Are you getting through?

May 20, 2005

The problem may be blocked "airwaves" and not mental deficits, says the author.

For what seemed like the 10th time, I'd just finished answering the same questions posed to me by Mrs. Clemson, a patient whose large cell lymphoma had come roaring back after a complete remission. Toothless and bald from chemotherapy, she'd grown up on a farm and had a fifth-grade education.

A resident cornered me as I walked out of Mrs. Clemson's room.

"How do you have such patience?" he asked. "I find her totally exhausting, and so does the rest of the staff. She's like a broken record." He put his hands up to cap his ears.

The attending calls me to task I was one of a group of 10 who were following Dr. Conrad around as he came upon Mrs. Clemson, whose lymphoma had just been diagnosed. Closing the curtain between her and her roommate, he invited us to squeeze into the tiny space beside her bed. After introducing himself, he asked whether she understood what would happen during the bone marrow biopsy that I'd be performing that afternoon and why we were doing it. Bewildered, she gazed up at me and the other unfamiliar faces peering down at her.

I was stunned and miffed. The previous afternoon I'd taken time from my packed schedule to explain the procedure in detail, reassuring her that she'd experience only minimal discomfort. "Do you have any questions?" I'd asked. She'd indicated that she didn't.

As the residents stepped outside the room and leaned against the corridor wall, Dr. Conrad came directly up to me. Standing there in his freshly-starched, full-length white coat, his name under his left front pocket, he said, "People don't like surprises."

"But I did talk to her about the procedure," I responded unapologetically. "I was in there yesterday for more than 15 minutes."

"Well, why is it, then, she doesn't have any recollection of that conversation?"

"I don't have the slightest idea," I said, shrugging my shoulders.

Conrad smiled slightly, but not in a friendly way. "Well, give me your best guess."

"Perhaps she just isn't that bright," I responded.

The glibness of my response caused the other residents to shift in their places.

"Have you spent much time with this patient, Dr. Conrad?" I continued.

"Only this morning," he said, retreating slightly.

Senior doctors examined pa-tients only once a week-using the other days to discuss cases among themselves in the conference room. This lack of hands-on supervision irked my fellow residents, who griped about it frequently among themselves. Perhaps Conrad knew about our feelings, but he continued his thought.

"Sometimes, the airwaves get blocked when you're dealing with patients who have these kind of diseases," he said softly, as if imparting a priceless secret.

"What do you mean blocked airwaves?" I was confused.

"Maybe we can clarify this point for you sometime," Conrad said, shaking his head slightly. With that, he moved to the next patient, the other residents and I trailing behind him.

Sometimes, we all appear a bit stupid A week later, I was just about to go downstairs for my daily run when I came across Dr. Conrad in the 12th-floor solarium, where the resident cubicles were.