“OK, one more patient to go,” I said to myself with my eyes quickly scanning the patient list in my hands. I was in the elevator, going up the spanking new glass tower in the giant tertiary care hospital I call my workplace. Today was turning out to be a better Monday than usual. I had worked over the weekend, so I knew the patients. And there were no major surprises or turn of events on them. So, rather uncharacteristically for a Monday, I was on my way to see the last patient of the day at 4:10 p.m. Woohoo! I’d surprise the kids by being home by the time they got back from swimming. They would like that. A little smile played on my lips as I walked down the hallway to 8416.
The door was ajar. I poked my head in as I knocked. “Hi Mr. M”, I greeted him cheerily, “I’m Dr. Sadhu, one of your kidney doctors, I saw you a few days back.” After I saw the patient for the initial consult about the middle of last week, my partner had rounded on him the rest of the week. I didn’t see a glimmer of recognition in his eyes but he smiled nonetheless. “C’mon in, gorgeous,” he waved me over. I let it go.
When I saw him last, he was post-op only a couple of days and in pain. Apart from the soreness over his sternal wound, he was uncomfortable from limbs swollen with accumulated fluid from kidneys that had taken a hit during the major surgery, likely hemodynamic perturbations. He had been tired from just being moved with assistance from bed to chair and did not say much or ask many questions when I broke down for him what was going on with regard to his kidneys and why I was seeing him. I wanted him on a low salt diet, I had reminded him at the very end, and he responded with, “You’re the boss!”
“No, that’s most definitely Dr. P”, I said jovially, referring to the CT surgeon who’d cracked open his chest two days before and with masterful skill restored blood flow to the parched myocardium grateful for the nourishment.
Gray eyes crinkled as he smiled. He had salt and pepper hair that was now disheveled. I took him in within a few seconds, as only a physician looking for clues does. Breathing was effortless — pulmonary congestion was down. His posture more erect telling me post-operative pain had subsided. A glance at his legs revealed what I was expecting — they were almost back to their normal selves. All of these little clues were pieces of the jigsaw. Together with the information the EMR gave me on him, they swam around arranging themselves beautifully to complete the puzzle in my brain. Stable vital signs, consistently negative fluid balance the last few days, a metabolic panel with improving renal function and a potassium level hovering close to lower limits of normal and diuretic doses that were gradually tapered down and converted to oral yesterday. His kidneys were improving as his heart healed and pumped stronger.
He was midway through lunch — another good sign of progress. I asked him some questions and then requested permission to listen to his heart and lungs.
“That can wait,” he replied. “Come and sit here by me,” he patted the hospital bed right next to him. As I began to politely decline, his eyes flitted down to my hands, still holding his rounding report which gave me all his vital information over the last 24 hours. “Oh, you’re married,” his voice trailed off with resignation. I gave an uncomfortable little chuckle and proceeded to complete my examination: lungs clear, pedal edema all but gone. I delivered the good news to him — the progress I saw in all the little clues, some on paper and some on his person. “That’s all fine and dandy, but you should really laugh more,” he responded. “Yeah…?” I said without really paying attention, my eyes scanning his 24-hour report to make sure I wasn’t missing any detail. “Yes, all the nurses laugh more than you,” he was petulant. “Maybe because I’m not a nurse”, saying the first thing that came to me. “You’re not? So, what are you, a chiropractor?” By now, I couldn’t tell if he was serious or just being flippant. I kept my tone professional. “I’m Dr. S, your kidney doctor today. If you don’t have any questions, I’ll see you later”, I said as I turned to leave.
As I walked back down the same hallway, I felt my face getting all hot. This felt unfair. I was trying to do my job to the best of my ability and felt pummeled back repeatedly.
I had come across my fair share of flirtatious patients before. I had been greeted with “Hi beautiful!” in exchange for a “Hello, Mr so-and-so”. Some of the sweetest patients I’ve encountered are the veterans at the VA hospital and clinic I trained at. Some of them were notorious for extemporaneous marriage proposals in response to “How are you feeling today, sir?” But in those occasions before, there was mirth in the air. A belly laugh, a wink — a hint that it was all in jest. That after we had laughed about it, we could shake it off and still be physician and patient. That sacred bond. Hallowed. That bond, whether it was over a single encounter or lasted almost a lifetime, still felt the same. The reason that makes us physicians wake up in the morning and go to work. This time was different. Maybe the patient’s tone of voice, maybe his persistence. Maybe the patient not taking the hint that it was time to stop.
Inappropriate behavior, even if not always full-blown harassment, takes away from the relationship between patient and doctor and makes patient care harder. Especially in a circumstance where we are tied by the decorum of our profession, where we are not able to retort quite like the situation may demand, it is just plain unfair.
Sanghamitra Sadhu is a nephrologist.
Image credit: Shutterstock.com