Mistake

In my mind I still see this twenty-three-year-old woman, too young to die. Delores tells me she is hurting in the legs and in the chest, a mild ache. More tired than usual. Doesn’t like her extra weight; feels short of breath when walking up a flight of stairs. Stairs don’t fly even though they ascend—how strange the English language. Mountain trails ascend, but we climb up trails, but not up a flight of trails. Patients, like poets, their every word has a hidden message.

More tired. Don’t like my extra weight. Short of breath.

Each word a patient loans me, I value it and hold it in safekeeping like a precious gem. My patients’ inflections, like a diamond cutter’s tools, shape and polish their stories. I cup their gems in my gifted hands, rotate the words in the light of my compassion and knowledge, my loupe, admire the beauty and find the flaws. My profession commands me to be a diligent gemologist. I don’t expect a flawless diamond. Who in this universe can craft their story without flaws?

Like diamonds only reflecting the best quality of light, my patients may hold back information that reflects badly on their character. They keep their flawed facets hidden. These flaws add to their personality and help me see their uniqueness. My compassion and empathy may encourage them to verbalize their “flaws.”

Before I meet Delores, I face a closed door shielding the patient’s emotions. Behind this door is the answer to why she wants my help. Sure, I read answers she gives to questions on a computer-generated health questionnaire. They contain facts—for example, leg pain—not emotions behind the symptoms. From these emotions I learn the real reason she is here. Is she afraid, sad, worried, frustrated? Does she have death on her mind; sense the worst? Pain is the book’s cover, the feelings are the plot, and the patient and doctor are the characters.

I remember as a first-year medical student at the Medical College of Virginia in the early 1960s, I walked by the hospital late one night after studying for an anatomy exam. A few lights still shining in the windows among twelve stories enticed me. I yearned for the day I could be in those rooms to talk to patients, hear their stories, learn about their mysteries, and help them. I wondered what was wrong with me, why I didn’t like memorizing which muscle attached to which bone. My first insight early in my career as a physician that I can now put into words: the patient doesn’t care how much I know until they know how much I care. How quickly four years of medical school and residency training blurred that focus, the cataract of my medical education.

For example, at morning teaching rounds in a dimly lit room with two beds separated by a partially drawn beige curtain, a few minutes of talking to the patient was followed at the bedside by ten minutes of bantering back and forth among the doctors and students about diagnostic tests, about test results, and which diagnoses were most likely to apply to this patient. The second patient in the room could hear everything about her roommate. During these rounds I didn’t hear much discussion about the patient’s care outside the hospital. They didn’t say, Who is at home to help her? or Will she be able to go back to her job? Rather the questions were, What other tests should you have ordered, doctor? What did you think of her reflexes? Was her liver tender, enlarged? Eye contact with the patient was often avoided during this part of teaching rounds. More important to my mentors was how accurately I could spout back lab test and X-ray results without referring to the chart. If I said, I don’t remember exactly her total bilirubin level, but I think it was slightly elevated, it was not good enough as evidenced by the attending physician’s glare or smirk.

Delores’s experience in the exam...