Monday, June 11, 2007

What You Need When Your Moles Are Fine

These days I’ve been a little out of my element, working in a dermatology surgery office for the last week, getting daily reminders to wear sunscreen (really y’all. Melanoma is no joke), and learning good and important things about skin cancer and rashes, but aching to be back in the community-based health settings that ground me more than I’m ever aware when I’m in their midst.

My patients these days are all insured. They are people who have the time and resources and savvy necessary to make it to specialist appointments. They are offered coffee by our sweet, smiling nurses if they have to wait longer than, say, 20 minutes before being seen. But ultimately the differences are deeper and more significant than coffee and TV in the waiting room. Being insured means that these patients won’t die of skin cancer, because they have a place to go if someone notices a weird-looking mole. Their lives are longer and higher-quality, partially because they have access to healthcare. It’s a totally different world.

And, also, not.

The other day I had this skin cancer patient in his 80s who patted my hand while I was asking him about his moles and said, “My moles are fine. Let me tell you what happened to us in Katrina.”

I listened to the whole thing, how they were four houses away from the London Avenue Canal, how now he and his wife and three cockatiels and two miniature schnauzers are all living in a microscopic apartment out in Kenner but they’re rebuilding, how he and his nephew go out and work with the contractors a few afternoons a week to speed things along because “you may not have noticed, young lady, but I’m getting along up there in my age and who knows how much time we’ve got left.” This man uses a walker to get around, and I could probably circle his whole upper arm with my thumb and forefinger, but you never know. There’s definitely quite a few things in the world that would surprise me more than if I saw him up on a roof with a tool belt.

After about 20 minutes the doctor I was working with came in, looked at my patient’s forehead and said, “yep, looks like it’s doing fine. Come back in three months.”

My patient was like, “Thanks, that’s what I thought.”

And put on his hat which had this twinkly little blue feather in it, and leaned his mottled gnarled hands into the railings of his walker, and eased himself deliberately out of the high uncomfortable chair he’d been waiting in, and turned and winked—yes, winked--at me as he was walking out the door and said, “young lady, if I’m still alive when you’re done with all this, you could be my doctor any day.”

I’m always amazed and a little sad when patients tell me this. I know enough to know that it has pretty much nothing to do with me; it’s much more about healthcare and the general lonely state of things for so many people in our world. More often than not what most people crave is simple, gentle, loving attention. There’s something that gets me deep when I think about this man waking up early and shaving and buttoning up his dress shirt and putting on his hat and driving here (oh my gosh, was this man driving? Can he even see above the windshield? Did his wife or nephew drive him instead? How many people’s days did this visit impact?), all the way from Kenner, when he knows his moles are fine.

I wonder about what this person’s motivations were to go to the doctor today. It wasn’t to get news about his skin, because he already knew his moles were fine. It certainly wasn’t to tell some random medical student his Katrina story, although I think that ended up being an important part of the day for him.

I think he came to fulfill a duty. He had an appointment, and even if he didn’t really see the meaning behind it or agree with the doctor’s rationale for scheduling it, he kept his word and showed up. And he was patient and tolerant with us while we did what we felt invested in doing, but ultimately I’d guess that the meaningful part of that visit for him was the part where he told me an important story about his life.

I get humbled when I remember that my job is all of this. That of course I need to know stuff, but that also in a lot of cases being able to listen to people is even more important than what I know about their clinical condition. And listening is about much more than being nice. It’s about turning my expectations of healthcare on their head, letting go of my own ego and my own agenda enough to legitimately see that if my patients expect their healthcare to be a place where their stories are honored, then it's my job to figure out how to make that happen.

Time and again, I feel like I’m learning the same lesson: that once I accept how little I understand, and recognize the limitations of my own vision, and let myself be guided by the wisdom of the people around me, that’s when the real beauty comes.


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