The exam room is my sanctuary

November 4, 2005

Delivering basic care to patients makes practice hassles bearable, says the author.

I close the door firmly behind me, trying to keep the chaos out. Taking a deep breath, I give thanks and ask for wisdom. It's a privilege to enter this room. I must never forget that. I greet the patient who's waiting for me, and sit down on my stool. "Don't look at your watch," I remind myself as Mrs. Carter (I'm not using real names) tells me how she's doing. On some workdays, when I fear the temptation to look at my watch will become too great, I leave it on my office desk.

Mrs. Carter is an elderly woman who's in for her weekly follow-up after being discharged from the hospital a month ago. It was during that hospitalization that she found out that she had metastatic lung cancer. The specialists at the cancer center told her that there's nothing they can do. And so her cancer grows, silently invading her body, robbing her each day of energy and, more importantly, of hope. Accompanying her on this visit, as they have on previous ones, are her husband, her daughter, and her granddaughter. Mrs. Carter's daughter carries a tape recorder, which will permit her family to review what I've said after they get home.

Mrs. Carter had a good week, all things considered. Although she still has a cough, it seems better after the course of antibiotics I've put her on. Her shortness of breath also seems under control, although she still wakes up at night periodically, unable to bring up the secretions lodged in her throat. She was also able to leave the house several times this week. And on Labor Day, she joined her entire family for a picnic that they'd planned for weeks.

Rising from my stool, I get out my stethoscope. I observe Mrs. Carter's lungs are clear today, and her oxygen level is fine, as long as she uses her portable tank. But her heart is still beating too fast-and I'll need to do something about that. Also, the swelling is still more prominent in her left leg than in her right-which was an early clue to her diagnosis. As for her sodium level, it's actually gone up a bit. She must be sticking to her fluid restriction, I think.

I give her a couple of prescriptions-one to help with her congestion, another to slow down her heart. I tell her that I will see her again next week, but that she should be sure to call the office if she needs anything sooner. She gives me a hug, says "thank you," and apologizes for taking up so much of my time. "Now go see your other patients," she instructs me. At this, her husband shakes my hand, and her daughter turns off the tape recorder, thanking me as well. Although Mrs. Carter is my patient, her daughter and I have become friends. Together, in the midst of sadness, we share a brief moment of peace.

Once again–the world intrudes

The noise is almost deafening as I leave the exam room.

"Mrs. Smith from the plan called," my nurse tells me. "She needs you to call immediately! She says Mr. Brown's form needs to be filled out by tomorrow." I examine the form she hands me-it's five pages long, and it's been nearly a year since I've seen Mr. Brown.