“Oft expectation fails and most oft there
Where most it promises, and oft it hits
Where hope is coldest and despair most fits.”
One of the many wonderful things about the practice of medicine: there is never a dull day. I can see ten people who present with the same symptoms in one afternoon, and they’re all different. Some are well off; some are poor; some are young and helpless; others have weathered a lot of adversity and know how to take care of themselves. No one receives the same treatment. Each soul has its own set of goals. They vary widely. A good doctor needs to learn in a big hurry how to manage expectations. Including his or her own.
Dr. Blackandwhite, a prominent professor and scholar, provided me with a great forum to teach my students about learning how to temper our desires. He taught at a local university. He had a moderate amount of success. By his mid-fifties he had made it to the rank of full professor. He had published a couple of books and several articles in respected journals. For the two years prior to our fateful visit he had been able to accumulate a small national following. He was able to travel and was rewarded with small stipends wherever he went to speak.
He was not an easy man to handle. I don’t know what it is about many teachers of thought that makes them feel that personal hygiene is not important. He was not familiar with the concept of using deodorant; maybe even of showering a few times a week. His clothes were always wrinkled. Correction: crumpled; as if he had spent an extra few minutes wringing his shirts and pants as much as he could.
Something I said or did impressed the man (although he never told me so), because his wife soon became a patient. Unfortunately she shared her husband’s lack of enthusiasm for soap and ironed clothes. She was a liberated being, she was. Also a professor; a mentor to many impressionable young women; a feminist. An enemy of razor blades. She felt that women who shaved their legs and under their arms were showing subservience to an idealized concept that men forced on them.
The hygiene was not my major problem with him. He expected to be seen within seconds of his due appointment time. For our first visit I was ten minutes late. He gently reminded me that his time was just as important as mine. That he expected more prompt attention. Then he overextended his allotted visit time by fifteen minutes, because he had a lot of questions and he wanted me to provide him with references that supported my course of treatment.
I get it. I hate to wait when I go to doctors, or lawyers, or restaurants. But many times it just can’t be helped. In my office the most common reason for me not to be on time is that one or two patients came in late but loudly demanded to be seen next. I have a few choice people that I can count on will be at least a half hour late for their visits. One of them is married to a doctor; she bitterly complains to the receptionist if I ask my nurse to let her cool her heels in the waiting room so that I can see the people who were kind enough to show up on time.
My attempts at coaxing my patients to be prompt are feeble and have met with failure. There was the time when I decided to tear into the next patient who did not show up on time. In came Mrs. Meek, 45 minutes behind schedule. This was my chance. I sternly lectured her on how disruptive she was to my morning.
“I’m sorry, doctor. The Call a Ride van was late. I was so worried about not being on time that I called a cab to bring me in. That cost me thirty dollars that I don’t have; that was grocery money. I don’t even know how I’m going to get back home; I may have to wait here until my daughter gets off work.”
I reached into my wallet, gave her two $20 bills, apologized for being such a jerk, and swore never to bring the subject up again. And I haven’t, with anyone.
Back to the professor. He came in one day; very excited; he had been asked to lecture in Spain. I was lucky enough to be running on time, and I was truly excited for him. Having a small national group of fans is one thing. There’s something about transcending your borders that I find quite appealing and impressive.
A few weeks later he called; wanted to be seen the same day as an urgent appointment. Everything went wrong that afternoon. Two sick employees; one angry patient; a couple of emergencies. I was way behind when I looked at my schedule to see who was next, and I see his name.
Talk about “Oh crap” moments.
I devised a strategy. I would burst into the room, and before he could have a chance to look at his watch or open his mouth I’d ask him about his trip to Spain. The only thing he liked more than to be on time was to talk about himself and his lectures.
My plan worked. Before I was halfway inside the room I said in a loud voice:
How was Spain?
“It went very well. I brought you this.”
He handed me a brown lunch bag; the kind you would use to take a sandwich to work. But this one was unique. It outmatched his shirt in how wrinkled it was. For sure a hundred sandwiches had been inside this bag. A few mustard and ketchup stains lent it some character.
No matter. The international authority had gone to Spain and had thought enough of me to bring me a present. So there was no gift wrap: how could I expect it from this man? I was touched.
Thank you. You shouldn’t have. Very nice of you. Let’s see what’s inside!
I opened the bag. Inside was a Zip lock freezer bag. I pulled it out. Inside the Zip lock bag was a fairly large bowel movement. Formed; brown; tapered at the end. As normal as a BM can be.
I put the Zip lock bag back inside the lunch bag. An awkward silence ensued. I just profusely thanked this man for bringing me a piece of crap. I’m trying, very hard, to make some sense out of this.
Then it hits me. Of course! This is not a BM. He brought me a piece of mazapán from Toledo. This almond-based pastry is brown at the edges. The shape was a bit unusual, but maybe he had talked to the nuns at the monastery who make mazapán; maybe this was made special for me.
I slowly take the Zip lock bag out of the lunch bag again. I take another peek. No question about it: this is definitely not mazapán. Back inside its home goes the BM. More silence ensues. Very awkward.
I never get flustered in my exam rooms. I can give you terrible news in such a way that I can have you thanking me when you step outside. I can deal with anything. But a crap present is a new challenge; I don’t know what to say.
Then it occurs to me. I broke my routine. The first thing I teach my students: always examine the patients the same way, in the same order; look at lab results in a preestablished fashion; answer phone calls with a plan. I always look in the chart to see what the nurse has written down as to why the patient is here. For this visit I was so worried about being late that I had neglected to read the chief complaint. I opened the chart and there it was, my salvation in her handwriting: “Had diarrhea in Spain. Wants stool checked.”
I take in a huge breath of relief.
Oh! You want me to check this.
He hurriedly nods. I can see now that he’s just as embarrassed as I am.
But this is normal!
He nods again.
“I know. I figured that maybe you can find a clue; a remnant of what made me sick.”
But this is normal, I say to myself.
Sure; we’ll send it away. Odds are that it won’t give us an answer, though.
He nods for the third time.
I stand up; we shake hands. Both of us can’t wait to get out of this room.
The stool was normal.
Eighteen months ago I was in Toledo. I went to the convent; I bought mazapán. I thought about the professor’s stool, but it didn’t keep me from enjoying the pastry.
Another great thing about medicine: we can discuss blood, mucus, and stools at lunch and no one feels queasy in the least. Makes for some interesting meals in my house.
Soon after this incident I decided to stop doing primary care. I never saw the professor again.