2022

He shunned the sunshine. He also refused to come into the mobile medical van where we saw patients. He’d been sitting on the curb, across the street from the van, in the shade, every day for a week. The van’s male physician and nurse had been unable to entice him to step into the van for an exam, to talk with them, or to accept anything from them. Maybe a woman would have more luck? So I went over to him.

It is no secret that medicine and art are intimately linked. Consider the utility of music therapy, the innate beauty of medical illustration, and the use of the performing arts to promote healing. As a jazz saxophonist, I have always seen playing and listening to music as a form of relaxation. But what I never realized was how connected playing a musical instrument can be to performing a medical procedure like endoscopy. That may seem an unlikely pairing to some, but they are not so different after all.

How to thank the on-call physician? Not on MyChart. My brain previously so flustered I couldn’t put a name to the voice; only by checking “Medications,” where he’d written a thorough note, could I make the link, but impossible to message directly.

Lori is here today with a chief complaint of dizziness and headache. At least that’s what my medical assistant tells me. But after practicing family medicine for almost twenty years, I’ve learned that there’s usually more to the story.

I recognize the expectation to match the story and physical exam to a reasonable diagnosis, especially one that the patient can trust. All in 20 minutes. No pressure at all!

Very early on a Sunday morning, my friend Marla called asking for help. She was in excruciating pain—bone metastases, as it later became clear, from her breast cancer. She’d been instructed to head to the emergency room and needed a ride.

For the fifteen years that I have been at my current job, I have held onto my patients’ stories. Tucked into special pockets in my heart, they would be brought out whenever their “owner” came in for an appointment, where the story would take on a new form, then be stored away again. There were stories of shame and heartbreak, stories of joy and triumph. People confessed their deepest fears, shared events never revealed, and confided fledgling hopes and dreams. These stories are signs of patient-physician trust and of sacred human-to-human connections.

I used to stick needles into veins. I learned how on manikins and co-workers’ extended arms of trust. I never took a class. I wasn’t a nurse. I was a white middle-class health educator in central valley California teaching farmworkers and homeless men and women about a new epidemic called AIDS. Educators were needed who were comfortable talking about sex and condoms, hope and death, and drawing possibly infected blood.

I have a neuroimmune illness that for years was considered not to be “real” but that changed my life. On top of that, I’m unable to tolerate many medications, which have too often been prescribed for me with no consideration of what I’ve told doctors about their debilitating side effects. But about eighteen years ago, an angel entered my life in the form of a physician who did his initial training in India and then finished up in New York. I don’t know if it was his Eastern orientation that made him so patient-oriented, listening seriously when I needed his help, but he was perfect.

Your words topped mid-sentence again. Will I speak to fill the awkward silence as you search for the words, or hope you complete the thought? Your quiet blank look hangs like milk fog, white, colorless as music at rest when I can still hear it playing. I search your face as finally you finish speaking, apologizing to me again.

The diagnosis was FND. I had never heard of Functional Neurologic Disorder. When you first described symptoms to medical staff, they first thought you had MS, especially after many falls.