Friday, January 21, 2011

Small Suspicious Minds

I received a call at around 3:00 in the afternoon.

"Dr. N, Dr. M wants to send a patient over for a parotid needle. Is that OK?"

Normally, it takes a couple of hours for a patient to come over from a clinic and check in to the hospital for a needle. "You had better OK it with the call person, in case it runs late."

She called me back a couple of minutes later. "I've scheduled it for 9:00 tomorrow morning."

The next morning, while I was triaging cases, the tech came into my office. "I've consented the patient. She is ready in fast-track room 27. Come when you are ready."

I finished my tray and headed to the ED. Typed my physician code into the keypad to gain entrance into the ED. Fast track doesn't get moving until around 11:00 a.m., so all was quiet and dark. I walked into room 27. My patient was sitting on the hospital bed - a 60 plus year old woman. Her companion sat in a chair by the bed. He was husky, not obese - dressed in a khaki hunting jacket. Despite his age, he still had a full head of hair and a stylish beard. The hair was slicked up with grease in a style better suited to the 1950's. As I walked across the room to introduce myself to the patient, he stated in a gruff manor, "Huh. I wasn't expecting a woman."

I glanced over at him to see if he was joking. He wasn't, and reiterated his previous statement with emphasis. "Nope, I really wasn't thinking you would be a woman." I crossed over to the counter to check the consents, and said lightly, "Well, what exactly were you expecting?"

"Not a woman."

I resisted my urge to tell him that this was his lucky day. Instead, I introduced myself to the patient and listened to her story, about the nodule on her parotid. It had been there for about a year and despite being treated with multiple bouts of antibiotics for a recent bout of pneumonia, it had grown a little in size. Her PCP wasn't worried about it, but she was. I usually introduce myself to my patient's companions, but his gruff manor had put me off, so I wasn't sure if this was a friend or husband. Neither person acknowledged each other's existence during the procedure, so I assumed they had been married for a long time.

The small knot on the right side of her face was mobile, which was a good sign. As I steadied the needle in the gun, her male companion asked, "So are you a foreigner?"

Had my distinctly Southern accent thrown him off? I answered, "Well, in fact I was born at UAMS."

"So does that mean you are a foreigner?"

He had me confused. He wasn't smiling, he wasn't flirting, he was dead serious. I asked, "What exactly is your definition of a foreigner?"

"You know, someone born in India, or China, who is practicing medicine here in U.S.A."

Every bone in my body was itching to engage him in heated discussion, but the rational part of me knew it would end badly. So I said, "I was born in Arkansas. I've lived here my whole life."

"So how do you pronounce that foreign name?"

"Oh! Well, it is Norweigan. Like I've told everyone my whole life, I live in a nest and I'm rude. That's how you pronounce it."

He wondered aloud, "Are you really rude?"

I looked at him and smiled. "No, I'm not at all rude." Nothing like you, I thought to myself.

I stabilized the mass in front of my patient's ear, and hit it on the first stick. It was cystic, so I was able to reduce it to almost nothing, draining the fluid into the syringe. The tech prepared the fluid for me to look at under the scope. Nothing surprising, nothing alarming. Mr. anti-woman/foreigner walked over to my scope and stood next to me during my evaluation.

"So are you like CSI? I watch that show. This looks like CSI."

"As a matter of fact, yes. Would you like to look in the scope?"

I adjusted the eyepiece for him. He was in complete awe. "What is this stuff that looks like hair?"

I told him, "It's not hair, just degenerated cellular material. But I don't see anything bad, which is a good sign."

His female companion was ecstatic that I had reduced her year-long lesion to almost nothing, and the tech escorted them both to the ED exit. When he returned to the room, we both laughed - a long awaited catharsis to a very strange experience. I read about these people - but never think they really exist. Or that I will ever encounter them. Guess I am wrong.


The Mother said...

In my brief foray into the clinical world I have noticed two things:

Most people are really nice.

And then there are the rest of them...

rlbates said...

Nice post! Love how you handled it.

Kyla said...

Gah! Some people...

You handled it nicely, though.

Gizabeth Shyder said...

I guess I know these people do exist, but most seem to have enough frontal brain inhibition to keep their views to themselves.

gcs15 said...

"You catch more flies with honey than with vinegar."

That old saying came to mind when I read this.

You handled this situation with such grace. Kudos! It's always best to avoid conflict whenever possible for the sake of the patient. Sometimes it's not so easy.

I practice in the South, too; I have run into a lot of difficult patient situations. There are many ways to charm people. This guy comes across as very defensive; he's probably sensitive about his lack of education and polish. I bet he warmed to you because you treated him as an intelligent human being and didn't ignore him or patronize him.

Often patients and families are just plain scared or upset, and the physician happens to be the nearest target. Sometimes I have to step back mentally and remind myself of this. I've seldom met a person who showed overt personal hostility towards me. (One, maybe.)

I don't mean to excuse bigotry. But I can understand his fear of the unfamiliar in a situation like this. I wonder what he would have done if you had actually been a "furriner!" :-)

Having said all this about practicing in the South - I saw one of the most difficult patients EVER last week in the office. She was from New York City. Let me just say again: "American by birth, Southern by the grace of God!"

I did my residency not far from your digs, by the way...

Gizabeth Shyder said...

gcs15 - thanks for your comment - you have a lot more patient contact than me so you glean wisdom from your experiences.

I can't stand the shift of attitude when traveling North. I can sense it on the plane - in the airports. In general, the people in Southern states are so much more kind and patient, at least to strangers.

I know Memphis has a strong program in neurosurgery. One of my classmates trained there and is back here in private practice. Took care of a friend of mine with emergency back issues last weekend! Such a small world.

Ginger said...

OY, I've had one of those before! They crack me up! I'm impressed by your restraint.