Disclaimer: There are some amazing medical writers (I grew up reading the Vital Signs medical column in Discover Magazine), and I really admire their work. During my medical career, I have had countless moments where wonderful, funny, poignant, meaningful or just plain horrible things happened with patients. They are important memories, and some could make good stories, but patient privacy is an incredibly  meaningful moral and legal concept. Since I post these stories to Facebook, and I have a few local friends who were also patients or patient-parents, I want to be crystal clear that I will NEVER write, nor do I tell people, what we talk about in the privacy of an exam room. The story below took place decades ago, and I have removed as much information as I could. If, despite these steps, my sharing a story about a patient makes you personally uncomfortable, please let me know. The trust that every single patient I have ever cared for has extended to me is honestly the most valuable gift I’ve received. 

We are trained that as part of the medical note the chief complaint is supposed to be “a succinct statement of the problem ‘in the patient’s own words’“. One of the saddest chief complaints I’ve ever written down in a medical record is “I just want my dog to come back“.

I had an urgent care job that was frequently as much psychiatric care as it was for physical problems. Like much minor or urgent care work, my job was to deal with problems that at least one medical professional had already judged as “not serious“ or “not worth a doctor’s time.” The man I was seeing whose words I am quoting had several issues with anger and substances. He had a hard life, with few bright spots. His truest companion was his dog. His favorite thing to do was to sit on his porch with his dog, drink a beer, and smoke a cigar. One very bad day, he had fought with his wife, and in anger, he kicked his dog. The dog ran away in fear, and disappeared for a few days. The next time he saw the dog, it had been taken in by a neighbor across the street. He felt terrible. Guilt, anger, shame, I would imagine. He told me that now he had to sit on his front porch, drink his beer, smoke a cigar and look at the dog that wouldn’t come near him again. He knew he needed help, but didn’t know what kind of help he needed or could get when we met each other.

We talked for a while, and discussed medication and therapy options. He was lukewarm about both. He knew what he wanted, but had no real sense of how to do the work it would take to get it. It was professionally frustrating for the young me, and so profoundly sad. The last thing I remember him saying to me was “I’m not apologizing to that dog. I’ve got my pride.”