I’ve heard it all before. You know — doctors are lousy patients. Maybe we know too much or expect perfection that we ourselves can’t deliver. I don’t know the answer. However, what I do know is that every once in a while it is instructive for a physician to undergo a procedure he orders on his patients. I don’t mean for fun mind you, but when it is necessary, it does help provoke compassion and empathy for what our patients must endure.
Many years ago, as a cardiology fellow, I had intractable abdominal pain and was admitted to Methodist Hospital in Houston. Following several doses of Demoral, (after which I didn’t have a care or pain in the world), I realized how people could become easily hooked on narcotics. Following a barium enema, (yes I know I am really dating myself now), I don’t think I ordered another one of these ever again. My diagnosis was irritable bowel syndrome, which I always thought was a funny name for a disease. Is there a petulant or easygoing bowel?
In May 2011, after too many doses of Ibuprofen for a different malady, I had severe chest pain one night causing me to flee to the ER. As a cardiologist, I was of course convinced that I was having an MI. Despite a normal EKG, enzymes, and recent normal perfusion stress test, I persuaded one of my partners do a cath. After the pre-med sedation it was easy, and I was surprised when he told me my arteries were normal. Not possible I thought. After all, I have high cholesterol, Type A personality, and strong family history of early heart disease, (at least on my father’s side). I was so stunned in fact that the next day I had to go look at the pictures myself. A week later, as an outpatient, I had an EGD that confirmed severe erosive gastritis from the NSAID meds. Goodbye Advil, and hello Prilosec.
When I turned 50, I had the obligatory colonoscopy that was normal. But after another 14 years, my family doctor was after me to do another one. I finally relented. Not much had changed other than Propofol, (yes a truly wonderful drug), but wait! I was now prescribed the “new and improved bowel prep” which provides a cleaner colon. Instead of drinking a gallon of water and electrolytes the evening before, the prep was now a two-stage affair.
The first awful tasting dose I downed at about 5 p.m. the evening before. This was chased with 32 ounces of water. Of course the fun started an hour or two later. In theory, the second dose was to be taken 10 hours to 12 hours after the first dose, which for an 8 a.m. case would have been around 3 a.m. or 4 am. The only problem was I could not stop pooping all night long. So much to the chagrin of my gastroenterologist; I passed on the second bottle.
“How did your prep go?” asked the cheerful nurse at the endoscopy center. My ever-witty wife answered for me, “He had a blast.” I did provide feedback to the GI doc however. “You know this two-stage prep may be better for you, but it is definitely not better for the patient. They should give a free box of Depends with this stuff.” He chuckled of course, but after discovering my incomplete prep, which I had warned him about, I don’t think he found it humorous.
Here’s the problem: Patients are different and one size does not fit all. I usually have no difficulty in the gastric motility department. So why then should my prep be the same as the eternally constipated middle-aged or elderly woman? The answer, of course, is it shouldn’t.
In the end, (no pun intended) everything turned out normal. As my GI friend was wheeling me into the endoscopy suite, and just before I got shot up with the goodnight medicine, he said, “You know a rep was just in my office and showed me a new prep which is only 8 ounces and you take it once the night before.” Now he tells me!
“We’ll see you in five years,” he said as I was whisked away in my wheelchair, and I shouted back, “Don’t call me. I will call you.”