The Extra Mile

The test referral reads: “Hand weakness. Carpal tunnel syndrome?”

With the patient, I proceed through the history, the examination, the testing.

It soon becomes clear their condition is much worse than carpal tunnel syndrome. Instead, it is a motor neuron disease, a group of rare, progressive, neurodegenerative disorders.

The diagnosis will be unexpected. Devastating.

I am sure the patient knows the testing I’m doing is far more than expected. I try to walk the line between discretion and respect. I conclude the test, bid the patient farewell, and write up my report for the referring physician.

Then I pause.

And then I pick up the phone and also call the referring physician.

I explain what the tests suggest, what worries me, what might matter next.

Our shared sadness fills the silence that follows.

I sign off and sit with the call.

Is this the extra mile?

So much of medicine is expected effort: a history taken, an examination done,
a test ordered, a report sent, a box ticked.

This is not that. This is something more. There is no applause for this, and usually no acknowledgement. The patient may never know it happened.

I do not do it to be thanked, nor to be seen as thorough, nor because I am asked to do it.

I do it because this small extra action reminds me why I am here.

It’s not quite a subversion of a system that counts work narrowly and discards what cannot be measured, but it is an act reflective of my agency.

My much younger self set out to help people. Perhaps this extra mile helps several.

Ross Carne
Malvern East, Victoria, Australia