Takes One To Know One

12 06 2011


Warning: Certain details in this post concern a disease and may be a little bit graphic in description.  Reader discretion is advised.

We had an interesting discussion in class once, about whether as medical students we should try a watered-down version of the liquid concoction that patients drink to clear out their bowels before a colonoscopy. There were opinions on both sides, and mine generally sided with those who believe that as doctors we can’t possibly experience every procedure to understand what it might feel like for the patient, and even if we did, the experience may actually make us less empathetic.  One of the doctors admitted that he tried the solution and found no ill effects, so he really couldn’t relate to why his patients kept complaining about it!

That class, though, made me consider the importance of experiential learning – when is it appropriate?  And useful?

While it may not always be true that you have to experience something to understand something, sometimes it may help.

In med school, we are often told that our job is:

To cure sometimes,
to relieve often,
to comfort always

Truth be told I had some sense of what those words are getting at, but I think I didn’t quite understand the whole picture.

That is, until a recent bout of sickness.

I think it was a combination of stress from shows and school, the viruses and other microbes that had been stewing in me all winter, and my immune system constantly being weakened by the unfamiliar cold of Montreal that had finally given me the worst flu I had ever experienced in my life.

I felt so sick that I didn’t want to eat (which is as serious as a symptom can get for me, because that’s one of my primary methods of enjoying life), and then I felt chills and headaches so bad that I couldn’t even get up to walk 2 minutes to the pharmacy to get drugs that might have helped.  The worst of it, of course, is that I didn’t have people who could take care of me, and I had never really learned how to take care of myself during an illness like this.

I remember doing my research online to confirm that my symptoms were definitely caused by influenza viruses, and then I knew that the flu would be gone in five days, so my main plan was to just wait it out (with fluids, rest, Advil, etc), without going to the doctor, because he would tell me to do the same thing.

I took as few drugs as I could for the flu symptoms, both because I couldn’t make myself go buy them and because I didn’t want to spend the money.  I knew that I just had to wait five days.  It’s nothing, right?  Absolutely nothing.

Boy was I wrong.

Even if the time course of an illness is well delineated based on past evidence, such as in the case of the flu, while you experience the disease, it can be the most horrific experience of your life.  Even though I knew it would be over soon, I was so frustrated during those few days that felt like eternity, because my headache and hot/cold flashes prevented me from being able to sleep, and my illness completely annihilated my desire to eat.  Despite my belief that my mind could control the situation (i.e., mind over matter), I became very depressed and so frustrated because I knew I needed to eat and sleep to recover, but I could not do it, no matter how hard I tried.

And then, of course, it got worse.

I started getting bumps on my lips.  At first, it was just one little bump, and it was annoying, so I kept breaking the blister every time it would form.  Little did I know, but I think that blister was actually a cold sore, and by bursting it repeatedly, I let the herpes simplex viruses get out and about.  The result was that one little bump quickly turned into, and I’m not joking here, fifty bumps all over and around my lips.  I thought maybe I needed to go see a doctor at that point, but I felt so hideous and so lethargic because of the continuing course of the flu that I had even less desire to go outside.

I knew that the majority of the general population is carrying this herpes virus on their lips, but the reason why we don’t all have cold sores all the time is because our immune system is strong enough to suppress the symptoms of the virus.  Unfortunately for me, my immune system was under severe attack by the influenza viruses, and thus, it allowed for the opportunistic expression of the herpes virus on my lips.

I thought maybe I just needed to wait it out until my immune system fought off the influenza virus, then the cold sores would naturally resolve themselves.  Thus, my strategy remained the same: starve out the diseases.

Unfortunately for me, everything just got worse.  I continued to feel horrible from the flu, and the cold sores on my lips got so bad that my lips were just bleeding everywhere all the time, with pus and constant inflammation.  And worse yet, my gums and other oral mucosa were starting to get inflamed as well from the virus.  I didn’t know the virus could affect the inside of my mouth as well as the outside.

I felt awful and looked hideous, and I didn’t know what to do.  I felt so helpless, and thinking that it would all be over soon did not help me at all.  In fact, there were moments when I thought I would never get better.  I was no longer thinking logically.  I was no longer able to detach myself and think like a medical student.

I had completely become the patient, and it was only then that I finally admitted that I needed help.

I went to a walk-in clinic and waited for hours with bandages all over my mouth to try to cover up how awful I thought I looked.  I finally saw a doctor, and he prescribed valacyclovir for the cold sores.  He said that this medication is preventative so I should have seen someone earlier instead of waiting until this stage in the viral infection.  The funny thing is that I knew that fact already, and yet I still couldn’t motivate myself enough to go see a doctor before I felt like I absolutely had no choice.

Ultimately, and thankfully (knock on wood), I made a complete recovery, and I ended up, surprisingly, learning quite a few lessons about medicine.

My experience with the flu taught me that symptom management is extremely important.  Regaining functionality despite having the disease is what it’s all about (even if the disease is supposed to be short-lived).  When we can’t do things that we normally take for granted, like swallowing, life’s joys, including singing and eating for me, are greatly diminished, and that is extremely detrimental to a patient’s mental health, which further impedes recovery and healing, no matter how short the disease trajectory.

A really “mad case of the herp” – on my lips – taught me that part of what’s damaging is a disease’s attack on someone’s self-image.  My lips were like mountains of pus and swollen yellow on red, cracked canvas.  I couldn’t look myself in the mirror without cringing, and again, it did not help my recovery in the least.

Even though curing a disease is nice, and sometimes it’s possible, the most important lesson I learned as a patient is that the journey matters.  No matter how long or short the time a patient spends with a disease, how the patient is treated in the meanwhile – how they look and feel during the disease – makes all the difference.

Even if we think we know the endgame of a disease, the uncertainty is devastating, and the wait, as I found out, can be deadly.

And that’s why our goal as doctors is to relieve often and comfort always.

But the biggest lesson out of all of this?

I need to find me a GP in Montreal, ASAP.





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