The pungent odor of rotting tissue fills the air. The patient, Mr. T, is lying on his side, staring emotionless at the wall, covered in blankets in a dimly lit room. I was aware that Mr. T presented to the ED for evaluation of a diabetic foot, but no amount of information could have prepared me for this patient encounter. In the room, he does not turn to make eye contact but quickly and loudly declares, “Who’s there?” After explaining my name, role, and purpose for entering his room, he defensively questions, “How many years of experience do you have?” Mr. T only wants to speak with the most experienced practitioners. I explain to Mr. T that I might not have all the answers or information he desires, but my questions and examination are an important step in determining the best plan of action. Reluctantly, he allows me to ask a couple questions and perform a physical exam.
Mr. T has undergone a prior below-the-knee amputation of his left leg. His right leg is necrotic up to the knee with a terrible open wound the length of his foot, with maggots crawling throughout it. He knew he had a wound for several years but did not seek a medical evaluation. It was not until about two weeks ago when he saw a television broadcast about a local podiatrist who was getting sued for operating on the wrong foot that Mr. T took this as “a sign from God” to get his foot evaluated. Without fail, this lawsuit is something Mr. T brings up to everyone who enters his room. For Mr. T, this story appears to serve as a personal defense, a way to gain a sense of control and strength by using the intimidation of legal action.
As I progress through my questions, Mr. T makes it vehemently clear that he does not want his foot amputated. He will do anything he can to avoid amputation. Suddenly, he turns the questions back to me. “What’s the derivative of 2x^3?” Mr. T quickly replies, “6x^2!” As taken aback by this random calculus question as I am, I surprisingly know the answer. However, Mr. T beats me to it. Mr. T continues to ask random questions about calculus or history. He wants to prove that he is intelligent and educated, someone who will not let the health care system take advantage of him.
Despite this impromptu math lesson, I continue to examine Mr. T. I realize he never makes eye contact with me. I see his eyes are opaque and he is unable to participate in a neurological exam. Mr. T is blind. The diabetes has destroyed his eyes as well. As I sit down in the chair next to his bed, I know he cannot see me, but it is evident that he can feel me come down to his level. I can sense the fear, sorrow, and potentially even guilt that Mr. T is feeling. I assure him that he will receive excellent care, and I go to present his case to my team.
Mr. T taught me that many patients do not want to fall victim to a standard treatment algorithm: that altruism should precede the algorithm. Amid the challenges of a bustling ED, the algorithm says to identify the problem and provide the appropriate treatment or consult the necessary speciality service if necessary. Sitting down and asking the patient “What matters most to you?” is often excluded from the algorithm. From a position of knowledge and extensive training, it is efficient for medical practitioners to identify problems and offer the medically accurate solution to those problems. This process often excludes an assessment of the patient’s core desires. Too often the medically appropriate decision is imposed on patients who have the competency to oppose this decision. Informed consent is often viewed as a task to be completed rather than a journey to be embarked upon.
My journey with Mr. T truly began when I took a seat next to his bed. Though he could not see me, the act of sitting down spoke in a language of compassion that transcended visual barriers. It was in those moments of genuine connection that Mr. T, burdened by pain and the isolation of his condition, found a safe place to express his fears and concerns. In those moments, I learned that true empathy requires more than medical acumen; it demands a willingness to see beyond the symptoms and embrace the person behind the ailment.
As health care professionals, we are entrusted not just with the responsibility to diagnose and treat but also with the profound duty to understand and alleviate the human experience of illness. The path to preserving empathy in medicine lies not only in the textbooks and protocols but in the intentional act of sitting, listening, and recognizing the unique narratives each patient carries. It is a commitment to acknowledging the individuality of suffering and responding with compassion, even when faced with the relentless march of time and tasks.
In the realm of medical practice, where the efficiency of algorithms threatens to overshadow the humanity of patients, let us not lose sight of the essence of our calling. For it is through the lens of empathy that we gain the clarity to perceive the unspoken stories, the silent pleas for understanding. Through my interaction with Mr. T, I learned the importance of not only treating the patient but also understanding the person beyond their medical conditions. In these moments, providers take on the role of a fellow companion rather than a domineering captain. We begin to walk alongside our patients rather than standing above them. It is vital that we strive to cultivate not just medical expertise but also the eyes to discern the person behind the patient and the stories etched in the tapestry of their suffering.
What story have you seen in a patient's life recently? Share in the comments.
Dr. Bronson Ciavarra is a current neurosurgery resident at Baylor Scott and White Medical Center - Temple, TX. He enjoys woodworking, making pizzas, spending time on the ranch, and lake days. Bronson is passionate about medical humanities, philosophy of mind, and brain-computer interfaces. Dr. Ciavarra is a 2024-2025 Doximity Op-Med Fellow. All names and identifying information have been modified to protect patient privacy.
Illustration by Jennifer Bogartz
