Wednesday, December 01, 2004

The Nervous Patient

A cancer specialist requires a certain amount of calm and equanimity, what I call the proverbial reassuring manner, in order to provide effective care. The reason why is blatantly obvious. Our patients battle horrific diseases that often leave them weak and depressed. Many times they are faced with no hope for cure. Is it no surprise, then, that some of them become nervous? And if you, the patient, are aflame with anxiety, would you enjoy listening to a loudmouth, restless, high-strung oncologist who likes to quote discouraging statistics, and is adept at inappropriate smiling?

Of course not. This is why we cancer docs must teach ourselves to counsel with tranquility. It is not easy to learn at first - a young oncologist is lucky if he or she trains under a professor who has mastered the art of giving out bad news in a way as to not cause a family riot. With time and experience, though, most of the great oncologists develop the poise needed to deal with high-stress encounters with desperately ill people.

Still, though, there are some patients who are so tormented with worry that their emotions make the doctor a nervous wreck. I met one such nice gentleman this week.

My new patient, just diagnosed with metastatic lung cancer, was attempting to deal with the panic that comes when one in perfect health last week is now sitting on the edge of a hospital bed, listening to descriptions of his various organs bulging with tumors, all documented clearly by a CT scan. My patient's anxiety was not only apparent, it somersaulted all over the room. He peppered me with questions, starting out with "Are you sure this is cancer and not an infection?" Classic Kubler-Ross stuff, I thought to myself. As I discussed what I knew about his situation with him, sitting calmly beside him in a chair, I used my most reassuring if not downright serene manner. I explained the facts of his case, came up with a plan to help him, outlined the logistics of the next several day's worth of tests, and did my best to raise the flag of encouragement over his bedpost.

Except, it didn't work worth a hoot.

The more I tried to allay his fears, the more nervous he became. He sat rigidly in his chair, repeating questions that I had answered earlier. Clearly, I thought to myself, he is overwhelmed, and it is time to call it a day. Let the passing of a night hopefully bring solace to him, and pick up our conversation tomorrow.

Great idea, except now I began to feel anxious.

I felt that because I left him as nervous as when I entered the room that I had failed, maybe not in my primary mission, which was to dispense essential information about the cancer, but in my inability to inspire confidence or at least a modicum of hope. The more I flapped my gums, the more my words just sounded annoying.

With this in mind, I unleashed the secret weapon of the medical oncologist, the mysterious strategy we cancer docs keep hidden from public view, to be used only in the event of a dire emergency, such as this one:

I scheduled an office visit for the patient and his whole family.

If there's one thing I have learned about caring for the nervous patient it is that the best way to relieve distress is to form a bond of friendship with him or her. To form such a bond, continue to counsel the patient - it is as simple as that! By sending the indispensable message "I care", the doctor creates trust, trust that the patient knows his doctor will act in his best interest - will become his advocate, in good times and in bad. My feeling is, the more time spent supporting the patient, the more confidence the patient will have in your support. Thus is revealed one oncologist's answer to the problem of the agitated patient: keep talking - and keep listening.


At 3:10 PM, Blogger Amy said...

Your post is a refreshing and inspiring point of view on counseling patients. I have seen many hem-oncs in two different countries (I have had polycythemia vera for 13 years) and I've felt that most of them have shared a sort of dark sense of humor and don't listen all that well, I think mostly because they're in a hurry.

Fortunately, my current doc is relaxed and hears everything I say--I've been seeing him for eight years, and it did indeed take quite a bit of time for me to trust him. His unhurried manner and just overall pleasantness and what you call "equanimity" accounts for much of that. Besides being a good doc, he's just a good guy to spend time with.

At 6:33 PM, Blogger Dr. Craig Hildreth said...

To Amy:
Nice to hear you have found one of the good ones - they're out there, but they are indeed hurried. Often these doctors lose their focus on why they are even in the profession. Lord knows, we can get overwhelmed - just today I was counseling a patient's family as I was walking to my car in the parking lot! (late for another appointment, of course)

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Many of our modern drugs have harsh side-affects and cost the “earth”, so the next time you come down with a cold or the flu or anxiety chest pain, why not try a gentle alternative that costs next to nothing?

Instead of immediately forking over large amounts of money for over-the-counter drugs, go to the kitchen cupboard and see what you can find to relieve your symptoms including anxiety chest pain.

Here are some helpful hints for anxiety chest pain …

A simple hot compress applied to the face is very soothing to those throbbing aches and pains of a blocked sinus, while a few drops of eucalyptus oil on a handkerchief can provide welcome relief for similar conditions. While supplements of vitamin C, D and zinc will shorten the lifespan of a common cold, a hot lemon drink is also extremely good. And be sure to cuddle-up in bed when you have a cold, as it will make the body sweat out the germs.

Cool lemon juice and honey are a great soother for a sore throat and gives the body much-needed vitamin C at the same time The juice of one lemon in a glass of water is sufficient. Melt the honey in a little hot water for ease of mixing.

A smear of Vaseline or petroleum jelly will do wonders for those sore lips and nose that often accompany a cold.

A 'streaming cold' where the nose and eyes water profusely, can respond to drinking onion water. Simply dip a slice of onion into a glass of hot water for two seconds, then sip the cooled water throughout the day. Half an onion on the bedside table also alleviates cold symptoms because its odor is inhaled while you sleep.

People prone to catarrh may find that chewing the buds from a pine or larch throughout the day will clear up their condition in just a few days.

Do you suffer from sore eyes? If your eyes are sore from lengthy exposure to the sun, try beating the white of an egg and then spread it over a cloth and bandage the eyes with it. Leave the preparation on overnight. Soft cheese (quark) is also a good remedy for this condition.

For those unpleasant times when you suffer from diarrhea, two tablespoons of brown vinegar will usually fix the problem. Vinegar can be rather horrible to take, but who cares! The problem is more horrible. Vinegar can usually be found in most people's cupboards, so you don't need to worry about finding someone to run to the shop for you in an emergency.

Sleepless? Instead of reaching for sleeping pills, which can quickly become addictive, try this: Drink only caffeine free tea or coffee starting late in the afternoon.. Go to bed earlier rather than later, as being overtired tends to keep people awake. Make sure the bedroom is dark and quiet. Use only pure wool or cotton sheets and blankets. Polyester materials can cause sweat and make you thirsty (if your child constantly asks for water throughout the night, this could be the reason).

And don't watch those scary movies just before retiring! If you still can't sleep, make a tea of lemongrass or drink a nightcap of herbal tea containing chamomile. It's easy to grow lemongrass in your garden or start a flower pot on the balcony for ease of picking. Simply steep a handful in boiling water for five minutes. Honey may be added for a sweetener.

Of course there will be times when you do need modern drugs, so if these simple remedies don't have the required affect, be sure to see a health care professional.

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