In your eyes

I just saw the French film "The Butterfly and The Diving Bell" which is among the most beautiful movies I've ever experienced. For anyone who doesn't know, it's the story of a man who has locked-in syndrome and can only communicate by blinking one eye. So I got to thinking about how patients communicate, or are treated by myself and my colleagues. I cannot tell you how many times I've watched a doctor or nurse enter a patient's room in an intensive care unit, and assume that they cannot hear what they are saying. I have heard flippant conversations about people spoken literally over their bodies. I have also seen much more respectful and respectable acts. I have seen hospital transporters carefully lift a hand of a patient on a stretcher over a chest to make a patient's arm more comfortable. I have seen patients try to express themselves despite a tube in their airway. I have seen patients with Brocas aphasias unable to find words but understanding everything said to them. And I have seen patient suddenly erupt in anger as they begin to process a new diagnosis- one patient even called one of my early mentors a "bitch" even though she was very thoughtfully and patiently discussing his care. In each of these scenarios, the common theme is the struggle to convey thoughts and feelings about the most difficult topic: one's health.

The truth is, doctors do receive formal training in these topics. I spent countless hours with mock patients counseling them through bad news. I spent an equal amount of time in my own clinic in residency actually breaking that news. I never took these moments lightly- when I had to look someone in the eye and let them know that, on that day, their life was changing forever. And there was always a moment, after I did my talking, of silence. A lot of doctors are uncomfortable by this silence- but even 60 seconds of silence gives a patient a moment to consider what has transpired- a moment to feel. And then, after that had passed, I would take a deep breath. Sometimes anger would follow. Sometimes tears. But most often, I was impressed by how brave people are when they need to be. Like the hero in "Butterfly," who when confronted with an impossible situation rises above it to learn to communicate and express himself, many patients are more than capable of doing the same. But will doctors allow for that crucial minute of silence that enables them to do so?

This chapter is insightful http://www.actabiomedica.it/data/2008/1_2008/wilde_menozzi.pdf and touches the issue gracefully. I read materials like this in medical school and they helped me tremendously. But what helped me most of all was taking that deep breath, and looking into a patient's eyes, waiting patiently for what transpired, and being willing to roll with whatever came my way after that moment passed. Close your eyes and imagine a moment like that. Maybe your 50, or 90- and someone tells you that you are sick. Someone tells you that you are going to get sicker and may or may not recover. Do you want them filling the next moments with forced empathy? With words or encouragement? Or do you want a moment to breathe- and to go deep inside your self. Maybe even just to blink.