Five Tips for Achieving a Rewarding Patient Care Experience

She is grabbing for tissues, dabbing her eyes to avoid ruining her perfectly sculpted winged eyeliner. She inhales sharply and begins to speak; stories of childhood secrets, unwanted touch, and shame tumble out. All these months I’ve suspected trauma may have been lurking behind her unrelenting headaches, but it took time for her to trust me.

I check the clock. Forty-three minutes behind. Three patients waiting.

How am I supposed to wrap this up?

His palpitations stalk him. They attack in the quiet moments—in the seconds he begins to believe he might be okay. Last week, he was admitted to the hospital. He shows me the list of five new prescriptions. “But why am I feeling worse?” he asks.

Maybe it’s a medication side effect? I wonder.

Or maybe it’s that they are threatening to fire him for the shifts he missed while in the hospital, or that he might not be able to make rent this month and pay his mother’s medical bills in Guatemala without that job. Or maybe it’s the years of earning a pittance, walking to work at 4 am in the biting cold, then standing all shift to pull apart the bad parts of lettuce heads—sending picture perfect bundles to high-end supermarkets so the rich don’t see the rot.

Maybe . . .

I adjust his medication doses, check his position on the psychotherapy wait list. I try to convince myself that this will make all the difference.

“On a scale of 1 to 10, how bad is your pain?”

“Eleven,” he says, wide-eyed, then reaches backward, stretching his fingers toward his spine. He tells me how the pain started—after the men held him down in the concrete cell, their knuckles landing in rhythmic strikes against his back. The hurt settled in there years ago. The MRI doesn’t show the damage, but his body remembers.

At first, I aim for cure: medications, back injections, creams, and patches. He is patient, but still hurts.

Later, I begin to explore more beneath the story. “What do you live for? What are you proud of? How did they wound your dreams?” I place my hand on the ache. And he answers.

Her baby is squirming, crinkling the white exam table paper as he arches his back. I carefully observe his movements, place a gloved finger into his tiny palm, smile at the feel of his firm grasp.

I remember when she first grasped my hand, with an iron grip as she labored and pushed. Her first child—with a head full of hair and eyes like the father he would never know. We didn’t know then what was to come: her hallucinations, the psych hospital, the sweet-tongued social workers, the baby in the arms of another family, the pills, the tears, the grief.

Now, that baby sits with her, 3 years old and playing a game on his tablet as I examine his baby brother. I look up at her, and she smiles broadly, proudly.

“Thank you for everything,” she says, and offers her arms up to me. Tears dance on my eyelids. For a moment, I lose myself in that embrace.

Her desperation reverberated through the phone line. She’d been home with diarrhea and fever for 5 days, but the fast-food giant where she worked was refusing to pay for her sick time without a doctor’s note and an office visit. “They won’t take my word for it,” she added, dejectedly.

“OK,” I had told her, indignation about her situation settling in my chest. “Come in at the end of the day. I’ll find a way to see you.”

Now, I steal a glimpse of the sunset through the slats in the window shades as I pause outside her exam room door. The sky is a bright crimson. My stomach rumbles. I won’t make it home for dinner on time, after all.

I fill my lungs with air and smooth the front of my lab coat. I think of the hope I had when I first donned a white coat as a medical student, ready to soak in all the tips from my teachers and learn to heal.

I think about broken promises—that gaping space between the idealism of a fresh white coat and the messy reality of human connection.

I place my closed fist on the pale wood of the exam room door, knock, and enter, with a smile.