Auld Lang Syne

Me: Hola. Soy Dra—Puede sentarse en esa silla azul.

Patient: ¡Oh!  ¡Hablas español—qué bueno!  Dios te bendiga---ohh, tengo muchos problemas mi’jita, me hicieron cirugía en la rodilla, estuve en el hospital por una semana, después, una facilidad para terapía...ahora puedo caminar,pero, ves aquí (motioning toward her knee and leg)no puedo doblar muy fácilmente, y camino lentemente...no tengo nadie para ayudarme en casa.  No puedo ir de compras, no puedo salir de mi apartamento, ¡ojalá que Dios me de la fuerza para continuar!!!

Me:  Lo siento oír esto, espero que Usted esté bien, pero una pregunta, ¿cómo están los ojos? 

I remember during one particular class in medical school, an instructor brought a patient actress into the classroom.  He and the actress were simulating a patient visit for us.  He asked her the reason for her visit, in an effort to elicit the chief complaint.  But, this woman never answered him directly. She never really told him why she was there, why she had scheduled an appointment. Her throat wasn’t sore.  She had no headache.  No backache.  She wasn’t  gaining weight or losing it.  She seemed perfectly fine and content, just to sit right there on the examining table and went on and on about personal goings-on in her life. She talked about anything and everything else: her family, how she keeps busy, friends who have visited, an old surgery she had years ago. She said how wonderful it was to be married for 63 years, to her high school sweetheart, and how she doesn’t really travel anymore, since she lost her beloved more than two years ago now. 

When the demonstration was complete, the instructor turned to us, the students, and asked the real purpose of this ‘patient’s’ visit. I answered that there was no purpose. There was no chief complaint. She was there for attention, for company, for friendship—whatever, but she wasn’t there for anything that could be treated with anything other than a listening ear and a concern for her as a human being.

I went to Pennsylvania State University College of Medicine and at the time of my attendance Penn State was among the few pioneering schools that used patient-actors in an effort to simulate real-life patient encounters for the medical students.  I didn’t realize the great value of this particular demonstration at the time.  I wouldn’t recognize the value—and the truth—of this scenario until years later, when I myself was seeing and treating patients. 

I remember being a busy resident in NYC along with one, maybe two other residents, and having to race through 60+ morning patients before rushing off to the midtown clinics in the afternoon where another 60 would be waiting for us. In order to get through each exam in a timely fashion—and get to the afternoon session on time—I  had to focus on the physical exam and little else. Very little room was left for conversation.  You can imagine what a monkey wrench in the works it would be, to have a patient come in and contentedly review his life story, when asked why he came to the clinic that day. I would try to redirect the patient, but a patient who’s there for company and conversation doesn’t leave the normal pauses between the sentences of speech.  Pauses mean a chance for redirection to the task at hand, and a patient who is there for company doesn’t want to let that happen!  As a novice doctor and overworked resident, frustration was a theme regularly experienced.

That was over ten years ago. Now, I get it. I know that there are patients who come for more than just a diagnosis and medication. I know that some, many, come for caring. For attending to. For concern. For an ear to listen and not much more. And the English speakers do this, y personas quiénes hablan español.  And it’s OK, because we as human beings are social beings who must share our concerns every now and again, not all of which can be contained in a ten minute examination. 

Patient: Mis ojos son sanos. Aunque, están lagrimeando cuando miro la televisión, o cuando voy afuera de mi casa. Pero es difícil ir afuera, como te dije antes, con mi rodilla así, y, bueno, cuando no tengo nadie en mi familia quién vive cerca de mí, es casi imposible encontrar la ayuda que necesito.  También yo le cuido a mi nieto de vez en cuando, pero ahora no puedo porque no puedo mover la pierna fácilmente.. y él estuvo enfermo, tiene cinco años ahora,-- ¿Te dije ya cómo él se enfermó?—le pasó a él en la escuela....

I always take a few extra minutes to listen because sometimes, the listening is the most effective treatment of all. 

 

Optika u Zadru