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Teaching and Learning Moments

Dr. Colgan is medical director and assistant professor, Department of Family Medicine, University of Maryland School of Medicine, Baltimore〉.

One night while working late at the health center, I noticed a man in the waiting room who moved his body slowly with the aid of two waist-high wooden walking sticks. This was towards the end of a twelve-hour day of seeing patients in an inner city academic primary care clinic, and I was looking forward to going home. I wondered which doctor would be seeing him—and with a sinking heart, suspected that doctor would likely be me. As the clock neared 7:00 P.M., the medical assistant asked me if I wanted my 6:00 P.M. patient, who had only just arrived, to reschedule. “No, I'll see him,” I said. This was how I met Michael.

What was most striking about him was his head of tangled hair. It was neither well combed nor recently washed. When we did make eye contact, I found one eye looking towards me, and the other angled a bit to the right. Michael's coat was as old and worn as the library book he was reading. Surprisingly, he was reading an esoteric philosophy textbook that I imagined had not been checked out for years. I felt bad for having noticed several stains on his shirt (some new, some old). He did not have control of his body, and he would occasionally twist this way and that. His mouth struggled when he spoke. “I'm sorry I was late,” he said, before I had the chance to introduce myself. The purpose of tonight's visit was for a refill of antidepressant medication. After finding samples of what he needed, we worked out a plan for a follow-up visit. We talked about the book he was reading, and he asked whether he would be able to resume a search for employment. Standing up from the stool, I extended my hand and told Michael I looked forward to seeing him again. Still apologetic, he attempted to close the visit by whispering once again, “I'm sorry I was late.” Patients had apologized before, but I sensed there was more he wanted to say. I asked, “Why were you late, Michael?” I was not prepared for his answer.

I learned that Michael relies on public transportation. He told me that he had taken the No. 7 bus from his apartment across town to the closest stop near our health center. He had walked the remaining twelve blocks in a severe downpour, no doubt relying heavily on the support of his walking sticks. I asked how long it had taken him to make this trek, and he replied, “About forty minutes.” I was shocked. This must have been excruciatingly difficult for a person in his physical condition, but if Michael were hurting that night, he didn't complain to me, his physician. How could he not have been hurting after such a difficult struggle to get there? And after his difficult struggle, he had felt the need to apologize twice for the inconvenience he had caused me. In family practice, we are afforded an opportunity to be intimate with and to help others who are from within and without our culture, both able and disabled. However, in our fast-paced practices, we often are caught up in our little worlds and may forget our ultimate purpose.

Two years have past since I've seen Michael. He did not keep his follow-up appointment, and I've been unable to locate him. I learned an important truth from Michael that night. If another patient arrives late, I'm going to think twice about asking him or her to reschedule. I don't want to lose an opportunity to meet another member of my human family who has much to teach me.

© 2002 Association of American Medical Colleges