Look. Look as far as the eye can see. And when you have done that, look again. Do you see the hills? Or do you see the sea? Do you see the heads of skyscrapers so close they make the outline of mountains? And if you look beyond that, do you see white cotton candy dancing across a baby blue sky?
What do you hear? Do you hear the sounds of moaning? Aches and pains? Or do you hear the eerie silence of one struggling to speak?
Here I am sitting on the window ledge in a hospital room. There are three patients here. One is my grandmother; the other I have not seen; the other seems around my age. The latter is crying in pain. She is in a sickle cell crisis. I cringe. I wonder, how can I allay this agony?
I look at my grandmother. And let me tell you, if I did not know the goodness of God, my tears would gush like the hydrant’s water. A week before, my grandmother had a massive stroke. She could no longer speak. She lost sight in her right eye. She could not swallow. She could not walk. And she lay there in the bed, still, but aware that I had walked in. And she knew who I was. She could nod her head, and she could squeeze my hand. So, I swallowed the tears before they reached my eyes and spoke through the lump in my throat. I greeted my grandmother, smiling through my mask, prayed with her, sang hymns and read the Bible with her.
From this day on, I did my best to visit my grandmother every day, and we would go through our routine. Her speech was improving, but her strength was waning. Her grip weakened by the day. I had trouble reconciling that with the report from the medical team that the physical therapist was working with her.
In fact, I asked my grandmother, “Did they take you out of the bed to walk?”
With preternatural clarity she said, “Nooo.”
And to my follow up: “So you mean to tell me they are lying?” she resounded, “Yes!”
I laughed to myself. But, I wondered how can I trust a medical team that cannot give an honest report. These emotions were intensified as they insisted on performing a percutaneous endoscopic gastrostomy (PEG) after my grandmother started regaining the ability to swallow. The team went as far as to decrease the feeding for my grandmother’s nasogastric (NG) feeding. Thank God, my mom is a registered nurse, and realized the feeding was being decreased. Soon, she found out that without our consent they signed my grandmother up for a PEG and thus stopped her feeding. But upon my Mom’s realization, the team had to taper up the feeding.
I even recall when a doctor came in with a medical student to place a new NG tube in my grandmother.
The doctor told the student, “Let me show you the technique.”
Yet, this physician moved with no finesse. My grandmother started bleeding through her nose.
When I pointed this out, the physician quickly remarked, “No. There is no blood.”
But we all saw the blood tainted mucus flow lateral to my grandmother’s philtrum. Ultimately, no NG tube was placed, the medical student saw poor technique, and I felt jaded and burdened. Jaded because the field I was about to enter was failing my grandmother, and burdened because I would have to do everything in my power to be the best physician I could be so that my grandmother’s story would not be the testimony of my patients. This would be my motivation to master my material and deliver the highest quality health care.
In experiences like these, I am reminded of the humanity of medicine. When I pray, I pray that systems are in place to avoid and minimize error. I pray that the medical team is empathetic. I pray they remember that empathy is not about how they feel, but how they make their patients feel. I pray that they will look. To take a moment to pause and consider implicit biases and determine what they see. I pray the hospital environment is conducive to healing and growth. And I pray that even though the stroke may have taken my grandmother’s speech, the medical team would have still heard her speak.
This is what patient centered care is about: the practice of medicine through the perspective of the patient, the pursuit of wellbeing with patients as the tour guide, an experience where healthcare providers ask their patients: “What matters to you?” It is a place where the white coat facilitates humility not hubris, a place where patients’ family members can walk in and see hope, feel assurance, and know the best has been done even if death is at the door.
As a prospective physician, I purpose to engender trust by being professionally personal and honest. I endeavor to see my patients as individuals full of culture, experiences and personalities as unique as their fingerprint. And I will remember my grandmother’s story. I will look. I will see. I will hear. I will be.
Note: My grandmother died 17 days after this encounter. It was May 10, 2021, the day after Mother’s Day.
Image credit: “Downtown Manhattan New York Skyline – Desktop Wallpaper edition” by caruba is licensed under CC BY-NC 2.0