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Lessons From the Practice What the Doctor Ordered ELLIOTT B. OPPENHEIM, MD, Bellevue, Washington
M/Irs Ritchie is a dour, precise woman whose husband is
LVI a structural engineer for the Boeing Commercial Aircraft Company. Their lives center around careful planning for the future-meticulous attention to health matters such as cholesterol levels, sufficient exercise, and a high fiber diet. Regularity in all matters is the desired result, but "This knee, Doctor, this knee knocks my schedule off . . . I cawn't wawlk," she explained in her broad north London accent. She is, in my experience with her, a woman who smiles little and who remembers surviving on potato skins and squash through the Nazi terrorism of her country. That year, right before Christmas she got a "burst," as she calls it, of "my arthritis," where the prepatellar bursae on both knees swell up with fluid and limit her walking. "I will admit to doing a bit of gardening over the weekend . .. my daffodils needed tending and my tulip bulbs . . . they just keep me on the run." She narrated this portion of her saga without the smallest smile, missing the obvious humor. To her, gardening is important business, after all. I picture her garden looking like a horticultural operating room-that neat and orderly. We solved the knee trouble with one of the high-powered anti-inflammatory medicines. She thanked me, and as she rose from the examination chair, cocked her head at an awkward angle, peering out over her half-glasses. "There is something else." Rising to her full stature, wrapping her Harris tweed coat around her shoulders, neither buttoning it nor tying her scarf, she continued. "Oh, it's not important." She reconsidered and threw her emotions into reverse and I could almost feel the gears grind. "I would like to hear what you have," I coaxed. "I am so depressed . . my son says I don't smile anymore," she revealed, exhaled, and then deflated, slumped into the chair. I followed her example and sat down. This was too important to put off. "You do look down in the dumps. I wonder what it could be?" "I don't know; I have a beautiful new home, a new car, my husband is the best anyone could ask for . . . there is nothing wrong, yet I feel so bad." She punctuated that by plucking an embroidered pink hankie from beneath her sweater sleeve at the wrist, then knotted and unknotted it as if it were a life metaphor: she was in knots. "Maybe it is this time of year . .. so far from Wembly." "You miss your family?"
"Oh, yes, yes . . ." she whispered. She was in pain, a pain I have known, a pain common to any person feeling the deep hollow of missing family at any time of year. "I have a terrific idea! Why don't you go to England and see your family? You and your husband make a bunch of money, and you're both near 70. Why don't you just go?" "Oh, Doctor." The corners of her mouth turned up slightly. "Oh, Doctor, I never do anything unless I have cautiously planned. You know how Mr Ritchie and I are." "Mrs Ritchie, this isn't a crazy idea." "I just don't know what we are saving for if it isn't for this," she said and knotted up her hankie once again. "When was your last trip to England?" "Three years ago, and it was . .. [she sucked in a breath, almost as if she were entering a dream state] . . . grand. Oh, my mother was so surprised and we saw all my friends. Mr Ritchie and I grew up together, and we lived on the same street all our lives 'til we married. Oh, just thinking about this, I feel so much better." And she smiled a broad smile, one of immense satisfaction. "It sounds to me as if this trip would be better than any gift either one of you could ever buy at any store. These are the years when you should reap those sown crops." "I think you are right." She smiled again with an inner ease. "If we don't go now, who knows what will happen by next Christmas?" Mrs Ritchie folded my prescription in half, then in half again and creased it to make a perfect square. She stowed it in her purse, buttoned her coat, tied her scarf, and scurried out of my office. "I have never done anything this silly before," were her parting words to the nurse as she grinned in childlike glee. *
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"Lessons From the Practice "presents a personal experience ofpracticing physicians, residents, and medical students that made a lasting impression on the author. 7tese pieces will speak to the art of medicine and to the primary goals of medical practice-to heal and to care for others. Physicians interested in contributing to the series are encouraged to submit their "lessons" to the series' editors.
(Oppenheim EB: What the doctor ordered. West J Med 1991 Jun; 154:739) Dr Oppenheim is in private practice in Bellevue, Washington. Reprint requests to Elliott B. Oppenheim, MD, Crossroads Family Practice, 1811 156th Ave, NE, Bellevue, WA 98007.
JONATHAN E. RODNICK, MD STEPHEN J. McPHEE, MD Series' Editors
Lessons From the Practice What the Doctor Ordered ELLIOTT B. OPPENHEIM, MD, Bellevue, Washington
M/Irs Ritchie is a dour, precise woman whose husband is
LVI a structural engineer for the Boeing Commercial Aircraft Company. Their lives center around careful planning for the future-meticulous attention to health matters such as cholesterol levels, sufficient exercise, and a high fiber diet. Regularity in all matters is the desired result, but "This knee, Doctor, this knee knocks my schedule off . . . I cawn't wawlk," she explained in her broad north London accent. She is, in my experience with her, a woman who smiles little and who remembers surviving on potato skins and squash through the Nazi terrorism of her country. That year, right before Christmas she got a "burst," as she calls it, of "my arthritis," where the prepatellar bursae on both knees swell up with fluid and limit her walking. "I will admit to doing a bit of gardening over the weekend . .. my daffodils needed tending and my tulip bulbs . . . they just keep me on the run." She narrated this portion of her saga without the smallest smile, missing the obvious humor. To her, gardening is important business, after all. I picture her garden looking like a horticultural operating room-that neat and orderly. We solved the knee trouble with one of the high-powered anti-inflammatory medicines. She thanked me, and as she rose from the examination chair, cocked her head at an awkward angle, peering out over her half-glasses. "There is something else." Rising to her full stature, wrapping her Harris tweed coat around her shoulders, neither buttoning it nor tying her scarf, she continued. "Oh, it's not important." She reconsidered and threw her emotions into reverse and I could almost feel the gears grind. "I would like to hear what you have," I coaxed. "I am so depressed . . my son says I don't smile anymore," she revealed, exhaled, and then deflated, slumped into the chair. I followed her example and sat down. This was too important to put off. "You do look down in the dumps. I wonder what it could be?" "I don't know; I have a beautiful new home, a new car, my husband is the best anyone could ask for . . . there is nothing wrong, yet I feel so bad." She punctuated that by plucking an embroidered pink hankie from beneath her sweater sleeve at the wrist, then knotted and unknotted it as if it were a life metaphor: she was in knots. "Maybe it is this time of year . .. so far from Wembly." "You miss your family?"
"Oh, yes, yes . . ." she whispered. She was in pain, a pain I have known, a pain common to any person feeling the deep hollow of missing family at any time of year. "I have a terrific idea! Why don't you go to England and see your family? You and your husband make a bunch of money, and you're both near 70. Why don't you just go?" "Oh, Doctor." The corners of her mouth turned up slightly. "Oh, Doctor, I never do anything unless I have cautiously planned. You know how Mr Ritchie and I are." "Mrs Ritchie, this isn't a crazy idea." "I just don't know what we are saving for if it isn't for this," she said and knotted up her hankie once again. "When was your last trip to England?" "Three years ago, and it was . .. [she sucked in a breath, almost as if she were entering a dream state] . . . grand. Oh, my mother was so surprised and we saw all my friends. Mr Ritchie and I grew up together, and we lived on the same street all our lives 'til we married. Oh, just thinking about this, I feel so much better." And she smiled a broad smile, one of immense satisfaction. "It sounds to me as if this trip would be better than any gift either one of you could ever buy at any store. These are the years when you should reap those sown crops." "I think you are right." She smiled again with an inner ease. "If we don't go now, who knows what will happen by next Christmas?" Mrs Ritchie folded my prescription in half, then in half again and creased it to make a perfect square. She stowed it in her purse, buttoned her coat, tied her scarf, and scurried out of my office. "I have never done anything this silly before," were her parting words to the nurse as she grinned in childlike glee. *
*
*
"Lessons From the Practice "presents a personal experience ofpracticing physicians, residents, and medical students that made a lasting impression on the author. 7tese pieces will speak to the art of medicine and to the primary goals of medical practice-to heal and to care for others. Physicians interested in contributing to the series are encouraged to submit their "lessons" to the series' editors.
(Oppenheim EB: What the doctor ordered. West J Med 1991 Jun; 154:739) Dr Oppenheim is in private practice in Bellevue, Washington. Reprint requests to Elliott B. Oppenheim, MD, Crossroads Family Practice, 1811 156th Ave, NE, Bellevue, WA 98007.
JONATHAN E. RODNICK, MD STEPHEN J. McPHEE, MD Series' Editors
