thriving in the shadows

There is a fern that sits in my window, bright green in color with spiky leaves that have, on occasion, painfully sunk themselves into my fingertips.  This window is a hospitable place for the fern, with his brethren the rubber plant, the oxygen-generating calathea and a flamingo flower that shoots curled hot pink flowers out from behind its leaves.  This is the first time that I’ve had a place where abundant sunlight meets space inside the house, where these plants have thrived and where they stand on the silver shelving glossy and healthy.  They reach out to fill the space, sprawling towards the window, the fern’s tentacles reaching for the glass and resting on the window ledge to capture the maximum sunlight.

There is another plant, one for whom the sunny window is too bright, too glorious.  This one looked sickly and dry until moved into the relative shadows.  It is not a nocturnal creature, nor does it shun others.  It simply cannot stand the hot rays shining forth with all their intensity.  Moved into the shade, watered less, but loved just the same, it has dropped its brown leaves in favor of long, pointed, dark green ones that now even envelop a delicate celery-hued green flower.

I see this behavior in people as well.  At first meeting, they are shy and subdued, for me, often in the confines of an office with shiny instruments and the light scent of hand sanitizer.  I whisk in, white coat whirling, making space between the absurdly placed chairs between and the brown exam table and the slow computer containing data from all reaches of their distant past.  With new patients, it is often a blessing to have a blank record.  I sit and face them and listen.  They start tentatively, some with a list, others lamenting the loss of their old doctors, many moving from far away places to start a new life.  Often it is in times of great stress, handing over trust in healthcare to a little girl with a stethoscope, thoughts swirling about damage from the movers, children settling into a new school, meeting with a new oncologist, their new job in banking or HR.  It is with this ultimate trepidation, the apprehension lining the corners of their eyes, that they come to me.

Sometimes even when they leave I do not have a sense of their impressions, polite thank yous and great to meet yous peppering the widening space between us as they turn down the carpeted hallway to the checkout desk.  Sometimes it seems that they are still trying to figure out how we will fit together, what will happen as the months go on.  They look searchingly into my eyes, sometimes surprised at the answers, waiting until 15 minutes or so into the visit to shed tears, to confess the spiky things in life which are likely to blame for their stress and their ill health.  There are fights with only children, recent separations from long-term partners, bouts of anxiety at a diagnosis and workup.  All poured out to a young stranger with green-rimmed glasses and a sympathetic expression.

They walk out with papers in hand for tests and notes for work, with my explanations and guidance swirling around in their heads.  I have no idea how much they will remember of it, if they will think of questions later (I would).  I often call back, with new information, or to remind them of a test, to check on them after they’ve had a particularly tragic life experience.

I understand those quiet and reserved few because I am also this way…I shy away from the harshness of blinding light and attention, preferring to organize and direct in the penumbra.  These patients thrive when they are able to go home and process, take the time to weigh actions and consequences, to talk to others and process instructions.  They are the ones for whom I cannot tell the initial reaction to my words, or my presence, who communicate with me but not excessively, who quietly have tests completed and wait on the results.  They are also the few who ultimately write emails and cards, who bring presents thanking the office and their doctors for our care.

Caring for people requires entwining flexibility with persistence, and adjusting the pace of change to the individual.  I have a long way to go to be as excellent as I want to be, and I anticipate this will always seem like a remote goal.  As much as we learn there is always so much more.  I know, however, that the episodes of listening and action lead to understanding and development toward individual success.  These are the true origins of personalized medicine.

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