Time Will Tell
"When in doubt, tell the truth."
– Mark Twain,
Following the Equator
K. Patrick Ober, MD
Affiliation with the Medical School: Professor of Internal Medicine (Endocrinology and Metabolism)
Place of birth: Ames, Iowa
Where you grew up:
Ames, Iowa (until age 2)
Conrad, Iowa (until age 12)
Brandon, Florida (until 18)
East Lansing, Michigan (until 21)
Gainesville, Florida (until 25)
Winston-Salem, NC (Where the growing up continues...I hope.)
College & Medical School: Michigan State University, University of Florida College of Medicine
Major in College: Biochemistry
Goals: Do some good in the world every day. Create some laughter in the world every day.
Personal Philosophy on Life and/or Medicine:
1. The journey is more important than the destination.
2. Never take yourself too seriously.
"When in doubt, tell the truth."
– Mark Twain,
Following the Equator
Jennie and I go back a long way.
When I met her, I had just finished my fellowship and was new on the faculty. It was 1979.
Jennie [not her real name] was a patient I saw in consultation.
She was 17, and she was sick. She had some sort of wasting, debilitating disease. She was nauseated, constantly. She was thin, and her weight had been falling for months. She had terribly low blood pressure that dropped even lower when she stood up, severely limiting her functional capacity. She was afraid, and so was her mother, who was seated at Jennie's bedside when I walked into the room. Somehow, this high school girl from 100 miles away had ended up on the adult nephrology service by virtue of some impairment in her tests of kidney function, an increase in blood potassium, and a decrease in blood sodium.
It was 1979.
I was a consultant, a freshly-minted endocrinologist, my fellowship just completed, in my first year on the faculty.
Ultimately, Jennie was found to have Addison's disease. She was started on therapy. Since then, I have seen her in my clinic, once a year, on average. I don't think she has ever skipped a year, except maybe during the interval she was being treated for a malignancy while still a young woman in her 30s. She was left with some sequelae of her therapy, but she didn't let it slow her down. Some years I would see her a little more frequently, such as the time her thyroid went a little crazy and we had to work together to get it settled. But, every year since 1979, once a year on average, we get together to see how she and her Addison's disease are doing.
She has done well with it, and [truth be known] she doesn't really need to see me. She has an excellent primary care doctor at home. I sometimes mention that she really does not need to make her annual trek to Winston-Salem. "But, Dr. Ober," she says, to defend her decision to return to me each year, "how can I NOT come to see the person who saved my life?"
I always feel odd when that sort of thing comes up. Yes, she has Addison's disease. And no, she would not be alive now without therapy. But, I explain, I didn't do anything any doctor would not have done. If she chooses, she can say that medical science saved her life, and that is fine. But not me. If I rush into a burning building and pull you out just before the roof collapses, I saved your life. But I didn't rush into a burning building, descend into a collapsed coal mine, or jump into the Arctic Ocean on anyone's behalf...I did what a doctor, any doctor, would do, should do, must do. Through the years, though, I have learned not to debate the point. Instead, I just shrug my shoulder with an "aw, shucks" expression of humility, and then I move the conversation on.
Mostly, though, as I said, Jennie has done well. Our clinic visits are largely about "what's going on in your life, Jennie?" And each year, for a long time, it was a bit different each year, as it should be with a young person. When she started feeling better, she went back to school. Once her formal education was finished, she found a job, and changed to better jobs as they came along. She fell in love [I assume -- I didn't ask her overtly, but she was quite happy when told me about her wedding and showed me the pictures]. She had babies, and each year she told me about how her two babies were doing, and she brought pictures of them to show me, and we talked about how the girls were growing up, as we talked about how Jennie was doing.
The girls grew up. They went to college. At her last visit with me, a few months back, Jennie brought both of her adult daughters with her so I could meet them in person. It was odd. They were both copies the young Jennie I remembered, so that the 17-year-old Jennie from 1979 now somehow seemed duplicated before my eyes, with the original 1979 Jennie proudly by their side, the same Jennie who [as far as I was concerned] was still the original 17-year-old Jennie herself, from way back when she was a sick, frightened girl in a hospital bed.
One of Jennie's daughters was recently engaged. Jennie and I talked about wedding planning, and what the mother of the bride might wear. I know nothing of those things, of course, but Jennie indulges me, nods respectfully at my fashion advice, and has a sparkle in her eye that tells me that she knows that I am bluffing and making up wedding advice for her entertainment, but it's OK, because I am the doctor who saved her life, after all, and she is amused to see me amused by thinking I am deceiving her by pretending I know something about a topic I am entirely ignorant of.
Observation: After people have been your patients for about 20 years, they start to keep track of the duration of your relationship. "Dr. Ober!" -- Jennie greeted me at a clinic visit a few years back -- "do you know that this is our Silver Anniversary?!" [I didn't know that one.]
Sometimes I get quizzed about the duration of our relationship by my patients, Jennie and others. They seem to want to know if I have paid attention to the passing of our time together. "Am I a real person to him?," they seem to be asking, "or am I just a recurring task for him on a checklist for the day, a job to be done before he can go home?"
A couple of years ago, as we were reviewing the medications that replace her missing adrenal and thyroid functions, and as I was asking general health questions, and as we were looking at her recent labs together, Jennie seemed to have something on her mind. "Dr. Ober..." [she starts, then there is a pause, some hesitation, and a serious facial expression...and I sense that an important question is coming at me]..."do you know how long we have been seeing each other?" I paused, and thought about how she had phrased the question. She could have asked, "Do you know how long I have been seeing you?"...but she didn't. For one thing, she knew the answer to that question, so there was no reason to even ask it that way. Her phrasing, "Do you know how long we have been seeing each other?" was a different question altogether. It was really a question of whether I valued her trek down the mountain every year, whether my interest in her and her home and her family and her life and her health was a sincere one, or whether I was just going through the motions.
Fortunately, it is always easy for me to answer Jennie promptly. I was a new faculty member in 1979. That is when I met Jennie, the sickly 17-year-old girl. Everything that year was memorable. She was memorable. "Jennie," I replied, with false modesty at my quick reply, "I believe we have been seeing each other for 33 years..."
I awaited her praise, for being attentive to detail.
The praise didn't come.
Her motive was different from what I had imagined, it turned out.
Her question was not even vaguely a test of my attentiveness.
She was setting me up for a punch line.
She just needed for me to say "33 years," and then the path was clear.
"DR. OBER!!," she almost exploded with pseudo-agitation, betrayed only by the twinkle in her eye and the grin on her face, "I DO believe that ONE of us is getting OLD!!"
[You got THAT one right, Jennie...]
For some reason, it seemed as though we had some extra time to chat at our last visit. Maybe I had a cancellation that had opened some space? [I always like to give the gift of extra time to my patients, when it happens, to compensate for those other times I cut things a little short when I don't have all of the time I wish I had for them.] Maybe it was because I was talking to this 50-year-old woman who had once been a 17-year-old girl, and realized that I had been honored to spend her adult life with her, a bit at a time, in 15-30 minute segments annually. Maybe I was dropping some inhibitions by thinking about what it even meant to be another person's doctor for 33 years, and contemplating which one of us had really benefited most from that long relationship...
Maybe her comment ["I DO believe that ONE of us is getting OLD!!"] had loosened things up for both of us, and opened a door to another kind of conversation. My intention in extending our talk might have been to "mess with her" a bit, just as I "messed with her" when I gave her "mother-of-the bride" clothing advice, and as she was now "messing with me" with her "ONE of us is getting OLD!!" line.
I am not sure.
"Jennie," I started, "I have a confession I need to make to you..."
She has a serious look now. Intent.
"Do you remember back when we met, when you were in the hospital and so sick, and we found out you had Addison's disease?"
I have my best straight face on. My serious doctor-talk face.
She holds onto every word.
"Well," I continued, "when I made your diagnosis, I didn't really know ANYTHING about Addison's disease! I had never diagnosed anyone with Addison's disease before. In a way, I was practicing on you!"
She seemed to take it all pretty well. [She knew more was to come.]
I went on to explain -- now having had my little joke with her -- that I had been exaggerating just a bit, as she suspected I had. [Remember, I had previously advised her about what to wear as mother-of-the-bride...] I explained that I really had treated a good number of patients with Addison's disease before seeing her, patients who had been diagnosed earlier by someone else; I had done the testing in lots of other people who turned out not to have it; I had read the literature on it; I had given lectures on it; I had passed exam questions on it..but her distinction was that she WAS the first "from the start" Addison's disease patient of my career....
After all, she had been coming down the mountain so reliably for all of these 33 years, and I thought she might like to know that.
And I thought that was the end of this year's visit.
But it wasn't.
She paused, with a thoughtful expression, saying nothing for several seconds, but just on the verge. She was looking for the right words.
Then, with hesitation, she starts...She obviously has something to share with me.
"Dr. Ober," she begins, "since we are being so honest with each other today...[pause]..."
"I guess I have something I should tell you..."
"OK..." I reply.
"You remember when I was in the hospital, and I was so very sick, and you came to check on me, and you asked me all of those questions...?"
"Sure!" I said, "Just like it was yesterday..."
"Well..." Jennie continued, slower, more cautiously now.
"Well...after you explained everything to us, and then you left the room, my mother looked at me, and do you know what she said?"
"I give," I answer. "What did your mom say?"
[I am imagining she said something like "What a nice doctor he is!" or "Isn't he so smart!" or some equivalent...but I will wait for Jennie to deliver the exact words...]
"Well, if you really want to know," Jennie continues, "My mom said 'THAT doctor has NO idea of what he is talking about!'"
["Oh, God," I think to myself. "Really? REALLY? Was I THAT bad at the bedside? Did I do a terrible job explaining? Did I just look clueless?...Her mom thought I had 'NO IDEA!' of what I was talking about?! Wow! What a terrible spot for a parent to be in..."]
"Seriously?" I am stunned by the revelation. "Your Mom REALLY said that to you?" [I am now hoping Jennie is messing with me...]
"She DID say it!" Jennie answers. "Truly! That's EXACTLY what she said...'THAT doctor has NO idea of what he is talking about!' Those were her EXACT WORDS!!!"
[Jennie seems to be taking undue pleasure in repeating that...Certainly a lot more pleasure than I am taking in hearing it...wait!...ah!...Am I seeing a little grin on her face now??]
[Oh, man...come to think about it, though...1979?...I probably was inept...]
"OK, OK...tell me how I blew it. What gave me away? I thought I was doing a good job. What did I do that made your mom think I was such an idiot??"
"Well," says Jennie....pausing....and there IS a grin on her face, now, for sure..."when you saw me in the hospital, you said you were 99% sure you knew just what my problem was, and you were going to have the nurse come into my room and give me some important medicine in my vein right away...AND you said by the next morning I should feel as good as I had ever felt in my life, and I would feel perfectly normal..."
[Bigger grin. Jennie continues.]
"My mom looked at me when you left the room, and she said that I had been SO sick for SO long, she knew I couldn't possibly feel that much better in the morning. She just knew it wasn't possible. And, so, she was convinced that YOU had NO idea of what you were talking about."
"And," Jennie continues, "....you know what else?"
[Now the biggest grin I have EVER seen on Jennie's face...]
"No," I answer, with increasing trepidation about where all of this is going..."I don't know what else..."
"The next morning, when I WAS my usual perfect-feeling self for the first time in months, my mom said 'Jennie, I think you might just have the BEST doctor in the WORLD!'"
Jennie had waited 33 years to mess with me, and had saved the punch line all that time.
"So," Jennie concludes, as we walk toward the clinic's checkout window, "Since you ARE the best doctor in the world, are you going to give me an appointment to come back next year?"
Let's plan on that...