Since I ran out of time yesterday, today I drove back to Manchester and visited my office. Everyone seems to be doing well. I missed a couple of my pals and didn't get to visit the family practice side because I was running out of steam (sorry, I'll start over there next time so I can be sure to see you, Linda, ChiChi, Anne and other FP friends!) I did want to tell you about one quite moving experience I had. I saw one of my patients coming in and said hi, hugged him, exchanged pleasantries as he walked by with the MA to his room. I took care of his mother who died in my care about a year ago after I discovered her cancer was back. I was chatting with someone else when he came out and he came over specifically and said "I've been thinking and I don't know what you have, but you don't deserve it and I'm really sorry you have it." In light of the fact that his mom who was one of the nicest people on the planet had died not long ago from a disease she did not deserve, this really touched me. I was so glad he told me this and really value his thoughts and wishes and appreciate that he told me. He was clearly quite affected by my being an obvious cancer patient and I was touched by that as well. When I regard myself, it seems like it's just me--not really interesting or out of the ordinary; I mean I spend 24 hours a day with myself. I forget the thing about how I feel about my doctors is how my patients feel about me. I am very lucky to get to be a doctor.
I also got some fabulous cards from patients who were doing well, but wanted me to know that they were coming back to me from their "fill in" PCPs, one who had gotten a successful organ transplant, one from my nearly oldest patient who is extremely lively and would be n good health for a 75 year old (except she's over 90).
Then I came home and tied on my warp and started weaving my newest experiment. So far, so good or at least no disasters. Terry has a friend who is a ceramicist. She told him once about something she had made that when it came out of the kiln looked horrible and it just happened to break. I was thinking how tremendously satisfying it must be to just drop and shatter your work that you don't like. When I don't like something I've woven, I can cut it off the loom, but it doesn't really get destroyed and it would not be very satisfying to cut it into bits, but to just drop something and have it fly into a whole bunch of pieces, gone forever! Maybe I'm in the wrong medium.
I also voted and went for a surprise three mile walk this afternoon. There were no stickers in Exeter which disappointed me.
This evening was back to school night for grade six so I went off to middle school. I was expecting to be unimpressed (because honestly we didn't like the middle school much when Emily was there), but I was actually quite impressed with Ellie's teachers, their attitudes, organization, how smoothly the whole thing went, etc. I had been hopeful for a good year, but now I'm really expecting it. We hear every year about how wonderful her class is, that they are kind to each other, that they are respectful, conscientious, pleasant. They already went on a field trip to Pawtuckaway and the teachers said they had never done that in the second week of school before. One of the teachers said for the first time in 28 years of teaching she was not using a seating chart. The vice principal said that the teachers at all the feeder schools said that this year was filled with extraordinarily nice kids. What a tremendous piece of good fortune for Ellie (and us).
That pretty much sums up my day, another really lovely, low key day filled with pleasant activities. Patrick asked me to recount the specific incident that made me feel like Dr. Hill thought similarly to how I do so here it is.
I think this happened on my very first night in Lebanon. When I first was walking into the liquid tumor ward, I saw a man with "John Hill" written on his lab coat so I stopped him and said that I had been instructed to hand these (my slides) only to him so here they were. I actually thought of something Patrick says and handed them to him with two hands. They were in a little cardboard box that looked kind of like a folio. He came back hours later after having looked at them and asked for my story and gave me the scoop as he saw it. You may recall how I got my diagnosis. Briefly, I had a virus in March, felt really really terrible and got a set of labs, really just for entertainment purposes because I felt so terrible. My ANC was 700 and I was a little anemic and leukopenic but had no blasts. I thought I am probably B12 deficient, let's take some B12 and recheck in a few weeks. Weeks turned into months and I rechecked on June 14, with a marrow to prove the leukemia on June 15.
When we went over my case, one of the things we really focussed on was why were my labs terrible in March? Dr. Hill didn't think the time course was right for that to be early leukemia and thought it might have been a pre-malignant condition (myelodysplastic syndrome MDS) which would alter the treatment plan for the AML if it were. We talked a lot about that and the implications and if there were any other blood test I had had around anywhere and then he offered that he didn't think it would have made a difference if I had gotten the lab work done sooner. I was feeling pretty foolish and badly for not having taken better care of myself and done them sooner, but I didn't think I had voiced this thought so I was a little surprised that he had picked up on it. What came next was what really got my attention however. He then said, "That's really what I think. If I thought it would have made a difference, I would tell you if you asked. [pause] If you didn't ask I wouldn't have said anything about it if I thought the delay would have made a difference." This answered exactly the question I was thinking, but was not going to ask. It is also exactly what I have said to patients, and without being asked, just like in his case. I think it is probably in the doctor communication books "too much information," but I wouldn't be able to stop myself from saying it because it is very important to me that my patients really feel I am honest with them. I felt that Dr. Hill's telling me came from exactly that same impulse--a little too much info, a little off track, but so important to the relationship that he couldn't let the moment pass without saying it.
Maybe you feel like this is standard stuff, but I don't think it is. Offering the reassurance without my asking for it and then offering reassurance that he wasn't just saying it again without my asking and finally the TMI topper of "I just wouldn't say anything unless you asked if I thought it had caused you harm" without any request for clarification on my part was such a familiar train of thought to me that I really felt like I could trust him. Here was a person I understood and who would understand me.
Of course, a relationship is not built on one moment only even a fabulous one, but rather many hundreds of little moments and there were many others, some of which I've mentioned and some of which I will mention as they happen or as I have a day without much else to talk about besides a conversation from two months ago. This, however, was when I decided that I would be OK in Dr. Hill's hands.
I hope you are able to relax in the care of your very own doctor. If not, don't be a knucklehead like me, go get yourself a doctor you are comfortable with and visit them.