Treating the Patient's Spirit, Not Just the Disease

Treating the Patient's Spirit, Not Just the Disease
Denise Anne Hayes
<http://www.medscape.com/viewarticle/555073?rss>
<http://www.medscape.com/viewarticle/555073_print>

"Danielle was a 10-year-old leukemia patient undergoing her
third, painful round of chemotherapy when I first met her. I
was an anxious, apprehensive student, entering the isolation
room of my very first patient. As I introduced myself to the
frail child, she hardly removed her expressionless gaze from
the sealed, dusty window overlooking hospital construction.
She knew I would be just another hospital staff member to
poke her, prod her, and relentlessly question her from where
I hid behind my precautionary gown and mask. Even as I made
small talk about the newest pop music star or offered her a
coloring book to pass the time, her only response was to
shrug her shoulders, and to turn up the volume of her
television from the remote control on her bed.

Danielle spent most of her inpatient stay alone in her
hospital bed. Her parents could only visit after work, and
only occasionally did a grandparent, an aunt, or a cousin
stop by. They would enter her room enthusiastically with
baskets full of board games, chocolate treats, and stuffed
animals, only to emerge shortly thereafter, choking back
tears. The child was too weary to play games, too nauseous to
eat, too disheartened to befriend yet another teddy bear.

I left the hospital that first day feeling like a failure,
and for months I felt uneasy entering Danielle's room. Every
day I would peek in to ask how she was feeling, but I was
always met with the same blank stare, and often a look of
disgust. "At least she makes eye contact with you," one of
the nurses joked. I realized I would virtually have to stand
on my head to get through Danielle's wall of silence. And, as
it turned out, I literally had to do just that.

I knocked on her door one beautiful June day, when it seemed
that the rest of the world was enjoying the summer sunshine
while this gloomy child sat in her room with curtains drawn.
I was disappointed in myself for allowing Danielle to be so
miserable while the other pediatric patients were enjoying
cheerful therapeutic activities that helped heal their tiny
broken spirits. Her hardened stoicism went far beyond her
years, and I was determined to find a way to bring back the
radiant child that I was sure she had once been.

I walked in and found the stone-faced little girl sitting on
her bed, and a man in a chair who introduced himself as "Dr.
Scott." He was in jeans, a T-shirt and a baseball cap, with
no stethoscope or reflex hammer in sight. "Danielle's been
coming to see me at my pediatric practice since she was
born," Dr. Scott said. "Now that she's here in the hospital,
when I get a day off, it's my turn to come see her." Danielle
appeared to blush in response to all of this attention. "I'm
not like most doctors, so Danielle sometimes gets embarrassed
when I come around. I've been known to start wheelchair races
with the nurses, even to stand on my head!"

Completely intrigued by this doctor, whose service to his
patients apparently did not end on his day off, I replied,
"Well, headstands are one of my specialties." With that Dr.
Scott jumped up, grabbed two pillows from a shelf, and threw
one at me. "Well, then, I challenge you to a headstand
contest!" When I saw just the hint of a curious smile on
Danielle's weary face, I knew this was the chance we had all
been waiting for.

We placed our heads on the pillows and lifted our legs into
the air, the lemon-yellow isolation gowns hiding our faces.
What followed was the inspiration that, I believe, will stay
with me throughout my career in medicine. Danielle began to
giggle. She muffled her laugh with her hand, but for just a
moment, she was a normal, healthy child, enjoying a moment of
pure silliness. We had broken through Danielle's wall.

When the contest was over (Danielle decided that Dr. Scott
was the winner), 4 wide-eyed doctors in gleaming white coats
stood peering over each other's shoulders through the glass
door. They shook their heads, unable to comprehend this
unique bedside manner. We just laughed, joining Danielle in a
moment of triumph over the tragic part of her disease that
had so mercilessly consumed her spirit.

From then on, Danielle began to talk, teaching me firsthand
just what it was like to live with leukemia. To the delight
of everyone who knew her and had watched her transformation,
Danielle would go into a stable remission shortly thereafter
and would never require admission to the hospital again.

Humanism in medicine is defined by moments such as these, in
which it becomes clear that treating a patient's spirit and
dignity goes hand-in-hand with treating the illness. By
fostering the development of Danielle's own sense of courage
and inner strength, Dr. Scott was able to help the little
girl prevail not only over her cancer, but also over her
pervasive sadness and hopelessness. His service to the
patients he cares for is unique in that it is performed not
only in the role of a physician, but also in the role of a
mentor and friend. In pursuit of a more humanistic service to
the community, it often becomes necessary to step out of the
white coat and into the patient's world, empathizing with
their feelings of frustration and powerlessness.

The impact that this type of selfless service has on medical
care is as invaluable as extensive clinical knowledge and
cutting-edge therapies. These altruistic, noble deeds
exemplify the humanism that is at the core of every field of
medicine. It is personified by the nurse whose gentle touch
reassures a frightened patient, the medical student who takes
the time to listen to a patient's fears and concerns, and the
doctor who will literally stand on his head just to make a
patient smile."

This essay won first prize in the 2005 Arnold P. Gold Foundation
Humanism in Medicine Essay Contest and originally appeared in
Academic Medicine. Denise Hayes was a third-year student at
Georgetown University School of Medicine when she wrote this.

Denise Anne Hayes, third-year student, Georgetown University
School of Medicine (2005-2006)


--
Matti Narkia