A Doctors Journal: Poems from Private Practice
Searching for the poetry of life is not just another checkbox—after documenting vital signs and recording the review of systems—to be completed after each patient visit. Rather, it encourages us to be cognizant of the human side of our patients. Or, as one doctor phrased it, “Acknowledge the patient’s underside, their soft belly side, the side they do not show the rest of society.” One of the many privileges of being a healer is that patients are willing to share this side with us. I am astounded at how often I think I know a patient, only to later learn more about this person’s “poetry of life.” It also reminds me why I love medicine so much.
In the next few Guest Commentaries, I will share some longer poems, each of which has important life lessons that we all can learn from if we focus on each patient.
THe Apologized, Twice
One night while working late at the health center in the middle of one of the worst downpours I had ever witnessed, out of the corner of my eye I caught sight of a man lumbering into our waiting room soaking wet. I judged him to be no more than 30 years old, but he walked slowly with the aid of 2 mid-thigh-high wooden walking sticks. This was towards the end of a 12-hour day seeing patients in our inner city academic primary care clinic and I remember I was longing to go home.
At 6:50 PM, the medical assistant asked me if I wanted my 6 PM patient, who had only just arrived, to reschedule. I said I’d see the patient, not knowing at the time that it was the same man I saw earlier. This was how I met Michael.
A New Patient
When I walked into the examining room, I was first intrigued by Michael’s appearance. What was most striking about him was his head of tangled hair. When we did make eye contact, I remember thinking how strikingly innocent and needful he was.
Michael’s coat was as old and worn as the library book he was reading. In his hand, he held an esoteric philosophy textbook that I imagined had not been checked out by anyone for many years. I felt bad for having noticed several old and new stains on his shirt and was slightly embarrassed to be so obviously better dressed than he was. Michael did not have control of his body, and he would occasionally twist this way and that. His mouth struggled when he spoke. He had difficulty holding his body still or making it do simple things like laying down his book, which he did when I entered the exam room.
“I’m sorry I was late,” he said, before I had the chance to introduce myself.
Suddenly filled with curiosity, I wanted to know more about him. I was surprised to learn that his parents, whom I used to take care of when I practiced elsewhere, had referred Michael to me. I remembered them as a silver-haired couple, who sat in a different room in another city 5 years earlier, telling me how they were looking forward to moving to a warmer climate in California. They spoke in passing of their only son, Michael, who lived in the city where I now worked and who had been born with a neuromuscular disorder. Although they expressed some concern about moving away, they exhibited calmness about them that I assumed was the reward for decades of successful parenting. They seemed to be confident he would do well. “Would you be his doctor?” they asked upon learning that I, too, was leaving to practice in the same city.
Checking Michael’s records, I learned that he had sought my help once before but was seen by another physician in my absence. A year earlier, a potentially life-threatening infection prompted his direct admission to our hospital, after which he underwent emergency surgery. Several months later, he was discharged from a rehabilitation unit to return home and care for himself again. So many questions ran through my head during the first few minutes of our encounter: Did his parents come to see him? Did he have friends to visit him? Did his neighbors watch out for him? Would he be missed at the mailbox if something happened and he didn’t show? I was struck then with his seemingly lonely independence.
The purpose of tonight’s visit was for a refill of an antidepressant medication. We talked about the book he was reading. He sought my opinion as to whether or not he would be able to resume a search for employment once again. Throughout the visit I was struck by how different he looked from the man I saw in the waiting room and how accommodating his behavior was to me, the doctor, the one he needed right now to get a refill for an expensive pill that helped treat his mental illness. How did he afford this medication on a disability income?
After finding samples in our drug closet of what he needed, we worked out a plan for a follow-up visit. Standing up from the stool (a doctor’s cue that the visit is over), I extended my hand and told Michael I looked forward to seeing him again. Still apologetic, he attempted to close the visit by whispering once again, “I’m sorry I was late.” Patients have apologized to me before for this very reason, and often I accept their apology and continue my day without giving it a second thought. Sensing there was more he wanted to say I asked, “Why were you late, Michael?” I was not prepared for his answer.
The Road Less Traveled
I learned that Michael relied on public transportation. This was the reason he didn’t move with his parents—the bus system where they live is nowhere near as good as the one in our city. He told me that night he had taken the number 7 bus from his apartment across town to the closest stop near our health center. He walked the remaining 12 blocks from the bus stop, in heavy rain, with the aid of his 2 wooden walking sticks. I asked how long it had taken him to make this trek down the rainy street and, without expression, he said about 20 minutes. I was shocked. This must have been excruciatingly difficult for a person in his physical condition.
At the 1996 Democratic National Convention, Christopher Reeve, the actor who suffered a grave spinal cord injury, gave an unforgettable speech. Some of what he said reminded me of Michael and his family. Reeve said, “Over the last few years we’ve heard a lot about something called family values. And like many of you, I’ve struggled to figure out what that means. But since my accident I’ve found a definition that seems to make sense. I think it means we’re all family and that we all have values. And if that is true, if America really is family, then we have to recognize that much of our family is hurting.”1
These thoughts filled my mind as I looked at Michael. If Michael was hurting that night, he didn’t complain to me, his physician. How could he not have been hurting after such a difficult struggle to get here? The image of this civil, soft-spoken, disabled man is perhaps familiar to many of us. He may have been like many men we see on a city street corner, an image that cues us to turn the other way. If our eyes meet, we are forced to face something painful we would rather ignore.
The fact that a member of our family felt the need to apologize twice for the slight inconvenience he had caused me has to touch your heart. Michael’s story represents but one of many more that go unnoticed, and that should make us weep. As medical practitioners, we have been given a special opportunity, a privilege, to share in an intimate and helpful relationship with patients from our cultures, as well as those from completely different backgrounds. In our fast-paced practices, it is easy to get consumed by busy days and tight schedules. Further, the increasing dominance of technology in medical practice creates an atmosphere that makes it easy to trivialize the need and value of the healer’s art.
As healers, what can we take away from Michael’s story? One lesson may be that cultural diversity also includes those who are different then us—and not just based on ethnicity, socioeconomic class, or religion. Those who live with disabilities are outside of my culture. Perhaps, we need to remind ourselves to listen more actively so that we may hear our patients and tap into what makes them unique individuals. If we do not look outside our culture, we may miss meeting other members of our human family. Most importantly, if we overlook the opportunity to extend our hand to someone in need, we will ultimately be the ones that find ourselves alone and unfulfilled.
Michael never returned to see me for his follow-up visit. Two years after our initial encounter, I found him waiting in another exam room on another doctor’s schedule. I asked if it would be alright if I saw him and he agreed. He told me that since we last met he had been diagnosed with a more serious mental illness and was hospitalized for several months. He was still looking for a job and still loved to read. I did my best to reconnect with Michael and urged him to come back and see me, so that I could be his regular doctor. He said he would.
When he didn’t keep his follow-up visit, I called Michael’s home repeatedly. There was never an answer, and I continue to be unable to reach him. It has been 10 years.
From this experience with Michael, I have changed my practice for the better. Now, if a patient arrives late, I think twice about asking him or her to reschedule and try to consider each individual’s story.
Richard Colgan, MD, is a professor at the University of Maryland School of Medicine in Baltimore, MD, and the vice chair of medical student education and clinical operations in the Department of Family and Community Medicine. He is also the author of Advice to the Healer: On the Art of Caring by Springer.
1.Reeve C. We, The People. 2000. The Christopher Reeve homepage. www.chrisreevehomepage.com/editorial-wethepeople.html. Accessed July 27, 2015.
Further Reading and Resources:
1.Colgan R. I’m sorry I was late. Acad Med. 2002;77(10):946.
2.Williams W. The Doctor Stories. New York, NY: New Directions Publishing Corporation; 1984.