Doctor; Your Diagnosis. My Death

copyright © 2010 Betsy L. Angert.  BeThink.org

Dearest Doctor, I have come to my senses.  Days ago, when you offered your diagnosis, I died.  No, not literally.  Had you done me in, I would not be here to write what I hope will help inform your bedside manner.  Well, in my case only the way in which you approach a patient who merely sits in an examining room chair near you is the concern.  You may recall our time together began so innocently. We sat down to review the results of annually scheduled blood-work.  I had not felt sick all year or on that day.  You had even expressed, it had been so long since we last saw each other.  You scanned the pages, and proclaimed, that I must have returned to my bulimic ways. My spirit perished.  I had done nothing of the sort!  Yet, you said you were sure I had.

The pain you inflicted killed what could have been a relationship built on trust.  Today, I realize your proclamation was but part of a pattern.  Indeed, you reminded me that during our last consultation, a year ago, you also decided that I must be near death.  In August 2009 you insisted that I arrange for an appointment, which you openly stated, would affirm your fears. I must be seriously ill. Yet, once that test was done, it affirmed that I was as I am better, than fine.

Upon further reflection, and after the telephone conversation I initiated hours after my appointment, I thankfully, feel more serene.  No, you did not change your diagnosis nay your assertion that I must be vomiting.   Still, the talk helped me, although it seemed to alienate you.  I wonder if you now have a sense of how I felt and feel since you pronounced me dead and a liar, or do you merely believe of me, “The lady doth protest too much.”

Might you ponder that my grievance is grounded.  Oh, how little you know of bulimia, and me.  In the two plus years we have had an acquaintance, I see you for maybe, ten minutes a visit.  Since only once did I come to your office for other than a check up, what you observed this week is true. I rarely visit.  When I do, you are booked.  Patients arrive back-to-back.  We chat for a bit, but not really.  All is said and done rapidly.  I wonder, might the speed of conversation and the shallow nature of a consultation affect your appraisal.  After all, you too are human; although from what you said to me today, it seems at times such as this you define yourself as a trained medical professional, more perceptive than a mere mortal.

During my most recent appointment you admitted, you did not even recall what I had shared so often; I disdain exercise.  I was never amongst the anorexic/bulimics who think they must work out endlessly. Only injuries incurred late in life took me to my current routine, a daily swim in the pool.

I know you recall that I swim, only because I often come dressed to swim.  Even that concerns you, exposure to the sun.  Do you remember that I switched to an indoor facility.  Probably not.   While the truth of the locale and my loathing exercise may not be memorable or visible in an office visit, what can be seen is a sign of bulimia.  My teeth.  

Doctor, did you notice what my Dentist and Dental Hygienist have?  My once translucent boney choppers are now denser.  The color has returned to white.  For so long, even when you and I first met, the hue was dark gray.  Other dental conditions were already on the mend when I first entered your sphere.  Deep groves, once etched into the enamel, gone.  With my tongue, or a look, I can tell, the surface is smooth once more.  As I said in our phone conversation, less than twelve hours after you declared me dead,   Charlene stated with delight, “Your teeth finally look alive.”

Funny. Charlene, my dental hygienist, detects a difference in my body and being since I left bulimia behind.  Yet, you are intent on my being ill.  Charlene sees and speaks of how my life without food benders and bile has helped me be healthier.  Yet, you dear Doctor, only see standards, the stats that you think are real, more real than me.  

You do not see, hear, or open your mind to who I might be.  I marvel as recall the day Charlene had expressed a doubt.  She offered, in Dental School professors taught the conventional wisdom.  Teeth do not substantially re-mineralize.  Enamel and density loss are permanent.  However, Charlene wonders aloud.   She has come to accept that what she learned may not be valid.  Months earlier she mused, “Well” after much assessment, “I have witnessed the metamorphosis.”  There is a change.  

Transformation from bulimia to health has occurred for Charlene, for me.  Then there is you, dear Doctor. Apparently, what was, will always be in your mind.  Oh, Doctor, if only you had truly engaged me in the past two years . Had you looked and listened or even spent more than a scant few minutes with me in any of our sessions, just maybe you would have learned that supposed facts and figures may not mean whatever it is medical professionals teach.  

Might you think to speak to me rather than seek the “expertise” of more and more specialists [sic] before you declare me to be on my deathbed?  I know not what to say.

I tried to talk to you, to share my reality, my family history, and myself.  My words fell on deaf ears. You so sweetly fight me at every turn.  When I worked to offer an analogous story, you scoffed.  Might I assume that you see me as less knowledgeable, credible, or just crazed.  Perchance, I might try to tell the tale again?  Perhaps, the read will help you to authentically relate.  

As I said, the day after you delivered your diagnosis I traveled to the dentist to have my teeth cleaned. Many friends have tried to convince me to go to a Dentist in fairfax, but I have built such a rapport with Charlene, I couldn’t think about changing dentists now. By the way, dental visits last for well over an hour and I go every few months.  Charlene and I talk the entire time.  This week, since I had just seen you and was so devastated, my exam and your evaluation were the topics of discussion.

Charlene smiled and stated she is all too familiar with Doctors such as you.  While she has had her own experiences her Mom’s was most worrisome to her.  While under the care of her Doctor, Charlene’s mother’s organs were forever damaged.   The Doctor thought it wise to bring this adult female’s blood levels to “normal.”  However, with age her heredity set in.   What had been usual for the patient was no longer as it was.  

Yes Doctor, I acknowledge that you listened to this story, for seconds, and then, abruptly interjected your disregard of my attempt to share personal accounts, or the details of my family history.  Doctor, you preferred the argument, “Charlene is not a Physician.”  Might you trust the words of others Physicians, those who have misdiagnosed me or correctly assessed my well-being?

Please indulge me.  Allow me to present a nonfictional narrative.  Eight years ago, after a serious automobile accident, an Orthopedic Surgeon told me I would not be able to walk for at least a half a year, probably more.  He assured me that one leg would be shorter than the other for the rest of my life.  I needed full bed rest for at least six months, maybe seven.  The specialist said he could not speak to the pain I had in my chest and ribs.  He saw nothing in the X-Rays.  Weeks later, another bone MD whom I thought it wise to consult, was shocked to discover my broken sternum and four fractured ribs.  

That Surgeon, I will call Doctor Thom, was more than a second opinion; he saved my leg, heel, my life.   Dr Thom told me that I needed to begin an exercise regime immediately!  He then showed me exactly what he wanted me to do as soon as possible.  While he concurred, I could not walk or bear even the slightest weight on my heel, I could get around on my hands and knees.  My father, relieved went to the store and purchased the best fluffy-filled cotton kneepads money could buy.

Dr Thom helped me realize that the pain in my chest was very real.  He helped me to feel safe, secure in the knowledge of what I could to.  Dr Thom spoke of a means for stability, and provided time frames.   Most importantly he attended to my needs, not as just another “patient,” but as me, Betsy!

Thankful that this physician asked of my history, and accepted that two past injuries necessitated a regular daily swim, I was able to feel comforted by his care.  Indeed, months before I was authorized to walk, with a promise from me that I would not place my leg on the ground, not even in water, Dr Thom prescribed a return to the pool.  Yes Doctor, he wanted me to swim unlike you who said, stop the swim or at least cut the time in the water done to near nil.  Fifteen minutes or less a day?  Doctor, have you read the research and recommendations for minimal daily exercise? Perhaps you have no desire to do other than prove yourself right.

For me, what is right is a healthy relationship with one’s body and other beings.  If only we had genuine caring, sharing exchanges.  I believe we do not.  In each of our talks, your trepidation for what you feel is my impending death, is inescapable.  It seems to shade your every diagnosis..

Doctor, I know you are not G-d. You do not have the power to give me life.  However, a professional such as you, can cause my demise.  The innumerable reports that document a patient’s passing at the hands of his or her physician cannot be ignored.  

Certainly, I may have over-reacted or reacted as any healthy person would to your decree; I lie or I die, possibly both.  Imagine my surprise, I entered your office the picture of health, and was pronounced a perishable commodity.   You said, were you to review my chart in a hospital, you would order a full body transfusion.  Until you were certain why results of the blood tests were so dire, you wanted me to see four specialists and a therapist.  A therapist?  

That statement alone spoke volumes; however it was a hush in comparison to the stated accusation.  You were concerned that I had returned to the world of bulimia.  Oh had you, or most any Doctor who diagnoses, what professionals call an eating disorder, experienced the thrill of leaving that past behind, you might understand how wonderful it is to have my life back.  

For years now, days, weeks, months, decades, devoted to food do not consume me.  Close to a decade has passed since I spent more time bingeing and purging than you do sleeping or working. Can you imagine? What might you feel if you were finally free of all that constrained your very being?

Oh Doctor, I know you cannot conjure up such a connection.  Were you able to relate to my reality you would not have said and done as you did.

You dismissed my words, my truth, all that I had learned, felt, and experienced in the twenty-five years and three months that I battled with the bulimia.  More significantly, you concluded that the many years since I last vomited were null and void.  In your infinite wisdom, you decided that a Doctor knows much more about an individual than the person, his or her self, does.

With few visits in our past, and little conversation, you know what is real for me?  You think practitioners who have never met me before will assess my health more accurately.    Based on what, more standards of “normal.”

Your counsel crushed any sense of a connection.  Your stated distrust of me is as a surgical knife; it cuts to the core.  When a Doctor doubts a patient, the effect is profound.  At least it has been in my experience.  However, it seems you are not truly interested in my experience or that of others.  Oh, how I wanted to explain my truth when we spoke on the telephone today.  Your response, “He, she, or I am not a trained medical Physician.” may have cured me of that desire.

However, happily I was able to sneak in one thought whilst we chatted.  A Doctor I am acquainted with has often expressed, medical school is like a technical college.   Practitioners and Surgeons are analogous to Mechanics.  For each, diagnosis is the greatest challenge.  An educated guess, or “evaluation” only captures what is typical.  You offered no thought on what another Physician pronounced his truth.  Perchance, you are still of the mind that you know what you know.  

As an Educator and an observer of humanity, I share what I believe.  Knowledge is not power!  Empathy empowers.  If only you chose to be empathetic, to consider what is beyond book knowledge. Perhaps, then, people, patients, might be real to you rather than fall into one or two categories. Terminal or test-proven fit as a fiddle.

Reference for review and reflection . . .

• Bulimia & Your Teeth, By Brian McKay, DDS.  Reprinted from Eating Disorders Recovery Today. Spring 2007 Volume 5, Number 2
• The benefits of: Swimming.  By Brigid Delaney.  Cable News Network. May 24, 2007
• High Water Marks, By Judy Foreman. Boston Globe. Page 2 June 14, 2010
• How much physical activity do adults need? Centers for Disease Control and Prevention
• America’s Health Care System is the 3rd Cause of Death  Barbara Starfield, M.D. Journal of the American Medical Association, 284(4), 483-485 2000