Disclosure

Jack's youthful appearance and boyish eyes were betrayed by a body more fitting his grandfather. He hobbled into the office in his usual manner. His ambling gate was hampered by painful knee joints which creaked and crackled with every movement. His forty year old posture was marked by the cruelty of early onset rheumatoid arthritis.

His visit to the rheumatologist had been modestly fruitful. After injections to both knees, he was able to stop using the wheel chair. But joint replacement surgery was coming on the horizon. No matter how long he tried to prolong the inevitable, his day of reckoning was near.

He leaned back in his chair and tried to get comfortable. As he closed his eyes the sweat began to poor down his face. He reached over to the desk and helped himself to a tissue. He dabbed his forehead and looked in my direction.

If I knew how painful my forties would be, I would have had a lot more fun in my thirties!

We both laughed, but I knew that he was only partially joking. We spent alot of time in the exam room talking about what this disease was doing to his self image. The physical toll was matched, if not overcome, by the metal anguish of disability. Once a track star in college, he now considered himself a cripple.

As so often happens, I struggled to express comfort and understanding without being demeaning. How could I know what it felt like for Jack to not be able to ruff house with his kids;to not be able to pick up his crying daughter? I had no inkling of the painful stiffness he woke up with every mourning or the feeling of nausea brought on by his medications.

I found myself repeating familiar words.

I won't even pretend to know what it feels like to walk in your shoes because I haven't. But I've seen people in your situation and I know it is very difficult. Let's see if there are some things I can do to lessen your burden.

Jack sat quietly for a few moments absorbing my words. When he looked up, our eyes met and he started to speak. What he said next caught me completely by surprise.

I read your blog.

I felt a sense of doom arise from the pit of my stomach. I mentally scanned through my last few posts. Had I said anything inappropriate? Jack recognized the look of panic on my face and quickly reassured me.

I was really impressed! It would have never occurred to me that doctors think about such things.

As I listened to the squeaking of Jack's walker as he rolled toward the checkout counter, the weight of his words began to sink in.

Maybe our patients don't know that we suffer through difficult decisions. Maybe they don't realize that our insomniac brains toss and turn during sleepless nights where worry and fear become our dark companions.

And they likely don't realize that the pain and suffering we witness leaves disfiguring scars.

How could they?

Unless, of course, we tell them.