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I had a patient nearly succeed in killing herself recently, despite my best efforts to intervene. She is a type of patient that scares every doctor: She doesn’t like medicines or ‘chemicals’ that she doesn’t understand, but she takes 20 pills a day of various supplements and herbal remedies that she doesn’t understand. She complains of an endless list of bizarre symptoms (her left eye cramps when she urinates or whatever), when the only diagnoses on her chart are fibromyalgia, irritable bowel syndrome, and anxiety. She lists 14 drug allergies, but the symptoms experienced with those drug allergies don’t make any sense. And worst of all, she says, “I know my body.” I get chills just thinking about it.
That patient is dangerous, because one of these days, she’ll actually get sick, and I’ll miss a recognizable disease in all the random background noise of her being in touch with her body. And then I’ll have to explain to the husband how his wife died of a bladder infection while under my care.
On her first visit with me last year, Karen opened the conversation: “I’ve heard a lot about you.”
Me: “Don’t believe a word of it. Those people have no idea what they’re talking about.”
Karen: “Everybody says you’re the smartest doctor in this part of the state.”
Me: “Oh, well, those people obviously know exactly what they’re talking about.”
Karen: “Good. Because my previous doctors were all a bunch of idiots.”
Over my career, I’ve learned that that’s a bad sign. Because when all her previous doctors were idiots, that means that I’m not just her new doctor, but I’m also the next idiot. If no one else can meet her needs, then what are the odds that I’ll be able to do so? So I keep my eyes open after I hear that.
She called me recently, saying that she felt terrible and that the medicines I was giving her were killing her.
Karen: “I stopped that stuff you gave me a couple of days ago. I felt just horrible.”
Me: “Which medicine did you stop?”
Karen: “I can’t remember.”
Me: * pause *
Karen: “I felt horrible. That drug just didn’t fit with my system. I know my body, and it was making me feel horrible.”
Me: “How did you feel? What exactly were you feeling?”
Karen: * spends several minutes listing every side effect she’s ever read off of any warning label for any drug *
Me: * interrupts Karen * “Ok, so you’re off whatever medicine that was now. Ok. So do you feel better?”
Karen: * pause * “Well, I just stopped it a few days ago.”
Me: “So you feel better now?”
Karen: “No. I feel horrible like I said.”
Me: “Why don’t you come into the office, so I can figure out what’s wrong?”
Karen: “I told you. It was the medicine you gave me.”
Me: “So you feel better now that you’ve stopped it?”
Karen: “No. I feel horrible.”
Me: “So why don’t you come into the office, so I can figure out what’s wrong?”
And around and around we went. I couldn’t get her to come in. She didn’t need to see me, because “I know my body.” I got her to promise to call me if she got worse. And we hung up. Both of us rolling our eyes, wondering what the other one was thinking. I went to bed that night wondering if she was actually sick this time, or if she was just in touch with her body.
I don’t sleep much.
The next morning, her husband found her on the floor of their bathroom. She was semi-conscious and didn’t know where she was, or who he was. He called me, very stressed out, as you might imagine. I had him call 911. They took her to the ER.
I called the ER doc, to give him a heads up. He asked what he should be looking for. I said, “I’m really sorry, but I have absolutely no idea.” He said “Thanks a lot” and hung up. “Happy to help,” I mumbled, as I clicked off my phone.
They scanned her head, looking for a stroke or a bleed. They did bloodwork looking for every disease under the sun. They did chest X-rays, CTs, EKGs, and God knows what else. She was extremely dehydrated. Her pulse was racing and her BP was barely detectable. So they were pushing IV fluids. She was in kidney failure, probably from the dehydration. She finally produced a little bit of urine, and they found a raging kidney infection with sepsis.
Once they figured that out, they called me to ask if she had any drug allergies. I didn’t even look at her chart and said, “Nope.” So they gave her two antibiotics (both of which, as it turns out, were on her allergy list). They worked well, and today she is recovering nicely. Thank God.
But she nearly died of a bladder infection. That I could have found in my office with a $2 urine dipstick, and fixed with maybe $5 worth of antibiotics. Except that I couldn’t have treated it, because she says she’s allergic to every antibiotic in the world.
Her hospital bill will probably be over $100k and she nearly died. She was lucky her husband found her when he did. And she was lucky the ER doc did such a nice job, so quickly. Nice save, buddy.
I would have called him to thank him, but I didn’t want to have to listen to him asking me how a patient of mine nearly died of a bladder infection.
This story may sound odd. But it’s not.
My patient may sound irrational, but she’s not. At least, not any more irrational than the rest of us.
Black Lives Matter has burned down cities for over a year protesting how many blacks are killed by white cops. While they ignore how many blacks are killed by other blacks. While ignoring the social problems that lead to such violence in their neighborhoods. While refusing to acknowledge that when a criminal resists arrest, he is engaging in a high-risk activity.
When you have a problem, it always feels better once you decide that it’s someone else’s fault. But the catch is that at that point, the problem becomes un-solvable. The first step to solving a problem is to take ownership of it. Blaming others makes that impossible. Which then makes it impossible to solve the problem.
It’s not that my patient’s illness is her fault, of course. It’s just that she needs to play a role in fixing the problem, regardless of why it happened. And if she refuses to do so, then things might get out of hand.
It’s hard to know who to blame for the problems in the black community, although it really doesn’t matter as much as we wish it did. All that really matters is improving things now, regardless of how we got here. And that will involve those in the black community playing a role in the improvements. And there are many, many people in black communities doing exactly that. God bless them.
This is why Black Lives Matter is so toxic. BLM is not just unhelpful – it is setting back progress that is hard earned by those who live in these communities and want to improve them.
When BLM encourages blacks to blame others for their problems, then progress stops (even if others are partially to blame for those problems). When BLM encourages blacks to be resentful and distrustful of whites, then it becomes more difficult for us to work together to improve anything.
Fear of others trying to help, because they might discover that perhaps your problems are at least partially your problems, is understandably met with deflection:
“It’s a Black thing. You wouldn’t understand.”
“I know my body. Your drugs are killing me.”
It’s very difficult to fix a problem that you refuse to acknowledge. It’s very difficult to accept help from someone that you don’t trust. So we take herbal supplements and we burn down cities. These responses may not seem to be completely rational.
But at least we’re doing something, right?
Strange that things aren’t getting any better…Published in