The Hidden Pearls of Medicine: Stories from Our Patients

I am finally getting a chance to sit down and open up Kitchen Table Wisdom, a book of short excerpts on life by Rachel Remen. Her stories bring to my memory all of the small pearls which my patients have to offer. I have walked away from many patient encounters left with a sense of wonder. Each patient has a story, and as a physician I have the privilege of listening to that story. I still remember walking into the hospital for the first time as a medical student, many years ago. I had shadowed a couple of times before medical school, but not nearly enough for me to make any lasting impressions of the hospital or to feel comfortable there. No – my most memorable experiences in the hospital had been my own. As a young child, I was in the hospital for a few nights here and there. But, since the age of five or so, I had managed to avoid hospitals – and, for the most part, doctors in general. I often even avoided writing down any medical problems on my basic history and physical exam records for school. Interestingly, that approach to life had somehow landed me here – in the hospital, as a medical student and aspiring physician. I still have not figured that one out.

I walked in to the hospital, more nervous than I had ever been before. Short white coat, stethoscope, freshly sharpened pencils in my pocket. I kept thinking to myself, over and over again, Who am I? The image I had seen in the mirror only minutes before was of a stranger. I’m not a doctor, I remember thinking. I will never really be a doctor. And, to some extent, I hope that is true. I hope that I have not lost my identity as a person, or as a patient, solely because my role in the hospital has changed. I strive to be a doctor who understands what it is like to be a patient. Although that becomes more difficult as time goes on, my patients help me to do this every day.

I remember vividly my very first patient in the hospital. She was a young girl with diabetes who had had multiple recent admissions to the hospital for diabetic ketoacidosis. By not taking her medications faithfully, she constantly wound up in a situation where glucose was coursing through her blood but could not get to her vital organs because she lacked insulin, the hormone that allows cells to take in glucose. As a response, her body went into crisis mode, producing ketones and a resulting acidosis that could be deadly.

I had a long discussion with her about her illness. I listened and asked questions – I had nothing else to offer her, as I had just started my classes in medical school and barely even understood her disease. She understood it well. I remember being impressed, even surprised, by that – here I was, a medical student with years of education beyond high school, learning about diabetes from a high school student. I continue to be amazed by how well people understand their bodies – and their illnesses. Ever since this conversation with my first patient, I have never underestimated that.

She taught me about some of the struggles she faced while growing up with a lifelong illness. Everything that was simple for the people around her, family, friends, classmates – like eating ice cream cake at a birthday party, or going for hours on end without food while on a long bus trip to a museum – was not so easy for her. She was becoming frustrated and wanted to give up on following a strict regimen. I could hardly blame her. The problem was that, in the process, she was putting herself in grave danger, time and time again. The problem was that, as much as she wanted to live like a “normal” person, she could not.

I wished I could do something for her – take the pain away, ease her burden, provide her with the right words so that she would feel inspired to take care of herself again. But all I could do was listen to to her. She knew far more about her life and her illness than I ever would. She taught me a lesson which would stay with me for years to come: illness is a personal experience, and in order to truly care for patients, you cannot simply treat the disease – you must treat the illness. You must let the patient guide your approach. And you must listen – because their words are not something that textbooks can recreate, and it is often within their words that lie the answers to what kind of care – medical or otherwise – they seek.

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6 Responses to The Hidden Pearls of Medicine: Stories from Our Patients

  1. Pingback: Grand Rounds Vol. 6 No. 46: The Power of Listening « Dispatch From Second Base

  2. Jackie Fox says:

    So this newly minted medical student should have said, “COMPLY OR DIE” to a high-school girl. Yeah, right, let me know how that works for you. I’ve heard it’s really hard for kids to be compliant with chronic illnesses because they want to be like everyone else. Is this cruel to be kind method really what works with them?

    I agree that if this girl kept coming back her doctor needed to have a tough talk with her and so did her family. But how do we know that just being listened to didn’t help? Do we know if anyone did this before this student listened? You said it was all you can do–don’t ever underestimate the power of being heard. Maybe she didn’t come back as quickly after just getting a chance to talk about how she wished she could be normal.

    And here we have a resident who still gets a sense of wonder from patients, and considers hearing our stories a privilege. You are going to have a great career. Your patients are going to listen to you because they trust you. Not all of them, and not all of the time–but a lot of them will.

    Knowing how to read people and whether to be tough or gentle comes with time–for some of us it never comes at all.

  3. Mom! says:

    As a teacher I always found the expectations of some parents to be unrealistic. When all else fails….family support, community values, peer influence…there are always some who turn to education and charge teachers with the responsibility of the family and community. In the end, we are only teachers. We encourage, support and believe in our students. We are often the only people to do that in their lives. Teachers don’t raise children and they cannot control the environment or the support or lack of support a student gets. So it is with a physician. Kindness and gentle guidance coupled with respect are the best a physician can do. It is never cruel and nor would you want it to be.

    • RD Carter says:

      I sometimes equate teaching and healthcare with bad parenting. WE have to get a backbone and teach people to do the right things for themselves so they stop being so dependent on our kindness.

      Our society is failing because we have lost the ability to limit our own self destructive behaviors and the people we counted on (policemen, judges, doctors, teachers) to tell us when we’ve stepped over the line have lost their backbone to call us on our B.S.

      And THAT is the fundamental reason why our health, our schools, our homes, and our communities sem to be in such disarray today. We need to be brave and learn how to say, “No, that behavior will not be tolerated.” And then be willing to stand behind our words everytime an infraction occurs.

      We’ve given too many chances in our quest to spare feelings, to be kind, and look where it’s gotten us.

  4. RD Carter says:

    As one who follows a physician’s orders at the bedside, I agree that illness is a personal experience for each one of our “customers,” as our healthcare facilities have come to name them. Although I understand how you’ve come to view your patients, I must strongly disagree with your view on treatment for these types of patients.

    Our society has become so mindful of the gentle sensibilities of our fellow man, that we have forgotten how to do what’s best. And by “best,” in the medical sense, I mean recommend and expect, no, DEMAND, that our patients be compliant.

    It is NOT okay that the young high school girl with DKA did not follow the strict regimen her illness prescribes. Her attending doctor’s lax attitude with her treatment and care is the reason she kept returning with advanced stages of her disease. By allowing her to ignore her medication expectations, her family doctor is telling her, and all the nurses who continue to care for her on her multiple hospital admissions, that he DOES NOT CARE WHETHER SHE LIVES OR DIES, because by her not following his advice she is essentially saying the same thing. She doesn’t care, so why should he.

    And this is what seperates the doctors from the physicians.

    PLEASE, I beg you, do not become a doctor, a person so ascribed to the disease of kindness, that he forgets it is his duty, responsibility and promise to take care of these sick people, even when they don’t want to take care of themselves. Remember, sometimes, it is KIND to be CRUEL.

    Maybe you should have told that young girl to stop feeling so sorry for herself and live her life before her parents had to bury her, because she was “tired” of not LIVING a normal life. At least she was still living.

    Thank you for listening. And I have no doubt your kindness will be an asset to your patients. Just don’t let it be their death. Congratulations on your journey.

    RD Carter

    • AK says:

      Our society has become so mindful of the gentle sensibilities of our fellow man, that we have forgotten how to do what’s best. And by “best,” in the medical sense, I mean recommend and expect, no, DEMAND, that our patients be compliant.

      The trouble with this approach is the defiance it would create in a person who is, shall we say, less than meek.

      If I am approached with factual information delivered in a respectful manner, no problem. Should ANYONE “demand” ANYTHING from me, they would be responded to with a hearty “f*ck you”.

      People should not be babied. They also should not be treated in a punitive manner as if being berated by an angry parent.

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