Listening…

I am a regular NPR listener, mostly Morning Edition and All Things Considered, but today I happened to be listening midday, and I caught the program Tell Me More, and, specifically, an interview with Neil Conan, who is apparently retiring from hosting the program Talk of the Nation (TOTN) which I have listened to, on and off, since it’s inception with host John Hockenberry, who was probably the first paraplegic I ever knew about (and subsequently, due to the large number of flying bullets in Baltimore, where I practice medicine, I see more than my share of paraplegics and quadriplegics).

And, during the interview, when asked “…why do you think people have called up to trust you with their stories all these years?”, Neil Conan said:

“It has taught me to have enormous respect for people who I don’t understand. To sit in the studio and have those stories come to you and learn to listen. That’s what I’ve really come to understand. Susan, again, my great mentor, used to say, I used to be terrified about – I don’t know what the next question is going to be, I would write down lists of questions. And she would say, stop it. Just listen. And they will tell you what the next question is.”

And, that struck a cord for me.  As a physician, one of the greatest gifts that I receive is the opportunity to hear people’s stories.  And, that was particularly poignant and pertinant for me last week, and it’s been sitting with me for a few days, percolating as a potential post here.

I saw three patients that day (yes, I know, light day – it was hot, and there were cancellations).

Patient #1:

A young lady, less than 30 years old, who was hospitalized recently at our institution, and had multiple organ failure (heart, liver, kidneys, and brain) – all due to heavy alcohol use.  I learned the bare bones of the history from the discharge summary that was provided by my colleagues who took care of her during her nearly life-ending hospital stay, but the story was fleshed out by the patient and her extremely supportive grandmother.  When my patient was 19, she was in college and was called out of classes to learn that her step-mother had stabbed her father to death at 1am that morning.  Her response to this news was to start numbing the pain with alcohol, and, starting with beers, she progressed to drinking 1 1/2 quarts of hard liquor a day for the past 10 years.  She has two kids, and the father of her children is with her, and is supportive, as is a large number of family members, including the lovely grandmother who was with her.

I was intrigued by the idea of what became of her step-mother, the murdered of her father.  I couldn’t ask…

I listened to this story, and thought about the call I received when I was 19 years old, and was going daily to the hospital Neonatal Intensive Care Unit to visit my premature infant daughter, and the voice of my mother on the other end of the line telling me that my father had died an accidental death (thank goodness he wasn’t murdered)…I felt my patient’s pain so acutely…

I couldn’t share with her my parallel story, and it wouldn’t have been appropriate for me to do so, but I did spend some extra time with her, urging her to avail herself of psychologic/counseling support services, which would be available to her through the alcohol rehab program that she was scheduled to see the following week.

My primary goal with this patient was to ensure that her infectious process was under control (and, it was), but it seemed far more important to connect with her, and help her deal with the underlying issues…

Patient #2:

Young black man, strong, tall, strapping (what does that mean, really?), who was hospitalized for cavitary lung lesions, which often suggest to us infectious-minded folks tuberculosis, and, yes, he had been incarcerated (a risk factor for TB acquisition), but he is an upstanding citizen, with a good job, and the reason for his incarceration was DUI – had he had white skin, I am reasonably certain he would never have been put in jail – and, he ended up having an unusual fungal infection, and the ultimate diagnosis is still up in the air, but, the good news is, he’s doing better, and tolerating therapy.  He defies all the stereotypes – he is educated, had a job (he’s on temporary disability, because he can’t breathe!!), and he’s motivated to get back to his life.  He has never used drugs, he quit smoking when his breathing became problematic about a year ago, and he, like Patient #1, has a supportive and present family.

He defies the odds of living in Baltimore – at least, as represented by the usual patient population that I see.

Patient #3:

An older white lady, accompanied by her husband.  She had a bilateral lung transplant less than a year ago, and had been hospitalized for pneumonia, and has suffered a number of other post-transplant complications since the transplant.  She was a grandmotherly type, and has several grandchildren, and she told me a little of her life story.  She lives in a rural part of Maryland, and her husband worked in law enforcement, and, as she was relating the story of his career, she mentioned that at one point, she was fearful for her life when “blacks” would follow her around and threaten her.

I liked her, and she and I are technically the same skin-color, and yet, I was so acutely aware, at that moment, that the people she was fearful of were represented by my previous two patients, who had themselves suffered so much.

Why did she warrant the bilateral lung transplants?  Her history says COPD – was that due to a long history of cigarette smoking, or was it some idiopathic or autoimmune process that led to her lungs failing?  I have no idea.  My job that day was to assess her current state of health with regard to infectious processes, and manage her antibiotic therapy appropriately.

We had an ethical workshop during my residency, where we discussed three cases – a diabetic who couldn’t stay away from sweets, an alcoholic who drank himself to death, and a heroin addict who couldn’t stay clean.  Almost universally, the heroin addict was condemned, and the diabetic and the alcoholic were excused from blame for their excesses.

We judge people based on our personal stories.  But everyone has their story.  We need to listen to each other.  We are all humans together – there is no one who is lesser or higher.

I ponder these questions daily in my interactions with my patients….

2 thoughts on “Listening…

  1. Ahhh… Janaki – and that's the message of our lives and the work we do: "everyone has their story. We need to listen to each other."

    Thanks for the clear, concise reminder.

    1. jkuruppu says:

      it's constantly amazing to me how important listening is. i have another post brewing about how we educate doctors…the interview with Neil Conan comments on how people who interview for a living (and that certainly includes physicians) often fall into the trap of thinking more about what we are going to say, or the next question we are going to ask, but the real job is to listen, because then the next question becomes obvious.

      thanks for stopping by – i love having these little moments of contact with you. shabbat shalom.

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