Indexing Title: CLEYSONs Medical Anecdotal Report [06-02]

MAR Title: Intimidating profession and emotional turmoil
Date of Medical Observation:  January 2006 

Narration: 

Two years ago, my friend in high school sought my help regarding her 49-year-old mother who had a right breast mass.  When I examined her, the mass was well defined, solid and non-tender. My diagnosis leaned to a more benign condition but because of her age I planned to do fine needle cytology. I explained to them the condition and the plan. I saw the reluctance from the patient’s face and I was bombarded with repeated questions.  In some point of our discussion I was kind of frustrated that we were all going in circles. And in the end, the patient refused to have the procedure done.  And that was the last time I heard from them until… 

One evening in January 2006, one of my friends in high school send me a message asking me if I could take a look at our friend’s mother. I asked him why he was the one asking me for the favor and not our friend. He said that she was embarrassed to ask me herself. I wondered why, she was closer to me than my other friends, then it hit me…she was the same patient I saw two years ago. I called my friend and asked her what happened to her mom. She told me that the patient had been consulting another public hospital for almost a month now. Several work ups were done including core needle biopsy of the right breast mass. I felt the agitation, anxiety and fear in my friend’s voice and I can’t get any useful information from her. So I asked her if she would meet me and if I could take a look at her mother and the work-ups done. It took her about two weeks to bring her mom to the hospital to meet me. When I examined her, she had an ill-defined mass on the right breast. It was hard with skin retraction. She had a biopsy result of Invasive ductal carcinoma, breast right. We were again engaged into a long tiring, frustrating question and answer conversation regarding the nature of the mass, etiology, plans, what will happen, how many days to live etc. I congratulated myself that day because not once did I lose my patience. During our conversation, her sister narrated their experiences in the other hospital, the way her mother will look at her with fear without even understanding what the doctor said. Although it was delivered in a funny way, it gave me an idea how frightened her mother was. When I told her that she needed an operation, she didn’t answer; she was just sitting there staring at me. I have not encountered a patient that transparent. I could see and felt the different emotions that run through her, but the most apparent was fear. Fear of her disease and of the operation; fear for her children and grandchildren, fear for her future and most especially fear of death. At that moment, I know I have to do something, so I started talking to her, I explained her illness, her choices, the complications, advantage and disadvantages of the operation, the plans after the operation, everything, I told her everything, I did not leave any single detail. At that moment, I saw understanding in her face but still she was reluctant to undergo operation. I told my friend that even though they will agree for the operation the decision was still hers. We parted our ways with a decision that she will undergo the operation.  

When I admitted the patient I noticed that she rarely smiles; I have even caught her looking from afar. A day before her operation, I visited her in her room and saw her eldest daughter crying. I asked them why and she said that her mother was having second thoughts again. I talked to her, asked her of what she really feels and what her fears were. Although I have an idea of what was really going on through her, I want her to talk about it. In my experience I know that sometimes it helps you a lot when you’ve got to speak out your fears. She told me that she really wants to have her operation but she can not take off her mind the bad results that happened to other people and the consequences that might happen because of her hypertension. She told me that the previous doctor told her that she was more at risk because of her hypertension, and the post-operative pain that she will experience might make her blood pressure shoot up leading to stroke. At that moment, I understand her fears more than before. I assured her that we will take care of her and that we will not do anything to harm her. If ever her blood pressure will go up, we will give medications to bring it down and after the operation I will make sure that enough pain relievers will be administered to her for her not to feel so much pain. I felt the release of breath from her and she looked at me, transmitting her gratitude and trust in me. It was a wonderful moment! 

We went through the operation without much problem. And when she was about to be transferred to the ward I asked her if she was alright and if she was in pain. Her smile was from one ear to another and she held my hand and said that she was fine and she thanked me. She was discharged after two days and I noticed that she was now laughing at her daughter’s antics and jokes. At that moment, I know she will be well and she will face the future with more strength and confidence.  

Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements)  

Being a doctor has been my dream since I was a child. In high school, I would wonder how I will be able reach that dream. And through hardships and long night of studying I became a doctor.  In my years of being a physician, I have never thought of what other people think of me. I didn’t change that much anyway. But this encounter with my high school friend made me realize that my profession itself is quite intimidating. She told me so herself. It was the reason why she was so reluctant to approach me. If not for her mother and the confusion she and her family regarding her mom’s condition she will not ask my other friend to contact me. My profession made her thinks that I’m a different person now and that I’m too high for her to reach. I told her that I’m still the same girl in high school, the only girl in class who had her uniform tucked in.  

Her mother gave me a wonderful lesson that I will cherish until the end of my profession. She gave me the knowledge of how and what patients with cancer or other diseases experienced—the emotional dilemma, the confusions and fears. If we know just a little of what they are going through, we will be more patient with them. We will understand their fears and be able to give encouragement. She made me realize that I will be a better doctor if I will give time to interact with my patients. She makes me see that in treating surgical patient does not evolve in surgery or operation alone, I can go beyond that!!!  

I’ve learned two things in this story: First, people get intimidated by my profession alone and second, the emotional turmoil that a patient go through.

These two will be my tools in interacting with my patients. I will always keep in mind that some people get frightened by the doctor, so in dealing with them I should talk to them as an equal. I will explain to them their illness in simple words as possible, and be more considerate and tolerant.  Bear in mind the mixed emotions and confusion that they are going through.