What does it mean to connect? How do we connect to our patients? To their families? To the doctors, nurses, and other healthcare providers whom we work with? To our classmates? To our teachers? To our own morals and value system? What are the barriers to making these connections? What factors help foster them? How do we maintain and cultivate them? When does disconnect arise? Describe a time during your LIC experience of feeling connected or disconnected to an individual or the people around you. What happened? How did it make you feel? What did it teach you?
Robert Pope, “Visitors”, 1989.
Henri Matisse, “The Dance (II)”, 1910.
When a Bond Breaks
There is a little girl lying on the hospital bed, thrashing her head to keep track of the flurry of scrubs and white coats. She is a beautiful blond, with the kind of childhood purity that fades with the realities of living.
“Ouch! Don’t do that!” she says to the physician pressing her belly.
As the nurse approaches her with a needle, she holds her ground: “I’d rather wait until my daddy is here before you do that!”
A young EMT emerges from the room, and his words spill out as though from a child confessing a wrongdoing: “She was in an MVA. Mom was found dead at the scene.” His eyes swim, and I am acutely aware of the air escaping my lungs.
She calls out repeatedly for her daddy but does not cry. She does not ask where her mother is. For reasons I do not know, Mom had been worried about taking this drive with her daughter. She was on the phone with the father when she lost control. He heard everything, including his little girl screaming, “Mommy’s dead! Mommy’s dead!” My attending strides out of the room as his face crumples and tears spill down his cheeks. I do not follow as he pushes through the crowd.
My eyes burn, and the room blurs. A nurse walking by hands me a handful of tissues. “Keep these with you,” she murmurs, folding my hand around them. We keep moving. Other patients are waiting. I cannot help but think, “You don’t know how lucky you are,” as we listen to their concerns. I realize I often forget this too.
When we return to the little girl, there is a bear of a man standing beside her bed, his hand completely enveloping hers. He is not what I expected, although I had not realized I was expecting anything. He wears a dirty mechanic’s shirt and steel toed leather boots. He has strong, rough hands and a big belly. He leans over to comfort his little girl as she is poked and prodded, his eyes red and glistening.
He is a father who faces parenthood alone. He is a soul with one of the deepest wounds. I am a witness. We are both helplessly human.
Hayley Cunningham is a recent graduate of the University of North Carolina School of Medicine and is headed to Duke for Internal Medicine residency. She was encouraged to write as a participant in UNC's Asheville Longitudinal Program, and she hopes to continue this practice throughout residency to help her process difficult experiences and to commemorate the wisdom of her patients and mentors. She ultimately plans to pursue an infectious diseases specialty and care for patients with HIV, and also to provide gender affirming care for transgender patients. May 2019
Beneath the Surface
I felt excitement throbbing in my head, and nervousness fluttering in my stomach. Tonight, I was going to pilot a foot care station in the free clinic where I volunteer. The clinic hides in plain sight of downtown Boston, filled with people seeking sleep on its vinyl floors. I had come to know some of the regulars; however, I had not been able to really engage beyond the surface.
As I began to lay out the towels, fill the buckets, and prep soap and creams, a figure that usually sat in the back of the room meandered over.
“Is there foot washing tonight?”
His reserved voice was returned with a nervous timber from mine, and an offer to also rub his feet if he would like. I sensed his reservation and a tone of exhaustion taking over. A minute later he slid into the folding chair and began to nervously tap his hands. The fluttering in my stomach began to skip along to the same beat. I asked for permission and slowly began removing his footwear. As the laces cracked open, he winced.
“I am sorry about the smell, it’s been a while since I have been able to wash.”
Reassuring him that this was normal, I gently slid off the tight shoes and peeled back the baggy socks. I began to inspect his feet in the manner I had been taught in class. I did not see pathologies. I saw that his feet were a window into his life... cracking calluses from use without rest, tender soles from carrying a heavy burden, tinea pedis from being left out in the rain too long. I rested his well-used feet in the warm soapy water and began to gently rub, trying to push away the pain and distress that had seeped into them.
“I cannot tell you how wonderful that feels.”
A gentle silence spread between us. As a first year medical student I have been frustrated by the formalities and barriers I have sensed between my patients and me, discouraged by the lack of a medium to demonstrate how I care. In this moment I felt closer to a person than I had in weeks.
I began to ask about his daily life: where he goes, how he stays dry and safe, who he spends time with, what has been on his mind. The conversation turned into a tune between us, which carried on until the water was cold. As I finished up, I mentioned how I would be back next week and would be more than happy to help try and connect him to any other help or services he might need.
“No that was just right, that was just what I needed.”
Little did he know that was just what I needed as well.
Henry Ashworth is an M1 at Harvard Medical school interested in community health and emergency medicine. He became interested in narrative medicine through experiences with trauma-informed care and the ability for both mediums to help patients and healthcare providers connect and relate to each other.
Some Good Company
My first week on the medicine clerkship had been pleasant but mundane, with elaborate diagnostic workups revealing “constipation” and “shoes-too-tight.” Before meeting my new patient Monday morning, I typed “cirrhosis physical exam findings” into Google Images, and tried to imagine him embodying that cartoon prototype. I walked down the fluorescent ward to room 607, and upon entering observed a tan recliner overburdened by my patient. Glistening, hairless, yellow legs dangled off the edge of the footrest, with drops of clear fluid expelled onto the linoleum floor below. His protuberant abdomen commanded the room: “sextuplets in their last trimester,” he would later joke. Walking to his right side, I tapped his shoulder and asked to examine him. Without looking at me, he replied, “I’m in 10/10 pain from my chest to my toes. Do not touch me.”
Hours later, the eight white coats of our medical team swarmed his recliner. My attending expertly instructed me and my co-medical student on how to search for his obvious ascites. We gave his abdomen a whack to demonstrate the fluid wave. My patient clenched his teeth in agony, muttering, “I hate student-learners.”
Ashamed, I spent the rest of the day hiding behind my computer in the resident room. I checked off all of my to-do boxes, an ever-satisfying sensation of success.Yet as I went to leave for the night, 607 beckoned me. In that dimly lit room, my patient’s hand was violently shaking as he attempted to bring mashed potatoes into his mouth. His eyes narrowed when he saw me at the doorway. “You people always seem to arrive just as I’ve removed the lid of my tray.” I held my breath, and slowly started to withdraw from the room. His face softened, as it became clear that I was the one to be pitied. He shook his head, and said: “I’m sorry, I shouldn’t be so rude to my first real visitor. Take a seat. What do you need?”
I perched on the edge of his bed. “How’s the food?”
“I can’t taste anything anymore- the vodka burned off all my taste buds.”
I nodded with vague understanding, then asked, “So what exactly brought you into the hospital?”
He shook his head. “It’s pretty embarrassing, but basically I got stuck in my bathtub. When the EMTs came, they had to fling me onto the ground, like a beached baby seal.” He grinned, and a smile engulfed both of our faces. I relaxed into the lumpy mattress, a spot that quickly became my favorite in the hospital. With wide, bright blue eyes, he asked, “Hey, they aren’t about to kick me out of here, are they?”
I assured him that he still had a few upcoming tests and procedures, but wondered out loud why he was afraid to leave. “At home I’m about to die alone. At least here, it’s nice to have some good company.”
I am a third year student at Harvard Medical School. I am particularly interested in global and community health, and hope to pursue dermatology or internal medicine. I enjoy writing narrative medicine because it gives me the opportunity to reflect on and add creativity to meaningful patient encounters.