Chapter Eighteen: The Man in the White Coat

My very first, yet fuzzy, memory of the man in the white coat was when he asked me: “Do you know how brave you are?”

I was a wide-eyed 8-year-old girl with my dark hair parted in two high ponytails. My Dad held my right hand as a lady in duck-printed clothing held up a sharp device with little green wings on each side. She tied what looked like a flat rubber band around the middle of my arm and asked me to make a fist. I later found out that the medical term for the flat rubber hand item was a rubber tourniquet, which allowed the maps of windy, blue veins to pop out so drawing bloodwork from a particular vein was easier. The man in the white coat was my +nephrologist, **Dr. Winthrope. He was a fresh-faced and young doctor then with thick and wavy, sandy-colored hair and a white coat that drowned his svelte figure, absence of love handles.

“You get a lollipop after this,” Dr. Winthrope said, smiling widely.

I was wordless and stared hypnotized at the little device with wings. I turned to my Dad and asked: “What is that? Is it a butterfly?”

My Dad opened his mouth to respond, but the lady said with a big grin said as she held the butterfly near my left arm: “It is a butterfly! She is going to fly on to your arm now. She will probably pinch you just a little bit, but it will be over before you know it.”

I wanted to say to her that I liked the ducks on her clothing because they looked happy and free with their big, innocent eyes and rounded beaks. I wanted to say to this man in this white coat that I wanted the cherry-flavored lollipop now. Before I could say any of these things, the butterfly went into my arm and a searing and pinched pain made tears fill my eyes. Red liquid from my arm slid out to the butterfly and into tubes. I turned away and looked up at my Dad wordlessly as I bit on my lower lip.

My Dad’s response was to squeeze my hand even harder, which made the tears roll faster down my cheeks. I wanted to tell my Dad that he was hurting my hand, but my left arm began to twitch. This lady with the duck clothing said: “Hold still, sweetie.” The man in the white coat put his hand on my wrist and said: “Almost done.” Then, the butterfly came out and the lady placed a cartoon-decorated band-aide on to my arm.

“You are just too brave of a little girl,” the lady said to me and began to wipe my wet face.

Dr. Winthrope patted me on the head and presented me a cherry-flavored lollipop. “All for you—the bravest girl there ever was.” My face was dry. My tears gone. The cartoon-decorated band aide was bright and blinding against my pale skin. I greedily opened the plastic wrapper and stuck the lollipop in my mouth.

The butterfly that I was one so hypnotized with when I was a little girl and that I encountered each time I saw Dr. Winthrope was actually a butterfly needle. Dr. Winthrope was an all-too familiar face and presence in my Father’s and my life. My memories of him were always smiling at me awkwardly with a glint of humbled pride in his eyes that had aged from innocence in his medical youth to now crinkles of crow’s feet, streaks of whitened hair, and a fuzzy moustache from the many pediatric kidney patients that he was in charge of.

After the success of my second kidney transplant and into my teens, a routine appointment involved the nurses chatting up a storm with me as they weighed me and checked my height and blood pressure, a whole lot of waiting in the waiting area with my Dad half falling asleep, and then finally being called in by Dr. Winthrope. With a weary smile plastered on his face, he asked my Dad: “So, how is Mary doing today?” My Dad opened his mouth to answer and then I would always slice in: “Mary is doing very good, Dr. Winthrope.” I often gritted my teeth as I thought bitterly: “I hate when he asks my Dad how I’m doing about my own health. I hate being talked about in the third person.” As if reading my mind, Dr. Winthrope complied by turning to me. He did his annual physical check-up with checking my eyes, ears, and placing his stethoscope under my shirt to check my heartbeat and then on my back: “Big Deep Breaths, Mary.” I inhaled and exhaled as deeply as I could. He always ended the examination with checking my ankles if there was swelling and his lukewarm hands went on to my lower left side over the transplanted area to make sure that it “felt right,” meaning no tenderness, swelling, or redness.

My favorite or most memorable part of my appointment with Dr. Winthrope was when my Dad and I ended the appointment with sitting across from him in his impeccable office with diplomas hung proudly on the bare white walls and piles of paperwork on his desk. His hands would move in this fluid and almost mesmerizing method as he looked at my Dad and said: “Looking good!” I beamed with happiness as if I received an excellent grade on a test whenever he smiled and spoke to me with the extraordinary results that my second kidney transplant was functioning at top-notch speed.

Dr. Winthrope then rattled off bloodwork results that I had to have done, the same lecture that I had to lose weight, reviewed my many medications, and ended with signing his name off with flourish on all he prescribed. Just when my Dad and Dr. Winthrope would stand up, I almost always stopped them and said: “I have a question.” Just because both of them fed me dog biscuits of minimal praise, attention, and information about my own health did not mean that I had to keep silent. I spat off index cards full of questions from how was my blood pressure related to the function of my kidneys to trying to lessen the amount of medications I had to take to how long could I go without getting a third kidney transplant.

Each answer to my question was directed to my Dad and me with unwavering confidence. At the time, I did not appreciate all his patience with dealing with me—a tiny tyke of a gal that had no problems or hang-ups with drilling him with concerns and questions I had about maintaining my health. He ended our appointments with a cheerful: “See you both next time!” After each appointment, My Dad and I gossiped like little girls about Dr. Winthrope.

“He uses his hands a lot,” Dad and I agreed.

“He tells me to lose weight, but he has gained weight over the years, too,” I proclaimed when I was in my teens and just starting to lose the pounds that Prednisone had assisted in packing on.

“Yeah, he has a belly now, but you have to do what you have to do for you health,” My Dad pointed out.

On the car rides back home after the routine appointment with Dr. Winthrope, I asked my Dad: “Dad, do you think there is anything that Dr. Winthrope is scared of? He seems perfect. He can answer every question that I ask him about my health.”

My Dad paused and responded candidly, “Well, that is his job, and just because someone looks confident does not mean that he or she is confident. Maybe…well…maybe he is scared of you.”

I laughed. “Why would he be scared of me?”

“Everyone has a weak point. Everyone gets scared and especially when it comes to health because it involves life and death. Besides, you are a tough as nails patient.”

“What do you mean by that?”

“Well, you always ask him questions.”

I spat defensively: “I always ask a lot of questions. Not just about my health, but everything.  I am curious. I want to know what is going on. What is wrong with that?  Dr. Winthrope barely talks to me. He mostly talks to you—about my own kidneys, my own health, and my own body. He throws me a smile and a pat on the back or head as if I were still a little girl that did not know any better about that stupid butterfly needle. I want to know what is going on in and with me. That does not make me tough. That makes me proactive.”

My Dad shook his head, gave me a crooked smile, and chuckled: “You are so stubborn.”

“I think I got that from you,” I retorted. My Dad and I chuckled.

By the time I was in college, it was about six to seven years after my second kidney transplant. My health was fairly stabilized and so required bloodwork to measure my kidney function and appointments with Dr. Winthrope became quarterly visits that were like an intriguing mystery game to me. I wanted to find something or anything that could poke at Dr. Winthrope’s superior confidence and medical expertise just for fun, but I never could find anything that could or would faze him—until my Dad made an announcement to me in as casual of a tone that he could when I was about 20-years-old.

“So, you know that you have a doctor’s appointment with Dr. Winthrope coming up.”

“Yeah?” I said warily.

“So, I was thinking that maybe you want to go alone,” My Dad suggested nonchalantly.

A bubble of excitement formed in me. “Really? You think I can handle it alone?”

“You can do anything,” my Dad confirmed.

“Should we tell Dr. Winthrope?” I asked.

My Dad’s eyes seemed to twinkle with mischief. “No, let it be a surprise—for both of you.”

To prepare for this supposed special occasion of independence that I was finally going to my nephrology appointments on my own, I dug out a massive black binder and a collection of dividers and labels. Sprawled out on the floor were endless sheets of papers. Test Results. Doctor correspondence. Insurance documents. My Father smiled bittersweetly and said: “All yours now.” I tried to laugh, but it came out as more of a strangled choke. I could not believe how much paperwork there was. My eyes became sore and watery from seeing my name, social security, and foreign numbers from lab results and costs for each test. But, I meticulously chugged ahead with labeling and filing every single sheet in the correct section: Results, Insurance, Correspondence, Information, Questions, etc., etc., etc. My hands were sore and my eyes numb from all the organizing, but I felt strangely satisfied from this paperwork torture. I was prepared. I was ready. I was the independent and proactive patient that could take on anything and anyone, including and especially Dr. Winthrope. The day before my appointment, I thought and wrote out questions to ask and information to update him on. I imagined Dr. Winthrope’s surprised and delighted smile to see me and him now saying: “See you next time!” rather than: “See both of you next time!”

As pathetic as it was, when I approached the door to my nephrologist’s office, my heart pounded with hesitation and strange happiness and euphoric excitement. I beamed with pride the first time when I waltzed into that office all on my very own. The front desk with the familiar receptionists were accustomed to me clutching tightly on to my Father’s hand and so they asked: “Hey, Mary, where’s your Dad?” I puffed out my chest, grinned, and loudly declared: “I’m here on my own!” They smiled and said: “Well, well, well, it looks like you graduated!”

The friendly nurses that had become my surrogate mothers shot me candied smiles and outfits decked out in flowers and cartoons when they called out my name. The first words that escaped from their mouths: “On your own? Where’s your Dad?”

My goofy smile was still pasted on to my face. “Dad said that I could handle seeing Dr. Winthrope on my own. And, I can.”

The nurses smiled endearingly at me and began to bombard me with questions: “So, how is college going? Studying psychology, right? Know what you are going to do? Do you have a boyfriend yet?”

My smile began to falter. I hated it when adults asked me what I was going to do with my life and if I had a boyfriend. Probably because both of my responses were in the “No” zone. How does anyone know 100%+ what to do in this thing called life? Why was having a boyfriend so important? I played the game of saying that I wanted to work in healthcare—a broad answer that seemed to satisfy them as they took my blood pressure and weight. I played the game of saying that the boys were just scared of me because I already had an arranged and special relationship with someone else: My Health. As usual, I inhaled for both the blood pressure measurement and weight. They then said to me as they presented a shiny urine cup: “Time to pee. “ The numbers on the scale and blood pressure machine were magnified when I went to see Dr. Winthrope alone for the first time. The color of my pee and the process to pee in that small cup mattered more to me than before when I had my Dad around.

I sat in the waiting room amongst children who ranged from sad and sullen to children with sweet smiles and simple joy. I saw children in parents’ laps or absorbed in a latest puzzle and rewound to my childhood, remembering and reminiscing that I was once that child who looked up at my Dad or buried my face in toys to occupy my time and mind. To sit in that waiting area and play the observer rather than the observed was extremely strange and startling. I eyed the empty chair next to me. I was so accustomed to my Father there, reading his newspaper or half falling-asleep. In response to the emptiness, I held on tighter to my healthcare binder and continued to re-read the index cards of questions.

The nurse called me in to go into the exam room. There was more waiting. When Dr. Winthrope finally came in with his sandy-blonde hair now whitened and sticking out everywhere, his moustache and eyes lifted in surprise: “Mary! You are here on your own?!”

I sat with my masterpiece health binder in my lap and a pen in my hand that I fiddled with nervously. I could not read his expression if it was a pleasant or unpleasant look of surprise, so I just nodded and smiled in response. Needless to say, as soon as the examination began with the stethoscope and eyes and ears check, awkwardness seeped in. It was quiet and strange. Dr. Winthrope attempted to cover up the oddness with asking: “So, how is school going for you?”

“Okay,” I said cautiously, “I’m studying psychology, sociology, and communications.”

“That will keep you busy. You know what you want to do?”

I exhaled a sigh of relief that he did not ask: “What do you want to do with your life?” I replied: “Maybe go into healthcare. Something with helping people.”

He gave me a paternal smile and looked me warmly in the eyes: “You would be very good at that.”

I beamed with pride.

For so long, I felt as though I was treated as the stupid child who did not know anything at all about my body and my health, but how could I not when my body and my health were all MINE? I was born in this body. I had listened and absorbed every and any change related or unrelated to my kidney condition. I struggled for so many years to fully understand firsthand what was happening to my kidneys, the physical side effects that resulted from the medications, my body, and me, but seemingly did this as a third-party observer. Growing up, I listened and concentrated hard to understand what others were discussing when it came to me and what everyone’s decision was with MY HEALTH, MY BODY. But, being there alone with only Dr. Winthrope and without my Dad, and to have Dr. Winthrope finally look at me and hold a conversation with me about my health and my personal life was a huge triumph for me.

At the end of our first appointment, Dr. Winthrope said: “I’ll see you next time! Tell your Dad that I said Hi!”

I practically danced out of the doctor’s office. That night when my Father asked me how it went, I gave an intoxicated grin as though I had won the lottery: “It went great!”

In the doctor appointments that followed, I finally spoke what I felt and asked whatever questions I had without my Father’s words or input. I took notes about what Dr. Winthrope and I discussed. We discussed a lot about decreasing the dosage of certain medications or ending them all together because the long-term side effects would cause a multitude of new health problems and I could happily do without. I researched, read, and tried to digest and understand every little thing that Dr. Winthrope and I spoke about. When I began to lose the weight from Prednisone, Dr. Winthrope showered me with praises and enthusiasm. I requested copies of any bloodwork and test results and promptly filed them away in the correct section of my health binder. The copy machine became my best friend. The numbers that once befuddled and frustrated me were now familiar and my lifesavers in telling me that my kidneys were functioning. The lower the Creatinine level, the better and higher my kidney function soared. Insurance companies and their madness of charging for every and any little morsal of a health-related matter were now making sense. I typed up a list of my medications and carried it around in my wallet as my lifeline. The nurses and I chattered a lot over measuring my blood pressure and weight. The ++phlebotomist soon learned where my good veins were to draw blood and I would grin and say: “I know you are a straight shooter!”

My Dad was stunned and speechless from my meticulous attention to my health details and my organizational skills. He said: “If I had known that you were going to manage your health documents like this then I would have had you start seeing Dr. Winthrope when you are 16-years-old. You know, in Chinese, we say that you are ‘li hai.’

I looked up from my health binder. “What does that mean?”

“You are very talented, amazing, and ferocious when it comes to all this stuff with your health,” My Dad explained.

I grinned. “No better person to handle my health than myself.”

I was not the doormat patient that complied with every word and order my doctor dictated. Nor was I the beast of a patient who argued on every turn. Instead, I was the proactive patient who was determined to work WITH Dr. Winthrope to make informed choices about my health, my body. I did not blame or hold a grudge towards Dr. Winthrope who probably found it strange and even aggravating at times to deal with me as the proactive patient. For so long, he had dealt with me indirectly. I understood that it was an adjustment for him as well because he was most likely accustomed to speaking to parents and not to children who were the patients. I gave credit and praised him from that first appointment alone with appointments that followed. He always took the time to answer my questions when we met and emailed me answers to the many questions I had. Sometimes after tossing around medical jargon over my kidneys and health status when I saw him for a quarterly appointment, we even talked about my university life and he talked about his family. We formed a sort of camaraderie and I felt blessed to have a nephrologist that I trusted professionally and personally. I greatly respected him. It was a rarity and wonderful that my health was in the hands of a capable individual, but more than that, that him and I could work together for my kidneys to keep functioning and for me to continue living my life to the fullest capacity.

Then, on one particular day when I went to see him for my routine appointment, I noticed that he was different. He looked tired, distracted, and weary. He was unusually quiet and all about the medical facts rather than normally asking me how life was. When his hands went on to my belly to make sure that my kidneys felt normal and that my ankles were not swollen from sodium intake, his hands were stiff and robotic. I wanted to ask him what was wrong, but I did not feel that it was in my place to ask him. After all, he was still my doctor and I was still his patient. It was not as though I was his therapist or anything like that. It was even stranger and more uncomfortable when I finally sat across from him and he was behind his mahogany desk with my lab results in his hands. He put the paperwork down, knitted his fingers together, and his expression was serious and tired. I was scared. I immediately thought the worst that my kidneys had rejected again and I had to have another transplant. I was just about to ask him that, when he jumped in with a question that completely stunned me: “How old are you now?”

My mouth felt like cotton. I suddenly felt like I was in a 4 X 4 prison cell being interrogated. “Uhh…22-years-old.” I was so confused. Dr. Winthrope must know how old I was. I just told him about graduating from college and the onset of the job search.

His knitted fingers were doing a nervous clench and unclench dance together. That scared me even more, because I was accustomed to his wide hand gestures when he explained something to me. He smiled gently: “That’s right. You told me about your graduation.”

“Uh-huh,” I said haltingly.

He cleared his throat. “Well, I have to make a referral for you to see an adult nephrologist now.”

My stomach began to ache. “What do you mean?”

“I am a pediatric nephrologist, so there comes a time that the patients have to make the transition to an adult nephrologist,” Dr. Winthrope said factually.

I sputtered: “But, you have known all about my medical stuff since…well…forever. Can’t you just make the exception to continue seeing me?”

He sighed and then shook his head. He proceeded to find his prescription pad.

I digested this news slowly. That is when it dawned on me. The truth was that our doctor-patient relationship should have ended when I was 18-years-old because age 18 is the legal adult age in the eyes of the U.S.A. The fact that he delayed this and continued my care when he no longer needed to or was required to showed me that he was a human being underneath his white coat and medical knowledge.

He was writing out the names of two adult nephrologists on his prescription pad. When he handed the piece of paper to me, I wondered if any memories of me filled his head as it did mine. I had special memories of him presenting my favorite cherry-flavored lollipop when I succeeded at not a teardrop from the latest blood drawn. I saw him in my mind with his wavy sandy-colored hair, asking me: “Do you know how brave you are?” I saw him boom out proudly when I had lost over 40 pounds: “Look at you and all the weight you lost!” I remembered giving him holiday cards to express my thanks for saving and maintaining my life. I flashbacked to anguish and pain in his eyes when I was nearly suicidal from depression and had suffered from my kidney rejection from my second kidney transplant, a bright smile on his face when he recited the latest and lowest Creatinine levels to me in these recent years, and the small chats that created our extraordinary and one-of-a-kind patient-doctor relationship.

I could not meet his gaze because I felt this utter sadness and loss engulf me. I could not believe that I was going to lose such an instrumental figure and a damn good doctor and person in my life. He was irreplaceable. This could not happen, but it was. Why was I so attached? Why was I taking this so hard? Why did I have to take everything so damn personally? What was going to happen to my kidneys and health now that I had to go to someone else who literally did not even have a clue about the health journey I had been through since I was 3-years-old? Maybe I was taking all of this hard because of Prednisone, I thought and chuckled at this. No. The truth was I was going to miss Dr. Winthrope as a person and as the man in the white coat that I had known forever.

I swallowed hard as I shakily took the piece of paper from him. His fuzzy moustache lifted up when he smiled at me and he said softly: “You can email me if you have any questions or concerns anytime. Anytime at all.”

All I could pathetically mumble when I looked at him was: “Thank you—for everything.”

Dr. Winthrope was my pediatric nephrologist since I was 3-years-old. I knew him as the man with the white coat with endless medical knowledge and who acted as a coach to my Father to care for a sick child and the doctor that saved my life and watched me grow up from two life-saving kidney transplants. After almost 20 years, I had finally found Dr. Winthrope’s weak point—caring too much about his patients, caring too much about me. After all these years, I was humbled to see the human being in him and that his confidence was shaken that I was about to leave.

Though Dr. Winthrope may never have admitted it, I imagined it difficult for him to let go of me as well. Dr. Winthrope and I shook hands and I turned to leave. I closed the door softly and that was the last time I saw him.

To me and after all these years, Dr. Winthrope was and still is more more than just the man in the white coat.

+A doctor that specializes in chronic kidney diseases and kidney transplantation

++Technician trained to draw blood

**Denotes fake name to protect privacy of individual

3 comments:

Jennifer said...

Great job Mare! As always, you have a clean writing style!

Eva said...

I really liked this chapter, esp. the ending.

Anonymous said...

I guess you will want to place a facebook button to your blog. Just bookmarked this url, however I must do this manually. Just my $.02 :)