Physician, Heal Thyself
After a long day's work as a pediatrician at an academic medical center in Providence, RI, nothing says "relief" like a visit to my therapist. I don't see him often, but he has helped me through many life transitions. I think we both agree with the Buddhist precept that the only constant in life is change.
One evening after work, a couple of years ago, I arrived early in the neighborhood of my therapist's office. I was hungry, but there wasn't time for a meal, so I stopped at a pharmacy to peruse the snack aisle. The smallest and cheapest option available, a bag of roasted pumpkin seeds, seemed perfect.
I had just time enough to consume the seeds and still arrive punctually at my appointment.
As I outlined my most recent emotional travails to my therapist, I started to notice an uncomfortable, itchy sensation in my hands, on my face and on my legs. It wasn't the kind of itch that can be scratched, and it came accompanied by a disquieting sense of unease. Simultaneously, my tongue started to thicken, making it more and more difficult to talk.
My therapist didn't comment or seem to be aware of the rapidly evolving changes in my body, but the progressive swelling of my tongue and lips made me increasingly conscious of how much effort it took to form words. These sensations were new, unfamiliar and most unpleasant. Suspicious of an allergic reaction, known to me only through my medical reading and care of patients, I felt a growing alarm--and on my therapist's face, I began to read an anxiety that mirrored my own.
"Jaghn," (his name, or so it sounded to me when I spoke it) "Ah gout togot fahmasi." Did I see his pupils dilating behind his glasses? Tracking my own autonomic nervous system responses seemed to be making me hyper-aware of his reactions, too. His anxiety was understandable: He's not a physician and likely couldn't do much to help me with this fast-developing medical emergency. I left off describing my woes--they seemed trivial now in view of what was happening--and excused myself from his office.
Feeling no little urgency, I walked the two blocks back to the pharmacy where I'd bought the package of pumpkin seeds. There I bought some antihistamine tablets and a small bottle of juice to wash them down. After swallowing the pills, I sat on a bench in the entryway to wait and see if the antihistamine would help.
As I sat there, a woman walked by--a medical student with whom I'd worked. I called out to her.
Whether she didn't hear me or just chose to ignore me, I'll never know, but she walked right past me without stopping. Was she intimidated by my status as a faculty member? Inhibited by the fact that I was a man? Or did she simply not register my presence, given that articulating words did not come easily to me just then?
At this point, I felt something even more alarming: The swelling began to extend down my throat. I stood up and walked back to the pharmacy counter.
"I'm having an anaphylactic reaction," I told the pharmacist with great effort. "I need a shot of epinephrine." (It's possible that I wrote something down rather than saying the words aloud. My memory gets fuzzy here.)
"Do you want me to call 911?" he asked.
"I don't think that's necessary--but I need an EpiPen." (Or did I just shake my head and make the signal for EpiPen in some sort of universally understood language?)
"You'll need a prescription for that," he said. Feeling as I did at that moment, the thought seemed ridiculous.
"I'm a physician," I said. "Can I write the prescription and give myself the injection?"
For the second time that day, I watched another person's face mirror my alarm.
"Okay," he said finally. He handed me a prescription pad.
At this point, even writing was a challenge, but I managed to scrawl the prescription and my signature and handed the paper back to the pharmacist along with my pharmacy copay.
He brought me the EpiPen.
I looked at it. At this point, my Bruce Willis/Clint Eastwood machismo failed me.
I turned to the pharmacist.
"Can you inject me?" I asked. Or maybe I just pointed to my arm. I was pretty sure he'd never done something like this, but I trusted that the procedure would be simple.
He thrust the EpiPen against my arm, and I felt its brief sting.
Within moments, my feelings of suffocation and my tongue's swelling began to subside.
"Thanks very much," I told the pharmacist, and left.
I returned to my therapist's office and, after a brief explanation, resumed the recently interrupted session.
After all, I still had a few minutes left--and we had to schedule our next appointment.
About the author:
Randy Rockney is a pediatrician and professor of pediatrics and family medicine at Alpert Medical School, Brown University, where he has been on faculty since 1986. He is director of undergraduate medical education in pediatrics at Brown and a staff pediatrician at Hasbro Children's Hospital. In his role as pediatric clerkship director, he encourages medical students to write about their experiences. "Inspired by the excellent English teachers at the public high school I attended in Los Angeles, I have written personal and therapeutic essays, though never enough, ever since then." His pieces have appeared in the journals Academic Medicine, Ambulatory Pediatrics, Cell 2 Soul and Surfing Medicine (the journal of the Surfer's Medical Association).