Looking for a narrative today? I can do that. For you.
She looks less than thrilled to see me when I enter the room, and begins to stammer when I ask why she’s here. I’m immediately concerned that this is going to be a difficult interview, with confusing information and an uncooperative patient.
“I’m not sure how I’m supposed to say this,” she tells me flatly. “It’s hard to tell people all your business.”
“Honestly, I’ve heard it all at this point,” I assure her. “Just get it out however is easiest for you.”
For a second, her flat affect lifts as she lets out a nervous giggle that folds her small frame in half. She slowly begins to describe her symptoms. Nothing out of the ordinary, really, just your run-of-the-mill urinary tract infection symptoms. I proceed through my usual string of questions, teasing out her current symptoms and past medical history and medications.
“Oh,” she adds quietly at the end. “I think I smell. Everyone notices. It’s embarrassing.”
This takes minute to register. Mostly because, well, she doesn’t smell, and as she elaborates, I begin to realize that antibiotics won’t even begin to get to the root of this woman’s real problems.
“It’s okay, though,” she assures me. “I’m a big girl.”
I ask her to explain. And then, I listen. I listen about how she isn’t sure what smell they’re talking about, but she lost all of her friends. No, really, she just lives alone and doesn’t leave the house unless she absolutely has to. No, there’s no family or friends in this area and there’s no one she calls for support. She doesn’t pursue any hobbies she enjoys anymore. She’s stopped going to church because she’s self-conscious, even though she’s devoutly Christian. She’s afraid to go to the grocery store because she feels judged, so sometimes she just doesn’t eat. In fact, she’s lost 20 pounds these days, but maybe it’s just because she’s been walking a lot.
Her eyes get misty at this point. “I don’t want to cry,” she insists. “I’m a big girl.”
“It’s okay,” I tell her, softly resting my hand on her arm. “Sometimes it takes a stronger girl to recognize when it’s time to get some help.”
In the end, I spend nearly an hour listening to this woman in what was meant to be an acute care appointment. I make her a referral to primary care and beg her to attend in hopes that they would refer her to mental health, a referral that I can’t make directly from my clinic because of insurance mumbo-jumbo.
“Please go. You don’t have to deal with this by yourself. And you shouldn’t. You deserve so much better than this,” I plead.
Her brown eyes gleam with tears once more. “Okay,” she concedes. “I’ll go. I promise. You’ve been such a good listener. Thank you so much for caring.”
Content with my small victory, I offer her one last treatment: “Would it be okay if I gave you a hug?”
For the first time, her face lights up.
And for the first time since starting this rotation, I recognize the importance of just listening, and enjoy the unbelievable feeling of knowing I may have actually made a difference.