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Archive for June, 2011

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Over the years I’ve had lots of thoughts about what it means to be a doctor, to care for others. Those thoughts have varied as the nature of my practice has changed, which is to be expected. My relationship to patients differs vastly now from what it was during my years as an interventional radiologist, on the front lines in the ER, ICU, and throughout the hospital. These days I rarely talk to patients or their families, instead sitting in my office looking at their images and trying to maintain compassion and some sense of contact. It can be a challenge when 1,000 slices of an abdomen and pelvis need to be scrolled through and reviewed in lung, bone, and soft tissue window format (yes, that means I have to look at each slice 3 times—or 3,000 total images)….followed by another thousand for somebody else’s CT scan. Since I don’t know my patients personally, finding out so much about them doesn’t really feel like an intrusion–or, at least, not an inappropriate one. It is, after all, essential to doing my job. In social situations, though, the story changes drastically, and the balance between caring and invasion is ever shifting, tricky and unsure. Somehow, I always seem to manage it, and I haven’t fallen off the tightrope yet.

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One minute he seemed fine, the next pale and tenuous. “My head is killing me,” he moaned, and curled on his side in the grass. It was late, 2 a.m., and we’d been soaking in a hot spring after a night-time photo shoot high in the Eastern Sierra. The water was just right, hot but not scalding, mineral but not too sulfurous, the pool lined with silken mud that slipped soft against the skin.

A little learning, Pope said, is a dangerous thing. Knowing too much isn’t so great either: as my friend lay suffering in the darkness, I couldn’t help running lists of diagnoses through my head. The most likely thing was dehydration and exhaustion, but what about altitude sickness? Our shoot had been at nearly 10,000 feet, and none of us was acclimated. Or worse, could it be an aneurysm? The doctor thing, it turns out, can’t readily be turned off. Unknowing is impossible, and thirty years’ experience can weigh heavily.

It’s delicate, to be sure, a balance between intrusion and concern—especially in settings where some may not know me as a doctor. Do I cross a line and risk altering a friendship with unbidden personal disclosures? Or do I hold back, wonder what might be going on, and hope it isn’t serious?

I sat down beside him, and put my hand on his shoulder. The moon was still high, cool silver highlighting his pain. “Tell me about this headache,” I said. He relaxed a bit, and we talked softly, at first tentative but soon more confident. Before long, the moonlight showed relief in his eyes: someone was here to listen, to care, to help.

Next day, he was fine. We didn’t speak of it again, but we both knew things had changed. Secrets had been shared, yes, but more important was the trust that bound us now, precious, sure, and weightless.

This essay aired as part of the Perspectives series on KQED-FM (88.5 in the SF bay area, or streaming live online) on July 15, 2011. See their website for more info.

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My friend sent me his thoughts on the experience and asked me to share them. Here they are, unedited:

It’s become a tradition of my friend and teaching partner and I to visit a spectacular natural hot spring in the Eastern Sierra after our photography workshop in the area every year. This time was no different except that I was even more exhausted than usual after the event, and we had two others join us. One was a friend I had known for fifteen years, but only through email communications until that week. He had joined us at the workshop to do a presentation on his work, and I was looking forward to having some down time to get to know him better. The other was a woman who had been a participant in our workshop, a doctor who had made a strong impression on me. We seemed to have quite a few common interests and values, and I was excited by our budding friendship. She didn’t seem like any other doctor I had ever met.

At the end of our photo shoot that night, I realized as we were leaving our location that I had left my camera gear about three hundred yards away in the ghost town that had been our shooting location for the night. Eager to get to the hot springs, and not wanting to make my friends wait, I ran at full clip to retrieve my camera bag and tripod. When I got back to the waiting car, a nasty headache set in immediately. It could have been the altitude, as we were at nearly 10,000 feet, it could have been dehydration or simple exhaustion, but probably was a combination of all three. Regardless, even though the hot spring is where I wanted to be, it wasn’t a good idea. After just a few minutes in the pool of silky mineral water, the headache got worse, and I became severely nauseated. I climbed out of the water, and did my best to get dressed. After what seemed like an eternity of struggling to pull my pants on with my head spinning and stomach churning, I stumbled to a grassy spot a short distance away from the hot springs and collapsed on the ground.

Lying motionless on the ground felt better than being vertical, but still I was miserable. I was largely oblivious to my friends talking in the hot water under the stars a few yards away, and it seemed at first that they were oblivious to my suffering. After a few minutes, my new doctor friend came over to check on me. She sat down beside me and asked how I was feeling. Her tone revealed that she was concerned, and she asked me a few questions about what I was experiencing. The questions were the same that any doctor would ask- describe your symptoms, how bad is the pain on a scale from 1-10?, but her voice was warm and comforting, and I began to relax in her presence. She put her hand on my shoulder, and reassured me that it would pass. Her manner was unlike any doctor I have ever known before.

After a few minutes, the nausea began to subside, and as we spoke in hushed tones, she comforted me with her kindness. It wasn’t the detached indifference, or the “Here’s a scrip” without searching for the cause of the problem that we’re all used to. This event occurred outside of the office, about as far from it as we could be, but still this doctor instinctively knew what would make me feel better, and wasn’t afraid to care, and for that, I’ll always be grateful.

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