February 2018

The Medicine

by Karen Hitchcock

Please, go on

When you’re a doctor, nothing is ever Too Much Information

The minute I was accepted into medical school I became, in the eyes of my friends and family, a professor of every clinical specialty, with a sideline in veterinary medicine. The calls started almost immediately. Overnight, I transformed into that respected (if occasionally lethal) person in the medieval village who had no training but was somehow the one everybody went to for treatment and counsel. I had a new authority I hadn’t earned, didn’t want and (despite anxious protestation) couldn’t negate.

After I graduated it became harder to cry complete ignorance. Saying I didn’t know turned me into an object of contempt. It’s difficult to know and harder to be right about a clinical scenario related by email. A few years ago a particularly hypochondriacal family member (who only calls when she has a medical concern, usually a single episode of diarrhoea) thought she’d broken her little toe. Terrified, she told me the story and symptoms. I said it probably wasn’t broken, but even if it was she wouldn’t score a cast, and that she should just be gentle with it and it’d get better by itself. She sounded doubtful. I reassured her. Her doubt escalated. “Well, if you’re worried,” I said, “maybe go see your doctor?” Later that day I received an SMS – no words, just a photo – of an X-ray of her foot with a big red arrow pointing to a tiny cracked bone. I could feel it so sharply, her contempt.

When my siblings had children my task was to advise, from interstate, over the phone, about the need or not for their infant to be hospitalised. I’d listen to long, rambling stories about mucus and vomit and what might be a rash and someone they knew who knew someone whose kid was just like this and was reassured by their doctor and the kid ended up in intensive care, almost dead. For a very junior doctor who’d never laid eyes on a sick child, these calls were a source of great distress. I’d listen, my mind screaming unspeakable words, words like meningococcal meningitis, acute lymphoblastic leukaemia and osteosarcoma. I’d say, “Does he have a fever?” They’d say, “Hold on,” and come back and tell me his forehead felt hot. Everyone’s forehead feels hot. Everyone’s throat looks red. How else would we score days off school? I bought electronic thermometers for all my family members and told them not to call me without a readout. I completely understood their impulse to call me and probably would’ve done the same. I do do the same, to my friend Mike, a very experienced physician in his late sixties. In the past few months he’s talked me down from a self-diagnosis of imminent diabetes (because I found a tiny skin tag) and melanoma (that was a blood blister), and he stopped me getting an MRI for my achy, post-work-out knee.

If you’re planning on having a doctor in the family I recommend a general practitioner. One of their greatest skills is the ability to triage the mournful from the sick. And the sick from the sick-sick. Without a full set of obs, a battery of blood tests and an X-ray or two, hospital doctors like me aren’t very good at that, especially not early in our careers. Picking the sick from the sick-sick is the most useful skill a family-member-doctor around the dinner table or on the end of a phone can have. Quiet, febrile, floppy and anuric (not passing urine) is emergency-department bad. Screaming and snotty is probably a-trial-of-paracetamol bad.

I know that these phone calls and corridor consults are not recommended practice. And I suppose that technically my every response should be “go see the GP”, but rules and recommendations often get bent and broken for good reason. My brother, for instance, lives on a farm a few hours’ drive from after-hours services and has a son prone to asthma. Advising him and his family to drive to the city and wait half the night in the busy emergency department each time he called would be an outright abandonment of my sisterly duty. I know him. I know the kid. He finds running it all by me to be helpful.

Unlike my family, my friends and acquaintances always apologise profusely before they ask me anything medical. And afterwards they are grateful to a degree I never deserve. Sometimes they just need to know what kind of doctor they should call, what the word on the street is about orthopaedic surgeon Mr Such-and-Such, whether wanting a second opinion sounds neurotic, if I know a good geriatrician north of the river. I’m usually of no material help at all. I’ve faxed the occasional referral, written a script or two. It is the very rare occasion where my knowledge, connections and my friends’ needs align.

Strangers mention their aches, pains and troubles obliquely, or in tiny flickers, all the time. They’d quite like to tell a sympathetic ear, and I can’t help myself, I love it. Yesterday the supermarket cashier had sore and poorly healing teeth with CPAP mask complications, the elderly man next to me in the queue at the post office had a sick wife (long story) and catastrophic house fire (longer story), my daughter called me from camp with a headache (pressure from the snorkel mask she’d had on all day), and her best friend needed advice about dressing her cut foot. A medical degree doesn’t confer authority so much as dissolve the line between a polite story and what my daughters would call “TMI”. Get a medical degree and nothing is ever again Too Much Information. The apologies are unnecessary. None of it is onerous or burdensome: to listen, even without all the answers. I invite it – often quite literally. It’s the position I’ve adopted, how I feel part of the world. I’ve been insatiably curious about sentience since childhood but now my “please, go on” face isn’t weird and creepy and strangely over-freckled, it’s something approaching trustworthy. Doctorly, if you will?

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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