Blog | Thursday, December 15, 2016

Without question


I was taking care of this grown man who was sick. His mama was at the bedside and she was worried about her manchild. Which makes sense because she's his mama.

Now.

This patient of mine has his own life, his own house, his own kids, and his own concerns about his health. And when I first rounded on him that first day, I was explaining everything that was happening to his body while his mama sat at on a chair holding her pocket book and nodding deferentially. She asked one or two super generic questions, but only if I paused and asked. There was a lot going on with him and I knew it was a big thing to get their heads around. His mom looked kind of like a deer in headlights.

“You sure you don't have any questions?” I asked them both. Even though I was mostly aiming my thoughts at the mother.

The patient answered, not his mom. “Um, no. I think you've explained it all to me.”

“What about you, ma’am?”

She simply smiled, lifted one hand and said she was fine. And all of it was pleasant and good. Albeit a little bit unsettling.

Yeah.

So after that first day, for whatever reason, I always seemed to round on him when no visitors were there. I'd come in and he'd say, “Dang. You just missed my mom!” That would make me feel like his mom had more questions for me. And I would reassure him that he could have the nurses page me when his mother was there if she wanted to talk to me. He said he would and that was that.

No one ever called.

The last hospital day came. I walked into his room early that afternoon and prepared to examine him. He was the last person I was planning to see before heading over to the medical school across town for a small group teaching session.

“What you know good, sir?” I asked. After three or four days in the hospital, we'd moved to more informal greetings.

“Nothing, Miss Manning! I'm just waiting on you to give me the verdict.”

“Okay. How are you feeling?”

“As well as I think I'm gon’ feel ‘fore I leave here. I'm ready to get up out of here.”

“Okay. Well it looks like we're in a place where it's safe to discharge you.” He pumped his fist when I said that. “Sounds like we're on the same page.”

“Good stuff.”

I asked if he had any questions and he said he had none. I reached out to shake his hand and my eyes wandered over to the window sill. What appeared to be a pair of multicolored reading glasses were resting there next to a McDonald's coffee cup. There was lipstick on the edge of the cup, too.

“Did I miss your mama again?”

“Man. She just can't win for losin’. She went to go feed the meter and I said, ‘Watch Dr. Manning come in soon as you go.’”

“Aww man.”

“She all worried ‘bout me and stuff.”

“I hear you. Being a mama is hard like that.” That made him chuckle when I said that.

We made a little more small talk and I headed out. I picked my tote bag up from where the clerk was hiding it for me in the nurses station and scuttled up the hall toward the elevators. I looked at my watch and I was making excellent time for my commute over to main campus.

Yup.

I stepped onto the lift and took a deep breath as it stopped on what seems to be every single floor. After what felt like a million years, I finally make it out of the hospital. Checking the time once more, I smile since I know I'll make it with time to spare.

But then something happened.

I saw this man paying to meter for his car. And he looked relieved as he was doing it since the city of Atlanta will ticket you in less than one second if your meter dies. For some reason, I just sort of froze for a moment, watching him stick the “PAID” coupon on his dashboard. And, of course, imagining my patient's loved one doing the same.

Aaagggh.

I squeezed my eyes shut and gave and exaggerated sigh. My head swung to the right and stared up at the hospital. And then I made up my mind.

Five flights of stairs and five minutes later, I was back at my patient's room, panting and out of breath. Just as anticipated, as soon as I came trotting in I saw his mother settling back down into the chair--reading glasses in one hand and coffee cup in the other. And when she saw me huffing and puffing in that doorway, her eyes widened and a big smile erupted over her face.

You know? I'm not sure why but something made me feel intensely like I needed to go back to see her. Which, in a way, is pretty ridiculous, you know? I mean this patient was grown, man. And sure, he'd been handed a pretty heavy diagnosis, but still. This was not child.

But. He was her child. And, it appears, she was a big piece of his support team--a team he was definitely going to need.

And so. I came on in, pulled up another chair and sat down. I leaned on my elbows and tried not to look like I was in a hurry.

“Oh! I thought I'd missed you, Dr. Manning!”

“You know? I was leaving out and decided to come back. Just in case you wanted to talk.”

And you know what? She did want to talk. Talk about her son and his prognosis and how she could be of support. Of how she felt scared and how even when they are all grown up, they're still our babies. She wanted to know if I had kids and if they were boys or girls. And really, she just wanted to talk long enough to feel just a little less anxious about what her boy was up against. Not really questions. But there was more to discuss. There was.

Yeah.

So here's what I learned: I learned that sometimes people don't have questions. But that doesn't mean they don't want to talk. In that quick little instant, I shifted a piece of my practice based on a subtle new realization.

Yes.

I will still finish my discussions with ”What questions do you have for me?” I sure will. But from now on, I'm going to start following up with one more question--”Is there anything else related to you hospitalization that you'd like to talk to me about?”

Yes. That.

And you know what? I've only been doing this for a couple of weeks now. But it's astounded me how many people bite on that second request. Questions? No. More you want to talk about? Yes.

Ah hah.

And no. The whole “listening to that hunch that you need to go back” lesson wasn't the take away for me. Although it is a very important thing to recognize when it happens and one that I've learned previously the hard way.

Anyways.

By the time we finished, there was only ten minutes remaining before my teaching session was to start. I texted my second year student small group and asked them for a last minute modification in our meeting plans. I apologized profusely and felt appreciative for their understanding. We ended up meeting outdoors on the patio of a local restaurant closer in than campus--which was easier for me coming from Grady. They were gracious and easygoing and that lightened my load.

Tremendously.

When we finished, I said I'd stick around in case anyone had questions.

Or things they wanted to talk to me about.

You know what? No one had questions. But two people did have something they wanted to talk about. Important stuff, too.

Imagine that.

I'm so glad that I'm still learning, man. Still listening and learning and growing and trying.

Yeah.

Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.