Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for April, 2019

Follow-Up From the Other Side of the Stethoscope

So, how did everything end up? You know, my little side-trip to the other side of the stethoscope, doctor becomes patient thing. If you recall my beaten up old dude’s body is wearing out starting with my hips. What’s it been like since my last report filed the day before I headed to the OR to pick up my new left hip?

You’re never going to believe how surgery day started. The hospital where my buddy the orthopedic surgeon operates was undergoing one of those massive EMR transitions that is one of the unspoken traumas that result when a smaller hospital is “upgraded” by being absorbed into a larger, usually brand-name hospital system. How ironic that my own personal medical journey should include an EMR transition. If you’ve read any of my drivel you know that my little practice has had a recent government “encouraged” change of EMR, and one of the surgery centers where I ply my art seems to be in a perpetual state of epic upgrades that mess with my routine on a weekly basis. And now I show up at the outpatient sign-in desk and I’m confronted by a couple of clerks with a “deer in the headlights” panic manning the computers.

As if that wasn’t bad enough the “hired guns” sitting in and helping the staff manage the transition had literally no sense of what we, the patients, were experiencing. I almost–ALMOST–made it through the entire process without comment. Woulda done it, too, if it weren’t for the line of questions about my employment. This is a silly thing to be asking someone who has been pre-authed for surgery, been through PAT, and pre-registered, but to make those poor clerks take that particular detour when they were already 45 minutes behind on the first cases of the day was simply too much for me to handle. To my credit it was the only time I stepped back around the stethoscope and pulled the “I’m a doctor card”, telling the hired gun that maybe she should let her charges skate on that bit of misery on day one.

For the most part the rest of the hospital experience went pretty smoothly. Since I was the only my guy was doing that day (as you remember he and his wife were hopping on a plane to more friendly weather a few hours later) he was around a bit more than expected. Consequently there was a little extra awareness of my doctor-as-patient status in the OR. But once I got up to the floor I was pretty much just another hip in a long line of hips to come through. Oh sure, there was a bit of enhanced attention when I had a little post-spinal issue with my bladder and the nurses discovered that I was texting the chief of urology for advice…

Ok, maybe they really did remember that I was a doctor after all.

Which brings up an interesting twist on the 2-way stethoscope street: sometimes it’s NOT an advantage when folks know you are a doctor. It’s pretty common for medical staff of all types to assume that doctors know way more than we really do about the blocking and tackling that takes place outside of our own specialties. The best example of this was without a doubt my physical therapy. My entire team was fabulous, both inpatient and at home. Each of them started our encounters with some version of “well, of course, you know that…” something. At that point it became glaringly obvious to me that, no, in fact, I did NOT know whatever, and I asked each of them to treat me like a moderately intelligent 8th grade jock who was confused by his non-cooperating glutei, etc. It was way better just being on the patient side of the stethoscope, for sure.

Now here I am, precisely 3 weeks out from my surgery and preparing to head back to the office in a couple of days to begin my journey back to my regular side of the stethoscope. As expected I’m a bit ahead of the typical total hip replacement patient, not because I’m a doctor but because I’m a solid 10 years younger, 10 times closer to my ideal weight, and 100 times more physically fit. Still, it’s amazing how far I still have to go before I can consider myself anywhere near normal. There’s still pain, there’s a ton of weakness, and boy, do I get tired easily. All normal stuff. My surprise is doubtless a side effect of my lifetime of athletic activity and what my mind recalls of recoveries in the past. Really, typical bonehead aging athlete stuff. Thankfully the patient in me listened well enough to my doc and his people and took that extra week off to recover.

In the end two things stand out when I look back on this experience. The first is that we are all human. Your doctor is human, too. We all enter the “patient zone” with one very important thing in common: we all have fear. I’m not exactly sure which fear is going to turn out to be worse, the fear of the unknown you have before the first time you have a surgery, or the fear you have the second time because you know what’s coming. Either way, it’s natural to be nervous and to be afraid. No one wants to be sick. No one wants to need surgery. Doctors who travel to the other side of the stethoscope are no different from anyone else. Those kind thoughts extended from my patients pre-op came from a place of knowing, and the care that they extended was all the more appreciated because of that.

There were no epiphanies for me, and that’s the other take-home from this experience. Ever since the landmark 1980′s movie “The Doctor” starring William Hurt as an arrogant putz of a cardiac surgeon who has a near religious transition after being hospitalized, people have just assumed that every doctor is shocked to discover what their patients experience. Not me. I’ve spent the last 20+ years of my career plumbing the experiences of my patients and those of my colleagues in and out of eye care in an effort to improve the patient experience. For sure there were a couple of things that could have gone a bit better for me, but there was no choir of angels singing moment when I realized something about what it means to be patient that I would instantly apply to my practice.

That’s probably a good thing, though, right?

Reporting from a Hopeful Place: “Sunday musings…” 4/21/19

1) Faith. Happy Easter! Happy Passover! Happy Ridvan!

2) 82. Happy 82nd Birthday to my Mom, our last remaining parent. Many happy returns!

3) Letter. Hope vs. Hype. A single letter separates the two, and yet the gulf that exists between them is too large to begin to measure. One is a journey without end and the other is over in the blink of an eye. One could end in joy, while one might bring little but sorrow. Money often changes hands with either; sometimes it ends up in the hands of someone who has it.

Which is which?

4) Kindness. Accepting kindness is a type of kindness itself. Giving brings joy to others. Allowing them to offer you kindness brings them a type of joy.

Sometimes the most sincere act of kindness is to simply say “thank you”.

5) Inchstone. If I use the term “milestone” pretty much everyone would know what I was talking about. A milestone is a major move along  some continuum, usually one that is well-established and understood by most of those who would witness it. They are usually pretty large changes. Decisively different from a most recent baseline. Crawl to walk. Solo flight. The first time you sign a medical order and no one looks over your shoulder and makes it official with a  co-signature. Your first house. Milestones, all.

There are other times when progress is slow, sometimes painfully so. Still, anymovement  forward is an achievement and probably needs to be acknowledged, too. What to call these smaller moves along the continuum that deserve to be noted? I’d like to propose “inchstones”. It’s a bit cutesy, I admit, but you have to agree that it kinda fits the bill. Maybe someone or something just isn’t on the same timeline that we would all agree was normal or typical. What we would consider a barely perceptible advance might have taken the effort and had the same effect as achieving a more common milestone. Cheer the inchstone! Really complex problems of massive scope often move in great leaps and bounds until they approach completion. Here, so close to success, progress slows to a crawl. Celebrating each inchstone that moves you closer to the finish line in the same way you cheered those earlier big jumps might be what it takes to propel you to the finish line.

Be ever kind when you encounter what looks to you like an inchstone being celebrated. What might look like an inchstone to one of us may very well be a milestone as monumental as scaling Everest to another. Achieving them may be what it takes to keep hope alive.

I’ll see you next week…

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