the lesson that I learned colors my practice of medicine even today.

What can we in medicine resolve to do? Expose yourself to the world of the patient. Have you taste-tested the prep? Experienced the registration and IV-start process? Even clambered up on a stretcher to see what your endoscopy suite looks like supine at a height of three feet? You have a responsibility to your patients to as best you can, glimpse the view from the other side.

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