writing down the sun

The Mean Doctor Blues

Posted in writing by annie on July 8, 2007

Reading Emily Yoffe’s piece for Slate in which she recounts her experiences being a human guinea pig for a bunch of med students filled me with a wistful longing. How I wish my experiences with doctors were anywhere near that hopeful.

To be honest, most of my doctor encounters have been pretty uneventful. I inherited a charming, handsome general practitioner from my mother, Dr. B., and he is my primary care provider. He listens pretty well, and if I have to wait an ungodly amount of time for an appointment, that’s offset by the walk-in hours he provides with his physician assistants on staff, and an eclectic assortment of magazines in the waiting room (not to mention a TV that isn’t tuned to Fox).

So why is it that it’s the bad experiences that stick in my mind? Specifically, one encounter in particular, with a doctor I nicknamed “Dr. Pig Jowls” – for a reason I can’t relate here, as it would identify the unfortunate man pretty clearly. Dr. PJ was my brother’s surgeon during his final illness – esophageal cancer. Jim’s diagnosis came too late for treatment, so we were left with palliative care, part of which involved inserting a feeding tube, after which Jim would never eat solid food again. An awful enough fate, to be sure, so why the fates decided that we needed the additional hell of Dr. PJ escapes me.

I say “we.” Surely, it was Jim who was exposed to the worst of it, being the patient and the one dying. But it was my mother and I who, oddly, became the angry ones – angry enough to consult the hospital administrator, who said all the right things but apparently did nothing, and whom we never heard from again.

Dr. PJ’s assault began with the first appointment. His nurse coldly demanded $200 before Jim would be allowed in the hallowed halls of his treatment rooms. Jim, having been out of work for months prior to this, didn’t have the cash. My mother, being a senior citizen on a fixed income, didn’t have it either. So until I could help them out, they were stuck. They’d traveled 45 minutes south to his offices, and the staff knew they were coming. They couldn’t have told them up front this was going to happen? More to the point – what?! You’re going to turn away a dying man who can’t eat food because you won’t bill for $200? And – how much?! Dr. B, by way of comparison, charges $50 for a visit, and that’s average around here. True, Dr. PJ’s a surgeon, but still – $200 is a princely sum in these parts.

The offense wasn’t over with the loan shark tactics, unfortunately. Dr. PJ’s rudeness extended all the way to the operating room and then some. After Jim’s surgery, Mom (a retired RN and former hospital administrator, whose mind was plenty sharp back then) questioned both Dr. PJ and the nursing staff repeatedly on the protocol. She was told by both – don’t use the tube until Dr. PJ sees him again. That appointment was two weeks away. In the meantime, my brother choked down liquid shakes (and promptly threw them back up again).

Shortly after the second visit, Jim’s tube became dislodged when he stumbled while going to the bathroom. Mom took him back to the hospital, where Dr. PJ was to reinsert it. She called to ask me to step in for her, as she was due in the Social Security office to see about getting Jim some benefits, and someone needed to be there when the doctor came out. This was to be my first – and last – encounter with Dr. Pig Jowl.

Mom warned me prior to leaving that he had been ugly to her and to Jim that morning. Specifically, he’d said in a loud and sarcastic voice that if Jim was just going to rip the tube out, he wasn’t going to keep putting it back in. My blood ran hot in my veins. I knew Jim would never have torn the tube out deliberately – he demonstrated no signs whatsoever of not accepting his fate. In fact, we’d all been so impressed that Jim – the alcoholic, the emotionally damaged one who strongly resisted acknowledging any flaw or problem – had risen so gamely to this seismic challenge and kept his balance so beautifully. There was something heroic in the way he faced his death, all along.

But here was Dr. PJ, accusing Jim of deliberately sabotaging his handiwork. This tidbit set the mood for the confrontation that followed. He threw open the doors to the waiting room about an hour later and looked for Mom. I recognized him immediately – having never seen him before – and walked over with a polite smile to introduce myself. His eyes narrowed as he quizzed me about my relationship to Jim; he was reluctant to give me any information, and sounded exasperated when he asked where my mother was.

I took a pause and said loudly, “She had to go to Social Security office to get his benefits started before he dies. She asked me to step in. What do you have to tell me?” It had the intended effect – all eyes were now on him, and he knew it.

He started off in a low voice, as he began to recount the procedure, which went well. But he lost it again quickly as he started to insist that Jim had been drinking before the incident and that he simply could not do that anymore.

I think I yelled, “What?!”

Dr. PJ was accusing my alcoholic brother of drinking. Drinking alcohol.

Let me count the ways this is absurd:

  • Jim was barely able to walk by this point, let alone drive a car. He hadn’t left the house except when driven by one of us for weeks.
  • Jim could barely tolerate drinking lemonade or Coke. Alcohol would have made him gag and vomit.
  • If Jim couldn’t drive or walk, where was he supposedly getting this alcohol? From my 80 year old Southern Baptist mother who’d been haranguing him to quit drinking for the last 30 years? Somehow, I doubt it.

Still, Pig Jowl insisted my brother had admitted this to him. What he’d said, I quickly fathomed, was “I’ve had something to drink.” Jim, like me, was the child of a nurse and a pharmaceuticals salesman. He’d grown up around the medical profession, and knew that you’re not supposed to have anything to drink or eat before surgery. He’d told his doctor this, who interpreted it as an admission that he’d been trying to get sloshed.

While this was playing out in my mind, Dr. PJ was blathering on. Furious, I interrupted him and said “Why did you tell my mother that Jim couldn’t use the tube before he saw you, two weeks after the insertion of the tube?”

He blinked. “I said no such thing.”

“Oh, yes, you did,” I said, “and there are witnesses to this.”

He steadfastly refused to admit it, suggesting perhaps my mother was “confused.”

I threw up a hand to shut him up. “I’m going to the administrator right now.”

“Fine,” he said. “The offices are that way.” He gestured off to another set of doors across the lobby, turned on his heels and stormed out.

That was the last I saw of him.

I went straight to the administrator’s office, but only a VP was able to see me. She was very nice – she’d lost her husband to cancer, she said. She offered me a milkshake recipe that her husband had been able to tolerate. She seemed concerned about the blatantly incorrect post-op directions Mom had received but seemed to blame the nurses, instead of PJ. She said she’d pursue the matter and vaguely mentioned some “chain of command” the corporate owner of the hospital required be followed, and it might “be awhile” before I heard anything.

And that – three years ago – was the last I heard from her.

Since that time, I’ve struggled to let that go. Yet every single time something brings it to mind (something like Yoffe’s piece – and no, it doesn’t happen often) the maddening sense of frustration and howling indignation on my brother and mother’s behalf comes flooding back. I wish I’d ripped him a new orifice – verbally, of course – right there in the crowded lobby. I wish I’d been able to inflict as much emotional damage as he did on my family.

But, I didn’t. I did “the right thing.” I complained, bitterly, if politely, to the “right people.” And nothing happened. Well, nothing as far as I’m concerned. My family received no apology, no satisfaction. My brother died the day before New Year’s Eve that year, not even managing to see a new year dawn. And just two years and one month after that, my mother was dead, felled by her own battle with cancer.

So, I hope those med students that examined Ms. Yoffe are also getting some fundamental education in how to be a human being with their patients. I hope that they are being told even now by some professor that there will be serious consequences for a failure of civility as gross as Dr. PJ’s. I hope – but I don’t hold out much hope. It seems arrogance is as much a vaunted quality as skill with a stethoscope in the medical profession these days. Would that it were different.

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