MARY HARRIS: Hey, it’s Mary. Just a quick heads up that this week’s episode is a repeat. It’s one of our favorites, so we wanted to give new listeners a chance to hear it. We’ll be back with a new show next week.
BEN: I smoke a loooot of marijuana.
MH: Would you ever consider telling your doctor what you’re up to?
BEN: I’m leaning towards no, because he knows everything about my life, and I’m afraid he might change how he sees me.
MH: This is a guy named Ben. And he has a confession: he lies to his doctor about smoking pot. He says he’d rather tell the truth. But he’s afraid that if he does? His doctor won’t work as hard to take care of him. Debra’s secret — is a little more extreme.
DEBRA: I went outside of the United States to go get a gastro sleeve.
MH: What’s a gastro sleeve?
DEBRA: They take 80 percent of your stomach and they get rid of it.
MH: Why’d you leave the country to get it done?
DEBRA: Because they would not do it here for me. I was 187 pounds, I’m 5 foot 3 inches, and, uh, no doctor would touch me. Not even if I paid them.
MH: Gastric sleeve surgery is for weight loss. Debra didn’t weigh enough to get it here in the U.S. But she wanted it anyway. So she did some research, found a doctor in Tijuana, and booked a flight.
MH: Did you tell anyone you were doing this?
Debra: I didn’t tell anybody here! I didn’t tell my husband until two weeks before I was leaving.
MH: She didn’t tell her kids or her doctor, either. They weren’t happy about it. But she’s glad she did it anyway. We got these calls because a couple of weeks ago, we asked you to share what we called your “health confessions”.
Hi y’all, my name is Kerissa and I’m from Texas…
Hi, thanks for taking my call...
Hey, how’s it going today?...
MH: Your secrets about your health, or the gambles you take.
I’ve been diagnosed with chronical kidney failure. I don’t…
I have a ritual of chopping up cloves of garlic and just swallowing them…
I let the doctor figure it out and if he can figure something out, great, if not,
then I take my chances, alright?
MH: I’m Mary Harris, and you’re listening to Only Human. A show about the amazing ways our bodies work, and what happens when they fail us. When we asked for your health confessions — we weren’t sure what you’d come back with. It turns out you guys have all kinds of things to share. Including a lot of vices. Some of you eat the wrong things, some of you use drugs. And a lot of you keep from your doctors. These are the sins of omission.
MH: Are you driving around or are you in a — are you stable?
CHRISTIAN: I, uh, I’m driving around, um…
MH: This is a guy we’re calling Christian. He told us that he has seizures. But a different kind of seizure than you’re probably imagining. His seizures make him jolt up in the bed in the night. For a little while, he can’t move. And then he goes back to sleep. He’s been getting these seizures for a long time, since he was a teenager. He takes medication for them — but lately they’ve been getting worse. And Christian’s not telling his doctor.
CHRISTIAN: I have one story of my epilepsy that I would like to share – one of the reasons why I don’t tell my doctors...
MH: Yeah, tell me.
CHRISTIAN: Um, so, in 2005, I traveled to Colombia, South America. And, the night before our flight back to the United States, you know, we had a great night out and I didn’t go to sleep until maybe like 3, 4 o’clock in the morning. So I had about an hour’s sleep. And I fell asleep on the airplane. On the flight, mid-flight, I had a seizure. But the seizure I had was unlike any seizure I’ve had before or ever had since. I had grand mal seizure. I had a real, like, a real…what you see on TV kind of seizures.
M: Did other people on the plane know what was happening?
CHRISTIAN: I...So I punched the guy next to me. With my arm, just jolted and hit the gentleman. I - I struck him. And he said, “what happened?” and that’s the last thing I remember and then I blacked out.
MH: When he came to, he was wearing an oxygen mask, and the plane was on the ground. He’d caused an emergency landing.
CHRISTIAN: I remember I was wearing a pink polo shirt and it was dark red because apparently I bit my tongue. And somebody tried to give me my medication. And my shirt had the yellow remnants from the pills so, like I — I may have, like, spit up a little bit or...whatever happened. But, it was the most embarrassing experience of my life. The very next week, I got a letter in the mail from the Department of Motor Vehicles saying that my license was suspended. You know, they said, “It’s a pretty serious thing for you to make a 747 emergency land.” And I was like, “You’re telling me.”
MH: To get his license back, Christian had to visit his doctor every six months for two years. Now, he’s afraid that if he tells his doctor that the seizures he has at night are getting more intense — he might lose his license again. So instead, he’s self-medicating. He’s found a way of getting more pills than his doctor prescribes. He says doctors just don’t get what losing his license would mean for him.
CHRISTIAN: I live in a place where you need to drive. And if I were no longer able to do that because I was honest with my doctor, that would just be crushing.
MH: So does this go beyond your doctor? Are you not telling your family that you’re having these incidents?
CHRISTIAN: That’s correct. So this is my... dirty little secret. And I don’t really share it with anybody except you, apparently.
MH: You might be wondering, is it reckless for Christian to drive? We called two neurologists to ask that question. We described his symptoms, and both doctors said that if they had a patient with his history -- a long-standing pattern of seizures that happen only when he’s asleep -- they would consider it safe for him to drive. But they also point out that Christian might be putting himself at risk, because poorly controlled seizures can increase the risk of memory problems, and of something called Sudden Unexpected Death in Epilepsy. We passed this on to Christian, and he’s taking steps towards seeing a doctor.
Keeping your seizures a secret is pretty extreme. But it’s common for most of us to keep things from our doctors. We wanted to know -- are the doctors onto us? So we asked our reporter, Amanda Aronczyk, to try to find out. Hey, Amanda -
AMANDA ARONCZYK: Hey there, Mary.
MH: So what do doctors think of all this?
AA: So one of the people I talked to was Dr. Henry Lodge, he is an internist at Columbia University Medical Center in New York. He says that doctors know we’re not always telling the truth.
DR LODGE: I wouldn’t call it lying. It’s very hard to share… things that we feel uncomfortable about. And so we know for a fact that patients tell you either non-truths or less than the full truth all the time. Um.. alcohol. Right. Clearly... You tell us how much you drink, we write it down faithfully. We’re never surprised if you come in a year later and say, “you know, actually it’s a fifth of vodka.” So we teach this in medical school - that basically, this is tough information. And some of it the patient is not telling themselves the truth. Some of it they are, but they are embarrassed to tell you. Some of it they don’t want it in their record. So we think it’s a disservice to the patient to assume that they are telling the truth and it’s a disservice to the patient to judge them for it.
AA: I am probably not going to shock any of you when I tell you that doctors also eat badly, they do drugs, they put off exercise - just like the rest of us. Dr. Lodge admitted to having a hamburger problem. Doctors just have to live with more “cognitive dissonance”: You know you shouldn’t do it, you do it anyway and your justifications... are complex. Here’s Dana March’s story. She is a professor of public health.
AA: Is this something you’ve confessed to people before?
DANA MARCH: Well, there are people who know.. what I’m about to confess. I started, initiated a “smoking behavior” at the age of 39.
AA: I love that you call it a “smoking behavior”.
DANA MARCH: A “smoking behavior”.
AA: Why is it a “smoking behavior” as opposed to “I just started smoking”?
DANA MARCH: Because it’s, I actually, I vape. So-I smoke electronic cigarettes.
AA: So you didn’t start smoking?
DANA MARCH: I...initiated a smoking behavior. I don’t want to say, “I’m a smoker,” it’s not smoking cigarettes, it’s a completely different category.
AA: Do you think you’re addicted?
DANA MARCH: Do I think I’m addicted. Let me put it this way: I deliberately leave my vape home when I come to work and when I get home, I’m really glad to have it again. (laughter) I’ll put it that way. I said to myself, I’m going to quit when I’m 40. And…
AA: Did you quit when you hit 40?
DANA MARCH: No! No, I totally didn’t. But I will quit, I know that I will quit, I will quit.
AA: Do you feel any better for having confessed that you’re a vaper?
DANA MARCH: Yeah, it makes me want to quit now. (laughter) It makes me want to quit that I’ve confessed.
MH: Good news, Dana March just emailed us to say - she’s really doing it. She’s quitting.
Coming up after the break: the dark side of doctor’s confessions. What happens when a doctor’s mistake risks a patient’s life? And a warning: there’s some swearing, and it gets pretty graphic. You’re listening to Only Human. We’ll be right back.
MH: Hey everyone, and thanks for listening. One reason we wanted to air this show again is because we thought it would have a special resonance right around now. Looking back on 2015, maybe you’re admitting to some missteps with your health… and thinking about how next year you could be a little better.
If you’ve got a resolution you’re worried about sticking to, we have a secret project coming up designed to help you with just that. We’re not announcing it for another week -- but if you want to be the first to find out about it, like us on Facebook or follow us on Twitter @onlyhuman. We’ll let you know before the next podcast how you can be a part of it.
MH: This is Only Human and Amanda takes it from here.
AA: So we’ve all been there, right? You go to the doctor. You’re sent to a tiny windowless room, and you put on what is essentially a large paper bag, open at the front. You know the doctor has an eye on the clock and a hand on the doorknob. You get like a little bit of time together. Dr. David Bell, another doctor at Columbia, says that one reason we hide things from our doctors... is that the relationship is just so odd.
DR BELL: It’s definitely not like any other relationship out there that I can meet you for the first time, I can start talking to you, and within 15 minutes, learn incredible amounts about you and your life and sometimes incredible sensitive information. And then the next step is sometimes, I have to examine any and all parts of your body. You don’t do that in a normal relationship, (laughs) so...
AA: This isn’t how you’re spending your Friday nights with your friends.
DR BELL: Exactly - this is not how I’m spending my Friday nights with my friends… (laughs)
AA: It’s really weird on either side of this relationship. And the one time Dr. Bell was sick enough to go to the hospital himself, he found being a patient made him feel really vulnerable. Dr. Danielle Ofri’s confession has everything to do with learning what it’s like to be a patient. She works as an internist at Bellevue, a public hospital in New York.
DR. OFRI: The first time I was a patient, when I was pregnant…
AA: This, wait, th-that couldn’t have been the first time you were a patient?
DR. OFRI: A real patient. Really - you know, I’ve never really been sick.
AA: You’ve never been sick?
DR OFRI: I’ve been lucky.
AA: Knock, should we knock wood. Knock the desk. And how - you hadn’t broken any bones?
DR. OFRI: Nothing. Never been in the hospital - other than working there. So on my way to get my first ultrasound amniocentesis for my first pregnancy, I got lost in the hospital and it was my own hospital.
AA: For those of you out there who haven’t had babies - that amnio is a test to make sure the baby is okay. Dr. Ofri figured it wouldn’t be that big a deal. But from the moment she got to the hospital - she felt lost.
DR. OFRI: And so I—I start, you know, walking up and down the halls, looking at all the signs up on the ceiling. And every room looks the same, every floor looks the same. It’s very...it’s very Kafkaesque. And I finally find pediatric cardiology. Okay, it has to do with kids, I’ll go in here. And I ask them, you know where do you guys do amnio? and ultrasound? Well, [depends what your doctor’s preference is] They could do it radiology, they could do it in genetics. They could do it in high risk. Are you high risk? I don’t know, Am I high risk? And I guess the anxiety of the procedure all began to build up - I remember I began to tear up. And I remember getting into the elevator to another floor and two attendings walk in with their nice, crisp NYU attending physician coats, which is what I wear but I wasn’t at that moment. And I realized that if I was wearing my coat, we’d have this acknowledgement, we would nod, we’re part of the same guild. But all of a sudden, here I am in street clothes. I’m kind of shaky. My—my eyes are all red and like, they don’t even notice me. Like, I’m just a patient.
AA: She finally got to the right place….
DR. OFRI: I think it was the coldest room I’ve ever been in. I mean like meat locker cold, frigid. And those gowns, as you know, do very little to insulate you. So now like I’m — all this anxiety, I’m freezing, and then they do that betadine cleaning, which again, I’ve done a million times.
AA: That’s that yellow, dark yellow, ocher-y… Right.
DR. OFRI: And I never really realized that the betadine feels awful. It makes you feel really exposed, because now your skin is wet. And it’s cold. And then I watch the nurse unfurl the needle. So I’ve used these needles and I’ve put them in people’s lungs and abdomens and spinal columns, you know, all through my training. But being on the business end of a needle? Completely different. Suddenly it looked like it was a meter long. And I mean, it looked so big. And she’s like, just a little pinch. Well, it wasn’t a little pinch, it hurt! (laughs) and then, the thing just disappears inside you, and I’m like, holy smoke, when’s it going to end?
AA: That sounds horrible.
DR. OFRI: And I’m watching the ultrasound, which is kind of very fuzzy, it looks like a 1950s TV and suddenly I lose all faith in technology. Like there is no way those fuzzy black and white images are going to protect my baby, are going to guide this huge needle from impaling my baby or my intestines, or whatever is in there! And I felt like the rug was pulled out from me, it seemed all like the height of shamanism. Like just give me garlic cloves, it can’t be any more reliable than this fuzzy thing guiding this enormous needle that’s not going to kill my baby or me. And then suddenly, the yellow fluid comes, they reach the amniotic fluid and they take out a few things. But watching the fluid go out was also a little freaky. Like, that stuff belongs inside. What...what’s it doing outside? You suddenly feel really exposed.
AA: And have you revealed to anybody at this point that you’re actually like, this doesn’t feel very good, I need a moment here?
DR. OFRI: Uh... Not really, not really. It also feels like you can’t stop it.
DR. OFRI: There’s a step, step two, step three, step four. And you just… Unless there’s you know blood gushing or fire, you’re not in a position to stop it. This is the way it goes, and you’re so…”freaked out” is the only word I can think of. You’re really not in your normal state of mind.
AA: Ultimately, everything was fine, she had a healthy baby girl. But that incident left an impression. Dr Ofri realized that despite nearly a decade of seeing patients, she had never stopped to think about what it was like to be one.
DR OFRI: How often do I send my patients off with, you know, here’s six referrals, for these tests and these doctors…
DR OFRI: Go take care of them and come back to me. You know, can they find the place? Can they read the instructions? Do they get confused? Do they speak English? You know, there are so many steps just to get to the medical care. Forget getting through IT. And I’d never really thought about it. And to me as a doctor, that’s all incidental, that’s just, you know, the run up to the actual medical procedure, but for the patient, getting there is not incidental at all.
AA: “Confessions” is a loaded word - we think of sins but also of mistakes that we’d rather not tell anyone. Sure, we all screw up. But in the world of medicine, even small mistakes can be disastrous.
DR MUIR: I made a call that didn’t go well. That I regret.
AA: This is Dr Owen Muir. He’s a psychiatrist at NYU. And two years ago, at a different hospital, he had a patient who was coming in every week for psychotherapy. But then the man missed a couple of sessions. Eventually he got back in touch with Dr Muir.
DR MUIR: He came to me one night and told me about a plan to end his life. [AND] One of the ways we evaluate suicidal people is not just by just what they say. What you say is less important than the risk factors you have for acute suicide.
AA: So it’s less what you say, and more what you’re doing?
DR. MUIR: It’s more what’s happening in your life. So we have like all of these risk factors: like are you male? are you younger or older? do you have guns in the home? do you have recent stressors in your life including like break ups or loss of a job? Do you have physical pain? Do you have global insomnia? like you can’t sleep all the time. Do you have what’s called psychic anxiety, like you can’t even sit still in a chair? Do you have access to, you know, highly lethal means? Do you have a plan? Do you have intent? Do you have prior suicide attempts? Do you have a family history of suicide? Some of these things, of course, will be static and never change. And some change. And he had some of these risk factors. So I actually called for him to be brought to the emergency room, against his will.
AA: It had been a long day. So instead of writing up what happened with this patient, Dr Muir gave the ER his cellphone number...
DR MUIR: And I gave the hand off to the ER verbally. And I went home.
AA: And what were you supposed to do? You were supposed to write everything down?
MUIR: So every time you see a patient, you write a note.
AA: A note.
DR. MUIR: A note. And you write in the note what happened in the session and there’s a plan. When the patient got to the emergency room, there was no note for them to reference. The patient told a very good story. His wife did not want him admitted to the hospital. And he was discharged from the emergency room.
AA: If you had finished the note, you think they would have kept him?
DR. MUIR: If I had had a note in the chart that said, “this guy is going to kill himself for x, y, z reasons,” It’s really hard to discharge someone when the note 10 minutes before he shows up in your ER says that.
AA: And were you surprised to discover he was gone?
DR. MUIR: I was shocked. And I had made a grievous error.
AA: Dr. Muir called the suicidal patient. And the man’s wife answered and she said they were going on... vacation. Technically Dr. Muir had not made a mistake - he had 24 hours to write that note. And the ER didn’t call him. The man never came back for treatment. And Dr. Muir doesn’t know what happened to him after that.
AA: God, that’s like, how shitty. It’s just shitty to not know. I don’t think I could live with the not knowing.
AA: I mean, I guess you just have to get used to... sometimes having patients that you can’t help?
DR. MUIR: I mean, but that happens for every doctor, right? Oncologists have end stage cancer patients. And the four courses of chemotherapy won’t work and there is no next step.
AA: But what you have to think about and deal with on a day to day basis is so much murkier…
DR. MUIR: Yes.
AA: Do you ever sort of feel like, oh yeah they’re great, they’re on the way and now they’re better?
DR MUIR: Some people have dramatic improvements. I mean, there’s a reason I’m a psychiatrist and not an oncologist, right? I like watching people get better, it’s meaningful to get better from a mental illness. And it happens more often than not. But there are some people who suffer for a long period of time, and I’m not going to be able to change that.
AA: Dr. Owen Muir is now doing a fellowship in child psychiatry. And he says that ever since that patient, he’s very prompt about finishing up his paperwork.
AA: So why confess? For all the reasons you might think of: It’s cathartic. It’s a step towards forgiveness. But will it keep you from messing up again? A couple of months ago, an academic medical journal published what was essentially a collective confession. It was an essay written by an anonymous medical school professor about med students who had witnessed terrible behavior by their superiors. And it was so shocking that it was picked up by Buzzfeed, CBS, the LA Times... even Cosmo. The essay was published in the Annals of Internal Medicine, and I asked the editor-in-chief — her name is Dr. Christine Laine — to read from it. And if you tend towards the squeamish, now is the time to listen to something else.
AA: You guys published two incidents in this article, that was written by this person and they’re both pretty — they’re pretty gross and they’re pretty… graphic? And I really was like, oh, well do we sort of skirt around this and you tell me kind of what happened, but I think I need you to read it.
DR. LAINE: Ok.
AA: Yeah, do you mind?
DR. LAINE: Do I — I mean the whole…? The whole thing?
AA: Not the whole thing, but maybe, um, if you could read from, “‘What happened?’ I asked him.”
DR. LAINE: Ok. ‘What happened?’ I asked him. I was scrubbed into a vaginal hysterectomy. The patient was under general anesthesia. My attending was prepping the patient’s vagina. He picked up a clamp holding sterile cotton balls and dipped them into Betadine. While he was cleansing and scrubbing her labia and inner thighs, he looked at me and said, ‘I bet she’s enjoying this.’ My attending winked at me and laughed.
AA: Dr Laine, the journal editor, said that every time she reads this essay, it makes her stomach turn.
DR. LAINE: And it also makes me kind of angry, um, angry for all the patients who this particular physician encountered, angry for young physicians who witness this type of behavior in their senior colleagues, and angry at myself and others who have witnessed colleagues being disrespectful to patients but were too timid to silence them.
AA: The second incident in the essay is about when the anonymous author was a student in med school. So, all of these names have been changed. //Anonymous is doing an OB-GYN rotation. And a woman named Mrs Lopez gives birth to a baby girl. Anonymous puts the newborn in the mother’s arms. All of a sudden there’s blood everywhere- lots of it. Mrs Lopez’s uterus won’t contract.
DR. LAINE: What you do in that instance is, you give some medications to help the muscle contractions so the uterus contracts down and stops the bleeding, and the other thing that you do is that you physically — the physician — physically goes in there, grabs the uterus, and squeezes down on it to tampen on the bleeding.
AA: Anonymous doesn’t know what to do. So a superior, Dr Canby, steps in to help.
DR. LAINE: So this, again, this is the, the narrator talking. So I hear the anesthesiologist say, “Ketamine is in.” I look at Mrs. Lopez—her eyes are half-closed and vacant. Dr. Canby instructs me to hold her knee. He places his left hand inside her vagina, makes a fist, and presses it against her uterus. I look down and see only his wrist; his entire hand is inside her. Canby puts his right hand on her abdomen and then massages her uterus between his hands. After a few minutes, he feels the uterus contract and harden. He says something like, ‘Atta girl. That’s what I like. A nice, tight uterus.’ And the bleeding stops. The guy saved her life. I was blown away. But then, something happened that I’ll never forget. Dr. Canby raises his right hand into the air. He starts to sing ‘La Cucaracha.’ He sings, ‘La Cucaracha, la cucaracha, dada, dada-daaa.’ He looks like he is dancing with her. He stomps his feet, twists his body, and waves his right arm above his head. All the while, he holds her, his whole hand still inside her vagina. He starts laughing. He keeps dancing. And then he looks at me. I began to sway with the beat. My feet shuffle. I hum and laugh along with him. Moments later, the anesthesiologist yells, ‘Knock it off, assholes!’ And we stop.
AA: It’s... an awful moment. The essay is titled “Our Family Secrets.” And it’s not just about the transgressions of a few individuals. But the way a top-down profession can silence people, and make them complicit in behavior they know isn’t right. When the editors met, they fought over whether or not to publish.
AA: What did you fight about?
DR. LAINE: It was pretty — pretty heated discussion. You know, some people in the room worried that this was a pretty extreme example and that us publishing it would suggest that this sort of behavior is more common among physicians and would damage the profession’s image. But, in a way, not publishing it would be metaphorically like dusting our colleagues’ bad behavior under the rug.
AA: There’s no way to know how often these kinds of violations happen. These are just anecdotes. But for Dr Laine, any single incident is one too many.
DR. LAINE: There are medical students in 2015 that are taking selfies in the delivery room with the patient up in stirrups. There’s a female anesthesiologist who is making really disparaging remarks about the male patient during a colonoscopy. So I think these things are happening. It’s not like the problem has completely gone away and we’re dredging up history by publishing this essay.
AA: Why, why did you call it “Our Family Secrets”?
DR. LAINE: Yeah, well, that was the title the author chose and we thought that it was, um, appropriate. I think the profession is somewhat of a community or a family and that we need to talk about these secrets.
AA: Not everyone agreed that this collective confession was helpful. The OB GYN Newscalled it “irresponsible and inflammatory.” And they said their profession had been unfairly targeted. The Journal stands by the essay. Dr Laine says there’s what’s written in the textbook and then there’s the “gray” curriculum. These are topics that are harder to teach. Like ethics, respect, cultural sensitivity. And there are lessons to be learned by observing the mistakes of others. She told us she’d already heard from several medical schools that were using this essay for teaching, which is exactly what Dr. Laine wanted.
MH: That was our reporter, Amanda Aronczyk, talking with Dr Christine Laine, editor in chief of the Annals of Internal Medicine.
MH: Thanks for listening to Only Human — and help us get the word out. Tell your friends. Share this episode on Facebook. And if you haven’t already, subscribe to the podcast in iTunes.
Only Human is a production of WNYC Studios. This episode was produced and edited by Molly Messick and Amanda Aronczyk. Our team includes Elaine Chen, Paige Cowett, Fred Mogul, Kenny Malone, and Kathryn Tam. Our technical director is Michael Raphael. Our executive producer is Leital Molad. Special thanks to Emrys Eller, Joseph Frankel, Winn Periyasamy, and Lena Walker. Jim Schachter is the Vice President for news at WNYC. And I’m Mary Harris. Happy Holidays from all of us here. Talk to you next week.