heartbeats

Today one of my patients asked me how long I'd been a doctor. I get that question frequently in resident clinic, because they know we're all in training. Sometimes I want to answer that I'm not one yet. Other times, I want them to stop giving me a hard time. Today, I just told him how long, which is not very long.

The patient asked, "Do you like it?" I said I did, and that I didn't take it for granted, and that I was lucky to get to do something I love. He nodded fervently and said, "Yeah I used to be a computer repairman, and I used to just jump out of bed every morning, I was so excited to go to work every morning."

I thought that was nice, and a nice surprise.

Towards the end of our conversation, he was sort of starting sentences but not finishing them. I said, "Is there anything else going on?"

He asked defensively, "Like what do you mean?"

I shrugged. "I don't know. You just seemed like you had something more you wanted to tell me."

He then told me he was embarrassed. I thought, here we go, and braced myself for some unnecessarily explicit conversation about sexual dysfunction. As usual, I was wrong. He told me he was embarrassed because he'd been clean for a long time, but this past month, he'd been feeling down, and done cocaine a few times. A tiny little detail that changes the entire appointment- the guy has a mechanical heart valve and an underlying condition that makes him prone to cardiac problems. He absolutely can't be smoking cocaine if he wants to stay alive.

Interesting where conversations take a doctor and a patient behind closed doors.