If you have ever been in therapy, you likely discovered that while you share personal details about your life, the therapist reveals little information about theirs. From my understanding, when and what to disclose is part of a therapist’s training. In contrast, in medicine, relatively little about self-disclosure is taught. Instead, it is up to the individual to figure it out on their own.
I turned back to look at him only once, that insane parody of Jesus on the rood, his face turned away in death, arms stretched wide, a small white towel draped over his manhood. I stood there in the E.R. covered in the blood he’d spray-painted me with as he lay dying from a gunshot wound to the chest. Blood spray in my hair, my eyelashes, on my lips and in my mouth. My new white shoes with the stylish aerating holes, also bore the shocking red of a life too soon ended.
Earlier this year, my beloved family practice doctor retired. Over many years, I had had ample opportunity to appreciate his diagnostic skill, his professionalism and his kindness. Moreover, I felt I could always trust that he would respect my wishes. I had a real partner in my health care.
Ma lived a blessed life: more than six decades of marriage, two professionally successful children (a physician and a teacher), and three wonderful grandchildren. Yet, these gifts mattered less to her than her forty years working in a baby/children’s store. When health issues forced her to retire at age eighty-two, she lost her heart and her spirit. Ma spent the days in her old recliner, wearing only a tattered white T-shirt and equally torn white underwear. She only got up to use the bathroom and wander the halls of her apartment building at night.
Dear Pulse readers:
When I was about twenty years old and living in New York, I wandered into a men’s clothing store on Canal Street. There, an army jacket caught my eye. I liked it right away. It was stylish–in a counterculture-rebel sort of way–and I decided to try it on.
It fit perfectly.
The only problem was, it cost more than I wanted to spend.
“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.
The last patient on the last day of my critical care rotation arrived at the ED by airbus. She was 21 years old, barely responsive, and accompanied by border patrol. The ED called us about 30 minutes later, once they’d stabilized her. We arrived in her room, and the ED resident recounted what had occurred. She’d required intubation and several rounds of CPR to achieve resuscitation. The situation had calmed for a moment, but then she started to convulse. They administered medications and her shaking stopped.
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 stood in a line and palpated his thyroid. We then reformed the line and asked him to follow our fingers with his eyes. One last time we formed a line and listened to his irregular heartbeat. As we left his room, we each shook his hand and thanked him. I was the last to exit, and as I walked out, I heard him let out a long sigh. I turned around and saw him sink into his bed.
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.
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