At the beginning of medical school, I had started developing a vision of the physician I wanted to become. My background working as a nurse had allowed me to spend ample time at the bedside, helping me better understand how patients personally experience their lives in the hospital. I had many interactions with families asking difficult questions about their loved ones’ prognoses and with patients dealing with pain and uncertainty. In my first year of medical school, these perspectives fueled my hopes to become a more compassionate physician.
While this is still my best intention, I have also come to see my previous experience in healthcare as a double-edged sword. As a nurse, I was indoctrinated into many aspects of medical culture and the medical gaze, some admirable and some less so. I remember one early morning as I was helping to bathe a patient, a surgical resident came into the room. They proceeded to ask their checklist of questions that they would later present in rounds, while my patient was undressed, waiting for the washcloth still in my hand. I became familiar with the ways in which all of us–a resident, an attending, a nurse, basically anybody wearing scrubs–can easily lose our emotional awareness of the people around us, our minds honed in on our own agendas. We get used to seeing patients as less than fully autonomous. We are the subjects; they are the objects of our care.
At the end of my mostly virtual MS1 year, I was craving to meet patients again, to listen to their experiences, and to remember the positive impact a patient-physician relationship can have. I wanted to practice engaging with patients on an interpersonal level before I begin clerkships: to simply be a listening ear in the room and not “the medical student on your care team today.” I wanted to focus on being fully present with a patient, meeting them where they were at. This was what motivated me to spend my only summer of medical school in the Spirituality and Health program.
The first time I knocked on a patient’s door, I rehearsed what I would say before I walked in. “Hi, I’m Justine, I’m a medical student in a Spirituality and Health program. I was wondering if I could talk to you about how you’re doing in the hospital.” I asked the patient for permission and waited for them to invite me in, acknowledging their autonomy over their time and energy.
“What can I call you?” My role did not include scanning the patient’s chart ahead of time, synthesizing vitals and lab values and weighing differential diagnoses in my mind. I did not already know the patient as First name/Last name/DOB. Instead, I asked them to tell me what they would like me to call them, allowing them to set the terms in establishing the beginning of a rapport. I hoped that by asking “What can I call you?”, I could help patients feel more like themselves and facilitate a sense of familiarity. One patient told me to call him “Lefty”, a childhood nickname from when he had tried to swing at another kid with his left hand (the patient was very pleasant and had no future intentions to swing at people).
“How have you been doing in the hospital?” Understandably, some patients asked if I was part of a patient satisfaction survey team or what data I was trying to gather for the hospital. When I affirmed that I was interested in listening to their experience and that I was there to learn, it once again gave the patient freedom to use their own voice. Often, they would begin telling me about the day that crushing back pain or some other severe symptom had pivoted them to the ER and then the oncology unit, where cancer became part of their reality. Sometimes, they traced their story backwards to when the symptom started and how it progressed over time, leading into conversations about their lives outside of the hospital, their family members, their work, their daily habits. I was surprised that I sometimes stayed in a patient’s room talking with them for hours. When I wondered if I was being a burden, I learned how to communicate that I was happy to stay, but that they could also ask me to leave at any time. I was rarely asked to leave, and it dawned on me that my presence provided a comforting companionship for people. For that time, they were not alone in bearing witness to the whirlwind of thoughts and emotions that accompanied them.
“What keeps you going?” In this one question, I learned more about the core of who people are than any question I have learned to do in an H&P. I met an older man in the oncology unit who seemed unflappable when talking about his new cancer diagnosis and his first chemotherapy treatment. In response to this question, he plainly explained that the course of several decades of life experience—including the tragic death of his young adult son—had given him a capacity to buffer both the highs and lows of life. He had trained as a competitive cyclist when he was younger, and he compared his upcoming radiation and chemotherapy to one of the hills he was familiar with surmounting. He was unafraid of the uphill exertion ahead because he had experienced and overcome many before. Some patients began to tear up talking about their children, or their marriage, or their parents who were their first examples of strength. Another patient relied on his sense of humor to sustain him, and he gave names like “Steve” and “Craig” to each of his IV’s to bring levity into his situation. Other patients spoke of their faith in God and their prayers to trust Him, even as they themselves may not always understand their suffering. They alluded to a future hope, of understanding one day later down the line.
I talked to two or three patients every afternoon for six weeks- some interactions were filled with heavy conversation and meaningful silence. Others were buoyed by familiarity and comfort as we listened to oldies music or watched Cast Away for hours. My experiences were different each time, but I asked these same questions in each encounter and walked out of rooms feeling like the patient had given me much more than I had given them. As the Spirituality and Health program neared its end, I felt like I had to wake up from a good dream and return to the harshness of reality. I feared once again that my idealism in having genuine interactions with patients would wane with the grind of medical training. When I imagine my future self beginning clerkships in just a couple of months, I certainly predict that I will be busy and necessarily task oriented at times. I am wary that I will betray my intention to be a compassionate future physician because I did not sleep enough the night before, or I am taking my work too seriously, or I neglect to have meaningful interactions with my patients that go beyond a transaction of medical data.
I prayed with several patients during the Spirituality and Health program, which led me to read a study that surveyed how patients respond when a physician offers prayer. Surprisingly, patients did not prioritize whether the physician had a similar spiritual background, religious training, or had even gotten to know them first. What was most important to patients was whether the physician had shown them genuine kindness and respect. I realized that my vision to maintain humanity and compassion towards my patients can be distilled into this simple takeaway.
Even as I reflect in this essay on what is ahead, I remember that the ability to connect with patients as people first will always be an option available to me. I may not have the same luxury to spend hours with a patient, and it may not always be easy. But it can be simple, even in the form of the question “What keeps you going?”, which opens a wealth of insight into who they are and the things they hold on to that are more vital than any medication or treatment that I can give them. As I begin entering the rooms of many patients very soon, I hope I will not forget to bring my presence and my witness to the lives of the people in front of me. More often than not, they have a story to tell, if only I make the space and come to listen.
Justine Wang is an MS2 at the Perelman School of Medicine.
Image by Tracy Du, an MS2 at the Perelman School of Medicine.
