Consider the quality of our caring, not just the quality of our care

I have kept some of my books from medical school displayed on the shelf, including suggested contemplative readings meant to tenderly inculcate students with a sense of compassion.

Like so many fledglings, we soar off into our chosen paths. Many new realities and considerations take hold. I shall refer to these as the “business, logistics and politics” of medicine. How can we ensure that we are adhering to the standards of care? How can we monitor billing, and what do we need to know about bundling? What about electronic medical records and meaningful use?

During my first year of clinical practice in neurology I met an older man who had recently experienced unexplained moments of near immobility. He usually came to his office visits with his wife. They had been together for nearly five decades. When we tried to find out what might be causing his new difficulty, brain imaging ultimately revealed recurrent, metastatic cancer. Conveying these results was like stepping over the gaping threshold of a new phase of life with them. It was a crease that marked the beginning their last chapter together.

I am not a surgeon or an oncologist. But, the patient, his wife and I continued having a number of conversations during the ensuing months, discussing human considerations about morbidity of aggressive cancer treatment versus quality of life. We reviewed data and weighed the projected quantity of remaining time, and the unquantifiable value of them spending the summer away together at their cottage by the beach. In the end, the only “medicine” I could offer was listening and considerate conversation. Months later he passed away. I received an email announcing the memorial service, which I did not make the time to attend.

The next year I received an email from the deceased patient’s wife with a brief friendly message and an attachment. I flagged it but attended to many other “business and logistics” matters, instead of opening the attachment. One night a couple of months later I reflected on what made my work worthwhile. And, sitting there, I knew that the possibility of delving into humanism in medicine, and genuinely connecting with my patients and their families was a fundamental part of that. At that moment I remembered the email, and then I searched for it and read the attachment.

Tears welled up as I read the bereaved wife’s tender, deeply personal story of grappling with existence and meaning, with memories of and mourning for her husband. She chose to share this with me because I played a role in this part of her life. Since then she and I have exchanged several messages. And it is, again and again, clear to me that choosing to connect, through listening and responding, or holding a hand, or holding a gaze, or attending a memorial service, is part of what makes the practice of medicine so potentially powerful and fulfilling.

We inevitably continue moving forward in the gale of steady change that is upon us and awaits us – the “business, logistics and politics” of medicine.  But, during the few quiet after-hours moments, when we break from our frustrations and open the door of our minds and hearts to what we might look back on and value and remember, let’s also consider the quality of our caring, not just the quality of our care.

*In order to protect confidentiality and comply with established privacy guidelines certain aspects of the clinical narrative have been altered. 

Shanna K. Patterson is an assistant clinical professor of neurology, Columbia University.

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