Don’t to forget to walk in your patients’ shoes

With summer vacations over and school back in session, I should have gotten up earlier. The usually tough morning commute into Columbus was downright brutal, and I found myself getting repeatedly annoyed as I rushed to make it to clinic on time. Somehow, legally, I managed to make it right at 8 a.m., the start of my weekly asthma clinic. Though I arrived a bit later than usual, I still intended to follow my Wednesday morning routine of grabbing a hot tea from the break room and chit-chatting with the clinic staff and residents. That idea was quickly thwarted by one of our nurses: “Hey Dr. R, your first patient is waiting for you in room 2. Dad’s in a rush.” I found myself getting annoyed again as I reviewed their medical record.

Knowing the family well, dad immediately greeted me. “Sorry for the rush, but I start a second job today and need to be there by 9.” I knew that dad was already the night manager of a local 24-hour coffee shop, and he confirmed that he still worked there. “With the kids older we need more money, so got this additional six-hour-a-day job.” I congratulated dad while inside being amazed that he was working 14- to 16-hour days to give his family a chance at a better life.

The morning continued to be busy but around 11:30, I saw a chance to finally get that morning tea. Again this was thwarted. “Your 8:40 just got here. Brand new and got lost. OK to see them?” the nurse asked. “Sure, they’re new,” I replied as that annoying feeling came back again. “Three hours late!” I thought.

It was the eight-year-old son of a family of recent immigrants from northern Syria. As I obtained the history, I learned my patient had an admission as an infant for respiratory issues and then was fine until two years ago. At that point, the family started to move from region to region to escape the conflicts in their area. So, dad wasn’t sure if the breathing problems were really asthma or from the squalid conditions they lived in. I asked for family history to help clarify risk: “Mom had asthma,” dad replied through an interpreter. “Had? Did she outgrow it?” I asked to which he replied with tears running down his face, “She had it lifelong … but was killed by ISIS two years ago.” I was definitely taken aback by the reply.

Afternoon clinic was a resident session and was the usual chaos of 20-plus patients with a mix of new immigrants being seen for the first time, sick visits (croup is here early this year) and last-minute school physicals. While multi-tasking listening to one of our senior residents present their patient while trying to figure out a vaccine record from Yemen, one of our nurses asked, “There is a mom in the lobby wondering if you can fill out this sports participation form. She needs it by 4 p.m.” This, of course, led me to feel a sense of being annoyed again, but I muttered, “Sure.” And I took the form. “They probably have had this form for weeks!” I thought.

After quickly seeing the resident’s patient and letting two other families know that I will be with them shortly, I got down to filling out the form. Completing it, I entered the waiting room and looked for the family, knowing them fairly well. Mom and her daughter both looked wet. “Sorry about the rush, Dr. R — our car broke down, and we can’t afford another one. We need to take the bus everywhere, and it has been hard time-wise.” Simultaneously mom looked apologetic and sad. “I got your form Ava,” looking at the daughter and hugging me.

Just like that, it was almost 5 o’clock, and I knew phone calls, and refills still awaited me and got that annoyed feeling again. One of the residents presented the last patient, who recently came from Burma. The family was concerned that their three-year-old was delayed with his language. “Does he have autism?” they anxiously asked. The resident did a masterful job of going over the reassuring M-CHAT results and stating that the language delay seemed to be an isolated issue and not a sign of autism. Mom was relieved. The family had not been able to see a medical provider in over a year, worrying about autism the entire time. They finally had their fears assuaged. “We will set up speech therapy, and I think he will do fine,” I added.

By now, it was well past our official close time. The residents finished up their work and left one by one for the evening. The last one tapped me on the shoulder. “See you Dr. R … Are you OK?” “Yeah, just deep in thought … see you next week.” I smiled. Yes, deep in thought thinking that despite the busy schedule, the interruptions and the paperwork demands, I have a job that doesn’t require me to work 16 hours a day every day. I have a job that allows for my family to have healthy food on the table, opportunities for a good education and a safe neighborhood where the kids are not afraid to play outside. Where my beloved wife won’t get randomly killed by ISIS. I have a profession where perfect strangers, many of whom new to our country and from locations where they cannot trust anyone in authority, tell me their biggest fears and concerns and trust that the residents, and I will do the right thing for their beloved children. It’s humbling.

As I was finishing up for the day, I pushed the last refill request electronically to a local pharmacy and realized that I was annoyed one last time today. This time with me, for failing to walk in my patients’ shoes and for forgetting that we serve in a noble calling.

Alexander Rakowsky is a pediatrician.

Image credit: Shutterstock.com

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