Recently during rounds on a busy inpatient teaching service at a county hospital, I led a group of medical students into a patient’s room. I asked the same question I have asked well over 10,000 times: “What do you see?”
Observation is a powerful tool at the bedside, and offers us an opportunity to learn from one another.
My student replied, “I see a white man sleeping in no acute distress.”
I repeated the question to my intern as I worked up the ladder of hierarchy. “I see a man lying flat in bed suggesting he does not suffer from orthopnea,” she replied.
Up next was the resident. “I see a man who is poorly responsive to any of our communications or observations because, as we all know, he has had a massive stroke and has a terminal prognosis.”
It was now my turn. I reminded them that those were all excellent observations, and there were no right or wrong answers.
“I see a man who is dying. We know that from our assessment and the expert opinions offered by multiple consultants including the neurology service. However, I see no greeting cards, no family portraits, no home blankets or pajamas. I do not see a bible nor do I see any other signs that this man has had a single visitor. What I see is a human being who is dying alone, and no one should die alone.
Having asked the question for over 20 years, I was not at all surprised by my team’s response. It was not what was said but instead what was communicated through body language. “That’s interesting, Dr. Mehta, but we have more patients to see, and we’re going to be late for noon conference.”
What I saw the next day brought tears to my eyes.
My team had purchased a smiley face helium balloon from our hospital gift shop, and had tied it to the patient’s bedside as a reminder that he would not die alone.
There was more of an effort to talk to him, and I was touched to see team members holding his hand during these conversations. We would never know if he heard our words but our gesture reflected the empathy and humility that is so often forgotten in today’s chaotic world of medical training.
Our patient passed away three days later, and the team moved the balloon to our call room as a gentle reminder that healing begins with feeling. In that singular moment of a memory burn of a lifetime, my students became my teachers, and I was humbly reminded why we do what we do as physicians.
Niraj Mehta is an internal medicine physician and the author of Hopes and Fears Dreams and Tears: A County Memoir and founder, the Cupcake Man Project.
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