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The Art of Medicine

A precious commodity

Katers, Laura A. MS, MCHS, PA-C

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Journal of the American Academy of Physician Assistants: January 2019 - Volume 32 - Issue 1 - p 58
doi: 10.1097/01.JAA.0000550290.16769.e2
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I've heard it said that the most precious human commodity is the gift of attention. The ability to listen to another—to offer attention—giving over to the nuances of inflection, intonation, how a person rolls their rrrr's, the mannerisms of the hands, a timely placed smirk, a furrowed brow, a slow or fast blink. What we say and don't say.

I was rather ill many years ago, hospitalized several times with an immune system meltdown. I'd lost 30 lb rather quickly and observed a stark antithesis of myself emerge. I was sick. Loved ones continued to tell me, “You look great!”—even though I was a frightening shadow of myself. At the same time, my grandfather was dying from a recurrence of cancer. He'd had a good life, he said, and he was ready to go. We had candid talks about what it means to be sick, to lose one's identity, about wanting to give up. It was during one lengthy hospital stay, after one of the most difficult days of my life, when Kathy arrived at my bedside.

Kathy was a certified nursing assistant whom I hadn't met before. The other nurses caring for me were excellent, and my room became a social hub where staff stopped by frequently to say hello. The attention was wonderful, but I was so tired. What I wanted to talk about—with anyone—was the one thing I was having the hardest time dealing with on my own.

I was afraid. At the time, I was a freelance writer and photographer and didn't have health insurance. I had scaled mountains, run marathons, and now I was afraid I wouldn't get better, that things wouldn't be okay. At 28 years old, I was the youngest person on the floor and the staff paid attention. Kathy arrived at 10 p.m., a whisper in the moonlight, sat down, and asked me the one question I craved to be asked: “Are you scared?” My answer was a resounding “Yes!” She shared the recent loss of a young friend to terminal illness. Not much older than 40 herself, she told me nothing scared her anymore. If I wanted to talk, she had time. We stayed up late and I unraveled my darkest fears and frustrations. Her attention gave me the one thing none of the well-meaning doctors or drugs could.

I recalled Kathy years later during my first week of practicing primary care, when a 35-year-old man arrived with a chief complaint of constipation. He was from out of town, didn't know anyone, and felt silly going to urgent care for constipation. “I mean, it's not that bad!” he said with a forced laugh. It was a Friday, and I had time. After a thorough history and physical examination turned up nothing, I asked him, “Is there anything else?” When we are unwell, or scared, we often put on a brave face so others don't worry. In all honesty, we lie. I'm good. Couldn't be better. Life is good, can't complain! Such are the events that led to my own mother passing away at 68 from diabetic ketoacidosis. Preventable. Treatable. But we never knew how bad it was because she put on the bravest face of all.

So, I asked this man if there was anything else, and I watched. His clenched, white knuckled hands shook slightly in his lap. His gaze was downturned. His shoulders sagged forward, his chin nearing his chest. One ankle rested on the opposite knee: defensive. He was so quiet. At first he appeared impeccably dressed in a suit and polished shoes. Then I noticed the stained tie, the mismatched socks, the hole on the hem of his sleeve. What I saw was myself in a hospital bed, my mother's inability to ask for help. To be vulnerable. Oh, I'm fine! Am I?

I made up tests to keep him longer. Sixty minutes was how long it took for me to cut through his resolve, to gain his trust. For him to confess he came Seattle to die, by his own hand. When he left, on his way to a psychiatric care facility, he confessed he came to the clinic not because of constipation but as a last resort. He needed someone to notice.

I adhere to this philosophy by heart: Everyone is suffering a silent battle you know nothing about. Be kind to everyone. I believe we learn to care by being cared for. To love by being loved. To heal by being healed. To listen by being heard. I never saw Kathy again, but as soon as I recovered I applied to PA school. After all, people like Kathy are the real reason we heal. There are pills and prescriptions and appointments to keep, and then there is the greatest service we can provide our patients: our unwavering, focused attention. Because attention allows connection, and without that, where would any of us be?

Copyright © 2019 American Academy of Physician Assistants