Published July 31 2013
If you ever wanted to be a physician, then follow along. You can be this patient’s cardiologist:
You are on call for the emergency room and receive a call, in the middle of the night, to treat a young man who passed out momentarily after experiencing chest pain. You correctly identify the problem and order medication for him. You feel good even though you did not get paid for your time or trouble. The young man has no insurance.
He returns to you every few months. His heart is doing fine with medication. He finally obtained health insurance, but refuses to find a family doctor because he likes you and trusts you so much.
Next visit, he tells you that he has had another serious problem since he was young and he did not feel comfortable telling anyone. He thinks his left leg never belonged to him and he wants it amputated. He is longing for an artificial leg, which he feels would make him extremely happy.
You realize that he has a well-recognized psychological condition, apotemnophilia — the long-standing desire for amputation of a specific limb. However, you explain to him that you would not be able to find a surgeon to amputate his perfectly normal and healthy leg and insurance will not pay for it.
He tells you that he has saved up enough money to pay for the surgery. He reminds you that plastic surgeons do all kinds of things all the time to make people look better and feel happier.
You tell him that his thinking process is not normal. He questions, who decides what is normal? What right does society have to deny him something that he finds so indispensable for his personal happiness?
You recommend he see a psychiatrist. He absolutely refuses. You cannot force treatment on him, as he is not suicidal and he has no intention of harming others.
You ask him to find another physician, as this is not your line of work. He again politely refuses. What would you do at this point?
Here’s what I did: I thought of advice from one of the great physicians of all times, Sir William Osler. “The good physician treats the disease, the great physician treats the patient who has the disease.”
During conversations with this patient over the years, I happened to find out that he has a girlfriend with whom he is truly in love. I arranged for her to come to the office without his knowledge. He was so ashamed of his thoughts, he never told her. I advised her to somehow make him feel that his legs are desirable to her.
Next office visit, he told me that he found a family doctor. He is fine with his leg. He is getting married and buying a house with the money he saved. For the first time, I saw true happiness in his eyes.
After all, happiness comes in all shapes and forms. Most of us, at sometime or other, need a little help to find the right kind of happiness.