I had my first interaction with a patient last week (I’ll call him John). He was a reticent and withdrawn teenager, who, when I first approached, was reclining on an arm chair with earbuds plugged, staring off into a corner of the sterile room. His grandfather, who had brought John to the hospital, looked equally disinterested. My task was to interview him, and my supervising physician would evaluate me on my interviewing skills – whether I asked the right questions, how well I was able to solicit answers, etc. I knew right away as I saw John that it was not going to be easy.
And it wasn’t. It felt like wading across a wide, swampy moat – a moat that John and his grandfather had dug even before I spoke a single word. John was at the hospital for a routine service, and as far as they were concerned, I was a disturber of their relative peace. As I introduced myself and explained to them why I wanted to talk to them, John’s grandfather sternly warned that our interaction better not last more than they needed to stay at the hospital for John’s visit. “No more than thirty minutes,” he said.
I began asking John questions about his illness, and the effect it’s had on his life. Yale’s patient interview curriculum – which prides itself in its radically patient-centered approach – had promised me that if I ask an open-ended question and shut up for 3 seconds, the patient would fill the silence with a lengthy response. John, though, met all of my questions with a terse response and a sideways glance.
“How has having [your condition] been for you?”
“Just…normal. It’s just normal.”
After about 15 minutes, I started to ask about his family. I learned that he had previously lived with his mother, and visited his maternal grandmother every week (the grandfather he was with was his paternal grandfather). Nowadays, though, he lived with solely his grandmother. I asked him if he could tell me why. John’s grandfather, who had been listening the whole time, stepped in. “That’s getting personal.” I had crossed a boundary.
I gave up. There was no use in pursuing my agenda anymore, and as I let go, what surfaced was an apology. I told them that I was a first year medical student – naive, blundering, just learning to crawl in this medical profession; that I am sorry if I offended them. I was told by my teachers that I needed to treat patients as whole, and should ask about the lives they led beyond the hospital; I was just trying to understand who they were…
I asked John about the music he was listening to. He liked dubstep and electronic dance music.
“Dude, so you like beatdrops?”
And for the first time, he smiled.
We went on to chat about his schoolwork, and how he had starved himself of video games for 6 months for the sake of his grades. He had straight A’s. More smiles.
Donald Berwick, in his address to the graduating class of 2010 at Yale Medical School, noted that a good physician is not the one who readily dons the white coat (with its accompanying pedestal and power) but the one who readily gives it up.
Congratulations on your achievement today. Feel proud. You ought to. When you put on your white coat, my dear friends, you become a doctor.
But, now I will tell you a secret – a mystery. Those who suffer need you to be something more than a doctor; they need you to be a healer. And, to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off. You must recover, embrace, and treasure the memory of your shared, frail humanity – of the dignity in each and every soul.
I wrote before about the phenomenon of ‘the bridge’ in medicine – that to become a doctor is to enter a world from which there is no returning. The irony is that becoming a healer precisely requires this return. I must learn, no less, to become human again.
The finding is in the giving-up… It is a principle that harkens me to the poetry and truth of Christ’s paradox: “Whosoever wants to save his life will lose it; and whoever loses his life for me shall gain eternal life.” So I gladly seek the place in which I become nothing – the place where I unmask all that I’ve toiled to put on to find that I am, in the end, simply Christ’s beloved. And in that place of nothing (which is the place of everything) I gain the vision to see John for as he really is: not as “a difficult patient,” but as fellow man, deserving of love.
This is the place where medicine transforms from a “giving to” or “fixing,” to “walking with.” It is where true ministry and healing is possible.