Medicine Archives - Page 21 of 26 - Man, Medicine, and Mike

I Want a Vernors

People from Michigan know what Vernors is. For those of you that don’t, it is a ginger ale type of soft drink. It originated in the Detroit area and still has about 80% of its sales in Michigan. I will explain later the significance of Vernors.

It was 1989. I was a 3^rdyear medical student doing my general surgery rotation. I was on the trauma surgery service. It was really very intense. I learned a lot.

One of my earliest patients was a man who was seriously injured right at the end of his 4^thyear of medical school. As an inexperienced medical student, it was kind of intimidating taking care of another medical student / new physician. He was intubated (breathing tube down his throat) and on the ventilator. His sedation had been lightened enough however that he would open his eyes as I came into the room to examine him.

Every day I would go to check on him and examine him. Each time he would look at me as I was in the room. I would talk to him, explaining that I was the medical student and that I was on the service that was taking care of him. I wondered what he was thinking. I was very anxious that he was silently critiquing my technique. Did I listen carefully enough to his lungs? Did I spend enough time examining him? Was I doing everything the way I was supposed to? Each time I entered the room it felt a little bit like a practical exam from our physical diagnosis class.

The pattern continued for days on end. I continued to try to do my best. Every day I felt anxious as I went into his room. Every day I wondered what he thought of me.

The resident paged me to tell me that he was doing well enough that he could be extubated (have the breathing tube removed). This would mean that he would be able to talk to us. I went to his room. I anxiously watched and waited while the endotracheal tube was removed. What would he say? Would this be the moment when he would berate my inexperience and my incompetence? Would he criticize my performance over the past several days?

I held my breath as the tube came out. He coughed and we suctioned his throat. We waited to ask how he was doing and to see what he would say. He had gone from a full and active and healthy life to sudden severe injuries. So much had changed. This was the first time to hear from him after all of his experiences.

Here were his words: “I want a Vernors.”

Really? That was it? Nothing profound? No commentary or criticism of me and my performance?

It was indeed it. He wanted a Vernors. The nurses had to make sure his swallowing was intact and then they would work to get him a Vernors. And so our care of him continued to go on.

There are some very important lessons buried within this story, however.

First, it isn’t about us (me). How ridiculous I was to think that this story had anything to do with me or my performance. Honestly. It had nothing to do with me. This wasn’t my story. This was his story. We absolutely have to remember this in medicine. We are indeed impacted by our experiences in taking care of patients. We have to find ways to cope and deal with the stresses that we feel. But the focus in our care of the patient is on the patient. It really is not about me and how I feel.

Rana Awdish’s^[1]is a physician who survived a terrifying sudden illness. In her book she tells about a resident who was focused much more on himself than on what was happening to her as the patient. The resident even came back not to check on her, but instead to tell her how traumatized he was by her near fatal experience. Reading her well written book you become shocked by the lack of insight of the resident. When you read it from her perspective it becomes crystal clear that while we all need to learn how to process, in medicine the focus is on our patients.

So also, in life others are going to have traumatic experiences. When we see what happens to them it can impact us also. But I would hope that we would have the maturity to look at what is happening from their perspective. It is about them, not you.

Are we mature enough to look beyond our own needs to be true friends to those who are in need. We of course might have feelings about what is going on. But our first focus should be on what they are feeling, what their needs are and how we can help them.

It amazes me how easy it is for me to fall into selfishness whenever I am stressed. He wanted a Vernors. Of course. His throat was dry and sore. He was sick. He wanted what he had as a child when he didn’t feel well. He wanted a Vernors. That was what was important.

The second big lesson is about our false self-consciousness. I was so focused on what he was thinking of me. Frankly, the vast majority of people are not thinking about you. They are thinking about themselves. They really are not noticing us. We obsess and worry and fret about what others are thinking about us. But instead they are fretting and worrying and thinking about themselves! I do not mean to imply that we are all selfish all the time. But what I am saying is that I think a large amount of the time when we are worried what others are thinking about us, they are not thinking about us.

Relax. Be real. Stop being so self-conscious. People may not be noticing the little spot or pull on your shirt. They may not be noticing that annoying hair that keeps falling out of place. They may not be obsessing over the mismatch between your belt and your shoes or whatever it is that is worrying you. Most of the time they are thinking about something else entirely. And really, we would all be much happier if we would just stop worrying so much about what others are thinking of us and instead would just enjoy being with them.

Sometimes, they just want a Vernors. They are not spending all of their energy judging what I am wearing or how my hair looks or grading my physical examination technique. In fact, patients are far more concerned with what is going on with their health, whether I can help them, and what I am going to say about them and their health than about me.

He wanted a Vernors.

Can I be a really good friend to you and think about your needs instead of my own when life has really thrown you off? There are times that it is not my story, but it is your story. Please forgive me if I sometimes forget this.
Can I be a mature human being and stop obsessing about myself and instead just accept you and let you accept me? Can we just be friends and enjoy our friendship?

Maybe that could just be a secret phrase we could have. “Maybe he/she just wants a Vernors!” Then we will know – it is time to think about things from their perspective. It is time to support rather than take. And we will also stop obsessing about ourselves. The hair out of place may not matter. They might be more worried about their hair that is out of place!

^[1]“In Shock” by Rana Awdish, https://www.ranaawdishmd.com

Dependency

He has a terminal diagnosis. It is taking him slowly. No one can know how long he will last. It is weakening him and that is hard for him.

It was a routine clinic day for me. I was bopping from room to room working through my day trying to keep on time. I hate being behind in clinic. I keep pushing to get my notes done between patients. I rapidly scan the chart for the next patient. I see that he was recently hospitalized. In the hospital he didn’t respond very well to the treatment. He is home now but it doesn’t look very good for him.

When I enter the exam room seeing his face “clicks” something in my mind. I am a visual learner. Seeing him and his wife helps me remember a lot about him. He is a big and muscular man. He is the type that has always been strong in both body but also spirit. He is the type of person that you could rely on to always be there and to always get everything done.

He looks different now. He is clearly being weakened by his disease. His color is not good. It is still him, but it is as though the battery has been partly drained. The strong muscles are not getting the energy they need. This is going in the wrong direction. As his doctor, I do not have a thing that I can do to alter that.

I tried to engage him in a goals of care discussion. I don’t think that the hospital will ever be a good place for him. It won’t help him. It will likely just weaken him even more. If we are smart, we would keep him in his home. I honestly think he will live longer if we don’t ever put him in the hospital again.

If we don’t talk about this proactively the hospital is where he is going to end up. That is the default and easy pathway in the U.S. It amazes me how it is always so much hard work to fight against that. Every time it is heavy lifting. I think – for him – this may be the most important thing that I can do today.

What does he want? What are his goals? What are his fears? What would be an unacceptable outcome for him?

He doesn’t want to be a burden on his family. He will want to be hospitalized purely so that they don’t have to take care of him. His wife was shaking her head firmly. She has no problem taking care of him. I know that we can get hospice or other home care resources to him. Even so he doesn’t like the dependent role that he was been forced into.

It has become clear that this is about so much more than just whether or not he wants to be hospitalized again. It is about how to accept and handle dependency on others. He is not wanting to talk about it, but he needs to. His wife knows it. I know it. And deep down he knows it.

I cross the line and start talking about my cancer journey. They knew I was off on a medical leave. They didn’t know why. I explain it to them. I then take it further and talk about some of the lessons. I talk about what it meant to me to be a man. I had strength. I had stamina. I could push myself. And then I could push myself more. I could work late. If I couldn’t get things done at night, I would secretly set my alarm earlier. It could even be extreme if need be to get the job done. I could and I would shoulder the responsibility for whatever I needed to get done. Sleep was good but I could sacrifice it at will to meet the needs of my work, my family, and my life. Sleep was the margin that I could and would sacrifice.

I told him that this was who I was. He nodded and tears formed in the corner of his eyes as I could tell that we were connecting. This was who he had been.

But no longer.

Shortly before my surgery I lost my stamina. Perhaps it was the tumor. Perhaps it was the stress. I couldn’t keep up the pace anymore. The surgery was staggering to me. It was enough to roll over in bed, let alone do anything physical. Radiation continued the story. Chemo turned it from a short story to a novel.

I told him how my wife insisted on driving me to my radiation appointments. I thought I could go alone. She insisted that I not.

He and his wife started nodding. I had struck another point of agreement and understanding.

I told them how we are in this life together. As much as I wish I could be the man that I was before it was not intended to be. I told them that I believed my Lord had forced me into dependency. Sarah and my family and friends and colleagues needed to take care of me. I needed to accept having others do things. I had to accept the role of dependency.

I told him it was ok. His years of strength and serving and supporting his family were wonderful. In this chapter if he needed to have the roles reversed it was ok. He didn’t have to like it. But his wife and his children needed to take on supporting him.

JJ and Sarah trying to cut the Christmas tree for me while I was recovering from surgery. So maybe they were not very good at it!

I told him that his wife and children too were being traumatized by his illness. They have been forced into a feeling of helplessness as they watched him fading. They were desperate to do something to help. In their grief they needed something physical that they could do. The energy that they exerted helping him was the only tangible means that they would have to fight. His willingness to let them come and help him was a gift. He needed to understand that as the leader of his family he needed to help them to be able to grieve. His illness was calling him to do something hard.

He had to let others serve him. He had to accept dependency.

It was ok.

By now, the tears were evident in his eyes. He understood. I understood. We didn’t have to like it. But as strong men, we can and would do whatever was best for our family.

The doors were now open. We talked about home care services. We talked about hospice. We talked about continuing to endure – to work to stay alive – for now – if that is what was best. We talked about the inevitability of death for every one of us. “A recent study has shown that human mortality is close to 100%” We laughed. Then we talked more. In his case now, we talked about the important questions of “how” and “where” rather than “if” or “when”.

I didn’t really change much in terms of his medicines. But I like to think I was a good doctor. I provided the treatment that he desperately needed.

Thank you, Lord, for letting me be your servant in the exam room this last week. Thank you for letting my cancer journey be used for good. It makes it just a little bit better if it could do some good. It is not that I wanted the cancer. But at least, in that moment, it was good.

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