A Spoonful of Hope

While I was back in Madison for the holiday season I thought I could use my time to shadow some physicians. I have also been hearing a lot more from my peers about exploring the option of osteopathic medicine and have started to wonder about it myself. My sister recently graduated from the Kansas City University of Medicine and Biosciences with her Doctor of Osteopathic Medicine, and I have had the benefit of hearing from her and her colleagues about their experiences. These two factors made me think it would be beneficial to see a D.O. at work. Luckily one of my mom's co-workers, and the Division Chair of Pain Management and Rehab Medicine at UW-Madison is a Doctor of Osteopathic Medicine and was happy to let me shadow him for a few days in the clinic. (I'll call him Dr. X).

Right off the bat I could tell that this would be a unique experience from the other shadowing opportunities I have had. Previously I've followed a neurologist on her inpatient service and a family practice physician who worked in a majority Latino community. Both had exposed me to a variety of patients, but for the most part they were either fairly healthy or  had end-stage disease. In contrast the patients we saw at the pain clinic were mostly elderly, with the majority having quite a few co-morbidities. From diabetes to smoking, obesity to cancer, these patients had all definitely seen a lot in terms of their health.

About half of the patients knew what their diagnosis was from previous visits and were back to have their treatment adjusted due to inadequate improvement. But the other half of patients who came in were looking for a diagnosis. As Dr. X and his resident worked through the standard questions and performed a routine neurological exam on each patient, I quickly became familiar with the signs they were looking for. Dr. X had me engage with the patients right away, and I started to learn just how each reflex is associated with a different level in the spine. In some of the patients I could feel the inflammation surrounding a herniated disc or see the subtle degenerative changes in the MRI. In terms of shadowing a Doctor of Osteopathic Medicine, I thought one of the most impressive aspects was just how hands on and personable Dr. X was with each patient. He was quick to isolate the pain on each patient, encouraging him/her to try different stretches and positions by demonstrating them himself. I was even lucky enough to see him use osteopathic manipulation on a young lady with "loose joints." Shadowing him was maybe the first time I had seen a physician be so hands-on in his practice, and I found it inspiring.

I was also excited to see just how beneficial it is to have a foundation in pharmacology; like I mentioned, many of the patients have co-morbidities and are on a whole host of medications. Part of each patient examination was devoted to figuring out if the side effects or drug interactions of certain medications were causing additional pain. One gentleman who came in was a retired professor and enjoyed social dancing, gardening and handy-work. We quickly bonded over our mutual love of ballroom dancing; unfortunately his constant arm and neck pain was preventing him from enjoying his hobbies to the full extent. I could feel his frustration at the peripheral neuropathy that had developed as a result of his recent chemotherapy. But I could also see the determination radiating from him to find some way to cope with the pain and enjoy his life.

Many of the patients were like this: distressed with their inability to meet their own goals but hopeful that the visit would elucidate some of their difficulties. Dr. X would spend around 20-30 minutes just talking to each patient, often asking about mutual acquaintances or other family members. Soon I found myself eager to hear about each patient's past medical histories, their life stories and their desires and goals for the future. Dr. X explained to me in between patients that it's important to realize what the patient really wants out of his/her treatment, and to learn how to approach him/her in a way that shows confidence and some level of control, while being completely honest. Whether he was explaining to a neurosurgery ICU nurse brimming with tears the importance of taking it slow, or he was trying to persuade a tenacious, older man (who "doesn't need doctors") that a back support would be beneficial, Dr. X was able to find a way to reach each patient in the way that was necessary.

I was truly astounded by his ability to comfort patients and asked him at the end of the first day how patients handled the news that they may be troubled by chronic pain for the rest of their lives. He looked at me carefully and stated very clearly that he doesn't ever let them give up hope. No matter what they come in with, most of his patients are willing and ready to do whatever it takes to find some relief. And therefore his primary job as a physician is to be their coach, be their guidance counselor, give them the hope that they are looking for. One of the last patients we saw demonstrated just how important this rule is: he had come in six months prior with pain from a protruding disk that was pressing on a nerve. By sticking closely to the recommended regimen of stretches, exercise and "taking it easy," he had been able to heal himself. The disk had reabsorbed the protrusion and he no longer had any pain. He may have been only one of fifteen patients we saw who was "healed," but he was an important reminder of just how hope and persistence can work.