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"So what do you think it is with doctors not seeking help?"

Diane Barnes with My Stroke of Luck Sandwich Board

That was the first audience question at my talk back Saturday night. What indeed!

Everyone has heard, "Doctors make lousy patients," and "A physician who treats him or herself has a fool for a patient." But despite those aphorisms, and though we joke about it amongst ourselves, many of us persist in self diagnosing, self treating and directing our own care.

Of course we are knowledgeable, skilled and confident, and spend our working hours diagnosing and treating disease in others. We have all seen so many cases of just about every disorder in the medical literature, that we have an encyclopedic reference compendium. We know our symptoms, we know diseases, so by logical extension, who would know better than ourselves?

(We've also seen delayed diagnoses, and misdiagnoses, which may make us more than a little wary of relinquishing control.)

But more importantly, we've all survived medical school and training, which required a high degree of self control and sacrifice. In many ways, medical training is training in denial -it demands denial of our own physical reactions such as hunger, sleep deprivation, exhaustion, pain, even, at times, normal bodily functions in order to do our job. Training demands we surpress many of our natural reactions and feelings, including sadness, grief, embarassment, revulsion (ever had to pick maggots from a wound?), and even, sometimes, empathy, to function in some of the extreme circumstances in which we find ourselves.

And that training fosters a culture of invincibilty - or at the very least, one of not wanting to appear weak or vulnerable. So ask for help???

But in the particular case of stroke, another factor is at work: brain damage! From the instant the brain is injured, one's thinking is impaired. Not to discount invincibiity or denial, but no matter how logical and sensible one might ordinarily and previously have been, a damaged brain is a damaged brain, and won't think straight!

In my case, there were a few other factors. First, I am a woman, and a mother, and my children were number one in my mind. I was more concerned about doing for and taking care of them than I was for myself. Misguided, of course, especially for a single parent, as without me, the children would have no one. But I am not alone. Delayed treatment of stroke and heart attacks are common in women, who often stop to take care of their loved ones perceived needs (pick the kids up from school, make spouse dinner) before seeking help. In fact, some associations are now specifically targeting women in drives for prompt, early diagnosis and treatment of stroke and heart attack.

Second, my experience as a physician weighted in: exposure to many young stroke patients with devastating outcomes, reading biweekly CT scans of a nurse, a single mother, comotose for months after a devastating stroke and my first patient in medical school, who beat all the odds to survive a ruptured, abdominal aortic aneurysm, but was all but brain dead. Were those cases typical? No. The majority? No. But those were the cases I remembered as I drove with the worst headache of my life. Those were the cases that frightened me. Anecdotal, atypical, outliers... But indelible. And with a damaged brain, all I could see.

And I was sure I was going to die. My pessimism in those days? For sure. But also, perhaps, a primal fear from a 5th grade memory of my best friend, an only child of a single mother. Her mother came home from work one day with the worst headache of her life, took 2 aspirin, went to bed, and died in her sleep of a brain hemorrhage.

So, with all that coursing through my damaged brain, I went to the hospital only as a last resort.

So, do I excuse myself for delaying treatment? No. I was wrong, I was stupid, I could have created serious havoc. Do I forgive myself? Of course. I did what I thought was the best, at a time I couldn't think straight.

But whether you've had medical training or not, you can take a lesson from my mistakes. Ask for help. Go to the hospital. Do the right thing, so no one will ask, "So what do you think it is with you not seeking help?"


I'll be devoting the blog to answering questions from the Q & A's and Talkbacks. So if you have a pressing question, write me, and I'll try to address yours too.

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