Based on the events of August 12th, 2014
“Only Muggles talk of ‘mind reading.’ 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, Potter… or at least, most minds are.” He smirked. “It is true, however, that those who mastered Legilimency are able, under certain conditions, to delve into the mind of their victims and to interpret their findings correctly…”
– Severus Snape, Harry Potter and the Order of the Phoenix
For all of Professor Snape’s pretentious speeches, the art of Legilimency was never actually taught at the Hogwarts School of Pre-Medicine – there was only some hodge-podge about resisting mind-reading through emotion-blocking training (Occlumency). Throughout all my years of reading about Harry Potter’s disastrous Occlumency lessons, I always wanted J.K. Rowling to get to the meat of the matter and teach us Legilimency… that way, Harry would be able to mind-read answers to questions off of Hermione and pass his History of Magic exam.
Naturally, I was pleased to find out that “Legilimency” is a significant part of the Penn State Hogwarts College of Medicine curriculum. As modern magical medical students, we are expected to ask patients about their lives without actually telling them what we’re looking for. For example, we would ask, “I’ve heard you’re not feeling well,” or even better, “What can I do for you?” instead of, “When did your chest pain start?”
In our preliminary clinical skills training, we were instructed to allow the patient to talk, maintain eye contact, and above all, listen without interrupting the story. The concept assumed that patients would often tell us what we needed to know, without being bombarded by dozens of close-ended questions, if we only granted them the chance to speak freely. In the process, we would also gain valuable insight into the personal, cultural, and socioeconomic circumstances that influenced their health.
Having observed hundreds of patient interviews over the past year as a clinical scribe, I thought that leading a patient interview was going to be a walk in the park. I was the first student to volunteer in front of an audience of two senior physicians and nine first-year medical students.
I began the interview in high spirits. I introduced myself to our lady patient and said brightly, “What can I do for you today?”
The patient sighed. “I have chest pain.”
“Okay. Could you tell me more about that?”
Our patient described her problem in about 1.5 sentences and stopped to gaze expectantly into my eyes. An awkward silence developed between us while I waited for her to say more and simultaneously attempted to construct a mental list of meaningful open-ended questions.
“Could you tell me more about what the pain feels like?” When she sat in her chair and stared, I offered some options. “Does it feel dull, or – “
I tried to conjure up an open-ended equivalent to “How severe is your pain?”, but I could not think of one. Instead, I asked her, “Could you tell me more about why you’re worried about the pain?” I was aiming toward a discussion of her family history.
“My husband was worried about it, so he asked me to come in.”
The entire interview continued on for an excruciatingly slow fifteen minutes. I had been trained to listen to a talkative patient, but I had no idea how to manage a reticent one. I was constantly scrambling to think of questions without spoon-feeding her the answers, or resorting to a relentless onslaught of yes-or-no questions reminiscent of the ER (“Has the pain gotten worse over the past hour? Do you have any personal or family history of hypertension, type 2 diabetes, or high cholesterol? Have you had anything to eat within the past hour? Are you a heavy drinker?”). Since I was interviewing a standardized patient (an actress), and not a real patient, I called “time-out” on numerous occasions and beseeched my classmates for advice. The entire experience was mortifying, but my professors had expected worse; in fact, they were pleasantly surprised to see that a student had volunteered to interview a patient.
The next stage of the patient-encounter experience was the patient chart. This part should have come easy to me, I know – I’ve lost count how many patient charts I’ve filled out over the past year of my life – but when I sat down to write what I had learned about the patient, I was appalled to find that I didn’t remember much. I had been so focused on formulating questions and trying to look attentive and professional to my patient that I had forgotten all of the details of the interview. I jotted down the patient’s medical problem in the Chief Complaint section – “Chief Complaint: right-side chest pain.”
I glanced nervously around the room; my classmates had already filled up their charts with flowing paragraphs of gorgeous handwriting. I looked back at my single line of text and sighed. My classmates soon completed their write-ups and turned them in to the pile; I scribbled down a couple of last words and handed mine to my professor just as he was leaving the classroom.
My mind slid into hyperdrive on my walk back home, replaying all the events of the day that I simply wanted to forget –
“Hold on. Chest pain – the heart’s in the center of the chest but tilts toward the left side – “ I pictured the patient with her finger over her chest, tracing the route of her pain, “– and she had her hand over her chest across from my right side, which would be her left – “
At that moment, I might as well have overdosed on my legendary 100% Pure Hot Sauce Soup – I felt sick to my stomach. After a couple of hours of moaning and absent-minded demolition of chocolate-coated almonds, I presented the issue to my mom.
“Ammu, I did something really awful today!”
“I mixed up my patient’s left and right sides on her chart but that’s stupid because why would cardiac pain be restricted to the right side and we just had a whole class on wrong-leg amputations last week and now my advisor’s going to think I’m a complete idiot and – “
My mom laughed until tears streamed out of her eyes. To re-sensitize the mood, my sister pulled out my purple stethoscope and listened for my mom’s heartbeat. It was there, of course, right where it should have been. When she placed the chestpiece on my chest, however, Nashat frowned.
“I’m sorry, Homaira, I don’t think you have a heartbeat,” Nashat said solemnly, after a minute of focused searching.
I forgot all about the disastrous writing assignment until the next afternoon, when my advisor emailed me his comments as an attachment. I hastily archived the message before I could read any of it.
The following day, I forced myself to open the attachment on my phone while I was walking home from school. I scanned through my muddled handwriting and found a single comment scrawled at the bottom of the page:
I concluded that my first patient interview had not gone too badly, after all; but I also knew that this session was only the beginning of our training as professional Legilimens. Our classes on medical humanities, healthcare systems, and Sorcerers’ Perspectives on Medicine all feature cleverly disguised lessons on Advanced Medical Legilimency.
And unfortunately, even accomplished Legilimens can’t always mind-read straightforward answers to the mysteries we encounter every day in the clinics…
Descending the corridors of the Hogwarts dungeons, and into the depths of a patient’s mind…