Thursday, February 10, 2011

#27 The Clues in the Conversation

“No, that is not right,” Rudy said in response to my third attempt to ascertain his reason for coming to see me.

I am in trouble now I thought glancing at the clock. Twenty minutes had passed and I still had not even pinpointed the problem. What I did have was fifty pages of medical reports and test results with symptoms and complaints that Rudy insisted were not accurate.

“How can I help?” I had asked directly fifteen minutes before. Leaning across my desk he passionately described a number of vague aches and pains that appeared to come and go. I listened intently and finally at one point repeated back to him word for word his latest description starting with, “So you are concerned about……”

“No, no,” Rudy shook his head rigorously. He was not concerned about that symptom. In addition, he was upset that his doctor, who had ordered many of the tests whose results were piled up in front of me, did not seem to understand him.

As easy as it is to criticize doctors given the present state of the health care system, I could find not a single fault with the thorough way his physician had analyzed the situation. If Rudy had not been understood, it was not from lack of trying on his doctor’s part. I empathized with the maligned internist.

I had been trying to listen so hard that my eyes were watering and I still was not getting it. Talking with Rudy was not improving my understanding so I reviewed in my mind what I did know. Rudy was prosperous and productive. This I knew because I recognized his name and Daisy, the woman who referred him to me called him “a business genius”. His medical records indicated he was in his early forties and his lean and toned physique were a testament to many hours at the gym. According to the extensive test and procedure results in front of me, there was nothing notably wrong with him.

Could he just be anxious? I wondered. I hated going down this road as so many patients are dismissed as anxious when practitioners cannot figure out what is really wrong. I flipped through the paperwork again and spied his diet diary. It was a mass of scribbles squished chaotically on to the page. I had seen papers written by 3rd graders that were neater. Then, I remembered a conversation I had with my attention-to-details assistant, Tania. She had mentioned that she was having a tough time scheduling Rudy because he was hard to reach by phone and did not use e-mail. I remember wondering how such a successful business owner could function without e-mail and as I was recalling that conversation I suddenly an idea occurred to me.

Rudy was still talking and leaning against the front of my desk when I looked up and interrupted him. “Ah ha, I’ve got it,” I said pulling his papers together and talking with more authority and confidence than I felt.

He looked at me wearily. After all, I was not impressing him up to this point with my stellar detective skills.

“You obviously would like to feel better,” I stated without waiting for agreement. “And I have identified three things that you are going to have to do that will help.” I glanced up to gauge his reaction. He took a breathe, stopped talking and slumped back into the chair. We were in agreement at last. Coming up with three healthy interventions for an overly busy person was not going to be difficult.

Rudy was a fit 40 some year old guy who was experiencing some of the annoying symptoms of middle age. He needed to make a few life style adjustments to optimize his energy. He was not 23 any more but he still had some long standing bad habits that he could get away with then but were not working so well now. This is what I think he had come for but in my view, this was not the most pressing problem. The more interesting issue was what appeared to be a significant learning disability in an otherwise wildly successful person. I wondered how much of his life had been spent covering up or compensating for his learning quirks.

I was having trouble communicating with him because he could not prioritize or organize his thinking. This is why when I repeated exactly what he said he did not agree with himself. It is also why he had thousands of dollars worth of tests looking for the cause of symptoms he claimed he really did not have. The thoughts he said out loud were not necessarily the most relevant ones. His communication was a jumble of important and insignificant information all mixed together. He needed help sorting his chaotic thoughts and a plan with a clear structure.

If organizing his thoughts was this difficult, no wonder he avoided e-mail. Writing must be a nightmare for him. Yet, there were significant areas of his life around his business where he was organized and brilliant. I would bet good money that getting through high school had been pure hell. Luckily, a horrible high school experience is not necessarily a harbinger of future failure because learning differences do not have to be crippling. If a person plays to their strengths and works with or hires people to handle their weak areas, they can succeed spectacularly as Rudy had.

But heavy compensation exacts a toll, especially when people do not understand the nature of their learning differences. Every activity that requires skills in their weak area will be more stressful. They may feel overwhelmed more easily and can get frequently frustrated. To avoid failure some procrastinate while others bully those around them to divert attention from themselves, depending on their nature. The behaviors that result from poor compensation could fill a psychology textbook. I have seen people unwittingly destroy marriages and relationships, lose jobs, fall into depression, suffer from chronic anxiety and become violent.

Rudy had an intense personality and I could not help but wonder how much of that was due to the stress of working around cognitive obstacles. Did he realize how tiring it could be to communicate with him in some areas? Was it equally exhausting for him? I wondered what he knew and how open he would be to discussing his cognitive quirks Exploring and perhaps coming up with some strategies to improve some of the ways his brain worked was how I wanted to help but decided he might not see that as help.

I decided I would have to build some trust and a connection before broaching this potentially touchy subject. And my analysis could be dead wrong leaving him to wonder about what kind of learning disability I had. Consequently, I decided to address what he wanted first and then see if there is an opening next time. Assuming that is, there is a next time.

1 comment:

  1. Kelly, Your insights into this case are excellent. I look forward to seeing how you build trust with this client, which will open the door to examining his diet and lifestyle, both of which may help with his issues. Good luck andh keep us posted! Amy Stone