The Next Patient

An internist describes a routine office visit of a patient with intractable constipation. After reiterating his usual advice, the physician unwittingly discovers in his patient an undercurrent of sorrow. For a fleeting moment, they make an emotional connection, but then return to their previous roles.

Turning next to the uppermost patient record in the pile on my desk, I saw with dismay the name Thomas O'Connor on the label. I had referred Mr. O'Connor 6 months ago to the gastroenterologist, Dr. James Chang, because everything I had prescribed had failed. Here he was again, back to me for a physical. Tom's persistent complaint, that he couldn't move his bowels, had worn down Dr. Chang too. In fact, after trying again every known treatment, he had Tom swallow some radio-opaque tablets, and he proved by x-ray that they passed through his system in normal fashion. Tom still insisted that he had not had a bowel movement. If Jim Chang hadn't been able to help him, I thought, as I entered the exam room, what could I do?

How are you, Tom? I haven't seen you …