*A fictional column. All patients are composites. This is reflection, not medical advice. Full disclaimer at the end.*
—
Monday. 8:36 AM. Clinic was supposed to start at 8.
The patient has, before sitting down, told me three things she has read. She has not yet told me anything about her body. She does not, I suspect, fully think of her body as separate from the things she has read about it.
The things she has read are arranged in her phone in a folder named after her condition, which she has not yet been told she has. She has, however, decided. She has the diagnosis. What she has come for is the confirmation.
She shows me a screenshot from a forum for people who have, by their own description, “been failed by the medical system.” I have met many. Some have been failed. Some have not. None of them like being asked to consider which group they belong to.
I look at her lab work. It is mostly normal. There is one number that is mildly out of range, the kind almost everyone, at some point, will have. The body wanders. The lab catches it on a Tuesday.
“You have this,” she says. “I’ve matched all the symptoms.”
The symptoms she has matched are: fatigue, weight that does and does not stay, hair that does and does not stay, moods that come and go, a feeling that something is wrong. I want to tell her that this is also the symptom list for being alive in your thirties. I do not.
“Tell me what’s been bothering you the most.”
She pauses. She has not, I think, been asked this in a while. She has been asked, by an internet she is paying close attention to, to fit her experience into a list. The list does not have a column for which symptom is the loudest.
She tells me. She tells me for eight minutes. Her sister. Her sleep. The man at her work who has made her life worse for two years and whose name she will not say out loud. The dog she had to put down last winter. The way her father, who is fine, has begun to look older from across the dinner table.
I sit. I listen.
I do not order the test she has asked for. I order a different one, a smaller one, and one she has not heard of, which I describe gently because the language matters. I tell her we will see her again in six weeks. I do not tell her that I think most of the symptoms she has matched will, by six weeks, have shifted. They will. They always do.
She leaves with a referral to someone who is much better at the man at her work than I am.
The coffee is, by now, cold. I have not yet drunk any of it.
—
10:48 AM. The patient is a man in his fifties who has been waiting nine months for this appointment. He has been told this twice in the waiting room. He sits down, slowly, and the chair makes a small sigh that I think might be his.
“How long have you had the symptoms?”
“Six years.”
“Six years.”
“Six. And a bit.”
He has waited six years to mention it to anyone, and nine months to see me. He has, in his lap, no folder, no notes, no phone, no calculator. He has only his hands, which are large and rough and folded in a way that suggests he has spent a working life folding them.
I ask what changed. Why now.
He looks at the wall behind me for a long moment.
He says, “My wife told me to.”
We talk for a long time. The condition is, in fact, almost certainly real, and it has, in the slow patient way that bodies have, been quietly getting worse. It is not too late. It is not even particularly late. He has, by waiting, mostly inconvenienced himself.
I tell him the next steps. I write them down. He nods at each one, the way a man nods at instructions he has already, mentally, decided to follow because someone he loves has asked him to.
When he stands to leave, he looks at me. He says, “Thank you for the appointment.”
I say, “You’re welcome.”
He says, “I know it took a long time.”
I say, “Yes.”
He says, “I think I was also taking a long time.”
—
At 1 PM I do not eat. The patient with the search bar has, I imagine, already taken her phone out in the parking lot. She is reading, in the front seat of her car, about the test I have ordered. She is comparing it to the test she asked for. By tomorrow she will know more about the test than I do. This is, in its own way, a kind of love.
The man with the nine-month wait is, by now, walking back to a wife who told him to come. The condition is, in him, slow and treatable and tired. So is he.
The coffee is cold. The afternoon clinic begins at 2.
—
**Disclaimer**
Doctor’s Diary is a work of fiction. All patients, conversations, clinical findings, laboratory values, treatment decisions, and outcomes described in this column are invented composites. They do not depict any real individual, living or deceased. Any resemblance to a specific person, encounter, or institution is coincidental and unintended.
This column is published for reflection and literary purposes only. It is not, and is not intended to be, medical advice, a clinical opinion, a diagnosis, a treatment recommendation, or a substitute for professional medical evaluation, examination, or care. Nothing in this column establishes a doctor-patient relationship between the author and any reader.
Do not start, stop, change, or interpret any medication, test, diet, lifestyle measure, or clinical management on the basis of anything written here. If you have a clinical concern, consult a qualified healthcare professional in person. In an emergency, contact your local emergency services immediately.
The author writes anonymously. The views expressed are personal literary reflections and are not official guidance from any institution, regulatory body, hospital, university, professional society, or government agency. Information may not reflect the most current medical consensus, guidelines, or evidence and is provided “as is” without warranty of accuracy, completeness, or fitness for any particular purpose.
The author, Hormone Insight, and its operators accept no liability for any action taken, or not taken, on the basis of content published in this column. By reading this column you acknowledge and accept these terms.
