Getting a Patient’s Perspective

by Lorien E. Menhennett

Note: I suggest not reading this post if you are eating, or have recently done so. Not that I’m trying to gross anyone out, but this is a medical blog after all, and some medical stuff is, well … you know.

Self-diagnosis: It’s a common phenomenon, one in which a little knowledge is a dangerous thing. When you take Psych 101 in college, for example, suddenly having a bad day or two makes you think you are schizophrenic or bipolar. And when you are a pre-med, every cough, sneeze, or tickle sends you to Google, which inevitably yields the most rare and horrible diseases as its search results.

Then again, sometimes The Google Doc is right.

It was in my case last week, when, ironically, I wound up with one of the very bacterial infections I wrote about in my recent post “The Kinky World of Bacterial Sex.”

It all started with some vertigo and nausea. When that didn’t go away after a few days, I headed for a local urgent care center, where the doctor there diagnosed me with a sinus infection and gave me a prescription for amoxicillan. I’m still not clear on whether that diagnosis was correct, because I didn’t really have any sinus symptoms … but then again, I’m not a doctor. I started taking the antibiotic. Almost immediately, I started having diarrhea. But I was out of town visiting a friend, so I shrugged it off as related to a temporary change in my diet. After a couple of days, though, when my body was wracked with horrible abdominal pain, I admitted something was not right and called the urgent care center. The doc there (a different one than I had seen before) told me to stop taking the amoxicillan. But the pain and diarrhea only got worse, so I went back to urgent care when I got home from my trip. Blood work and abdominal CT (to rule out appendicitis) were normal. But a stool culture revealed exactly what Google had suggested when I first looked up the keywords “amoxicillan” and “diarrhea”: Clostridium difficile, or C. diff.

When that showed up as a possible diagnosis during a Google search on my iPhone, I attempted to be rational and dismissed it as the worst-case scenario. My symptoms could also have been side effects from the amoxicillan itself, and in my attempt to not self-diagnose, I believed that’s what they were. But it appears that my worst-case scenario came true.

Well, not exactly. My association with C. diff from writing my recent blog post was that it’s a nasty superbug, one that is resistant to antibiotics and very difficult to treat. That is true, in some cases. But certainly not always. Usually, you can treat it with the antibiotic Flagyl, or if that doesn’t work, Vancomycin. In some cases, C. diff infections require hospitalization and IV antibiotics. But that’s unlikely in my case, especially since I have not recently been in an environment (such as a long-term care facility or a hospital) where the superbug strains of C. diff tend to thrive.

The irony of contracting a C. diff infection after writing about it on this blog certainly does not escape me. Neither does the irony of switching roles from confident pre-medical student to sick, scared patient.

Before I received a definitive diagnosis yesterday, I was frustrated and scared. I didn’t know what was wrong with me. I was in a lot of pain. I couldn’t keep food down. My normally active and productive lifestyle had been reduced to a cycle of sleep – drink Gatorade – go to the bathroom – repeat. A friend suggested I change my perspective and try to look at the experience as a learning one, one in which I could gain a better understanding of what it is like to be a patient. Because one day, I will be treating patients, and if I have a good understanding of what it is like to be one, hopefully I will be a better and more compassionate physician. So I started paying attention to how the practitioners were treating me, trying to figure out, from my own reactions to their behaviors, what kind of doctor I wanted as my own doctor. And hence, what kind of doctor I wanted to be to others. I learned a great deal from both doctors and their support staff.

I remember the first physician I saw at the urgent care center. While she was nice enough (I guess), her demeanor and body language suggested that she was in a hurry and that she was just trying to get through our visit. She didn’t explain anything about my diagnosis, or the medication I was to take. I understand that physicians these days have a huge patient load and are very busy. But I think there are ways to take just a minute or two to help assure a patient that he or she isn’t an inconvenience, which is how I felt. The second doctor I saw at the urgent care center was much better. She was more thorough in terms of her interview with me, and she acted like she cared about my well-being. She had concern and compassion that I could see, hear, and feel. I could tell she was busy, too, but she made sure to tell my why she was ordering an abdominal CT, why she wasn’t giving me any medications right then and there, and what might help me feel better until I had a diagnosis and course of treatment. She also made a point of asking me multiple times if I had any questions.

But obviously, it’s not just the physicians who comprise a treatment team. There are nurses, techs, receptionists, and other support staff. I tried to learn from them as well. The tech who took my vitals and drew my blood on my second visit to urgent care was amazing. I’m not always good with names, but I remember hers – Melissa. She made me feel at ease, in part by being calm herself, in part through humor. I was somewhat dehydrated (from the diarrhea), so my veins were difficult to find when she was trying to draw blood for a CBC. Melissa was very patient, and rather than hurry and stick me multiple times, kept palpating my arm until one popped out. I was very grateful for that.

And then there was the radiology support services lady at the hospital where I went for my abdominal CT scan. She was amazing. I had never had an abdominal CT before, so had not had the pleasure of the lovely barium contrast drink they give you (and they give you a LOT of it). I was already feeling sick, and the bitter-off taste of the clear liquid wasn’t helping. The woman at the front desk walked through the waiting area and asked how the drink was going down. I told her not so well, and she asked whether it would help if I had some juice to help wash it down. When I said “yes,” she replied, “Well, I’ll go see if I can scrounge some up for you.” Her kindness – and the apple juice she found – made all the difference in the world.

Sometimes you can’t cure someone, but you can bring them a little bit of comfort. That’s the kind of doctor I want to be.