Friday, April 30, 2010

The Golden Smile

A few years back, I met a very endearing patient. Sweet and likable. Polite and respectful. The interaction was thoroughly enjoyable, fun even, and by the time I had finished treating her in our ER, Miss Claire had wormed her way onto my favorite patient list. Maybe even into my heart.

I had walked into her treatment room not quite knowing what to expect. By the triage report, Miss Claire seemed a little off-center. She had complaints of some shortness of breath for the past two weeks. And she smoked. However, she didn't have any complaints of a recent cough or cold and denied any chest pain or recent trauma. She believed, according to her nurse's charting, that "my next-door neighbors are spraying fumes through the wall that are making me sick." Interestingly, she did have a psychiatric history, although the nurse didn't specify.

Armed with this knowledge, I slid the glass door to her treatment room open, pushing the privacy curtain aside as I stepped in. And as I did, I was greeted by one of the biggest, most genuine smiles I think I have ever seen.

Miss Claire was sitting upright in her cot, alone, just waiting for someone, anyone, to walk into her room. She didn't have a book or magazine. Her TV wasn't turned on. She was just patiently and good-naturedly waiting. And that anyone who walked in? Well, lucky me.

I held out my hand as I approached this smiling patient, feeling a very nice vibe to the room.

"Hello, Miss Claire. My name is Doctor Jim and I'll be taking care of you today."

"Hello, Dr. Jim. I'm sure glad to meet you, sir," she replied, taking my extended hand into the both of hers, warm and soft, and squeezing it gently. Still smiling.

I had a chance to take in her unique appearance as we made small talk. For being on the young side of fifty, Miss Claire certainly didn't look her age. She had smooth, unwrinkled skin, barring the furrowed creases at her lips' edges. Her laugh lines. She had dreadlocks, thickly-braided and black, pulled back from her face and tied in a loose bundle at her neck's nape. She had high cheekbones that danced and small ears that wiggled with each facial expression.

It was hard to pinpoint the exact charm of her warm smile. Her eyes, richly-browned chestnuts, were alive and sincere to the moment. Her smile itself, well, it encompassed the bulk of her face's frame. Full lips outlined her white, rectangled teeth. And the topper? She had a gold-plated incisor that sparkled, with just the slightest head movement, from the overhead lights.

Her golden smile.

I sat on the available bedside stool and got down to business. "Miss Claire," I said, "I read the nurse's notes about what brought you here today. Do you mind if I ask you a few more questions?"

"I would be glad to answer any of your questions, Dr. Jim."

I reviewed her complaints, listening to her patiently explain, again, that she was having shortness of breath, for over two weeks, that she felt was most likely due to her neighbors infiltrating her walls with fumes. "What kind of fumes, maam?" I asked. "Oh, I don't know," she said, not losing her smile, "I guess 'carvon mitoxide' or something like that. And sometimes the fumes smell like frying bacon."

On review, she didn't have a fever. Or a cold. Or chest pain. Or any calf trauma (a cause of lower extremity blood clots that can occasionally travel to the lungs). Nothing suspicious, really, that would raise my hackles to think she might have a serious illness.

"And maam," I continued, "may I ask you about your mental history?"

"Of course you can, Dr. Jim." She had a history of bipolar depression. And sometimes, she admitted, she heard voices. "But I'm on medicine for all of that," she assured me. She was not having any suicidal or homicidal ideations. She had never tried to harm herself or anyone else. She did have a counselor and did meet with him on a regular basis. With all of my questions, she proudly faced them head-on. And with a beguiling pleasantness.

She had even gone so far as to have her apartment supervisor come to her residence and "check things out." Everything had checked out fine, including a normal "carvon mitoxide" reading.

I really liked this woman. And to her credit, she was easy to like.

I proceeded with my exam. Great vital signs. Good pulse-ox. A completely normal exam, including regular heart sounds and clear aerations of her lungs on auscultation. Given Miss Claire's age and waiting time, her nurse had ordered an EKG, a CXR, a d-dimer (a nonspecific blood test that, if positive, increases suspicion for a blood clot), and a carbon monoxide level. Ultimately, the results all returned favorably.

At one point, after I had reviewed Miss Claire's EKG and CXR, I stopped in her room to explain those results and let her know that her blood tests should be returning shortly.

She was still smiling.

I decided to slow down for a few minutes and, after walking to her bedside, sat down on the vacant stool. "You know, Miss Claire," I said, relaxing, "you have one of the most welcoming and kind smiles I think I have ever seen. What a great way for you to greet the world."

"Thank you, Dr. Jim. There ain't no sense in showing the world anything else, now, is there?" I nodded my agreement at this wise woman. "And," she continued, "you seem to be smiling as much as me, sir." I thanked her back, flattered by her genuine compliment, before we continued on and had ourselves a fine ten-minute conversation.

After her normal blood work returned, I had two conversations on Miss Claire's behalf. One, to her counselor, who, upon learning I was calling on behalf of Miss Claire, said "Isn't she the sweetest lady?" Her counselor was going to follow up with her the next morning. The second call was to Miss Claire's family doctor. Although I think Miss Claire's complaints were based on a mild paranoia, I wanted her family doctor to follow her closely in the event she needed any further, non-emergent work-up, including allergy testing. The office nurse gave me a follow-up appointment, ending our conversation with "Isn't she a pleasure?" She certainly was that.

I entered Miss Claire's room one last time, explaining to her the disposition and follow-up plan. I assured her that I was quite pleased with her test results. "If you're pleased, then I'm pleased, Dr. Jim."

"I am pleased, Miss Claire," I replied, before hesitantly continuing. "It was a pleasure meeting you today, maam. A privilege, really. And whatever you do, don't ever lose that smile of yours."

After our goodbyes, Miss Claire shuffled down the ER hallway toward the exit, her discharge papers in hand. I lingered in the hallway, watching her leave, appreciating her warm greeting to every person she passed, whether it was a faint "hello" or a friendly nod of her head. Or both. I smiled to myself, watching the wonders of her kindness in action.

What a beautiful individual.

Golden smile and all.

As always, big thanks for reading. A special thanks to Dr. Kevin, from KevinMD.com, for kindly requesting and reposting one of my earlier works yesterday. I am honored. Have a great weekend. See you Monday, May 3...

15 comments:

Amber said...

I just want to say your blog is always a pleasure to read. Keep up the great writing!

Katie said...

One of my good friends has a huge smile she is always wearing to the point where we've nicknamed her "Smiley." It's really hard to be upset with Smiley... (She also has the cutest little southern bell accent that makes me just want to put her in my suitcase and take her home with me).

And I concur with Amber.

<>< Katie

rlbates said...

Wonderful!

merinz said...

A smile will always take you more places than a frown!

My Mother used to say 'you catch more flies with honey than vinegar'.

NikkiK said...

i wonder what it says about me that I kept waiting for the bad news, especially when you emphasized how much you liked her.

i'm thrilled that this story is just about her cheer. thanks for the lift!

rheumablog said...

People like Ms Claire are the best kind, I think. I love her reaction to your compliment about her smile -- and yes, she's right.
Nice post, Dr. Jim.
-Wren

Classof65 said...

There are some people who can face life with a smile, and those smiles are contagious!

However, I wouldn't totally discount her complaint about her neighbors -- meth labs have been found in the most unlikely places... or there is the possibility that her neighbors have been spraying pesticides after the ultra-wet winter. Could someone follow up with a home visit to Miss Claire's house? This may not be imaginary at all.

Karen said...

With so many people somber-faced and growling, isn't it nice to meet up with someone who is pleasant and polite. She sounds like she spreads sunshine wherever she goes. Nice story :)

Janelle said...

I just finally ran across your blog and I have to say I love it. It's very easy to get cynical in this world and you bring out the humanity in each of your patients. Keep writing!!!

tracy said...

What a wonderful post Dr. i especially appreciate the way you so kindly delt with her mental health issues...i wish all doctors were like you.

TonjiaT said...

sometimes they touch us when we least expect it.. :-)

Smalltown RN said...

Well you know doc...I have always said our patients bring something new to the table. Some challenge us in so many ways...and others like your Miss Claire just make us smile and remind us why we do what we do.

Your story is so heartfelt...I could actually visualize this woman sitting on the examination table looking around the room almost singing prior to you entering the room.

Yes it is patients like those that brighten our day and lives...thank you so much for sharing such a wonderful story!!!

Jabulani said...

What a lovely post. Reading it gave me a smile of my own. My daughter has an Eeyore toy that when you squeeze it says, "Your smiles make my frown turn upside down."

SeaSpray said...

Aww she sounds delightful! I hope her concerns resolve for her.

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