Tuesday, July 31, 2012

Day 45 thoughts on doctors and dogs

Today Ana brought her beautiful German Shepherd, Rykka, over to go for a walk with Maggie and you can see the results below. Maggie will defer to all dogs so she lost her tennis ball for a while. We had a great time and both dogs went home and slept for ages which is, of course, the whole point of the exercise.
They look like they are in a desert, but it's just a road at PEA. Both dogs are wet from their time in the river and look who has the tennis ball.

I love this picture of Maggie. It is hard to get a good picture of her because she usually looks like a huge shadow. I have the tennis ball and she is ready for me to throw it!

The correct order has been restored to the world and Maggie has the tennis ball again.
  I went for a trial run of a little running yesterday and probably ran 1 mile spread out over a 2.5 mile expedition so with the two events together I got a fair amount of exercise. I was so tired this afternoon that I took my first nap in a couple of weeks. I was, of course, worried that this meant Something Bad was going on--leukemia is sapping all my strength; I have mysteriously stopped making red blood cells and am now way anemic. I tell my patients who are cancer survivors that for the rest of their life, whenever something goes wrong with their body, their first thought will be that this is the cancer back. My patients tell me that after about ten years that the hypervigilance fades. I'll let you know in 2022.

In a related topic, I have been aware (and I think I've talked about this here) that one of the main things doctors do for their patients is to hold worries for them. I am worried about relapsing; a lot of my patients are worried about not being able to live independently; people worry about being short of breath or in pain or alone or scared and not having the help they need. Dr. Hill cannot tell me that I won't relapse; I cannot tell my patients they will be able to live independently forever or promise them that I can fix their symptoms--even a very unsophisticated patient could tell that those are not things that can be promised to them. What I want Dr. Hill to do for me is to say, "we'll watch you closely for signs of relapse; we'll check your labs and do bone marrows a lot and if you relapse we'll catch it early and treat it aggressively." I want to take my worry which feels like a huge shopping bag, so weighty that I am afraid it will burst the handles off the bag and hand it to Dr. Hill. Somehow when he takes it from me, it magically morphs into a tiny grain which he can put in his pocket and which only weighs a little bit for him. He has a whole pocket full of them so it's not like he is carrying nothing, but it's not the back breaking load for him that it was for me.

That is part of the magic and privilege of being a doctor. I've been on the other end of that a lot and can tell that just handing the worry over to me is therapeutic for people. I have held the weight in my hand and seen how it feels to me: what its heft and size is, how it nestles right in with the others in my pocket when I drop it in. Now that I've been on both sides, I can see the magical transformation and feel the change in dimensions.

I think the difference between the worry the patient feels and the worry the doctor feels is two fold. For me, it is difficult to think beyond what would happen if I relapsed (or for my elderly patients to think what would happen if they could not live safely at home). There is just this whole terrifying territory out there. Dr. Hill has seen lots of relapses and he knows just what we would do. He has a plan. He is not helplessly paralyzed with worry because he is an experienced guide. The other difference of course is that the experience is different for us. Dr. Hill would be a guide in the territory of relapse. I would go live there. My experience of my patient's loss of independence is purely empathetic and not experiential either. I know that Dr. Hill would be sad if I relapsed, but not as sad as I would be which is what makes the worry shrink to something he can handle. I think the real magic is that, knowing that it is not the same burning issue for him that it is for me, I can still hand over the worry to him and it is relieved for me. It really works if he accepts it properly.

Magic--that is what I do for a living. I am a magician. I am grateful to my magicians and yours.


  1. What an interesting, revealing metaphor, Mary! You're a talented writer, and it's a pleasure (circumstances aside) to get insight into your thoughts and experiences though this blog.

  2. Hey! look at me! I figured out how to respond to comments! Now all I need to do is stop using the exclamation point and find the period. ah, much better.

    thank you. The experience is not really one I would have signed up for voluntarily, but I have been fascinated to find out what it is like to be a patient with a serious disease. There are times when I am just as surprised as everyone else when I find out what I'm going to say, too.