Bedside Manner

You never knew my name. But one year later, I still remember yours.

We’re the same age, after all.

I was there, squeezing your hand, as they peeled off each of your dressings and you tried not to cry out in pain.

“Do you want to be a good psychiatrist?”

When Dr. G posed this question to me, I was a senior medical student on the last day of a month-long elective on the inpatient pediatric psychiatry unit. I knew by then from Dr. G’s teaching, and from his demeanor, that his questions were often not questions. They were, instead, buckets, drawing from the dark wells of patient stories to make the unknown known, the unseen seen.

Being a child of medical parents brings special challenges. For example, such children grow up with a unique idea of appropriate dinner conversation. When I exclaim, “Guess what I saw at work today!” my children interrupt to inquire if my story has blood or something “gross” in it. And they regularly yell, “HIPAA!”—a reference to the federal patient privacy regulations—even though I always deidentify patients.

Boundaries, respect, culture and personality are all parts of bedside manner. Boundaries and respect are, ideally, reciprocal between physician and patient. I want to project warmth, humanity and concern but I don’t want to burden my patients with my fears, frustration and anger.

During a delivery of a young woman of her first child, she said to me “You look really scared. Are you okay?” I had just found a concerning fetal heart tracing, and my bedside manner was not helpful to her. I quickly tried to rearrange my face.

I graduated from high school in June of 1972 and was headed to college in the fall. I was happy and healthy . . . until I wasn’t. In the middle of that summer, I was overcome by extreme joint swelling and pain.

My pediatrician referred me to a specialist at Duke Medical Center. When Dr. Smith came into the exam room, he greeted me warmly. He listened attentively to my story—nodding, taking notes, a look of concern on his face.

We gathered around Mr. Ramon’s bed. His breathing was labored, his skin looked pale, and his eyes were shut tight. Everyone had the same thought on their minds.

Please let me translate for my family.

The voice came from the back of the crowd. A young lady stepped forward and introduced herself as his granddaughter. She looked like she was still in high school.

I’ve heard my grandparents say, “If you spend some time with certain doctors, half the disease will be gone.” They were the first to teach me the importance of good doctor-patient communication, and that when a doctor listens closely, it makes a huge difference. Years later, in my early days as a junior doctor, this lesson was driven home to me by one of my patients.

No one tells you when you are having surgery that the surgeon is not the most important person in the room. In terms of safety, it’s the anesthesiologist. I learned this the hard way.

“But I wanted to learn more about amyloidosis.” No: the stated goal of Physical Diagnosis Rounds is for the intern to become more comfortable interacting with any patient, better at building bond every time. The instruction sheet explains that we are only secondarily in the market for giant spleens and diastolic murmurs, much as those captivate.

I’ve always had a streak of perversity that pops up when someone wants me to do their bidding. That’s why I fought constantly with my mother, why I insisted on speaking broken Spanish to a Venezuelan official whose English was flawless, and why I refused to smile one night at work when I was starting an IV.

I no longer see the tubes, the apparatus, or hear the respirator’s cadencing rhythm.  Your face is calm, relaxed, somewhat naked without your glasses. It seems fuller somehow; I hope (in vain?) that it is swelled with peace (and nothing sinister). I kiss your shiny forehead, saying hullo. It would have been on your cheek, but this is tricky at the moment. I expect your smile to leap up as it always does but your face is impassive.