“Why didn’t you tell anyone that you’re a doctor?” I’d known this emergency room doctor since I was an intern in 1995, fresh out of medical school. He looked the same as I remembered, as if no time had passed at all — hunched over on his stool, weary, but wearing the same half-smile. Even though I didn’t work at the hospital anymore, he seemed embarrassed that I didn’t get the “professional courtesy” of being rescued from the waiting room instead of sitting there all night long. Perhaps he was also ashamed of how much the ER had changed. Since the pandemic, the once reasonably tidy linoleum floored room with the modular furniture had become frantic and overwrought. Where there were once enough places for everyone to sit, and an average wait of two hours, now lines of people in wheelchairs were pushed up against stained couches where the limbs of unfortunate (and some less than sober) souls hung off the edges and brushed against one another’s knees for a whole night or beyond. The sliding doors opened and closed all night with a whoosh and a gust of chilly December air.
“It’s okay,” I said. “It seemed busy. I didn’t want to make a fuss.” I was still digesting the several ER “regulars” who sat across from me hunched under blankets with their partners eating salty snacks from the vending machine.They had clearly been prepared to stay the night in the waiting room. And I felt badly for the young guy endlessly pacing the narrow path between the couches while holding up his enormous, soiled, brown pants up. But it was true the whole left side of my head was pounding and tender to the touch. My hip was achy, and my forearm had a patch forming small bubbles of blood. I gathered I’d grazed it on the wooden bath mat that was next to me when I woke up after passing out on the tiled bathroom floor near eleven the night before. It was six am by the time I saw the doctor.
“I’m going to tell the boss. We need to take care of our own. So what happened to you?”
“I fell in the bathroom. Hit my head. I don’t know what happened. I think I just need a CAT scan since I had a brain bleed ten years ago, in 2012. I’m not sure if you remember that.” He shook his head, a softening of his eyes noting that he did. The news of that event, when I was still on staff at the hospital, had spread quickly. I’d had the proverbial “worst headache of my life” while running on a treadmill; a symptom we learned in medical school could signify a subarachnoid hemorrhage — blood in a space where it shouldn’t be, where cerebrospinal fluid exists. I’d been lucky it wasn’t from a pulsating artery, like most of those bleeds are, so I didn’t need surgery. It healed on its own without any lasting effects.
“I’m sure you’re fine,” he said, barely checking me out despite my swollen head, bleeding arm, and the bruised hip I made sure he saw by pulling down my gray pajama pants while he did his quick once over of my body. He was most interested in performing a neurological exam, having me walk on my toes and heels and doing an index finger-to-nose maneuver to be sure I hadn’t had a stroke. “You’re not even 60. That’s when we worry about subdural bleeds.” This was the kind of bleeding that occurred after falls, where blood gathers under the skull and can dangerously compress the brain.
My mind went back to actor Bob Saget’s death just months before, alone in a hotel room, reportedly from a fall like mine. So he was 65 to my 56, but still. As fortunate as I’d been told I was that I didn’t have an arterial bleed ten years ago, I’d never found out why I bled in the first place. But this doctor, though kind, wasn’t worried about a bleed or even curious about why I fell. Although I didn’t say so at the time, it bothered me.
Once I got home, I looked up my record in the patient portal and there they were: fake answers to the questions in the “social history” part of my “history and physical” assessment. The medical interview is the cornerstone of any physician-patient interaction and involves several well-prescribed sections: the chief complaint, the history of present illness – the details that led to the visit, the past medical history, medications, allergies, family history, review of systems, and social history. This last one provides an opportunity to create a broader context for a patient’s concerns and may include birthplace, occupation, education, functional status, sleep habits, and religion, all of which may be crucial to understanding health concerns and how to approach them. But social histories are also meant to encompass behaviors that are critical to understanding a patient’s current health status — like smoking, drinking, sexual history, and illicit drug use.
***
In 1990 when I was twenty-three and doing premedical studies, I worked as a secretary for an ObGyn on the upper east side of Manhattan at a practice connected to Cornell University. Our patients dressed in heels and full makeup to see the all-male doctors, and the doctors came into the hospital to deliver babies even if they weren’t on call because their patients were celebrities.
One particular patient was beyond well-known; her family was infamous. I’ll call her Susan since that was the pseudonym we chose for her obstetrical admission to the hospital. Before I did my usual patient intake, the office manager Ms. Solo — older and more stern than one might expect at what I’m now thinking was her age of fifty or so, in her shapeless, below the knee black frock and comfortable shoes, took me aside and told me what not to ask Susan: her family history, her use of substances, and her abortion history. “Just fill in the demographics, okay?” she said, glaring at me. Ms. Solo had worked with the practice for decades already, a proud product of that medical era where hierarchy and the unwritten rules for very important patients lived large. She was protecting her doctors and patients from uneducated newbies like me who didn’t understand the ways things worked.
And so, as instructed, I left the “social history” blank. Realizing that what I was expected to do was protect the patient from embarrassment in the moment, or exposure should her record be leaked, it still seemed strange— if not unethical—to omit certain details of her life and history. What if she were to admit she was smoking or drinking during her pregnancy? Might this not create an opening for a conversation about the potential impact of her behavior on her health and that of her baby? Even more, weren’t we supposed to engage in personal and private discussions in doctors’ offices and in the process create connected bonds that build trust? But no. I learned then that certain people are not expected to be open or vulnerable, or perhaps even allowed to solicit support. We didn’t even give high-profile patients that choice. Instead, we just avoided certain critical questions deemed too sensitive. Around the time, Ms.Solo had scolded me for not wearing skirts and panty hose: “The doctors like to see legs,” she’d said in such a matter of fact way that it made me feel as though I should have known this without being told.
I left that job soon after.
***
In 2012, during the nine days I was in the hospital for the subarachnoid hemorrhage, I was cared for by an emergency room doctor, an intensive care team, neurosurgeons, internists, nurses, chaplains, and many others. But from the ER to the ICU, despite the fact that I was a doctor, no one asked what I thought might have led to the weakening of what was most likely a tear in a vein in my brain. And I didn’t tell them what I thought either. I was no longer a doctor in training; I knew the code well by then. I wasn’t to reveal things that doctors—and famous people—should be more ashamed of than everyone else. This is, of course, not to imply that other people are always honest with their doctors, nor that they don’t feel shame. But this level of structurally sanctioned dishonesty was something else. Perhaps, unlike the situation with celebrities where we were protecting them, with doctors no one seemed to want to know these truths. Maybe others in healthcare were worried a peer would be stamped as unfit to practice, or perhaps people would be forced to reflect on their own unhealthy behaviors. Maybe it was acceptable to avoid finding certain things out since the demands of the job made them understandable and doctors were given a pass. Or perhaps we doctors were still held high on that same pedestal, and it pained others to admit there is no escaping the frailty implicit in being human. Whatever the reason, it was easy to keep my secrets safe when not a single person on my medical team dared ask if I even had any. When I returned home and accessed my records all those years ago, it was the first time I realized that the taking of my own “social history” had not only been avoided; it had been fabricated.
***
The fact is, in November 2012, I was pretty healthy. I was in a relationship with a wonderful man who would become my second husband. But in the years leading up to that day, I was anything but stable. In the wake of the 2009 collapse of my marriage, up until I met my boyfriend in 2011, I’d been drowning in grief and in a constant search for ways to get away from it. My three very young children were each devastated in their own ways from the severing of our family bonds, and with it their sense of stability in the world. Those years, I walked around with a hole blown into my gut, centerless and frail, feeling like a failure or a monster for making this happen. The pain was so profound that I briefly became another person who lacked any concern at all for her own well-being. The only time I felt all right was when I didn’t feel at all, which is to say when I was under the influence of alcohol, tobacco, drugs, and engaging in risky love affairs. I was just getting it together when my worn out brain blew a gasket while I was running hard on the treadmill. I’ve little doubt that my two years of self-destructive behaviors at least contributed to the circumstances that led to a brain bleed. But I easily hid this fact behind the cloak of my profession. Even if I’d been asked, and been honest, I’m pretty sure they’d have downplayed my actions and curtailed the uncomfortable conversation. “We all party sometimes, right? I’m sure it was just a fluke.” Because doctors do party, yes, and sometimes to excess. I learned this after my divorce when I joined in. Or they might say, “You just popped a blood vessel,” as one physician friend said later, again without knowing any details of my life: “could happen to anyone.”
But just as in 2012, it didn’t just “happen” to me, in 2022 when I woke up on the bathroom floor with a head injury. Ten years later, this event also didn’t occur without context, despite what my medical record says.
I’d been drinking too much again. I was stressed by work, recovering from the personal and professional challenges brought on by the pandemic. I’d been self-medicating, despite my history of avoiding feelings with substances and dopamine rushes; despite my already low-ish blood pressure, which put me at risk of dehydration and fainting—at risk of exactly what happened when I got up too quickly from bed after the several big glasses of red wine that had allowed me to once again fade away from my life. Maybe I wasn’t 60 yet, but I still believe I could have died had I hit my head on the toilet or the bathtub; this because I still hadn’t managed to find a better way than escape to deal with hard emotions.
Because of my profession, I—like Susan due to her famous family—was spared, or rather denied, a potentially truthful moment between healthcare provider and patient that might have made a difference. But what if I had told my friend, the emergency room doctor, that I thought I had a problem, and asked for his advice? Maybe he would have minimized the drinking as I’d expect, but maybe he also has his own story, a secret he keeps hidden because he’s learned the same rules I have. Maybe we could have shared a vulnerable moment whose emergence could signify the beginning of something new. I didn’t have that chance that night, and—although I doubt he looked at it that way—neither did he.
So maybe it’s up to me, to all of us in medicine, to finally bring this issue out into the light—to own up to the shame we’ve taken on that stops us from admitting that we too are human and sometimes deal with suffering in much the same ways that those sitting with me in the emergency room did.
Perhaps I didn’t tell anyone I was a doctor that night because I was hoping to be treated just like everyone else.