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Medical Economics is proud to unveil the honorable mention entries in our 2015 Physician Writing Contest. We believe the essays exemplify what connecting with your patients is truly about, and demonstrate the levels of heart, determination, and empathy you strive to bring into every exam room, every day. Thanks for reading.
I was a new doctor, recently out of residency, eager and ready to fix the world, or at least my small corner of it. One of my first patients was Sara, an elderly woman with a quiet and sweet disposition who quickly became one of my favorites. She came in often, ostensibly for blood pressure checks but I suspected more often than not, simply to visit with my staff, to enjoy some human interaction, and socialization.
One day, Sara was scheduled as my last patient and I was looking forward to ending my busy day with an easy visit with a relatively healthy patient just needing a blood pressure check. Walking into the exam room, Sara was sitting pertly on her chair and her face bloomed into a smile when I entered. I helped her onto the exam table as her arthritis wouldn’t allow her to scale such heights without assistance. Sara kept a small yellow notebook that she used to dutifully track her blood pressure, each entry lined out in perfect pencil rows. As I looked over her log, I asked how her granddaughter’s soccer team was doing that year.
As our small talk wound down, Sara mentioned she’d scraped and bruised her shin due to a collision with a coffee table. I told her I would be happy to take a look at it and I bent down to help her remove her Velcro- fastened tennis shoes and the knee length socks underneath.
Her scrape and bruise were minimal but her toes were another issue entirely. Sara’s toenails had grown thick and yellow, curving sharply and painfully into the surrounding soft flesh of her toes. Noticing my reaction, she looked at me sheepishly and admitted that her arthritic fingers and back would no longer allow her neither to reach down, nor the strength necessary to trim her nails.
Nonplussed, I grabbed a fresh set of toenail clippers and scissors from my procedure drawer, made Sara comfortable on the exam table, and proceeded to trim Sara’s nails. We chatted amiably while I worked, discussing our mutual love of gardening, concern over an abnormally dry winter, and the way roses just didn’t smell enough like roses nowadays.
Sara thanked me profusely as I helped her slip back into her socks and shoes. As I waved off her thanks, I noticed tears welling up in her eyes. Concerned, I asked if she was all right. Sara then said something I would never forget: She was thankful for my care and shocked a doctor would take the time to do something as mundane as cutting a patient’s toenails. She said she was going to go right home and write my name in her Bible.
When I related this story to my husband that night, I was bemused that anyone would think so much of such a small thing. Is cutting toenails an act worthy of having one’s name inscribed in a family Bible? It would be years later until this question was answered for me in a very personal way.
My son Devin was 13 and in that tween stage of still possessing chubby cheeks and flyaway hair, awkward in his gait as his legs ambled away from boyhood youth and toward adulthood. It was the night before Easter and we were sprawled across the living room looking forward to a Saturday night movie with popcorn. Thirty minutes into the show, Devin complained about some minor neck pain, and knowing that he had played basketball earlier in the day, I gave him some Tylenol and sent him off to bed with a heating pad; my diagnosis was a cervical sprain and muscle spasm, nothing a good night’s sleep couldn’t fix.
I woke up that night, foggy headed and confused, to the sound of Devin calling up to my husband and I from his room below. It was dark, the kind of dark when you know that no one else in the world is awake but you. As I struggled for comprehension, the words “I can’t feel my legs” simply didn’t make sense. My husband and I dragged ourselves out of bed and downstairs to Devin’s room, annoyed with what at first hearing we assumed was Devin being silly, or perhaps yelling out in a dream.
Throwing on Devin’s light, I pulled down his comforter and sheets. Devin lay in an unnatural position, his legs splayed and his hands curled inwards. I reached down and pressed my finger on his chest and grasped one of his hands in mine. In the way that only fear can make time seem to slow, I turned to my husband, hanging hesitantly in the doorway, and said, “call 911.”
Devin underwent emergency surgery to stop the blood flowing from the epidural space at C7, his hematoma pushing the spinal cord forward. The MRI showed merely a small thread of cord where once had been a trunk. What followed was three months of ventilator alarms, pneumonia that collapsed a lung, and complete paralysis from the chest down, with the exception of his left arm and hand. Perhaps worst of all, Devin’s only means of communication was by facial expression and spelling out his thoughts one letter at a time by pointing at the alphabet attached to a clipboard.
One day, about a month before Devin was taken off the ventilator, it was my husband’s turn to relieve me from spending the night at the hospital. It had been an exceptionally exhausting day after a ventilator alarm-ridden night, punctuated by helping the nurse turn him every two hours. Morning was spent cajoling him to eat something. Anything. That was followed by physical therapy, neurology meetings, respiratory therapy, the psychologist, then lunchtime with more cajoling to eat something. Anything. By the time I nosed my car into the driveway, it had dawned on me that I hadn’t eaten anything myself all day.
As I trudged up the porch, I saw tucked up by the welcome mat a pretty box wrapped in tissue, filled with Tupperware bowls. Reaching for the note taped to the package, I recognized my friend Jackie’s elegant scrawl. As I unloaded what was nothing less than a four course meal for two, I remembeved the look in Sara’s eyes the day I clipped and trimmed her neglected toes. A name written in a family Bible and a chicken dinner are unlikely placeholders for the same emotion but I was sure I knew exactly what Sara felt that day.
Toni L. Hero, DO is a physician in West Linn, Oregon