The patient - a 25-year old woman with history of chronic constipation since childhood. Lacking her daily toilet visits, she felt compromised so much to quit university to look for a solution. She tried everything, she said, and it ruined her body - "like being thrown down from a cliff and have your body smashed," to quote her exact words. "My body is a machine barely functioning," she mumbled, staring into the air. If any consolation is to be sought, she is the definition for beauty for Taiwanese - snow white skin, clear complexion, almond-shaped eyes, slightly puckered lips. Hopes of small talk, however, was dashed with her matron mother standing guard 24/7.
"Yes doctor, we tried everything and they just don't work. Now she sneezes at the slightest wind and doesn't eat anything."
"You don't eat?" I asked, alarmed.
"I only take some sugar water and protein drinks. I think if I don't pass, I shouldn't eat,"
It is no wonder she doesn't pass motion. Because she doesn't eat at all!
"I wanted to ask about DNR, doctor."
"What about it?" Impatient after 50-minutes of "my body is smashed" and "I'm allergic to mint, alcohol, bad aura, and handphones."
"I don't want my body to be cremated too quickly if anything happens to me. I read an article and it says most people who died of oversedation will eventually wake up. Bodies of morphine overdose victims were usually found different from their original buried position."
A chill climbs up my spine. "There's nothing to worry about for your operation tomorrow. The anesthesiologist will do everything they can to NOT let you into oversedation, and we will take appropriate measures in the event that really occurs, which chances are very very slim."
After another 20-minutes of DNR and keeping my body fresh if I die, I am released from her ward full with suspicion that she, is indeed paranoid. She will have her large intestines removed the following day, a surgery that will end her nightmare of passing stool once every 30 days. But I doubt she will ever be satisfied with the surgical outcome and side effects - diarrhea, intestinal stenosis, anesthetic nausea, vomiting etc.
I flip open my Mini-CEX booklet for a score card. We have to complete one sheet every week, and she is my only patient this. I skim through the basic skills for scoring.
Humanistic qualities / professionalism / patient's perceptionsI certainly don't qualify on that, I said to myself. I personally think her constipation has more of a psychogenic or psychiatric component in it - think about it, her over-protective mother, her obsession about passing stool, and her not eating - where will the stools come from?
Item no. 4: the doctor respects my beliefs
from: Hauck FR, et al. Family Med 1990
And I do not respect her or her family's decision to seek alternative treatment, later complaining that they "ruined" her body, and expect us to magically correct everything with surgery or drugs. I have a strong urge to suggest they go see a psychologist, but we have to be so careful nowadays even suggesting a pregnancy test is demoralizing enough for the patient to say hello to medical lawyers. Medicine has become a service sector, where "the customer is always right".
I am not saying that I object to doctors respecting to patient's beliefs, but limits must be set. We are humans, too, and bending too much might just drive us crazy in this crazy enough environment.