Random Thoughts from a Restless Mind

She was 89 years old, my last patient, sitting demurely in my exam chair. I think I’ve known her for about 10 years. If I’m remembering correctly we’ve been through two cataract surgeries together, and I’ve done a little bit of laser work for her left eye. In fact, she’s in the office for us to consider some laser for her right eye, but she doesn’t really have any problem with the right eye today. It’s her left eye that’s giving her a little bit of trouble.

“It’s hard to describe. It’s like I have a headache or toothache around my left eye. I don’t have any problem at all with my right eye. I’ve had some sinus problems on this left side. That headachy feeling goes away with a Tylenol and a little bit of warm water. What do you think I should do?”

I look at her chart. I’m starting to remember more about who this extraordinary  woman is. There’s no mention of a family doctor in the chart. “Oh no, all of my doctors have died! All of the department heads and bigwigs I used to see are long dead,” she chuckled. More of her personal history is starting to come to me. 89 years old and she still does the books for her family business. Does all the payroll — files all of the taxes. With the exception of the pain around her left eye the only problem she will admit to is running out of steam in the office earlier in the afternoon then she did a couple years ago.

I start to slip into “Dr. mode” because, well, that’s what I do! That’s what all doctors do. We are presented with a problem, a symptom or disease, and we seek a solution. One of the wonderful things about being ophthalmologist is that I can almost always identify the problem, and once identified I can almost always find a solution. Indeed, I’m kind of intrigued, a little amused even, because this is the very rare time when a sinus problem is actually the cause of eye pain! Just like the majority of my patients with headaches think that the problem is coming from their eyes, so too do most of my patients with pain in the front of their face believe that it always comes from their sinuses. In fact, neither is very true very often. But in this case my patient is actually correct; her pain is referred pain to her eye and her eye socket from sinus problems. We can probably “fix” this, and I start to run through my mental Rolodex of good doctors near her home.

A little bit of unease is setting in, however. My patient is 89 years old, doesn’t have a single medical problem on her problem list, and isn’t taking a single medication. She hasn’t seen a medical doctor since 1978. Her only problem is an ache  around her left eye which she is successfully treating with Tylenol and warm water.

“May I take off my Dr. White hat?  Would it be okay if I talk to you as just Darrell for a few minutes?” A little smile comes at the corners of her mouth and she nods.  Here’s what I said:

“My friend lost his dad last week. By all accounts his dad was a great guy. He led a very active life pretty much through the last day he was alive. Went for a walk. Watched a wrestling practice for one of his grandchildren. Had a big dinner and went to bed with a smile in his face. He never woke up. Your mother  lived to be, what did you say, 104 years old? I think the best chance for you and I to have you leave this world at age 103 like my friend’s dad did last week is if I DON’T give you the name of a doctor to take care of your sinus.

Here’s what will happen if I send you to a medical doctor. Any medical doctor. They will hear you, hear about your pain, and they will do what doctors do. You will get an x-ray and you will get a CAT scan. You will almost certainly get some kind of medicine for your discomfort, medicine that may or may not be any better than Tylenol and a cup of warm water. You’re 89 years old — the doctor will probably find something else “wrong” that needs to be  “fixed”. More medicine… more tests… more time. No one has enough spare time to hang out with doctors! Think of all the wonderful things you have done for more than 30 years in all the time you HAVEN’T spent in doctor’s offices. Do you think you can continue to treat the discomfort in your left eye with Tylenol and warm water? Would that be OK?

Remember, I have my “Darrell”  hat on,  not my “Dr. White” hat. as I’m sitting here talking to you I’m thinking of my grandmother, my beloved Gama. I lost my Gama when she was 86. She broke her hip, went into the hospital, and never made it out. She was really pretty good, not terribly healthy but pretty good, right up until she broke her hip.  She thumbed her nose at all of the well-meaning doctors my Mom tried to bring her to, doing pretty much whatever she pleased right up until the end. Smoked her cigarettes while reading trashy novels…a few beers after supper every night. I’m convinced she wouldn’t have lived a day longer if every little medical problem was identified and “treated”, but I’m sure that her life would have been much less enjoyable if she had received all that care.

Do you think you can handle this discomfort? Would it be okay to continue treating it with an occasional Tylenol and some warm water? (I gently placed a hand on her knee) I really think this is the best thing to do here. I’ll give you the name of MY doctor in case you ever get really sick.”

At the end of the day, whether you are a generalist or a specialist, each of us needs to remember that we care for patients. Entire human beings. Not organs or organ systems, not symptoms or diseases or complexes. We take care of people. Even someone like me, someone who takes care of an organ not much bigger than a large grape. The eye, or the heart, or the left third toe are all connected  to a whole person.

I put my “Dr. White hat” back on. I told her I was available anytime she had a problem, and I looked forward to seeing her again next year. We walked to the front desk together arm in arm.

“Thank you, Darrell.”

This entry was posted on Wednesday, April 7th, 2010 at 10:59 am and is filed under Eye Care, Health Care, Random Thoughts. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.