On showing, not telling (or a meditation on compassion)

On Friday, a fellow student told me that I made an impact on a med tech. They told me her name, but I couldn’t quite remember her. I am sure I’d recall her face, though.

She wanted me to know that saying hello in the mornings meant a lot to her. She and the other techs thought that we were a friendly group of medical students and sad to see us leave. This sits oddly and well with me.

This sits oddly because I feel like this is such a low bar for friendliness: saying hello to colleagues. That said, I see how this act of compassion and acknowledgement can stand out among the crowd. Physicians, especially residents trying to both learn and perform medicine at the same time, have many demands for their time, attention, and patience. The hierarchy below can seem invisible to those up high, and those toward the bottom of the totem pole feel the effects of social stratification most strongly.

This sits well because I didn’t even recall doing this. I do remember greeting the familiar faces every morning, even if I had to look at the staff photo-board to relearn their names. I don’t think it took significant effort on my part despite an impression on those around me.

Additionally, on Friday I saw the most adorable patient-physician interaction.

My attending, Dr. Mishriki, made rounds on new patients admitted to the teaching service. This one elderly patient was described in her chart as ‘pleasantly demented’ and after a lovely solo interview and physical exam, I agree with that assessment. She seemed joyful to talk with me and followed my line of questioning quite well, despite being unable to remember much about the past few weeks or specifics of her past. She cooperated with my physical exam to the best of her ability, despite having a soft-cervical spine collar to protect her rigid neck.

A conga-line of Dr. Mishriki, three medical students, two interns, one third year resident, and a pharmacist walked into her dimly lit room around 10a, with breakfast uneaten on her tray and herself upright and seemingly ready to begin the meal. Dr. Mishriki took his time interviewing her, ever patient and careful while trying to learn why she presented to the emergency department with an altered mental status. He proceeded to the physical exam, carefully checking her hands and listening intently to her heart for any aberrations from the normal lub-dub.

Before concluding the interaction, Dr. Mishriki asked her if she wanted any syrup on the short stack of pancakes in front of her. “Dry pancakes are a terrible waste, in my mind,” he said to her with a wry smile on his face. He proceeded to carefully and methodically cover them with an even coat of single-serving maple syrup. It seemed natural to him, like an older son caring for an infirm mother. With the history and physical gathered and the meal prepared, he handed her a knife and fork and wished her well.

The what of medicine is relatively simple: what are the presenting signs and symptoms for gastritis? What are the lab values associated with hemolytic processes? What are the findings on imaging for lobar pneumonia? Read a lot and you’ll eventually soak up this huge body of knowledge. Or enough that you won’t hurt anyone.

The how of medicine is soft and wuzzy. How do you talk to a patient if they are upset with their husband, who is sitting right next to her? How do you care for a person who is circling death, but refuses to talk about the subject with palliative care? How do you have meaningful interactions with patients, if you do not make the time to greet your colleagues in the morning?

So far, the answer seems to me as simple as caring with compassion. Care for yourself so you have the energy to give. Care for your team because you are in this together. Care for and about your patients because they depend on you.

Now, let’s see how long I can keep this up.

Long Form Sundays

On Death Podcast

16 thoughts on “On showing, not telling (or a meditation on compassion)

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