Posts Tagged 'Progress Notes'

A Doctor’s Advice

My friend, Dr. Barbara Brennan, who gave up her practice because of her CFS, or Chronic Fatigue Syndrome, told me a very touching story about her last conversation with her gynecologist.

Dr. Brennan worked hard, and seemed to be inexhaustible until her illness stopped her in her tracks. In this medically underserved area we all work hard, and many of us looked to her as someone to admire, because she didn’t seem to tire of what she did day after day.

Barbara Brennan told me that there was one colleague who had told her to take a hard look at what she was doing.

Samuel Baumgarten was Barbara’s gynecologist for many years. He had delivered two of her children and when she came in for her annual checkup he always took time to ask how she was doing as a physician. She confided in him that she wished she wasn’t working quite as hard.

Sam had stopped delivering babies a couple of years earlier as his patients grew older, and focused more on gynecologic surgery. He had also cut his workweek from four to three days a week. He told Barbara that five days a week was too much for any doctor.

In his mid sixties, Samuel Baumgarten was youthful and always seemed relaxed and in perfect health. He was an avid skier, tennis player and sailor. He never wore a tie. He followed the Red Sox and gave the impression that medicine was important to him but never kept him from being a human being also.

The last visit Barbara had with Sam he had urged her to think about changing her situation.

“You’re working too hard” he lectured her. “No one is indispensable, not even you or I.” He looked very serious, almost stern as he spoke to his younger colleague and patient.

“People may say that only you can help them, but after you’re gone, they’ll say ‘She was good, but who do I see now?‘”

She often heard those words echo in her mind on days when fatigue started to creep up on her. She did start to think about what she might want to – or need to – do in the next few years in order to avoid burnout.

Two months after that appointment Samuel Baumgarten died suddenly while skiing down his favorite slope.  Barbara heard one patient after another say what a good gynecologist Dr. Baumgarten had been and in the next breath ask whom they should see now.

Barbara herself had to do the same thing, choosing to see Sam’s younger partner Sandra, who was ten years his junior and a nice enough woman, but not a mentor the way Sam had been.

His words came back to her often during the first weeks of her illness as she struggled with her guilt over not showing up at the office. They helped her make her final decision to quit her practice. And she imagined her own patients, one by one, wrapping things up the same way:

She was a great doctor, but who do I see now?

Physician, Heal Thyself!

Dr. Barbara Brennan practiced Family Medicine in a nearby town for a decade. She was busier than most of her colleagues. Her patients adored her and she had earned a solid reputation as a crackerjack diagnostician. She worked long hours at the clinic and she ran a tight ship at home, managing a large household and even found time to be active in her community. She would be up at five to get everyone in her house on their way, and when she arrived at her office at eight, she always looked beautifully put together and on top of the world.

She never seemed hurried or harried. People wondered how she did it. Her husband, also a physician, admired his wife both as a woman and as a colleague. He had more years behind him as a doctor than she, but he often found himself asking for her medical opinion.

Dr. Brennan had many patients who appreciated her razor sharp diagnostic skills. She diagnosed a pheochromocytoma, a case of fallopian tube cancer, and several other rare medical conditions. She was also well known for her psychiatry skills. In rural America, primary care physicians deliver the majority of psychiatric care. Barbara Brennan moved comfortably between crisis intervention, brief psychotherapy, antidepressants, mood stabilizers and ADHD prescriptions.

There were two kinds of clinical problems she avoided. She didn’t enjoy doing the minor surgical procedures some primary care doctors see as bright spots in their day, and she didn’t enjoy treating fibromyalgia and Chronic Fatigue Syndrome. Suffering from some arthritis herself, she found it draining to work with patients she thought sometimes dwelled too much on their symptoms. It saddened her to see fibromyalgia patients focused on what they couldn’t do, instead of making the most of their physical abilities.

One Friday morning, at the end of an unusually busy week that even Dr. Barbara Brennan thought would never end, she noticed a strange tingling sensation over her right eye. As the day progressed, the tingling turned into a burning pain down most of the right side of her face. She became nauseous and developed a migraine. She had worked in spite of having migraines before and steeled herself to make it through the day. A slight dizziness set in, and she had trouble concentrating.

Finally home, she put dinner on the table, but didn’t eat anything herself. She looked in the mirror for a rash on her face. She asked her husband to double check closely for her. By eight o’clock she went to bed, exhausted and with a throbbing migraine.

Saturday morning her shingles rash was there, subtle at first. Her husband confirmed it and called the pharmacy with a prescription. Her headache was still there and she was still nauseous and lightheaded. She had to move slowly to avoid vertigo and she noticed it took her longer to find words, even to figure things out. As a physician, she knew she must have developed a touch of encephalitis – brain inflammation.

She expected to be out of work for a week, but complications set in. She broke out in hives from the antiviral medication and had to stop taking it after only three days of treatment. Without the medication the shingles flared up again and she became profoundly tired. Over the next few weeks she developed joint pains and muscle aches. She got a sore throat. She felt as if her mind and body moved in slow motion. All she accomplished was to get everybody off in the morning, and by the time she got the dishwasher loaded it was already almost noon. She didn’t take naps, she didn’t even sit down much – it literally took her so much longer to do the simplest things.

She cried in frustration: “What’s wrong with me?”

Her husband looked into her eyes, the right one still framed by the slight scars left by the shingles, embraced her and said what she knew but didn’t want to believe: “You have a post-viral syndrome, maybe early Chronic Fatigue Syndrome”.

Months have passed and Dr. Brennan has not returned to work. She is convinced that she has CFS. She didn’t like it in her patients and she is fighting to beat it in her own case. She now knows first hand how real and devastating this condition can be. She is learning to listen to her body, always doing as much as she can, pushing ahead just a little, so that eventually she can get her stamina and her health back. Sometimes when she pushes herself too hard the sore throat, body aches and tingling over her right eye remind her to slow down again. 

I asked Barbara the other day if she would ever resume her practice. Her answer was: “I can’t afford to ignore my own health. In that job, and at that pace, I did just that.”

Dr. Brennan is living by her own advice – Physician, Heal Thyself!

(Here’s to you, Barbara! With respect and best wishes…)

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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