Gastroenterology

I must admit, I was pleasantly surprised with how much I liked the gastroenterologist I saw yesterday afternoon. The closer it got to the appointment, the more I resented having to go. I would say it was apropos that my stomach was killing in the afternoon and I was so bloated after eating that I couldn’t find a shirt cut generously enough to accommodate my enormously swollen belly. I need some sort of maternity wear designed to expand for all nine months of growth in a one-hour span. I had to settle for an uncomfortably tight shirt that stretched skin tight over my rotund protuberating belly. I was drilling with self-consciousness as I waddled from the parking lot into the hospital where his office is located. It seems like the only department people would imagine such a form heading to would be OBGYN for delivery, or at least a final nine-month check-up.

The waiting room was hot and all three of the other patients were in a much later life stage than me and on supplemental oxygen. That said, I enjoy the company of old people, except for the requisite yelling to be heard. One sweet lady (who I learned was named Betty and who enjoys Dr. Phil among many tidbits of information) could not believe I was over the age of fifteen. She literally asked to see my license after the receptionist scanned it in. After confirming that I’m 31, she said, “well, I’ll be,” which is actually a saying I don’t understand but I think means, “you’re right.” (Of course, I’m right; I know my age, but she was so convinced I was fifteen or younger.) We talked (shouted) while waiting for our appointments. I was fading because I was too hot and quite tired. Because I get up at 3am, by my 4:00pm appointment time, I’m spent and would much prefer to be laying on the couch relaxing.

The room was sterile. The smell of hospital permeated every corner of the office and the fluorescent lights hummed incessantly. I played on my phone while waiting and texted with friends. My anxiety was high because I don’t usually like seeing new doctors myself and I feel embarrassed about my digestive issues and my grossly distended tummy (pun intended). When the doctor knocked on my door, I stood up and gave him a firm handshake. I deliberately forced myself to make eye contact, though it makes me feel naked. He asked my least favorite, too broad open-ended question right of the bat: “so, what’s going on?”

My mind went blank. I do better with more specific questions about my symptom history to start because it helps focus my mind and build rapport and comfort with the provider as I begin to open up and start painting the picture of my health history and current complaints. I clam up and feel overwhelmed by questions that are too broad. Thankfully, I had used my list method and pulled up my GI history and symptom list that I compiled in the morning, which also included bullet points about my multisystem symptoms and current list of specialists whom I am seeing for my various medical issues. As much as it seems like western medicine doctors focus in on the pertinent symptoms to their sole system of specialty, I try to present a more complete picture of my ailments, even those that sound unrelated (for example, rheumatological problems).

The list tactic was effective at pulling me out of my initial mental blank and giving me a launching pad from which to start describing my past history and more recent digestive issues. It’s awkward to enumerate in detail the specifics of your bowel habits and “stool quality,” yet I was able to keep the fact that this is his specialty and he’s heard it all in the forefront of my mind and let that comfort put my shame and desire to be politely cryptic to rest. Perhaps my natural tendency to be direct and wear my heart on my sleeve makes it easier to speak openly about all the characteristics of my stool and bathroom problems.

After our discussion, he examined me, including palpating and auscultating my bloated belly. I cringed when he asked to examine it and I flushed red as I watched him rip the stethoscope ear pieces out of his ears when my hyperactive, loud bowel sounds hurt his ears. “Wow; I didn’t need any amplification for that,” he mused. I laughed, but was secretly mortified. I could tell he wasn’t making fun of me, but speaking sincerely.

Following the brief physical exam, we sat and talked about his assessment and the next steps to take. I loved his communication style and how well he explained everything. It parallels his very methodical approach to diagnosing and treating. He detailed each sequential step and what would result if that step yielded a positive finding or a negative finding. He then traced both of those divergent paths to their next step, the potential findings from that, and the subsequent steps from there, and so on. He ran through the entire plan twice and then had me ask questions and repeat it back to confirm understanding. At the end, I was confident in my comprehension of the plan and agreed in the proposed logical sequence of steps. I even thanked him for being so clear and thorough. He led me to check out and I scheduled the indicated procedures for the first step (a colonoscopy and upper endoscopy).

I was exhausted by the time I got home, both in terms of physical body fatigue and communicative/emotional depletion. Despite this feeling, I was proud at how well I expressed my concerns and shared openly with the doctor, how prepared I was with my list, and that I stuck through going to the appointment and driving there even though I was so tired and didn’t feel optimistic about the usefulness of going. I was rewarded for my stick-to-itiveness and efforts by a compassionate, smart, diligent, and concerned provider who seems invested in helping me find answers and feel better, even if doing so will require many steps. I feel I was matched with a doctor who is a good fit for my needs as a patient. Even though the late appointment disturbed my evening routine and sleep schedule, it was worth the hassle and disruption. I have a good feeling that this will lead to a better quality of life.

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