Enlarged spleen

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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