In my crowded triage room, I hear the emergency-room physician say, “Trauma blood, STAT!”
I have been rushed to the ER after throwing up liters of blood at home. I have GI bleeding.
I’m tipped back on the gurney, head lower than my limbs, with my mean arterial pressure in the low mid-60s. Paddles are ready; transfusion begins.
Two days later, I undergo an endoscopy. Is it ulcers? Something else?
It’s been an interesting year. Eight months after having a large kidney stone removed, I was diagnosed with very early stage cancer—small, low grade, etc. The treatment (surgery) would very likely cure the cancer. The specter of cancer meant that I found this surgery physically easier, but emotionally much harder.
The aftermath of the surgery was interesting in unexpected ways, too.
Six months after surgery, at one of my periodic follow-up visits, I was sitting awkwardly at the end of the exam table, dressed in the standard patient gown and sheet, and waiting to see Becky, the nurse practitioner I’d been assigned to that day.
“The odds of anything going sideways are less than one in a hundred,” the cardiologist said.
I was only half listening—too busy signing the papers indemnifying the Medical Colossus against any undue outcomes from my pending cardiac catheterization and probable stent placement.
“Less than one in a hundred,” he repeated.
No problem, I thought.
Reflecting on the start of my medical studies and career, I realize that it took me more than ten years to refine my ability to practice the art of listening. Partly that may have been because English is not my mother tongue; but it was also because listening is an arduous task. As Kate Murphy writes in her book You’re Not Listening: What You’re Missing & Why It Matters: “Understanding is the goal of listening, and it takes effort.”
My first hard lesson in this area occurred when I was a medical student, doing research at a needle-exchange program. A patient named Haris had been screened for HIV, and his test result was positive. He was the first patient to whom I had to give such bad news.
The toughest work emails always seem to come on days when I am post-call, feeling tired and pensive. This particular email came from Patient and Guest Relations at the urban hospital where I practice as a neonatologist.
“I received feedback from a patient who claims that she had a negative interaction with you…during her C-section surgery. She is requesting a visit from you….”
My heart sank.
Donna dropped her blood-thinner tablets on the floor prior to surgery.
“It’s a sign I shouldn’t be taking them,” she said.
Now, sometime later, it makes me smile to think of it; she’s recovered well from the surgery and has resumed her medications. I’d told her to stop taking them just prior to the surgery—a complex hernia repair—and to resume them the day after, but she’s the type of person who does what she wants, what she thinks is best.
I had to drive across town for my appointments with the high-risk obstetrician. I had been referred to him by my normal-risk obstetrician due to my age (thirty-six the first time, and now again at thirty-nine) and my two previous miscarriages.
The waiting room was never crowded. It was dimly lit, with photographs of babies and children plastered across one wall.
Today, as at every visit, I studied the photos fiercely while waiting for my name to be called.
My patients do not speak. Or rather, my patients do not speak using words. Instead, they have taught me the art of body language—of noises, expressions and postures.
I read the movement of ears, the way pupils dilate or constrict. Watch for the tremors, for the hunch of a spine, for the described bows or stretches that could indicate abdominal spasm. Search for the hint of a leg being favored, for the inaudible signs of pain. Wait for tongues darting over lips. Offer food that may be sniffed at or turned away from. I’ve learned to respond to fear with gentleness, to preempt the sharpness of tooth or claw with slow movements.
For more than thirty years, I’ve practiced general pediatrics and adolescent medicine with a private group practice in New Rochelle, just north of New York City.
Today I saw an adolescent girl for a checkup. Before this, I had seen her for a sick visit or two, but I didn’t know her all that well. She was accompanied by her father, whom I was meeting for the first time.
I started the checkup, as I always do, by asking if they had any special concerns.
Editor’s Note: This piece tied for first place in the Pulse writing contest, “On Being Different.”
I learned from my grandfather how to lie to doctors the same way that baby birds learn chirping: by mimicry.
“All healed,” I would translate for my grandfather at appointments. “I used to smoke, but not anymore.” “The pain is very faint.”
A good apprentice, I knew that he was lying, and I translated it anyway. I was eight years old, and a fast learner.
“I usually talk through the procedure as I go,” I say, pulling on a pair of blue nitrile gloves. “So you aren’t surprised by anything, so you know when to expect a sensation.”
The patient is lying on the table, eyes fixed upwards. One of the ceiling panels is illuminated with the green leafy branches of a tree—an image meant to calm and soothe, though I doubt it’s doing much for this woman.
“Or I don’t have to talk,” I tell her, arranging the instruments on my sterile tray as silently as possible. “We can be quiet or chat about other things.”
In the spring of 2021, as a third-year medical student in the midst of the pandemic, I worked on a research thesis while continuing to build my clinical skills. Every other week, I would visit the endocrinology clinic and see patients with my research mentor.
It was a day like any other at the clinic. Wearing the usual blue surgical face mask, I knocked on the exam-room door, and asked permission to enter. After sanitizing my hands, I began my introductory spiel while heading to the computer. Sitting down, I glanced at my patient, Jim—a man in his fifties, sitting across from me.
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