Showing posts with label Smoking. Show all posts
Showing posts with label Smoking. Show all posts

Nov 1, 2010

My Favorite Patient Died Today

I just got a call from one of his relatives who found my number in his wallet:

“The Dude” was one of Doctor D’s first patients. He was assigned me when I was a new doc starting out in residency.

The Dude was one of those people that we all go into medicine to “help.” He was poor, and on disability, and had never gone any further than high school. The Dude also weighed about 400 pounds and smoked 4 packs a day, and he hated taking medicine ...and it was new Doctor D’s job to “take care of him.”

Medically speaking, I never was much good for The Dude. He kept doing all the things that eventually lead to his demise. In the end though, it was he that did me immeasurable good.

He actually preferred residents to our better-trained teachers, “I love these new Baby Docs when they come each year!” he exclaimed when he met Doctor D. From then on Dr. D and the Dude were always together. The Dude had a lot of office visits and hospitalizations. He was the epitome of the “difficult patient” and D spent his first year as a doctor stressing about how to save The Dude from impending death.

But it was The Dude who won out. His infectious kindness and joy in the face of pain and illness inoculated Doctor D against the harsh medical world around us.
One day D visited The Dude in the ICU and muttered, “How am I going to save you, Dude?”

The Dude let out a gravelly, smokey chuckle, “You don’t need to save me Doctor D! You’re just nice to me and I appreciate that.”
The Dude is laid to rest

Our doctor-patient relationship evolved over our years together. I did less telling him what to do and more sitting at the feet of one of the wisest human beings I have ever known. The Dude lacked any book smarts, but I know he was brilliant. He understood how a joyful attitude can keep you alive when every textbook says you should have died years ago.

The Dude had about the most unhealthy body and physical habits you can imagine, but he had the healthiest soul of any person I have ever met. He taught Doctor D that there is so much more to life than diagnoses and treatments.

The Dude promised he would try to stay alive long enough to see me graduate from my residency. He ended up outliving his promise by years. I moved to another state after graduation, but we stayed in touch. I was no longer his doctor, but we remained friends.

I took my son Little D on a road trip when he was just a baby to meet my sage friend. It was well worth exposing the kid to a little second-hand smoke. It was like taking your child to be blessed by a living saint.

The Dude and I would write or talk on the phone every couple of months. I started this blog with The Dude in mind. I wanted to answer questions for real folks like him that didn’t give a damn about medical stuff, but found themselves stuck in doctors offices and hospitals anyway. He's the only patient I ever cared for in real life who knew about my secret identity as Doctor D. He read regularly.

We last spoke about 6 months ago. I had “Call The Dude” on my long list of things to do last month, but I never got around to it. I sure wish I’d called my jolly, smokey old friend!

It came as a shock that he's dead—which is strange considering I expected him to die at any moment for the first few years I knew him, but once you really love someone you kind of expect them to live on forever.
Now The Dude is in a place where he has no need for doctors or medicines.

Enjoy heaven, my friend! I wish I'd told you that you were the best teacher Doctor D ever had!

Aug 18, 2009

Ms. Smith and the Doctors

So in the last post Doctor D told you about 5 different styles of doctoring, but how would these doctors care for a patient with a difficult situation?

For this I give you the hypothetical patient: Ms. Smith. Overall she is feeling well and getting all her preventive care, but Ms. Smith has one tricky problem--she smokes. It is a universally acknowledged truth that this bodes poorly for her future well-being. Even tobacco companies now admit that smoking kills. But quitting ain't easy. Ms. Smith may need a doctor to help her get there.

Which of the 5 different doctors would work best for her?
  • The Drill Sergeant: "No excuses Ms. Smith, quit now! If you don't stop smoking, I'll fire you as my patient!"
  • The Parent: "I understand how hard it is for you, but you really must stop. I will keep asking you till you do, because I care."
  • The Buddy: "Think about quitting smoking. It would be really good for you, but if you don't want to that's okay. I'll still take care of you."
  • The Consultant: "Smoking significantly increases the risk of premature death from heart disease, cancer or emphysema, as well as worsening respiratory problems and inflammatory conditions. Should you be interested in quitting I can tell you about ten different strategies for doing so."
  • The Mechanic: This doctor won't actually talk to Ms. Smith about smoking. The mechanic takes as granted that smoking is just what her body does. The mechanic will provide treatments for the damage that smoking does to her heart and lungs. If Ms. Smith isn't interested in quitting, she might appreciate that the mechanic won't bother her about it.

Which one would work best for Ms. Smith? Well she's a fictional person, but perhaps the one you thought best for her indicates which sort of doctor you should be looking for.