Lesson From a Patient
I had a patient in residency with a most unusual name. My standard practice is to obscure folk’s identity, but since this was decades ago, and he was 75 then, I guess it is not too bad a HIPAA violation to tell you his full name- Delano I. Dentifiey. He went by D.
Back in those days the homeless could come see us interns for free (it may have been the origin of the cliche you get what you pay for) and D was was a regular patient of mine.
D was beyond humble. He was poor, and schizophrenic, but he was appreciative, and we got along. One time he came in with a rapidly growing mole on his face, and wanted me to take it off.
I tried to explain. “Come on, D. That thing looks bad- I think you ought to see the Derm boys or maybe even the plastic guys.”
D gave me his usual blank stare, and would only grunt, and say, “You my doctor.”
I brought in the George Mooney, the Chief Resident, for a second opinion, but D went catatonic on him, and wouldn’t say a word.
We talked it over, and George wanted me to press on. “D’s right, Doc” he said. “You’re his doc. He isn’t going to let anyone else do it.”
Well, we got D to scrawl an “X” on the sign here line, perhaps the worst excuse for informed consent ever, except I did tell him I didn’t have the proper training for the job. I draped him the best I could (D was scared of being covered up) to keep a sterile field, then proceeded with a piece of minor surgery that was well intended, but inept nonetheless.
Sure enough, the pathology was squamous cell carcinoma, but the margins were clear. I was ecstatic. I’d cured him!
The joy was short lived, though. My nice surgical work quickly became as mess, and my best efforts to patch him up failed. He was rid of his cancer, but try as I might, he was going to have a big scar.
One day a big plastic man was in to give us a lecture, and someone told him D was on the schedule, and everyone had to go look at my disaster. Well, in front of the whole residency program, that Professor proceeded to tell everyone how many different ways the procedure could have done better. He said there was no choice now but to let it granulate in by secondary intention. (Ie, the way nature would heal it up if you didn’t have nothing to do with it.)
I was a good resident, and made Chief my last year, but on that day, and in the weeks that followed, I was a regular medical Charlie Brown. I heard it in the hallways- “Did you see that case Bibey did? What a wreck!”
D was unfazed. He came to the clinic every week, brought his knitting, and patiently waited. (D was the ultimate “patient” I tell you.)
“I’m sorry D. I didn’t know it would take this long to heal.” I apologized.
“You my doc.”
I thought D’s wound would never heal, but by the start of my second year it did, and the scar didn’t look too bad, either. D never complained about my doctoring and stuck with me to the end of the program. When I left to go back home to N.C., we exchanged gifts. D gave me some of his knitting, and I gave him some pants and a sweater, and told him to make sure to check in at the shelter come winter.
To this day, I remember the lessons D taught me. I only take off the most minor facial lesions, and then only when the patient fully understands. After explaining I could leave a scar, and they might lose a point in their next beauty contest, one old farmer said, “That’s O.K. Doc, I gave those up years ago.”
The bigger lesson was D’s faith, not so much in his Doc, but the simple faith in the healing relationship we all should have in the doctor business, was rewarded. There is a lot more to healing than pills and doctors, and D, with his humble educational background, taught me that. The most important lesson for me was that the patient is everything- our reason for being, and without them we might as well go to the house. I never forgot D’s faith in me, undeserving as it may be.
If D is still alive, he is very old. Should you ever be in a big town in Tennessee with a famous Medical Center, and run into a homeless guy with a worn out pair of white doctor intern pants, and the inside label reads “Dr. Tommy Bibey” in perma-marker, you’ll know it’s D. Whether anyone notices that little scar on his face or not, I am proud for them to know he was my patient.