Rebekah was 37 going on 75. She was a round woman with sad eyes, heavy arms, and stringy hair. I don’t think she meant to walk with her nose in the air, it just pointed that way. Rebekah took her health seriously and she remembered everything the doctors ever told her that she wanted to hear. She brought three things to every visit: a plastic grocery sack of pill bottles, an allergy list, and a lumbar spine MRI report from 2009. The report smelled like stale cigarettes and her allergy list included water because it made her vomit. Before I had electronic health records, Rebekah’s paper chart was four inches thick.
Rebekah’s enabler was her husband, a man she’d known since childhood and married at 16. Troy never left her side. He was her walking stick, her chef, her housekeeper, and chauffeur. While Troy made the world go round, Rebekah sat. On good days, she sat and ate raw veggies with a bottle of ranch dressing and she drank diet Pepsi. On bad days she sat and ate Doritos straight out of the bag, washed down with Mountain Dew. Rebekah had a lot of bad days.
When I came to town, I was gifted Rebekah’s care from one of my partners, along with a number of other patients given up as lost causes. Rebekah was on a long list of conflicting medications and had a problem list including chronic pain, atherosclerosis, heartburn, headache, bipolar disorder, anxiety, lupus, degenerative disk disease, and fibromyalgia. I made several attempts to wade through her chart and make sense of it all, but many key records were missing and no matter how many requests for information I made, the records never got faxed.
Over time, I tinkered with Rebekah’s meds, dutifully tracked her labs, and saw her regularly in the office. I provided her with guideline-based care and made numerous referrals. But Rebekah never got better. Better from what, I didn’t know exactly, but she never seemed to have any improvement in her daily function no matter how much I mucked with her meds and tried to help her set tiny, highly achievable goals.
After innumerable visits where Rebekah went on about her problems and I attempted to check all the right boxes so as to bill appropriately for the encounter, I lost it. I mean, I. Lost. My. Sh*t. I shut my computer and said, “Enough.” And then, I unleashed years of pent up frustration and anger on this poor woman. I told her I was tired of listening to the same complaints. I had exhausted my vast arsenal of ideas. I was frustrated with her refusal to help herself. I told her that perhaps she would be better served by a different physician, because clearly, I had failed her.
Almost as soon as the words were out of my mouth, I regretted them. It was unprofessional, selfish, and childish. I apologized. Rebekah looked at me as if realizing for the first time, I was in the room with her. And then we both started to cry. I handed her a box of tissues and grabbed one for myself.
“Don’t leave me,” she said. “You’re the best doctor I ever had. You’re the only doctor who ever listened to me and tried to help.”