Every day I care for patients with galvanized ideas about how best to manage their health as a result of consulting with Dr. Google. Sometimes their ideas indicate they’ve completely misunderstood what they’ve read, are comical, and maybe even dangerous but I do my best to listen out of respect for their efforts. However, I will admit that as soon as I hear: I read on the Internet or The Internet said I groan imperceptibly and brace myself for a possible battle of wills.
The Internet has emboldened patients to question medical advice and this can be a positive thing. But, the rubber meets the road when patients forget what defines good medical practice; accurate interpretation of scientific information mixed with experience, compassion, and intuition. Further, until such time that Dr. Google can actually examine you through SKYPE or Face-Time, the findings of a physical exam, which is critical in diagnosing and treating any ailment, will always be missing. And last but not least, Dr. Google cannot ask you important and clarifying questions. A perfect example of this in my work occurs when a woman calls to report painful urination which she believes is from a bladder infection and for which she’s requesting an antibiotic. I have a strict policy of not prescribing medications over the phone. Also, if a prescription might be involved I need more information to be certain about what’s happening. So, whenever painful urination is someone’s chief complaint I also ask: BTW – do you have a new boyfriend? And, did you have intercourse several times this past week? A pregnant pause followed by audible twittering adds Vaginal Friction Burn to my list of possible problems.
Athletic and enthusiastic intercourse might cause a bladder infection, but it always causes some degree of genital abrasions which burn like Hell when urine splashes on them – hence, painful urination. My prescription in such cases is to bench the Sex Olympian for 3-4 days, let the tissue heal and then hand her some good personal lube and send her back to center court. No antibiotic needed.
Despite my 25 years in practice, there are always things I come across in patient care that I don’t know how to treat and that require research on my part. But at least my patients can talk with me about how best to solve their problems. Why bring a consultant into the room you’ve never met, you can’t have a conversation with, and who won’t help you think things through? This is exactly who Dr. Google is.
Next time you need medical advice, voice your chief complaint to Dr. Google and see what he has to say. But in the meantime, I encourage you to find a living, breathing health care provider you can trust. And, keep an open mind, just in case they tell you something different than Dr. Google does.
The happiest day of my life was the day I got married. After 19 years, I still feel this way. I know, I am part of the lucky few and am grateful for this every moment of my life. Anyway, my best friend, Mark, was part of our wedding ceremony, lending his blessings in Hebrew while we circled a beautiful Huppa behind our house. Even though I received a condolence card from my mother the following morning, (some people just have bad manners!) I still recall that weekend as distinctly joyous and fortunately, unforgettable. One of the most beautiful photographs taken at our wedding was of Mark and I, standing with our arms around one another, looking straight at the camera with smiles that were genuine and representative of our shared happiness; I had actually found someone I loved enough that I would agree to the confines of married life and he was still alive to participate in the occasion. Mark had inherited PKD from his father – a fatal kidney disease kept somewhat at bay by two kidney transplants. But, Mark died last week at the age of 62. Having stayed true to our friendship, I was a frequent visitor and caller during every hospital stay, long and lonely days at home, and present 24/7 with him and his wife for a week when they participated in the first 12 person kidney swap at Johns Hopkins.
The morning of his death I had a dream about rats – one of my true and unfortunate phobias. Since childhood, I have been afflicted (and blessed) with prophetic dreams that are both hypnagogic and contorting of the truth. When I awake – and always with a sense of dread – I have to identify the real-life situation represented in allegory or metaphor form in the dream. On that morning, rats appeared and were grabbing hold of someone’s leg and not letting go, despite the fight the person was putting up. At first, I thought I was being attacked but then I realized I was watching the attack take place and heard myself say: “This is not about you, it is not your fight.” Then, I woke up relieved to be out of the Nether-land in sleep that has always been a restless, sometimes terrifying, and frequently fore-telling place for me since childhood.
I had never watched someone die before. I have dealt with death as a midwife many times – stillbirths, late-term losses, and immediate infant deaths were my domain in my midwifery practice for years. I managed them better than my partners did and was therefore elected to be the on-call person if we all knew in advance that life and death had crossed paths on the same day and that the outcome was in death’s favor. These cases were hard, to be sure. But fetal and newborn deaths are simpler: we have no choice but to accept what has already been determined for us. There is terrible grief to wrestle with and an abundance of “whys:” Why did this happen, why me, why now, why my baby? But the process of dying as an adult, once brimming with life, humor, and a keen eye for the most beautiful and ridiculous things life dishes up is another story all together.
Mark and I stayed true to our shared sense of unrepeatable, shockingly irreverent humor until the last day I saw him. Nothing was sacred as far as we were concerned and we made fun of situations that most folks would never make jokes about: suicide, ruinous sexual affairs, lecherousness, incest. We were seamless with our comedic quips; no sooner had one of us said something than the other had a perfect come-back line. I loved it and frankly, it has kept me alive during some of the hardest times in my life. I think that this was true for Mark, too. If nothing else, it provided momentary comic relief when darkness was everywhere.
I miss him already and suspect that this will be the case forever. Nonetheless, I am in search of humor again, hopeful that it will show it’s face in places that perhaps I never saw before because I had such rich humor with Mark. I guess the old-adage is really true: Where there is life there’s hope.