Many of us say we go into medicine for the chance to really connect with patients and hear their stories. When I teach residents, I remind them that there is no such thing as a boring patient. Yet as the demands of our profession pile up, we often forget those intentions, myself included. The majority of our patients become medically “boring.” We get lazy and sloppy with our intention to connect.
Janet was one of these “boring” patients at first. I was a brand-new intern when I first saw her, and I was pretty much just trying to survive my first rotation in the ICU. I was more concerned about my performance on rounds than my performance as a human being. So I viewed her as just another bad case of chronic obstructive pulmonary disease. Personality-wise, she was considered to be “difficult.” The ICU team had attempted to get her down to the CT scanner for a lung exam multiple times, but she repeatedly had panic attacks, delaying the procedure and frustrating the entire team. Even after the CT scan confirmed she had cancer, nobody seemed surprised, let alone upset.
In addition, her BiPAP machine was so loud I could barely talk to her over the noise. Perhaps those were some of the reasons why I didn’t bond with her well at first. Or perhaps those are just my excuses.
Circumstance, not my own efforts, brought us together. I received a page one night letting me know that she was short of breath. I went to evaluate her, and soon enough, we began talking about her time as an usher at a local theater where coincidentally I used to attend a lot of performances as a child. We bonded over “Cats,” “Sweeney Todd,” and “Porgy and Bess.” The musical “Rent” was coming to town and I told her I couldn’t spring for the price of tickets. She berated me until I agreed to go. “Do it for me!” she said.
I went. She was ecstatic, loading me with questions the next day.
Over the next several days, we went deeper. She opened up about her experience as a victim of domestic violence and her ultimate triumph in leaving her abuser. As a result, she had spent much of her life alone, choosing solitude over abuse.
Here was this fascinating, heroic person right in front of me, and I hadn’t seen her for who she was because I was too busy trying to be a standout intern. Janet was the reason I went into medicine — to have these meaningful relationships with patients — and yet I didn’t see her until it was almost too late.
This realization hit me harder when she suddenly and quickly decompensated. I was able to be at her bedside as the chaplain said a prayer over her wheezing, struggling body, and I watched my friend become a totally different person in a matter of hours. She passed away later that evening.
My experience with Janet taught me early in my career that, if we truly want meaningful relationships, as many of us claim we do, we can’t afford to wait. There won’t be a sign on the patient’s door, right next to “MRSA precautions,” that says, “This patient is a good one. This one is special. Get to know them.” For every patient we bond with, there are dozens of others that we might miss. Each is a vessel full of stories and experiences through which there is the potential to be amazed.
Janet, in the words of the beloved musical “Rent,” there is “no day but today” to treat every patient as fascinating. Thank you for your teaching.
What lessons have you learned through patient care? Share your experiences in the comment section.
Elena Hill, MD, MPH, is a family medicine physician who trained in Boston and is currently practicing in the Bronx, New York. Her clinical interests include addiction medicine, chronic pain, and narrative medicine as a means for sharing her patient's amazing and inspiring stories.
All names and identifying information have been modified to protect patient privacy.
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