The Reason

At the suggestion of a colleague, I submitted one of my blog posts to the FMEC ‘This I believe’ contest. To my surprise, it was selected as an award winner, and this past Sunday, October 22nd, I attended their annual Northeast meeting to read my essay (accompanied by a slide show of my photographs) and receive my award. It was tremendous fun and energizing, and has renewed my determination to return to teaching family practice residents, at least part time, over the next year.

Here is the essay in its revised form. 

It was my third year of medical school. I was roused from sleep to see two coughing sisters, ages three and four. The common cold is straightforward, even for a third-year medical student, so after a short history and exam, the mother and her two well children with colds were on their way. While writing my notes, I complained to the nurse that the visit had been a waste of my time.

The next morning I was told to check with Dr. Haggerty, Director of Ambulatory Pediatrics, before clinic. 

I remember his cluttered desk, the piles of journals and charts, and especially the enormous wall map of Rochester that dominated his office. When he asked about the sisters from the night before, my heart sank. What had I missed?  Pneumonia? Meningitis? 

He interrupted my panicked defense of their management to ask if I knew where they lived? Puzzled, I said no. Handing me the charts and two red stick pins, he said: “Mark their apartment and the ED on the map. 

The ensuing dialogue went like this:

Question: “How far do they live from the hospital?” Answer: “About a mile and a half.”

Question: “How did they get to the hospital?” Answer: “I don’t know.”

Question: “Do you think they drove?” Answer: “Probably not.”

Question: “Is there any public transportation that late?” Answer: “No.”

Question: “So, how could they get here?” Answer: “They must have walked.”

Question: “Did they get a warm welcome in the ED?” Answer: “No.”

Question: “How’s your imagination? Why would a mother walk that far in the middle of a freezing night with two toddlers?” It was easy to imagine plausible if horrifying scenarios, but hard to give them voice. “Maybe they were keeping her intoxicated or abusive boyfriend awake? Maybe there was no heat or food in their apartment, and she hoped they would be admitted. Maybe...” He stopped me.

“They always come for a reason," he said. "It may not be obvious, and it may not be your kind of reason. But they always come for a reason, and it’s your responsibility to discover it. Until you know and understand The Reason, you can’t help them with what they came for.” 

That conversation didn't last more than 10 minutes, but its impact persists to this day. Thanks to his suggestive questioning and patient pauses I came to understand that patients don’t wake me up in the middle of the night, never mind become ill, to make my life difficult. They come because something dreadful - something frightening or painful - is happening in their lives.  I have long since stopped counting the times when asking more questions, taking the time to listen, and then imagining what their lives are like, has made a difference. Almost 40 years later, Dr. Haggerty's message remains true: 

It’s not about me. It’s about them.


 

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