The patients behind the cool cases

“Wow, cool case,” was the response from the residents in continuity clinic on Monday morning as I told them about a patient I had seen over the weekend at our main campus urgent care. Ironically, or maybe more tellingly, I thought the same thing; “that was a cool case.”

The “cool case” was a senior in high school who was eagerly looking forward to her college career but woke up with unilateral eye pain. As the day progressed, she started to lose her sight in that eye necessitating the visit to the urgent care. She tried to be as composed as possible, but with her mom and me both looking more and more worried as the visit progressed, she finally broke down.

“I have big plans for my life, but I didn’t expect to go blind.”

She sunk her head down sadly looking at her feet. I started to think out loud about what the cause may be and the next steps needed.

“This may be an optic neuritis” I explained. “Don’t see this much but let’s see if the eye specialist is still next door in the emergency room. I’ll call them.”

There is an adage in sports that “no pain, no gain.” While most of the recent blogs, discussion pages, etc. focus on legitimate doctor’s pains such as burnout, long hours, increasing bureaucratic obligations, and uncertain reimbursements, we at times lose sight of the suffering and pain of our patients. Yes, we have pain scales, but they are grossly inadequate to capture the angst and anxiety that patients and their parents/guardians feel. Yet, much of what we know as doctors are based on learning from our patients’ pain and suffering.

For example, I feel confident taking care of tight asthmatics since I have seen so many children struggling to catch their breath and managed their case. While I focused on the physical problems, these children were definitely feeling angst. Coming with these children were the worried parents, who were trying their best to stay composed but exquisitely feeling their child’s struggles. It is these moments of human suffering that form us as physicians and make us able to care for others. So indeed pain does lead to gain, and it is often others pain that leads to our gain.

As I came back into the room, my patient was already ready with questions after she and mom spent some time with Dr. Google.

“We looked it up … if I have optic neuritis, does that mean I have MS? My uncle died from complications of MS,” her voice trailing off sadly and still looking at the floor.

I tried my best to remain positive: “The eye specialist is indeed still here, and he can see you in the main ER. I’ll transfer you over shortly. Let’s see what he finds before we worry about the long-term.

Several years ago one of our residents in clinic asked her colleagues and I if we would like to see a “cool rash.” Of course, we agreed. Who doesn’t like cool cases?

As we walked into the exam room, the resident gently stated to a little girl, “Thanks for letting my friends see your rash as well. This way they can learn to help others.”

After we all took our turn with the exam, the resident handed our patient a stack of stickers.

“Twenty-five of them Dr. R. Five for each person that learned from her. It’s the least I can do to thank her.”

I loved this approach, and we still do this in our clinic providing stickers to each of the “cool cases” that draw all of us into an exam room.

Back at the urgent care, I came back one last time into the room.

“Doing OK?” I asked.

“Trying to stay positive” was the reply.

“Let’s see what happens. You are in good hands with our eye doctors. By the way, I know this is not a great time to ask, but is it OK if I share your case with the residents in clinic on Monday. We don’t see this often so they can learn a lot hearing about you.”

“Of course,” she replied looking up to make eye contact, which was not surprising since her future goals include being a teacher.

I then handed her a stack of stickers and thanked her for allowing us to learn from her illness.

“Dora the Explorer. I know I’m too old for these, but I still love getting stickers” she replied, with a small grin. “You don’t need to give me these.”

As the transport tech led them out of the urgent care, I stated, “Trust me, it’s the least I could do.”

Alexander Rakowsky is a pediatrician.

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