No Words for Thank You

Tibet - photo by JoAnn Sturman

by Scott Sturman

Looking back over a nearly forty year medical career, advancements in technology and interference from bureaucrats have redefined the practice of medicine, but patient attitudes, particularly those receiving government sponsored care, are no less significant.  Early in practice, most welfare patients seemed to appreciate the efforts of the medical staff who treated them.  There was a tacit understanding the care they received resulted from the sacrifice, generosity, and ethical commitment on the part of physicians, nurses, and hospital administrations.  This relationship has changed.

In the series Game of Thrones Viserys Targaryen arranges for his sister Daenerys to marry Drogo, the Dothraki king, in order for the Targaryens to reclaim the Iron Throne.  It’s a match of power politics, for at first glance it is difficult to imagine an odder couple.  Drogo is a brute of a man and epitomizes his culture’s savagery and thirst for violence, while Daenerys appears meek, sheltered, and physically graceful.  They are worlds apart and speak no common language.  When Daenerys, also known as Khaleesi, receives her wedding gift from Drogo, she asks her knight Jorah Mormont how to say “thank you” in the Dothraki language, so she can express her gratitude to Drogo personally.  Mormont replies, “Khaleesi, there are no words in Dothraki for ‘thank you’.”

Obstetric floors specializing in indigent care provide a glimpse into the mind set of the welfare class.  Most patients are either young or have had a generational affiliation with government funded health care.  The likelihood that any of them have ever paid for medical care is vanishing small.  It is a way of life, an expectation, and a right. 

Labor epidurals are the standard of care whether a patient pays for the service or not.  The technique provides great benefit but is not without medical or legal risk.  Within minutes after the nerve block is placed, the patient realizes near complete pain relief.  And who is more likely to offer the physician an unsolicited “thank you,” the paying patient or the welfare patient?  Ironically, it is almost always the former.

On occasion after the procedure and prior to leaving the patient’s room I’ll ask her, “What do you say when someone does something good for you?”  The answer depends, of course, whether Dothraki is one’s primary language.  More often than not, there will be a pause and a reply more in the form of a question, “Thank you?”  Yes, that is the right answer, but one that should not have to be coaxed or coerced and whose meaning is frequently lost on those who view medical services as an entitlement.  

      Passion Tree - photo by JoAnn Sturman

(No kidding, we found this tree along a path in Costa Rica)