Creative Non-Fiction
By Conrad Murphy
My feet found the steps and I opened the door to Harmony Health Clinic. Immediately I’m flanked on each side by a food pantry and personal care items that patients can take with them as they enter or leave the clinic. A few smiling faces looked up from desks, computer monitors, and folders as I walked through the entryway. These faces either gave up a weekday evening of meeting with friends or a tempting morning of extra sleep on Saturday to be here to work.
“Hey, how are you? How is your daughter?”
“It’s good to see you again, thank you for coming!”
New students have made it too, unsure where to go or what to do. Excitement and nervousness feel exactly the same, so just tell yourself you’re excited. A couple of patients have already checked in and rooms are waiting to be filled. Anxious hands placed stethoscopes around necks and pens in coat pockets. This must be where physicians get their poor handwriting.
With nervousness briefly placed aside, a manila folder full of demographics, chief complaints, medications, and referral notices spilled out for my first patient. Words that haven’t been seen, doses that haven’t been studied. Medical students don’t know what they don’t know. That’s what scares them (me) most. In moments we would be face to face with a patient and charged with helping to address their health without knowing even a fraction of the breadth of human physiology required to arrive at a reasonable diagnosis. It’s daunting, but we didn’t yet know that our lack of medical knowledge was a strength today.
The first patient was a new patient, a mother that cleaned houses for a living and came into the clinic to resolve a recurring rash that spanned her shoulders to her hands. We talked a little bit about the rash and spent the remainder interacting with her children and playing with tongue depressors. The attending provider prescribed a cream and an oral medication with instructions to return in a couple weeks to ensure the rash has gone away. An easy case, straightforward and clear. The mother left the exam room relieved that her kids were thoroughly entertained throughout the whole process.
The second folder was lighter than the first, another new patient. An older woman was there to establish care and hadn’t seen a physician in months. My classmate and I saw her on our own first, to gather all of the relevant information before presenting her case to the attending physician.
“How can we help you today?” The keystrokes sped up and her electronic record started to fill with the story of her health. An older woman with hypertension but otherwise very healthy. I clicked through the different parts of her note, filled in vital signs, and recorded her current prescriptions. Of all of the sections in her note, the “Social History” was the page that I spent the most time on. We found out about her stresses, recent changes in life, even her dreams for the next several years. She was looking for a new place to live and excited about seeing her grandchildren in a few weeks. She was celebrating another year without drinking alcohol and the date of her last drink was a couple months after the day I was born. After gathering our notes we left her for a few minutes to present her case to the attending physician. Only his kind eyes were seen above his mask, but his attention was fully given to us. Forgiving our missteps and scattered thoughts of our presentation he said, “Let’s go see her.”
As we entered the room he greeted our patient with enthusiasm and care. Almost immediate rapport was established as his voice reached her ears. His presence in the room was an anchor for the patient, the foundation of the room built on his assurance and demeanor. I sat silently, typing in missed details that he gleaned from our patient’s story.
As our visit lengthened the nature of the conversation shifts. Our attending probed delicately into her life and the atmosphere in the room changed. It felt as though our physician was gently taking the walls of our patient’s mind down and adding them brick by brick to the walls of our exam room. He was building something new.
“Where are you staying now?” The physician asked.
“With some friends when I can.” she said.
“Where are you staying when you can’t stay with your friends?”
“In my car.”
“How often is that?”
“Two to three times a week,” she said.
At this point in the visit it was glaring how much we missed in our initial visit with this woman. Our assumptions clouded our vision and we forwent vital parts of her history. I stood watching her explain her struggles completely to the doctor. It felt as though a heavy veil fell upon the four of us in the room.
“God has seen my suffering and will bring me through it,” she said. Tears slowly fell down her face and rested on her mask as she looked up at the physician. She, like others who have come into our clinic, walked the streets without any obvious signs of distress or worry. A transparent, heavy veil often fell on our patient with no one else to help distribute the weight. We could never know by seeing her in the grocery store or the bank that her world was slowly collapsing.
She built the walls of her life high because survival demanded it. We all may build our walls higher or lower, but their strength is constant. However, our doctor took the bricks of her wall and laid them down. He poured the foundation of the exam room floor and built a House of Hidden Suffering. A place where burdens or fears are revealed to entrusted souls and are momentarily shared between them. The Christian faith holds that God is The Great Physician. Obviously one that heals, cures, and cleanses, but to our patient it seemed that her God walked alongside her and listened to her. She was telling us that God shared her burdens when no one else was there. As care providers, we’re charged with seeing and confronting realities that the public does not. We’re charged to see what God sees. That burden struck me.
Legally, we’re required to safeguard her records behind locked doors, both physical and virtual. We forget that we must safeguard her suffering hidden in our hearts, to let us be changed by them and to respond appropriately with more than a differential and treatment plan. To be even a good physician, we must sometimes let the veil rest on us.
Walking into the clinic, my classmates and I were most worried about our lack of knowledge. Experience isn’t something you obtain until just after you need it. Although our deficits were obvious, our inexperience gave way to humility. Our minds were free to focus intently on our patient and provide sincerity if not much else. The challenge to me is maintaining that crucial focus while slowly, over years, medical knowledge and experience is gained. I often feel that every time I commit a new piece of medical information to memory, some other memory or experience must be discarded. I dearly hope that I retain the lessons I’ve learned in the house that we’ve built here.
Conrad Murphy is a third year medical student at UAMS who lives in Conway with his wife, Sarah, and two daughters, Reuelle and Reniah.