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One Physician’s Exam Room Epiphany


Instead of being just an objective observer of illness, I have started to identify with my patients.

Practicing cardiology for over 30 years, I have grown used to hearing the same patient complaints. However, lately my reaction to this litany of symptoms has changed. Instead of being just an objective observer of illness, I have started to identify with my patients.

“I’m having trouble sleeping, and I’m tired much of the day. I could take a nap right now,” my first patient of the day says after I asked the obligatory, “How are you feeling?”

“Me too,” I say to myself. I have just been diagnosed with sleep apnea, am still struggling with a C-PAP machine, and can empathize.

My first patient of the afternoon, who is only 65, bemoans arthritis in his knees, shoulders, and feet, and no longer being able to play singles tennis. The week before I had my right knee injected with steroids after decades of jogging, racquetball, hiking, skiing and fishing. My orthopedist jokingly told me before the needle, “You know your meniscus only has a warranty of 40 years.”

An hour later, a 62-year-old woman fears she’s developing Alzheimer’s dementia because she can’t remember some names and faces like when she was younger.

“That doesn’t sound so unusual," I think, remembering how I forgot a referring doctor’s name of many years just the week before.

Another one says he gets “short of breath when he bends over to tie his shoes.”

“Uh-oh.” Now, I’m starting to sweat and it dawns on me. “I’m becoming one of my patients!” Until now I was able to fool myself into thinking I was really younger and healthier than most of the people who walked into my exam room –– but not anymore. We are brothers and sisters in arms –– simpatico.

My shoulders ache from years of fishing and pulling boats, large fish, and anchors. My hands ache from slapping rubber handballs against a wall and an opponent in college. It seems like my joints have had more steroid injections than a professional athlete. Finally, foot pain drove me to the podiatrist last year, who showed me an x-ray and says the main joint in my big toe is gone now, and is “bone-on-bone.” I have a partial joint replacement where he widens the joint, removes bone fragments from inside, and places a titanium disk on the tip of the proximal phalanx.

Empathy is a funny thing. It is an easy emotion to avoid until you start to feel unwell. When I was young, I thought that growing “old” would be a gradual phenomenon. Yet, it seems that now the aging process is just a cruel and sudden bombshell. I get out of the shower, and as I towel off, I can’t help by notice my burgeoning waistline. Then the next week, I notice I have the start of “man boobs.”

“This can’t be me,” I think to myself –– I’m supposed to look thin and young. Aging has leveled the playing field. Still I can’t help but think it ironic that as I talk with, and observe, my patients, we have more in common than we are different. And in the end, it has always been this way. I just didn’t recognize it.

David M. Mokotoff, M.D. has been a private practicing cardiologist in St. Petersburg, Fla. for 29 years. He is the founder of Bay Area Heart Center, and enjoys writing humor, political commentary, industrialization of medicine, and thoughts about the endangered doctor-patient relationship.

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