After 40 years of giving advice professionally it has become something that I cannot turn off.
It is, as we say in Quebec, my “deformation professionelle”, a play on the French for medical education. I assume that I have the right to just tell people what they should do, whether they ask me or not.
Since my retirement I have started exercising more than I ever have before. As a result, I am in the locker room at the Y twice a week. My two aquafit classes are quite different. One class is during the women’s only swim where many of my former Hasidic Jewish patients are either jumping around with me, or swimming in the other part of the pool. The other class is mixed, and Dave has recently joined. It is taught by a former ballet dancer who is a stickler for form, and he berates us constantly to keep our shoulders down and our abs tight.
A few weeks ago, as I was drying off, I heard a woman talking to her friend on the phone. They were discussing how, since her eight-year-old was home, he wanted to help her shine the silver for Shabbat. She was hesitating to let him use the silver polish because it seemed too toxic and stinky. I butted into this conversation completely unannounced. “You know that you can use toothpaste to polish silver,” I said. The woman looked at me curiously. “Yes, toothpaste makes an excellent silver polish, it is my six-year-old grandson’s favourite thing to do on Friday afternoons. And then your silver smells “minty fresh” rather than horrible.”
“What a good idea,” she said. “I’ll try that!”
Most of the locker room discussions have a more medical bent than that one. I have often discussed vaccines. There is a woman, very antivax, who slowly has come to believe that I am not evil and may have a good point, although she’s not changing her mind. She was impressed when I told her about how COVID vaccines had been shown to save thousands of lives of pregnant women and their babies, without impairing their fertility. This fact surprised her and thankfully she was able to really hear it.
Recently the discussions have been about flu, and why, even though the vaccine is not great this year, you should still get the shot. It is quite amazing to me how even educated people know so little about what a vaccine is and how it works. These three-minute locker room lectures on pathophysiology, aided by the input of a nurse educator who is also in our aquafit class, seem to be much appreciated. Or, at least, I like to think so. Although perhaps it is my way to keep feeling important . . .
Occasionally, I feel that I have materially helped people through these discussions. In the mixed class, there is a wonderfully well-preserved woman in her 80s. She is still able to jump around with the best of us. Her stamina and agility are a tribute to her lifelong exercise habits and to the health advantages of being in the upper income quintile. This week she asked my advice. “I know who you are, Dr. Feldman,” she said. “I volunteered at the hospital for many years. Can I ask you something?” Standing in the corridor, between the Health Club door and the regular locker room, I nodded. “Since our family doctor retired, we had to get a private doctor outside of Medicare. My husband is 96-years-old, and the private family doctor did a prostate blood test, and it was very high.” I restrained a snort. Who does PSA testing on a 96-year-old? There is practically 100% certainty that there is a prostate cancer.
“Then we saw a private urologist, and after the MRI, he wanted to do a biopsy but thought it was too dangerous to do it in the private operating room. Then he changed his mind and said he would just do a simple operation, but that we would need to pay $20,000 for it because it would also have to be in the hospital. That’s a lot of money, and we can’t even claim it.”
This conversation was making me feel even more chilled and clammy than I already was. “How is your husband mentally and physically?” I asked.
“His memory is not good at all,” she said. “And of course his heart has not been strong since he had those two heart attacks.”
“Can he pee?” I asked. To me this was the key question. This case seemed like a disaster waiting to happen. Subjecting a demented, sick, very elderly man to surgery would only be justified, in my opinion, if he was on the point of retention. “Oh no,” says my questioner. “He can pee.”
“Look,” I said, “I don’t know him and have not examined him. You must ask his doctor if he thinks that he is in retention. Ask him to really outline the advantages and disadvantages of the surgery. I think this is a very risky thing to do. The cancer is not the issue. Remember when people reach 96 the aim is to do no harm and keep them safe.”
“Thank you, that’s what I was thinking,” she said, reaching over to give me a hug before disappearing into the health club. I opened the door to the regular locker room and got into the hot shower. ‘Did I do the righr thing?’ I mused while washing my hair. Did I know enough to give an opinion? Was I too ready to believe that the private doctors where motivated by monetary gain rather than patient well being? Was I just not ready to give up giving advice?
When I got upstairs, Dave was waiting for me. “What took you so long?” he asked.
“Just shmoozing,” I said.