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Thursday, February 16, 2012

Doctor Heal Thyself?

There's an old saying, "Doctors make the worst patients."  This may or may not be true, but I can tell you being both a doctor and a patient is......well a bit weird.  I'm not exactly sure why, but I have a few ideas. Tomorrow I'll have a chance to experience being a patient once more and maybe that will shed some light on the issue.

I have a condition called subglottic stenosis. This is a fancy way of saying I have scar tissue that has grown in my upper airway.  We're not sure why I got this. It is a condition which is usually congenital and usually diagnosed in children. In adults it almost always happens due to trauma to the airway, either being on a ventilator, or trauma to the neck. In my case, I have idiopathic subglottic stenosis. Idiopathic is doctor speak for "we have no idea why you have it".

At any rate, the condition causes a narrowing in my airway. This limits my breathing and makes it hard for me to tolerate any kind of physical activity or exertion.  It also means that any cold or allergy problems I have make it worse. Imagine breathing through a drinking straw all the time. Well, that's how I feel.  I was diagnosed with this problem in 2007. Tomorrow I'll have the procedure to fix it for the third time. It's a simple surgery where they use a laser to burn off the tissue and restore my airway to near normal size. It may or may not come back again, but at least for some time I'll get relief of my symptoms.

Here's some pictures of my first surgery
The picture in the upper right hand corner is before the procedure.That tiny little hole is what I breathe through. If you head straight down that hole you'd hit my trachea and then lungs.  This is about the size of a baby's airway. The picture in the upper left hand corner is the picture after the laser burns away the scar tissue. That is about 2/3 of what a normal adult airway should be but you can see it's a huge improvement.  The other 2 pics show after the doctor inserted a balloon to dilate the area before the laser. After the laser he injects medication into the area to try to reduce swelling and future scarring.

I think being a patient is hard for me and other doctors for several reasons. First, we know what happens backstage. Not to say there is anything scary or wrong going on, but we do know every conceivable thing that might go wrong. All the things that we would assure our patients hardly ever happen.  Like any other patient I have to realize that the benefits of the procedure outweigh any risks.

Second, our colleagues and people we supervise are going to see us naked. Yes, it is just weird having someone you will see next week in the staff meeting while in a gown and no undies. Just weird. At least a regular patient will hopefully never see the nurses or doctors again. With me, there's a chance I'll be chatting with them at lunch tomorrow.

Giving up control is very difficult for doctors. We're used to calling the shots, making the hard decisions. Naturally each of us thinks his or her way of doing things is the best. As patients we have to sit back in the passenger seat and let someone else drive. And anyone whose ridden while their spouse drives knows how hard that is. No matter how much you trust that person, sometimes you get jumpy if traffic piles up.

I think all doctors should have to experience being a patient at some point. It certainly has taught me a lot about how to help patients through their procedures. For instance, I always try to stay away from too much medical jargon.  When I've been a patient I notice so much doctor speak being used. Of course I know the language and I don't need an interpreter, but many patients won't necessarily know what intravenous fluid or endotracheal tube means.

And even with all my advantages knowing all the risks and benefits. Knowing exactly what the anesthesiologist will do, what drugs they will use, what the nurses will do, how the surgeon will perform the procedure, being a patient is just plain scary. I think it is so important for all of us healthcare providers to remember that. We deal with these things everyday. We live in this land of needles and x-rays and drugs and scalpels. Our patients do not. It's like being dropped on a different planet.....naked.

The biggest advice I can give to patients is that you should never be afraid to ask questions. Never be afraid to let your nurse or doctor know that you do not understand something they have said. If you feel uncomfortable about something, let someone know.  But also, choose physicians and hospitals where you can place your trust. It's important that when you are at your most vulnerable you know you have someone that is doing everything to help you. And then......try to relax. Being anxious and uptight can only make things more difficult.

Finally, do what your doctors say. Rest when they tell you, eat what they tell you and don't do things they've told you NOT to do. This is the hardest for doctors. We all think we're superhuman and that we can be back to work seeing patients sooner than we should. We all think we know better. Well....we don't. And we often tell our patient's one thing and do another. Of course not me. NO, no me. I promise I will do what I'm told. I want to feel better.

I want to get back to my workouts and Taekwondo classes and heck, being able to climb the stairs without sucking wind. I am thankful that my health problem is simple to fix. There are many way worse things that can happen. For the time being, I'm going to let my doctor self rest and turn myself into patient me. At least I'm going to try!

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