One of the most frustrating things I encounter at work is trying to help people who doesn’t want to help themselves.
Here are the 10 top clinical signs (for the novice):
1. The beautifully tanned patient who is sunburnt all over, (looking like he/she has just spent their weekend on the beach), and is about to go into the operating theatre to have a melanoma excised.
2. An obsession with blenders. The lap band is tight to maximise weight loss, the patient is supposed to be on a portioned healthy vitamised liquid diet. Instead, he lives on a ‘vitamised diet’ of Big Mac and French Fries, liquified via a blender. ‘I just don’t understand why I am not losing weight…
3. The dangerous oxygen tank. The patient who just had 1/2 of his right lung removed for cancer – so now he is dependent on oxygen – lighting up a cigarette in the hospital courtyard. Taking a drag on their cigarette in between inhaling a whiff of oxygen from their mask. Honestly – if you want to kill yourself, that’s ok, but to blow up the hospital???
4. An X-ray that shows a new fresh hand fracture through plates and screws over an old fracture. Excuse: ‘Well, punching my fridge is better than punch my Dad in the face, rght?’
5. The MIA patient. The patient was called for the operating room, but he couldn’t be found anywhere. Because he was outside for his ‘last smoke’ before having half f his lip removed for lip cancer. ‘You only told me that I couldn’t eat or drink before my anaesthetic, you didn’t say I couldn’t smoke.’
6. Patients with bags of ‘unfilled’ medication scripts. One is really unsure as whether these patient don’t take their prescribed medications (for their heart disease, cholesterol, diabetes, infections etc), because they can’t be bothered, they don’t want to or they just ‘don’t believe in taking medications.’
7. DNA’s (did not attend). Patients who have appointments for their cancers to be assessed and removed do not turn up to their appointments despite multiple phone calls, or simply, they have important work-commitments or holidays and need to move their appointment to 6 months later when things are quiet (and the cancer will be inoperable.)
8. The broken plaster on a broken arm. Sometimes, the non-existent plaster on a broken arm. ‘I know my arm is broken, but it got so itchy I had to take the plaster off’.
9. The gigantic fungating cancers. It takes time for cancers to grow. When I see a very very large cancer, I wonder why patients don’t come in when it was the size of a coin. Once I had a patient with a skin cancer on his chest. It was the size of a dinner plate, and it had already eaten into his breast bone. I asked him why he left it until now to come, he said that he only came in because it was growing into his neck and he couldn’t hide it behind his business shirt and tie at work anymore. Did he know it was a cancer? Yes, but he was too busy at work to take time off for an operation.
10. The smoker with a cigarette dangling out of his neck. The throat cancer patient who had his throat removed now has to breathe out of his tracheostomy. He was found lighting up with a cigarette taped to his tracheostomy. A short-cut highway of delivering poisons directly into his lungs. Well, I guess he won’t get oral cancers from smoking this way.
The Differential Diagnoses:
1. I have a severe case of NFI (No F&%$* Idea)
2. I am so f$%#@ scared that I’d rather bury my head in the sand
3. My health is my doctor’s responsibility because that’s their job to fix it
But sometimes we just have to face the harsh diagnosis of: I don’t Give a Shit about Myself.
Mrs Warren* came into my practice yesterday.
Mrs Warren is the mother of Hannah*. Hannah was a 35 year old beautiful young mother of three children, who passed away from metastatic breast cancer two weeks ago. Hannah was my patient three months before she succumbed to her illness.
I heard Mrs Warren’s voice at the front desk reception.
I stayed in my office, consumed by guilt. When Hannah was dying in hospital two weeks ago, one of the nursing staff informed me about her readmission into hospital. ‘Things are not good, I don’t think it will be long.’
‘Maybe I should pop by and visit.’ I thought, mentally swiping at the tears that threatened to clog up behind my eyes.
‘I think they will really like that. Hannah loved you. She thought the world of you.’
I started, then realised I had thought out aloud, the nurse was just responding to my comment.
Days, then weeks passed. I couldn’t bring myself to visit her. Several times I walked towards her room – steeling myself to walk in to face her emaciated semi-conscious form on the bed, surrounded by her grieving family – then finding myself turning, striding rapidly away.
Hannah was my age. She was a lawyer, a lawyer who studied hard, worked long hours, made sacrifices and achieved. She once told me that she was the youngest associate ever to be offered partner. She told me how there was no female lawyers in her department at which we both smiled simultaneously in mutual understanding. She said she sees a reflection of herself when she looks at me. As I do, when I see her.
I never went to see her, I never said goodbye. I never attended the funeral. AFter all, I told myself, she wasn’t a friend. She was a patient. The only thing I did, was to write a card to her family.
Now her mother is standing in my office. And I am kicking myself. I should have made more of an effort. It would have just been ten minutes of my life; After all, my ten minutes would have been nothing compared to ten minutes in her last days. My cowardice overwhelmed me, I found myself hiding in my office, afraid to move. Or breathe.
‘Hello Mrs Warren, we are so sorry to hear about Hannah.’
‘Thank you.’ I imagined her waving her hand elegantly. Mrs Warren always reminded me of a grand matriach, she moved and spoke with such pride and grace. ‘I just wanted to come in and thank the doctor for her card.’ A sniffle. ‘It was so lovely that I had to read it to Hannah yesterday.’ A brief silence was followed by a sharp snap of a handbag. Must have been a tissue. I could almost see her in my mind, using the task as an oportunity to gather her composure.
‘You know, we had so many people at the funeral last week, the church had to leave the doors open.’ There was less wobble in her voice. ‘We got so many flowers and cards.’
‘She had so many specialists, but doctor was the only one who sent a card. Please thank her for me, we were so pleasantly suprised……’
I shut the door.
Tears were running down my face. I was humbled.
It seems the two minutes it took for me to write a card was enough for them.
*All names have been changed to ensure confidentiality and protect privacy.