After my interview with Mrs. Goldstein, I took her into my examination room and told her I was going to start by checking her blood pressure. She told me that her pressure would be high because she had "white coat syndrome."
This form of anxiety reaction is quite common in physician offices, but Mrs. Goldstein's pressure was normal for her age. We speculated that the reduction in blood pressure from her usual doctor's office reading was due to relaxation brought on by the sight of the violin and her thoughts of Mozart's concerto.
A number of my patients tell me that I always get a lower blood pressure reading than their other physicians.
These stress relievers aren't just for patients: Physicians also experience stress. I needed to tell the book editor with lung cancer that his emphysema was so severe that it prevented him from undergoing surgery to remove the tumors and that it also made him a poor candidate for radiation or chemotherapy. There would be no treatment, in other words. He asked me how long he had to live.
This is not an uncommon question in my office, and I tried to answer honestly. Each time I do, I worry that I will give incorrect information and falsely raise or lower hope. My patient seemed to accept what I told him calmly.
Not long ago I came across his obituary and realized that my projection of the time he had left had been correct. As I read, I also learned that he had been the editor of a favorite book of mine, one that had provided me with enjoyment as well as an escape from the pressures of medicine.
Back in my office, Mrs. Goldstein had spied photographs of my dogs and my family and asked me about them. I spent a few minutes telling her about the individuals in the photos -- my wife, stepchildren and my two playful Havanese -- before discussing her medical condition.
Her shortness of breath turned out to be due to emphysema, essentially an aging process that had occurred within her lungs. I told her that I could not reverse the damage done but that I would prescribe a medication to relieve her symptoms.
I asked her to let me know in a month if it was helpful. As she was leaving, she quickly glanced around the office and told me that she was happy that she had come.
"This is very unusual," she said. "I don't want to leave."
I walked her to the receptionist's desk and as I did, I am sure I heard my violin playing.
--
Adams is a pulmonologist in New York City and the author of "The Asthma Sourcebook" and "Healing Through Empathy."
