Transformed by an Annoying Patient

I did not smile when I saw his name on the schedule. His previous visits had been difficult for me as he had presented with symptoms that defied physiologic explanation. He had vague abdominal pains that came at sporadic intervals and had no relationship to meals or activity. The pains were brief and mild and there were no changes in his bowel function, appetite, weight or ability to exercise. Making the diagnosis even more challenging, he had not experienced the symptoms in the last several weeks before his office visit.

In spite of these facts he was intensely concerned about his pain and almost demanded that I do something about it. I dutifully reviewed his symptoms, performed a physical exam and explained why his symptoms did not mesh with gall bladder disease, liver disease, ulcers, reflux, pancreatitis, cancer or irritable bowel disease. I told him we could be confident that he did not have a serious condition.

He thanked me for my opinion and demanded to see a specialist anyway. I did not think it was necessary or that the specialist would find anything, but I referred him anyway, hoping that his fears would be put to rest. As expected the specialist did multiple tests and found nothing. Predictably, the patient’s fears remained.

While months had passed since I had seen him last he communicated these persistent fears to me soon after I entered the exam room. They weren’t the reason he had given the receptionist when he scheduled the appointment, but they were clearly the reason he was there. He was certain something was wrong with him and that we were missing it.

I reviewed the notes from the specialist and saw that she had been incredibly thorough in her approach. She had left no stone unturned and had gone as far as possible in insuring that the patient did not have any significant illness or disease. Reading her notes the thought went through my mind, “What am I supposed to do now?”

What I wanted to do was scream, to grab the patient by the shoulders and shake him and tell him to get over it, that he was being foolish and he needed to let go of his worry. We had done our jobs and evaluated him thoroughly. There was nothing physically wrong with him. He needed to understand that the problem was in his head and not in his abdomen.

That’s what I wanted to say, but I didn’t say it. I wish I could say it was because I was moved with compassion, that I understood that his sensations were real to him and that his fears were genuine but that would be lying. I didn’t say it because I was afraid he would be offended and complain about me to the insurance or leave a negative review online. It was fear of negative consequences that caused me to take a different approach.

Having failed at a strictly medical approach I turned my attention to his fears and his feelings. I asked him what he was worried about. I listened. I then explained to him the limits of modern medicine, that oftentimes we do a better job telling patients what they don’t have then we do at explaining the cause for their symptoms. I told him that I wanted to help, that I wanted to give him an answer, but that I did not know if I could.

As I focused on him as a person I sensed a change in our interaction. It seemed that by expressing concern about what he was feeling he felt less of a need to get me to believe his complaints. As I made his feelings my focus he became more accepting of my words.

Something changed in me as well. As I focused on his feelings my perceptions were altered. He became a real person with real fears and concerns instead of a complaining intrusion on my day. He became real to me. His discomfort and fears began to matter.

Out of concern for his feelings I sent him to a second specialist. He accepted my warning that we might not find a cause and was grateful that I cared enough to pursue his diagnosis further. He left the office on a positive note.

He left me humbled. I am ashamed to admit it but there was a time, in the old days before the age of online reviews, when I would have dismissed his concerns without fear of repercussions or worry for his feelings. Confident in my diagnosis and the irrationality of his fears I would have sent him on his way. I would have been a jerk, but for the most part I would have gotten away with it.

Our encounter has led me to reflect on a harsh a human nature. We can do bad things and be bad people when we think we can get away with it. While the desire to avoid negative consequences can occasionally lead to good behavior this is not the way I want to live my life. I want to be a person who loves and serves first from my heart.

I want to be the type of person for whom “getting away with it” doesn’t matter because I have no desire to do “it” in the first place.

Bart

Note- as with many posts, some details have been changed to mask the identity of the patient so neither he/she or my office staff can know who it is. 

Thanks to all who read, share and comment, and to all who subscribe to the blog. 

A Little Self-Hate Can Go a Long Way

There are things I absolutely hate about myself, aspects of my personality I despise and long to change, inherited tendencies I wish I could kill and bury. While it is possible that focusing too much on my list of faults could lead to poor self-esteem and a life of guilt and shame I am convinced that failing to address these traits would have a worse result. I would be a very bad man. I need to be better.

Among the things I wish I could change-

-          I am not a good listener. Wait, that is too kind. I am a terrible listener. My racing brain causes me to think of responses before some is halfway through a second sentence.

-          I inherited my father’s temper. I have a tendency to lash out and be unkind. I need to slow down more and think of the feelings of others.

-          I am inpatient and intolerant of the faults of others. It is too easy for me to point fingers and criticize. I need more grace.

-          I am a worrier, my anxiety can cause me to be fearful about things that may never happen and seldom do.

-          I have an unhealthy need for affirmation, I can work too hard trying to please others.

There is not room in a blog post for the complete list, so I will stop here. Needless to say, I have a LOT of things I am working on. But to me, that is the point. I am working on the list. I am not content with the person I am, not satisfied with where I am in my personal life. I need to be better.

This desire to be better is not limited to external actions. I need to think better thoughts as well. In the dark reaches of my brain lurk some pretty terrible things, things which if allowed to take hold and grow would result in terrible deeds. I realize what the Apostle Paul meant when he spoke of “taking every thought captive to make it obedient to Christ.” I have thoughts that need to be put in jail, rehabilitated when possible and executed when not!

I am not alone in my struggles against and within myself. The need to struggle against the evil within is a universal one. Those who excuse their bad thoughts and behaviors, those who justify their actions instead of working to be better, will ultimately be exposed to the world as the wretches they are.

We are seeing this now on a daily basis. Each morning we wake to new reports of the terrible behavior of some celebrity or person in power. From Harvey Weinstein to Kevin Spacey to Mark Halperin there appears to be an unending stream of immoral behavior flowing from the hearts of powerful men. The natural question arises, “How could they do such terrible things?” As I hear these stories I find myself replying, “This is what happens when you don’t hate the evil inside.”

This is what happens when you make excuses for your perversity, when you consider yourself more important than others, so special and important that your desires deserve to be met. This is what happens when being a good person, being a better, kinder person, does not matter enough. The process is always the same. First we tolerate the evil desire, then we excuse the evil behavior.

If we want to be better people we need to change our priorities as a society. We need to lessen our emphasis on self-esteem and feeling good about ourselves and encourage more balanced self-assessment. When it comes to the evil in our hearts and minds, the world can use some more hate.

- Bart

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Pooping on Camera.

“You need to check your phone, alerts have been going off from your office alarm!”

I had just returned home from walking the dogs and this was not the greeting I expected from my wife, but in response to her words I walked over and picked up my iphone. I knew what she was talking about because I had recently installed the Ring surveillance camera behind my office and it was connected to a app on my phone. (There is a secluded area near the air conditioning unit that homeless people consider a place to camp, and after one too many Monday morning clean ups I had invested in the camera hoping to end the problem.) This was the first time the alert had appeared on a weekend.

I opened the phone app and clicked on the button to view the live feed of the area. No one was there. I clicked on the history tab and selected a video of the movement that had triggered the alert. I saw a recorded image of disheveled man in an orange cap walking back and forth as if he was looking for something. He then walked out of the shot. It seemed nothing had happened. I clicked on the tab of the previously recorded video from a few minutes earlier. It showed the same man conducting similar surveillance. I wondered if he was a homeless person scouting for a campsite but as he seemed to have left I took no action.

A few hours later my wife and I were out shopping when I noticed I had missed another alert from the camera. My wife peeked over my shoulder as I opened the app and called up the video. She wishes she hadn’t. Some things are best left unseen. We watched as the same man in the same cap again walked into the frame. He looked to the left and right, as if checking to make sure no one could see him. He then took his foot and dragged it through the gravel, clearing a bare spot of dirt and making a shallow pit. Then he turned around. And reached for his belt. And lowered his pants. And did the deed. 6 feet from the air conditioning unit at my office, right there in the dirt. It was disgusting.

15 minutes later the alert went off again. This time I caught an intruder live, rummaging in the shrubbery. It was a different man, in a blue tank top. I tapped the phone icon in the Ring app so I could talk to the man in real time. “This is private property,” I said, “You need to leave!”

He stared up blankly in the direction of the speaker, as if he did not understand. I repeated myself, slowly and clearly, yet got the same blank stare in return. I wasn’t sure whether he didn’t understand or just didn’t care. I decided to call the police and ask them to come and shoo the man away. The dispatcher told me they would send an officer to investigate.

In just a few minutes the alert went off again. This time the live feed showed the police officer walking in the area behind the office. I clicked on the speaker button on the app and introduced myself. I told him I did not see the man any longer. He told me there were men trimming the trees at the office and that it must have been one of them. I told him about the previous man’s actions and encouraged him to watch his step as he left.

My wife and I finished shopping 40 minutes later and, still bothered by the previous video, decided to drive by the office. We wondered if we might see the mysterious defecator walking in the neighborhood or sitting in the office parking lot. We turned on the side street where the office is located and pulled up to the curb across from the office. Parked near the office was the tree trimmer’s pick up, a large red truck piled high with branches and trimmings. On the top of the pile, tying things down was a disheveled man in an orange cap. We gasped. The pooper was one of the gardening crew!

I was livid, more than I was when I had seen the act on video. It is one thing to have a wandering vagrant lacking in luck or cognitive abilities make a mess on one’s property. It is an entirely different thing when the mess maker is someone you are paying to clean up that property! I felt violated. I got out of my car and approached the truck, holding up my phone as evidence as I looked up and addressed the orange ballcap wearing pooper-man.

“I have a surveillance camera on this property,” I said, “and I saw you take a dump behind my office.” I don’t know exactly what response I expected but I know I did not get it. The man showed no sign of embarrassment. He simply shrugged his shoulders, said “I’ll clean it up,” and returned to his branch stacking. It was as if he was saying, “No big deal, sh— happens.”

I let him know it was a big deal to me. “You will clean it up now,” I said, “Or I will call the police.” I was not certain of an exact law the man had broken but I was pretty sure that he had to have broken at least one and I knew of no other approach that might motivate him to act. He seemed annoyed at my demands but began to move anyway. He climbed down from the truck, grabbed a shovel and went behind the office, later emerging with a bucket in his hand. I had no desire to look in the bucket, instead I asked him if he had cleaned it up. He nodded and said, “Sorry,” again shrugging his shoulders.

I don’t think he was sorry. Based on his actions and responses I do not believe he thinks he did anything wrong. His “regret” was over being caught, not in what he had done. The only behavior he is likely to change after today is his degree of surveillance. The next time he feels the need to defecate on the job he will probably look for the nearest video camera, not the nearest bathroom. I say this because I believe who a person who does not know that pooping in a person’s yard is inappropriate, a person who had no shame over crapping in public, probably does not spend a lot of time thinking about right and wrong. He does what he feels like doing in the moment.

I can think of a lot of famous people who are a lot like the pooper man, people who decided long ago that right and wrong don’t matter. Men and women to whom what matters is whether or not they can get away with their disgusting behavior, not avoiding behavior that is disgusting.

My message to them is the same as my message to the pooper man. Someone is watching, even when no one is around. Nothing we do is hidden from the eyes of God and someday we will all give account for the messes we have made!

- Bart

PS: The man is not alone in his bathroom habits. There is a "Mad Pooper" on the loose in Colorado . 

Thanks to all who read the blog and share it with others. (although this one is a little less share appropriate!) Those who wish to receive future posts can subscribe to the blog or follow me on Twitter @bartbarrettmd. 

Blessed by a Dying Man

He was a bear of a man, in two varieties. He was big, strong and burly, an imposing presence like a grizzly. He is also warm and kind, always ready with an encouraging word, like a teddy bear. He is one of those remarkable patients who always takes the time to ask me how I am doing and truly is interested in the answer. On more than one occasion he has asked me if he could pray for me before he left the office. It made me feel guilty at times. I was the one who was supposed to be making others feel better.

He is only one kind of bear now. The big bear aspect of his nature has faded. Cancer has removed almost 100 pounds from his frame and the tumor compressing the nerves to his left arm has resulted in incapacitating pain. He has been on hospice for over a year now, his disease incurable and his death imminent. It is hard for him to get out as much as he used to which makes the still present teddy bear side of his nature more difficult to share.

As encouraging others has been such a major part of who he is the isolation has been difficult for him. He has been wondering why he is still around, why God has yet to take him home, why he must live in so much pain when there is so little he can do for others.

He shared these thoughts with me when I stopped by his home on Friday for a hospice visit. There was not much for me to do from a medical perspective. For the last several months the only changes in his care have been increases in the dose of his pain medicine. He has been in agony, daily choosing to endure the pain rather than be comfortable yet sedated and less present for others. As bad as the physical pain is as we talked I could tell that the emotional pain was taking a greater toll. He felt he had little to give others and that was breaking his heart.

In almost the same breath as his sharing a sense of worthlessness he told me that I had been on his mind for the last several weeks and that he had been praying for me daily. He asked me how my family was, if everyone was okay. If there was anything or anyone who needed prayer it was clear he wanted to know. He told me that he loved me, not just as a doctor, but as his friend. We spoke for a few minutes more and I tried my best to encourage him.

As I turned to go he stopped me and told me to wait. He reached for his wallet and I could tell he wanted to give me a gift. “Please, no,” I said, “You do not need to give me anything! This is my job!” He shook his head insistently and told me that he wanted to give me something. He took money out of his wallet.

“Take the girls in your office to lunch on me,” he said. I hesitated, he would not take “no” for an answer. He wanted to do something, to make a difference in my life. I realized how important it was to him. He wanted to bless me, to bless my office, in any way he could. He needed to bless us, because that is who he is. He is a man who lives to bless others. I let him shove the money into my hand.

I left his home, once again moved at his kindness. As unsure as he is about why he is still around his purpose is clear to me. He is a testimony to others about what it means to be a Christian. He embodies Jesus’ teaching about putting others ahead of ourselves, of loving selflessly. He is a blessing to others, and a blessing to me. Like the Savior in His moment of suffering, my patient is choosing to consider the needs of others.

 Bart

Thanks for reading. Pray for my patient, Mr. R, that God will comfort him and encourage him. Consider sharing this post and asking others to pray for him as well.

Learning the Power of "No"

I wanted to be an actor. I had no reason to think I could succeed in the arts, but I loved the theater. I had no formal training, I couldn’t sing at all, and had never taken a single dance lesson. My stage experience was limited to a couple of very low quality high school productions but that didn’t stop me from enrolling in college as a theater arts major. I had a dream. I wanted to act.

The dream died my first day of college. I do not remember what prompted the moment of reflection but after my first, very boring day at Cal State Fullerton I sat and reflected on the reality of my goals. Given my complete lack of musical talent there was no hope for Broadway. Drama or comedy were a possibility, but I was not leading man material. I was not particularly good looking. I had a very slight build and was not particularly tall (somethings never change!). “Romantic lead” was not going to ever appear on my resume. If I was going to be an actor I would have to do it the hard way. I would have to have another job and scrounge for any role I could find, likely as a bit player or character actor.

While many similarly endowed have gone that route and eventually succeeded I realized there would be another barrier to success, my beliefs and values. As a committed Christian, there were limits to the roles I could accept. There were things I would not say, even in character, and things I could not do because of my faith. There would be times I would be forced to say, “No.”

As I pondered all of these facts in my head I realized I had no choice. The chances of me making it as an actor, making it to the level of being able to one day provide for a family without compromising my values, were nil. My dream had to die and it did. As I had no idea what I wanted to do with the rest of my life I dropped out of school to reconsider my life path.

This story from my past came to mind this week as I read more of the tales of abuse and harassment in Hollywood. The lurid accounts of shameful and disrespectful behavior validated the conclusion I reached almost 40 years ago. So many have given up so much in pursuit of acting careers, preyed upon by lecherous men like Harvey Weinstein. It seems it is almost impossible to make it as an actor or actress without compromising one’s values.

As disgusting and offensive as the actions of Harvey Weinstein were I cannot ignore the reality of why they continued for so long. Men like Weinstein do what they do because there are men and women who are desperate enough to allow them to. Morals are tested, challenged and frequently cast aside. One compromise leads to another, and the compromises of one person lead others to feel pressured to similarly give in.

Strings of compromise lead to entitled expectations from powerful people who make or break careers. Actors and models who are willing to take off their clothes and imitate lewd behavior on camera for money or the opportunity at fame should not be surprised when others think they may be willing to do the same in private. When you have established a price, people will try to buy you.

The solution to this problem isn’t only to punish the perverts (although the punishment should be severe). The solution requires values and boundaries. People need to be willing to accept the potential adverse consequences of saying, “No.” They may lose coveted roles or even their careers to the whim and spite of a power-hungry sleaze, but they will keep their dignity.

They may lose a Hollywood career, but they will not lose their chance for happiness. They will have the same opportunities for happiness as the rest of the world, the happiness that comes from being a good spouse, parent, friend or co-worker. They can have joy that surpasses fame, the joy of being a good person who is true to their values. They can live a fulfilling life that is not subject to the whims of another, fulfillment dependent on neither fame nor income level.

I do not know any celebrities but my distant observations are that few of them appear to be truly happy. Most of the people I know have lives of better quality. I know I do. I have been happily married to my best friend for over 35 years. I have close relationships with my adult children. I have no skeletons in my closet and no terrible secrets waiting to be discovered. I also have my values and my dignity.

-          Bart