Teaching and Learning Moments
I was in Nogales, a rural border town in Arizona, for my third-year pediatric outpatient rotation, scampering through a busy day in clinic. My patient was a baby boy in for a one-month checkup. His mom had her two other kids with her, and she looked exhausted. My patient was healthy except for a terrible diaper rash with raw, extensive epidermal sloughing. His mom and I were concerned about it; even my attending was a bit taken aback. She counseled the mom and handed her a tube of diaper rash cream. As a father of a one-year-old, all I could think was, “How could this mom let the rash get that bad?”
A week later, my afternoon clinic was canceled, so I joined a nurse and a public health student visiting a low-income family with a new baby. As we drove to their home, the kind, elderly nurse told us in broken English that the mom had moved back to Mexico when her husband had gotten out of prison because he wanted her to live with him again. She fled back to the United States when he abused her. Back in Nogales, she was newly pregnant and selling tamales on the street to pay for a single-bedroom basement full of mold. My attending had discovered the family’s living conditions and advocated for discounted public housing and resources.
When we arrived at the house, which smelled of tamales, a four-year-old ran up to me and started yanking on my extendable ID badge. Shocked by the child’s familiarity, I soon realized that this child was the four-year-old I had been playing with while my attending talked to his mom about her baby’s diaper rash.
The public health nurse showed a video made more than a decade earlier about car seat safety and babies sleeping on their backs. The one-month-old cried during the video and needed his diaper changed. The mom grabbed a new diaper and wiped his bottom a few times. The baby screamed louder as she wiped his still-eroded and tender skin. While she fastened the new diaper, I could see it now had yellow stool stains.
After the video and a pleasant conversation with the family, the nurse asked the mom if she had any concerns or questions. The mom again asked about the diaper rash. We all had seen it, and the nurse and public health student both looked at me with questioning concern. With the help of the nurse who translated, I repeated my attending’s instructions and further explained that none of the stool from the baby’s bottom should carry over to the new diaper. We then said our goodbyes and continued on.
This simple coincidence of patient continuity was a reality check for me during my time in the trenches of medical school. I was initially ashamed of my quick judgment; this mom was clearly trying her hardest given some difficult circumstances. I was also surprised at how learning a little bit about my patient dramatically changed my level of empathy for his mom. I found myself wishing that I could have that level of understanding for all my patients.
On reflection, I can see that it is unrealistic to have the same deep empathy I felt for this family for all my patients, which may have its own set of problems. I think the real mistake I made was not working to understand my patient’s circumstances. My attending made the effort and subsequently bettered the family’s social situation. I had been lazy and passed judgment.
Empathy serendipitously found me that day and taught me a work ethic that didn’t involve patient volume or textbooks. I hope I can become the physician my attending modeled, one who works hard to understand and find empathy for the patients who confound me.
The author thanks Dr. Paul Gordon for reviewing a draft of this essay and encouraging him to submit it for publication.