Ofri - What Patients Say, What Doctors Hear

ALSO BY DANIELLE OFRI

Singular Intimacies: Becoming a Doctor at Bellevue

Incidental Findings: Lessons from My Patients in the Art of Medicine

Medicine in Translation: Journeys with My Patients

Intensive Care: A Doctors Journey

What Doctors Feel: How Emotions Affect the Practice of Medicine

It was late on a Thursday evening and I already had one foot out of the clinic door when my office phone rang. It was Oumar Amadou. I am not feeling well, he said. I need to see you, Dr. Ofri.

The sun had set and the clinic was closing up. I had already locked up my file cabinets and turned off the computer. I need to see you now, Mr. Amadou said. The annoyance in his voice was apparent even with his thick West African accent.

In the few months Id known Mr. Amadou, Id probably fielded fifty phone calls from him. He always had something bothering him, or needed a form filled out, or a medication refilled, and he always needed it right away. He constantly showed up at the clinic without an appointment, assuming I would be available to see him right then and there.

But he also had a severe heart condition, even though he was only forty-three years old. At our first visit hed hauled out a tome of papers from a cardiologist in Pittsburgh. The papers detailed a severely malfunctioning heart, one that had required a pacemaker, a defibrillator, and several stays in the ICU.

So when he called on a Thursday evening, I took his concerns seriously, despite the irritating tone of his voice and my depleted reserve of patience for him. I questioned him about his symptoms to see if he might be experiencing congestive heart failure or an arrhythmiathings for which I would send him to the emergency room immediately.

But he had no specific symptoms, just a vague sense of not feeling well. I wasnt scheduled to be in the clinic the following day, Friday, but because of his poor heart I didnt feel comfortable having him wait until Monday.

Please come to the clinic tomorrow, I said, to the urgent-care section. I explained that I wouldnt be there but that he would be evaluated by one of my colleagues.

When I arrived on Monday morning there was an indignant voice-mail message from Mr. Amadou. I come Friday, but you no there, so I go home. I need to see you! My hands slapped into my lap with frustration. Either he hadnt understood what Id said or he was simply being stubborn.

The next three days were a series of missed phone messages between us. If he was feeling sick, I told him, he should come to urgent care right away. If he didnt feel too bad, we could give him a regular appointment. He left repeated voice mails saying, I need to see you, Dr. Ofri, seeming not to acknowledge any of my messages to him. Whenever I called back, I got only his voice mail.

Midday on Thursday, just as I was saying good-bye to the last of my morning patients, contemplating the possibility that I might actually have five minutes for lunch, Mr. Amadou popped into my line of sight. It had been a week now that wed been trading messages. Tall and lanky, dressed in a powder-blue tracksuit, he signaled anxiously at me. I need to see you, Dr. Ofri, he called out. It is very important.

I was unprepared for the rush of anger that flooded over me. It wasnt just that I was about to lose that rare opportunity to eat lunch after an exhausting morning, but that Mr. Amadou would just walk in the door and assume I would drop everything and give him a medical evaluation that instant.

Yes, he had a bad heart and all, but that didnt give him a free pass to be so demanding. Obviously, whatever was bothering him couldnt be so bad given that hed chosen to spend the week trading messages with me rather than come to the urgent-care clinic. I needed to draw a line.

Mr. Amadou, I said tautly, you cannot just show up to the clinic without an appointment.

I come here to see you, Dr. Ofri, he said.

Yes, I know, I said, growing more exasperated. But I have other patients with scheduled appointments. If its something that cant wait, you can use the urgent-care clinic today. Otherwise, you need to make an appointment like everyone else.

I no see other doctor, Mr. Amadou said. I only want to see you. I need to see you today.

I knew that if I gave Mr. Amadou a medical visit right now, Id reinforce the idea that he could simply walk into my office at any time. Hed be at my doorstep every week! But I also understood the severity of his cardiomyopathythis was not the type of patient I could take a chance on, annoying or not.

Okay, Mr. Amadou, I said, sighing heavily, just a quick visit. Next time you must have an appointment.

Mr. Amadou smiled broadly as I led him from the waiting room and I knew I was going to regret this decision. He had now figured out how to get an instant appointment: just be annoyingly persistent until I caved.

The medical assistant was about to leave for lunch also but I gave him a beseeching smile. Could you please do a quick set of vital signs for Mr. Amadou? I asked. He hesitated, raised an eyebrow, then finally assented. With relief, I gestured for Mr. Amadou to enter the assistants room.

Mr. Amadou took two steps and then paused in mid-footfall. It was like a movie that abruptly froze, catching a character in the midst of an action. He seemed to hold his lanky body aloft, almost as though the muscles were debating whether to move it forward or backward. But it was all an illusion, as he collapsed to the floor with a heart-stopping thud.

There is always that dreadful moment of silenceprobably less than a second, but it feels like an hourwhen you realize something terrible has occurred. Its that stomach-lurching moment as your body and mind are shocked from the ordinary to the emergency. Its a vexing if brief time lag in which you need to blink several times, it seems, before you can accept the new reality.

I dropped to my knees and pressed my fingers to his neck to check a pulse. Mr. Amadou, I shouted. Can you hear me? He was breathing rapidly, his upper back slumped against the door frame, the rest of his lengthy body stretched out in the hallway. Tell me whats going on. Are you having any pain? He placed his right hand over his chest. My heart, he said faintly, and I was swamped with a horrific wave of guilt.

By now a crowd had gathered around. The nurse was checking Mr. Amadous blood pressure. His pulse was 130. His fingers were so cold that the oxygen saturation monitor could not pick up a reading. I called for oxygen and a stretcher while I crammed my stethoscope under the jacket of his tracksuit. We loaded his listless body onto the stretcher and began wheeling him rapidly to the emergency room.

Disconsolate, I held Mr. Amadous hand as we pressed down the hall, striding briskly to keep my pangs of remorse at bay, praying that he was going to be okay. We rolled him into the triage bay of the emergency room and I explained the situation to the ER doctor while the nurses hooked up monitors and started an IV. As we finished the handoff of medical care, I turned back again to Mr. Amadou. I took his cool, clammy right hand in my two hands and gave it a squeeze. His fingers were frigid.