April 4, 2013
First-year medical student Benjamin Adler has reflected on the early lessons of learning how to be a doctor through excellent role modeling. Clearly Ben has the wherewithal to process in real time and ponder the situation afterwards. There are so many things a textbook or a lecture can't teach—but if one is open to it, the teaching pours into the open and willing mind. Ben has captured that so well.—Hugh Silk, MD
(Editor's note: This story was awarded an Honorable Mention in the 9th Annual Gerald F. Berlin Creative Writing Prize competition—see today’s related story)
I timidly open the door to the exam room, putting my best doctor face on and running through the pointers Dr. D shared with me. Anna came to the office for an urgent care visit complaining of headaches. I’m armed with 20 minutes of headache research, a 5-minute debrief with Dr. D on key questions to ask and why, and my slowly developing interview skills. Taking a History of Present Illness from a patient feels like wearing new shoes that are still too big for me. Plus they don’t match my pants or shirt. But they are mine now, and the more I wear them the less I trip over myself.
“So what brings you in today?” As I ask this simple, open-ended question, I start to gain some confidence and settle into my funny shoes. I wasn't at all prepared for tears though. She’s convinced it’s something awful, and terrified that her life might be in danger. Tears roll down her cheeks and she sniffs back her runny nose between sharp, shallow breaths. It’s the first time a patient has ever cried in front of me. As I reflect on the moment, I realize this is a milestone in my medical education, in my slow acculturation to the physician world, in my transition from learning the science to taking care of “fellow creatures in pain.”
I cycle through anything in my head, searching for the right thing to say. How can I comfort her? Is this fear warranted—could her life be in danger? What questions should I ask to make sure I get her story right? Can I offer anything to reassure her? This patient is scared and vulnerable. She’s entrusting me with her biggest fears. I felt a weight on my shoulders. I needed to find out what was wrong with her, or at least put her at ease.
I bring myself back to the exam room, realizing I had let a long pause drag on. “I can imagine how scary this is for you. I don’t know enough yet to figure out what’s causing your headaches, but Dr. D is excellent and he’ll be in real soon to talk with you and help figure it out.” I trudge through my remaining questions, still blanking on what I could say to comfort her.
Walking briskly back to the charting room, I find Dr. D. With my shorthand notes reminding me of all the details I wanted to include, I share Anna’s story. Dr. D asks a few clarifying questions and nods. I forgot to ask a few things but he seems content with my case presentation.
We return to the room and Dr. D sits down close to Anna. She starts to tear up and continues to express her pain and concern. Dr. D listens and places his hand on her forearm. Gentle but not tentative. It looked so natural. Why didn't I think of that? She wiped away another tear as her shoulders relaxed and breathing steadied. His simple touch provided relief for many of her symptoms. To my surprise (but probably not to Dr. D’s), she tells him that a family member died last year, and she’s been having flashbacks.
Now for the next stage of Dr. D’s lesson in primary care. “I’m going to start with a very thorough exam to make sure I feel that there’s nothing scary going on. Does that sound okay?” At each stage he explains what he’s doing and shares that the result is normal. Anna smiles.
Dr. D’s course in doctoring lurches forward again. “I think this could even be a good headache because it brought you in to us so we can maybe talk about these feelings you’re having. I’m really sorry to hear about your niece. We can help you get through this.” Anna seems significantly more settled and agrees to meet a counselor who works with Dr. D.
I thought back to how I had frantically raced through things I might say to comfort her. I had put such a high value on making everything better. From watching Dr. D and thinking more about it, it became clear this wasn't the way to approach the situation. I frequently won’t be able to cure patients. But the next time a patient comes to me in crisis, I can apply my learning as a thorough, patient diagnostician and read between the lines to consider what else may be causing headaches. And know when to reach my hand out to comfort.
Each Thursday, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.