Blog | Monday, October 1, 2018

Pollyanna


Her: “Do you think we should do any more testing?”

Me: “I think we should check another round of cardiac enzymes, don't you?”

Her: “I don't know, Dr. M. The timing aligns with the crack use.”

Me: “That's true.”

*silence*

Me: “Cocaine accelerates coronary heart disease. So, like, even if you use, it adds risk both short term and long term.”

Her: “I get it. I guess I'm just trying to think through what we would do next, you know? If the cardiac enzymes are positive. Would we suggest cardiology come do a cardiac catheterization?”

Me: “If they are suggestive of an acute coronary syndrome? Yes.”

Her: “Hmmmm. But let's think this through. So then we do the cath and it calls for an intervention. And then the intervention calls for the patient to take anti-platelet medicines that must be taken.”

Me: “And that if they don't take them they'd be worse off.”

Her: “Exactly. So I am torn. This isn't because I don't want to advocate for the patient. It's actually because I do.”

*silence*

Her: “So what do you think?”

Me: “The same thing. Check them.”

Her: “Really?”

Me: “Yeah.”

Her: “And if the cardiac enzymes are positive?”

Me: “Consult Cardiology.”

Her: “For a cath? And intervention?”

Me: “Yeah.”

Her: “You wouldn't be scared of doing harm?”

Me: “I'm always scared of doing harm.”

*silence*

Me: “Listen. I should tell you. I'm a total Pollyanna. An eternal optimist, often to fault. So I want you to know that I truly get what you are saying. But I always have this little idea in my head that I can encourage the patient to quit. Like, if your heart depends upon it? And I believe right along with you that this isn't your lot in life and that you can recover? Yeah. I tell myself that this might be the day. The discussion that turned the ship around.”

*silence*

Me: “But I get it.”

Her: “I get what you're saying, too.”

Me: “You make great points.”

Her: “Let's check one more set. And if they are abnormal, we will cross that bridge when we get to it.”

Me: “I like that plan.”

*silence*

Her: “Hey Dr. M? What's a Pollyanna?”

Me: “You don't know what a Pollyanna is?”

Her: “I'm a millennial.”

Me: “Then Google it.”

Her: *smile*

Me: *smiles back*

Let's be clear: My resident is sensitive and empathic. And this discussion is as old as crack cocaine itself when it comes to ethical dilemmas at Grady. But regardless of that and all that I see, I can't shake my optimism. Some piece of me always believes that this might be the day.

Yeah.

I love this job.

Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.