It was a slow day in neurology right up till the end when things got exciting.
We got a consult for a man with vertigo and possible stroke that may have occurred several weeks ago.
Five minutes into the exam I got the distinct feeling that he was faking it. I felt like a jerk. I put my suspicions aside and really tried to ensure the resident and I gave him a thorough exam. And we did. Later, the attending came and he gave him an even more rigorous exam. In the hallway afterward he told us all he was suspicious as well. We went back in the room. My attending asked about stress in the man’s life. He revealed that four months ago his wife had died and lately he had been having suicidal thoughts.
Earlier, the attending had taught us that sometimes patient’s will embellish symptoms that they really do have in order to get the attention/treatment they think they deserve. A lot of this is a reaction to being blown off by other physicians who didn’t make them feel like they really cared about their condition.
What I’ve learned from all of this, from this whole week really, is that just because a patient is pretending to have an illness that they don’t have, it doesn’t make them any less your patient and it doesn’t give you the right to be any less compassionate than you would be if they would have had the disease. They are still suffering, just in a different way than they seemed to be at first. Of course it feels like the patient is working against you, making it harder to do your job, or stealing time and resources away from patients who really need it. That is obvious. But I have found myself asking, “can a really thorough exam be just the treatment they need?”. We are giving them more than CT scans and testing reflexes. In a round about way, we are giving them love. A kind of love they are lacking or maybe never received in the first place. An unconditional open ear and a patient, kind heart for them to speak into. I think we can talk all day about having compassion in a classroom but until you’ve seen a physician actually disperse compassion to someone who the rest of the world would think twice about, I don’t think it is really instilled in you. It’s the kind of thing you have to see to believe exists and to believe that you will be capable of one day. At times it is a love that goes against logic but as I’ve learned this week, even in neurology, matters of the heart often take precedence over those of the brain.
After I was released from my duties I went back to see a patient I had checked on earlier in the day. He had said he felt lonely so I figured I should see how he was doing. I sat and talked with him for about 20 minutes. He reminded me of my grandfather who I rarely get to see. I guess in a way I hope someone would do the same for my grandfather if he was lonely in the hospital. Sometimes, the medicine most needed is friendship.
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