I heard my attending walk into the clinic before I saw him, ski boots heavy on the polished linoleum floor. Then the swish of nylon snow pants rubbing together as he walked, before a loud sigh of relief as he shook off his heavy parka.
Dr. Hall was one of a rotating cast of physicians staffing the only urgent care for miles, perched on the edge of a mountain that attracted skiers from all over during the snowy winter months. As the rotating medical student, I was drawn to the remote setting by my expectation that the combination of steep, icy inclines, and daring athletes would yield many patients to care for. Much to our patients’ delight, attendings like Dr. Hall often skied during the daytime, monitoring their phones for a call back to clinic heralding the arrival of a new patient.
Our patients arrived in every form — some walking, recounting their injuries only as a brief aside to an otherwise epic tale of daring jumps or winding slaloms. Others arrived supine, scared, and strapped to a stretcher, having only seen the faces of ski patrol looming down from above as they were expediently sledded down the mountain.
Sana was somewhere in-between, her lips downturned into a frown, arriving with a shoulder that looked obviously out of place, even to my inexperienced eye. Sana was reserved in expressing her discomfort, but her questions betrayed her fear: Would she have to drive 30 minutes to the nearest hospital? How was she going to write with an injured shoulder? She arrived alone; who would drive her home?
As Dr. Hall walked in, trailing melting snow behind him, I quickly filled him in on the pertinent details — Sana had fallen onto her shoulder, had an obvious deformity, and received pain medications at triage. We reviewed Sana's X-ray together, and I watched as Dr. Hall traced the dislocation with his finger before approaching where Sana sat, cradling her arm in her opposite hand.
“Are you tough?” Dr. Hall’s question broke through Sana's nervous silence. She gave a reluctant smile, then a small nod, and said “yes” with surprising confidence. Instantly, I felt the tension in the room defuse. Dr. Hall grinned, then gently explained to Sana that her shoulder was dislocated and would need to be adjusted back into place. Sana's questions bubbled to the surface again, and Dr. Hall patiently answered each one before obtaining her consent.
Then, “Ready?” Sana nodded. Dr. Hall smiled. “Remember when you said you were tough?” As Sana thought back, Dr. Hall quickly eased her shoulder into its original position in one quick maneuver. Sana gasped in relief, then laughed out loud, drawing out Dr. Hall’s and my own surprised laughter in response.
Spoken differently, Dr. Hall’s words may have felt like a challenge, or even confrontational. But watching him ask with a conspiratorial tilt of his head and maybe even a wink, instead, it felt like he was empowering Sana with her own words. Remember when you said you were tough? Remember what you know you can survive? Remember how strong you are?
I’ve noticed much of our care for our patients happens in these in-between moments, the liminal space separating our diagnostic process from our treatments. We probe our patients with endless questions, no doubt in service of identifying the source of their pain, but we sometimes neglect to pause in our diligence to carefully choose the best healing words. As I learned from watching Dr. Hall interact with Sana, whose day was abruptly turned upside down by an unexpected, painful injury, our patients respond to our humor, our encouragement, and our empathy — sometimes even more than they do to our deliberate explanations in medical jargon.
Dr. Hall wasn’t testing Sana with his question, I realized. He knew she was scared, and that wasn’t going to change, but he recognized an opportunity to reassure her and maybe even draw out a laugh in the process. He went off-script, guided only by intuition to ask a question I’d never heard at the bedside before, and it worked.
Sana left clinic wearing a sling, and Dr. Hall returned later to see our next patient, another skier with an injured shoulder.
“If you get this one right, I won’t ask you another question all week,” he said, scrutinizing the new patient’s shoulder X-ray before asking me about a rare dislocation pattern.
I got the question wrong. And the one after that as well. As I felt the sting of embarrassment, Dr. Hall’s earlier words to Sana echoed in my ears: “Remember when you said you were tough?”
I thought of Sana. Being tough didn’t mean not wincing — it just meant relying on yourself to get through the most uncomfortable moment. While Dr. Hall’s words were intended for our patient, they resonated with me, too. Humanism in the care we provide our patients uplifts every member of the care team. I chose to pursue a career in medicine because I wanted to connect with patients when they were experiencing our most fundamental human emotions— fear, anger, sadness, relief, surprise, hope. Mulling over Dr. Hall’s words to Sana reminded me of my own grit, a quality that I have relied on daily as a new intern.
When Dr. Hall asked her, I would have understood wholeheartedly if Sana's answer was no — it’s hard to feel tough when life takes an unexpected turn. But I’m grateful Dr. Hall asked, and even more so for the example of how much we all stand to gain when we bring our creativity, compassion, and sensitivity to the bedside. Creating space for pride in our strength, and even a little laughter, in the clinic felt like the art of medicine at its finest.
Do you consider yourself "tough"? Share in the comments.
Dr. Anjali Misra is an emergency medicine resident in Boston, MA. She is passionate about health equity, prehospital care, and public health. She is a 2024-2025 Doximity Op-Med Fellow.
All names and identifying information have been modified to protect patient privacy.
Illustration by Jennifer Bogartz
