PRACTICING AND LIFE MEMBER CATEGORY WINNER
2015 RICHARD SPEAR, MD, MEMORIAL ESSAY CONTEST
been healthy prior to this illness. He reported no prior known diseases, no recent fevers or illnesses, no toxic ingestions.
“Truck surfing,” he stated, rather plainly. He neither made eye
contact nor volunteered other information. I gathered from the
emergency room team that he had been competing with a friend to
see who could hold on longer to the side exhaust stack of a moving
semi-truck travelling on the highway. When the truck driver realized
this, he applied the brakes, and the young man fell at full speed onto
the asphalt concrete highway. The young man suffered intense trauma, with resultant severe muscle breakdown and kidney failure. He
required intensive care for several days. Afterwards, he recovered,
with normal kidney function and no long term physical injury to
remind him of his extremely poor judgment in recreational activity. I wondered what motivated him to carry out such a dangerous
action. Was it depression, ambivalence about his future, or simply
impetuous and foolish decision making? I reflected how unexpectedly fortunate this young man was, to walk away from such intense
trauma with minimal physical wounds, whereas similar situations
have resulted in dramatically worse outcomes.
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joy and personal growth that violence stole from her. I had only
focused on what I expected, the organic and neurological causes
of headache with a narrow differential. Sometimes recognition of
the unexpected is almost too much to bear.
These varied experiences show me that there is always a third
entity in the physician-patient relationship. It is the subjective,
personal part of health care, the underlying struggles that each
patient brings into the equation. These distinct and unseen concerns have a penultimate impact on the need for patient support,
delivery of health care and patient outcomes. My professional aim
is to recognize that the hopes, fears, and concerns of patients do
not automatically get discussed in between blood pressure, glucose
control, and blood chemistry results, yet they play such a pivotal
role in the overall effect of care. My goal is to recognize that in
every patient encounter, the unexpected is right in front of us.
Note: Nina Vasavada, MD, practices as assistant clinical professor
at the Division of Nephrology at the University of Louisville.
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In clinical practice now, I find myself in a marginally comfortable
space: somewhat at ease with recurring patterns of health and
disease, but still regularly caught off guard by new presentations of
illness, unexpected complications, and diagnoses that were only
remotely considered. The disconnect is often between the provider,
who wants better clinical outcomes, and the patient, who may seek
higher quality of life, better sexual function, and energy to complete the work day without medication side effects. Several patients
have explained that part of the joy of taking a vacation is taking a
“vacation” from their medications. Medication holidays, such as
missing diuretic doses so as to not interrupt Thanksgiving holiday
visits, make for predictably busy office and hospital services after the
holidays have passed. It is remarkable how expectations for plans
of care differ greatly between provider and patient.
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It has been 19 years since I was that third year medical student reading my young patient’s obituary. I re