Lessons From My Greatest Teachers:
My Patients, One Life, One Story, One Lesson
My inspiration for Lessons From My Greatest Teachers stems from my love of story and its inherent lesson. I loved reading Aesop’s Fables as a child, and I delighted in sharing those instructive stories with my children. Tiny morsels of wisdom have the power to transform us. A fortune cookie is an enduring example. Similarly, the square paper at the end of a teabag offers the same pause for reflection. I feel inspired to use story as a chance for reflection in medicine as well. Students are tasked with comprehending diseases and their epidemiology, pathophysiology and attention to treatment and pharmacokinetics- all enduring and important lessons. But the art of medicine and the care of the human as an individual are where the application of knowledge come to satisfying fruition for the practicing clinician. The individual is not merely a theoretical entity as in textbooks, but rather the patient come to life when we begin our practice. I offer my stories as examples of all that remain important: the disease, its evolution, as well as its face.
Excerpts From My Upcoming Book:
I hope you enjoy the excerpts below.
My Why: to students, future clinicians, and all enthusiastic readers
I write this book to honor the patients who make our lives as practicing physicians possible. I cannot do what I do without the willing participation of patients who lay bare their souls and set aside their privacies in order to get well. They place their faith and trust, their hopes for comfort and wellness in our hands. It is not for us to judge them. To the contrary, it is for us to thank them- for their trust. I cannot underscore this enough: we must thank them for their trust in us. To assume that our degrees entitle us to any human story without a touch of gratitude or the assurance of our best efforts is to forget the dignity of human life and its attendant fragility. If you have never been a patient yourself as you ascend this profession, perhaps the stories that I share may prove provocative. But I ask that you remain ever humble and poised, approaching each patient with novelty. To you they may become yet another case of hypertension, diabetes or cancer, but to them, you may be their first and most important answer to health. Try to remember that every time that you pass through a curtain or knock on a door. Try to approach each patient, their questions and their disease as if they were your first.
I am not going to resonate with everyone. You will not resonate with everyone. And we will wish we could. Or start the blame game. We will attribute misgivings or misfires in an interaction to someone or something. The reality is this: we are never going to please 100% of the people 100% of the time. Their past histories, method of engagement, biases about doctors or life or medical history will jade and possibly set you both up for a misfire. Irrespective of the history or the baggage that may accompany a patient, my experience teaches me to try and remain humble, try to remain open, and try to remain kind. There will be pushing of buttons. There will be dissatisfactions. You may have to clean up for previous providers or circumstances that had nothing to do with you. The same goes for teachers who may have students for whom orchestrating a new plan of care becomes requisite for a learner who has been scorned, misunderstood or, tragically, forgotten.
When my late father chose his spine surgeon, he deliberately chose competence over compassion. In fact, it was well known that this surgeon had a temper, an unattractive temperament, and an ego. When my father chose to correct him when he spoke of the wrong lumbar levels that were to be attended, the surgeon brusquely replied, “Do you want me to do the surgery or not?”
My friend underwent ankle surgery following a tri-malleolar fracture. Not an insignificant injury and one that would leave her couch bound and pained, she asked the surgeon what she could do for pain control and anticoagulation. His response came with gruff indifference: “Are you going to do what I tell you to do, or go to someone else to manage the pain?” That someone else was her primary care physician.
A 28 years old mother of twin boys presented as a new patient to my panel. She had been added urgently due to a dental intake revealing Stage 2 hypertension. She came to me as a 15 -minute visit. She was dressed in a short Ralph Lauren lighter green shirt dress. Her lashes extended out to me, and her hair was of a long red wig that she could easily snap side to side like Cher’s if she wished. She was polite. And she was scared. She sat calmly as I asked her about gestational hypertension, family history, smoking and drug use. Her body mass index was 27, and she stood 5’10” in height. When it was her turn to share, she fought back tears; her father remained incarcerated, and her mother suffered mental health. She had 7 years-old twins with Autism, she never suffered hypertension in pregnancy. She smoked two blunts a day, but never cocaine or meth. She had a boyfriend whom she barely mentioned who sat at home unemployed. With COVID-19, she had lost her third shift line managerial position. Times were tough. She told me she was all alone; her only family were her “babies” who were her sole responsibility. She stated for all the ER visits she had had, post delivery of her twins, she had always suffered elevated blood pressure, “But nobody ever told me anything to do about it.” She had never been taken seriously.
I work for a Federally Qualified Health Center (FQHC). If one were to read up on all the stipulations that must be met in order to meet this designation, it would likely leave you floored. It is no small task. We are the support system for the uninsured, and offer additional services such as dental, vision, mental health, pharmacy and phlebotomy. Many of my patients live on the streets or in shelters. It is never lost upon me when a patient comes in smelling Downy fresh. I always thank them for taking the time to wash before their visit with me. Their attention to self and this detail is not without merit or mention. But not all patients will have the time or means to do so.
I had a patient come to me with excoriated feet – there was no bottom layer evident on the underside of either of his feet. Dwelling in moist socks and shoes that scarcely fit, he walked around with very pained steps. I was horrified, yet also embarrassed. I was embarrassed by the number of shoes afforded me, the availability of clean socks, and a home in which to wash and store them. I gave him a warm soapy solution in a plastic bin in which to soak. I left him alone and turned off the lights so he might relax. I then promised him a better pair of shoes were he to return to the clinic the following day. My husband and he happened to share the same shoe size. The shoes were worn but in excellent condition. He made it back to pick up the shoes.