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Teaching and Learning Moments

I Could Hear the Tears

Elkin, Baila1

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doi: 10.1097/ACM.0000000000004123
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Even over the phone, I could hear the tears.

I was working with the Minnesota Department of Health making COVID-19 contact-tracing calls as part of a new remote elective. Specifically, I was working on the Hospital and Deceased Queue, calling the loved ones of hospitalized patients acting as a proxy for those who were too sick to talk or had died. Interviews punctuated by tears were not unusual; by its very nature, the work was emotionally charged.

When COVID-19 hit, I had been poised to start my third year of medical school. After 2 grueling years, primarily in the lecture hall, I had been so excited to get to the clinic—to see patients! Because of safety concerns and personal protective equipment shortages, my third year had started as a letdown, with a lot more Zoom sessions and a lot less interaction with actual patients than I had anticipated. This contact-tracing elective presented a unique opportunity for patient contact.

In medical school, we were taught strategies to facilitate making a personal connection with patients during interviews. I tend to be more formal and a little stiff, especially when I feel nervous, so making that connection had been difficult for me then. It was even more difficult now. However, over the weeks of making contact-tracing calls, I began moving away from filling out questionnaires and toward having real conversations. And I started talking about feelings—not symptom-pursuit “How are you feeling?” feelings either. Emotions. It felt uncomfortable at first. Emotions? My job here was to record facts. But I discovered the 2 can go hand-in-hand. Taking time to acknowledge emotion gave the people on the other end of the line space, which facilitated the information gathering I was so myopically focused on. And so I started paying attention: What were people saying? When were they saying it, and how? What were they not saying?

My current interview had started with laughter, which was uncommon. The woman I was speaking to was hospitalized with COVID-19 and in the background of the call, I could hear a mesh of machine beeps and nursing staff bustle. Despite being hospitalized in the midst of a global pandemic, she initially seemed brimming over with enthusiasm, even cheerfully informing me at one point that she had put me on speakerphone because her nurse was giving her a shot! It was in describing a visit from her grandson that she grew quiet. Since she was required to socially distance, she told me, she had not been able to hug him. I listened to her voice choke off, swallowed into the ambient beeping and background murmuring—and I could hear the tears. As she silently cried, I froze, wondering what to do.

Yes, I had more questions. We would get to them. Yes, I felt unsure of what to say. That uncertainty had grown familiar. The silence stretched 1 heartbeat, 2. Then, I said, “Tell me about your grandson. It sounds terribly hard to see him but be unable to come physically close.”

And she did. Talking seemed to lighten the weight of sadness for her. After, we circled back and completed the interview, laughing once more.

My contact-tracing interviews were completely patient-driven, in the sense that I had no time limit. In the future, I will not have the luxury of unlimited time. I hope to have the luxury of face-to-face contact. Whatever variables differ, I will keep as a constant the necessity to acknowledge emotion. To my future patients I say this: When you give me the gift of your feelings, I may still freeze up for a moment, wondering how to best show that I care. But I will take this lesson that a global pandemic taught me and give space and significance to your emotion—and we will look at it, together.


The author would like to thank Dr. David Power, Department of Family Medicine and Community Health, University of Minnesota, for his feedback.

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