The first day of any new rotation during intern year is difficult, but I never thought my first day of clinic would involve a hurricane-induced power outage in the middle of interviewing a patient. On that first day, I was excited to take on the responsibility of caring for patients — but was also so nervous that I pored through my patients’ charts an obsessive number of times.
When I read that a patient was coming in for an anxiety medication refill, I was fully prepared for what I thought would be a quick appointment. No problem, I said to myself. I confidently walked into her room and started to ask her about her medications and the purpose of her visit.
As the patient answered, she became tearful. I realized then that this was going to be more than just a regular refill appointment. We began talking more intimately, and the patient described to me how difficult things had been for her. “Working in health care is so hard right now with the COVID-19 surge … My chronic pain is unmanageable … My marriage is going downhill … I don’t know what to do.”
I could see and hear in this patient’s voice how hard it was for her to reach out for help. She said, “I have really been trying to get through this on my own, but I just can’t take it anymore. I thought I could just push through.”
As I consoled her, I was thankful for the years of standardized patient encounters, psychiatry rotations, and clinic encounters as a student so that at the very least, I knew what to ask next. I felt the weight of responsibility as this patient’s official primary care physician, and I tried to rattle off every important question without sounding like a robot. “Are you sleeping? Eating? How long have you been feeling this way? Have you ever thought about hurting yourself?”
My patient opened her mouth to respond, put her face in her hands, and began sobbing. Should I reach out to someone else? I wondered. Before I had time to decide, the lights in the room went off. Suddenly, I was sitting in a completely dark room. The power had gone out. Did I do this? Did I break the clinic? I thought wildly.
I fumbled in my pockets for my phone, hoping to use the flashlight if only to make it to the door to let some hallway light in. Surely there is a generator for the hallway lights, right? I got the door open and some light was able to enter the previously pitch black room. My patient and I had lost our sense of privacy with a now wide-open door and nurses and doctors streaming down the hallway to ensure all the patient room doors were open.
Nevertheless, I turned back around to her. “I am so sorry about the lights,” I said. “I will figure out what is going on in a moment, but did you say that you have thought about hurting yourself?”
She replied yes, she had. “But I don’t truly want to kill myself, and I don’t have a plan,” she said earnestly. She quietly added, “It’s better that the lights are out because now you won’t be able to see me like this; you won’t be able to see my tears.”
My attending entered the room, all of us with our phone flashlights on, and we collectively discussed this patient’s story, her pain, and the severity of her depression. As we gathered a fuller picture, we emphasized safety and goals. Without any computers or phones to distract us, without any orders to immediately put in, kindness and compassion became the dominant form of communication. We told the patient that she had children and a career to live for. We also stressed that we would be here to help her through this; it would be a journey we would all take together. Medication changes would be made, outpatient therapy would be undertaken, and pain management would be a priority.
After hearing about all the help we would provide, the patient seemed to have hope. She looked at us and said, “Thank you for being so nice. Not all doctors are so nice.”
Somehow, in the dark, it had become easier for her to talk about the things she might have felt ashamed to discuss in the light of day, with a masked figure in a white coat staring back at her. And similarly, for me, in the dark it became possible to stop feeling nervous about interacting with a potentially suicidal patient my first day of rotation, and to just grant this patient the support and attention she needed. I learned in that encounter that in the dark, we are all just people, unable to see, but better able to listen. If we make the best of even the most unexpected predicaments, we can help each other grow and heal.
How have you learned to manage chaos when interacting with patients? Have you ever encountered an unexpected situation that improved your patient communication? Share your experiences below.
Dr. Maulik A. Patel specializes in providing medical care for adults by empowering patients to be the best managers of their own health. As a geriatrician, Dr. Patel considers the whole patient before treating medical conditions — their physical, emotional and mental health as well as their illness. He enjoys the challenge of piecing together a diagnosis based on symptoms and lab or imaging results.
Christie Savas is an internal medicine resident originally from Atlanta, Georgia. Upon completing her undergraduate degree at Georgia Institute of Technology, she worked in the corporate business world for a few years. She then decided to return back to school to study medicine at Mercer University and is passionate about primary care and building long-lasting relationships with her patients.
Image by: Benja Boonyakitsombat / EyeEm / GettyImages