A Work Excuse

Bibi and Dwight, both in their mid-sixties, always move as a unit. They have been married for forty years. Early on, they were athletic and adventurous, but over the past five or six years Dwight has developed macular degeneration and a fairly severe case of arthritis.

I have seen him once a year for a physical and usually no more. At his last two physicals, Bibi brought up her concern that Dwight was tired. She has always been present for his visits, even before his eyesight started to fail him. He always downplayed his fatigue and blamed it on his age.

This time I focused my exam on different causes for fatigue and ordered several blood tests. Bibi seemed pleased, but Dwight seemed distant and unengaged. I suspected he might be depressed about his arthritis and near blindness. We agreed to have a follow-up to go over the test results.

The only remarkable thing about his results was a borderline low thyroid function, which usually doesn’t cause any symptoms at that level.

As it happened, Bibi had her own appointment with one of my colleagues at the same time as Dwight came back to go over his test results.

After greeting him, I started:

“Well, Dwight, all your blood work looks fine…”

“I was sure it would”, he interrupted. “Listen, Doc, I know why I’m tired”, he said with a tone of frustration in his voice.

“I love Bibi, but she’s not like you or me”, he began whispering. “From the crack of dawn till way past anybody’s normal bedtime, we have to work. In the spring and summer it’s the gardens. We grow more vegetables than we could possibly eat. In the fall it’s the raking and the firewood. We are three years ahead on wood now. In the winter we dust and reorganize all her books and knickknacks. We never relax; we never sit down and talk. She always has to be busy. She’s wearing me out, Doc!”

He raised his arms in a gesture of exasperation.

“Help me, Doc!”

Just then, there was a knock on the exam room door. Autumn, my nurse, peeked in and said:

“I’ve got Bibi here, are you ready for her to join you?”

I glanced at Dwight. His eyes sank to the floor as he nodded.

“So, how is my boy?” Bibi said as she sat down next to Dwight while I quickly gathered my thoughts.

“Well, it’s nothing serious”, I said, “but Dwight has subclinical hypothyroidism, which is due to an autoimmune process in the thyroid. Some people get quite tired with that, more than you might expect from the thyroid numbers alone. Coupled with his arthritis, I expect Dwight to be more tired both physically and mentally than he was a few years ago.”

Both Bibi and Dwight had their eyes on me as I came to my concluding statement:

“I think with more rest built into his day, he should be good for many more years.”

As we said good-bye, his knotted hand squeezed mine quite hard for a person with arthritis.

1 Response to “A Work Excuse”

  1. 1 cathy April 27, 2010 at 9:20 am

    I love that you did that for him. Poor man.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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