A different perspective

July 6, 2007

Why, the author wondered, was a patient with multiple health problems always cheerful? The answer enlightened him.

As physicians, we can't always cure our patients, but we can empathize with them. Early in my career, a patient who faced pain with grace and stoicism taught me a lesson about the nature of the human condition.

Mr. Tran (not his real name) was referred to me by a colleague soon after I started my suburban practice. My first clue that he wouldn't be a typical patient was the phone call I received from a fellow family physician, who described Mr. Tran's various ailments, including lung cancer with previous pneumonectomy. It was uncommon to get a "heads up" call of this nature regardless of the patient's problems.

I met Mr. Tran the next day. He was a small man, maybe 5 feet 6 inches tall, 130 pounds, balding, in his early 60s. He spoke softly, in broken English with a Vietnamese accent. His wife accompanied him. Both were dressed in their finest clothes. When I walked in, Mr. Tran stood up, bowed to me, and thanked me for caring for him. I was unsure how to respond. We spoke briefly and reviewed his history. He was retired, his lung cancer was in remission, he felt well, and his hypertension and arthritis were under control. He asked me for nothing and we agreed to recheck every few months.

When Mr. Tran came for a physical, again with his wife, he was frail and anemic, but-as always-impeccably dressed and seemingly happy. He presented me with a plate, handpainted with mother of pearl inlay, showing the Three Sisters of North, South, and Central Vietnam in traditional gowns. I couldn't stand it any longer. I said, "Mr. Tran, in the short time I've been your physician your health has worsened. All I do is give you terrible news, and yet you always smile and thank me. How can you bear this burden so calmly?"

Then, in his halting, dignified voice, he revealed the secret of his serenity.

"I was a general in the South Vietnamese army. In 1975, I was captured and taken to a North Vietnamese re-education camp. My family escaped on one of the last helicopters out of Saigon. I was kept in solitary for nine years. The only time I saw anyone was when they came to beat me. These scars on my back remind me every day of the whippings I received. I lost 60 pounds. They injected me with chemicals and told me they were doing 'experiments' on me. The only thing that kept me alive was the hope of one day seeing my family again. Eventually I began to think I would die there. But I was freed in 1985, flown here, and reunited with my wife and sons. I lost nine years of my life, and I refuse to let these small health problems take away more of my time with my family." A single tear rolled down his cheek.

I sat with a large lump in my throat. Mr. Tran was deeply grateful for the time he was granted to be with the people he loved. His physical health was of little concern to him. I now understood the gifts, the reverential behavior. He just wanted others, including his doctor, to care about him, to connect to him as a human. Ultimately, that was all I could do as his body slowly deteriorated.

Mr. Tran helped me learn that what many patients want is not a cure for their problem, but a caring touch, a smile, or a kind word. I think we tend to feel frustrated by these patients, because we can't "fix" them. But we do help them just by listening to them, and caring for them as fellow humans.

Ironically, I lost Mr. Tran, not to his multiple cancers, but to a health insurance change. He needed referrals to his specialists, which I couldn't provide because I was "out of network." I responded by calling a friend and giving him a "heads up" about a special patient who would be seeing him the next day. I'm sure he wondered why I would take the time to call.

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