This is Not a Lending Library

The first time it happened, I was convinced that the book was somehow misplaced.  We had had an open house in the department, with large groups touring our new and very high tech facility.  I thought perhaps the cleaning service had tucked the book away for safe keeping.  But it was odd that of the three large format coffee table books in my consultation room, only one particular book went missing. The second time it happened, I was shocked because the inevitable conclusion was that a patient had taken it. The third time—well, it almost happened again on Thursday but it didn’t because now I am on high alert.  This, in spite of the fact that I wrote inside the blue cover, “Dr. Fielding’s Book—please do not borrow!”

When new patients come into my department for their first visit, they are taken into a comfortable room, furnished with a couch, two armchairs, a coffee table and two end tables.  There are large framed photographs on the wall, seascapes and landscapes with bright horizons. Sometimes patients have a little wait between the time that my oncology nurse takes their vital signs and gets the basics of their history, while I am looking at CAT scans and PET scans and bone scans so that I can better make recommendations. When we opened five years ago, I thought it would be nice if I brought in some picture books for patients to look at, because I know that when I am at the doctor and am nervous about a test, or frightened by a possible diagnosis, I can’t concentrate on words.  I would rather look at pictures, especially calming, soothing pictures.

Since the beginning, there have been three books on that coffee table.  The first, a gift from my daughter, is Eliot Porter’s “The Color of Wildness.”  The second, a gift to myself, is Alison Shaw’s “Vineyard Summer.” And the third, a gift from a friend, talented photographer Karla Ogilvie, is simply called “Encinitas InSight.” The cover of Karla’s book is irresistible. The picture is of two boats, painted blue, each with a name and number, long since pulled onto dry land and converted into houses. Nothing speaks to the off-beat and wonderful character of our town the way these grounded boat houses do, except perhaps the Cardiff Kook, a bronze life sized surfer who is dressed up for every major holiday.  Since our department is in Encinitas, I guess it makes sense that it is that book which keeps disappearing.

On Thursday, I saw an 83 year old woman with an early stage skin cancer.  My medical student took her history in the consultation room, and then he moved her into an exam room where he did the basics of the physical exam.  When I came in, the first thing I noticed was that she was clutching the Encinitas book, having moved it from one room to the next.  I greeted her, and trying very hard not to be too obvious, I gently pried the book from her hands and placed it on the chair beside her, while I spoke to her about radiation therapy and took a look at her skin.  We covered all the basics, and she elected to proceed with treatment.  As she got up to leave, I saw her glance sideways at the book, and I dove for it.  Handing it off to the medical student, who understood the subtle hand signal as I waved him to return it to its rightful place in the consultation room, I escorted her to the front desk to make her treatment planning appointment.

Karla has been a great sport about all of this.  Every time the book disappears, she pretends to be flattered, and she comes back to the department with a new copy.  I’ve stopped asking her to autograph the book for me personally though.  It’s only a matter of time before the book goes on walkabout again.  Karla, if you’re reading this, maybe it’s time we started selling your book.  On the other hand, knowing you, I am sure that you are thinking that if that’s what a new cancer patient needs to be calm, comfortable and happy, so be it.  Thank you from the bottom of my heart.

A Room With a View

Space is always at a premium in any bustling medical office, and my department is no exception.  In the four years that we’ve been open, the patient volume has nearly doubled.  We’ve added a second physician, a second nurse and several additional radiation therapists.  My office manager does financial counseling in her tiny office that is more like a closet, and my physicist has doubled up with his own physics resident. Now we have a rad onc resident rotating with us and we’ve had medical students nearly continuously since July, both welcome additions to our daily routine but our “zen” is being stretched a bit thin. The question has come up—where do we put everyone?  As we walk the hallways looking for walls to knock down and more closets to turn into offices, all eyes turn to me, and it is clear that the vultures are circling.  Everyone wants my consultation room!

Long ago my mentors taught me two important concepts.  First, that it is the very first meeting with the patient and the family that gives them the lasting impression of the department and the doctor—first impressions do count.  Second, that talk about cancer and radiation therapy is threatening and scary and is best served up when the patient is fully clothed, in a comfortable chair, preferably in a room with a window.  Not that anyone wants to jump out of course, but somehow the sunlight pouring in makes patients feel like there is an escape hatch from that claustrophobic feeling they have when they suddenly realize that their lives have been forever altered.  As a consequence, all of the departments that I have built or directed have had a room, simply and comfortably furnished, where the patient and his family or friends are taken for the initial part of the consultation.   My consultation room has a couch, a coffee table and two large armchairs .  Landscape photos line the walls and the picture books on the coffee table are mine.  The large window faces south, and the sun streams in all day.

By the time we move to the actual exam room, there is an ease, and a familiarity, like we’ve all just met some old friends over coffee and the undressing and gowning for the physical exam goes smoothly and quickly. From our “customer satisfaction surveys” I would venture to say that most patients leave a lot happier than they enter.  So as we walk the halls looking for more space for our growing department, I tell my vultures to back off—that the large sunny consultation room is sacred and it is not going to go away because it is a neutral space between the fear of the waiting room and the vulnerability of the exam room. It is the space that makes my patients feel like they are human beings, not specimens, not tumors, and not cattle waiting to be prodded down the chute to an uncertain fate.

Now all that being said, there are two little issues I’d like to raise.  First of all, whoever took my coffee table book containing lovely photographs of our local community, could you PLEASE bring it back?  And second, when I sank into that armchair on that warm summer afternoon, I did not, I repeat DID NOT fall asleep as I was explaining radiation therapy for prostate cancer to you.  You only imagined that I fell asleep.  And it was only for a minute.  Really.