Maybe it was the white coat I was wearing, the inexplicably long strides I was taking, or the fact that he had his eyes glued to me as soon as I walked through the door, but everything felt so official. Unnatural. Completely the opposite of what I was expecting.
Up until the moment I walked in the room, I had delusions of walking in, being greeted with a wonderful smile, and having an absolutely engaging, perhaps even cathartic conversation with the patient. We would laugh and joke about our age difference, I thought, and share pithy sentiments about how much we both miss home. Unfortunately, it seems that I didn’t anticipate that people stuck in an hospital, especially those who have been there for a long time 1) are not, by no fault of their own, jolly folk, and 2) see a white coat and anticipate being poked and prodded or exhibited to an audience, not expectant of a whimsical conversation about the universality of life’s travails.
It was in this rather unsettled atmosphere that I attempted to introduce myself.
“What?” Of course he was hard of hearing. I was certainly off to an auspicious start.
“Hello sir, I’m a first year medical student, and I was wondering if I could speak to you as a part of an assignment. We have been asked to…”
“Are you here about taking me somewhere else?”
Hmm? That was unexpected. Apparently the doc had told him that morning that he would be going to stay in some sort of care facility before he could finally get home, and like any other normal person, he was distraught. Eventually, with all the enunciation I could muster and the loudest voice I dared to use, I was able to introduce myself properly and convince him that I wanted nothing more than to talk to him. To my relief, his shoulders relaxed, his facial expression changed to what could be optimistically regarded as “resigned,” and I, on cue, grabbed a chair, sat down, and began trying to fulfill the goals of my first assignment––to “connect” and “listen”––in earnest.
Though the conversation had not started in the most ideal way, I was unfazed. I began to implement everything I knew about trying to be a good listener––I leaned forward slightly, made eye contact, deftly changed the subject when I felt it had run its course and spoke softly and infrequently. I offered my condolences for his unfortunate situation, and tried to commiserate with him about the unique homeness of home. However, despite my efforts, the conversation gradually waned, and fifteen minutes after I had walked in so stridently, I excused myself and walked out, far humbler and a little confused.
It’s been a few weeks since that encounter, and I think I now have a better idea as to what happened. It would be easy to blame the fact that he had received disheartening news a few hours prior, that he had trouble hearing what I was saying, or that the rather stilted start to our conversation was too disadvantageous to overcome. I could say that it was understandable because I was four days away from my first patient interview class, and therefore I wasn’t armed with the full arsenal of interview tactics. However, it’s pretty obvious to me now that it wasn’t at all that I didn’t have enough techniques to unleash on him; instead, it was something beyond them.
To be sure, I’ll have practice and internalize the various aspects of the medical interview endlessly to be an effective clinician; there is no substitute for sheer effort and repetition, especially in trying to cover the vast scope of a proper patient history without seeming robotic and unnatural. However, knowing our physical diagnosis notes cold is not an end in itself. Rather, it is only to ensure that a lack of knowledge does not impede our true goal––to be able to express real empathy.
It’s really hard to be able to express empathy if we’re struggling to remember what we’re supposed to do after the social history; in turn, without real empathy behind our words, our efforts will appear less genuine at best and utterly forced at worst. With enough practice, maybe I would have been able to use my patient interview techniques in an organic and natural way, and as a consequence make him feel genuinely cared about. It would definitely have helped me avoid so many cliches (“there’s no place like home”) or be generally less awkward (“it’s not home, but it’s better than the hospital, right?” I’m still dying a little inside after that one).
What’s crazy is that I totally thought I was being empathetic, but I didn’t realize that I wasn’t really until now. It seems that the shock of finding out how little I know about nearly everything is a pretty ubiquitous experience among us medical school rookies. But that’s another post altogether; for now, I’m just going to have to work up a healthy appetite for humble pie.