{"product_id":"bedside-manners-isbn-9781400080526","title":"Bedside Manners","description":"Have you ever wondered what life is like on the other side of the stethoscope?\u003cbr\u003e\u003cbr\u003eCombining the grace and precision of a poet with a down-to-earth, compassionate manner, physician and NPR commentator David Watts reveals what it’s really like to be a doctor today. From difficult diagnoses, irreverent colleagues, brave survivors, and examining room embarrassments, Watts uncovers the world of contemporary medicine and shares the emotional truths and practical realities at the heart of every doctor-patient relationship.\u003cbr\u003e\u003cbr\u003eWatts’s warmhearted and understanding attitude toward his patients—and their foibles—is evident on every page of this surprising, poignant, and intimate look inside the life of a doctor who could very easily be your own.“David Watts is a gifted storyteller with a sense of the poetic, macabre, ironic, and surreal. He combines eloquence, erudition, and an ear for the gritty vernacular of the examining room and ER—a thoroughly satisfying read.”—Leonard Shlain, author of \u003ci\u003eThe Alphabet Versus the Goddess\u003c\/i\u003e and \u003ci\u003eSex, Time and Power\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“Watts can compress humor, pathos, and bewitching ambiguity into a few pages. Acting like a doctor, as he counsels himself, carries the risk of arrogance. Being a doctor demands a profound and grateful openness to the unknown.” —Steven Winn, arts and culture critic, \u003ci\u003eSan Francisco Chronicle\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“These encounters with his patients by a wise, kind doctor are finely wrought in language that is always clear and compassionate. They are a welcome addition to the growing body of literature from the experience of medicine.” —Richard Selzer, surgeon and author of \u003ci\u003eThe Whistler’s Room\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“Even the most routine checkup will never be quite the same. Watts’s sympathy for both physicians and their patients subtly changes our understanding of what it means to heal and be healed, and to put our trust in the hands of a practitioner who is just as complex, flawed—and human—as we are.” —Francine Prose, \u003ci\u003eO, The Oprah Magazine\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“Always sensitive, sometimes hilarious.” —\u003ci\u003eSan Francisco Chronicle\u003c\/i\u003e\u003cbr\u003e\u003cbr\u003e“Candid, poetic prose . . . You’ll wish your doctor were half as attentive.” —\u003ci\u003eNewsweek\u003cbr\u003e\u003cbr\u003e\u003c\/i\u003eDavid Watts, M.D., is a poet and a regular commentator on NPR’s \u003ci\u003eAll Things Considered\u003c\/i\u003e. He lives in Mill Valley, California.\u003cb\u003eWhite Rabbits\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003eFrank is in my waiting room, which means I'm going to be spending a  lot of time chasing rabbits—little questions he brings on small  crumples of paper that skitter around on my desk, issues he's  researched on the Internet and gotten emotional about that usually  don't have anything to do with his own circumstance. What's worse,  he's about to have an operation, which means he's really going to be  worked up.\u003cbr\u003e\u003cbr\u003eI'm remembering that he's the guy with too many colonoscopies. \"Well,  something might have gone wrong since the last one,\" he'll say. True,  but mostly not true. Still, you can resist that argument only so long  and then you find yourself torquing another scope through the colon.\u003cbr\u003e\u003cbr\u003eAnd it's not a trivial deal. He goes vagal in the mid-transverse  colon, drops his blood pressure, looks like the life force is beating  it out of town on the lam. We haven't killed him yet, but we may have  come pretty close. And it probably doesn't do a lot of good for his  oxygen-starved brain cells that his blood turns to molasses like  that. Besides, watching him go shocky sends my coronaries into spasm.\u003cbr\u003e\u003cbr\u003eI made him sign a release before the last one. That was after the  cardiologist told him no more colonoscopies until he got his carotid  arteries fixed. Even the S word, stroke, couldn't deter Frank.\u003cbr\u003e\u003cbr\u003eI'm not going to have a stroke, he said.\u003cbr\u003e\u003cbr\u003eIt struck me that he has one set of evaluators for a real disease  that could do real harm and another set for the harmless imaginary  one.\u003cbr\u003e\u003cbr\u003eHe wrote a long letter releasing everyone this side of Kansas from  any kind of liability connected with colonoscopy. This is a man who  knows what he wants even if it doesn't make sense. We did it, but not  before I secretly cleared it with the cardiologist. And we survived.  All three of us. But I told him no more nonsense until he got a  little more blood flow to his critical body parts.\u003cbr\u003e\u003cbr\u003eNow the time has come. 'Bout time, I say. The vascular surgeons are  ready to ream out his carotids, but he wants to ask me a few  questions first. I knew that. And I know what's coming—so here we go.\u003cbr\u003e\u003cbr\u003eI understand you can get a stroke from this operation.\u003cbr\u003e\u003cbr\u003eThat's true.\u003cbr\u003e\u003cbr\u003eHow common is it?\u003cbr\u003e\u003cbr\u003eI don't know. Not very common. It's a question you should ask the  vascular surgeons.\u003cbr\u003e\u003cbr\u003eThey don't hold still as long as you do.\u003cbr\u003e\u003cbr\u003eTie them down and ask them. Meanwhile, they don't do the surgery  unless the risk of waiting outweighs the risk of the surgery itself.  It's a complicated formula and I'm sure it's only partly accurate,  but that's the intent. It has to do with the extent of stenosis.\u003cbr\u003e\u003cbr\u003eWhat's that?\u003cbr\u003e\u003cbr\u003eNarrowing.\u003cbr\u003e\u003cbr\u003eHow narrow is mine?\u003cbr\u003e\u003cbr\u003eNinety percent, both sides.\u003cbr\u003e\u003cbr\u003eIs it safe to say it's small?\u003cbr\u003e\u003cbr\u003eWhat's small?\u003cbr\u003e\u003cbr\u003eThe risk of stroke.\u003cbr\u003e\u003cbr\u003eIt's small. Smaller than if you didn't have surgery.\u003cbr\u003e\u003cbr\u003eHow long will I be in the hospital?\u003cbr\u003e\u003cbr\u003eDon't know. These days, probably not long.\u003cbr\u003e\u003cbr\u003eThree days?\u003cbr\u003e\u003cbr\u003eThereabouts.\u003cbr\u003e\u003cbr\u003eI read that they will put me on something to thin my platelets.\u003cbr\u003e\u003cbr\u003eYeah, probably.\u003cbr\u003e\u003cbr\u003eWhat'll that be?\u003cbr\u003e\u003cbr\u003eIt's up to the cardiologist and the vascular surgeon.\u003cbr\u003e\u003cbr\u003eWhat are the side effects?\u003cbr\u003e\u003cbr\u003eAnd I'm thinking to myself, This is an example of how questions get  asked for the sake of asking. Fueled by their own passion, they  spring from a point beyond the platform of knowledge. How would I  know the side effects if I don't know the drug?\u003cbr\u003e\u003cbr\u003eI can't answer that.\u003cbr\u003e\u003cbr\u003eA long silence.\u003cbr\u003e\u003cbr\u003eThe rabbits were moving from one pile to another.\u003cbr\u003e\u003cbr\u003eWell, I have some questions about these bor . . . I can never say it.\u003cbr\u003e\u003cbr\u003eWhat?\u003cbr\u003e\u003cbr\u003eSounds in my abdomen.\u003cbr\u003e\u003cbr\u003eBorborygmi.\u003cbr\u003e\u003cbr\u003eYeah, that. I keep getting these loud noises.\u003cbr\u003e\u003cbr\u003eYou always have that.\u003cbr\u003e\u003cbr\u003eYeah, but I don't believe it's normal.\u003cbr\u003e\u003cbr\u003eI know you don't believe it's normal, but you've always been normal.  Every colonoscopy has been normal. We've studied you from teeth to  toenails and there's nothing in there. Nothing.\u003cbr\u003e\u003cbr\u003eWhat do you listen for if you think you've got cancer?\u003cbr\u003e\u003cbr\u003eNow we've come to it, I thought. This is the root of the  multitudinous colonoscopies, the driving force for the unseen  locomotive: failure to believe negative data. Failure to temper the  fear that something is wrong somewhere.\u003cbr\u003e\u003cbr\u003eI am careful to speak the truth. But truth comes in many packages and  it looks different to different people. For Frank I will speak it in  a way that wants to bring him back to earth. Just somewhere along  terra firma. It would be a mistake to lay out all the variables. That  would give him too many openings to hang himself on yet another  obsessive rope of worry. So I overstate.\u003cbr\u003e\u003cbr\u003eYou don't have cancer.\u003cbr\u003e\u003cbr\u003eHow can you be sure?\u003cbr\u003e\u003cbr\u003eYou don't have cancer. Since he cannot shut that door, I shut it for him.\u003cbr\u003e\u003cbr\u003eHe acts like he didn't want to hear this. He looks uneasy, fumbling  with his notes as if they, by their meticulous preparations, will  ride him over this unpleasant hiatus. They do not. He is forced to  accept and move on.\u003cbr\u003e\u003cbr\u003eWell, what do abnormal bowel sounds sound like?\u003cbr\u003e\u003cbr\u003eI could be offended by that question. Layered into it is distrust of  my ability, my training and experience to listen and report, as if  only he, with his untrained ear, can decide what is normal. I  conclude it is an accident of distraction. Of obsession. He is  blinded by his worries.\u003cbr\u003e\u003cbr\u003eI indulge him; I'm not sure why. But I can feel that I'm getting  close to my limit.\u003cbr\u003e\u003cbr\u003eBowel sounds are abnormal if they are absent for one minute in all  four quadrants of the abdomen, if they are high-pitched and occur in  rushes as they do during a dynamic obstruction, or if they are  amphoric, meaning that they sound cavernous, like water dripping in a  very wet cave—\u003cbr\u003e\u003cbr\u003eHe interrupts: Can you be more specific?\u003cbr\u003e\u003cbr\u003eNo.\u003cbr\u003e\u003cbr\u003eNo?\u003cbr\u003e\u003cbr\u003eNo. End of lesson.\u003cbr\u003e\u003cbr\u003eWell, I want you to hear—\u003cbr\u003e\u003cbr\u003eI've listened to your belly a hundred times.\u003cbr\u003e\u003cbr\u003eNo, I mean—\u003cbr\u003e\u003cbr\u003eAnd he brings out a little velvet pouch, something you might see  holding a family heirloom, a watch perhaps, the lovingly engraved  kind, made of gold and wound by a tiny gold key. He lays it on the  table and starts clumsily trying to extricate whatever it is that is  wedged inside.\u003cbr\u003e\u003cbr\u003eAnd with a straight face he says, I made a recording of these bo . .  . bo . . . bobo . . . rygeums, or whatever. I want you to listen to  it.\u003cbr\u003e\u003cbr\u003eBy now he has the recording device out on the table and is fumbling  with it, trying to get it to play. It's not cued to the proper place  and he is madly forwarding and rewinding. I realize I am most amazed  not by the weirdness it takes to record one's own bowel sounds, not  by his solipsistic assumption that I will find this of such great and  compelling interest as to arrest my whole practice while we await the  multimedia presentation, but that I will tolerate his time-consuming  fiddlings with this bowel-noise recording device of his while  patients fully deserving my attention wait their turn. Were it not so  humorous, it would be maddening.\u003cbr\u003e\u003cbr\u003eWithout thinking, my body has stood up and is leaving the room. I  babble something polite like I have to see someone down the hall, and  am gone before I can laugh or burst out with something I'd be sorry  for. I am tempted to relate this story to those in the hallway, but  who would believe that there's a guy in my office playing a recording  of his own bowel sounds?\u003cbr\u003e\u003cbr\u003eWhen I return, he's found it. He plays me ten seconds of static, mike  noise, adventitial sounds. And in the background, harmless bowel  mumblings.\u003cbr\u003e\u003cbr\u003eNormal, I pronounce.\u003cbr\u003e\u003cbr\u003eAre you sure?\u003cbr\u003e\u003cbr\u003eSure.\u003cbr\u003e\u003cbr\u003eHe is incredulous, but I leave him no openings. I am not in the mood  for encores.\u003cbr\u003e\u003cbr\u003eHe is quiet for a moment. Then he rallies. I was reading about  fistulae, he says.\u003cbr\u003e\u003cbr\u003eOh no.\u003cbr\u003e\u003cbr\u003eYeah, and how do you know if you've got a fistula?\u003cbr\u003e\u003cbr\u003eFrank, I say. Cut it out. You've got a real problem in your carotids  and you're out there trying to invent something in your gut you'd  rather talk about. We've been there. Done that. Checked you out,  first class. All is well in loop-de-loop land.\u003cbr\u003e\u003cbr\u003eI have stunned him to silence. Even so, I know I've not heard the  last of this. When he is away from me and my slaps in the face of the  disease he believes in so furiously he almost wants it, doubts will  filter in along the periphery and eventually, because they are  welcome there, occupy again the pathways to the center of his being.  He will build them up meticulously, like a young man smitten with a  model airplane project, with the same concentration and enthusiasm of  one whose grand vision is somehow tied to what he is building, all  energies now turned in the same direction, recruiting evidence,  plotting how to convert the heathens who refuse to see the obvious.  Oh, for someone to share his vision.\u003cbr\u003e\u003cbr\u003eIt's not me, I say.\u003cbr\u003e\u003cbr\u003eWhat?\u003cbr\u003e\u003cbr\u003eFrank, go have your surgery. And blessings be upon you. For Christ's  sake, just do what you need to do. You'll live longer.\u003cbr\u003e\u003cbr\u003eHe gathers up his rabbits and tucks them in his pocket. As I watch  him, he looks like a man picking up chess pieces at the end of a bad  game, not accepting the outcome.\u003cbr\u003e\u003cbr\u003eThen he leans over the desk. Can we talk about this again? he says.\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cbr\u003e\u003cb\u003eThe Doctor with Food on His Shirt\u003c\/b\u003e\u003cbr\u003e\u003cbr\u003eHe was a doctor with food on his shirt, she said.\u003cbr\u003e\u003cbr\u003eYou don't like to see that, I said. You don't like to see a  doctor with food on his shirt.\u003cbr\u003e\u003cbr\u003eAnd, she said, he put me in a room that wasn't a room but open space  with a curtain around it, short as a miniskirt.\u003cbr\u003e\u003cbr\u003eYou don't like to see that, I said.\u003cbr\u003e\u003cbr\u003eHe said he didn't know what Asacol was and why I was taking it. I  said it was for my disease. He said he didn't know why they gave  Asacol for that disease. I said I'd been taking it for years—Hmm, he  said—for my disease and I thought that everybody who had this  disease took it. He said he noticed that I worked for that company  that had the big scandal recently and what did I know about that  scandal because he was interested in what did I know about it. And I  said I'd rather talk about my disease, which was why I came, to talk  about my disease.\u003cbr\u003e\u003cbr\u003eYou don't like to see that, I said. You don't like to see a doctor  who doesn't want to talk about your disease.\u003cbr\u003e\u003cbr\u003eAnd people were walking up and down outside my curtained-off open  space, which was not a room, talking loudly about weight-loss pills  and which one worked best, and how Josie's boobs really looked a lot  better now that she'd got them fixed.\u003cbr\u003e\u003cbr\u003eAnd he asked me a couple of questions which I don't remember but I do  remember it didn't sound like he knew very much about my disease, or  maybe nothing at all, because he looked at me and said you look okay,  you look okay to work—just like that—and I said aren't you going to  examine me and he said okay and put his hand on my belly. But I know  you can't tell the color of the colon inside by putting your hand on  the belly outside.\u003cbr\u003e\u003cbr\u003eHe didn't look at the disease, I said.\u003cbr\u003e\u003cbr\u003eHe didn't look at the disease, she said. He might not have known where to look.\u003cbr\u003e\u003cbr\u003eMaybe he's a hired gun, I said.\u003cbr\u003e\u003cbr\u003eWhat do you mean, hired gun?\u003cbr\u003e\u003cbr\u003eMaybe he's a paid killer.\u003cbr\u003e\u003cbr\u003eWhat do you mean, paid killer?\u003cbr\u003e\u003cbr\u003eI said, Maybe they have paid him to kill off your disability, the  disability you paid into, working all those years at that company  with the scandal and the days that made your disease worse, and  paying in each month to social security and state disability, that  money you paid, in case you needed it later and now you need it and  they want him to kill it off.\u003cbr\u003e\u003cbr\u003eBut isn't the system supposed to take care of you? she said. That's  what they said when they withheld all that money: The system will  care for you when you need it.\u003cbr\u003e\u003cbr\u003eI said, It's cheaper for the system to pay a doctor who will file a  report to kill off the disability I put you on, and that you deserve  because your colitis will not stay under control as long as you work  for that company, cheaper than it is to pay your disability. It's  economics.\u003cbr\u003e\u003cbr\u003eShe said she could see that and it sure felt that way but she didn't  understand the part about how a doctor could train under that oath to  do—what is it?—do no harm? And then go around killing off her  disability like that.\u003cbr\u003e\u003cbr\u003eI said, Let me tell you a story. Suppose you're a doctor whose  practice is not going well and all the patients seem to be going down  the street to the doctor who doesn't have any food on his shirt. And  every patient who sees him is one patient fewer who sees you and  you're looking around for some way to pay the overhead and buy a  biscuit for breakfast and the disability company sends you a patient  with ulcerative colitis who can't work anymore and you look at her  and say, She looks like she can work, and they pay you for that. Pay  you pretty well. For that. And you keep your office and your buscuit  and maybe you know the principle or maybe you don't know the  principle, that if you say no to the disability company they won't be  as inclined to send you any more patients, but as long as you keep  saying \"back to work\" and things like that, they will keep you busy.\u003cbr\u003e\u003cbr\u003eAnd she said, Oh.\u003cbr\u003e\u003cbr\u003eAnd then she asked, What did he say in his letter?\u003cbr\u003e\u003cbr\u003eAnd I read her the part about how she looked okay and he didn't see  why she couldn't do some work of some kind.\u003cbr\u003e\u003cbr\u003eAnd she didn't say anything.\u003cbr\u003e\u003cbr\u003eAnd I said, You could make an appeal, and she said, That's the kind  of stress that makes my disease worse and that I'm trying to avoid by  all this, and I said, I understand, and she said, I'll be okay. But I  sure could have used some of that money.\u003cbr\u003e\u003cbr\u003eI said I was sorry and then something about how you don't like to see  things turn out this way and she said, Thanks, and we sat for a while  not saying anything.\u003cbr\u003e\u003cbr\u003eAnd then she said, You know, I found out he's not a gastroenterologist. He's a weight-loss doctor.\u003cbr\u003e\u003cbr\u003eAnd I said, Was he fat?\u003cbr\u003e\u003cbr\u003eAnd she said, Yes, he was.\u003cbr\u003e\u003cbr\u003eAnd what kind of food was it, anyway?\u003cbr\u003e\u003cbr\u003eAnd she said, I'm not sure. It might have been tomato. Pizza sauce or something.\u003cbr\u003e\u003cbr\u003eAnd I said, You don't like to see that. You don't like to see a doctor with food on his shirt.","brand":"Crown","offers":[{"title":"Default Title","offer_id":46303051841765,"sku":"NP9781400080526","price":19.0,"currency_code":"USD","in_stock":false}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/1842\/7735\/files\/9781400080526.jpg?v=1767722349","url":"https:\/\/k12savings.com\/products\/bedside-manners-isbn-9781400080526","provider":"K12savings","version":"1.0","type":"link"}