A patient came into the office a few weeks ago, and tearfully thanked me for saving his life.
I am not bragging.
It’s just that a patient thanking you happens really rarely; much more rarely than “you are doing nothing for me,” and “I waited too long to see you,” and other complaints. So when it happens, it’s usually enough to stop me in my tracks. It makes me uncomfortable, actually. Because what do you say? “You’re welcome?” I usually end up with something inane like “Oh you!” Sometimes, I say, “Don’t thank me, it’s what I do,” but I don’t like that because I think we need to hear a heart felt thanks occasionally, or else the profession just gets too dark.
This patient was referred for fatigue, and very borderline anemia. Everyone with anemia gets referred to gastroenterology, because anemia frequently means you’re losing blood somewhere, and the one place where you could be losing blood chronically and invisibly is the GI tract. “Iron deficiency in the elderly is a colon cancer until proven otherwise” was one adage I learned in medical school, and I literally still repeat that to myself multiple times a day.
And this gentleman had a mild case of anemia, but his main complaint was fatigue. He said that when he walked, especially up the stairs, frequently he felt that he “just couldn’t do it any more.” Those were his words. No chest pain, no shortness of breath, just couldn’t do it any more.
Another faultless adage I learned is, “No one has ever died from GERD, but they have died of a heart attack.” Meaning, before you do your elective procedures for mild problems, if you are concerned about heart trouble, evaluate that first.
People are always complaining of fatigue. “I’m so tired, I have no energy…” and you put down “fatigue” in the chart. But I think true fatigue is experienced by few. The kind where you were playing soccer with your kid the day before yesterday, but today you can’t get up out of bed? (that was a lymphoma patient) Or the kind where you can’t go up the stairs a full flight without sitting down on a step in the middle.
So, looking at this patient, I don’t know why his fatigue struck a cord for me.
Long story short, I sent him to see a cardiologist, whose consult said, “Probably nothing, but given age and smoking, will do a stress test.”
“I had the stress test,” the patient told me, “and within 2 weeks I was having a coronary bypass. Quintuple. They said I was a walking time bomb. You saved my life.”
I saved his life. I didn’t do the stress test, and I didn’t do his surgery, but there was something about his complaint of “fatigue” that was different to me from all the rest, so I singled him out and saved his life. It’s crazy. And I’m not bragging; in fact, I pretty much can’t believe it. What if I hadn’t?
He teared up. I put my hand on my chest to cover the hives I was breaking out in. I also teared up. I am sure that there is a rule about hugging patients, but this man wanted to shake my hand and hug me, and I did. I saved his life, after all.
Would it be hubris to view myself like this:
I don’t think so either.