Listening is what a patient needs most

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Hard time is here
And ev’rywhere you go
Hard times is harder
Than th’ever been befo’

The opening lines of a century-old Delta blues song rings out among the stars and the dark of a rural Virginia night.  I sit tenuously awake atop an old wooden stump in front of a farmhouse, where four minds sleep peacefully inside. It is 3:00 am. From the window I hear the sound of the needle dragging across the old, worn out record until it bleeds muffled sound into the crisp mountain air. Grass fields illuminated by the light of the moon ripple in the wind like waves on the surface of water. In this place, the wailings of man and guitar propagated across generations have never seemed so poignant.

In my mind and with my hands and heart I have plumbed the depths of the blues, searching for the same muse that whispered ideation into the ears of legends. Mississippi John Hurt, Robert Johnson, Skip James. I have listened and felt, trying desperately to understand their passion and mystery. Their music is coarse, dissonant; more torn from the necks of their guitars than played. Their lyrics talk vaguely of troubles with women or work. Yet underneath the simple rhythms and lyrics looms a tempestuous beast that howls of injustice, exhaustion, and despair.

In this mountainside land I take solace from my duties in life, but whatever respite I might enjoy is marred by my inability to sleep. I am plagued by the thought of the endless monotony of medical school. By the lords of lecture hall I am fastened to firm chairs in whitewalled rooms, poring over factoids that fail to pique my interest and fall through the ever- expanding cracks in my memory. I am dreadfully uninspired to the point of cynicism. I fear for my future, trapped in labyrinthine hospitals far from the quiet and tranquility of a cool summer’s night.

These thoughts bring me from my bed, away from the warmth of a woman and into the black of night. I envy her peaceful sleep. She will wake early to till the earth, to prepare for the natural force that turns soil to crop. I will leave, to return to the mill where my mind will be molded and manipulated until it is a product suitable for the wards. In an effort to forget, I listen to the words of the old blues man.

You know that people
They are driftin’ from do’ to do’
But they can’t find no heaven
I don’t care where they go

My thoughts bring me to a patient I met early in the year, a middle aged black man who was likely to die where he laid. I saw the lines in his face, and felt my own expression reflect his pain. Tubes punctured his arms and neck, and oozed a cocktail of chemicals that slowly sapped the life from his cells. His eyes were vacant, and spoke of a man who was robbed of any reason to live. With difficulty, he spoke of his story.

He was a musician. In his youth he had gotten involved in the blues scene and traveled across the country playing gigs and getting by. His raspy, harsh voice was telling of years of use, like the worn out old guitars of the blues masters. I pictured his hands tweaking the guitar strings, transmuting the inner workings of his mind into the potent, rich sound of vibrating steel. In his eyes I saw a hint of joy at the recollection of his former life, but it was only transient. He was soon subdued by the harrowing reality of his condition. Confined to the white walls of his hospital room, he would never play the blues again.

“Don’t forget what you’ve got,” he said.

His words had the same lyrical simplicity, the same implicit depth as the words  of the blues masters. This man was an embodiment of the music I adore. He exuded the raw emotion that he once poured into his music. He had spent his life perfecting the medium through which he could achieve the pinnacle of self-expression, only to be stripped of his life’s work, of his entire identity. The beating of his heart that once flowed into deftly crafted rhythms was reduced to a series of turbulent green lines and obtrusive beeps on a machine. In my mind’s eye I saw the beast, trapped within him, clawing and scratching at its cage, begging to be released.

People if I can ever get up
Off this old hard killin’ floor
Lord I’ll never get down
This low no mo’

I listen to the sound of the night bugs in concert with the music; the flapping and beating of wings, a cacophony of sound, oddly harmonic in these rolling hills. Here I feel genuine inspiration, a rare luxury. Creative thoughts fill the crevices of my mind like cool water, and quell the flames of cynicism that have begun to grow. I imagine the patient I met also sat and pondered in many a place like this. He too felt the rush of inspiration, the breadth of emotional sustenance that such beauty can provide. He heard the hum of the record and felt the immediate acquaintance with the deepest and most fragile aspects of another.

This quality that continues to draw me away from the peace of a rural night and towards the septic, sullen air of the city. In music they call it the blues. In medicine they call it empathy. The croon of a blues singer is the close cousin of a patient’s moan. Both are primal expressions of exasperation; cries for companionship, like a wolf’s lonely howl. In both instances my ear serves as a final resting place for such troubled sounds, as a vehicle of recognition for the lament of those in pain.

The blues taught me to listen, to understand that appearances and first impressions only scratch the surface of what lies within. Of all the tubes, wires, drugs, needles, stitches and scalpels, at times my most valuable resource will be my ear. It is often what a patient needs most. I struggle through the pitiful life of a medical student to ensure that my ear does not go unused, that the work of the blues masters is not lost.

I rise from the old wooden stump and head back inside. I should try to get some sleep. I pass the record player on my way to bed. The music of the blues player that sings softly is preserved in bumps and ridges on vinyl, so that the workings of hands and heart are preserved forever. I leave it playing and climb into bed. When I close my eyes I picture not the simple patterns of notes on the guitar neck, but the worn out shoes, tattered clothes, and weary eyes of the blues man, whose final cry whispers softly into the night.

Well, you hear me singin’
This ol’ lonesome song
You know these hard times
Can’t last us so long.

Geoffrey Kaump is a medical student. This post originally appeared in The Doctor Weighs In

It was written as part of a narrative medicine curriculum at Georgetown University School of Medicine, taught by Margaret Cary, MD. Her students’ stories reflect the depths and the heights of medical school; most importantly, the stories reflect the magic and wonder of becoming physicians.

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