Patient of 19 years presents in the emergency room of Hospital Universitario Fundación Jiménez Díaz on March 15, 2016, at 01:30, reporting throat pains, suspecting a foreign object. Patient reports difficulty swallowing and breathing, has not experienced increased salivation. Doctor inspects the throat and oral cavity but visualizes no obstruction. Cervical and lateral x-rays of the throat and oral cavity reveal no obstruction. Endoscopic inspection of esophagus by ENT reveals no obstruction. Patient is instructed to strictly avoid pain and anti-inflammatory medications. Patient should return if he experiences immunological response (inflammation) during the next 5 days, in the event that foreign object is present.
There was a fish spine stuck in my throat.
In the emergency room of a private hospital, my host father and I waited two hours for attention. I squirmed in my seat. I stared pensively forward, maintaining my head for fear of pain, denying my predicament. My host mother and IES negotiated by phone with hospital professionals, all for the frustrating end of a doctor’s pawing my throat and prodding my tongue with a depressor. They had no ENTs on call. They sent me away, to return the following morning.
“Yes, well, sorry,” said the English-speaking doctor. She said little more.
Eyes drooping from exhaustion, emotional distress prolonged well into the night, yet aroused by the persisting pain, I wobbled into a taxi en route to a public hospital. There, with the program director from IES, we waited another two hours for more appropriate attention: an x-ray, inspection by an ENT, endoscopic examination, all in a fifteen minute flurry. I could feel the bone. I waved fingers at the location. Like a spiny bridge whose supports dug into opposite esophageal walls. Help, please.
But he couldn’t see it.
He discharged me. He didn’t show me the x-rays or endoscopic images, he barely conversed with me, he didn’t reassure me. He spit out a diagnosis and sent me home. I was bewildered. He was wrong. It betrayed the obvious and painful reality —I could feel it there, swallowing, breathing, prodding. There was a fish spine stuck in my throat. That night I barely slept, exclusively preoccupied that my throat would inflame itself at any moment and I would surely suffocate in the night. By the fish spine.
In my latest run-in with the Spanish healthcare system, this time featuring brick-and-mortar establishments of the private and public variety, I happened upon a diagnostic dilemma that plagues medicine: when medical “reality” contradicts patient “reality.”
In the United States of Certain Distrust for Doctors, Americans frequently disagree with (and ignore) their medical professionals. We stop antibiotic courses when we “feel better,” despite strict orders and the bacterial resistance it breeds. Stories of cancer patients and paralysis victims that “proved the doctors wrong” permeate our media, even though the majority pass away or purchase wheel chairs without notice. Our nation harbors reactionary attitudes towards vaccinations and medications, patients opt for “alternative medicine,” and many die because of it. Beyond the States, I can’t be sure. But given Spain’s homeopathic bend, the same likely applies there as well.
Perhaps our individualism and “can-do” spirit has generalized to medicine —we believe our will can supersede even medical fact. But our emotions and experiences contribute too. In my kerfuffle with the salmon spine, I was truly convinced that it remained lodged in my throat, even after damning evidence to the contrary, conjuring delusional scenarios in which the spine had burrowed into my esophageal wall far enough that it therefore remained unseen.
Two stories. Two accounts of the same reality. Which one is lying?
Having unequivocally survived the fish spine without immunological response nor suffocation nor death, I must admit: my story is lying. That is, medically lying. The doctor’s reports far more accurately detail the physical reality. But what about the emotional one? What about the patient’s perceived reality? At the time, my story —as I perceived it— wasn’t a lie. It was my truth. Invented in my head, yes, and misled by the lingering pain of swallowing (and completely consuming) a fish spine, yes, but still the perceived truth.
The medical reports were lying too.
In the unthinkably complex reality —all including, all excluding— we cannot perceive anything purely or objectively. That’s the human reality. But in the case of medicine, where our closest approximation of objetive reality is king, this creates conflict. Because patients don’t believe it. Because humans are subjective. Humans are emotional. Humans swallow fish bones and panic and envision their suffocation in their sleep because, although medicine is rational, they aren’t.
When skepticism meets medicine, when patients with armchair medical degrees (or WebMD) dismiss their doctors, the issue is often patients. But it’s doctors too. It’s the non-empathetic forty-something that begrudgingly woke at three o’clock to check a paranoid tourist’s throat, rushing the tests and patient out the door. It’s the insufficient reassurance and, often, insufficient emotional services —why do cancer patients reject doctors’ diagnoses? Surely, the answer is emotion. And surely it’s better resolved with chemotherapy and psychological therapy. It’s a lack of education, too, when doctors’ tight schedules prevent the detailed consultations necessary for patients to understand their pathology, their test results, and (if applicable) why their treatments matter.
This fish spine is the story of modern medicine: miscommunication. And it offers a lesson in the empathetic, interpersonal arts: that reorienting and retuning our communication between patients and doctors might forward public health more than any breakthrough could.