Progress

GW was here today. He had a stroke last year. It left him with almost no deficits. However, it did leave him with the determination to stop smoking. He hasn't had a cigarette for nine months. Sometimes, people stop smoking. I'm not sure that it's because of anything I did or didn't do. I try, of course, to help people to stop smoking. I'm pretty sure that the stroke is really the thing that got him to do it. Strokes have a way of being very persuasive. They are even more persuasive than doctors. Anyway, it doesn't really matter what got him to stop it. He did it. It's inspiring and it makes the people who practice at medicine happy. We win little battles in medicine.
Well, anyway, GW tells me that he has purchased a treadmill. I suspect that the next time I see him he's going to tell me that he exercises. I did tell him that would be good for his health. His stroke told him the same thing, so that's two of us working together on the project. I asked him to go on it for five minutes a day. This is a great exercise program. It's great becuse it's manageable. Sometimes people want to have these giant undertakings. Nature isn't like that. It works slowly. It makes progress one step at a time. It's kind of similar to the practice of medicine: every once in a while there is a small success. Then we have to remember that it isn't that one person out of the twenty or thirty or forty (in some cases) patients that we see who is doing well. It's one person who has had a major change in their life. Someone's life has changed. There isn't any more than that can happen. That's progress.

The Other Thing

MW was here yesterday. She has been my patient since about 2000. She had several strokes. She is diabetic, hypertensive and obese. She had developed stroke-related Parkinson's at one point, but it cleared up. She has neuropathy from the diabetes. She has developed moderately severe dementia. Her husband is an excellent care giver. He keeps track of everything about her. He always brings her medication list and provides an excellent history about her. He is actually also a patient of mine because he had Guillain-Barre syndrome a few years back - I see him for his issues about once a year or so. He had a heart attack a few weeks ago. They wanted to do an angiogram but his nephrologist wouldn't let them because he thought that the dye would ruin his kidneys and cause renal failure (he only has one kidney). My wife is fond of saying that if you worry about something it will be the wrong thing to worry about. Well, Mr. and Mrs. W have always been worried about Mrs. She has been "clearly" the "sick" one that they need to tend to. I guess they should have been worried about "The Other Thing". Of course the trick is that we never know what "the other thing" is going to be until it is.

Everyone is very busy worrying about all of the wrong things much of the time. I know that worrying is not good for our health. I don't know if they worry everywhere or if it is a very "American" thing. It seems that there isn't enough "inner peace" around these days. There is too much "wanting" and "worrying". I think that they are related. With increased "peace" we can accept the illness that is there now without worry. Those of us who can do that seem to do better.

I told AM yesterday that she would do very well with her knee surgery. I know that because she is that way - she accepts the illness that is there without worrying about it. It's a rare trait among my patients.

Wednesday Sickness Levels

KW and FW (married) were here today. They are both having nerve problems: one in the hands and one in the feet. PN was here, she has Parkinson's with autonomic features. She is fainting again. She doesn't take enough fluid. BM (I know, bad initials) came in for pain from neuropathy which was a little worse. KC was here. She has Lupus, and I'm worried it may have affected her brain. Actually she has seizures from it, but now something else is up. VR came for follow-up from his stroke. He has aphasia, so he can't talk well and he gets frustrated at times. He went to speech therapy and that helped. LW came in - I don't know what happened to him or what he had. I had thought at one time he had Parkinson's, but I was wrong. I think he had drug-induced parkinsonism that I diagnosed wrong. I'm not seeing him again for a year because he is doing great. CL came in because she doesn't want to have back pain after surgery that she's going to have in two weeks to take out her kidney (she has cancer in her kidney). There's not much I can do for that, though. HN came. Her husband (he was my patient) died from Myasthenia Gravis (MG) because someone told her that his symptoms of swallowing trouble were not related to MG so he went into a "Myasthenic crisis". Anyway, she's doing better now. She gets migraines. There were three new patients today, all with nerve problems - either neuropathy or post-herpetic neuralgia.
Everyone who sees me is "sick", or they wouldn't see me. (Although there are a couple of people who insist on coming in even though they are REALLY not sick. I've tried to tell them that they don't have to come in here anymore and they just show up sooner than if I schedule them for a follow up. They develop some sort of new problem.) But there is a certain degree of "sickness" that I expect. In the morning I look at the schedule and see who is coming. Then I know how much "illness" there is. Today there was a lot less illness than expected. This is good, because it's harder when there is more than expected.
Anticipation is very interesting. It puts the reality we experience in context. We need to try to see what happens as what happens rather than as what happens compared to what we are expecting. Obviously, I don't do that very well with my days. I anticipate how much illness there will be. So at the end of the day today I am happy because the day was "easy". No one was "sick". For someone to be "sick" they would have to be worse than I expected. If they are better than I expected, then they are "doing well" - that isn't "sick". Perhaps my happiness is a "good thing" but it isn't really. It's there only because the events were favorable compared with the expectations.
I'm going to try not to anticipate how "sick" people are "supposed" to be.

Holiday Dying

Happy Thanksgiving! Two people died. Neither one was a patient. One died Wednesday and one Thursday. They didn't realize, I suppose, that they were dying during a holiday. One person had a ten year old daughter, the other a fourteen year old daughter. It was Mothers of daughters that died. One had very malignant cancer throughout the bones which was discovered only a couple of months ago, and the other one had very severe liver failure. The liver failure mother died in surgery receiving a liver transplant. That's always so difficult, because people get very excited that there is finally a liver. There is a severe liver shortage (actually, there is a shortage of all organs for transplants) so people wait a long time for a liver. It means hope, not death during surgery.
I don't really like mothers dying. It's a difficult thing. It's hard to see the good in Mothers dying. Of course, we all die and we all know that.
It's hard to see the good in people dying at Thanksgiving holiday.

The greatest challenge that we face is the dying. There is only one way to react: be nice. If we can go to the funeral and say "I was the best friend that I could have been" then we can do no more. I see many people who are near death and they know it. Either they know because of their illness or they know because of their age. Those who report that they are "ready" are those who were nice. They did everything that could have been done to be nice to those who they met. Those who fear death, on the other hand, are those that were probably not as nice as possible. This is how we deal with our personal death. It's like that for the death of the others.

The part that has really no obvious solution is the empathy-suffering for the children. Now there are these two young girls without mothers. Of course, there's nothing that I can do for either one of them. I guess that if I could be nice to them it would help a little bit, but only a very little bit. It is our nature to want to take away that sort of suffering. Of course, we can't. The only thing we can do is to be nice.
It's not always enough, it's just all that we can do.