Q and A.

 This week on rounds at Grady. . . . .

Just finished up talking to one of my patients about what was going on with his body. Serious things were on the top of the list--all of them dealing with big organs in his body with important uses. First up? The liver. We go into the issues with how his liver is functioning and also how important the liver is to the body.

"Your liver is kind of like a giant filter and a plant that manufactures all sorts of important things." He seemed to like that description, so I keep it moving.

Next are lungs and test results related to those.  I launch into this whole soliloquy about his x-ray results and what they may or may not mean. I review the level of his oxygen that day and what I was hearing when I put my stethoscope to his chest.

Lastly, I discuss the goals of care. What he can expect, what we are looking into, what we still aren't sure about. I draw pictures on a sheet of white paper and add arrows to help him get the point. The whole process, complete with his queries for clarification took quite some time.

He looks somewhere in between being with me and being bored. Which is better than bored only.

Finally, I ask a simple question. "What questions do you have for me?"

And, seeing as he is looking partially bored, I prepare for a predictable response of "nothing" -- but, see, am already positioning myself to ask the same question again in a different way.  "What questions do you think your family would have for me--or you when they call you?"

"None."

Dang. None? No questions? Come on. There's got to be at least one question. And if there is at least one, I want to know it.

Because I am rounding by myself and this is a good time for us to just talk and talk and for him to just ask and ask. Time is on our side and I am not under any pressure to leave or run to the med school or dash off to a meeting. So I want to know, for real, "What questions do you have for me?"

And finally, finally, finally he looks at me with his strikingly jaundiced eyes and his sallow complexion. He doesn't speak he just stares after I ask for the umpteenth time, kind of like he's trying to tell if I really want to know what concerns him. And I wait patiently to show him that I do really want to know.

"Okay. I do got one," he eventually says. "But you may not know the answer to this question."

Hmmm.

"You are right. I might not. But it's worth a try. What is the question?"

Could it be a question to clarify a medical term I inadvertently used? Probing concerns about prognosis, perhaps?  Maybe he would point out an issue with a medication like "this one gives me diarrhea" or "that one make my head swimmy."  Either way, he had one and that preface made it sound like it was a good one.

And so. I wait for him to ask. And finally he did.

The question?


"What's a brother got to do to get a good CAPPUCINO up in this piece?"


No. Not kidding.  That was his question.

And yes. He was right--I didn't know the answer.


***
Happy Wednesday.



Clearly this is playing on my mental iPod. . . . .