Frustrations From The Front Lines: A Doctor-Patient Interaction

I chose to chronicle the story below as a way to supplement the Psychological Impact chapter of this website.

"You need to see a psychiatrist" - Dr. Dalton, Santa Monica, CA
In January of 2005, I moved to Los Angeles and took a full-time job managing a Huntington Learning Center. Less than a month into my new job, I began to experience the familiar gurgling in my lung, which unfortunately meant that my lung was once again leaking air. Each time my lung gurgled, it caused chest pain that lasted for one to two days. After two weeks of this routine, I finally went to St. John's emergency room in Santa Monica. The ER doctor concurred that my lung was leaking air, and that possibly there was a very small lung collapse. He said that not much could be done and advised I stay off my feet and take it easy for some time.

One week later I had a follow-up appointment with a pulmonogist, Dr. Dalton. My girlfriend and I went to the appointment together. I told Dr. Dalton my history of over a dozen collapsed lungs and, at that time, three major lung surgeries behind me. I explained that I could feel my lung gurgling and that I suspected I had blebs which were leaking air and causing pain. I had been through a similar experience years earlier when, after months of gurgling, pain, and leaking air, my lung finally collapsed.

A chest X-ray showed that I had newly formed congenital blebs (weak spots) on my lung. This confirmed my suspicion that it was blebs which were leaking air, which is well known to cause significant chest pain. However, Dr. Dalton told me flatly that my pain was likely a result of surgical pain. This didn't make any sense, since the most recent lung surgery was seven years earlier.

When I pressed Dr. Dalton further, again explaining that I could feel my lung gurgling and leaking air, which was directly correlated to my chest pain, he told me that this was impossible. Dr. Dalton believed that because I already had corrective surgery, my lung could no longer leak air or collapse. I reminded Dr. Dalton that my own history proved otherwise. When I was 16 I had corrective surgery on my right lung, but three years later it collapsed badly. In other words, the thing that Dr. Dalton had just said was "impossible" had already happened to my other lung when I was younger.

Dr. Dalton rolled his eyes and responded "Let's talk about something else. You seem very stressed and I think you should see a psychiatrist". Dr. Dalton then began to write on a prescription pad, saying "I'm also writing you a script for Ativan, an anti-anxiety medication". This caught me completely off guard. If I was becoming stressed during my appointment, it was because my lung doctor was completely dismissive of my complaints! Angered by Dr. Dalton's flippant attitude and reckless indifference, I wanted to steam furiously out of his office. But since I was quite limited by chest pain, I left quietly, feeling defeated and deeply upset. In reality, if I was correct and my lung was leaking air, it was a potentially dangerous situation that would inevitably result in a collapsed lung.

Exactly one week later, my lung collapsed badly - 40%. Everything that had been dismissed by Dr. Dalton - the leaking lung, the chest pain - was absolutely real. An ambulance brought me to St. John's hospital and I was seen in their ER's trauma room. I was treated by a very kind, very sympathetic, female ER doctor who recorded my medical history, administered IV morphine, and immediately ordered a chest X-ray. About 15 minutes later my girlfriend arrived and we waited for the results of my chest X-ray. Strangely, the ER doctor returned and told me that she did not see a lung collapse on my chest X-ray (she turned out to be wrong). She also told me that she had spoken with my pulmonary doctor, Dr. Dalton. What she said next shocked me - she said that Dr. Dalton insisted on knowing whether I had seen a psychiatrist yet... In fact, rather than come see me in the ER, Dr. Dalton recommended a "psych consult".

My heart stopped. My girlfriend and I looked at each other incredulously - I was in excruciating chest pain, having just been brought to the ER via ambulance, with a history of over a dozen collapsed lungs and multiple lung surgeries, and Dr. Dalton wanted to know if I had followed his advice and seen a psychiatrist? I was astounded, and frustrated almost to tears.
"Did he, does he, do you guys think that this is all in my head??" I asked.
"No" responded the ER doctor, "You certainly have a long history of document, of real lung problems. But he [Dr. Dalton] felt that what's going on now might be related to stress and that you might benefit from talking to someone about it".

I felt as if I had been stabbed in the back. The one man who I sought out for help, a pulmonologist, had not only ignored my lung problems, he had now caused an ER doctor to question the validity and urgency of my situation. Everything changed in the course of one quick phone call to Dr. Dalton. I was immediately moved from the ER's "Trauma room" to a regular ER room. The ER doctor no longer had a sense of urgency in her voice, but seemed much more calm, and even spoke to me now as if I were a child. I could sense that she still felt bad for me, but it was a much different form of sympathy now, one that bordered on condescension.

I knew that my lung was collapsed, but I also knew that nobody would believe me now. Any credibility I had when I initially arrived in the ER was now effectively undermined by Dr. Dalton. I begged the ER doctor to show my chest X-ray to a radiologist, because I knew from past experience that radiologists are much better trained at spotting collapsed lungs. But she politely denied my request and left the room. The ER doctor ordered a CAT Scan to rule out a Pulmonary Embolism. She said that when I got back from my CAT Scan, she would like to talk about setting me up with a psych consult.

Of course, no psychological consultation was necessary. The CAT Scan revealed that my lung was collapsed significantly (40%). I was admitted to the hospital and two days later I underwent a Complete Pleurectomy surgery which I chronicled in Part I of this website. It's difficult to know whether Dr. Dalton was inspired by arrogance or by narrow-mindedness, but either way his dismissive attitude cause significant anxiety and suffering which could have been easily avoided. Unfortunately, it is my experience that these types of confusing, stressful, and even contentious doctor-patient interactions are often the norm rather than the exception.