A Disaster of A Doctor's Appointment

Earlier this week I had an appointment with a pain specialist.  I'm still having a difficult time controlling my pain so I had a great deal of hope that this doctor would be able to help me.  What happened during the appointment left my family and I almost speechless.  In fact, we (my mother, father, Nate and I) left there happy and smiling.  The next morning, after we had time to process what had transpired, we realized that the appointment was not only a disaster, it trumped the appointment with Dr. No Bedside Manner (an earlier blog I wrote in January).

The appointment was scheduled for 2:30 in the afternoon.  We arrived at 2pm (as instructed) and were told that the doctor was running about an hour behind.  We smiled and told the nurse that it was no problem and we were happy to wait.  After all, we have been to enough doctors to know that a little bit of a wait is just part of the process.  Three hours later my parents are starting to get anxious that we are still in the waiting room.  After four hours, they call me to have my blood pressure taken.  There was a patient who had been waiting for a long time as well to see the same doctor and he became agitated to the point where the doctor came out to speak with him.  This was my first glimpse of 'Dr. Strange' (my new nickname for him).  From where I was sitting I could see the interaction between the patient and the doctor perfectly.  The patient is explaining that he is a diabetic and he needs a certain shot and he's been waiting for hours already.  Dr. Strange offers to move him into another waiting area and informs him that he has other patients waiting and if moving to another waiting area doesn't suit him, he can come back another day.  The response from the doctor was far from apologetic, it wasn't even empathetic.  But what was particularly bothersome was the smile that Dr. Strange had on his face.  It was a wide, teeth showing kind of smile; completely incongruent with the situation at hand.  To say it was inappropriate is an understatement.  I say to myself, "He's a little weird, but if he's a good doctor that takes away my pain, I'll wait the 4 hours and put up with the odd smile any day."

Next, my parents and I move into a room and we are seen by the physician that is the fellow working with Dr. Strange.  A fellow is a doctor that is specializing in a particular field of medicine.  Dr. Fellow was great.  He listened carefully, grasped everything that we said, made some great suggestions, and looked at the tumor inside my ear.  He happened to know my mentor and asked how I knew him. I told him that I was a student of his in the doctoral program at CAU.

About 20 minutes later Dr. Fellow and Dr. Strange both enter the room.  Dr. Strange still has the creepy smile on his face.  Dr. Strange greets everyone in the room  and then he says to me, "So you're a psychologist."  I tell him no, I'm a psychology student.  I realize that he either spoke very little to Dr. Fellow, or he just doesn't listen when people speak.  Throughout the visit he kept referring to me as a psychologist.  I conclude that he's just not a very good listener.  At one point my dad and I say something about psychologists and insurance and I say how that's a double edge sword.  Dr. Strange responds by saying, "Yeah, every time I see a psychologist I pay them in cash; try to help the poor guys out a little bit."  I had no idea what he was trying to communicate so I said nothing.  But looking back I speculate that he might have been saying he views psychologists as charity cases?? Seriously!? (Side note to mentor - I can't believe I forgot to tell you that one!!)

He starts the consult by asking what happened, what medications I'm taking, what's happened since radiation etc.  He then asks how many Percocet I'm taking and I tell him that it depends on my patch day.  By the third day of the patch I'm taking 1 percocet every 2 hours.  He askes, "How many is that?"  I tell him, "Well, it's not really exactly like that because at night I don't take 1 every two hours."  Meanwhile he is interrupting me asking how many is that over and over again.  Everyone stays quiet for a second - we're all confused that he can't do the simple math.  I then say 12 but really it works out to about 9.  He concludes that I'm taking too much Tylenol.  When I tell him that while I was hospitalized I was taking 2 Percocet every 4 hours (I'm trying to communicate that none of the doctors had a problem with the amount of Tylenol I was taking), he asks, "How many is that?"  After skipping a perplexed beat, I say, "The same amount."  He responds by changing the subject and says, "Maybe we should give you a dose of 50mg for the patch." About a minute before this statement I had explained to him that my oncologist told me to try two 25mg patches if one didn't give me full pain relief.  I overdosed on the two patches.  Clearly simple math is not Dr. Strange's forte.  My dad reminds the doctor that I overdosed on the 50.  Dr. Strange (perhaps slightly embarrassed, but still smiling freakishly) says, "Well we want to keep doing what is working." Someone should tell Dr. Strange that patients see him because whatever they are doing is NOT working!  So he then suggests switching the patch to every other day instead of every third day and switching the Percocet to 1 every 4 hours (a lower dose of Percocet than I've been on for a very long time).  Before I could digest the information, he asks, "What does the tumor look like?"  I tell him that it is the largest my physicians have ever seen for the type of tumor they believe it to be and it's amorphous in shape.  He then says, "Is it like a golf ball?"  Everyone in the room stays quiet for a couple of seconds.  Most people do not come up with the image of a golf ball when you say large and amorphous.  I respond with a description of how it goes from the base of my skill to my eye balls without actually reaching my eyes, down my neck, and out through my ear.  Dr. Strange then goes on to explain how there is not a particular pill for a large and a-typical glomus tumor.  We all just stare at the doctor wondering if he's trying to make a joke.  He continues to say that he's going to start me on a medication specifically for nerve pain.  Dr. Fellow has already explained that this medication does not work like Percocet or other medications designed for acute pain.  It needs to be monitored and titrated for the patient.  Dr. Strange doesn't mention anything about titrating the dosage.  Next the doctor wants to look in my ear to see the tumor.  I notice that he doesn’t place the sterile cap on the equipment.  He takes a look without actually placing the device in my ear.  I know that the tumor is deep and there is no way to see it without actually placing the device into my ear.  Dr. Strange says nothing about the tumor but he asks if anyone has tried to remove the wax (which is all he saw).  I tell him no, that we have seen several ENT specialists and they have all insisted that we not touch anything inside of the ear – BECAUSE THERE’S A TUMOR (with a large blood supply) IN THERE!  While Dr. Strange is pretending that he saw the tumor and digesting that his patient just stated the obvious, I ask him when he thinks I will be able to return to my "normal life."  The medications make me drowsy and my mind is not as sharp as it normally is.  He completely dismisses my question and tells me that he doesn't even tell patients that they can't drive on Percocet.  He states that these medications don't have any effect on cognition.  As someone who is experiencing the effects of these medications, I can assure you that the medications affect my cognition.  I can tell that pursuing this course of conversation is not going to get me anywhere with Dr. Strange so I drop it.  He then prints the prescriptions and shakes everyone’s hands goodbye.  As he's doing this he says, "It's always nice to have someone with you when you come, but maybe not all these people."  My father then notices that he's wearing a little girl's picture on his lab coat and asks if it is his daughter.  He says, "Yes, do you have any more children?"  My father responds, "I have 5, this is my oldest."  Dr. Strange then says, "Damn Catholics!"  His response was so out of left field that we all laughed.  But looking back it was highly inappropriate.  Then, I ask the doctor, "When do I see you again? Do I need to make an appointment."  His response was, "Well, don't be a stranger."  We left there without a follow-up appointment.

The next day I had individual conversations with my parents and Nate asking them what they thought of the appointment.  Everyone agreed that it was a disaster.  Dr. Strange was beyond odd.  We had a good laugh reminiscing about the crazy things that had come out of this guy's mouth and his inability to do simple math.  We wondered why we had left there happy and smiling and concluded that it was just so shocking and we had been worn down after 4 hours of waiting.

I'd be a hypocrite if I didn't consider that Dr. Strange may have just been having a particularly hard day and while most doctors would have canceled their patients for the day, he was considerate enough to keep his appointments.  I don't know what the events of Dr. Strange's day were that led up to my experience at that appointment.  I wish Dr. Strange the very best and hold nothing against him.  But the bottom line is that I simply can't trust Dr. Strange with the one aspect of my condition that largely controls my current quality of life.  The day after I saw Dr. Strange I made an appointment with another pain specialist.  I am seeing him this Wednesday.  Fingers crossed that the consult goes much better! 

I thank Dr. Strange for providing me with a good story to tell and I thank my parent’s and Nate for being there with me as my witnesses.  Otherwise I don’t think anyone would believe this craziness!