TUESDAY: Bedside Manner

BY JEAN FRANCES DIEMERT

Copyright is held by the author.

DR. STYLES was proud of the way he addressed his patients. He had learned over the years not to call a patient by his or her first name. That could be considered demeaning, especially since Dr. Styles expected to be addressed by his professional title. He was especially challenged addressing women. Some women preferred to be called Ms. whether single or married. Others liked the prefix Mrs. There were some who insisted upon Miss, like the patient who had been briefly and unhappily married and had gone to court to change back to her maiden name, thank you very much, and she would not countenance being called Mrs. And then there were patients, both men and women who felt that the formal address was cold and designed to distance the doctor from the patient emotionally. He just couldn’t win until he happened upon a solution. One morning during rounds he simply said, “Hello you. You look so much better this morning. I think you can go home this afternoon. I’ll see you in a week, OK?” After that he addressed all of his patients as “YOU” and no one objected. He learned to say it with warmth and that was that.

Dr. Styles didn’t like to give a patient cause for concern, although that was part of his job. He had to convey results of tests whether positive or negative. Sometimes he had to inform a patient that the cancer had spread and the prognosis wasn’t good, but he preferred to be the bearer of good news. He had the kind of face that was meant to smile, not to look serious. Even in the midst of a serious discussion he couldn’t help the pleasant expression on his face and he was very good at sugar coating bad news. In his telling, there was always another treatment, another drug. There were articles in the journals every week with reports of breakthroughs in the wars against cancer, heart disease, diabetes and others. There were experimental trials, blind studies, and newer drugs. Some of his patients were comforted by his manner; others took it with a grain of salt. They were used to his bouncing in and out of the room like a cheerleader, always ending with a meaningful gaze and his “I’ll see you next week.”

Today, Dr. Styles approached the small examining room where one of his favorite patients waited for news of her latest CT scan. He knew it was unprofessional to have favorite patients but as in any population, there were all types of patients. This morning’s patient had been coming to him for almost three years, ever since she had been diagnosed with inoperable colon cancer. She always had a smile, a self-deprecating comment and unfailing confidence despite the odds. She also looked good. She hadn’t that gaunt and sickly look and although she had lost her hair, she managed to make it look like a fashion statement with funky earrings and colorful scarves.

As Dr. Styles entered the room this morning, his favorite patient was sitting up straight on the examination table with her legs crossed in a yoga pose. Seeing this caused him to smile and then a wave of lethargy enveloped him. He pulled out and sat in the nearest chair. This was unusual and his patient was immediately wary. He wore his indefatigable pleasant expression but he couldn’t fool his patient. He had bad news.

“I’ve reviewed the results of yesterday’s CT scan and it shows some progression of the cancer cells into the adrenal glands where it has not been before, as well as more cells in the lymph glands. Fortunately, there is no more metastasis in the liver but,” he sighed. “Unfortunately we have to take you out of the blind study.”

“I’m off the study?” said his patient, as though that were the most important bit of information.

She had been accepted into the experimental study through the efforts of Dr. Styles who had seen dramatic results in other forms of cancer through the infusion of antibodies, not the typical chemicals, into the bloodstream. She had been on the study for almost 5 months and she had been feeling better than when she had been on standard chemo treatment. She preferred it if only because she didn’t have to wear a portable pack of chemo over the weekend as she had before.

“You can’t be on the study, so yes.” Dr. Styles couldn’t look her in the eyes. But then he brightened, the old cheerleader coming to the fore. “Look, you. We’ll put you back on chemo for eight courses and then we’ll do another CT scan and go from there. You did well with it didn’t you? Very little nausea as I recall?” His patient sat slumped over on the examining table, her normally straight posture abandoning her. “As a matter of fact, I did have a problem with nausea. Quite a bit, actually. I just don’t like to complain. I am not happy about getting back on it to tell you the truth. I am getting tired of all of it; trying to always be the good patient, keeping up that great attitude, trying to be strong. I just don’t know if I have it in me to keep fighting if it means not feeling well. I’m tired all the time and it takes all I have to go to work every day. I have nothing left when I get home. I remember reading in a classics course in college that at the door to Hades was a sign that read, “Abandon hope, all ye who enter here.” I was young at the time and it went against all that I had been taught and experienced in my life. It goes against my religion but I must confess I understand it now, that feeling of abandoning hope.”

She looked at Dr. Styles and saw that he was devastated. He couldn’t bear to see his star patient in despair. He couldn’t think of anything to say.

So she smiled at him. She would play along if only to console him, as St. Francis said, “Let me seek not to be consoled but to console.”

“I’m tired Dr. Styles, and I hate being nauseous and I hate being here. But I trust you so let’s get started.”

Dr. Styles stood up and took both of her hands in his. He looked very grave. “Thank you, Patty,” he said, without asking for permission.

“You’re welcome Len,” she said.

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