Sunday, August 21, 2016

a conversation that matters

True story:

Just yesterday a friend and former patient of mine stopped me after church to tell me how much better she was feeling since my husband—the consummate family physician—had seen her at home the previous Sunday. It's true. He made a weekend house call even though he wasn’t on-call that day.

She’d been suffering from incapacitating neck pain and headaches for a couple of weeks, but hadn’t called my husband about it because she was in palliative care for an oppositional defiant malignancy that nothing could stop. She didn’t call him about the pain because her oncologist and hospice nurse had already called in prescriptions for narcotics that hadn’t touched it. She understood the concept of palliative care to mean that nothing more could be done for her so she assumed the pain was part of the process.  

Nevertheless, even though her specialists were not treating the cancer anymore, the goal of my friend's medical care was to keep her as comfortable and functional as possible, for as long as possible. I reminded her that incapacitating pain is not considered by most patients to be comfortable. When a patient who is otherwise still independent becomes housebound because of it, she is not really functioning. She deserved to be treated for the pain.

Her husband was the one who finally called my husband who then took time out of his weekend off to listen to her story and examine her. Based on what he found, it was apparent that her problem was muscular. It had nothing to do with the malignancy. After one day on a muscle relaxant and low dose steroids, the pain subsided. She slept through the night for the first time in weeks. And to her relief, the pain has not recurred, which explains why she was able to get to church this weekend. Why her appetite came back. Why she was smiling despite her generally poor prognosis.


Rita Charon, in her ground-breaking book, “Narrative Medicine—Honoring the Stories of Illness,” presents an unconventional approach to gathering information from the patient. She simply invites the patient to “tell me what you think I should know about your situation.” Then she listens. She doesn’t scribble down notes or tap away at her keyboard while the patient is speaking. She listens.

Had my friend’s oncologist or nurse used this approach, I think she would have told them, “I’m having severe pain in my neck. I can’t move it when the pain comes on. Then I get a severe headache. It’s so bad I can’t leave the house. I can’t eat. But they said nothing more could be done for me so I didn’t want to bother you about it." 

That miscue resulted in weeks of unnecessary suffering for a woman who had already suffered enough.
“Be brave enough
to start a conversation that matters.”
~Author Dau Voire~

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