Getting Sick: Iatrogenic Woes

February 1971

A junior in high school living and learning at a boarding school in Austin, she enjoyed the occasional free weekend in Houston with her sister, her husband and their two young daughters.This trip started out like all the others. A happy reunion with family, a different routine, freedom from tasteless school cafeteria food.  She remembers eating Fulshear sausage dripping in barbeque sauce, maybe too much but it tasted so good.  A freshly made bed waited upstairs. If her real home was thousands of miles beyond, this had to be second best.

No one would have expected that she'd not make it back to school for class on Tuesday. No one would have predicted she'd get sick enough to be popped in the hospital with a nasogastric tube and IV fluids to decompress a hugely distended stomach and guts which simply quit working for over a week. No one would have expected she'd be out for the better part of the trimester, leaving the hospital to recover in Aruba and then back to school in late March.

I know that what happened to me was iatrogenic.  When all that rich food and a possible overlay of irritable bowel syndrome or norovirus infection gave me the belly gripes, I was able to get a Saturday appointment with my sister's internist. I remember getting an injection which would "relax your belly" which was apparently in knots. In retrospect, this was not a good move on his part.

I don't blame the doctor. The problem is my unique and unpredictable patho-physiology, an unusual, amplified reaction to a medication designed to relax the gut and offer relief of symptoms. In my case, the drug paralyzed my entire GI tract. I know very well that patients don't come to us with an instruction manual about which drugs may have a paradoxical, harmful reaction in their system.

I put together my theory about a drug causing my gut woes and hospitalization only after having a similar experience years later, during my thrid trimester of pregnancy with Laura. I self medicated my abdominal discomfort and bloating with an anti-motility drug and paid the price. A drug that should have helped me backfired so badly that I wound up in the hospital for three days until my insides started working again. Paralysis.

I used to think that the term iatrogenic meant that the doctor made a mistake in the care of his or her patient. Not so. Iatrogenesis plagues all physicians. We deal with human physiology which presents without an accurate road map. We do the best we can. I doubt any of us intends to cause harm.

How We Dress Matters

Once upon a time, the Chairman of Medicine (also my mentor) practically blew a gasket when he saw one of his faculty members wearing blue jeans to work on the weekend. The doctor was rounding on the hospital wards, seeing patients on a Saturday morning.

I wasn't present to witness what occurred in the moment but there were all sorts of stories floating around. What I do remember like it was yesterday was what The Chief told us residents as we gathered for Morning Report in the conference room adjacent to his office shortly after this event. His words have stuck with me forever; they are so ingrained that conscious thought about the issue comes up only when I happen to see a colleague in jeans.. In the 30 years since The Chief imparted his wisdom on the subject,  I wouldn't dream of putting on a pair of jeans and heading into work, weekend or not.


"When you dress like that [jeans], the message you send to your patient is loud and clear; you'd rather be out on the golf course or anywhere else rather than where you are right now."

I think he was/is absolutely correct. Yesterday was Sunday and I was on call, rounding in the hospital. Standing in a patient's room with three attentive and concerned family members at the beside hungry for information and a sense that their loved one was in good hands, in walked a surgeon, dressed in blue jeans.. Was it just my impression or was every word out of his mouth colored by what he had chosen to wear?

I may be old school but, in my view, jeans of any kind have no place in a hospital except on visitors. The Chief said it best.

Intermission

I want (desperately) to post on this blog. Flooded with ideas, I'm struggling to focus. What I need to do is stop thinking so much and just write. Write.

In part I'm plagued by wanting what I say to stand up to a self imposed standard. "It's got to be good", I tell myself. An overwhelming need to produce at my peak, to write my best does nothing but push me into paralysis.

"I'll write later", the voice inside says. Procrastination is alive and well in my soul.

I find myself pondering a potential post and sinking into weariness considering all the seemingly important background facts or figures or data or proper recollection that need some research;  any one of number of other details which spoil the spirit of writing.

Here's my resolution: Begin again and ignore the background noise  that wants to disrupt what could be good stuff emanating from my screen.  Hit the publish post button. Just go with the sentences longing to be free.

What's in a Name? A Lot.

Between college graduation and my first day of medical school, I changed my name. Well, not exactly my given name: Catherine, or my last name but my "for short" or nickname. That sweet little name my parents bestowed upon me and which I accepted willingly fell into the deep hole called the past when I transitioned into a new phase of my life. I figured the time was ripe for change. I  had moved from upstate New York to Texas, starting out anew, turning over a new leaf, and maybe becoming someone different when I matriculated in medical school. I introduced myself as Kate to everyone I met.

My parents and all who ever knew me before I turned 22 know me as "Kitty". To my 94 year old Dad, I'm even more than "Kitty", I'm "Kitty Kat". Sigh. It's sweet and he'll never change, nor should he. But, the name "Kitty" didn't feel right to me, nor did it seem to fit me once I reached my twenties. My family still calls me Kitty from time to time before they catch themselves. I suspect when they talk of me (I won't say about me) out of my presence I'm probably "Kitty" all over again.

My birth name, Catherine felt stately and wise but too formal. Catherine also left the door open to others shortening it to Cathy which would never work for me. Kitty wasn't a name for the long haul of life. So, Kate she became; a name that fits my skin, a name I chose for myself instead of the other way around.

I don't think my parents ever really understood why I decided to do this. My siblings and their families indulged me my independence and choice.  My husband, his family, my children, and anyone who has ever met me after I started medical school know me by the name I preferred to be called. And all that is good.

Sometime my colleagues write my name as "Cate" because Catherine is spelled with a "C". Sometimes my patients call me "Katie" or Catherine if they're feeling formal. Whatever.  More on being addressed by my first name in a professional setting by a patient later. That's an interesting issue and has definitely changed over time.

There's no more worrying about my nickname from the past except around those who knew me back in the day. These folks have license as the only ones allowed to use that name in my presence. If I ever hear it slip out of the mouths of others, I cringe (curdle may be a better word) inside and if they keep it up, they eventually learn never to go there again.

Names are important.

"We Are Powerful Beyond Measure"

This blog launches as a sister blog to Ahead of the Wave on this very special, yet sober day in my life; the one year anniversary of my Mother's death. I've been procrastinating for weeks about my first post for Back in the Day, a blog about my life in Medicine. There is no more time to put off what bubbles forth from my heart. There is no excuse to wait for perfection, to stall the process hoping for a smooth ride. My Mom's death from old age and dementia reminds me that she always wanted to write about her life but put off the process endlessly. She left stories untold and that is a tragedy.

The time for me is now. 

Mom was an an enormous inspiration and source of strength in my life. She steadfastly believed in me and always asserted that I could be whoever I wanted to be. She loved deeply and unconditionally. I know she would have enjoyed reading this blog and from somewhere, I feel her inspiration and support in this new project.

I'll begin my blog with a favorite quote from Marianne Williamson. The words come from her book, A Return to Love: Reflections of the Principles of a Course in Miracles. She captures beautifully the simultaneous exhilarating and terrifying truth of our abilities and talents. She admonishes us to shine our light so that others may be encouraged to shine as well.

She says;

"Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us."

How often do we fear our inadequacy when our power is just beneath the surface? How often do we turn away from our strengths to hide in the shadows?

Marianne follows with an explanation.

"We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we're liberated from our own fear, our presence automatically liberates others." 

And so it goes.

And so, today I begin my new blog, Back in the Day, a series of posts about my life in Medicine. I'd like to think that this quote of Ms. Williamson is a steady theme, fueling my creativity. All my life I've struggled to find my talents and to transform my uncertainty into light, a light that shines, inspires, and comforts others.

No more delays. Here we go.