117. Do Something

36 year old Ashley recently ran a marathon.  She is 5-5 and weighs 130.  Her first words to me are, "people say I look pregnant. I need you to do something about it" 


Internal scarring from her two cesarean deliveries cause a retraction of subcutaneous tissue at the site of the incision, with a subsequent small bulge above the incision.  I acknowledge that scar tissue has resulted in unwanted anatomic changes.


But I don't tell her that she looks pregnant.  And I can't how imagine friends or co-workers could come to that conclusion.  Are they feeding into a serious self-image problem?  Or is she making it all up to stir me to action, thinking, I guess, that I can perform or approve some type of corrective surgery?


My options:
1.  Reassure her: "No, you look fine; your friends are just jealous."
2.  Pass the buck: "We don't have cosmetic surgery here, you need a cosmetic surgeon."
3.  Tell it like it is: "You have a body-image distortion."
4.  Or, a Rogerian:  "I see what you mean; sounds like you are really frustrated to have worked so hard but still short of your goal."

116. Memory

Talk with 88 yr old Rose for five minutes, about the weather or the goings on at her retirement home or her current medical problems (bladder, it appears), and you think, that's how I want to be like when I'm 88. Her eyes sparkle and maintain contact with whoever is speaking.  Hair in place, rosy cheeks, a straight back.

Then you ask about some bleeding that she apparently experienced recently, and she just shrugs her shoulders and says, "You know I have early Alzheimer's, and my memory isn't worth anything."

Sometimes Alzheimer's wears the face of depression, confusion, a wordless inward withdrawal; or sometimes anger and frustration and stubbornness.  But there can also be an engaging and seemingly engaged senior who just can't seem to remember anything that happened yesterday or the day or the week before that.

Memories.

115. Independence Day

Seems only reasonable for a themed post.  We are all into patient independence these days. Forget "paternalism," where the doctor made all the decisions not only about the course of treatment but also whether or not the patient should even know the diagnosis.  Forget "informed consent," where the doctor still made the decisions but at least informed the patient who then gave consent.  Welcome "shared decision-making," where all the options, risks, benefits are laid on the table with a full discussion and then a consensus decision.  I suppose the next stage in this progression is, "you've googled it, tell me what you want me (the doctor) to do."

So, a 26 year old walks in and says she wants a hysterectomy because of painful menses.  She's already had a tubal ligation, so she's made it clear that she doesn't want/need her uterus for it's natural function.

Removing the uterus doesn't guarantee absence of pain.  "I know that."  And there are potentially life-threatening risks to major surgery.  "I know that too."  Can we keep the ovaries intact?  "No."

Okay, how does July 25th sound?