Not just Bones and Muscles

A few weeks ago, an elderly patient with advanced metastatic cancer came to see me in my palliative care clinic. She did not speak English. She came in with her daughter, who translated as the patient did not wish to use an interpreter. She told me about her worsening pain. We had a good visit; I got to know the patient and her daughter a little, and we made plans to start a new pain regimen. I asked the patient to return a couple of weeks later for a follow-up visit.

She came back alone.

When I entered the room, Mrs G (not her actual name) was visibly anxious and distressed. I sat on a chair next to her. We were both wearing face masks. I do not speak Mrs. G’s language. I asked the nurse working with me to wheel in a tripod with an iPad we were going to use to connect with a live interpreter. As she went to fetch it, we waited in silence.

A minute later the nurse came in and I stayed in a chair next to the patient, positioning the tripod two feet away. I wanted the interpreter – Carlos (not his actual name) – to see us both.

Happy to finally break the silence, I asked Mrs. G how she was feeling and waited for Carlos to translate. When he started speaking in Mrs. G’s native language – his words flowing fluently and melodically from the iPad’s speakers, Mrs. G immediately relaxed, her shoulders dropped and she smiled.

It was a subtle but noticeable change.

She naturally felt relieved being able to communicate. But I suspect her change also signaled something else.

Watching her felt as if she was stepping into a different world. Her world. Her world of sounds, language and her history.

“Humans are never really alone. Even when we’re by ourselves spatially, like sitting in a room, our thoughts are filled with others; our bodies are even potentially carrying the skin cells of others and a variety of other things. So we are always thinking with and about other people, even when we’re not with them.”

A. Fuentes

It reminded me that effective doctoring needs to take our social niche seriously into account. And it rarely does.

“Right now most of medicine is built on a failure model: the idea that something’s broken, we go in there and fix it. When in fact, an evolutionary focus asks, what are the patterns and processes?”

A. Fuentes

During our conversation, I learned that the reason Mrs. G’s daughter was hospitalized. Mrs. G was worried and distressed because she could not visit her. She felt isolated and lonely.

During her visit, we talked about her pain medications and how to take them. She told me what worked and what didn’t. We adjusted our plan for her pain regimen, and I sent the prescriptions to her pharmacy and made sure she understood the instructions. But then we talked about her daughter. And we listened. Carlos and I.

But at the end of the visit she was smiling and looked somewhat relieved.

I wished her Happy Holidays, and she replied with a long list of best wishes for me and my family that Carlos dutifully translated. I reciprocated, waved to her and left her in the room with Carlos. I went to fetch her post visit summary, written in her language, and a slip for a follow-up appointment.

We thought we could cure everything, but it turns out that we can only cure a small amount of human suffering. The rest of it needs to be healed, and that’s different.

Rachel Naomi Remen

Additional reading:

  1. Here is Krista Tippet’s interview with Agustin Fuentes and Rachel Naomi Remen.

One thought on “Not just Bones and Muscles

  1. Thank you Dr. Chwistek! You immediately noticed that there was a language barrier, so you used your resources to make sure your patient was able to communicate with you, and comfortable speaking her native language.
    What impressed me was you “really” listened to her and her concerns. She was not just another patient, she was a human with concerns, worries and maybe issues to be resolved. And you listened. That is what most of us want, to be heard and not blown off as if our concerns, issues and questions don’t matter. Please listen to me. As a caregiver I need to be heard too. God bless you for your kindness.


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