There’s no prescription for that…. (Lisa Saldanha)

I sat in the doctor’s office, rummaging through my oversized, brown bag. The nursing student shot a wary look at me, remarking, “You seem very stressed”. I tried to brush it off, laughing, but then proceeded to drop the contents of my bag all over the floor. Who was I trying to fool? Ever since my committee members had refused me permission to write up and defend my thesis, my stress levels had been through the roof. For the past three months stress had consumed my entire being, and my eyes constantly burned from lack of rest.

At least the itching had stopped though.

Over the past couple of weeks, I started breaking out into progressively worse bouts of hives. While I’ve experienced stress hives since I was a teenager, they usually were small patches of angry welts confined to my back or upper thighs that resolved within a couple of hours. But these hives were massive. I could barely sleep with the frenzied need to itch. Allergy medication managed to quiet them for a day or so, but then they always returned with a vengeance.

I woke up at 2am on fire. Itching brought no relief. Welts covered my entire body, and I was terrified. I had no idea what was happening, and the pain was getting too much to bear. Why was I getting these hives?! This could not be just from stress – I must be allergic to something! My mind scrambled through all the food I consumed during the day, but nothing seemed out of the ordinary. I couldn’t think of anything else, except to walk over to the ER in the darkness. The night air was cool on my skin; I had slathered myself in Calamine lotion, and could only think how comically sad I would look to a stranger.

The resident spent less than 2 minutes with me – after I spent over 2 hours waiting – before prescribing 50 mg of prednisone b.i.d. I gulped the tablet down gratefully, before walking home and crawling into bed. I was exhausted, and confused, but hopeful that finally the itching would stop. I woke up hours later, my skin smooth and weltless. Thank God!

For one whole day I felt wonderful. Never did I realize how debilitating the simple feeling of being itchy could be.

And then the pacing started. I paced up and down in my apartment, waves of depression washing over me. My mind was racing, and I started crying uncontrollably. I could not stop pacing. My graduate school supervisor had warned me that I might experience a little “loopiness” on prednisone, but I never expected this. At the ER, no one had mentioned side effects at all. I didn’t know what to do – I felt psychotic. I was actually scared to stay at home by myself. If I stopped the prednisone would the hives come back? If I kept taking it, was I going to do something insane?

I stuffed everything back into my bag, and thankfully the nursing student left me alone. I could hear her outside the door talking about me. How unprofessional, I thought, but I was too tired to really care. Within a few minutes, my assigned doctor at the McMaster Family Clinic walked through the door. He had a friendly face, and sported a Hawaiian shirt with khaki shorts in stark contrast to his iron-grey curls. This was the guy who was supposed to help me?

He listened patiently to my story, without interrupting, without judgment. My desperation was palatable; something in me had shattered the day of my committee meeting. I was terrified of failing my Master’s – the very thought made me want to choke. I could feel my stress levels rising again.

Once I was done, he calmly asked, “why do you think you’re getting hives? Let’s problem-solve this together. You’re clearly very clever”. I told him how stressed I’d been feeling, but also that I thought the severity of the hives had to be allergy related. There was no way that this was all due to stress!

And then he started talking to me about my life. He asked me how school was, and how I was coping. No one had asked me that. I was surrounded by an amazing support system, which constantly picked me up when I was down, but no one had thought to ask me that question. Maybe everyone was afraid of the answer. He listened while I rambled, trying to make things sound better than they were – trying to reassure myself. He paused, looked at me kindly, and said, “Your Master’s does not define you”.

I had been waiting to hear those words for so long, but at the same time, I couldn’t believe them. I repeated them in a dazed, incredulous fashion, questioning him. So he said them again: “Your Master’s does not define you. You are not your Master’s”. He made me recite a list of things that I enjoyed outside of graduate school, and reminded me once more that graduate school was not who I was, it was just one piece – I was so much more as a person.

He then asked me if I was planning on applying to medical school, to which I nodded an emphatic “yes”. I suppose he saw both excitement and despair in my eyes, as he then decided to share something personal with me. He told me how much success he’d enjoyed as a doctor – he’d received numerous awards, loads of recognition, and basically sounded like the shit. “But…it took me 7 attempts to get into medical school. So, if you really want it, you will get it”. I breathed a sigh of relief.

**

My encounter with that doctor has always stayed with me. He didn’t do anything that I would consider medically outstanding, except confirm that it was ok to stop taking the prednisone. Yet, whenever I reflect on the true meaning of the doctor-patient relationship, I think of that half an hour I spent in his office. He knew I needed someone to listen to me, and so he did. He knew I needed reassurance, and so he provided it. He took the time that no one else had, and it made a world of difference to me. I can’t even count the number of times afterwards I repeated to myself, “You are not your Master’s”. He was empathetic in a practical way that allowed me to take onus of my emotions, and come to terms with the adverse side effects of prolonged stress. He was a good doctor.

As I interview more and more patients, I’ve come to the conclusion that it’s not the medicine that really matters. Knowledge of medicine is the key to solving many patient problems, true. But, at the end of the day, patients will remember the way you made them feel, not what medications you prescribed. They remember that you calmed them when they were anxious; you listened when everyone else was busy; you took the time to explain that complicated procedure once more; you smiled and you meant it.

If I can make my patients feel the way that doctor made me feel in that moment, then I will consider myself a good doctor. He didn’t solve anything for me, or make the stress go away, but I felt validated as an individual throughout.

Knowing that I was still skeptical at the end of the interview that stress alone could cause such a severe physical reaction, he arranged for me to have an allergy test. Finally I was going to get to the bottom of this!

It was negative.

 

by Lisa Saldanha

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