Read Making Rounds and Oscar (2010) for Free Online Page B

Doctor, too long!"
    I smiled at her, wondering to myself if I would ever get to the point where I wouldn't remember how long I'd been married. I know that Ruth's attempt at humor was just a ruse to hide the fact that she really had no idea. She could have been married ten years or a hundred.
    "I have to admit, Mrs. Rubenstein, that I share some of your husband's concerns regarding your memory."
    She shook her head and reached over to put her hand on mine as a gesture of reassurance.
    "Oh, Doctor, I'm just tired. I really have a lot on my mind."
    "That might be the case, Ruth, but I am a little worried that there may be more going on. Would you let me order some more tests?"
    "But, Doctor, why would you want to order more tests? Tests for what?"
    I couldn't keep beating around the bush.
    "Ruth, I'd feel better if you'd allow me to order a few more tests."
    She shrugged and offered grudging approval. "If you think it's really necessary."
    "Ruth, how long has your husband been concerned about your memory?"
    She became defensive.
    "I don't know, Doctor. He keeps telling me that my memory is not as good as it used to be. Well, of course it's not as good as it used to be." She pointed at herself, smiling. "Look at me: I'm an old lady!"
    I laughed at her candor. If nothing else, she still had a sense of humor. But it's a common misconception: Age really has nothing to do with memory, and problems with memory are never normal aging. People assume the two are related because memory problems become more common as we age. Yet memory impairment is always abnormal and should be worked up.
    "You're not that old," I said. "You could actually pass for twenty years younger!"
    "Well, thank you, Doctor," she said, and I think she actually blushed.
    I decided not to make any further comments until I brought Frank back into the room. I finished her physical exam and excused myself to allow her to get dressed.
    By the time I returned with her husband, in a matter of mere moments, her mood had changed. I looked directly at Ruth and could see the quiet desperation in her face.
    "Doctor, all of these memory tests that you did. They're all silly. I'm okay--right? I just have a lot on my mind these days."
    But her eyes said something else. She knew there was a problem. People usually do.
    I couldn't meet the gaze and looked instead at the floor between us.
    Now they knew.
    Sometimes there are tears when I deliver bad news. This time there was only silence. I'd rather have tears. At least you can do something. You can reach over and grab a box of tissues from the counter. You can place a reassuring hand on someone's shoulder.
    Silence is the worst.
    In medical school, they used to teach you to be detached but empathetic when giving bad news. Listen and support but don't get involved .
    Easier said than done.
    I'm human and I get to know my patients. I meet their families and hear about their children and grandchildren. I get to celebrate their successes and be there for them during the difficult times. It is the part of the job that I find most intoxicating--working to develop a trusting doctor-patient relationship where my patients can feel comfortable sharing everything. A doctor's office should feel like a safe place, an arena in which you can bring out your demons or your angels, your deepest fears and most intimate secrets. In return I have to be honest. That can be the worst part of my job.
    "I'm sorry, Mrs. Rubenstein. The memory testing that we did shows there are parts of your memory that are not working as well as they used to. These tests I'd like to run will give us a better sense of what's going on."
    The blank expressions on their faces told me they didn't understand.
    "Mrs. Rubenstein, I think you have a type of dementia, the medical term we use when you have a problem with memory."
    Silence. No tears. I could hear the second hand tick on the clock over the door, the same clock she glanced at when taking her test.
    It was Frank who