THE POINT OF CARE

THE POINT OF CARE BLOG . . . “Varicella!”

Varcella!

Earl Stewart, Jr.

My girlfriend chose to celebrate the anniversary of her birth in the form of a game night in November of last year.  Not particularly being a connoisseur of all things games, at least since I left high school, I must admit that I had not had the chance to play a lot of the ones we played that night.  However, one can’t help but to enjoy the collective reasoning and teamwork that goes into such an amusing escapade, joining together as a group with a common purpose of defeating the other team, to make its members crumble in daring defeat, and to have some good-natured fellowship with new and old friends.

Seeing that this was soon after she and I first met, I had the opportunity to corral with many of Daphne’s Ph.D-type colleagues, which is always very exciting for me.  We in Medicine have a tendency to talk only about the ins and out of medicine when we get together in an outpatient setting, over glasses of Chardonnay, and offer our own chief complaints as to why reimbursements are never enough, hospital staffing issues are always a drag, and must share that one patient experience that seems to make all hell break loose at any moment’s notice.  For me, I find it quite, for a lack of a more inventive term, remarkably refreshing to commune with folks of other specialties of life, to pick their brains, and to learn what subtle cogitations they have to share that just might make me and my self better for the moment.

I must admit—I don’t remember the name of the game we were playing when, in an instant, and still here just over 6 months later, I’m reminded about Varicella.  Now, I had, and many of us have in our youth, been faced with the dreaded Chicken Pox and the pruritic ravage that the illness brings, yet woe to the over-65er who has never suffered the nature of that itch and winds up with a recurrence of the virus in the form of the more dreaded Shingles, where the itch quite vehemently turns into an often unilateral, dermatomally-confined, hot, just plain old uncomfortable skin eruption.  Well, I was reintroduced to this topic during our game.

It was my turn, and whatever the game was, we were trying to guess the name of something on a card after the dissemination by the card holder of several clues to the correct answer.  Clues like, “skin,” or “rash” or “itching” or “burning” all seemed to draw my mind, as the one medical house officer in the room of very educated 20-somethings, not to the actual carded answer of “Shingles.”  No, I had to first and foremost yell out “Varicella,” much to the chagrin of my team members and to the amusement of all others in the room.  Hell, even I laughed, because I, for the life of me, didn’t even understand why I went first to the medical term instead of the more colloquial connotation of the entity.  Then, my perturbation transformed quickly into vexation?  Was I losing the ability to speak free of medical jargon?  Was I doing this a lot with my patients—speaking above their heads, so to speak?

That game night  in celebration of the life of my lovely lady taught me something.  It reminded me of the artistic nature it takes to practice medicine.  There is, indeed, an art to knowing all the medical terminology and learning the foreign language that we speak daily to colleagues, and putting that all away via translation to the patient who just wants to know what the hell is going on with him in the plainest and most layman of terms.  He doesn’t want to know that he has “healthcar- acquired pneumonia likely precipitated by recurrent aspiration events that will respond to an empiric course of vancomycin and pipericillin-tazobactam.”  All he wants to know is “Sir, you have pneumonia.  We are going to treat you with antibiotics and monitor your progress to see how you respond.”  That’s it.  Nothing more.  Nothing less.

It’s a skill that consistently evolves over the course of one’s career, I’m told by more seasoned physicians—knowing just how effectively to explain the complexities of a medical diagnosis and its conjoining treatment to those who it plagues, especially when they have little to no medical education and just want to know if it is a matter of living versus dying.  In those times, we must be direct, cut out all of the fat, trim down the hedge,  get to the nitty-gritty of the stuff, and just make it plain.  Patients , when they want to know, what it plain.  The adage goals to always “keep it simple, stupid.”  Communication is so very important in everyday medical practice that it hurts to say otherwise, and the most important communication in the process frankly occurs between a doctor and her patient.  Let’s all be reminder that our patients are to be spoken to and spoke with, not spoken over or above or even spoken at.  My reintroduction to Varicella was a helpful, personal reminder to follow that very same creed in daily donning the white coat.

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