Doctors are teachers too

Madame Theriault refused a rectal exam but agreed to get me some stool cards, the first one the next morning, Saturday. Sadie, the lab tech, had enough blood to send off a B-12, folate and iron studies. We agreed to be in touch Saturday morning and Tuesday. If she gets worse, she will go to the emergency room.

The man who felt bad all over had a bilirubin twice the upper limit, his liver enzymes were elevated and although he didn’t have a fever, his white blood cell count was elevated. I explained to him and his wife that his bile ducts were plugged and he was being poisoned from inside by all that bile and there may even be a brewing infection in his gallbladder. The ambulance had just come back from the hospital, and after they loaded him on the rig, I called the emergency room again and said “I’ve got another one for you”.

The neurosurgeon on duty returned my call just after five. He was able to look at the MRI images as I told him about the patient’s physical exam and his two-week history of back pain with sudden urges to urinate or defecate (which in my office note had been transcribed as “deprecate” by the voice recognition software). He told me to have the patient call his office Tuesday morning, and they’d get him into the Wednesday neurosurgery clinic. I called the patient and told him the news. He was feeling quite a bit better on the prednisone I had prescribed. I explained what the MRI report said about how tight his spinal canal and the exit holes for the nerves were.

And, speaking of nerves, I also sat down with the woman with beginning neuropathy and described how it usually starts at the end of the longest nerves. Her big toe is a hair shorter than the two affected toes, so it may be next. We also talked about how better blood sugar control can sometimes make neuropathy better, but not always.

Eight o’clock Saturday morning, I sat with a fifty-something man with poorly controlled diabetes. He is a junk dealer, who always fixes his own vehicles.

“Walk me through your day, tell me what you’re eating,” I asked him. After he did, I explained:

“You can keep eating a pretty balanced diet like you’re doing, and take some more pills or even insulin, and we can get your blood sugars down, or you could get more radical with your diet and avoid taking more medicines.”

“Well, I sure don’t want the needle,” he answered. I went on:

“I’ve got my old van out there in the parking lot. It’s a flex fuel thing that’ll run on regular gas or ethanol. If it started to sputter on gas and my mechanic told me to try ethanol, I’d be thinking, like, I’ve been putting gas in my cars for over forty years, and I don’t know anybody who uses ethanol in their car — why me, why should I have to change now, at this age? But, then again, what if my van starts to run better, isn’t it worth switching?”

He shrugged. “So what do I eat?”

“Think of it this way, you’ve already eaten almost all the carbohydrates a person should eat in his lifetime. That’s why people with the right genetic predisposition develop diabetes if they eat more carbs than they can burn right away. Eat protein, and green vegetables; humans can survive quite well on that, just like my van could run on only ethanol.”

Every day I find myself speaking very plainly about how diseases and the human body work. It almost feels like that is the biggest part of what I do. In doctoring, it isn’t enough to know what to do; my job is to help each patient understand their illness and their options for conquering or living with it. Unlike a surgeon, I seldom deliver complete cures that don’t involve a lot of self-care in the form of medication or lifestyle changes.

The simple word “doctor” is derived from the Latin “docere”, which means “to teach” and “to point out”. That is what I do, every day, every chance I get. And as health care continues to get more complex with more and more options for every disease, I find myself doing more and more of it, with greater and greater satisfaction the longer I do it. It is a labor of love.