Doctor and patient connect over a shared passion.
On a sun-drenched evening last summer, I admitted an elderly woman with anemia. She had been sent to the hospital after a three-point drop in her hemoglobin was noted on lab work earlier in the day. The mundane nature of the case comforted me as I walked to the emergency department.
Wanting to prove my efficiency as a June intern, I asked pointed questions about the sources of her bleeding, weight loss, and prior cancer screening. I breezed through her social history. In an elderly patient, I was focused on whether she lived independently, climbed stairs, and had home health services. This information would help me discharge her before she got admitted.
The following morning, I was pleased with my presentation of her case. I had provided a concise retelling of her one-month history of fatigue followed by a visit to her primary care physician who found her to be profoundly anemic. Her stool had been darker than usual, indicating a likely GI bleed. She lived alone but had family nearby to help.
My attending paused. “Did you know she has a master’s degree in English?” My eyes lowered. In my race to discharge her, I hadn’t stopped to ask about her personal or professional life. And yet, this was salient information and personally interesting to me. Literature brought me to medicine. In college, I realized
that physicians, above all else, need to be skilled communicators. This knowledge sustained me as I completed a bachelor’s degree in English literature and a master’s degree in narrative medicine while preparing for medical school.
I returned to her room later that day. Sheepishly, I asked about her educational background, already knowing the answer. Her eyes enlivened as she told me about her studies in English. We talked about what she was currently reading, or re-reading in this case. She spoke of her favorite poem, “The Windhover,” by Gerard Manley Hopkins. It describes a bird suspended in midair, taking survey of the land, before swooping down to earth in a moment of breathtaking agility. The observer’s response in the poem captures his, and my patient’s, delight: “My heart in hiding / Stirred for a bird,—the achieve of, the mastery of the thing!”
The passion with which she spoke of this poem, and the intensity of the bird’s actions within it, contrasted with my resigned approach to her common diagnosis. I imagined myself hovering over my patients, not decisively descending as the windhover, but arriving with the stilted demeanor of an “efficient” intern.
On the day she was to be discharged, I brought her my favorite poem by Robert Penn Warren, called “Evening Hawk.” It, too, features a bird of prey. But here, the hawk’s flight pattern represents the passage of time: “His wing / Scythes down another day, his motion / Is that of the honed steel-edge, we hear / The crashless fall of stalks of Time.” We reflected on the beauty in this imagery, wing flaps propelling time and ushering in the night.
She declined further inpatient workup for her anemia, and we discharged her to consider an outpatient colonoscopy. Although I didn’t identify the cause of her anemia, I did learn that some questions are more important to ask than those about stairs and home services. In doing so, I identified a shared interest in poetry and we stood together, not as doctor and patient, but as lovers of the written word arrested by its enduring beauty.
Reprinted from Academic Medicine with permission of Wolters Kluwer Health, Inc. Listen to Dominic Decker read his essay here.