There are two framed pictures above my desk. One is of three trees on a green line of grass and the other is a group of buildings with smoke billowing from the chimneys. Both were drawn for me by a patient named Michael. The drawings aren’t very good. It’s just crayon on printing paper. There aren’t any white spots left on the page but you can tell exactly when Michael got tired of meticulously coloring in the sky. I also think he might have lost his red crayon at some point while coloring the bricks of his buildings and had to switch to a slightly different color. Honestly, the drawing are pretty terrible, but I love them, because Michael drew them for me. He signed them, and he gave them to me like they were his rendition of The Starry Night and Café Terrace at Night.
One more thing I should probably tell you. Michael is 49. He’s also schizophrenic, and sometimes aggressive and violent when he’s hallucinating, and he may have been one of the many patients that have taken a swing at me. I’ve honestly lost track of all those.
Oh, I’m sure you were imagining me working with some sweet little 5 year old who came in to get his check-up before starting kindergarten and that we talked about his big boy class and his new backpack but those who know me well know that I want no such contact with small children.
I spent three years of college working weekends at “The Pen” or Peninsula Hospital for those that didn’t work there. I spent 12 hour shifts as a counselor/psych tech on the floor working with our patients. In that time I learned a lot of things, like how to make a shank out of a toothbrush, good places to inject heroin if I didn’t want it to be noticed, which halfway houses allowed you to smoke on their back porch, and how to get bitch-slapped and still manage to walk a patient into the “time away” rooms. At this point you’re probably thinking that my job was terrifying, and sometimes it was. There were really good days too though. There were days I learned how effective the 12 step programs of AA and NA can be; I figured out how to do a motivational interview long before anyone told me there was a name for what I was doing, I learned that sometimes you can break someone’s pending anxiety attack by talking about their kids or where they grew up. Most importantly, I learned how to talk to patients like people, not patients.
Almost every time Michael came in to the Pen, he was suicidal and off his meds. He would cry and tell me about things that he had done wrong and people he had hurt. Sometimes these people were real, like his mother who he yelled at and his counselor in outpatient that he threatened; sometimes they were a product of his delusions or hallucinations since he stopped his meds. Whether his wrongs were real or not, however, they were real to him. He felt that things had happened so he wanted to talk to someone, and he was always sad if no one was there to listen. Sometimes I listened and made things better, sometimes what I said didn’t help at all. One day after he was feeling more like himself, he came out of the bathroom with his curls all wet and combed back on his head and asked if he looked nice. I told him if he were 30 years younger I would take him out myself, and he beamed for the next hour.
So at this point I have rambled on for about 500 words and you’re thinking that you’ve heard Michael’s story and it’s all very sweet, but I should just get to my point. All I’ve done so far is talk about Michael and his pictures. That is the point though.
Each patient has a story. It doesn’t matter if your patient is angry, homeless, uninsured, or psychotic. This person is your patient, and as long as you keep them alive, they are a person. As a doctor, people will literally put their lives in your hands. It doesn’t matter that you’re busy or that you think they won’t notice if you ignore them. Talk to your patients. Get the “patient’s perspective of illness” that everyone keeps referring to. Be the doctor that your patients would want to invite over for Sunday brunch and send the rest of their family to visit.
If you miss your patients’ stories, you miss the most important part. You miss knowing that Michael’s yard had three trees in it when he was younger or that he lived in a big city where a lot of the buildings blew out smoke. You miss knowing that talking about his mother when he’s angry only makes him angrier or that coloring is a way for him to calm down. You miss that he dropped out of school and he “doesn’t read so well” and that sometimes makes it hard for him to keep all his medications straight by himself and that when he gets really lonely he also gets really sad and that’s when he thinks about suicide.
Can you imagine what you could learn from just an extra 10 minutes? It won’t be every patient that you get to talk to for long, or every patient that sticks with you like Michael has with me, but it’s important to know that these patients exist and that you will never know who that patient is until they have made a lasting impact on you. Take every opportunity you can to not just see a patient but a person, and remember that you are not just a doctor but also a person yourself.