Overall Runner-up: What are you reading? Ask patients more than medical questions

February 10, 2012

The author asks a patient what he's reading and begins a brief friendship that has forever affected his patient care. The patient proves that there is more to people than meets the eye and reminds the doctor that even in the darkest of patients, there is hope.

"You got a hit in the ED." The words were a clipped, verbal hit and run, because my resident knew what was coming.

"Come on, man! It's almost 4 o'clock! I'm out of here in 10 minutes!" I said along with a few other unprintable choice words. "OK. What is it?"

More unprintable words in response. There went my plans for getting home early for an all-important night of riding my bike and watching television.

Fifteen years ago, I was just past the halfway point of my intern year in internal medicine. My fuel tank of idealism had run dry and was refilled with common intern experiences-anger, boredom, fatigue, self-pity, and despair that the debt and sacrifices were irreversible mistakes. Cynically, people had been replaced by impersonal references: "the GI bleeder in room 18," "the three A-fibs on telemetry," or any other patient problem that was on the never-ending carousel of notes and discharge summaries. Amid this negativity, however, I met a remarkable man-a person needing to turn his life around, but who would help me see my life in a better light.

In many stories that change us, we don't start out by acting our best. And as with similar stories, this one is not filled with a lot of action or a black-and-white ending. I like to think of it as a story of two people on the wrong track who reoriented themselves the right way.

A LEARNED MAN WITH MUCH TO TEACH

I slapped the automatic door plate and stormed into the emergency department, muttering angrily to myself.

"Where's the admit?" I grunted at the secretary.

Without looking up, she calmly responded, "Room behind you."

The patient, Paul, turned out to be far more complicated than a quick detox. A man in his late 50s who looked about 80, he was indeed drunk-shouting, then laughing, then closing his eyes, and ignoring me. My exam was as brief as possible-I had to turn my head at the smell of urine, vomit, and teeth not brushed in days. He was dehydrated, tachycardic, and had a low fever, high creatinine level, acute pancreatitis, astronomically high blood sugar, and a putrid leg infection.

My back was turned as I said, "Get well, sir. I'll see you in the morning."

I scribbled off some quick admission orders and raced home.

I planned on seeing Paul late the next morning during rounds. Our inpatient census was always high during winter months, and I was eager to tie up loose ends on patients who were possibly going home. Later, I'd work with patients who were in for the long haul. And I honestly wasn't looking forward to dealing with the sight, smell, and moodiness of a man in withdrawal.

I went to check on Paul after morning conference and some breakfast.

"Not here," rasped his roommate, a cheerful man with flushed cheeks, reddish-purple nose, and end-stage chronic obstructive pulmonary disease. "Said he was going to find a sitting room"-he paused for a breath and a deep cough-"to get a book and read."

"Hmmm," I said. "OK. Thanks, sir."

Paul had found someone to wheel him-intravenous attachment and all-to a brightly lit visitors' lounge with a few tables and chairs, a couch, and a vending machine. He'd had a bath and change of gown. His gray hair was slicked back. His eyes were those of a friendly and intelligent man. Thick, dark-framed glasses made him look like a physics professor from a 1950s movie. He seemed to be less gaunt and about 25 years younger than the day before. I found him absorbing the words of an old trade paperback that was missing part of the front cover.

"What are you reading?" I asked.

"A story of a British reporter in South Africa at the time of the Boer War," he replied.

From my question came an impromptu lecture on 20th-century Africa-the big names such as Cecil Rhodes, the villains like King Leopold II of Belgium, the chessboard of European colonies, the independence movements, and the triumph and tragedies of the post-colonial continent.

Paul was a self-taught man. "I just love to read," he told me.

Paul was eager to learn about my background, my interests, and my decision to become a doctor. He took time to offer advice, but he mostly listened as I told him how I was letting myself become defeated and bitter by internship. But when I tried to learn about him, Paul became evasive.

This was the paradox that, as a new doctor, I couldn't figure out. How could such a bright and friendly man, blessed with a brilliant mind, keep ruining himself? Records from past admissions were sprinkled with stark phrases: "no current permanent address," "estranged from son," and "wife out of the picture"-a man without family, a home, a career, or much hope.

In response to my question, "What kind of work do you do?" Paul vaguely replied, "Oh, I do some stuff with a friend who sells baseball memorabilia." Or when I asked about his family, he'd say, "Yeah, I have some kids," before changing the subject. My guess was that he felt the shame of people he had let down and about lost opportunities.

And I never could pull back the curtain on the most pressing question: "How do I help you get better and turn your life around?"

I talked to him about alcohol rehabilitation, but Paul regarded the subject with a pessimistic cynicism that many alcoholics carry. "I've done that," he said. "It's just not for me. I know I can make myself quit. I don't need the help. This time, I'm serious."