The Lost Art of Bedside Manner

From what I've been able to gather, Grandpa is going to be fine. The doctors haven't exactly been forthcoming with information. It's no wonder he feels bewildered by the whole experience. The kidney doctor, as he introduced himself to us, asked a question, which Grandpa clearly didn't understand, then furrowed his brow at the awkward, inappropriate response. Instead of rephrasing or attempting to explain himself, the doctor moved on, asking another question, equally perplexing but seemingly unrelated to the first. Grandpa still didn't understand. He tried an answer. The doctor smiled condescendingly, and Grandpa smiled back, thinking he must have gotten it right.

I followed the kidney doctor out of the room. I wanted to know why Grandpa's primary physician had requested he be looked at by a "kidney doctor" (my fingers mimed quotation marks around the patronizing phrase). I wanted to know how the low sodium problem was related to his kidneys. Is this an indication of renal failure? Are we talking about dialysis? Will he have to be anesthetized to put in a catheter? Or is it the other way around - does low sodium damage the kidneys? Are the problems even related? Would he care to venture a guess or even share his general suspicions about why this happened? Can it actually be, as Grandpa keeps insisting, that he just drank too much water, diluting his sodium levels? I launch this tirade of questions at the kidney doctor. He opened Grandpa's chart again, read silently to himself for several moments, then ticked off his responses. "Any other questions?" I think he was actually offended, the smug fuck. I explained it all to Grandpa, and I think he followed me about 80% of the way.

I've listened to Melvin's interactions with his doctors, and it pains me to keep my mouth shut. Melvin's alone. His wife had an accident while visiting family in Ohio, and she wouldn't be back to Oklahoma for another two weeks. His step-daughter and her husband stopped by once in the two days I was there, staying for all of about half an hour. I can't actually see the conversations between Melvin and his doctors, but the thin sheet that divides the room doesn't otherwise afford much privacy. Melvin is slightly hard of hearing, and he speaks in a low rumble with a thick Okie accent. I understand every word he says perfectly, but I've been listening to this dialect since I was born. He catches about every other sentence the first time around, and rarely needs you to repeat one more than once. Still, our conversations require patience. One of Melvin's doctors has a very thick accent, Indian or Pakistani maybe, and very little patience. He tries to explain that Melvin needs a pacemaker.

"You have said you do not wish to have the pacemaker. It is necessary. Your heartbeat is very irregular, and this worries me. The pacemaker is necessary. But you say you do not want it, and if you do not want to reconsider that, then we need to consider other options. But I must tell you Mr. H_______, you really should reconsider."

"I'm in here for my groin," his voice is raised, but matter-of-fact. When rednecks encounter foreign accents, they raise their voices, presuming the volume will help bridge the obvious language gap.

"I understand, Mr. H_________. I am not concerned with your groin. I am a cardiologist. I am your cardiovascular surgeon. I want to talk to you about a pacemaker."

"I was lifting the luggage, but it didn't hurt until later that night. It was cold. I collapsed. My groin." Melvin tries to simplify his story. He is pointing at the soft area above his left hip. He repeats, "It's my groin."

"I understand, Mr. H_________. You should reconsider the pacemaker. You have an irregular heartbeat, and it requires treatment. This is very serious, Mr. H__________. Get some rest now."

This guy didn't understand shit. Melvin had no idea why this guy was talking about a pacemaker, and he certainly didn't want to buy one of those just because he was getting old. As Melvin explained to me later, they try to get you to opt for what they call "election surgery," because the insurance companies were paying for it anyway. But Melvin wasn't going to be having any election surgery. He hadn't needed a pacemaker up to this point in his life, so he really couldn't understand why he should buy one now. This same logic guided Melvin's thinking on diabetes. "They've been telling me I'm a borderline diabetic for forty years, but I haven't been diabetic yet, so how can I be diabetic now, all of a sudden?" In all of the conversations I heard between Melvin and his team of physicians, I never heard one of them provide an adequate refutation of either of these misguided beliefs. I'm glad Melvin and I are going to have some time to talk.


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