Patients are crazy. I mean, they must be. “Sir, I’m going to stick this needle into your chest to remove some fluid from your lung. Hopefully it makes you feel better.” His response? “Okay.” That’s it. “Okay.” Not “Geez, aren’t you kinda young?” (I am) or “Have you ever done that before?” (I haven’t). Just “Okay.” Complications include pneumothorax, infection, poking the heart with the needle (I’m sure there is a medical term for this) and death… but I get the thumbs up.
Over the holidays, I had the pleasure of returning to the road (motivation: debt) and working with my friends on both Christmas Eve and New Years Eve (neither of which are Stats). Eyes opened by my experience as a medical student, where every day you learn that the world of things you don’t know is even bigger than you suspected, I stood back and began to say to myself: “This person is crazy for trusting me.” We show up and say things that any one of us “in the know” would scrutinize to the ends of the earth. (Ever called an ambulance? I didn’t think so).
“Sir, I’m not going to take you the hospital across the street. Instead, we are going on a 45-minute ride to a Cath Lab. Hopefully you don’t arrest on the way.” Does he ask us why or say, “That sounds like a bad idea”? Nope. He says “Okay.”
“I’m sorry, Ma’am, but I have to ask the firefighters to cut the roof off your Lexus sedan.” I know what my response would be. Hers? “Okay.”
Every day, we show up in people’s homes. They tell us secrets. They let us inspect, palpate and auscultate all sorts of parts that aren’t usually privy to public presentation. They let us give them drugs, they let us stick needles in them, they let us carry them down the stairs in a rickety chair made circa 1979. All, for the most part, without a peep. Just a soft affirmation that they trust us to do what is best for them.
I’m not sure why I never realized this before. Maybe I did when I was new and forgot as my confidence got the best of me. If I trusted myself, why shouldn’t they? But now that I’ve been thrown off my game and placed in a whole different world, I have a new appreciation for the blind trust our patients place in us. Loathe would they be if my patients knew that for two out of every three procedures I perform, I consulted Wikipedia and YouTube just a few seconds before entering the room. I mean, really, how am I supposed to remember how to do an ulnar nerve block? I can barely find an ulnar pulse! But out comes the needle, and shakily, I start stabbing away. “Are you done yet?” the patient asks. “Almost, dear, just a few more seconds (and a bit of luck) and we’ll be all done.”
Don’t even get me started with neurosurgery, cardiac transplants, and end of life conversations. Surely we must sound ridiculous when we describe drilling through skull, swapping out organs, and allowing death to make its move. But apparently we don’t; patients place enormous trust in our ability to make good decisions that affect not us, but them. And for the most part, when our case is laid out, they say “Okay.”
I think back to every time I visited a friend or family member in the hospital, and how little trust I suddenly placed in the very system I have dedicated my professional life to. Second guessing everything – checking every pump, every lab record, every vital sign. Perhaps our insider knowledge of what can go wrong taints our ability to trust those who care for people close to us. The stakes become personal, and trust can be hard to foster.
Most of us have treated patients who are, or whose family members are, health-care professionals. It is, I think you’d agree, a whole different style of call management. Our communication changes, our demeanor changes, and we become hyperaware of every little thing we do, every little thing we say, because we know that in order to win the trust of our customers, we have to be that much better. I don’t take offense to this increased scrutiny; to do so would be hypocrisy.
In fact, I kind of wish every patient would demand this near-perfection from us. It would motivate me to be diligent, be thorough, be not good enough, but absolutely stellar. Not some of the time, or most of the time, but every time. Most patients do not demand this, of course. They lack the background knowledge, the experiential learning, the trial-and-error moments that develop clinical judgment and wisdom. And because they lack that, they just trust us. It’s wholly humbling. And crazy.