I've heard that respiratory failure is one of the more painful ways to die. In renal failure, once you're off dialysis, toxins build up in your blood and you slip into a coma, going gently into that good night. In respiratory failure, you are hungry for air: it's a set of diseases that causes anxiety.
Similarly, then, patients living with lung disease live actively with their disease. They sense it, feel it, accommodate it, fear it around the clock or spontaneously here and there. Cystic fibrosis, asthma, emphysema are debilitating conditions around which patients may define themselves. This morning I met a very healthy appearing young woman, dressed nicely for her office internship, ready to start her college semester next week. On exam she seemed totally fine: no cyanosis, no clubbing, perhaps some very brief end-inspiratory wheezes but no extraordinary breath sounds. You would not pick her out walking down the street. Yet she has cystic fibrosis, a very treatable form, and when I told her I'd once met an older lady with CF during a lecture, she said, "An older woman? That's good to hear!" Raised with CF, treated with a drug only made available in 2012, she lives with a sense of her own mortality. She is comfortable enough with her mortality to allude to it in a comment to me, while I look at her and see a healthy person, and deny to myself the possibility of serious illness.
All of this to speculate as to why I've found the physician-patient relationships over the past week (shadowing in pulmonary) so profound, even as compared to a previous weeks in cardiology and endocrinology. It could just be the particular physician, but it could also be that hypertension and even type 2 diabetes are relatively silent diseases (for diabetes that's a questionable statement that certainly depends on the patient and how much insulin affects their daily living, but those in denial are able to live in denial, it seems). Over the past few days we've had patients cry in the office; express joy and gratitude over improved asthma; dismay over worsening, untreatable emphysema. My attending lingers with his patients, dreamily reminiscing about his intern days, thoroughly explaining the mechanisms underlying symptoms or treatments. I think it keeps them coming back, improves their disease self-maintenance. How privileged to be a fly on the wall for conversations that have been years in the making.
Similarly, then, patients living with lung disease live actively with their disease. They sense it, feel it, accommodate it, fear it around the clock or spontaneously here and there. Cystic fibrosis, asthma, emphysema are debilitating conditions around which patients may define themselves. This morning I met a very healthy appearing young woman, dressed nicely for her office internship, ready to start her college semester next week. On exam she seemed totally fine: no cyanosis, no clubbing, perhaps some very brief end-inspiratory wheezes but no extraordinary breath sounds. You would not pick her out walking down the street. Yet she has cystic fibrosis, a very treatable form, and when I told her I'd once met an older lady with CF during a lecture, she said, "An older woman? That's good to hear!" Raised with CF, treated with a drug only made available in 2012, she lives with a sense of her own mortality. She is comfortable enough with her mortality to allude to it in a comment to me, while I look at her and see a healthy person, and deny to myself the possibility of serious illness.
All of this to speculate as to why I've found the physician-patient relationships over the past week (shadowing in pulmonary) so profound, even as compared to a previous weeks in cardiology and endocrinology. It could just be the particular physician, but it could also be that hypertension and even type 2 diabetes are relatively silent diseases (for diabetes that's a questionable statement that certainly depends on the patient and how much insulin affects their daily living, but those in denial are able to live in denial, it seems). Over the past few days we've had patients cry in the office; express joy and gratitude over improved asthma; dismay over worsening, untreatable emphysema. My attending lingers with his patients, dreamily reminiscing about his intern days, thoroughly explaining the mechanisms underlying symptoms or treatments. I think it keeps them coming back, improves their disease self-maintenance. How privileged to be a fly on the wall for conversations that have been years in the making.
No comments:
Post a Comment