Tag Archives: Etiquette

How to Help Your Doctor Get the Job Done

23 Mar



If you’ve ever had to undergo strings of medical tests or lengthy procedures, you know that there are plenty of doctors, nurses and technicians out there who could do with a few lessons in etiquette and bedside manner. I could spend years on this blog documenting every moment I was snapped at, interrupted, or made to feel like a nuisance while I was fretting about test results or mounting pain. It would take me a decade to do justice to all the horror stories I’ve heard from friends and fellow patients.

But the poor manners of all those (probably overworked) professionals who made a tough situation worse render the kindness of others all the more dazzling. (I love you, Nurse Wilson!) And it’s crucial to bear in mind that the patient’s version of things is only one side of the story. Medical professionals rarely get to see people at their best – their job is to witness and inflict pain all day. They must remain objective while navigating a sea of misery and fear, where not everyone claiming to be severely sick really is.

In order for doctor and patient to have the best possible experience, both have to be aware of what the other requires. Which is why I’m handing over the mic to Dr. Leana Wen, who’s penned an excellent article called “The 10 Types of ER Patients” this week. Her pieces of sound advice include:

No. 3: The Googler. The Internet can be a powerful tool for empowering patients, but please use it responsibly. Looking up your symptoms yourself might turn up that you have a brain tumor when you have food poisoning or that you are pregnant when you have belly pain (and you’re a man). Use the Internet to help you understand your diagnosis and treatment and to come up with questions—not to diagnose yourself.

No. 4: The “Pain All Over” Patient. We call it the “positive review of systems” when you say yes to everything we ask. Headache? Chest pain? Shortness of breath? Fatigue? Muscle aches? Yes, yes, of course, yes. Some illnesses really affect many parts of the your body, but more often than not, patients will say yes to convince us they are ill. We know you aren’t well, so tell us the truth. (If you don’t, you run the risk of undergoing unnecessary testing.) If everything hurts, try to tell us your story. When did you last feel normal and well? What happened then? And please don’t exaggerate. If you say that your pain is 15 out of 10, but you’re eating lunch and texting on your iPhone, it’s hard for us to calibrate your symptoms.

Head over to Slate to read the whole thing.




When Food Preferences Surpass Politesse

24 Nov

yuck(Image by Boris Drenec used under Creative Commons license via)


Perhaps not quite in the spirit of Thanksgiving, I’m about to alienate half the people I know: I don’t have much patience for openly picky eaters over the age of 20. The covert ones don’t bother me at all. But announcing to your host that you simply won’t eat mushrooms or mustard or millet is to revert to your 10 year-old self, brazenly acting on the assumption that anyone cooking for you will find your pig-headedness as endearing as your parent or guardian apparently did. I don’t particularly like pears or peas or plenty of other things, but if I learned anything from my time as an exchange student with the American Field Service, it’s that intellectually curious, culturally respectful, fully-grown adults eat whatever is set in front of them. Or at least try a few bites and then leave it to the side without advertising their distaste.

Unless, of course, it threatens their health. I recently hosted a friend who has celiac disease and who apologized several times in advance for the inconvenience. While the sincerity of his remorse was indeed helpful because it was convincing, I assured him there was no need for shame. I’ve had friends with juvenile diabetes and colitis and who need to be fed through tubes. At my wedding, where guests had been requested to bring cakes instead of presents, I chased down every single baker in order to mark any desserts containing traces of peanuts, oranges, or coconut. I never mind offering vegetarian options because they accommodate a wide array of dietary restrictions with both cultural and medical bases, just as alcohol-free beverages are helpful to kids, recovering alcoholics, devout Muslims, and pregnant women alike. But my tolerance generally ends there. Because beyond that boundary seems to be where stubborn intolerance for all sorts of food spreads like the plague.

According to the cover story of Die Zeit this week, less than 1% of Americans are gluten intolerant, yet 28% of Americans purchased gluten-free products last year. The percentage of Germans who purchase lactose-free products has tripled in just five years. Such sky-rocketing numbers sound much more like successful marketing trends than biological shifts in the population. Inordinate media attention to rare medical issues always inspires swathes of people to self-diagnose rather than check with their doctor. In response to what sometimes does seem like an epidemic of hypochondria, a kindergarten in Hamburg has recently taken to demanding medical documentation for any alleged food restrictions among its students. Die Zeit writes that parents were insisting their untested children had food allergies after the appearance of the slightest yucky face. Of course a child at risk for anaphylactic shock is better safe than sorry, but to teach a child to regularly cry wolf is to teach them to rely on their most narrow-minded instincts.

This is not a call to villainize health advocates or burn certain cookbooks. On the contrary, the greatest thing about the human culinary tradition is its diversity. When I grew up in the Eighties on Long Island, skim and lite and sugar-free products were in fashion,  but anything organic or “foreign” or “ethnic” was scarce because what’s wrong with some good old American spray-on cheese? Sushi was gross (“It’s raw fish, you know!”), vegetarian dishes were for pansies, and escargot was what made the French so weird in the first place. (See this Indiana Jones clip.) Kids today are growing up more environmentally conscientious and more open to exploring new cultures, and I am glad to see the American tradition of grimacing at all the icky cuisine of the savages and the smelly Europeans go the way of the Twinkie. But there’s no progress in simply switching the grimace from the sight of imported cuisine to the sight of anything that isn’t in line with the latest imported health fad.

While it seems many finicky eaters think their aversion to certain foods resembles a disability (“Please don’t criticize me for something I can’t do!”), it often resembles ableism (“I refuse to budge on this issue!”). We cannot be open-minded and at the same time refuse to leave our comfort zone. As the Food Commander writes in his excellent Huffington Post article, “Unless you suffer from a disease or real (unlike imagined) food allergies, … kindly embrace the fact that your body is not all that fragile. Humans survive every day in conditions way worse than, say, a four-course dinner in an Upper East Side townhouse.”

Outside of a meal, it can be fun to explore cultural differences and personal preferences: why so many Chinese love meat but dislike butter, or why German senior citizens detest turnips. It’s also amusing to try to argue the illogic of taste. (One such argument culminated in one of my relatives bellowing, “I am not a fan of the bean!”) It is also imperative that we eventually discover which food restrictions have been caused by environmental changes and which have been encouraged by marketing trends. But the fun comes to a screeching halt when these discussions ooze onto the dinner table.

Such candidness often has innocent origins. In these rather unrepressed times, where dinner guests discuss everything from politics to polyamory, why not share our honest opinion of what’s on our plates? This approach, however, ignores two very important facts. Firstly, unlike in a restaurant or your own home, the meal laid out for you has been paid for by someone else. Secondly, unlike the selection of films or games or whatever else it is you don’t like about the home you’re in, the meal laid out for you is the result of someone else’s time and effort. To go so far as to scrutinize it (“Is it organic?”) or disparage it (“It’s too bad it has olives in it!”) is to spit on the dinner invitation that was extended to you out of sheer generosity.

I know what it’s like not being able to participate in communal activities. This blog is all about those who have no choice about being an exception to the rule. Those who have bona fide difficulties digesting certain foods—perhaps akin to my difficulty walking long stretches—should not feel ashamed. But shame should not be supplanted with complacency, either. As my friend with celiac disease said, it is usually regrettable to have to limit one’s range of experience, and it is always regrettable when it involves rejecting an offer of kindness.

Indeed, my proudest moment during my bout of stenosis last year was pulling off a Thanksgiving dinner with my partner that fed 17 people while I was still recovering from spinal surgery. If any of this year’s guests cannot stomach something, they will hopefully follow the example of my more gracious friends who keep things discreet, at least at the table. I don’t subject them to judgment by examining their plates for leftovers and threatening to deny them dessert because they spare me the insult of telling me exactly how my offering failed to satisfy them.

They also resist the temptation to dive into an unsolicited monologue of healthier-than-thou moralizing, a tendency that accompanies food more than any other health issue. I’m usually the last to squirm at medical stories, but I’ve been thinking lately that if I have to hear about the details of the latest nutritional research every time I put a spoon to my mouth, maybe I should start lecturing about my back problems every time I see someone wearing heels or sitting at a computer.

Eating is a necessity and a health issue and an environmental issue and a cultural tradition. I love learning from friends and researchers about the different ways we all eat, and the socio-political forces of the food industries are absolutely fascinating. But I won’t ever admire someone merely for eating homemade bread or fine delicacies or simple fare or whatever it is that the Paleo diet currently dictates. Those I do admire cook joyfully in their own homes and, when invited to someone else’s home, plunge their hands obligingly into whatever their host has set out for them, whether it’s okra or Oreos. As minority rights activist Andrew Solomon has pointed out, a truly tolerant culture celebrates additive social models, not subtractive ones.

Or, more simply, I will always care a lot more about your table manners than your diet.



What To Do When I Go FWOMP!

23 Jun

(Image by Stephen Alcorn © 2003 http://www.alcorngallery.com)


“HEEEEEY!” Friends were at the door, back fresh from a vacation that had seemed far too long for me to endure. At the sound of their dulcet voices calling me in unison, I jumped from my chair, rounded the corner, darted down the hallway toward their open arms, and FWOMP! Iwassuddenlyhorizontal.

My friends gasped, “OMIGOD, ARE YOU OKAY?!” Apparently this time I was, from what I could tell of the pain, and I bounced up before they finished asking, throwing my arms around them both at once and laughing, “How’s that for a dramatic hello?”

“You’ve been drinking again, haven’t you?” one of them smiled.

“Yes!” I beamed. “You know exactly what to say! How was your vacation?”

We chatted for about five minutes, made plans for the next day, and said hasty goodbyes because their toddler was itching to get home. As I shut the door, I rubbed my knee, looked at my partner, and shook my head. “I’m gonna have a new bruise on the left to match the right.”

Two weeks before I’d gone flying down the same hallway, but that time it had really knocked the wind out of me and left a cut needing a bandage. I had reacted a little less wryly – diaphragm spasms are never pleasant and they forced me to let out a yell that sent my partner running from the kitchen. But after my initial roar, I switched to hollering, “I’M FINE! I’M FINE! DON’T PANIC! I’M FINE!” Our guests came peeking out of different rooms, everyone asking me how I was.

I was fine, but I was mad. Mad at gravity, mad at the pain, mad at my useless tendons and weak muscles that cause me to stumble on average about every ten days. But I wasn’t that mad. I’ve gotten used to it, after all.

Because my anterior tibilias tendons on both legs were severed some time during my first limb-lengthening procedure, I use different tendons to lift my feet when I walk. They compensate relatively well, but since they cause my feet to point slightly outwards rather than straight ahead, I’m a walking accident waiting to happen. It’s compounded by the fact that my muscles fatigue more quickly than others’ due to my dwarfism. It’s been this way since I was twelve and changes only in that the bigger I get, the harder I fall.

Since I was my surgeon’s only known case of tendons severing during limb-lengthening, most people with dwarfism do not face this problem. Some do, however, when their greater susceptibility to fatigue combines with their having to carry an average-sized trunk around on exceptionally short legs. In other words, had my tendons not severed, I may or may not have had this habit of losing my balance. It’s exasperating and inconvenient, but what can I do about it?

Laugh, for one thing. Over the years, I’ve decided a woman falling down is both hilarious and revolutionary—what with the delicate ballerinas we’re supposed to be—and drinking too much is just one of many lovely excuses to offer for it. Years ago I fell while carrying an armload of water glasses and promptly ended up in the emergency room with stitches and a black eye. From the physician named Dr. Goebbels to the nurses insisting my partner leave the room so that I could be free to explain what had happened, the opportunity for sick jokes was everywhere.

Friends have kept records of my losses in the battle against gravity. Some are critical, sighing, “EMILY, that’s the second time today!” while others are cheerleaders: “It doesn’t count this time because the ground is uneven.” (And can I just point out that the German word for gravity—Schwerkraft—literally translates as “heavy force”? I love German.)

Of course, I’m not always at my best when it happens. Often I fall because I’m particularly tired and this results in my being particularly bad-tempered about it. That I kvetch the most to those I know and love the best is logical, but not entirely fair.

When my peers witness me falling for the first time, many of them don’t know what to do. I’m trying to get better at telling them. If I’m not badly hurt, but still somewhat hurt, I try to shout that I’m okay to curtail their apprehension. Taking a minute to help me up and, depending how close we are, offering me an arm until I’m steady on my feet is almost always appreciated. Breaking into a panic and giving me the sense that it’s my job to calm them down is less helpful.

Most people who have to deal with pain caused by disabilities don’t want any more sympathy or attention beyond what we would give someone with a light headache. (In fact, many of us want a tad less sympathy than what some with mundane headaches go fishing for.) If I’m not hurt, anything you say to keep the mood light as a Screw-you! to my heavy fall will be invaluable. If I am hurt, any offers to help before I have to ask will be worth even more. And if your gentle-yet-practical manner demonstrates particularly good caregiving skills, I’m going to tell you so. Experience has made me a particularly good judge.

And I’m not embarrassed when I fall, so please don’t be embarrassed for me. At best, it’s as disruptive as a mighty sneeze. At worst, it’s a mood-killer.

The one fall that still makes me cringe to this day happened as I was stepping off a stage after delivering a poem to thunderous applause. I spent the summer before my senior year of high school at a young writers’ workshop in the Berkshires, where I found all the beauty, intellect and acceptance I been dreaming of ever since I first put pen to paper. Reciting one of my pieces to giggles and cheers made me feel as great as anyone on any podium has ever felt. The moment had been just perfect. And then, I slipped. The handsome emcee looked sincerely concerned: “Are you okay? Are you okay?” He had to keep asking because I was mumbling my answer, mortified to even acknowledge what had just happened. In my head I was begging everyone in that room, Please remember my poem and not my fall. Please.

Then again, “And Emily came tumbling after” is a poem in itself. It doesn’t work as well in Germany, what with no one having grown up with Mother Goose, so I’ll have to settle for the joke about being drunk. That one’s an international success.