(This post was previously published in 2005 in Perspectives, the newsletter of the New Jersey Academy of Family Physicians.)
Sometimes I think I’m pretty smart. Of course, whenever I start to believe that, something always brings me back to my senses.
Take fourth year of medical school, for instance. The family medicine team admitted an elderly gentleman with a very swollen abdomen. My senior resident wondered whether he had liver disease or congestive heart failure. He was short of breath and had some leg swelling, but no jaundice, nausea, or venous distention. Just a beach-ball belly.
Eventually, we diagnosed cirrhosis and liver failure. Mr. H. had drunk heavily in the past, and although he denied any alcohol use in the last five years, his daughter suspected otherwise. After several doses of Lasix, he felt much better. At least, I think he felt much better. You see, Mr. H. was almost completely deaf, and most of our conversations went something like this.
Me: “Good morning, Mr. H.”
Mr. H: “Eh?”
Me: (a little louder) “I said good morning.”
Mr. H: (cupping a hand to his ear) “Eh?”
Me: (shouting into his ear) “GOOD MORNING!”
Mr. H: (looking confused) “Global warming?”
I wasn’t the only one with this problem. On the third hospital day, after reading the abdominal CT, my resident tried to inform Mr. H. that he had cirrhosis. The rest of us stood in the room and listened to their conversation.
Resident: “We got the results of your CT scan.”
Mr. H: “Eh?”
Resident: “Your CT scan. We got the results.”
Mr. H: “Oh. That’s nice.”
Resident: “Mr. H, you have cirrhosis.”
Mr. H: “Eh?”
Resident: “Cirrhosis.”
Mr. H: “Say that again?”
Resident: “Liver disease. CIRRHOSIS.”
Mr. H: (with a sudden look of comprehension) “Oooooooh!”
Resident: “Do you understand? CIRRHOSIS?”
Mr. H: (nods vigorously) “Yes, yes! I have multiple sclerosis!”
It took me till the day of discharge to come up with what I thought was a brilliant plan. So Mr. H. couldn’t hear me; fine. I could just exploit another one of his senses.
That morning, I marched into Mr. H’s room carrying a small dry-erase board and a magic marker. Mr. H. woke up to see the words “Good morning! How do you feel?” written in block letters a foot from his nose.
Groggily he reached for the board and squinted at it. I felt very pleased with myself. At long last, Mr. H. and I would have a meaningful interaction, and I’d get some useful clinical information, like whether he had residual shortness of breath.
It wasn’t to be. After moving the board closer to his nose and squinting at the words I’d printed, Mr. H. looked at me and said plaintively, “How am I supposed to read this without my glasses?”
