Pain and the Patient

I’m fortunate enough not to have medical problems that are seriously debilitating enough (and presumably chronic or permanent) to potentially jeopardize my career by making the existence of them public. On another note, it is unfortunate that, at least up to this point, physicians are often discouraged to expose their own medical conditions that their colleagues or their employers might perceive as being potentially detrimental to their performance in providing care (especially mental health conditions such as depression, ADHD, etc.). While I understand why an employer might hesitate to hire such as physician (for which there are many), it seems to me that it would be useful for medical schools to very aggressively engage the health issues of future physicians in order to insure that their health conditions are taken care of by or manageable by the time they start practicing. Medical schools do often require certain standard functions (i.e. motor skills), but they don’t seem to actively aim to deal with health problems of the future physician population. In fact, at least from my limited exposure thus far, health insurance plans for medical students is remarkably flimsy and short-sighted.

Back to my story: I’m feeling pain on the right side of my head (for you medical students out there – about two centimeters anterior to my right ear) from the removal of an epidermoid cyst, also known as a subcutaneous inclusion cyst, by a dermatologist. This sort of cyst is typically benign, and about a year ago a pathologist did a biopsy on the cyst and did indeed find that the tissue was not cancerous. Amusingly, I’ve spent the past few days after the initial draining of the inflamed cyst (of pus and necrotic, or dead, tissue) last Friday explaining to my fellow medical student classmates exactly what happened to the side of the head. To my delight, they have all taken a very professional approach to it (those that have asked). This experience reminds me of two very interesting aspects of the experience of patients in general: 1) pain, and 2) embarrassment.

Pain, for obvious reasons, hurts. I’ve found that that closer I come to becoming a doctor, the more readily I express feelings of pain. Why? Pain can be an important message from the body about what is going on, whether the problem is a matter of damaged tissue (i.e. via injury, deterioration, etc.) or the transmission of sensation (i.e. something is pressing against a nerve, or an improper signal is being sent to the brain). In fact, when anesthesia was introduced early in the twentieth century, surgeons hesitated to adopt its use because they typically used the pain of the patient as a route to understanding how to approach the disease during the surgery. However, I remember a time when I didn’t complain much about pain, and in retrospect, it’s very striking for me to realize how destructive and psychologically painful it can be to feel severe pain chronically or on a regular basis. When I was growing up, I had moderate asthma, and there was hardly ever a time when I wasn’t coughing, spitting out sputum, or wheezing. My throat was almost always scratchy and irritated, and my chest and abdominal muscles were frequently sore from all of the coughing. It’s unbelievably frustrating to feel constant pain – especially for young patients (i.e. less than fifteen years old), how does this change the way they view life? For me, some part of me felt that I was cursed and that it was unfair that I was feeling so much pain while others weren’t. However, that part was dwarfed by the sheer magnitude of the pain itself – you just can’t think about much else.

Concurrent with the years during which my asthma was most difficult to manage, my mother was suffering from ovarian cancer, a disease which caused her considerable pain, up until her death when I was 13. Perhaps not surprisingly, seeing her in pain and seeing the way she bravely and quietly dealt with pain actually served as a model for me when I was dealing with my asthma – I just bit my lip and waited for salvation. For her, it didn’t (at least, not in the form of a cure), but for me, it did: I grew out of asthma, and I also was an early beneficiary of the drug montelukast (better known as Singulair, and no, I don’t have a financial conflict of interest in mentioning this). Nonetheless, it was this experience with my mom, and not the advice of doctors, that shaped the way I dealt with pain. From my perspective as a pediatric patient, my pediatricians were not particularly concerned with any feelings of pain I suffered, and this may have been because I didn’t express them. However, when I did express them (i.e. when I felt pain that I didn’t know the source of), they were often attributed to “growing pains.” While probably the best explanation, I think some part of me liked my doctors a little less each time I heard one say that: after all, had they ever felt such pain? I think I wanted my doctors (perhaps unfairly or unproductively) to take my pain more seriously. Even if they didn’t address it more extensively, as a young patient, I still would have wanted someone to say, “I know what you’re going through. Lots of people have done it before, and I think you can make it through this too.”

On the second note, embarrassment, I realize now how difficult it is for people outside the medical community to understand and approach visible signs of distributed medical care that they encounter in everyday life. For example, I’ve been walking around with a huge wad of sterile gauze taped to the side of my head for the past few days. While some of the medical students around me have expressed intellectual curiosity, no one else I have encountered in public has taken it in stride. In fact, I’ve had my fair share of awkward stares and leers from passers-by, which makes me acutely aware that the general public doesn’t know how to approach uncommon signs of health care provision. Most people understand what happened when you see someone in a cast or a sling. But a bandage on the side of the head? Not so much. Again, it’s important to know what the other person is going through.

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