In some of my previous entries, I have mentioned how important it is for patients to bring a friend or relative to their first appointment. Most of the time, we welcome the spouse or best friend who is able to hear and process the information we are giving, especially if the patient herself or himself is still in the “deer in the headlights” phase of cancer awareness. Personally, I don’t mind if you bring a recording device—I realize that there are complex facts to be absorbed and difficult decisions to be made. There are occasions, however, where the addition of extras can be counterproductive. Bringing your mother in law along with your grandchild still in diapers can be distinct distractions to the doctors and nurses involved in your care, especially if the latter leaves stains on the newly upholstered chairs. There are those “significant others” who are actually adept at alienating the people you most want to make friends with. Those are the personalities that can make your doctor and nurse retire to the back room where they punch holes in the drywall while considering their escape plan.
First there are those I call the pirates. These are the people who commandeer the ship and make it all about themselves. Each time I ask the patient a question regarding a symptom, the pirate pipes in about the time he or she had that very same symptom, and what it meant. If I ask about a family history, I get the story about the time the pirate’s Aunt Nellie had this same kind of cancer, and about all of the terrible awful side effects she had from treatment. These are the guys and gals who will tell you that your patient can only have an 8:15 appointment; because that is the only time their ship can sail over to radiation therapy to give the friend or spouse a ride. They are often pleasant but always insistent—they want to make sure that I know how disruptive this disease has been to their sense of self importance and their place in the patient’s universe. By the consultation is over, I have a complete medical history on the pirate, and know their allergies, sexual deviations and food preferences, whether I actually know about the patient or not.
Worse are the pit bulls (and I mean no offense to the breed—you know I speak metaphorically here.) These significant others come in with the assumption—no, the CONVICTION– that the doctor is negligent, ignorant, and literally out to harm their spouse or friend. They are prepared to fight to the death. When I ask the patient a question, the pit bull answers with a snarl. The pit bull assumes that he must protect the patient at all costs, even if that means literally biting the hand that is offering help. These are the friends and relatives who are actually dangerous. They are usually engineers, scientists, professors, and mathematicians who have been on the internet, calculated the risks, and are going to teach you how to do your job so that they can make sure you don’t kill their special person. They are smart and they have done their homework. They have completely forgotten that I am here trying to help.
We had such a pit bull recently, who accompanied his girlfriend, a lovely patient with cancer of the pancreas. For the most part, I have stopped giving my email address to patients and families due to their propensity to spam me and my unwillingness to read every internet joke every passed around, and don’t even get me started about those chain emails. In a momentary lapse of judgment, I did however give mine to her significant other. After all, his earnestness was compelling. He wrote to me daily with each incident that his girlfriend experienced, his theories of why she experienced that particular thing, and his antidote for the problem. And each time I replied with advice, he wrote me back with the reasons that I could not possibly know what I was talking about. Despite our differences, in the end, we tamed him with kindness. His girlfriend did well through treatment, and four months later she is still in remission. Our pit bull became a pussycat.
One thing I will never forget is his email signature. Improbably, and without a trace of irony he signed each email, “Best, Dick.” Really? I sure hope so, for her sake!