“Why do you want to be a doctor?”

I answer without hesitation, “I want to help people.”

“There are many ways to help people.”

“I want to save lives.”

“There are many ways to do that too. So I’ll ask you again, why do you want to be a doctor?”

“Because I believe in it.” 1/
I think about that exchange now and then, some times more than others.

Why do we do the things we do?

What do we really believe in?

My next clinic patient is one I’ve known for many years. He is visiting me today via Zoom.

I always look forward to talking to him. 2/
As soon as the visit begins, I notice that his camera is angled off-center so I can’t get a clear look at his face.

I ask if he can adjust it, but he says he’s having technical issues.

No problem. I can adapt.

It isn’t just the camera though.

Something feels off today. 3/
Almost immediately I can tell that he sounds subdued. He isn’t cracking his usual jokes.

I’m comfortable with silence, even in the heart of a busy clinic day.

Silence is often where the healing happens.

After asking how he’s doing, I let the silence between us grow. 4/
The question, when he asks it, is one I don’t expect.

“Doc, which kills you faster? Blood pressure you don’t control, or blood sugar you don’t control?”

The surprise on my face must register, because he explains further.

“I just can’t afford all these medications anymore.” 5/
He continues.

“The way I see it, doc, I only need to stick around 4 or 5 more years. That’s how long my pet dog has left, then I ain’t got no more family and it’s me all on my own. So I figure maybe take the diabetes ones and skip the blood pressure? Or every other day?” 6/
As I review his meds and start discussing our options with him, he adds one last remark.

“And I’m real sorry doc. I know we go back a ways, but I can’t afford my co-pay. I’ll pay you later. Promise.”

And just like that, I understand why his camera is angled. 7/
And just like that, I’m again struck by the cruel illusion of what I do.

The system I’m part of.

This patient did everything right; got insurance, paid his taxes. And he still has to barter years of his life.

And he can’t bring himself to look me in the eyes as he does so. 8/
Our healthcare system is too often unethical, immoral, unsustainable.

The insurance paradigm is focused on revenue generation. It strips the basic human dignity from patients, to the point where they can’t even make eye contact anymore.

I know that I’m part of this system. 9/
He’s old enough to be my father. Some part of me imagines that he is my father. Tears threaten my vision, as a hot anger floods me.

Now I wish I could angle my camera away.

I ask him if I can write about him. Because people need to know.

His response lingers with me. 10/
“Sure you can doc. But people already know. Lots of people deal with this. It ain’t that people don’t know. It’s just that nobody cares. Nobody gives enough of a damn to change anything. Nobody... cares.”

The visit ends.

My Zoom window closes.

His window closes too. 11/
I feel it.

There’s something insidious here.

A casual cruelty we’re all complicit in.

“I can’t go to rehab, insurance won’t cover it.”

“Insurance won’t pay for that medication.”

“I can’t afford any of this.”

“I’m uninsured.”

This isn’t right. None of this is right. 12/
Twenty years ago, I gave a medical school interview.

I wore my best suit. I sat up straight.

I said I believed in medicine. I meant it.

Some part of me once burned brightly, but that fire is down to flickering embers.

Our lives mean more than this.

More than this.

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More from @TheRealDoctorT

12 Sep
((For part one of this story, please see below.

When we left our dynamic duo, they were investigating the disappearance of Lord Simon Byron.

Sherlock seemed convinced of foul play, but was stunned when the Lord appeared safe and sound...))
Forgive me, dear reader. I have committed that most egregious of errors in story-telling.

The mistake that drives Holmes mad with irritation.

Even now, I can hear his voice in my head, “Watson, start at the beginning! How can I deduce anything without a complete picture?” 1/
So let me start at the beginning.

The year is 1890.

My name is John H. Watson, and I am a physician and former army man. A bullet in the Battle of Maiwand a decade ago gave me a limp, and an honorable discharge.

Sherlock Holmes is my friend.

Together, we solve mysteries. 2/
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5 Sep
“So, what do you think happened here Holmes?” I look to my angular companion. I have my theories, but no answers.

We have reached the point in the investigation where I will be dazzled by Holmes’ intellect. The puzzle pieces are ready.

But Holmes remains silent, pensive. 1/
Finally, he speaks.

“Watson, the question isn’t what happened here. That much has been obvious from the day we arrived.”

My brow arches. “Oh, has it? Could you please enlighten us lesser minds?”

Holmes sounds impatient, “Clearly, Lord Simon Byron was murdered.” 2/
I splutter, “Sherlock, in order for there to be a murder there has to be a body.”

Holmes looks almost pained as he explains, “The body has been hidden in plain sight.”

“But where?”

“Ask the widow.”

“Holmes, technically she’s not a widow yet!

“Fine! The soon-to-be widow!” 3/
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3 Sep
The moment is captured by the camera forever.

A little girl leans in to blow out the candles on a birthday cake.

Around her, everyone leans forward expectantly, ready to cheer. Ready to shower her with love.

In the background, her grandmother smiles warmly.

This moment... 1/
This moment means the world to the grandmother.

It is the culmination of a long and difficult path.

Building bridges with an estranged daughter. Learning to let go, to forgive.

To anyone else, it’s just a girl’s birthday party.

To grandma, it’s a second chance.

It’s love. 2/
When I first see the photo, I don’t know the story behind it. I have not yet been told.

My gaze is drawn to it, on the table, and then moves on to the patient.

A Code Blue is being run.

The elderly woman is having a LUCAS device attached to her.

Minimizing our exposure. 3/
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27 Aug
What happens to a secret nobody remembers?

Does it cease to be?

There was something important I used to know.

Something that saved me, once.

Is it gone forever? 1/
I reach the hospital early in the morning and begin my rounds just like any other day.

Except today is different.

Today, I have a Helper. He’s waiting for me outside the first patient’s room, and nods a greeting.

I nod in return, then knock on the door, and enter. 2/
Who is this Helper? I’m not sure. Am I the only one who can see him? Nobody else seems to look his way.

The first patient sits up in her bed as I enter. She smiles. I say hi, ask her how she’s doing.

The time-honored rituals.

History. Exam. Assessment. Plan. 3/
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20 Aug
I ask a question.

The patient falls silent, and seems to be thinking. I say nothing, and quieten my mind.

The urge to ask again and redirect is strong.

I don’t.

The clock ticks.

The appointment is running late.

This will cascade through the rest of my day.

It’s okay. 1/
Sure enough they suddenly remember an important detail. It changes my line of questioning.

Not every silence ends in revelation. But this one did, and I would’ve easily missed it.

We call them the “patient.”

Patience is expected of them, in their suffering.

But us? 2/
When I was younger, a teenager, my family moved to upstate NY, to the town of Schenectady.

The name comes from the Mohawk word, “skahnéhtati,” meaning “beyond the pines.”

Our house was on the edge of a forest reserve.

My dreams extended beyond the pines, and into the wild. 3/
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13 Aug
The thing about reflections is no two people see exactly the same thing.

As Henry looks in the mirror, he sees memories.

The first time he wore this shirt was when Mary bought it for his birthday, so many years ago.

It still fits, and he smiles.

Henry is going on a date. 1/
The bow-tie seems a little much at first, but what the heck. He adjusts it carefully, the finishing touch.

“Looking good Hank.” He compliments himself, grinning.

The grin reminds him, almost forgot.

His teeth!

He puts in his dentures, and chuckles.

The doorbell rings. 2/
For a moment he contemplates leaving behind his walker. But he’s already fallen twice recently.

“Don’t be a fool Henry.” He can hear Mary’s voice in his head, and see her gently disapproving smile.

He takes the walker, holding on to it carefully as he walks to the door. 3/
Read 18 tweets

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