Teaching and Learning Moments
Another morning. Another ward round with the residents. Another lonely old man, who did not know or seemingly care where he was. If “lying in bed” implied free will, it did not describe him. He was so cachectic that he almost was not there at all. He had been living nearby at his kibbutz in a home established for frail elderly members. He was brought to the hospital the night before for what we jokingly called “the visit of the general.” A mirthless designation, it always meant one thing: general deterioration in a debilitated, usually demented old person. It could have many causes, but just one outcome—getting much closer to the final moment. I took his hand and spoke to him. Was that a flicker of response in the weary old eyes? I tried again, explaining and encouraging in a few simple words. We did what we could, and I touched his shoulder in farewell. The round moved on.
Sitting in Vienna’s airport a couple of weeks later, I suddenly saw him again. At least I saw his name again. Yes, it was definitely him—a barely recognizable photo taken in better times and a detailed description of his life in a national newspaper. I read his obituary, mesmerized. My patient was a hero. His accomplishments were equal to few. He was barely 18 when he joined a Jewish resistance group in the ghetto, jumped the train to Auschwitz but was caught, survived the concentration camp, and escaped the horrendous “death march.” He then made it to Israel, joined the newly established Defense Forces, and became a self-taught, internationally recognized expert in tank warfare and then a young general. His second career in the Foreign Office was as successful. He became a leader again, this time in organizing essential aid to Africa. Had I known all this about his life, would I have treated him differently? Better? I daresay not. And yet I felt that my second encounter with my patient, far away from home, in that Vienna airport was a powerful moment. Was it the distance from home and the isolation that made me reflective, in a way that my busy daily routine never could?
At any time, with no effort at all, we can name dozens of “good” reasons that alienate us from our patients, creating an invisible wall that is harmful to us both. If only we could remember instead that every one of our patients is far more than the sum of his or her symptoms, physical findings, blood tests, and imaging results. These details have a tendency to keep accumulating, demanding all of our processing skills and capturing our attention, often to the exclusion of anything else. My patient’s story was a poignant reminder of how much we are missing. Most patients do not have such an exceptional record, but every patient has a unique story to tell. We must remember this during each encounter, be aware of it, and acknowledge it by being curious, by asking a personal question, by reacting to the reply. Paying even a small tribute to this often-transparent but all-important part of each patient’s life will benefit us as physicians and as caring human beings. The patient–physician relationship with its myriad implications will thrive, and so will our patients. We must not let routine overwhelm us; we must remember that meaningfulness never ceases.
Ami Schattner, MD
Dr. Schattner is a visiting scholar, Ethox Center, Oxford University, Oxford, England, and professor of medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel; e-mail: amiMD@clalit.org.il.