by Jamie Weisman '98M
Photography by Victor Balaban
The Most Valuable Thing a Doctor Can Know
If I didn't tell you, you would have no way of knowing I am sick. I ride my mountain bike, work out on a Stairmaster at the gym (though not as often as I ought to), and sometimes I stay up very late studying. I got married last September; I recently graduated from medical school; I sleep late on Sundays and read the paper in bed with my dog curled up at my feet. In other words, I lead a normal life, except for the fact that once a month, I go into a room full of sick people and get an IV put into one of my veins. Through the plastic tubing of that IV, over the course of about three hours, I receive an infusion of gammaglobulin, or antibodies, to make up for the fact that, for some unknown reason, the antibodies I make myself don't work. This has been my monthly ritual for the last seven years, and I expect it will be for the rest of my life.
Before getting gammaglobulin infusions, I was constantly ill with infections, from sepsis to shingles. I'd had three operations, four lymph nodes removed, five bone-marrow biopsies. I'd been called a hypochondriac by my boss and been told by a hematologist that in all likelihood I have or will soon have cancer. I had visited doctors from Minnesota to Massachusetts seeking an explanation for my disease. At last, I was started on the protocol I currently follow. I give myself injections at home every other night before I go to bed. Next to the alarm clock and the lamp and whatever book I'm reading, there are a few syringes and alcohol pads so I won't forget my shots. And once a month I go the infusion room at the Emory Clinic to get my gammaglobulin, or my "juice," as my nurse, Sarah, calls it.
The infusion room at Emory is set up to be as comfortable as possible. The pink armchairs tilt back; the legs rise up. Televisions are suspended overhead with individual controls and speakers. The nurses who work there know us all by name. They are used to dealing with chronically ill patients. They keep track of birthdays, weddings, surgeries, the birth of grandchildren, check-ups. There are warm blankets and snacks, and if we fall asleep, a nurse will turn off the television for us, and we can snore. These are nice amenities, but the greatest comfort of all comes from the other patients.
The gathering of patients in the infusion room forms a sort of de facto therapy group, a place where we can share the burdens of our conditions without hurting family members or feeling that we are taking up too much of our doctors' time. In the infusion room, we're all on equal footing. We all know what it feels like to be put to sleep for surgery and that horrible sensation of waking up from anesthesia, a stranger calling your name, your body convulsing with the tube pulled out from your throat. We know the post-operative confusion; we've been seen naked by nurses and doctors. We know what it is to wait for biopsy results, to argue with insurance companies, to get sick from medication and have to take it anyway. These are the things we discuss, while we eat sandwiches and listen to CNN and swap gardening tips and movie reviews.
My monthly trips to the Infusion Center have been as essential to my medical education as any course in anatomy or physiology. My own experience with disease inspired me to go to medical school, but the patients I have met in the infusion center have educated me. They have shaped the doctor I will become. I know illness from the inside out. I know not just what goes wrong in the body-how the white cells start to divide out of control in leukemia, how the heart weakens in congestive heart failure, how blood clots clog the arteries in stroke victims-but also what this means for the human being who happens to be intimately connected to that body. I've learned part of this myself, through experience, but most of it I've been taught by the patients in the infusion center who have become my friends.
Just about everyone I see regularly [in the infusion room] knows I'm in medical school, and they take pride in educating me about the subtleties of their conditions. Nora describes her battle with chronic leg ulcers. "Nothing works," she says, "not bandages, not keeping them elevated, not blood thinners." Every time I see her, she rolls up her legs to show the wounds and instructs me, "Find a cure for this while you're at it." Another woman, Diane, has uveitis, an inflammation deep in the eye that makes sunlight horribly painful. She tells me, "I know it's coming when I wake up feeling like there's an ice chip in my eye. By that afternoon, it's flaming red." I know what I'm supposed to look for to diagnose uveitis, but I never knew about the ice chip. These patients educate me not just by showing me the full human dimension of their illness; they actually teach me, in words much clearer than textbooks, what their diseases feel like, look like, even smell like. Nora says, "I can't stand it. My feet smell like defrosting steak."
I, in turn, try to answer questions they may think are too stupid for their doctors: Who needs white blood cells anyway? How come I'm at risk for a stroke just because I have lupus? I try to help them, but in fact we help each other. Jennifer has lymphoma, and she's scheduled for a cord bone marrow transplant. She's nervous, and Emily, who's two months post-transplant and feeling great, warns her she's going to feel pretty awful from all the chemo before the transplant, but afterwards-she stands up and twirls-"Well look at me!" She takes her wig off her head. "My hair's even growing back!" I will remember both of them later when, on my dermatology rotation, I watch a lip biopsy on a bone marrow transplant patient to assess the success of the transplant. I'll stay in the room, and I'll know when she starts to cry because she's having difficulty holding the numbing liquid in her mouth that it's not because of this one difficulty. It's because of months and months of pain, sickness, and uncertainty. Our diseases overwhelm us at the strangest times. One patient told me that when it was all over, and she was in remission, she found herself crying in the grocery store as she tried to choose a jar of jelly for her son's sandwiches.
These are the kinds of things I've learned through my visits to the infusion room. You won't find them in a textbook. You may hear snatches of this wisdom secondhand from your attending physicians, but I am a lucky medical student, in an odd way. I have learned these insights from the patients themselves, on lazy afternoons when I have nothing to do but wait for a bag of liquid to deflate. Over the beep of IV pumps, the drone of the television sets, the soft whispers of nurses, I've been taught the most valuable thing a doctor can know: All illness takes place in a body which belongs to a human being.
Jamie Weisman graduated from Emory Medical School in May and is now starting her dermatology residency at Emory. She has won the Atlanta Medical Society essay contest twice, and her fiction has been published in national literary magazines. Her husband, Victor Balaban, is a doctoral candidate in psychology at Emory and a professional photographer. They are currently combining their interests and talents by collaborating on a book about Jamie's experiences during her internship year.
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