June 14, 2024

Story 1: Problem Solving and Preparation

Originally Published on LinkedIn on April 5, 2024

My Mom was a little dynamo. She walked two miles multiple days a week, ran a bible study class, was a prison minister, and a lector at church. She had a cough for six months before her diagnosis. She went to her internist, who diagnosed allergies and sent her home with various medications. She went back every couple of weeks for months with the same diagnosis – allergies. She was coughing so hard at one point that she went to urgent care. Same diagnosis. I went with her multiple times and tried to impress upon the Doctor that this didn’t seem normal to me. I told them she was missing valuable time with her family, which wasn’t like her. I asked them to investigate further. They told me I was worrying too much. They listened to her lungs and heart, did a chest x-ray, and told her to return in a couple of weeks if she didn’t feel better.

I took her to my allergist twice, but he couldn’t find anything she was allergic to. He concluded that the cough resulted from irritation caused by the cough. Six months after the cough started, she was referred to a pulmonologist who looked at the same tests that the others had looked at and ordered a CT scan. What made her so smart? Something her internist should have known.  I learned later that if you have ever smoked, you should have a chest CT once a year. Like most Americans, my Mom had been a smoker. However, she had been smoke-free for 35 years.

The results of the CT were disturbing, so the pulmonologist ordered a PET scan. After the PET scan, my Mom made an appointment with her internist to review the results because her pulmonologist was on vacation. When we were called back, the nurse noted we were there for the PET scan results. Once in with the doctor, he asked – “so what brings you here today?” The nurse reminded him of the purpose of the appointment, and he responded that he hadn’t looked at the test results yet. He pulled them up on the screen, spent approximately 30 seconds looking at them, and then announced that it was metastatic cancer. My Mom said she didn’t want to spend the remaining time sick from chemo, and the doctor asked if she had a DNR. My Mom said no, and he instructed the nurse to get one. He and my Mom signed it, and we were out of there in 5 minutes. She gets a death sentence, and they don’t even talk about the options or the expectations of what those six months would look like. I watch the news and hear stories about treatments that don’t necessarily make you sick. I tried to ask about those options, and the Dr. was busy signing a DNR and telling her to pin it to the back of her door where the Rescue Squad would see it.

I hate this guy.

Most of the time, things are what they are supposed to be. Every once in a while, they are not. Many people in Richmond have allergies, but it’s not normal to cough for six months. If you go through the motions of your job, you will only see what is most likely. Great employees, including sales reps, keep asking why. Why is this still happening? Why didn’t the first solution work? What can I do differently? Apparently, her doctor didn’t think in those terms. He assumed allergies because everyone in Richmond has them in the Spring.  When her cough continued through the summer and fall, he didn’t try to figure out why. He wasn’t willing to question his judgment when my Mom and I asked if the cough could be something besides allergies.

Second lesson: be prepared. When I think of my Mom getting in my car that day to head to the doctor, I want to wring the doctor’s neck. She was worried but hoping for the best. The damn doctor could have looked at the report before he walked into the exam room. The nurse knew the appointment’s purpose, and I assume that was because she saw it in their system, the same system the doctor uses. He could have looked, and then maybe he would have led a more thoughtful discussion following his death pronouncement.

Maybe his lack of preparation is why he let the cough go for so long without doing anything. Perhaps he wasn’t looking at his system data and seeing that she had been in and out of his office for months. Maybe he never noticed that he had prescribed antibiotics, steroids, various other allergy medications, and cough medicines, none of which had worked.

We all have tons of information at our disposal. It’s there to make us more informed and help us make better decisions. But those won’t happen if you don’t look at it and think about what it means.

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