Mr. J. was a nicely dressed elderly gentleman brought into the emergency room by paramedics. He wore pressed khakis, a cardigan sweater, and carried a copy of Steinbeck’s “The Grapes of Wrath”. It was 11 o’clock at night, and as a junior resident in my second year of training in emergency medicine, it was my responsibility to keep my “side” of the ER moving. All told, I would evaluate dozens of patients on a night such as this. It felt overwhelming. Mr. J. was pleasant, without complaints, and when I finally made my way into his exam room, he politely asked me why he was there. I blinked at this question, thought for a moment, and pulled up a chair.
In the ER, I have found, people are often depersonalized. The sheer volume passing through our doors each day and night is dizzying, and while sometimes patients need medical intervention, sometimes they just want to be heard. I believe that when people feel heard, they feel valued. And sometimes, I believe, listening itself can heal.
As it turns out, Mr. J forgot that he had fallen in his front yard three days ago, and then forgot that he’d forgotten. I realized this not from our conversation; we mostly talked about his son, a successful attorney in nearby Boston, and his garden, which, he proudly explained, he still tended himself. As he described his recently planted Begonias, I noticed the grass stains on the elbows of his sweater. When he finished, I examined him, said thank you, and stepped out. The whole thing took about seven minutes. His blood work and EKG were normal, but the CT scan of his brain showed a large subdural hematoma, a collection of blood inside the skull that had likely occurred from a fall in the garden a few days before. No surgical intervention was required, but I admitted him to the hospital where he was fed, watched, and prevented from having a second, ugly fall that might have done much more damage.
I know that I will fight the challenge of offering my hands but withholding my ears for the rest of my career. As I get more comfortable treating heart attacks and headaches, back pain and bladder infections, severed fingers and psychotic breaks, it will become easier to function on autopilot because I’ll think I know what to do. But when I stop listening, I may miss a grass stain that points to the fragile blood vessel quietly emptying its contents into delicate brain tissue. And sometimes, it will just be a grass stain. I’m still going to try to listen. Because maybe the most difficult diagnosis to make, and the worst to miss, is the need to be heard. In the swirling chaos of the E.R., remembering that need will be a challenge. But it’s what makes us human, and ultimately, more alike than we are different. If that need represents a malady, I believe we don’t need a cure.
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