Standing in the hallway, I look attentively to the computer screen while the attending skims the records. “This is a longstanding patient of mine. I’m just going to have you listen while we do a visit with our psychologist,” he says. With the paucity of chairs, I stand. I wondered if it would add an unnecessary sense of urgency to the seemingly comforting timelessness to my attending and psychologist’s voices, peaking only periodically to comfort an otherwise frustrated and intermittently shouting, tearful patient. My feet start to hurt.
“Is this really going to take an hour? Why are we spending so much time discussing her living situation? When are we going to ask her about her seizures?” I wondered to myself.
Leaving the room with the neurologist, he tells me of her history of physical and sexual abuse of her family. He tells me of the physical trauma that left her blind, with recurrent seizures. He tells me of her co-existing anxiety disorder, mild cognitive impairment, and intermittent explosive disorder. He tells me of her low socioeconomic state, her lack of family and friend support, and how, despite her intermittent frustrations, her living situation with a roommate is the best option for her.
“We’re spoiled here,” I think to myself now as a second-year resident in internal medicine. Our resources offer options to vulnerable, underprivileged patients in a large, metropolitan city. But are they truly effective? Are we truly effective? How do we know? Well, one Friday morning, I knew.
The medical assistant approaches me and asks to introduce me to my patient. “Dr. Ramo, your patient is blind and wants to trust who she is talking to.” I recognized her voice and her facial mannerisms. What I didn’t recognize was her excitement to get a new yearly calendar book to mark her appointments or her keen recollection of a due pneumonia vaccine. I didn’t recognize her joy nor her knowledge of specific antiepileptic medication dosage changes. She mentions to me how much she appreciates how much her neurologist facilitated her appointment transportation and kindly wishes me a happy Thanksgiving.
I stare at the computer screen again. “Aula Ramo, medical student, was present during the encounter,” her neurologist wrote in our first encounter four years ago. He mentions her seizure medications. What he doesn’t mention, however, the extent to which he listened to her social concerns. He doesn’t mention the countless hours and network of resources that it took to recognize and tailor the patient’s care plan to her special situation, leading her to trust and hope in our health care system and leaving her time to focus on preventive measures such as her pneumonia vaccine and keep her adherence to her appointments despite all her medical and socioeconomic barriers.
Today I knew. I knew the power of listening. I knew the power of teamwork. I knew the power of a caring health care system.
The author would like to acknowledge Gregory L. Barkley, MD and Andrea J. Thomas, LLP.
Aula Ramo is an internal medicine resident.
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