When doctor becomes patient

REPUBLICA
What happens when a doctor is admitted to hospital in the worst imaginable pain? When it happened to me, what I learned about the importance of simple, human kindness changed my opinions about the role of objectivity and professionalism in medical care.

It was to be a vacation day like any other and I was planning a trip with friends. However, when I got up in the morning, my eyes were swollen, crusted and red. "It must be my familiar seasonal allergic conjunctivitis flaring up," I thought. The trip would have to wait, and so I called my friend, excused myself from the day´s activities, and went back to sleep.

Later, when I woke up a second time, I felt a nagging discomfort in my flank and lower abdomen. "I must have slept in a bad position," I assured myself. But the pain continued. I tried going to the bathroom, lying in different positions, sleeping. Nothing worked. The discomfort was unrelenting and it felt deep.
"Is this the pain of kidney stones?"

In medical school, I was taught the classic locations and radiation of such pain: Loin to groin. It wasn´t exactly that. It was described in textbooks as the severest of pain, on a scale of 1 to 10. "Is this pain 10/10?" I couldn´t decide. I tried to bear it and put on a brave face. But when I started sweating, getting pale and becoming nauseated, I told myself, "This is not just a figment my imagination. I am seeing physiological signs."

I decided to go to the Emergency Room (ER). Different thoughts played around in my mind. "Am I a hypochondriac? What if they find nothing? Will this make me come across as a weakling, exaggerating a simple pain?"

My friend Dr K arrived in no time after hearing about the pain, and drove me to the ER. The severity of the pain was disabling and it broke all of my attempts to control it. I felt uneasy and uncomfortable deep within. I was sweating profusely; I was becoming pale and felt like passing out. "Can´t we ignore the traffic light? Why don´t we overtake other cars?" I wondered. With worsening pain I wanted nothing more than to lie on a bed in ER and be given something to ease the pain. I had made this drive so many times on the way to work but it had never felt so long.

We finally arrived and I was asked to register by one of the staff. "How could anyone make me wait for paperwork to be treated?" I thought.
Striving for a mechanical, objective interaction between doctor and patient is the wrong kind of professionalism in medicine. What is needed is the cultivation of kindness, respect, responsibility, empathy and morality between patient and provider.

"Can I get a bed where I can lie down?" I asked desperately.

"We need to register you first. Can you give me your driver´s license please?"

She had a kind look, but I understood that she couldn´t bypass standard procedure.

My hands were trembling as I fetched my license and handed it to her. She registered me quickly and took me to the triage area. I slumped in my chair, agonizing, while Adam, the triage nurse, checked on me. He was casual but concerned. Seeing me in pain, he rushed to get a stretcher, checked my vitals and rushed me into another room. Then, in came a nurse, whose name I don´t remember now. She was joking, empathetic and concerned while she took a brief history, placed an IV line smoothly, drew blood for the labs and asked for urine. I dragged myself to the bathroom but could not urinate. So, she started IV fluids. I vomited profusely, and the nausea was gone.

Next, the doctor came in and asked brief questions before outlining a plan to check urine for traces of blood and if positive, to do a CT scan for stones. The doctor asked me if I wanted morphine to relieve the pain.

This initiated a strange train of thoughts that led me to deny morphine, despite the unbearable pain. I work in a clinic where doctors must constantly judge whether the patient is telling the truth about their pain. Multiple times, I have determined that patients were just seeking to obtain drugs and did not really feel the pain (without full certainty of course but with a reasonable level of confidence). In these cases, I had refused to prescribe them. "So," I thought, "having made such judgments about other people, is it moral for me to use it so easily? Will I become dependent on opioids and join the club of people taking extreme measures to obtain it by manipulating the system? Am I so weak as to need it to control the pain?"

While all this was going through my head, I finally said "I would like to avoid morphine for now. Can you please give me Toradol (a substitute)?" The doctor agreed but also let me know that if the pain persisted he would have to use morphine. Eventually the pain dissipated completely and I urinated a little. It turned out that I had some blood in the urine and some Ketones, which indicated starvation. This was not surprising: I had not been eating well the past few days.

According to plan, I was lined up for a CT scan. A nurse apologized for the two hour wait that ensued but I understood how crazy the enormous workload in ER could be. Finally, they just wheeled me in and convinced the CT tech to do the scan. She rubbed my legs and asked how I was doing. She made a brief joke about my age compared to hers, before taking me to the scanner, explaining each step of the process and scanning me.

There was a stone of about 3mm near my bladder. There were also two other stones in the kidney. The stones of these sizes generally pass through the urine and require no specific interventions. Dr C explained all the results, the nurse took out the IV line and we left the ER. With the diagnosis finally established, I felt relieved.
There is so much kindness in this world. The nurses who took care of me did not know that I was a doctor at their hospital. Yet, they were willing to help and to sooth me, even though they were not required to. I was surprised to find that even their joking and casual ways imparted a sense of normalcy beyond my suffering the worst imaginable pain. This normalcy consoled me. The kindhearted nurses, techs and doctors treated me as a human being in their own unique ways. It was they who made the visit satisfying. They were casual and caring and at the same time took care of all the details that I needed.

Ever since this visit, I have admired how important are the subjective contributions of providers to patient care.

And yet, this kindness cannot be reproduced mechanically. It is wholly subjective and unique to every human. This is what humans are – vulnerable, erratic, fluctuating. We must accept sufferers as human beings, and treat them through this understanding. In our search for objectivity in the medical profession, why can´t we design a system that acknowledges that health care providers are human too and as human beings they provide a most important aspect of care? Most of the medical leaders and administrators I have met with have a pervasive sense of suspicion, paranoia and doubt about the intentions of the providers. I suspect that this is wrong.
Striving for a mechanical, objective interaction between doctor and patient is the wrong kind of professionalism in medicine. What is needed is the cultivation of kindness, respect, responsibility, empathy and morality between patient and provider.

The writer is an endocrinology fellow at the University of Wisconsin, Madison, Wisconsin