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Brandt's Rants: Four Lessons Being a Patient Taught Me

Brandt, Robert, MD

doi: 10.1097/01.EEM.0000542259.30959.29
Brandt's Rants

Dr. Brandt is an emergency physician with the Grand River Emergency Medical Group in Grand Rapids, MI. He was the winner of the 2008 Writer's Digest Short Short Story Writing Competition (http://bit.ly/1kIBaOf). Read his blog and other articles at http://brandtwriting.com, follow him on Twitter @brandtwriting, and read his past columns at http://bit.ly/EMN-BrandtsRants.

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I leaned painfully and awkwardly forward while intubating a patient, and suddenly realized another person in the room needed help—me. My side throbbed, and I contorted in agony. The nurses had commented earlier that I looked uncomfortable, but I brandished the usual I-can-handle-anything attitude so treasured by physicians and continued my shift through the discomfort. Suddenly, a troop of rabid, invisible, manic monkeys started stabbing me repeatedly with rusty ice picks in my left side. At least it felt like that.

I could no longer go on. I hobbled to the nurse's station, picked up the phone, and called one of my partners. This is my second most embarrassing interaction with the medical field. The first? I'll tell you at the end.

Let me back up here a minute to talk about urine. I had noticed two weeks earlier that I urinated more frequently and my urine was much darker than usual. Being a guy and a physician, I used my skills to assess the situation. “Meh, it'll be fine,” I said, the typical guy's initial approach to any problem. After a few more days, however, I realized that it had not gone away, so I got a urinalysis. I figured I had a UTI, though I wasn't sure how I could have gotten one. Blood. Lots of blood. No WBCs or nitrates.

“But I don't have any flank pain,” I thought to myself; it couldn't possibly be a kidney stone. And if I didn't have a stone, I must have cancer. This was how my brain worked. Not knowing was terrifying.

Fast forward to a few days before I attempted to intubate while writhing in pain. I got a CT, and it turned out I had a kidney stone after all. Yay. Great. Grand. I had always been told that kidney stones hurt. Wow, I must be really amazing. I must have some pretty incredible pain tolerance. I mean, just look at me going day to day without any ... WHAM! The pain train slammed into the station a few days later, and I found myself a patient in the ED.

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Four Lessons

First, I learned from this experience that Toradol is a gift from God made of liquefied magical unicorns and rainbows. Seriously, it blew my mind how much better I felt. If you are not giving Toradol the first instant you can to all your kidney stone patients, please start today.

Second, being a patient is scary. Terrifying, in fact. We become so accustomed to patients in discomfort and working diagnoses that we often forget the human element. This is true not only when a scary diagnosis is found but also when the patient has ... nothing.

I have found that our residents will sometimes dismiss the patient with little explanation when everything comes back negative. Telling patients we have ruled out all the bad things they were terrified of gives them great peace of mind. My residents seem to hate telling patients with a negative workup that they have no clue what caused their discomfort. I explained that we still have to tell them that we don't know what's wrong, but more importantly, that we also know what is not causing their pain.

I start this conversation with “Good news! We don't know what is wrong, but we don't see appendicitis or diverticulitis or cancer.” The patient came in with fears, and just saying, “Everything looks fine; go home,” without saying what it is not is simply a missed opportunity to provide peace of mind and alleviate fear. This is often the reason the patient came to the ED in the first place.

Third, if and when you become a patient, just be a patient. Hang up the stethoscope, and just be the patient. Doctors and nurses often make terrible patients. Don't be a terrible patient.

Fourth, wash your hands on cruise ships, especially when you wear contacts. Remember I said I would tell you my most embarrassing interaction with the medical field? Years ago I went on a cruise, and at that time I wore contacts. Also, I get seasick.

We had just arrived in our tiny room on the first day of the cruise. We had not yet departed, and I went into the miniature bathroom and applied my scopolamine patch. Then I put in my contacts. Correction: I put in my first contact. My wife, between contact applications, reminded me that I should wash my hands after handling the patch. I poo-pooed her, but washed my hands nonetheless.

Thirty minutes later, I became the laughingstock of the cruise. Our group of medical school buddies walked outside, and one noticed that one of my pupils looked enlarged, nay, enormous. I dismissed the allegation until I walked outside and felt the full blast of the sun like an atomic bomb going off in my skull. They continued to laugh as I realized, as usual, my wife was right. Lesson learned.

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