Relationships

The “doctor-patient relationship” is an often-discussed paradigm. It’s one of those things that prospective applicants talk about during interviews, and that older physicians love to pontificate upon. For me, it was something I looked forward to, but have only rarely experienced in all the glory I thought it was going to be.


The other day a lady saw me in the elevator, and excitedly addressed me by my name...


Who was she again?


She went on to say how great it was to see me…



Do I know you?


And she told me how great she was doing…



Do you have me confused with someone else?


And she thanked me profusely…

And then I remembered. Of course! She came in with abdominal pain, and we saw on her CT scan something concerning for a mass. We took her to the operating room and performed a major colonic resection. She ended up having a T3 lesion, and the oncologist was considering chemo. Her post-op course was longer than expected, but otherwise fine. She should do well.


And how could I have forgotten? How could I? I spent every day for about two weeks seeing this lady, and I spent about 3 hours with my hands literally inside her abdomen operating. And I had totally forgotten.


Maybe it’s because we all, on some level, try to disconnect with patients. How could we not? I thrive on emotions, and am at my best when I am emotionally engaged, but even I distance myself at times. We build connections, establish trust with patients and their families, but then it’s helpful to turn it off when it’s time to cut.


Or maybe it’s because the relationships we form aren’t really that secure. How could they be? We see patients for a couple of minutes a day. Even if we do this for a week or two, that’s really not that much time.


Or maybe it’s because this relationship – while life-altering for my patient, was just another day at work for me. It was incredibly intense for her, and business as usual for me.


My cousin recently lost her child during a C-section. She carried him for 9+ months, and was used to feeling him move every day. And so, a day or two past her due date, when she no longer felt him, she rushed to the hospital. Some monitors were placed and quick tests were run, and soon she was in the OR where the doctors were trying to get that child out of her as quickly as possible. But it was too late. He was dead. She held him for 3 hours – the funeral is this weekend.


My cousin, along with her family, is appropriately crushed. Her life will never be the same again. And it’s all because of a most unique relationship – one that developed daily over 9 months, but one that didn’t even involve speaking or touching, only a magical sort of feeling. In one very plebian sense she had no time with him at all; and yet in another, every second of her being has been spent making him, and preparing for life with him.


I guess it’s really not time at all that defines a relationship, but rather intensity. Our challenge as physicians is to make every patient feel that we are giving to them the same sort of intensity that they are feeling within themselves.