The following is a post that was in the IBDList. Tom, the list moderator,added the comment at the end set off by brackets. The IBDList is a veryvaluable Maillist server for people interested in Crohn's and colitis.If you like the sort of stuff you see here you would like to get the IBDList.
I had an interesting emotional response recently with a patient whowas put into remission by surgery. This woman had her first attack of Crohn'sabout a year ago. She did well with steroids, almost came off prednisoneafter a slow taper, then went back on with a flare. On attempting to retapershe had another flare that turned into abscess. Surgery was required. TheCrohn's diseased tissue was very thickened, and perhaps it would neverhave healed with medical treatment.
I had seen her about once ever month or every other month during thistime and I got to know her well. When she came in for the post op checkupshe was off all her medications and doing very well, eating anything shewanted, all the visible steroid effects gone. While I should have beenhappy that she would not have to see me anymore, I found myself somewhatsad. It was feeling the feeling of loss.
Clearly what was happening was that the patient and I had been havingsuccess at dealing with the Crohn's, and much of the satisfaction for mewas the continued followup and advice that kept her going and the improvementshe had following my advice. Knowing that I would not have to do that anylonger was, I think, the basis for this. I think another aspect was thatshe came to surgery without my having given the advice. Having a patientgo sour is disconcerting to the physician (certainly more so to the patient),but there is something of a feeling of "how dare that Crohn's diseaseget worse just as I was dealing with it." Part of GI training is tohave the knowledge that surgery is not an evil to be avoided, but rathera tool to be used as needed.
I recall a post Tom put up on the IBDList a while back about havinga feeling of loss when in remission from IBD. The loss was in not doingthe dietary restrictions and other things that had become routine, or familiar,to daily life.
Oh, the reason I put this up is that this is a list about IBD, livingwith it, and treatment of it. While I don't think there is anything inthis post that will affect what anybody does, it is the case that IBD affectsmany people besides the patient, and the physician is one of them.
Stephen Holland, M.D.
[ Thanks for an interesting perspective. I know that when a GI I hadbeen seeing for a number of years retired, I missed him as a person asmuch as missing the physician. I never considered that he also might havefeelings of the loss of day-to-day contact with his set of patients.
Diabetics these days often have a team of professionals helping themwith their disease since it affects so many areas of physical, emotionaland spiritual life. In a way it is too bad that the medical community oftendoesn't take a more all-encompasing approach to diseases such as IBD thatare influenced by more than just the steriods or sulfa drugs. Maybe oneday the insurance companies will realize that a combination of treatments,along with a healthy look at eastern or alternative medications and procedurescan actually be cheaper than the most common methods of symptom-treatmentor emergency-care medicine. -tom]
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