No matter what I do for Robert, it is never enough.
He arrives at the office in a cloud of anticipatory dissatisfaction. He knows that his ankle will probably hurt even more tomorrow, his cough will be worse, his poison ivy will have spread. I am just one in a long line of major disappointments for him, doctor-wise, and I suspect he will soon be looking for someone better.
In the meantime, we are stuck with each other. “Here I am again,” he says. We both silently groan.
I would suffer more psychic trauma from Robert and patients like him were it not for ones who are just the opposite, the ones for whom everything I do is a small miracle of healing. I pass my hands over them, and the next day, whatever is wrong is almost gone. Queen of the medical arts, that’s me; I could probably dose these people with powdered newt and achieve the same results.
How to explain these discrepancies?
I say and do the same things for Robert that I do for everyone else. He may certainly expect less and less from me over the years, but it’s not all in his head — he definitely stays sicker for longer after a visit than others do.
What transforms the doctor from huge disappointment to miracle worker in these situations is simply the velocity with which the patient seeks medical care.
Not one of the various mundane ailments involved — the average ache, sprain or virus — is amenable to much in the way of treatment. Each will run its course in a predictable arc of misery sometimes made a little better by rest, heat, ice, fluids, soup and various pharmaceutical pats.
And Robert has very little tolerance for discomfort. He operates under the conviction that a truly healthy person never gets sick or even plunges briefly under the weather. When something goes wrong, he panics and mobilizes immediately: After the third sneeze, he is putting on his shoes, and by the 20th, he has arrived in our waiting room.
Given that the average cold lasts five days, Robert has many sneezes left to go even after he is dosed up. No wonder I seem to do nothing for him. In fact, seeing me seems only to prolong his misery.
The non-Roberts are made of sterner stuff. They can weather the first few hundred sneezes, but eventually get to a point where they can’t take it one minute more. Then they drag themselves in for help, invariably when things are at their worst.
Of course they feel much better the next day, but not because they have seen a miracle worker. Rather, it is their timing that is miraculous: They had already begun to slide down nature’s curve from sick to well.
Much is made of the psychologic power of the placebo, the pill that harnesses the mind’s power and works if you believe in it. The placebo effect, though, is as much about timing as it is about belief. Seek medical care for many common problems at just the right time, and you are likely to find that whatever you are offered works wonderfully well. Come too early, and you will find it useless, even harmful.
Only when a treatment is studied methodically and given to thousands of ailing people along the curve of illness can anyone figure out if it actually changes that curve. Otherwise, it’s all an illusion of timing.
People will protest that they find magnets, megavitamins and a host of prescription products fabulously effective. Likely as not, though, they reach for their treatment of choice when they cannot stand one more minute of whatever the problem is. And so the testimonials flow, misdirected to the intervention instead of the healing powers of timing and time.
I feel for Robert, sitting out there in the waiting room, mopping his not yet red, not even slightly chapped nose. In all his pessimism, he is one of life’s true optimists, operating in the eternal hope that someday, finally, the healing arts will live up to their name and grant him, a true believer, the early reprieve he deserves.
And someday, perhaps, if he is lucky (or unlucky, hard to say which), his wish will come true. Life offers up many disease trajectories. The predictable arc of the common cold and the waveform of the bad back or arthritic knee are just two of them. Other diseases are more like Niagara Falls: downhill all the way unless a well-timed medical treatment intervenes.
So perhaps someday, Robert the Early will arrive just in time to be saved from his pneumonia, heart attack or stroke. Assuming, of course, that whoever Robert’s doctor is by then, and I bet it will not be me, still has the right timing, too.
PUBLISHED: MARCH 9, 2015. By ABIGAIL ZUGER, M.D.
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