Choosing to be vulnerable” in-Training, the peer-reviewed online publication for medical students

It’s morning outside, the sun barely kisses the horizon. The curtains were drawn in an attempt to force out any light from the room. But a faint sparkle comes through the curtains, illuminating John’s face. Or what his face should be, at least. He’s pulled the slack off the crisp, white hospital laundry and holds it taut from his toes to his forehead. A backpack is open on the chair next to her bed, full of loose papers and tattered clothes.

“John?” I invite myself to stand next to his bed. “Are you awake?”

The hospital has a knack for turning its visitors into light sleepers, and John is no exception. As I suspected, John is awake. He slowly loosens his grip on the corner of the sheet near his left eye. Once he recognizes the green glasses resting on my half-masked face, he frees his whole head in one quick motion.

“You ask questions you already know the answer to, Sammy. It is refreshing ! Her mouth curves into a smile that comes out of her mask and reaches her eyes.

I part the curtains and pull out a chair next to him, like I did yesterday morning and the morning before. John has been in the hospital for three days, after a spike in PCP.

—

John’s first day here, I wasn’t quite sure how to approach it. The internal medicine resident had almost warned me about this aggressive middle-aged man who had been brought in for bizarre and erratic behavior outside a New York City subway station. “You don’t have to take on the new patient if you don’t want to.”

Whether out of curiosity or overconfidence, I entered this room without hesitation. It was just a few weeks into my first clinical rotation and I was ready to take every opportunity to learn and hopefully impress. But when I entered his room, I realized that I had never met a psychotic before.

“Hello,” I said quietly, barely audible above the beeping monitors in the adjoining rooms.

—

“Angel dust,” John told me when I asked him why he had been taken to the hospital.

“Before, I felt nothing. Then when I started to feel again, everything fell apart and I started using drugs to feel detached again, even though I hated it. He stopped.

“I’m sorry,” I started, unsure if those were the words he wanted to hear.

“Do you already feel like this? Alive but numb?

A moment of silence passed as I thought before my vision was blurred by tears. I hesitated to say anything, wanting to maintain a level of professionalism with my patient. But when I saw him looking at me and waiting for an answer, I noticed his eyes were starting to glow too.

Right now, the facade I had to keep seemed far less important than this patient – ​​this person – who was undoubtedly calling me for a connection. I nodded, tears starting to seep through my mask. “Yeah,” I finally said. “I see what you mean.”

Soon I heard the rest of her story, going back to her twenties. John had lived countless lifetimes, and I had the privilege of sitting across from him in this one. He remembers his time as a chef and then as a tattoo artist, his favorite tools a knife or a needle. He wasn’t that different from back then. But now, twenty years later, he has used knives and needles as weapons against himself.

We took a moment to just be before I ask to perform a physical examination. Our tears eventually dried up, but the connection I made with John underpinned every remaining interaction I had with him. He told me stories no one else on the team would ever hear.

—

I think of that first conversation as I sit across from John now. He speaks to me with a level of candor that no one else on the team has been able to unlock. He calls me his guardian angel every morning since we first met. I see that John embodies the complete opposite of everything the medical team warned me about. Far from being unpredictable and accusatory, he is gentle and cautious, even from day one. “I can tell you have a nice energy.”

—

Somehow I managed to persuade John to try to be at least friendly with everyone else on the team. He didn’t trust them like I did, but all the hospital staff no longer got yelled at or accused of stealing their breakfasts. Soon after, he was sober and ready for release. He told me all about his plans to visit friends in the boroughs and the steps he would take to stay safe, sober, and “away from bad crowds.” John left this hospital empowered to change the trajectory of his life for the better, but he also left me empowered to always choose vulnerability and connection with my future patients.

As I progress through medical school and into the next stage of my training, I will keep John and many other patients I have had the privilege of serving in the back of my mind. I’ve always known that healthcare providers change the lives of their patients, but I never expected patients to change my life so much. Taking the time I now have as a medical student to listen to patient stories builds my patients’ trust in me as a provider. I make them feel comfortable enough to share the information I need to better serve them. When I make space for patients to share their voices, they have the opportunity to process the emotions surrounding their illness; on top of that, showing up for them in this way allows me to treat my own as well. Each of my patients has allowed me to develop my ability to practice empathy, patience, critical thinking and effective communication – to hone the skills we need to encourage healthy living.

At a time when patients and doctors have more and more priorities and less time for medical visits, it’s easy for patients to feel like entries in a long list of medical record numbers. Larger patient volumes can generate more profit, but we cannot lose sight of our obligation to deliver high quality care in the time available to us. To do this, we must build and maintain meaningful connections with our patients and not let prejudice diminish our respect for their humanity. A connected life starts with breaking down the walls of cold stoicism and continues with building each other, not despite of our vulnerabilities but because of them.

Author’s note: The patient’s name has been changed to preserve confidentiality.

Image Credit: “Sunrise Through the Curtains” (CC BY-SA 2.0) by quinn.anya