I limped into work one morning and, tired from the day which had yet to begin, paused when I did not recognize the name of my first patient. This likely meant that I saw him once, enough to—maybe—remember the basics of his health care, but not his name. If that sounded weird, it was the way my brain worked after twenty years of being a doctor.
I pulled up his chart and—yeah—I totally remember this guy. We had one visit, and the kidney disease and multiple abdominal surgeries, when put together, drew a memorable constellation. Yes, I remember all of his medical problems, but nothing—nada—about his name.
I reviewed our initial visit and cataloged how this patient had four, maybe five, major organ dysfunctions, none of which I could fix. The most obvious, but the one that lurked in the background, was his kidney function. At the time, he was in a zip code just north of dialysis. I stared at the computer, unsure of where, exactly, that left me.
My office note reminded me he had an AV fistula, prepped for the inevitable dialysis. He also had a large abdominal hernia that no sober surgeon would touch. He struggled to walk and had shiny, swollen legs, which hurt to look at. I sat behind my desk, not sure if I had the emotional strength to do something, anything, meaningful for this man. But, as I often did, I put on my white coat with the knowledge that my patients expected me to face uncertainty with them. I walked into his room and did just that.
Once seated, I was at eye level with a sullen and exhausted man, the one I remembered. I fumbled through some small talk, unsure what could be achieved at today’s visit. And, before I collected my thoughts, the patient uncorked a meandering story, one that was circuitous and hard to follow. Mind you, I had not figured out if today’s visit was a follow-up or a new problem-oriented visit. This fact did not matter as, once he gathered momentum, there was no stopping him.
A bit confused but aware that something significant had started, I pushed back from my computer and listened. I didn’t often do this, as I needed to take notes and prepare for what a patient asked of me. This interaction seemed different, and it was.
His story was not a tale of woe, something I heard every day. Intentionally or not, such a story was designed, in part, to elicit, “Oh my God, I am so sorry,” from the doctor. By the third paragraph of this particular story, or, more accurately, this recitation, it was obvious: this story was not about pity or sympathy. What was it about?
Over the next ten minutes, I received a mini-review of the life events that rendered this patient in his current state. Delivered without sadness or blame, it was refreshingly candid, and its honesty shined through the awkward delivery. The importance landed hard with me.
When I tried to clarify some things, my patient waved me off. At one point, he even said, “You need to know these things; that’s why I am telling you.” He stared hard at me, through me, the body language of shut the hell up. I received his message loud and clear—listen and understand—who I am and how I got this way.
When the thirty-minute visit was over, I had not been prescribed any medications, ordered any tests, or changed any medications. And, honestly, I had barely typed on my computer. Viewed through that lens, it was not typically what happened during my workday.
And yet, here is why I cannot stop thinking about this whole affair: he welled up with tears at various points in the story but did not actually cry. I felt a deep—no, profound—connection to this patient.
Had this story of survival and persistence ever been told to anyone else? I don’t know. But it was told to me, the internal medicine doctor who would be involved in starting and then stopping dialysis. To do this properly, I needed to employ humanity and compassion, and, more importantly, I needed to know this man. I did not expect it, but that’s exactly what happened when I shut my mouth, sat in my seat, and gave a fellow human being my attention. I learned far more than just his name, James.
Ryan McCarthy is an internal medicine physician.
