Roxana Preis - Patient-centered Ethics: Pathography

Jul 16, 2022 at 03:42 pm by pj

It was my second to last day in the Pediatric Behavioral Services unit. It never got easy to see how many pediatric patients were admitted to the unit due to their suicidal thoughts. I already knew mental health was a big issue, especially in young people, but it was impactful to see it firsthand. I witnessed patient after patient admitted for attempts or thoughts of killing themselves. Though countless of stories were heard, one encounter stuck with me and reinforced the value of simply being present.

My preceptor instructed me to talk to J, a 15-year-old male who was baker acted after telling a friend he was going to hurt himself by cutting his wrists. So many thoughts went through my mind at this point. “How will I able to help him?” “How will I convince him that his life is worth living?” “Will I understand what he is going through?” “Will he even want to talk to me?” Little did I know this was going to be one of the easiest, most honest, and natural conversations I ever had with a patient.

I went to look for J in the intake room, I introduced myself and asked him if it was okay for us to chat. He agreed. I found a quiet place so that he would feel comfortable. I started by saying, “Tell me what’s going on.” That was all he needed to open up and share his story. He told me about his struggles, emotions, past relationships, and thoughts he was ashamed of. He shared things he hoped for in his life. I sat there trying to take it all in as he kept sharing the details about his journey. My role as a medical student was to gather pertinent history for his visit, but at that moment I felt the need to stop writing on my paper and just listen. He even shared what was probably the most conflicting moment of his life. He explained that he struggled with suicidal thoughts for a while, but this time was different. He revisited the moment that brought him here with me. He explained that he had grabbed a knife with thoughts of harming himself and he just stood there for a while. He said he held the knife against his wrist feeling confused, sad, lonely, and lost. He was not sure what made him stop but he was glad he did. I was glad he stopped. I was grateful to have the opportunity to speak to him and hear his story. Our encounter was cut short by the nurse who would take him to his room where he would spend the night.

After he left, I tried to gather the few notes I wrote down. I returned to my preceptor and presented his case. For some reason it did not feel right. He talked to me about his personal emotions and deep thoughts. Presenting his story in such a formal, objective manner just did not do it any justice. That moment reminded me that our patients are more than a 2-minute elevator speech. They are vulnerable humans with an infinite number of complex emotions and experiences that should be acknowledged and appreciated. That day I drove home thinking and wishing I would have done more for J.

The next and last day of my rotation in Pediatric Behavioral Services, we started with inpatient rounds. The team went through the plan for each patient. I was eager to know what the plan was for J. The nurse started presenting his case and added “Also, he really enjoyed talking to a girl yesterday. He kept mentioning how comfortable he felt talking to her.” She looked over at me saying, “I think it was you. Were you talking to him yesterday?” I said yes. We discussed how he longed for that one-on-one interaction. Though I initially felt like I failed J, this encounter reassured me that I did exactly what J needed – listen.  In medicine we embrace the ability to treat our patients’ medical conditions and mitigate their ailments, but it is essential that we take a moment to reflect on the human who we are treating. Sometimes words are not even necessary. Sometimes just the act of being present is more than enough. As I continue my journey to becoming a doctor, I will reflect on that moment with J.  I will remind myself that there is so much more that comes with a patient than the medical conditions listed in their chart. A human is more than just a review of systems. There is a story to be heard and appreciated from every patient. It is not our patient’s job to tell it, but it is our job to welcome it. As we continue our careers as physicians, I firmly believe that we can measure how well we cared for our patients by how many stories we carry with us. A listening ear is the best tool we will ever possess.