Thursday, February 10, 2011

Nephrologist: say it three times, backwards

The surprising thing about being, so help me, 57 years old (as of yesterday: happy birthday to me!), is that your insides age just like your outsides. Or maybe a bit more.

You can't see in there, and if you're not having any obvious problems, you can (wrongly) conclude that everything is chugging away normally.

I seemed to be chugging away normally, except that my doctor (not the one I complained about a few posts ago) noticed an elevation in something called creatinine. Oh dear. Creatinine isn't a good thing if it's elevated. It was, in fact, elevated just a tiny bit, but this particular doctor, being a specialist and a nitpicker, decided to refer me to another specialist who turned out to be an even bigger nitpicker.

This was Dr. Schachter, the nephrologist.

Nowadays, instead of doctoring the whole person, most docs choose one part of the body and study it furiously. There are advantages and disadvantages to this approach.

The advantage is, these guys really know their stuff. Though I didn't know Dr. Schachter and didn't at all know what to expect, I was amazed at how thorough the exam was: far more thorough than the cursory open-the-mouth-and-look-at-the-horse's-teeth thing I have come to expect once a year from my family doctor.
The not-so-good thing is that, in focusing on only one body part, you can forget about all the rest, or not put it in the context of the whole person.

This guy, the nephrologist, had done a dizzying battery of tests on my blood and urine, stuff I'd never even heard of, but that didn't matter because he knew what it was. And he knew all the right questions to ask. He asked a lot of them. This might have got my back up, since some of it was pretty personal (I'm kind of attached to my kidneys), but for some reason it didn't.

Maybe it was bedside manner, a kind of professional concern that is missing from most medical care these days. It's as if doctors are afraid their patients will get attached to them or, even worse, trust them. This is why I often have that shoo'ed-out feeling with certain of my doctors. When you're feeling anxious about something and have it brushed off as hypochondria or sheer foolishness, it hurts.
When you hear horror stories of blatant misdiagnosis or doctors who overlook serious disease completely, it makes your hair stand on end.

This guy, however, well, for some reason I felt completely comfortable, and who knows why. For one thing, he was very (very very very) young. I swear these guys get younger every year. It could be that med schools are finally telling these guys and dolls to please, please consider the whole person while you're focusing so fiercely on those kidney-shaped organs on either side of the torso.

I noticed several other things about my visit. One was that the office, almost brand new, had been built so close to the exit of the Skytrain station that I blew right past it and couldn't find it. The hidden message seemed to be: don't rely on your cars so much, folks, it ain't healthy. Or maybe the property was cheaper, I don't know

Another thing: the waiting room was full, and the average age of the patients must have ranged from 85 - 90. Most of them looked in rough shape, as if they spent most of their time in waiting rooms. One very elderly woman had one of those oxygen thingies on a pole, and she had to wheel it around with her.

I was the blushing young flower of the group at 57. It was strange. Yet, in spite of how ill everyone looked, there was lots of joking and laughing going on, mostly about the indignities of the procedures. I saw this as a form of valour, of not just enduring serious illness but finding a way to transcend it.

After poking, prodding, listening to this and that, and tapping me all over, Dr. Schacter talked to me about my kidneys. They were in pretty good shape at this point, but pretty good didn't mean perfect. I was surprised to learn my blood pressure is somewhat elevated. Ye gods! My body is ageing. So what's happening to this piece of meat inside my skull?

Looks like I will be returning to this oddly-located office at intervals, but I don't mind. Dr. S. is a real sweetheart, the kind of person who makes older women proudly exclaim, "My son, the doctor!".

And the place has one other advantage. It makes me feel so young.