The cancer surgery to remove part of his tongue, throat, and lower jaw, and the reconstruction took me about seven hours. Little did I realize that he was going to be a lot more challenging outside of the operating room than inside.
His first days after surgery were rocky. His prior drinking issues kept the Internal Medicine team busy finding the balance between alcohol withdrawal and over-sedation. After several days of careful, difficult medical care, he awoke.
His first comment to me the day he woke up was, “When I go home, I will need plenty of OxyContin.” Hmmm, I thought. Not a good sign.
A few days later, his stepson was admitted to the same hospital floor. My patient got out of bed, walked down the hall, and tried to get his son's friends to give him drugs.
A couple of days later, my patient’s wife announced that she was seeking a divorce. Her lawyer apparently pointed out, however, that the only reason she was able to stay in their home was his disability check, a source of income she would lose if they were no longer married. The relationship was miraculously salvaged.
As discharge approached, the family repeatedly refused to answer the door when the company providing the home health equipment tried to make deliveries. Only after the social worker called the police to investigate did the family finally open the door and accept the supplies.
The next day, one of the family’s friends stood in the hospital hallway and loudly berated the social worker for calling the police.
The morning of discharge, I made the final trip to my patient’s room to wish him well and take care of the final details. “Did you give me my prescription for OxyContin?” Ummm, No.
Follow-up appointments were rarely kept and, on the rare occasions when he did show up, his eyes were glazed and his questions focused on his narcotic prescriptions. My attempts at teaching him about his cancer and its care went unheeded.
Clearly, his world was not my world. I admit the entire experience of trying to care for him left me completely frustrated. He appeared to have neither interest in nor understanding of what we tried to do for him. I shake my head and remember that at one point in my teenage years, I truly wanted to be a veterinarian. At the times when I have had patients like this man, I feel as though my wish had been granted.
What was missing? We had no way to penetrate each other’s worlds. It is an old problem. William Carlos Williams, the talented poet, writer, and family physician who practiced medicine among the poorest immigrants of Patterson, N.J., in the early- and mid-20th century, had many patients with whom he had nothing in common and with whom he could barely communicate. Still, Dr. Williams, crusty as he was, found ways to discover the patients’ secrets that helped him cross the barriers. He took time to meet the families, discern the situations, and learn the stories, all the while sputtering about his patients’ seeming lack of care for themselves or their children. Dr. Williams was able to spot the surprising insight, the fleeting “thing” that underlay the story being played out before his eyes. Those moments of discovery fill his writing.
We still sputter. It is difficult! I am not proud of my interactions with and my reactions to this man; he was demanding, drug-seeking, and chronically unhappy. He was abusive to people whom I respect and admire.
I am no better or worse than the next person in dealing with the cultural chasms. Experience is a great teacher, however, and I am determined to do better next time. I think I will start by trying harder to understand the story before me.
The following is feedback received for this blog:
What a pleasure to read a blog that is thoughtful and content-full. To hear a respected physician and surgeon question decisions, motivations and meaning enriches all of us. And it reveals the physician to be the caring, insightful person he is. I particularly love the whimsy in "one slight problem." Great story. Keep it up!
- Richard Holloway