Today I was told the reason for a hospital visit was hearing voices that said horrible things. I was told it wasn’t a regular occurrence, only once a year. I was told when they were young they witnessed their father kill their mother. Every year, around the time, the voices come.
The chart said Chief Complaint: auditory hallucination with homicidal and suicidal ideation. Diagnosis: PTSD.
The attending apologized for assigning this patient. He didn’t expect the history I gave. In a sense, though I am in training, he wanted to protect me. I’m learning right now, I shouldn’t have to face burdens like that right now. I’m supposed to be taking thorough histories of simple complaints and performing physical exams with majority normal findings. But these aren’t textbook cases. These are complex, real human beings with histories that can shock us, with unexpected life experiences that can bring us to tears, can inspire us, can cause us to shake our heads. They are stories always requiring us to lend an open ear and a comforting touch, to say it’s okay, you can trust me.
Form relationships, provide intimacy, gain trust.
In order to do that, the physician is burdened with carrying the stories of others. We can’t ignore. We can’t remain ignorant. We can’t be oblivious. We can’t turn our cheek and say this is too much I want nothing to do with it. We can’t remove our extended hands. We have to ask questions we shouldn’t know the answers to, sometimes we don’t want to know the answers to. We have to place ourselves in the midsts of crisis in order to perhaps provide some sort of relief. We carry people with us, we have to witness their suffering, we insert ourselves in a moment of their life and incorporate them into the rest of ours. We build relationships, intimacy, trust. And it isn’t easy, to open yourself in a way that allows you to receive.
In the moment I didn’t know what to say. I was a student, granted important information, shocked, trying to search for the right words. I fell upon a generic empathy statement we were taught in class-that is very tough and you are very strong to have faced that and to overcome it as you have. It felt wrong to me, as if I should have said or done more.
But as simple and generic as those words felt, I was told thank you for saying them. Then I saw a smile and I knew I had said the right thing. I hadn’t done nothing.
Though the physician is burdened with carrying the stories of others, it is a privilege. We confront the mind, its memories, experiences, and thoughts, in its rawest form and we try to make sense of it. I had a moment with relationship, intimacy, trust. I was allowed in, though I didn’t have to be, to try to understand a curious place.
What I should have said is thank you. Thank you for believing in me, so young in my training. Thank you for opening up, for entrusting me with carrying the weight of your words, to allow me to make you smile briefly. Thank you for teaching me.