Listening

“Hey, Doc, still dying. What’s new with you?” That was what one of my long-time patients said in response to my canned greeting upon entering the exam room.

Yes, I knew he had cancer; I’m the one who first felt it in his breast. Yes, I had seen the pathology report and subsequent scans indicating metastasis. Yes, I was coming off a much-needed, too-short vacation—reminded in an instant of the brevity of life by this wonderful man.

When I hear the stories of your mother–her brilliance, sense of humor, activism–I feel that I knew her on some level. After all, I know her daughter, taught well by this woman I never met. A great listener, but also one to share, trade stories, talk it out; throw around ideas like playing catch in the yard, bare-handed, because that’s what friends do. Catching words like a ball, bare-handed, stings a little, but we still do it.

It was 6:30 a.m., and I was nearing the last hour of a nighttime rotation on labor and delivery. Over the previous eight hours, my team had overseen two vaginal deliveries and two c-sections, one emergent. During this procedure, as the medical student on the team, I was charged with requesting hemostatic agents, STAT, from the main OR. As I ran past the patient’s anxious husband with the hemorrhage cart, I informed him, trying desperately to hide the terror in my voice, that his new baby boy was healthy but that the doctors were still treating his wife.

One of my regular acupuncture patients, he arrives looking pale, not his usual cheery self. I try to make a joke, but he remains empty-faced. Something’s clearly wrong.

“Let’s sit down,” I say. “What happened?”

“My mom died,” he says. I feel my heart sink.

I remember the curtains like a mantle enfolding us, protecting us from the darkness of the night. Only a dim light glowed in the room. The thrum of the oxygen machine—dedoov … dedoov … dedoov—made it hard to sit comfortably in my recliner. 

I watched his face, his hands, his upper body slowly going up and down in their own rhythm. I recalled how privileged I’d felt when his relatives asked me to watch over him in his last stage of life. 

I stare straight ahead at the computer screen, trying to blend in with the other medical tools in the room: IV drips, ventilator, feeding pump, chest tube canisters, nurse. I listen to my patient’s mother read to him.

She’s reading from a book my mother read to me many times. Listening to the story sends me back to my childhood. I’m cuddled up in my mom’s arms, in my pink flannel pajamas, in my parents’ warm, familiar bed.

The eternal goal for those in the medical profession is to accomplish treating, curing, and healing our patients. This has become particularly challenging with so many encounters now limited by Zoom, time constraints, masks, compartmentalization due to specialization, and shared anxiety due to the pandemic. But the challenge is one we must meet. The integrity of our profession depends on it.

I would make the case that listening is the universal medicament—an alchemy that transcends all else in clinical medicine. It is not limited by technical skill but instead is enhanced by the health professional’s willingness to be a witness to the patient’s story.

Here’s but one example: In the 1970s, when I was practicing as a primary-care physician, if one of my patients suffered a heart attack I would ask them, “Why did you choose that day to have your heart attack?”

I was surprised by the insights my patients offered. Virtually all of them who’d suffered a heart attack were trapped in life situations in which they had lost control. For them to be truly healed, they needed help uncovering the biopsychosocial, spiritual, and ecological interrelationships in their illness. This required a profound level of listening that went

Since mid-January, I have focused on listening. One morning the phone’s ring pierced my slumber. I listened intently to my mother’s words and tone as she explained that my father was hospitalized. New urgency and concern cut through her usual anxiety, altering the quality of her voice.

While attending a music retreat several years ago, I had the opportunity to play a piano duet with a more experienced piano player. As we prepared for the recital, it became evident that it wasn’t enough to focus on my part. I also had to listen to what my duet partner was playing in order to make pleasant-sounding music.

Sometimes, when dealing with patients, we get the real “story behind the story” only at the end of the visit or after several visits.

I leaned toward the physician I was shadowing and apologized. I had a class to get to. She nodded and said, “No problem. Hopefully today was a good experience.” She didn’t shake my hand, as her finger was the only thing blocking a hole in her patient’s common iliac artery. I wished I could stay longer, but class called. Med school puts you in odd situations.

“There’s always time to check in,” my supervising physician told me the other day, offering to chat about a patient who was not doing well. Would it be unprofessional to tell her that my problem is wishing I’d checked in not with the patient, but with my friend who’s now gone forever?

On a cold, February morning in 2017, I received a phone call from the resident psychiatrist on the psych unit at University of Maryland Medical Center. He introduced himself as Dr. Shapir Rosenberg, the doctor taking care of my twenty-five-year-old son, Adam.

With his warm and patient voice, he said, “Your son entered the psych ER with a drug induced psychosis. He was admitted to the psych unit and stabilized with Haldol. He’s doing much better. I wanted to reach out and ask about his history. Is this a good time to speak?”