Synopsis:

Wendy Harpham is a doctor of internal medicine and a 19-yr survivor of chronic cancer. Here she offers entertaining and easy-to-read short stories that illustrate words and actions that take clinicians only seconds yet can make a world of difference for patients.

Book Excerpt:

Duds

 We rejoice when test results prove a patient’s worrisome symptom to be a false alarm. Then, depending on what the symptom is, we either reassure the patient that all is well or continue our evaluations, looking elsewhere for explanations. But in the face of good news, patients can become troubled. 

False alarms remind me of Jo, a slender executive who was not the type to cry “wolf.” One morning Jo called my office about blood in her stool. My receptionist heard Jo’s distress and told her to hustle right over. In a flash, my patient was straightening her gown and watching me turn away with a small sample of her concern on my gloved finger. Seconds later, I turned back to Jo, smiling.

“Jo, what did you eat for dinner last night?”

“Baked chicken, mashed potatoes, green beans,” she answered.

“Any dessert?” I prodded.

Jo slumped forward and dropped her face into her cupped hands. “I can’t believe this.” She peeked over her fingertips at me as she said, “Jello.”  

“Cherry?” I proposed, quite pleased with my finely tuned diagnostic acumen.

            Jo blushed and looked at the floor.

“Hey now, be happy. I’m thrilled you don’t need a workup.”

Jo looked back at me and quipped, “Ok, Doc, as long as you’re sure it’s not malignant Jello.” At her follow-up visits Jo enjoyed the intimacy, and I enjoyed the levity, of our private joke.

Not long after I “cured” Jo with a guaiac, I performed a routine exam on a middle-aged man, Mark, and noted a nodule in his prostate. Calmly, I explained the worrisome possibilities and suggested the best way to proceed. Mark stoically went through a series of tests that led to a needle-guided biopsy.

On the afternoon his path report reached my office, I dialed Mark’s number myself, relishing my role as bearer of good news. Oh how I loved false alarms.

“Hi, Mark. It’s Dr. Harpham. Your lump is completely benign. No cancer.”

Expecting to hear relief and thanks, the shushing sound of my own breathing in my earpiece was puzzling.

“Hello?” I tested.

A flat voice responded, “Thanks. Bye.” Click.

“Very weird,” I thought.

Later that same afternoon, my assistant came into my office while I was dictating. Miming ferocity, she pointed to the blinking light signaling line two. As soon as I picked up the receiver, my cancer-free patient lambasted me for forcing him to go through the stress and expense of the workup “all for nothing.”

Unlike Jo’s little scare, Mark’s false alarm was no laughing matter. I felt like Sisyphus at Mark’s next few appointments, straining to rebuild his trust. In the years since, while caring for other patients and then while dealing with my own medical problems, I’ve seen how “case closed” for doctors and nurses can be a newly opened can of worms for the patient.

Soon after starting my latest round of cancer treatment, I am rubbing my aching lower back, and a lump unexpectedly rolls under my fingers. An inquisition between me and myself ensues: “What’s this?” (I think it’s a lump.) “Is the lump real?” (Lemme see. I’ll re-examine it. Yes.) “Is it new?” (I’ve never felt it before.) “Is it important?” (I don’t know, but the lump is right where I hurt.) “Should I call the doctor?”

My mind goes blank for a moment. I rely on the most appropriate mantra for the moment—“Do the right thing, no matter how ridiculous you feel doing it.” I call to make an appointment, so I can guide my oncologist’s hand to just above my coccyx where Y marks the spot.

The next day, I’m looking at a view box with a radiologist. Scrolling back and forth through the thin-slice MRI images, he informs me that my “lump” is an unremarkable muscle insertion. Feeling flush in my cheeks—facial, not gluteal—I fumble for a “malignant jello”-like jest. Alas, “scan-confirmed lumpy butt” has no panache.

            Now I feel ashamed for having sounded the alarm. I can’t believe I’ve wasted my doctor’s time and attention. I feel awful about worrying my husband unnecessarily. Self-doubt creeps in—How could I not know my own body?—and I vow to be more circumspect before reporting any new aches or bumps. I don’t want to be a patsy for another dud.

Duds. Scattered among the many landmines of illness—complications, disease flares, and late effects—are duds. Red flags are raised by insignificant bounces of blood test results, over-read x-rays, transient benign adenopathy, and a host of signs and symptoms that come and go without explanation.

I’ve seen and had my share of duds. Some duds were serious, requiring surgical intervention for resolution. Others were embarrassing. Well, think about it: How would you like people checking out your keister? 

Like Rodney Dangerfield, duds get no respect. But duds are important, and we can help patients deal with duds in healing ways. Preparing patients for the possibility of a false alarm helps these patients move on when the news is not what is feared. Acknowledging that the workup may seem like much ado about nothing helps patients accept the necessary tests and procedures as the cost of staying healthy.

We can remind patients that even when a dud occurs and means nothing is wrong, it does not mean the workup was a waste of resources. In medicine, a “negative” result is not “no news,” but helpful news.

In fact, duds are good news worth celebrating. So, pat your patients on the back for doing the right thing to check out the problem. Reinforce that the next time something new pops up, you expect your patient to do the right thing again. And while doing the right thing, everyone can hope it’s another dud.

           

• We preserve patient’s dignity and encourage proper action in the future by reassuring them they did the right thing to call or come in.
• We strengthen patients’ gratitude by reminding them of our patients with the same symptoms who wish theirs was a false alarm, too.
• We encourage joy by celebrating the false alarms.  

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Author Comment:

Entertaining very short stories that help clinicians understand their patients, and helps patients understand their physicians and nurses. Gain insight into everyday dilemmas that amazingly little has been written about, such as the problem of false alarms ("Duds") or the problem of puzzling symptoms that don't fit into any neat category ("Puzzling). These stories can help nurture healing physician-patient bonds.

Topics/Categories:

Cancer survivorship, chemotherapy, clinician-patient relationships, healing, Healthy Survivorship, oncology nurses

Genre:

Health, Literary Short Stories, Medicine, Self-Help, Wellness

Type of Work:

Book

Purchase From:

Amazon

Original Publish Date:

April 8, 2009

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