Mary Harris: Alright everybody, Amanda Aronczyk is here with me and she’s told me that I need to give you a little warning at the top. We have some adult language and some adult situations. So you’ve been warned.
Amanda Aronczyk: Now picture a big room, there’s about 300 people there.
AA: People dressed up a bit, sort of business casual, sitting around tables with tablecloths and there’s wine and cheese. And one by one a dozen doctors each stand up, they approach a podium at the front of the room and address the crowd.
Doctor 1: When I was a first year medical student...
Doctor 2: Some 50 years ago or so, I began my training in internal medicine…
Doctor 3: I love working in the ICU for many reasons…
AA: It was a story slam... by doctors.
MH: A doctor slam!
AA: Yeah, a doctor slam hosted by the Annals of Internal Medicine.
MH: Yeah, it’s a journal; it’s usually scientific research.
AA: Yeah, it’s not the moth. So this is a little unusual, but they have this regular feature called On Being a Doctor. It’s totally fascinating. Because I think Doctors are there for these very intense moments. They’re there for birth. They’re there for deaths -- and for any illness you might have in between. But we rarely hear what their take on it is.
MH: I feel like when I go to the doctors it’s kind like all about me. You’re not thinking about what they’re feeling.
AA: I think we think that they are just use to it because that’s their job. But of course there are patients that they remember that impact them deeply.
So I’m going to play you an example. This is a story from a guy named Dr. Mohammed Nayeemuddin. He’s doing his residency right now in Philadelphia. And he had this patient. A 30-year old man. And the man had this horrible asthma attack. And nobody found him for 3 days.
MH: That’s so horrible.
AA: The man was alive but he wasn’t going to survive. So his mother says to the doctor: look the one thing he really wants is to be an organ donor, can you make that happen?
MH: What did he say?
AA: Doctor says yes. And then he goes to prepare the son.
Dr. Nayeemuddin: And I went into the OR, ready to get started and his mom came up to me and she gave me an iPod and said can you hook this up to the sound system? So we can play this as our son dies. And I said sure. And the song started and it started with “Candle in the Wind.” It’s a really lovely song. And I saw tears in everybody’s eyes. And then “My Heart Will Go On” came on. And I thought that was also very appropriate. Then “California Girls” came on. And I thought, that’s a little different. And then Katy Perry’s “I Want To Touch Your Peacock” came on. And for those of you who haven’t heard it, it goes, “I want to touch your peacock. Cock. Cock.” And everybody started laughing and I started looked around and wondered, what’s going on? And the family just started telling me about how amazing a person he was and how much he loved laughter and he used to just do everything he could to bring laughter to their lives and that’s how they were going to remember him. And the rest of the playlist was just outlandish and beautiful and it became a dance party at some point…
AA: For the record, the lyrics are actually, “I want to see your peacock.” I fact checked it.
MH: I’m so glad you fact checked that.
AA: And all the stories were kind of like this.
Mary: Tragic…but kind of funny too.
AA: Yeah, and full of frustration and anger and joy and some really unexpected things too. You’re going to hear that in the stories coming up.
MH: So today on Only Human, we’re having our own Doctor Story Slam. You’re going to hear three stories. Doctors talking about the patients who changed their lives. And how they practice medicine. And just a note, all of these doctors got permission from their patients to tell these stories or they changed a couple details to make their patients anonymous.
MH: Alright, who are we going to hear from first?
AA: This first story is from Dr. Richard Weinberg. He’s been writing about being a doctor for several decades now. He thinks a lot about patients and also about stories.
MH: So what kind of doctor is he?
AA: He’s a gastroenterologist. That means he deals with digestive diseases, so anything from swallowing to ulcers to liver problems.
This is about a patient, back in the 1980s, a young woman in her twenties. She came in with a common complaint: stomach pain. But clearly there was more going on.
Dr. Weinberg: Well, the thing that struck me was that she was extraordinarily unkempt. She had this big bulky sweater on, her hair was sort of greasy and matted. So that was sort of weird. And trying to talk with her is almost impossible.
AA: What did she say was bothering her?
DW: Well, she said she had chronic abdominal pain, her stomach hurt.
AA: And that’s it, my stomach hurts?
DW: My stomach hurts. Where does it hurt? All over. When does it hurt? All the time. Does anything make it worse or better? I don’t know.
I mean there was nothing, there was nothing helpful coming forth no matter what questions I asked. So this very quickly in my mind looks like a completely hopeless case. That I wasn’t going to be able to do anything.
AA: He was the third gastroenterologist she had been to. They had tried every medicine, run every test. And he was out of questions about her stomach pain.
DW: So I asked what she did for a living. And she said she ran her father’s bakery. So I said, well, I love pastries. You know, I go to the French Gourmet Bakery all the time to get their Napoleons, they’re so good. And this like, clicked a switch on with this young woman. She just looked up with fire in her eyes. And said, I wouldn’t feed a Napoleon from the French Gourmet Bakery to a dog.
DW: So to this led to about 10 minutes of animated conversation.
AA: And there’s no part of you that’s saying this is so off topic we’re supposed to be talking about why she feels sick?
DW: No, I really like pastry.
AA: (Laughs) So you’re in for this conversation about pastry?
DW: I’m in. I want to go to this bakery now. So where is it? What time does it open? Are you going to be there? It’s was just… wow.
AA: Where can I get more Napoleons?
DW: Right. Abdominal pain is getting me nowhere. Napoleons and pastries, now we got some place to visit this weekend. So this was great.
DW: Then all of a sudden, that was it.
AA: That was it?
DW: She was quiet again. There I am, I have a weekend destination for pastry and a patient I have absolutely no idea what’s wrong with.
AA: In that ten minute conversation, Dr. Weinberg learned that this patient was a devout Catholic, she was an artisanal baker, and Italian. But he had no new ideas on what would help her symtoms.
DW: I look on her chart, there was one medicine that we use for this that she hadn’t tried, so thank goodness there was something to do. I wrote a prescription. No more words at all. And she left. And um, I said to myself well, that’s the last time I’m going to see her.
AA: It wasn’t the last time. She called, made another appointment, and a week later, she was back his clinic.
DW: She got into the room and there she was in the corner, completely withdrawn and not particularly communicative.
DW: Again. At that point, looking at her, she had these incredible dark bags under her eyes.
DW: So I had already asked every question I could, I asked, so are you getting enough sleep? And she said, no I’m not. And so I asked why? And she said I have a nightmare.
AA: A nightmare?
DW: A nightmare. Not nightmares. Not plural, but singular. I have a nightmare. So the next obvious question is, can you tell me about your nightmare? And she must’ve taken about 30 seconds sitting there.
AA: Was that an awkward 30 seconds between the two of you?
AW: No, it was a suspenseful 30 seconds. It was like… what is going to happen here? Because clearly there was some kind of threshold. This was extraordinarily important for this person. So it was either going back away from the precipice or take a leap. And she took a leap.
DW: And she told me about her nightmare in which she’s…. in a dark church, and the lights are dim, and all of sudden monks or some sort of entities grab her and drag her to the alter. And pour holy water down her mouth and choke her. And she looks up. And more entities are coming up the aisle. Holding huge lit candles. And they’re getting closer and closer. And then she wakes up.
DW: Clearly this is a symbolic dream of being raped.
AA: What did you say?
DW: I asked the next extremely hard, but obvious question. I said, have you ever been raped? And then she said yes, I was. When I was 14 my sister’s boyfriend raped me late night in the bakery. And did you ever tell anyone? And she, just at this point she broke down crying. I couldn’t tell anyone, it would kill my father and destroy my family and no one would have believed me anyway. You’re the only person I’ve ever told.
AA: Oof. Had anyone ever said anything like that to you?
DW: No. And this was back in the dark ages of any kind of awareness of sexual assault, its, its prevalence, its impact on people. You just didn’t talk about it.
AA: And that’s a long time to sit with something like that.
DW: It is. And then she told me everything that happened. And it ultimately explained even her symptoms. She couldn’t eat. She couldn’t go to mass. She couldn’t take communion. She felt defiled and damaged and dirty. And then fell into this ritual of penitence. Almost. Remember she works in a bakery with lots of good-looking things. She would finally start eating things and eat and eat and eat and then she would purge. She would vomit. She developed bulimia.
AA: And do you remember, did this come out over multiple visits or was this really one visit?
DW: This came out in 15 minutes. It was one of the most remarkable exchanges in an examining room I’ve ever had in my life.
DW: I’d never encountered this before. We’d never been taught about sexual assault in medical school. In those days. This horrible event had infected her entire life and yet she was struggling to survive. Still managing the bakery, still trudging across town from doctor to doctor and finally, clearly this was the cause of everything. And now I’m saying, oh my gosh, what am I going to do now? How I am I going to help this person? Because I don’t know what I’m doing. How on earth do you help someone who has experienced something like this.
AA: Remember this was 30 years ago. Dr Weinberg said there were less resources, but he could recommend her to a psychiatrist or a rape counselor. But she refused to go. Instead every week she came to see Dr. Weinberg, the gastroenterologist. She would be his last patient of the day so they could talk. Meanwhile, he searched for articles about the connections between rape and eating disorders. But he didn’t find much. He even asked a psychiatrist friend about what he should do.
DW: I told him about the situation, I said what… is there anything else I should do? And I’ll never forget he said, “Is she comfortable talking with you?” I said yes, it seems to be. And then question number two is, “do you think she’s getting any better?” And I said, I think she is getting a little better. He said, “Well, that’s the way we do it. So just keep on doing what you’re doing.”
AA: Wow.You must have felt so out of your depths.
DW: Well it was… it was and it wasn’t. In that…. the gastrointestinal tract is this tremendous transducer of emotions. And anyone who’s going to make their life’s work in the digestive system should have at least some knowledge of how emotions affect... In fact this is such an intuitive knowledge that every language has idioms that expresses the connection between emotions and your G.I. tract. You can start at the top. The news was hard to swallow. When I heard it I got all choked up. I have butterflies in my stomach. My guts are tied in knots. My roommate is a pain in the, you know where. So from top to bottom there are all these expressions that show you, that how you feel and what your emotions are, can affect the way your whole digestive system works.
DW: As it turned out, as the weeks and months went by, listening seemed to be doing some sort of good. And she didn’t look so unkempt anymore. Her hair was a little bit neater. And the bags under the eyes resolved. And then one time, there was a smile.
AA: Why did you laugh? Did it seem like it came out of nowhere?
DW: It was just wonderful.
AA: Did you worry about her when you wouldn’t see her for a few weeks or if a month went by?
DW: I wondered what she was doing, but I wasn’t worried because she seemed to be doing well. And then there was a time when I don’t think I had seen her for two months and I figured well, you now, she’s all better, and she’s found her way and I’m glad I could help with that.
AA: And is there a little part of you that’s disappointed, like she’s gone, and I’m not going to see her again, and I’ll never really know?
DW: I did see her one more time. And it was as usual at the end of the day. I looked out at the waiting room and there was this beautiful young lady sitting there. And I… she looked familiar. And then I realized it was this patient. She’d come back. But she was dressed so elegantly as if it was going to be a night on the town. And I realized that she dressed up for me. And that this was the last time I was ever going to see her. This was a leave-taking. She said that the reason I really came was to bring you this, I wanted to bring you a gift. And it was a beautiful little box with a bow. So I said, well, thank you very much. Do you want me to open it now? And she said please do. And I opened the box and inside were a dozen immaculately, perfectly done, Napoleons.
MH: That was Dr. Richard Weinberg. He’s a writer and a gastroenterologist in North Carolina. So Amanda, this was thirty years ago, how did this woman change how Dr. Weinberg thought about his patients?
AA: I think this was the first time that he really understood that people sometimes come in, they’ve got some complaint: my stomach hurts, my back hurts, but that’s not really the story. And so this one was important to him because it was the first time he understood that he needed to establish a rapport with the person, so he could really understand what was wrong.
MH: Yeah, it’s about more than symptoms.
AA: It’s not just the little symptoms and the pills I throw at it; it can sometimes be much bigger than that.
MH: So what’s coming up, Amanda?
AA: Two more stories. In the first, a doctor learns a little too much about a couple’s sex life. And in the second one is about a doctor early in his career meeting a patient who he agonizes over.
MH: Alright, you’re listening to Only.
MH: Last week we talked about something everyone’s heard of, but few people actually understand: placebos. And we asked you guys if fake medicine has ever made you feel better.
On Facebook, Jenny Densmore told us when she starts to feel sick, it’s mind over matter:
“I will often tell myself that I just don’t feel very well that day, but am not going to get sick or feel bad enough to miss out on any plans or work.”
She says this mantra, works for her.
Rahul Schroff told us his parents taught him about the healing properties of a common kitchen spice: if he twisted an ankle, they would make a paste of turmeric and water and rub it on his foot.
“I didn’t believe that it would work,” he told us. “But listening to this episode really made me feel better about it. I’ve always thought that believing a medication will work has an impact.”
Tell us your stories - we love hearing from you! You can find us on Facebook or Twitter or Only Human.org
MH: This is Only Human, I’m Mary Harris.
Today, inspired by a Doctor Story Slam, we are hearing stories from doctors. About the patients who changed their lives.
Amanda, who’s next?
AA: Next is a story from Dr. Reeta Mani.
MH: Okay, where is she?
AA: She is in Bangalore, India, now, but back when the story happened she was working at a large public hospital in South Mumbai.
MH: What kind of doctor is she?
AA: She’s a microbiologist. And at the time she was working at an HIV clinic in a large public hospital. And as you might imagine in a large public hospital
there are too many sick people, and not enough time. So sometimes a doctor will make assumptions about the person sitting in front of them.
DRM: I don’t remember his true name, because this happened more than ten years ago, but let’s call him Rohit.
AA: At the time, she was working at an HIV clinic where anyone can walk in and get the test.
DRM: So from the place I used to sit in the counselor’s room I could see part of the reception area where patients used to be seated.
AA: Usually when Dr. Mani looked up from her desk, she saw hundreds of sick patients.
DRM: And I remember that Rohit was quite well dressed for a public hospital. He was wearing jeans and a very nice, stylish shirt.
AA: She figured he could probably afford a private hospital. So maybe he was there because the test was anonymous. She didn’t know. Then it was his turn for a pre-test counseling session: Had he done anything high risk?
DRM: He admitted to going to commercial sex workers in India, as well as on many of his trips abroad.
AA: Ah-ha. He had paid for sex. He had been with prostitutes.
DRM: Yes, unprotected sex.
AA: So she does the test. He is HIV positive.
DRM: Many people are surprised or shocked at the report. But he wasn't. In fact, but he was unusually quiet.
DRM: When I handed the report to him and he just abruptly stood up. And I thought he avoided my gaze and just walked away.
AA: Before he left he told the doctor that he didn’t have kids. But he was married. So he’s supposed to bring his wife in for testing. Dr. Mani wasn’t sure if see would see him again.
DRM: But then I was bit surprised when she came...she was quite attractive, she was smart and she had a very good career going on.
AA: The doctor met with the couple together and then saw them one on one. When she met with the wife, who we’re calling Anjali, she admitted she was a mess.
DRM: When Rohit had mentioned to her about his being HIV positive, she had gone through all phases of denial and then anger, depression. And then she felt really hurt and betrayed. And she said that the initial few years of the marriage they really had gotten along really well and they felt very much in love. But that hadn’t stayed the same. And he even suspected that she probably even had an extramarital relationship.
AA: Anjali told Dr. Mani that she had considered taking her own life. Rohit had ruined everything. And now she might be HIV positive too.
DRM: In spite of telling me all of this. She said she was ready to forgive Rohit. She said she wanted to remember all the wonderful times that they had together. And this was a time that she needed to support him. Of course we didn’t mention what we knew about Rohit.
AA: How did she think he got it?
DRM: She thought it was just a one-time mistake that he committed.
DRM: In one of his stray moments when he wasn’t himself.
AA: The doctor feared that Anjali was just like the many women she saw at the clinic, day in and day out, women infected by their husbands. Women who had no choice, but to stay loyal.
DRM: And that is when I went through a mix of emotions. I initially felt angry and then I thought, oh my god this woman who’s so smart who has a good career, she was ready to forgive him. And I even thought probably she was plain stupid to do this. This was what I was thinking to myself. I continued to remain as poker face as I should have been.
AA: Do you think you managed to have a poker face?
DRM: Uh. I think so (Laugh).
AA: She talked a reluctant Anjali into getting the HIV test.
DRM: They were back the next day, both of them, and she was positive.
AA: The doctor said that sometimes what happens next is pretty ugly. The wife blames the husband. Husband blames the wife. It’s a miserable thing to witness.
AA: But that is not what happened with this couple.
DRM: They surprised us. They were quite calm as if they were prepared for this verdict. And it was in fact very nice to see that both of them comforted each other. And I saw Rohit helping her out of a chair. He held her hands.
For a moment I felt happy. That at least this suffering had brought them closer. What more can we ask for? And then they left.
AA: They decided to be treated at a hospital closer to their home. And that was the last time the doctor saw Rohit and Anjali.
A few months later, Dr Reeta Mani was working on a research project on the differences between two strains of HIV: Dr. Mani was testing the blood samples collected at the public hospital.
DRM: To know, how many of them were HIV-1 and how many of them were HIV-2.
AA: And while she was testing the samples, she discovered something.
DRM: It was at that time we found that Rohit was infected with HIV-2 virus and Anjeli was infected with HIV-1. So apparently, they hadn't acquired the infection from each other. Each of them had acquired it from a different source.
AA: They had both gotten it from other people?
AA: Rohit and Anjali hadn’t listed any other risk factors. They must have both contracted HIV from having sex with other people. Dr. Mani and her team debated what to do. They decided not to tell the couple.
DRM: For treatment purposes it wouldn’t have made any difference then.
AA: Do you think that finding out that they got HIV from different people would have been bad for their marriage?
DRM: Well, I don’t know. This disease had brought them closer. And we did not want more skeletons to, you know, tumble out of the closet.
AA: Didn’t they have a right to know?
DRM: No, they did not. Because medically the testing was done only as a research project. So it was not mandatory for us to call them and reveal this information to them.
AA: But morally, did you owe it to them to tell them the truth?
DRM: No, because we are in the medical profession, and we are not here to do any moral policing. So we thought it was best to leave it at that.
AA: Years later, Dr. Mani still remembers this story. Because it changed how she practices medicine.
DRM: I’m much less judgmental about anybody. Not only with HIV but with so many other diseases as well.
AA: Because you just never know.
DRM: We just never know. And even if we feel the patient is telling you the truth. It can never ever be the whole truth.
AA: Why do you think it’s not the whole truth?
DRM: Because that is what happened, right? I mean Anjali obviously hadn’t told us the whole truth.
AA: Right you have these people in front of you. And in theory of all the people in the world they should be honest with, they should be honest with their doctors, but still. There’s shame and regret and secrets.
MH: That was Dr Reena Mani. Today, she’s a virologist with the National Institute of Mental Health and Neuroscience in Bangalore, India.
Her story, “Keeping Secrets” was first published in the online journal, Pulse -- “Voices from the Heart of Medicine.” You can find more stories at pulsevoices.org
MH: Alright, we have one last story.
AA: And this one was actually from the Doctor Slam I told you about at the start.
MH: Why did you pick this one?
AA: This one really moved me. And I think it was because you that doctors are there for these really intense moments, but sometimes they never get to find out what happens at the end of the story. And the patients just disappear.
MH: So who’s telling the story here?
AA: We are going to hear from Dr. Michael LaCombe. This is from about 50 years ago when he began his training in internal medicine. And as part of that training, he and the other residents had a mandatory 6-week rotation on the psychiatry ward.
Dr Michael LaCombe: We all dreaded it. You have to picture a ward that’s locked. There are patients of every description standing in their doorways. Staring at you. Not interacting, it’s very, very foreign.
AA: Did they lock you in too?
DML: Yes. Remember that this was the early sixties, there was not much one could do. The major tranquilizers had come out only a few years before. But many patients, especially those who were terribly ill, either did not respond to the major tranquilizers or couldn’t take them.
AA: On his first day he was assigned to follow a single patient: Nancy. She was 17 years old. And he was told to visit with her for two hours in the morning, two hours in the afternoon. All he knew about Nancy was that she had schizophrenia.
DML: She was delusional. She heard voices. I had some sort of abstract notion that these voices that she heard, controlled her. And she was a cutter. She was a schizophrenic who cut herself.
AA: So you as her doctor. You’re a doctor at that point, right?
DML: Yes. Barely.
AA: And you walk into the room, and what did you think?
DML: Well, the whole thing is very intimidating. You know, I guess… I was, 26, 28 years old. I think she was probably ten years younger than me. I can’t remember her ever maintaining eye contact with me, not, not once during the 6 weeks. She would sit on the bed, the bed the was never made. And she would look down. I wasn’t getting much from her. It was mostly what I was saying.
AA: And the assignment was to go in and talk to this woman: Two hours in the morning, two hours in the afternoon, that’s a lot of time.
DML: Yeah, it is a lot of time.
AA: What do you possibly talk about for all that time?
DML: Oh I suppose I would talk to her about…You know, I had this little boy. This was our first son, Mike. And whenever I had free time I would take him fishing. I would often use that as a topic. And talk to her about the mechanics of fishing, how he enjoyed it. These types of things.
AA: Did she say anything in response? Did she respond to your stories or asks you questions?
DML: Amanda, I really don’t recall her ever asking me a question, where I was from.I had this feeling when I went in that she was glad I was there. That she liked the visit. And yet, when I’d go in and find her covered with blood and I would just say, Oh Nancy, she would be ashamed and then I’d think I don’t want her to be ashamed. I don't want to shame her. I’m just genuinely upset; I'm hurt that she’s hurt.
AA: When the six weeks were over, he moved onto his next rotation in another part of the hospital. But he would still go back to that part of the hospital because he wondered how Nancy was doing.
DML: Was she getting better? Was she still cutting herself? Was she even there or was she released? And so I’d stop by maybe once a month. And, really don't remember there being any change.
AA: Dr. LaCombe kept going back for about three years. And when his training was done, he went to see Nancy for the last time.
DML: What I remember is telling her I would write to her. And when I left the attending said: “She will hold you to that. If you have promised to write to her, you have to write to her.” And I said, I will. And I wrote her or uh would send her a postcard or a small greeting card several times a year.
AA: How long did you do that for?
LACOMBE: Pheeew. A couple years I think.
AA: Would she ever write back?
LACOMBE: No. No she wouldn’t.
AA: Then the 50 years passed. Fifty years that Dr. LaCombe said were filled with the excitement of medicine, of diagnosis, of treating disease. But there were also days where he was worn down. When he felt deadened by the weight of hospital bureaucracy and an uncaring administration. Days when his students didn’t seem to listen.
In the twilight of his career, he had days when he wondered if anything he had done had mattered. And if he had done enough for his patients.
Two years ago, he was at his job as a cardiologist at Maine General Medical Center. And he was having one of those days, when he stopped by the hospital mailroom.
DML: Hospital mail is full of what we call throwaways. And sometimes quite frankly, physicians just reach in and grab the mail and throw it in the trash. And I sort of leaf through it and I saw this greeting card and it had a return address. And um, last name that I didn’t recognize.
AA: He opened the card: On the front there’s a drawing of a boy. The boy is about three or four years old and he’s fishing. Dr. LaCombe realized the card was from Nancy. After almost fifty years she had finally written him back.
He read the card.
DML: Dear Dr. LaCombe, many years ago when you were doing a rotation on the psych ward, I was one of your patients. It is long overdue that I should thank you and tell you how well my life has turned out. I have an amazing husband of 31 1/2 years. And three wonderful kids. None crazy. I went to school got my nursing degree. And now I work for a doctor who is like I remember you. I saw this card a long time ago and thought of you fishing with your son. I hope life has been good to you and yours. You deserve to be encouraged for being you, when a crazy...when a crazy cutting teenager needed a friend.
DML: Okay, Amanda. You got me.
AA: I didn't mean to get you Dr. LaCombe.
DML: And that’s it.
AA: What was it like to get a card like this so many years later?
DML: Well, you know. You can’t imagine. I mean, here it is now a year and a half since I got the card. I’ve probably read it three dozen times through and I still break down. Because, you really don't know, if you’re honest with yourself, you really don’t know what effect you have on people. Not on your kids, not on your spouse, certainly not with your patients.
MH: That was Dr. Michael LaCombe. He first told this story at the Story Slam last fall.
Thanks to Dr. LaCombe, Dr. Christine Laine and the journal for all of their help.