Tuesday, June 11, 2013

So, what do you think of my thinking?

I've talked a lot about the personal meaning I make from the whole leukemia experience involving in part that I am going to be a much better doctor because of it. Here's a concrete example of how.

I've used this particular little talk twice with patients. Once it made no difference at all and once it really made a difference for the patient. It's a talk for people who are a little delerious and who may not want to take their meds for it because they don't trust anyone. Here it is verbatim so you have to imagine my voice and the way I talk while you read it.

So, I don't usually tell patients this, but I think it might be helpful. I don't know if you know, but I had cancer last summer (aside: one of the patients was so paranoid that I showed him my port scar to prove it which really helped). It came out OK; I'm in remission and stuff (aside: this part of the talk feels a little off and I try to gloss over the I'm in remission part b/c the person I'm talking with hasn't been), but the worst part of all of it: the pain, the nausea, the chemo, whatever the part that was worst, was the part where my husband told me I wasn't thinking very well. I mean, there's nothing you can say to that that doesn't make it worse and it's such a horrible and scary thing to have someone say. I'm not sure, but I wonder if the cancer might be trying to wreck your thinking up. Just a little bit, but it's such lousy sneaky stuff that it might be trying really hard to. Can I tell you what I was thinking? (segue to part of the talk where I explain what I think might help)

The first time I said this to a patient, it was not helpful, but the second time, it felt kind of miraculous. The patient was willing to give a try to a med he had been unwilling to try before (sadly, it didn't work, but it felt really important to everyone to try to make Plan A work and this particular med was necessary for Plan A). His behavior dropped down a couple of notches from almost impossible to manage to just tough and right after agreeing to this he had the nicest interaction he had had with a family member in weeks (maybe not related, but maybe). I really think this worked to reach this particular patient at that particular moment and it was something I could not have done or even understood without the leukemia experience. I just really did not understand what the experience of not thinking well might be like.

As an aside, a nurse and I were discussing a delerious patient and I told her that when Terry (and Tommie, too!) told me I was not thinking very well that that was really the low point of the whole experience for me and she said, "Even for you, Mary? with all you know about this stuff?" Ah, if only cognition ruled it all, huh?

Not related to cognition. Maggie in the Exeter River two summers ago.
I am grateful to have come out on the other side of the leukemia. I am hopeful for no return trips.

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