AANS Neurosurgeon | Volume 28, Number 4, 2019


From Physician to Patient (and Back Again)

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Most of us will experience becoming a patient at some point in our lives. Only a few miss out due to sudden death. For some, being a patient is unnerving, as it is clear evidence of our own mortality. Others may perceive it as a growth experience. Still others find strength in being able to overcome disease. Any of these force us to examine our values or find meaning in our lives — and experiencing illness can teach us how to be better physicians.
When I was a senior in medical school, I saw my mother die. It was an unexpected death. Because of circumstances, I was forced into a somewhat dual role. It caused me tremendous pain and turmoil, but also taught me empathy in a way no lecturer could.

Fast forward to two years ago, when I awoke one morning with a severe pain in my abdomen. I called my nurse practitioner to have her round for me. I called my chief to let him know that I was in the ER as a patient. It was the beginning of a course of multiple hospitalizations, surgeries, chemotherapy and complications of chemotherapy. I had to ratchet up my pain scale several times. What I had previously thought was 10/10 pain was little more than mild discomfort relative to what became my new 10/10. Gastrointestinal symptoms needed to be similarly reassessed. More significantly, I saw my own mortality, not as years in the future, but potentially close in time.

Quality of Care, Both Good and Bad
I also experienced good and bad in some of the care interactions: the young surgeon who delivered the diagnosis, but stated he knew nothing about the problem; the surgical oncologist and second-opinion surgeon who both gave me hope; the oncologist who seemed knowledgeable but distant.

There was the nurse friend who stayed with me through my first night after surgery, helping to reposition me, massaging my feet, bathing and lotioning me, bringing me yogurt when I finally could eat; other nurses who attended to my needs, even wiping my butt when I couldn’t twist due to pain and cleaning up when I couldn’t make it in time; and my physician and nurse colleagues who visited both in and out of the hospital, sending food to the house after my discharges, helping me shop for food when I could do a bit more, taking me and the kids to movies and dinner.

There was the anesthesiologist who couldn’t believe that his epidural didn’t work for me; instead, I got a horrific rash over my back from the prep, or tape or both. Then there was the anesthesiologist who listened when I said it wasn’t working and removed it; the recovery-room nurse who hinted to the resident that I must be an addict because I knew the names of medications, who in turn responded that of course I would, since I was an attending neurosurgeon at a neighboring hospital. (My hospital didn’t do the type of surgery that additionally was thought might be necessary.)

Wacker and kids 2

Dr. Wacker is shown here with her children, Paul and Katie.

How Perspective Changes
Each of these care interactions could be seen as a lesson — some in how to act and others in how not to act. These experiences also made me acutely aware of many of the problems that our patients experience. Pain management was certainly a lesson, as I experienced far more severe pain than ever before in my life. Even though I have cared for many drug-dependent patients, I wonder how often I doubted their real pain, as mine was doubted. And, how these experiences made me want to have a little extra available, in case, like I have seen with many patients. Recently, I saw the still partially full bottles of narcotics amid my now large collection of medications, most of which I got during or after chemotherapy due to side effects.

I also became acutely aware of how illness can affect finances, as I have spent more for medical care than entertainment and travel. I now understand from a personal viewpoint why so many patients are bankrupted by illness. Some people I got to know going through chemotherapy were going through bankruptcy at the same time. On the personal level, my children asked for vacations, and I have too often said, “When mommy is better,” or “When mommy is working again.”

Family connections seem important to refresh. Old differences seem so unimportant now. Helping my children to know their legacy seems also important, as I don’t know how long I will be able to pass on the stories.

Fortunately, I have responded well to treatment and am again planning for the future. I am again in the clinic and the hospital and the operating room. But it’s not the same because I am not the same. My values have changed. I don’t want to be a workaholic like I was for so much of my career. My family and friends are so much more important than work. I want to take more time off to spend with them, to do the things I have been putting off.

Being a patient or being a family member changes us. It can teach us much about the human condition. It is education that can make us better physicians.

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