A fictional column. All patients are composites. This is reflection, not medical advice. Full disclaimer at the end.
Tuesday. 8:47 AM. Clinic was supposed to start at 8.
The first patient is always the test. She arrives with a folder. Folders are bad. Folders mean she has been to other doctors. Folders mean someone, somewhere, gave her a printout and she has memorized it.
"Doctor, my thyroid is destroyed."
I have not yet sat down. My coffee, on the desk, is still hot enough to burn me, which I know because I tested it on my lip thirty seconds ago in the corridor.
"Which part of it?"
She looks at me as if I have asked her which part of her soul.
The number on the lab report is 2.1. The number is fine. The number has been fine for four years. She has visited six doctors in those four years. Two of them are friends of mine. One of them I trained.
"Your thyroid is alive and well."
"No. It is destroyed. Look." She points at the 2.1. A number sitting placidly in the middle of the reference range, like a duck on a calm pond.
"This is normal."
"Yes, but it was 1.8 last year."
I sit down. I drink the coffee. It burns again. I had hoped, in the thirty seconds between the corridor and the desk, that it might have cooled. It has not.
We talk for twenty-two minutes. I draw her a thyroid. I draw the gland in her brain that talks to the thyroid. I draw, for reasons I cannot fully explain, a small face on the gland in her brain. She is unmoved. The little face stares back at me from the prescription pad, as confused as I am about how it got there.
She leaves with a follow-up in six months. She will not come. She will go to a seventh doctor. He will draw her a thyroid. The thyroid will be normal. The cycle continues, beautiful in its way.
9:11 AM. Patient two. New diabetes. The number on his lab report is 11.4, and that number means his blood sugar has been quietly catastrophic for months. He does not know he has diabetes. He thought he was tired because of work. He thought he was thirsty because it was hot. He thought the weight loss was because he had, finally, started taking care of himself.
I tell him.
He cries.
I have been doing this for fifteen years and I still do not have a good system for the crying. The tissues are on the desk. I push them across. He takes one. I take one too, because my eyes have started, embarrassingly, to do their own thing, and I am supposed to be the professional in the room.
We make a plan. Medication, lifestyle, dietitian, follow-up in four weeks. He nods at each item. He is not listening. He is forty and he has just been told his body has been trying to tell him something for two years and he did not hear it.
When he leaves, he shakes my hand. He says, "Thank you, doctor." For what, I do not know. I have given him a disease he already had.
The rest of the morning passes in the usual way. A woman whose immune system has decided, for reasons known only to itself, to attack her own thyroid. A man with high cortisol that turned out to be a steroid cream from his cousin. A young woman who wants to know if she will ever have a baby. (Yes, almost certainly.) A gentleman with a tumor in his head who has decided he does not believe in MRIs.
At 1 PM, I eat something I find in my drawer. I cannot remember putting it there. It is, somehow, still soft.
I think about the first patient. Her thyroid is fine. She does not believe me. She will spend the next decade looking for someone who tells her it is broken. Somewhere out there is a doctor who will. He is not necessarily a bad doctor. He is just a doctor who, on a particular Tuesday, will be tired enough to give her what she wants.
I think about the second patient. He cried. His numbers will, six months from now, be much better. He will become one of those patients who reads everything, asks careful questions, brings printouts. A different kind of folder. The good kind.
I drink the rest of my coffee. It is, finally, cool.
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.
