Listening with an Invisible Ear

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 far beyond the pathophysiology of stress, sticky platelets, and occlusion of a coronary artery.

Here’s another example: I was asked to evaluate an elderly, childless widow preoperatively for treatment of hypertension. She was to be operated on for a malignancy of the uterus. She was vehemently opposed to the surgery and said something to the effect of “I don’t want surgery down there!”

At a follow-up appointment, I asked her, “Did your husband bring home an infection ‘down there’? If so, there is no relationship between the malignancy and what happened to you.”

She had the surgery and lived contentedly for another 20 years. I had no conscious motivation for asking the question I did. There seems to be a spiritual, silent avenue of communication when one allows deep listening—nonverbal listening—to be part of a patient interaction.

In order for healing to occur, there must be this level of listening. Both the patient and the health professional must reinforce each other’s listening, hear the profound meaning behind the words, reach into the transcendent. In this numinous place, true healing occurs.

It is profound encounters like these that will continue to sustain our profession through these troubled times.

Joseph Fennelly
Madison, New Jersey