Monday, August 6, 2018

Cancer: Bedside Manner

We saw two oncologists, a surgeon, an anesthesiologist, and seven or eight nurses of various levels of competency since the diagnosis. Not counting the local doc and his nurse who first put us on this path.

House and Wilson. Whatever you do, DO NOT
Google their fanfic. Trust me on this. 
We have also watched 8 seasons of House, starring Hugh Laurie and Robert Sean Leonard as Gregory House and his oncologist colleague, James Wilson. Here’s what our take-away is: the pretend doctors, even the made-up, grouchy-pants ones that are written so as to be assholes, still have better bedside manners than most real doctors.

There’s a reason for this: in fiction (or more specifically in this case, in TV shows and movies), it’s necessary for the audience to understand what the plucky schoolteacher or the recently widowed father of a really bright little girl is going to have to face in fighting this terrible disease. So the pretend doctor outlines in very simple language what’s going to happen in act two (and maybe act three or act four, depending on the narrative structure). This is also done to introduce conflict and tension into the story, which will be ratcheted up, stair-step style, as the story progresses. We get the blow by blow from one or more of the supporting characters; “She’s having a seizure! That can only mean... it’s spread to her brain!”

We get all of this to draw us into the story, and by the end of it, when House or whomever gives the patient, now wrapped like a mummy and suspended from wires to keep from bursting into flame, jams a hypodermic into their arm and injects them with Plot Device Cure #23, and the symptoms immediately go away, and the young teacher opens her eyes and asks if her students passed the midterm test, we all breathe a sigh of relief and then we change the channel.

Yeah, none of that happens in real life.

I always feel like I'm doing it wrong. Thankfully, we
haven't run into Nurse Ratchet...yet...
Someone walks into the room, usually a nurse, and starts speaking in media res, “ you’re going to want to wear gloves and socks with grips on the bottom, since you’re going to be so woozy. You may lose your balance. Also: do you have band-aids?”

Excuse me? Do you have the right room? We tell her we don’t know what she’s talking about. The nurse looks confused. “Haven’t they gone over the protocol with you?”

“No. We just found out it’s some sort of cancer in the ladybusiness.”

The nurse scowls. “They were supposed to go over this with you. Have you been scheduled for chemo yet?”

“No, again, we just found out today. Like, fifteen minutes ago. The doctor is making phone calls.”

Now the doctor comes in and tells the nurse in the room to make the calls he was going to make when he left. He turns to us and says, “Okay, so we’re going to do 9 to 12 weeks of chemo, followed by surgery, and then more chemo as a follow up. Sound good?”

What? Do we have a choice? And why are you speaking as if we’ve been having this conversation for weeks?

I am only exaggerating a little. Mostly. I’m not unsympathetic to their side of things. After all, we are just one patient among the ten thousand they have to deal with. And cancer treatment is so documented, so regimented, so “by the numbers” now that it’s like stepping on a conveyor belt. So, when you want to get off of the belt and ask where the machine is taking us, they get confused, and a little put-out. After all, they’ve done this a ba-jillion times before. I joked with more than one nurse, “Please forgive us if we are asking a lot of questions. It’s our first cancer.”

They don’t laugh. They never laugh.

This admittedly impressive and exceedingly professional machine needs one extra cog in the mix: someone to sit us down in a room and say, “Okay, what do you want to know?” Our final doctor, the gyno-oncologist, did that, but everyone else has acted like Winston Wolf from Pulp Fiction. And I felt a lot like Vincent Vega (do I even have to say this is NSFW?):

Time is of the essence, and the sooner the better. But we needed thirty minutes to an hour to just sit with this and think about questions and ask for timelines and basically get our heads around our lives now being centered on these weekly treatments. Oh, and paying for all of it, too. This isn’t cheap. The first part of this three-step plan has blown through our deductible, but we’re on the hook for a few grand. All before the surgery. You’d think they would want us calm and collected when they hand this dump truck of information over.

I wonder if it’s too late to ask for Dr. House and Dr. Wilson?

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