Tuesday, May 1, 2012

The Interview

A few years back, my wife and I were sitting on our living room couch watching the local evening news when a segment ran regarding a patient's option, often neglected, to interview a physician prior to agreeing to receive care from that particular caretaker. The interview, the segment continued, could involve questions ranging from professional training to personal attitudes and outlooks on life. Not a bad idea, I reasoned, if the required care was non-emergent. A physician sharing a similar perspective of his patient's well-being could only be beneficial, right? But in an emergency room setting, wouldn't this type of interview only delay necessary treatment? I couldn't imagine a patient with crushing chest pain taking the time to ask me of my residency training (Upstate NY) or how I felt about fitness training (all for it).

Of course, I was wrong. My following shift, I encountered an older, scholarly-looking gentleman who had presented to our department with complaints of acute abdominal pain. After introducing myself to both himself and his wife, I began to ask the patient important history questions when he suddenly interrupted me.

"Doctor," he asked, "before I agree to let you treat me, can you tell me where you went to medical school?" Although surprised, after watching the news segment just two days earlier, I anticipated that an encounter like this would eventually happen. "In Philadelphia," I answered. "And where in your class did you graduate?" "In the top ten percent," I replied. His questions kept coming. "And where did you complete your residency?" "Did you serve as chief resident your final year?" "How long have you been working in this emergency room?" As I patiently answered his questions, I began to wonder if the word "acute" was the right word to describe his abdominal pain.

Finally, though, he appeared satisfied with his interview. "Okay," he said, "I give you permission to treat me."

"Well, sir," I said, deciding to turn the tables on him, "I am not sure I want to treat you." I caught him off-guard. He looked inquisitively at me as I paused for good effect before continuing. "I have one question I want to ask you before I agree to treat you."

"Okay, Doctor," he said, "what is it?"

I took a deep breath and smiled as I spoke. "How will you be paying me for your visit today?" We both laughed. Regardless of his answer, he knew I would be his treating physician.

I hadn't thought about this encounter until just recently, after I had walked into Room 17 to introduce myself and examine a patient my resident was currently treating.

In the dimly-lit room, I found Bertha, alone without company, lying in a cot with hospital blankets pulled up to her chin. She was a 93 year-old woman sent to us from a local rehabilitation unit with complaints of chest pain. She had been placed there recently to recover from a bout of pneumonia. Bertha looked her age, appearing frail in size, her tiny body barely poking it's physicality into her covering sheets. Her face was graced with creviced wrinkles and framed with an unkempt gray bob. Her hazel eyes, however, belied her years. They were fierce and focused, guarded even, glistening with anticipation as I approached to introduce myself.

"Hello, ma'am," I said, reaching for her hand under her covers, "my name is Dr. Jim and I will be following your treatment today with Dr. Brad, one of our resident physicians who I am supervising."

She looked me carefully up and down as I continued. "Is your chest pain gone?" She nodded yes to my question. "Do you need anything right now?" She nodded no. "Is it okay, ma'am, if I listen to your heart and lungs?" She nodded yes.

I pulled my stethoscope from around my neck, placing it's diaphragm on her chest wall while inserting the listening buds into my ears. While bent over her and listening, I watched her face closely, appreciating her unique eyes. Suddenly, though, her lips moved. Unable to hear her, I stood up while removing the ear buds. "What is that, ma'am?" I asked.

With a soft, quiet voice, she asked me "Where did you go to medical school?" I told her. "And where did you do residency?" I answered her again. "Do you enjoy being a doctor?" I told her yes, very much so. I wasn't sure if another interview was in my future, so I flipped the coin on her.

"Why do you ask, ma'am?" I questioned her. "Did you once work in the medical field?"

She shook her head. "No, I didn't. But my daughter was going to be a nurse." I waited for her to continue but she seemed absorbed in her memory. "What happened?" I finally asked, my curiosity peaked. "Unfortunately," Bertha answered, sadness sweeping across her face, "she wrecked her car late one night while driving home from a training shift and died. She was nineteen."

I grabbed Bertha's hand again and held it, humbly reminded that every face I encounter holds a story. And quite honestly, I could not even begin to imagine the pain that would come with losing a child. "I'm so sorry," I said, stroking the back of her hand.

"Don't be," she said, "I still had a wonderful life." She went on to explain that she had six children total, four of which were still alive but unfortunately not nearby geographically. This explained why she had been placed into a rehab unit from her assisted-living arrangement while recovering from pneumonia. "They are here, though," she said, lightly tapping her heart with her free hand.

After another pause, I had to ask my next question. "What happened to your other child?" "Oh," she answered thoughtfully, "we had a retarded son that died in adulthood. My husband and I managed to care for him at home until he passed." She went on to proudly explain that it was no small feat to raise a mentally-challenged child in earlier days--that most were institutionalized. "And your husband?" I asked. "Well, he and I were married for 53 years before he passed away. That was quite a few years ago. But, we managed to stay together and keep our love the whole time." We talked a few more minutes, her insightful words leaving a significant imprint upon me.

Finally, I finished my exam. Before leaving her, I thanked Bertha for her time and for sharing her life story with me. Happily, she did very well for us in the ER and was admitted to observation.

Just returning from my recent unplanned medical leave, I felt Bertha's story grab my shoulders and shake me. Not just shake me, but rattle my soul. My encounter with her was a well-timed reminder of just how privileged I was to be an emergency physician.

And suddenly, it dawned on me. I was the one who benefited most from the interview process with a patient. Sure, there is history-taking involved with my job, to find out the specifics of an illness that might help me provide the most focused and complete care to a patient. But this other "stuff," this personal information that a patient shares with me, isn't this more like an interview? I don't necessarily need to know everything a patient shares, but doesn't it all provide a much more complete picture of the person I am trying to help? And, besides, can't some of my patients' shared life experiences help me along my own life's journey?  

A resounding yes and yes, if you ask me. I think I'm going to call the local news station and thank them for their meaningful segment...

As always, big thanks for reading. Also, a HUGE thank you to all the personal emails and posted comments from my last posting. Your warm welcomes and kind words are greatly appreciated. I have some of the coolest readers ever...