In this era of expensive and modern testing, it is important to remember the lessons garnered from listening, touching and empathizing with patients.
Anne was familiar to the staff as the "crazy" and ignored patient who moaned incessantly and without apparent reason. One day, I gathered the courage and hesitantly approached her.
"Help me. Please help me, someone!" she pleaded to anyone who cared to listen. Almost instinctively, I held her hand but was not sure what else to do or say.
With approval of the nursing home staff, I helped feed Anne. I am sure the recounting of these experiences during my medical school interview contributed to my acceptance into school later. My professors there affirmed that a patient's history provides 90% of the information necessary for clinical assessment-so much more than elicited from sophisticated medical testing.
I returned to the nursing home during my third year of medical school. Mrs. Ngo was an elderly bedbound patient who spoke only Vietnamese. She needed assistance with all activities of daily living. Her stroke had deprived her of the ability to enjoy food, see her family, and vocalize her emotions and needs. Although the nursing staff reported that Mrs. Ngo was doing reasonably well and was free of pain, she seemed listless and apathetic to me, and she had lost a significant amount of weight recently. The differential diagnosis of failure to thrive in geriatrics-depression, malignancy, infection, inflammation, end organ failure, sarcopenia-coursed through my mind.
Mrs. Ngo's family valiantly attempted to provide her with emotional support in the long hours they spent with her, without sign of clear improvement. My early experiences taught me 2 critical points: 1) even patients with advanced dementia are able to express their needs, if not through speech, then through other means such as gestures and body language; and 2) patients all have innate physical, emotional, and spiritual needs that are experienced and persist through chronic debilitating illnesses, including dementia.
I discussed with Mrs. Ngo's family her interests during her youth-her personal music interests, favorite foods, travels, and hobbies. In an effort to meet her needs, her family introduced a Vietnamese satellite radio station, historic pictures of the Vietnamese homeland, and national foods. As a result, Mrs. Ngo would squeeze my hand harder and seemed to become more responsive, alert, and happy. Mrs. Ngo was fortunate to receive this loving medical and family care before she passed away.
Mrs. Ngo was my grandmother, and I treasure the brief but touching times I spent with her as a grandson and medical student. My desire to become a physician was embedded in my desire to maneuver the most challenging encounters with the sickest patients, holding hands with and learning from them and sharing their lives even as they are dying. My decision to pursue training in family practice and geriatrics was derived from my experiences with the patients with whom I was so fortunate to interact early on. In this era of expensive, modernized testing, we must remember that the information we garner from listening, touching, and empathizing with patients ultimately is much more revealing and rewarding.
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HIEN NGUYEN, MD Temple Hills, Maryland