Oh, By the Way, Doc

Sherman Waltz had been through a lot since I saw him just before his 83rd birthday in late November to review the results of his CT scan. He had a large tumor in his liver. The cancer surgeons at our referral hospital sent him on to Boston because of the type of surgery he needed and because of his age and underlying medical conditions, dominated by severe emphysema. He is oxygen dependent even at rest. He pulled through the liver surgery without complications, but on the second postoperative day he fell and broke his hip.

Poor Sherman ended up in the Operating Room again, this time for a new hip. Again, the operation was a success. He was transferred to a rehabilitation hospital, where he caught pneumonia, which brought him to the brink of respiratory failure, but he pulled through again.

Finally back home, and with concerns that his new hip was still painful and stiff this long after the surgery, he came to see me. He wasn’t keen on going back to Boston to follow up on his hip surgery if I could help him get that taken care of closer to home. We agreed to have him se an orthopedic surgeon nearby.

We reviewed his medications, his level of functioning at home now, and the follow-up plans for his cancer. We also established that his pneumonia had cleared.

“You’re amazing,” I told him. “Three life threatening conditions in less than three months, and I couldn’t tell just looking at you!”

He smiled his typical shy smile as he adjusted the oxygen prongs in his nose and cautiously rose from the exam room chair. He turned toward the door, then back again towards me as he cleared his throat.

“Oh, By the way, Doc,” he said with his hand on the door handle. “Do you think I could try some Viagra?”

The Apostolic Nature of Our Profession

I twice had a priest for a patient and I have been the personal physician of a handful of protestant ministers of various denominations. In each of these doctor-patient relationships I have found myself entering a ministerial role vis-à-vis my pastoral patient.

I have had reason to temper the hypochondriachal tendencies of one man of the cloth, and I have cautioned another that taking care of one’s body is a form of stewardship, and as such, just as important as taking care of one’s spiritual health. I have urged a minister to quit smoking and a priest to temper his sweet tooth.

Each time I have done one of those things I have been reminded of the apostolic nature of both our professions. People come to each of us, clergy or physician, with hearts and minds that are at least to some degree more open to hear what we have to say because of the office we hold, the cloaks we wear, that make our words somehow carry more weight than those of friends, relatives or family members.

As physicians, we need to be very careful with the authority and weight people grant our words, actions, even intonations and gestures. We need to be careful not to completely disregard that aspect of our interactions, because we may not always know what need we may fill in any given encounter. It may seem politically incorrect to encourage people to put you on a pedestal, but we need to be careful to keep separate the office we represent and the human beings we are. When a judge speaks to us from the bench, we assume he is not speaking as a private citizen, and the same is often true when a physician speaks to his patient behind a closed exam room door.

Imagine someone going to confession to reveal their innermost, secret weaknesses, only to hear the priest volunteer that his own weaknesses are even worse. In the moment of administering the sacrament of confession, the priest isn’t interacting with you only as a fellow human being, but as an apostolic officiant in an ancient ritual. This may seem outmoded, but, like it or not, as physicians we also fill that kind of role some of the time, and we don’t always know in advance when we are asked to save someone’s pocketbook, someone’s life or someone’s soul.

We haven’t all taken an oath to do what we do (not all countries hold their physicians to the Hippocratic Oath), but we are all part of an ancient fraternity that has cared for the sick and injured for thousands of years, and we need to show humility and let that calling and that tradition work through us, or we will only be technicians. When even clergy come to us for advice that goes beyond the technical, we need to be humble and accept that, now and then, what we do is greater than what we know.