Bedside Manners: One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer

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9781400080519: Bedside Manners: One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer
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In beautifully crafted vignettes, physician and NPR commentator David Watts explores the world of modern-day medicine and reveals the emotional truths and practical realities at the heart of the doctor-patient relationship. Bedside Manners is an engaging, often surprising investigation into what happens when we sit down and talk openly about vital issues of health and mortality.

Combining the grace and precision of a poet with the down-to-earth, compassionate manner of a doctor who deals with the problems of real people every day, Watts describes situations both odd and touching: the patient who stays awake during an endoscopy to ward off demons; the woman who recites poetry to get through a frightening treatment; the man who arrives at Watts’s office bearing Internet research on syndromes that have little to do with his own condition; and the seventy-four-year-old architect who faces a tough cancer diagnosis with dignity and courage.

Readers will come away from these tales of difficult diagnoses, irreverent colleagues, brave survivors, and examining-room poseurs sharing Watts’s own sense of humbled astonishment. As he tells each story, Watts closes for the reader the protective distance many doctors employ, and touches all of us who have felt vulnerable in the position of patient. Refreshing, wry, and reassuring, Bedside Manners holds important lessons for both healers and those who seek their help.

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About the Author:

David Watts, M.D., is a poet and a regular commentator on NPR’s All Things Considered. He has published three books of poetry and organized the Writing the Medical Experience workshops at the Squaw Valley Community of Writers and at Sarah Lawrence College. He lives in Mill Valley, California.

Excerpt. Reprinted by permission. All rights reserved.:

White Rabbits

Frank is in my waiting room, which means I'm going to be spending a lot of time chasing rabbits—little questions he brings on small crumples of paper that skitter around on my desk, issues he's researched on the Internet and gotten emotional about that usually don't have anything to do with his own circumstance. What's worse, he's about to have an operation, which means he's really going to be worked up.

I'm remembering that he's the guy with too many colonoscopies. "Well, something might have gone wrong since the last one," he'll say. True, but mostly not true. Still, you can resist that argument only so long and then you find yourself torquing another scope through the colon.

And it's not a trivial deal. He goes vagal in the mid-transverse colon, drops his blood pressure, looks like the life force is beating it out of town on the lam. We haven't killed him yet, but we may have come pretty close. And it probably doesn't do a lot of good for his oxygen-starved brain cells that his blood turns to molasses like that. Besides, watching him go shocky sends my coronaries into spasm.

I made him sign a release before the last one. That was after the cardiologist told him no more colonoscopies until he got his carotid arteries fixed. Even the S word, stroke, couldn't deter Frank.

I'm not going to have a stroke, he said.

It struck me that he has one set of evaluators for a real disease that could do real harm and another set for the harmless imaginary one.

He wrote a long letter releasing everyone this side of Kansas from any kind of liability connected with colonoscopy. This is a man who knows what he wants even if it doesn't make sense. We did it, but not before I secretly cleared it with the cardiologist. And we survived. All three of us. But I told him no more nonsense until he got a little more blood flow to his critical body parts.

Now the time has come. 'Bout time, I say. The vascular surgeons are ready to ream out his carotids, but he wants to ask me a few questions first. I knew that. And I know what's coming—so here we go.

I understand you can get a stroke from this operation.

That's true.

How common is it?

I don't know. Not very common. It's a question you should ask the vascular surgeons.

They don't hold still as long as you do.

Tie them down and ask them. Meanwhile, they don't do the surgery unless the risk of waiting outweighs the risk of the surgery itself. It's a complicated formula and I'm sure it's only partly accurate, but that's the intent. It has to do with the extent of stenosis.

What's that?

Narrowing.

How narrow is mine?

Ninety percent, both sides.

Is it safe to say it's small?

What's small?

The risk of stroke.

It's small. Smaller than if you didn't have surgery.

How long will I be in the hospital?

Don't know. These days, probably not long.

Three days?

Thereabouts.

I read that they will put me on something to thin my platelets.

Yeah, probably.

What'll that be?

It's up to the cardiologist and the vascular surgeon.

What are the side effects?

And I'm thinking to myself, This is an example of how questions get asked for the sake of asking. Fueled by their own passion, they spring from a point beyond the platform of knowledge. How would I know the side effects if I don't know the drug?

I can't answer that.

A long silence.

The rabbits were moving from one pile to another.

Well, I have some questions about these bor . . . I can never say it.

What?

Sounds in my abdomen.

Borborygmi.

Yeah, that. I keep getting these loud noises.

You always have that.

Yeah, but I don't believe it's normal.

I know you don't believe it's normal, but you've always been normal. Every colonoscopy has been normal. We've studied you from teeth to toenails and there's nothing in there. Nothing.

What do you listen for if you think you've got cancer?

Now we've come to it, I thought. This is the root of the multitudinous colonoscopies, the driving force for the unseen locomotive: failure to believe negative data. Failure to temper the fear that something is wrong somewhere.

I am careful to speak the truth. But truth comes in many packages and it looks different to different people. For Frank I will speak it in a way that wants to bring him back to earth. Just somewhere along terra firma. It would be a mistake to lay out all the variables. That would give him too many openings to hang himself on yet another obsessive rope of worry. So I overstate.

You don't have cancer.

How can you be sure?

You don't have cancer. Since he cannot shut that door, I shut it for him.

He acts like he didn't want to hear this. He looks uneasy, fumbling with his notes as if they, by their meticulous preparations, will ride him over this unpleasant hiatus. They do not. He is forced to accept and move on.

Well, what do abnormal bowel sounds sound like?

I could be offended by that question. Layered into it is distrust of my ability, my training and experience to listen and report, as if only he, with his untrained ear, can decide what is normal. I conclude it is an accident of distraction. Of obsession. He is blinded by his worries.

I indulge him; I'm not sure why. But I can feel that I'm getting close to my limit.

Bowel sounds are abnormal if they are absent for one minute in all four quadrants of the abdomen, if they are high-pitched and occur in rushes as they do during a dynamic obstruction, or if they are amphoric, meaning that they sound cavernous, like water dripping in a very wet cave—

He interrupts: Can you be more specific?

No.

No?

No. End of lesson.

Well, I want you to hear—

I've listened to your belly a hundred times.

No, I mean—

And he brings out a little velvet pouch, something you might see holding a family heirloom, a watch perhaps, the lovingly engraved kind, made of gold and wound by a tiny gold key. He lays it on the table and starts clumsily trying to extricate whatever it is that is wedged inside.

And with a straight face he says, I made a recording of these bo . . . bo . . . bobo . . . rygeums, or whatever. I want you to listen to it.

By now he has the recording device out on the table and is fumbling with it, trying to get it to play. It's not cued to the proper place and he is madly forwarding and rewinding. I realize I am most amazed not by the weirdness it takes to record one's own bowel sounds, not by his solipsistic assumption that I will find this of such great and compelling interest as to arrest my whole practice while we await the multimedia presentation, but that I will tolerate his time-consuming fiddlings with this bowel-noise recording device of his while patients fully deserving my attention wait their turn. Were it not so humorous, it would be maddening.

Without thinking, my body has stood up and is leaving the room. I babble something polite like I have to see someone down the hall, and am gone before I can laugh or burst out with something I'd be sorry for. I am tempted to relate this story to those in the hallway, but who would believe that there's a guy in my office playing a recording of his own bowel sounds?

When I return, he's found it. He plays me ten seconds of static, mike noise, adventitial sounds. And in the background, harmless bowel mumblings.

Normal, I pronounce.

Are you sure?

Sure.

He is incredulous, but I leave him no openings. I am not in the mood for encores.

He is quiet for a moment. Then he rallies. I was reading about fistulae, he says.

Oh no.

Yeah, and how do you know if you've got a fistula?

Frank, I say. Cut it out. You've got a real problem in your carotids and you're out there trying to invent something in your gut you'd rather talk about. We've been there. Done that. Checked you out, first class. All is well in loop-de-loop land.

I have stunned him to silence. Even so, I know I've not heard the last of this. When he is away from me and my slaps in the face of the disease he believes in so furiously he almost wants it, doubts will filter in along the periphery and eventually, because they are welcome there, occupy again the pathways to the center of his being. He will build them up meticulously, like a young man smitten with a model airplane project, with the same concentration and enthusiasm of one whose grand vision is somehow tied to what he is building, all energies now turned in the same direction, recruiting evidence, plotting how to convert the heathens who refuse to see the obvious. Oh, for someone to share his vision.

It's not me, I say.

What?

Frank, go have your surgery. And blessings be upon you. For Christ's sake, just do what you need to do. You'll live longer.

He gathers up his rabbits and tucks them in his pocket. As I watch him, he looks like a man picking up chess pieces at the end of a bad game, not accepting the outcome.

Then he leans over the desk. Can we talk about this again? he says.
The Doctor with Food on His Shirt

He was a doctor with food on his shirt, she said.

You don't like to see that, I said. You don't like to see a doctor with food on his shirt.

And, she said, he put me in a room that wasn't a room but open space with a curtain around it, short as a miniskirt.

You don't like to see that, I said.

He said he didn't know what Asacol was and why I was taking it. I said it was for my disease. He said he didn't know why they gave Asacol for that disease. I said I'd been taking it for years—Hmm, he said—for my disease and I thought that everybody who had this disease took it. He said he noticed that I worked for that company that ...

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