Real World Reflection: Learning to connect with medical patients
Alvernia senior Dylan James completed an internship at the newly opened Oakbrook Health Clinic in the fall of 2015, serving the residents of a severely poverty stricken area of the City of Reading.
Every household in Oakbrook is below 80% of the average household median income in Reading and 93% of the households are below 30%. That means that a family with a single mother and two children has less than $20,090 in household income.
With his eyes on medical school, James chose to intern at Oakbrook because it was a good fit for his future plans to serve local, low-cost primary care needs, and was only a short drive from campus.
None of the names in his reflection (below) are real.
I guess the best place to start would be Linda.
On my second day of work, I was sent in to see Linda and take her patient history, something that still put me out of my depth at that early juncture (it still does, but not to the same degree). Linda was a regular, diagnosed with everything under the sun and bound to be diagnosed with whatever she wasn’t already diagnosed with at some point in her life, if not by a doctor then by herself. She spoke a unique sort of fractured English in which she put emphasis on any uses of “the” and dragged out the last syllable of every sentence (“I have THE painnnnnnn. It’s in THE left armmmmm.”) Within five minutes she began to mention her crippling depression, within ten her suicidal ideation, and within fifteen was sobbing. She drew me into a hug, and I drew myself inwards and attempted to piece together why I was doing this. I’ve always been a worrywart about rules regarding peoples’ personal lives in an official setting; not so much the “legality” of it, but the morality. By what basis was it okay to send in an untrained person to hear the very private life story of another individual for educational purposes? Isn’t that, on some deep-down level, callous?
Every sit-down with a patient is like that. You’re trying to ask pertinent questions regarding their health, but before long you end up as the shoulder to cry on, or the witness to inner turmoil, or just the person who needs to be there to facilitate the patient’s venting. There’s a funny sort of cognitive dissonance to the whole thing. You’re sitting down with them in this very sterile and clean environment, specifically designed to be absent of personality and set up for maximum efficiency, while they pour out the dirtiest and most emotional facets of their lives. Before long the whole notion of separating the “medical world” of clinics and hospitals from the “real world” just dissolves because you can’t possibly reconcile the two as different; it’s a comfortable illusion, almost set up more for the patient than the provider.
Coming up with ways to cope with stress was also a fun activity. I had this crazy idea in the early weeks of working at the clinic that I should be doing something to separate that world from my own; build back up the illusion to prevent myself from thinking about the patients too much, their plights and crises. This idea came from the fact that I was losing sleep at this point, being kept awake by a few specific patient interviews. After a close friend knocked some sense into me and made me realize that the whole idea of compartmentalizing my life to minimize thinking about patients is something that can only eventually lead to a disaffected hardening of my outlook towards everything (which I thank him for), I gave up that tack and switched to something else, or four. All kinds of dumb little rituals like journaling and cataloguing emotions. But eventually I figured out the trick: it’s to not resist. You don’t look for ways to combat the stress, you simply let it happen. You let every patient break your heart.
The doctor who I was interning for remarked that my taking of patient histories improved over the course of the semester. I don’t attribute that to practice because I know the exact moment that the improvement happened. It was when I finally surrendered to the deluge and let it flow over me. It’s this odd blissful feeling, a kind of attached detachment, with gaze focused outwards rather than in. More of a Tao thing than a Zen thing I suppose.
We talk about growth a lot in relation to experiences like these, but I’m never sure what type of growth I’m supposed to be undergoing, or what to even look for in that regard. Sure, there was a lot of growth vis-à-vis the objective, medical side of this internship: learning proper patient history procedure; attaining proficiency in hypertension, diabetes, asthma, and hyperlipidemia; looking for patient cues that could indicate different diseases; etc. But I almost feel like the change in mindset and proper understanding trumps that in some ways. People have always walked up to me in public settings and started talking to me about their life for as long as I remember, but now I know how to respond to them. I can better be the ear that they so obviously desire, and maybe even a mouth to form words that could be useful to them.
Because really, that’s what this is all about in the end. It’s not about me, it’s about Linda and her omnipresent aches and pains, and Julio with his uncomfortable iron rod in his leg, and Yolanda who’s already quite an elderly lady but who comes in with her even more elderly mother, and Terrence with his gigantic head gash and paralyzed left side, and Charla with her two healthy kids, and Matt who’s honestly really quite rude, and Emily who really needed help finding a counselor on her insurance plan and who we finally did find one for in a triumphant moment (albeit one not in the county), and Henry who comes in with a bloody rag which he hands to me before disclosing that it’s a specimen of his semen because – by the way, he forgot to mention – he’s having blood in his semen. It’s this constantly rotating cast of characters that take precedence here. They’re still rotating even now, their faces taking turns for top billing in my head. I don’t think I’ll ever forget them, and I don’t want to.
— Dylan James is a senior biology student at Alvernia University.
