When you notice that something is amiss with a patient or your reaction to them feels off, this is a clue to dig deeper. With time and enhanced trust in the doctor-patient relationship, things usually become clear.
It was a typical busy day in the clinic when I met a 42-year-old woman with a history of palpitations and anxiety referred for cardiac evaluation. As I walked into her room, I couldn’t help but notice thick eyeliner covering her upper eyelids, and baroque makeup (as she later described it). A further workup revealed supraventricular tachycardia (SVT). We discussed treatment options. She agreed to undergo the ablation procedure with one request, “Is it ok to ask for women staff only?” On the day of the procedure, I confirmed that all the staff were women.
I greeted her in the pre-op area. She wore thick eyeliner and baroque makeup again, with the same sweet smile. This time, she seemed a bit nervous and I tried to reassure her. As we wheeled her into the room, she pulled me aside and whispered, “Can you please make sure that my makeup is still on when I come out?” Our wonderful nurse ensured that the oxygen tubing didn’t smudge her makeup.
The procedure was successful. She thanked us for the exceptional care. Her follow-up appointments went well. We developed a strong doctor-patient bond and talked about life, movies, and politics. Every time, she wore the same thick eyeliner and baroque makeup. Often, she left the clinic complimenting me and our staff, “Every time I see you, you make me feel like I won the jackpot!”
Repeat monitors did not reveal SVT. I gave her the good news that she didn’t need to see me anymore and wished her the best. She took the news differently, and her tears turned into sobs. She wiped her eyes and cheeks. Her tears unmasked the scars. She had a faint healed cut under left eye and a deep scar along the left upper eyelid. After a few words of consolation, I excused myself to request my colleague to see my next patient so that I could give her more one-on-one attention.
She opened up. “Now you know why I insisted on leaving my baroque makeup and loud eyeliner on. My husband is a rich man. He loves me and showers me with gifts, but is possessive. That’s the reason I requested female staff. I know people stare at me and judge me. I weep inside. I know you are a heart doctor, but can I please see you once a year? Just until I cross the bridge of my fears and reach the other side.”
She continued to see me for many years. I encouraged her the best way I knew how as a fellow human. She attended one of my empowerment talks. Over time, she gathered inner strength and regained self-esteem. She eventually divorced and stopped anxiolytics.
She continued to wear baroque makeup and eyeliner, but her face had a different glow—a radiance of freedom and confidence.
Reflecting on her story, I realized that she taught me a few important life lessons:
1. We must never judge people.
If not kept in constant check, our own biases will affect our professional interaction—courageous communication and empathy are integral part of medicine and life.
2. Listen with an intent to understand why people act or say things that they do.
Making time to listen to your patient’s detailed history is the most important tool in diagnosing the problem—active listening is critical.
3. Treat every patient as a whole person—mental, physical, emotional, and spiritual ailments coexist.
Their treatments aren’t mutually exclusive and help us achieve overall well-being of our patients.
4. Try your best to create extra time when needed.
My patient needed my time beyond the procedural RVUs. Insurance companies and corporate healthcare systems cannot pollute our profession by distracting us with numbers and money.
5. A doctor-patient relationship is mutually gratifying and takes time to nurture.
Patients lift us up. Gratitude in medicine is a powerful antidote to burnout.
Every patient is special and unique in their own way. Their stories are an integral part of our lives as clinicians. Lessons learned from them will help us keep the joy of medicine.