Ashley Breanne Butler
We are quietly herded around the corner and out onto the floor of the men's hospital ward, a pack of wide-eyed white-coated learners, each more nervous than we would ever care to admit.
"Sanitize your hands, introduce yourself to the patient, divulge your credentials, ask what name the patient would like to be called…"
Our eyes flit past the patient to scan the room, gathering any accessory information as we mentally rehearse the next 23 golden questions that will solve the problem of Patient X. Like a flock of ducklings, we shuffle to an awkward halt at the foot of the bed near a slat-covered window overlooking the courtyard. It is here that our medical-student plans meet reality, and we meet Jon.
Jon is a tall, strong young man, resting his head back against the striped pillowcase that he brought from home. His dark eyes brighten when he sees us and a wide grin flashes across his face. He takes no time to warm up to us, his clumsy interrogators, and we slowly follow his lead and relax into his story. With slurred speech and laboured breaths, Jon explains that he is a professional athlete. He recently experienced what he thought was the flu, and in an alarmingly short period of time he found himself in the ICU with a progressive paralysis secondary to an infection with the Zika virus. Several times during our interactions I feel the need to sheepishly thank Jon for his patience with our endless questions, and just as many times he laughs and reminds me that the time spent with us is "the highlight of his day." In a moment of candor, he admits that his stay in the hospital has been both boring and lonely. I pause. "Boring" is not the descriptor that I would use to describe the experience of this young man, now unable to coordinate the legs that usually do his bidding so effectively. A "boring" stint in the ICU? A "boring" case of a poorly understood, emerging virus? "Boring" complications that made it difficult to eat, speak, or breathe? His comments stayed with me though, and later that afternoon I realized how deeply selfish I had been in my interaction with Jon. In my sincere attempt to be understanding and selfless – apologizing for patronizing him with questions and tests – I had robbed him of his own experience. I was impatient with the number of questions; he was not. I was wearied by the repetitive tests; he was not. I was sorry for his difficulty in completing some tasks; he was not. Jon was enjoying being listened to, interacted with and cared for in the midst of a day otherwise filled with charts, magazines, and solitude.
I am new to my role as a physician in training, but not to my role as a caregiver. That being the case, embarrassingly, I must label this experience a reminder of something I already knew rather than a lesson of something new. Jon graciously reminded me that our service to others is not about ourselves. If we selfishly place ourselves at the center of our medical practices, we will quickly become nothing more than a disjointed list of 23 questions, check-boxes, rehearsed encouragements, and halfhearted handshakes. The patient interview, I see now, is not so much about answering our questions as it is about answering those of the patient: "Will I be cared for?" "Can I trust this team to make big decisions?" "Are they genuinely invested in my well-being?"
This shift in focus changes everything, but what does it look like in practice? Is it feasible in the often time-constrained pursuit of clinical answers? The more I thought about this, the more I became convinced that the answer is an unequivocal, "Yes!" Effective patient care really must look very much like love. It looks like putting your agenda aside and sitting beside someone, no matter where they have fallen and no matter how many times you have found them there before. It looks like closing your mouth and opening your ears. It sets aside timekeeping and checklists to first acknowledge this person's needs as a human, in body and mind. Yes, it may be a bit less streamlined, a bit messier. It could mean that you find your heart breaks over their hurt or is frustrated over their obstacles. It might require that you push back on their behalf when their hope is stolen. It costs us much more to care in this way but I believe it is necessary to care well. I am so very grateful that Jon managed to teach me these things in our short time together. I needed the reminder that he gave me that day, and I look forward to many similar lessons from my future patients when I make the effort to quiet myself, care deeply and listen well.