On being a patient (as told in three health care interactions)

25-year old male presents to orthopedic sports specialist to image and diagnose a three-year history of R wrist pain upon flexion. No pathological findings upon MRI scan and review.

The year after graduating college, I worked jobs around Boston and lived in Southie. I drank socially and often because I didn’t know what else to do with myself when not working. As recent undergrads we continued our more bacchanalian habits for a bit.

A particularly raucous night, after drinking more than my fair share of gin, I gave out one too many enthusiastic fist bumps and woke up the next morning with a very sore right wrist. Flexing it hurt quite a bit, and it was very difficult to bear my full bodyweight in a plank position for weeks afterwards. Rest, movement, and lots of massage helped, but it had been a lingering pain and ache for the following three years.

With a medical school acceptance in the mail, my parents worried that an underlying issue in my wrist would affect my ability to perform medical tasks and procedures. So, I went to my PCP and asked for a referral, to ensure that things wouldn’t get worse down the line.

Meeting with the ortho, he skillfully examined my wrist, taking it through a number of practiced reflex and range of motion tests in rapid succession. Taking a very genial and almost fraternal, brotherly approach to the interview, he casually asked me about my activities, the pain associated, and my relieving factors. Watching him look at the x-ray films, I could see his brain working through the two angles of my wrist to piece together a diagnosis.

“Inconclusive,” he concluded. He suspected a fusion of my lunate and triquetrum, two small bones of the wrist: this would be very rare and would need an MRI scan for a higher resolution image to confirm. With the orders in place and a follow-up scheduled in two weeks’ time, I leave his office with the understanding that my wrist is alright, but potentially interesting.

“You’re not as special as I thought,” he said– leading the next appointment with that, I was a bit confused. Clarifying, he means that my wrist doesn’t have the carpal bone fusion that would have been unusual. A bit glad, but feeling like I somehow inconvenienced him: he says to continue what I’m doing unless it gets significantly worse.

24-year old male presents to PCP to establish care, of good health and no additional interventions recommended– patient requested baseline bloodwork drawn.

While applying to medical school and living up in NH, I fast approached the end of coverage under my mother’s insurance plan. As 25 drew nearer, I made sure to milk the plan for all its worth with a trip to the dentist and physician. With my relatively itinerant lifestyle the past few years, I didn’t stay long enough in one place to develop a relationship with a primary care provider (PCP).

This is how I met Dr. Issam El-Bizri one cold March morning in Portsmouth, NH. He practices out of a small office building, near the Portsmouth Regional Hospital main campus. Filled with other medical offices and related businesses, the walk to the third floor consisted of long fluorescently-lit hallways and white walls without much personality. The waiting room was equally sparse, but packed with a delightfully diverse slice of the seacoast’s population. Young and old, temporarily-abled and disabled alike, it felt more like a NYC subway train rather than an NH medical office.

Dr. El-Bizri knocked on the exam room and strode in: a handsome and bearded man of average height, tanned complexion, and if I had to guess, about a decade older than me and in good health. Shaking his hand, he invited me to take a seat while grabbing a yoga ball, sitting on it, and preparing his clipboard. Slightly accented, he introduced himself and asked me about myself in a casual, conversational style.

Looking back, with a few doctoring sessions and filmed interviews with actor-patients under my belt, I’m impressed with his ability to get me to open up. The cadence of his voice and his demeanor overall put me at ease very quickly, and his progressive and preventative tilt got my interest.

He asked me about my diet, my exercise, and even if I meditated– something I never thought I’d have a medical professional ask. It was fun talking to him and he expressed the same, saying that he helps me optimize rather than battle chronic diseases and that my health is on a great path if I can keep it up. I requested some bloodwork, including a lipid panel to gauge the effects of a diet that is high in fats, and testosterone and thyroid hormone levels to benchmark as I age.

In parting, he mentioned that if he were to do it all again, he might not enter medicine. The hours and the lifestyle are tough, especially if you like to roam the outdoors like he does, and that perhaps a coach’s life would better suit him. I could tell he was very good at doctoring, and that he obviously cares, but there’s only so much that a single mindful physician can do.

20-year old male presents to ER complaining of unrelenting coughing fits of unknown etiology, unrelated to respiratory infection, for past three days. Upon oropharyngeal inspection, a mass is noted on the posterior wall. Extraction with forceps revealed the cause to be a lodged popcorn kernel shell.

At the end of my rope, I decided that I needed help and that I shouldn’t wait to schedule an appointment with my PCP.

The coughing had been interrupting my sleep for the past two days, starting without any gradual onset or sniffle– I simply began coughing and hadn’t stopped for almost seventy hours straight. The soreness in my diaphragm came to the forefront of my attention every few minutes with a powerful spasm. A headache began to loom from the constant, regular spikes in blood pressure from the coughing fits. Luckily, I had no responsibilities because I was home for Thanksgiving break during college, but that also left me with few distractions from the coughs.

I had no idea what was going on– it felt like I was trying to cough something up, but it never came out. I felt a scratch in the back of my throat, but a blind sweep with my finger had no positive or negative effect. Cough medicines and throat lozenges held no power here.

I drove myself to the local ER, because no 24hr urgent care centers were open over the holiday weekend. The ER waiting room was empty, with a local news channel playing in the corner TVs. After a wait, I met with a nurse who took vitals and a quick history of my odd illness. He then passed me off to the physician, who took a quick look at my throat and she told me there’s something attached to the soft tissue of the pharynx near the uvula, the hanging bit.

After a considerable amount of fussing, I relaxed enough for her to use a pair of forceps/tweezers to grab the mass– my gag reflex seemed heightened due to the coughing, so this frustrated her quite a bit. The relief was immediate and complete: no more need to cough. Looking back, I recalled that I had watched a movie earlier in the week at the theaters and had housed an impressive bucket of popcorn during the screening. A halved kernel shell had lodged itself against the flesh of my pharynx and my natural and persistent gag reflex had failed to remove it.

Terribly humbled, I traveled home to tell my family that a bit of popcorn had brought me to my knees.

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