Tuesday, April 23, 2013

What's in a Name?

When I was a resident, I had a very interesting and unusual patient, CH.  She had very little wrong with her medically, but she needed a lot of medical care, and there were days that I honestly dreaded being her care-giver.  I was reminded of her today when I received a message from a patient that included the comment that my name was M-D, MD, "Cute."  CH was the only other patient who has ever mentioned that to me.  Immediately, I flashed back nine years.

I first met CH during my first year of residency.  She had become a regular patient of one of my senior residents, Dr. T.  At time she was homeless and without resources.  He happened to be working in the Gyn ER when she turned there looking for help for a minor medical problem.  They connected, and he started letting her stay there when she was in need and the place wasn't busy.  Eventually, her life got a bit more stable, but she was stuck to him like white on rice.  I worked with him for several months out of my first year, and so, inevitably, I became acquainted with her but had little real contact.  She needed him for support, and not the kind of support that physicians in training, who are focused on the medical side of everything, usually have on the mind.

And then, like all residents, Dr. T. graduated.  As his graduation approached, he warned her that she would need to pick a new doctor and gave her a list of the people with whom he had worked and thought she might like.  She looked at my name and decided that "M-D, MD" must be a sign and chose me.  I was not excited about this.  She was notorious for showing up unannounced anywhere Dr. T. happened to be working.  I was busy and focused and didn't need the extra work.

Our first few meetings were awkward.  I couldn't figure out what her actual medical problems might be, and I couldn't figure out why she needed to be seen so frequently.  To make matters worse, though she had an appointment for the first visit or two, soon thereafter, she started to show up every afternoon I was in clinic and create a stir by demanding to see me.  I admired Dr. T. and wanted to do right by him but couldn't bear the thought of seeing this woman.

My dedication to Dr. T. won out and I kept seeing her.  Eventually, the clinic staff just knew that she was coming and didn't argue.  I had at least twelve patients booked every clinic afternoon and adjusted my practice to get them seen and still have enough time to talk to CH for a while, usually half an hour or more.  I eventually set some boundaries and got her to come later in the day so that I could get most of my work done before she arrived.

I learned a lot about her in the three years that I was her doctor, and very little of it had anything to do with her medical history.  I learned about her childhood and younger adulthood. I learned about the challenges she faced throughout life.  I learned about how she had become homeless, and I watched her slowly climb out of homelessness.  I learned about her love for literature and writing and her desire to go back to school and get a masters in fine arts.  I learned about the difficulty acquiring Chapter 9 housing so that she could move out of the shelters.  Later, I learned about her hatred for the kind of life she was living in Chapter 9 housing.  I learned about the frustration of the public medical system when all you need is dentures to replace the teeth that were pulled because of damage from your history of binging and purging and it takes years to get them.  I learned about the trials of taking the bus from Long Beach to the East Side of LA every week to see your doctor.  

Above all, I learned from her how to be a better doctor.  I learned to set side my curiosity about how I could help from a medical standpoint because she helped me understand that sometimes helping doesn't always mean doing something.  In fact, I did almost nothing medically to help her.  Over three years, I managed to work the system to get her bone density checked and kept her up-to-date with her pap smears and mammograms.  Other than that, I was just a sounding board, an empathetic listener at times when there was no one else.

When it was time for my own graduation, saying goodbye was hard.  I wouldn't miss the stress of trying to cram so much work into so little time in order to create space to talk to CH every week, and yet, I cried a little.  We had a connection.  Moving ahead with my new life, I thought about her a lot at first but less as time moved on.

Fast-forward to 2011: letter arrives in the mail shortly after I return from maternity leave.  An update from CH.  She has completed her MFA.  She is doing well.  Life is good.  So much has changed for both of us.

It would probably come as a surprise to all of my friends from residency for me to say that my time with CH was one of the most valuable parts of my training, but six years later, I truly believe that.  She taught me so much about the importance of listening and empathy, and she forced me to learn how to provide that kind of attention while at the same time providing quality care to other patients.  Largely because of her, I can stop the business-as-usual of medicine and be present for a patient with other needs and then re-engage to provide the medical care other patients need and still stay--at least relatively--on schedule.  Most importantly, I have learned when to stop being such a "doctor" and start being a "supporter."

Who knew having this name would get me here?

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