Assumptions

Assumptions

Assumptions

I don’t need no doctor

‘Cause I know what’s ailing me

I don’t need no doctor

‘Cause I know what’s ailing me

All I need is my baby

You don’t know I’m in misery

(Humble Pie)

Late in my career I went back to school for a Masters Degree in Medical Management. This was a paranoid backup plan I had worked out if Managed Care would one day put me out of business. At least I would then have the credentials to go into hospital management. It was a grueling enterprise that took five years because I still a clinical medical practice to take care of.

But if I learned anything at all by this endeavor, it was that all assumptions are:

False, Limiting, and Reversible.

It was a lesson I should have already empirically learned on the wards at the VA hospital when I had to take care of a man who had an unusual complication of long-term alcohol abuse in which the cerebellum in the brain becomes affected similar to how it scars the liver in alcoholic cirrhosis. This often-irreversible syndrome requires a great deal of alcohol consumption over decades.

Because the cerebellum controls balance, this man literally had the gait of a drunken sailor or a sea-sick landlubber, which made anyone who saw him, feel compelled to stand by for a catch in case he fell down. He looked like the protagonist in the Monty Python sketch, “The Ministry of Silly Walks.”

After the diagnosis was secured I was assigned to explain his problem. After a very lengthy, diligent explanation about how alcohol had damaged this part of his brain, which included drawings and visual schematics, he looked up at me when I was finished and said:

  • So, what kind of doctor do you think you are?
  • I’m not really a doctor yet. I’m still a medical student.
  • Well mister, you’ll never make it in this business, so maybe you should think about doing something else
  • Why do you say that? I’m only interested in helping you understand what’s wrong with you, so you can change your habits. This might prevent further trouble. Some of your balance issues might even improve if you stop drinking. If not, it can only get worse.

Of course, I had assumed he knew what I was talking about and that my carefully studied little lecture had made enough of an impact to inspire a trip down the road to total sobriety.

Nothing was further from the truth, because the opposite reaction had  caused him to completely lose any faith, trust, or confidence he might have had.

  • That’s just what I’m saying, pretty boy. You can’t possibly know what you’re talking about. Like I said, I been drinking hard for over thirty years.
  • Correct. That’s the point.
  • Not really. So, the point is you can’t be right, because this is the first time in thirty years something like this ever happened to me. So, it can’t be the booze. Now what’s really wrong with me?

What I really wanted to say was:

  • Well, perhaps you  can’t really cure being Irish.

Unbelievably, déjà vu came knocking thirty years later when our next-door neighbor in the Hamptons presented to the hospital with liver failure associated with ascites. This is a condition in which the liver is so scarred it cannot properly function, subsequently causing the abdominal cavity to fill up with clear yellow serous fluid. In being a serious sign that portends a very poor short-term prognosis, it can even make a man or woman look ten months pregnant.

Usually the kidneys shut down next or nearly unstoppable upper G.I. hemorrhaging occurs expressed as continuous vomiting of blood. This is a result of extremely high pressure in the varicose veins located in the lower esophagus that dilate because the liver doesn’t work; causing back-pressure into the spleen; which also enlarges.

His predicament was no surprise, as I would notice him regularly wandering around his yard, starting to drink his beers at ten a.m., which he conveniently parked in front of him on the home-made shelf provided by his expanded abdominal girth. Meanwhile, his wife, who had smoked her lungs to death, was inside their house attached to an oxygen tank.

As a perfect pair, the couple was a veritable monument to self-inflicted abuse.

When he was hospitalized with cirrhotic liver disease, I saw him briefly when I stopped by his bed for a courtesy call, but was taken aback when he asked me what was wrong. He said his doctor told him he had liver failure. When I reaffirmed that his problem was the result of years of drinking to excess, he dismissively parroted the man at the Boston V.A. by saying it could not possibly be true for the same precise reasons I heard many years before. He said he had consumed beer all day long for well over half a lifetime but this was the first time something like this had ever happened to him; ergo alcohol could not be the problem.

Saying nothing more than “good luck and get better”, I just walked away because I had seen that that movie once  and it wasn’t very good the first time around. In this case he wasn’t even Irish. He was just an ignoramus.

Enough said about assumptions.

My mother put it differently whenever I did something that I assumed had seemed like a good idea at the time; but turned out just the opposite.

  • But mom. I thought…
  • So, you know what thought did, don’t you?
  • No mom, what?
  • A man thought he had to fart.

Anyone who studies medicine comes to know it as a discipline in which two great truths are axiomatic:

A: Never make assumptions.

B: Never, say never.

Especially never assume that a patient knows what you are talking about or understands anything you are saying without soliciting your own personal validated feedback. One must ask at the end of the visit:

  • Did you understand what we discussed and do you have any other questions?

As far as patients are concerned, they believe that too many doctors speak a foreign language, but are often afraid or too intimidated to ask for an understandable translation. They just nod their heads like dumb jack-asses, or worse, talk through the explanations without listening, then go home to tell family or friends.

  • The doctor didn’t spend any time with me at all. And he didn’t tell me anything either. He’s an incompetent boob.

That is, assuming the doctor really takes the time to speak plainly, or unless the patient has taken it upon himself to become an overnight Internet expert about his own personal health; in which case, he does not need a doctor anyway.

So, there it is. Just another one of life’s many negative feed-back loops.

The father is Jim Beam

 

intranet.tdmu.edu.ua

 

 

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Dad Goes Blind

Dad Goes Blind 

When my father was in his eighties he made an appointment to see his ophthalmologist because of a sudden visual disturbance when he was driving. He described it as severe blurring whenever he was trying to look up.

The doctor couldn’t find anything wrong with him, including the fact that there was no change in his long-standing nearsightedness. But because of the nature of the symptoms he sent him for a CAT scan of his brain.

This study revealed a very large arachnoid cyst that seemed to be pressing on the right side of his brain; a finding that caused a great deal of consternation that he might requires delicate neurosurgery to have it removed.

Of course this led to a consultation with a neurosurgeon, who put him through another series of tests, only to conclude that his neurologic function was intact. He opined that my father should simply be watched and periodically reevaluated in lieu of having immediate brain surgery. Apparently the cyst was not pressing on his optic nerve or his brain’s visual centers.

My mother was of the opinion that the cyst may not have been responsible for changes in his sight but seized upon it’s presence to explain any of his personality quirks that she didn’t like. She said she always suspected he must have had some sort of hole in his brain in the first place.

After about six months of medical tests, worries, concerns, and the agonizing family fretting that goes along with wondering if a major brain operation was going to be in the offing, my father solved the problem himself when he realized that he had been using my mother’s farsighted progressive bifocals instead of his own glasses when he got behind the wheel of the car.

Because he was nearsighted, he probably couldn’t see his own glasses case. He then assumed that any glasses in a reachable glasses case would do. When the dust finally settled on the entire affair he still couldn’t “see” what all the fuss had been about. He said:

  • So I made a mistake. What’s the big deal anyway? It could happen to anyone.

This was opposed to the situation involving my second wife’s mother, who almost did lose her vision because she had a benign meningioma compressing her optic chiasm. She would certainly have gone blind if she didn’t have it operated on.

Having the middle name Vituperation, she was a bitter, mean-spirited woman, who never had anything kind or nice to say about anyone or anything. So harboring thoughts like my mother’s theory that  my father’s cyst may have altered his personality, I began to hope that my mother-in law would come out of the operation a bit sweeter, kinder or gentler than when she went into it.

Unfortunately, because that was not the case, I suggested to my wife that if the tumor recurred and required repeat operative intervention, perhaps we could ask the neurosurgeon to look around for her Mean Streak. If he could excise that part of her brain along with the pesky mass of balled up tumor cells, life would be good.

  • Doctor, does a mean streak show up on a CAT scan of the brain?
  • Only if it’s malignant. Last one I removed left the patient totally mute.
  • Do tell.

 

The Waiting Room

  • Excuse me miss, but I’ve been waiting here to see the doctor for about an hour and I’m getting a little bit annoyed. I am a new patient and I do not care to be treated like this. It’s a bad first impression. So can you tell me when the doctor will see me?
  • I’m sorry sir, but I don’t think it’s possible that the doctor is going to be able to see you at all today.
  • What? That’s ridiculous. I’ve had this appointment for three months; I’ve already waited here for over an hour today and now you’re telling me the doctor can’t see me? This is outrageous. You haven’t heard the end of this one. I’m going to file a complaint with the State Medical Board.
  • Please calm down, go back and have a seat sir. The doctor is running behind but I assure you that he will be with you in just a few more minutes.
  • But I thought you just said the doctor couldn’t see me?
  • That is true sir. The doctor will be with you shortly, but the doctor will still not be able to see you.
  • What kind of nonsense is that?
  • The doctor is blind.

Assumptions: They are false and they are limiting. But they are also reversible