By Jeremy Gerber
The Frist Global Health Leaders (FGHL) program affords young health professional students, residents, and fellows the opportunity to serve and train abroad in underserved communities for up to one semester. In doing so, they will bolster capacity in clinics in need of support as well as offer training to community health workers to promote sustainability upon their departure from these communities. As part of the program, they blog about their experiences here. For more information, visit our program page.
I was asking all the usual questions of Ms. Camila, a middle-aged woman presenting with dysphagia. “When did this start? Does it hurt when you swallow? Any other problems?” Our conversation was being mediated by a telephonic interpreter, as my Spanish vocabulary was limited to locating the nearest restroom and not accurately interviewing and assessing my patients. I was frantically trying to type my notes into the EMR while listening to her responses, intermittently glancing up from my keyboard to make eye contact. Amid her response to what I thought was an ordinary question, I suddenly heard her begin to sob. I quickly looked up from taking notes. Had I come across as uncaring because of lack of eye contact? Had one of my “ordinary” questions been too abrasive and insensitive? Giving her my full attention, I digressed from the course of my medical questions to ask a more personal one. “What is it that is upsetting you? Would you like to talk to me about it?” The patient declined to elaborate on the reason for her obvious distress, so we continued with our previous conversation.
I made extra efforts during the rest of our time together to show her that I cared about her problems and that we would do everything in our power to ensure that she was taken care of. I reassured her that we would rule out life-threatening and serious causes of her symptoms and attempt to find an explanation for her dysphagia. I believe that the reason for her distress was related to her traumatic history of thyroid cancer and her anxiety that her current symptoms were related to a return of her disease. Nevertheless, I cannot be certain, as she declined to share more with me. Apparently, I was in desperate need of a lesson, because the next day I had an almost identical experience with another female patient.
Reflecting on this, I have concluded that my goal should not be to avoid having a patient cry under my care. It is never comfortable to have someone tear up in front of you. Nevertheless, crying is often a healthy way to express and release emotions, and it should not be stigmatized as shameful, even in front of a medical professional. Rather, I should welcome the emotional openness of my patients. I should view these moments of intense patient vulnerability and need as great opportunities to provide holistic, compassionate service. I pray that I will not be a callous instigator of pain with my medical interviews, but that even when my careful and sensitive questioning prompts expressions of grief from my patients, I will be an instrument of healing.