The Seven Words That Changed My Perspective on Patient Care

PART I

While in a mobile care van looking for anyone who might need help, we find a man sitting in a wheelchair trying and failing to light a cigarette with shaky hands. There is dried blood running from dirty wounds all over his body. After he consents to wound care and we start rubbing away some of the blood, he begs us to stop. “Don’t do this to me; you’re hurting me more,” he whimpers. Looking for other ways to help him, my attending motions for me to look in the van. When I return with clothes and snacks, the team has moved on to help someone else. Although they can hear and see me, I’m still nervous about speaking with this man alone as an inexperienced medical student. I hand him everything and he mumbles a soft thank you. “How did this happen to you?” I ask. He slowly looks at me with pain in his eyes.

“No one’s ever asked me that before.”

I listen as he tells me that his wife passed away 10 years ago after a grueling battle with cancer. The night she passed, he drank for the first time in 5 years, stumbled into the road, and was hit by a speeding truck. The next morning he learned that he was paralyzed from the waist down. With nowhere to go, he returned to the street where he was hit and never left. He tells me stories about his wife while smiling from ear to ear. “I don’t remember the last time I talked about her,” he says with a chuckle.

PART II

It’s 4:30 pm and I’m wrapping up a long shift at the clinic. Finally finished with my notes, I start to pack up when I hear a knock. I’m greeted by my attending, “One of the no-shows came. Is it alright if you see her?” I agree and log back into my computer. “Just so you know, she’s always cranky. Don’t take anything personally,” she says as she leaves the room. The nurse brings the patient in and closes the door. After I introduce myself she becomes visibly upset, “I’m already in so much pain, I was stuck in the car for hours, and now I have to see a student instead of my doctor?” She scoffs, crosses her arms, and looks away. Offering reassurance doesn’t help and all of my questions are met with sarcasm or 1-word answers. Trying to understand her situation I ask, “Are you happy with the care you’re receiving?” She looks at me for the first time and I see her shoulders drop.

“No one’s ever asked me that before.”

I finally gather that she was diagnosed with rheumatoid arthritis in her early 20s and has had unrelenting pain since then, and she has bounced between several doctors due to issues with transportation and insurance. After her appointment, she pauses in the doorway to look at me. I see a grin flicker across her face before uttering, “Thanks for listening,” as she turns away.

PART III

My hands tremble as I open the door on the first day of my hospice rotation, scared that I might say the wrong thing to someone during such a vulnerable time. I start rounding with the attending and hold my breath as we walk into the first room. My eye is drawn to the patient in her bed who is displaying signs she will pass on soon. Next to her is her daughter whose gaze meets ours. “Good morning doctor!” she says in a cheery voice with a huge smile. Her demeanor is so unlike what I was expecting that it startles me. The doctor excuses himself to do a physical exam on the patient and there is a sudden silence. Realizing I haven’t said anything yet, I say, “How have you been doing through this?” Gesturing toward her mother she says, “Oh, she’s been doing about the same. It’s been so long we’re just waiting for it to be over.” The doctor returns to join us. “But how have you been doing?” I ask again. I can see her smile drop slightly as her eyes well up with tears.

“No one’s ever asked me that before.”

I hug her and she hugs me back, I can feel her chest heave as she cries. When I let go, the doctor hugs her as well. “He gives the best hugs,” she says as she shyly wipes away tears.

THE GIFT OF GENUINE CURIOSITY

After tossing my backpack into the passenger seat of my car, I sit staring at the steering wheel wondering how no one had been asked these questions before. I start my car and drive home in silence. A common thread emerges in each of these encounters—the profound impact of a simple personal question. “No one’s ever asked me that before.” It echoes with a sense of longing and unmet needs.

I slowly pull into my parking spot. I’m staring at the steering wheel again, this time feeling a bit lighter at the thought of the transformative impact we can have on our patients. I think of the ways elicitation of personal narratives through open-ended questions can foster the expression of fears and struggles, aiding in both emotional and physical recovery. I contemplate a future where compassion flourishes alongside medical expertise, nurtured through a greater incorporation of patient-centered care. The power of a question, the gift of genuine curiosity, and the desire to understand patients in the context of their life stories could be the tools necessary to bridge any existing gap in quality of care. Realizing my responsibility to honor the stories still untold, I turn off my car and head inside.