Mr. B (names and details have been changed to protect patient confidentiality) had been in the hospital for maybe two weeks after his surgery, and he had been told he was leaving soon. I had seen him at 4:30 that morning, and in the darkness he told me that he was excited to be going home.
His daughter, who had been keeping vigil by his bedside for nearly every minute of his stay, was also thrilled.
I came back closer to 8 that morning with the resident responsible for Mr. B. The resident was under a ton of pressure to get to the operating room as soon as possible and Mr. B was the last patient we were seeing.
As it turned out, Mr. B had just been started on this complex medicine that required blood tests to judge its effectiveness. Yesterday, the blood tests had shown that the medicine was working well; today, they showed that Mr. B's blood levels were rising and that they were just short of toxic.
Under pressure, the resident told Mr. B and his daughter very quickly about the tests and what it meant for Mr. B's care and then rushed off to the OR.
I walked out of the room with him, thinking about how confused and scared Mr. B and his daughter looked. I said goodbye to the resident, and then walked back to Mr. B's room.
"Do you understand what just happened?" I asked. They didn't. They didn't know whether the new tests meant that Mr. B was very sick or whether they meant that he could go home. They were worried.
So I sat, and I talked to them for a few minutes, and I explained everything I knew about the medicine and what the results of the blood tests meant. I told them that he wasn't sick, but he also wasn't leaving the hospital.
When I left the room, they told me they felt better. Maybe they weren't going home like they thought they were, but they knew what was going on. I had removed some of their uncertainty.
As I walked home that day, another story popped into my head.
For three days during first year, both sides of my neck had been stiff. I had learned only a couple weeks earlier that "bilateral nuchal rigidity" was a sign of bacterial meningitis.
To illustrate the severity of bacterial meningitis, the lecturer who had taught us about it told us a story. There was a high school basketball player in Durham, he told us, who played a game one night, came home and felt a little tired, so he went to sleep. The next morning, his mother had trouble waking him up, so she called 911. The kid died on the way to the hospital.
Of course, that story was racing through my mind from the moment my neck first started to feel stiff. I was sure that I had bacterial meningitis, and it was just a matter of time until I died. I knew the other signs and symptoms of meningitis-fever, Kernig's sign, Brudzinski's sign (don't worry about what that means), amongst others-and I didn't have any of those, but the facts couldn't sway me. I was certain that I had meningitis and that I was going to die just like the basketball player.
Instead of just letting myself die, I decided to go to Student Health. On the way there, I stopped in to see my adviser to schedule an appointment. Coincidentally, my adviser happened to be the lecturer that told the story about the basketball player that was the source of my current terror.
"Hey Dr. Drucker," I said as I turned to leave after making the appointment, "is it possible that I have meningitis?"
"Why do you ask?" he asked.
"Well," I said, "I've had this stiffness on both sides of my neck."
Dr. Drucker looked unconcerned.
"Are you standing in my door?" he asked. I nodded. "Are you talking to me?" he continued. I nodded again. "Are you delirious with fever?" he pressed. I shook my head. "You don't have meningitis. If you did, you'd be much sicker. Welcome to second semester; you'll probably diagnose yourself with every disease you learn about from here on out," he concluded.
I didn't wind up going to Student Health, and the stiffness in my neck was suddenly much less painful.
Dr. Drucker was right. By the end of the year, I was convinced that I had diabetes, pneumonia and at least half a dozen heart attacks. After all, I was always tired, sometimes coughed, and occasionally had some pain in the vicinity of the left side of my body (usually at the same time that we were learning about heart pathology).
Apparently this is normal for medical students learning about disease processes. As a general rule, we're sleep deprived, eat poorly and spend an unhealthy chunk of our time thinking about disease and death. This produces a whole bunch of non-specific symptoms related to exhaustion and a whole bunch of obscure (and not-so-obscure) diagnoses related to them. Basically, I was a living, breathing illustration of the cliché "a little bit of knowledge is a dangerous thing."
It was true for me, and it was also true for Mr. B. The little that Mr. B thought he knew-that he was supposed to go home-was what wound up scaring him. And not only is it true for Mr. B, it's true for a lot of patients. The disparity of information between doctors and their patients is striking. There's a reason that doctors train for so long-there's a lot to learn.
When patients don't know or understand their health, it scares them. This fact, combined with the knowledge gap, means that doctors have a tremendous responsibility to communicate with their patients and to make sure that their patients understand them. A little knowledge is a scary thing for patients.
But with responsibility comes opportunity. Just by talking and explaining, doctors can effectively treat and cure patients' fears.
And sometimes, that's all the patients want. Just ask me and Mr. B.
Alex Fanaroff, Trinity '07, is a second-year medical student. His column runs every other Thursday.
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