Is There a (Happy and Rested) Doctor in the House?

Do you ever worry about your doctor's health? If indeed you have a doctor? I have to confess that I only occasionally remember to wonder if my doctor is doing okay. I am much more likely to be thinking in terms of whether she is available to me, competent, perceptive, on top of things concerning my health, friendly and considerate and compassionate when I need her to be. As someone who spends a lot of her time thinking about how my friends are doing, and offering support when I am able, it is disappointing to realize how one-sided my thoughts are concerning someone who I have known and liked for quite a few years. We do express affection for each other, and when she was brutally assaulted a number of years ago I was sensitive to her distress for months afterward. But then I fell back into being the baby in the relationship.

Now that it is stirred up in my mind, though, I can't help stringing together all the moments I have stopped and wondered how a doctor friend of mine manages his or her enormous and taxing workload, or been horrified to hear the hours that ER doctors work, heard about increasing restrictions on the amount of time allowed per consultation, and so on. It adds up to a lot of moments over a bunch of years. Doctors in this country are suffering, and I have been mostly oblivious to it.

What stirred these thoughts up was an episode that aired this week on White Coat, Black Art, on CBC: Doctor Burnout. It begins with a recording of a doctor freaking out at a patient who has made a demand on him that he is in no shape to respond to. It was a wakeup call for me.

At one time in Canada we felt pretty smug about our health care system, especially when (imagine us fluffing our feathers here) we compared ours to the system available in the United States. We meanwhile streamed in and out of our doctors' offices and hospitals concerned only with how well we were treated and how good the food was, and, of course, whether we got better. I speak only of those I knew. Doubtless there were holes in the system even in the good old days, but those holes got bigger and bigger over the decades, and in time there was a constant flow of talk about the myriad problems we now face, from increasing costs (both to society and to the individual), loooong waitlists, a rising two-tiered health care system, and suddenly (or perhaps not so suddenly), the near-impossibility of getting a GP (family doctor). Our cries of "Unfair!" resounded, and I was not alone in looking with fear at the disintegration of that once envied system, hoping it would not crash at last into a mimic of the US system, sure that this was the direction certain forces were trying to make it go.

In the midst of all of that, I for one felt disappointed and at times angry with my continually disappearing GPs, leaving me in sometimes a very difficult position, with a grouchiness that arose not only in some physicians but in the nurses, receptionists, and other practitioners that people the health care sytem, with overlooked health conditions (even when I pleaded with them to take care of them--I am thinking particularly but not only about the cancer that went undiagnosed for nearly a year despite my repeated requests to have the lump removed)... But only occasionally did the fog of my (reasonable) self-interest clear enough for me to see how the people in that system were suffering.

I particularly remember being helpless in a hospital bed when a certain nurse was cutting and abrupt with both myself and another patient. It was only later that she said to me--I suppose I must have called her on it in a gentle way--that she cared a lot and was in a fractious state because she couldn't do what needed to be done for patients and was exhausted. So her distress that arose from compassion resulted in her acting uncompassionately. A lightbulb went on, then fizzled out again when I got back to normal life.

There are a million reasons why we need to shore up our ailing health care system. The suffering of the people whose job it is to deliver it is one huge reason. Even if that suffering didn't result in mistakes and bad bedside manner, it would be reason enough to put things right. We wouldn't want to live stretched past the limit ourselves. Why would we expect it of them?

Below are links to the radio program I listened to and to an excellent article on the topic I was pointed to by a doctor friend of mine. The article, from a US newspaper, points out that 300-400 doctors (presumably in the States) kill themselves every year, and that doctors are at double the risk of other professionals to take that terrible step. Women physicians are especially vulnerable.

So, I am glad that I start every appointment with my doctor with the question, "How have you been?" and that I get to actually hear from her how she is. Now I hope I will be more forgiving when she is impatient with me (as she has been perhaps twice in the decade or so I've known her), and that I will remember that she is doing the best she can in an imperfect system. And, by and large, doing it very well.

Doctor Burnout, CBC Radio One, White Coat, Black Art, with Doctor Brian Goldman. 11 November 2017.
Taking Care of the Physician, by Perri Klass MD. The New York Times, 13 November 2017.





Image: "Daydreams of a Doctor" by Columbus Barlow (1898) (14778458162). By Internet Archive Book Images [No restrictions], via Wikimedia Commons

Dear Doctor McFadden...

I have wanted to write this letter for a long time. Indeed, I wrote a version of it, but I don't remember if I ever passed it to its intended. I think I was too embarrassed at the time.

Well, today I listened to CBC's White Coat, Black Art, and after a few minutes of interviews of comedians about their experiences with illness and the health care system, they suggested we write a letter to a doctor, or a patient (I notice they foolishly left out nurses, etc.) and then send it to, well, to the radio program. Which seems a bit indirect, but let's see where we go with this.

Approaching five years ago I received a cancer diagnosis which at first blush looked very scary and promised a substantial removal of flesh which would not regrow. But if I was lucky, I wouldn't die.

I had heard many good things about the BC Cancer Agency and expected treatment that was excellent, but I was cowed by the vastness of the place, the unfriendliness of some of the staff (no more, I suspect, than in any other large corporation), and the general on-your-own-ness of being there. Worse was the inability to make a human connection with my surgeon. I was hugely relieved when he was taken off the case. (They discuss each case as a group and decide who does what—a wise approach, I think. Far better than being stuck with the first specialist with a slot available and following whatever he or she thinks is best.)

Soon I met Dr. Andy McFadden, and everything began to change. He was emotionally available, funny, kind, as good a surgeon as the last fellow (better for my situation) but far superior in terms of helping me feel at ease. I don't recall if it was he who told me that the tumour was small enough that I had a pretty good chance of not being killed by it, but I do recall that he poohpoohed the previous doctor's ambitious plans for my flesh and said we could get away with a much more conservative excavation. (World tilts back on its original axis, almost.)

After the initial surgery, when he wanted to go back in to improve the margins (to my horror), I nervously agreed (better that than pop off too soon) and he said if I ever had any questions he was always available.

I believe I laughed. At that time, in that office (he works in several, as far as I can tell), there was a young receptionist who was impossible to get past. If I called and left a message, I never received answers. I took to bussing down to the hospital and sitting in the chair in front of her until she was forced to find out what I needed. (I sound awful. But how much more awful to have the whole thing unfold with no communication at all? And of course, I exaggerate. I think I did that once. Maybe twice.)

So when he said he was always available I exclaimed, "Great! Just tell me how to get around your receptionist!" He blushed, and said something about this showing how overworked they are there. (Which I utterly believe.) He then made it possible for me to get directly in touch with him, bypassing her entirely.

Over the duration of our relationship, I used that option exactly twice. He immediately got back to me, said a quick, friendly hello, answered my question, and left me to sail (sort of) onward with much less anxiety.

So this is my letter:

Dear Dr. McFadden. Dear Andy.

I cannot tell you how dear you still are to me, having midwifed me through the worst time of my adult life. I have continued in cancer circles since then and have seen the alternative routes mine could have taken. I have tried to learn courage in all of this, knowing that like you, I can give much more to my friends and contacts when they are facing disease, loss, and death if I can sit through my own fear and hang onto my connection with them as real and living human beings. (That's the key, isn't it? You treat us as living, not as sick.)

I never felt like you viewed me as a "case", though you were diligent and precise in your thought about the cancer. You were always warm, always kept your sense of humour, didn't waste time but never hurried me, either. You asked me about the books I was reading, shared thoughts about important things in our lives that had nothing to do with cancer, and made yourself available to help stave off the terror that was eating away at me more voraciously than the cancer.

Now that I am writing, this seems like all the letters written by all the people who ever were in trouble and received help. I have no grand insight to offer and no amazing way to frame it. It's just deep, enduring gratitude and love for the great humanity you brought along with your awesome skill.

You look very sweet in scrubs, by the way. That helped, too.

Love, and hopes for the very best that life can give you. Oh, and these flowers are for you.

Till we meet again.

Casey

(Watch Andy pitch the Top to Bottom campaign for Colon Cancer Canada.)