The little voice tells me that I am fraudulent. All the other doctors know more. They understand renal tubular acidosis. Even the residents (trainees) knew about ADAMTS13 antibody in TTP (Thrombotic thrombocytopenic purpura, a blood disorder). Now, an article later, that fragment is addressed, but an ocean of ignorance beckons. How dare I do consultations in the ICU when I have never intubated anybody?
Upon entering an exam room, a doctor surely hopes to be greeted with a warm “How are you today?” and an exchange of pleasantries before getting into the purpose of the visit. But what if a diagnosis has been made and major surgery has been advised? In such cases, honest patient responses are of course an option, and doctors have, again surely, heard them all. But I've never met my surgeon, so I feel uncomfortable being emotionally forthcoming from the outset. My anxiety, my fears for the future, my lack of control over my circumstances might overwhelm the room.
“Neurodegenerative,” the neurologist repeated slowly, studying Nancy’s face as she spoke. Dr. Wang had placed her small figure on a chair near Nancy’s and leaned toward her as she explained the nature of the undifferentiated dementia that she’d produced as a diagnosis.
I sat in the exam room with Bill, who was here for HIV treatment. Staying on medication was important. It would make HIV undetectable in his blood, reverse his immune system damage and prevent the development of resistance to medications.
“In the past month, how many doses have you missed?”
He met my gaze. “None. I take them every day.”
Bill’s labs said otherwise. His virus level remained high. His pharmacy said he hadn’t picked up his medication in two months.
My father-in-law, a brilliant and respected professor at a small local college, was frequently contacted at home by students, faculty and staff. On my first night of residency "home call" (pre-cell phone), I answered the house phone and received a request to speak to Dr. Dodson.
It was midway through a crazy-busy Monday morning in the office: a full schedule plus two urgent walk-ins. I was starting to pray for a no-show to help me get caught up.
Roger was my next patient, a 70-year-old man with hypertension and diabetes, a long-time patient who had not been in for a while. Feeling the pressure of my busy schedule, I decided to skip my usual routine of looking over the recent encounters and studies in the chart before going into Roger's exam room. I knocked, entered and greeted him with a smile, handshake and, "Nice to see you, Roger. I hope you have been feeling well since your last visit."
Why did I avoid science and math in college? Why did I feel my successes in high school were somehow a fraud? When I earned a B.A. in American Studies and a Masters in City Planning, these did not feel fraudulent. They made sense: I cared about civil rights and social equity.
As for my undergraduate premed work, I viewed it as an experiment. If I didn’t make it to medical school, I still had my former career, even if I had decided it was one that would not fulfill me. My wonderful grandfather told me, “If you can’t see yourself happy in 30 years, leave!" He told me his own story: "When your grandmother was pregnant with your mother, and it was a recession, I was at lunch with a friend. I told him it was not the job for me. I did not even go back for my hat!”
When my niece was three years old, I told her to go hide. She turned around and laughed, certain that if she couldn’t see me then, she too, must be concealed.
A flashback to medical school: 6:00 a.m. surgery rounds. Pimping or, in proper terms, the Socratic method. My kryptonite.
“Fake it till you make it”: this was my mantra many times during medical school and residency. Quite often along the way, when I put my white coat on, I felt like I was playing dress up.
The resident leading our team was brilliant. He rarely needed help or correction. He developed threads and insights that gave me the rare sensation of delight that comes from seeing a mind at work far above the crowd I am standing in. There was little work to do in supervision.
When he asked me for help with the Pen Guy--what his family called him--I paused and then nodded. Perhaps he saw me falter.
Every day I become a player on Shakespeare’s stage. I get up, do my ablutions, and then go about my business: writing; teaching part-time at the local university; strolling through the tree-lined neighborhood; walking to the library to replenish my supply of books; and, napping, watching television and napping again. I smile at students and colleagues, bid pedestrians a good day, and share a book recommendation with the librarian.
It is all an act: a pretense.