Anecdotally Speaking

The superfluous, a very necessary thing. --voltaire

Tuesday, January 09, 2007


Medical Care, Caring for Patients

The patient is about my age. I do not know her well. She usually sees one of my partners, but on this day the pain was exceptionally bad so she came to the office to see me for some relief.

It is difficult for patients with chronic pain to see a new doctor for the first time. They have to start all over from scratch. Even with good medical records available they still have to explain everything all over again, answer the same questions again but worse, they must deal with the new physician's doubts and suspicions about the diagnosis, the treatment plan, even about their own veracity.

It is difficult for a physician to see another doctor's chronic pain patient. We all have our own problem patients and so we do not want to inherit another one. Besides, these patients tend to be complicated and time consuming and are often deceitful and manipulative. More often than not, most encounters end up with both parties being dissatisfied in one way or another.

This particular patient suffered from the condition of trigeminal neuralgia, sometimes still referred to by the classic moniker "tic douloureux." I was taught in medical school that this dreaded disorder was one of the most, if not the most, painful conditions known to man. Before effective treatments were available, patients apparently would frequently put themselves to death to escape the relentless agony that this disorder subjected them to.

I read this patient's record and listened to her story. She has been on every treatment possible in every combination imaginable. Most treatments at one time or another have helped to some extent. She has seen a neurosurgeon who thinks that surgery in the area of the nerve may be beneficial. She has a date scheduled for the operation and she is hopeful about the outcome.

She says something when she is telling me about the neurosurgeon that makes me think. She tells me that she can never really explain to people how bad this thing really hurts. Her family, her friends, every one she knows, they try to understand but she says no one seems to get it. It is as if they seem to think she is exaggerating it or making it up, and she feels hurt and cut off and lost.

It is not hard to know why this is the case. If this is indeed the most severe pain a human being can ever experience, then none of us has any frame of reference to relate to her experience. She is indeed alone in her experience. I am thinking what a difficult burden that would be to bear when she already carries an unimaginable one.

However, she told me that the neurosurgeon seemed to understand, that he "got it," and how that was such a comfort to her. I reflected on this. The neurosurgeon has never had trigeminal neuralgia, how could he communicate to my patient this sense of understanding of the unimaginable overwhelming pain she lives with day in and day out?

A quality that I think is essential to practice medicine as a physician is that of sympathy. Some may not agree, but I think to care effectively for a patient requires it. I am told that the term "patient" from the original Latin derives it's meaning from "the suffering one." Physicians help people, sympathy is essential.

However, not everyone possesses another quality. I do not know if it is rare or common, but some exercise it exceptionally well, and some not at all. It is the quality of empathy, to actually be able to understand another person's feelings or difficulties as if you were in their shoes. It is an ability to understand more completely, more thoroughly, more accurately, to identify and to relate.

I think that that is what the neurosurgeon accomplished. It is what I try to accomplish. To imagine what I myself will never experience so that I may understand my patient and thereby better serve them. I think empathy makes good physicians excellent physicians and I think patients are drawn to empathetic physicians.

My patient that day needed empathy, because without it she was alone and lost, oppressed with a horrible affliction. I did my best, I provided medical care for her.

When I interviewed medical schools for admission, they would ask, "Why do you want to be a doctor?" My answer of coarse was, "Because I want to help people." I certainly can elaborate on that answer, but very simply, it is what I do, I help people, and it is a great thing.

Patients with Trigeminal Neuralgia (TN) no longer have to feel alone and abandoned. The Trigeminal Neuralgia Association (TNA), a national non-profit organization which was founded in 1990 by TN patients and their family members, now serves over 30,000 patients world-wide.

TNA provides
*one-on-one support via a 1.800# (1.800.929.3608) or email (,
*support groups across the country and around the world,
*free information and educational programs, and
*a website ( which is the number one resource on TN and related facial pain conditions for patients, their families, doctors and other medical professionals, policymakers, and the public.

We also provide medical and dental professionals with training as well as information for their patients.

If you or someone you care about has been diagnosed with Trigeminal Neuralgia or another facial pain condition, please contact TNA for support and information. With TNA, hope will become a reality again.

Jane Boles
TNA Executive Director/CEO
I have had TN for 13 years. I have been on as many as 25 pain pills a day. The online support group I used got me through the worst of times as they truly did understand. It isn't just the pain. It's how the pain affects and changes who you are - and how that affects those around you - especially those you love. And how that, in turn, also affects you.

But it took my own researching (at the time) to find treatment information. The only neurosurgeon or neurologist who knew about Gamma Knife for TN was 500 miles from me. (I live in the Rocky Mountains.) I found him online.

Am so glad groups like Jane's exist! They do understand.

I had the GK procedure and have been 85% pain free for 6 years. I got my ability to live back.

Thanks for writing about it. And for caring. Good blog.
I remember where I was when I first became self-actualized. I was three years old and I had been lying in bed for about an hour. Then it happened. Afterwards, I walked into my living room and told my parents "I am not afraid of dying". I write this because your nature, David, is a reflective one. I wonder when you became self-actualized.
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