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Saturday, July 6, 2013

Even an MD can learn a thing or two from their patients

On my twitter feed this morning: "Some nurses enter your room to look at the monitor & collect data. Others ask how you are. What kind of teacher are you?" Got me thinking I should post the talk from Dr. Amy Cowan at my grandmothers funeral a few weeks ago. One of the finest talks in any setting I have had the pleasure of hearing in person.

"I first met Jeanne last year in clinic. It was the beginning of my fellowship in geriatrics and the prior three years of residency had left me tired, worn out and slightly suspicious. I was used to sleep deprivation, long days on my feet in the hospital and keeping an objective distance from my patients. This distance I believed would protect me from disfiguring heartache. It would legitimize me as a physician and keep my life perfectly organized. Work over there. Personal life over here. I failed to realize the human connection I had with my patients was part of what gave my work its meaning. My failures were overlooked by Jeanne. She saw it instead for what it was...a learning opportunity. Over the course of a year Jeanne would start out as my patient, become my teacher and later a member of my chosen family.

Before I ever met her I could hear her laughing. A distinct chuckle coming out of Exam room 3. I walked in to find a trim, once tall woman, shock of curly white hair, blue eyes, long denim skirt, navaho belt and turquoise jewelry. There was something in me that recognized something in her. Any flicker of recognition vanished as she told me in a dismissive voice, I wasn’t exactly what she was expecting.
“You aren’t a short, fat man, honey!” And just like that we both burst into irreverent laughter. And just like that there was a crack in my medical armor.

Like any patient she had concerns and requests or so she claimed. She used to tell me that we met for a reason. That she came to the VA to find me. I didn’t really understand this until she died. It wasn’t meant as a compliment. In addition to completing her tasks with friends and the church, waiting to say good bye to her grandson Zach and embracing her beloved daughter with all she had, Jeanne also left a legacy with me. Jeanne let me fail as her physician. When I could have been listening, I was typing, my attention focused on a computer monitor not on the patient. When I could have asked her how she wanted the end of her life to be, I ordered tests and wrote prescriptions. About the only thing that she considered useful was a sheet with a few hand written suggestions about symptom management I had once given her.

With time and more practice I began to ask the questions I hadn’t asked. I became a better a listener. I slowed down. I turned away from the computer. I turned my iPhone to silent mode. I made eye contact. Clinics became less frenetic. There was less of me driving a snow plow pushing my agenda and more asking my patients what was important to them. There was also more laughter, story telling and once even an impromptu poetry reading in Geri fellow clinic B. With the increased connection there was more depth, more joy and meaning. Jeanne once told me to know rich joy, you have to taste sorrow. She was right. If my eyes welled up with tears, well so be it.

In the listening I became someone better. It wasn’t just ordering the correct diagnostic test or consult, but I started to ask myself how did I make my patients feel? Did my patients leave feeling small? Overwhelmed? Frustrated? or were they empowered, did they feel worthy? Over the year, Jeanne was content to let me progress at my own pace, but she wasn’t about to give up her independence or integrity for cancer, or because some young VA doctor thought it best. Jeanne egged me on to listen and then go teach other doctors how to do the same. Up until her death she continued to make discoveries about herself. Perhaps we both did in parallel. I learned how to be more present for my patients from Jeanne.

I wrote the following after one of my last home visits with Jeanne.

I kick off my shoes and pull an extra pillow to tuck under my neck as I make myself comfortable next to her on the bed. Each time I see her there is less of her. Her physical body continues to dwindle becoming almost transparent, as if held up to the light one might see how the mechanics of a heart or lungs work. The pink bedspread separates us from each other, but not the immodesty of death. And hers is looming. The sides of our heads touch. Her shock of white hair stands on end. My long brown hair a reminder of the room’s vitality absorbs what’s coming. As she talks her left hand seems so large compared to her frail body. She moves it about like a conductor leading an orchestra, while her wedding ring slides around her fourth finger. Her voice is quieter, conserving but not constricted. She’s not slowing down in what she tells me. There are discoveries to share, scripture passages to quote, jokes to retell and gratitude to make testimony of. We lay next to each other imagining that we are camping and the Milky Way is stretched above us. Her boney legs crossed, our hands, mine full and fleshy holds her nearly transparent one.

It’s in this simple moment that I see the progress that’s been made for both of us. She quietly reminds me to teach other doctors how to listen. Perhaps I had to go through the sleep deprivation and the isolation of medical training to be able to be exactly where I am today. Residency was instrumental in my preparation, but hardly adequate and Jeanne recognized this. I had to learn who I truly was before I could be present for the people in my life now.

Here I am on an island of a bed holding hands with an elderly woman slowly leaking urine, a pelvis full of tumor, laughing about her expression about not giving a big bird what anyone thinks. “Bury me with a fork honey,” she says. “Why?” I ask. “Because everyone knows that life is like a buffet! You need to bring a fork, because the best is yet to come.”

No matter your educational level or age you will still learn. Sometimes the best lessons are the ones the students teach.

Great writing, but an even better story that everyone can learn from. Thank you Dr. Cowan and especially thanks to my grandmother Jeanne Lawler.

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