Poisoned by a Doctor! (And other Accusations)

“You doctors just want to give me poison and I am not going to take it!” I have been accused of many things in my 20 years of practice but intentional poisoning was something new and the patient's words surprisingly harsh. He was angry from the moment I walked into the room. He was first offended when I questioned his reasons for not taking the medications his cardiologist had prescribed. He had experienced some slight swelling of his legs, decided that this side effect was too severe and made the decision on his own that the medication was unsafe. He was convinced that the doctor had put his health in danger and that I wanted to do the same.

When I explained that this was a relatively common side effect with this medication he became angry. “Why would you prescribe a medication when you know there are side effects?” He was nearly shouting and his faith was contorted in anger. He was MAD!

“Because it is an effective drug and the side effects only happen ten percent of the time!” Was my reply.

He would have none of it. It was his opinion that no doctor should ever prescribe any medication if there were any side effects. I tried to explain to him the nature of side effects and how they were outweighed by the benefits of treatment. I spent the next 20 minutes trying to explain to him the nature of heart failure and why medicines were crucial for his health. I explained how the medications worked and why the side effects were reversible or manageable. He argued with me every assertion I made. He told me that doctors were dishonest people who cared more about money than they did people, unscrupulous individuals who would just as soon poison someone as treat them.

I finally gave up. As calmly as I could I told him that if he was going to refuse care for his heart failure that I would not be his doctor. If he didn't trust me it would be impossible for our relationship to continue. I explained that my preference would be for him to remain a patient and be healthy but that remaining a patient and being healthy would mean following my instructions. He continued to argue with me so I opened the exam room door and gestured for him to leave. “You will need to find another doctor,” I told him, and sent him on his way.

After he left I composed a letter summing up what had happened (detailed documentation is required when a patient is dismissed) and put it in the mail. I reviewed our conversation and concluded  by saying,

“You made it clear that you do not trust doctors, myself included. The physician/patient relationship has trust as its foundation. Your good health and medical treatment is dependent on you following expert medical advice. Our lengthy conversation today proved to me that you are unwilling to do this.

If you wish to remain a patient in my practice, you will need to accept and follow my recommendations, and schedule appropriate follow up visits. If you are willing to follow my recommendations and respect my judgment and opinions, please schedule a visit to move forward with your care.

If you plan on continuing to argue with my recommendations and refuse to comply with treatment plans, I must insist that you seek care elsewhere.”

I had my staff send the letter via certified mail, convinced that I would never see him again. Which is why I was so taken aback when I saw his name on the schedule 5 weeks later. I entered the room cautiously, prepared for another conflict.

It never came. He was incredibly apologetic from the outset. I asked him what changed his mind. He told me it was the letter! He realized that I was serious about his health and decided right then that he didn’t want to see anyone else. 

His dramatic change of heart was something else I had not seen in 20 years of practice. I was truly impressed with his humility and told him so. We agreed on a new medication plan for his heart and blood pressure and arranged a follow up visit. It was a very pleasant encounter.

It was also educational. He taught me that people can change, even those who seem intractable and unreasonable. He reminded me of the power of forgiveness and the beauty of a fresh start. I am actually looking forward to our next visit.

- Bart 

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Growing in Love after 77 Years

They have been married for 77 years. Les is 97 and Betty is 93. Age has affected them physically, mobility is difficult and they require assistance in caring for themselves and moving around. Even with their motorized scooters getting to the dining room at the assisted living facility has become difficult, so staff brings their meals to them in their small apartment. There seems to always be a styrofoam container of the previous meal present when I come to visit.

Routine is important to people in their nineties and they are no exception. They sit in their same recliners for most of every day, watch the same TV shows (It is ALWAYS on Fox News), and he tells the same jokes over and over again.

There is something else about them that never changes. They love each other. Even more, they like each other. They enjoy one another’s company. A few months ago he was hospitalized twice in a matter of days with pneumonia. There was a concern that he was losing the ability to protect his airway and might not be well enough to remain in their assisted living facility. He was told he needed to go to a nursing home so he could be kept out of the hospital. I told him he could stay in assisted living with his wife if but that if he got sick again he would need to go on hospice or be transferred to a nursing home. Since a nursing home would mean separation from his wife the decision was a simple one for him. He would rather live a few months or less with his wife than live a few years more without her. “I want to stay with Betty,” was his firm answer.

Their story stands in stark contrast to many of the stories I hear in my office. Unhappy marriages are so common they appear to be the norm. Patients who speak fondly of their spouses, who talk about marriage as if it is a gift, stand out as exceptions. When patients hear me talk about being happily married for over 32 years they are often surprised. Long, happy marriages are not something they often see.

I often wonder why this is. 

As with so many things in life I think success in marriage is a matter of choice. Successful marriages occur when a man and woman make a conscious decision to build a quality marriage. Happy couples understand the costs associated with this commitment. Sacrifice and self denial are required daily. Faults need to be overlooked or graciously accepted and effort needs to be made to intentionally focus on the good things in a spouse’s character and personality. Over time, things that once required effort become second nature, and love grows. When we focus on the good in our spouse they grow in value and we enjoy them more. 

Lisa and I are 44 years behind the example set by Les and Betty Miller, my grandparents, but we are on our way. We have experienced firsthand the joy that marriage to your best friend brings, the work required to keep a marriage strong and the contentment that comes from not wanting to be with anyone else. Life with your one love is a very wonderful thing.

- Bart

If you are in a marriage that is unhappy, get help. Your marriage is worth fighting for. If you are in a marriage that is “just okay” get help. Fight to improve it. You will never regret making your relationship with your spouse your top earthly priority! Remember you can subscribe to the blog by clicking the button on the page or follow me on twitter @bartbarrettmd.

A Good Man Dies. Or Does He?

Allan Meyer died last week. Although he was in his 80’s it was unexpected. He was a friend to my wife and her family for over fifty years as well as a consistent source of encouragement to me. He was a natural encourager. He seemed to seek us out every Sunday, as if had a special radar he used to seek us out so he could greet us with a smile, a kind word and a silly joke. He was a lover of people who frequently visited friends and church members who were hospitalized. He was a good man. Today is his memorial service. I expect it to be a long one. There is a lot to say about Allan and a lot of people who will want to say it. 

It seems that this is how it works, that the true value of a life comes into clearer focus when it ends. Death is the time when our true worth and accomplishments are understood. Death is the great commonality, an event shared by all regardless of culture, ethnicity, social status or religious faith. It can be delayed but it can never be avoided. Everyone dies. When they do, people reflect on who they were and what they did.

Death also brings with it a question. What comes next? The answer to this question defines all human existence and brings the standard by which all lives are measured. Answers vary, yet all of the possible answers have profound ramifications for how people think and live.

The secular answer to the question of what comes next is simple. Nothing comes next. The  final heartbeat and last breath represent the moment when the person completely and totally ceases to be. Nothing remains of their personality, their emotions, feelings or memories. They are just gone. Death is the absolute end.

People of faith answer the death question differently. For them life follows life. The body ceases to function but the essence of the person, the personality and thoughts, the soul and spirit, continue on. 

Believing that something comes next changes everything. If there is a next life, particularly if it is an enduring life, then earthly actions must be measured not solely on their immediate impact but according to their impact on the life to come. Earthly wealth and accomplishments decrease in importance. Faith assumes the preeminent position and character qualities such as love and faithfulness and a person’s relationship with the Divine outweigh those things which can be seen by the eye. 

While worldly achievements are in large measure dependent on when, where and to whom a person is born  the things that matter for eternity are available to all. Faith, hope and love are gifts that can be received and given by the poorest of the poor.

A person’s true answer to the what “what next” question can be determined from a distance. Those who pursue pleasure and happiness with vigor, who work hard build a name or legacy for themselves, and strive for earthly success are living as if this life is all there is, as if they embrace the secular view. Further evidence of a temporal mindset is seen in rejection of moral absolutes. 

People who hold onto earthly goods more loosely, who are more willing to forego wealth and security in this life and more willing to give their lives for a cause are living as if there is an eternity.

What we believe about death defines our entire existence.

• From what I observed, Allan was a man who believed in eternity. It is why he lived as he did and loved as he did. I look forward to seeing him again.

- Bart

Prayers for Allan's family will be appreciated. He is at peace, it is those who remain who are suffering. 

A Lesson I Learned in Prison

"You're a doctor?” The prisoner’s smile was large and his laughter was deep. “You ain’t no doctor!” He had met doctors before and in his judgment my personality and demeanor were totally inconsistent with the medical profession. He didn't know  me well as our interactions were limited to softball games twice a month. I was part of a church team that had been playing games against the prison team for several years so we didn't see each other often.

Our teams were polar opposites. The prison players were large and muscular men, most of whom were of Hispanic or Black descent, almost all of who were significantly tattooed. We were on the pale, scrawny and inkless end of the athletic spectrum. We had very little in common in our daily lives but found common ground on the softball field.

I was the youngest player on the team. When we first started going to the prison I was just 22 years-old. I was not comfortable back then with starting deep conversations with older men I hardly knew so I related to the prison players the only way I could. Like any self-respecting athlete, I starting talking trash. I soon realized I had unwittingly opened a door to better conversation. My joking insults showed that I viewed them as people, not as targets for conversion. Laughter became a bridge.

For the following 7 years of play I continued to joke and have fun with the inmates. I didn’t talk much about myself so they were not aware that I was attending medical school. The last game I played was the Saturday after I graduated, just before I moved away to start my residency training. Realizing I would never see these men again I intentionally said my good-byes to the prison players between innings. Many shared the one inmate's assessment, I was not like any doctor they had known. To them I was too young and too much of a jokester.

Looking back I see the inmates' amazement as a compliment. The response was not due to a perceived lack of  intelligence or ability, it was because they knew me to be genuine, fun-loving and approachable. As I consider it, I think their perception is something to strive for. It was and is a good thing to be viewed by others first  for who we are and how we treat others, not by our education and profession. A valuable lesson I learned in prison!

 - Bart

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Afraid of a Doctor. Needlessly Sick

Fear causes people to do stupid things. 

Several weeks ago a patient came in for a visit. She has diabetes, high blood pressure, significant anemia and a history of blood clots. Since she has so many medical problems I had instructed her to come in for follow up at three month intervals. Over a year had gone by since I had seen her last. It had taken multiple phone calls from staff and a refusal to refill a medication to finally get her to return.

I asked her why it had taken so long.

"I was afraid," was her answer, "I thought you would be mad at me!"

Even though this was not the first time someone has declared me to be a frightening person I was still surprised. I am her doctor, not her dad! What is there to be afraid of? I can't really do anything to her, I have no way to punish her, yet she was afraid. All I want for her is for her to be healthy to help her help herself. Why would she be afraid?

The answer is simple. She is afraid because she is a person, and people live in fear of things.

While the specific fears may vary, we all are afraid of something. We are afraid of big things such as death, disability and financial ruin, and we are afraid of little things such as embarrassment, darkness and spiders. (Why is it that EVERY nurse that has ever worked for me is afraid of spiders?)

And yet, the Bible tells us that fear is a completely useless feeling, that it has no place at all in the life of a believer. Why? John the Apostle explained in a letter to the church- "There is no fear in love. But perfect love drives out fear, because fear has to do with punishment."

We are afraid of bad things happening but should not be because we are perfectly and completely loved by God. Our faith assures us that we need not fear ultimate punishment. Since our final destiny is secure fear has no place!

Earlier in his letter John described the love that God has for His people, writing "See what great love the Father has lavished on us, that we should be called children of God! And that is what we are!"

We are so like my patient. God loves us, cares for us and sent His Son to die for us, yet we hide from Him due to a  foolish and misguided fear of punishment.

We need to set our fear aside and see ourselves as He sees us, as perfectly loved children. Children loved by a gracious Father who will never forsake us. Even when there are spiders!

 -Bart

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