but sometimes, it’s inspiring. A busy morning begins with a call from a patient, who thanks me for taking care of her during her fibroid embolization. She wants reassurance about resuming certain activities, and a reminder of when to get a follow up MRI. Later that morning, a lung biopsy results in the patient sputtering blood, but he makes it through the episode without intubation. I breathe a sigh of relief.
I am cruising as I begin my mid-morning case, a lower extremity angiogram, following overnight lysis initiated by a colleague. He placed a small tube in a blocked artery to slowly drip a strong clot-busting medication over several hours. The artery behind the knee has re-opened, but the arteries below the knee look like a pruned tree. Prominent collateral pathways suggest the problem has been going on for some time. I consult with the referring vascular surgeon about the utility of continuing the medication another night. Should we continue the treatment, with a questionable chance of improvement, and the looming risk of unintended bleeding elsewhere in the body? We discuss it with the patient on the table. The patient struggles to understand the surgeon, who has seen many cases like this, and glazes over the details. I fill in with some additional explanation.
seeing the patient’s close friends, who are waiting for their update. I give them the abridged version of what I just went over with the patient. We pace down the hall together, toward my next patient, who’s already waiting. The man’s friend looks perplexed by my words; he needs more. I excuse myself a moment and ask the two men to have a seat in the waiting room. I perform a 5 minute paracentesis and return to them with a sheet of scratch paper.
I draw a schematic of their friend’s arteries. It’s no Netter diagram, but a cartoonish depiction of the vascular system, its multifocal occlusion, and its muscular collateral pathways. Their faces brighten with understanding, and concern. They confirm the patient has been having symptoms for at least a few weeks now. I explain the plan to look for the source of the problem with an ultrasound of the heart. I go a step beyond that which I usually might, when rushing to my next case.
Taking the time to illustrate what you have done is so helpful in our field, in which the anatomy and disease processes are opaque and often confusing to our patients. Drawing a picture to demonstrate a concept is not a novel idea, but one I could employ more often. As physicians, we constantly need to translate the technical and medical nature of our work into lay language for our patients. But sometimes it’s hard to put the concepts into words the patient can understand. I could point to a diagram on the internet, but this would be less impactful. What is happening to a particular patient, and his or her picture, are so personal.
That day, I could not cure the gentleman under my care. But for a moment, I was truly great at what I do. I was able to shed light on the problem, using some creativity. You can use your own gifts, whether skill with words, humor, illustration, or other means. When the patient’s friend shook my hand, thanking me heartily, it was one of the best parts of my day.
The path can be riddled with failures, even if you're doing it right. In this recording, I share some of my gaffes with you.