Doctor, no offense but I don’t want to see you

Doctor, no offense but I don’t want to see you

It was already close to the end of the workday in my clinic but there was still a new consult to see. It was the usual – a recent heart attack with diabetes, metabolic syndrome and hypertension. Pardon me, I meant to say – there was a new patient named Mr Lowry with the above-mentioned medical conditions.

I went through the chart quickly – some of the medications could be further optimized, blood pressure could be better controlled, the weight would have to come down. I asked the patient the usual questions – no, no recent chest pain; yes, he can walk for couple of blocks until his knees start hurting; yes, he quit smoking; no, he has not been able to lose weight. Mr Lowry answered the questions readily enough though he did not offer additional information or ask questions.

I asked him to take off his jacket and get on the exam table for a quick physical. As I leaned closer to help him push the T shirt up to listen to his heart, I could see there was writing on the shirt. I could only make out the word “today” as the shirt was riding up on Mr Lowry’s generously sized belly. “What’s written on the shirt?” I asked, curious. I received the first smile of the visit, and Mr Lowry pulled the shirt down so I could see. I DIDN’T WANT TO BE HERE TODAY, the shirt read. As I puzzled, my patient burst out laughing. “This is my hospital shirt”, he explained. “I wear this to all my doctor visits. My wife knows that it needs to be washed every time I have an appointment”.

The smug joke masked a deeper truth – my patient was trying to set his own narrative for his medical appointments. He didn’t want to be “recent non-ST-elevation MI, diabetes, obesity”. He was “Mr Lowry who doesn’t want to be sick”.

There is something freeing in naming the negative emotion. It is now out there and identified. In regards to Mr Lowry, it made it easier for me to find the motivation for lifestyle change – “you need to take your medications, lose weight, etc – so that you don’t have to see me anymore”.

Over the next day, I kept going back to the shirt. Is it somehow more powerful to elicit a negative emotion rather than positive one? Politicians certainly know that fear moves people to vote more than a desire for a positive change. The generic “you should exercise to be healthy” is less motivating than “you should exercise so that you wouldn’t get a heart attack”. It is especially motivating if the heart attack has already happened once – now the fear has teeth. When I ask my patients what is the most important thing I can do to help them, the answer often comes in negatives: “I don’t want to be short of breath”, “I don’t want to be tired after walking 10 steps”, “I don’t want to be in the hospital”, “I don’t like the hospital food”.

Few weeks ago, Mr Herkel was admitted to my hospital service. He was an epitome of a healthy 53-year old – slim, fit, didn’t smoke, exercised regularly. Part of the reason he had kept himself healthy was his bad genetic lottery – most of the men on his father’s side of the family had already had heart attacks or died by his age. And now, when he had developed chest pain that refused to go away, he anxiously checked himself into the emergency room. The type of chest pain he had was not especially worrisome – but due to the significant family history, we did a thorough workup nevertheless. His careful lifestyle had counteracted his genetics – the tests showed no heart disease. Mr Herkel’s relief was palpable. “No offense, doctor,” were his parting words, “but I sure hope I will never have to see you again!”

As for Mr Lowry, I am waiting for him to come back one day with a different T-shirt. The one that says, I DIDN’T NEED TO BE HERE TODAY.

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Self-care tip: Sometimes, a powerful negative emotion may be a motivation for positive changes in your life. But you have to name the emotion first and evaluate it. Be smart.

Question: Have you had a negative emotion change your life for the better?  Tell us your story.

Blue Corvette and Cowboy Boots

Blue Corvette and Cowboy Boots

Some people love their cars and some people don’t.

I drive a Honda Civic – a perfectly serviceable car. It hasn’t been washed for half a year – after all, there is water restriction in California, or so I tell myself. There is a dent in the back bumper from that time when I tried to parallel park and a post magically appeared behind my car. I haven’t bothered to fix that dent nor the scratches that the car got when I fearlessly drove through a felled tree on the road. It’s not that I don’t love my car. I just love its functionality more than its appearance.

Several years ago, as I was walking to my job at the hospital, I saw a colleague getting out of an electric blue Corvette. The car was beautiful – compact, sleek, sparkling in the sunlight. My colleague happens to be not only a very tall but also a somewhat heavy man, so he had some difficulty getting out of the car – the Corvette was not made for his body habitus. Nevertheless, he looked positively radiant. I asked him later, “Why did you spend so much money on an expensive car that is too small for you and does not have that much functionality?” (perhaps I haven’t mentioned that I am not a very polite person). His answer surprised me. “It makes me happy”, he said. “When I get up in the morning and think about facing the day in front of me, I know there is always a bright spot in the beginning – I get to drive my Corvette to work. And that makes me happy.”

I pondered this. There was no way any blue Corvette was going to make me happy. Even a bright orange Aston Martin couldn’t make me happy. And I like orange. But I had to admit that I could not judge my colleague or somehow downplay his joy over something I didn’t understand. People are different. Happiness is relative, and in the eyes of the perceiver.

Over the years, I have had many conversations with my patients about what makes them happy. I have started looking at it as part of the treatment for their heart disease. People who can name sources of their happiness are usually more motivated to take their medications and to follow the lifestyle advice. Additionally, there is a small secret that the physicians may not tell their patients – and I just exposed it in case any of my patients happen to read this blog – tying the lifestyle advice to the sources of happiness makes it more likely to work. It doesn’t have to be a big thing – more often than not happiness comes in small packages. It can be a father, now less short of breath, able to play catch with his son. It can be a chronically ill patient now able to take an airline trip to see a new grandbaby. It can be singing a solo in church, making a trip to the grocery store, walking around the block.

Just recently, a patient I had not seen for few months, literally skipped into the room for his clinic appointment. “Are you seeing this?” he asked triumphantly, a big smile on his face. Well. Sometimes patients forget that I see dozens of them every day, and expect me to remember everything that was said at their last visit. I searched my brain as I was looking at him. Ah. The cowboy boots. Mr Golnach was wearing beautiful patent-leather ornately decorated boots that might as well have walked down from an expensive store window display. This had been his dream – to get his leg swelling down so he can finally put his beloved cowboy boots on. Clearly now, between better diet and regular medications, his heart failure was compensated well enough where the boots had become a possibility. “Isn’t this great,” he sighed happily. “Now I can die”.

Self-care tip: Find sources of happiness in your life, small and big. Naming them will add quality to your life, and keep you motivated to live better.

Question: Tell us your story about an unexpected source of happiness. 

Listen To The Intention In What People Say

Self-Care Tip #107 – Listen to the intention in what other people say.  Be a friend to yourself.

Knowing when to stand up.  To speak out.  There’s so much said about letting things go that when we don’t, we can feel, if not see, the people pinching up inside.  “Uck!”  But that can’t always be good, keeping quiet.

Trying to connect is hard to do in silence.  It’s hard to do in sound too, if it doesn’t penetrate.  Connections are penetrating experiences.  They get inside and hook us.  They touch our simple selves and although foreign, don’t corrupt us.  That is the Love’s job – the cleanness of it.  We are touched but still clean because of Love.  Without it, getting touched can feel contaminating, dirty.

In an earlier blog post, “Criticize if You Love Me,” I spoke about the love it takes to deal with a problem, and not walk away.  The comments made the post bigger and better by highlighting how much courage it takes not only to give criticism, but also to receive it.  And more often, I was told about the pain people received from criticism.

There are 2 parts here.  The “Giver” and the “Taker.”  Giving criticism can be more about the person giving it than anything to do with the person receiving it.  It is in reality often an attempt by Giver to connect.  And when it doesn’t feel that way by Taker, it becomes disconnecting.

 

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2 parts, remember?  Which ever side we are on, we have a choice.  We have a choice to connect.  Knowing something of the intention of Giver to connect must help that choice some, even when it doesn’t feel like what they are saying has anything good in it.

The real part of us is sacred.  Any contact to our simple selves is a privilege.  It is a privilege to both parties – Giver and Taker.  Both parties can be blessed and then in that exchange, Giver becomes Taker.

So think about what you want to say to someone you love and give.  Now, think about what you are hearing.  Take it.  And connect.

Question:  Do you find yourself on one side or another?  How do you connect?  Please tell me your story.