Losing My Confidence

I am excited 2012 is here.  Time to start over.  The final weeks of 2011 were hard on my ego…taxed my confidence.  With luck, the New Year will be kinder.

Practicing medicine is a challenge.  Treatments that do not work.  Smokers that will not quit.  Second, third, fourth and even fifth opinions. Unnecessary delays in therapy. New research discoveries that undermine trusted maxims. However, during these last weeks patients themselves have assailed my faith in me, as the doctor.  A trend I hope will not continue.

Ellen is an arthritic 84-year-old woman, for whom I have had the pleasure of working with over many years.   Her sight became poor, so we had surgery performed to remove cataracts.  The procedure went well.  When I saw her 3 weeks after the operation, I expected the common observations after that hazy optic glaze is lifted.  She would say how wonderful it is to read.  How striking are the colors and how bright the light.  Perhaps notice it was time to buy a new TV. Therefore, I was excited as she shuffled into the exam room.  Ellen looked around, stared at me for a moment and exclaimed, “I had no idea you were so old!”   She is the octogenarian with the walker and I am old.  Ouch.

Not long after I had a visit with Bill.  I explained to him, at length, in detail and for the seventh time, the importance of taking his medicine. I gushed about how it had almost no side effects and that it could extend his life.  I promised it would help him get out more and enjoy his grandchildren.  His response, proving me again the master communicator, was simple.  “But doc, will it help me move my bowels?” Cancer loses to colon, every time.

Vivian has been visiting me frequently.  In fact, I see her almost every week.  She brings me baked bread.  I explain cancer. She cooks pierogies.  I discuss chemo.  She gifts lasagna.  I do tests.  She cooks.  I talk.  She fails to do anything I tell her.  I grow fat. She gets worse.  I am confused about the purpose of our relationship.  She, somehow, remains happy. Cannolis tomorrow.

I really enjoy my time and conversations with Ed.  However, I am exacerbated.  He is charming, polite and humorous.  Ed is also completely non compliant with my medical recommendations. Befuddled, I ask why?  Ed says that he is concerned that I worry too much.  He says I should relax or I might have a stroke.   He explains:

“Doc, I have high blood pressure, high cholesterol, diabetes, heart disease, liver disease, anemia, an aneurism, kidney disease and now cancer.  I should be dead by tomorrow morning.  But, I won’t.”

“Why,” I ask.

“Because, I am as dumb as a box of hammers.”

My mouth hangs open so long, I lose the blood supply to my jaw.

With my confidence at an all time low, it was time for a boost.  As it were, my rescue came as a somber event.  Stan, my patient of 2 years, died.  He had been ill for months, requiring at least two or three blood transfusions each week, just so he could move around.  Finally, while staying in the hospital, his heart failed and he was gone.  It was time to call his wife.  As a former Hospice Director with 25 years in oncology practice, now here was something I could do well.  Call the new widow, gently explain his passing, and give my condolences.

“’Bea, hi.  This Jim Salwitz.”

“Hello, Doctor Salwitz, is something wrong?”

“Yes, Bea. I have very sad news.”


“Stan has died.”

Stan has died?”

“Yes, just a few minutes ago.  I was with Stan here at the hospital.  He died quietly.

“He was comfortable.  He was not in pain and did not suffer.  I am sorry.”

“Are you sure?”

“Am I sure?”

Yes, are you sure?”

“Ahhh, yes.  I was there. He died ten minutes ago.”

“Well, why don’t you give him a transfusion and see if that helps.”

I am optimistic that 2012 will be better for my spirits.  If not, I may have to get a puppy.


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    • James Salwitz, MD

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