Sometimes a doctor can only listen

Originally published in The Ottawa Citizen March 19, 2002
Original Title: Bygone Days

Some days or weeks, for good or bad, become more memorable than others. They serve up a combination of events that can turn your day into a rollercoaster of emotions.

Such a day occurred in early March. There were 20 patients that day, some with straight-forward problems, others alone in the wilderness.

Bill, a veteran, came in to talk about his ten years of living with memories of Somalia. He now suffers from Post Traumatic Stress Disorder (PTSD). It was recently recognized by the Defense Department as a real condition. Memories remain vivid and haunt PTSD sufferers. He told me of four children playing with a hand grenade. It exploded and blew pieces out of their bodies. They tried to provide medical care but medical supplies in the field were limited. Transporting them to the field hospital was agony for everyone. Helpless to save them he is haunted by this and many other horrific events that have left this stoic man emotionally damaged.

What do you say to someone who has experienced something that many cannot imagine?

Wayne has Panic Disorder. He has come for a follow-up now that he is on Paxil. He is less dependent on Alprazolam (Xanax) to calm his panic attacks. In fact within the next few weeks he should not need them at all. His life will return to normal.

David comes in for his blood pressure check. Unfortunately, I have to tell him that he has tested positive for Human Immunodeficiency Virus (HIV). This hits him out of the blue. He already suffers from Major Depressive Disorder. It will now only get worse. I try to offer him hope knowing that survival rates continue to increase. There are people who continue to live long and productive lives with the right combination of medications. He has many friends who have HIV and is terrified because of what he has seen. We arrange an appointment at the HIV clinic.

Ronda, newly pregnant and happy, brings a refreshing bit of new life to break up the melancholy of the day.

A 15 year-old boy comes to talk because his stepfather and mother are to divorce. He has spent the night talking his dad down from a cocaine and alcohol high. Usually it is the parent who cares for their child. Why is this boy being put into this position?

Christine has tremendous problems with her eight month-old daughter’s digestive system since her birth. Investigated by specialists they find she cannot tolerate breast milk or most formula preparations. Her daughter has not been able to sleep well because of cramps and gas. This mom is exhausted from sleep deprivation and stress. Finally she finds a special formula available from the United States that works. Each can, which lasts about two days, costs $80 (CDN). Her insurance company will not pay the cost of it even though it is medically necessary. She does not know what to do.

Valerie recently found out her daughter’s compromised speech and development is due to a rare genetic disorder. She cannot cope with her despair. Her daughter will never be able to talk or be independent. Her worst nightmare has come true. She has monitored her grief and coping skills for the past month. She has come in for help and treatment of her depression.

Jessica, a mother of a six year-old daughter laments how her husband’s major depression has affected them. He denies he has a problem but his behaviour refutes this claim. He shuns his family and has left them financially destitute. On father-daughter school day he purposely did not show up leaving his daughter alone whilst all her friends enjoyed their day. He also willfully ignored her birthday party and has effectively damaged this little girl to the point where she said to me, “no one wants to be my friend.” It is more than heartbreaking.

Some days have no happy endings. Sometimes all you can be is a sounding board trying your best to be compassionate and understanding. Physicians are trained to fix problems. Most family doctors do the best they can with the limited resources available to them. It is indeed humbling when there are no answers or readily available solutions to solve our patient’s ills. When that happens all we have left is our ability to listen and offer support.

I get home at the end of this day. My seven year-old and 18 month-old sons run up to give me a hug at the door. Salvation.

A short follow-up about Dr. Lee, a family medicine resident trying to remain in Ottawa to complete her residency. In true bureaucratic fashion, the Ministry of Health abdicated all responsibility for funding her position at the University of Ottawa. Now she, her husband, an emergency room physician, and their nine month-old son are headed to Calgary. Ottawa’s loss is Calgary’s gain. Thanks to MPP Gary Guzzo for trying his best to help.

© Dr. Barry Dworkin 2002

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