Becoming a patient changes a doctor’s perspective on the people in his care

By Paul Konowitz, M.D., Medical Director of HealthAngle

This is the fourth installment in a series about Paul Konowitz’s personal and professional struggles as a surgeon with a life-threatening disease.

Residency training, those arduous five years that I spent learning the craft of the medical and surgical treatment of diseases of the ears, nose, and throat, left me with the false assumption that my own subsequent surgical practice would be filled with only the most interesting and complex cases, just as my mentors had. I finished my training with the surgical skills to tackle the most difficult problems, and with the bravado to go with it. I could remove a voice box, explore a neck after a gunshot wound, remove a foreign body from the esophagus, eradicate an ulcerating, spreading tumor of the throat, and perform facial plastic surgery with the best of them. Only I failed to see, from the perspective of this ivory tower, that the real world of an ear, nose, and throat physician is not always so “glamorous” and may not always be so fascinating. I soon realized that I would have some of these complex patients, but also that my days would be spent taking care of more mundane problems such as impacted wax in the ears, postnasal drip, chronic sore throat, and nosebleeds. At times, especially in my early years of practice, this was at times demoralizing and tiresome. I thought to myself, why did I invest so much time, and spend so many sleepless nights, only to not have the super-selective referral practice just like “the gods” that trained me?

With time, and a developing sense of professional maturity, I soon realized that it was unrealistic to think that I would start off in practice in the same fashion as my residency teachers. My mentors had, at one time, been just like me, seeing both the interesting and the routine until ability, affability, and time eventually resulted in a medical practice consisting of patients with the most intricate and interesting problems. This happened to me as well, to some extent, although being in a community-practice setting, I continued to have many patients with everyday issues. Some days in my office were exciting, and some days were dull.

In the days and weeks following being diagnosed with pemphigus and beginning my treatment, I approached seeing patients in my usual way, treating each person with dignity and respect. But as my mood and physical condition deteriorated, I began to resent the “good health” of many of these patients who were coming to see me with their own problems. With irritability increasing at an ever-alarming rate, it became harder and harder each day to listen to the complaints of patients about problems that were not nearly as severe as mine. As I listened to the patient lamenting about his chronic cough, or the patient obsessed with her runny nose when she eats, all I could think was shouting at them, “Do you know I have pemphigus? How would you like to switch places? If you think you have it so bad, look at me.” I was clearly feeling that the doctor should never be sicker than the patient, but since I was keeping my own illness a secret, how were they to know about my condition? How were they supposed to care about me?

My perspective on what was a mundane or routine problem was certainly changed in the months to come as I went from doctor to doctor-patient, and then solely to patient. I eventually learned that what is “everyday” to the physician may be all-consuming to the patient. And if it is a problem that is not necessarily severe from the perspective of the physician, that doesn’t mean that it is not a serious problem to the patient. I learned to realize the great satisfaction in caring for patients, no matter how significant or insignificant their problems might seem to me, as I learned about the real joy in medicine — something that many of my colleagues who have never been in my position have failed to see. Severity of illness is most certainly in the eye of the beholder.

Sharing my secret

I thought I would be able to continue indefinitely, maintaining my busy practice, taking high doses of prednisone, pain killers, and other medications, going for intravenous infusions, and suffering unrelenting throat pain twenty-four hours a day. My wife, also a physician, knew better. She and my two teenage daughters were a source of strength and focus for me. I needed to persevere to preserve my income and, more important to me at the time, to prove to them that my condition was not that serious and that our good life would go on. I was determined not to have my children experience the stress of living with a sick parent and to have anything but a stress-free and happy existence. My illusion was just that — a facade that everyone in my life could see through. I couldn’t hide the pain, the frustration, the fear and the sadness growing toward depression. I no longer had much interest in anything except myself. I had difficulty sleeping, no desire to do anything, and I was getting sadder. I needed professional help.

To my rescue came an acquaintance who was a psychiatrist, whom I had known for many years and whom I had actually recommended to several of my patients. I never imagined that I would need to see her; I always believed that I could deal with my own emotional struggles, no matter how serious they might be. As she witnessed my gradual but obvious descent into profound depression, my wife of (then) sixteen years convinced me otherwise.

As I climbed the steep fifteen or so stairs to my friend the psychiatrist’s office, the self-imposed stigma of seeing a therapist was no longer present. I just didn’t care anymore. My wife helped me make it up the stairs and into the psychiatrist’s chair, and the three of us began a process that would change my life forever. Not only would I would receive help for the short-term bind I was in, but over time, I would learn what made me tick and receive insights that would make me a better person for my family, friends, and patients.

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