Maybe it’s just a manifestation of my southern roots, but I always introduce myself to patients as Dr. Grubbs and I always refer to them as Mr. Such-and-such or Ms. Whomever. Admittedly, this felt a bit strange with 20-something year old Karl Washington. Not only because I was old enough to be his mama, but also because he had a boyish way about him that made it seem silly to call him Mr. Washington, when I wanted to say— Oh Karlie, how clever of you to tape a cartoon face on the end of your dialysis catheter and give it a name! Still, I called him Mr. Washington the last time I saw him before left to get a kidney transplant. For patients who I connect with and remind me of where I come from, I can’t help but morph into a hybrid. Sweet-natured, motherly Ms. Armstrong naturally became Ms. Lillie over time. I get that the same is true for some patients who develop a special affection towards me. The devoted son who always brought his legally blind Arabic speaking mother to see me, eventually translated that they were here with Dr. Vanessa, not Dr. Grubbs.
This I found heartwarming, yet still respectful, which for me is much of the point of all the doctors and misters and mistresses in the first place. The rest of the point, for me anyway, is to maintain that bit of distance between doctor and patient. I am your doctor, and while I may come to care for you beyond the basic love one has for another human simply for being human, I am not your friend, sister, or daughter. And I will never…(never ever?)…yes, never ever will I be your lover.
This may come across a bit cold, but it’s just going to have to be that way. Because if medical advice were a block of stone, some doctors would give it to you essentially untouched. It would be based upon test results and experience. It would be accurate, but cold and you might get cut on the sharp edges. Caring doctors would smooth out those edges. It would still be accurate, but they’ve considered that this is not just about a disease, but about a person too. But friend, sister, daughter, lover? They would chip away at that stone until it becomes their vision of you, their vision for you. Hell, you might be left with a pebble after they get done with it. You don’t want that. You want a caring doctor. That’s what I try to be.
I’m not sure what Mr. Anderson wants, because when he calls me Dr. Vanessa it doesn’t feel heartwarming. It feels like eww. And since he doesn’t work in a field remotely related to healthcare, it felt like eww last year when he sent me a request to connect on LinkedIn.
Mr. Anderson is in his mid-fifties and has stupid high blood pressure. Stupid is beyond ridiculous, but one notch below insane, which is the point at which folks have strokes. At stupid, I’m just watching his kidney function tick away at a rapid clip. If he continues at this rate, he will need dialysis in about 2 years.
You would think this information would cause a modicum of concern to register on his face. Yet, he just sits there looking at me so blankly I once got a bit Rush Hour Chris Tucker on him and said, “Do you understand the words that are coming out of my mouth!”
He nods yes, but that he doesn’t want to allow the information to stress him out. The information and the near insane blood pressure appear to be a distant second to the emphasis he places on the vague, can’t quite put his finger on it, but not quite normal feeling one of his medicines might be giving him. Same thing he said with an entirely different batch of pills.
I am not sure I believe him when he says he consistently takes what I’ve already prescribed, but I advise him to increase this one, continue the others, cut back on salt, have no more than one alcoholic beverage a day, and not start smoking cigarettes or crack. I tell him I’d like to see him back in two months.
“Isn’t that kind of long?” he complains. “I need to see you more often.”
Eww, I think again, but since you can’t say things like that out loud to people without hurting their feelings, instead I say, “Two months is the time frame I would usually see someone with your level of kidney function. Why do you think you need to see me so often?”
“Well, it just seems like we could get my blood pressure under control faster with more frequent visits.”
I have known Mr. Anderson for more than 2 years. He has known of his high blood pressure for at least twice as long.
“You are right in that getting control of your blood pressure could and should happen faster. But I don’t need to see you in clinic to do that. You could call or email me with your blood pressure readings from home and we can discuss adjustments to make between visits.”
His brows furrow slightly and he looks away like this isn’t what he wanted to hear.
“Do you check your blood pressures at home?” I ask.
He shakes his head.
“Do you have a blood pressure cuff?”
He shakes his head again.
Somehow the need to see me so often doesn’t feel motivated by an overwhelming desire to control blood pressure and stave off dialysis. Again, it just feels like eww.