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Following Doctors' Orders
“I’d always been healthy,” says Harborview nephrologist Dr. Michael Ryan. So healthy that he didn’t have a primary care doctor. When the kidney specialist began to have abdominal pains in early 2009, he took some Mylanta and wrote it off as a possible ulcer, at times mitigating symptoms with food. “It seemed like if I ate something it sometimes would get a little better,” he says, but when the pain got to the point it woke him up at night, he got up, had a bowl of cereal, and went back to bed.
One night he dreamt he had an intestinal obstruction, prompting him to wake up and examine his abdomen. Later, he asked his girlfriend, also a Harborview doctor, for a second opinion. They both felt something about the size of an orange.
Yet it was still another couple of weeks before Ryan finally gave in and asked a gastroenterologist friend at Harborview to take a look. The reality that the stomach pain might be something serious struck Ryan when he pulled up his own CAT scan images. “My first thought was, ‘Who’s going to see my patients?’ My second thought was, ‘Oh no, I’m not going to have kids now.’”
Throughout the process of his diagnosis, Ryan had some uncomfortable reminders that it was nearly impossible for him to just be a patient. Waiting for his biopsy in a Harborview bed, he found himself next to one of his patients—who proceeded to ask him for a prescription refill. It was the first of a series of encounters with familiar faces—“med students, residents—all out of context,” he says—that prompted him to switch hospitals and move to the Seattle Cancer Care Alliance where he found a little more privacy.
Within a week, Ryan learned he had lymphoma and began aggressive chemotherapy to shrink the tumor. Doctors confirmed his concern about having children. He put work on hold during treatment as side effects got progressively worse—one of his lowest points was when his extreme low blood pressure upon standing rendered him prone on someone’s front lawn because he couldn’t walk the rest of the way home.
In conversations with his oncologists, Ryan realized just how complex doctor-patient communication could be. “As a patient, you hang on everything—facial expressions, body language,” he says. “It’s a blur sometimes but you remember the emotions being conveyed.” His oncologists pronounced his 40 percent chance of being alive in five years as relatively good news, but for Ryan, the patient, “I heard that I’m a goner. For me that was saying I have a less than a 50 percent chance of being alive in five years.” He worked on his will and told his girlfriend that she ought to break up with him.
She didn’t. They were married in May 2011, about a year after a PET scan confirmed that the chemotherapy had worked and Ryan’s tumor was just a small lump. Then the couple received more stunning good news—they were going to have a baby. “I was shocked and a little bit worried,” says Ryan, who had quipped, ‘Now I really can’t croak!’” Last year, they welcomed their second child.
While one of the upsides to being a doctor during his experience was getting a diagnosis and treatment quickly, Ryan admits to downsides: “Some physicians treat [doctors] dif-ferently and they seem to be afraid to ask the righ questions. They defer to you sometimes. I feel much hap-pier [being treated] as a lay person.”
He does his best to approach his work more mindfully now, including how he orders labwork, delivers the results, prescribes medication, and speaks with his kidney patients. “We use medical terms that are very jolt-ing, so I try to ask more questions and allow for more questions, or ask people what they heard,” he says.
Meanwhile, he now has a primary care physician and follows some of the guidelines from the book Anticancer: A New Way of Life including keeping his stress down, exercising and diet changes. He says, “It’s really a privilege to be a doctor. I think [this experience] made me appreciate even more what my patients go through and gives me more appreciation for how tough my patients really are.”