Our professor was midway through his introductory lecture on healthcare systems – specifically, on how to help a patient navigate the convoluted catacombs of the healthcare system – when he was rudely interrupted by someone pounding on the lecture hall’s front doors. He paused to gawp for a moment, but the pounding only grew more insistent; the massive double doors quivered on their hinges. Dr. W looked flustered.
“Err…” He waved apologetically at the class of 150 first-year students. “Just give me a moment – “
He approached the entrance; but before he could lay his hand on the door handles, a woman burst inside – a woman wearing short gym shorts and a sports jacket, in sharp contrast to all of the medical students in ties, dresses, and white coats. Her tousled hair jutted out in all directions, her eyes were locked tight, and her face was contorted into a tearless wail.
“I need to see my doctor, I need to see my doctor!” Her eyes flitted throughout the lecture hall in obvious desperation. “Is my doctor here? I thought I heard his voice on the microphone – “
Dr. W stood motionless while an older lady, a nurse from the medical center, rushed down the aisle of the lecture hall to greet the wailing patient.
“Er, could this be done somewhere else?” Dr. W began tentatively. “We’re in the middle of lecture.”
Neither the patient nor the nurse paid any heed to Dr. W’s quiet plea. Meanwhile, the rest of the classroom simmered with poorly-hushed whispers. Some students could hardly contain their laughter. My neighbor and I exchanged incredulous looks. After numerous classroom antics (refer to my post on “Professionalism”), the pupils of Penn State Hogwarts knew better than to regard all of their classes with utmost seriousness.
We watched as the nurse calmed the patient down and led her to the front of the lecture hall. They decided to have a “private” conversation right there, since two empty chairs were conveniently ready for them.
At this revelation, Dr. W startled. He unclipped the microphone from his chest pocket and offered it to the patient. “Could I give you this microphone so the students can hear you too?”
The muffled snickers around the classroom erupted into laughter; however, the energy promptly faded away as the “patient” unraveled her story, aided by copious wads of tissues (kindly supplied by Dr. W). Her character had just been diagnosed with breast cancer, and was so overwhelmed that she had run away from the radiologist before hearing her full diagnosis.
After listening to the patient’s story, the nurse began speaking calmly, quietly, as though she were whispering a lullaby. She explained the recent advances in cancer treatment, and assured the patient that support would be available through challenging times. Most importantly, the nurse emphasized the positive aspects of the patient’s story, especially that she had a loving family who would care for her through her illness. By the end of the interview, the patient’s breathing had steadied, and she was even beginning to smile.
I had watched countless such soothing conversations before, but only this one gave me reason to sweat profusely in my seat. We would be expected to conduct a similar interview the following week, and I already knew from my first disastrous Clinical Skills class that speaking to a patient was not always an intuitive task.
At the end of the show, the actress wiped her tears on a handful of tissues and waved merrily at the audience. With the spell broken, the classroom returned to its baseline level of rumbling and whispering. Nonetheless, my mind remained restless.
How do you talk to a patient going through unimaginable challenges? Our Sorcerers’ Perspectives Scientific Principles of Medicine class is consuming the vast majority of our first semester, and yet, for all its convoluted diagrams on hypoxanthine-guanine phosphoribosyltransferase deficiencies in Lesch-Nyhan syndrome and gamma-carboxy glutamate residues in the synthesis of blood clotting factors, biochemistry doesn’t teach us how to wriggle out of treacherous patient interviews. I guess that’s why we have classes on Medical Humanities and Healthcare Systems Navigation…
One week after the wailing patient disrupted our Healthcare Systems class, I was one of the first students to volunteer to interview a standardized (actress) patient in front of my small group. The moment this lady walked into our room, I was mesmerized by her character; she spoke with a voice that was unbelievably weary, sounding as fragile as a butterfly’s wing. She had a long history of chronic medical problems, as well as family-related instability. She told me, “I feel that I’m such a burden to my family. I can’t do anything for them. I can’t cook, I can’t drive, my treatment is taking over my life. I’m such a burden…”
I was dumbstruck and tongue-tied. I didn’t know how to reassure the patient, as the nurse from the previous week had done by emphasizing the wailing lady’s supportive family. I realized then just how accurately Professor Snape had described the essence of Medical Legilimency:
“The mind is not a book, to be opened at will and examined at leisure. Thoughts are not etched on the inside of skulls, to be perused by any invader. The mind is a complex and many-layered thing… those who have mastered Legilimency are able to interpret their findings correctly…”
Mind-reading in medicine is not as important as the interpretation of that priceless information, and summoning the right memories into the forefront of the patient’s mind. This process can help the patient shovel out the topmost layer of pain and loss to remember the little things – all the giggles and birthday parties and strolls in the woods…
In other words, summoning the right memories is the key to healing. If I can only manage to master this skill over the next four years, I will be very well prepared to practice medicine.
To be continued in Legilimency in Medicine, Part 2.5: Summoning Memories, Continued