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ON BEING A PATIENT

Trust

right arrow Samuel C. Durso, MD

17 December 2002 | Volume 137 Issue 12 | Pages 1004-1005


"How'd you miss that frog, Doc?" There was a tinge of irritation in Ezra's voice.

No use making an excuse. I steadied my balance, planting both feet astride the flat-bottomed boat and squeezed my eyes shut to stop the stinging. Sweat ran over my brow, down my cheeks and into the corners of my mouth. It had a bitter, coppery taste from the headlamp.

"That's awright. Don't worry about it. I'll put you on another one."

Ezra could be a demanding teacher, but he was also practical. Razzing me wasn't going to put more frogs in the boat. There were half a dozen in a burlap bag behind me. In spite of countless forays hunting and fishing together in the marsh, frogging was new to me.

I opened my eyes and replanted my feet in anticipation of our moving. He eased his paddle over the side of the boat and pushed us forward out of the thick algae and grass.

"Let's go over there. Should be some frogs in those lily pads, Doc."

A click followed by the soft electric purr of the trolling motor, and Ezra maneuvered us into open water. The din of insect sounds subsided as our movement created a little artificial breeze. By then I had stopped thinking about the mosquitoes. I stood over the front of the boat holding a 10-foot pole tipped with a spring-action gig, concentrating on keeping my balance and looking for the reflection of frog eyes in my headlight.

The nighttime marsh was alternately black and silver. Overhead, little patches of spring sky shone, and occasionally the moon could be seen peeping through heavy clouds. It might rain. My headlight swept ahead 20 or 30 feet. I looked over the side of the boat and let my lamp beam penetrate the tea-colored water. Except for a brown-green glow, I saw nothing.

"Keep your head inside the boat, Doc. We run over an alligator and startle it, it could lash its tail gittin' outta the way an' take your head off. I seen a guy get his neck broke that way."

Something to remember. I redirected my light beam ahead of the boat looking for the white reflection of frog eyes. Snake and turtle eyes were different. I looked out for alligator eyes too.

I was struck by the irony of this doctor–patient relationship. In the office our relationship was somewhat conventional; he was deferential and treated my expertise with a bit of awe. He was the heart patient and I was his doctor. The marsh was different. Here Ezra and I were in each other's hands. The field was more nearly level. I was the greenhorn who needed his expertise to get in and out of the marsh in one piece. I enjoyed his friendship, but I also valued entering an inaccessible wilderness with a master guide. He liked the companionship, but also the reassurance that his doctor was with him and could pull him out of the marsh if need be. I felt a twinkling insight into the patient's predicament—trusting a doctor to get through a dangerous stretch. What was the basis for that trust?

A year earlier, Ezra was hauled out of the marsh in congestive heart failure; a hunting buddy dragged him (reluctantly) to my office on the advice of my senior partner, also on the hunt. Ezra was small and wiry. Used to hard work, he figured his breathlessness was nothing more than "flu." I examined him and told him what I thought was wrong. He registered surprise, but not doubt. Later, as I got to know him, this relatively early trust puzzled me, because I learned just how deeply he distrusted authority. A lot of this stemmed from his real-life experience with overconfident doctors, lawyers, and judges he guided in the marsh. Yet for some reason, he chose to trust me early in our relationship. What accounted for this? Perhaps it was transference of trust from my senior partner, Joe, to me. Was it self-confidence, confidence that he could tell if something I told him didn't sound right? I don't think it was necessarily my wordy explanations of his problem. He told me, "Don't worry about explaining everything. You jus' get me outta this and I'll stick to you like glue." Maybe it wasn't completely rational—something more akin to personal chemistry.

I scanned ahead of the boat for frog eyes and alligator eyes. To my right and left, I saw wide-space amber reflections like little periscopes just visible above the water's surface.

"Doc, we're getting hung up in this algae. You're gonna need to get out and pull us through this."

Surprisingly, my first reaction wasn't to question the logic of getting out of the boat and wading through an alligator-infested marsh. Perhaps my predicament was a bit like the resignation a patient with no good alternative feels when a surgeon diagrams his or her outlandish plan on their abdomen. What were the options? I knew the bottom was too soft to push off with our gig-poles, and I couldn't think of a better idea. I was resigned to our predicament. Moreover, Ezra was just eminently trustworthy to me. Of course I had plenty of reason to trust him—we were close friends by now, and during our many excursions into the marsh he had never steered us wrong. Still, I couldn't help wondering: Was he an alligator expert? He knew this would be safe? I put down my gig, removed the headlight and battery, and readjusted the shoulder straps to my waders.

"What'll the alligators do when I wade ahead?"

"They'll move away. Don't worry about 'em. Keep both hands on that rope tied to the front of the boat. If you step in a hole, your waders'll be fulla water an' sink you like lead. You'll need the rope to pull yourself up."

"You mean an alligator hole?"

"Yeah."

These were 20 feet in diameter and might be 7 or more feet deep this time of year, wallowed out during the dry season. I was glad he pointed this out. It would have been easy enough to drown with waders full of water, and Ezra, with his weak heart, probably wouldn't have been able to pull me out.

I lowered myself over the boat's edge, boots sinking into the mud and waders immediately filling with water. I pulled myself through the mud and around to the front of the boat. Grabbing the nylon rope, I started slowly tugging us forward out of the grass and algae and into open water. Being out in front of the boat felt eerily like going under the knife. I felt a strong urge to focus on trusting Ezra. Without my lamp, I couldn't see light reflecting from the alligators' eyes, but at the surface level I could see the small black silhouettes of their foreheads disappear. Little eddies appeared where their eyes had been.

Without warning, my head slipped under the water; I can only liken the sensation to the moment before anesthesia works, when you give in to trusting that you'll come out on the other side of the experience alive. After a split second of disorientation, I realized that I had stepped over the edge of a hole. My waders, already filled with water, pulled me down a slimy embankment. In total blackness, I focused on not letting the rope slip out of my hands. A thought flashed through my mind: He says the alligators are gone; I'm sure he's right; my legs are intact. I reached the bottom of the hole and began to pull the rope hand over hand until the rope was vertical and the boat directly overhead. I pulled myself out of the water and grabbed the bow. I wiped my eyes. Ezra was leaning over the edge, his headlamp on, looking at me; the surgeon was going to tell me that I was still in one piece.

"Hey, Doc, you awright?"

"Yeah. I think we're clear of the grass now, you can use the motor."

I was glad that was over and climbed into the boat.


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The Johns Hopkins University School of Medicine Baltimore, MD 21236

Requests for Single Reprints: Samuel C. Durso, MD, Johns Hopkins Geriatrics at White Marsh, 4924 Campbell Boulevard, Suite 205, Baltimore, MD 21236; e-mail, sdurso{at}jhmi.edu.





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