What’s Important: Patience in Patients’ Care
2020; Wolters Kluwer; Volume: 102; Issue: 8 Linguagem: Inglês
10.2106/jbjs.19.01394
ISSN1535-1386
Autores Tópico(s)Healthcare Policy and Management
ResumoI’ve been thinking about magnetic resonance imaging, sleeping bags, bank cards, and health care. A month or so before Thanksgiving, I went in for an MRI, and the results were not good: claustrophobia! But I’m getting ahead of my story. Failing to notice an early frost on the steps leading to my office, I took a tumble, landing me in perhaps the finest orthopaedic clinic in Seattle with a mangled shoulder and an immobile right arm. The surgeon did not like what the radiographs revealed and ordered an MRI. With pain approaching an 8 on the Richter scale, I requested the earliest available appointment. Eagerly and gratefully, I showed up the next day well before my 7:00 a.m. procedure. I did not have an ounce of anxiety as the professional and pleasant technician dutifully and thoroughly waved the metal detector over my clothing. I distinctly recall that, once cleared and lying on the table, I was looking forward to a 30-minute nap. Then she strapped me down, and I was blindsided by my first full-on panic attack—me, a normally cool, calm, 60-something-year-old man. Before she could even get near the button that she’d have to push to transport my body into the magnetic abyss, she took my word when I announced, “Nope. I’m done!” Without needing to offer further explanation, thanks be to God, I was pardoned. The technician loosened the straps as I promptly bolted straight up—my adrenaline flowing and my anxiety refusing to subside. Of course, embarrassment joined in, which I tried to deflect with an attempt at humor by pulling the “HIPAA card.” “Remember, you are not allowed to tell anyone about my failing the test.” I appreciated her calm, nonjudgmental response, “Let’s call it an ‘incomplete.’” She assured me that this happens more often that I would imagine, while citing rough statistics and exuding nothing less than patient care—“patient” in both senses of the word. She did not minimize what I was feeling, try to talk me out of it, or nudge, let alone press me to try again. Nor did she rush me out of the room. She treated my immediate condition with calm and kind understanding, not robbing me of my dignity. When the time was right, my technician broached rescheduling “so we can get those shoulder pictures.” “Shoulder? What shoulder? I’m fine.” It took hearing the technician say something about sedation before I could even consider relenting. Eventually, we scheduled a mulligan, but only after I was assured that they were amenable to putting me under completely at my next tee time. On the drive home, residual anxiety crept in, making me feel that my car had shrunk. Opening the windows, I found myself searching my past. Maybe this wasn’t my first episode? I remembered that as a kid, there was no way I could zip up a sleeping bag as long as I was in it. And more than once, I had panicked when I couldn’t get a shirt off my back and over my head quickly enough—mild compared with the onslaught in radiology, but possibly related? I recollected how my mother, before she left this earth, reminded me each year on my birthday that I had resisted delivery. She repeated how my shoulders (yes, my shoulders) were too broad to reasonably negotiate the passage. Not to minimize Mom’s trauma, but I’m not so sure I enjoyed the delivery myself. Were primal memories resurrecting panic on the cusp of entering an MRI’s “noninvasive” diagnostic black hole? Admittedly, I’m fumbling for clues to the origins of my MRI flight instincts. All I know is that the episode was so sufficiently unnerving that I told my health-care provider to add “MRI” to the “allergies” field in my electronic health record. We finally completed a successful MRI. As promised, they put me under before strapping me down, and I enjoyed a deep sleep while they captured some nice pictures—although they noted that I still moved some during the filming. In filling out my patient satisfaction survey, while I had nothing but praise and gratitude for all of my caregivers, I noted it might be helpful for them to heed the advice of that bank card commercial and ask patients, “What’s in your wallet?” As it turns out, the magnetic strips on all of the plastic in my pocket were demagnetized, resulting in invalidating my credit cards and the hospital losing some parking revenue. But I digress. The scan revealed a torn rotator cuff. Surgery followed. I’m happy to report that my shoulder is as good as new. However, I will confess that having my arm Velcroed to my chest for what seemed like an eternity provoked enough claustrophobia deja vu to warrant a prescription for clonazepam (0.5 mL as needed), which got me through a handful of episodes that followed. When Thanksgiving finally arrived and it was my turn to give thanks, I expressed gratitude for anesthesia and MRIs—in that order. And most of all, I was thankful for health-care professionals, from radiology technicians to orthopaedic surgeons, who, regardless of the letters after their names, incarnate the last 4 letters in their profession. I appreciate their “care,” not just the cure.
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