Leaving the Room

Sure enough.  There was a lump in his throat.  We had talked about it, and I was already worried he might have an abscess.  Of course, maybe he just had a uvula. It’s amazing what folks will find in their throats when they are looking for the first time.

I got out the light and I looked.   It wasn’t his tonsils, or the spot where the tonsils would be if he had any.  Instead it was behind the base of the tongue, pinkish, and floppy.  “I have no idea what that is,” I said, using the following words:  “Well, sure enough, you have a lump.  You know, it’s hard to see it well and so it’s hard to know exactly what it is.  Actually it could be lots of things like an abscess or some other kind of swelling.  And there are lots of ways to look at it.  Like I could refer you to a specialist, or we could do a CT scan, or someone can look with a camera.” 

“Sure,” the 20-year-old looked at me with wide eyes.

“And we’ll have to figure out how to do that, since you don’t have insurance.”

“Uh-huh,” he looked worried. 

“Let me go talk to some folks about that,”  I said.  Then I left the room. 

Leaving the room is one thing I really miss about being a resident.  There’s so much pressure in the room, to know the dose of everything, to be confident in your assessment, to draw detailed anatomical diagrams of disease processes.  Sometimes you just want to leave to take a breath, to think.  To ask someone else what they think. 

Now, I do not “look like a doctor.”  You might not pick me out of a lineup.  I’m not a tall, grey-haired man.  Nor do I always “look old enough to be a doctor.”  Depending on whether or not the Beastie is screaming for milk at night or T.P. has croup, or if GB forgets to get into bed before he is somnambulant and I have to wake up at 2:30am and drag him off the hardwood floor into the bedroom, the age I appear to be might vary by 10 years the next morning.  If I’m feeling well-rested and refreshed, chances are my patients will politely ask more than once if I am actually a doctor or maybe just got lost on the way to P.E. class.  If, on the other hand I’ve aged overnight from a mere 90 minutes of interrupted half-sleep followed by checking on the respiratory status of 2 or more of my family members, funny thing, no one asks me my age.

I’m always conscious of how credible I might appear, though.  And every time I think about coloring the 15 or so grey hairs on my right hairline, I think again.  I’m going to need all the credibility I can get.

So when I show up to work looking like a barista AND I need to ask someone else for help, it probably undermines my credibility as a doctor.   But what’s best for the patient always comes first.  So I left the room.  And I found the Dinosaur. 

He was busy, “but I’m always busy.”  He shuffled with me back to the patient’s room.  He walked in and greeted the patient by name.  Wait, I hadn’t told him the patient’s name.   “I know this guy.  I’ve known his family for years.”  He got out the light and looked into his throat. 

“You’ve had your tonsils out of course, so they would be inflamed but there’s nothing there.  That swelling at the base of your tongue is probably a lingual tonsil.  It will get better.  No abscess there.”  He smiled at me.

“Thank you,” I said, as he left the room. 

“Anytime.”

“Well, so I guess that’s it.  Want to come back the next time I’m here and we’ll make sure it’s getting better?”

“OK,”  he smiled, fair game.

I wrote out his slip.

“You know, I think the Dinosaur delivered me,” he said as we walked out together.

See, this is why I want to be a family doctor.  Someday, maybe I’ll get it together enough to know a family like this.  Someday I’ll have seen enough tongues and throats and rashes and variances that I can look and reassure and then ask about Aunt Matilda.  I’ll see the kids I deliver grow up to have kids of their own.  Then one day I’ll need to go to the doctor for some problems of my own.

And if she needs to leave the room for a minute in the middle of it all, I’ll let her.  I’ll probably be relieved.