I have Bell’s Palsy: Part 4, What it’s like to be a patient (as a physician)
(aka what was going through my head when I woke up and subsequently sought treatment for Bell’s Palsy.
Yes, it was very different to be a doctor at the same time as being a patient. No question I was treated differently – an idea that is a bit uncomfortable actually, but I do appreciate how nice everyone is trying to be.
When I woke up on Saturday and realized what was going on, there was a bit of panic. “Shit, I have Bell’s palsy!” “What if my face gets stuck this way!?” and then quick realization that I’d need a prescription. I knew that steroids, if started early on, might help my chances of full recovery, which are good to begin with anyway, in theory. I thought about calling a doctor friend, but it was early and I should probably not put them in the position of having to treat me. I actually drove to the walk-in at the clinic I work at, not realizing it wasn’t yet open and not really sure I wanted to go in. I could have returned but I would have been embarrassed to go in anyway, and I wasn’t sure if the doctor that day would be as up on the evidence as the ER anyway.
My eye is so dry- I keep having to use my hand to force my eyelid to “blink.” My mouth is dry but maybe it’s just the numbness in my tongue that makes it feel that way, I don’t know. Is driving safe since my left eye is basically useless? I don’t know. I don’t really want to wake anyone to help me.
So, I drove to the ER. I abused my doctory privileges and parked in one of the many vacant “doctor on call-back” spots. I wasn’t on call, but I did want to be as close to the ER doors as possible so I could sneak in and sneak out without seeing many people I knew.
Arriving at the hospital, I see lots of nurses that I’ve worked with before. I keep apologizing to them, embarrassed to be taking their time, but also grateful that (I think) I’ve gotten along with them. I like them, and (I think) they like me. There’s no one waiting, so I get triaged right away; my lisping speech drags me through the Emergency Contact information and other intake data. I continue to meekly apologize. Saying a postal code clearly takes more effort than I had anticipated.
As instructed, I bring my chart over to the Ambulatory area and plunk myself down. I start to read my book, but keep reading over the same sentence. It’s so weird to be a patient here. Hearing doctors laughing, seeing ultrasound carts roll by, etc. I realize how sound travels there and how busy a place it is. I wonder if I was guilty of any audible transgressions when working Emerge? One doctor spots me, says my name and assures me they’ll see me in a second, and buzzes off. I’m again embarrassed that I am getting special attention. Granted there was only a couple of other people waiting and based on the position of the charts in the rack, they had probably already been seen or had arrived after me and were not sick. Still, there’s no question that doctors are treated differently. I would say treated “better” but I’m not sure that’s how I felt.
The doc comes and gets me, introduces himself formally (although we know each other), and invites me to sit in a room. History, exam, and then we talk about the plan. He’s a good doctor – young enough to be up to date, and old enough to have some experience under his belt. Of course, his neuro exam is different than my neuro exam. Things that I say that are important to me are not interpreted as important to him. I still feel we are talking about the same thing though. I briefly freak out when I misinterpret what he says – he said something like “you’ve got no forehead sparing” and I took it to mean the opposite which would be a bad thing (indicating a central lesion, like a tumour or stroke in my brain). Quickly I realize yes yes we are on the same page, I’m just on edge. I wonder, do my patients feel a bit tortured when I talk to them about serious stuff? Do I really put them at ease?
He tries to reassure me that I’m not having any tumour or stroke. I reassure him that I agree that it’s Bell’s Palsy. He invites me to follow him BEHIND THE COUNTER, aka, into doctor and nurse (not patient!) territory. I’m reluctant. I appreciate that he wants me to be involved in the decision making but in that moment, I just want to be fixed. My hesitant posture is not detected and a chair appears for me beside his. We sit and he opens UptoDate, probably the most trusted physician resource. He focuses on the the treatment section and prognostication. Together we read the evidence and negotiate a plan.
For most patients, they wouldn’t want to pay the $60 for an anti-viral for which there is limited evidence. Well, based on the pathophysiology of the disease and the few studies that suggest the drug may be helpful, I opt in for it. I could have a cheaper one if I could take it 5 times a day – which I could, I think I’m pretty reliable, if motivated by fear - but it wasn’t the exact drug that was marginally supported by the evidence. Then we figure out the steroid course; high dose then taper? High dose for 10 days straight? There’s no easy answer but what the computer says is probably keeping in mind that patients don’t like the side effects of prednisone. Well, I won’t either, but I’m happy to tolerate them in spades if a higher/longer dose offers better recovery potential.
We finalize the plan. I’m going to see an ENT for follow-up, but I am again not sure this is going to change anything. I’m reassured by the ER doc that this is not special and is part of his normal practice. I reluctantly accept. The ER doc and staff have been nice to me, definitely left with a sense of “okay, good, now I just have to wait” and less worries of “I’m an idiot for wasting ER time on this problem.”
I’ve got my prescriptions in hand, time to head to the pharmacy, where I learn a few more things . . .