Who Gets Believed? by Dina Nayeri;

Author:Dina Nayeri;
Language: eng
Format: epub
Publisher: Penguin Random House LLC (Publisher Services)
Published: 2022-12-19T00:00:00+00:00

In our forties now, Adam and I laugh about our college days over Zoom. I tell him about my prenatal theater, Josh’s struggle to see a doctor. He tells me about the ER minefield. People come in for all kinds of secondary reasons, besides the apparent emergency: a dose of painkiller, narcotics for a party, a doctor’s note. Frequent fliers know every nurse, doctor, and PA by name. Some are homeless, desperate to escape the cold, to be fed; they come in with a new ailment daily. A jaded fifth-year intern will say, “Oh that’s just Lenny. Give him his sandwich and send him along.” To that, Adam says, “Let me tell you about the day the last ten Lennys died.” There is always the day when the frequent flier dies. When the true warning signs come, the frequent flier knows just where to go. But after all those turkey sandwiches, he is rarely believed. It’s a classic wolf cry. At the end of the story, Adam reminds his interns, the wolf always comes.

Adam tells me about a sweet lady, partially blind, who came in once a week. “Every doctor’s seen her fifty times. ER doctors are cynical schmucks. We knew ninety-nine percent of her visits were for nothing. But you don’t want to miss the one time it’s something. Clown shoes . . . ” He glanced down at his hands. “We knew her,” he says, “and one day she died.”

Who is hardest to believe, I ask Adam, and who does most of the disbelieving?

Of countless medical biases he’s seen, Adam describes three notable ones: the Google bias (used to dismiss teens and the elderly), the poverty bias (used disproportionately against poor people of color), and the you-should-be-healthy bias (a quick way to disbelieve women).

“Two weeks ago,” Adam tells me, “a precocious fourteen-year-old comes in with appendicitis.” The boy arrived in urgent care vomiting, with extreme belly pain. He told the nurse, I have appendicitis, explaining that the pain began in his umbilicus (he used that word), then moved to his right hip, and that, in the car, the road bumps gave him sharp aches. “A first-year med student knows this is a textbook presentation of appendicitis.” The nurse chuckled. “The patient’s been googling!” She told him it was probably gastroenteritis and gave him food and drink, delaying his surgery by three hours. Eventually, the boy ended up in the ER, but the appendix might have burst while he was waiting for surgery, and because of his full stomach, he might have vomited, aspirated, and ended up on a ventilator in the ICU for a month.

The more seasoned the medical professional, I’ve noticed, the less frequent their eye-rolling over patients who research. Maybe because that knowledge isn’t threatening; they don’t need to distinguish their medical degree from Google results. “But nurse practitioners don’t have even ten percent of a physician’s training,” says Adam. “They don’t know what they don’t know.” The most effective mid-levels understand that and guard for blind spots.

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