The Patient Was…

The patient was in his late seventies and, like many of my older male patients, he had both advanced ischemic heart disease and prostate trouble.

Ischemic heart disease, also known as coronary heart disease, is due to blockages in the arteries carrying blood and oxygen to the heart muscle. His prostate trouble was known as BPH or Benign Prostatic Hypertrophy, where the prostate gland enlarges and interferes with the flow of urine from the urinary bladder to the outside.

The patient was a small, feisty individual, aggressive in business, opinionated on just about everything. He probably represented at least a form fruste, or incomplete picture, of the so-called Napoleon Complex or Little Man Syndrome, which can include aggressive social behavior and a focus on money and status in an effort to compensate for a lack of height.

He was usually demanding and expected special access to my time, which did not exactly endear him to my secretary. He also complicated her life by refusing to pay his full bill, instead reducing his payment by one cent. He seemed to enjoy the difficulty that it caused with our bookkeeping, and when I offered to reduce his fee by one cent he insisted he would deduct a penny from that also. It was another way he had of seemingly gaining advantage in any situation.

Colleagues of mine wondered why I didn’t discharge him from my practice. Well, it was my belief that everybody deserved medical care, and if I dismissed him maybe nobody would pick him up. You can’t choose your relatives, they say, and I felt the same way about patients except in instances of the most egregious behavior. And his didn’t qualify.

He came to the office on a regular basis and required close attention because of the advanced nature of his heart disease. As that came under better control, he began to emphasize how his enlarged prostate gland was causing him considerable distress. His sleep was interrupted frequently by the urge to go to the bathroom. He had increasing difficulty in starting and then controlling the flow of urine. His urologist suggested he needed surgery, and that judgement was correct, in my view.

His heart disease represented a real risk during and right after surgery. The stress of the actual operation, the physiologic changes during the procedure, the effects of the anesthetic medications, all posed risks to this man with a bad heart. As I had in other cases of patients with advanced heart disease undergoing surgery, I arranged to be in the hospital during the operation. I told this man that I would be in the post-operative Recovery Room when he came from the operating theater.

He was still asleep from anesthesia when he arrived in the Recovery area, but I stayed at his bedside, expecting him to waken shortly. After a normal interval, he stirred a bit, opened one eye, saw me, and said, “How did the market do?” He then promptly fell back asleep.

A while later, when he became fully awake from the effects of anesthesia. I was at his bedside. I said to him, “Do you what you asked me when you just began to wake up a while ago?”

“No, I don’t actually remember,” he said. “But I bet I asked you how the market did.”

“That’s right,” I said. “What kind of question is that right after surgery?”

“Last night I called my broker at home,” he said. “I invested two-hundred-fifty- thousand dollars in the stock market.”

“Why did you do that?” I asked.

”Because,” he said, “I knew I’d come through surgery to see how my money did.”