Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Once more, I had learned my lesson about pain and vulnerability

H. Lee Kagan, MD
Physician
September 6, 2014
Share
Tweet
Share

The nasogastric tube was killing me. It had been in place for twelve hours now, threading its way up my nose and down my throat, past my esophagus, into my stomach. Try as I might, I couldn’t swallow away the nasty lump stuck to the back of my throat. And every time I tried, it hurt.

Decades before, as a physician-in-training in upstate New York, I’d put in more nasogastric (NG) tubes than I could remember. At the time, I hadn’t regarded NGs as a big deal. But now I was having my first personal experience with this vile little snake, and it sucked — in every sense of the word.

Two days before, I had come down with a viral gastroenteritis, or stomach flu as it’s often called. Twenty-four hours into my illness, the miserable feeling that some dead critter lay rotting inside me still hadn’t eased.

By midnight on day two, I found myself sitting up at the kitchen table with my head on a pillow, the only comfortable position I could find. My belly was distended, and I was into my seventh hour of non-stop hiccups. You didn’t need to be board certified in internal medicine, as I am, to know that something was wrong. This was not how viral gastroenteritis plays out.

Despite her protests, I convinced my wife that I could drive myself to the ER at the hospital where she works as a nurse educator. No need for both of us to lose a night’s sleep. She could catch up with me in the morning.

At 1 a.m. the ER was quiet. In just over an hour, an intravenous line was started, blood was drawn for lab tests, medications for pain and hiccups were administered, and my abdomen was x-rayed. The films showed loops of bowel holding stagnant fluid layered over with gas, a condition called an ileus. It meant that peristalsis had stopped — my intestines weren’t moving things along as they normally would.

The ER physician confirmed my suspicions: Having failed to take in enough fluid and electrolytes by mouth, I’d allowed myself to become dehydrated and depleted in potassium. As a result, my intestines had simply said, “We’re done.”

I thought of the innumerable times I’d admonished my patients about staying hydrated.

Turns out, I sheepishly admitted to myself, I’m not such a good patient.

By midmorning, my no-nonsense internist was standing next to my ER gurney. My abdomen was silent as a graveyard, and my gut needed to be decompressed. The only way to do that is by gradually suctioning out the fluids and gas via a tube in the stomach.

“There’s no way around it, my friend,” he said. “We have to stop putting off the inevitable.”

“I know,” I reluctantly agreed.

I made no protest as the tube was snaked through my nose and down into my stomach.

ADVERTISEMENT

Now here I was alone in my hospital room in the middle of the night, unable to sleep because it felt as if someone had shoved an umbrella handle down my throat.

I lay in my bed trying not to swallow, ruminating on how we torture our patients in order to get them better. I couldn’t believe how blithely I’d done this to people in the past.

It occurred to the writer in me that here was a story: A seasoned doc, humbled and transformed by his own illness and hospitalization, learns to be more empathetic. It’s a very satisfying arc.

But no, I thought, it’s a cliché, a trope I’ve seen a thousand times before. It’s a staple of the genre.

Don’t get me wrong. It’s not an unworthy theme, and it’s certainly a daily reality in medicine. But here’s the real question, I thought, lying there in the dark: Why do I need to relearn this truth for the hundredth time?

I teach this stuff — how to connect with patients — to the students at the medical school. I’d repeated it countless times: “There is no better lesson for a doctor than to be a patient.” And yet, that night, the feeling of empathy for my patients felt like a revelation. Why?

I recalled a trip my wife and I made to the Gulf Coast in 2005. Hurricane Katrina had recently blown through with devastating effect. We volunteered to work in a small town in Mississippi. The working-class community’s medical infrastructure had been washed away by the storm.

We slept and worked in primitive conditions, but at the end of our ten-day stint we felt rejuvenated, even exhilarated. We’d been swept up in an ocean of giving, and it was almost like a high.

Six weeks later, we attended a sumptuous dinner at the Aladdin Hotel in Las Vegas, part of a weekend medical meeting. Katrina’s aftermath was still making headlines, and those who sat at our table were eager to hear our accounts of what we had seen and done.

I told them about the man with a tracheostomy, a surgically created opening in his windpipe, whose radiation therapy for laryngeal cancer had been interrupted. His wife had to suction the opening clear of mucus by hand while the couple struggled to survive in a tent with no electricity on the property where their house had once stood.

I shared how we’d come home to Los Angeles having relearned a number of lessons — about our common humanity with people whose lives are very different from our own, about gratitude and about what really matters in life.

“But alas,” I added, “There’s one more lesson I’ve learned since coming to Las Vegas.”

All eyes were on me.

“I’ve learned that I can learn all those lessons, and then, six weeks later, while getting dressed for a fancy dinner, I can complain to my wife that the rooms at the Aladdin are not nearly as nice as the rooms at the Venetian.”

I’d laughed to myself after making that observation to my wife. What fools we are, I thought, to imagine that the task of making ourselves better human beings is ever finished.

So what exactly is the half-life of a lesson? Is it possible to learn empathy once and for all?

When my wife gets up in the morning, her first waking thought is, What can I do for others? Me, not so much.

But I’m trainable. With a little gentle prodding, I can be put back in touch with the better angels of my nature, decide to play on their team for a while. I think I’m like most people. Life hands us little reminders and, if we’re lucky, we notice them.

At dawn, the day-shift nurse came in to do her clinical assessment of me.

“Good news. You’ve got bowel sounds,” she pronounced, lifting her stethoscope from my belly.

Fabulous, I thought. Between that and the gas I’d passed during the night, it meant that my gut had reawakened and was back on the job.

“Would you mind double-checking those sounds?” I asked. “Just to be sure they’re there.”

She did, and they were.

My personal diagnosis? I no longer needed the NG tube. But I didn’t share this with the nurse, nor did I offer her news of my nighttime revelation regarding the power and fragility of empathy. I just said, “Thank you very much,” and waited for her to leave.

It was Sunday morning. It would be several hours before my physician came in. I didn’t begrudge him the time with his family; but I had an umbrella handle in my throat.

I reached up and peeled the tape from my nose.

Once more, I had learned my lesson about pain and vulnerability.

I know I’ll never forget this, I told myself as my fingers tightened around my NG tube.

I began pulling and thought, Who am I kidding? I’ll settle for hoping I never forget this. I kept pulling until the tube was out.

H. Lee Kagan is an internal medicine physician. This article was originally published in Pulse — voices from the heart of medicine, and is reprinted with permission.

Prev

MKSAP: 42-year-old woman with crampy abdominal pain

September 6, 2014 Kevin 1
…
Next

Her life made her into the physician she is today

September 6, 2014 Kevin 2
…

Tagged as: Gastroenterology, Hospital-Based Medicine

Post navigation

< Previous Post
MKSAP: 42-year-old woman with crampy abdominal pain
Next Post >
Her life made her into the physician she is today

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by H. Lee Kagan, MD

  • A geriatric patient with questions her doctor never heard before

    H. Lee Kagan, MD

More in Physician

  • Gaslighting and professional licensing: a call for reform

    Donald J. Murphy, MD
  • When service doesn’t mean another certification

    Maureen Gibbons, MD
  • Why so many physicians struggle to feel proud—even when they should

    Jessie Mahoney, MD
  • If I had to choose: Choosing the patient over the protocol

    Patrick Hudson, MD
  • How a TV drama exposed the hidden grief of doctors

    Lauren Weintraub, MD
  • Why adults need to rediscover the power of play

    Anthony Fleg, MD
  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech
    • When service doesn’t mean another certification

      Maureen Gibbons, MD | Physician
    • Financing cancer or fighting it: the real cost of tobacco

      Dr. Bhavin P. Vadodariya | Conditions
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech
    • When service doesn’t mean another certification

      Maureen Gibbons, MD | Physician
    • Financing cancer or fighting it: the real cost of tobacco

      Dr. Bhavin P. Vadodariya | Conditions
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Once more, I had learned my lesson about pain and vulnerability
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...