The Haversian Canal

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September 10, 2006

Listening

I was in the middle of applying to medical schools and, coincidentally, I had to go to Bethesda's dermatology department where, as it happened, and a buddy of mine was applying for residency. He had even taken me to their Grand Rounds. But now I was the patient. And I'd been in the exam room nearly an hour.

“I don't need a graph. What's your issue?” Thus spoke the chief dermatology resident at Bethesda. I knew this “chief resident” guy was smart. And I needed his help to heal the skin on my fourth proximal interphalangeal joint. It looked like the skin had little holes in it, like I'd dropped concentrated hydrochloric acid on my finger in Organic Chemistry over a year ago. After months of visits to other providers, this was my second visit to the ivory tower. The inflammation was just a spot, a little bigger than a pencil eraser. Why wouldn't it heal?! I'd been prescribed anti-fungals, anti-bacterials, anti-histamines, steroids. In the mean time, I'd also gone mountain-biking, swimming in the ocean, and changed countless poopy diapers. Maybe the acid had only activated some dormant process that had been waiting for years. In recent years I'd been in the engineering department of a ship. My hands had been soaked in fuel oils, lubricating oils, and, treat of treats, bilge water: the collected putresense of a ship that collects in the bottom of the hull. The next ship I'd been on was nuclear-powered. I didn't know what was the causitive agent was, but I'd had a year to think of possibilities. The medical student who'd taken my history had worked very hard to smile, but I was clearly the nightmare patient—I knew just enough to be really annoying. “Some patients just know so much about their own diseases!” the fourth-year student had said, her smile revealing gritted teeth, as she'd extracted herself from the thirty-minute interview from hell to go brief the chief resident.

Was the chief being rude by not listening? Yes. Did he need to be rude? Probably not. Was it better to be rude? Quite possibily. In retrospect, they were asking about the forest and I was telling them about the trees. It really wasn't a profoundly difficult problem, merely one I didn't understand. And, nice as it may have been, I'm not sure either they or I had the time for a complete course in immunology and inflammation, which is probably what I would've wanted before I understood the issue to my own satisfaction.

So, back to our little dialogue. How did I, the patient, respond?

“I don't need a graph. What's your issue?”

“They...”

“Who? Who's 'they'?”

“At the Naval Academy clinic, the PA gave me Westcor ...”

“Butter. Westcort's butter. Then what?”

“I came here and you gave me Clobeta...”

“Clobetasol. Are you taking it?”

“No, not n...”

“Why not?”

“Goodman and Gilman's says...”

“It's strong shit. The best. Why aren't you taking it?”

“You told me to take it for ten days.”

“So why's it still there?”

“That was month ago.”

“Why'd you stop?”

“'Cause it's steroids. I didn't want my adrenal glands to shriv...”

“Was it getting better?”

“Ye...”

“Take the clobetasol. Here's another scrip, get some more. You'll be fine. You're not taking enough of this to have any systemic effects. If you were smearing this over your entire arm, I'd be concerned. Take the clobetasol till it goes away.”

Exeunt.

Posted by Niels Olson at September 10, 2006 6:33 PM

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Posted by: anna at September 19, 2006 2:59 AM

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